Implementation guidelines for non-government community services

Standard 6. Consumers

Page last updated: 2010

Consumers have the right to comprehensive and integrated mental health care that meets their individual needs and achieves the best possible outcome in terms of their recovery.

The consumer standard is not assessable, as it contains criteria that are all assessable within the other standards. The intent of gathering these criteria under one standard is to ensure that all of these elements are examined together.

Treatment of consumers (criteria 6.1, 6.2)
Consumers rights and responsibilities (criteria 6.3, 6.4)
Relationships (criterion 6.5) (partially applicable to the sector)
Identification of clinician (criterion 6.6)
Partnerships (criterion 6.7)
Informed consent (criterion 6.8)
Care plans (criterion 6.9)
Access to information (criterion 6.10) (partially applicable to the sector)
Right to involve (criterion 6.11)
Exit plans (criterion 6.12)
Continuity of care (criterion 6.13)
Consumer records (criteria 6.14, 6.15)
Contact (criterion 6.16)
Service planning (criteria 6.17, 6.18)

Treatment of consumers (criteria 6.1, 6.2)

Consumers of mental health services have the right to be treated with the respect and dignity equal to any human, at all times. Wherever possible, consumers should be able to access a staff member of their own gender if required.

Under some circumstances, consumers may be subject to the provisions of mental health and related legislation, or have a legal guardian lawfully authorised to make a decision on their behalf, which compels the consumer to receive treatment. Services provided must be consistent with the applicable legislation.

Consumers rights and responsibilities (criteria 6.3, 6.4)

The consumer statement of rights and responsibilities, provided on admission to the service provider and at regular intervals thereafter, should include:
  • consumers' safety and wellbeing being upheld by the service provider
  • consumers' rights to privacy and confidentiality (within articulated safety and legal constraints) being upheld
  • consumers having the right to seek other opinions regarding the care, assessment, and services provided to them
  • the relationships between consumers, carers, family and friends being respected and honoured and, with the consumer's consent, used to support recovery
  • consumers work in partnership with service providers toward recovery goals
  • the language, cultural, and gender needs of consumers are reflected in recovery goals as determined by the consumer
  • consumers' complaints and grievances are addressed without compromising service provision to them
  • consumers have the responsibility for maintaining their own health and welfare, and for setting their recovery goals, nominating those, if any, from whom they want support
  • consumers treating staff with dignity and respect.
Education about rights and responsibilities should be an ongoing process that might take different forms as a recovery journey progresses. The service provider can help the consumer to understand information through making sure there are opportunities for the consumer to ask questions, using interpreters and peer support workers and consumer advocates.

Arrangements should be in place to offer support to consumers, their families, staff and visitors immediately following a critical incident. Top of page

Relationships (criterion 6.5) (partially applicable to the sector)

Least restrictive alternative is an important concept to understand. Generally, services in a community setting would be regarded as being less restrictive than, for example those provided to a consumer as a voluntary in-patient in a hospital. They would be much less restrictive than those provided to a consumer as an involuntary patient in hospital.

The more restrictive the environment, the more it is likely to remove some rights and decision making capacity from the consumer.

Existing carer relationships and the capacity, willingness and needs of carers are key considerations when determining the most appropriate treatment, services and support for consumers. Individual consumer needs should be taken into account to determine what would be the least restrictive environment.

The environment should enable effective treatment and support to occur and services to be provided that are consistent with recovery goals, while ensuring safety and protection of other consumers, staff, visitors and members of the public.

Identification of clinician (criterion 6.6)

The staff member involved in initial contact could be called a case manager, care coordinator or key worker. They coordinate the assessment, treatment and support.

This criterion might or might not be relevant to a non-government provider of community mental health services according to the client group and the nature of services provided. For consumers who are receiving services through a public or private hospital clinical team, the care coordinator role is likely to be filled by the member of that treating team who has key worker responsibilities.

Partnerships (criterion 6.7)

Each consumer participates fully in the development of their individual treatment, care and recovery plan and in the evaluation of outcomes to ensure that goals are achieved. A copy of the plan is given to the consumer wherever possible. In the non-government sector, 'treatment' might not be an appropriate title for the plan. 'Care and recovery' might be more accurate. In this sector it should always be possible to give the consumer a copy. Top of page

Informed consent (criterion 6.8)

Consent to care is obtained by:
  • providing information about the choice of services, supports and (when relevant) the treatment available
  • ensuring that this information is understood
  • supporting consumers to make informed choices.
The importance of understanding what is required for informed consent is a relevant consideration.

Care plans (criterion 6.9)

Each consumer should have an individual comprehensive treatment, care and recovery plan which is based on the consumer's assessment and which has been developed in partnership with the consumer and their nominated carers.

If a multi-agency multidisciplinary team is providing different elements of care and support, information about care and support will be a shared responsibility. Alternatively if it is a sole provider, then they have sole responsibility to ensure the consumer has current and accurate information about the services provided.

In the context of non-government community based services, 'services provided' might be a more accurate descriptor than 'treatment and care'.

Access to information (criterion 6.10) (partially applicable to the sector)

A small number of non-government community mental health service providers might have a primary responsibility for clinical care, but generally treatment options would be the responsibility of a private or public mental health service acute or post acute clinical care team, or a GP.

Service providers should ensure that consumers are given information about other support services appropriate to their recovery goals, not only the service they are accessing through the service provider.

Consumers should have access to information about their mental illness, the principles of recovery-oriented mental health practice, treatment options, risks and benefits, effects and side-effects, ongoing care and rehabilitation arrangements. This information should be discussed with consumers by an appropriate member of the care team, with the discussion being recorded in the health record. Top of page

Right to involve (criterion 6.11)

Consumers have the right to nominate who is involved in their treatment, care and recovery planning. This does not only include carers and family members, but also staff and service providers where this does not impose a risk to the consumer, carer or service provider staff.

Exit plans (criterion 6.12)

Appropriate arrangements should be made for an exiting consumer. They should always include an exit risk assessment.

Consumers and carers should be helped to identify early warning signs of relapse. Exit plans should include symptoms of pending relapse and an accompanying relapse management plan.

As appropriate to the type of services provided and the conditions under which they are provided, exit plans should include some or more of the following:
  • nominated health care provider for example general practitioner or private psychiatrist
  • shared care arrangements with general practitioner, private psychiatrists and non-government organisations, if applicable
  • earliest possible involvement of nominated service provider and arrangements for ongoing follow-up
  • community resources likely to be required
  • other people likely to be involved
  • other details identified by consumer and carers
  • preferred method of evaluating the outcomes for the consumer
  • plan for identifying early warning signs of relapse
  • information on how to re-enter the service provider
  • service provider point of contact in relation to the most recent episode of treatment and support.

Continuity of care (criterion 6.13)

Follow-up arrangements should be planned and in place before exit. They should be documented in the individual health record.
The consumer is given formal introductions to various community agencies where necessary. Community-based agencies and programs may include education providers, community recreation programs, paid or voluntary work, supported or other employment and consumer-run support services. Top of page

Consumer records (criteria 6.14, 6.15)

Consumers are given information about how to access their own health records. This should include information on who can access records on their behalf.

Consumer information sheets on privacy legislation are available from the Health service providers page on the Office of the Australian Information Commissioner website (www.privacy.gov.au),

Contact (criterion 6.16)

This criterion is most relevant to providers who are involved in supported community accommodation. More broadly, support for re-establishing and maintaining significant social relationships is a responsibility of all service providers and is fundamental to a recovery approach.

In relation to accommodation, what is important for recovery are flexible visiting times, quiet space for meeting with visitors and access to a means of contacting family and friends.

Service planning (criteria 6.17, 6.18)

Service providers should use methods appropriate to their individual service to engage consumers and carers in all areas of service planning, delivery, evaluation and quality assurance activities.

Staff induction processes should include training in how to gain consumer participation and awareness in how important it is.