Key Principles



Overview

Two key elements underpinning the 2014 Mental Health Act are recovery oriented practice and supported decision making. It is important that you understand these principles well in order to commit to implementing the provisions related to nominated persons and carers.

Alignment with recovery oriented practice and the establishment of supported decision making are central to the reform objectives of the Mental Health Act 2014.

flowchart of the outcomes of the reform

Reform objective

Reform actions

Reform outcomes

Recovery framework

Establish a recovery-oriented framework for treatment and embed supported decision making

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Presumption of capacity

Second psychiatric opinion

Advanced Statement

Nominated person and recognition of the role of carers

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Outcomes

  • Patients are informed and treatment preferences are respected
  • Patients are supported to make or participate in all treatment decisions
  • Patients understand and are supported to exercise their rights
  • Improved patient, family and carer involvement in treatment decisions

Source: The Mental Health Bill 2014. An explanatory guide. P.3

Recovery Oriented Practice

A consumer’s personal and social relationships are a key domain in recovery oriented practice and are critical to an individual's well-being. Mental illness not only has an impact on those who may experience it themselves but also significant people in their lives and those that support and care for them. It is important that those who are in a caring role are recognised and supported. The clinician, by working together with the consumer and the people who are significant in their lives, can support the consumer’s recovery and respond to the needs of those people in a caring or otherwise supportive role. Cultivating and supporting a productive three way relationship between the consumer, the people who are important in their lives and clinicians has the potential to harness their value in what is ideally a shared endeavour. For clinicians who approach practice in this way, carers and the nominated person role are valuable resources that can be mobilised and supported to assist in the consumers’ recovery.

Nine principles of Recovery Oriented Practice

  1. Promoting a culture of hope
  2. Promoting autonomy and self-determination
  3. Collaborative partnerships and meaningful engagement
  4. Focus on strengths
  5. Holistic and personalised care
  6. Family, carers, support people and significant others
  7. Community participation and citizenship
  8. Responsiveness to diversity
  9. Reflection and learning

These principles are detailed in the Practice Guide for working with nominated persons, families and carers Appendix 3.

Supported Decision Making

Supported decision making is based on a presumption of capacity; that is, that people with serious mental illness are presumed to have the capacity to make decisions about their treatment. However, it is recognised that there may be times when people do not have capacity and this can change over time.

Within the Act, the role of the nominated person and carers sits alongside provisions relating to the presumption of capacity, the use of advance statements and access to second opinions as mechanisms to facilitate supported decision making. The establishment of a new advocacy program (though not part of the Act) is a further measure that enables supported decision making.

Practitioner chatting to client

Seven Decision Making Principles (from Supporting Decision Making – A Guide to supporting people with a disability to make their own decisions)

  1. Everyone has the right to make decisions about the things that affect them.
  2. Capacity to make decisions must be assumed.
  3. Every effort should be made to support people to make their decisions.
  4. Capacity is decision specific.
  5. People have the right to learn from experience.
  6. People have the right to change their minds.
  7. People have the right to make decisions other might not agree with.

The Act also provides guidance about determining whether a person has capacity to give informed consent.

The following principles are intended to provide guidance to any person who is required to determine whether or not a person has the capacity to give informed consent under this Act—

  • (a) a person's capacity to give informed consent is specific to the decision that the person is to make;
  • (b) a person's capacity to give informed consent may change over time;
  • (c) it should not be assumed that a person does not have the capacity to give informed consent based only on his or her age, appearance, condition or an aspect of his or her behaviour;
  • (d) a determination that a person does not have capacity to give informed consent should not be made only because the person makes a decision that could be considered to be unwise;
  • (e) when assessing a person's capacity to give informed consent, reasonable steps should be taken to conduct the assessment at a time and in an environment in, which the person's capacity to give informed consent can be assessed most accurately.

Mental Health Principles

The mental health principles from the Act that are most relevant to the nominated persons and carer provisions of the Act are:

  • c. persons receiving mental health services should be involved in all decisions about their assessment, treatment and recovery and be supported to make, or participate in, those decisions, and their views and preferences should be respected;
  • d. persons receiving mental health services should be allowed to make decisions about their assessment, treatment and recovery that involve a degree of risk;
  • j. children, young persons and other dependents of persons receiving mental health services should have their needs, wellbeing and safety recognised and protected;
  • k. carers (including children) for persons receiving mental health services should be involved in decisions about assessment, treatment and recovery, whenever this is possible;
  • l. carers (including children) for persons receiving mental health services should have their role recognised, respected and supported.