DOMAIN Promoting autonomy and self-determination

Although the human rights of people accessing mental health services may be impacted by mental health and other legislation, the principles outlined in this domain are applicable regardless of people's legal status. In this way, practices should always be directed towards facilitation or resumption.

Core principles

Mental health services have a responsibility to involve people as partners in their mental health care.

Mental health care aims to promote people's self-determination and to support people's capacity to manage their mental health.

Lived experience and expertise is recognised, elicited and acted on in all decision-making processes.

Every person should have access to high-quality recovery-oriented mental health care that is responsive to their particular needs.

Recovery-oriented mental health care encourages informed risk taking1 within a safe and supportive environment. The safety and wellbeing of people accessing the service and their support networks is central to the provision of mental health care and the service environment is organised to ensure people's safety and optimal wellbeing.

  1. Informed risk taking here refers to what is documented inliterature on recovery as dignity of risk or positive risk taking. Informedrisk taking involves optimising informed choice and consumer-led decisionmaking, even where this involves a degree of perceived risk. Consumer-led literature on recovery highlights the importance of self-determination, self-responsibility and supporting people to decide the level of risk they areprepared to take with their health and wellbeing. However, in the context of amental health service setting, practitioners and service leaders are requiredto balance the need to encourage informed risk taking with the need to create asafe environment and adhere to duty-of-care obligations. Nevertheless, riskmanagement processes should always be oriented towards promoting consumerchoice and restoring choice as soon as possible if it is limited in any way.

Key capabilities

 

Mental health professionals

Behaviours
  • provide all the necessary information to support people to make decisions about their mental health care
  • inform people of their rights and actively protect and promote these rights
  • support people to exercise their rights
  • remove barriers that unnecessarily limit people's rights
  • make every effort to ensure people's safety, comfort and wellbeing at all times
  • consider people's varying levels of vulnerability and resilience at different times.
Attitudes
  • recognise and support people's rights of self-determination and choice
  • are committed to facilitating the involvement of people accessing the service and their significant others in all aspects of service delivery
  • acknowledge and value people's lived experience and expertise.
Skills
  • are informed and skilful in supporting people's self-determination, decision making and informed risk taking, without compromising safety
  • are able to support people's self-advocacy and to advocate on people's behalf when required with a view to facilitating a restoration of people's self-advocacy as soon as possible
  • continue to develop the skills and capacity to support people to exercise their rights and make decisions about their mental health, wellbeing and lives.
Knowledge
  • have knowledge of human rights principles and relevant frameworks
  • are aware of consumer and carer movements and advocacy groups, and support their involvement in service delivery and service improvement
  • have knowledge of relevant legislation and policies on consumer rights and consumer and carer participation in a range of processes.

Good practice

  • Assist people to make informed decisions about their mental health care by providing information, resources and other support.
  • Sit down with people to explain their rights upon admission or initial contact and regularly throughout the period of service and using different media to ensure that people are well informed of their rights.
  • Engage in ongoing dialogue and enquiry about people's needs, wishes and experiences.
  • Use advanced directives, advanced statements or equivalent.
  • Develop the required knowledge and understanding of the Victorian Charter of Human Rights and Responsibilities Act 2006 and understand principles of self-determination, privacy and informed consent.
  • Take care to create a safe and supportive environment in which people feel safe and secure; this includes avoiding practices that people may experience as traumatic.
  • Recognise the shared responsibility of staff and people accessing services to maintain an environment that feels safe and secure for everyone.
  • Seek feedback from people accessing the service and their significant others to inform ongoing practice.

Good leadership

  • Ensure that systems are in place to inform people of their rights at all times and through a variety of different media; this information should be routinely communicated upon admission or initial contact and regularly throughout the period of service.
  • Set up systems to actively seek lived experience and expertise from people accessing the service and their significant others.
  • Make it easy to provide feedback and make complaints (for example, provide open access for families and clients to make complaints in multiple forms).
  • Ensure consumer and carer consultants are represented in feedback and complaints processes (such as on panels or review teams).
  • View feedback and complaints as opportunities for service improvement and set up systems to ensure that feedback and complaints are translated into service changes and that these are communicated to staff and clients.
  • Review local policies and procedures to incorporate principles of autonomy, self-determination and choice.
  • Ensure that position descriptions reflect the requirement to understand and be able to communicate rights and to enact people's rights in practice.
  • Support staff to work well with informed risk taking as an important part of promoting people's choice and self-determination.
  • Engage in an active and ongoing discussion with staff about risk.
  • Be clear about people's responsibilities as well as rights.
  • Encourage staff to communicate transparently with people.
  • Ensure that wherever there are limitations on a person's choice, autonomy and self-determination, that these limitations are removed as soon as possible

Resources

Videos