Transcript Advance Statements and Nominated Persons

What are
Advance Statements?
What is a
Nominated Person?
Principles underpinning SDM (1)
1. Decision-making is seen as relational - the person is
encouraged/enabled to draw on their own networks to help them
make decisions
2. People are capable of making decisions about most areas of
their lives.
3. Everyone has a will and can communicate their will and
preferences. These preferences can be built into valid decisions.
4. The person should receive whatever support they need and
wish to receive in order to make decisions.
5. Competency can be learned, influenced, enhanced and
suppressed.
Cont.
Principles underpinning SDM (2)
6. The person makes and retains control over the decisions made
and takes responsibility for them.
7. People have the right to take risks in their lives.
8. People do not always make good decisions but can learn from
their mistakes and experience.
Adapted from Carter, B. (2009). Supported decision making
backgrounds and discussion paper, office of the Public Advocate
http://www.publicadvocate.vic.gov.au/file/file/Research/Discussio
n/2009/0909_Supported_Decision_Making.pdf
From CPN slides “Supported decision-making what does it mean for me?”
What are
Advance Statements?
video
Advance statements
• The new MHA enables a person to make an advance
statement to record their treatment preferences in the
event that they become unwell and require compulsory
treatment.
• Advance statements facilitate a collaborative treatment
approach at times where a patient is so unwell that
they are unable to communicate their treatment
preferences.
Advance statements
• They assist the authorised psychiatrist to understand
the patient’s treatment preferences and enable the
authorised psychiatrist to make treatment decisions
that better align with the patient’s treatment and
recovery goals.
• Advance statements improve communication, give
patients greater control over their treatment when they
are subject to a compulsory treatment order and
promote an improved patient experience.
(from The Mental Health Bill 2014 – An explanatory guide)
Where is this in the new MH Act?
Sections 19-22
Where is this in the new MH Act?
Division 3—Advance statements
Section 19
What is an advance statement?
An advance statement is a document that sets
out a person's preferences in relation to
treatment in the event that the person
becomes a patient.
Treatment
Section 6 What is treatment?
For the purposes of this Act—
(a) a person receives treatment for mental illness if things
are done to the person in the course of the exercise of
professional skills—
(i) to remedy the mental illness; or
(ii) to alleviate the symptoms and reduce the ill effects
of the mental illness; and
(b) treatment includes electroconvulsive treatment and
neurosurgery for mental illness.
QUIZ question
Using the previous definition of treatment, which of the
following are treatment options?
a.
Talk therapies
b.
Employment
c.
Medications
d.
Pet care
e.
Seclusion
f.
ECT
QUIZ answer
Using the previous definition of treatment, which of the
following are treatment options?
a.
Talk therapies
b.
Employment
c.
Medications
d.
Pet care
e.
Seclusion
f.
ECT
QUIZ question
What is an advance statement?
a.
A document that sets out a carer’s treatment
preferences
b.
A recorded discussion between clinician and client
discussing the client’s preferences
c.
A document that sets out a person’s treatment
preferences in the event they become a patient
d.
A will
QUIZ answer
What is an advance statement?
a.
A document that sets out a carer’s treatment
preferences
b.
A recorded discussion between clinician and client
discussing the client’s preferences
c.
A document that sets out a person’s treatment
preferences in the event they become a patient
d.
A will
Making an advance statement (1)
Section 20 Making an advance statement
(1) An advance statement may be made at any time and
must—
(a) be in writing; and
(b) be signed and dated by the person making the advance
statement; and
(c) be witnessed by an authorised witness; and …
Making an advance statement (2)
d) include a statement signed by the authorised witness
stating that—
(i) in the opinion of the witness, the person making the
advance statement understands what an advance
statement is and the consequences of making the
statement; and
(ii) the witness observed the person making the advance
statement sign the statement; and
(iii) the witness is an authorised witness.
Making an advance statement (3)
(2)
An advance statement is effective from the time it is
made until it is revoked.
Documents
It is not necessary to use a prescribed form.
A blank page can be used as long as it includes all the
components mentioned earlier (i.e. in writing, signed,
witnessed).
Non-treatment preferences can be recorded as
other/additional.
Utilising an advance statement (2)
Under the Act the “authorised psychiatrist”:
(a) must, to the extent that is reasonable in the
circumstances, have regard to all of the following…..
(ii) the views and preferences of the person expressed in his
or her advance statement;
When –
Section 71 Providing treatment without consent (page
73(92))
and more…..
Utilising an advance statement (3)
And also when (for example)
•
Section 46 Making a TTO (page 49(68))
•
Section 48 Deciding on CTTO vs ITTO
•
Section 55 Making a TO
•
Section 64 Granting a leave of absence
•
Section 93 Application to MHT for ECT
and more …..
Overriding an advance statement (1)
Section 73 Circumstances in which patient's preferences
in advance statement may be overridden
(1) An authorised psychiatrist may make a treatment decision
under section 71(3) for a patient that is not in accordance
with that patient's advance statement if the authorised
psychiatrist is satisfied that the preferred treatment
specified by the patient in the advance statement—
• (a) is not clinically appropriate; or
• (b) is not a treatment ordinarily provided by the designated
mental health service.
Overriding an advance statement (2)
(2) If an authorised psychiatrist overrides a patient's
preferred treatment in accordance with this section, the
authorised psychiatrist must—
(a) inform the patient of the decision and include the
reasons for the decision; and
(b) advise the patient that he or she has a right to request
written reasons for the decision.
(3) An authorised psychiatrist must provide written reasons
for his or her decision under this section within 10 business
days after receiving a request made under subsection
(2)(b).
Revoking an advance statement (1)
Section 21 Revoking an advance statement
(1) An advance statement is revoked if the person who made
the advance statement—
(a) makes a new advance statement under section 20; or
(b) revokes the advance statement in accordance with
subsection (2).
Then, as for the making, any statement of revocation must
be in writing, signed and witnessed accordingly.
Again, a form is available.
QUIZ question
All patients are required to have an Advance Statement.
TRUE
FALSE
QUIZ answer
All patients are required to have an Advance Statement.
TRUE
FALSE
Consider this:
Your client, Zac, says he has put together an Advance
Statement with his friend and wants to bring it to your next
meeting for you to sign.
What do you need to consider in this meeting with Zac?
Some suggestions:
• It needs to be signed by Zac in front of the witness (you).
• Is Zac aware of treatment vs non-treatment preferences?
• Can the listed treatment preferences reasonably be provided by
his MH service?
• Does Zac understand what an advance statement is and the
implications of it?
• Does Zac understand how to revoke or change it?
• Is Zac’s carer aware of the statement and its content?
• Is Zac’s nominated person (if applicable) aware of the statement
and its content?
• Recording in CMI and putting in clinical file / SMR.
What is a
Nominated Person?
Nominated Persons
• A patient will be able to nominate a person to receive
information and to support the patient for the duration
of the compulsory treatment order.
Nominated Persons
• The nominated person will assist a patient to exercise
their rights and represent the patient’s views and
preferences.
• They will be consulted at critical points in the patient’s
treatment such as intake and discharge planning and
will be able to express their views.
• The nominated person is not able to make treatment
decisions on behalf of the patient.
Where is this in the new MH Act?
Sections 23-27
Where is this in the new MH Act?
23 Role of nominated person
• The role of a nominated person in relation to a
patient is—
• (a) to provide the patient with support and to
help represent the interests of the patient; and
• (b) to receive information about the patient in
accordance with this Act; and
Where is this in the new MH Act?
23 Role of nominated person (cont)
• (c) to be one of the persons who must be
consulted in accordance with this Act about
the patient's treatment; and
• (d) to assist the patient to exercise any right
that the patient has under this Act.
• (Video)
What were the critical things the
clinician discussed with Paul about
appointing a nominated person?
Establishing NP
24 Nomination of nominated person
(2) The nomination of a nominated person must—
• (a) be in writing; and
• (b) be signed and dated by the person making the
nomination; and
• (c) specify the name and contact details of the person
nominated; and
• (d) include a statement signed by the nominated person
that he or she agrees to be the nominated person; and
Establishing NP
• (e) be witnessed by an authorised witness; and
• (f) include a statement signed by the authorised witness
stating that—
– (i) in the opinion of the witness, the person making the
nomination understands what a nomination is and the
consequences of making a nomination; and
– (ii) the witness observed the person sign the nomination; and
– (iii) the witness is an authorised witness.
Establishing NP
• (3) The person nominated to be the nominated person must
not be the person who witnesses the nomination.
• (4) A nomination made under this section is effective from
the time it is made until it is revoked.
Documents
It is not necessary to use a prescribed form.
A blank page can be used as long as it includes all the
components mentioned earlier (i.e. in writing, signed,
witnessed).
Utilising a Nominated Person
Check with the client.
CMI should tell us if the client has an NP and who it is.
Utilising a NP
Under the Act the “authorised psychiatrist”:
(a) must, to the extent that is reasonable in the
circumstances, have regard to all of the following…..
(iii) the views of the patient's nominated person;
When –
Section 71 Providing treatment without consent (page
73(92))
and more…..
Utilising an NP
And also when (for example)
•
Section 46 Making a TTO (page 49(68))
•
Section 48 Deciding on CTTO vs ITTO
•
Section 55 Making a TO
•
Section 64 Granting a leave of absence
•
Section 93 Application to MHT for ECT
and more …..
• (Video)
What were the critical things the
clinician discussed with Joanna in
her role as both Paul’s nominated
person and carer?
Revoking an nominated person(1)
25 Revocation of nomination
• A nomination is revoked if—
• (a) the person who made the nomination—
• (i) makes a new nomination under section 24; or
• (ii) revokes the nomination under section 26; or
• (b) the nominated person declines to act as a nominated
person in accordance with section 27.
QUIZ question
All patients are required to have an Nominated Person.
TRUE
FALSE
QUIZ answer
All patients are required to have an Nominated Person.
TRUE
FALSE
Consider this:
Your client, Beth, says she has chosen a Nominated Person
and wants to bring the completed form it to your next
meeting for you to sign.
What do you need to consider in this meeting with Beth?
Some suggestions:
• It needs to be signed by Beth in front of the witness (you).
• Is Beth aware of the requirements of the Nominated Person role?
• Is the NP aware of the requirements of the Nominated Person
role?
• Do Beth and the NP understand how to revoke or change the NP
selection?
• Is Beth’s carer aware of the NP selection?
• Recording in CMI and putting in clinical file.
Questions?