Promoting supported decision-making and recovery-oriented practice

Promoting supported decision-making and recovery-oriented practice

The Mental Health Act 2014 (Vic) promotes supported-decision making and recovery-oriented practice for people receiving mental health services.

Focus on supported decision-making

The principles of the Act reflect a shift in the provision of mental health services towards a focus on self-determination where a person is entitled to make their own decisions about treatment including decisions that involve risk (the ‘dignity of risk’).

They also reflect a move away from a focus on substitute decision-making (where decisions about treatment are made by someone else, such as their treating psychiatrist), towards supported decision-making (where the person makes the decision themselves and can be supported to do so).

These principles are also reinforced by the provisions relating to capacity and consent to treatment at sections 68–71, which include that a person is presumed to have the capacity to give informed consent to treatment and can make decisions that others may regard as unwise. They also mean that a person may be able to receive some of their treatment on a voluntary basis even if they are subject to a compulsory order.

Section 71 also effectively limits the treatment a person can be given against their wishes; only when it is the least restrictive in the circumstances, as determined by a range of factors, in particular the person’s own views and preferences.

The Act also provides new tools for supported decision-making, including:

  • advance statements (ss. 19–22) – a document that a consumer can write which sets out their views and preferences about treatment if they are made subject to compulsory treatment. An advance statement must be genuinely considered and respected by decision-makers such as the authorised psychiatrist (see s. 46(2)(a)(ii), s. 71(4)(b), s. 73) and the Mental Health Tribunal (s. 55(2)(b))
  • nominated persons (ss. 23–27) – a person that a consumer can appoint who can provide them with support and information, help them exercise their rights, and who must be consulted at various times if the person is subject to compulsory treatment
  • second psychiatric opinion (ss. 78–89) – which can be sought from any psychiatrist and whose views about the application of the treatment criteria, or any changes to the person’s treatment must be genuinely considered by their psychiatrist if they are subject to compulsory treatment.

In addition, the new Independent Mental Health Advocacy service (IMHA) can support people who are receiving compulsory psychiatric treatment to have as much say as possible about their assessment, treatment and recovery.

Recovery framework

Promoting recovery-oriented practice is a fundamental part of the legislative scheme introduced by the Mental Health Act 2014 and is an important concept for lawyers and advocates to understand. ‘Recovery’, though not defined in the Act, is about ensuring the person is put at the centre of their treatment and care.

As the (then) Minister for Mental Health noted in her Second Reading Speech when the legislation was introduced to parliament:

‘Recovery is about maximising individual choice, autonomy, opportunity and well-being during a person’s life and accordingly is a self-defined process that is highly individual’ (p. 471)

The Department of Health and Human Services’ Framework for recovery-oriented practice (2011) which identifies the principles, capabilities, practices and leadership that should underpin a recovery-oriented approach to mental health service delivery states that recovery: ‘encompasses notions of self-determination, self-management, personal growth, empowerment, choice and meaningful social engagement’ (p. 2).

Unlike a clinical or ‘biomedical’ concept of recovery, which focuses on a particular ‘outcome’ such as where the symptoms of mental illness are reduced or absent, there is no one definition of what recovery means in a mental health context.

Rather, it can sometimes be described as an individual ‘journey’, unique to each person. It is defined ‘by the person’ and is ‘informed by the person’s unique strengths, preferences, needs, experiences and cultural background’ (​Slade, 2009, 100 ways to support recovery: a guide for mental health professionals).

In the Act, recovery is explicitly referred to in the mental health principles (ss. 11(1)(b), 11(1)(c), 11(1)(d)). It is also reflected in the obligation on the authorised psychiatrist and the Mental Health Tribunal to have regard to a person’s own individual recovery goals and views and preferences about treatment and in giving effect to ‘least restrictive’ treatment, even when the person may be subject to an order for compulsory treatment.

Other safeguards in the Act

The principles of least restrictive treatment and promotion of autonomy and dignity are reflected in and supported by other reforms in the Act including:

More information

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For more information about mental health treatment and services, see the Independent Mental Health Advocacy service (IMHA) website.