MENTAL HEALTH ACT 2014 TREATMENT, SUPPORT AND DISCHARGE PLANNING FAMILY AND CARER RIGHTS

1. MENTAL HEALTH ACT 2014 TREATMENT, SUPPORT AND DISCHARGE PLANNING FAMILY AND CARER RIGHTS

2. The Western Australian law which allows for people experiencing mental distress to be treated (and perhaps detained) without their consent is called the Mental Health Act 2014. We’ll call it ‘the Act’ from now on. Here’s how it’s set out. The Act has 29 Parts (A Part is like a chapter in a book) Page number Each Part (chapter) has a number of Divisions A copy of the Act can be downloaded from the Western Australian Mental Health Commission webpage. https://www.mhc.wa.gov.au/media/1245/mental-health-act-2014.pdf

3. Let’s have a look at a typical page in the Act Name of the Act Part Division Section of the Act If you’re looking for a particular Section in the Act, just scroll down until you see the Section number on the left hand side of the page.

4. This is the part of the Act which tells us what different words/terms mean in this Act. To find the definition of ‘carer’ under this Act, we’ve got to go to S280 (1)

5. Relevant Definitions These definitions are adapted from the Glossary of Terms in the Family and Carer Handbook to the Mental Health Act 2014 https://www.mhc.wa.gov.au/media/1436/family-and-carer-handbook-to-the-mental-health-act-2014-version-2-1.pdf Close family member: Under the Mental Health Act 2014, this is a family member who is not also the person’s primary carer, or their nominated person, but who nevertheless provides ongoing care or assistance to the person. If a person identifies as an Aboriginal or Torres Strait Islander person, then a close family member includes any person recognised this way under customary law or tradition. Carer: This is a term defined under the Carers Recognition Act 2004, Section 5 that can apply to family members, friends and even neighbours who provide ongoing support and assistance (unpaid) to people who have a mental health illness. Someone who provides a service while on contract or while doing voluntary community service is not considered to be a carer. Nominated person:An adult, such as a friend, who has been formally nominated (named) in writing by a person to receive information and be involved in decisions about their treatment and care. Any person, even a child, may propose someone to be their nominated person, but they must understand the impact of making the nomination. They can name only one person at a time. The person who made the nomination can revoke (stop) it at any time, in any way they choose.

6. The Objects tell us about the purpose of the Act – what it’s meant to achieve. These are the 3 objects which directly relate to family and carers. Individual words in a law are powerful and important. For example, the word ‘facilitate’ means ‘to make easy or easier’. Services have a responsibility to act in accordance with the ‘letter of the law’.

7. Charter of Mental Health Care Principles The Act is founded on 15 principles. The following information is taken from the Family and Carer Handbook to the Mental Health Act 2014 https://www.mhc.wa.gov.au/media/1436/family-and-carer-handbook-to-the-mental-health-act-2014 version-2-1.pdf Principle 14: Involvement of other people A mental health service must, at all times, respect and facilitate the right of people experiencing mental illness to involve carers, families and other personal and professional support persons in planning, undertaking and evaluating their treatment, care and support. Principle 7: People of Aboriginal or Torres Strait Islander descent  A mental health service must provide treatment and care to people of Aboriginal or Torres Strait Islander descent that is appropriate to, and consistent with, their cultural and spiritual beliefs and practices and having regard to the views of their families and, to the extent that it is practicable and appropriate to do so, the views of significant members of their communities, including elders and traditional healers, and Aboriginal or Torres Strait Islander mental health workers. Principle 7: People of Aboriginal or Torres Strait Islander descent A mental health service must provide treatment and care to people of Aboriginal or Torres Strait Islander descent that is appropriate to, and consistent with, their cultural and spiritual beliefs and practices and having regard to the views of their families and, to the extent that it is practicable and appropriate to do so, the views of significant members of their communities, including elders and traditional healers, and Aboriginal or Torres Strait Islander mental health workers. (Refer to Sections 50, 81 and 189 of the Act for more detailed information). Principle 6: Diversity inclusive A mental health service must recognise, and be sensitive and responsive to, diverse individual circumstances, including those relating to gender, sexuality, age, family, disability, lifestyle choices and cultural and spiritual beliefs and practices. “English is Mum’s third language behind Mandarin and Indonesian so it was important that mental health staff recognise that she had difficulty being able to express her needs and what was going on for her due to the language barrier.”

8. What are patient and carer TSD Plan Rights? Let’s check out Sections 186 – 188 of the Act ALLtreatment, care and support provided to an involuntary* patient (includes Community Treatment Orders) The TSD Plan must outline the treatment and support that will be provided to the patient while in hospital and what will be offered after discharge • Section (s)186 • ALL treatment, care and support provided to an involuntary* patient • (includes Community Treatment Orders) must be governed by a TSD Plan. • The TSD Plan must outline the treatment and support that will be provided to the patient while in hospital and what will be offered after discharge • Section (s)187 • The patient’s psychiatrist must ensure that: • The TSD Plan is prepared as soon as possible after the patient becomes involuntary. • It is reviewed regularly. • The patient (and others such as carers) must be given a copy. *Note: only applies to involuntary patients but s547 referring to Chief Psychiatrist’s Standards and National Standards means voluntary patients have most of the same rights.

9. ALLtreatment, care and support provided to an involuntary* patient (includes Community Treatment Orders) The TSD Plan must outline the treatment and support that will be provided to the patient while in hospital and what will be offered after discharge • Section (s)187(2) • The plan must be prepared, reviewed and revised having regard to the Chief Psychiatrist’s guidelines. • Check out the Guidelines and Standards at www.chiefpsychiatrist.wa.gov.au • Who is the Chief Psychiatrist? The Chief Psychiatrist (CP) is: • an independent officer whose powers and duties are detailed in the Act; • responsible for the treatment and care of patients of mental health services and • responsible for the monitoring of standards of care delivered throughout the State. • The CP and his team make up the Office of the Chief Psychiatrist (OCP). • Further information is available at www.chiefpsychiatrist.wa.gov.au.

10. Section (s)188 • The patient’s psychiatrist must ensure that the patient and Personal Support Persons (PSPs) are involved in the preparation and review, of the TSD Plan and a record made of their involvement. • Patient capacity is not needed to consent to the plan being implemented – the person authorised by law can consent. • ALLtreatment, care and support provided to an involuntary* patient • (includes Community Treatment Orders) • he TSD Plan must outline the treatment and support that will • be provided to the patient while in hospital • and what will be offered after discharge s422 and s423 – a patient can apply for a Compliance Order to ensure that a TSD Plan is prepared, reviewed or revised. (Note – this is not available to voluntary patients). Note: There are exclusion powers. This might include a situation where an involuntary patient refuses to consent and the psychiatrist considers the refusal to be reasonable (s288) or the psychiatrist considers that it is not in the patient’s best interests (s292).

11. s394(1)(d) – The Mental Health Tribunalmust have regard to the patient’s TSD Plan when making a decision on a review of involuntary status. s395(3)– While the Tribunal cannot make an order or give a direction about a patient’s TSD Plan, it may make a recommendation that the psychiatrist review the TSD Plan and about the amendments that could be made (and give a copy to the Chief Psychiatrist). ALLtreatment, care and support provided to an involuntary* patient (includes Community Treatment Orders) The TSD Plan must outline the treatment and support that will be provided to the patient while in hospital and what will be offered after discharge • What is the Mental Health Tribunal? • The Mental Health Tribunal (the Tribunal) is an independent statutory tribunal established under the Act. • Its role is to: • oversee the involuntary treatment imposed, and certain decisions made, under the Act; • safeguard the rights of involuntary patients in WA; • conduct informal hearings for a range of matters; • invite the attendance of the patient, the patient's legal representative and or advocate, as well as carers, close family members and personal support persons to hearings. Representatives of the patient’s treating team also attend the hearing. • The Tribunal who conducts the hearing of your family member or friend’s case will comprise a lawyer, a psychiatrist (not the treating psychiatrist) and a community member. The hearing is held at the health services where the person is detained. • Adapted from: • http://www.parliament.wa.gov.au/publications/tabledpapers.nsf/displaypaper/4011798abc93342dfb05d9034825830e0005da53/$file/1798.pdf

12. What’s included in a Treatment, Support and Discharge plan? ALLtreatment, care and support provided to an involuntary* patient (includes Community Treatment Orders) The TSD Plan must outline the treatment and support that will be provided to the patient while in hospital and what will be offered after discharge Patient’s name and personal details Case Manager’s name and health service information Start and review dates of the plan Details re the person’s mental health, alcohol and other drug use, physical health, gender / sexuality, legal issues, accommodation, employment, interests…. Results of recent assessments Issues / Problems Strengths / Talents Goals Actions Signatures (other information may also be included as templates vary across health services) An example of a TSDP plan is available in the 2018 Mental Health Advocacy Service Treatment, Support and Discharge Plan Inquiry (pages 77-79). https://mhas.wa.gov.au/assets/documents/TSD-PLANS-final-report-19-March-2018.pdf

13. How to get a Treatment, Support and Discharge Plan… • Ask for the Treatment, Support and Discharge Plan when the person is admitted. • “I understand that a TSD Plan starts from Day 1. When are we meeting to discuss it?” • All the Standards say that the plan is to start on admission. • Ask who organises the TSD Plan, how to be part of drafting the plan and when a meeting will be held to get your input. • As soon as discharge is mentioned, all discussions should be recorded as part of the TSD Plan. • On an acute ward, weekly updates should be expected. • Check out what language is being used to describe the TSD Plan. It may also be referred to as a Care Treatment Recovery or Management plan. • We are not talking about a Discharge Summary which is a different document. • You can call the Mental Health Advocacy Service yourself. The MHAS acts for the patient and can check if a TSDP plan has been completed.

14. Some peer wisdom and advice • Remember your intention and purpose. • Your aim is to work together with the person, doctors, nursing staff, support • services etc. to get the best outcomes for the person receiving care. • You are less likely to be listened to if you get emotional or angry. You may • have a right to be emotional or angry but it may not help you to be heard. • Take a deep breath, release tension, think before you react. • Read the notes on the next slide about preparing for meetings. • It may be a marathon, not a sprint! • The journey of a family member, carer or supporter can be fraught. It can be physical, emotional and mentally draining. This can have an impact on yourwellbeing. • It is really important to take good care of yourself. Spend time with supportive friends. Seek peer and professional support. Do things you enjoy. • Know your rights. • Be confident that you have rights as a family member / carer under a number of laws and Standards. These include the WA Carers Recognition Act 2004; National Carer Recognition Act 2010; the National Mental Health Standards 2006.

15. HANDY TIPS IF YOU ATTEND A MEETING • (Remember – you can ask for one too) • BEFORE • Find out about the hospital / health service. What does it say on their webpage about their values and approach? • Consider taking someone with you and what they’ll do (support, record, keep focus…) • Decide together what you want to get out of the meeting-write down what you want to achieve. • Send through information beforehand to avoid repeating your story on the day. • Ask who’ll be at the meeting and what their role will be. If you don’t want too many people there, do say so. • DURING • Be confident that you have knowledge and expertise that is valuable. • Record the names and roles of the people attending the meeting. • Agree on the purpose of the meeting. • Take notes (or ask the person with you to do so). • Record agreed actions with the timeline and person responsible. • Find out the contact email address of the person co-ordinating the meeting. • AFTER • Send an email to confirm what was agreed. • Debrief. • Practice self-care. • Take the next steps. • If you’re not happy with how the meeting went and can’t see a resolution, ask about the complaints process. • Contact the Mental Health Advocacy Service at any stage for further information. www.mhas.wa.gov.au. Freecall from landlines: 1800 999 057. Tel: (08) 6234 6300

16. USEFUL CONTACTS AND RESOURCES • The webpages of these groups and agencies contain useful information and guides about the Mental Health Act 2014, including family and carer rights. • Mental Health Advocacy Service: Tel: 1800 999 057 www.mhas.wa.org.au • Mental Health Commission (WA): Tel:(08) 6553 0600www.mhc.wa.gov.au/media/1436/family-and-carer-handbook-to-the-mental-health-act-2014-version-2-1.pdf • Mental Health Matters 2: www.mentalhealthmatters2.com.au • Carers WA: Tel: 1800 242 636 www.carerswa.asn.au/carers-wa-services/policy-research/carer-friendly-policies-and-legislation • Mental Health Law Centre: Tel: (08) 9328 8012 Freecall: 1800 620 285 • www.mhlcwa.org.au • Health & Disability Services Complaints Office (HaDSCO): Tel: (08) 6551 600 www.hadsco.wa.gov.au/aboutus/services.cfm • Health Consumers Council: Tel: 9221 3422 Country Callers 1800 620 780 www.hconc.org.au • Mental Health Tribunal: Tel: (08) 6553 0060 www.mht.wa.gov.au • Helping Minds (Mental Health Carer Advocates): Tel: (08) 9427 7100 • www.helpingminds.org.au/services