Mental Health and Related Services Act 1998

Section 37

Form 8

An authorised psychiatric practitioner, medical practitioner, designated mental health practitioner or police officer (the Applicant) may apply to the Tribunal for a warrant to apprehend a person for the purpose of being assessed under the Mental Health and Related Services Act 1998. Refer to Approved Procedure 19A - Assessment Warrants 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
Address:
Grounds for the application Application is herewith made to the Tribunal for a warrant to apprehend the abovementioned person on the grounds that: ☐ The person may be unable to care for himself or herself; and ☐ The person may fulfil the criteria for involuntary admission on the grounds of mental illness or mental disturbance; and ☐ All other reasonable avenues to assess the person have been exhausted.
Other details supporting the grounds for this application
Applicant details
Full name of Applicant:	Signature:	Date: / /
Work location:
Applicant is: ☐ An authorised psychiatric practitioner ☐ A medical practitioner ☐ A designated mental health practitioner ☐ A member of the police force
Tribunal Approval
I have reviewed the application for an Assessment Warrant made in relation to the abovementioned person and I am satisfied that: ☐ The person may be unable to care for himself or herself; and ☐ The person may fulfil the criteria for involuntary admission on the grounds of mental illness or mental disturbance; and ☐ All other reasonable avenues to assess the person have been exhausted. As such, the application for an Assessment Warrant is: ☐ Approved ☐ Not Approved
Full name of Tribunal President (or delegate of the President):	Signature:	Date: / /

Form Requirements

☐ Copy sent to Tribunal

☐ Form placed on clinical file

NORTHERN TERRITORY CIVIL AND ADMINISTRATIVE TRIBUNAL

Mental Health and Related Services Act 1998

Section 37

Warrant to apprehend a person

ON application dated the	/ /
Day / Month / Year
made by
Given name	Family name of Applicant
a/an	approved psychiatric practitioner/designated mental health practitioner/ medical practitioner/member of Police
of
Name of facility/agency/practice/police station
It being established to the satisfaction of the Tribunal, based on the details contained in the Form 8 provided to the Tribunal for the purposes of this application, and signed by:
on	/ /
Given name	Family name of Applicant	Day/Month/Year
that
Given name	Family name of person
date of birth:	/ /
Day / Month / Year
of
Address of person
(1) may be unable to care for himself or herself; (2) may meet the criteria for involuntary admission; and (3) all other reasonable avenues to assess the patient have been exhausted. THE TRIBUNAL ISSUES THIS WARRANT pursuant to section 37 of the Act authorising an authorised psychiatric practitioner, a designated mental health practitioner, a medical practitioner or a member of the Northern Territory Police Force to apprehend and control the above named patient and:- In the case of an apprehension by a member of the Police Force, to bring the patient to an authorised psychiatric practitioner, a designated mental health practitioner or medical practitioner for assessment to determine whether the patient is in need of treatment under the Act; In the case of an apprehension by an authorised psychiatric practitioner, a designated mental health practitioner or medical practitioner, to assess the patient to determine whether the patient is in need of treatment under the Act. AND in either case, this shall be your sufficient warrant.
DATED	/ /
(Signature of Tribunal President or delegate of the President)

Addendum to warrant to apprehend a person under section 37 of the Mental Health and Related Services Act 1998

Criteria for involuntary admission on the grounds of mental illness (section 14)

That –

(a)	the person has a mental illness;

(b)	as a result of the mental illness:

(i)	the person requires treatment that is available at an approved treatment facility;

(ii)	without the treatment, the person is likely to:

(A)	cause serious harm to himself or herself or to someone else; or

(B)	suffer serious mental or physical deterioration; and

(iii)	the person is not capable of giving informed consent to the treatment or has unreasonably refused to consent to the treatment; and

(c)	there is no less restrictive means of ensuring that the person receives the treatment.

Criteria for involuntary admission on grounds of mental disturbance (section 15)

That –

(a)	the person does not fulfil the criteria for involuntary admission on the grounds of mental illness;

(b)	the person's behaviour is, or within the immediately preceding 48 hours has been, so irrational as to lead to the conclusion that:

(i)	the person is experiencing or exhibiting a severe impairment of or deviation from his or her customary or everyday ability to reason and function in a socially acceptable and culturally appropriate manner; and

(ii)	the person is behaving in an abnormally aggressive manner or is engaging in seriously irresponsible conduct that justify a determination that the person requires psychiatric assessment, treatment or therapeutic care that is available at an approved treatment facility;

(c)	unless the person receives treatment or care at an approved treatment facility, he or she:

(i)	is likely to cause serious harm to himself or herself or to someone else; or

(ii)	will represent a substantial danger to the general community; or

(iii)	is likely to suffer serious mental or physical deterioration;

(d)	the person is not capable of giving informed consent to the treatment or care or has unreasonably refused to consent to the treatment or care; and

(e)	there is no less restrictive means of ensuring that the person receives the treatment or care.