Implementation guidelines for non-government community services

Standard 7. Carers

Page last updated: 2010

The MHS recognises, respects, values and supports the importance of carers to the wellbeing, treatment, and recovery of people with a mental illness.

The intent of this standard is to ensure that carers are informed and involved in the treatment, care and recovery planning of the consumer when the carer has an ongoing role to support the consumer.

In the context of this standard 'carer' refers to family members or friends of people with a mental illness whose life is affected by the mental illness and includes the partner, parent, friend or child of the consumer.

Identification of carers (criterion 7.1)
Partnerships (criteria 7.2, 7.3)
Provision of information (criterion 7.4)
Diversity of carers (criterion 7.5)
Age of carers (criterion 7.6)
Confidentiality (criterion 7.7)
Consultation (criteria 7.8, 7.9, 7.10)
Exit information (criteria 7.12, 7.13)
Training (criteria 7.15, 7.16, 7.17) (partially applicable to the sector)

Identification of carers (criterion 7.1)

Carers can be parents, partners, brothers, sisters, friends or children of any age. A carer can also be a state or territory Guardianship Board or tribunal-appointed guardian or administrator. Service providers should have policies to address these possibilities. Child and Adolescent Mental Health Services (CAMHS) sometimes work more closely with carers than other services and might deal exclusively with the parent or carer, depending on the consumer's age.

Issues of custodial and non custodial parents and legal guardianship should be considered and addressed, as well as whether the carer is a consumer within another service provider. Policies and service delivery protocols should address these situations.

It is important for service providers to understand that there is a range of ideas in the community about what a carer is. Not all carers will identify, or describe themselves, as carers, or want to be referred to as carers.

Evidence that this criterion is met could include:
  • service provider referral forms should include a request for information about carers and their involvement
  • service provider intake or initial assessment processes should have procedures to identify carers and their involvement
  • service provider intake or initial assessment processes should have procedures to identify consumers who are under Adult Guardianship arrangements
  • documenting individual service reviews that include consideration of carers and their role. Top of page

Partnerships (criteria 7.2, 7.3)

Partnerships and communication are a principle of recovery-oriented mental health practice. Unless consumers make an informed consent not to involve carers, services should be delivered in partnership with consumers and carers.

Carers should be engaged as soon as possible when consumers enter the service. Service providers should continue to seek information from carers that contribute to the services provided and achievement of recovery goals. Carers should be involved in individual service reviews and in exit planning.

Where carers are not identified at the referral or initial assessment stages, service providers should continue to attempt to identify whether there is carer support.

A carers' rights and responsibilities statement should be provided to and discussed with carers as soon as possible.

The statement should be guided by the requirements of state or territory carers' acts and charters where they are in place, but should generally include:
  • confirmation of respect for the valued role of carers
  • confirmation that carer wellbeing is important to the service provider and consumer recovery
  • confirmation of respect for carers rights, choices and opportunities to enjoy optimum health, social, spiritual and economic well being and to participate in family, social and community life, employment and education
  • recognition of the challenges carers face in balancing their caring role with other roles and their own needs, and support for them to achieve that balance
  • information about recovery-oriented mental health practice
  • what information will be provided about the mental health condition, and the services being provided to the consumer
  • information about confidentiality obligations, the limits to confidentiality commitments and how service providers engage with carers when consumers do not want personal information shared
  • support for carers to contribute information and views that might help service providers to support consumers and contribute to recovery goals
  • confirmation that the relationship between carers and consumers is respected and honoured
  • a commitment to working in partnership with consumers, carers and other service providers
  • confirmation that the language and cultural needs of carers will be respected. Top of page
Consumer consent will always be one determining factor in how a service provider manages carer participation. Other ways that carers are involved, and the extent to which it is appropriate to involve them, will vary across different service types and in relation to different consumer, family and carer situations. Social and cultural factors should also be taken into account.

Practical strategies to support partnerships with carers at the individual level will vary according to whether or not there is consumer consent, and to the needs and wishes of the consumer and carer. Opportunities for carers to ask questions about their rights and responsibilities and to be given information should be provided throughout all phases of care.

It is important to understand that partnerships around the services provided to individual consumers are only one way that partnerships can be established with carers. With the right skills, training and support, carers can also be involved at the organisational level and systemic levels.

For example at the organisational level, a carer could represent carers on the board, contribute to program reviews and evaluations and the development of the strategic plan, participate as a member on staff selection panels, or be involved in staff training.

At the systemic level a carer could represent the service provider on mental health region's Carer Advisory Group, participate in a staff training program for a public mental health service or be part of a carer advocacy organisation. At this level, consumer consent for carer involvement is not needed unless the role has a direct connection to the consumer in which case their consent may be required.

Evidence that these criteria are met could include:
  • a carers' rights and responsibilities statement
  • the carer being given information about the organisation and the services being provided to the consumer and about mental illness and recovery-oriented service delivery
  • documenting that the carer is included in individual service planning and reviews and other discussions about treatment and support, including discharge planning or the cessation of a service
  • a carer's plan being in place as part of the consumer's individual service plan
  • training for staff on strategies for communicating with carers who are developing effective partnerships with carers and families
  • documenting the involvement of carers at the organisational level
  • documenting support for carers to contribute at the systemic level. Top of page

Provision of information (criterion 7.4)

Written material on carer rights and responsibilities and on the National Standards for Mental Health Services should be prominently displayed in service providers' public areas and be available on websites where there is one. They should also be provided to carers personally on request or when they are involved in initial intake and assessment processes. For states and territories that have a Carers' Act or a Carers' Charter, information about them should also be provided.

The information should be available in formats and languages appropriate to the diversity of the catchment community.

Evidence that this criterion is met could include:
  • documentation to confirm that carers have been provided with a service provider Carers' Rights and Responsibilities Statement, a copy of the National Standards for Mental Health Services (2010) and, as applicable, the relevant state or territory Carers' Act or Carers' Charter
  • documentation to confirm that carers have been provided with information about service provider complaints management processes
  • documentation to support that carers have been advised about mental health carer advocacy and support groups and organisations.

Diversity of carers (criterion 7.5)

Carers of Aboriginal and Torres Strait Islander persons, culturally and linguistically diverse (CALD) persons and persons with disabilities should be specifically identified and supported by service providers within and outside their communities.

Evidence that this criterion is met could include:
  • documenting that census data has been analysed
  • respect for and responsiveness to diversity in service provider service delivery principles and values statements
  • documenting that staff have been trained in cross cultural awareness
  • documenting the use of interpreters with consumers and carers who are not proficient in English or who are deaf
  • board membership and staffing diversity that reflects the catchment community
  • specialist positions, for example culturally and linguistically diverse and Aboriginal and Torres Strait Islander liaison staff
  • making available to carers, information in the main community catchment languages dealing with issues such as rights and responsibilities or the programs offered by the service provider
  • intake procedures taking into consideration cultural and linguistic needs
  • building alterations and modifications to reduce physical access barriers. Top of page

Age of carers (criterion 7.6)

Service providers should consider the needs of carers who are children or aged persons and provide information on how they can access support.

Evidence that this criterion is met could include:

Documentation to confirm that information is provided to young and aged carers about organisations that can assist them, including but not limited to:

Confidentiality (criterion 7.7)

Service provider staff require a sound understanding of the confidentiality principles of the Mental Health Act and Commonwealth, state and territory legislation, which define what information can be conveyed to families and other carers and under what circumstances.

How to engage with carers when a consumer makes an informed decision that they do not want the carer involved in their recovery journey, or to be provided with personal information, is discussed below in relation to criteria 7.8 and 7.9.

Evidence that this criterion is met could include:
  • documenting that information about confidentiality requirements has been provided to staff and volunteers in orientation programs
  • documenting how carers are engaged and supported when consumers make informed decisions that carers are not to be provided with personal information or to be partners in their recovery journey. Top of page

Consultation (criteria 7.8, 7.9, 7.10)

Carers need access to information on consumer mental health status and how service provider programs complement any medical and other treatments and contribute to recovery.

Any discussions with carers about the personal aspects of consumer care should be in accordance with Commonwealth, state or territory privacy legislation. The service provider's primary duty of care is to the consumer. Any consequences to the consumer should be considered when they do not give consent to disclose information to the carer.

Decisions barring carers from involvement change the way service providers engage with carers but do not mean there should be no contact with carers. Carers in this situation will often have very high needs for support. Safety issues for consumers and carers will need to be evaluated to determine how the organisation proceeds.

Ways that service providers can provide opportunities for carers to participate in these circumstances, without breaching consumer confidentiality decisions, can include ensuring that carers:
  • have access to information about their consumer's mental health in general terms, and reassurance about the supports that monitor the consumer's well being
  • still have the opportunity to present their issues, to have them listened to and taken into account in the assessment, planning and delivery of services to the consumer
  • have opportunities to be involved in the organisation at the service level, even though their involvement in decision making about the consumer is limited
  • have service provider support to help them access carer support and advocacy services.
Evidence that these criteria are met could include:
  • documenting what information is provided to carers that does not require consumer consent
  • documenting what information is provided to carers with consumer consent
  • documenting what information about confidentiality requirements is provided to staff and volunteers in orientation programs
  • documenting how carers are engaged and supported when consumers make informed decisions that carers are not to be provided with personal information or to be partners in their recovery journey. Top of page

Exit information (criteria 7.12, 7.13)

Carers should have access to information on respite services, counselling, crisis support, education and training to maximise their wellbeing and ability to care and advocate for the consumer.

Services that could provide this support are listed under criterion 7.6. Those listed are organisations with a national presence but advice should also be provided about other state and territory based services that can provide ongoing support to carers once the consumer exits the service.

Evidence that these criteria are met could include:
  • giving carers information brochures detailing available sources of ongoing support
  • displaying posters and brochures in service provider public areas, providing information on respite services, carer respite centres, carer resource centres and carer counselling programs
  • providing information on service provider websites.

Training (criteria 7.15, 7.16, 7.17) (partially applicable to the sector)

Staff should be trained to consider and understand the ongoing needs of carers when a consumer is exiting a service and to be aware of the services to which they can refer carers for ongoing support.

Evidence that these criteria are met could include:
  • documenting the training of staff in the ability to assess carer capacity to provide care for the consumer after discharge
  • the use of carer assessment tools to assess carer capacity to provide care to the consumer
  • giving carers information about available sources of ongoing support when a consumer exits the service.
Policies and procedures to demonstrate compliance with standard 7 will include, but not necessarily be limited to, those that address:
  • carer rights and responsibilities and how they are conveyed to staff, volunteers, consumers and carers
  • carer identification
  • what information is provided to carers and how that information is provided
  • how carers are involved, the structures and activities that are in place to facilitate their involvement at the individual, organisational and systemic levels
  • engagement with local and regional carer support services, including specialist groups such as those for children of parents with a mental illness or culturally specific carer support groups, and how those links are established and maintained
  • confidentiality provisions, and the management of situations in which the wishes and needs of a consumer conflict with the wishes and needs of their carer
  • arrangements for the resolution of carer complaints and disputes.
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 also necessary to demonstrate how the policies and procedures have been implemented and guide organisational practices and behaviours.