4.3.1 Queensland (QLD)In 2003 the Queensland Government released a Carer Recognition Policy. This was a whole of government policy that was followed by a Carers (Recognition) Act, 2008. A Consumer, Carer and Family Participation Framework is currently in the final stages of review. This aims to provide public mental health services across Queensland with clear guidelines regarding consumer and carer participation. An audit tool is included to ensure carers are identified and engaged by the mental health service.
The Mental Health Act 2000 mandates that each consumer provided for under the Act, is to be linked with an Allied Person to ensure that their wishes are made known to the mental Health Review Tribunal. However, it is not a requirement for the Allied Person to be the consumer's carer, nor is it considered always desirable.
The Mental Health Directorate's Statutory Administration Policy Unit (SAPU), which leads mental health legislative policy analysis and development, is currently piloting the Audit Tool 7 – Carer Survey. SAPU has also agreed to investigate alignment between The Carer (Recognition) Act 2008 and the Mental health Act 2000. Additional work is also underway to ensure alignment with the Consumer, Carer and Family Participation Framework. Top of page
Queensland has identified that there are barriers that exist in identifying carers, especially in rural and remote areas. Carer workers from across the State were recently asked to detail strategies they have employed to identify and engage with carers. Their responses were collated and widely circulated to promote and improve consistency across the State. These strategies have been reported as Good Practice Examples at the end of this section.
In 2008 Queensland Health introduced a Carers Matter component to their web site. This was reviewed in 2009 and contains a range of information regarding mental illness, access to services, issues carers may face etc. It has been supported by the development of a range of brochures. This development is ongoing.
There is also a commitment to increasing carer involvement in mental health services as reflected in the following practice guidelines.
- Carer involvement should be negotiated at the earliest possible stage between the consumer, the carer and the mental health service.
- Carers should be engaged in a partnership with the consumer and the mental health service to support and assist the consumer in their recovery from mental illness.
- Carers should have access to a mental health professional who has been designated as a contact person.
- Carers should be provided with information, support and options that will enhance and maintain their own well–being.
However, some very interesting work has been undertaken in Townsville, Northern Queensland where practice standards have been developed for family/carer participation in mental health care. The standards are based on a recognition that mental health outcomes are improved when there is full sharing of information in partnership between consumers, families/carers and clinicians.
Flow charts have been developed to assist clinicians in decision making regarding sharing of information in situations where consumers do, or do not give consent. Top of page
4.3.2 New South Wales (NSW)Mental Health Services in NSW are currently delivered within the context of the five year plan launched by NSW Health in 2006 and summarised in the document: NSW: A new direction for Mental Health – a five year plan to improve care for people with mental illness.
Individual Area Mental Health Services generally have specific local policy documents associated with carer participation although it is not known if these specifically address the issue of identification.
In addition, NSW has a whole of government approach to identifying, recognising the needs of, and supporting carers. This is documented in the NSW Carers Action Plan 2007–2012. As part of the funding allocation to Carer Support Services, Area Health Services are required to develop a local Carer Action Plan that outlines the carer support strategies it will implement to address the five priorities for action outlined in the Plan.
As part of this approach NSW Health funds four Non Government Organisations (NGOs) to provide Mental Health Family and Carer Support Services across NSW. There is one NGO service provider in each Area Health Service. It is the role of these NGOs to provide:
- Education and training packages which teach families and carers about mental illness and its management and help to build coping skills and resilience;
- Individual support and advocacy services for families and carers of people with a mental illness; and
- Infrastructure support for peer support groups. Top of page
The Mental Health Act 2007 (NSW) also recognised the notion that families and carers of someone with a mental illness need greater access to information about the consumer. This legislation recognises how important it is that carers, including family members, are given access to information that would assist them in providing care. However, the legislation also acknowledges the need for consumers to maintain control regarding who is to be provided with information about them.
The 2007 Act balances these views by:
- Enabling consumers to nominate a particular person to be their 'primary carer' so this person can receive information and be involved in treatment planning;
- Establishing a process for identifying who will be the primary carer when the consumer is not able to or does not nominate a particular person; and
- Enabling consumers to exclude a person or persons who they do not wish to receive information about them or their treatment. Top of page
4.3.3 Australian Capital Territory (ACT)ACT Mental Health Services are currently directed in their service delivery by Mental Health – Building A Strong Foundation: A Framework for Promoting Mental Health and Wellbeing in the ACT, 2009–2014.
The purpose of this framework is to guide investment in the development and implementation of activities to promote mental heath and wellbeing in the ACT over the next five years. The framework does not specifically address the issue of carers.
Mental Health ACT undertook a project to develop a model for engaging consumers and carers across all levels of Mental Health, ACT.
The Framework that has been developed sets out principles for participation and the structures required for continuous improvements to the quality of relationships between consumers, carers and staff of Mental Health ACT, and the quality of services. The Framework also acknowledges the need for systemic change that will support genuine consumer participation and carer participation, with a focus on organisational development, workforce development and re–sourcing that will build capacity within Mental Health ACT and the community.
The Framework details strategies for consumer participation and carer participation in policy development, service planning, implementation and evaluation, individual advocacy and systems advocacy, staff development and research. It does not address the issue of carer identification.
The Mental Health (Treatment & Care) Act 1994 is also being reviewed to ensure the Act reflects best practice in mental health law as it has developed over the last 10 years. Top of page
4.3.4 Northern Territory (NT)The Mental Health and Related Services Act (2006) has provided significant impetus for changes in attitude and clinical practice regarding the identification and engagement of carers in the delivery of services in the Northern Territory.
Under the Act, in most situations, the same information is provided to a person's primary carer as is provided to the person receiving treatment. Generally carers can expect to be provided with this information unless the consumer says they do not want this to happen and their doctor believes that it is not in their best interests to do so. In situations where the consumer actively refuses consent the doctor responsible for his/her care will decide if providing the information is in the person's best interests. If it is, the information can be given to carers. However, if it is not, the doctor can withhold the information. If this happens, the doctor is required to inform carers of their options, which may include applying to the Mental Health Review Tribunal for a review of the decision.
Carers have wide ranging options to information including that they are:
- Notified of an involuntary order;
- Given information about how make an application to or give evidence to the Tribunal;
- Given information about rights under the Act;
- Notified of a Tribunal decision following a review;
- Given information regarding the availability of legal and support services;
- Provided with information about medication under s88;
- Included in discussions regarding treatment options;
- Provided with information about discharge planning under s89;
- Given information on how to make a complaint; and
- Given information on how to contact the Community Visitor. Top of page
In 2009 a Carers Guide to The Mental Health and Related Services Act (2006) was released. This is a very comprehensive document that currently sets the benchmark within Australia. This guide has drawn on existing documents including some excellent stories that were included in a publication produced by Lifeline for carers of people with a mental illness. More information regarding this document can be found in the section on Good Examples. The NT Guide for carers has contributed to the development of the welcome pack for carers developed as part of this project.
The term 'carer' is defined in a very inclusive manner reflecting the Northern Territory population profile.
It would appear from discussions undertaken during consultation that there has been significant change in clinical practice towards a more carer inclusive partnership approach to service delivery since the introduction of The Mental Health and Related Services Act (2006). Top of page
4.3.5 Western Australia (WA)WA was the first State in Australia to pass the Carers Recognition Act in 2004. This legislation recognises the significant role that carers play in the community and provides a mechanism for their involvement in services that impact on them. All public health services are obliged to comply with the Act.
The following information guides, specifically for use in the mental health area, were published in 2007 as part of the implementation of the Act:
- Carers guide to information sharing with mental health clinicians; and
- Communicating with Carers and Families.
In 2009 the WA Government announced the establishment of a Mental Health Commission (MHC) as a separate department from March 2010. In order for the MHC to lead reforms of the mental health system throughout the State, minor amendments will be required to the draft State Mental Health Strategic Plan and Policy, 2010–2020.
The MHC will undertake work on the draft Plan to agree on priority actions for mental health reform. It is proposed that the draft Plan document previously developed by Pricewaterhouse Coopers is considered a 'green paper'/consultation document and placed on an internet website for public comment. Top of page
In 2004 Service Standards for Non–Government Providers of Community Mental Health Services was released. Standard 5 relates to 'Participation of Carers and Significant Others'. In order to achieve this Standard services are required to have in place a range of policies and practices including 5.1 which states:
Processes to Identify and Inform Carers
The service has a process in place to identify carers/significant others when the consumer enters the service, and to make information about carers' rights and responsibilities available to them.
The degree to which this standard is audited is not known.
Carers are also recognised by the Carers Recognition Act 2004 and Carers Charter. There are government agencies and non–government advocates that can assist with complaints of discrimination or inequity.
Carers WA is funded to support the representation of carers' perspectives on mental health issues. This is primarily achieved through carers' participation in governmental committees or advisory groups for the planning, development and delivery of mental health services. Top of page
4.3.6 Victoria (VIC)Specific Victorian State Government policy or protocols regarding the identification of carers has yet to be developed however the issues are discussed in: Review of the Mental Health Carer Support Program and carer support and resource workers (mental Health), Final Report – 2008 and Caring together – An action plan for carer involvement in Victorian public mental health services – 2006.
The Mental Health Reform Strategy 2009–2019, Implementation Plan 2009–2011 provides a succinct statement of actions to be undertaken by government and key partners over the next two years. The plan forms the basis for an annual reform activity report and a three–year progress report covering 2009–2012.
A whole–of–government mental health outcomes framework (with agreed measures) is being developed and is expected to be available in early 2010. The purpose of the framework is to provide a shared basis for planning and monitoring progress across government and the various levels of the service system that impact on, or are directly targeted to, people affected by mental illness. This includes people with or at risk of mental health problems, their families and the broader community.
The Victorian Mental Health Act 1986 has recently been reviewed and in July 2009 the Government made a commitment to repeal the current Act and to introduce a modern Act that improves safeguards, protects human rights, promotes supported decision making and greater carer involvement. The Government is currently finalising its policy for new mental health legislation. It is anticipated that the Mental Health Bill will be considered by Parliament in 2010 with full implementation expected to occur from 2012. The likely changes in the treatment of involuntary clients will reflect the strategy's emphasis on supporting consumer participation in decision making and the more meaningful involvement of carers and families in treatment and recovery planning. Top of page
The recently developed Caring Together: a Carer Participation Action Plan reaffirms the importance of effective and responsive partnerships between consumers, carers and professionals. A key strategy to improve carer participation described in the Action Plan is the identification of best practice examples in clinical mental health services and the psychiatric disability rehabilitation and support services.
In addition specific information for carers is distributed via area mental health services in the booklet: Information for families and carers of people with a mental illness – 2004. This may be supplemented by additional local carer support information compiled by individual area mental health services.
Victoria has established approximately 30 part–time Carer Consultant positions. It was reported to us however that this program requires further development by way of increased training and support to minimise turnover and to ensure consistency in approach across services.
Examples of 'good practice' were found in Victoria in the form of Psychiatric Medication Information, A Guide for Patients and Carers at St Vincent's Mental Health Service. Top of page
4.3.7 Tasmania (TAS)Tasmania's Mental Health Consumer and Carer Participation Framework was developed in 2006. This provides the overarching policy framework for engagement with carers. The Department of Health and Human Services' (DHHS) Consumer and Community Engagement Strategy and Policy, which is still in draft, identifies who carers are and in what circumstances they should be included. Once endorsed, the DHHS Engagement Policy will inform the development of specific mental health policies.
At a service delivery level, Mental Health Services does not currently have policies and procedures that identify a person's carer and the information to be shared with this carer, as part of the admission process. It is envisaged that such matters will be considered as part of the implementation of the recommendations of the Consumer and Carer Participation Review.
The Tasmanian Mental Health Act 1996 provides 'persons responsible' with a number of roles including the ability to apply for a person's involuntary admission to hospital. A person responsible may also give consent to medical treatment on behalf of a person with a disability who is incapable of giving his or her own consent to the treatment, by virtue of the Tasmanian Guardianship and Administration Act 1995.
Tasmania is in the process of drafting a new Mental Health Act. It is anticipated that the new legislation will refer to 'support persons', rather than 'carers' to ensure broader inclusion of all relevant support people. It is also envisaged that the new legislation will clarify the role of support persons by, for example, requiring them to be provided with a range of information at key points along the person's treatment pathway.
Separate information packs are not currently provided to carers at the time of admission to services. Top of page
4.3.8 South Australia (SA)The SA Health Consumer and Community Participation Policy Directive, 2009 defines carers, and clearly indicates that "for the purpose of this policy, "carers" are included in the category of consumers." There is not such a distinction made for particular identification and participation of carers within treatment and care processes. This policy emphasises Consumers (including Carers) and community.
South Australian Mental Health Services emphasise and recognise more specifically the distinct role of carer in the Southern Mental Health Consumer and Carer Participation Framework May 2009. There is also an acknowledgement within the Framework that:
Recognises that working in partnership with our consumers and carers requires a cultural change, and that different strategies are required to support the partnership.
There is also a clear expectation that services will adhere to, and report on, the principles of the "SA Carers Recognition Act 2005 and Carers Charter", by "involving carers in the planning, delivery and evaluation of policies, programs and services".
In Mental Health some good carers packages of information have been formulated for provision to carers. Currently distribution is reliant on self identification as a carer.
The State also supports the inclusion of the specific Carer Standard (7) in the revised National Standards for Mental Health Services.
The report Stepping Up: A Social Inclusion Action Plan for Mental Health Reform 2007–2012, by the South Australian Social Inclusion Board made the following recommendation relating to carer participation. Top of page
The carers and families of consumers must be seen as partners in the care process. They should be included in care planning processes and, with the agreement of the consumer, receive timely and appropriate information and support.
The issue of how carers are identified in order to be given this information or to be engaged as partners has not been addressed.
A number of part–time Carer Consultant positions have been established in South Australia. Over the last year the role and function of these positions has been reviewed and increased support structures put in place. This has lead to greater stability for people appointed to these positions.