Supporting Consumer Decision-Making in Healthcare - Report Example

Running Head: Mental Health Suрроrting Соnsumеr Dесisiоn Маking Name Institution Date Suрроrting Соnsumеr Dесisiоn Маking The Principles Underpinning Supported Decision Making in Mental Health ACT Victoria 2014 Background The Mental Health Act Victoria 2014 describes clearly the principles for the rights as well as treatment for people undergoing treatment which is compulsory and may have been placed on orders that are compulsory for treatment. Part 3 of this Act provide these principles that are said to have main repercussions for advocates who are working with people who are subjected to treatment which is compulsory. The mental health principles were set to underpin the decision under sec 11 that, people who are in receipt of mental health services ought to be allowed to decide on their assessment, treatment as well as recovery which involves a degree of risk” (Queensland, Government, 2014). The mental health principles set by the Mental Health Act Victoria 2014 serve as a guideline that health care practitioners must refer to when providing mental health services. Therefore, it is important for all health care providers to recognize the importance of the mental health principles during their practice of providing mental health care to patients. Recognition of the mental health principles is mandatory by every person when performing a particular job or function or even when in exercise of any power according to the Mental Health Act Victoria 2014. The Principles People who are receiving mental health care services should be governed by the following mental health principles including; When a Patient does not give Consent The Mental Health Act Victoria 2014 demands that patients with mental illness should be provided with treatment. The patient is regarded as the only person who can provide or refuse to provide informed consent to receive treatment. According to the Act, not anyone else or another body which has been provided with authority by the law has the power of making decisions on behalf of the patient can provide or refuse to provide informed consent to receive treatment (Department of Health, 2011). Even a person who is responsible as described in the Guardianship and Administration Act 1986 or even under the Mental Treatment Act 1988 has no power to provide or refuse to provide informed consent in the place of the patient. However, psychiatrists are authorized by the Mental Health Act Victoria 2014 to make decision of treatment for a mental ill patient who; has no capacity to provide informed consent to the treatment that is proposed and authorized by the psychiatrist. Secondly, the mental ill patient may have the capacity to provide informed consent to the proposed treatment that has been authorized by the psychiatry; however, this patient has not yet provided the informed consent to the particular treatment. The Nursing and Midwifery Board of Australia (2013) describe that, any decision for treatment or care should be motivated by the need to meet the patient’s health needs for the purpose of improving their health outcomes. What the Act stipulates is that, psychiatrists who are authorized have the power to make the decision for treatment to the patient on the basis that, the psychiatrist who is authorized has satisfaction of there being no other was which is less restrictive to treat the patient apart from the one that the psychiatry has proposed. Psychiatrists are not permitted by the Mental Health Act Victoria 2014 to make treatment decisions that are concerned with electro convulsive treatment or even neurosurgery for patients with mental illness. Providing mental health care services considering methods that are least restrictive as much as possible According to the Mental Health Act 2014 handbook, the patient with mental illness should be assessed and treated considering a way which is least restrictive while preferring their voluntary assessment as well as treatment. Presumption of Capacity According to the Mental Health Act Victoria 2014, the administration of medical treatment can be provided to a mental ill patient who provides consent to such treatment. Additionally, a patient who has capacity also has the capacity for refusal of medical treatment. As set out in the Act, a patient is said as having the capacity to pride informed consent when that person can understand, can remember and can make use of information which has relevance to the medical decision and can communicate clearly their decision. However, capacity must be determined to assess the ability of the patient to make a meaningful decision. A patient who is on treatment order and have the capacity to provide informed consent can be provided with treatment against their wish when a certain criteria is met. In determining capacity, the Act provides several principles that can be used by psychiatrists who have been authorized to assess the patient’s capacity including; the capacity to provide consent is very specific in relation to the decision that must be made, the capacity of the patient to provide informed consent might have changes over a period of time, assumption of the lack of capacity of a person should not be based on the appearance, age, behaviour or even condition or even that the patient has made a decision which is considered as unwise (The Mental Health Act 2014 Handbook). The assessment of the capacity of a patient should be carried out during a time and within an environment when their capacity can be assessed most accurately. When it has been determined that, the patient does not have capacity in making a specific decision to treatment, the psychiatrist who is authorized is allowed to take the step of making the decision for treatment for the patient. However, the Act provides that, the provision of information as well as support of the patient in participating in the decision making should be encouraged as much as possible (Department of Health, 2011). Minimally, the psychiatrist who is authorized must put into consideration the views as well as preferences of the patient concerning the treatment. This should also include the views that are expressed in the patient’s advance statement, the views of the person nominated by the patient, family and caregiver when making treatment and care decision of the patient. Promoting recovery as well as therapeutic outcomes that are best possible According to the WordPress (2014), in promoting recover, the authorized psychiatrist is permitted by the Act to provide mental health care services to a mental ill patient with the objective of achieving the best therapeutic outcomes possible while considering the full participation of the life of the community. In considering whether the decision of treatment is beneficial to the patient, the authorized psychiatrist must put in mind the need of the patient views as well as preferences in relation to the medical treatment, the patient’s nominated person views, guardian views, caregiver views, parent views, if the treatment provides a solution to the mental condition, the consequences that the patient may experience if such treatment is not provided and a second opinion from a medical practitioner who is registered. Participation as well as support while making Treatment decision Even if mental ill patients are allowed to make all decisions about their assessment, treatment and recovery that involves a degree of risk, the Mental Health Act Victoria 2014 stipulates that, they should be supported when making or participating in those decisions while respecting their views as well as preferences. Urgent Medical Treatment The Act has permitted psychiatrists who are authorised to provide treatment to mental ill patients in situations when they cannot make decisions of informed consent in relation to the treatment and the treatment requires to be provided as an urgency matter. This means that, the patient’s autonomy to make treatment decisions will be tampered with. Here, a matter of agency means a treatment provided to save the life of the patient, for prevention of any damage that is serious to their health and reduces their suffering due to pain and distress. The psychiatrist does not need to wait for a decision from the patient and is legally authorised to make a treatment decision on the patient’s behalf and it is satisfactory that the treatment is a requirement for urgency matter (Parliament of Victoria, 2014). Recognition and Response of Needs The Mental Health Act stipulates that, even though the mental ill persons have the autonomy to make decisions concerning their medical needs, their medical as well as other health needs must be recognised and responded. Needs such as; individual needs, primary needs of children and young people with mental illness, wellbeing, their children safety as well as other dependents needs, involvement of cares roles in medical decisions recognised and respected (Victoria Legal Aid, 2014). Compared to the Mental Health Act of 1986, the Mental Health Act Victoria 2014 was specifically set for the state of Victoria in the Commonwealth of Australia (WordPress, 2014). The focus on care is on the individual patient with the engagement of their families as well as persons who are nominated. This Act has created definitions that are specific for various terms that are associated with mental health care service. The aspect which is key to this Act is that, it states the mental health principles that apply to every person involved with mental health care services. The Act has introduced a new aspect in the definition of the capacity of a patient and the capacity of a patient to provide informed consent. Reflect upon and discuss the tensions, benefits, enablers and challenges to using a supported decision making approach in your every day practice. The Act Health (2009) describe that, a supported decision making approach is one that involves the community in the enhancement of knowledge as well as understanding, intervention and provision of support early enough and when necessary. It also involves the development of and working with other support systems in the community settings. The main focus of a supported decision making approach is the achievement of mental health services that are based on recovery for the public as well as other sectors in the community, while acknowledging the role played by other services that are key including; consumers, caregivers, primary care, allied health, social as well as private services. As described by the The Federal Substance Abuse and Mental Health Services Administration (SAMHSA) (2010), a supported decision making approach is highly recommended to improve communication between those who provide health care services and patients. Improved communication is achieved through the integration of complete information as well as tools for decision making with respect to two way dialogues. This helps in balancing information related to conditions of mental health and options for treatment considering the preferences, cultural values, beliefs as well as goals of the patient. When used effectively, a supported decision making approach can improve communication by making it more fruitful, efficient as well as empowerment for service providers and patients. According to (Drake & Deegan, 2009), the use of a supported decision making approach comes with many tensions, benefits, enablers and challenges. They are discussed as follows; Tensions Tensions arise due to misunderstandings that arise during the decision making process. Some health care providers have the notion that they already do it and there is no need of involving other people or systems in the decision making process. The patients or the people receiving the health care services will not agree and this creates a lot of tension in the decision making process. Time management is also a factor that increases tension when using supported decision making approach. The need for consultations and application of tools in the decision making process creates tension for the involved parties who may not have time for the process (SAMHSA, 2010). There is the notion that, health care providers assume that the patients may not be interested with their services. The reason is that, they may not have experience, a belief that the patient’s opinions do not matter and the expected cultural norms from elders that are different from those of experts. There is also the notion that, the patients also may not have the capability to partner with the health care providers in the process of decision making. Benefits The use of a supported decision making approach comes with many benefits such as setting the stage for a fruitful dialogue. The approach empowers the parties involved in the decision making process in making choices that are believed to have support in their recovery. Therefore, every person will follow their chosen options for the achievement of quality care. It enhances cultural competence in that; there is expression and reflection of cultural beliefs as well as practices that are relevant in supported decision making approach (Act Health, 2009). The decisions that are made serve as a strategy for managing risk since they enhance the meaning as well as depth understanding in the process of informed consent. A supported decision making approach provides a structure that can be used to share information, look at options and promote honest in the decision making process. This is a very important aspect of ethics in the treatment of mental health. In The Mental Act Victoria 2014, a supported decision making approach is encouraged to ensure the patient is provided with the best treatment outcome. A supported decision making approach helps in aligning health care services together with key principles as well as best practices of modern services in mental health. When decisions are supported, health care providers and patients are able to broadly think on the available options that can be used in supporting recovery. These options include; traditional treatment as well as services, hobbies, employment, having time with family members as well as exercise (Slade, 2009). Enablers As described by the U.S. Department of Health and Human Services (2011), a supported decision making approach is highly successful with the motivation of providers to ensure that it is implemented and believe that it will positively impact the clinical process. To enable the implementation of a supported decision making approach various way can be used. It is important to involve the people who make use of the services as well as those who provide the services in the development of an implementation plan. To achieve this, a work group of service providers as well as people who use the services must be established for the purpose of exploring how the supported decision making approach will be implemented. SAMHSA (2010) denote that, as a routine practice, mental health patients must be actively involved in the establishment of a supported decision making approach. To ensure that patients take part in the planning as well as implementation of the supported decision making approach, it is important to coordinate with peer organizations, provide patients with training as well as materials and hire decision support staff. Enhancing the competency of staff by providing basic information as well as agency support is important for the purpose of enhancing their skills as well as building comfort with the supported decision making approach (Act Health, 2009). To enhance staff competency, it is important to share and recommend articles as well as resources about the supported decision approach. It is also important to involve staffs in discussions and training as well as encouraging them to attend workshops and conferences that are relevant. Slade (2009) argues that, establishing a decision support centre is an important aspect that enhances the implementation f a supported decision making approach. This involves providing consumers with accessibility of decision aids, support as well resources that can help them in preparing for fruitful meetings. Availability of training centres like waiting areas and peer run services, resources such as workbooks, worksheets, videos and tip sheets will help in the implementation of the supported decision making approach. It is also important to make the supported decision making approach an organizational mandate for the achievement of continuous improvement of quality services. Challenges The use of supported decision making approach has its own challenges. The people who use the services may not be willing to make use of the supported decision making approach. Others may fear that their privacy will be exposed and will not support the approach and a fear that their needs may not be catered for (SAMHSA, 2010). References Department of Health. (2011). Framework for Recovery-oriented Practice. Health. State Government of Victoria. pp. 9-23. Retrieved from http://docs.health.vic.gov.au/docs/doc/0D4B06DF135B90E0CA2578E900256566/$FILE/framework-recovery-oriented-practice.pdf Drake, R. & Deegan, P. (2009). Shared Decision Making is an Ethical Imperative. Psychiatric Services, 60(8), p.1007 The Federal Substance Abuse and Mental Health Services Administration (SAMHSA) (2010). Innovations in Practice: Shared Decision Making in Mental Health. Information for Mental Health Administrators. Retrieved from http://www.mentalhealth.va.gov/communityproviders/docs/Administrator_Issue_Brief_508.pdf The Mental Health Act Victoria 2014. Electroconvulsive Treatment: Chief Psychiatrist’s Update. Health. Victoria Government. pp.1-4. Retrieved from http://docs.health.vic.gov.au/docs/doc/FB10C2842FD27584CA257D0700169E4D/$FILE/ECT%20update%20-%20final.pdf The Mental Health Act 2014 Handbook. Recovery & Supported Decision Making: Mental Health Principles. Victoria. Retrieved from http://www.health.vic.gov.au/mentalhealth/mhact2014/recovery/principles.htm Parliament of Victoria. (2014). Mental Health Bill 2014. pp. 20-26. Retrieved from http://www.legislation.vic.gov.au/domino/Web_Notes/LDMS/PubPDocs.nsf/ee665e366dcb6cb0ca256da400837f6b/d5f4227eea352e41ca257c8300112bd7/$FILE/571160bi1.pdf Queensland Government. (2014). A Journey towards Autonomy? Supported Decision- Making in Theory and Practice: A Review of Literature. Office of the Public Advocate Systems Advocacy. pp.26-28. Slade, M. (2009). 100 Ways to Support Recovery: A Guide for Mental Health Professionals. Rethink Recovery Series. Vol.1. Retrieved from https://www.slhd.nsw.gov.au/MHealth/cms/files/Consumer_Info/Recovery_Resources/100_Ways_to_Support_Recovery.pdf U.S. Department of Health and Human Services. (2011). Shared Decision-Making in Mental Health Care. Practice, Research, and Future Directions. Retrieved from https://store.samhsa.gov/shin/content/SMA09-4371/SMA09-4371.pdf Victoria Legal Aid. (2014). Mental Health Law: Introduction to the Mental Health Act 2014. Lawyers and Legal Services. Retrieved from http://www.legalaid.vic.gov.au/information-for-lawyers/practice-resources/mental-health-law/introduction-to-mental-health-act-2014 WordPress. (2014). Changes to the Mental Health Act, Victoria. Retrieved from http://ambofoam.wordpress.com/2014/06/05/changes-to-the-mental-health-act-victoria/ Read More