Implementation guidelines for public mental health services and private hospitals

10.5 Treatment and support

Page last updated: October 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.

Guidelines
Suggested evidence

Guidelines

The intent of this Standard is to ensure that the defined community has access to high quality treatment and support.

The person responsible for the coordination of the consumers care is involved in the admission, treatment and discharge planning.

Best available evidence (Criterion 10.5.1)

In conjunction with the treating clinician, the MHS delivers treatment consistent with current evidence-based guidelines and legislation. The MHS can facilitate access to continuing professional development to help service providers stay knowledgeable and skilled. It should also provide access to resources and current clinical practice guidelines.

Treatment and services (Criterion 10.5.2)

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

Treatment and support systems should be applicable to the consumers' age, stage of development, physical health, and stage in their recovery process.

In rural and remote settings practitioners must ensure processes for frequent monitoring (through primary care or wellbeing services) to identify and respond to Aboriginal and Torres Strait Islander consumer needs.

Further information on culture and diversity is available in the guidelines for Standard 4 Diversity responsiveness.Top of page

Information on therapies (Criterion 10.5.3)

Information about the purpose, importance, benefits and risks of proposed treatments needs to be provided to the consumer. This information should be delivered in an appropriate language and media, such as verbal and written information in the relevant language. The service should use family or cultural brokers when necessary.

In private MH services, this information is usually provided by the treating clinician. Where this has occurred, the consumer's health record should show that the treating clinician has provided this information to the consumer.

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

Informed consent must be obtained before treatment. The MHS must have a consent form or access to a copy of a consent form that has information about:
  • the type of treatment
  • steps in the treatment process.
The MHS should obtain consent or see evidence that consent has been obtained:
  • before any treatment or intervention commences
  • when services are changed
  • when services are added
  • when the consumer makes an informed decision about changing their treatment.
This should be documented in the consumer's health record.

Clinical trials and experimental treatments (Criterion 10.5.4)

Appropriate ethical authorisations need to be obtained before consumer's can participate in clinical trials and experimental treatments. In the case of Aboriginal and Torres Strait Islander consumers, this should include the NHMRC guidelines for research in Indigenous populations and clearance by statebased Indigenous research ethics committees.

Least restrictive (Criterion 10.5.5)

Individual consumer needs should be taken into account when determining the least restrictive environment. The environment should enable effective treatment to occur, while ensuring safety and protection of other consumers, staff, visitors and members of the public.

Further information on the least restrictive environment is available from the guidelines of Standard 1 Rights and responsibilities and Standard 6 Consumers.

Because restrictive practices (Mental Health Authority provisions and depot medications) are used more frequently in Indigenous populations, particularly in rural and remote settings, all such decisions should be regularly reviewed and explained to both the consumer and relevant carers.

Medication management (Criterion 10.5.6)

The MHS should have a process in place for a pharmaceutical review of prescribing, storage, transport and administration of medications. There should be a system in place for the use of personal medications during transit situations, such as on admission to hospital and transfer from one service to another.Top of page

Adherence to evidence-based treatment (Criteria 10.5.7, 10.5.8)

Strategies to promote adherence to treatment include:
  • establishing and maintaining shared care arrangements between the MHS and the primary health care provider

  • monitoring the consumer's psychiatric state through collaboration with the consumer, carer and the primary health care provider

  • providing ongoing education to the consumer and carers, with the consumer's informed consent, about the consumer's illness and options for treatment

  • establishing an overall treatment plan in collaboration with the consumer, their carers and their primary health care provider

  • enhancing adherence to the treatment plan—this requires accepting psychosocial intervention, vocational goals and addressing relationship issues. An atmosphere of tolerance in which the consumer feels free to discuss treatment critically improves adherence

  • increasing the understanding of the effects of the illness

  • assisting consumers to cope with their interpersonal relationships, work, and other physical health needs

  • identifying stressors and early warning signs that could initiate relapse. Early warning signs are often non-specific and may just present as a change in mood, anxiety or social withdrawal.
The strategies detailed above are adapted from MJA Practice Essentials: Managing schizophrenia in the community (Harry H Hustig and Peter D Norrie, 1998).

Continuity of care (Criterion 10.5.9)

The MHS should have in place systems for dual case management with alcohol and other drug services, collaborative treatment with other service providers such as aged care, psychiatric disability support, disability services and court liaison services.

The MHS should ensure the involvement of other related service providers when making decisions regarding individual treatment of consumers.

Because of the burden of social adversity and comorbidity in some Aboriginal and Torres Strait Islander communities, diverse agencies and organisations are involved in ongoing care. The MHS should ensure coordination and communication across the services and sectors.

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

Medication forms part of the treatment strategies provided by the MHS and is intended to allow the consumer to function as well as possible while reducing their specific symptoms. Each prescription is documented. Each medication should be reviewed regularly including its appropriateness and any effects due to multiple medications and drug interactions.

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

Evaluation of treatment (Criterion 10.5.11)

There should be written evidence of appropriate treatment information including:
  • information about the illness or disorder
  • the range of treatments available
  • potential benefits and possible adverse effects
  • the length of time before treatment will begin to have an effect
  • costs and choices of therapy, medication and other technologies
  • options for the 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
  • consent process.
Top of page

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 may include education providers, community recreation programs, paid or voluntary work, supported or other employment, and consumer run support services.

Self-care programs (Criteria 10.5.13, 10.5.14 and 10.5.15)

Self-care, independence, health and wellbeing should be part of the education program provided by the MHS. Peer workers and consumer educators are important contributors to the education program.

Relationships with family, carers, sexual partners, friends, peers, cultural groups and the community are encouraged.

When applicable the MHS provides a range of treatment and support, or referral to the appropriate services and programs so that consumers can live independently in their own accommodation, shared accommodation, supervised or supported residences and public refuges. These services need to be relevant to the age of the consumer, for example necessary skills required by CAMHS consumers may include 'risk-safe behaviours'.

A range of programs based on individual needs should be available. It is recognised that some people will require ongoing care while others will require a brief episode of care. All programs should attempt to maximise a person's independence and involvement with their community.

In Aboriginal and Torres Strait Islander communities, practitioners should be aware of culturally informed self-care and allied programs (such as men's groups) and be able to help consumer access these resources. Practitioners should also be aware of the resources and services available for the wider community and how to access these programs when appropriate for specific Aboriginal and Torres Strait Islander consumers.

The MHS should provide consumers and their carers simple and easy to understand information and education on:
  • the consumer's condition, including how to care for themselves after they leave the service
  • how to follow the service plan and achieve the expected results
  • how to use medications, supplies, and equipment in a safe and effective way
  • how to develop the skills necessary to meet their own needs and become as independent as possible through self-care programs
  • self care resources available from the MHS, other service providers and the internet
  • improving and maintaining the consumer's overall health and wellbeing
  • accommodation options
  • employment options such as apprenticeships and traineeships
  • peer-based support programs and services that promote recovery
  • appropriate inpatient activity programs.
The MHS must ensure that access to appropriate programs is available and that this is in settings where consumers are not isolated. This is particularly relevant for rural and remote Aboriginal and Torres Strait Islander populations. This may require that carers are present or able to visit, or additional resources may be required for Aboriginal and Torres Strait Islander consumers to maintain community contact.Top of page

Accommodation options (Criterion 10.5.16)

The MHS should explore accommodation options that suit the individual needs of the consumer. Factors to be considered include:
  • proximity to primary care providers, family members and carers
  • mobility
  • visual and hearing impairment
  • single sex accommodation
  • space for family members where children are concerned.
Where supported accommodation is not provided by the MHS, there should be close collaboration between the MHS and the accommodation provider to facilitate access to other treatment and support programs.

MH services operating in areas with significant Aboriginal and Torres Strait Islander populations should ensure that supported and transitional accommodation options appropriate to Indigenous consumers are available. This includes flexible options in regional centres close to specialist and tertiary services, which are connected with in-community options.

Support systems (Criterion 10.5.17)

Whenever possible the MHS should work with the consumer to find ways to access support programs. These programs should reflect the identified needs of each consumer taking into account their age, stage of development, physical health, and stage in their recovery process. Consumers should be able to choose support programs that are most suitable to them. Practitioners working in rural and remote settings should be aware of the available resources and ways to overcome any problems of location or social disadvantage.

Support programs include:
  • residential and supported housing
  • vocational support systems
  • education programs
  • employment programs
  • family programs and family interventions.

Suggested evidence

Evidence that may be provided for this standard includes:
  • completed consent forms or copies of consent forms
  • evidence treatment, care and recovery plans that diversity has been considered
  • medication management and notification of adverse drug reactions
  • access to, and availability of, evidence-based guidelines
  • evidence that consumers and carers received treatment, care and recovery plans
  • details on available support programs
  • a review of the consumer's health record
  • policies and procedures covering:
    • consent
    • research or clinical trials
    • medication management
    • guardianship
    • discharge planning
    • referral
    • shared care arrangements.