Appointment and patient rights

AMHS Administrators: Roles and responsibilities

Appointment and functions

Administrators play a critical role in the administration of the Mental Health Act 2016.

An administrator is appointed for each authorised mental health service by the chief psychiatrist.

Administrators have key functions under the Act, namely:

• to the extent practicable, ensuring the operation of the authorised mental health service complies with the Act, and
• taking reasonable steps to ensure patients of the authorised mental health service receive appropriate treatment and care.

These obligations relate to both involuntary patients and voluntary inpatients.

It is expected that administrators will put in place systems and procedures in their service, and provide ongoing training for staff, to ensure these functions are properly performed.

General obligations for patients

Where the Act provides that an authorised mental health service is responsible for an involuntary patient, such as patients on treatment authorities, forensic orders or treatment support orders, the administrator of the service has overall accountability for the treatment and care of the patient under the authority or order.

For each patient, the administrator must take reasonable steps to ensure:

• the patient receives the treatment and care planned to be provided to the patient, as recorded in the patient’s health records
• to the extent practicable, the patient receives the treatment and care appropriate for any other illness or  condition affecting the patient, and
• the patient’s treatment and care complies with the requirements of the Act.

It is expected that administrators will put in place systems and procedures to monitor compliance with the Act.

Administrators must also ensure that:

• systems are in place for recording the patient’s treatment and care, both planned and provided, and
• regular assessments of patients on treatment authorities happen as decided by an authorised doctor.

Less restrictive ways of treatment

The Act promotes the ‘less restrictive way’ to treat a person, as an alternative to involuntary treatment under a treatment authority.

Less restrictive ways of treatment are:

• if the person is a minor - with the consent of the minor’s parent
• if the person has made an advance health directive - under the advance health directive
• if a personal guardian has been appointed for the person - with the consent of the personal guardian
• if an attorney has been appointed by the person - with the consent of the attorney, or
• with the consent of the person’s statutory health attorney, other than the Public Guardian.

A template Advance Health Directive has been prepared for use by mental health consumers.

The template directive allows the consumer to give consent to health care at a future time when the person does not have capacity to consent.

Under the advance health directive, the person may appoint an attorney to consent to this healthcare. The person may also consent to other health care or appoint an attorney for other health care matters in the template directive.

The person may ask an administrator to keep a record of the advance health directive on the person’s health records. The chief psychiatrist will ensure that systems are in place to enable this to be recorded.

The administrator must comply with this request and give the person written notice confirming the advance health directive has been placed on the record system.

Similar arrangements apply to Enduring Power of Attorney, under which a person may appoint an attorney to consent to health care at a time when the person does not have capacity.

If the advance health care directive or Enduring Power of Attorneyis revoked, or an attorney resigns, the person or attorney must give the administrator written notice so that the records can be amended.

Nominated support persons

A person may appoint one or two nominated support persons.

If the appointing person becomes an involuntary patient, a nominated support person may:

• receive notices for the appointing person under the Act
• receive confidential information relating to the appointing person
• request a psychiatrist report for the person if the person is charged with a serious offence, and
• act as the appointing person’s support person or represent the appointing person in the Mental Health Review Tribunal.

A person may request the administrator to keep a record of the appointment of a nominated support person or persons on the record system. The administrator must comply with this request.

If the appointment is revoked, or the nominated support person resigns, the person must give the administrator written notice so that the records can be amended.

Statement of Rights

Under the Act, the chief psychiatrist must prepare a Statement of Rights for patients and support persons.

After admission of an involuntary or voluntary patient to an authorised mental health service, the administrator or delegate must:

• explain the statement of rights to the patient
• if requested, give a copy of the statement of rights to the patient, and
• if requested, give a copy of the statement of rights to the patient’s nominated support persons, family, carers and other support persons.

The administrator must display signs in prominent positions in the service stating that a copy of the statement of rights is available on request.

Independent Patient Rights Advisers

Authorised mental health services must have systems in place to ensure that patients are advised of their rights under the Act.

Public sector authorised mental health services must appoint an independent patient rights adviser or advisers in accordance with the relevant Chief Psychiatrist Policy.

The main function of independent patient rights advisers is to ensure that patients and support persons are advised of their rights under the Act.

Advisers will play a key role in communicating between patients, support persons and clinicians.

An independent patient rights adviser must act independently and impartially and is not subject to the direction of another person in the performance of a function under the Act.

Administrators have an important responsibility to ensure that independent patient rights advisers are respected within their service and can perform their functions effectively.

Second opinions

Provisions of the Act apply if an authorised mental health service has been unable to resolve a complaint about the provision of treatment and care to a patient.

In these circumstances, the patient, or an interested person for the patient, may request the administrator to obtain a second opinion about the patient’s treatment and care from another health practitioner.

The administrator must make arrangements to obtain the second opinion from a health practitioner who is independent of the patient’s treating team.