Implementation guidelines for non-government community services

Standard 1. Rights and responsibilities

Page last updated: 2010

The rights and responsibilities of people affected by mental health problems and/or mental illness are upheld by the mental health service (MHS) and are documented, prominently displayed, applied and promoted throughout all phases of care.

The intent of this standard is to ensure that consumers, carers, and any other people affected by mental health problems are provided with information that will assist them to understand and exercise their rights and responsibilities while accessing mental health services (service provider).

Dignity and respect (criterion 1.1)
Legislation (criterion 1.2)
Informed consent (criterion 1.3)
Rights and responsibilities information (criteria 1.4, 1.5, 1.6) (partially applicable 1.7)
Privacy and confidentiality (criteria 1.8, 1.9)
Involvement in care (criteria 1.10, 1.11, 1.12)
Access to records (criteria 1.13, 1.14)
Advocacy (criterion 1.15)
Consumer feedback (criterion 1.16)

Dignity and respect (criterion 1.1)

All consumers have the right to treatment that respects their dignity and privacy.

Evidence that this criterion is met could include:
  • demonstrating appropriate layout and design of the service provider's facilities, including adequate personal space in communal areas and private interview rooms
  • clean and welcoming reception areas and waiting rooms that enable consumers to have personal space
  • training of staff in reception areas in how to greet consumers respectfully and make them comfortable while waiting to be seen
  • where consumers are placed in an environment not optimal for privacy due to overriding considerations such as safety and risks, showing that they are treated respectfully and that privacy is established as soon as practicable
  • showing that consumer expectations and goals for their recovery are fundamental drivers for the services they receive
  • ensuring that private rooms with adequate sound proofing are available for assessments and consultations.

Legislation (criterion 1.2)

The service provider should ensure they have access to and comply with legislation, acts and guidelines related to their service. There are many sources for this information. Current information on applicable legislation, acts and guidelines, such as an extract from the Privacy Act or fact sheets are available from Health service providers page on the Office of the Australian Information Commissioner website (www.privacy.gov.au)

Information provided on this website includes:
  • national privacy legislation
  • consumer information 'My Health My Privacy My Choice'
  • information sheet on the Privacy Act
  • guidelines on health privacy
  • guidelines on research privacy
The Office of the Australian Information Commissioner website (www.privacy.gov.au) provides links to:
  • privacy legislation in all states/ territories
  • International Human Rights instruments.
Evidence that this criterion is met could include:
  • documentation of how the organisation identifies and applies relevant legislation
  • information provided to staff at orientation
  • supervision documentation
  • organisational policies and procedures that incorporate and demonstrate how compliance with legislation and guidelines is monitored. Top of page

Informed consent (criterion 1.3)

Informed consent means that a person:
  • is provided with appropriate and adequate information
  • is capable of understanding the nature of the information and the consequences of a decision made in relation to this information
  • can freely make decisions without unfair pressure or influence from others.
An individual cannot give valid consent if they lack the capacity to make an informed decision.

However, a person with a mental illness might experience changes in both their mental state and their needs, and their capacity to provide informed consent may fluctuate.

In obtaining informed consent, the service provider should consider the following:
  • information might need to be provided in different ways depending on the consumer's needs and mental state at the time
  • what the consent applies to should also be made very clear - what information will be shared, with whom and how
  • the need to avoid assumptions that consent provides a blanket approval for sharing information
  • consumers have the right to change or retract their consent.
Consideration should also be given to the consumer having the opportunity to nominate someone they trust to make decisions on their behalf if they are unable to give informed consent.

Evidence that this criterion is met could include:
  • demonstrating that information about informed consent is provided in different ways depending on the consumer's needs and mental state at the time
  • documentation to demonstrate that consumers are informed about what information will be shared, with whom and how and that they have the right to change or retract their consent
  • evidence that consumers are informed about and provided with opportunities to make advance directives in relation to the services they receive
  • evidence that the service provider's intake or initial assessment process includes procedures to identify consumers who are subject to relevant orders or arrangements such as community treatment orders or adult guardianship arrangements. Top of page

Rights and responsibilities information (criteria 1.4, 1.5, 1.6) (partially applicable 1.7)

The Mental health: statement of rights and responsibilities (1991) is available on the Department of Health and Ageing website (www.health.gov.au) and links to human rights standards that Australia has agreed to uphold are available at the Australian Human Rights Commission website (humanrights.gov.au).

Evidence that these criteria are met could include:
  • a commitment to upholding consumers' rights being explicit in the organisation's statement of values or service principles
  • having posters on display, statements on web sites, policies and procedures in place in relation to:
    • consumer rights
    • upholding and respecting consumer rights, and responding to concerns
    • consumer complaints
    • staff and volunteer codes of conduct
    • duty of care
    • privacy and confidentiality
  • demonstrating that information about their rights is given to consumers when they come into the service, and that it is provided in a format appropriate to their age, communication needs and their cultural background. This may include the translation of documents into other languages
  • providing all consumers who enter the service with a copy of the National Standards for Mental Health Services
  • ensuring that a simple, accessible process is in place to receive and address consumer complaints, including support for the consumer to access an advocate to support them during a complaint resolution
  • providing information about consumer rights to their families or legal guardians as appropriate
  • providing information about human rights for people with mental illness in the orientation program for new staff and volunteers
  • providing information to consumers about mental health advocacy organisations, mental health legal centres, peer support workers, and consumer or carer consultants. Top of page

Privacy and confidentiality (criteria 1.8, 1.9)

Respect for privacy must be demonstrated while ensuring that risks are properly addressed and managed and that the service is safe for the consumer, other consumers, staff, visitors and members of the public.

Confidentiality of personal information should be in accordance with Commonwealth, state and territory legislation.

Meeting confidentiality requirements includes ensuring that consumers understand both the commitment to maintain confidentiality and the limitations of that commitment. Limitations include conflicts between a duty of care to the consumer and the duty to maintain privacy and respect confidentiality. For example, if there are concerns that a consumer might hurt themself, or pose a threat to another individual or group, or that someone else poses a threat to a consumer, confidentiality might need to be broken to ensure the safety of those concerned.

Confidentiality might also need to be broken for the organisation to comply with its obligations at law.

The need for confidentiality does not bar carers from discussions about treatment, care and recovery plans, unless the consumer has refused or withdrawn consent, in which case general discussions may take place.

While the consumer has a right to have others involved in their care, it is important they also have a right to refuse it when the service provider nominates others to be involved, providing refusal does not impose a risk to anyone.

Evidence that these criteria are met could include:
  • service provider facilities having private interview rooms
  • residents having space for personal possessions including a lockable wardrobe or drawers (accommodation services)
  • consumers being given information on entry into the service (in formats that are appropriate, for example to their age, communication and cultural needs) about confidentiality and its limits
  • confidentiality and its limits being covered during orientation for new staff, volunteers, contractors and students
  • expectations of organisational behaviour being made clear - for example workplace signs reminding staff that consumer files must not be left on desks, that computer screens must be turned off when not in use and not be visible to the public
  • material such as posters and brochures on privacy and confidentiality - for example Privacy Commission fact sheets - being displayed. Top of page

Involvement in care (criteria 1.10, 1.11, 1.12)

Mental health service consumers being involved in their care is fundamental to the recovery approach.

Evidence that this criterion is met could include:
  • consumers being given information about their rights and their own role in recovery goal setting, individual service planning and review
  • documenting the consumer's active participation in developing their recovery goals and individual support plans
  • review arrangements demonstrating how the consumer was actively involved in the process
  • consumer feedback arrangements.
Further information can be found in standard 5 promotion and prevention. Top of page

Access to records (criteria 1.13, 1.14)

Consumers having access to personal records is a strong demonstration they are actively involved in their own recovery. Where necessary, they should have the right to amend incorrect personal information, or to add an alternative view.

Consumers having access to their own records should be in accordance with Commonwealth, state and territory legislation. Any legislative exclusion should be appropriately applied. Access can be restricted in some circumstances. Restrictions should only apply after very careful consideration. Denied access should be explained to the consumer in a format appropriate to their personal circumstances.

Evidence that these criteria are met could include:
  • documenting that consumers have been given information about their right to access their personal records
  • documenting when consumers have requested access and the outcomes. Top of page

Advocacy (criterion 1.15)

Independent advocacy enables consumers to exercise their rights and remain in control of their situation. It empowers them.

Advocacy ranges from the formal such as the state and territory-based Public Advocate or Public Guardian, to the informal, where an advocate is a trusted friend or family member nominated by the consumer.

Non-government services have the option of formal advocacy, employing peer support workers, or having volunteers whose role includes consumer advocacy.

Community legal services, including specialist mental health legal services also have an important advocacy role.

Evidence that this criterion is met could include:
  • displaying posters that advertise the role of the Public Advocate or Public Guardian
  • displaying posters and information on how to access advocacy services
  • complaints management information brochures containing information about rights to engage an advocate, and how to do so
  • employing a peer support worker or having trained peer support volunteers
  • collaborating in initiatives with advocacy organisations
  • documenting in their personal records any support that consumers have been given to access advocacy and support services. Top of page

Consumer feedback (criterion 1.16)

A core requirement in working within a recovery framework is consumer feedback about their individual services and the service provider organisation more broadly.

Evidence that this criterion is met could include:
  • documenting consumer involvement in initial assessments and individual service review processes
  • annual formal consumer feedback surveys with findings being used to support continuous service improvement
  • regular consumer feedback meetings conducted by the service provider
  • documenting consumer contributions to service provider strategic plans and service evaluations
  • posters and brochures displaying service provider compliment, complaint and grievance procedures
  • displaying and giving consumers information about external organisations they can access, such as advocacy service providers.
Policies and procedures that demonstrate compliance with Standard 1 Rights and responsibilities will include those that address:
  • consumer rights and responsibilities
  • management of personal consumer information including arrangements that support consumer access to all personal information held by service providers within legislative requirements
  • consumer advocacy
  • management of an informed consent process
  • privacy and confidentiality
  • complaints and grievances
  • use of interpreters including Auslan interpreters
  • cultural assessment
  • compliance with legislation.
It is important to remember that policies and procedures alone are not sufficient to demonstrate that a service provider is meeting a standard's requirements. It is necessary to demonstrate how the policies and procedures have been implemented and guide organisational practices and behaviours.