TREATMENT SUPPORT AND DISCHARGE PLANS INQUIRY (March to September 2017) March 2018 TABLE OF CONTENTS SUMMARY AND RECOMMENDATIONS ........................................................................................ 3 Background and aim of the TSDP Inquiry ....................................................................................... 3 Outcomes of the TSDP Inquiry ....................................................................................................... 3 Findings from the TSDP Inquiry - why the Act is not being complied with: ................................... 4 Recommendations ......................................................................................................................... 6 CHILD AND ADOLESCENT HEALTH SERVICES (CAHS) ..................................................................... 9 Summary: ....................................................................................................................................... 9 Bentley Adolescent Unit Inquiries: ............................................................................................... 10 Princess Margaret Hospital for Children Inquiries: ...................................................................... 11 EAST METROPOLITAN HEALTH SERVICE (EMHS) ......................................................................... 12 Summary: ..................................................................................................................................... 12 Armadale Health Campus Inquiries: ............................................................................................ 13 Bentley Hospital and Health Service Inquiries: ............................................................................ 14 St John of God Midland Hospital Inquiries: .................................................................................. 16 St John of God Mt Lawley Hospital Inquiries: .............................................................................. 18 NORTH METROPOLITAN HEALTH SERVICE (NMHS) .................................................................... 19 Summary: ..................................................................................................................................... 19 Frankland Centre Inquiries: .......................................................................................................... 20 Graylands Hospital Inquiries: ....................................................................................................... 21 Joondalup Health Campus (JHC) Inquiries: .................................................................................. 23 King Edward Memorial Hospital (KEMH) Mother and Baby Unit (MBU) Inquiries: ..................... 25 Selby Older Adult Mental Health Service Inquiries: ..................................................................... 26 Sir Charles Gairdner Hospital (SCGH) Inquiries: ........................................................................... 27 SOUTH METROPOLITAN HEALTH SERVICE (SMHS) ..................................................................... 29 Summary: ..................................................................................................................................... 29 Fiona Stanley Health Service Inquiries: ........................................................................................ 30 Fremantle Hospital and Health Service Inquiries: ........................................................................ 31 Rockingham Hospital Inquiries: .................................................................................................... 33 WA COUNTRY HEALTH SERVICE (WACHS) .................................................................................. 35 Summary: ..................................................................................................................................... 35 Albany Regional Hospital Inquiries:.............................................................................................. 36 Broome Health Campus Inquiries: ............................................................................................... 37 Bunbury Regional Hospital Inquiries: ........................................................................................... 39 Kalgoorlie Regional Hospital Inquiries: ........................................................................................ 41 ANNEXURES: .............................................................................................................................. 42 ANNEXURE 1 – ss186-188 of the Mental Health Act 2015 .......................................................... 43 ANNEXURE 2 – Details of the MHAS TSDP Inquiry ...................................................................... 46 ANNEXURE 2A – TSDP Inquiry Preparation Notes and Hints ....................................................... 47 ANNEXURE 2B – Prompt Sheet .................................................................................................... 49 ANNEXURE 2C – Dummy CMP using the TSD Plan Prompt Sheet ................................................ 56 ANNEXURE 2D – TSDP Inquiry Summary Document .................................................................... 61 ANNEXURE 2E – Letter sent out ................................................................................................... 63 ANNEXURE 3 – PowerPoint presentation ................................................................................... 65 ANNEXURE 4 – Graylands Hospital Collaborative Care Plans FAQ Information Sheet ................ 71 ANNEXURE 5 – Rockingham Hospital TSDP CMP template ......................................................... 77 2 SUMMARY AND RECOMMENDATIONS Background and aim of the TSDP Inquiry From March 2017 to 30 September 2017 Mental Health Advocacy Service (MHAS) Advocates conducted an Inquiry into Treatment, Support and Discharge Plans to ensure compliance with the Mental Health Act 2014 (the Act). Sections 185-188 of the Act 1 require that: • all treatment care and support provided to involuntary patients 2 must be governed by a treatment, support and discharge plan (TSDP); • the patient and any personal support persons (PSPs) must be involved in the preparation and review of the TSDP; • they must be given a copy; and • the TSDP must be prepared, reviewed and revised having regard to the Chief Psychiatrist’s Guidelines. These provisions were a major change under the Act when it was made operational in November 2015. It was hoped that they would lead to cultural change on mental health wards towards more patient-centred care as required by the National Standards for Mental Health Services. The patient’s psychiatrist is the person required by the Act (s187) to ensure that the TSDP requirements are met and the Mental Health Tribunal must have regard to the involuntary patient’s treatment support and discharge plan pursuant to s394 of the Act when considering a patient’s involuntary status. Details of the preparation for, and the conduct of, the Inquiry is set out in Annexure 2, including the information sent to mental health services before the Inquiry began and the reporting requirements of the Advocates. Community Mental Health Services were not included in the TSDP Inquiry, only hospitals. It was not an audit as it was generally accepted that most mental health services were not complying fully with the Act. The outcome sought was to educate mental health services and consumers through a process of having each Advocate 3 facilitate the production of a TSDP for 3 consumers which complied with the Act. Outcomes of the TSDP Inquiry The outcome was not achieved in that the Advocates were not able to produce 3 TSDPs each that fully complied with the Act, even after extending the period of the Inquiry from 30 June to 30 September 2017. There were a number of contributing reasons for this but the main reasons were that: • no mental health services were fully compliant with the Act, and many were not compliant at all, so the task was more difficult than anticipated; and/or • clinicians, including many psychiatrists, were unaware of the requirements of the Act and their responsibilities; and/or • clinicians did not have a process established to help them comply with the Act; and/or • Advocates either could not get staff co-operation or found themselves having to educate staff at a level that included suggested ways of engaging with consumers and carers and other practical aspects of compliance. 1 See annexure 1 for the full wording of the provisions of the Act. 2 This includes people on Community Treatment Orders and mentally impaired accused in an authorised hospital. 3 There were 34 Advocates as at 30 June 2017 in the metropolitan area, Bunbury, Kalgoorlie, Albany and Broome as well as a Youth Advocate and Aboriginal Advocate. 3 In short summary, no health service provider (HSP) was fully compliant with the Act. That remains the cases for most HSPs which means that patient and carer rights under the Act are being breached daily. Despite this disappointing result, however, the TSDP Inquiry: V resulted in education across the sector about the requirements of the Act; V has caused a shift towards compliance, or at least most mental health services have started to think about the changes they need to make to comply with the Act; and V there are pockets of good work being done by some mental health services including at Rockingham, Bentley and Graylands