What is the purpose of this paper? The purpose of this paper is to encourage discussion and feedback from people who access, or work in, Western Australia s mental health sector. The paper proposes a draft set of standards that have been developed by the Health and Disability Services Office (HaDSCO) for effectively managing mental health complaints. Following consultation, standards will be endorsed by HaDSCO to assist stakeholders in the mental health sector. Why do we need standards to effectively manage mental health complaints? HaDSCO is an independent statutory authority offering an impartial dispute resolution service for health, disability and mental health service complaints in Western Australia. Acting impartially and in confidence, HaDSCO also reviews and reports on the causes of complaints, undertakes investigations, suggests service improvements and advises service providers about effective complaint resolution. The functions of the Director in relation to mental health service complaints are set out in Part 19 of the Mental Health Act 2014. The National Standards for Mental Health Services 2010 provides a basis for measuring mental health service delivery, including services delivered by public inpatient facilities, community mental health centres and private sector providers. These standards, and others, provide a benchmark for people to assess the quality of service provided. Where this assessment falls short, a complaint may be initiated to seek resolution. Additionally, the complaint standards also aim to ensure that Principle 13 of the Charter of Mental Health Care Principles is complied with; this principle requires mental health services to provide information about legal rights and complaints procedures to those experiencing mental illness. Those seeking to complain about a mental health service provider may feel vulnerable to do so due to constraints on their usual freedoms, such as being held as an involuntary patient in a locked ward. This vulnerability may influence their decision to make a complaint for actual or perceived fear of recrimination from the service provider. In some cases there is a significant dependency on the services that are being provided, that may create a fear of loss if a complaint is lodged. For example, suitable accommodation can be difficult for consumers of mental health services to find. A consumer may fear loss of his/her accommodation if a complaint is raised. Such a fear should not occur, a principle that is reinforced by legislation (s345, Mental Health Act 2014). In 2015, the Hon Minister for Mental Health endorsed a Mental Health Partnership Agreement. One of the initiatives within the Agreement that was committed to was to develop standards to effectively manage mental health complaints. A draft set of standards, based on consultation and research, is available at Appendix 1. 1
The aim of developing complaint management standards is to effectively measure how well a complaint was managed using an accepted range of values, beliefs and actions that are set out in the Charter of Mental Health Care Principles. At a broader level, the aim is also to measure the effectiveness of existing public, private and not-for-profit sector s complaint management systems. To achieve this, HaDSCO has developed a draft set of eight standards based on feedback received from stakeholders in developing the Mental Health Partnership Agreement. These standards reflect important values, beliefs and processes to effectively manage mental health complaints. What principles underpin the process of managing a mental health complaint? The consultation process, when developing the Mental Health Partnership Agreement 2015, identified a broad set of principles that should be used to guide effective management of mental health complaints. These are: 1) In consultation with stakeholders, including consumer groups, complaint management processes must be designed to be clear, easy to navigate, transparent and accessible for all people (including, but not limited to, patients, consumers, carers, personal supports, guardians, advocates and service providers). All stakeholders must be kept informed of progress and outcomes at all stages of a complaint resolution process. Complaint management should be outcomes focused, not process focused, with options being made clear upfront. 2) When complex complaints involve multiple government agencies, a mechanism must be established to identify a lead agency and a resolution process. 3) Mental health services must be accountable, committed to continuous improvement, and open to solving problems in partnership with all people involved. 4) Most mental health complaints are best resolved early, informally and at a service level, conditional to natural justice and legislative obligations not being compromised and clear options being available if a complaint needs to be escalated. Advocacy support is an essential element to effectively manage and prevent complaints. 5) Where relevant, advocacy agencies need to be engaged to avoid unnecessarily escalating complaints, and preventing future complaints. Natural justice principles and other fairness considerations include: i. Reviews of complaints are undertaken by independent, objective and impartial officers via a transparent process. ii. Power imbalances are recognised and addressed. 2
iii. All parties have equal rights (except in instances where these rights are legally restricted) and should be treated with mutual respect, courtesy and dignity throughout the complaint process. Complaint outcomes can be appealed and/or reviewed independent of the original decision maker. iv. Complainants have a right to make a complaint without recrimination, and guarantees of this should be explicitly provided. Any change in service, including perceived withdrawal or loss of quality following a complaint may be considered prejudicial conduct. v. All parties must have an opportunity to present evidence relating to a complaint. 6) Where complaints involving alleged significant harm occur (for example, physical, sexual or emotional abuse, maltreatment or neglect), a formal, immediate and coordinated response must be taken to minimise the potential of further risk, particularly where complaints involve children and adolescents. 7) Confidentiality of information must be in line with relevant legislation. 8) Where relevant, the statutory independence of government agencies must be maintained. 9) Where a person is being detained against their will, timeframes to address their complaint should be significantly shorter, and advocacy support offered as a priority. Management Standards should be developed to clearly articulate timeframes for prompt management and resolution. 10) Depending on evidence and the substance of the complaint, parties to this Agreement are responsible to accept, reject or refer anonymous complaints. 11) Patients, consumers and carers will be supported through the complaint process, and given information about relevant support services, including the right to be supported by a relative, a support person, or a carer. 12) Special needs of people will be taken into account including, but not limited to, culturally and linguistically diverse people, people with disability, Aboriginal and Torres Strait Islanders, people in rural/remote communities, people with specific belief and faith systems, youth and adolescents, and people who are being legally detained. 3
Why are these standards important and what is their relevance to you? The draft Standards are important for three key reasons: 1. Human rights: It is particularly important for patients, service users, carers or anyone with an interest in improving mental health services to be aware of the Standards. When things go wrong for a person who has been provided with a service, people must know what their rights are, as outlined in the Standards, in order for a complaint to be effectively resolved. 2. HaDSCO: When complaints are received by HaDSCO, it is important for us to review the attempts that the service provider has made to resolve a complaint prior to it being accepted by HaDSCO. However, where there is a good reason, HaDSCO has the discretion to review complaints where the complainant has not raised their complaint directly with the service provider. These standards provide HaDSCO with a framework to consider mental health complaints on a fair, consistent and impartial basis. 3. Governance and accountability: It is important for service providers to be aware of their responsibilities relating to managing complaints. In November 2015, the Mental Health Act 2014 commenced. Section 308 of the Act requires that a person in charge of a service provider must ensure that there is a complaints procedure for investigating any complaint made to the person in charge about any mental health service provided by the service provider, and that the complaints procedure is reviewed regularly and revised as necessary. In addition, the person in charge of a service provider must ensure that copies of the most up-to-date version of the service provider s complaint procedures are freely available at the services provider s premises and that a person who requests a copy of the service provider s complaints procedure is provided with a copy of that version. It is envisaged that HaDSCO s Standards for Effectively Managing Mental Health will provide the guidance and support for service providers to achieve this legislative requirement, and will provide a solid foundation for developing, implementing, monitoring and evaluating complaint procedures 4
How can I provide feedback on the draft Standards? Your feedback on the Draft Standards located in Appendix 1 is welcomed and can be provided to HaDSCO by: - Email: mail@hadsco.wa.gov.au - Mail: Health and Disability Services Office, PO Box B61, Perth, Western Australia, 6838 Please provide your feedback by COB on 11 March 2016. 5
References The Effectively Managing Mental Health Complaint Standards have been drafted based on the following: 1. Consumer, Carer and Service provider consultation on the Mental Health Partnership Agreement, 2015 2. Mental Health Act 2014, (WA). 3. Charter of Mental Health Care Principles, Schedule 1, Mental Health Act 2014 (WA) 4. Australian Commission on National Safety and Quality Standards in Health Care 5. National Standards for Mental Health Services 2010 Commonwealth of Australia. 6. National Standards for Disability Services. 7. National Practice Standards for the mental health workforce 2013. 8. Ombudsman Western Australia Guidelines The principles of effective complaint handling. November 2010. 9. Health Management Policy 2015, Department of Health, Western Australia. 10. Council of Official Visitors Policy 2014 11. Australian/New Zealand Standard Guidelines for complaint management in organisations (AS/NZS 10002:2014) 12. Royal Australian College of Psychiatrists Code of Conduct and Ethics. 13. Australian College of Mental Health Nurses Standards of Practice 2010. 6
APPENDIX 1
Standard 1: Access and Cultural Awareness 1. People who lodge a mental health complaint, irrespective of cultural background, language, location, age, legal confinement must be able to easily access a service provider s complaint process. This Standard will be met by service providers achieving the following: 1.1 Information on making a complaint is publicly available in physical environments and on-line. 1.2 Information on how to make a complaint is available in different languages, and access to an interpreter service is made available to service users. 1.3 Where relevant or requested, male and female staff are available to manage gender-sensitive complaints. 1.4 are able to be lodged in a range of formats, including verbally, in writing and on-line. If a service provider requires a complaint to be submitted in any particular format whether verbal or in writing, and a complainant is reasonably unable to do so, support must be offered. 1.5 People who are particularly vulnerable, including involuntary patients, are able to lodge a complaint independently, not via a staff member. 1.6 Service provider staff will be trained in cultural awareness. Standard 2: Effective Process 2. A service provider s mental health complaint process will be designed to maximise the likelihood of a successful resolution. This Standard will be met by service providers achieving the following: 2.1 A service provider has an endorsed and written complaints procedure which is reviewed annually. 2.2 Decisions relating to complaints are transparent and take into account principles of natural justice. Reasons for decisions are provided upon request. 2.3 A complaint process must not be prescriptive, and should be sufficiently flexible to respond to different situations. 2.4 Training on how to effectively manage complaints is made available for staff. 1
Standard 3: Impartiality and Fairness 3 A service provider s mental health complaint process will be impartial and fair. This Standard will be met by service providers achieving the following: 3.1 A review or investigation of a complaint is undertaken by a party who has no actual, potential or perceived grounds of bias and/or conflicts of interest. 3.2 Where a complainant is not satisfied with the outcome of a complaint, alternative options are provided for the complaint to be further considered, including internal reviews and external referral to the Health and Disability Services Office. 3.3 Complainants are made aware of advocacy support that is available to them, in order to assist them to progress a mental health complaint. 3.4 are assessed in the context of relevant legislation, National and State Standards, Charter of Mental Health Care Principles, policies and procedures. Standard 4: Timeliness 4 Service providers will manage mental health complaints within acceptable timeframes. This Standard will be met by service providers achieving the following: 4.1 A service provider s complaint procedure specifies timeframes that complaints will be considered in. 4.2 When a formal complaint is received, a service provider acknowledges its receipt in writing. 4.3 Where complex complaints result in timeframes not being feasible, complainants are to be kept regularly informed of the progress of their complaint. 4.4 A system to manage and monitor the progress of complaints is in place. 4.5 Where possible and relevant, complaints are resolved as early as possible, and in the most informal manner possible. 2
Standard 5: Professional and Ethical Behaviour 5 People who lodge or manage a mental health complaint will be treated professionally and ethically This Standard will be met by service providers achieving the following: 5.1. A Code of Conduct is developed, or adopted, to guide staff on appropriate behaviours when managing complaints, underpinned by principles of professionalism, courtesy, honesty, respect and fairness pursuant to the person-centred approach as stated in Principle 3 of the Charter of Mental Health Care Principles. 5.2. Guidelines are available to support staff to manage trivial, vexatious and/or complaints without substance. 5.3. Staff have a right to be treated respectfully by complainants. Where relevant, staff are supported to manage complainants who are abusive or unreasonable in their demands. Standard 6: Confidentiality and Privacy of Information 6 A service provider s complaint procedure will ensure the highest levels of confidentiality and privacy for the people involved. This Standard will be met by service providers achieving the following: 6.1 Service providers ensure that information relating to complaints, and parties to complaints, is kept confidential (unless there is an actual or potential threat to human life or safety), or a complainant consents to the disclosure of information. 6.2 Information relating to complainants and their complaint is stored securely. 6.3 Complainants have a right to view records relating to their complaint, as per relevant Privacy and Freedom of Information legislation, s248 of the Mental Health Act 2014, and relevant guidelines. 3
Standard 7: Safety, Risk and Rights 7 People who lodge a complaint have a right to feel safe, and to have their human rights maintained. This Standard will be met by service providers achieving the following: 7.1 Where of a serious nature (e.g. death, abuse, harm), a complaint is immediately escalated to an Executive staff member. 7.2 Complainants have a right to make a complaint without fear of repercussion or retribution. A service provider has the responsibility to ensure that this principle is proactively conveyed to complainants, and that no barriers exist in this regard. 7.3 All parties should have sufficient opportunity to provide relevant information relating to a complaint. 7.4 Where there are safety concerns for staff, alternative approaches are used to resolve a complaint in order to minimise risk (e.g. paper based processes, video/teleconferencing). Standard 8: System Improvement and Coordination 8 must be effectively coordinated and result in improvements in service. This Standard will be met by service providers achieving the following: 8.1 Service providers are able to make a clear link between individual complaints, and consequential improvements to their service, particularly where complaint trends are identified. 8.2 Recommendations to improve services that arise from complaints are monitored to ensure they are fully implemented. 8.3 Where multiple agencies are involved, and subject to the authorisation of a complainant, a service provider proactively collaborates with other service providers to effectively coordinate complex complaints. 8.4 At the closure of each complaint, a service provider invites feedback on the complainant s experience throughout the complaint process. 4