Implementation guidelines for private office based mental health practices

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 remain knowledgeable and skilled, as well as provide access to resources and current clinical practice guidelines.

Treatment and services (Criteria 10.5.2)

Treatment options need to address Aboriginal and Torres Strait Islander persons, culturally and linguistically diverse (CALD) persons, religious/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.

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

Information on therapies (Criterion 10.5.3)

Information about the purpose, importance, benefits and risks of proposed treatments need to be provided to the consumer. This information should be delivered in an appropriate language and media for the consumers needs, such as verbal and written information in the relevant language. The MHS should provide this information in conjunction with the treating clinician, as the treating clinician may have discussed therapies with the consumer before they were admitted to the service, and should be documented.

Opportunities should be provided for consumers 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 treatmentTop of page
  • steps in the treatment process.
The MHS should obtain consent or sight evidence that consent has been obtained:
  • before any treatment or intervention begins
  • 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 consumers can participate in clinical trials and experimental treatments.

Medication management (Criterion 10.5.6)

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

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 states through collaboration with the consumer, carers and the primary health care provider

  • providing ongoing education to the consumer and their 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 the acceptance of psychosocial intervention, vocational goals and addressing relationship issues

  • an atmosphere of tolerance in which the consumer feels free to discuss treatment markedly improves adherence

  • increasing the understanding of the effects of the illness

  • helping consumers 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 nonspecific 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).Top of page

Continuity of care (Criterion 10.5.9)

Dual case management with alcohol and other drug services and collaborative treatment with other service providers such as aged care, psychiatric disability support, disability services and court liaison services should be developed whenever needed.

The MHS ensures the involvement of other related service providers when making decisions about individual treatment of consumers.

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

The use of medication forms part of the treatment strategies provided by the MHS and is directed toward maximising the functioning of the consumer while reducing their specific symptoms. Each prescription is documented. Regular review includes the 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.

Evaluation of treatment (Criterion 10.5.11)

There is written evidence of appropriate treatment information including:
  • information about the illness or disorder
  • range of treatments available
  • potential benefits and possible adverse effects
  • how long before treatment will begin to have an effect
  • costs and choices on the use of therapy, medication and other technologies
  • 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 the joint programs developed with other agencies. Community based agencies and programs may include education providers, community recreation programs, paid or voluntary work, and help from 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 are 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 partner, 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 for consumers to 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 need is available with recognition that some people will need continuing care while others will need a brief episode of care. All programs should attempt to maximise a person's independence and involvement with their community.

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 exit the service
  • how to follow the treatment plan and achieve the expected results
  • how to use medications, supplies and equipment in a safe and effective way
  • 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 MHS, other service providers and the internet
  • improving and maintaining the consumer's overall health and wellbeing
  • accommodation options
  • access to information on employment options such as apprenticeships and traineeships
  • access to information on peer-based support programs and services that promote recovery
  • provision of access to appropriate inpatient activity programs. Top of page

Support systems (Criterion 10.5.17)

Whenever possible and appropriate, ways to access support programs are developed collaboratively with the consumer and 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.

Support programs include:
  • residential/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 of diversity responsiveness in treatment, care and recovery plans
  • access to and availability of evidence based guidelines
  • medication management and notification of adverse drug reactions
  • evidence that consumers and carers received treatment, care and recovery plans
  • availability of support programs
  • range of support programs
  • consumer health record review
  • policies and procedures:
    • consent
    • research/clinical trials
    • medication management
    • guardianship
    • discharge planning
    • referral
    • shared care arrangements.