History and scope
Purpose and audience
Mental health and involuntary care
National Standards for Mental Health Services 2010
Principles of recovery-oriented mental health practice
Alignment with complementary standards
Using the practice standards
BackgroundMental health services are an important part of the health system. At the centre of mental health service delivery is the engagement between the practitioner and the person using the service. While interventions such as biological and psychological treatments are important, empathy, understanding and expert knowledge are critical to successful outcomes.
Australian governments are committed to supporting and developing the mental health workforce that provides services to people with mental illness, and their families and carers. People who work in mental health are among the major strengths of the system. Supporting practitioners to develop their skills, knowledge and attitudes is an important element of service quality and improvement. It also contributes to worker satisfaction and retention. Working in mental health offers particular challenges and benefits, and the workforce has a vital role in improving health and social outcomes for the community. Top of page
History and scopeThis document is the successor to the National Practice Standards for the Mental Health Workforce (2002), which applied to the following professions:
- Occupational Therapy
- Social Work
There have been considerable changes in mental health over the past 10 years, with increased service provision in the community, expansion of the non-government and private sectors, and greater focus on the role of the primary care sector in mental health. The practice standards apply to workers from the five disciplines in a range of healthcare settings including hospitals, community mental health services, and correctional facilities across metropolitan, regional and remote areas of Australia. These practitioners are engaged in public, private and non-government services. The practice standards relate to mental health practice across the lifespan including services for children, young people, adults and older people.
Other disciplines and workers outside the five professions listed above are also an important part of the mental health workforce and may also find these revised practice standards useful. Top of page
Purpose and audienceThis revised set of standards is intended to strengthen the workforce and to outline the values, attitudes, knowledge and skills required when individual members of one of the five professions listed above work in a mental health service. Implementing the practice standards will promote a coordinated and consistent approach to professional development and service improvement.
Entry-level practitioners and practitioners new to mental healthRecent graduates, and those who work with them, should use these standards. It is intended that workers will meet the requirements of the revised practice standards in their first two years of practice in mental health. The level of knowledge and skill of people entering the workforce may vary significantly, and will be affected by factors including experience and level of professional training. The transition from university to work, or from another area of health to mental health, is a time when experience in the sector should support new practitioners to synthesise theory and practice.
People from different disciplines and different backgrounds may take varying periods of time to meet the standards, depending on the nature of their training and experience.
Experienced practitionersMore experienced practitioners should use the practice standards to review their practice against current expectations. Changes in the service system, community and national directions are important to contemporary practice. The practice standards will also be useful in supporting and supervising less experienced workers. Top of page
Education and training providers and accreditation authoritiesThe revised practice standards provide a guide for education and training curricula. The aim of mental health curricula should be for students to achieve most of the practice standards by the time they complete their professional entry level course. Government, professional bodies, health services and education providers have a shared interest in developing competent beginning practitioners who can work safely and confidently in health services, including mental health services.
The practice standards can be used to promote collaboration with education providers in: undergraduate and postgraduate course development; pre-registration and undergraduate clinical placements; and supervision and research, and help build the existing and emerging mental health workforce.
Mental health servicesAdditional postgraduate studies and continuing education in the workplace will assist to expand knowledge and skills over time. Service managers should be explicit regarding their expectations of workers, and have a responsibility to provide mental health practitioners with opportunities for appropriate education, training and support to meet the standards. It is anticipated that education providers will use the revised practice standards, the National Mental Health Standards 2010, and discipline-specific competencies and standards to ensure graduates are aware of the core knowledge, skills and attitudes required in current and future mental health service delivery. Top of page
Review processIn November 2011, the Health Workforce Principal Committee (HWPC) endorsed a contained review to update the National Practice Standards for the Mental Health Workforce (2002). The Mental Health Workforce Advisory Committee (MHWAC) was funded by the Department of Health and Ageing to manage the review. Direct oversight of the project rests with a Steering Committee chaired by Health Workforce Australia (HWA). An expert group and project steering committee were formed early in 2012 to oversee the review, and included representatives from the National Mental Health Consumer and Carer Forum, professional bodies, government, the non-government sector and the private sector. A national consultation process was undertaken by Precision Consultancy, and this provided advice and feedback on the revised standards. Consultation included meetings in each state and territory capital city, meetings at rural towns (Cairns, Alice Springs and Orange), and six site visits to a mix of public, private, non-government, rural, metropolitan and remote services. Stakeholders had the opportunity to attend meetings, respond to an online survey, or submit a written submission.
This review has been informed by developments in mental health practice standards and competencies in other jurisdictions, including New Zealand's Let's get real and the NSW Health CAMHS competency framework.
LanguageWords and language are important in shaping ideas and framing concepts. This document draws on recovery approaches, and uses language descriptors such as person and people with lived experience, rather than terms such as consumers or service users. For similar reasons, these standards use the terms family and support networks to include family members, carers, partners, significant others, friends and anyone whose primary relationship with the person concerned is a personal, supporting and caring one. This approach draws on that of the National Recovery-Oriented Mental Health Practice Framework.
Mental health and involuntary careSome people experience mental health services on an involuntary basis. This can create tension regarding upholding human rights. Where this is the case, practitioners must ensure the relevant Commonwealth, state or territory mental health legislation is observed. Moving to less restrictive care and minimising the use of involuntary treatment is the desired aim and the importance of upholding the principles, values and attitudes outlined in this document remains. Top of page
National Standards for Mental Health Services 2010While the practice standards relate to the skills, knowledge and attitudes expected of those who work in mental health services, the National Standards for Mental Health Services (2010) (service standards) apply to the setting in which mental health care is provided. The revised service standards cover 10 areas outlined in the table: comparison of standards, and also include recovery principles. The 10th standard relates to the delivery of care, and includes a recovery standard.
The two sets of standards are intended to work together to support the ongoing development and implementation of good practices and to guide continuous quality improvement in mental health services. The service standards should ensure systems and processes are in place at an organisational level to provide optimum support for people using the service and their families. The practice standards should ensure mental health professionals’ work practices demonstrate person-centred approaches and reflect nationally agreed protocols and requirements. As such, the two sets of standards are intended to provide a foundation for the sector.
Table: Comparison of standards
|National practice standards 2013||National standards for mental health services 2010|
|Standard 1: Rights, responsibilities, safety and privacy||1. Rights and responsibilities|
|Standard 2: Working with people, families and carers in recovery-focused ways||3. Consumer and carer participation|
|Standard 3: Meeting diverse needs|
Standard 4: Working with Aboriginal and Torres Strait Islander people, families and communities
|4. Diversity responsiveness|
|Standard 5: Access|
Standard 6: Individual planning
Standard 7: Treatment and support
Standard 8 Transitions in care
|10. Delivery of care (supporting recovery, access, entry, assessment and review, treatment and support, exit and re-entry)|
|Standard 9: Integration and partnership||9. Integration|
|Standard 10: Quality improvement||8. Governance, leadership and management|
|Standard 11: Communication and information management|
|Standard 12: Health promotion and prevention||5. Promotion and prevention|
|Standard 13: Ethical practice and professional development responsibilities|
Principles of recovery-oriented mental health practiceThe National Standards for Mental Health Services (2010) principles of recovery-oriented mental health practice state that:
From the perspective of the individual with mental illness, recovery means gaining and retaining hope, understanding of ones abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self.
It is important to remember that recovery is not synonymous with cure. Recovery refers to both internal conditions experienced by persons who describe themselves as being in recovery— hope, healing, empowerment and connection—and external conditions that facilitate recovery—implementation of human rights, a positive culture of healing, and recovery-oriented services. (Jacobson and Greenley, 2001 p. 482)
The purpose of principles of recovery-oriented mental health practice is to ensure that mental health services are being delivered in a way that supports the recovery of mental health consumers. (Commonwealth of Australia, 2010 p. 42)
Six principles are identified that ensure recovery-oriented mental health practice. These are:
- uniqueness of the individual (which includes empowering the individual to be the centre of care)
- real choices (which includes achieving a balance between duty of care and support for an individual to take positive risks)
- attitudes and rights (which includes listening to, learning from and acting on communications from the individual and their carers)
- dignity and respect
- partnership and communication (which includes acknowledging each individual is an expert on their own life, and that recovery involves working in partnership with individuals and their carers)
- evaluating recovery (which includes measuring outcomes on a range of indicators in addition to health and wellness, such as housing, employment and social relationships) Top of page
Alignment with complementary standardsThe practice standards address core elements of common mental health practice across the five disciplines. They are intended to complement the valuable discipline-specific contributions of each profession, and to address the shared knowledge, skills, values and attitudes required when working in an interdisciplinary mental health service.
The practice standards should be used in conjunction with the service standards and the discipline-specific standards, competencies or curricula that apply to the individual practitioner’s profession.
The discipline-specific documents that may apply include, but are not limited, to the following.
For psychologistsThe Australian Psychological Society's:
- Code of ethics
- Ethical and practice guidelines and procedures
For social workersThe Australian Association of Social Workers':
- Australian Social Work Education And Accreditation Standards (2012)
- Code of Ethics (2010)
- AASW Practice Standards For Mental Health Social Workers (2008) Top of page
For occupational therapistsThe Australian Association of Occupational Therapists':
- Code of Ethics (revised 2001)
- Australian Minimum Competency Standards For New Graduate Occupational Therapists 2010
- Code of conduct for registered health practitioners (2012)
For psychiatristsThe Royal Australian and New Zealand College of Psychiatrists':
- position statements
- clinical practice guidelines
- ethical guidelines
- Code of conduct
- Code of ethics
For nursesThe Australian College of Mental Health Nurses':
- Standards of Practice for Australian Mental Health Nurses: 2010
- Code of Ethics for Nurses in Australia (2008)
- Code of Professional Conduct for Nurses in Australia (2008)
- National Nursing Competency Standards for the Registered and Enrolled Nurses Top of page
Using the practice standardsThe practice standards are aimed at: individual professionals; agencies and services; the five national professional bodies representing psychiatry, psychology, social work, nursing and occupational therapy; and education and training providers. It is the responsibility of individuals, services and professional bodies to encourage the incorporation of the practice standards into routine practice.
In conjunction with the service standards and discipline-specific mental health competencies and standards, the following provides advice regarding the potential value and contribution of the standards.
Develop standards of practiceThe practice standards offer a practical framework to provide direction for professionals entering or working in mental health services. They inform individual practitioners of the common skills, knowledge and attitudes they need to work within an interdisciplinary team environment or other form of mental health service. They also provide a benchmark for improving the quality of practice in mental health care and offer a tool for service providers and managers in relation to organisational management, supervision, business planning and performance development.
Guide professional development, including clinical supervision when appropriate, and mentoring and continuing educationThe practice standards are a useful tool in supervising practice, and they can also be used in mentoring. They can assist individual practitioners to identify their own level of knowledge and skill to practice in mental health, and their need for continuing education and professional development. The practice standards can be used to encourage reflection on attitudes towards people with mental illness, their family and carers. Top of page
Assist recruitment and retentionThe practice standards can provide a framework for recruitment and retention of mental health practitioners and as a guide for managers and supervisors preparing job descriptions, undertaking staff selection processes, and identifying supervision and professional development needs.
Accredit servicesUsing the practice standards in conjunction with the service standards can assist mental health services to develop or review their education and training strategies, ensuring practitioners work towards achieving the practice standards. This may assist services in gaining accreditation.
Develop undergraduate and postgraduate curriculumThe practice standards provide a useful framework from which universities and educational institutions can develop curriculum content relevant to current and future mental health practice at undergraduate and postgraduate levels. Professional bodies can work with education and training providers, and accreditation authorities, to support uptake of the practice standards within curricula for psychiatry, psychology, nursing, social work and occupational therapy.
Complement other practice and competency standardsThe practice standards complement the practice and competency standards developed by each of the national professional bodies. They also complement the competency standards developed by the Community Services and Health Industry Skill Council for people with other qualifications, skills and expertise working in a range of mental health service settings. Top of page
Key principlesThese key principles are consistent with national policy and requirements for delivering mental health treatment, care and support in Australia, and are embedded in the practice standards.
Mental health practitioners:
- promote an optimal quality of life for and with people with mental illness
- deliver services with the aim of facilitating sustained recovery
- involve people using services in all decisions regarding their treatment, care and support and, as far as possible, the opportunity to choose their treatment and setting
- recognise the right of the person to have their nominated carer involved in all aspects of their care
- learn about and value the lived experience of people using services, and their family or carers
- recognise the role played by carers, as well as their capacity, needs and requirements, separate from those of the person receiving services
- recognise and support the rights of children and young people affected by a family member with a mental illness to appropriate information, care and protection
- support participation by people and their families and carers as an integral part of mental health service development, planning, delivery and evaluation
- tailor mental health treatment, care and support to meet the specific needs of the individual
- in delivering mental health treatment and support impose the least personal restriction on the rights and choices of people, taking into account their living situation, level of support within the community, and the needs of their family or carer
- are aware of and implement evidence-informed practices and quality improvement processes
- participate in professional development activities and reflect what they have learnt in practice Top of page