Resource Book - Mental Health Coordinating Council

Transcription

Resource Book
Foundations of Peer Work – Part 2
1
© 2015 National Mental Health Commission
[This page has intentionally been left blank]
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Acknowledgements
Community Mental Health Australia (CMHA) acknowledges the traditional custodians of this
land.
CMHA acknowledges and greatly appreciates the funding provided by the National Mental
Health Commission (NMHC) for the Mental Health Peer Work Qualification Development
project.
CMHA acknowledges the work of Simone Montgomery (Learning and
Development Manager, Mental Health Coordination Council), Chris
Keyes (Project Manager, Mental Health Coordination Council) and lead
content developer Gillian Bonser (Paradigm Consulting Network) and
the invaluable contribution of the reference group members who have worked on this project.
National Management Steering Committee
Susan Adam (Co-chair)
Jenna Bateman (CMHA)
Michael Burge (Co-chair)
Jackie Crowe (NMHC)
Chris Keyes (MHCC)
Simone Montgomery (MHCC)
National Technical Reference Group
Jenny Burger (VIC)
Peter Farrugia (Richmond PRA, NSW)
Paul Nestor (SA)
Helen Staples (QLD)
National Carer and Consumer Peer Work Qualification Reference Group
Susan Adam (Peninsula Carer Council, Vic)
Julie Anderson (Vic)
Eschleigh Balzamo (Brook RED Centre, Qld)
Anne Barbara (SA)
Barbara Biggs (WA)
Michael Burge (Qld)
Indigo Daya (Voices, Vic and Mental Illness Fellowship, Vic)
Petra Elias (Consumer and Carer Inclusion Workforce, WA)
Peter Farrugia (Richmond PRA, NSW)
Fred Ford (NSW)
Deiniol Griffith (Mental Illness Fellowship, SA)
Patrick Hardwick (Private Mental Health Consumer
Carer Network Australia, WA)
Moira Munro (Perth Clinic, WA)
Heather Nowak (SA)
Lynette Pearce (Mental Health, Alcohol and Drug Directorate,
DHHS, Tas)
Ailsa Rayner (Qld)
Alexandra Rivers (NSW)
Colleen Simpson (Qld)
Helen Staples (Qld)
Lyn Mahboub (Richmond Fellowship, WA)
Carol Turnbull (Adelaide Clinic, SA)
Barbara Wieland (Adelaide Metro Mental Health Directorate, SA)
Norm Wotherspoon (Private Mental Health Consumer Carer Network
Australia, Qld)
Lily Wu (NSW)
CMHA acknowledges with thanks the lived experience cartoons provided by Merinda
Epstein (Our Consumer Place) and the other cartoons provided by Paradigm Consulting
Network. These images remain their copyright and have been included here with permission.
CMHA thanks all others who have contributed towards the development of this resource book.
This resource book is distributed by the National Mental Health Commission.
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National Training Package
CHC
Version
1.0.0
Original release
January 2016
Last revised
January 2016
Released for use
January 2016
Distributed by: National Mental Health Commission
Disclaimer
The National Mental Health Commission (NMHC) does not give a warranty nor accept any
liability in relation to the content of this work.
 2015 National Mental Health Commission.
This resource may be reproduced for delivery of the nationally accredited Certificate IV in
Mental Health Peer Work. It may also be reproduced for other educational purposes with
acknowledgement to the NMHC and all contributors.
Front cover logos, acknowledgements and footers are to remain on all documents. For
information relating to use of these resources, please refer to Guidelines for Use included in
the accompanying Companion Guide.
To reference this resource please use the following protocol:
Mental Health Coordinating Council. (2015). Foundations of Peer Work – Part 2: Resource
Book. Sydney, Australia: developed on behalf of Community Mental Health Australia for the
National Mental Health Commission’s Mental health peer work qualification development
project.
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Contents
Understanding Human Rights .................................................................................... 9
History: international treaties and conventions................................................................ 10
Australia’s human rights obligations ............................................................................... 10
Australia’s other human rights obligations ...................................................................... 12
Social justice .................................................................................................................. 15
Mental Health Statement of Rights and Responsibilities ................................................. 17
Legislation and Some Key Documents..................................................................... 21
Recovery Oriented Practice in Context - Key Documents & Legislation (Law) ................ 21
Legislation (laws) ............................................................................................................ 22
Carer Legislation, Policy and Procedures ....................................................................... 28
What is a Code of Practice? ........................................................................................... 30
Community Work Practice Standards ............................................................................. 31
The ‘National Framework for Recovery Oriented Mental Health Services’ ...................... 34
National Mental Health Plans ......................................................................................... 35
NSW Strategic Plan ........................................................................................................ 35
2 key sets of standards (Workforce and service standards) ............................................ 37
Standards and plans....................................................................................................... 38
Principles of recovery oriented mental health practice .................................................... 42
NSW Disability Services Standards (NSW Standards) (guided by the Disability Services
Act 1993 (NSW)) ............................................................................................................ 44
Some other useful documents ........................................................................................ 44
Duty of care .............................................................................................................. 46
Negligence ..................................................................................................................... 46
Dignity of risk .................................................................................................................. 47
Balancing dignity of risk with duty of care ....................................................................... 48
Ethical practice ......................................................................................................... 53
What are ethics? ............................................................................................................ 53
Key points about ethics .................................................................................................. 53
Ethics, codes of practice and codes of conduct .............................................................. 54
General ethical principles ............................................................................................... 55
Some Useful References ................................................................................................ 55
Peer work ethical principles ............................................................................................ 56
Values and ethics of mental health recovery and peer support ....................................... 58
Workplace Dilemmas...................................................................................................... 59
Ethical decision-making .................................................................................................. 60
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Ethical dilemmas ............................................................................................................ 68
Common ethical dilemmas for peer workers ................................................................... 69
Approaches and frameworks .................................................................................... 87
Using good practice frameworks..................................................................................... 87
What is a strength, and what is resilience? ..................................................................... 88
Strengths-based approaches.......................................................................................... 89
Holistic care .................................................................................................................... 91
Person-centred approach ............................................................................................... 93
Peer support and recovery ............................................................................................. 93
Connecting and disconnecting ........................................................................................ 96
Power and the drama triangle ......................................................................................... 97
Values-based practice skills ......................................................................................... 100
Record Keeping ..................................................................................................... 103
Collecting and managing consumer and carer information ........................................... 104
Principles of Record Management ................................................................................ 105
Information sharing ....................................................................................................... 105
Note-taking versus note-making ................................................................................... 106
Reflection on learning............................................................................................. 123
Appendix A: MHCC Law and Ethics Definitions ..................................................... 124
Appendix B: Glossary of other Key Terms ............................................................. 128
Appendix C: Key Legislation for Mental Health Workers ........................................ 136
Appendix D: Certified Peer Specialist Code of Ethics ............................................ 166
References ............................................................................................................. 167
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Acknowledgement of Country
Where possible, a traditional Aboriginal or Torres Strait Islander Elder from the area will be
invited to welcome the participants to their country.
Your trainer will also acknowledge and pay respect to the traditional owners and custodians
of the land on which the training occurs, and their elders both past and present, thanking
them for their wisdom and care for the land.
Note: There is a glossary and abbreviations list in the appendix of this book
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DAY 3
“The secret of change is to focus all of your
energy not on fighting the old…
but on building the new” Socrates
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Understanding Human Rights
Human Rights are the fundamental rights and freedoms of every person to have the things
they need to survive and thrive, to be treated with fairness and protected from injustice. They
outline the things you can do, be and have and how you should be treated by others
especially governments.
The following information is adapted from the Australian Human Rights Commission (2010),
‘Understanding human rights’, p. 4. The full document is available at:
www.humanrights.gov.au/education/understanding_human_rights
Who has responsibility for acknowledging human rights?
 Governments (think about how this might work in a totalitarian state)
 Organisations such as the United Nations, Amnesty International, the International
Committee of the Red Cross and so on
 Communities, such as school communities, town communities, club communities and
so on
 Individuals, such as you and me
What are some terms that describe what human rights are concerned with?
 Dignity, respect
 Every person has dignity and value.
 Responsibility
 Human rights are basic rights and
 Values
freedoms.
 Systems
 Human rights are concerned with equality,
fairness, dignity and respect.
 Moral and legal rights
 Human rights are about living a life free
 Justice, tolerance, equality
from fear, harassment or discrimination.
 Interaction between people
 All human beings are born free and equal in
and their community
dignity and right.
Where do human rights come from?
 Philosophies put forward by thinkers of the ancient world
(e.g. Plato, Marcus Aurelius, Cicero, St Augustine)
 Religious principles from a range of world religions
 Philosophical positions from thinkers of the Renaissance and Enlightenment periods
(e.g. Locke, Bacon, Descartes, Voltaire)
 Political struggles, such as the French Revolution, the American Civil War, women’s
suffrage and the collapse of the apartheid system in South Africa
Do you think human rights are important? Why?
 Unique value of each person and their common humanity
 Importance of recognising every individual’s dignity
 Need for freedom of thought, movement, ideas
 Need to operate as part of a community
 Value of mutual respect between people
 System of values by which individuals and communities can interact together
constructively
 Need for balance between rights and our duty to acknowledge and respect rights of others
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History: international treaties and conventions
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A ‘treaty’ is a written agreement between nations (or certain international agencies,
such as the United Nations) that is intended to establish a relationship governed by
international law.
Various other terms may also be used for such an agreement, including convention,
protocol, declaration, charter, covenant, pact, act, statute and understanding.
Each member country of the United Nations decides whether to sign up to each
convention.
While many nations might ratify (sign) a convention, there is no means of forcing
them to comply with its contents. Real commitment is demonstrated when nations
embed conventions into their own legislation.
Australia’s human rights obligations
Universal Declaration Of Human Rights
In 1948, the first international statement of human rights the Universal Declaration of Human
Rights was adopted by the member countries of the United Nations. While not legally
binding, the Declaration affirmed and recognised rights that had been violated before and
during World War II.
UNIVERSAL DECLARATION OF HUMAN RIGHTS - Simplified Version
This simplified version of the 30 Articles of the Universal Declaration of Human Rights has
been created especially for Youth for human rights and is available on their website:
http://www.youthforhumanrights.org/what-are-human-rights/universal-declaration-of-human-rights/articles-1-15.html
1. We Are All Born Free & Equal. We are all born free. We all have our own thoughts
and ideas. We should all be treated in the same way.
2. Don’t Discriminate. These rights belong to everybody, whatever our differences.
3. The Right to Life. We all have the right to life, and to live in freedom and safety.
4. No Slavery. Nobody has any right to make us a slave. We cannot make anyone our
slave.
5. No Torture. Nobody has any right to hurt us or to torture us.
6. 6. You Have Rights No Matter Where You Go. I am a person just like you!
7. We’re All Equal Before the Law. The law is the same for everyone. It must treat us all
fairly.
8. Your Human Rights Are Protected by Law. We can all ask for the law to help us
when we are not treated fairly.
9. No Unfair Detainment. Nobody has the right to put us in prison without good reason
and keep us there, or to send us away from our country.
10. The Right to Trial. If we are put on trial this should be in public. The people who try
us should not let anyone tell them what to do.
11. We’re Always Innocent Till Proven Guilty. Nobody should be blamed for doing
something until it is proven. When people say we did a bad thing we have the right to
show it is not true.
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12. The Right to Privacy. Nobody should try to harm our good name. Nobody has the
right to come into our home, open our letters, or bother us or our family without a
good reason.
13. Freedom to Move. We all have the right to go where we want in our own country and
to travel as we wish.
14. The Right to Seek a Safe Place to Live. If we are frightened of being badly treated in
our own country, we all have the right to run away to another country to be safe.
15. Right to a Nationality. We all have the right to belong to a country.
16. Marriage and Family. Every grown-up has the right to marry and have a family if they
want to. Men and women have the same rights when they are married, and when
they are separated.
17. The Right to Your Own Things. Everyone has the right to own things or share them.
Nobody should take our things from us without a good reason.
18. Freedom of Thought. We all have the right to believe in what we want to believe, to
have a religion, or to change it if we want.
19. Freedom of Expression. We all have the right to make up our own minds, to think
what we like, to say what we think, and to share our ideas with other people.
20. The Right to Public Assembly. We all have the right to meet our friends and to work
together in peace to defend our rights. Nobody can make us join a group if we don’t
want to.
21. The Right to Democracy. We all have the right to take part in the government of our
country. Every grown-up should be allowed to choose their own leaders.
22. Social Security. We all have the right to affordable housing, medicine, education, and
childcare, enough money to live on and medical help if we are ill or old.
23. Workers’ Rights. Every grown-up has the right to do a job, to a fair wage for their
work, and to join a trade union.
24. The Right to Play. We all have the right to rest from work and to relax.
25. Food and Shelter for All. We all have the right to a good life. Mothers and children,
people who are old, unemployed or disabled, and all people have the right to be
cared for.
26. The Right to Education. Education is a right. Primary school should be free. We
should learn about the United Nations and how to get on with others. Our parents
can choose what we learn.
27. Copyright. Copyright is a special law that protects one’s own artistic creations and
writings; others cannot make copies without permission. We all have the right to our
own way of life and to enjoy the good things that art, science and learning bring.
28. A Fair and Free World. There must be proper order so we can all enjoy rights and
freedoms in our own country and all over the world.
29. Responsibility. We have a duty to other people, and we should protect their rights
and freedoms.
30. No One Can Take Away Your Human Rights.
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Activity
Human rights are closely connected to fundamental human needs In the table below is a list of
some human rights. Identify the human need it meets and then add two (2) more of your own.
Human right
Eg right to work
Human need it addresses
Eg the Need for meaningful employment and sufficient financial
support for basic needs
Right to adequate food
Right to freely participate
in the cultural life of the
community,
Right to adequate
housing
Australia’s other human rights obligations
Australia has signed a number of human rights treaties, including:
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International Covenant on Civil and Political Rights (ICCPR)
International Covenant on Economic, Social and Cultural Rights (ICESCR)
International Convention on the Elimination of All Forms of Racial Discrimination (ICERD)
Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)
Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or
Punishment (CAT)
Convention on the Rights of the Child (CROC)
Convention on the Rights of Persons with Disability (CRPD).
However, we have never developed an Australian bill or charter of human rights, so these
rights are not contained in a single, easy-to-find place.
Individuals’ rights in Australia currently come from a number of different sources, including:
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international treaties and conventions
legislation and regulations
common law
government standards and policies
professional codes of practice and workplace policies.
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Convention on the Rights of Persons with Disability (CRPD)
This is the most important legal document relating to the rights of people with disabilities
(including ‘mental illness’). It covers people who have long-term physical, mental, intellectual
or sensory impairments that may hinder their full and effective participation in society on an
equal basis with others.
Australia ratified (signed) this convention in 2008. It was one of the first Western countries to
do so. By ratifying the convention, Australia has agreed to promote the equal and active
participation of all people with disability.
The convention outlines the rights of people with all types of disabilities, including the rights to:
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equality and respect
effective access to justice
enjoyment of personal liberty and security
freedom from torture, cruel, inhuman or degrading treatment, or punishment
live independently and to be included in community life
freedom of expression and opinion, and access to information
respect for privacy
respect for family life
health
work and employment
an adequate standard of living.
The convention talks about these rights in four different ways:
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‘recognise’ means having laws to ensure the right
‘respect’ means not doing something that would take the right away from someone
‘protect’ means making sure that services outside the government don’t abuse the
right
‘fulfil’ means taking steps to make sure everyone has the right in their life.
Principles for the Protection of Persons with Mental Illness and the
Improvement of Mental Health Care
The Principles for the Protection of Persons with Mental Illness and the Improvement of
Mental Health Care provide guidance and advice about how people with ‘mental illness’
should be treated in the healthcare system and by other services. They aim to maximise
personal choice, autonomy and freedom.
These principles are not legally binding, but they do influence and affect Australia’s policy
and obligations. They were adopted by the UN in 1991, but have not been fully incorporated
in Australian legislation.
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The principles confirm that people with ‘mental illness’ have the right to:
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live and work, as far as possible, in the community
be treated in the community in which they live
receive appropriate health and social care
receive medication only for therapeutic or diagnostic purposes
access their health and personal records
make a complaint about their treatment
know and understand their rights.
The full list of 25 principles is available www.un.org/documents/ga/res/46/a46r119.htm.
Convention on the Rights of the Child
These rights cover what children should be allowed to do, and how they should expect to be
treated.
More information is available at www.unicef.org.au/discover/Educational-Resources.aspx.
A fact sheet that summarises children’s rights under the convention is available at
www.unicef.org/crc/files/Rights_overview.pdf.
Convention of the Rights of the Child – plain English version
1. All children have these rights, no matter what their race, colour, sex, language,
religion, political or other opinion, or where they were born or who they were born to.
2. Kids have the right to grow up and to develop physically and spiritually in a healthy
and normal way, free and with dignity.
3. Kids have the right to a name, to an identity and to be a member of a nation or
country.
4. Kids have the right to special care and protection, and to good food, housing and
medical services.
5. Kids have the right to special care if they have any disabilities.
6. Kids have the right to love, care and understanding, preferably from parents and
family, but from the government where parents and family cannot help.
7. Kids have the right to go to school for free, to play and to have an equal chance to
develop, grow and learn. They have the right to learn and live in their culture. They
have the right to learn how to make good decisions and life choices. Parents have
special responsibilities for their education and guidance.
8. Kids have the right to get help, protection and relief first.
9. Kids have the right to be protected against abuse, neglect, cruel acts and
exploitation. Kids should not work before a minimum age, and never when it would
hinder their health or their moral, mental or physical development.
10. Kids have the right to live free from discrimination, prejudice and oppression. They
should be taught peace, understanding, tolerance, respect and friendship among all
people.
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Social justice
A life of opportunity and dignity, free from discrimination and disadvantage,
should not be an ideal. It is, in fact, a basic human right – one that we all share in
common (Human Rights and Equal Opportunity Commission, 2003, Social Justice and
Human Rights for Aboriginal and Torres Strait Islander people,
www.humanrights.gov.au/social_justice).
Image source: www.redroom.com.
Social justice is about making sure that every Australian – whether Indigenous or nonIndigenous – has real human rights, choices about how they live and the means to make
those choices.
It’s about acting when people’s rights are violated or when people are living in poverty or
experiencing disadvantage.
Social justice means that it is a human right to be treated equitably and fairly. It means
supporting people who are marginalised, living in poverty, dispossessed or disadvantaged in
our society. It means ensuring that all people have equal access to services like education,
water, sanitation and health care.
It can involve education and promotional campaigns. It can be about fighting for the rights of
individuals, but is often about groups and systemic change. Often this means working to
change policies, legislation or government priorities, and helping society to take
responsibility or change.
Social justice principles
The four principles of social justice are:
 equity
 access
 participation
 rights.
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Social justice issues
Social justice is what faces you in the morning. It is awakening in a house with an
adequate water supply, cooking facilities and sanitation. It is the ability to nourish
your children and send them to a school where their education not only equips them
for employment, but reinforces their knowledge and understanding of their cultural
inheritance. It is the prospect of genuine employment and good health: a life of
choices and opportunity, free from discrimination (Mick Dodson, Social Justice
Commissioner, Annual Report of the Aboriginal and Torres Strait Islander
Commissioner 1993).
Social justice issues include:
 health
 poverty
 education
 housing
 justice
 water and sanitation
 disability
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Indigenous rights
women’s rights
children’s rights (e.g. child soldiers)
peace
natural disasters
human trafficking
other human rights issues.
An example of social justice for Indigenous people
While Indigenous people are entitled to the full protection of the individual human
rights system that has existed for the past sixty years, their rights have continued to
be violated and they often experience poverty and disadvantage to a greater extent
than the rest of the population. The United Nations Declaration on the Rights of
Indigenous Peoples recognises the difficulty in realising human rights for Indigenous
people who have been disadvantaged on a systemic level by historical discrimination
and dispossession over past centuries (Ho, L, 2011, National Pro Bono Resource
Centre Occasional Paper: What is Social Justice? p. 3).
Social justice also includes recognising the distinctive rights that Indigenous Australians hold
as the original people of this land, including:
 the right to a distinct status and culture, which helps maintain and strengthen the
identity and spiritual and cultural practices of Indigenous communities
 the right to self-determination, which is a process whereby Indigenous communities
take control of their future and decide how they will address the issues facing them
 the right to land, which provides the spiritual and cultural basis of Indigenous
communities.
The Aboriginal and Torres Strait Islander Social Justice Commissioner advocates for the
recognition of the rights of Indigenous Australians and seeks to promote respect and
understanding of these rights among the broader Australian community.
Activity
What does social justice mean to you?
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Mental Health Statement of Rights and Responsibilities
The following extracts are from the Mental Health Statement of Rights and Responsibilities
(Commonwealth of Australia, 2012, pp. 7–8, 13–15 and 20–21).The full document is
available at:
www.health.gov.au/internet/mhsc/publishing.nsf/Content/8F44E16A905D0537CA257B33007
3084D/$File/rights.pdf.
Non-discrimination and social inclusion
Mental health consumers have the right to:
a. respect for their individual human dignity and worth at all ages and stages of life
b. respect for their privacy and confidentiality
c. respect for their health, safety and welfare
d. equal enjoyment of the highest attainable standard of physical and mental health
e. equal recognition before the law and the equal protection of the law
f. an adequate standard of living and social protection
g. equal opportunities to access and maintain
o health and mental health care
o housing
o education and training
o work and employment
o legal services
o income maintenance
o insurance
h. respect for their family life
i. have their sexual orientation, gender and gender identity taken into consideration
when receiving social support, health and mental health services
j. have their social, economic, cultural background and family circumstances taken into
consideration when receiving social support, health and mental health services
k. contribute to and participate in the development of social, health and mental health
policy and services.
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The right to mental health care
Mental health consumers have the right to:
a. be considered capable of making a decision (by the service or person providing care)
b. consent to, or refuse, medical treatment and other services, unless their consent is
governed by mental health or guardianship legislation
c. have their wishes respected and taken into account
d. have their lived experiences respected and taken into account
e. receive the support that they determine is necessary to assist them to make
decisions about health care
f. receive appropriate and comprehensive information about their diagnosis, options for
care and treatment and the availability of services
g. obtain timely, appropriate treatment, care and support
h. have their age, social, economic, cultural/geographical background and spiritual
preferences taken into consideration in their treatment, support and care
i. have their sexual orientation, gender and gender identity taken into consideration in
their treatment, support and care
j. have their right to privacy respected
k. have their right to confidentiality respected
l. be treated in the most facilitative environment with the least restrictive or intrusive
response or treatment
m. receive services in a safe environment that protects them from physical, sexual and
emotional harassment, abuse and violence
n. have families, carers and support persons involved in their assessment, support,
care, treatment, recovery and rehabilitation to the extent requested by them
o. be given appropriate reasons for the refusal of treatment
p. be referred to alternative or complementary services
q. where appropriate, receive mental health assessment, support, care, treatment,
rehabilitation and recovery that is coordinated with alcohol and drug use services
r. seek a second opinion
s. signify their wishes and preferences in regard to future treatment, support and care
t. be provided with information about ongoing assessment, support, care, treatment,
rehabilitation and services that support recovery
u. make a complaint regarding any facet of their assessment, support, care, treatment,
rehabilitation and recovery
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Carers and advocates
36. This statement acknowledges the contributions and expertise of informal, professional,
non-professional and statutory carers and support persons.
37. Australian governments and the Australian community should endeavour to assist carers
and support persons in their respective roles.
38. Carers and support persons who are young have special needs and are entitled to special
support and consideration.
39. Carers and support persons have the right to:
a. respect for their individual human worth and dignity
b. respect for their privacy
c. respect for their confidentiality
d. comprehensive information, education, training and support to facilitate their care and
support roles
e. receive services that assist them to provide care and support
f. contribute to and participate in the development of social, health and mental health
policy
g. place limits on their availability to the mental health consumer
h. access mechanisms of complaint and redress if they are dissatisfied with the treatment
or support provided to the mental health consumer
i. receive support for their own difficulties that may be generated through the process of
supporting, caring for or acting as an advocate for the mental health consumer
j. provide information concerning family relationships and any matters relating to the
mental state of the mental health consumer to health service providers.
40. With the consent of the mental health consumer, and where it is appropriate to do so in
accordance with legislation and policy, guardians, carers and support persons have the
right to:
a. contact the mental health consumer while they are undergoing treatment
b. participate in treatment decisions and decisions about ongoing care
c. seek and receive additional information about the mental health consumer’s support,
care, treatment, rehabilitation and recovery
d. be consulted by service providers about treatment approaches being considered for the
mental health consumer
e. arrange support services for the mental health consumer, such as respite care,
counselling and community care facilities
f. be provided with any information that the mental health consumer requests they should
receive.
41. Carers and support persons have the responsibility to:
a. respect the humanity and dignity of the mental health consumer
b. consider the opinions and skills of professional and other staff who provide
assessment, individualised care planning, support, care, treatment, recovery and
rehabilitation services to mental health consumers
c. cooperate, as far as is possible, with reasonable programs of assessment,
individualised care planning, support, care, treatment, recovery and rehabilitation.
42. Families, guardians, carers and support persons of children and young people have the
responsibility to obtain appropriate professional assistance if they believe that a child or
young person has a mental health problem or a mental illness.
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To uphold human rights requires more than legislation. It requires that consumers and
carers know their rights and that the professions are adequately trained in these and in
their codes of ethics and practice, standards and quality improvement systems. All such
systems need to be supported so that cultures in human services are caring ones. All
workplaces need to nurture an inclusive society able to respond to people when they are
at their most vulnerable (Mental Health Coordinating Council, 2011, NSW Mental Health
Rights Manual).
Activity
How do consumers and carers find out about their rights at your service?
Do you have culturally appropriate resources to inform people about their rights?
Can you think of a time when a person’s rights were not respected? What happened?
What should you do if a person’s rights have not been respected, or if they would like to
make a complaint?
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20
Legislation and Some Key Documents
Note:This information is provided as general information only, and should not be considered
or used as legal advice.
As mental health workers you need to be aware of the laws (legislation), framework,
standards and plans that should guide your work and the way you practice. The national and
state documents provide the context in which mental health services need to operate.
Legislation
The ‘National
NSW Mental
Health
Framework
for Recovery
Oriented Mental
Health Services’
Strategic Plan
"Living Well"
Recovery Oriented
Practice in Context - Key
Documents & Legislation
(Law)
National
Standards for
Mental Health
National
Mental
Health Plan
Services
(2010)
National Practice
Standards for the
Mental Health
Workforce
(2013)
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Legislation (laws)
Note:This information is provided as general information only, and should not be considered
or used as legal advice.
‘Appendix C’ - has more detailed information about relevant legislation for peer work.
There is also a glossary of legal and ethical terms in ‘Appendix A’
Another invaluable resource for peer workers, mental health workers and those they work
with is the: THE MENTAL HEALTH RIGHTS MANUAL: An online guide to the legal and
human rights of people navigating the mental health and human service systems in NSW (4th
Edition) 2015 http://mhrm.mhcc.org.au/home/
Legislation is often reviewed and updated. It is important to ensure that you are aware of the
latest version of any legislation. Your organisation should provide you with information about
the legislation that is relevant to your role during induction. It should also provide you with
information about any changes or updates. If you have any questions, you should contact
your supervisor.
There are a number of key pieces of legislation (laws) at both state and federal level that
workers need to be aware of. Depending on your work role, you might also need to be aware
of additional legislation.
At national level:


Commonwealth Privacy Act 1988 applies to both government and private sector
organisations across Australia
Commonwealth Disability Discrimination Act 1992 states that discrimination is
against the law if it happens in any of the following areas of life: employment and
work; education; disability rights; access to public places; providing goods or
services, including healthcare services; providing housing or accommodation; sale,
lease or disposal of land; membership of clubs and associations and treatment of
members; sport, including playing sport as well as coaching and sports
administration; administration of Commonwealth laws and programs
At state level there may be Acts relating to:
Work Health and Safety

Work Health and Safety Act 2011 (NSW) covers the prevention of work hazards
and other work-related health and safety issues
Mental health


Mental Health Act 2007– providing for the care, treatment and control of people with
‘mental illness’
Mental Health (Forensic Provisions) Act 1990 – outlining rules and procedures
that might apply to ‘forensic patients’, or people with ‘mental illness’ who have
committed crimes and were deemed mentally unwell at the time
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Information and privacy


Health Records and Information Privacy Act 2002– to protect the privacy of health
information in both the public and private sectors
Government Information (Public Access) Act 2009 – ‘GIPA’- to allow people to
ask for information from files and documents held by governments, including
personal information about them, but also to protect them from access by others
Discrimination

Anti-discrimination Act 1977– making it unlawful to discriminate against someone
because they belong to a particular group
Protection, including child protection

Children and Young Persons (Care and Protection) 1998 – to give the
government power to protect children and young people from abuse, and requiring
that some people, including health workers, must make a mandatory report to the
government if, during the course of their work, they become aware of a person under
16 years of age who they suspect is at risk of harm
Disability

Disability Inclusion Act 2014 (NSW) – ‘DIA’-The Act replaces the Disability
Services Act and has two main aims. The first aim is to explain how the government
will provide disability supports and services (until the rollout of the National Disability
Insurance Scheme (NDIS) expected to be by mid-2018. The second aim is to ensure
once NDIS is rolled out, people with disability in NSW will have access to mainstream
services and be part of the community. This includes providing access to services
necessary to enable people with disability to achieve their maximum potential as
members of the community, to achieve positive outcomes, such as increased
independence, employment opportunities and integration in the community, and to
have the same basic human rights as other members of the community.
How to get legal advice or information about your role and responsibilities:






Talk to your supervisor
Read the relevant policies and procedures they usually refer to any relevant legislation
Google the Mental Health Rights Manual (MHRM); THE MENTAL HEALTH RIGHTS
MANUAL: An online guide to the legal and human rights of people navigating the
mental health and human service systems in NSW (4th Edition) 2015:
http://mhrm.mhcc.org.au/home/
Read the legislation at:
o http://www.legislation.nsw.gov.au/
o https://www.comlaw.gov.au/
o http://www.austlii.edu.au/au/legis/cth/consol_act/
Legal Aid NSW helps people with their legal problems
Help over the phone: Call LawAccess NSW on 1300 888 529 to get started
LawAccess NSW is a free government telephone service that provides legal
information, referrals and in some cases, advice for people who have a legal problem
in NSW. We are a starting point to help with your legal problem:
http://www.lawaccess.nsw.gov.au/
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




Find information: factsheets and resources to help you with your problem:
http://www.legalaid.nsw.gov.au/publications/factsheets-and-resources
Get advice from a lawyer: We provide free face-to-face advice on most legal issues:
http://www.legalaid.nsw.gov.au/get-legal-help/advice
Help at court: We have lawyers to assist you at many courts and tribunals across
NSW:
http://www.legalaid.nsw.gov.au/get-legal-help/help-at-court
The Law Society Solicitor Referral Service - 1800 422 713:
http://www.lawsociety.com.au/community/findingalawyer/index.htm
Your local Community legal centre - Community Legal Centres (CLCs) are
independently operating not-for-profit community organisations that provide legal and
related services to the public, focusing on the disadvantaged and people with special
needs:
http://www.naclc.org.au/need_legal_help.php
Civil and administrative tribunal act 2013
NSW Civil and Administrative Tribunal (NCAT) was established by the Civil and
Administrative Tribunal Act 2013, (with Schedule 6 outlining functions specific to the
Guardianship Division).
NCAT commenced operation on 1 January 2014 and has merged 22 previously separate
NSW tribunals into one entity that now provides all specialist tribunal services. This
integration was intended to retain the ‘expertise formerly spread across the tribunals, while
increasing ease of access and restructuring back office administration’.
NCAT is made up of four divisions, each headed by a Deputy President with expert
knowledge in their area. The four divisions are as follows:
1.
2.
3.
4.
Consumer and Commercial Division
Administrative and Equal Opportunity Division
Occupational Division
Guardianship Division
Guardianship Division
The Guardianship Division within NCAT has replaced the Guardianship Tribunal of NSW,
which was established in 1989. Its functions are essentially the same as its predecessor,
with the Division conducting hearings to manage applications concerning adults with an
impaired decision-making ability.
What is a guardian?
A guardian is a person appointed to make legally valid decisions on behalf of a person with a
disability who is unable to make decisions on their own or without support.
The Guardianship Division within NCAT can appoint guardians for people 16 years of age
and over who are incapable of making their own decisions about their lifestyle. Generally,
NCAT only hears applications where there are no appropriate decision making
arrangements already in place or where an appropriate alternative to an application cannot
be found.
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Three separate organisations working together for people with disabilities
http://www.ncat.nsw.gov.au/Documents/gd_factsheet_three_separate_organisations.pdf



NSW Civil and Administrative Tribunal
NSW Trustee and Guardian
Public Guardian
NSW Civil and Administrative Tribunal
Appoints guardians for people with
disabilities aged 16 years and over
who are incapable of making their own
decisions and need a legally appointed
substitute decision maker.
It may be a friend/family member OR
Public Guardian
Public Guardian
can make decisions for the
person’s ACCOMMODATION,
Financial manager as substitute
decision makers for people who are
incapable of managing their own
finances
It may be a friend/family member (who
will be subject to the directions of the
NSW Trustee and Guardian) OR
in certain
circumstances
may directly
consent to
medical and
dental
treatments for
people who
are unable to
consent for
themselves.
can make decisions about the
person’s FINANCES
MEDICAL and DENTAL, HEALTH
CARE and SERVICES.
 Types of decisions they can
make are identified in the
Guardianship order
 May provide advocacy for
services and support but is not a
caregiver themselves.
Charges fees for:
 Financial and Asset
Management and
 overseeing private managers
(providing authorisation and
direction)
COMPLAINTS about the Public
Guardian should be directed to the
Complaint Support Officer at the
Public Guardian.
COMPLAINTS about the NSW
Trustee and Guardian should be
directed in writing to the Manager
Quality Service and Client
Relations at the NSW Trustee and
Guardian. If you are requesting a
review of a decision it is helpful to
outline why you think the decision
is not in their client’s best interests.
COMPLAINTS:
about the NSW Civil and Administrative Tribunal must be in writing and
can be made by email, or online by using the feedback form or the form can be mailed or
faxed direct to the Principal Registrar.
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What does NCAT consider in making a guardianship order?
NCAT will not make a guardianship order unless it is satisfied by the evidence before it that
the person the application is about:



has a decision-making disability,
the disability results in the person being partially or wholly incapable of managing
themselves, and
there is a need for the person to have a guardian appointed.
The contact details for NCAT are as follows:
 www.ncat.nsw.gov.au
 The Guardianship Division operates from Level 3, 2a Rowntree Street, Balmain NSW
2041
 http://www.ncat.nsw.gov.au/Pages/guardianship/guardianship.aspx
 For further information contact the NCAT Guardianship Division’s enquiry service on
(02) 9556 7600 or 1300 006 228.
Public Guardian
The Public Guardian promotes the rights and interests of people with disabilities through the
practice of guardianship, advocacy and education. The Public Guardian is part of the
Department of Justice. The Public Guardian is a statutory official appointed by the
Guardianship Division of the NSW Civil and Administrative Tribunal (NCAT).
A guardian will usually be authorised to make decisions on behalf of another person in
specific areas of a person’s life and for a certain length of time. In guardianship an area of
decision making authority is called a function.
The Public Guardian is the 'guardian of last resort'. This means that the Guardianship
Division of NCAT has decided no other person, such a family member or friend, can be
appointed.
NSW Trustee & Guardian
NSW Trustee & Guardian (NSW Trustee and Guardian Act 2009), commenced operations
on 1 July 2009 merging the Public Trustee NSW and the Office of the Protective
Commissioner.
NSW Trustee & Guardian's role is to act as an independent and impartial Executor,
Administrator, Attorney and Trustee for the people of NSW. It also provides direct financial
management services and authorisation and direction to private financial managers.
A financial management order is a legal document made by a court or tribunal that states a
person is not capable of making financial decisions. The document appoints another person
to be the financial manager to make decisions on behalf of the person. NSW Trustee and
Guardian (NSWTG) can be made the financial manager if there is no one else willing or able
to make decisions.
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Australia’s workplace relations laws
The Fair Work Act 2009 outlines the key elements of Australia’s workplace relations
framework. It was amended and added to by the Fair Work Amendment Act 2013 which
commenced operation on 1 January 2014. The effectiveness has been reviewed by the Fair
Work Amendment Act 2013 post- implementation review.
The Fair Work Act is a safety net of minimum terms and conditions of employment. It
includes protection against unfair or unlawful termination of employment
Fair Work Act is overseen by the Fair Work Commission and the Fair Work Ombudsman.


The Fair Work Commission is an independent national workplace relations tribunal.
It has a range of functions and the power to ensure the safety net of minimum
conditions, enterprise bargaining, industrial action, dispute resolution and termination
of employment are all correctly implemented.
The role of the Fair Work Ombudsman is to help employees, employers,
contractors and the community to understand workplace rights and responsibilities.
They enforce compliance with Australia’s Fair Work Act and other related workplace
laws.
For more information see:


Call the Fair Work Info line on 13 13 94.
Visit: https://employment.gov.au/australias-national-workplace-relations-system
NSW’s workplace relations laws
NSW Industrial Relations (NSW IR) is part of the NSW Treasury. It administers NSW
industrial and workplace legislation and regulate related employment matters by conducting
compliance activities. They work with employers and employees to promote “fair, equitable
and productive workplaces” and educate the community on the Fair work system. Some
NSW industrial acts that they regulate include:









Annual Holidays Act 1944 No 31
Employment Protection Act 1982 No 122
Industrial Relations Act 1996 No 17 (except parts, the Attorney General)
Industrial Relations Advisory Council Act 2010 No 76
Industrial Relations (Child Employment) Act 2006 No 96
Industrial Relations (Commonwealth Powers) Act 2009 No 115
Industrial Relations (Ethical Clothing Trades) Act 2001 No 128
Long Service Leave Act 1955 No 38
Public Holidays Act 2010 No 155
For more information see:


http://www.industrialrelations.nsw.gov.au/oirwww/About_NSW_IR/Legislation.page
http://www.industrialrelations.nsw.gov.au/oirwww/About_NSW_IR.page
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Carer Legislation, Policy and Procedures
Support to reduce the impact on carers – government strategies
Government legislation, policies and procedures can reduce the impact of caring on carers.
“Understanding the impact of caring helps to shape policy reform to:
1. support carers to combine caring responsibilities with paid work.
2. improve carer physical and mental wellbeing by reducing care mental health
problems.” (OECD. 2011, p85)
“Countries which want to maintain or increase reliance on family carers will need to
alleviate the burden of family carers and reduce the economic costs associated with
caring responsibilities” (OECD. 2011, p85)
Australian governments have certainly increasingly focused on the rights, participation and
involvement of carers in the recovery process. The impact on carers has also led to
establishing programs and new initiatives to provide carers with better support.
Carer Legislation
The government has put in place legislation to ensure carer rights and acknowledge the vital
social and economic contribution they make.
The Australian Government created the Carer Recognition Framework. It is composed of:
 The Carer Recognition Act 2010 and the
 The National Carer Strategy
The Carer Recognition Act 2010
This Act recognises the carer’s contributions and their rights. It also requires government
agencies and funded services to consult with carers and engage their participation. The
‘cornerstone of the Act is the “Statement for Australia’s Carers” which outlines 10 principles
that funded organisations as well as Australian government agencies need to incorporate
into their policies and consider when designing and delivering services for carers and
consumers.
The National Carer Strategy
This document outlines a vision, aim and priority areas, and was developed to increase
respect and support for carers.
The six priority areas are:
1. Recognition and respect
2. Information and access
3. Economic security
4. Services for carers
5. Education and training
6. Health and wellbeing
All of Australia’s states and territories have in place legislation or policies to support carers
and outline their rights.
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Legislation






Western Australia: Carers Recognition Act 2004
South Australia: Carers Recognition Act 2005
Queensland: Carers Recognition Act 2008
Northern Territory: Carers Recognition Act 2009
New South Wales: Carers Recognition Act 2010
Victoria: Carers Recognition Act 2012
Policy


Australian Capital Territory: ACT Carers Charter
Tasmania: The Carer Policy
The Statement for Australia’s Carers
1. All carers should have the same rights, choices and opportunities as other
Australians, regardless of age, race, sex, disability, sexuality, religious or political
beliefs, Aboriginal or Torres Strait Islander heritage, cultural or linguistic differences,
socio-economic status or locality.
2. Children and young people who are carers should have the same rights as all
children and young people and should be supported to reach their full potential.
3. The valuable social and economic contribution that carers make to society should be
recognised and supported.
4. Carers should be supported to enjoy optimum health and social wellbeing and to
participate in family, social and community life.
5. Carers should be acknowledged as individuals with their own needs within and
beyond the caring role.
6. The relationship between carers and the persons for whom they care should be
recognised and respected.
7. Carers should be considered as partners with other care providers in the provision of
care, acknowledging the unique knowledge and experience of carers.
8. Carers should be treated with dignity and respect.
9. Carers should be supported to achieve greater economic wellbeing and sustainability
and, where appropriate, should have opportunities to participate in employment and
education.
10. Support for carers should be timely, responsive, appropriate and accessible.
Applying the Statement for Australia’s Carers
The national statement is to direct the actions of government and government funded
services and workers in particular so that:
 Workers have an awareness and understanding of the Statement for Australia’s
Carers
 Human resources policies are consistent with the Statement
 The Statement’s principles are reflected in the development, implementation,
provision and evaluation of ‘care supports’
 Carers are to be consulted in the development and evaluation of ‘care supports’
 That annual compliance reports are developed.
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Activity
In what ways does legislation impact on your role as a worker?
What is a Code of Practice?
Codes of practice are practical outlines or guidelines on how you should perform certain
workplace activities or practices. For example WorkCover NSW have a number of approved
code of practices to assist workers to achieve the health, safety and wellbeing standards
required under the NSW Work Health and Safety Act and related WHS Regulations
Many of the codes of practice belong to specific industries eg demolition, spray painting,
welding, construction etc. There is not a particular code of practice for community services
but a number of generic ones cover community services workplaces. These include:











First aid in the workplace
Hazardous manual tasks
How to manage work health and safety risks
Labelling of workplace hazardous chemicals
Managing electrical risks in the workplace
Managing noise and preventing hearing loss at work
Managing risks of hazardous chemicals in the workplace
Managing the risk of falls at workplaces
Managing the work environment and facilities
Preparation of safety data sheets for hazardous chemicals
Work health and safety consultation, coordination and cooperation
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For example:


First Aid Code of Practice covers information on first aid kits, procedures, facilities
and training for first aiders. It explains how to provide adequate first aid facilities in
the workplace
Hazardous Manual Tasks Code of Practice, refers to tasks that require “a person
to lift, lower, push, pull, carry or otherwise move, hold or restrain any person, animal
or thing involving one or more of the following: repetitive or sustained force high or
sudden force repetitive movement sustained or awkward posture exposure to
vibration”. Each of these factors can stress the body and lead to injury.
Community Work Practice Standards
Practice standard define the standards associated with a profession e.g. nursing or social
work. Below is the community Work Practice Standards for the Australian Community
Workers Association and available on the ACWA website.
http://www.acwa.org.au/resources/ACWA_Practice_Standards.pdf
In brief there are 6 standards
Standard
STANDARD 1
Ethical practice
STANDARD 2
Regulatory framework
STANDARD 3
Development and
supervision
STANDARD 4
Client rights
STANDARD 5
Confidentiality
STANDARD 6
Acknowledgement of
diversity
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Description
A community work practitioner understands and has a
commitment to ethical practice, human rights, individual worth
and social justice Indicators
A community worker complies with the legal, regulatory and
statutory framework that underpins the rights of clients with
whom they work Indicators
A community worker continues with professional development
and professional supervision throughout their career.
A community worker acknowledges through his or her practice
that individuals, families, groups and communities have a
fundamental human right to access services and supports
A community worker respects and maintains client
confidentiality, privacy and ensures professional boundaries
A community worker demonstrates awareness of the diversity
of clients and service users in all professional practice
31
The complete version is:
PREAMBLE:
The practice standards are designed to promote excellence in community work practice and
provide a guide to all community work practitioners. The standards document replaces the
ACWA Core competencies.
DEFINITIONS:
Community worker: A community worker is a person who through professional training and
field education has the knowledge, skills and values to work in an organisation or program
intended to promote or restore the social functioning of individuals, families, social groups or
larger communities.
Client: The term client refers to an individual, family, group or community with whom a
practitioner works.
STANDARD 1 Ethical practice
A community work practitioner understands and has a commitment to ethical practice,
human rights, individual worth and social justice
Indicators:
1.1
1.2
1.3
The community worker’s relationship with clients or client groups is based on the
principles of respect and human dignity regardless of the client’s own attitudes or
behaviour.
The principles of social justice, equity, individual worth, human dignity and selfdetermination are applied in all day-to-day professional practice, policy development
and implementation, and in all forms of written communication and record keeping.
Ethical behaviour is practiced in every situation, and ethical problems are managed in
reference to the Australian Community Workers Association’s Code of ethics.
STANDARD 2 Regulatory framework
A community worker complies with the legal, regulatory and statutory framework that
underpins the rights of clients with whom they work
Indicators:
2.1
2.2
2.3
2.3
Legal issues, principles and mechanisms, legislation, and statutory provisions affecting
the professional practice of a community worker are acknowledged and adhered to.
Client information is dealt with within the requirements of legislation including privacy,
confidentiality and freedom of information.
The rights of clients are paramount in the provision of information, support and
services.
Records and information systems relating to clients, resources, programs and projects
are developed and maintained in accordance with legislation and organisational
policies and requirements.
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STANDARD 3 Development and supervision
A community worker continues with professional development and professional supervision
throughout their career.
Indicators
3.1
3.2
Professional supervision is sought or offered wherever appropriate and possible.
Competence in practice is maintained by undertaking relevant professional
development.
3.3 Personal and professional limitations are addressed by consulting others and seeking
appropriate professional or peer support.
3.4 The community worker applies critical analysis to the profession, human service
agencies and organisations, and social institutions.
3.5 The community worker is responsible and accountable for his or her own actions,
decisions and professional development.
STANDARD 4 Client rights
A community worker acknowledges through his or her practice that individuals, families,
groups and communities have a fundamental human right to access services and supports
Indicators:
4.1
4.2
4.3
4.4
4.5
Services are designed to meet individuals’ and communities’ right to selfdetermination.
Clients are not disadvantaged or disempowered by the inherent imbalance of power
and authority that exists between the community worker and the client.
Appropriate techniques, assessment, planning and research are in use when engaging
with clients and communities.
Processes are in place to actively engage clients and communities in developing
programs and policies.
Service, program and project provision is regularly evaluated and monitored to ensure
compliance with human and legal rights
STANDARD 5 Confidentiality
A community worker respects and maintains client confidentiality, privacy and ensures
professional boundaries
Indicators:
5.1
5.2
5.3
Professional relationships with clients, communities, colleagues and other
professionals are maintained. An organisational complaints procedure is in place to
address noncompliance.
Client and organisational information is kept confidential; informed consent is sought
before any confidential information is shared unless this is required by law.
Adequate record keeping is in place to protect the privacy of clients.
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STANDARD 6 Acknowledgement of diversity
A community worker demonstrates awareness of the diversity of clients and service users in
all professional practice
Indicators:
6.1
6.2
6.3
Demonstrated recognition of diversity in all its forms and provision of services that do
not discriminate on the basis of individual or group characteristics, values, beliefs and
practices.
Demonstrated processes to gain information from relevant individuals and Indigenous
and ethnic communities to ensure professional practice is appropriate and sensitive to
community and client needs.
Policies, programs, research design and client services are appropriate and sensitive
to client needs
The ‘National Framework for Recovery Oriented Mental Health
Services’
The ‘National Framework for Recovery Oriented Mental Health Services’ is a guide for
mental health workers and services to Australia’s national framework for recovery-oriented
mental health services. It provides definitions of the concepts of recovery and lived
experience; describes the practice domains and key capabilities necessary for the mental
health workforce to function according to recovery-oriented principles; and provides
guidance on tailoring recovery-oriented approaches to respond to the diversity of people with
mental health issues, to people in different life circumstances and at different ages and
stages of life.
Extract from the national framework for recovery-oriented mental health services Executive
Summary p1
“The national framework for recovery-oriented mental health services provides a vital
new policy direction to enhance and improve mental health service delivery in
Australia. It brings together a range of recovery-oriented approaches developed in
Australia’s states and territories and draws on national and international research to
provide a national understanding and approach to recovery-oriented mental health
practice and service delivery. It complements existing professional standards and
competency frameworks at a national and state level. The framework supports
cultural and attitudinal change and encourages a fundamental review of skill mix
within the workforce of mental health services, including increased input by those
with expertise through experience.
The framework defines and describes recovery and lived experience, describes the
practice domains and key capabilities necessary for the mental health workforce to
function in accordance with recovery-oriented principles, and provides guidance on
tailoring recovery oriented approaches to respond to the diversity of people with
mental health issues. It is underpinned by extensive research and consultation and
informed by lived experience,” (National Framework 2013 p1)
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The two reports are available for download:
 A national framework for recovery-oriented mental health services: Policy and theory
(2013) Commonwealth of Australia 2013
http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-nrecovpol
 A national framework for recovery-oriented mental health services: Guide for
practitioners and providers (2013) Commonwealth of Australia 2013
http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-nrecovgde
National Mental Health Plans
The ‘Fourth National Mental Health Plan’ emphasises coordination and collaboration between
government, private and non-government service providers to deliver a more connected care
system so that people with ‘mental illness’ can participate more fully in the community.
It is available at:
www.health.gov.au/internet/main/publishing.nsf/content/360EB322114EC906CA257670001
4A817/$File/plan09v2.pdf.
The Fifth National Mental Health Plan is currently under develop. The reference group has
been appointed
NSW Strategic Plan
Living Well: A Strategic Plan for Mental Health in NSW 2014-2024
“In December 2014, the NSW Government adopted the
Strategic Plan for Mental Health in NSW, developed by the
Commission…
The Plan, which sets out a 10 year vision for better mental
health and wellbeing, includes 141 Actions that together will
create a strong platform for better mental health and wellbeing
for everyone in NSW.”
http://nswmentalhealthcommission.com.au/about-us
“The Strategic Plan sets out actions and future directions for
reform of the mental health system in NSW. It maps a
demanding agenda for change that puts people – not
processes – at the heart of its thinking. It asks that the NSW
Government recommit to completing the process of reform
begun with the Inquiry into Health Services for the
Psychiatrically Ill and Developmentally Disabled (Richmond
Report) in the 1980s in particular by taking two important steps - closing the remaining
stand-alone psychiatric institutions and shifting the focus of mental health care from
hospitals to the community.
The Plan does not directly govern the operation of services but instead lays out directions
and principles for reform which agencies and service providers must find ways to embed in
the supports they offer to people in our community.
http://nswmentalhealthcommission.com.au/our-work/strategic-plan
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10 key focus areas of the plan
1: Planning for our future
6: Better responses
2: Making it local
7: Care for all
3: Getting in earlier
8: Supporting reform
4: Putting people first
9: Governance of mental health within NSW Health
5: Providing the right type of care
10: Broader context of reforms
The NSW Mental Health Commission’s Vision
Our vision is for the people of NSW to have the best opportunity for good mental health and
wellbeing and to live well in their community and on their own terms.
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2 key sets of standards (Workforce and service standards)
National Practice Standards for
the Mental Health
National Standards for
Workforce
Services
(2013)
(2010)
Mental Health
1. Rights, responsibilities, safety and
privacy
1
2.
3.
Rights and responsibilities
Safety
Consumer and carer
participation
4. Diversity responsiveness
5. Promotion and prevention
6. Consumers
7. Carers
8. Governance, leadership and
management
9. Integration
10. Delivery of care (supporting
recovery, access, entry,
assessment and review,
treatment and support, exit and
re-entry)
2. Working with people, families and
carers in recovery-focused ways
3. Meeting diverse needs
4. Working with Aboriginal and Torres
Strait Islander people, families and
communities
5. Access
6. Individual planning
7. Treatment and support
8. Transitions in care
9. Integration and partnership
10. Quality improvement
11. Communication and information
management
Includes the:
• Principles of
recovery-oriented
mental health practice
Key occupations it applies to:
• Nursing
• Occupational therapy
• Psychiatry
• Psychology
• Social Work.
but useful for other workers
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3 extra implementation guides
• Public mental health services and
private hospitals
• Non-government community
services
• Private office based mental health
practices.
37
Standards and plans
Standards and plans are introduced by governments as a guide to service delivery and to
provide for continuous improvement, as well as a reference for consumers and carers about
what they can expect from mental health workers and services.
National Practice Standards for the Mental Health Workforce 2013
“Australian governments are committed to supporting and developing the mental
health workforce that provides services to people with mental illness, and their
families and carers. People who work in mental health are among the major
strengths of the system. Supporting practitioners to develop their skills, knowledge
and attitudes is an important element of service quality and improvement. It also
contributes to worker satisfaction and retention. Working in mental health offers
particular challenges and benefits, and the workforce has a vital role in improving
health and social outcomes for the community” (National Practice Standards for the
Mental Health Workforce 2013 p4)
In February 1999 the Commonwealth, in conjunction with the Australian Health Ministers
Advisory Council National Mental Health Working Group (AHMAC NMHWG), released
Learning Together: Education and Training Partnerships in Mental Health. This report
identified five professions that make up the bulk of the mental health workforce: mental
health nursing; occupational therapy; psychiatry; psychology and social work. The report
identified the common ground between all five disciplines working in the mental health sector
and proposed that processes for collaboration be established between ‘the higher education
sector, the Commonwealth and State Governments and the professional associations’.
These standards were last revised in 2013.
The 2013 standards outline capabilities that all mental health professionals should achieve in
their work. They are intended to complement discipline-specific practice standards or
competencies of the professions of:





nursing,
occupational therapy,
psychiatry,
psychology and
social work.
These standards are not a legal requirement, but they provide practical benchmarks and
describe the knowledge, skills and attitudes required by workers in the mental health sector.
Full copies of the standards are available on the internet:
National Practice Standards for the Mental Health Workforce 2013:
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-nwkstd13-toc
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Standard 2 relates specifically to consumer and carer participation. It identifies the following
skills and activities:
Standard 2: Working with people, families and carers in recovery focused
ways
In working with people and their families and support networks, mental health practitioners
support people to become decision-makers in their own care, implementing the principles
of recovery-oriented mental health practice. The mental health practitioner:
1.
Works with people and their families and carers as partners
2.
Engages in practice that reflects that the person exists within a context of family,
significant people, community and culture
3.
Applies the principles of self-determination and supports people and their family
members and carers in being decision-makers in their recovery processes
4.
Expresses hope and optimism, applying a strengths-based approach and valuing the
person’s and their family’s/carer’s knowledge and perspectives
5.
Demonstrates respect for family members’ and carers’ roles, acknowledging diverse
family capacities, experiences, value systems and beliefs
6.
Identifies the impact of the person’s mental health needs on their family and carers,
including partners, significant others, children, parents and siblings, and supports
referrals and interventions to help meet these needs
7.
Engages with families and carers in treatment, care and decision making to the extent
possible and supported by the person
8.
Uses language that demonstrates respect for the person, family and carers at all times
9.
Facilitates family and carer involvement, addressing barriers and supporting
connections with the person
10. Identifies the needs of family members and carers in circumstances where the person
has chosen to exclude their involvement in his/her treatment and care and supports
interventions to meet these needs
11. Works with family and carers in such a way that they feel heard, informed to the extent
possible and supported
12. Assists people and families and carers to contact appropriate peer advocates and
consultants
13. Encourages feedback on service delivery, policy and planning from people and their
families and carers
14. Facilitates social inclusion, social connectedness and engagement of people in
activities that offer meaning, satisfaction and purpose to the person, such as
recreation, education and vocation
15. Provides information in a format that is accessible to educate people, family members
and carers on mental health issues and conditions, physical and co-morbid health
conditions, mental health services, other support services and self-help organisations
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State/territory plans, charters and frameworks
States and territories also have plans, charters and/or frameworks in relation to mental
health care and service/funding provision these are regularly updated and reviewed.
National Standards for Mental Health Services (2010)
The National Standards for Mental Health Services were released in September 2010.
“While the practice standards relate to the skills, knowledge and attitudes expected of
those who work in mental health services, the National Standards for Mental Health
Services (2010) (service standards) apply to the setting in which mental health care
is provided. The revised service standards cover 10 areas outlined in the table below,
and also include recovery principles.”
The third standard is a specific standard on consumer and carer participation. This standard
(Standard 3) sets the expectation that mental health services “actively involve consumers
and carers in planning, service delivery, evaluation and quality programs” (Australian
Government. National Standards for Mental Health Services 2010. p11). Services are also
expected to involve consumers and carers in the implementation and maintenance of the
standards.
How could peer workers contribute to the outcomes for standard 3?
The 10th standard relates to the delivery of care, and includes a recovery standard. The two
sets of standards are intended to work together to support the ongoing development and
implementation of good practices and to guide continuous quality improvement in mental
health services. The service standards should ensure systems and processes are in place at
an organisational level to provide optimum support for people using the service and their
families. The practice standards should ensure mental health professionals’ work practices
demonstrate person-centred approaches and reflect nationally agreed protocols and
requirements. As such, the two sets of standards are intended to provide a foundation for the
sector.” p6
The first national standards for mental health services were originally developed in 1996.
The revised standards (2010) place greater emphasis on recovery and apply to a diverse
range of mental health services – public, private and non-government organisations – and
where mental health care is delivered, such as drug and alcohol services, community-based
mental health services and primary care services.
There are three guideline documents that accompany the standards. These guidelines
explain how to implement the standards, and give clear directions for mental health services
on how the standards apply to different services. One of the guides targets non-government
community services. The other 2 are for public mental health services and private hospitals
and private office based mental health practices
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Comparison of the national workforce and the service standards
The workforce standards and the service standards have been compared to show where
and how they cover similar topics.
National workforce practice standards
2013
National standards for mental health
services 2010
1 Rights and responsibilities
Standard 1: Rights, responsibilities, safety
and privacy
2. Safety
3. Consumer and carer participation
Standard 2: Working with people, families
and carers in recovery-focused ways
6. Consumers
7. Carers
Standard 3: Meeting diverse needs
Standard 4: Working with Aboriginal and
Torres Strait Islander people, families and
communities
4. Diversity responsiveness
Standard 5: Access
10. Delivery of care (supporting recovery,
access, entry, assessment and review,
treatment and support, exit and re-entry)
Standard 6: Individual planning
Standard 7: Treatment and support
Standard 8 Transitions in care
Standard 9: Integration and partnership
9. Integration
Standard 10: Quality improvement
8. Governance, leadership and management
Standard 11: Communication and
information management
Standard 12: Health promotion and
prevention
5. Promotion and prevention
Standard 13: Ethical practice and
professional development responsibilities
http://www.health.gov.au/internet/main/publishing.nsf/Content/5D7909E82304E6D2CA257C
430004E877/$File/wkstd13.pdf
Full copies of the standards are available on the internet
National Standards for Mental Health Services (2010):
http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-servst10
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Principles of recovery oriented mental health practice
Extract from: the National practice standards 2013 p6.
The National Standards for Mental Health Services (2010) principles of recovery-oriented
mental health practice state that:
From the perspective of the individual with mental illness, recovery means gaining
and retaining hope, understanding of ones abilities and disabilities, engagement in an
active life, personal autonomy, social identity, meaning and purpose in life, and a
positive sense of self.
It is important to remember that recovery is not synonymous with cure. Recovery
refers to both internal conditions experienced by persons who describe themselves
as being in recovery— hope, healing, empowerment and connection—and external
conditions that facilitate recovery—implementation of human rights, a positive culture
of healing, and recovery-oriented services. (Jacobson and Greenley, 2001 p. 482)
The purpose of principles of recovery oriented mental health practice is to ensure
that mental health services are being delivered in a way that supports the recovery of
mental health consumers. (Commonwealth of Australia, 2010 p. 42)
1. Uniqueness of the individual
Recovery oriented mental health practice:
 recognises that recovery is not necessarily about cure but is about having
opportunities for choices and living a meaningful, satisfying and purposeful life, and
being a valued member of the community
 accepts that recovery outcomes are personal and unique for each individual and go
beyond an exclusive health focus to include an emphasis on social inclusion and
quality of life
 empowers individuals so they recognise that they are at the centre of the care they
receive.
2. Real choices
 supports and empowers individuals to make their own choices about how they want
to lead their lives and acknowledges choices need to be meaningful and creatively
explored
 supports individuals to build on their strengths and take as much responsibility for
their lives as they can at any given time
 ensures that there is a balance between duty of care and support for individuals to
take positive risks and make the most of new opportunities.
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3. Attitudes and rights
 involves listening to, learning from and acting upon communications from the
individual and their carers about what is important to each individual
 promotes and protects individual’s legal, citizenship and human rights
 supports individuals to maintain and develop social, recreational, occupational and
vocational activities which are meaningful to the individual
 instils hope in an individual’s future and ability to live a meaningful life.
4. Dignity and respect
 consists of being courteous, respectful and honest in all interactions
 involves sensitivity and respect for each individual, particularly for their values, beliefs
and culture
 challenges discrimination and stigma wherever it exists within our own services or
the broader community.
5. Partnership and communication
 acknowledges each individual is an expert on their own life and that recovery
involves working in partnership with individuals and their carers to provide support in
a way that makes sense to them
 values the importance of sharing relevant information and the need to communicate
clearly to enable effective engagement
 involves working in positive and realistic ways with individuals and their carers to help
them realise their own hopes, goals and aspirations.
6. Evaluating recovery
 ensures and enables continuous evaluation of recovery based practice at several
levels
 individuals and their carers can track their own progress
 services demonstrate that they use the individual’s experiences of care to inform
quality improvement activities
 the mental health system reports on key outcomes that indicate recovery including
(but not limited to) housing, employment, education and social and family
relationships as well as health and well being measures.
These Recovery Principles have been adapted from the Hertfordshire Partnership NHS
Foundation Trust Recovery Principles in the UK.
In addition to the 2 key mental health standards documents it is useful to be familiar with the
disability standards.
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NSW Disability Services Standards (NSW Standards) (guided by the
Disability Services Act 1993 (NSW))
The disability service standards were recently revised (2014) to better support NGO’s
introduce more person centred delivery. The aim is to provide a quality framework and
improve service delivery to people with a disability, their families and carers. While
psychiatric disability is included in the definition, it is not a recovery term is one that many
people don’t want to use. However services that do provide disability programs accessed by
people with mental health issues the standards must apply.
The previous 10 standards have been streamlined to 6 standards:
1. “Service Access - focus on the importance of readily available information that is
adapted to individual need and outlines the features and capacity of services so that
each person knows how to access a service and is treated fairly by service providers
2. Individual Outcomes - shift to person-centred approaches, providing information and
support that reflects a person’s individual and cultural needs - that service providers
support each person to exercise choice and control over the design and delivery of
their services
3. Participation and Inclusion - focus on people with a disability being valued members
of their communities through active and meaningful participation - Service providers
develop connections with the community to promote opportunities for active and
meaningful participation
4. Feedback and Complaints - each person can expect a complaint to be dealt with in a
manner that reflects their individual and cultural needs, and have support and the
opportunity to participate fully in the process of complaints’ resolution
5. Service Management - each person receives quality services that are well managed
and delivered by staff with the right values, attitudes, goals and experience. - each
person receives quality services which are effectively and efficiently governed.
6. Rights - focus on people with a disability receiving services that promote and respect
their legal and human rights and which enable them to exercise choice and
participation like everyone in the community Family Relationships National and NSW
approach to address concepts across all standards (Incorporated across” (ADHC
2014, p2)
These standards are a very powerful tool for supporting consumers and carers in ensuring
their right to service delivery that is respectful, takes account of individual difference, is
accountable and is non-discriminatory. Workers should ensure that they and the consumers
and carers they work with are aware of these standards and make the best use of them in
ensuring that services are delivered in accordance with the Disability Services Act.
Some other useful documents
Mental Health Rights Manual
A Consumer Guide to the Legal and Human Rights of People with Mental Illness in NSW
(3rd Edition) 2011
This Mental Health Rights Manual (the Manual) is a resource for consumers involved in the
NSW mental health system as well as carers of those consumers. The aim is to provide a
guide to key areas of the law and on how to get help. It is written in plain English, free of
legal and/or medical jargon. It is also a useful tool for carers and workers across the mental
health and community sector.
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Written in plain language, the manual is an invaluable readily accessible resource, bringing
together vital information crucial to anyone having to navigate the mental health system,
enabling them to become acquainted with their rights, the legal and service system, and
access support and guidance.
It is available for free on the MHCC website (www.mhcc.org.au).
Disclaimer:



The legal and other information contained in this Section is up to date to 13
September 2010.
This Manual only refers to the law and practices applying to the Australian state of
New South Wales (NSW).
MHCC does not guarantee the accuracy nor is responsible for the content or the
currency of the content of external documents and websites linked to this Manual.
The Framework for Mental Health in Multicultural Australia: Towards culturally
inclusive service delivery
“The Framework for Mental Health in Multicultural Australia: Towards culturally inclusive
service delivery
The Framework has been developed to help organisations and individual workers to:


Evaluate their cultural responsiveness
Enhance their delivery of services for CALD communities.
The Framework is mapped against current practice, policies and plans. Its implementation
will not only assist services to fulfil their existing safety, quality and accreditation
requirements, but also offers an ongoing process of assessment and development.”
http://framework.mhima.org.au/framework/index.htm
The Gayaa Dhuwi (Proud Spirit) Declaration
“Aboriginal and Torres Strait Islander Leadership in Mental Health – together we are
stronger”
The declaration considers Aboriginal and Torres Strait Islander leadership across all parts of
the Australian mental health system to achieve the highest attainable standard of mental
health and suicide prevention outcomes for Aboriginal and Torres Strait Islander peoples
It is a companion declaration to the Wharerātā Declaration for use by Aboriginal and Torres
Strait Islander peoples.
http://natsilmh.org.au/sites/default/files/gayaa_dhuwi_declaration_A4.pdf
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Duty of care
Understanding duty of care is important.
Duty of care is the duty to take reasonable care,
so that other people are not harmed.
We all have duty of care. For example, staff members have a duty of care to consumers and
carers, to each other and to the community; and employers have a duty of care to staff
members, to consumers, to carers and to the community. Duty of care overlaps with work
health and safety in this regard.
Duty of care comes from the legal concept of ‘negligence’, which is part of common law.
Common law is when judges and courts interpret the law by deciding cases on the basis of
how similar cases have been decided in the past (this is the principle of ‘precedent’).
This means that it can often be difficult to find the common law that applies to a situation, as
it is not based on an Act of Parliament, but on decisions that judges have made about what
is considered appropriate at a particular time and under particular circumstances.
Negligence
There are three important things that a judge will look for when deciding if someone (e.g.
you, or your employer) has been negligent:
1. Duty of care is the obligation to take reasonable care to prevent injury arising from an
act or omission. If someone is relying on you to be careful, and that reliance is
reasonable under the circumstances, then it will generally be that you owe that
person a duty of care.
2. Breach is a failure to take reasonable care. A breach has occurred when it can be
proven that the person who has the duty of care has not provided the appropriate
standard of care. In deciding whether this is the case, we consider the following
questions.
o What standard of care would be expected of any other reasonable person or
worker who performs the same duties?
o Is the risk of this type of harm foreseeable?
o Is the risk significant?
o Would a reasonable person have taken precautions? Consider:
 the probability that the harm would occur if care was not taken
 the likely seriousness of that harm
 the burden of taking precautions to avoid the harm
 the social utility of the risk-creating activity.
3. Injury, loss or harm are the results caused by the breach to the person to whom the
duty of care was owed.
Duty of care and negligence laws exist as a way to compensate injured people, including
providing funds for expenses, such as medical costs. An injured person gains compensation
by taking a person or organisation to court to prove that they were injured as a result of a
breach of the duty of care by the other person or organisation.
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Dignity of risk
‘Dignity of risk’ is a term that comes from the disability movement. It refers to a person’s right
to make informed choices and to take risks in order to fully experience life, take advantage of
opportunities and learn from mistakes.
Patricia Deegan (1996) highlights the dignity of risk and the right for consumers to fail. She
believes that we should not pathologise the poor choices that people with ‘mental illness’
might make. Poor choices, mistaken judgements, lack of insight, repeated mistakes and selfdefeating choices are not necessarily reflections of ‘mental illness’. They are the ways in
which most of us grow and learn!



Don’t automatically assume that a consumer’s poor choice is reflective of their
‘mental illness’.
Openly challenge your co-workers who jump to such conclusions.
Practise ‘normalising’ the choices a consumer is making.
The concept of ‘dignity of risk’ is associated with duty of care.
As workers, our concern to fulfil our duty of care to consumers or carers should not shield
them from all possible risks, especially if this might actually prevent them from enjoying a full
and rich life.
Dignity of risk is about ‘allowing beings to manifest themselves, with as little interference and
the most cooperation possible’ (Kuhn-White, 1992 p. 5).
Dignity of risk refers to a person’s right to experience all that life has to offer,
even though taking part in an activity may entail some element of risk.
To put it simply, dignity of risk means letting people do their own thing, make their own
choices and take some reasonable risks without constant worker or organisational
interference.
It doesn’t mean that workers ignore their duty of care responsibilities. A worker might, for
example, provide the person with information about the choices they are making and the
risks they are taking. There will still be times when the worker has to take action to protect
the person, so that they are not negligent in their duty of care. Workers should always be
actively working to encourage freedom of choice and autonomy.
‘Mental illness’ is often viewed differently from physical ill-health. Therefore, workers might
view a consumer of mental health services taking risks differently from a person with a heart
condition smoking, for example, and assume a more directive or autocratic approach. These
are ethical considerations that we all need to reflect on in our work. We also need to
acknowledge our own cultural context and belief systems in our work practices.
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Balancing dignity of risk with duty of care
Dignity of risk
Duty of care
Person’s right
to make
informed choices
and take risks
Legal duty to take
reasonable care
to protect person
from harm
Balancing
Activity
‘Dignity of risk’ and ‘duty of care’ are common terms within mental health services. The
Principles of Recovery-oriented Mental Health Practice state that:
recovery-oriented mental health practice ensures that there is a balance between
duty of care and support for individuals to take positive risks and make the most of
new opportunities.
Think about a situation you have been in with a person where you experienced tension
between dignity of risk and duty of care. Write down the following components of your
experience.
Duty of care:
Dignity of risk:
How did you balance them?
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Would you do it differently now?
In your own words, why do you need to understand duty of care in your work?
In your own words, why do you need to understand dignity of risk in your work?
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Activity
Choose one of the scenarios, read it and answer the following questions.
Jenny
Thirty-three-year-old Jenny has a diagnosis of bipolar disorder and a mild developmental
delay. She lives in a four-bedroom home with three other women who also have mental
health problems. As a peer worker your role is to provide support and assistance to the
group of women seven days a week.
Jenny has recently started spending time with a new male friend and is extremely happy
about this. However, Jenny’s housemates have begun to complain to you about the amount
of time her boyfriend is spending at the house and that they don’t feel safe around him.
Today, one of the women has telephoned and told you that Jenny’s new boyfriend has been
approaching her for sex in return for drugs and/or money. More recently, he has threatened
to damage the house and hurt the women living there if they say anything about this to
Jenny or anyone else.
You arrive at the house to provide support and realise that Jenny’s boyfriend is there.
What privacy issues are raised?
What are the possible risks and safety options?
What is your duty of care?
Who do you talk to, and what do you say?
What do you do?
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John
John is a 48-year-old man living with a diagnosis of schizophrenia and alcohol dependence.
He often attends the day program where you work to socialise and eat an affordable lunch.
More often than not, John arrives drunk and harasses the other consumers for money and
cigarettes. There have been many discussions with John about his behaviour but he insists
that alcohol is legal and he’s allowed to drink if he wants to.
Recently, John has begun to fall over when drunk, sometimes causing injuries to himself.
There are steep stairs at the day program venue and yesterday, as John fell over, you tried
to grab him and injured your shoulder. He fell onto another consumer who was also injured.
John lives with his parents, and a friend of his who also attends the day centre has told them
what has been happening. They have called you to request an urgent meeting with you to
discuss the situation. John has consistently told you that he does not want his parents
involved in the services that he receives.
What privacy issues are raised?
What can you tell his parents?
What can be discussed?
What do you need to say to John?
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Gweneth
Gweneth has been the official carer for her son Brian for 10 years – ever since he was
diagnosed with psychosis. She and Brain are very close and generally get on well.
Lately, however, she has been feeling worn out and very stressed. Brian has not been
sleeping, and that has affected her sleep as well. He has also been spending time with
people who make her uncomfortable. Last night, four of them came around to the house and
were drinking until late. One of them threatened her and swore at her. She is feeling
frightened and has rung you for help.
She doesn’t want to ban them from the house or upset Brian, and she won’t go to the police.
You arrive at the house with a new peer worker for your scheduled weekly visit. When you
arrive for the visit, three of them (including the one who allegedly threatened her) are there.
Gweneth is distressed and wants you to come inside so she feels safe.
What do you need to say to Gweneth?
What will you say and do?
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Ethical practice
What are ethics?
Ethics is about beliefs, and the way we think and behave. It is about the rules of
behaviour and human duty, morals and values: that is, understanding right and
wrong, justice and injustice, good and bad, and doing the right thing.
(National Health and Medical Research Council, 2006, ‘Keeping research on track: A guide for
Aboriginal and Torres Strait Islander peoples about health research ethics’, p. 4).
Ethics are often described as the set of moral principles that guide our behaviour and
decision-making, helping us to answer the question, ‘What should I do in this situation?’
Ethics help us to identify right from wrong, and good behaviour from bad. But often it is not
that easy, as there can be good and bad on both sides of a situation. A person can be left
trying to choose the better of two options that are really about competing values or priorities.
We call this an ethical dilemma, and it requires ethical decision-making.
Key points about ethics





Our ethical beliefs and attitudes are extremely important personally and
interpersonally. Values are formed and absorbed by us all as we develop from
childhood and through adulthood.
Beliefs and values have a cultural context and are complex; therefore, ethical
constructs may be politically and religiously loaded.
At the heart of ethics are understandings about how we should act in our world and
how we should treat other people.
Ethics are beliefs, moral values and understandings about right and wrong, held by
an individual, group, culture or profession.
Many professional groups have codes of ethical practice to guide their behaviour,
including psychiatrists, nurses, psychologists, social workers, counsellors and
psychotherapists.
Activity
Why do we need to know about ethics?
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Ethics, codes of practice and codes of conduct
A code of ethics defines the fundamental principles (like respect, integrity, trust,
openness ) that should guide worker’s approach. It provides guidance in terms of ethical
and moral responsibility. It is more general than a code of conduct and describes the
principles and values of “what” is important and should be considered in making a
decision.
A code of conduct defines the required standards of behaviour and actions of a worker.
It clearly describes expectations so people know ‘how to’ act.
There are a range of factors that you need to be aware of in order to make sure you take an
ethical approach to the working relationships you have with people.
These documents according to the NSW Council of Social Service outline the relevant
principles or standards to guide worker’s performance. This is important as mental health
workers are often working with the most vulnerable, disadvantaged and marginalised people.
They also help to establish effective, open and accountable organisations.
Codes of Conduct
A code of conduct should outline specific expected behaviour and actions in certain
situations. They should align with and reflect the Code of Ethics and organisational vision,
mission, values, policies and procedures and relevant legislation.
While codes of practice are written for specific professions or job roles, codes of conduct
refer more to actions, behaviours and approaches.
It must be clear and unambiguous indicating required outcomes or rules to be followed.
While they are more specific than codes of ethic they are rarely broad enough to cover every
circumstance but do provide general direction on many matters. If your situation is not
covered then discuss any concerns with your supervisor or seek clarification from another
appropriate person.
Topics typically addressed by codes of conduct include:










Drug usage
Standards of work
Confidentiality and privacy
Personal gifts and benefits
Discrimination
Conflict of interest
Complying with laws and regulations
Personal use of the organisation’s resources
Bullying and harassment
Responding to illegal or questionable activity
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General ethical principles
In the section on lived experience, we discussed the five ethical principles. However, they
are included again here so you can easily refer to them in the following activities.
Kitchener (1984) identified five principles as the foundations of ethical decision-making.
Consider these principles whenever you are trying to determine how to respond in a certain
situation. They may not provide all the answers, but they are a good place to start.
In addition the Josephson Institute of Ethics after considerable community consultation
published the 6 pillars of character. This is a list of characteristics an ethical person would
display. It has been included in the following table with Kitchener’s principles.
Kitchener (1984) five ethical
decision-making principles
"Six Pillars of Character" developed by The Josephson
Institute of Ethics

Fidelity: be trustworthy
a) Trustworthiness: honesty, integrity, promise-keeping,
loyalty

Autonomy: respect choice
b) Respect: autonomy, privacy, dignity, courtesy,
tolerance, acceptance

Beneficence: do good
d) Caring: compassion, consideration, giving, sharing,
kindness, loving

Justice: be fair
e) Justice and fairness: procedural fairness, impartiality,
consistency, equity, equality, due process

Non-maleficence: do no
harm
c) Responsibility: accountability, pursuit of excellence
f) Civic virtue and citizenship: law abiding, community
service, protection of environment5
The very nature and structure of ethics is determined by
the particularities of a community’s history and convictions (Singer, 1993, p. 1).
Some Useful References
Association of Child Welfare agencies and Australian Community Workers Association
(2013) Code of Ethics http://www.acwa.org.au/about/code-of-ethics
Family and Community Services (FACS) (2013) Code of Ethical Conduct. Accessed from
www.facs.nsw.gov.au/coec
Gentile, M. (2010) Managing Yourself: Keeping Your Colleagues Honest; Change
Management; Harvard Business Review., March 2010 Issue. Accessed from:
https://hbr.org/2010/03/managing-yourself-keeping-your-colleagues-honest
McNamara C ( ) Complete Guide to Ethics Management: An Ethics Toolkit for Managers.
Accessed from http://managementhelp.org/businessethics/ethics-guide.htm on the Web
NCOSS (2012) Council of Social Service of NSW (NCOSS) Management Support Unit
Information Sheet 31: Ethical Frameworks: Codes of Ethics and Conduct
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Peer work ethical principles
Australia does not have a current nationally agreed set of ethical principles. However,
several have been developed internationally. Three have been included here for you to
consider.
White (2007) developed ‘Ethical Guidelines for the Delivery of Peer-based Recovery Support
Services’. He suggested that there were 18 ethical principles for peer support, as listed below.
Ethical principle
Explanation
1. Gratitude and
service
Carry hope to individuals, families and communities
2. Recovery
All service hinges on personal recovery
3. Use of self
Know yourself; be the face of recovery; tell your story; know when to
use your story
4. Capability
Improve yourself; give your best
5. Honesty
Tell the truth; separate fact from opinion; when wrong, admit it
6. Authenticity of
voice
Accurately represent your recovery experience and the role from
which you are speaking
7. Credibility
Walk what you talk
8. Fidelity
Keep your promises
9. Humility
Work within the limitations of your experience and role
10. Loyalty
Don’t give up; offer multiple chances
11. Hope
Offer self and others as living proof; focus on the positive – strengths,
assets and possibilities rather than problems and pathology
12. Dignity and
respect
Express compassion; accept imperfection; honour each person’s
potential
13. Tolerance
‘The roads to recovery are many’ (Wilson, 1944); learn about diverse
pathways and styles of recovery
14. Autonomy and
choice
Recovery is voluntary; it must be chosen; enhance choices and
choice making
15. Discretion
Respect privacy; don’t gossip
16. Protection
Do no harm; do not exploit; protect yourself; protect others; avoid
conflicts of interest
17. Advocacy
Challenge injustice; be a voice for the voiceless; empower others to
speak
18. Stewardship
Use resources wisely
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CODE OF ETHICS
For Georgia Certified Peer Specialist Project
www.gacps.org/CodeOfEthics.html
The following principles will guide Certified Peer Specialists in their various roles,
relationships and levels of responsibility in which they function professionally.
The primary responsibility of Certified Peer Specialists is to help individuals achieve their
own needs, wants, and goals. Certified Peer Specialists will be guided by the principle of
self-determination for all.
Certified Peer Specialists will maintain high standards of personal conduct. Certified Peer
Specialists will also conduct themselves in a manner that fosters their own recovery.
Certified Peer Specialists will openly share with consumers and colleagues their recovery
stories from mental illness and will likewise be able to identify and describe the supports
that promote their recovery.
Certified Peer Specialists will, at all times, respect the rights and dignity of those they
serve.
Certified Peer Specialists will never intimidate, threaten, harass, use undue influence,
physical force or verbal abuse, or make unwarranted promises of benefits to the
individuals they serve.
Certified Peer Specialists will not practice, condone, facilitate or collaborate in any form of
discrimination on the basis of ethnicity, race, sex, sexual orientation, age, religion, national
origin, marital status, political belief, mental or physical disability, or any other preference or
personal characteristic, condition or state.
Certified Peer Specialists will advocate for those they serve that they may make their own
decisions in all matters when dealing with other professionals.
Certified Peer Specialists will respect the privacy and confidentiality of those they serve.
Certified Peer Specialists will advocate for the full integration of individuals into the
communities of their choice and will promote the inherent value of these individuals to those
communities. Certified Peer Specialists will be directed by the knowledge that all individuals
have the right to live in the least restrictive and least intrusive environment.
Certified Peer Specialists will not enter into dual relationships or commitments that
conflict with the interests of those they serve.
Certified Peer Specialists will never engage in sexual/intimate activities with the
consumers they serve.
Certified Peer Specialists will not abuse substances under any circumstance.
Certified Peers Specialists will keep current with emerging knowledge relevant to
recovery, and openly share this knowledge with their colleagues.
Certified Peer Specialists will not accept gifts of significant value from those they serve
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Values and ethics of mental health recovery and peer support
Mary Ellen Copeland and Sheryl Mead (2004) identified the following 15 values and ethics
for peer support work.
1. There is hope. A commonly held belief has been that people who experience certain
kinds of ‘symptoms’ can never get well, and will probably worsen over time. However, it
is now known that people can and do get well and go on to do things that they want to do
with their lives (Copeland; 1991; Ralph & Corrigan, 2005).
2. Self-determination, personal responsibility, empowerment and self-advocacy are vital to
recovery (Copeland, 1991).
3. Treating each other as equals with dignity, compassion, mutual respect and
unconditional high regard is essential.
4. We must afford all people unconditional acceptance as they are, as unique, special
individuals, including acceptance of diversity with relation to cultural, ethnic, religious,
racial, gender, age, disability and sexual preference issues.
5. There are ‘no limits’ to recovery.
6. Recovery and peer support are about choices and options, not final answers.
7. Participation in all activities is voluntary.
8. Each person is the expert on himself or herself.
9. Clinical, medical and diagnostic language are to be avoided.
10. The focus is on working together to increase mutual understanding, knowledge and
wellness.
11. Peer support and recovery initiatives are adaptable to anyone’s personal philosophy.
12. The emphasis is on strategies that are simple and safe for anyone and away from
strategies that may have harmful effects.
13. Responses to difficult situations need to be ‘normalised’.
14. The focus must be on strengths, and away from perceived deficits (Rapp, 1998).
15. The body of knowledge is always expanding and is infinite.
Activity
Which of these three lists most closely fits for your work role and organisation? (If your
service does not have a list which ones do you think are most important to your
organisation?)
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Workplace Dilemmas
An ethical dilemma is a complex situation that involves a mental conflict between moral
principles or competing values. Two or more options clash and whichever is selected
generally other values can’t be met.
Some common excuses for avoiding or not making a hard ethical decision:






It’s standard practice –this is how we do it here
No one is going to know.
It’s not a big deal – discounting or minimising the consequences
It’s not my responsibility- ignoring things or failing to speak up even when you now it
is wrong
I want to be loyal and not rock the boat
We don’t have the time, dollars or staff to do this differently
(loosely adapted from Gentile 2010)
Closing your eyes or ignoring an ethical dilemma is insufficient and unethical.
For as we know…
“The only thing necessary for the triumph of evil is that good men should do nothing.”
-Edmund Burke
Consulting a Supervisor – about workplace dilemma
When neither the code of conduct nor code of ethics clarifies a workplace ethical dilemma
then it is important to consult your supervisor and organisational policies. Be open and
honest and seek assistance early.
If during the process you identify information or a better process that could be helpful to
other workers you should also report that to your manager
What are some of the strategies that you could suggest to your supervisor to improve legal
compliance or ethical practice? What other suggestions can you offer?
 Training for workers;
 Forms to declare conflicts of interest,
 A notice board on recent changes to legislation,
 Elected representatives to sit on policy review groups



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Ethical decision-making
Sometimes situations arise where there are at least two sets of values involved, and you are
being asked to decide which is the more important. As a peer worker you want to work
collaboratively with the consumer or carer to safeguard their rights; however, sometimes the
best way of doing that is not clear. Ethical dilemmas can be seen in terms of:



competing values – for example, working with a consumer or carer who is abusing
drugs raises their right to self-determination versus the value of protecting human life
and health
multiple sets of competing values – the consumer’s priorities may be different from
those of their family or carers; for example, a consumer’s parents urge you to request
a community treatment order because they believe you can breach their son if he
goes out socially in situations where he abuses alcohol
values dilemma – where the worker’s values conflict with those of a carer or
consumer; for example, a carer makes decisions based on religious beliefs that are
different from yours.
Expert support for ethical decision-making
If you have an ethical dilemma, or would like some assistance in making a good decision,
talk to you supervisor or contact the St James Ethics Centre’s free, confidential and nonjudgemental ‘Ethi-Call’ ethics counselling service on 1800 672 303 to speak with one of
their trained ethics counsellors.
Ethical decision-making models
Model 1
This model has been adapted from the NCOSS (2012) ‘Ethical Decision Making Information
Sheet’ (http://ncoss.org.au/projects/msu/downloads/resources/information%20sheets/13ethical-decision-making-2012.pdf) and the St James Ethics Centre webpage ‘What is ethics’
(www.ethics.org.au/content/ethical-decision-making).
The model includes the following steps.
1. Stop and think
2. Review
3. Make a list of options
4. Consult
5. Choose a course of action
6. Implement your decision
7. Evaluate your decision
1. Stop and think
2. Review
3. Make a list of options
4. Consult
5. Choose a course of action
6. Implement your decision
7. Evaluate your decision
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Action
 Stop the momentum of events long enough to permit calm analysis.
 Effective decision-making is more likely to occur when the mind is alert
and free from pressure.
Questions
 Is it an ethical issue (as opposed to a legal or technical decision,
practice issue, organisational issue, complaint, etc.)?
 Is this my/our decision?
Action




Questions
 What ethical guidelines are relevant to this situation?
 What is the key ethical issue?
 What values are involved? What values are in conflict?
Action
 List the options and develop actions.
Questions
 What are the most important principles?
 What are the risk/benefits if these principles are/are not acted on?
Action
 Discuss and review with colleagues, supervisors and other stakeholders.
 Compare with similar cases where a reasonable precedent has been
established.
Questions
 Have I considered all relevant perspectives?
 Have other options been suggested?
Action
 Reasoning, analysing and balancing information from a range of sources are
important in values-based practice and ethical decision-making.
 Assess what course of action will produce the most good and the least
harm.
 Review the options taking, into account respect for the rights and
dignity of all stakeholders.
Questions










Reflection
You might also want to reflect on the following.
 Would I be happy for this decision to be on the public record, and for
my actions to be open to public scrutiny?
 How would I feel if someone did this to me?
 What would happen if everybody did this?
 How would I feel if my actions were to affect my family (child, partner or
parents)?
 How would the proposed course of action affect my character and the
reputation of my organisation?
 Have I considered that the ends may not justify the means?
1. Stop and
think
2. Review
3. Make a
list of options
4. Consult
5. Choose a
course of
action
6. Implement
your
decision
7. Evaluate
your
decision
Gather information about values and facts – this is critical to the process.
Workers need to be aware of the values and the diversity of those values.
Review the available, relevant information.
Consider both your personal and the organisation’s values and assumptions.
Is it legal?
Is it consistent with my role and boundaries?
Does it meet the ethical principles?
Is it consistent with human rights and other relevant rights?
Whose values and preferences does it address?
Whose values and preferences will not be met?
Is it consistent with the organisation’s policy and procedures?
Will I feel the same about this situation if I think about it a little longer?
If this were common knowledge, would I behave differently?
Am I comfortable with this decision?
Questions  Did the decision address the needs and concerns of all stakeholders?
 If it happened again, would I do anything differently?
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Model 2
This model was developed by William White in ‘Ethical Guidelines for the Delivery of Peerbased Recovery Support Services’ (www.bhrm.org/recoverysupport/EthicsPaperFinal6-807.pdf).
It focuses on risks; however, in ethical decision-making, considering strengths and wellbeing
or thinking in terms of safety can also be useful, and more in line with recovery principles.
A peer-based model of ethical decision-making
A model of ethical decision-making is simply a guide to sorting through the complexity of a
situation and an aid in determining the best course of action that one could take in that
situation. White proposes that those providing recovery support services ask three questions
to guide their decision-making.
Question 1: Who has the potential to be harmed in this situation, and how great is the risk
of harm?
This question is answered by assessing the vulnerability of the parties listed in the table
below and determining the potential and severity of injury to each. Where multiple parties
are at risk of moderate or significant harm, it is best not to make the decision alone but to
seek consultation with others given the potential repercussions of the situation.
Significant risk
of harm ( ✓ )
Vulnerable party
Moderate risk
of harm ( ✓ )
Minimal risk of
harm ( ✓ )
Individual/family being served
Recovery coach (peer worker)
Service organisation
Recovery support services field
Image of recovery community
Community at large
Question 2: Are there any core recovery values that apply to this situation, and what course
of action would these values suggest be taken?
X
Core recovery value
Suggested course of action
Gratitude and service
Recovery
Use of self
Capability
Honesty
Authenticity of voice
Credibility
Fidelity
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Humility
Loyalty
Hope
Dignity and respect
Tolerance
Autonomy and choice
Discretion
Protection
Advocacy
Stewardship
Question 3: What laws, organisational policies or ethical standards apply to this situation,
and what actions would they suggest or dictate?
Question 4: Where risk of injury is great to multiple parties, document:
What I considered:
Who I consulted:
What I decided and did:
The outcome of the
decisions I made and
actions I took:
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Model 3: Strengths and Concerns Ethical Decision-Making
Name of worker
Position
Date
What is the issue that needs
a decision?
What are the key points?
What are the ethical issues
or concerns?
Who will make the decision?
(will it be Supported? Collaborative? Individual?
Organisational? )
Names of others involved and their role
Name
Role
Needs
Values
Fears
What is the decision that had
been made?
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Type of Risk
Stakeholders
Safety strategy
Eg Dignity of Risk re getting a job in
hospitality
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M
L
Community
H
Organisation
Peer worker
Concerns
Ratings: N=None
L=low M=medium
H=high risk
V=very high
Carer, Family
Friend
Rating
Consumer
Consider both likelihood and seriousness
M
N
65
List possible safety strategies or
considerations to keep people safe and
promote ethical decision-making
Make contact with AA buddy daily, meet with
support worker weekly, visit GP to discuss
options, try to get shifts in coffee shop not bar
Reviewing the Ethical Basis of the Decision
Recovery principles checklist
Is the solution
compatible?
1. Hope
 Yes
 No
2. Self-determination, empowerment,
and self-advocacy
 Yes
 No
3. Power sharing and equality
 Yes
 No
4. Fosters open and mutual
understanding and trust
 Yes
 No
5. Mutual respect and dignity
 Yes
 No
6. Empathic, warm and compassionate  Yes
 No
7. Supports wellness and recovery of
all parties
 Yes
 No
8. Individual and cultural acceptance
 Yes
 No
9. Values uniqueness and individuality
 Yes
 No
10. Places no limits on recovery
 Yes
 No
11. Promotes choice and consent
 Yes
 No
12. Involves no coercion
 Yes
 No
13. Acknowledges lived experiences and
 Yes
person as expert in own life
 No
14. Recovery and strengths language
 Yes
 No
15. Strengths focused and builds
capacity
 Yes
 No
16. Initiatives are flexible and adaptable
to specific situation
 Yes
 No
17. Upholds rights
 Yes
 No
18. Safety focussed
 Yes
 No
19. Life is dynamic and changing and
can be transforming
 Yes
 No
20. Holistic view of person and life
 Yes
 No
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Comments Reviewing Ethical Solutions:
Ethical checklist
Autonomy – “Does it respect
choice and self
determination?”
 Yes  No
Does it consider all key
 Yes  No
stakeholders (including
extended family or community
where appropriate)?
Beneficence - “Will it bring
good and benefit to the key
people ?”
 Yes  No
Does it consider needs?
 Yes  No
Non Maleficence - “Is it not
harm”
 Yes  No
Does it consider values?
 Yes  No
Fidelity - “Is it open, honest
and does it maintain trust?”
 Yes  No
Does it consider fears?
 Yes  No
Justice – “Is it fair”
 Yes  No
Is the solution rights based?
 Yes  No
Is it recovery focussed?
 Yes  No
Is it trauma informed?
 Yes  No
Was the solution
collaboratively developed?
 Yes  No
Is it free of bias? (not
 Yes  No
influenced by power dynamics
or prejudice)
Are there any conflicts of
interests in managing this
situation?
 Yes  No
Is it legal?
 Yes  No
Does it consider culture?
 Yes  No
Is it evidence based?
 Yes  No
Comments
©2013 Winangay Resources used with permission
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Ethical dilemmas
Sometimes your personal values and principles do not match the values and principles of
the people you are working with or your program or organisational values.
To complicate matters, ethical dilemmas rarely arise in the form of stark choices between
absolute right and absolute wrong. There are usually shades of grey and competing values.
These situations can cause a worker a great deal of inner conflict and concern.
Common ethical dilemmas encountered within the workplace include issues relating to
friendship, dual relationships, gift giving and sexual behaviour. Workers should be
particularly aware of issues relating to professional boundaries.
It is important that you acknowledge such situations and discuss them with your supervisor
or mentor, to help you make a decision about how you can best deal with the situation.
Activity
In groups, consider the statements below, and apply an ethical model of decision-making.
Would you or could you:
 Give a consumer or carer your colleague’s home telephone number?
 Come to work drunk or hungover?
 Come to work dressed in your beach clothes?
 Have a relationship with a carer/consumer?
 Take money from a carer for petrol?
 Get a second job that starts at 3pm?
 Leave a consumer’s or carer’s file in the car?
 Lend money to a consumer or carer?
 Accept a present from a carer or consumer?
 Recommend a relative’s or friend’s business to a consumer or to their carer?
 Photocopy a large number of personal documents during work, or after hours?
 Use the organisation’s car to run your own personal errands?
 Ostracise or spread rumours about a colleague?
Notes:
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Common ethical dilemmas for peer workers
This section explores a number of common ethical dilemmas. However the list is not all
inclusive and many other situations can result in dilemmas. If one arises for you refer to
service policy and procedures and consult with your supervisor.
Boundaries
• Dual Relationships
• Boundary Crossing
and Violations
Reporting
Unethical
Conduct In
Others
Confidentiality
Common Ethical
Dilemmas for Peer
Workers
Conflicts of
Interests
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Informed Consent
Mandatory
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69
Boundaries and limits
A boundary is the limit of an area or a dividing line. Boundaries are what we call the ‘limits’
we place around a relationship in order to protect ourselves and other people and to
separate ourselves from others. Like everything else in peer work there are very diverse
perspectives on boundaries.
For some people boundaries are firm and inflexible: they are used by professionals to keep
people in an ‘appropriate’ relationship to their professional role. Others feel that traditional
‘professional boundaries’ are too restrictive to the peer worker. It is thought that they might
distance people and hamper the authenticity required for peer work. They don’t see
traditional boundaries as appropriate in peer work, as ‘we don’t have fixed roles with each
other’ (Copeland & Mead, 2013).
Some prefer the term ‘limits’ rather than boundaries. Rather than arbitrary blanket
boundaries applied to everyone, they prefer limits to be negotiated in each situation.
Generally, boundaries and policies are needed for clarity. However, wherever possible, it is
thought negotiation of limits, along with role modelling of boundaries, helps builds trust.
The key is to talk honestly and check that the boundaries and limits used create ‘greater
safety for both parties’.
‘Boundaries are influenced by where you are, who you are with, and the cultural
backgrounds of yourself and others’ (Henze & Sweeney).
Some organisations require peer workers to sign codes of conduct that include set
boundaries, which they believe make for safe workplace practice. Organisations create
boundaries to protect the rights of everyone who works at and uses the service.
Woodhouse and Vincent (2006) recommend that steps be taken to ensure that the
boundaries between peer workers and carers/consumers are ‘carefully drawn and
sensitively enforced’, in order to strengthen awareness that the relationship is goal focused
rather than friendship oriented.
You should clarify what is expected at your workplace with regard to boundaries and how
they should be communicated to workers and program participants. You will need to clarify
whether these are the same for all workers, or whether your workplace acknowledges the
unique differences of the role of peer workers. In some cases, especially with new peer work
programs, some negotiation and advocacy at your workplace may be necessary.
Regardless of whether you believe in established or negotiated boundaries, it is important to
ensure that the rights (including privacy) of people accessing the service are protected.
Why are boundaries important?
 They demonstrate respect for others
 They promote honesty
 They foster trust between individuals
 They maintain the safety and rights of everyone involved
 They clarify roles and expectations
 They demonstrate professional integrity (Henze & Sweeney).
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Professional or Role boundaries
Professional or Role boundaries between a worker and a service user commonly relate to
things like physical contact (touch, hugs), giving and receiving gifts, appropriate clothing, use
of language, relationships or contact outside work, language, self-disclosure and so on.
Explicitly stated boundaries exist to protect consumers from misuse or abuse by workers
and to establish the ‘professional nature’ of the relationship (Borys, 1994; Brown, 1994;
Gabbard, 1994; Pope & Vasquez, 1991). However, when working from principles of
mutuality, reciprocity and equality, some traditional professional boundaries don’t apply,
or are blurred. It is important to be clear about what boundaries apply in your workplace and
for your work role. Make sure you are familiar with relevant policies and procedures and with
your duty statements or job description.
Activity
What boundaries or limits are required by peer workers in your workplace?
If you are not sure whether you are crossing a boundary or limit, what should you do?
How comfortable are you at negotiating boundaries or limits?
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Dual (or multiple) relationships
Dual (or multiple) relationships refers to any situation where multiple roles exist between a
worker and a consumer. Examples of dual relationships are when a consumer is also a
member of the same club, a neighbour, a team member, friend, family member, co-worker
and so on. It might involve playing in a sports team, attending a party, attending church or
attending the gym at the same time.
In rural communities there is a smaller pool of mental health staff and therefore an increased
likelihood of personal encounters and dual relationships. Dual relationships involving personal
and professional involvement are highly likely and often inevitable (Brownlee, 1996).
Simple interactions, such as a chat on the street or even a cup of coffee (as cited by Corsini,
2005) may well have influence over both individuals’ mindsets, thus in the counselling
profession this is generally considered unacceptable. Such events can induce emotional
attachment, which can be misread and damaging to counselling goals and/or outcomes.
However, while not encouraged, dual relationships are sometimes acceptable in certain
circumstances (such as in rural settings) and not seen as unethical.
To address these difficulties, workers should confirm with their supervisor so they have clear
and realistic boundaries with respect to their professional relationships with the people they
work with.
One of the more difficult ethical dilemmas occurs when a worker forgets that they are in a
professional relationship and becomes over-involved with a person and potentially violates
their rights. This becomes particularly problematic when professional relationships inevitably
have to end and the worker cuts off all contact.
Care also needs to be taken to ensure that role conflict or overload doesn’t occur, and that
worker self-care is not compromised.
Professional boundaries need to be observed to ensure that professional standards are
maintained. Professional boundaries do not mean avoiding another person and their
problems. Acting professionally helps you to deliver quality care to someone whom you may
not like personally.
Ethical issues concerning boundaries and dual relationships are among the most complex
and difficult for peer workers. Other than explicit prohibitions concerning sexual contact with
consumers and carers, many of the boundary situations that arise are difficult to assess
ethically. What constitutes a boundary violation in one situation may be ethically acceptable
in a similar situation in a different location or service. (Caldwell, 2005).
It is important that standards and policy guidelines provide workers with an understanding of
what constitutes boundary crossings, boundary violations and dual relationships in that
particular workplace, so workers can discern not only the highest standards for ethical
behaviour, but the highest standards for practice.
What dual relationships do you or could you have?
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Boundary crossings
Boundary crossing is blurring or bending a boundary in a way that does not cause any harm
or exploit another person. This might occur on a situation-to-situation basis. For example,
you might cross a boundary for cultural reasons.
Boundary crossings are not generally harmful to service users, and can actually be helpful.
They involve some flexibility or relaxation of a ‘professional boundary’. Some approaches or
programs may require them; for example, home visits mean meeting consumers outside the
office. Boundary crossing may also include hugs, bartering, small gifts or more personal selfdisclosure and story sharing.
Boundary crossings are not necessarily unethical, but they could be.
Boundary violations
Boundary violations are generally clear-cut. They are serious breaches of a person’s rights
that could harm and/or exploit them, particularly a person who has less power or control in a
situation. Examples include: sexual advances (including flirting), sexual relationships,
inappropriately intimate relationships, verbal aggression, put-downs, physical aggression,
violence, stalking, pressuring (coercion), bullying, harassment, and borrowing or lending
money.
Boundary violations occur when workers cross the line of decency and violate or exploit
service users. They are harmful to the service user and always unethical.
Boundary crossings might be defined as ‘bending’ the boundary, while boundary violations
are breaking the boundary and damaging the relationship.
Signs of boundary violations
While in isolation none of these behaviours may indicate a boundary violation, they could be
indicators of a potential problem.
Indicators can include a worker:








developing strong romantic feelings for a consumer/carer
spending significantly more time with one consumer/carer than others
having very personal conversations with a consumer/carer
receiving calls at home from a consumer/carer
giving and receiving gifts
doing things for a consumer/carer rather than enabling them to do it for themselves
believing only they can offer the right services to a consumer/carer
physically touching a consumer/carer.
Also be mindful of times when you feel responsible for others’ circumstances. If we are
feeling compelled to respond, we may be enmeshed – that is, our boundaries may be
blurred with theirs. We need to remember that the person is responsible for themselves and
although they may be feeling powerless it is not for us to rescue them. This kind of boundary
violation is not helpful for enabling self-determination.
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Some guidelines for avoiding boundary violations
Finance: No lending, borrowing or receiving of money – not only from people you support,
but also from other people within the organisation.
Conflicts of interest: Openly declare any conflicts of interest. A conflict of interest is when
your judgement or actions might be influenced, or might be seen by others to be influenced,
by personal or family interests – regardless of whether you are influenced or not. For
example, recommending a family member’s business, offering work to a relative, and
influencing a decision that could lead to you receiving a pay rise or bonus are all conflicts of
interest.
Gifts: Do not accept gifts of any significant value. The amount will depend on your
organisation’s policy, but it is often limited to $20–$50.
Sexual contact: No sexual or inappropriately intimate contact with people you support,
including dating and other types of intimate relationships.
Home and work boundaries: Work issues should not intrude on your home and family life.
People you support should not visit or stay in your house. Phone contact should be within
work hours and on work phones where possible. Your private contact details should remain
private.
Power differences
In community-managed mental health work, the framework for trauma-informed recovery
orientation recognises the impact of power differences in service settings. This maximises a
human-rights approach, promoting self-determination, supporting autonomy and
empowering consumers to learn about the nature of their condition and to take responsibility
for their own recovery.
Some services still mirror the power and control experienced in abusive relationships that
people may have experienced in the past or in the present, making recovery difficult and
escalating the risk of re-traumatisation. This is not ethical, and may require advocacy to
bring needed change.
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Activity - Using the list of work situations below, classify each of these by placing a tick in the column that best fits
Boundaries
Keeping Crossing Violating
Classify each item below by placing a tick in the correct column
the boundary the boundary the boundary
1. Taking a person that you are providing peer support to home to live with you
2. Providing information about rights and responsibilities
3. Chatting at your local school fireworks night
4. Writing a song or poem together
5.
6.
7.
8.
9.
Agreeing to provide peer support to someone you used to date
Having sex with a person you are providing peer support to
Coming in to work when you are sick, because people need you
Lending or borrowing money to or from a person you are providing peer support to
Talking with your partner at home about your work, and mentioning the name of someone you are
supporting
10. Explaining informed consent
11. Giving a welcoming hug to a person you have known for a while
12. Meeting at the beach for a weekly appointment, and going for a walk as you talk
13. Buying a lottery ticket together
14. Accepting a tin of homemade biscuits
15. Buying drugs or alcohol for a person you are providing peer support to
16. Dating a person you are providing peer support to
17. Recommending your brother-in-law’s business to a person you are providing peer support to
18. Accepting a thank you card from a person you are providing peer support to
19. Letting the air out of a co-worker’s car tyre on April Fools’ day
20. Accepting an expensive gift at Christmas from a person you are providing peer support to
21. Not maintaining confidentiality (except in the special situations mentioned earlier)
22. Sharing or using drugs and alcohol with a person you are providing peer support to
23. Lending a CD to a person you are providing peer support to
24. Giving your home phone number to a person you are providing peer support to
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Boundaries
Keeping Crossing Violating
Classify each item below by placing a tick in the correct column
the boundary the boundary the boundary
25. Providing peer support at work for a member of your own family
26. Arranging to go out together on a Saturday night as part of a group outing
27. Teaching the person you are providing peer support to how to knit while you talk
28. Giving the person a hug when they are crying or distressed
29. Working through your lunch break
30. Going on holidays together with a person you are providing peer support to
31. Accepting a homemade birthday cake from a person you are providing peer support to
32. Giving a person you are providing peer support to a lift in your personal car
33. Having a coffee together when you meet by accident at the shopping centre on the weekend
34. Buying everyone an ice cream on an outreach visit
35. Accepting a thank you bunch of flowers from a grateful person who had a bad week and valued your
support
36. Sponsoring a person you are supporting for a local charity fun run
37. Asking a person you are supporting if they want to sponsor you for a local charity fun run
38. Sitting for an artistic portrait by a person you are providing peer support to
39. Taking home stationery from work
40. Publishing a sector research paper together with a person you are providing peer support to
41. Staying back late at work
42. Accepting a request to be ‘friends’ on Facebook with a person you are providing peer support to
43. Borrowing $20 from petty cash until you get paid the next day
44. Sharing some of your medication with a person you are supporting who uses the same medication
because they have run out
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Peer work experts have the following advice about boundaries:
 Better to be safe than sorry – always err on the side of caution
 If in doubt about the boundary, take it up the line – consult your supervisor or another
relevant person
 Pay particular attention to the meaning for the other person
 Consider the context. For example, whether hugging a person who is crying or
distressed is appropriate might change depending on your and their genders,
sexualities, cultures, religions and so on.
Confidentiality
The National Mental Health Consumer & Carer Forum Position Paper on Privacy,
Confidentiality & Information Sharing (2011) includes the following definitions:
Privacy relates to an individual’s ability to control the extent to which their personal
information, enabling identification, is available to others.
Confidentiality is an obligation that restricts an agency from using or disclosing any information
in a way that is contrary to the interests of the person or organisation that provided it.
Privacy and confidentiality are enforced by legislation and underpinned by professional
codes of conduct to protect mental health information from unauthorised disclosure.
Confidentiality of both verbal and written communication requires a worker to keep people’s
personal information private and secure, treating it and the person with respect. It is
fundamentally about protecting a person’s privacy rights. Confidentiality is ethically and
legally required and protects the rights of the consumer, carers and others.
When you begin working with a new consumer or carer you need to inform them about your
organisation’s confidentiality policy and the limits to confidentiality.
Limits of confidentiality
There are some situations that are outside the limits of confidentiality.
1. If, for example, a person is at risk of harming themselves or another person (such as
through suicide, weapons, threats, violence and so on), you are required to report
this by informing a supervisor or manager.
2. If you have concerns about the neglect or abuse of a child or other vulnerable
person, you are also required to report this.
3. You also have a legal responsibility to report any crime you become aware of (for
example, if you are made aware of a murder).
4. If a court subpoena is presented to you or your organisation, then the information
requested must legally be released.
You need to be clear, and the person needs to be clear, about who you will be sharing their
information with. In most organisations this generally includes your supervisor and other
team members. If this is true at your workplace, the person needs to understand that you will
be sharing their information in this way. They cannot ask you to break your code of conduct.
What is recorded or shared and how at your workplace can be clarified with your supervisor.
The trick is to work within the code of conduct, boundaries and limits required by your
organisation’s policies and procedures.
Remember the golden rule: When in doubt check with a team leader, experienced
worker or your supervisor.
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Informed Consent
Informed consent is an important ethical and legal responsibility for workers.
Information should not be released without permission or ‘informed consent’. Informed
consent means ensuring that the person really understands what they are agreeing to and
any consequences (both good and bad) of their decision. When you started your
employment you would have been given the policies and procedures relating to privacy and
confidentiality for your organisation. If you are not aware of these, please discuss this with
your supervisor. They should not only tell you what to do with regard to confidentiality, but
also how to do it, as well as any forms needed before you release information.
Information needs to be ethically gathered. You should always explain the purpose for
collecting any information, as well as how it will be used and securely stored. You must
explain the benefits and risks to the person of supplying the information, as well as the risks
of not supplying it. You also need to inform them of the limits of confidentiality.
It is important that the consumer or carer understands all relevant facts about any service or
program you are offering, and any consequences of the decisions they are making or
consent they are giving. It should be seen as a human right and an ethical requirement to
ensure that people have a full understanding of their choices in disclosing information or
accepting services.
The worker also needs to ensure that the consumer or carer understands all the potential
benefits as well as risks or adverse effects. Giving informed consent requires ‘capacity’,
which refers to a person’s ability to make their own decisions. A person may lack capacity in
some areas, but still be able to make other decisions.
These may be small decisions, such as what to do each day, or bigger decisions like where
to live or whether to have an operation or join a program.
An important aspect of the consumer–worker or carer–worker relationship is the
development of trust and rapport. A premise for creating trust and rapport is good
communication. Good communication is based on honesty. Thus, informed consent is not
only an ethical requirement for the worker, but also a condition to achieve the collective
goals of the relationship.
Consumers and carers are entitled to know about all matters that affect them. They deserve
to know the likelihood of harm (physical or mental) that could result from treatment, the
possibility of side effects, the probability of success for treatment, the limits of confidentiality
and the likely duration and cost of treatment (Corsini, 2000).
An effective way to ensure that people are adequately informed is to produce a standard
information disclosure statement (a contract), which comprises the worker’s and the
consumer’s or carer’s responsibilities and rights. A well-defined statement will provide
valuable information about areas such as confidentiality, record keeping, treatment,
management, relationship boundaries and more.
Mandatory reporting
Mandatory reporting (or duty to warn) is one of the most contentious topics in mental health.
In some situations a worker has a legal obligation to make a ‘mandatory report’, such as in
cases of child abuse or neglect. However, workers don’t always find that easy. Mandatory
reporting often requires breaking consumer/carer confidentiality. This is usually in order to
protect the consumer, the carer or the community as a whole, when a consumer/carer poses
a threat to their own safety or the safety of others.
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When laws and values conflict, how will you deal with this inconsistency?
Most cases of information disclosure in mental health work benefit the consumer/carer, such
as sharing information with colleagues or supervisors in order to obtain an alternative
opinion or perspective.
However, mandatory reporting requires that the best interests of the community or society
are given precedence over a consumer’s or carer’s interests. A common basis for reporting
is the imminence of danger for the individual (self-harm) or others (such as their partner).
A worker’s values must defer to their legal obligations. To fail to report suspected abuse is to
break the law and has consequences including large fines and other punishments.
All workers should be regularly trained in mandatory reporting and identifying child abuse
and neglect.
Children in the Workplace
To keep children safe from potential abuse anyone working with a child or young person
under 18 years of age must undergo a Working with Children’s’ Check (WWCC) to
demonstrate they have no history of abuse. This task must be undertaken by the
organisation and regularly updated.
Every worker in the organisation needs to be cleared before children are permitted in the
workplace or a new children’s program begun.
This can cause a challenge if someone you are working with arrives for an appointment with
their children. As a result most organisations have a policy and may undertake WWCCs in
case an issue or situation arises.
For example many young carers are under 18 years. They may attend to receive services
themselves or to accompanying the person they care for. Occasionally a worker may bring
their own children to work for the day or a meeting.
All organisations should have policies and procedures addressing children in the workplace
and making it clear how to manage this.
What ethical dilemmas in relation to children might you encounter in your work role and how
would you resolve them?
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Conflicts of interest
What is a conflict of interest?
[A conflict of interest is] a situation in which a person has a private or personal
interest sufficient to appear to influence the objective exercise of his or her official
duties (C MacDonald, 2002, Journal of Business Ethics 39:1–2, pp. 67–74).
A conflict of interest occurs when a person allows a personal interest to clash with a
professional duty.
It is quite possible that in our work life there will be conflicts between our own personal
values, those of our family and friends, our professional values and the values or policy of
our organisation.
When there is conflict in the above interests, it is important to recognise them and to resolve
the conflict in an ethical manner. When personal values and interests are pursued during
work time, or when you are using information only accessible to you as a worker for the
benefit of yourself, family or friends, a conflict of interest exists.
A conflict of interest refers to a conflict between someone’s private interest and their official
duty.
Conflicts of interest include:
 accepting gifts, favours or bribes for doing your work duties
 improper use of official or personal information (e.g. leaking tender information)
 giving favours or special services to friends or relatives
 outside employment or outside activities that interfere or conflict with your ability to
perform your duties in an effective and professional manner
 membership of an organisation, political group or board that interferes with you
professionally performing your duties
 money-related conflict (e.g. charging the organisation for dubious services).
Identifying a conflict of interest
The following questions can help you to identify whether a conflict of interest exists.
 Can I or my family, friends or business associates benefit directly from this situation?
 Would a fair and reasonable person in this same position make the same decision?
 Have I considered all options on an equal basis?
 Would my actions withstand public scrutiny?
 What is my duty as a professional worker?
 Have I discussed this with my supervisor?
Resolving a conflict of interest
Where you think a private interest could be influencing a decision or action of yours, it is
important to immediately discuss this with your supervisor or manager.
Wherever possible, ensure that your behaviour is transparent, and avoid or remove yourself
from the conflict of interest. As soon as you identify a conflict of interest you should declare it
to your supervisor and provide all relevant details so they can impartially resolve the
situation.
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Resolving a conflict of interest may include:
 rearranging your duties in relation to this conflict
 discontinuing your private association or interest
 continuing with your work duties
 having to meet certain conditions.
It is important to reflect on areas that might be potential conflicts of interests. You need to
consider whether your values or actions are in conflict with the organisation’s expectations or
best interests.
It is critical that you discuss any actual or potential conflicts of interest with your supervisor
and together agree on any appropriate actions. You need to do this even if you think the
situation is resolved. For example, if a family member applies for a job and you exclude
yourself from the interview panel (in an attempt to resolve the potential conflict of interest),
unless your supervisor understands your reason, they might misunderstand and think you
are uncommitted.
As a worker, it is not recommended that you have dual relationships. For example, don’t
have a niece, neighbour or gym friend as an employee or service user. However, this may
not always be possible, especially in rural services. If someone you know from outside your
work approaches you for a service, discuss it with your supervisor first.
If a family member or friend asks you to move them up a waiting list or provide them with
additional services, again, tell your supervisor.
Dealing with unethical conduct in others
It is important if you become aware of inappropriate or unethical behaviour that you let your
supervisor know. If it is your supervisor who is acting improperly or concerns you in some
way then you need to go to their boss.
This can be challenging and difficult if you are in a junior position. However, it is ethically
important that services be transparent, as most services are using public money to operate.
If the issue is serious, such as a major work health and safety breach, and the organisation
does not act, then you might need to report it to another body, such as WorkCover or the
Ombudsman’s office.
If it is an unlawful act, then it is very important for the community and the public interest that
you report it. If the situation is serious then it is important that you keep it private and do not
discuss it widely or publicly.
You will be protected against discrimination as a result of your report if:
 your claim is reasonable
 you have reported the matter to an appropriate person
 you have documented it appropriately
 you are not just being mischievous.
Useful further reading
http://legacy.communitydoor.org.au/resources/etraining/units/chccs301a/section2/section2topic08.html
http://legacy.communitydoor.org.au/resources/etraining/units/chccs301a/section2/section2topic11.html
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Activity
In small groups, discuss the ethical dilemmas involved in at least three of the following
scenarios.
Scenario 1
You live in a rural town. One Saturday night you attend your cousin’s 21st. It’s a big affair in
the Land Council Hall. When you arrive you realise you are the peer worker for three of the
guests. You know that they don’t want it known that they are using the service. One of them
approaches you when you are alone at the food table and starts to ask your advice about
some trouble they’ve had this week. Your organisational policy permits you to attend
community events even if consumers and carers are present however it does not allow
personal contact outside of work hours. For family reasons, you can’t leave the party.
Scenario 2
A consumer/carer who has depression and is currently finding life challenging tells you that
one of your co-workers, who you are close to, hasn’t been turning up for appointments, or
comes late and leaves early. You that know this co-worker has also used the work car to run
personal errands which is a breach of organisational policy. You don’t want to get him in
trouble, as he is a friend and you recommended him for the job.
Scenario 3
You live with your partner and two kids in a small rural town. You have been Ameeka’s peer
worker for over a year. She comes in for her regular Thursday appointment and starts to tell
you about a guy she met at a party on Saturday night that she really likes. He has been
staying with her ever since. This morning, while discussing with him her plans for the day,
she mentioned that she was coming to see you, and he told her that he was your stepbrother. You haven’t seen him for a year or so, since your parents split up, and you don’t get
along now. You have heard that many years ago he spent 3 months in jail on drug related
charges but you didn’t know him then.
Scenario 4
You overhear a colleague telling someone on the phone how hot and sexy one of their
consumers is. He doesn’t use her name but he does describe her in fairly graphic physical
detail. You also know that he has been looking at pornography on the work computer at
lunchtime. You are very uncomfortable around him as he makes personal remarks about
your figure or clothes and so you have been increasingly avoiding contact with him.
Scenario 5
Your aunty has unexpectedly dropped in to see you at work. While she is waiting in
reception she asks several people in a loud voice what they are doing there. One of them is
quite uncomfortable and doesn’t answer. Your aunty feels snubbed and makes some
derogatory remarks about ‘stuck-up’ Asian people. The consumer complains to her worker,
who discusses it with your supervisor. Your supervisor has asked to talk to you this
afternoon.
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Scenario 6
Your sister was staying with you on the weekend and got sick. She has been admitted to
hospital and you are left with her four kids. You have no sick leave and have missed a lot of
days lately. You have a number of urgent workplace activities you need to complete and
several people who are expecting to see you.. You are worried that it might be the last straw
with your supervisor if you don’t go in today. You can’t get anyone to take the kids. You
wonder if the supervisor would let you take the four of them to work but you doubt it.
Scenario 7
You are out for drinks with colleagues after work. One of the other workers, who has had a
lot to drink in a loud voice, starts to discuss her frustrating day with one of the consumer’s
carer. She doesn’t mention his name but she does mention other personal details that mean
others could identify who she was talking about..
Scenario 8
Your best friend’s younger brother is living with a ‘mental illness’ and is unhappy with the
service he is with. You have known him since he was little, know him well and really like him,
as he is a nice guy. You regularly attend social activities together. Your friend has told him
about your service and he wants to come. He has the right to attend any service he chooses,
however your service targets people 18 years and older. He won’t be 18 for 6 months but is
planning to say he is 18. You hate conflict and don’t want to tell your supervisor that you
know him. However not telling will breach your service code of conduct.
Scenario 9
Your service is currently recruiting, and you know that one of the applicants has a history of
violence towards women. According to the grapevine he also uses drugs, and occasionally
deals drugs. You have no evidence, and it is not first-hand information. You don’t want to be
unfair, but you also don’t want to work with him.
Scenario 10
You are a peer worker doing a home visit to someone who is becoming increasingly unwell.
During the visit you observe that her 10-year-old daughter is caring for the other three kids,
including making the baby’s bottle and changing his nappies. She is doing it well, and is clearly
experienced. She also makes sandwiches for the older kids and washes up. Her mum makes
no attempt to help, but she is keen to talk to you. You are worried about the welfare of the 10year-old, who seems to be so busy working that she isn’t playing or being a kid.
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Scenario number:
What are the main ethical issues or potential issues?
What is at least one legal factor (eg legislation or common law concern) you would need to consider?
What do you say and do?
Scenario number:
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Scenario number:
Scenario number:
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DAY 4
Approaches to
peer work
Don’t judge or look at my past too hard…
I don’t live there anymore
Recovery is the bridge between
who you were and who you are
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Approaches and frameworks
Using good practice frameworks
Using good practice frameworks and approaches create a strong foundation for peer work
practice. Good practice frameworks assist you to:
 build and maintain trusting working relationships
 empower people to lead their own recovery
 work collaboratively in recovery-oriented ways
 bring about real change
 achieve outcomes
 improve quality of life
 create sustainable gains
 facilitate your own recovery and growth
 develop your emotional intelligence
 make sustainable gains by learning and growing through change
 work effectively with consumers and carers
 implement the principles and foundations of recovery and of recovery-oriented practice.
The only real voyage of discovery exists, not in seeing new landscapes,
but in having new eyes (Marcel Proust).
Activity
What are your strengths? Using the strength cards provided, list 10 of your strengths.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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List three other strengths that you would like to develop.
1.
2.
3.
In groups, discuss how you could develop these strengths.
What is a strength, and what is resilience?
A strength is a skill, ability or talent. It is the capacity or the aptitude that helps you succeed
and to achieve your outcomes.
Resilience is the flexibility and elasticity to spring or bounce back in the face of adversity or
challenges of life.
Some of the main aspects of resilience are listed below, along with the behaviour and
function associated with each aspect.
Aspect of
resilience
Behaviour
Function
Self-reflection
Asking tough questions and giving
honest answers about yourself and the
situations in which you find yourself
Dispels denial and confusion, generates
clarity, serves as a springboard for
taking the necessary action to solve
problems
Independence
Distancing emotionally and physically
from trouble, such as from the
pressures of family, friends and
circumstances
Provides physical and emotional safety
Relationshipbuilding
Connecting with people who matter
Provides friendship, understanding,
material and emotional support, and
sometimes even love
Initiative
Meeting challenges by taking charge
of problems and looking for solutions
Solves problems, generates a sense of
competence and mastery
Creativity
Using imagination in a positive,
satisfying way
Helps express difficult feelings
Humour
Laughing at yourself, finding what’s
funny, even in sadness or pain
Introduces liveliness and lightheartedness in sombre situations
Morality
Doing the right thing, using your
conscience, thinking of others as well
as yourself
Generates a sense of being a good
person, even when surrounded by
badness
Adapted from Wolin, S. (2003). What is a Strength? (The word ‘insight’ which is a red flag for
many consumers has been substituted with the phrase ‘self-reflection’)
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Strengths-based approaches
When you look at the glass pictured here, do you see it as half full or
half empty? In any situation or relationship, we can choose to focus on
the strengths or on the problems and deficits.
The strengths-based model focuses on ‘possibilities rather than
problems, options rather than constraints, wellness rather than
sickness’ (Rapp, 1998). This represents a radical departure from the
deficit-based approaches of the medical model.
Having a strengths-based approach involves training ourselves to be
mindful and to notice the strengths, in order to see the possibilities and potential. It involves
having hope and using encouragement, which actually helps you to grow.
Strengths-based practitioners believe that:
 all people have value and deserve dignity and respect
 all people have strengths, gifts and capacities
 all people can change
 all people have the right to self-determination, freedom and choice
 strengths can grow and develop
 each person is the expert in their own life and situation
 focusing on problems rarely fixes them and takes time, energy and attention
 focusing on strengths makes us stronger and more resilient
 developing our existing strengths often leads us to further growth and development.
Research shows that a strengths-based approach improves self-care, confidence, selfesteem, resilience and other capacities.
Working from a strengths perspective involves two main areas of focus:
 asking strengths-oriented questions; and
 developing practical skills.
Within a strengths-based approach, it is ‘essential to explore, understand and respect the
person’s perspective on the self and the world, the difficulties they are experiencing, and the
meaning they make out of experiences and events’ (Marsh & Dale, 2006). This approach
offers techniques that may be used by workers to assist consumers and carers in setting
goals and facilitating change.
In other approaches, we might ask, ‘What is wrong?’. In a strengths-based approach, we
ask, ‘What is going well?’ ‘What is working?’ or ‘What are you doing well?’
It is important to remember that focusing on strengths does not mean being ‘positive’ all the
time or ignoring reality, safety or risks.
Strengths-based practice offers a genuine basis for tackling so much of what mental health
services try to deliver on a daily basis. It attempts to identify a positive storehouse of
individual resources from which to draw when faced with the negatives that inevitably
accompany the tackling of problems.
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DeJong & Miller (1995) suggest the following strategies when interviewing for strengths:



Exploring for exceptions – times when the problem could have occurred but didn’t
Imagining a future where the problem has been solved, and describing how life would
be different (this is known as ‘the miracle question’)
Assessing coping strategies – asking questions that show how the person managed
despite the presence of the problem.
A true strengths-based approach is one that governs the way we think about people and the
way we go about our work on a daily basis. It is not an option to apply only to certain people
or to particular parts of our practice, but can be the basis for all our actions and interactions.
Appreciative inquiry
Solving problems by focusing on what’s going right.
Developed by David Cooperrider in the 1980s, ‘appreciative inquiry’ is a strengths-based
approach to problem solving. Rather than focusing on what is wrong, it explores what is
working well and works on doing more of that.
Appreciation involves recognising and valuing the contributions and strengths of processes,
things and people. To inquire is to curiously explore and discover in order to develop greater
awareness and understanding. This will assist in identifying new possibilities and directions.
The 4D approach
Appreciative inquiry uses the ‘4D’ approach, as shown below.
You begin by identifying and defining the issue in positive terms eg ways to improve,
accelerate, redirect etc.
Discover
Dream
Design
Deliver
Step 1: Discover
In groups, consider what is the best thing about what has happened in the past or is
happening now. Ask people to tell a story about what they most appreciated or valued or
their greatest highlight about the past or present, and share their thoughts in pairs or small
groups.
For example, ‘What have you enjoyed most about working here?’ ‘What is the greatest thing
you or your team has achieved this year?’ ‘What is the best thing about this organisation?’
‘What are you most proud of?’ ‘What was our greatest promotion strategy?’ Share some of
these stories briefly to the rest of the group.
Then look for trends of themes in the stories and begin to analyse the data you gathered
through the stories. What themes or common ideas did your notice in the stories?
Step 2: Dream
With your group, dream about ‘what might be’. Consider how you can reinforce the strengths
and positives identified in the discovery phase or take them to a new level. Brainstorm
creative and innovative ideas for the organisation to move forward or accomplish something
by building on one of the good points for example. Once the dream or vision is clear then
move on to the next step.
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Step 3: Design
Work out the practicalities required to implement the dream. Identify the systems, processes,
strategies and steps needed to make the vision a reality.
Step 4: Deliver
This involves implementing or delivering the dream. It includes managing contingencies and
working out who will do what, when and where to make the needed changes. It includes
working out the evaluation, review and strategies needed to sustain the changes.
Once completed, the cycle starts again.
Activity
Appreciative Inquiry: In pairs, work through the first two steps of appreciative inquiry ‘discover’ and ‘dream’ - using the following questions:
‘What has been the best thing about doing this course?’ and
‘What would you like to see more of?’
Holistic care
BODY
Individuals
Holistic = Whole person and all parts of their life
Holistic care focuses on all aspects of the person’s
life: physical, mental, social, emotional and
spiritual. These are called the five domains and
when they are healthy and in balance we say there
is social and emotional wellbeing (SEWB).
Holistic care involves considering all five domains
and identifying any needs that the person thinks
are important to them, including:
MIND
EMOTIONS

physical health

mental health

culture/spiritual/religion

legal issues

employment or work concerns

finances

education or training needs

emotional support

accommodation and housing

family and community

positive thinking

relationships
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SOCIAL
SPIRIT
Ecosystems
Networks and connections
From a broader perspective, the holistic approach
can involve looking at the person within the
context of their whole environment, their friends,
family and the broader community.
An ‘ecosystem’ is a community of living and nonliving things that work together.
The ecosystem perspective is an approach that
focuses not just on the individual but also on their
environmental situation, their networks and the people they relate to. In this approach:
 the individual is the centre of the ecosystem
 individuals exist within networks of families, friends, carers and consumers
 families exist within neighbourhoods
 neighbourhoods exist within communities
 communities exist within larger societies or regions.
Each level can impact on the actions, beliefs and choices of the other levels.
In collective cultures, such as Aboriginal and Torres Strait Islander communities, the
emphasis is on being part of a group. Decisions are made in this wider context, so meeting
the individual’s needs means including all those they want involved.
The individual will indicate whether they have close and ongoing relationships with family
and friends or with an identified carer or consumer to consider. With the person’s
permission, working with their broader context can be very helpful and result in better
outcomes for all involved.
Working with family, carer and other networks
Carers, families and friends can be very important allies in the recovery process for
consumers.
Historically in services, carers and families were not considered in collaborative ways.
Parents were blamed for their offspring’s mental illness and, therefore, professionals
did not communicate with families. Very little information was given to family
members regarding medication, symptoms, etc., so families floundered and made
awful mistakes (Drummond, R., n.d.).
Nowadays, however, national policy encourages consumer and carer participation in
planning, program development, delivery, review and evaluation processes.
In NSW a family-friendly mental health service is one that:
 considers the family and carer network throughout the consumer’s journey
 supports consumers to involve their families and carers in the most appropriate way
for both the consumer and the family and carer
 provides general information to families and carers, such as about how the mental
health system works, and factsheets about different mental illnesses, treatments and
so on
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recognises family and carer needs, and provides information and/or referrals to help
them to access support, information, education and advocacy
recognises that the needs of families and carers change over time, and responds to
these changes
recognises their own personal and organisational values, and ensures that they
operate to the benefit and not detriment of families, carers and consumers
(http://www0.health.nsw.gov.au/mhdao/fc_mh_program.asp).
Peer workers should, with the consumer’s permission, try to work collaboratively with their
carers, families and friends in real and innovative ways. The emphasis should be on creating
real networks in communities, including with neighbours, and on developing natural supports
as potential resources for both consumers and carers. Peer workers can also work
separately with carers and families to support their own needs and recovery.
This approach can enhance social inclusion and reduce isolation and segregation. It involves
focusing on community and network solutions rather than adopting a ‘service solution
mentality’.
Person-centred approach
A person-centred approach puts the person at the centre of all decision-making that
affects them.
 It is about having choice and having control
 It is empowering
 It is about encouraging voice and participation
 It is about holistic, person-driven processes.
Some people are uncomfortable with the term ‘person-centred’, as it implies that we are
choosing to place the person in the centre, but it is their life and they are the only one with
the right to place it anywhere. Some people prefer the term ‘person-driven’, as it suggests
that they are driving and setting the direction of their own life.
When a worker treats a person with respect, listens well and seeks to maximise the person’s
choice, control and participation, then the person is naturally at the ‘centre’.
Peer support and recovery
Mental health peer support sits within a ‘recovery and hope’ framework and is one type of
recovery-oriented practice. As such, it aims to meet all the values and principles for
recovery-oriented services outlined in the National Mental Health Strategy’s ‘A national
framework for recovery-oriented mental health services’ (2013).
In addition, peer work has some unique characteristics, values and practices, as discussed
below.
Lived experience
The first is that it values lived experience. This was covered in detail earlier in the course,
and your lived experience has been and will continue to be drawn on during the course
activities.
Peer support is based on the belief that people who have overcome adversity can
provide support, encouragement and hope to others in similar situations (Davidson et
al., 2006).
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The lived experiences of both the person and the peer worker are valued and respected, and
generally provide the initial connection on which to start and build a relationship based on
mutual understanding.
Reciprocity and mutuality
The second unique value is reciprocity and mutuality. This refers to the fact that both people
grow and learn from each other. It is understood that the learning is a two-way street and
that, wherever possible, equality is the aim. With reciprocity both people give and receive – it
is not just one person helping the other.
‘Intentional peer support is about relational change; a commitment to mutuality,
negotiation, noticing power dynamics, and a transparent agreement that both people
are there to learn through the process of their relationship. This starts with the very
first contact and is carried through by an on-going process of self/relational
assessment’ (Mead, S., 2006).
In the peer relationship both the person and the peer support worker are valued and
respected. Both can benefit from the relationship; however, the aim is for the primary
attention and purpose to be supporting the person’s recovery journey. The purpose of the
relationship is to support the person to move forward in their recovery and achieve their
goals, so the focus of the relationship needs to be on the other person’s needs and goals.
Woodhouse and Vincent (2006) recommend that steps are taken to ensure that the
boundaries between peer specialists and service users are ‘carefully drawn and
sensitively enforced’ to reinforce awareness that the relationship is goal rather than
friendship orientated (McLean, J., et al., 2009).
We will look at this quote in more detail later, but the focus in a peer relationship is on
achieving recovery goals. The peer worker has a duty of care and responsibility to ensure
that the relationship is primarily about the person and not the peer worker.
Balancing the relationship is important. While the other person is the focus of attention the
feeling must be of equality rather than a power imbalance. The power dynamics need to be
managed carefully so the person stays in control, directing the process and remaining the
expert in their own life. As a peer support program in New Zealand puts it, it is about ‘withness’, which is about being present ‘with’ or beside the person
(http://www.tepou.co.nz/improving-services/peer-support).
The aim is to avoid slipping into the traditional roles where one person is doing all the
helping and there is no mutual learning or growth.
When there’s no assumption of power over, or expert/recipient, many people become
willing to hear/think/see in new ways (Mead, S., 2006).
Peer support is about supporting the person to move forward on whatever pathway the
person chooses.
Hard times arouse an instinctive desire for authenticity (Coco Chanel).
Honesty and transparency make you vulnerable.
Be honest and transparent anyway (Mother Theresa).
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Being authentic: ‘walking the talk’
A key component of peer work is forming authentic relationships.
This often requires stepping outside your comfort-zone, and making space in your life and
mind, to create authentic relationships with another person. A pre-requisite is a willingness to
be real and not be too busy, too selfish, too filled with ourselves and our purposes to make
space for others. Going through the motions is not enough – we need to engage in real and
meaningful ways.
Relationships are key in recovery. We need to connect with the consumer/carer we are
working with.
To do this we need to reflect on our self and aim for the following:
1. Be genuine, warm and real
 Be yourself (and notice when you’re not)
 Be real and honest
 No pretence, personas, facades or role playing
2. Be self-aware
 Aim to feel secure and accepting of who you are
 No need to falsely build yourself up or pull others down
 Be humble and comfortable in your own body and space
 Be consistent and congruent – match your words and body language
3. Be trustworthy
 Act with integrity and honesty
 Keep your word and do what you say you will do
 Be transparent in your communications with others
4. Value others
 Value people and show respect
 Treat everyone as special and important
5. Be approachable and open
 Put others at ease and help them to relax
 Don’t judge others (and notice when you are)
 Accept people for who they are and where they are at
(not who you think they should be)
6. Be present and mindful
 Not distracted or preoccupied
 Value every moment – nothing is more important than now
7. Be constant and resilient
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Hang in there and don’t give up
Overcome barriers and obstacles
Withstand the storms
Be comfortable with difficult conversations and strong emotions
Manage conflicts
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8. Be available and willing to share
 Be willing to listen and hear stories of joy and pain, and ‘hold’ hope
 Be willing to share stories
 Be willing to use ‘their’ language, concepts and understandings
9. Be self-reflective
 Reflect on your thoughts, interactions and actions
 Ask yourself the hard questions
 Gather and act on feedback
10. Create safe spaces
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Create spaces of emotional safety. Within these spaces, authentic
relationships, where matters of significance can be discussed, may arise
(Taylor, 1992; Scott, 2011).
I believe the greatest gift I can conceive of having from anyone is to be seen,
heard, understood and touched by them.
The greatest gift I can give is to see, hear, understand and touch another person.
When this is done, I feel contact has been made (Virginia Satir).
Connecting and disconnecting
We often focus on the importance of connecting, however, we also need (when appropriate)
to be able to disconnect. For example, if we have had someone share deeply with us, then
afterwards we need to be able to disconnect and not continue to carry heavy feelings home
or to the next person we see.
If we become overwhelmed emotionally, attention may focus on us rather than on the person
we are there to support. From the perspective of mutuality, sharing our feelings can be
beneficial. However, doing so while we are overwhelmed is rarely optimal and may in turn
overwhelm the other person or leave them uncomfortable about how to respond. This is not
the intention of the peer work role.
While we need to be aware of what we are hearing when someone is sharing, for our own
wellbeing we also need to ensure that we do not ‘own’ or absorb all the emotions and
experiences being shared. We also need to be alert when things are being shared that might
trigger or re-traumatise us.
Self-care is essential for our wellbeing and also for our longevity in this field of work. In these
situations the practice of mindfulness and the skill of allowing strong emotions to pass over
us can produce a healthy disconnection.
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Power and the drama triangle
Power differentials
As previously discussed, peer workers need to be aware of the impact of power differentials
(differences) in service settings. When peer workers adopt a human rights approach
promoting self-determination and supporting autonomy, this encourages individuals to
engage in self-reflection and positive decision-making, and to shape and direct their own
recovery.
Some services still mirror the power and control experienced in abusive relationships that
consumers and carers may have experienced in the past (or present). This can make
recovery harder to focus on and escalate the risk of re-traumatisation. It is not considered
ethical and may require advocacy by you to bring about needed change.
The drama triangle
An understanding of power differentials and roles is useful.
The drama triangle, developed by Karpman (1968), is a model of dysfunctional social
interactions and power dynamics.
Karpman argued that there are
three archetypal roles in the drama
triangle: victim, rescuer and
persecutor. People might have a
preferred position or they might
move (sometimes very rapidly)
between the roles.
Rescuer
Persecutor
Victims deny all responsibility and
act in a helpless and hopeless
manner. They may feel powerless,
Victim
incompetent and inadequate. They
like to be treated with ‘kid gloves’ and may seek compassion and support. Victims often look
for a rescuer; however, colluding does not empower, instead it creates dependence.
Rescuers constantly try to be helpful by taking on other’s responsibilities, while ignoring
their own needs. They want to solve problems, be useful and feel needed. They often think it
is best if they do it all, as they will do it best and others will get it wrong. They might complain
about their treatment and they are sometimes martyrs. Underneath, they might resent what
is occurring. Rescuing can, for some people, be a coping strategy that helps minimise their
own pain and discomfort, while giving them an outlet and purpose.
Persecutors will blame the victim, and are highly critical and negative. They bully and
harass with threats, blame, put-downs and even violence. They can be overwhelming and
use standover tactics. They might feel inadequate underneath, but on the surface they ooze
power, and unpleasantness. They seem to thrive on conflict and loud disputes.
Signs of unhealthy roles or boundaries
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Focusing on someone else at the expense of oneself
Continually rescuing or caring for (rather than caring about, which is the healthy option)
Feeling the need for approval
Inability to say no
Feeling responsible for another’s needs
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Feeling angry/hurt if others don’t take our advice or help
Getting joy in life from helping others; this makes a person dependent on others
accepting their help and being appreciative – if others don’t like what they do, the
person gets hurt or angry and say things like, ‘After all I have done for you ...’
Can lead to learned helplessness in the other
Complex and enmeshed relationships
Over-concern for others
Development of dependent relationships
Loss of capacity for self-direction
Unclear and shifting boundaries
Use of fear, obligation, guilt and emotional blackmail
Feeling a duty or heavy burden to meet others’ needs
Individual choices are seen as disloyalty or an attack (Mahboub, L., 2013).
Activity
Which role are you most prone to? Why do you think that is (i.e. what do you think you gain
from that role)?
What would it take for you to give up that role?
The alternative ‘healthy’ triangle
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Three other, healthy roles are possible as an alternative to the three roles above.
Learners/travellers, rather than being victims, grow and develop new skills and knowledge;
or do new things in new ways, see new things and go to new places.
Coaches/mentors/trainers, rather than rescuing, teach the new skills the learner needs,
provide knowledge and support change. At times they act as role models or mentors, and at
other times they coach in new skills as well as train in new ideas, models and practices.
Encouragers/inspirers, rather than persecuting, encourage and inspire the learner by
acknowledging strengths, reframing events and inspiring hope. They can be the cheerleader,
encouraging the traveller on!
Activity
Which of these roles will you have as a peer worker?
Provide an example of when you might use each one.
Questions for reflection
Reflect on an interaction you are or were involved in that relates to Karpman’s drama
triangle. You might find it useful to ask yourself the following questions (Orriss, M., 2004).
 What am I not doing?
 Want do I need to do?
 Who is taking responsibility for whom? Who am I talking responsibility for?
 Am I allowing the other person to take responsibility for themselves and their
actions?
 Who has the power? How do I know?
 Have I agreed to more than I want to do?
 Am I doing more than half the work?
 Am I owning my power positively and appropriately?
 Am I using it to set my own boundaries and take responsibility for myself and my
actions?
 What boundaries do I need to set up?
 Am I using my power to take care of myself properly?
 What am I feeling about this situation? What would I like to feel?
 What actions do I need to take to make sure that I deal with this in the best possible
way so that it has the best possible outcome?
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Values-based practice skills
There are four main skills required for values-based practice.
Awareness: Workers need to be aware of all the values and the diversity of those values. It
requires practice to identify the range of values. One way that values can be revealed is in
the language used by the person – the words, the analogies and the emphasis. Reflecting
on this during and after meetings with a person can help to increase your awareness. As
mentioned below, good communication and questioning skills are also important.
Communication: Supporting decision-making is central to values-based practice, and this
often involves resolving differences. This in turn involves advanced communication skills, as
does working closely and collaboratively with a person. All of these skills include strong
listening, good questioning and clear communication.
Knowledge: Gathering information about values and facts is critical to the process. To
gather information takes a lot of listening as well as good questioning.
Reasoning: Analysing and balancing information from a range of sources is important in
values-based practice. Logical reasoning is a key prerequisite to making or supporting a
decision.
Interpersonal skills are also important
To work with people and identify values requires good ‘people skills’, also called
‘interpersonal skills’. They help to build trust and strong relationships.
There are a number of other key understandings that inform values-based practice.
The ‘two feet’ principle
All good decisions require two feet on the ground: you need to have both the facts or
evidence about the situation and the values of the key people involved.
Know the facts
Know the values
Evidence-based
practice requires
awareness of the
research and evidence
that is relevant to your
practice, and how
strong the evidence is.
This evidence needs to
inform and be applied in
your work so that you
offer the best services
possible.
Being aware of the differing
values of all key
stakeholders, and working
with values in positive and
constructive ways to make
decisions and inform
processes and practice,
involves listening to,
learning from and acting on
communications from the
person and their carers
about what is important to
each of them.
The ‘squeaky wheel’ principle
Like a squeaky wheel, we only tend to focus on values when they are
clearly different or in conflict. But values need to be a priority even when
they are not yet clear or openly stated.
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Degree to which you are currently putting
this value into practice
A little
bit
Some
Quite a
bit
Most of
the time
Happy
with
current
level
Would
like
this to
change
Desire to change
Not at
all
Consider your own
values and what is
important to:
1.
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2.
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3.
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4.
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5.
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1.
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2.
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3.
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4.
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5.
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Actions you might take
Top 5 PERSONAL values
Top 5 WORK values
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Sensory awareness
Find a comfortable place outside. If you can, remove your shoes. Either sit or stand.
Close your eyes for a moment and become aware of your feet touching the ground. Feel the
grass, sand, soil or ground between your toes and under your feet. Feel the solidness of the
ground and the bedrock below it.
Be aware of the strength you feel from the ground and the sensations in your legs.
Feel any breeze touching your body or the warmth of the sun or the cool of the shade.
As you open your eyes, be aware of the colours and shapes around you. Let your eyes
travel slowly taking in your surroundings – not just the big things but also the small things
like an individual leaf or blade of grass that stands out from the others.
Then slowly take a deep breath, flaring your nostrils and smelling the air around you.
Become aware of the freshness of the air, the smell of the trees, flowers or grass. See if you
can smell hints of the ‘smaller’ smells – the undernotes of fragrance that without awareness
you might have missed or lost.
As you smell, be aware of the sounds around you – the wind in the trees, the distant traffic
and people walking or talking as they pass by.
Depending on your setting, there might be things to taste as well. If not, allow your other
senses free rein until you feel part of the land and space around you.
If your mind wanders, let your thoughts float by and bring your attention back to your senses
and the things around you.
Activity
What other mindfulness activities have you tried? How well did they work for you?
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Record Keeping
To create records we gather information about the person and their experience. We need to
protect this information, keeping it private by locking it up and not discussing it with others
without permission (called ‘consent’). We also need to meet legal obligations (NMHCCF,
2011, p. 5).
As a peer worker, the formal records you might need to write and store include:
 referral forms
 consent forms
 initial contact forms
 person-directed records (e.g. advanced directives, wellness
plans, wellbeing plans)
 individual service plans or recovery plans
 individual program plans
 formal or informal assessments
 service plans or agreements
 reports, e.g. incident reports
 evaluation and feedback forms
 other information that is collected about people, which may include:
o notes on activities, events, strengths, needs, aspirations, goals, milestones,
outcomes, achievements and concerns
o responses to questions and other information provided by or for the
consumer/carer
o observations on physical appearance, behaviour, awareness or ‘sharpness’
(acuity)
o file information including personal contact details, nature of services received,
hours of contact and case notes
o information provided by the person’s family, carers and others
o information provided by other workers and agencies.
What other records do you keep?
Your position description and organisational guidelines and policy will identify your
responsibilities and procedures for information collection and storage. If there are no
organisational guidelines, peer workers should consider (and discuss with their supervisor)
the amount and type of information to be collected, in order to balance the capacity to deliver
appropriate services with possible breaches of privacy.
A general rule of thumb is to report events objectively, and not to include any opinions or
value judgments about behaviours. Consumers must be informed of the type and extent of
information that is collected and stored about them.
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Collecting and managing consumer and carer information
There are four critical aspects to effective information management:
1. Accuracy – this involves
Currency
careful listening and checking
that your interpretation is
correct; reading existing files
and checking that the
information being collected is
consistent; and checking all
Collecting
Privacy
Accuracy
data collected with consumers,
and Managing
carers and others who are
providing information.
Information
4. Currency – this means
ensuring that all information for
which you are responsible is
Consultation
up-to-date, including: policy
documents, contact lists,
information that is made available to consumers/carers, and their files.
5. Privacy – perhaps the most important aspect of information management. It includes
confidentiality, sight and sound privacy, storage of information, use of information,
reasons for collection of information and so on.
6. Consultation – when collecting information on consumers and carers, you will
involve the person and perhaps others in the process. You may need to consult with
other workers and managers in your own organisation, and others to which
consumers and carers are being referred.
Managing information about and for people living with mental distress, their families, friends,
advocates, and support and service agencies is an important part of maintaining effective
work-based relationships.
People have the right to know that information collected about them is
used, shared and stored in such a way that their privacy is protected
at all times. Informed consent is required to release that information
and, when information is shared with consent, it must be accurate
and current. So maintaining up-to-date records is important.
Privacy and confidentiality provisions in relation to mental health care
refer to all consumer and carer information and formal records that are communicated
verbally among mental health service staff and between staff and consumers and carers.
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Principles of Record Management
Records management (RM) and Records and Information management (RIM) is the
supervision and administration of soft copy (digital) or hard copy (paper records), regardless
of format. A well maintained records management system supports services to provide
quality accountable service system. It includes the confidential and secure collection,
access, maintenance and disposal of records.
Covers paper records, media and electronic data (covers digital/ computer record and cloud
storage)
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Confidentiality of all personal records shall occur at every point in the cycle
Accountability and Transparency
Integrity, authenticity and Honesty
Objective and factual not assumption or subjective
Comprehensive – cover all relevant topics
Currency –completely in a timely fashion and kept up to date
Protection –Secure storage , confidentiality maintained - only shared with others with
person’s consent
Transportation of records must align with organisational policy eg kept secure etc
Compliant with laws, organisational policy and procedures
Accessible and Retrievable – the person can access their records and make any
changes
Maintenance - Records shall be maintained in line with organisational policy
Disposal -Records shall be disposed of in line with organisational policy
Your position description and organisational guidelines and policy will identify your
responsibilities and procedures for information collection and storage. If there are no
organisational guidelines, peer workers should consider (and discuss with their supervisor)
the amount and type of information to be collected, in order to balance the capacity to deliver
appropriate services with possible breaches of privacy.
A general rule of thumb is to report events objectively, and not to include any opinions or
value judgments about behaviours. Consumers must be informed of the type and extent of
information that is collected and stored about them.
Information sharing
The Queensland Government developed a resource in 2011 to provide guidance to mental
health workers on how to share information about a consumer, called ‘Information sharing:
Between mental health workers, consumers, carers, family and significant others’ it is
available at www.health.qld.gov.au/mentalhealth/docs/info_sharing.pdf. It highlights that
the sharing of information as often as possible between workers, consumers and those
involved in helping a person’s recovery is central to person-centred support. It explores the
benefits of information sharing, and asks us to look for opportunities to share information in
ways that will benefit the consumer’s recovery and support the safety and wellbeing of
others.
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In seeking consent, it says, it is important for workers to:
 explain the reasons for and benefits of sharing specific information
 use language that is clear to ensure understanding
 remind the consumer that they can withdraw their consent at any time
 at the end of the discussion, clarify to ensure that you both have a shared
understanding of what has been agreed
 document what was agreed according to your organisation’s record-keeping policy.
When it is not possible to gain consent, sharing certain information may be appropriate as
permitted by law.
If the consumer currently lacks capacity to give consent, ongoing attempts to obtain
informed consent should be made as their mental health changes and improves.
Note-taking versus note-making
Organisations have different perspectives and requirements on what records must be kept.
As a worker you need to be familiar with these expectations. As a peer worker, you should
make sure that your record keeping is in line with the values and principles of recovery and
peer work.
Record keeping (about people), like all our work, needs to follow the principle ‘nothing about
us without us’. This means that any documentation, file notes and records need to be made
collaboratively and led by the person. This can be challenging and is certainly a point for
considerable negotiation. Keeping careful records of recovery stories can track and show
choices, achievements and, most importantly, progress. Records are part of a person’s story
and history. They allow a person periodic review and reflection on the journey taken so far.
Note-taking
It is not necessary to write down every word that is said. Note-taking is not like minutetaking. When meeting with a person, intense listening is often better than furious writing.
Notes taken in meetings are often about recording decisions and information. Note-taking
should be a collaborative process and should support the recovery process.
Remember that what you write down is important. If there is a complaint or grievance,
your records will be reviewed. A person’s records may be reviewed by a number of different
people and organisations.
Note-making
Is the person keeping a record, journal or notes about their own recovery process?
Some services stress the important difference between note-taking and note-making. These
services believe that notes kept by the peer worker, or other workers, create potential
barriers to developing strong recovery-oriented relationships. The priority is on maximising
empowerment and keeping accountability – records are low on the list.
In other services the person is encouraged to develop their own notes/records, with support
as required. The peer worker may or may not keep a copy of the notes made, or they may
simultaneously make a record to keep for service accountability purposes.
The critical thing is transparency, for the person to feel empowered and able to access any
record relevant to them. They must have a sense of control, so a collaborative process is
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often a good approach. The key is to negotiate the process and to deeply listen and respond
to the person’s desires and preferences.
In some services, funding requirements or organisational policies require all workers to keep
records. Many of the records you keep will be to meet organisational policy and procedural
requirements.
This is often seen as a risk-management strategy, such as in the event of the organisation
being involved in a legal matter. It can be important in the event of, for example, a
subpoena, a WorkCover inquiry, a quality review or a complaint.
Certain other types of records are also kept for legal reasons, including incident forms,
timesheets, referral forms, reports, performance appraisals, professional development plans,
memos and organisational letters.
Some records are kept for organisational accountability requirements, including statistics
showing that the service is providing enough hours, or enough services to enough people.
Whenever records are kept, there are legal and ethical matters to consider.
Activity
Do you make or take notes about a person’s recovery journey at your service? What is the
process at your service?
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Remember: A person’s records may be viewed by a number of different people and
organisations, as shown below:
The person
Collaboratively developing them
Gaining access to them to review or
recall a matter, or to review or evaluate
their recovery progress
Critical incident review/
complaints
Internal investigation by the
service following a critical
incident or complaint
Insurance companies
Workers’ compensation,
personal injury claims
Coroner’s court
Investigations of deaths and will
make recommendations to
other legal bodies
Healthcare team
As part of ongoing treatment
and communication, and for
research and auditing
Service Records
Health Care Complaints
Commission (HCCC)
Similar to the professional
registration authorities, use
when investigating a complaint
Courts: civil and criminal
Health care records will be
used as evidence, e.g. in the
coroners court
Consumer’s relatives or
guardians
May request to see notes
especially after something
goes wrong (this requires
the consumer’s consent or a
legal right)
Professional registration or
accreditation authorities
eg. nurses registration boards
when conducting investigations
Managers or other workers
For awareness if they are a new
case worker, or in supervision,
etc.
Other workers and services
With consent they can access,
e.g. as part of a referral
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National standards for mental health services 2010
Several criteria in the national standards apply to information collection, storage, access
privacy and consent including:
Standard 1: Rights and responsibilities criteria
1.3
All care delivered is subject to the informed consent of the voluntary consumer and
wherever possible, by the involuntary consumer in accordance with Commonwealth
and state / territory jurisdictional and legislative requirements.
1.8 The MHS upholds the right of the consumer to have their privacy and confidentiality
recognised and maintained to the extent that it does not impose serious risk to the
consumer or others.
1.13 The MHS upholds the right of consumers to have access to their own health records in
accordance with relevant Commonwealth, state / territory legislation.
1.14 The MHS enacts policy and procedures to ensure that personal and health related
information is handled in accordance with Commonwealth, state / territory privacy
legislation when personal information is communicated to health professionals outside
the MHS, carers or other relevant agencies.
1.16 The MHS upholds the right of the consumer to express compliments, complaints and
grievances regarding their care and to have them addressed by the MHS.
The National Mental Health Consumer & Carer Forum position on
privacy, confidentiality and information sharing
It is the position of the NMHCCF that:
 the privacy of consumers is a basic human right
 each consumer’s right to privacy should be balanced with their nominated carer’s
need to give and receive information relevant to their caring role
 nominated carers should be identified, supported and incorporated into service
provision
 nominated carers play a vital support role in a consumer’s recovery and should be
included in information exchanges, where appropriate and with the consumer’s
consent
 nominated carers’ involvement should be regularly reviewed
 consumer and carer participation is essential in developing best practice guidelines
for information sharing.
Activity
How do you think the national standards and the NMHCCF position statement affect the
work you do?
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Activity
Documentation dos and don’ts
1. Documentation Dos
Write down as many good habits as you can think of that you should remember when
developing documents and records.
2. Documentation DON’Ts
Write down as many bad habits as you can think of that workers should avoid when
developing documents and records.
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 Write legibly
If people can’t read what you
have written, it might as well not
be there. If it does go to court you
will be asked to explain it. If you
can’t read an entry, ask the
person who wrote it to explain it
to you and, if necessary, rewrite
it.
 Label all notes
Notes need to be labelled on
both sides of the page, including
any correspondence that is
received that is placed into the
person’s file. This becomes an
issue when notes are
photocopied.
 Record who you are
 Record the date and time
Without the date and time it is
very difficult to establish the
sequence of events and leads
to more questions being asked.
 Document all changes,
actions and outcomes
This is the ‘golden rule’. Notes
should follow this format and
these are the questions that will
be asked of the record when being
reviewed. You should document in
the light of the whole person, and
any change or significant event
should be documented, together
with what action was taken and
how it turned out.
(name, title, signature)
This is so your entry can be
traced to you. It relates to
professional accountability – if
people have questions
regarding what you wrote they
can find you.
The do’s of
documentation
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They will be much more
accurate and hold much
more weight. If you put a
summary of what was said
there is always the question
regarding your interpretation
of what was said.
 Use permanent
black or blue pen
only
This avoids entries
fading. This includes not
using pencils or felt-tip
pens (textas), whose ink
washes away with water
and doesn’t photocopy
well. If records are
photocopied, colours
other than black or blue
ink may not be clear.
 Make time to do it well
Given that documentation is the
record of the care that you gave,
and what you will be asked to
answer to, it is important to give it
the time it deserves rather than
just 15 minutes before you finish
for the day.
 Records must be factual and
objective
Notes must only include facts.
Colloquial terms, emotive language and
waffle leads to workers’ professionalism
being questioned and lawyers asking
questions. Be definite in any
observations and beliefs, and don’t use
language such as ‘it appears that ...’.
 Use the person’s words
 Records are
Contemporaneous (i.e. at
the time)
Record events straight away. It
is important to write what you did
at the time you did it, not at the
end of your shift or later. If you
do write things down later, make
sure you record when you
actually did them.
 Check records before
and after you write
them
Ensure that you write the
correct entry in the right
person’s notes. It is difficult
to prove you did something
if it is not in the notes.
111
 Notes must be in line with
recovery-oriented practice
and peer work principles
Ensure your record keeping
meets the principles of recoveryoriented practice and peer work.
 Don’t make assumptions
Only document what you
know, not what you suspect.
(Write ‘The person reported
being assaulted’, not ‘The
person was assaulted’, if
that’s all you know.)
 Don’t use unapproved abbreviations
Be aware that all services have different
approved abbreviation lists.
 Don’t scribble
 Don’t use terms you
are not sure of
If you write it there is an
assumption that you
believe what you wrote.
Therefore you must fully
understand all the terms
you use.
 Don’t document care
given by others
If you wrote it, you did it,
and you may be asked to
explain it. This is how a
court analyses records.
memory
You should not rely on
your memory, but
document immediately.
You cannot write
records retrospectively.
The don’ts of
documentation
 Don’t make
 Don’t enter notes in
advance
If you enter an action in
advance and then fail to do
it, and something happens
as a result, you could be
seen as both liable and
negligent.
 Don’t leave spaces
Space allows other people to add things to your
notes. Any spaces should be ruled through with
a straight line. Be aware that legal bodies will
go to the extent of using a forensic specialist to
review notes to see if they have been added to
or changed.
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 Don’t rely on your
out errors
It might look like
you are hiding
something.
112
generalisations
You need to be factual.
Generalisations only lead to
confusion and
misunderstanding that the
courts will need to ask you
to explain.
 Don’t repeat or copy
other information
If you repeat or copy other
information, such as
observations or medications,
you might copy it incorrectly
and leave yourself open to
significant criticism.
Reflecting on your own work, which of the following things do you practice?

The do’s checklist
 Record the date and time
 Take time to do it well
 Use the person’s own words
 Label all notes
 Write legibly
 Document each change, action, outcome
 Use only permanent black or blue pen
 Be objective and factual
 Contemporaneous (ie at the time) Record events straight away
 Record who you are (name, title, signature)
 Check records before and after you write them
 Reflect recovery-oriented practice and peer work principles

The don’ts check list

Don’t use unapproved abbreviations

Don’t make assumptions

Don’t rely on your memory

Don’t use terms you are not sure of

Don’t leave spaces

Don’t document care given by others

Don’t scribble out errors

Don’t make generalisations

Don’t repeat or copy other information

Don’t enter notes in advance
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Activity
Option 1: What’s wrong or right with this documentation?
Based on the do’s and dont’s listed above, consider what is wrong and what is right about
the following documentation examples.
Example A
12th Feb 2009 (14.35hrs) Jules is stressed and struggling with carer role and rest of family.
Signature (Printed name), Job title.
Example B
12th Feb 2009 (14.35hrs) Jason given his medication. All care attended. Signature
(Printed name), Job title.
Example C
12th March 2009 CPW 13.50hrs. Maria hurt herself in the garden, She was exhausted as
her son had been pacing all night. Went to shops and doctor’s. Signature (Printed name),
Job title.
Example D
12th March 2009 PW 13.50hrs. Mark said he hurt himself in the garden. He was restless and
fidgety when we went out. Went to shops and doctor’s. Signature (Printed name), Job title.
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Example E
12th April 2009 Peer Worker 10.00am Visited Holly as arranged at her home. She was up
and dressed to go out grocery shopping as planned. She stated she’d ‘had a terrible night’s
sleep’. She reported not sleeping well for past week. We spoke about sleep and how she
needs sleep to maintain her mental health. She stated she wanted to go to the doctor to get
sleeping tablets because the last time she was like this she ended up run down, caught a
virus and was sick in bed for a fortnight. She rang GP at 10.30am. GP spoke to Holly. GP
told her the script would be ready to pick up later today. Drove her to the shops as her car is
in garage. Talked about coping strategies on the way. Collected groceries and dropped Holly
back home approx. 12pm. Next visit planned for 14th April. Holly requested we meet at the
local library. Signature (Printed name), Job title.
Example F
20th April 2009 Peer Worker 11.00hrs Visited Harry as arranged at 10am at his unit. He was
up and dressed to go out grocery shopping as planned. He stated ‘I had a terrible night’s
sleep’. He reported not sleeping well for past week. We spoke about sleep and how he
needs sleep to maintain his wellbeing. He stated he wanted to go to the doctor to get
sleeping tablets because the last time he was like this he ended up in hospital due to his
paranoia. Phone call to GP at 10.30am. GP spoke to Harry. GP told Harry script would be
ready to pick up later today. Collected groceries and dropped Harry back home approx.
12pm. Next visit planned for 14th April. Harry requested to visit the local library. Signature
(Printed name), Job title.
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Option 2: Notes
How can you ensure that the person controls the process for documenting their recovery,
and that the process is transparent?
How do you like to record notes about your recovery?
Create a file note or entry that you would be happy to have collaboratively written with a peer
worker about your recovery. Share it with a colleague or your small group.
Based on your entry above and those of others at your table, list the characteristics of good
notes.
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Visual note taking – graphical representation
While most records and notes are in written form, it is often useful to record some types of
information in graphical (diagram) form. In particular, this allows workers to capture a picture
of the person’s family. Many workers, particularly those who are visual learners, find that
seeing a visual representation of the family makes it easier to recall details than reading
pages of written notes.
These diagrams can also be drawn in collaboration with the person or even by the person
themselves. As a result they can be very empowering and accessible to the person as they
may find them more useful than written notes.
Whichever style or type of diagram is chosen, there are many benefits to visual
representation:
 It is an accessible format for a service user (less literacy required)
 It allows you to form an overview of service provision (identifying current service
relationships and possible gaps or alternative options)
 It promotes transparency in record-keeping – diagrams can be drawn in partnership
with the person
 It increases understanding of relationships within a cluster (family, household or
network);
 It can increase continuity of care by acting as a resource to assist with quickly
familiarising new workers to the individual or family so the person doesn’t have to tell
their story yet again.
We will now look at three specific types of visual representations:
 ecomaps
 genograms
 social and emotional wellbeing
Ecomaps
An ecomap is a visual representation of a person or organisation and the system and social
environment that surrounds them. It promotes a systemic view of the world and the person’s
experience in it. There are many different ways to draw ecomaps. Below is an example of an
organisational version.
Centrelink
Local council
community
workers
Multicultural
service
Local health
service
Local
hospital
My
service
Local
doctors
Aboriginal
Medical
Service
Community
centre
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117
Department of
Housing
Ecomaps are more commonly used to draw the system and social environment surrounding
an individual or their family. The family is drawn in a circle in the centre (squares for males,
circles for females) and lines are added to show relationships.
Example: family ecomap
Local fourwheel-drive
car club
Department of
Community
Services
Mental
health
service
Neighbourhood
centre
Church and
women’s group
activities
Work in
advertising
office
Ben
38 yrs
Viv
37 yrs
Mental health
crisis team
RSL
club
Merry
19
Jono
16
Alison
15
Rob
13
Extended
family
Meadow
TAFE
Holly
4
Noel
2
Counsellor
Meadow
Preschool
Meadow
High School
Meadow
Playgroup
Local health
centre
Meadow
Football
Club
Add names, ages and connections with community services and other key contacts.
Key
Male
Relationship
Strong line = strong
connection
Important or positive
connection
(variation to using a strong
line)
Female
Direction of energy
or
Stress or tension
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Tenuous relationship
118
Genograms
A genogram is a diagram that shows a family’s history, strengths, challenges and behaviour
patterns. It can map several generations and show patterns or trends in the family over
generations. It is based on constructing a family tree, and then adding symbols, dates and
other information to convey important family patterns and trends. Additional information can
be added to identify patterns such as ages, occupations, AOD use, domestic violence (DV),
illness, child abuse, incarceration, disability, mental health issues, recreation, beliefs and
education.
Example: family genogram
Paul
Rachel
James
Ellen
Bella
Sally
Sara
David
Beth
Terr
y
Kaye
m. 1989
fostered
Jim
Lance
Anna
Lee
Key:
Male
Relationship
Female
Household
Deceased
Fostered
Stillborn
Engaged
pregnancy
Divorced
miscarriage
Separated
Additional symbols have been developed for specific purposes, such as an abuse symbol
and a disease symbol. Search the internet to find out more.
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119
Social and emotional wellbeing map
Social and emotional wellbeing maps were originally developed to map extended Aboriginal
and Torres Strait Islander families but have subsequently been used more generally. They
allow you to rapidly identify important people and relationships to an individual or family.
They identify key strengths and issues or concerns faced by family members.
A large rectangle is drawn, filling most of the page. A circle is drawn in the middle of the
rectangle for the main individual (they could be a consumer or carer). All the people who
share the house and all the people who have daily or weekly contact are drawn in circles
within the rectangle (red circles for support people, blue for social contacts). Lines are drawn
to show the strength and type of relationship. Descriptions of relationships, ages, strengths
and concerns are added in or near each circle. Other significant family members are drawn
in circles outside the rectangle. They are not part of the person’s social or emotional network
or only have intermittent involvement.
Example: social and emotional wellbeing (SEWB) map
36yrs Friend for 12 years;
play cards, visits Francis or
talks every day
[Francis also visits her, and
they meet for coffee]
Daisy
Irene
42yrs Sister Very critical
and thinks Frances should
‘get over it’
Ronnie
38yrs Friend for 15 yrs;
play cards, visits Francis or
talks every day, goes to
church with her
[Francis visits her often,
and drives her to church]
24yrs Partner to Tina,
gardens for Francis and
does house repairs
[Francis knits him
jumpers]
Francis 38yrs
Living with
depression and
anxiety – close to
grandkids, daughters
and friends
Janice
Beth
Tina
22yrs Daughter Lives in flat in town, visits
daily, shops for Francis and drives her to
doctor, cares well for her 3 children
[Francis babysits for her and helps when
the kids are sick. She also reads to them,
lies with them and sews /knits for them]
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120
63yrs Mother Cooks for
family and helps with
washing and housework
[Francis drives her to
church and to medical
appointments]
Kiarna
Doug
43yrs Husband Contributes
money to pay bills, close to
grandkids, drinks and smokes
heavily. Has his own room but
watches TV with family and
interacts with kids
C
23yrs Daughter Contributes
money to pay bills, cooks for
family and helps with washing
and housework; lives at home
with her 3 children
[Francis babysits for her and
helps when the kids are sick.
She also reads to them, lies
with them and sews/knits for
them]
Aunt who
lives in the
city
Contact at
Christmas
Uncle Joe
(Elder)
Great uncle
Sonny
31yrs Brother
Lives with wife
in another state
Key:
Grey
The individual
Red
Carer and emotional support
Blue
Regular ongoing social contact (takes to football, on outings etc.) but has no carer
responsibilities
Yellow
External person, e.g. extended family with irregular or distant contact
Green
Child
X
Deceased (dead)
Inside the rectangular border is a household and contains the members that live at the
premises and those that have an ongoing and immediate relationship to the premises
where the service user lives. Within the border you might place parents, immediate
siblings and other members that contribute to the family or close family friends, supports
and neighbours that have daily contact etc
Outside the rectangular border are family members who live elsewhere and have
ongoing but infrequent contact with the service user. Sometimes deceased family
members may be included if they contribute to the understanding of kinship and cultural
obligations
A dashed line or coloured area represents people who live in the same house as the
service user. This will change over time, so include a date
Links to service user
Shows which way the support goes
If support is mutual, arrows go both ways, e.g. she cooks for me weekly, I mow her lawn
Thicker line
Distant or not so strong relationship. Relationship may become more distant, e.g. if
someone is moving away from the household then you may change the line to a dotted
line and add note, e.g. ‘Planning to move to Newcastle’.
Strong support, e.g. Aunt Beryl provides good support and brings meals, so you might
put a thicker line and write words to explain further, e.g. ‘emotional support’ or ‘food’.
Negative relationship that can bring stress or distress for service user, e.g. a young
relative who gets drunk every Saturday night and gets into fights with others in the
household
Thick wiggly
line
Very bad or negative relationship, e.g. serious and regular domestic violence.
Dotted
lines:
A small house next to a person means they need accommodation to move them out of
the house
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Activity
Choose one of the diagrams above that is new to you, and try to draw your own family.
If you have time, try one of the other diagrams for your family or for someone you support.
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Reflection on learning
To maximise transfer of learning to your practice in the workplace, it is important to reflect on
the topics covered here and identify any areas that you would like to grow and build
knowledge and skills in. This table will be referred to again throughout the course.
Areas covered
in training
today
I’m feeling comfortable
about my knowledge
and skill in this area
I need to know and
develop skills in this
area a little more
I need to know and
develop skills in
this area a lot more
(✓)
(✓)
(✓)
Other areas I have identified that are not covered in the training
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Appendix A: MHCC Law and Ethics Definitions
Advocate
To speak or write in favour of; support or urge by argument;
recommend publicly. A person who speaks or writes in support or
defence of a person or cause; who pleads the cause of another in a
court of law.
Breach
The act or result of failing to obey or breaking a rule; a violation of
law, faith or a promise.
Bullying
Persistent ill treatment of an individual by one or more other persons.
It is usually continuous, intimidating and directed against a particular
person. Includes verbal abuse, finding fault, threats, sarcasm,
ostracism, sabotage of a person’s work etc.
Charter
A document, issued by a sovereign or state, outlining the conditions
under which a corporation, colony, city, or other corporate body is
organised, and defining its rights and privileges.
Civil Law
Decisions of courts, especially of reviewing tribunals.
Code of Conduct
A code of conduct defines the required standards of behaviour and
actions of a worker. It clearly describes expectations so people know
‘how to’ act in certain situations. It must be clear and unambiguous
indicating required outcomes or rules to be followed. While they are
more specific than codes of ethic they are rarely broad enough to
cover every circumstance but do provide general direction on many
matters. If your situation is not covered then discuss any concerns
with your supervisor or seek clarification from another appropriate
person.
Code of Ethics
A code of ethics defines the fundamental principles (like respect,
integrity, trust, openness) that should guide worker’s approach. It
provides guidance in terms of ethical and moral responsibility. It is
more general than a code of conduct and describes the principles
and values of “what” is important and should be considered in
making a decision.
Codes of practice
Codes of practice are practical outlines or guidelines on how you
should perform certain workplace activities or practices. For example
WorkCover NSW have a number of approved code of practices to
assist workers to achieve the health, safety and wellbeing standards
required under the NSW Work Health and Safety Act and related
WHS Regulations. Many of the codes of practice belong to specific
industries eg demolition, spray painting, welding, construction etc.
There is not a particular code of practice for community services but
a number of generic ones cover community services workplaces.
These include: ‘First aid in the workplace’; ‘Hazardous manual
tasks’; ‘Managing the risk of falls at workplaces’.
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Common Law
The system of law originating in England, as distinct from the civil or
Roman law and the canon or ecclesiastical law. Unwritten law
(especially in England), based on custom or court decision, as
distinct from statute law. In common law systems, the courts are
particularly influential in developing the law; although they may be
said to interpret the law, the growth in case decisions can be
regarded as effectively creating or developing the law, even though
(as in the UK) parliament is sovereign (subject to the jurisdiction of
the European Parliament).
Complaint
Management
Complaints Management refers to the system of managing
complaints from a service user, member of the public, stakeholder or
worker. A complaint is any expression of dissatisfaction about a
service, a worker’s actions, a service decision. Every service should
have a complaints policy and procedure and information about it
should be provided to all service users, as all people have a right to
complain and organisations are responsible for their actions and
decisions and those of their workers. Effective complaints handling
can resolve issues before they escalate and can also contribute to
quality improvement systems. Workers should encourage and assist
people to raise their concerns. Principles of effective complaints
management include: responsiveness, accessibility, fairness,
efficiency, and integration. Stages of complaint handling:
Acknowledge the complaint and ensure they are aware of the
procedure, consider the information, plan the investigation,
investigate, respond (take action), review and reflect on process,
implement systemic change as required.
Corrupt Conduct
Immoral or dishonest, and often illegal behaviour.
Corruption can take many forms including:
 Official misconduct
 Bribery and blackmail
 Unauthorised use of confidential information
 Fraud & theft.
Efficiency
The quality or ability to do something well or achieve a desired result
without wasted energy or effort. Competent in performance.
Equity
The quality of being fair, just or impartial. Actions, treatment of
others, or a general condition characterised by justice, fairness and
impartiality.
Fraud
Corrupt conduct; dishonesty; deliberately deceiving a person or
people to obtain money or some other benefit. Usually takes the
form of giving a false impression through a statement or conduct in
order to gain a material advantage.
Harassment
To persistently disturb, annoy, attack or torment someone.
Impartial
Just; unbiased; having no direct involvement or interest and not
favouring one person or side more than another.
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Integrity
The quality of possessing and steadfastly adhering to high moral
principles or professional standards.
Maladministration
Conduct that involves action, or inaction, of a serious nature that is:
 Contrary to law
 Unreasonable, unjust, oppressive or improperly
discriminatory
 Based wholly or partly on improper motives.
Mandatory Reporting
Mandatory reporting is a term for the community and health worker’s
legislative requirement to report suspected cases of child abuse and
neglect to government authorities.
Mandatory reporters are those that deliver services directly to
children and young people. This includes those that deliver health
care, welfare, education, children’s services, residential services or
law enforcement to children or young people. The law also requires
any person who manages an employee or volunteer from such
services, to report suspected risk of significant harm.
Ostracism
Exclusion from social events or groups, to banish or isolate another
person
Policy framework
A policy framework is a logical structure that is created to organise,
order, develop and maintain policies to increase their
implementation, usage and effectiveness. For example it may:
 a set of guidelines, as well as long term goals which are
taken in to account when policies are being made
 be a structure to cluster, categorise or group or otherwise
organise policies, so they are easier to find and understand;
 be a hierarchy of precedence where if in a specific situations
two documents in the hierarchy conflict, the document higher
in the hierarchy takes precedence.
 express the principles that will underpin most aspects of an
organisation's work and decisions, and guide the
development of policies and procedures
For example the National Framework for Recovery-Oriented Mental
Health Services provides a structure or skeleton so that all related
programs, services, policy and procedures can be developed or
shaped to fit.
Policies, procedures and systems fit together or build on each other
to create effective, fair, ethical, accountable and equitable structures.
Practice standards
Practice standard define the standards associated with a profession
eg nursing or social work. While there are no Work Practice
Standards for mental health there are generic resources for
community work. They were developed by the Australian Community
Workers Association and available on the ACWA website. The
community work standards are: Standard 1: Ethical Practice;
Standard 2: Regulatory Framework ; Standard 3: Development and
Supervision; Standard 4: Client Rights ; Standard 5: Confidentiality
; Standard 6: Acknowledgement of Diversity;
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Records Management
Records management (RM) and Records and Information
management (RIM) is the supervision and administration of soft copy
(digital) or hard copy (paper records), regardless of format. A well
maintained records management system supports services to
provide quality accountable service system. It includes the
confidential and secure collection, access, maintenance and
disposal of records. Covers paper records, media and electronic
data (covers digital/ computer record and cloud storage).
Right
In jurisprudence and law, a right is the legal or moral entitlement to
do or refrain from doing something or to obtain or refrain from
obtaining an action, thing or recognition in civil society. Compare
with privilege (which is a conditional entitlement and can be
revoked), or a thing to which one has a just claim.
Universal Declaration
Of Human Rights
In 1948, the United Nations member countries adopted the first
international statement of human rights called the Universal
Declaration of Human Rights. It is comprised of 30 Articles and is
still the primary document used today although other conventions
and declarations have been added since eg . United Nations
Convention on the Rights of Persons with Disabilities (CRPD).
Vilify
To speak evil of, or to defame. To make malicious and abusive
statements about somebody. Often discrimination against people on
the basis of their race, colour, descent, national or ethnic origin.
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Appendix B: Glossary of other Key Terms
Terms
Definition
Access and
Equity
This refers to ensuring the service is available to everyone who is entitled to
use the service; and ensuring that fair treatment and justice, is experienced by
everyone who is entitled to use the service. It includes identifying and
removing the barriers to entry for using the service.
Advocacy
is the act of representing, pleading or negotiating on behalf of another person
to promote, protect and defend their rights, welfare, wellbeing, justice and
quality of life.
AntiDiscrimination
refers to laws ensuring the right of people to be treated equally. These laws
aim to eliminate discrimination on the basis of disability, race, gender,
pregnancy, marital status, sexual orientation, age, and marital status.
Boundaries
Limits or restrictions between a worker and a service user commonly relating
to things like physical contact (touch, hugs), giving and receiving gifts,
appropriate clothing, use of language, relationships or contact outside work, ,
self-disclosure and so on. They exist to protect consumers from misuse or
abuse by workers and to establish the ‘professional nature’ of the relationship
Boundary
Violations
These occur when workers cross the line of decency and violate or exploit
service users. They are harmful to the service user and always unethical.
Carer
A person of any age who provides personal care, support and assistance to
another person because the other person has a disability, a medical condition
or a mental illness, or is frail. (Mental health statement of rights and
responsibilities 2012)
Citizenship
The term Citizenship in the context of marginalised groups (including those
living with mental health issues) refers to fully belonging and participating in all
aspects of community life. Citizenship as defined by Michael Rowe (2014)
involves “the person’s strong connection to the “5 Rs” of rights, responsibilities,
roles, resources, and relationships that a democratic society offers to its
members through public and social institutions and through “associational life,”
meaning social networks and voluntary groups and activities”.
This includes equal representation in areas like employment, education,
health, social relationships, financial resources, quality of life, housing and
other areas so they have the same ability to participate and the same access
to opportunities as other people.
Clinical
recovery
This is primarily defined by mental health professionals and refers to a
reduction or cessation of symptoms and ‘restoring social functioning’ (Victorian
Department of Health, 2011). See also personal recovery.
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Terms
Definition
Complex
trauma
refers to the impact of more than a single traumatic event. Both the traumatic
event(s) and circumstances and the impacts of the events are said to be
complex because they have ongoing, multi-dimensional consequences. With
‘complex trauma’ the impacts of traumatic events and circumstances are
commonly: Severe; Repeated; Occurring in childhood; involve an ongoing
relationship with the perpetrator of abuse (including in circumstances of
captivity)
Conciliation
is often used in disputes to identify a right that’s been breached and find the
optimal solution. The person doing this is often an authority figure who can
even give guidance on settlement proposals and strategies.
Confidentiality
this refers to keeping people’s personal information private and secure,
treating it and the person with respect. It is fundamentally about protecting a
person’s privacy rights. It is ethically and legally required; and protects the
rights of the consumer, carers and others.
Confidentiality is an obligation that restricts an agency from using or disclosing
any information in a way that is contrary to the interests of the person or
organisation that provided it. Privacy and confidentiality are enforced by
legislation and underpinned by professional codes of conduct to protect mental
health information from unauthorised disclosure.
Conflict
is a serious disagreement, argument or disharmony between two people who
hold different or contradictory perspectives on values or ideas.
Consumer and
Carer
participation
Consumers and carers have the right to participate in and direct their own
treatment making informed decisions about what they want. They also have
under national policy the right to participate at the organisation level in
providing feedback and perspectives on the services, programs, procedures
and practices. Ideally this will involve a genuine opportunity to design, develop,
and evaluate programs and not just a token or superficial involvement, in some
cases it may even involve the consumers making the choices and leading the
process. They may also choose to participate at the state or national level
influencing and advocating for better services and outcomes for consumers
and carers and providing expert perspectives and insights based on lived
experience. This may involve sitting on boards, committees, forums and
reference groups.
Dignity of risk
refers to a person’s right to experience all that life has to offer, even though
taking part in an activity may entail some element of risk.
To put it simply, dignity of risk means letting people do their own thing, make
their own choices and take some reasonable risks without constant worker or
organisational interference.
It doesn’t mean that workers ignore their duty of care responsibilities. A worker
might, for example, provide the person with information about the choices they
are making and the risks they are taking. There will still be times when the
worker has to take action to protect the person, so that they are not negligent
in their duty of care. Workers should always be actively working to encourage
freedom of choice and autonomy.
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Terms
Definition
Discrimination
refers to the unjust or prejudicial treatment of different groups or categories of
people, particularly on the grounds of race, gender, disability, age, ethnicity,
marital status or sexual preference. It involves bias, unfairness, unfavourable
treatment, limited opportunities, ridicule, threats or even abuse.
Dual (or
Multiple)
Relationships
This refers to any situation where more than one role exists between a worker
and a consumer. Examples include when a consumer is also a member of the
same club, a neighbour, a team member, friend, family member, co-worker
and so on. It might involve playing in a sports team, attending a party,
attending church or attending the gym at the same time.
Duty of care
is the duty to take reasonable care, so that other people are not harmed.
We all have duty of care. For example, staff members have a duty of care to
consumers and carers, to each other and to the community; and employers
have a duty of care to staff members, to consumers, to carers and to the
community.
Duty of care comes from the legal concept of ‘negligence’, which is part of
common law.
The common law that applies to a situation, as it is not based on an Act of
Parliament, but on decisions that judges have made about what is considered
appropriate at a particular time and under particular circumstances.
Early
intervention
Early intervention refers to the provision of specialist and support services for a
person either early in their lives or early in the development of the, a problem,
issue or mental health concern or early in the episode of an illness. The aim is
to promote social, emotional, wellbeing , improve quality of life and outcomes
or address health, behavioural or cognitive concerns. Intervening early can
result in better outcomes both now and in the future and has been found to
reduce the impact of mental illness in the short-term and across their life span.
Empowerment
Having the power and confidence to do the things you want. It is a feeling of
gaining power and freedom. Peer workers may work with the person to
collaboratively increase their capacity to confidently make choices and take
desired action.
Facilitation
is the act of making something easier. It is the process of leading or helping a
group to identify, plan and work toward their common objectives The person
doing this uses advanced communication and group management skills; and
focuses on developing processes and activities that allow people to work
together to achieve their desired aims and to solve problems.
Health
Promotion
According to the World Health Organisation health promotion refers to the
process of enabling and empowering people to have increased control over
and the ability to improve their health. It can have an individual, a group, a
community or population who are focus. It can produce social, emotional,
psychological and environmental outcomes. The first International Conference
on Health Promotion was held in Ottawa, Canada in November, 1986. It
identified the benchmarks and foundations for the emerging field of health
promotion.
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Terms
Definition
Holistic
This approach focuses on the whole of something, not just individual parts.
This approach focuses on the whole person, not just a diagnosis of illness but
on all of the things that make that person who they are: their total identity
including their social context; relationships; connections; their culture and
spiritual beliefs or practices; their emotional state; and their thinking and mind
function, as well as their health and physical body functions.
Human RightsBased
Approach
“Every person is free and equal in dignity and rights.” (Aust. Human Rights
Commission)
This approach involves empowering people to understand and claim their
rights, allowing them to actively participate and make informed decisions. It is
based on the P.A.N.E.L. Principles: Participation, Accountability, Nondiscrimination and equality, Empowerment and Legality.
Iatrogenic
Treatments that harm or have harmful or adverse effects are called iatrogenic.
The unfavourable effects can be physical, emotional, cognitive (thinking). It can
be from adverse effects of medication or an inappropriate or harmful treatment
approach for that person.
Informed
Consent
Workers seek this from those they work with before taking action or disclosing
anything. It ensures the person understands all relevant facts about any
service or program you are offering, and any consequences of the decisions
they are making or permission they are giving. It is a human right and an
ethical requirement to ensure that people have a full understanding of their
choices regarding disclosing information or accepting services.
Interpersonal
Trauma
This typically involves the use or abuse of power or betrayal by one person (or
group of people) over another person (or group of people). Trauma that occurs
at the hands of another person (or group of people) has the potential to impact
on the way the person understands and forms other relationships throughout
their life, including relationships with services. Interpersonal trauma involves a
betrayal of trust, which can generalise to a loss of trust in all other relationships
with people.
Limits of
Confidentiality
There are some situations that override privacy. For example when a person is
at risk of harming themselves or another person; concerns about the neglect or
abuse of a child or other vulnerable person; reporting any crime, eg murder,
rape etc; or if a court subpoena is presented.
Lived
experience
This refers to the experience people have of their own or others’ mental health
issues, emotional distress or mental illness, and of living with, and recovering
from, the impacts and consequences of their own or others’ mental health
issues, emotional distress or mental illness.
Mediation
involves resolving a conflict, dispute or controversy by using an independent
person to help two parties who are in conflict to come to an agreement or
settlement. The person doing this assists the parties to identify their needs,
priorities and concerns; then assists them to reach a mutually satisfactory
agreement.
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Terms
Definition
Mental illness
This refers to disturbances of mood or thought that can affect behaviour and
distress the person or those around them, so that the person has trouble
functioning normally. Mental illnesses include anxiety disorders, depression
and schizophrenia (National Mental Health Commission 2012).
Mutuality
This is a peer work value that ensures both people in a relationship feel
valued, equal and important. Wherever possible, equality is the aim. Power is
shared as much as possible. In the peer relationship both the person and the
peer support worker are valued and respected.
Negotiation
is a dialogue between two parties or individuals attempting to resolve an issue
or determine agreement on a matter themselves. It can involve bargaining and
compromise as they attempt to agree on a mutually acceptable position or
solution.
NonDiscrimination
refers to the fair, equitable and non-prejudicial treatment of people.
Peer leadership
approaches
Consumers and carers with lived experience and peer work experience may in
time find themselves leading or managing other peers with lived experience.
This could be informal mentoring and support to more formal line management
or supervision/ covision. It is important that peer leaders are committed to and
live out the values and philosophies of peer work, particularly role modelling
the principles of mutuality and reciprocity. There are also national initiatives to
identify, train and support peer leaders.
Peer support
This refers to people with lived experience of mental health issues supporting
each other in their recovery journey. Support may be formal or informal,
voluntary or paid. It may be stand-alone support or part of a program, project
or service run either by peers themselves or by professional mental health
service providers.
Person centred
Approach
involves creating a safe, warm genuine, respectful relationship that conveys
to the person a sense of positive regard, so they feel valued and see they are
the experts in their own lives and experiences. With support and
encouragement they will develop self awareness, find their own directions and
solutions and draw on their strengths and potential to change their futures and
manage their lives. The approach focuses on the person and their hopes,
dreams and aspirations. It is not about making a person fit into a service or
program but collaboratively holding hope and offering empathy to help them
design the supports, service or program they require. The person will then
solve their own problems and deliver their own solutions.
Personal
recovery
This is defined as being able to create and live a meaningful and contributing
life within a community of choice, with or without the presence of mental health
issues. See also clinical recovery.
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Terms
Definition
Prejudice
is a negative, adverse and hostile opinion or judgment about a person or
group/class of people. It is generally based on miscommunication, a
misunderstanding or a bias in judgment. It is commonly not based on facts,
sufficient knowledge or justified grounds.
Privacy
relates to an individual’s ability to control the extent to which their personal
information, enabling identification, is available to others.
Reasonable
Adjustment
This term refers to changes or modifications that an employer will make to a
work environment to allow people with disabilities to work both productively
and safely. To be employed the person needs to be able to perform the
‘important or inherent (required)’ tasks of the position; however they can
receive support for the other components of the task and role as long as it
doesn’t cause unjustifiable hardship to the organisation. The provision of this is
a legal requirement and an organisation may be eligible for some funding
support from the Australian government to modify the workplace. Mental health
issues are covered by this legislation and so peer workers can request special
support.
Reciprocity
This is a peer work value where people grow and learn from each other so
learning is a two-way street. In this sort of relationship support goes both ways
and both people give and receive – it is not just one person helping the other.
Both can benefit from the relationship; however, the aim is for the primary
attention and purpose to be supporting the person’s recovery journey. The
purpose of the relationship is to support the person to move forward in their
recovery and achieve their goals, so the focus of the relationship needs to be
on that person’s needs and goals
Recovery
“Recovery means gaining and retaining hope, understanding of ones abilities
and disabilities, engagement in an active life, personal autonomy, social
identity, meaning and purpose in life, and a positive sense of self.” - Principles
of recovery oriented mental health practice
http://www.health.gov.au/internet/main/publishing.nsf/Content/CFA833CB8C1
AA178CA257BF0001E7520/$File/servpri.pdf
Recoveryoriented
practice
This refers to the application of capabilities that support people to recognise
and take responsibility for their own recovery and wellbeing, and to define their
own goals, wishes and aspirations.
Principles of recovery oriented mental health practice include: Uniqueness of
the individual; Real choices; Attitudes and rights; Dignity and respect;
Partnership and communication; Evaluating recovery (by the person or the
service)
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Terms
Definition
Retraumatisation
Once a person has experienced a trauma, it is possible for other events to
trigger or inadvertently lead to re-traumatisation where the person reexperiences some feelings, thought, memories, body reactions or other
aspects of the traumatic experience. This is one of the reasons it is important
to operate from a trauma-informed perspective. It could be a word, a situation,
a picture, a smell, a touch, tone of voice, a time of day, an anniversary,
criticism, embarrassment, shame, humiliation, lack of control in a situation, use
of force, anger etc.
Role Conflict
Clash between two or more roles (eg being a peer worker and co-worker, peer
worker and friend, peer worker and carer, peer worker and mother, peer
worker and son).
The person experiences conflicting role requirements, including competing
ethical demands in the role, eg engaged as an advocate but not delegated
sufficient independence and autonomy to do so effectively.
Role Confusion
Concern or stress caused by misunderstanding about a role. It commonly
happens in two ways
when a new worker doesn't receive adequate orientation, induction or training,
so is uncertain about role requirements.
It also occurs when co-workers expect different things from the peer role,
applying direct or indirect pressure to meet their expectations, eg stating peer
workers should do certain things.
Role Strain
This refers to stress within a role, eg overworked, unrealistic expectations
This can be experienced as a result of a job exceeding current capacity,
competency or level of experience, eg work hours beyond optimal levels for
personal recovery, work requirements beyond ability of trained competency.
Self-Advocacy
involves representing yourself and your best interests. This includes asserting
and negotiating in your own interests, for example: speaking up for yourself
about your rights, responsibilities and interests; asking for what you want and
need; and speaking up and managing your own affairs and making your own
decisions.
Self-Stigma
is the internalisation and acceptance of society’s stigmatising perceptions of
mental illness. This can lead to a lack of self-esteem or confidence in a
person’s own capacity, a sense of worthlessness, social withdrawal,
dependency, reluctance to seek support or services and an excessive use of
alcohol and drugs.
Social Justice
This involves fighting against injustice; fighting for people’s rights; and fighting
for equal economic, political and social opportunities for all people.
Opportunities include access to education, employment, financial security,
housing services etc. This includes fighting for justice addressing
disadvantage, and opposing discrimination and prejudice. It also involves
promoting tolerance and valuing diversity and culture and lifestyle choice.
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Terms
Definition
Stigma
is a mark of disgrace or infamy, like a stain or blot on someone’s reputation. It
can be a physical mark or a social one. People with a lived experience of
mental health issues often experience labelling, stereotyping and this. It can
result in feelings of shame, blame, hopelessness or distress; as well as
misrepresentation and stereotyping in the media and a reluctance to accept
support or access services.
Strengths
based approach
focuses on the person’s abilities and capacities literally their strengths. Other
approaches may focus on what is wrong with the person (ie their deficits) and
concentrates on what needs to be fixed. Using a strength based approach
begins by identifying what is right and what is going well, then builds on these
strengths to further increase the person’s resilience and capacity. It is by
nature an empowering process that build confidence and autonomy and
discourages dependency. It is more than simple praise and encouragement. It
seeks to collaboratively identify and acknowledge the person’s real strengths
and potential rather than their limits.
Systemic
Advocacy
involves working as an individual or group to influence change in systems,
often organisational or government policy, laws, practices or programs. It can
include lobbying, media releases, campaigns, social action campaigns, writing
letters, petitions etc.
Trauma
refers to an individual’s response to an unexpected and extremely stressful
event or series of events that overwhelm the individual’s ability to understand
and cope. The response is individual and two people experiencing the same
trauma may react very differently.
Trauma can happen to anyone, however vulnerable people are at greater risk.
This includes people with disabilities, the homeless (particularly young people),
Aboriginal and Torres Strait Islander people and refugees, people in the
criminal justice system, women, aged and frail people
Trauma can affect a person’s brain development, thoughts, feelings,
behaviours, relationships and sense of self.
Vicarious
Trauma
Listening to a person’s thoughts, feelings and experiences about being
involved in a traumatic situation can actually lead to a trauma reaction in a
peer or support worker. This is known as ‘vicarious trauma'.
Just listening to a traumatic story being retold can expose a worker to images
and emotional reactions that are draining, frightening and distressing. Workers
are empathic and generally very caring. They are often very committed and
have a strong sense of responsibility, which can increase the likelihood of
vicarious trauma. They often have a strong desire to help, and can feel
helpless themselves if they can’t. Listening to very painful and distressing
stories can result in a worker struggling to release the feelings of concern and
heaviness later.
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Appendix C: Key Legislation for Mental Health Workers
The NSW Mental Health Act 2007
THE MENTAL HEALTH RIGHTS MANUAL (MHRM): An online guide to the legal and
human rights of people navigating the mental health and human service systems in NSW
(4th Edition) 2015 (http://mhrm.mhcc.org.au/home/)
Written in plain English, the Manual is an invaluable readily accessible resource, bringing
together vital information crucial to anyone having to navigate the mental health system,
enabling them to become acquainted with their rights, the legal and service system, and
access support and guidance.
It provides much more detailed information than the brief overview provided here.
The main purpose of the Mental Health Act 2007 (NSW) is to ensure the 'care and treatment'
of people in NSW who are 'mentally ill' or 'mentally disordered' (these terms are defined in
the Act and do not necessarily have the same meanings as when used elsewhere).
‘As defined in the Act …a mentally ill person (Section14) is:
1) A person is a mentally ill person if the person is suffering from mental illness and,
owing to that illness, there are reasonable grounds for believing that care, treatment
or control of the person is necessary:
(a) for the person’s own protection from serious harm, or
(b) for the protection of others from serious harm.
(2) In considering whether a person is a mentally ill person, the continuing condition
of the person, including any likely deterioration in the person’s condition and the
likely effects of any such deterioration, are to be taken into account.’
Serious harm can include:





Physical harm
Harm to your reputation and/or relationships
Financial harm
Self-neglect, and/or
Neglect of others (e.g. children and other dependents).’
Objects of Act
The Objects of the Act set out its fundamental policy and purpose and are an important
guide to its interpretation.
The objects of this Act are:
a. to provide for the care and treatment of persons who are mentally ill or mentally
disordered, and to promote the recovery of persons who are mentally ill or mentally
disordered,
b. to facilitate the care and treatment of those persons through community care
facilities,
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c. to facilitate the provision of hospital care for those persons on a voluntary basis
where appropriate and, in a limited number of situations, on an involuntary basis,
d. while protecting the civil rights of those persons, to give an opportunity for those
persons to have access to appropriate care,
e. to facilitate the involvement of those persons, and persons caring for them, in
decisions involving appropriate care and treatment.
The Objects of the Act also refer to voluntary and involuntary hospital treatment and to the
involvement of people dealt with under the Act and their carers in decisions about 'care and
treatment'.
The amendments to the Mental Health Act 2007 (NSW) were assented on the 28
November 2014 by way of the Mental Health Amendment (Statutory Review) Act 2014.
The Mental Health Act 2007(NSW) proclaimed on 31 August 2015 now states the primary
objective of the Act to be ‘to provide for the care and treatment of, and to promote the
recovery of, persons who are mentally ill or mentally disordered.’ The Act has removed the
word ‘control’ from, and introduces the concept of ‘recovery’ to, the Objects of the Act, and
refers only to ‘care and treatment.’ This change may reflect a legislative intention to give
greater weight to the views of consumers when decisions are being made about care and
treatment under the Act.
8 Principles for care and treatment
It is the intention of Parliament that the following principles are, as far as practicable, to be
given effect to with respect to the care and treatment of people with a mental illness or
mental disorder:
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The 8 Principles for care and treatment include:
(a) people with a mental illness or mental disorder should receive the best possible care
and treatment in the least restrictive environment enabling the care and treatment to be
effectively given,
(b) people with a mental illness or mental disorder should be provided with timely and high
quality treatment and care in accordance with professionally accepted standards,
(c) the provision of care and treatment should be designed to assist people with a mental
illness or mental disorder, wherever possible, to live, work and participate in the
community,
(d) the prescription of medicine to a person with a mental illness or mental disorder should
meet the health needs of the person and should be given only for therapeutic or
diagnostic needs and not as a punishment or for the convenience of others,
(e) people with a mental illness or mental disorder should be provided with appropriate
information about treatment, treatment alternatives and the effects of treatment and be
supported to pursue their own recovery,
(f) any restriction on the liberty of patients and other people with a mental illness or mental
disorder and any interference with their rights, dignity and self-respect is to be kept to the
minimum necessary in the circumstances,
(g) any special needs of people with a mental illness or mental disorder should be
recognised, including needs related to age, gender, religion, culture, language, disability
or sexuality,
(g1) people under the age of 18 years with a mental illness or mental disorder
should receive developmentally appropriate services,
(g2) the cultural and spiritual beliefs and practices of people with a mental illness
or mental disorder who are Aboriginal persons or Torres Strait Islanders should be
recognised,
(h) every effort that is reasonably practicable should be made to involve persons with a
mental illness or mental disorder in the development of treatment plans and recovery
plans and to consider their views and expressed wishes in that development,
(h1) every effort that is reasonably practicable should be made to obtain the
consent of people with a mental illness or mental disorder when developing
treatment plans and recovery plans for their care, to monitor their capacity to
consent and to support people who lack that capacity to understand treatment
plans and recovery plans,
(i) people with a mental illness or mental disorder should be informed of their legal rights
and other entitlements under this Act and all reasonable efforts should be made to ensure
the information is given in the language, mode of communication or terms that they are
most likely to understand,
(j) the role of carers for people with a mental illness or mental disorder and their rights
under this Act to be kept informed, to be involved and to have information provided by
them considered, should be given effect.
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These changes are now in force. The Mental Health Act 2007 now restates the primary
objective of the Act to be ‘to provide for the care and treatment of, and to promote the
recovery of, persons who are mentally ill or mentally disordered.’ The word ‘control’ has
been removed from the Act, and the concept of recovery has been introduced to the
Objects of the Act, which refers only to care and treatment. This change may reflect a
legislative intention to give greater weight to the views of consumers when decisions are
being made about care and treatment under the Act.
If it is decided that you have a 'mental illness' or are 'mentally disordered' as defined in the
Act, you can be:




taken to a hospital or psychiatric unit against your will for further assessment;
treated in hospital without you agreeing to this;
stopped from leaving a hospital that you've been taken to, including being kept
behind locked doors and forcibly taken back to hospital if you leave;
placed on a Community Treatment Order when you are not in hospital care, and
made to have regular treatment, usually medication.
Main rights under the Mental Health Act 2007 (NSW)
If you are being dealt with under the Mental Health Act 2007 (NSW), you have a right to be:
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be given a Statement of Rights
given information about treatment, treatment alternatives and the possible effects of
treatment;
be involved in the development of your treatment plan and any plans for your
ongoing care;
told your legal rights under the Act in a language that you can understand.
The Mental Health Act 2007 (NSW) does not give you a right to be admitted to a mental
health facility or to extend your stay (either as a voluntary or involuntary patient) if the
treating doctors don't think it is clinically appropriate or necessary.
The principle of least-restrictive care
There is a principle under the Mental Health Act 2007 (NSW) that mentally ill and mentally
disordered people should receive the care and treatment they require in the ‘least restrictive
environment consistent with their safe and effective care.’ An Authorised Medical Officer of
an inpatient unit or Director or delegate of a Community Mental Health Facility is required to
provide care and treatment in accordance with this principle.
Both aspects of the principle (‘least restrictive environment’ and ‘consistent with safe
and effective care’) are important and must be balanced. For example, if a person can
recover from the onset or a relapse of a mental health condition with care and treatment at
home, and with family support, they ought not to be admitted to hospital. Conversely, if it
would be unsafe or ineffective for a person to recover from the onset or relapse of a mental
illness at home (perhaps because the person refuses treatment), and they are a risk of harm
to themselves or others, an involuntary admission to hospital may well be the least restrictive
alternative.
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The principle of the least restrictive option is an important test for the type of mental health
interventions authorised under the Mental Health Act 2007, but it is applied practically rather
than theoretically. Consequently, any form of less restrictive care proposed must also be
‘reasonably available.’
The Mental Health Act defines three types of persons:
Voluntary patient: where an individual is mentally ill and agrees to go to hospital for
treatment;
Involuntary patient: includes both ‘mentally ill’ persons and ‘mentally disordered’
persons detained under the MH Act;
Forensic patient: a person with a mental illness who has been charged with a
criminal offence and is in prison, hospital, or on conditional release under an
order of the Mental Health (Forensic Provisions) Act 1990 or the Criminal
Appeal Act 1912.
Voluntary patients under the Mental Health Act 2007 (NSW)
Although the Mental Health Act 2007 (NSW) is mainly about involuntary treatment and
admission, it also deals with 'voluntary patients'.
If a person wants to be admitted to hospital for treatment and the hospital assesses them as
appropriately needing care and treatment, then the person is a voluntary patient and can
discharge themselves from hospital at any time, preferably having told staff so that they can
make appropriate after-care plans.
If a person decides to discharge themselves and the hospital think this is inappropriate, the
hospital can involuntarily detain the person for review before the MHRT as an involuntary
patient.
The rights and obligations of competent adult 'voluntary patients' under the Mental Health
Act 2007 (NSW) are fundamentally the same as other adult patients in general hospitals.
There are, however, some differences:
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The Mental Health Review Tribunal must review voluntary patients every 12 months
if they stay as a patient of a psychiatric hospital or unit.
A voluntary patient can be made an involuntary patient at any time without notice if
they are assessed as being mentally ill or mentally disordered under the definition of
these terms in the Mental Health Act 2007 (NSW). Although many voluntary patients
see this as unfair when it happens, the Mental Health Act 2007 (NSW) says this can
happen.
These changes are now in force. The Mental Health Act 2007, gives an authorised
medical officer of a public psychiatric unit the power to detain a voluntary patient in
hospital for a period of up to two hours for the purpose of assessing if he or she is a
mentally ill or mentally disordered person who ought to be detained as an involuntary
patient. It also requires an Authorised Medical Officer of a mental health facility to give a
person who becomes a voluntary patient a written Statement of Rights and to provide
them with an oral explanation of those rights. These changes are now in effect.
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The Mental Health Rights manual has useful information about the power of ‘enduring
guardian’ and guardians in admitting a person (voluntarily or involuntarily)
The Mental Health Act 2007 (NSW) allows children under 16 to be admitted as voluntary
patients by their parents. Where a person has a legally appointed guardian, the guardian
may be involved in decisions about admission and discharge.
In this respect, a guardian is automatically recognised as a person’s Designated Carer
under the Mental Health Act 2007 (NSW).
These changes are now in force. The Mental Health Act 2007 changes the term ‘Primary
Carer’ to that of ‘Designated Carer.’ A designated carer can also be a person who is a
close relative or friend who has frequent contact and interest in the care of a person with a
mental health condition. The 'relative' of a person who is an Aboriginal or Torres
Islander includes a person who is part of the extended family or kin of a person according
to the indigenous kinship system of the person's culture.
Involuntary Patients
Under the NSW Mental Health Act 2007 a person may be involuntarily admitted to hospital
either because they are ‘mentally ill’ or ‘mentally disordered’. They are assessed by two
'authorised medical officers' usually but not always psychiatrists.
The legal definition of mental illness in the Act differs from a clinical diagnosis of illnesses
such as schizophrenia or bi-polar disorder. The legal definition is used to decide whether a
person has a mental illness that will require treatment without his or her consent. A person
cannot be detained just because they have a diagnosis of mental illness. They can only be
detained if they are showing signs and symptoms such as delusions and hallucinations, and
suicidality which would put them in danger of self- harm (including harm to reputation,
serious neglect or a danger to others.
Forensic patient
The Mental Health (Forensic Provisions) Act 1990 (NSW) sets out how criminal proceedings
are dealt with in the Supreme, District and Local Courts when the defendant has a mental
disorder. It also deals with mental illness as a legal defence in criminal cases, as well as with
forensic and correctional patients, including setting out the role and powers of the Mental
Health Review Tribunal in reviewing forensic and correctional patients.
When a person is assessed as a ‘Mentally ill’ patient:
A person’s involuntary stay in a mental health facility may be extended by way of an
involuntary patient order. If a person is found to be a mentally ill person as an ‘assessable
person’ and must be brought before the Tribunal for a Mental Health Inquiry ‘as soon as
practicable’. This will usually take place within 2-3 weeks after the person is detained in the
mental health facility to allow sufficient time for the person to be fully assessed and for an
appropriate treatment or discharge plan to be developed.
When it hears an application for these orders, the Tribunal must decide if the person is a
‘mentally ill person’.
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The person is usually represented by the Mental Health Legal Advocacy Service or their own
lawyer. Prior to 21 June 2010, the enquiry was held in front of a magistrate (see NSW
Health handout “Becoming an Involuntary Patient”)
The Tribunal can set a review date for up to 3 months in hospital or discharge them.
However, the hospital is obliged to discharge a person as soon as they become well
enough. The review is necessary in case a person still remains in hospital.
Involuntary patients can be confined and given treatment against their wishes if they believe
it is in the best interests of the patient. However, the MH Act says: … any restriction on the
liberty of patients and other people with a mental illness or mental disorder and any
interference with their rights, dignity and self-respect is to be kept to the minimum necessary
in the circumstances. There is nothing in the MH Act 2007 that gives a hospital or any health
care professional special permission to restrain or sedate involuntary patients or put them in
seclusion.
Medication should be prescribed at the minimum level consistent with proper care to ensure
that the person can communicate with their legal representative.
A patient or primary carer can appeal against the Authorised Medical Officer’s decision If the
Authorised Medical Officer refuses to discharge the patient, or fails to determine the
application for discharge within 3 working days.
A person is considered a ‘mentally disordered person’ by law when they behave, for the
time being, in such an irrational way that temporary care, treatment or control of the person
is necessary as they are at risk of seriously harming themselves or others. This category is
most commonly used where a person is actively suicidal, loses control following a personal
crisis, or is psychotic under the influence of drugs.
When a person is assessed as ‘Mentally disordered’ they:
Can only be detained for three days, not including weekends and public holidays.
Can be confined and given treatment against their wishes, (see above).
Must be examined every 24 hours by an accredited person/doctor.
Must be released if the doctor decides the person is no longer mentally disordered.
May be detained for no more than three consecutive three-day-periods in any one calendar
month (in practice many are discharged the following day)
The NSW Mental Health Act 2007 provides authority to Ambulance staff (once they have
completed training) to transfer people to and from mental health facilities as well as sedation
and search powers. Police involvement should only be required when there are serious
concerns about safety of the person or others.
Carers
The Mental Health Act 2007 (NSW) has some new terms and categories of carers eg a new
category of persons called “Principal Care Provider” who are persons entitled to be informed
of a range of matters about the person for whom they provide care, including about their
admission, aspects of treatment and discharge.
A designated carer can also be a person who is a close relative or friend who has frequent
contact and interest in the care of a person with a mental health condition. The 'relative' of a
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person who is an Aboriginal or Torres Islander includes a person who is part of the extended
family or kin of a person according to the indigenous kinship system of the person's culture.
It is important to remember that all carers, people with mental illness and health care
providers have legal rights and responsibilities, both under the Mental Health Act 2007
(NSW) and under the general law.
The Mental Health Amendment (Statutory Review) Act 2014 (NSW) has replaced the term
“Principle Carer” with that of “Designated Carer.” It also introduces a new category of
persons called “Principle Care Providers” who are persons primarily responsible for
providing care and support to a person with mental illness. Principle Care Providers have a
similar right to information about the treatment of the person for whom they care to
Designated Carers.
Appointment of a Designated Carer
The Mental Health Act 2007 (NSW) allows a patient (both voluntary and involuntary) to
appoint a 'Designated Carer', who then automatically receives certain information about that
patient.
One purpose of changes to the Mental Health Act 2007 (NSW) back in 2007 was to
recognise the importance of carers and give them access to some information to help them
to provide care and support to a relative or friend who has a mental illness, whilst at the
same time giving the person with mental illness the right to control who will be accessing this
information.
The main features of this part of the law are that:
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a person with mental illness may nominate (in writing) a person as their Designated
Carer
a person with mental illness can also put in writing that they don't want a particular
person to be their Designated Carer
a person with mental illness can revoke (cancel) a nomination of a Designated Carer
nominations can be made at any time but stay in force for 12 months unless changed
(revoked) by the person with mental illness
in very limited circumstances, the nomination or revocation by the person with mental
illness can be overturned.
If a person with mental illness does not nominate a Designated Carer, one of the following
will be regarded ('deemed') under the Mental Health Act 2007 (NSW) as the Designated
Carer:
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a guardian (either Tribunal-appointed or an enduring guardian)
a spouse (includes de facto spouse), 'if the relationship between the patient and the
spouse is close and continuing'
a person who is primarily responsible for providing support or care to the patient
('other than wholly or substantially on a commercial basis')
a close friend or family member
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In practical terms, a person who is deemed to be the Designated Carer (rather than
nominated by the person with mental illness) continues as Designated Carer until the person
with mental illness either excludes them from their care; revokes their nomination as
Designated Carer, or nominates someone else as their Designated Carer. Under the Mental
Health Act 2007 (NSW) two people may now be nominated as a Designated Carers, as well
as the Principal Care Provider who is now recognised. The Act doesn’t say anything about
what happens if a person with mental illness does not nominate a Designated Carer and
there are two or more people who are eligible under the Mental Health Act 2007 (NSW) to
be the person’s Designated Carer.
The parents of a child under 14 who is a patient under the Mental Health Act 2007 (NSW)
are the Designated Carers of that child. The Mental Health Act 2007 (NSW) says when a
person with mental illness has reached 14 they can nominate their Designated Carer but
also says if they are between 14 and 18, they can't exclude their parents from getting the
information listed in the Mental Health Act 2007 (NSW).
Access to patient information
Just like other patients, patients with mental illness who are in hospital, can give permission
for other people to have access to their private health information. Before 2007, public
psychiatric hospitals had no standard procedures and rules to allow this to happen, and
family members and spouses of adult competent patients participated in the care of patients
in an ad hoc way. Often they were not given information about patients on the grounds of
'privacy', even where those patients had agreed (or would have if they were asked) to a
carer having access to the information.
Some family members want information about discharge and leave approved for involuntary
patients because, for example, they want to be able to make sure appropriate support is in
place or because they have fears of unwanted contact with the person. Click here to read
about helping your friend or family member to be discharged.
Under the Mental Health Act 2007 (NSW) Designated Carers have the right to be given
certain information. For more about this, click here.
Designated Carers do not have access to all patient information. The following information
remains confidential unless the patient consents to it being discussed with the Designated
Carer:
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Diagnoses
Treatment other than medication
Results and details of assessments and tests
Content of conversations between doctor and patient.
If the Designated Carer or any other family member or friend is given any of this information
without the consent of the patient, the patient could complain to the Health Care Complaints
Commission (HCCC) about a breach of confidentiality and to either the NSW or Federal
Privacy Commissions about a breach of their rights under the privacy principles. (Such a
complaint would be against the organisation or person that released the information not the
person to whom it was given.)
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Information to be provided to Designated Carers
The Designated Carer is to be told:
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if the person with mental illness is detained in hospital
if and when the person with mental illness is due to be part of a mental health inquiry
by the Mental Health Review Tribunal
what medication the person with mental illness has been given in hospital
if the person with mental illness is away from the facility without permission or fails to
return at the end of a period of leave
if it is proposed to transfer the person with mental illness to another mental health
facility or other health facility
if the person with mental illness is discharged from the mental health facility
if the person with mental illness has been re-classified as a voluntary patient
if the Authorised Medical Officer is proposing to apply to the Mental Health Review
Tribunal for an Electro Convulsive Therapy (ECT) Administration Inquiry or for a
decision about whether the person with mental illness is capable of giving informed
consent to ECT
if a surgical operation is performed on the person with mental illness and they do not
give consent or do not have capacity to give consent
if the Authorised Medical Officer is proposing to apply to the Director-General of
NSW Health or the Mental Health Review Tribunal for consent to perform a surgical
operation or special medical treatment that requires special consent under the
Mental Health Act 2007 (NSW)
The Mental Health Act 2007 (NSW) also requires the mental health facility to consult with the
Designated Carer about a discharge plan prepared for the release of the person with mental
illness from hospital.
A Designated Carer can also get information about the medication a person with mental
illness is obliged to take under a Community Treatment Order (CTO).
Access for Designated Carers and others to patient information with consent
If a person with mental illness agrees to their Designated Carer, any other carer, family
member or friend having access to the whole of their medical records, then no privacy or
confidentiality obligations are breached. Arranging for this access to be provided will usually
only occur after negotiation with the health care provider.
It is important to note that if a Designated Carer does not have automatic access to the
whole of a patient’s medical records. This is so, whether they have been appointed
Designated Carer by a patient or if they are ‘deemed’ under the Mental Health Act 2007
(NSW), to have a right to access the information specified in the Mental Health Act 2007
(NSW). To access other health information in the patient’s files, they need the patient’s
active consent, which would ordinarily be required to be in writing.
People who want to have maximum participation in their friend or family member's care and
treatment, and have that person's support for this, should encourage the person to nominate
them as their Designated Carer and to consent in writing to them being given access to all of
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the person's otherwise confidential files. It is best for the person with mental illness to do this
when they are well, have an independent person (such as a lawyer) help them prepare the
document saying this is what they want, and provide a copy of this document to all their
usual health care providers.
Community Treatment Orders (CTO)
CTOs can be issued in hospital or in the community. The treatment order is specifically
tailored to the person under the order, and failure to comply with the order can lead to them
being ‘breached’ and brought into hospital. A CTO normally is set for 6 months unless the
treatment team give good reason to do otherwise. For example, reasons given may be to:
stabilise a patient’s condition and to establish a therapeutic relationship with a case
manager/clinician in the community. CTOs can be made by an inpatient treating team; a
community mental health team and /or GP and must be reviewed by the tribunal. A CTO no
longer expires if the person is detained in hospital for assessment.
Mental Health Review Tribunal (MHRT)
The MHRT has an important role in the care and treatment of people with mental illness.
The MHRT has three full-time and approximately one hundred part-time members. When it
conducts hearings it is made up of three people: a lawyer, a psychiatrist and another person
experienced in mental illness who may be a worker, e.g. psychologist, mental health nurse,
OT, social worker etc., or a person with lived experience who is a consumer and/or carer.
The MHRT travels to hospitals and community health centres to hold hearings. Most
hearings are conducted by video and telephone used only when no other alternative
available.
The Mental Health Review Tribunal is a specialist quasi-judicial body constituted under the
NSW Mental Health Act 2007. It has a wide range of powers that enable it to conduct mental
health inquiries, make and review orders, and to hear some appeals, about the treatment
and care of people with a mental illness. The MHRT can make the following orders:
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Involuntary Patient Orders –conduct Mental Health Inquiries, to determine whether a
person detained in a hospital should be made an involuntary patient or continue to
remain involuntary; hear appeals against a medical superintendent’s refusal to
discharge an involuntary patient
Review of Voluntary Patients - Review informal (voluntary) patients, who are long
term hospital stay patients, usually every twelve months
Community Treatment Orders – Make, vary and revoke Community Treatment
Orders ; and hear appeals against a decision to make a community order
Reviews of Forensic Patients – Reviews the status of all forensic patients
Electro Convulsive Treatment (ECT) - Determine if voluntary patients have
consented to ECT; and approve the use of ECT for involuntary patients
Surgery and Special Medical Treatment Approve surgery on a patient detained in
hospital; approve special medical treatment (sterilisation)
Financial Management Orders - Can o order that a person's financial affairs be
managed by the NSW Trustee, on a Financial Management Order
Mental Health Advocacy Service
The Mental Health Advocacy Service (MHAS) provides free legal advice and assistance
about mental health law. They represent people in hearings that relate to their detention and
treatment in hospitals and the community, and the management of their money. The service
is able to assist:
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People who have been involuntarily admitted to a hospital
People appearing before the Guardianship Tribunal
Relatives and friends are welcome to call for advice
The service is part of Legal Aid NSW and is located at: Level 4, 74-76 Burwood Road,
Burwood NSW 2134. The contact telephone is 02 9745 4277
Website: http://www.legalaid.nsw.gov.au/what-we-do/civil-law/mental-health-advice
Official Visitors Program
Official Visitors (OVs) are appointed by the NSW Minister for Health to visit people in mental
health inpatient facilities in NSW and are available to assist consumers on Community
Treatment Orders.
OVs are independent from the health system and come from the community from a range of
cultural, professional and personal backgrounds.
They aim to safeguard standards of treatment and care, and advocate for the rights and
dignity of people being treated under the NSW Mental Health Act 2007.
OVs make regular visits to all inpatient psychiatric facilities across NSW; talk to patients,
inspect records and registers, and report on the standard of facilities and services. They
liaise with staff about any issues or concerns and report any problems to the Principal
Official Visitor and/or the Minister for Health.
OVs listen to consumers’ or carers’ concerns and help to resolve them, or, with permission,
can act to resolve it on their behalf.
Consumers, carers, family, friends, staff and other people with an interest in the care and
treatment of people with a mental illness can contact Official Visitors.
Consumers or carers can let the staff know if they want to see an OV during their next visit.
Telephone 1800 208 218 between 9am and 5pm Monday to Friday, free of charge from
within NSW.
If you need to speak to an Official Visitor outside of these hours, phone 1800 208 218 and
leave a message, or ask hospital staff to arrange it for you. The Official Visitor must be
notified of the request within two days.
You can also leave a letter in the Official Visitors Box in the ward, or write to:
Official Visitors
Locked Bag 5016,
Gladesville NSW 1675
For more information see The Official Visitors website http://www.ovmh.nsw.gov.au/
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Discrimination; Abuse; Privacy; Confidentiality; Duty of Care and Dignity of
Risk
Discrimination
Discrimination is when someone, because of a personal characteristic, is treated unfairly or
less favourably than others in similar circumstances.
Discrimination can also be when the same treatment of everyone has a negative impact on
someone because of a personal characteristic.
While this can be very negative, not all unfair treatment is considered to be discrimination
under our legal system.
Discrimination is prohibited by both state and federal legislation, which deal with certain
personal characteristics (called ‘grounds’) in certain circumstances (called ‘areas’).
Discrimination Legislation
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A quick guide to Australian discrimination laws (PDF)
https://www.humanrights.gov.au/sites/default/files/GPGB_quick_guide_to_discriminat
ion_laws_0.pdf
A quick guide to Australian discrimination laws (Word)
The Commonwealth Government and the state and
territory governments have made laws to help protect
people from discrimination and harassment.
The commonwealth has a number of discrimination laws
and the Australian Human Rights Commission has
statutory responsibilities under them. They include:
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Age Discrimination Act 2004
Australian Human Rights Commission Act 1986
Disability Discrimination Act 1992
Racial Discrimination Act 1975
Sex Discrimination Act 1984.
The Disability Discrimination Act 1992 covers people with
psychiatric disability and mental illness issues that impact
their daily.
The Commonwealth laws and the NSW law overlap but cover some different areas. As both
NSW laws and Commonwealth laws apply, you must comply with both. For example being
granted an exception/exemption in one state doesn’t necessarily grant one for the other.
The NSW government has their own legislation in relation to discrimination. The New South
Wales act is the Anti-Discrimination Act 1977.
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Commonwealth Legislation and grounds of
discrimination
Australian Human Rights Commission Act 1986
Discrimination on the basis of race, colour, sex,
religion, political opinion, national extraction, social
origin, age, medical record, criminal record, marital or
relationship status, impairment, mental, intellectual or
psychiatric disability, physical disability, nationality,
sexual orientation, and trade union activity.
Areas covered
Discrimination in employment or
occupation.
Also covers discrimination on the basis of the
imputation of one of the above grounds.
Age Discrimination Act 2004
Discrimination in employment,
education, access to premises,
Discrimination on the basis of age – protects both
provision of goods, services and
younger and older Australians.
facilities, accommodation,
Also includes discrimination on the basis of age-specific disposal of land, administration of
Commonwealth laws and
characteristics or characteristics that are generally
programs, and requests for
imputed to a person of a particular age.
information.
Disability Discrimination Act 1992
Discrimination on the basis of physical, intellectual,
psychiatric, sensory, neurological or learning disability,
physical disfigurement, disorder, illness or disease that
affects thought processes, perception of reality,
emotions or judgement, or results in disturbed
behaviour, and presence in body of organisms causing
or capable of causing disease or illness (eg, HIV virus).
education, access to premises,
disposal of land, activities of
clubs, sport, and administration of
Commonwealth laws and
programs.
Also covers discrimination involving harassment in
employment, education or the provision of goods and
services.
Racial Discrimination Act 1975
Discrimination on the basis of race, colour, descent or
national or ethnic origin and in some circumstances,
immigrant status.
Racial hatred, defined as a public act/s likely to offend,
insult, humiliate or intimidate on the basis of race, is
also prohibited under this Act unless an exemption
applies.
Discrimination in all areas of
public life including employment,
provision of goods and services,
right to join trade unions, access
to places and facilities, land,
housing and other
accommodation, and
advertisements.
Continued over page
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Commonwealth Legislation and grounds of
discrimination
Sex Discrimination Act 1984
Discrimination on the basis of sex, marital or
relationship status, pregnancy or potential pregnancy,
breastfeeding, family responsibilities, sexual
orientation, gender identity, and intersex status.
Sexual harassment is also prohibited under this Act.
Fair Work Act 2009
Discrimination on the basis of race, colour, sex, sexual
orientation, age, physical or mental disability, marital
status, family or carer responsibilities, pregnancy,
religion, political opinion, national extraction, and social
origin.
Areas covered
including discrimination against
commission agents and contract
workers, partnerships, qualifying
bodies, registered organisations,
employment agencies, education,
disposal of land, clubs,
administration of Commonwealth
laws and programs, and
superannuation.
Discrimination, via adverse action,
in employment including
dismissing an employee, not
giving an employee legal
entitlements such as pay or leave,
changing an employee’s job to
their disadvantage, treating an
employee differently than others,
not hiring someone, or offering a
potential employee different (and
unfair) terms and conditions for
the job compared to other
employees.
NSW laws
Legislation and grounds of discrimination
New South Wales: Anti-Discrimination Act 1977
(NSW)
Discrimination on the basis of race, including colour,
nationality, descent and ethnic, ethno-religious or
national origin, sex, including pregnancy and
breastfeeding, marital or domestic status, disability,
homosexuality, age, transgender status, and carer
responsibilities.
Areas covered
including discrimination against
commission agents and contract
workers, partnerships, industrial
organisations, qualifying bodies,
employment agencies, education,
provision of goods and services,
accommodation, and registered
clubs.
Sexual harassment and vilification on the basis of race,
homosexuality, transgender status or HIV/AIDS status
are also prohibited under this Act.
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For a situation to be discrimination 2 factors need to be present. These are called the
grounds and the area. Both are explained further below.
GROUNDS + AREA = DISCRIMINATION
Knowing about discrimination can help you to ensure that your service never does anything
that might be considered discriminatory. It is far better to avoid any possibility of a consumer
having grounds for making a complaint.
It is not discrimination if a person is unable to perform the inherent requirements of a
particular job. This must be determined on a case-by-case basis, according to the nature of
the job and the nature of the circumstances.
Step 1 – GROUNDS
To work out whether someone can take legal action for discrimination the first thing you
need to think about is the reason why they have been treated unfairly.
Has the person been treated unfairly or harassed because they are…… (Tick if yes)
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Male or female (sex discrimination)
Married, single or in a de facto relationship (marital status discrimination)
Pregnant (pregnancy discrimination)
Gay or lesbian (homosexual discrimination)
Too young or old (age discrimination)
A person with a disability, including physical, mental, cognitive or developmental/ or
intellectual, or illness or disease, past or present (disability discrimination)
A carer of someone, such as a child or family member
Transgender or transsexual (transgender discrimination)
Aboriginal or Torres Strait Islander or from a particular racial or ethnic background
(race discrimination)
Physical appearance
Of a certain religious group
OR they have been sexually harassed, or vilified on the basis of their race,
transgender status, homosexuality or HIV/AIDS status.
Sometimes the unfair treatment is obvious. For example, an employer tells the consumer
that they did not get a job because they have a history of mental illness. That is called ‘direct
discrimination’.
Sometimes the discrimination is less obvious – rules, practices or policies which can have
an unfair effect on a particular group. For example, it could be indirect discrimination if a
university student was excluded for breach of attendance policy without regard to his mental
illness having caused the problems in attendance.
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Step 2 – AREA
The next step in deciding if the person might have a discrimination case is to find out
whether it happened in an area of life that is covered by discrimination laws.
Was the person treated unfairly when they were…… (Tick if yes)
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At work (or in discriminatory advertising of a job)
At school, TAFE, university or college
Using a club or applying for membership at a club
Securing accommodation or dealing with a real estate agent or landlord
Trying to get a service or buy something, from e.g., a shop, a hotel, a restaurant, a
government department, police, transport etc.
Trying to use a public place or facility, such as public transport
Assessed for insurance
Eligible for or using government programs
Trying to gain access to justice or legal systems
Complaints about Discrimination
The first thing a person can do if they think they have been discriminated against on the
grounds of having a disability is to try talking to the person or organisation that appears to be
discriminating. If that is unsuccessful then a formal complaint can be made to the AHRC
Australian Human Rights Commission or the NSW Anti-Discrimination Board (ADB) within
12 months of the alleged discriminatory conduct or action. It is important that people are
aware of the time limit.
The Anti-Discrimination Board of NSW administers complaints under the Anti-Discrimination
Act 1977 (NSW). They can be contacted on (02) 9268 5555 or Toll free on 1800 670 812.
Refer to their website for information and fact sheets: www.lawlink.nsw.gov.au/adb.
The Australian Human Rights Commission covers all of Australia and administers a range of
discrimination laws including the Disability Discrimination Act 1992. They can be contacted
by phone on 1300 656 419 (local call) or 02 9284 9888
Refer to their website for information and fact sheets: www.hreoc.gov.au.
If you are unsure where to lodge a complaint, simply contact one of those organisations, and
they will refer you to the other one should that be appropriate in the situation.
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Abuse
Abuse is the violation of an individual’s human or civil rights, through the act or actions of
another person or persons. Neglect is a failure to provide the necessary care, aid or
guidance to dependent adults or children by those responsible for their care.
Types of Abuse
1. Physical abuse:
intentionally using physical force which causes, or could cause, harm to a child or adult for
example punching, pushing, hitting, slapping, burning, shocking, choking, throwing things,
kicking, inflicting pain, forced feeding, denial of food, use of weapons, deliberately causing
fear.
2. Sexual abuse:
forcing someone to take part in sexual activity against their will including Any sexual contact
between an adult and child 16 years of age and younger; or any sexual activity with an adult
who is unable to understand, has not given consent, is threatened, coerced or forced to
engage
3. Psychological or emotional abuse:
Threatening (including verbal assaults, threats of maltreatment etc), harassing humiliating,
intimidating, ignoring a person or denial of their cultural or religious needs and preferences.
4. Constraints and restrictive practices:
Restraining or isolating an adult for reasons other than medical necessity, absence of a less
restrictive alternatives to prevent self-harm, the use of chemical or physical means, denial of
basic human rights or choices (such as religious freedom, limiting who they can see, where
they can go or their access to property and resources).
5. Financial abuse:
The wrongful or improper use of another person's assets or denying a person the use of
their own assets or resources
6. Legal or civil abuse:
Denial of access to justice, or legal systems available to other citizens.
7. Systemic abuse:
Failure to recognise, provide or attempt to provide adequate or appropriate services,
including appropriate services for the person’s age, gender, culture, needs or preferences.
Types of Neglect include (but are not limited to):
1. Physical neglect:
Failure to provide adequate food, shelter, clothing, protection, supervision, medical and
dental care, or to place persons at undue risk through unsafe environments or practices.
2. Passive neglect:
A caregiver’s failure to provide, or withholding the necessities of life, including food, clothing,
shelter or medical care.
3. Willful deprivation:
Wilfully denying a person support, assistance or access to needed medication or medical
care, shelter, food thus exposing that person to risk of physical, mental or emotional harm
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4. Emotional neglect:
The failure to provide the nurturance or stimulation needed for the social, intellectual and
emotional growth and well-being of a child or an adult.
The National Disability Abuse and Neglect Hotline
The National Disability Abuse and Neglect Hotline is an Australia-wide telephone hotline for
reporting abuse and neglect of people with disability. The Hotline works with callers to find
appropriate ways of dealing with these reports.
If a caller reports abuse or neglect in a government-funded service, the Hotline will refer the
report to the government body responsible for funding the service. The funding body will
investigate the report.
If a caller reports abuse or neglect in any other situation, the Hotline will refer the report to
an agency or government department able to investigate or otherwise address the report,
such as the NSW Ombudsman or complaints-handling body e.g. Health Care Complaints
Commission.
The Hotline can be used by anyone to report cases of abuse and neglect of people with
disabilities who are using government funded services in Australia.
Types of government funded services used by people with disability include:
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open or supported employment
accommodation
community services
respite care services
If a caller reports abuse or neglect in any other situation, the Hotline will refer the report to
an agency able to investigate or otherwise address the report, such as an ombudsman or
complaints-handling body.
How to make a report
You can make a complaint simply by telephoning the Hotline on 1800 880 052. Anyone can
call the Hotline to report cases of abuse or neglect or to find out more about the service. The
Hotline is open from 8am to 8pm across Australia, seven days a week. The hotline staff can
also be contacted by email [email protected].
The Hotline is closely aligned with the Complaints Resolution and Referral Service (CRRS),
another initiative by the Australian Government supporting the needs of people with
disability.
See their website, (www.disabilityhotline.net.au) for more information.
Private Workers
You can make a complaint about private workers to the association to which they belong, i.e.
College of General Workers and the NSW Health Carer Complaints Commission
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NSW Health Carer Complaints Commission
The Commission’s Inquiry Service handles inquiries from people who are concerned about
the quality of the health care provided to them or to a family member or friend. The service
also responds to questions from health service providers in relation to complaints. Inquiries
are usually made by telephone or email. Sometimes people visit the Commission’s offices.
Telephone: (02) 9219 7444 Toll Free in NSW: 1800 043 159 TTY service for the hearing
impaired (02) 9219 7555 or contact the National Relay Service on 133 677 Fax (02) 9281
4585 Email: [email protected] Office: Level 13, 323 Castlereagh Street (corner of
Hay St) Sydney NSW 2000 Business Hours 9.00am to 5.00pm Monday to Friday
What kind of information will I need to report?
You will be encouraged to report:
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your name, address and age,
some information about the service in which the abuse is occurring,
the name of the person or persons responsible for the abuse,
the name, age and address of the person being abused.
You will also need to give permission for the Hotline to pass information onto other
organisations which can investigate your report. You will be contacted later to find out what
action has been taken and if you are satisfied with the outcome.
Child Protection
Children and Young Persons (Care and Protection) Act 1998 (NSW)
This NSW Act focuses on the welfare and wellbeing of children and young people and
outlines how children in NSW must be treated and cared for. In particular it covers concerns
of child abuse and neglect, child/youth participation and the care and placement of children
at significant risk who are placed in out of home care. In addition it covers a range of other
child wellbeing issues including licensing of child care services, employment of children,
care proceedings in the Children’s Court, etc
Mandatory reporting is a term for the community and health worker’s legislative requirement
to report suspected cases of child abuse and neglect to government authorities. Mandatory
reporting occurs in all states and territories although the legislation varies. The key
difference relate to who must report and what needs to be reported. The table below
produced by the Australian Institute of Family Studies summarises the requirements for
NSW
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Who is mandated to
report?
A person who, in the course
of his or her professional
work or other paid
employment delivers health
care, welfare, education,
children's services,
residential services or law
enforcement, wholly or partly,
to children; and
A person who holds a
management position in an
organisation, the duties of
which include direct
responsibility for, or direct
supervision of, the provision
of health care, welfare,
education, children's
services, residential services
or law enforcement, wholly or
partly, to children
Abuse and
neglect types
which must be
reported
What must be
reported?
Reasonable grounds to
suspect that a child is at
risk of significant harm;
and
Physical abuse
Sexual abuse
Emotional/
psychological
abuse
those grounds arise
during the course of or
from the person's work
New South Wales
requires mandatory
reporting for a person
under the age of 16 years
Neglect
Exposure to
domestic
violence
Legal
provisions
Sections 23
and 27 of
the Children
and Young
Persons
(Care and
Protection)
Act 1998
(NSW)
https://aifs.gov.au/cfca/publications/mandatory-reporting-child-abuse-and-neglect
Recent changes to the law
Following an extensive review of the NSW child protection system, the Children Legislation
Amendment (Wood Inquiry Recommendations) Act 2009 was introduced. It changed a
number of reporting conditions most importantly raising the reporting threshold to “at risk of
significant harm
Useful Contacts
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Government Site outlining legal requirements and processes
http://www.keepthemsafe.nsw.gov.au/home
Useful summary of mandatory reporting requirements in plain English
http://www.theshopfront.org/documents/Children_at_risk_-_mandatory_reporting__2010_version.pdf
Online Mandatory Reporters Guide
http://sdm.community.nsw.gov.au/mrg/screen/DoCS/en-GB/summary?user=guest
http://www.community.nsw.gov.au/kts/guidelines/documents/mandatory_reporter_gui
de.pdf
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Privacy and Confidentiality
An important part of protecting consumers’ rights is ensuring the right to privacy in relation to
personal information. Leaving files open or not locking files away at night, or discussing an
individual in inappropriate circumstances, can breach people’s right to privacy.
It can often be difficult to walk the line between ensuring consumers’ right to privacy, and the
legitimate needs of families, carers and other service providers for information. Health
records often contain very sensitive information of a personal nature. Consumers need to be
confident that their information will remain private.
Without this confidence, consumers may not seek help when they need it, or may be
reluctant to provide further information to the service. In particular, consumers have a legal
right to expect that information that is held about them will not be disclosed inappropriately to
others without their consent.
Appropriate disclosure may involve treating teams sharing information for the purposes of
care coordination (with the permission of the consumer) and worker supervision and
debriefing as part of professional development, learning and worker safety.
Commonwealth Privacy
The Privacy Act 1988 protects personal information. “Personal information is information or
an opinion that identifies you or could identify you. Some examples are your name, address,
telephone number, date of birth, medical records, bank account details and opinions about
you.” The Commonwealth law covers privacy requirements and managing credit information.
It applies to Australian Government agencies and private sector organisations. The Office of
the Australian Information Commissioner (OAIC) oversees the Act.
Recent changes to the law
On 12 March 2014 new amendments to the Privacy Act were introduced to make agencies
and organisations more open in how they are using and storing your personal information.
Changes introduced included:
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A new set of 13 Australian Privacy Principles (APPs)
changes to the way your credit information can be collected and used
new powers for the Office of the Australian Information Commissioner (OAIC) to
resolve privacy complaints and investigations.
Commonwealth Privacy fact sheet 24: How changes to privacy law affect you
http://www.oaic.gov.au/privacy/privacy-resources/privacy-fact-sheets/
A summary of Australian Privacy Principles (APP)
For private sector organisations, Australian Government and Norfolk Island agencies
covered by the Privacy Act 1988.
APP 1 — Open and
transparent management of
personal information
Ensures that APP entities manage personal information in an
open and transparent way. This includes having a clearly
expressed and up to date APP privacy policy
APP 2 — Anonymity and
pseudonymity
Requires APP entities to give individuals the option of not
identifying themselves, or of using a pseudonym. Limited
exceptions apply.
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APP 3 — Collection of
solicited personal
information
Outlines when an APP entity can collect personal information
that is solicited. It applies higher standards to the collection of
‘sensitive’ information.
APP 4 — Dealing with
unsolicited personal
information
Outlines how APP entities must deal with unsolicited personal
information.
APP 5 — Notification of the
collection of personal
information
Outlines when and in what circumstances an APP entity that
collects personal information must notify an individual of
certain matters.
APP 6 — Use or disclosure
of personal information
Outlines the circumstances in which an APP entity may use or
disclose personal information that it holds.
APP 7 — Direct marketing
An organisation may only use or disclose personal information
for direct marketing purposes if certain conditions are met.
APP 8 — Cross-border
disclosure of personal
information
Outlines the steps an APP entity must take to protect personal
information before it is disclosed overseas.
APP 9 — Adoption, use or
disclosure of government
related identifiers
Outlines the limited circumstances when an organisation may
adopt a government related identifier of an individual as its
own identifier, or use or disclose a government related
identifier of an individual.
APP 10 — Quality of
An APP entity must take reasonable steps to ensure the
personal information it collects is accurate, up to date and
complete. An entity must also take reasonable steps to ensure
the personal information it uses or discloses is accurate, up to
date, complete and relevant, having regard to the purpose of
the use or disclosure.
APP 11 — Security of
An APP entity must take reasonable steps to protect personal
information it holds from misuse, interference and loss, and
from unauthorised access, modification or disclosure. An
entity has obligations to destroy or de-identify personal
information in certain circumstances.
APP 12 — Access to
Outlines an APP entity’s obligations when an individual
requests to be given access to personal information held
about them by the entity. This includes a requirement to
provide access unless a specific exception applies.
APP 13 — Correction of
Outlines an APP entity’s obligations in relation to correcting
the personal information it holds about individuals.
Full version available at: http://www.oaic.gov.au/privacy/privacy-resources/privacy-factsheets/other/privacy-fact-sheet-17-australian-privacy-principles
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NSW Act - Privacy and Personal Information Protection Act 1998 (PPIP Act)
The NSW Information and Privacy Commission undertakes the privacy functions conferred
by the Privacy and Personal Information Protection Act 1998 (NSW) and Health Records
and Information Privacy Act 2002 (NSW).
The Privacy and Personal Information Protection Act 1998 (PPIP Act) outlines how New
South Wales (NSW) public sector agencies manage personal information and the functions
of the NSW Privacy Commissioner. It applies to “NSW public sector agencies, statutory
authorities, universities, NSW local councils, and other bodies whose accounts are subject
to the Auditor General.”
12 NSW Information Protection Principles
An agency must:
Collection
1. Lawful
Only collect your personal information for a lawful purpose. It must be
needed for the agency’s activities.
2. Direct
Collect the information from only you, unless exemptions apply.
3. Open
Tell you that the information is being collected, why and who will be
using it and storing it. You must be told how to access it and make
sure it’s correct.
4. Relevant
Make sure that your personal information is relevant, accurate, current
and non-excessive.
Storage
5. Secure
Store your personal information securely. It should not kept longer
than needed, and disposed of properly.
Access and Accuracy
6. Transparent
Provide you with details about the personal information they are
storing, reasons why they are storing it and how you can access it if
you wish to make sure it's correct.
7. Accessible
Allow you to access your personal information in a reasonable time
frame and without being costly.
8. Correct
Allow you to update, correct or amend your personal information when
needed.
Use
9. Accurate
Make sure that your personal information is correct and relevant
before using it.
10. Limits on use
Only use your personal information for the reason they collected it.
11. Limits on
disclosure
Person must be aware of and agree to any disclosure
12. Special
restrictions
cannot disclose sensitive personal information about you unless that
disclosure is necessary to prevent a serious and imminent threat
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Collection
1. Lawful
only collect health information for a lawful purpose. Only collect health
information if it is directly related to the organisation’s activities and
necessary for that purpose.
2. Relevant
ensure that the health information is relevant, not excessive, accurate
and up to date. Ensure that the collection does not unreasonably
intrude into the personal affairs of the individual.
3. Direct
only collect health information directly from the person concerned,
unless it is unreasonable or impracticable to do so. See the Handbook
to Health Privacy for an explanation of “unreasonable” and
“impracticable”.
4. Open
inform the person as to why you are collecting health information about
them, what you will do with the health information, and who else might
see it. Tell the person how they can see and correct their health
information, and any consequences, if they decide not to provide their
information to you. If you collect health information about a person
from someone else, you must still take reasonable steps to ensure that
the person has been notified as described above.
Storage
5. Secure
ensure that health information is stored securely, not kept any longer
than necessary, and disposed of appropriately. Information should be
protected from unauthorised access, use or disclosure (Note: private
sector organisations should also refer to section 25 of the HRIP Act for
further instructions).
Access and Accuracy
6. Transparent
explain to the person what health information about them is being
stored, why it is being used and any rights they have to access it.
7. Accessible
allow people to access their health information without unreasonable
delay or expense (Note: private sector organisations should also refer
to sections 26-32 of the HRIP Act for further instructions).
8. Correct
allow people to update, correct or amend their health information
where necessary (Note: private sector organisations should also refer
to sections 33-37 of the HRIP Act for further instructions).
9. Accurate
ensure that the health information is relevant and accurate before
using it.
Use
10. Limited
only use health information for the purpose for which it was collected,
or a directly related purpose that the person would expect. Otherwise,
you generally need their consent.
Disclosure
11. Limited
disclosure
only disclose health information for the purpose for which it was
collected, or a directly related purpose that the person would expect.
Otherwise, you generally need their consent.
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Identifiers and anonymity
12. Not identified
only identify people by using unique identifiers if it is reasonably
necessary to carry out your functions efficiently.
13. Anonymous
give people the option of receiving services from you anonymously,
where this is lawful and practicable.
Transferals and linkage
14. Controlled
only transfer health information outside New South Wales in
accordance with HPP 14.
15. Authorised
people must expressly consent to participate in any system that links
health records across more than one organisation. Only include health
information about them, or disclose their identifier for the purpose of
the health records linkage system, if they have expressly consented to
this.
Further reading
You can find more detailed information about the HRIP Act by reading:
Handbook to Health Privacy (PDF, 1.7mb)
If you find that you are having difficulties reading our documents or other material, please
contact us on 1800 472 679 so we can provide another option for you to access our
material.
The Health Records and Information Privacy Act, 2002 applies to both public and private
sector agencies in NSW. The Privacy Commissioner administers this act, resolves
complaints and protects and enhances privacy rights relating to the privacy principles in the
Personal and Privacy Information Protection Act 1998 (NSW). They can be contacted on
1800 472 679 or via email [email protected].
A Handbook to Health Privacy has been developed to explain the HRIP. It states “The HRIP
Act protects the privacy of people’s health information. It does this by requiring those who
handle health information to comply with 15 Health Privacy Principles (HPPs). The 15 HPPs
are the key to the HRIP Act. They are legal obligations describing what you must do when
you collect, store, use or disclose health information.
Privacy NSW recommends that you familiarise yourself with the 15 HPPs. The 15 HPPs are
contained in Schedule 1, which is located at the end of the HRIP Act. If you are based in the
private sector, you will also need to know about the special private sector provisions in Part
4 of the HRIP Act. These provisions are in addition to, and expand upon, the 15 HPPs. A
summary of the 15 HPPs is set out on the following page. You will find a more detailed
discussion of your obligations under the 15 HPPs, and the special private sector provisions,
set out in Part 2 of this handbook.”
The Act has fifteen health privacy principles directing how health information is to be
collected, stored and used.
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The most relevant principles to keep in mind are:

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



Health information can only be collected if it directly relates to the service’s role, that
is treatment and assistance and for management of the service.
The information should be accurate and up to date.
Individuals must be informed why information is being collected, what will be done
with the information and who else might see it.
If information about a consumer is to be collected from another person i.e. health
professional or family member, then the consumer must be informed, except where
Guardian has been appointed and a consumer does not have capacity to selfdetermination.
Information should be stored securely and disposed of appropriately. Ask your
supervisor what the requirements are as to how long records must be kept.
Consumers can seek access to their medical records and other personal information
and can request correction of any mistakes. This may be contentious when
consumer in disagreement with workers. However, a consumer can insert their point
of view for others to access, e.g. for MHRT review or hearings.
Health information can only be disclosed for the purpose for which it is collected, or a
directly related purpose that the consumer would expect. In other words, the passing
on of information to another person or organisation that is involved in the ongoing
care and treatment is permitted, if the purpose for which that information was
collected is discussed. Otherwise consent is required from the consumer to disclose
information to others.
Exceptions
All the exceptions discussed below should be approached with caution and discussed with
your organisation.



Information can only be disclosed without the consumer’s consent to an immediate
family member for compassionate reasons where the consumer cannot give consent
and it is not against their expressed wishes. Family members do not have an
automatic right to health information or records.
Information about the consumer without their consent may be disclosed to prevent
serious threat to the health or safety of an individual or the public.
Information may be required as evidence in court and staff may be subpoenaed,
however records do not have to be provided to the Police prior to the Court.
Advance Directives
Advance Care Directives are a relatively new way that you can give guidance to health care
professionals and health care providers about how you want to be treated in the future if you
lose capacity to make healthcare decisions due to age, illness or injury.
It usually includes information about where you do or do not wish to be cared for and by
whom, or what treatment you want or do not want. An Advance Care Directive can include
your wishes about any aspect of your life. For example, you can include in your Advance
Care Directive the name of the person you want to make sure your wishes are carried out,
and to make other personal decisions for you. An Advance Care Directive can also say who
you would want to have as your guardian if one needs to be appointed (however, to do this it
might be better to appoint the person as an enduring guardian).
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An Advance Care Directive must be made when you are considered, at law, to have legal
capacity to make your own healthcare decisions. They then function as an extension of your
common law right to determine your own health care when you lose capacity to make
decisions due to age, illness or injury.
Advance Care Directives have limited legal force in NSW. However, there is no NSW law
that deals specifically with the making or enforcement of Advance Care Directives. Advance
Care Directives are not effective in all circumstances. For example, you cannot avoid the
operation of the Guardianship or Mental Health Acts by making an Advanced Care Directive.
However, the Advanced Care Directive can be taken into account in any decision-making
that is required for you under those Acts.
Advanced Care Directives are often very important in end of life decision-making. NSW
Health has developed a web resource for health professionals (that is also very useful for
others) called End of Life Decisions, the Law and Clinical Practice. This web resource
provides information as to who can make end of life decisions and how they should be made
in the NSW context.
Advance Care Directives about mental health issues
Advance Care Directives are a relatively new way that you can give guidance to health care
professionals and health care providers about how you want to be treated in the future if you
lose capacity to make healthcare decisions due to age, illness or injury.
It usually includes information about where you do or do not wish to be cared for and by
whom, or what treatment you want or do not want. An Advance Care Directive can include
your wishes about any aspect of your life. For example, you can include in your Advance
Care Directive the name of the person you want to make sure your wishes are carried out,
and to make other personal decisions for you. An Advance Care Directive can also say who
you would want to have as your guardian if one needs to be appointed (however, to do this it
might be better to appoint the person as an enduring guardian).
An Advance Care Directive must be made when you are considered, at law, to have legal
capacity to make your own healthcare decisions. They then function as an extension of your
common law right to determine your own health care when you lose capacity to make
decisions due to age, illness or injury.
Advance Care Directives have limited legal force in NSW. However, there is no NSW law
that deals specifically with the making or enforcement of Advance Care Directives. Advance
Care Directives are not effective in all circumstances. For example, you cannot avoid the
operation of the Guardianship or Mental Health Acts by making an Advanced Care Directive.
However, the Advanced Care Directive can be taken into account in any decision-making
that is required for you under those Acts.
You can include in your Advance Care Directive that you want to be treated with particular
drugs and not other drugs if you become unwell.
You can include in your Advance Care Directive you don't want to be treated (or do want to
be treated) with particular procedures such as electro-convulsive therapy (ECT).
You can also put in your Advance Care Directive your wishes about life management
arrangements if you are admitted to hospital with a mental illness in an acute phase. This
could include, for example, details about what you want to happen about the care of your
children, the care of your pets, and who in your work place can be told
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If you become an involuntary patient under the Mental Health Act 2007 (NSW), it will be up
to your treating team to decide if they will follow your advanced directive. They may take it
into account, but they don’t have to.
Freedom of Information Legislation
Freedom of information, at state and federal levels, provides for consumers to request
information held by government, including personal information and medical files, but also
protects that information from access by others. People have the right to have access to
documents from the government. There is a fee to apply and not all documents are
available.
Commonwealth Legislation
The Commonwealth legislation that gives people the right to request access to documents
from Australian Government ministers, departments and agencies is the Freedom of
Information Act 1982 (FOI Act).
The FOI Act was reformed in 2010. These reforms placed new pro-disclosure requirements
on agencies and ministers and provided greater review and complaint rights for individuals.
The NSW Legislation: Government Information (Public Access) Act 2009 (NSW) (the
GIPA Act)
The Government Information (Public Access) Act 2009 (NSW) (the GIPA Act) replaced the
Freedom of Information Act 1989 (NSW) (the FOI Act) on 1 July 2010.
The GIPA Act establishes a comprehensive system for public access to government
information.
The Act makes government information more accessible to the public. It requires
government to make as much information as possible freely available and simplified the
process for people to access about themselves. Information is only to be restricted when the
department can prove overriding public interest against disclosure.
The public access to government information system is overseen by the Information and
Privacy Commission.
The Information Commissioner's roles include:






Promoting public awareness and understanding of the Act.
Providing information, advice, assistance and training to agencies and the public.
Dealing with complaints about government agencies.
Investigating agencies' systems, policies and practices.
Reporting on compliance with the Act to the Minister responsible.
You can find more information about the Information and Privacy Commission on its
website at www.ipc.nsw.gov.au
Contact the Information and Privacy Commission enquiries line on 1800 472 679 between
9am to 5pm, Monday to Friday (excluding public holidays).
Community Services Unit
http://www.community.nsw.gov.au/docs_menu/about_us/right_to_information.html
Police Information Unit
https://www.police.nsw.gov.au/services/information_access_unit_gipa
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Australian Law Reform Commission (ALRC)
The Australian Law Reform Commission is the federal agency that operates under the
Australian Law Reform Commission Act 1996 (Cth), and the Public Governance,
Performance and Accountability Act 2013 (PGPA Act).
The ALRC conducts inquiries into areas of law at the request of the Attorney-General of
Australia.
The ALRC undertakes research and consultations and makes recommendations to
government so they can make informed decisions about law reform. Over 85 per cent of
ALRC reports have been either substantially or partially implemented—making it one of the
most effective and influential agents for legal reform in Australia.
The ALRC is independent of government but reports administratively as part of the AttorneyGeneral's portfolio.
The purpose of the ALRC's is to make recommendations for law reform that:





“bring the law into line with current conditions and needs
remove defects in the law
simplify the law
adopt new or more effective methods for administering the law and dispensing
justice, and
provide improved access to justice”
http://www.alrc.gov.au/about
How to get legal advice or information about your role and responsibilities



Talk to your supervisor
Read the relevant policies and procedures they usually refer to any relevant legislation
Read the legislation at:
 http://www.legislation.nsw.gov.au/
 https://www.comlaw.gov.au/
 http://www.austlii.edu.au/au/legis/cth/consol_act/
 Legal Aid NSW helps people with their legal problems
 Help over the phone: Call LawAccess NSW on 1300 888 529 to get started
LawAccess NSW is a free government telephone service that provides legal
information, referrals and in some cases, advice for people who have a legal problem
in NSW. We are a starting point to help with your legal problem.
http://www.lawaccess.nsw.gov.au/
 Find information: factsheets and resources to help you with your problem http://www.legalaid.nsw.gov.au/publications/factsheets-and-resources
 Get advice from a lawyer: We provide free face-to-face advice on most legal issues
http://www.legalaid.nsw.gov.au/get-legal-help/advice
 Help at court: We have lawyers to assist you at many courts and tribunals across
NSW
http://www.legalaid.nsw.gov.au/get-legal-help/help-at-court
 The Law Society Solicitor Referral Service - 1800 422 713
http://www.lawsociety.com.au/community/findingalawyer/index.htm
 Your local Community legal centre - Community Legal Centres (CLCs) are
independently operating not-for-profit community organisations that provide legal and
related services to the public, focusing on the disadvantaged and people with special
needs.
http://www.naclc.org.au/need_legal_help.php
Resource Book
165
Appendix D: Certified Peer Specialist Code of Ethics
The following principles will guide Certified Peer Specialists in the various roles,
relationships, and levels of responsibility in which they function professionally.
1.
The primary responsibility of Certified Peer Specialists is to help individuals achieve
their own needs, wants, and goals. Certified Peer Specialists will be guided by the
principle of self-determination for all.
2. Certified Peer Specialists will maintain high standards of personal conduct and
conduct themselves in a manner that fosters their own recovery.
3. Certified Peer Specialists will openly share with consumers and colleagues their
recovery stories from mental illness and will likewise be able to identify and describe
the supports that promote their recovery.
4. Certified Peer Specialists will, at all times, respect the rights and dignity of those they
serve.
5. Certified Peer Specialists will never intimidate, threaten, harass, use undue
influence, physical force or verbal abuse, or make unwarranted promises of benefits
to the individuals they serve.
6. Certified Peer Specialists will not practice, condone, facilitate, or collaborate in any
form of discrimination on the basis of ethnicity, race, sex, sexual orientation, age,
religion, national origin, marital status, political belief, mental or physical disability, or
any other preference or personal characteristic, condition, or state.
7. Certified Peer Specialists will advocate for those they serve that they may make their
own decisions in all matters when dealing with other professionals.
8. Certified Peer Specialists will respect the privacy and confidentiality of those they
serve.
9. Certified Peer Specialists will advocate for the full integration of individuals into the
communities of their choice and will promote the inherent value of those individuals
to those communities. Certified Peer Specialists will be directed by the knowledge
that all individuals have the right to live in the least restrictive and least intrusive
environment.
10. Certified Peer Specialists will not enter into dual relationships or commitments that
conflict with the interests of those they serve.
11. Certified Peer Specialists will never engage in sexual/intimate activities with the
consumers they serve.
12. Certified Peer Specialists will not abuse substances under any circumstance.
13. Certified Peers Specialists will keep current with emerging knowledge relevant to
recovery, and openly share this knowledge with their colleagues.
14. Certified Peer Specialists will not accept gifts of significant value from those they
serve.
Resource Book
166
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Evaluation form for Foundations of Peer Work – Part 2 Resource Book
(Certificate IV in Mental Health Peer Work)
MHCC values your feedback. Please let us know what you think about this book.
Your comments can be anonymous.
Name:________________________________________________________
Tel:_____________________ Email: _______________________________
Please circle your responses to the following.
1. This Resource Book is:
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Please attach any other comments you would like to make and send this form to:
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