INFORM Summer 2008 - v9

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					                                                 INFORM
                               NEWSLETTER OF THE CHIEF PSYCHIATRIST

                                                      SUMMER / AUTUMN 2008


                                Information Management Edition
                                This edition of INFORM contains information about data generated by the
                                activities of the Office of the Chief Psychiatrist (OCP). The OCP structures its
Inside this issue:              activities around three program areas that enable the Chief Psychiatrist to meet
                                his *statutory responsibilities under the West Australian Mental Health Act
                                1996. These three program areas are Monitoring Activities; Legislative Duties
                                and Liaison; and Clinical Support. These programs and sub programs can be
Information                1    viewed      in    detail    on    the    Chief     Psychiatrist’s website     at
Management Edition              www.chiefpsychiatrist.health.wa.gov.au.

Complaints Managed         1    Mental Health Act (1996):
by the OCP                      *Section 9 (1) The Chief Psychiatrist has a responsibility for the medical care
                                and welfare of all involuntary patients
Chief Psychiatrist’s       2
                                 Section 9 (2) In respect of other patients, the Chief Psychiatrist is required to
Clinical Governance
                                monitor the standards of psychiatric care provided throughout the State.
Reviews

Matters Reported          4     Why does the Chief Psychiatrist require information and data?
to the Chief Psychiatrist       The Chief Psychiatrist collects data for the primary purpose of informing him as
                                to what actions are required for the:
Education Provided         5
by the OCP                                 ‘SAFETY, QUALITY AND CONTINUOUS IMPROVEMENT OF
                                                MENTAL HEALTH SERVICES TO CONSUMERS’
Sexual Vulnerability /     6
Intimacy in Licensed            A further purpose is to support the accountability of the Chief Psychiatrist to
Psychiatric Hostels             the Director General of Health.
Legal Advice               7    How ‘robust’ is the data?
Federal and State          7    Data collected is only as robust as the level and comprehensiveness of the
Initiatives in Regard to        reporting by the various stakeholders and their compliance with the systems
Seclusion and Restraint         that collect and maintain the data. Data is meaningful in the context for which
                                it is collected.
Not Enacting Mental        8
Health Forms                    The Chief Psychiatrist does not rely on a single source of monitoring information
                                or a single set of data but rather integrates all sources of information generated
AMHP Corner                8    by the OCP activities and reporting in order to make decisions about the type of
                                interventions required by the mental health services which will influence the
                                Safety, Quality and Continuous Improvement of Mental Health Services to
                                Consumers’.
  Contact Details:
                                Complaints Managed by the OCP
  For any further               477 complaints were managed by the OCP 2006/2007. The majority were
  information, please           lodged by patients (46.9%) and the next largest by relatives (22.9%). while 12.1%
  contact the Office of the     were lodged by ‘concerned others’. 33.3% of complaints were about Quality of
  Chief Psychiatrist on         Clinical Care; 27.5% about Rights/Respect; 16.3% about Access and 14.4% about
                                communication plus 8.6% other issues. All complaints are investigated and the
  Phone: (08) 9222 4462
                                complainant advised of the outcome.

  Or visit our website:
  www.chiefpsychiatrist.
  health.wa.gov.au
  Chief Psychiatrist’s Clinical Governance Reviews
The Chief Psychiatrist has conducted clinical reviews of mental health services since 1999 in order to monitor the
standards of psychiatric care provided throughout the State of Western Australia. In 2003 the clinical review
methodology was modified to reflect the Department of Health Clinical Governance Framework. The current
methodology also allows for the unique aspects of mental health service provision.

The Chief Psychiatrist’s Clinical Governance Framework consists of four pillars and eight areas of inquiry. Each of
the areas of inquiry are examined during a Clinical Governance Review. The framework can be accessed at –
http://www.chiefpsychiatrist.health.wa.gov.au/monitoring/clinicalgovernance.cfm

Pillar                                                                      Area of Inquiry
                                                                            Leadership and Organisational Capability
Consumer Value                                                              Consultation and Consumer / Carer Involvement
Clinical Performance and Evaluation                                         Clinical Audit
                                                                            Research and Effectiveness
                                                                            Use of Information to Support Health Care Delivery
Clinical Risk                                                               Clinical Risk Management
Professional Development and Management                                     Staffing and Staff Management
                                                                            Education, Training and Professional Development

Information about how a mental health service is performing in relation to the implementation of Clinical
Governance is obtained through a variety of sources and involves the collection of data prior to and during a site
visit. The type of information collected prior to the site visit includes complaint/compliments data, incident data,
operational and strategic plans, annual reports and monthly data reports. The site visit is conducted by a
multidisciplinary team and includes a consumer and carer reviewer.

During the site visit data is collected from staff, consumer, carer and stakeholder interviews, clinical records,
policies and procedures and via observations. Following the site visit the Chief Psychiatrist will make a series of
recommendations that relate to areas within the mental health service where improvement in clinical care and
service provision can be made in order to improve outcomes for patients. The mental health service is to ensure
that all recommendations are addressed and actioned over an audit period.

Recommendations by Area of Inquiry
During the period September 2003 – July 2006, ten clinical governance reviews were conducted, with a total of 300
recommendations made. The figure below shows the number of recommendations made within each area of
inquiry.

Figure: Total Number of Recommendations by Area of Inquiry

                                          80
                                                                            74


                                          70

                                                                                                             L e a d e r s h ip a n d O r g a n is a t io n a l C a p a b ilit y
                                               59
                                          60
                                                                                                             C o n s u lt a t io n a n d C o n s u m e r
         Number of Recommendations Made




                                                                                                             P a r t icip a t io n
                                                                                                             C lin ica l A u d it
                                          50        47

                                                                                                             R e s e a r c h a n d E f f e ct iv e n e s s

                                          40
                                                                                                             U s e o f In f o r m a t io n t o S u p p o r t H e a lt h
                                                                                                             C a r e D e liv e r y
                                          30                                                                 C lin ica l R is k M a n a g e m e n t
                                                                                      27
                                                                  25                       26

                                                                                                22           S t a f f in g a n d S t a f f M a n a g e m e n t
                                                         20
                                          20
                                                                                                             E d u ca t io n , T r a in in g a n d P r o f e s s io n a l
                                                                                                             D e v e lo p m e n t
                                          10



                                           0

                                                              A re a o f In q u iry
Chief Psychiatrist’s Clinical Governance Reviews
Assessment of the Status of Clinical Governance Recommendations
The table below is a snapshot as of February 2008 of the status of all recommendations for services that have
either completed the Clinical Governance Review cycle or are currently undergoing progress audits. This includes
three services having completed a final audit, and four services having undergone progress audits.

The current status of recommendations from the Clinical Governance Reviews is represented in the table below.

Table: Current Assessment - Recommendation Status by Area of Inquiry – All Services Audited
                                                                                   Partially     Not
                                                                     Achieved                             Total
                                                                                   Achieved    Achieved
Leadership and Organisational Capability                                 20            21         8        49
Consumer Value                                                           19            17         2        38
Clinical Audit                                                           5             11         0        16
Research and Effectiveness                                               6             8          4       18*
Use of Information to Support Health Care Delivery                       23            22         2        47
Clinical Risk Management                                                 6             15         0        21
Staffing and Staff Management                                            8             11         0        19
Education, Training and Professional Development                         9             9          0        18
Total                                                                    95           115        16       226

The table demonstrates that 42% of all Clinical Governance recommendations made as a result of the Chief
Psychiatrist’s reviews have been achieved, with another 51% being actively addressed by mental health services.

The Chief Psychiatrist will continue to engage with the mental health services by a series of progress visits until
all recommendations have been achieved. The aim of the visits is to work collaboratively with the service to
identify and address any challenges that the service may encounter in relation to the recommendations.

Feedback from the mental health services indicate a strong support for this collaborative approach to facilitating
the implementation of the recommendations.


Clinical Governance Review Timetable
The timetable of the Chief Psychiatrist’s Clinical Governance Review is available on the OCP website. Services
will be formally advised by letter of an upcoming review by the Chief Psychiatrist.


Standards Monitoring by the Office of the Chief Psychiatrist
The Coordinator, Standards Monitoring in the Office of the Chief Psychiatrist is Dr Theresa Marshall who is
available on 9222 4462. Dr Marshall, as well as coordinating the Clinical Governance Reviews, coordinates the
monitoring of care standards for Licensed Psychiatric Hostels and the standards for Non Government Mental
Health Services. Peter Bachelard-Lammas has contributed significantly to the ‘roll out’ of the monitoring of the
standards for Non Government Mental Health Services. The Administration Officer Standards Monitoring is Andrea
Kersten available on 9222 4462.
  Matters Reported to the Chief Psychiatrist
The Chief Psychiatrist (CP) is informed as a matter of first priority of any death of patients and serious incidents in any
mental health service (Operational Circular 2061/06). The Chief Psychiatrist also collects reported information on patients
whose events or death may have a relationship to mental health issues but have had no contact with mental health
services. Serious Incidents may include, but are not confined to, serious assaults on or by staff, other patients or visitors,
absconding of any forensic or detained involuntary patient or serious medication error in regard to a mental health patient.

Use of the Reported Information
The information the CP receives about deaths and serious incidents is used to prepare data and reports in order to gain an
overview of events in WA that may relate to standards of mental health care. The data and reports are used in a number of
ways:
     To examine specific incidents or deaths individually as they are reported and where necessary take immediate action;
     To inform the Clinical Governance monitoring processes which will result in recommendations to the service;
     To inform the Director of General of Health/ the Minister for Health and to assist with responses to Parliamentary
     Questions;
     Examine the data gathered over months, years or on a geographical basis to identify trends and where appropriate
     take action.

Important Qualifications of Reportable Matters Data
It is important that certain qualifications are understood in relation to the reportable information in regards to its
collection, use and interpretation.


        Applying styles in Word document templates
1. The information collected, data and reports generated by the Chief Psychiatrist are not for the purpose of demographic
   reporting. Data for demographic reporting requires a different approach to that employed by the Office of the Chief
   Psychiatrist. For example the CP recording process records the event in the month it is reported which may be sometime
   after the actual event. An increase in the number of deaths in any particular month under the CP process is accurately
        Use styles throughout a document                            Style Guidelines
   accounting for the deaths reported to him not the number of deaths that occurred that month.
        Apply the same style to maintain consistency                 Create text Sub heading when you need them
        for notified as a matter of priority of any death or serious incident so not all details of an incident may be known
2. The CP istext formatting
                                                                      Styles death, available in a at later date as some
   when it is first reported. Further information, such as the cause of that are may be knowntemplate should be
   information cannot the confirmed until anothera agency such asthe only styles applied to text in a document. death
             Highlight be text you want to apply style                  the State Coroner has confirmed a cause of
             to. long as two years).
   (sometimes asThis is the same as selecting text you
                                                                      To ensure compliance with the Communication
              want to make italics or bold.
                                                                      Style Guide and to ensure consistency each time a
3. The initial information may be inaccurate or unintentionally misleading. For example, if a serious incident is reported
                                                                      template is used, another facility, then this or
   whereby a patient was sedated for a prolonged period whilst being transported to do not modify these styles could be
              On the formatting toolbar click the drop
                     box on medication or                             create your own.
              downeither a the Style field. transportation issue. If such incidents were all categorised as ‘transportation’
   categorised as
                          ‘ medication’ to apply this                 The custom styles true number of incidents
   issues rather than a style you wantissue thento thecould be misleading about the follow the formatting as involving
              Select the
   medication.highlighted text.                                       outlined by the Communication Style Guide and
                                                                      should nature of the data
   The preliminary data, subject-to-amendment and potentially misleading not be modified. can then in turn affect how
              For the information and what actions may result from these interpretations. It is always worth bearing in mind
   one interprets example, this text uses the bullet style.
   too, that two individuals may interpret the same statistics or information differently. For example, an increase in
         This text uses the Body Copy style.
   reported deaths from one year to the next may be interpreted as an increase in the number of deaths when in fact it
         You can an increase in the reporting of deaths.
   may be due tochange styles simply be selecting a
         different style and begin typing or highlight any
4. Some incidents may involve persons who have had no contact with mental health services. The rationale for reporting
         text and select a style.
   this information is that there may be implications for mental health services. There may not be implications for services
   but the reported matter remains part of the data and reports.

Reporting
Two standardised reporting forms are available electronically for the reporting of Deaths and Serious Incidents. The use of
the standardised form has resulted in more detail than previously experienced. This has helped to reduce the need for
further clarification and the amount of amendments data has been subjected to. The CP will be seeking to improve the
system further over the coming months by introducing an online reporting system in which individuals log onto the Office of
the Chief Psychiatrist website and report directly by completing the standardised form. The Office of the Chief Psychiatrist
will be notifying services when the new system is in operation. In the meantime the forms can be obtained by emailing the
Manager janet.peacock@health.wa.gov.au

Janet Peacock, Manager Office of the Chief Psychiatrist coordinates the Reportable Matters for the Chief Psychiatrist and is
supported with the data management by Chris Hepworth, Information Management Officer.
Education Provided by the OCP
Staff at the Office of the Chief Psychiatrist provides education and training for mental health clinicians,
students and other government and non-government agencies. These education and training sessions are in
relation to activities of the Office of the Chief Psychiatrist and the Mental Health Act 1996. They can be
requested by any department or service and are usually conducted at no cost to the department or service
    A variety of By conducting education sessions the Office of styles for quick, consistent and flexible
requesting them. styles are available in the                   Use the Chief Psychiatrist ensures that clinicians
     others are
and templates informed and educated about lawful procedures and best practice.
                                                               formatting
Specifically, education and training is provided in 2 main areas:
    Custom styles or pre-defined styles include:               If you want to achieve consistency of the
• The Mental Health Act 1996 and other legislative issues;
                                                               communication documents, open the templates
• Clinical Governance Reviews of Mental Health Services.
         Body Copy
                                                               created and use the custom styles.
         Bullet
The Mental Health Act 1996 Education                           Styles are a quick and effective way to ensure
         Heading                                               formatting of text appears consistent throughout a
                                                               document. Act, is responsible text size, font
Tim Rolfe, having been involved with the implementation of the 1996 Formatting refers to for the continuing
         Text heading
education about the Act.                                       type, colour, paragraph spacing, indenting, bullets
         Text sub heading                                      and numbering.
For the six months July 2007 to December 2007 there were 22 education sessions on the Mental Health Act 1996
                                                               Pre-defined aimed at a different information so
(the ‘Act’) to over 400 individuals. There are a number of programs, eachstyles store all of this audience, which
         Page Headline
                                                               that at anytime in the document creation a style
range from a one-hour overview of the act to more specific aspects of the legislation such as referral issues and
         Page sub heading and many others.                     can be applied to selected text.
police powers. A summary of these course are provided below:
    Styles names may be slightly different in each
• Overview of the Mental Health Act;                           Styles incorporate the colour systems outlined in
    template. However, where possible the Act;
• Detailed Exploration of the Mental Healthsame                the Communication Style guide on page 12 and 13.
    naming Issues and Police been used
• Referral conventions have Powers; for common                 The visual identity of each colour palette is
    styles in for Non-Authorised Facilities;
• Overview each of the templates.                              available in individual templates.
• Background to Legislation and Brief Overview of the Mental Health Act;
• The Review of the Mental Health Act (1996) and Government response to the Review;
• Community Treatment Orders.

In addition to the sessions given in these main areas, Tim Rolfe provided 5 sessions on the Use of Seclusion
attended by over 120 mental health staff. Sessions on other specific topics are also given based upon requests
from a department or service for the OCP to provide education or training in a particular area. The OCP also
provided sessions on Confidentiality, Mental State Examination and the ‘Role of the Chief Psychiatrist’

There was also an Authorised Mental Health Practitioner Training Course over three days during the same
period.

Public presentations for the information of consumers, carers and the general public are given around topics
such as the Review of the Mental Health Act.


Helpdesk
The Office of the Chief Psychiatrist provides a telephone ‘Helpdesk’ on questions about the Mental Health Act
1996. Tim Rolfe as the Clinical Consultant takes most helpdesk calls but other staff will also provide assistance.
From July 2007 to December 2007 the OCP received 228 calls. The previous year 2006 to 2007 totalled 411 calls.


Clinical Governance Education
In 2007 (January to December) Dr Theresa Marshall provided 12 education sessions to mental health services in
relation to the Clinical Governance Framework and the Chief Psychiatrist's Clinical Governance Review Program.
This includes three 2-day training sessions for Clinical Governance Reviewers.


NGO Standards Monitoring Education
Towards the end of 2007 the self-assessment pilot project in relation to the monitoring of the Service Standards
for Non Government Providers of Community Mental Health Services commenced. Thirteen education sessions
were provided to Non Government Organisations in relation to the Chief Psychiatrist’s new NGO standards
monitoring program.
Sexual Vulnerability / Intimacy in Licensed Psychiatric Hostels
The management of issues of sexual vulnerability/intimacy for residents of Licensed Psychiatric Hostels came to the
attention of the Chief Psychiatrist. He determined that action should be taken to ensure that each Licensed Psychiatric
Hostel (LPH) had implemented policies and procedures that identified and protected residents who are sexually
vulnerable and who have diminished capacity to consent to a sexual relationship.

     Custom
Process            styles                                           Why use styles?
    Independent styles are available LPH’s
The A variety of Reviewers visited 13 in the (those            Use styles for quick, consistent and flexible
                                                        with multiple service sites counted as one) and applied a
      templates                                                formatting
standardised assessment tool giving a rating to the following components that relate to the management of sexual
vulnerability/intimacy issues:
      Custom styles or pre-defined styles include:                  If you want to achieve consistency of the
    • Review of Existing Policies                                   communication documents, open the templates
    • Staff Capacity
            Body Copy
                                                                    created and use the custom styles.
    • Mental Health Service Clinical Support
            Bullet
    • Environmental Management                                       Styles are a quick and effective way to ensure
    • Licensee Capacity
            Heading                                                  formatting of text appears consistent throughout
                                                                     a document. Formatting refers to text size, font
            Text heading
Findings                                                             type, colour, paragraph spacing, indenting,
            Text sub heading                                         bullets and numbering.
Overall, the reviewers found that the audit outcomes demonstrated lack of knowledge and limited understanding in a
                                                                     Pre-defined styles store all of this information within
number of the LPH’s regarding the broad concepts of sexuality and intimacy and the management of such issues so
            Page Headline
                                                                     that at anytime in the document creation a style
the hostels. This applied to both licensees and staff. Many staff had never had the opportunity to attend education and
            Page sub heading and many others.                        can be applied residents on the
training on these issues and did not see it as important to provide information to to selected text. issues of relationships
and consent. names may be slightly different in each
       Styles                                                        Styles incorporate the colour systems outlined in
       template. However, where possible the same                    the to reflect practice and the on did 12 seem
Policies had been developed for most of thefor commondid not seem Communication Style guidestaffpage not and well
       naming conventions have been used       LPH’s, but
informed on its each of the templates.                               13. The visual identity of each colour palette is
       styles in contents. Overall, the education of staff on their own policy was inadequate and responses indicated that
                                                                     available policy, or had documented and/or managed
they had not understood components of the policy, had not followed the in individual templates.
issues differently from the policy. The scope of the policies varied, some were limited and others lengthy. Usually, the
      Applying styles in Word document templates
admitting hostel received an inadequate history and background of the incoming resident, particularly in regard to sexual
behaviour, risk behaviours and triggers for inappropriate sexual behaviour. If they did receive advice on sexual matters, it
was usually verbal. Referral forms were often incomplete or did not have space for sexual issues/behaviours.
        Use styles throughout a document                              Style Guidelines
During the day , supervision appeared adequate in most of the hostels, however there were some LPH’s that only provided
        Apply at same style to maintain consistency                   Create text Sub heading when you need them
sleepover shiftsthenight. In addition, the bedrooms were not lockable, the building design did not facilitate supervision,
        for text bells and there were a number of residents who required significant monitoring in the daytime for their
there were no callformatting                                          Styles that are available in a template should be
                                                                      the throughout the hostels regarding locking of
inappropriate sexual behaviour. There appeared to be different policiesonly styles applied to text in a document. the
              Highlight the text you want to apply a style
bedrooms. Some believe that security is essential to facilitate privacy and safety for the sexually vulnerable residents.
              to. This is the same as selecting text you
                                                                      To staff holding a master key.
Others believe that it is a fire hazard if bedrooms are locked, even with ensure compliance with the Communication
              want to make italics or bold.
                                                                      Style Guide and to ensure consistency each time a
                On the formatting cooperation the clinicians and the hostels were generally satisfiedthese styles or
Most hostels reported improved toolbar click with drop                  template is used, do not modify with the support.
                down box on the was field.
Although clinician involvement Styledocumented in the notes by the hostel staff, there were inconsistencies within the
                                                                        create your own.
facilities, as to whether clinicians write in their own notes or resident files. There were few clinicians who used the hostel
documentation and the style you want to apply to the                    The custom styles follow the formatting as
                Select the knowledge of the independent reviewers, the licensees and staff do not receive written
                highlightedverbal.
management plans, only      text.                                       outlined by the Communication Style Guide and
                                                                      should not be modified.
              For example, this text uses the bullet style.
Actions
        This text uses the Body Copy style.
1. The OCP engaged a Project Officer with significant NGO experience to work directly with the 13 LPH’s to develop their
        You
   policies. can change styles simply be selecting a
        different style and begin typing or highlight any
2. The Mental Health Division provided funding to the Hostels Association of WA to provide a training programme for staff
        text on select a style.
   of Hostels andthe Management of Sexual Vulnerability and intimacy which ran for 15 weeks. (*training included the
   management of medication)

Outcomes
1. Each of the 13 Hostels has Policy & Procedure in relation to Sexual Vulnerability, Sexuality and Intimate Relationships.
     • These are signed off by the Licensee/Manger and have a review date.
     • They include guidelines as to clinical involvement with care plans for sexual issues.
2. Staff and Management have had training made available on sexuality.
3. Resources on sexual issues are available in LPH’s for residents and staff (Staff Handbook).
 Restraining Orders Act 1997 and the Mental Health Act 1996.

 Serving of Violence Restraining Orders and Involuntary Patients
   Custom styles                                                     Why use styles?
 There are two types of Restraining Orders, under the Restraining Orders Act 1997. A Violence Restraining Order may be made
   A variety is satisfied that a person has committed or may commit an act of abuse consistent andwho wishes to be
 when a court of styles are available in the                      Use styles for quick, against another flexible
 protected from it occurring or occurring again. A Misconduct Restraining Order may be made when a court is satisfied that a
   templates                                                      formatting
 person is likely to behave in a way that could reasonably be expected to be intimidating or offensive, cause damage to
   Custom the person behave in way that may                         you peace. Restraining Orders need the
 property orstyles or pre-definedastyles include:lead to a breachIfof thewant to achieve consistency ofto be served on the
 person to be bound by the order before they are effective.       communication documents, open the templates
         Body Copy
                                                                     created and use the custom styles.
 Although the behaviour that instigated the Restraining Order may be relevant to a patient’s referral and admission for mental
          Bullet
                                                                     Styles are a Act.
 illness there is no direct link between Restraining Orders and the Mental Health quick and effective way to ensure
         Heading                                                     formatting of text appears consistent throughout a
                                                                    document. enter or remain on the premises, therefore, a
 There is no obligation on a hospital to allow anyone other than a patient to Formatting refers to text size, font
 hospitalText heading police access to a patient and thus prevent them from serving a Restraining Order. However, the
          may refuse the                                            type, colour, paragraph spacing, indenting, bullets
 decision to refuse access should not be made lightly and should take into account all the circumstances of the particular case.
         Text sub heading                                            and numbering.
                                                                 Pre-defined styles store the patient, due to their
 Clinicians may be concerned about allowing service of a Restraining Order if they feel thatall of this information somental
          Page Headline
                                                                 that no restrictions in docu
 illness, is limited in being able to understand the order. There are at anytime in the serving Restraining Orders in these
          Page as heading and many others.
 circumstancessub a mentally incompetent person will be protected from prosecution for breaching the Restraining Order and
 there are good reasons for allowing service to occur.           ent creation a style can be applied to selected
    Styles names may be slightly different in each                   text.
 In template. However, where possible the same the person seeking to be protected is a staff member or someone in a
     general the factors to be considered are: whether
                                                                     Styles leaving the hospital without consent, the anticipated
 distant location, the level of supervision available to prevent the patient incorporate the colour systems outlined in
    naming conventions have been used for common
    styles in each of the templates.                                 the Communication Style guide on page 12 and 13.
 impact on the patient's mental health, the ability of staff to safely manage a patient whose condition has been aggravated by
                                                                     The visual identity of served it is palette is
 the service of a Restraining Order and the fact that until the Restraining Order has been each colournot effective to protect
 the person who is meant to be protected by it.

 The hospital, if refusing access to the police even for good reasons, should be aware that they may be exposed to criticism if
 an incident occurs and the perception is that it could have been prevented if the Restraining Order had been served.

 It should also be noted that those seeking to effect service may be under an obligation to continue to attempt to serve the
 Restraining Order and that refusing access at one point in time will not necessarily be the end of the matter.

 The bottom line is that before deciding to refuse police access to serve a Restraining Order a thorough assessment of potential
 risks to the patient, staff, hospital and others should be made by the treating team.

 Clinicians also need to be aware of patient confidentiality if providing information to the police.




Federal and State Initiatives in Regard to Seclusion and Restraint
                                                                       Beacon Demonstration Sites were established in all
 Federal                                                               states and territories and they now have funding
 In 2005 and as part of the Commonwealth Mental                        agreements in place with the Australian Government.
 Health Strategy a national plan for safety and quality                Work on a manual for the national projects, National
 in mental health with four national priorities was                    Mental Health Seclusion and Restraint Project Manual
 released. One of the four priority areas was ‘Reducing                is being finalised
 use of and where possible eliminating restraint and
 seclusion’.                                                           State
 As part of the National Projects for the Reduction of                 In 2006 the Mental Health Division in noting a variety
 Restraint and Seclusion a committee was convened and                  of policies and procedures in services in WA related to
 Dr Rowan Davidson, Chief Psychiatrist, is the WA                      seclusion and Time Out, convened a committee to
 member. In 2007 the National Documentation Project                    consider guidelines for policy and procedure in WA.
 included the establishment of a seclusion and restraint
 community of practice (CoP) and the development and                   When published by the Mental Health Division a policy
 pilot of data standards and indicators.                               and procedure document will guide the further
                                                                       development of policies and protocols.
Not Enacting Mental Health Forms
It was brought to the attention of the Chief Psychiatrist by an AMHP that in some cases referrers (Medical
Practitioners or AMHPs) are being asked not to enact Forms 1 (and 3) until there is a bed available. The
AMHP felt that this was inappropriate as referral implied a degree of non-cooperation and urgency.

The view of the Chief Psychiatrist is that a service should not be requesting that legal Forms not be
enacted. Following the completion of a Form 1 (and where necessary a Form 3), steps should be taken to
enact the Forms. There may be bed availability problems but that should not curtail the enactment of the
Forms.

It is recognised that due to bed availability the receival of the person in an authorised hospital may require
prioritisation and this could delay the actual receival of the referred person but that does not mean the
service should advise the referrer to delay enacting the Forms.

In line with the advice in the Supplement to the Clinicians’ Guide when there is a delay in receival the
referrer should ensure regular assessment of the referred person to indicate whether there is a change in
the person’s mental state. This could indicate that the referred person is becoming more unwell and having
a higher acuity raise the person in the priority list. Alternatively the change of mental state could indicate
that the person is becoming less acutely unwell and may not require to be referred.
The important issue is the safe clinical management of the person through the referral and receival process
which cannot be guaranteed through a policy of not enacting the Forms.




AMHP Corner
  The number of AMHPs in Western Australia on the           Sixty plus AMHPs also attended the AMHP Forum
  1 January 2008 was 472. The Office of the Chief           which was held in November 2007. The Clinical
  Psychiatrist conducted 3 further ‘Review of Skills’       Consultant at the OCP will continue to offer
  programmes in 2007 and trained 60 mental health           education and training programmes through 2008
  practitioners in the role. A number of AMHPs also         and is also able to attend AMHP meetings at
  resigned because they were no longer doing the            services on request.
  sort of clinical work that required them to be
  AMHPs and a few due to retirement.                        The new Mental Health Act may be passed some
                                                            time in 2008 and the role of the AMHP will
  The 6 monthly reports to the Chief Psychiatrist           undergo some change. The new Mental Health Act
  indicated that in 2007 AMHPs conducted 2189               Implementation Committee will consider changes
  assessments resulting in the completion of 185            to the education and training of AMHPs in the
  Form 1’s and 144 Form 3’s. However this may be            future. However if you have any ideas and
  an under-estimate, as despite a number of                 comments regarding a new AMHP training course
  reminders many AMHPs did not submit their                 please e-mail Tim Rolfe with the information on
  reports as requested. This was disappointing and          tim.rolfe@health.wa.gov.au.
  the Chief Psychiatrist would like to re-stress the
  importance of this data in order to make clear
  that the AMHP role has relevance.




    For further information, please visit our website –
    www.chiefpsychiatrist.health.wa.gov.au

				
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