16th Network MeetingEndorsed Report

25-26 February 2008 MelbournePage 1 of 5

SIXTEENTH (16TH) MEETING

THE ROYAL AUSTRALIAN AND NEW ZEALAND

COLLEGE OF PSYCHIATRISTS

309 LA TROBE STREET

MELBOURNE

VICTORIA

25-26 FEBRUARY 2008

ENDORSED

REPORT AND RESOLUTIONS

Glossary of Terms and Acronyms

ACHS / Australian Council on Health Care Standards
ACSQHC / Australian Council on Safety and Quality in Health Care
AHIA / Australian Health Insurance Association
AHMAC / Australian Health Ministers Advisory Council
AMA / Australian medical Association
APHA / Australian Private Hospitals Association
BPRC / The RANZCP Board of Professional and Community Relations
CCAC / Consumer Carer Advisory Committee
COAG / Council of Australia Governments
DoHA / Australian Government Department of Health and Ageing
ERG / Expert Reference Group for the RANZCP Implementation Project for the NPS
FaHCSIA / Australian Government Department of Families, Housing, Community Services and Indigenous Affairs
ICP / Identifying the Carer Project
Health Insurers (s) / Private Health Insurer(s) that pay benefits for psychiatric care
Hospital(s) / Private Hospital(s) with mental health beds
MBS / Australian Government Medicare Benefits Schedule
MHCA / Mental Health Council of Australia
MoU / Memorandum of Understanding
Network / Private Mental Health Consumer Carer Network (Australia)
NGO / Non Government Organisations
NMHCCF or Forum / National Mental Health Consumer Carer Forum
NPS / National Practice Standards for Mental Health Services
NSMHS / National Standards for Mental Health Services
PBAC / Australian Government Pharmaceutical Benefits Advisory Committee
PMHA / Private Mental Health Alliance
PMHA-CDMS / The PMHA’s Centralised Data Management Service

1.OPENING AND WELCOME

The Independent Chair of the Private Mental Health Consumer Carer Network (Australia) [Network], Ms Janne McMahon, opened the 16th Meeting of the Network (the Meeting) at 9:30 AM. The following representatives were present.

  1. Ms Janne McMahonIndependent Chair and Consumer Representative to the Private Mental Health Alliance (PMHA)
  2. Ms Julie HutsonQueensland
  3. Mrs Alvina HillNew South Wales
  4. Mr Trevor BesterTasmania
  5. Mr John KincaidSouth Australia
  6. Mr Patrick HardwickWestern Australia
  7. Ms Kim WernerVictoria

8.Mrs Ruth CarsonPMHA Carer Representative

  1. Mr Phillip TaylorPMHA Director (Secretary)
  2. Mr Wayne ChamleyNetwork’s MHCA Representative and MHCA Board

Member

1.2Invited Guests

Ms Vanessa HilleProject Officer

RANZCP National Standards for the mental health Workforce Implementation Project

2.Report of the 15th NETWORK Meeting

The Meeting noted that a copy of the previously endorsed Report of the Fifteenth Network Meeting, held on 13/14 August 2007, had been circulated with the agenda and papers for the meeting. The PMHA Director, Mr Phillip Taylor reported that a copy of the report had also been posted on the PMHA website.

3.United Nations CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITITES – NATIONAL INTEREST ANALYSIS

The Meeting noted that an invitation had been received from the Australian Government, Attorney-General’s Department, Department of Families, Housing, Community Services and Indigenous Affairs to participate in the consultation process for the United Nations Convention on the Rights of Persons with Disabilities – National Interest Analysis. After discussion, it was agreed that the Network should make a formal Submission that includes the following.

  • The ratification of the Convention should be supported as minimum standards with an obligation that signatory countries should be seeking to achieve a higher standard than the minimum articulated within the Convention.
  • The concept of asylum whilst generally noted as a stigmatisation for a mental health facility, should be note as sanctuary, shelter, or refuge wherein consumers are safe, rather than adding to homelessness and suicide rates via de-institutionalisation.
  • Australia would not currently be able to comply with the Convention in relation to people with a mental illness. At present, people with a mental illness are not free or protected from, certain discriminatory or abusive situations that compromise their human rights.
  • While the generic references to access, non-discrimination, employment and housing are acceptable, the following issues should be raised as they relate to mental illness, particularly in relation to the obligations imposed by the Convention.

Employment. All people with a mental disability have a right to employment through the availability of appropriate training, employment opportunities and non-discriminatory work places. Often, however, there are serious disincentives that diminish that right. Governments for example, may impose restrictions on welfare payments to an individual who is genuinely trying to enter the workforce, often under very difficult circumstances. While Governments and their Departments should be the agencies that lead by example, in many situations this is not the case for people with a mental disability.

Discrimination. Unfortunately, discrimination against people with a mental illness still exists. In Australian society, people tend to distance themselves from those with a mental disability, perceiving them to be ‘dangerous” and “unpredictable’. In particular, people with schizophrenia, alcohol abuse and substance dependency problems are all too often on the receiving end of a number of forms of discrimination. Frequently, discrimination against people with a mental disability is evident in Government Departments themselves.

Involuntary admissions and treatment. Under mental health legislation in Australia, involuntary admission, treatment, restraint and seclusion of people with a mental illness would potentially be at odds with several Articles of the Convention. As part of implementation of the Convention, a review of Australian mental health legislation should be undertaken to ensure that it is consistent with several the Convention’s articles. Mental health legislation should provide the greatest possible protection to the rights of persons with a mental illness, including their right to consent or to refuse treatment.

Article 5: Equality and non-discrimination. The general principles that are emerging nationally from several studies in Australia need to be included within any implementation strategies to ensure that the rights of people are protected who are detained or admitted on an involuntary basis.

Article 14: Liberty and security of the person. While it is acknowledged that there will be circumstances where people with a mental illness are detained against their will, it is essential that rights of those people are still respected under those conditions.

Article 15:Freedom from torture or cruel, inhuman or degrading treatment or punishment. The Australian Government’s push for the elimination of seclusion and the minimisation and elimination of restraint, including both by mechanical or chemical means, should be highlighted and strongly supported.

Article 25:Health. Under this Article, dot point 4 is particularly relevant to people with a mental illness and the particular issues of involuntary admissions, treatment, restraint and seclusion. The Article emphasises that persons with a disability should only receive medical treatment to which they agree. However, people with a mental illness can receive treatment involuntarily under mental health legislation. While it is acknowledged that in some circumstances involuntary treatment may be necessary, strong safeguards must be in place to ensure the rights of the individual are still protected. An individual’s previously expressed choices about treatment, such as advance directives, should be respected as much as possible.

  • In the Convention, there are some important omissions relating to housing, and the care and support of carers and families that must be taken into account within the implementation processes. The Australian Government and its relevant Departments must address the issues of the rights of people with a mental disability to access safe, clean and supportive housing that is free from discrimination. The carers and families of people with a mental disability must be supported in their caring roles.

Article 8 – Awareness-raising. There is a distinct hierarchy of health, even within the area of disability, and mental illness is the most stigmatised and least understood. There are particular challenges to the rights of the mentally ill, for example, involuntary treatment and restraint. Initiatives designed to raise awareness must specifically address the stigma associated with mental illness and provide specific education about the rights of people with mental illness. The Australian Government in any implementation of the Charter must address and continue to address this issue.

  • In relation to the foreseeable economic, environmental, social and cultural effect of implementing the Convention, the following is important.

People with a mental illness should have the same rights as everyone else to live, take part, and be included in, the community. Unfortunately, this does not always apply to persons disabled by a mental illness.

Legal issues impact on people with a mental disability. Under Community Treatment Orders orInvoluntary Treatment Orders, for example, they can lose the right to refuse treatment. Treatment can be forced upon them, often via depot injections. If people do not voluntarily attend a mental health service for medications, health professionals seek them out in their place of residence and require them to comply. Similarly, people disabled with a mental illness lose the right to attend to their own finances. Guardianship/Trustee Boards determine, under Administrative Orders, who will act on their behalf and what they will do with their finances.

Article 19: Living independently and being included in the community. In many ways, this Article encapsulates the essence of the Convention as it applies to people disabled with a mental illness. Australia, at all levels of Government, must acknowledge this Article and take appropriate steps to ensure people living with a mental disability enjoy the following.

The opportunity to choose where they live and who they live with.

Support services delivered within mental health services, community services, residential and other supports provided within the community.

 Prevention from isolation.

Equal access to health services, community services, employment and any other services and facilities available to other Australians.

Resolved (unanimous)

That the Private Mental Health Consumer Carer Network (Australia) [Network] recommends that the United Nations Convention on the Rights of Persons with Disabilities should be ratified as minimum standards with the obligation that signatory countries should be seeking to achieve a higher standard than the minimum articulated within the Convention. In doing so, the Network requests that the issues raised at the 16th Network Meeting be included in a formal Network submission to Australian Government, Attorney-General’s Department, Department of Families, Housing, Community Services and Indigenous Affairs.

Action: Ms McMahon/Ms Werner/Mr Chamley/ Mr Hardwick

4.australian commission on safety and quality in healthcare (ACSQHC) – national patient charter of rights

The Meeting noted that, on 22 January 2008, the Network received a letter from the ACSQHC seeking input into the development of a National Patient Charter of Rights. The National Charter of Patient Rights is one of nine priority programs on the current ACSQHC work plan. The Chair reported that there are currently several charters of patients rights including the Public Hospital Patient Charter, the Private Patient’s Hospital Charter, and the individual charters of private hospitals.

The Meeting then considered a copy of the Consultation Paper, which provided background information regarding the development of the Patient Charter, discussion of how a charter might be used, and a draft charter. The paper also included a summary of the issues and questions on which ACSQHC is seeking feedback.

A copy of the draft Overview including Principles, and Standard 1 - Rights and Responsibilities from the National Standards for Mental Health Services was also noted.

The Chair reported that the information obtained through written submissions will be used to develop draft recommendations on a National Patient Charter of Rights to put to all Health Ministers in June 2008.

After discussion, the Network agreed to develop a formal submission that includes the following.

4.1General Comments

The Network strongly supports the development of a single National Patient Charter of Rights that is applicable across all public and private health care settings. In the relation to mental health, the Charter should seek to compliment the National Standards for Mental Health Services (NSMHS). NSMHS address the specific rights of people with a mental illness when they are treated within a public or private mental health service. In relation to implementation, the requirements for the private sector should be considered no different from the other eight Australian state and territory jurisdictions.

4.2Advice on the National Patient Charter Principles

  1. ACCESS: Equity of access to public health care

Delete the word public from the title. Equity of access is relevant to all health care settings.

  1. RESPECT: Respect, dignity and consideration

This Principle is strongly supported in relation to health care being delivered in a manner, which respects the rights of consumers to be treated with respect, dignity and consideration.

  1. SAFETY: Promoting safe and competent care

In Australia, a person with a mental illness for their own safety or the safety of others can be admitted to hospital on an involuntary basis, mechanically or chemically restrained, or placed in seclusion. Under these distressing and difficult circumstances, it is particularly important that the rights of the consumer are still protected and not jeopardised by safety considerations. It is imperative that their rights be taken specifically into consideration within an environment that seeks to minimise and eliminate the use of seclusion and restraint.

  1. COMMUNICATION: communicating clearly throughout the period of care

Delete the words, particularly when plans change or something goes wrong from the first dot point under this Principle, so that it reads, open and appropriate communication throughout the period of care. This should be sufficient to cover anything that occurs during the period of care.

The third dot point addresses a patient’s right to have access to a qualified health interpreter and should be strongly supported. Where that is not possible, the use of unqualified staff is not supported.

  1. INFORMATION: being informed about services, treatment and care

At the end of the title of this Principle, the words in a timely manner should be inserted.

The inclusion of the two patient responsibilities at the end of this Principle appears inconsistent with other sections of the Draft.

  1. PARTICIPATION: informed decision making and informed choices

For some people with a mental illness, there will be times when they are unable to be involved in making fully informed decisions and choices regarding their treatment and care because of their mental status. This, therefore, should be done at the most appropriate point in their treatment and recovery when they can more fully understand the implications of any decisions or choices they might make.

  1. PRIVACY: ensuring personal information is secure

The word transfer should be inserted after the word disclosure to address the issue of the electronic transfer of information.

  1. REDRESS: commenting on care and having concerns addressed

Under this Principle, the third dot point should become the first. There also needs to be a requirement of health providers to be proactive in advising processes and actions for consumers to have their concerns dealt with.

4.3Response to Consultation Questions

  1. National Patient Charter of Rights and National Patient Charter Principles

A singular national charter of rights and its underpinning principles should be supported for use by patients and providers in both the public and private health care sectors.

  1. Rights included in the Charter

While the eight key patient rights are supported, the work that has been done on the human rights of people with a mental illness is significant. The rights enshrined within the United Nations Resolution on the Principles for the Protection of Persons with Mental Illness and the Australian Mental Health statement of rights and responsibilities, recognise the aspirations of all Australians to a dignified and secure way of life with equal access to health care.

While the right to Redress in its current form is acceptable, health care providers should be pro-active in advising on the processes for making a complaint.

  1. Points included in the Principles

The Commission should review the comments made earlier regarding mental health.

  1. Rights and responsibilities

The NSMHS contain a standard on a consumer’s Rights and responsibilities,wherein consumer responsibilities are clearly articulated, but with less emphasis than rights. While consumer responsibilities are important within the health care setting, the title Charter of Patients Rights infers the individual’s right to receive.

  1. Existing charters

To reduce confusion and duplication, multiple Charters should be avoided. A single nationally consistent Charter, that is applicable across both public and private health care settings, should be sufficient provided it is capable of complimenting other specific rights that might be enshrined in existing charters or other documents, like the NSMHS.

  1. Possible uses of the charter.

The Charter should operate to compliment the relevant standards against which public and private sector health care organisations are accredited. In mental health for example, the Charter would need to be aligned with the NSMHS, which are used for accrediting mental health services in both the public and private hospitals.

Resolved (unanimous)

That the Private Mental Health Consumer Carer Network (Australia) [Network] requests that the issues raised at the 16th Network Meeting on the Australian Commission on Quality and Safety in Healthcare (ACSQHC) Draft National Patient Charter of Rights be included in a formal Network submission to ACSQHC on the Charter.

Action: Ms McMahon

5.National practice standards for the mental health workforce – implementation project

The Meeting noted a copy of the National Practice Standards for the Mental Health Workforce (NPS) that were published in 2002, and articulate 12 Practice Standards to guide the workforce in the three main areas of knowledge, skills and attitudes. In 2002, the NPS were welcomed by consumer and carer groups across Australia as a practical guide on how consumers and carers should be treated within the mental health service settings. The mental health workforce referred to within the NPS comprises psychiatrists, psychologists, nurses, social workers and occupational therapists. The NPS are underpinned by the premise that any health professional entering the mental health workforce should have the opportunity to be educated by mental health consumers their family members and/or carers about their ‘lived’ experiences, requirements for adequate service and support, and the ability to work in partnership with mental health professionals. A two-year timeframe during which professionals could work towards meeting the requirements of the NPS from the time they began work in a mental health service, was established.