Working across service boundaries

There are principles and standards in relation to out-of-area placements, including special considerations for psychogeriatric and adolescent placements, financial responsibility and practice standards.

Principles to guide out-of-area placements

There are core principles to guide out-of-area placements:

• The wellbeing and safety of the patient and community must be considered before anything else.
• All people who present for admission to an inpatient service must be assessed with regard to their mental status and risk to self and others, regardless of their area of origin.
• If the person needs to be admitted, and they do not live in the catchment, the area mental health service to which the patient presents is responsible for the person’s immediate management and must notify the person’s area-of-origin service of the situation.
• If the person is awaiting transport and admission to another hospital, the duty of care lies with the area mental health service to which the person has presented. The area mental health service must determine and provide interim clinical management.
• If the person’s area-of-origin service has no capacity available, the authorised psychiatrist (or delegate) of the presenting area mental health service must either admit the patient or locate an appropriate service elsewhere at the cost of the patient’s area-of-origin service.

Psychogeriatric and adolescent admissions

If an acutely disturbed psychogeriatric or adolescent patient cannot be safely admitted to a psychogeriatric or adolescent service, and needs to be admitted to an adult service, it is the responsibility of the authorised psychiatrist (or delegate) of the presenting service to either admit the person as an adult inpatient or find an appropriate adult service elsewhere.

The responsibility for the person resides with the service to which the person presents.

Financial responsibility and out-of-area services

Guidelines on financial responsibility for out-of-area services are detailed in the Program Management Circular No. 3/95 ‘Accessing services across regions and areas’.

Practice standards and out-of-area placements

The following practice standards apply to out-of-area placements:

• All patients who present for admission must receive a thorough and documented assessment of their service needs.
• If the patient is held over in the presenting hospital, pending transfer to another hospital, all treatment and care must be documented and must meet appropriate standards of practice for inpatient management.
• Documentation must indicate that the patient’s area-of-origin service has been notified within 24 hours of the out-of-area admission.

Chapter 13 of the Mental Health and Wellbeing Act 2022 and cross-border ministerial agreements between Victoria and other states govern the interstate assessment, transfer, treatment, and apprehension of compulsory patients.

Victoria has civil cross-border ministerial agreements with the Australian Capital Territory (ACT), New South Wales (NSW) and South Australia (SA). The contents of these agreements vary but include interstate assessment, planned interstate transfers and the interstate apprehension and return of compulsory patients who are absent without leave in another state.

Victoria also has forensic cross-border ministerial agreements with the ACT and NSW. The forensic cross-border agreements cover the interstate apprehension and return of forensic and certain other patients who abscond interstate.

Victoria's cross-border ministerial agreements require updating. These agreements were signed before the commencement of the Mental Health and Wellbeing Act 2022 and refer to the repealed Mental Health Act 1986. However, transitional provisions in the legislation mean these agreements continue to operate.

Chapter 13 of the Mental Health and Wellbeing Act 2022 and cross-border ministerial agreements between Victoria and other states govern the interstate assessment, transfer, treatment, and apprehension of compulsory patients.

Victorian has civil and forensic cross-border ministerial agreements with the Australian Capital Territory (ACT).

The agreements set out the legal framework for the provision of mental health services between the state and territory. They rely on the provisions of the Mental Health (Treatment and Care) Act 1994 (ACT) and Victorian legislation.

The civil and forensic cross-border ministerial agreements with the ACT require updating. They were signed before the commencement of the Mental Health and Wellbeing Act 2022 and refer to the repealed Mental Health Act 1986. However, transitional provisions in the legislation mean these agreements continue to operate.

Mental health services with cross-border cases or questions should contact the Office of the Chief Psychiatrist at ocp@health.vic.gov.au for specific advice.

Civil agreement

The civil cross-border ministerial agreement applies to involuntary patients.

It provides for the planned interstate transfer of patients between Victoria and the ACT and the apprehension and return of compulsory inpatients who are absent without leave in either the ACT or Victoria.

Forensic agreement

The forensic cross-border ministerial agreement applies to forensic, security and certain other patients. It is confined to the apprehension and return of such patients when they are absent without leave in either the ACT or Victoria.

Chapter 13 of the Mental Health and Wellbeing Act 2022 and cross-border ministerial agreements between Victoria and other states govern the interstate assessment, transfer, treatment, and apprehension of compulsory patients.

Victoria has a civil cross-border ministerial agreement with South Australia.

The agreement sets out the legal framework for the provision of mental health services between the two states.

There is no forensic agreement with South Australia.

The civil cross-border ministerial agreements with SA requires updating. It was signed before the commencement of the Mental Health and Wellbeing Act 2022 and refers to the repealed Mental Health Act 1986. However, transitional provisions in the legislation mean these agreements continue to operate.

Mental health services with cross-border cases or questions should contact the Office of the Chief Psychiatrist at ocp@health.vic.gov.au for specific advice.

Civil agreement

The civil cross-border ministerial agreement covers:

• mental health assessments over the Victoria-SA border
• planned transfer of involuntary inpatients between Victoria and SA
• provision of compulsory mental health treatment over the Victoria–SA border for people subject to community orders
• apprehension and return of involuntary inpatients who are absent without leave in either SA or Victoria.

The civil cross-border ministerial agreement does not apply to forensic or security patients.

The interstate assessment, transfer, treatment and apprehension of compulsory patients is governed by Chapter 13 of the Mental Health and Wellbeing Act 2022 and cross-border ministerial agreements between Victoria and other states.

Victoria has three agreements with NSW:

• Civil and forensic cross-border ministerial agreements setting out the legal framework for the provision of cross-border mental health services between the two states (both agreements require updating ).
• The Albury Wodonga Health Memorandum of Understanding (MOU), which clarifies some of the legislative and oversight arrangements for mental health services delivered by Albury Wodonga Health.

The civil and forensic cross-border ministerial agreements with NSW require updating. They were signed before the commencement of the Mental Health and Wellbeing Act 2022 and refer to the repealed Mental Health Act 1986. However, transitional provisions in the legislation mean these agreements continue to operate.

Mental health services with cross-border cases or questions should contact the Office of the Chief Psychiatrist at ocp@health.vic.gov.au for specific advice or call 1300 767 299.

Civil agreement

The civil cross-border ministerial agreement covers:

• people seeking mental health treatment over the Victoria–NSW border
• transfer of compulsory inpatients between Victoria and NSW
• compulsory mental health treatment for people subject to community orders
• apprehension and return of compulsory inpatients who are absent without leave in either NSW or Victoria.

The civil cross-border ministerial agreement does not apply to forensic or security patients.

Forensic agreement

The forensic cross-border ministerial agreement provides for the apprehension and return of forensic, security and certain other patients who are absent without leave in either NSW or Victoria.

Albury Wodonga Health - Mental Health Memorandum of Understanding

Albury Wodonga Health is a public health service under the Health Services Act 1988 (Vic) that delivers cross border health services in North-East Victoria and Southern New South Wales. It operates two hospitals (Albury Hospital and Wodonga Hospital) and delivers a comprehensive range of community mental health services. Inpatient mental health services are located at Wangaratta and Albury.

The Memorandum of Understanding (MOU) aims to improve the quality and safety of mental health services provided by Albury Wodonga Health by clarifying some legislative and oversight arrangements.

The Victorian Department of Health and Human Services and NSW Health jointly signed the MOU. It clarifies:

• legislative requirements for the provision of mental health services by Albury Wodonga Health
• policies and guidelines that apply to Albury Wodonga Health’s mental health services
• communication arrangements
• handling of complaints
• the role of the Victorian Chief Psychiatrist
• the role of official visitors (NSW)
• the role of community visitors (Vic)
• the role of Accredited Persons (NSW).

The MOU is made in good faith and demonstrates an intention between the parties to work collaboratively to implement the MOU and improve oversight of Albury Wodonga Health’s mental health services.