An Advance Care Directive reflects someone’s wishes, in writing, of what they want to happen to them if they become incapable of making decisions for themselves. It usually includes what medical treatment and care they do or do not want. An Advance Care Directive can also include wishes about any aspect of their life, such as their values or goals. An Advance Care Directive can only be made by an adult with decision making capacity.
An advocate is a person who will support someone and help them stand up for their rights, needs and wants. An advocate can also sometimes speak or write on the behalf of another person. A person’s family or friends can be their advocates, or their advocate may be a professional. An advocate may or may not be a lawyer.
Alternative Dispute Resolution (ADR) is a way of solving problems without having your dispute determined by a court or a tribunal. ADR might occur without a complaint being lodged with a complaint handling body or a claim being filed in court. ADR could occur after a complaint or claim is made, but before it is finally decided. Sometimes ADR may have to be considered before you have the right to go to a Court or Tribunal to have your claim decided.
Anorexia Nervosa is one of the four types of eating disorders that are characterised by disturbances in thinking and behaviour around food, eating, and body weight and/or shape. Anorexia Nervosa is a serious psychological illness involving dangerously low body weight, whereby a person deprives themselves of food and may be engaging in excessive exercise in order to continually reduce body weight based on a false body image and a fear of becoming overweight/gaining weight.
An Apprehended Violence Order (AVO) is an Order made by a court against a person (defendant) who makes another person (the protected person) fear for their safety, to protect that person from violence, intimidation or harassment. All AVOs made by the court prohibit the defendant from assaulting, harassing, threatening, stalking, or intimidating a protected person. Other conditions can also be included. The defendant must obey the orders set out in the AVO.
An assessable person is a person detained on an involuntary basis under the Mental Health Act 2007 (NSW) in a public mental health facility who has not been reviewed by the Mental Health Review Tribunal (MHRT). The Authorised Mental Officer of a public mental health facility must present an assessable person to the MHRT for a Mental Health Inquiry as soon as practicable after the person’s detention in hospital.
In discrimination law, an ‘associate’ of a person with disability is a person with whom the person with disability has regular contact with, such as a close family member, a person with whom they live; a carer or another person with whom they are in a business, sporting or recreational relationship. Associates may sometimes be unlawfully discriminated against because of their relationship with a person with disability and is therefore entitled to complain of disability discrimination.
An Authorised Medical Officer is either the medical superintendent of a declared mental health facility, or a doctor who has been nominated by the medical superintendent to fulfil certain responsibilities and make certain decisions under the Mental Health Act 2007 (NSW). These responsibilities can include assessment of patients, care and treatment of people who are mentally ill or mentally disordered and decisions about discharge.
Bulimia Nervosa is an eating disorder. It is a serious psychological illness characterised by recurrent binge eating episodes followed by purging and/or over exercising.
Culturally and Linguistically Diverse is a broad term used to describe communities with diverse languages, ethnic backgrounds, nationalities, traditions, societal structures and religions.
Capacity refers to a person’s ability to make his/her own decisions and give informed consent. These may be small decisions, such as what to do each day, or bigger decisions like where to live or whether to have a medical procedure. A person may lack capacity in some areas, but still be able to make other decisions.
Choice and control refers to a person deciding what will enable them to live a fulfilling life. In the context of the NDIS, this may include deciding what supports and services they may need and want to assist them.
Cognitive impairment is defined by the Mental Health and Cognitive Impairment Forensic Provisions Act 2020 (NSW) as an ongoing impairment in adaptive functioning and in comprehension, reasoning, judgement, learning or memory, which has resulted from damage or dysfunction to the brain or mind. Cognitive impairment may arise from intellectual disability, dementia, autism or foetal alcohol spectrum disorder.
The term ‘Community Managed Organisations or CMOs represents the language used by the community managed mental health sector in preference to the term ‘non-government organisations (NGOs)’. It is preferred because it more closely describes the type of organisation, rather than just defining it as not being a government organisation.
A Community Treatment Order is a legal order made by the Mental Health Review Tribunal, or in some circumstances, a Magistrate. It authorises the compulsory care and treatment, usually including the regular administration of medication, of a person with mental illness living in the community. The order is implemented by a public community mental health service, often in collaboration with a range of community managed organisations providing psychosocial care and support services.
Conciliation is a process in which the parties to a dispute meet with an independent person called a conciliator. The conciliator helps to identify the issues in dispute, develop options, consider alternatives and tries to help parties to reach an agreement. The conciliator may give advice and guidance but will not make a decision for them. Conciliation is a type of alternative dispute resolution.
Agreeing to medical treatment is called ‘consent’. A provider of health care must take reasonable steps to make sure that a patient is able to give informed consent to treatment. This means you must be able to understand key aspects of any treatment suggested before asked whether you agree to the treatment. Key aspects include, for example, what the treatment involves and the potential risks of that treatment. You agreeing to the treatment once you have been given the information and state that you understand what you have been told, is called ‘informed consent’ to treatment. Informed consent by a person who has capacity has validity.
In this manual, a consumer refers to a person with direct experience of a mental illness, and who has received, is receiving or is seeking mental health services from a mental health service provider. A consumer may be a patient in a mental health facility or unit and/or, is a client of a community mental health service (whether public or community managed) where they may be receiving mental health care and treatment and/or psychosocial support services.
A correctional patient is a person in custody who has become mentally ill, needs treatment in a mental health facility and has been transferred to a mental health facility. The Director-General of the Ministry of Health (or a delegate) can order the transfer of a person in custody to a mental health facility. Sometimes, they may be transferred involuntarily. A correctional patient is not a forensic patient.
In the context of trauma-informed recovery oriented practice, cultural safety has been described as providing an environment that is safe for people: where there is no assault, challenge or denial of their identity, of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience, of learning, living and working together with dignity and truly listening. It reminds us that people who may not belong to the dominant culture or have lived experience of trauma may have been subject to oppression, abuse, and discrimination.
A designated carer is someone who is entitled to certain information about a consumer’s care and treatment and to be notified of certain events. A designated carer may also be a principal care provider (see below). A designated carer is nominated by the consumer but in many instances identified by treating clinicians as the person or persons who should be consulted about the person’s care and treatment planning and be informed about any related matters such as hearings, medication, discharge and recovery progress. Consumers can now nominate up to two designated carers.
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.
Disability is defined in the Disability Discrimination Act 1992 (Cth) as total or partial loss of the person’s bodily or mental functions; total or partial loss of a part of the body; the presence in the body of organisms causing disease or illness, capable of causing disease or illness; the malfunction, malformation or disfigurement of a part of the person’s body; a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; a disorder, illness or disease that affects a person’s thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour.
Electroconvulsive Therapy (ECT) is a form of treatment for some severe forms of mental illness. It involves the administration of an electrical current to one or both sides of a patient’s brain under general anaesthetic in order to produce a seizure. It may be recommended when other forms of treatment including medication and psychotherapy are ineffective or of limited use. ECT often this produces an improvement in depressive and psychotic symptoms. Sometimes, ECT is prescribed for people who for other medical reasons cannot tolerate certain medications that would otherwise be used to alleviate symptoms.
The Guardianship Act 1987 (NSW) makes it possible for a person with legal capacity to appoint an Enduring Guardian. An Enduring Guardian can make decisions for you in areas such as accommodation, health and services, if you lose the capacity to make your own decisions at some time in the future. An Enduring Guardian cannot make decisions about your money or assets.
An Enduring Power of Attorney is made by a person who has legal capacity to do so at the time. It comes into effect if that person loses capacity to make financial and legal decisions in the future. The person appointed to make these decisions is called the ‘Attorney’.
If a person with a mental illness or mental disorder is unable to manage their own financial affairs the NSW Trustee and Guardian Act 2009 allows for a Financial Management Order (FMO) to be made. The Mental Health Review Tribunal is one of the bodies with the power to make FMOs for management of part of or the whole of an estate. FMOs can also be made by the Supreme Court and the Guardianship Division of the NSW Civil and Administrative Tribunal (NCAT). When the Mental Health Review Tribunal makes a FMO, it appoints the NSW Trustee to manage the financial affairs of the person. The NSW Trustee manages the property, business and financial interests in close consultation with the person, and if appropriate, his or her nominated friend, relative, guardian or designated carer or principal care provider. The actual day to day management of the person’s affairs is undertaken by staff who work for the NSW Trustee.
A Financial Manager can make decisions about the ‘estate’ of a person who does not have legal capacity to make these decisions for themselves. The ‘estate’ of a person includes their financial, property and legal affairs. A Financial Manager can be a person, officer (e.g. NSW Trustee and Guardian), or organisation (e.g. a trustee company) appointed by a Tribunal (e.g. the Guardianship Division of NSW Civil and Administrative Tribunal, or the Mental Health Review Tribunal) or the Supreme Court of NSW.
Under the Mental Health and Cognitive Impairment Forensic Provisions Act 2020 (NSW), a forensic patient is a person who has been charged for committing a crime but is found unfit to stand trial or the act was proven but they are not criminally responsible because of a mental health impairment or cognitive impairment. Forensic patients can be detained in forensic facilities or in the community under the supervision of the Mental Health Review Tribunal.
In NSW, guardians can make some medical and lifestyle decisions for a person who does not have capacity to make the decision themselves. These decisions may include decisions such as where the person lives; the services they should receive, and what medical and dental treatment they receive. A Guardian does not have authority to make financial decisions on a person’s behalf. A guardian can be a person or officer (e.g. Public Guardian) appointed by the Guardianship Division of NSW Civil and Administrative Tribunal. A guardian can be a relative or kinship carer, a family friend or is a carer who has an established and positive relationship with the person. There is no legal definition of who may be a suitable person.
Guardianship is the legal relationship that is created when someone is given the legal authority to make certain decisions on another person’s behalf because that the person does not have the legal capacity to make these decisions for themselves. In NSW, Guardians are appointed by the Guardianship Division of the NSW Civil and Administrative Tribunal to make some medical and lifestyle decisions for a person. A Guardian does not have authority to make financial decisions on a person’s behalf.
The loss or limitation of physical, mental or sensory function on a long-term or permanent basis. For people with mental health conditions this would also include a loss of function on an episodic basis, which in many cases leads to long term or permanent impairment and subsequent disablement.
Involuntary patient orders are used to detain people with a mental illness in a mental health facility where the person does not agree on a voluntary basis to treatment and/or hospitalisation. If a person is detained for treatment in a mental health facility, they may be brought before the Tribunal for a mental health inquiry within 2-3 weeks. At a mental health inquiry, the Tribunal can make an Involuntary Patient Order and set a maximum period of detainment of no longer than three months. The mental health facility must provide the patient with a written statement of their rights before the mental health inquiry. If the mental health facility wishes to extend a person’s involuntary stay beyond the initial period set at the mental health inquiry, then they must apply to the Tribunal for a further Involuntary Patient Order before the first order expires. When making an Involuntary Patient Order the Tribunal must consider whether or not the patient is a “mentally ill person” (as defined in the Act), and if they are at risk of serious harm to themselves or others. If the Tribunal decides that the person is not a “mentally ill person”, or if other care outside the mental health facility of a less restrictive kind is available and appropriate, then the person must be discharged. Discharge can be deferred for a period of up to 14 days by the Tribunal.
Local Area Coordinators are organisations which are partners with the NDIA in local communities who work with people, their families and carers to access and manage the NDIS. LACs also help connect people to supports and services outside of the NDIS.
In the context of the mental health and the NDIS, mainstream services and programs are non-NDIS, government funded and/or delivered services that can be used by everyone. They include public health and mental health services, public transport, education, housing, justice, child protection and employment services.
The medical model of psychiatry is a process whereby treatment is informed by the best available research and scientific evidence and based on that evidence, doctors advise on, coordinate or deliver interventions for health improvement.
The term mental health condition is a broad term that refers to symptoms that may be caused by life events, genetic factors or birth defects. This condition can be temporary, episodic or lifelong. A mental health condition can include mood, anxiety, personality, psychotic and compulsive disorders. It includes, but is not limited to, those conditions and symptoms recognised as constituting mental illness under the Mental Health Act 2007 (NSW).
Mental health impairment is defined by the Mental Health and Cognitive Impairment Forensic Provisions Act 2020 as a temporary or ongoing disturbance serious enough to result in a mental health diagnosis and that negatively impacts the person’s emotional wellbeing, judgement or behaviour. A mental health impairment can arise from an anxiety disorder, an affective disorder, a psychotic disorder or a substance-induced mental disorder that is not temporary. A mental health impairment does not include feelings such as grief or anger, or the temporary effect of taking drugs. A substance use disorder is not included in this definition.
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 Tribunal has a wide jurisdiction, and conducts both civil and forensic hearings.
In the Mental Health Act 2007 (NSW), a mentally disordered person is someone whose behaviour for the time being is so irrational as to justify a conclusion on reasonable grounds that temporary care and, treatment or control of the person is necessary for the person’s own protection from serious physical harm or for the protection of others from serious physical harm.
A mentally ill person is defined in the Mental Health Act 2007 (NSW) as a “person suffering from mental illness and, owing to that illness, there are reasonable grounds for believing that care and treatment of the person is necessary for the person’s own protection from serious harm, or for the protection of others from serious harm”. Under the Act, mental illness means a condition that seriously impairs, either temporarily or permanently, the mental functioning of a person. They may experience delusions, hallucinations, serious disorder of thought form, a severe disturbance of mood or sustained or repeated irrational behaviour indicating the presence of any one or more of the symptoms already listed.
In the context of the NDIS, a nominee is a person who can make decisions for a person that is considered to lack capacity in decision-making processes and is not under a guardianship order.
An ‘official visitor’ is a person appointed to visit, inspect and raise any matter of concern about the conditions of persons who are detained or accommodated in certain restrictive environments or living under certain restrictive conditions. Official visitors are appointed by the NSW Minister for Health under the Mental Health Act 2007 (NSW) to visit NSW public mental health facilities. There are also official visitors to correctional facilities and official community visitors to a range of residential facilities accommodating people with disability in NSW.
In the context of the NDIS, a participant refers to a person with disability who has received an NDIS package as they have met the eligibility requirements.
A mental health peer worker is someone employed on the basis of their personal lived experience of mental illness and recovery (a consumer peer worker), or their experience of supporting family or friends with mental illness (carer peer worker). This lived experience is an essential qualification for their job, in addition to other skills and experience required for the particular role they undertake.
Lived experience is the knowledge and understanding acquired from living through or with something. This manual frequently refers to people with lived experience of mental illness; in this context it means people living with mental health conditions and all this entails (sometimes called consumers) and family or friends supporting someone living with mental illness (sometimes called carers).
A person responsible refers to someone recognised under the Guardianship Act 1987 (NSW) as having the authority to make most medical and dental care decisions for a person who does not have legal capacity to make these decisions for themselves. This person can be guardian; spouse or partner; or a person who provides unpaid care such as a friend or relative.
A Power of Attorney is a legal document in which a person appoints someone or a trustee organisation to make financial or legal decisions on his/her behalf. A Power of Attorney can only be made by a person who has legal capacity to do so. An Attorney must always act in the person’s best interests.
Principal care provider (who may also be a designated carer) is the person primarily responsible for providing support or care to a consumer (though not on a commercial basis).The principal care provider is entitled to the same information as a designated carer (unless excluded from being given information by the consumer).They 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.
Prohibited treatments refer to treatments that are not allowed for any patient in NSW under the Mental Health Act 2007 (NSW). Performing prohibited treatments on a patient is against the law and can lead to a criminal prosecution. Prohibited treatments are deep sleep therapy, insulin coma therapy, and psychosurgery.
In the context of the NDIS, a provider is someone who provides products or services to assist NDIS participants to achieve the goals outlined in their plan. If you do not self-manage any of your NDIS funding, as an NDIS participant you are required to use providers who are registered with the NDIS Quality and Safeguards Commission. All registered NDIS providers; must implement and comply with appropriate WHS and quality management systems, that meet NDIS practice standard requirements, the NDIS rules, and are relevant to the NDIS supports delivered. In the context of mental health and psychosocial services, a provider may be any service that provide clinical care and treatment or psychosocial rehabilitation and support services including, but not limited to housing, employment, education and training as well as information and advocacy services.
Psychosocial disability is not about a diagnosis, it refers to the social and economic consequences related to living with a mental health condition. It is a recognised term used to describe the challenges, or limits, a person experiences in life that are related to their mental health condition. Not everyone living with a mental health condition has a psychosocial disability.
Psychosocial rehabilitation (also known as psychiatric rehabilitation or PSR) promotes personal or individual recovery, successful community integration and an improved quality of life for persons living with mental health conditions. It is a defined intervention designed to target the specific difficulties that arise when people have a severe and enduring mental illness. Psychosocial rehabilitation services and supports are collaborative, person directed, and individualised, and an essential element of the human services spectrum. They focus on helping individuals develop skills and access resources needed to increase their capacity to be successful and satisfied in the living, working, learning and social environments of their choice and include a wide continuum of services and supports.
In the context of the Mental Health Act 2007 (NSW), psychosurgery is defined technically in terms of what the procedure involves, which is:
(a) the creation of 1 or more lesions, whether made on the same or separate occasions, in the brain of a person by any surgical technique or procedure, when it is done primarily for the purpose of altering the thoughts, emotions or behaviour of the person, or
(b) the use for such a purpose of electrodes within the brain to produce such a lesion or lesions, whether on the same or separate occasions, or
(c) the use on 1 or more occasions of electrodes within the brain primarily for the purpose of influencing or altering the thoughts, emotions or behaviour of a person by stimulation through the electrodes without the production of a lesion in the brain of the person but does not include a technique or procedure carried out for the treatment of a condition or an illness prescribed by the regulations for the purposes of this definition.
Reasonable means something that is fair, and necessary means that it is strongly needed. In the context of the National Disability Insurance Scheme, the National Disability Insurance Authority will only give participants funding for things that are fair and really needed to live a meaningful life and participate equally in the community.
The force necessary to prevent someone causing harm to themselves or others. The degree of force used must be proportionate to the degree of threat of harm.
Individual or personal recovery 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 difficulties. ‘Recovery’ can mean different things to different people; but in general, it means: gaining and retaining hope; understanding of one’s abilities and difficulties; engagement in an active life; personal autonomy; social identity; meaning and purpose in life, and a positive sense of self.
The NDIS Psychosocial Recovery Coach (Recovery Coach) is a new support item made available in 2021 to participants with psychosocial disability. The NDIS intends recovery coaches to support participants in numerous dimensions of recovery. These dimensions include increased independence, social participation, economic participation, self-control, and management of daily living. A recovery coach seeks to support a participant through developing a recovery-enabling relationship with them. It is achieved by dedicating specific time with the participant, and the people important to them, to develop an understanding of the participant, and their needs and desires. Collaborating with the broader system of supports is also part of the role. The goal of recovery coaches is to support the participant by finding out about different services and supports, and how these may be of assistance. Support in navigating mental health services, as well as better understanding and engaging with the NDIS, are also crucial elements of the role.
Recovery-oriented practice refers to the application of sets of skills and capabilities that support people to undertake the journey of individual recovery. This assists people to recognise and take responsibility for their own recovery and wellbeing, and define their own goals, wishes and aspirations.
Any restriction on a person’s freedom of movement, which may be actioned through the use of physical force, mechanical devices, the use of chemicals, or other means.
A restrictive practice refers to any conduct that has the purpose or effect of limiting a person’s liberty and freedom of movement. It includes but is not limited to all forms of restraint. Except in cases of emergency where a person’s liberty must be reasonably restricted to prevent them or someone else experiencing serious harm, restrictive practices are generally unlawful in the absence of the person’s consent.
Self-harm refers to any behaviour which involves the deliberate causing of pain or injury to oneself. This behaviour is generally used by people as an extreme coping strategy to manage distressing or painful emotions and feelings. Whilst the behaviour may be deliberate, it can be driven by a strong impulse that is uncontrollable.
Substitute decision-making refers to a situation where an adult who has legal capacity to make decisions for another adult who does not have legal capacity to make these decisions for themselves. The substituted decision has legal effect as if it were a decision made by the person. A substitute decision-maker may be entitled to make some decisions on behalf of another person without being given specific authority to do so under a Guardianship or Financial Management Order, or under Enduring Guardianship or Power of Attorney.
Supported decision making is the process of assisting a person to make their own decisions so they can identify and pursue goals, make choices about their life and exercise control over the things that are important to them. The person is always at the centre of the process, driven by the person’s needs and wants and their decision-making style. It is an approach designed to support people to exercise their legal capacity.
A tenant or renter is somebody who pays the owner of a property for the right to live in that property for an agreed period. In NSW, a tenant has tenancy rights under Residential Tenancies Act 2010 (NSW).
The term fitness refers to a person’s capacity to understand and fairly participate in a criminal justice process. Fitness will depend on a person’s ability to understand what will happen in the court process, to communicate their version of what happened, to tell their legal representatives how they want to be represented and to stay focused throughout the period of a trial. Someone may be unfit to stand trial due to a number of conditions and/or disability including mental illness, developmental or intellectual disability and physical disability.
A voluntary patient is someone who admits himself or herself to a public mental health facility in circumstances where they have the capacity to give informed consent to mental health care and treatment to be provided to them. An involuntary patient can become a voluntary patient is they agree to remain in a public mental health facility, A Guardian may also admit a person who does not have capacity to consent to treatment to a public mental health facility as a voluntary patient, if that person does not object to the mental health care and treatment being provided to them.
A work and development (WDO) order is an order made by the NSW State Debt Recovery Office which enables eligible persons to reduce or pay their fines through a broad range of approved activities. These activities could include courses, counselling, drug and alcohol treatment, volunteer work, medical or mental health treatment or mentoring programs.