Mental Health and Related Services Act 1998

Section 31

Form 6

Under section 31 of the Mental Health and Related Services Act 1998, a registered paramedic may detain a person in an ambulance for up to 6 hours and convey them to an approved treatment facility or hospital, where they believe that the person may fulfil the criteria for involuntary admission on the grounds of mental illness or mental disturbance. Refer to Approved Procedure 3 – Entry to Mental Health Services for further information.

Complete person details or affix patient label in box below:
Full name of person:
Also known as
Date of birth:	/ /
HRN:
Sex:	☐ Male ☐ Female ☐ Non-binary ☐ Not specified
Detention details At (time): hours, on (date): / / The abovementioned person was detained because the clinical assessment indicated that they fulfil the criteria for involuntary admission on the grounds of mental illness or mental disturbance. The person was then conveyed to the following approved treatment facility or hospital (provide details):
Facility or hospital name:	Arrival time: hours	Arrival date: / /
Reasonable measures use (i.e. use of force, restraint or medication)
☐ Not Applicable ☐ Reasonable measures have been used - please attach a copy of your completed electronic patient care report outlining actions taken and rationale i.e. type, duration or dose as relevant
Where used, these measures were to: ☐ Prevent the person causing serious harm to themselves or someone else ☐ Prevent behaviour of the person likely to cause serious harm to the person or someone else ☐ Prevent further physical or mental deterioration of the person ☐ Relieve acute symptomatology
Name of registered paramedic:	Signature:	Date: / /
Transition to approved treatment facility or hospital acknowledgement (Authorised psychiatric practitioner, medical officer or designated mental health practitioner to complete)
Name of clinician:	Signature:	Date: / /

☐	Form provided to authorised psychiatric practitioner (please specify practitioner name and method of sending form)

☐	Form placed in clinical file