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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 CarerA 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. More.

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

You can choose who you want to be your Designated CarerA 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. More. 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 CarerA 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. More.

In this section you can find out about:

• How you can appoint a Designated Carer, if you want to do this
• Who will be your Designated Carer if you don’t appoint someone
• What information can be given to a Designated Carer?
• How to exclude a person from being recognised as your Designated Carer

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 CarerA 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. More.

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 CarerA 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. More, the hospital or community team will assume a person from the list below is your Designated CarerA 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. More 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 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. More, then that person will be your Designated CarerA 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. More.

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 CarerA 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. More. 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 CarerA 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. More. 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 CarerA 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. More.

You will also need to ensure that your community case manager knows who you currently consider to be your Designated CarerA 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. More.

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 CarerA 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. More.

An Authorised Medical OfficerAn 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. More or Director of Community Treatment can decide someone is a Principal Care ProviderPrincipal 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. More 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 ProviderPrincipal 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. More.

A person cannot become your Principal Care ProviderPrincipal 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. More 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 a medical procedure. A person may lack capacity in some areas, but still be able to make other decisions. More at the time you exclude someone from being your Principal Care ProviderPrincipal 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. More.

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 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. More 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 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. More
• if you were admitted as a voluntary patientA 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. More
• if the hospital wants to apply to the Mental Health Review TribunalThe 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. for permission to give you electro-convulsive therapy (ECT) or for a decision about whether you are capable of giving informed consent 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, 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. More under the Mental Health Act 2007 (NSW)
• if the Authorised Medical OfficerAn 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. More wants to apply to the Secretary of NSW Health for consent  to perform surgery on you (if your Designated CarerA 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. More agrees to the surgery)
• if the Authorised Medical OfficerAn 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. More wants to apply to the Mental Health Review TribunalThe 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. 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, 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. More 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 CarerA 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. More 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 ProviderPrincipal 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. More 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 patient or under a Community Treatment OrderA 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. More
• your discharge into their care, provided they give a written undertaking you will be taken care of, and the Authorised Medical OfficerAn 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. More 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 OfficerAn 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. More refuses to discharge you
• a community treatment orderA 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. More; 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 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. More.

Updated March 20, 2020