Chapter 4 Section G: The role and rights of the Designated Carer and Principal Care Provider

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Chapter 4 Section G: The role and rights of the Designated Carer and Principal Care Provider

The Mental Health Act 2007 (NSW) recognises the important role of carers in the lives of people living with mental health conditions. The Act recognises two types of carers; ‘Designated Carers’ and ‘Principal Care Providers’

Normally, if information about your care and treatment is given to anyone other than you, without your clear permission, this would be a breach of confidentiality and information privacy principles. However, the Mental Health Act 2007 (NSW) allows for certain information to be given to your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D..

To find out more about the rights of carers, please follow this link.

You can choose who you want to be your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D.. If you don’t choose, then a person will be considered to be your Designated Carer because of their particular relationship to you. You can also exclude a person from being considered a Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D..

In this section you can find out about:

How you can appoint a Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D., if you want to do this
Who will be your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D. if you don’t appoint someone
What information can be given to a Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D.?
How to exclude a person from being recognised as your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D.

4G.1: Appointment of a ‘Designated Carer’

The Mental Health Act 2007 (NSW) allows you to appoint a person as your ‘Designated Carer’. Once appointed, your Designated Carer will automatically be given particular information about you, without you having to consent each time the information is provided. You can nominate up to two Designated Carers. If you want a particular person to be told about aspects of your care and treatment including having access to otherwise confidential information about you, then you should make sure that you nominate that person as your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D..

If you do not want a particular person or certain people told, then you can ‘exclude’ this person. You should make sure that the hospital has in writing your express wishes about this, especially if that person is your spouse or partner, a carer or someone else normally close to you. If you do not choose a Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D., the hospital or community team will assume a person from the list below is your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D. in the following order:

Your wife, husband or de facto partner ‘if the relationship is close and continuing’
A person who is primarily responsible for providing support or care to you (other than as a professional carer); or
A close friend or relative with whom you have frequent contact and who cares about your welfare

If you are Aboriginal person or a Torres Strait Islander, ‘relative’ includes a person who is part of the extended family or kin of the patient according to the indigenous kinship system of your culture.

If you have a guardianIn NSW, guardians are appointed by the Guardianship Division of NCAT 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. To read more see Chap 5 & 12D., then that person will be your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D..

If you are under 14 years old, your parents will be your Designated Carers. The Mental Health Act 2007 (NSW) says that when you are fourteen (14) you can nominate your own Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D.. However, if you are over fourteen (14) you will not be able to exclude your parents or legal guardians from receiving information about you until you are eighteen (18).

You can at any time change or cancel your nomination of a Designated Carer or your decision to exclude someone from being your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D.. Your decision should be respected unless your treating doctors or community mental health team think that you do not have the capacity to make this decision or that it exposes you to risk of serious harm.

Your nomination of a person as your Designation Carer only lasts twelve (12) months so you should make sure your intentions are clear and in writing every time you are admitted to hospital under the Mental Health Act 2007 (NSW). You should ask a hospital staff member for the relevant form to nominate or change your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D..

You will also need to ensure that your community case manager knows who you currently consider to be your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D..

4G.2: Principal Care Providers

A ‘Principal Care Provider’ is the person who is primarily responsible for providing support and care to you, other than professional carers. This person will often also be a Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D..

An Authorised Medical Officer or Director of Community Treatment can decide someone is a Principal Care ProviderThe amendments to the Mental Health Act 2007 (NSW) were assented to on the 28 November 2014 by way of the Mental Health Amendment (Statutory Review) Act 2014 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW), now recognises a new category of persons, who are referred to as a 'principal care providers'. A principal care provider is the individual who is primarily responsible for providing support and care to a person with mental illness. The principal care provider generally has the same rights to notice, to be consulted and to make requests as the 'designated carer' (formerly the 'primary carer'). To read more see Chap 12D. even if they are not nominated. This is to make sure that if your Designated Carers do not have the main responsibility for providing you with support and care, they can still receive or provide relevant information to your care and treatment. This means that sometimes three (3) people will be given information about you; your two Designated Carers and your Principal Care ProviderThe amendments to the Mental Health Act 2007 (NSW) were assented to on the 28 November 2014 by way of the Mental Health Amendment (Statutory Review) Act 2014 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW), now recognises a new category of persons, who are referred to as a 'principal care providers'. A principal care provider is the individual who is primarily responsible for providing support and care to a person with mental illness. The principal care provider generally has the same rights to notice, to be consulted and to make requests as the 'designated carer' (formerly the 'primary carer'). To read more see Chap 12D..

A person cannot become your Principal Care ProviderThe amendments to the Mental Health Act 2007 (NSW) were assented to on the 28 November 2014 by way of the Mental Health Amendment (Statutory Review) Act 2014 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW), now recognises a new category of persons, who are referred to as a 'principal care providers'. A principal care provider is the individual who is primarily responsible for providing support and care to a person with mental illness. The principal care provider generally has the same rights to notice, to be consulted and to make requests as the 'designated carer' (formerly the 'primary carer'). To read more see Chap 12D. if you have specifically excluded them from being given notice or information. However, you cannot exclude them if it puts you and another person at risk of harm. You need to have legal capacityCapacity 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 an operation. A person may lack capacity in some areas, but still be able to make other decisions. at the time you exclude someone from being your Principal Care ProviderThe amendments to the Mental Health Act 2007 (NSW) were assented to on the 28 November 2014 by way of the Mental Health Amendment (Statutory Review) Act 2014 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW), now recognises a new category of persons, who are referred to as a 'principal care providers'. A principal care provider is the individual who is primarily responsible for providing support and care to a person with mental illness. The principal care provider generally has the same rights to notice, to be consulted and to make requests as the 'designated carer' (formerly the 'primary carer'). To read more see Chap 12D..

4G.3: What information can be given to your Designated Carer and/or Principal Care Provider?

Your Designated Carer will be told:

if you are detained within twenty-four (24) hours of that detention, unless you are discharged or become a voluntary patientA voluntary patient is someone who admits himself or herself to a Mental Health Facility, or agrees to remain in a Mental Health Facility to which they were involuntarily admitted, of their own free will in circumstances where they have the capacity to give informed consent to mental health care and treatment to be provided to them. A Guardian may also admit a person who does not have capacity to consent to treatment to a Mental Health Facility as a voluntary patient, provided that person does not refuse or object to the mental health care and treatment being provided to them. during that time
there is an upcoming mental health inquiry, and when these will be held
if you leave the facility without permission or fail to return at the end of a period of leave
if it is planned to transfer you to another mental health facility or other health facility
if you are discharged from the mental health facility
if you are re-classified as a voluntary patientA voluntary patient is someone who admits himself or herself to a Mental Health Facility, or agrees to remain in a Mental Health Facility to which they were involuntarily admitted, of their own free will in circumstances where they have the capacity to give informed consent to mental health care and treatment to be provided to them. A Guardian may also admit a person who does not have capacity to consent to treatment to a Mental Health Facility as a voluntary patient, provided that person does not refuse or object to the mental health care and treatment being provided to them.
if you were admitted as a voluntary patientA voluntary patient is someone who admits himself or herself to a Mental Health Facility, or agrees to remain in a Mental Health Facility to which they were involuntarily admitted, of their own free will in circumstances where they have the capacity to give informed consent to mental health care and treatment to be provided to them. A Guardian may also admit a person who does not have capacity to consent to treatment to a Mental Health Facility as a voluntary patient, provided that person does not refuse or object to the mental health care and treatment being provided to them.
if the hospital wants to apply to the Mental Health Review Tribunal for permission to give you electro-convulsive therapy (ECT) or for a decision about whether you are capable of giving informed consentAgreeing 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, risks. You agreeing to the treatment once you have been given the information and understand it is called 'informed consent' to treatment. Informed consent by a person who has capacity is a valid consent. To read more see Chap 3B.1 & Chap 8F.3. to ECT
if an emergency surgical operation is performed on you without your consentAgreeing 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, risks. You agreeing to the treatment once you have been given the information and understand it is called 'informed consent' to treatment. Informed consent by a person who has capacity is a valid consent. To read more see Chap 3B.1 & Chap 8F.3. under the Mental Health Act 2007 (NSW)
if the Authorised Medical Officer wants to apply to the Secretary of NSW Health for consent to perform surgery on you (if your Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D. agrees to the surgery)
if the Authorised Medical Officer wants to apply to the Mental Health Review Tribunal for consentAgreeing 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, risks. You agreeing to the treatment once you have been given the information and understand it is called 'informed consent' to treatment. Informed consent by a person who has capacity is a valid consent. To read more see Chap 3B.1 & Chap 8F.3. to perform surgery or special medical treatment on you, and
if you have any matter before the Tribunal.

The Mental Health Act 2007 (NSW) also states that the Designated CarerThe 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 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW) has replaced the term 'Primary Carer' with the term Designated Carer.To read more see Chap 9 and 12D. should be consulted about the discharge plan for your release from hospital.

4G.4: What requests can your Designated Carer and/or Principal Care Provider make?

Your Designated Carer and/or Principal Care ProviderThe amendments to the Mental Health Act 2007 (NSW) were assented to on the 28 November 2014 by way of the Mental Health Amendment (Statutory Review) Act 2014 (NSW). These changes are now in force. The Mental Health Act 2007 (NSW), now recognises a new category of persons, who are referred to as a 'principal care providers'. A principal care provider is the individual who is primarily responsible for providing support and care to a person with mental illness. The principal care provider generally has the same rights to notice, to be consulted and to make requests as the 'designated carer' (formerly the 'primary carer'). To read more see Chap 12D. can request or apply for the following:

your detention in a mental health facility
a list of medication, and dosages, you have been given as an involuntary patientAn Involuntary patient is someone who is admitted and detained in a hospital or psychiatric unit for care and treatment under the Mental Health Act 2007. In most cases it refers to a person who is detained under an Involuntary Patient Order made by the Mental Health Review Tribunal. In some circumstances the term includes an ‘assessable person’ detained in a mental health facility prior to a Mental Health Inquiry. To read more see Chap 4C.5. or under a Community Treatment OrderA Community Treatment Order is a legal order made by a Local Court Magistrate or the Mental Health Review Tribunal. It authorises the compulsory care and treatment, usually including the regular administration of medication, of a person with mental illness living in the community.
your discharge into their care, provided they give a written undertaking you will be taken care of, and the Authorised Medical Officer is satisfied that there is an adequate plan in place to prevent harm to you or others
an appeal to the Tribunal where the Authorised Medical Officer refuses to discharge you
a community treatment orderA Community Treatment Order is a legal order made by a Local Court Magistrate or the Mental Health Review Tribunal. It authorises the compulsory care and treatment, usually including the regular administration of medication, of a person with mental illness living in the community.; and/or
access to see an official visitorAn ‘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 under certain restrictive conditions. Official visitors are appointed by the NSW Minister for Health under the Mental Health Act 2007 (NSW) to visit NSW 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..

Updated March 20, 2020