What are Advance Statements?

What is a Nominated Person?

Principles underpinning SDM (1) 1.Decision-making is seen as relational - the person is encouraged/enabled to draw on their own networks to help them make decisions 2.People are capable of making decisions about most areas of their lives. 3.Everyone has a will and can communicate their will and preferences. These preferences can be built into valid decisions. 4.The person should receive whatever support they need and wish to receive in order to make decisions. 5.Competency can be learned, influenced, enhanced and suppressed. Cont.

Principles underpinning SDM (2) 6.The person makes and retains control over the decisions made and takes responsibility for them. 7.People have the right to take risks in their lives. 8.People do not always make good decisions but can learn from their mistakes and experience. Adapted from Carter, B. (2009). Supported decision making backgrounds and discussion paper, office of the Public Advocate n/2009/0909_Supported_Decision_Making.pdf n/2009/0909_Supported_Decision_Making.pdf From CPN slides “Supported decision-making what does it mean for me?”

What are Advance Statements? video

Advance statements The new MHA enables a person to make an advance statement to record their treatment preferences in the event that they become unwell and require compulsory treatment. Advance statements facilitate a collaborative treatment approach at times where a patient is so unwell that they are unable to communicate their treatment preferences.

Advance statements They assist the authorised psychiatrist to understand the patient’s treatment preferences and enable the authorised psychiatrist to make treatment decisions that better align with the patient’s treatment and recovery goals. Advance statements improve communication, give patients greater control over their treatment when they are subject to a compulsory treatment order and promote an improved patient experience. (from The Mental Health Bill 2014 – An explanatory guide)

Where is this in the new MH Act? Sections 19-22

Where is this in the new MH Act? Division 3—Advance statements Section 19 What is an advance statement? An advance statement is a document that sets out a person's preferences in relation to treatment in the event that the person becomes a patient.

Treatment Section 6 What is treatment? For the purposes of this Act— (a) a person receives treatment for mental illness if things are done to the person in the course of the exercise of professional skills— (i) to remedy the mental illness; or (ii) to alleviate the symptoms and reduce the ill effects of the mental illness; and (b) treatment includes electroconvulsive treatment and neurosurgery for mental illness.

QUIZ question Using the previous definition of treatment, which of the following are treatment options? a. Talk therapies b. Employment c. Medications d. Pet care e. Seclusion f.ECT

QUIZ answer Using the previous definition of treatment, which of the following are treatment options? a. Talk therapies b. Employment c. Medications d. Pet care e. Seclusion f.ECT

QUIZ question What is an advance statement? a. A document that sets out a carer’s treatment preferences b. A recorded discussion between clinician and client discussing the client’s preferences c. A document that sets out a person’s treatment preferences in the event they become a patient d. A will

QUIZ answer What is an advance statement? a. A document that sets out a carer’s treatment preferences b. A recorded discussion between clinician and client discussing the client’s preferences c. A document that sets out a person’s treatment preferences in the event they become a patient d. A will

Making an advance statement (1) Section 20 Making an advance statement (1) An advance statement may be made at any time and must— (a) be in writing; and (b) be signed and dated by the person making the advance statement; and (c) be witnessed by an authorised witness; and …

Making an advance statement (2) d) include a statement signed by the authorised witness stating that— (i) in the opinion of the witness, the person making the advance statement understands what an advance statement is and the consequences of making the statement; and (ii) the witness observed the person making the advance statement sign the statement; and (iii) the witness is an authorised witness.

Making an advance statement (3) (2) An advance statement is effective from the time it is made until it is revoked.

Documents It is not necessary to use a prescribed form. A blank page can be used as long as it includes all the components mentioned earlier (i.e. in writing, signed, witnessed). Non-treatment preferences can be recorded as other/additional.

Utilising an advance statement (2) Under the Act the “authorised psychiatrist”: (a)must, to the extent that is reasonable in the circumstances, have regard to all of the following….. (ii) the views and preferences of the person expressed in his or her advance statement; When – Section 71 Providing treatment without consent (page 73(92)) and more…..

Utilising an advance statement (3) And also when (for example) Section 46 Making a TTO (page 49(68)) Section 48 Deciding on CTTO vs ITTO Section 55 Making a TO Section 64 Granting a leave of absence Section 93 Application to MHT for ECT and more …..

Overriding an advance statement (1) Section 73 Circumstances in which patient's preferences in advance statement may be overridden (1) An authorised psychiatrist may make a treatment decision under section 71(3) for a patient that is not in accordance with that patient's advance statement if the authorised psychiatrist is satisfied that the preferred treatment specified by the patient in the advance statement— (a) is not clinically appropriate; or (b) is not a treatment ordinarily provided by the designated mental health service.

Overriding an advance statement (2) (2) If an authorised psychiatrist overrides a patient's preferred treatment in accordance with this section, the authorised psychiatrist must— (a) inform the patient of the decision and include the reasons for the decision; and (b) advise the patient that he or she has a right to request written reasons for the decision. (3) An authorised psychiatrist must provide written reasons for his or her decision under this section within 10 business days after receiving a request made under subsection (2)(b).

Revoking an advance statement (1) Section 21 Revoking an advance statement (1) An advance statement is revoked if the person who made the advance statement— (a) makes a new advance statement under section 20; or (b) revokes the advance statement in accordance with subsection (2). Then, as for the making, any statement of revocation must be in writing, signed and witnessed accordingly. Again, a form is available.

QUIZ question All patients are required to have an Advance Statement. TRUE FALSE

QUIZ answer All patients are required to have an Advance Statement. TRUE FALSE

Consider this: Your client, Zac, says he has put together an Advance Statement with his friend and wants to bring it to your next meeting for you to sign. What do you need to consider in this meeting with Zac?

Some suggestions: It needs to be signed by Zac in front of the witness (you). Is Zac aware of treatment vs non-treatment preferences? Can the listed treatment preferences reasonably be provided by his MH service? Does Zac understand what an advance statement is and the implications of it? Does Zac understand how to revoke or change it? Is Zac’s carer aware of the statement and its content? Is Zac’s nominated person (if applicable) aware of the statement and its content? Recording in CMI and putting in clinical file / SMR.

What is a Nominated Person?

Nominated Persons A patient will be able to nominate a person to receive information and to support the patient for the duration of the compulsory treatment order.

Nominated Persons The nominated person will assist a patient to exercise their rights and represent the patient’s views and preferences. They will be consulted at critical points in the patient’s treatment such as intake and discharge planning and will be able to express their views. The nominated person is not able to make treatment decisions on behalf of the patient.

Where is this in the new MH Act? Sections 23-27

Where is this in the new MH Act? 23 Role of nominated person The role of a nominated person in relation to a patient is— (a) to provide the patient with support and to help represent the interests of the patient; and (b) to receive information about the patient in accordance with this Act; and

Where is this in the new MH Act? 23 Role of nominated person (cont) (c) to be one of the persons who must be consulted in accordance with this Act about the patient's treatment; and (d) to assist the patient to exercise any right that the patient has under this Act.

(Video)Video What were the critical things the clinician discussed with Paul about appointing a nominated person?

Establishing NP 24 Nomination of nominated person (2) The nomination of a nominated person must— (a) be in writing; and (b) be signed and dated by the person making the nomination; and (c) specify the name and contact details of the person nominated; and (d) include a statement signed by the nominated person that he or she agrees to be the nominated person; and

(e) be witnessed by an authorised witness; and (f) include a statement signed by the authorised witness stating that— –(i) in the opinion of the witness, the person making the nomination understands what a nomination is and the consequences of making a nomination; and –(ii) the witness observed the person sign the nomination; and –(iii) the witness is an authorised witness. Establishing NP

(3) The person nominated to be the nominated person must not be the person who witnesses the nomination. (4) A nomination made under this section is effective from the time it is made until it is revoked. Establishing NP

Documents It is not necessary to use a prescribed form. A blank page can be used as long as it includes all the components mentioned earlier (i.e. in writing, signed, witnessed).

Utilising a Nominated Person Check with the client. CMI should tell us if the client has an NP and who it is.

Utilising a NP Under the Act the “authorised psychiatrist”: (a)must, to the extent that is reasonable in the circumstances, have regard to all of the following….. (iii) the views of the patient's nominated person; When – Section 71 Providing treatment without consent (page 73(92)) and more…..

Utilising an NP And also when (for example) Section 46 Making a TTO (page 49(68)) Section 48 Deciding on CTTO vs ITTO Section 55 Making a TO Section 64 Granting a leave of absence Section 93 Application to MHT for ECT and more …..

(Video)Video What were the critical things the clinician discussed with Joanna in her role as both Paul’s nominated person and carer?

Revoking an nominated person(1) 25 Revocation of nomination A nomination is revoked if— (a) the person who made the nomination— (i) makes a new nomination under section 24; or (ii) revokes the nomination under section 26; or (b) the nominated person declines to act as a nominated person in accordance with section 27.

QUIZ question All patients are required to have an Nominated Person. TRUE FALSE

QUIZ answer All patients are required to have an Nominated Person. TRUE FALSE

Consider this: Your client, Beth, says she has chosen a Nominated Person and wants to bring the completed form it to your next meeting for you to sign. What do you need to consider in this meeting with Beth?

Some suggestions: It needs to be signed by Beth in front of the witness (you). Is Beth aware of the requirements of the Nominated Person role? Is the NP aware of the requirements of the Nominated Person role? Do Beth and the NP understand how to revoke or change the NP selection? Is Beth’s carer aware of the NP selection? Recording in CMI and putting in clinical file.

Questions?