Implementation guidelines for non-government community services

10.5 Treatment and support

Page last updated: 2010

The MHS provides access to a range of evidence based treatments and facilitates access to rehabilitation and support programs which address the specific needs of consumers and promotes their recovery.

The intent of this standard is to ensure that eligible consumers in the defined catchment community has access to high quality, evidence based treatment, care and support services that are based on the principles of recovery oriented mental health practice.

Best available evidence (criterion 10.5.1)
Treatment and services (criterion 10.5.2)
Information on therapies (criterion 10.5.3)
Clinical trials and experimental treatments (criterion 10.5.4)
Least restrictive environment (criterion 10.5.5)
Medication management (criterion 10.5.6)
Adherence to evidence based treatment (criteria 10.5.7, 10.5.8)
Continuity of care (criterion 10.5.9)
Use of medication and/or other therapies (criterion 10.5.10)
Evaluation of treatment and support (criterion 10.5.11)
Range of agencies and programs (criterion 10.5.12)
Self care programs (criteria 10.5.13, 10.5.14)
Accommodation options (criterion 10.5.16)
Support systems (criterion 10.5.17)

Best available evidence (criterion 10.5.1)

Service providers should deliver services consistent with current evidence-based research, guidelines and legislation.

Evidence that this criterion is met could include:
  • the evidence base on which programs and services are designed
  • documenting staff participation in continuing professional development to assist service providers to remain knowledgeable and skilled
  • outcomes of service reviews and evaluations that influence future practices.

Treatment and services (criterion 10.5.2)

Service options need to address Aboriginal and Torres Strait Islander persons, culturally and linguistically diverse (CALD) persons, religious and spiritual beliefs, gender, sexual orientation, physical and intellectual disability, age profile and socio-economic status.

Services should be appropriate to the consumer's age, stage of development, physical health, recovery goals and the stage in their recovery process.

More information on culture and diversity is available in the guidelines for standard 4.

Evidence that this criterion is met could include:
  • services with design features that specifically respond to the needs of the major diverse groups in the catchment community
  • staffing arrangements that reflects the diversity in the catchment community
  • documenting that staff have been trained in cross cultural awareness
  • documenting that staff have been trained in disability awareness
  • documenting the use of interpreters with consumers and carers who are not proficient in English or who are deaf
  • having specialist positions in the organisation, for example culturally and linguistically diverse and Aboriginal and Torres Strait Islander liaison staff
  • having consumer information available in the main cultural group languages
  • using evidence based culturally appropriate clinical instruments (if relevant to the types of services provided)
  • building alterations and modifications to reduce physical access barriers. Top of page

Information on therapies (criterion 10.5.3)

This criterion is relevant only to those non-government community mental health services that provide clinical and therapeutic services.

Consumers should be given information about the purpose, importance, benefits and risks of proposed treatments. The media and language should be appropriate to the consumers' needs.

Service providers should give this information in conjunction with the treating clinician or therapist, who might have discussed therapies with the consumer before their admission to the service. Informed consent must be obtained before treatment begins.

Consumers should be encouraged to ask questions about the therapies offered throughout the treatment process.

Evidence that this criterion is met could include:
  • documenting that informed consent requirements have been met:
    • before any treatment or intervention commences
    • when services are changed
    • when services are added
    • when the consumer makes an informed decision about changing treatment
  • documenting that consumers have been given information via means that are appropriate for their age, cultural and social circumstances about:
    • treatment options, the recommended treatment and why it is recommended
    • steps in the treatment process.

Clinical trials and experimental treatments (criterion 10.5.4)

This criterion is relevant only to those non-government community mental health services that provide clinical services.

Appropriate ethical authorisations need to be obtained before consumers can participate in clinical trials and experimental treatments.

Evidence that this criterion is met could include:
  • documenting authorisations
  • documenting what information is given to consumers about the purpose, importance, benefits and risks of the clinical trials and experimental treatment in an appropriate language and media for their needs. Top of page

Least restrictive environment (criterion 10.5.5)

The concept of least restrictive environment is fundamental to community re-entry and social inclusion for people with disabilities, including those experiencing a mental illness. It is a key element in working in a recovery based service delivery model.

Least restrictive environment means a consumer should have the opportunity and, as necessary, active support and encouragement, to participate in mainstream community services and activities to the greatest extent possible as they work towards their recovery goals.

Individual consumer needs should be taken into account when determining the least restrictive environment in which the service can be provided. This should include the extent to which recovery goals can be achieved through helping the consumer to access mainstream community services such as sporting and recreational clubs, transport, education facilities and community arts centres, rather than relying only on specialist mental health services and programs.

It is essential to consider the safety of consumers, carers, other consumers, service provider staff and members of the public when determining the least restrictive environment.

The least restrictive environment can change as the consumer moves through the recovery journey, and should be the subject of consideration in service planning and assessment reviews.

More information is available from the guidelines of standard 1 rights and responsibilities and standard 6 consumers.

Evidence that this criterion is met could include:
  • partnerships with mainstream organisations, around an individual consumer or group of consumers, for example with a sporting or recreational club, a university or TAFE college, or a community arts centre, to promote community re-entry and healthy lifestyles for consumers as part of their recovery
  • providing information to staff, and consumer and carer advocates about the range of support networks available in the community such as local community and volunteer groups, faith communities and educational institutions
  • individual consumer recovery plans that include the utilisation of mainstream organisations
  • documenting on consumer files that they are accessing mainstream services as part of their recovery. Top of page

Medication management (criterion 10.5.6)

This criterion is relevant to non-government community based mental health services that provide clinical treatment services or other services in which the consumer requires medication during their hours of attendance.

Service providers should have a documented and regularly monitored procedure for the safe storage, transport and administration of medications. There should be a system in place for the use of personal medications during transit situations, such as during transfer from one service to another.

Evidence that this criterion is met could include:
  • a medications policy and procedures
  • visual sighting of safe locked storage location
  • documenting the administration of medication.

Adherence to evidence based treatment (criteria 10.5.7, 10.5.8)

These criteria are relevant only to non-government community based mental health services that provide clinical treatment services. Non-government organisations should adhere to evidence based approaches to care and support across all areas of service delivery including provision of clinical treatment services where relevant.

Evidence that this criterion is met could include:
  • documenting the shared care arrangements between the service provider and the primary health care provider
  • documenting that the consumer's psychiatric state is monitored through collaboration with the consumer, carers and the primary health care provider
  • giving consumers and, with their informed consent, carers information and education about the consumer's illness and options for treatment, and the effects of the illness, including on interpersonal relationships, work and physical health
  • giving consumers and carers information and education about how to identify stressors and early warning signs that could initiate relapse.
(The strategies detailed above are adapted from MJA Practice Essentials: Managing schizophrenia in the community, Harry H Hustig and Peter D Norrie, 1998.). Top of page

Continuity of care (criterion 10.5.9)

To promote continuity of care, collaborative and coordinated case management with other service providers such as alcohol and other drug services, aged care, disability services, supported accommodation services and court liaison services should be in place where appropriate.

Evidence that this criterion is met could include:
  • documenting that arrangements are collaborative and coordinated
  • documenting on consumer files the involvement of other service providers in decisions regarding care and recovery plans.

Use of medication and/or other therapies (criterion 10.5.10)

This criterion is relevant only to non-government community based mental health services that provide clinical treatment services.

Medication is part of the treatment strategies of service providers and is directed toward maximising the functioning of the consumer while reducing their specific symptoms. Each prescription must be documented. There should be regular medication reviews that include consideration of the continuing appropriateness of each medication, as well as the use of multiple medications and drug interactions.

Any other therapies that may be used are reviewed regularly to ensure their appropriateness to the consumers' age, stage of development, physical health, and stage in their recovery process.

Evidence that this criterion is met could include:
  • medication charts
  • documenting medication reviews. Top of page

Evaluation of treatment and support (criterion 10.5.11)

For most non-government services that provide clinical treatment services, it is the support aspect of this criterion that is relevant. The treatment aspect is relevant only to those service providers who provide clinical and treatment services.

Consumers and carers should be engaged in all levels of evaluation.

Evidence that this criterion is met could include:

For support services:
  • consumer and carer feedback
  • service evaluation reports
  • documenting how evaluations have contributed to service improvement.
For treatment:
  • documenting information that includes:
    • the illness or disorder
    • the range of treatments available
    • potential benefits and possible adverse effects
    • how long before treatment will begin to have an effect
    • costs and choices with regard to the use of therapy, medication and other technologies
    • options for treatment setting - wherever possible treatment should be administered in a setting of the consumer's choice
    • likely consequences in the event of refusal of treatment
    • evaluation of treatment and support outcomes
    • the consent process.

Range of agencies and programs (criterion 10.5.12)

Consumers should have the opportunity to be involved in joint programs developed with other agencies. Community-based agencies and programs might include education providers, community recreation programs, paid or voluntary work, supported or other employment, and consumer-run support services.

Evidence that this criterion is met could include:
  • documented roles and responsibilities of organisations and individuals involved in joint programs
  • documenting on the consumer's files that they participated in a joint program. Top of page

Self care programs (criteria 10.5.13, 10.5.14)

Self-care, independence, health and wellbeing are success factors for recovery and should be part of the education program provided by the service provider.

Peer workers and consumer educators are important contributors to the education program. Positive relationships with family, carers, sexual partner, friends, peers, cultural groups and the community are also important and should be encouraged.

When applicable, the service provider provides a range of support options and referral to other services such as those with programs for consumers to live independently in their own accommodation, shared accommodation, supervised or supported residences and public refuges.

These services need to be appropriate to the age of the consumer, for example necessary skills required by CAMHS consumers may include 'risk safe behaviours'.

According to individual needs and recovery goals, and recognising that some people require ongoing care and support while others require a single episode of care and support, the service provider should offer a choice of referral to other services that will maximise independence and involvement with the community.

With consideration to the consumer's mental and physical health status, cultural background, and family, social and economic circumstances, service providers should provide the consumer and carers with simple and easy to understand information on self care matters that could include:
  • the consumer's condition, including how to care for themselves after they exit the service
  • how to follow their recovery plan and achieve their outcomes
  • developing the skills necessary to meet their own needs and become as independent as possible through self care programs
  • self care resources available from the service provider, other service providers and the internet
  • the importance of physical activity and how to improve and maintain overall health and well-being
  • accommodation options
  • education options and employment options such as apprenticeships and traineeships
  • peer based support programs and services that promote recovery
  • providing access to appropriate inpatient activity programs.
Evidence that these criteria are met could include:
  • brochures (from the service provider and other sources) that address self care issues
  • information provided to consumers and carers at assessments and reviews. Top of page

Accommodation options (criterion 10.5.16)

Specific housing and accommodation options should be explored that suit the health, cultural, family, social and economic circumstances of the consumer.

Where supported accommodation is not provided by the service provider, there should be close collaboration between the service and accommodation providers to facilitate access to the range of services that will best support the consumer to achieve their recovery goals.

Evidence that this criterion is met could include:
  • documenting links and collaboration between accommodation and other community support providers
  • consumer feedback on their satisfaction with their accommodation.

Support systems (criterion 10.5.17)

Whenever possible and appropriate, ways to access support programs should be developed collaboratively with the consumer and should reflect their needs and recovery goals. Their age, stage of development, physical health, and stage in their recovery process should be taken into consideration. Consumers should be able to choose support programs that are most suitable to them.

Support programs can be specialist mental health programs or mainstream services and could include but are not limited to:
  • residential and supported housing
  • community sporting and recreational clubs and community arts organisations
  • education programs and vocational support systems
  • employment programs
  • mentoring and peer support programs
  • family support programs and family interventions.
Evidence that this criterion is met could include:
  • documenting links and collaboration between the service provider and other community support providers
  • documenting on individual consumer files that they have been able to choose support programs that contribute to their recovery goals.