Participants continued to support the recommendations of the Network's previous Identifying the Carer Report, 2007. They sought information regarding the status of implementation of these recommendations. This information together with participants current suggestions has been summarised as follows.
5.7.1 Update of the Network's Identifying the Carer Report 2007 recommendations
Recommendation: carers recognition legislation be developed by all states and territoriesCurrent status:
Legislation currently exists in WA, SA, NT, Qld but not in Victoria, NSW, Tasmania or ACT. However all States and Territories have carer participation policies. Implementation processes developed for this legislation are currently not paying particular attention to mental health carers.
National Carer Recognition Legislation has also been drafted.
Recommendation: amend state and territory mental health legislation to mandate identification and support of carers/primary support personsCurrent status:
Mental Health legislation is progressively changing around the country to provide more consistency however this is a long and arduous process and of the eight separate Acts, the NT Act 2006 currently mandates more engagement than any other mental Health legislation in Australia. Top of page
Recommendation: revise the National Standards for Mental Health Services to include a carer specific standard
Carer specific standard now included. An implementation process for Standard 7 has yet to be developed. Mechanisms for specific measurement will also need to be built into accreditation survey processes such as ACHS EQuIP. This requires additional training for surveyors.
Recommendation: develop nationally consistent packs of information for carers similar to those given to consumers
This will be a product of the current project. Consultation participants continue to believe that admission protocols should require noting that carers have been identified and information packs provided. The availability of a Carer Consultant to support new carers to 'talk through' this information was seen as highly desirable. Top of page
Recommendation: develop carer identification and participation policies and protocols for implementation in each service to support changes in clinical practiceCurrent status:
This will be a product of this current project. Participants in this round of consultations have emphasised that opportunities for staff to receive 'carer sensitivity' and skills development training will be essential if any change is to be made in clinical practice regarding identification of carers.
Recommendation: appoint carer consultants / liaison officers to all servicesCurrent status:
Participants reported that the number of these positions has increased. It was noted that where these appointments have been made they have contributed significantly to:
- Staff support and training;
- Liaison between staff, consumers and carers, e.g. assistance with completion of admission protocols regarding identification of carers; advocacy for individual carers with staff/services;
- An increase in linkages to alternative options for information and support for carers such as referral to Carer Support Organisations;
- Provision of carer specific perspectives to staff meetings;
- Assistance with carer assessments; and
- Providing a specific point of contact for carers following discharge of the consumer.
However we were informed that there has been high turnover in these positions primarily due to the reasons listed above. Top of page
Recommendation: introduce at point of entry a specific colour coded form to enable consumers to identify carers together with the level of involvement they wish them to haveCurrent status:
This has been introduced by a number of private hospitals but, as yet, not by public hospitals. Participants in the current round of consultations continue to support this suggestion as outlined above under Assessment.
Recommendation: recognise and expand the importance of the potential role that GPs could play in the identification and support of carersCurrent status:
Participants continue to see GPs as potentially having a crucial role to play in the identification of carers as they frequently treat the whole family. It was felt that they are also well placed to keep this information up to date and to transfer the information when making referrals. The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme (Better Access) initiative, was seen as potentially playing a positive role in identification of carers.
Participants continue to highlight the need for all referral processes/forms to identify carers. This information should be an integral component of all referrals including:
- GP to psychiatrist;
- Psychiatrist to hospital; and
- Hospital to community service. Top of page
Recommendation: modify data systems to make collection of 'carer' information mandatoryCurrent status:
Participants strongly support this recommendation however also felt that a short list of 'sample' questions would need to be developed to assist this process. Asking about 'carers' will not illicit the information required.
Participants noted that Child and Adolescent Services are required to collect information regarding parents/guardians/etc. Electronic data collection forms are frequently organised in such a way that it is not possible to move on to the next section until this section has been completed. Participants continue to support a similar process being developed for all admissions. It was also considered important that these questions be re–asked at every admission as just copying the information from the last admission would lead to situations where clinicians are left trying to contact relatives or friends who are no longer involved, or who have moved.
It was also felt that asking for Next of Kin does not cover this issue.
This proposal was considered by the MHISS following the publication of the Network's 2007 Identifying the Carer Report. States and Territories had varying reactions to this recommendation. Some felt there were other mechanisms for collecting this information and others had different priorities for amendments to data collections. All noted that additional changes to data systems would entail significant cost implications. Top of page
Recommendation: encourage people with long term illnesses to develop relapse prevention plans and advance directives regarding care preferences and identification and engagement of carersCurrent status:
The development of such Plans has been slow to be implemented in any systemic manner. Their development continues to be supported. An example of such a Directive has been included in the Appendices together with a draft Ulysses Agreement which was also supported by participants.
Recommendation: develop legislation to provide for separate carers assessments as is currently available in the UKCurrent status:
Participants continue to support this option as they recognise it would require services to identify carers.