15 September Dr Andrew Moors Australian Commission on Safety and Quality in Health Care Level 5, 255 Elizabeth Street Sydney NSW 2000

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1 15 September 2016 Dr Andrew Moors Australian Commission on Safety and Quality in Health Care Level 5, 255 Elizabeth Street Sydney NSW 2000 By Dear Dr Moors Re: Consultation Draft of the National Consensus Statement: Essential Elements for Recognising and Responding to Deterioration in a Person s Mental State The Royal Australian and New Zealand College of Psychiatrists (RANZCP) welcomes the opportunity to comment on the consultation draft of the National Consensus Statement: Essential Elements for Recognising and Responding to Deterioration in a Person s Mental State (the National Consensus Statement). We strongly support the purpose of the National Consensus Statement to describe best practice in providing safe and effective health care to people experiencing deterioration in mental state. We are pleased that a number of psychiatrists were involved in its development, and we have sought broader input from RANZCP committees and members, including our Community Collaboration Committee, Aboriginal and Torres Strait Islander Mental Health Committee, Faculty of Forensic Psychiatry and state/territory branches. The RANZCP particularly welcome the centrality of recovery-oriented, culturally competent and trauma-informed values to the National Consensus Statement as these are also reflected in many RANZCP documents including our position statements on Acknowledging and learning from past mental health practices (Position Statement 84) and Recovery and the psychiatrist (Position Statement 86). We believe it is important to be especially aware of the fact that the ways in which the National Consensus Statement is interpreted by individual health services will be crucial to its effectiveness. Though useful at a high level, further specificities would be necessary for the appropriate governing of clinical practice. We therefore note the absolute need for health services to develop their own systems and processes which utilise the guiding principles and essential elements as a foundation of governance standards and not as a guide for clinical practice. 309 La Trobe Street, Melbourne VIC 3000 Australia T F ranzcp@ranzcp.org ABN

2 Please see the attached submission for more detailed feedback which we hope will be of assistance in further refining the National Consensus Statement. If you would like to discuss any aspect of our submission further, please contact Ms Rosie Forster, Senior Department Manager, Practice, Policy and Partnerships on (03) or Yours sincerely Professor Malcolm Hopwood President Ref: 0456o

3 National Consensus Statement: Essential Elements for Recognising and Responding to Deterioration in a Person s Mental State September 2016 maximising opportunities for recovery 309 La Trobe Street, Melbourne VIC 3000 Australia T F ranzcp@ranzcp.org ABN

4 Royal Australian and New Zealand College of Psychiatrists submission National Consensus Statement: Essential Elements for Recognising and Responding to Deterioration in a Person s Mental State About the Royal Australian and New Zealand College of Psychiatrists The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is a membership organisation that prepares doctors to be medical specialists in the field of psychiatry, supports and enhances clinical practice, advocates for people affected by mental illness and advises government on mental health care. The RANZCP is the peak body representing psychiatrists in Australia and New Zealand, and as a binational college has strong ties with associations in the Asia-Pacific region. The RANZCP has more than 5000 members, including around 3700 fully qualified psychiatrists and almost 1200 members who are training to qualify as psychiatrists. Psychiatrists are clinical leaders in the provision of mental health care in the community and use a range of evidence-based treatments to support a person in their journey to recovery. Introduction The RANZCP wishes to provide feedback to the Australian Commission on Safety and Quality in Health Care on the National Consensus Statement: Essential Elements for Recognising and Responding to Deterioration in a Person s Mental State. The RANZCP consulted widely in developing this submission, obtaining feedback from Committees and members representing expertise in psychiatry as well as state and territory perspectives and the insight of the RANZCP s consumer and carer representative committee. The RANZCP welcomes and supports the following elements of the National Consensus Statement: Guiding Principle 4: Response to deterioration in a person s mental state is person-centred, culturally competent and recovery-oriented in relation to Aboriginal and Torres Strait Islander peoples, that the National Consensus Statement recognises that broader issues related to social and emotional wellbeing impact on individuals mental states (4.4) and that Aboriginal mental health workers should be engaged in responses to deterioration in a person s mental state when appropriate (5.6) in relation to members of health-care workforces, that the National Consensus Statement recognises the need for organisational supports to ensure workers receive education about how to recognise feelings of moral distress and burnout, are supported to develop skills in self-care, reflective learning and providing peer support to colleagues, and are informed about how to seek help if required (8.8). Guiding Principle 5 The RANZCP supports Guiding Principle 5 but considers that it would be of benefit to clarify the terms family and carers in this context. We suggest that consideration should be given to the important role played by Aboriginal and Torres Strait Islander community elders and guardians, including registered adult guardians, in decision-making processes. While the RANZCP welcomes the stipulations in actions 3.5 and 5.2 that consumers provide permission before their families and carers are involved, clarification regarding the timing of this permission is also suggested so as to acknowledge the impact of deterioration in a person s mental state upon their capacity to provide permission at the time of the deterioration. Royal Australian and New Zealand College of Psychiatrists submission Page 2 of 4

5 Royal Australian and New Zealand College of Psychiatrists submission National Consensus Statement: Essential Elements for Recognising and Responding to Deterioration in a Person s Mental State Guiding Principle 7 The RANZCP supports Guiding Principle 7 in principle but we recommend that the phrase does not cause trauma is replaced with should minimise trauma. In consideration of the fact that entirely avoiding trauma may not always be possible when responding to deterioration in a person s mental state, the RANZCP notes that the principle should not preclude the provision of a response which minimises trauma in situations where no response can be provided which would guarantee the complete avoidance of further trauma. Essential Elements With regard to the Essential Elements, the RANZCP makes the following suggestions for consideration to include in the National Consensus Statement: Essential Element 6 We recommend that this element also refer to the need to communicate in ways which assist in promoting family unity, where appropriate. Essential Element 8 We recommend that this element also refer to support staff who may also require training appropriate to their role when dealing with people experiencing deterioration in their mental state. Actions With regard to individual actions, the RANZCP makes the following suggestions for consideration to include in the National Consensus Statement: Action 1.2 We suggest that this action should recognise that screening processes should take into account the fact that: o o a consumer s initial presentation may not represent their baseline mental state (i.e. deterioration may have already begun) a consumer s presentation may be affected by the context in which they present and thus may not provide a reliable indicator of their actual mental state. Action 6.2 To enhance this action, we suggest that it note the importance of using open-ended questions where appropriate to encourage truthful responses from consumers and carers when checking their understanding of communications Action 6.3 We suggest adapting this action to contain reference to people with visual, auditory or other disabilities impacting their communication. Royal Australian and New Zealand College of Psychiatrists submission Page 3 of 4

6 Royal Australian and New Zealand College of Psychiatrists submission National Consensus Statement: Essential Elements for Recognising and Responding to Deterioration in a Person s Mental State Definition of terms To help ensure clarity, the RANZCP would welcome the inclusion of some additional terms in Appendix A of the National Consensus Statement including: Aboriginal mental health workers, which we suggest should be replaced each time it appears with Aboriginal and Torres Strait Islander mental health workers and defined in accordance with RANZCP Position Statement 50: Aboriginal and Torres Strait Islander mental health workers which recognises the wide range of Aboriginal and Torres Strait Islander peoples with varying qualifications, skill levels and job criteria who are rightly covered by the term. distress which, without clear definition, risks being conflated with deterioration in mental state moral distress which may otherwise be conflated with distress and/or burnout. Royal Australian and New Zealand College of Psychiatrists submission Page 4 of 4