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.
Establish a recovery-oriented framework for treatment and embed supported decision making
Presumption of capacity
Second psychiatric opinion
Nominated person and recognition of the role of carers
Source: The Mental Health Bill 2014. An explanatory guide. P.3
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.
These principles are detailed in the Practice Guide for working with nominated persons, families and carers Appendix 3.
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.
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—
The mental health principles from the Act that are most relevant to the nominated persons and carer provisions of the Act are: