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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 Carer.

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

You can choose who you want to be your Designated Carer. 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 Carer.

In this section you can find out about:

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 Carer.

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

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 Carer. 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 Carer. 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 Carer.

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

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 Carer.

An Authorised Medical Officer or Director of Community Treatment can decide someone is a Principal Care Provider 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 Provider.

A person cannot become your Principal Care Provider 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 capacity at the time you exclude someone from being your Principal Care Provider.

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 patient 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 patient
  • if you were admitted as a voluntary patient
  • 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 consent to ECT
  • if an emergency surgical operation is performed on you without your consent 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 Carer agrees to the surgery)
  • if the Authorised Medical Officer wants to apply to the Mental Health Review Tribunal for consent 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 Carer 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 Provider 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 Order
  • 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 order; and/or
  • access to see an official visitor.

Updated March 20, 2020