Overview of the guide

The Mental Health Safety and Quality Engagement Guide aims to empower and support mental health consumers and carers who would like to participate and engage in improving safety and quality in mental health services. The guide provides practical guidance and information to help you contribute to, and partner with, services to promote positive change.

About the Mental Health Safety and Quality Engagement Guide

The Mental Health Safety and Quality Engagement Guide aims to empower and support mental health consumers and carers who would like to participate and engage in improving safety and quality in mental health services. The guide provides practical guidance and information to help you contribute to, and partner with, services to promote positive change.

The area of lived experience engagement includes many diverse terms and phrases that refer to people, roles and processes. This guide recognises that your preferred terminology in mental health may vary from both the terms in policy documents and the terms other people prefer.

Lived experience is used in this guide as a broad term referring to the personal perspectives on, and experiences of, being a consumer or carer, and how this becomes awareness and knowledge that can be communicated to others. The term covers people’s core experiences around mental health challenges and service use that may have occurred in the past or may be ongoing (sometimes called living experience).

See Appendix 1 for more detail on the language used in this guide.

The guide also provides useful information for service providers and planners who would like to improve their processes for engaging with mental health consumers and carers on safety and quality issues. Although consumers and carers can engage with services on safety and quality issues in many ways, this guide focuses on strategies for engaging at a governance level. This means encouraging people with lived experience to partner in planning and decision- making to ensure high-quality, person-centred and family-centred care.

We chose this focus to complement existing consumer and carer guides, and to support consumers and carers to promote systemic change in all aspects of mental health services.

A focus on safety and quality

Safety means the absence of preventable harm to people during the process of health care, and reduction of unnecessary harm associated with health care to an acceptable minimum. Safety includes adhering to clinical and work standards for health and safety, and ensuring that people don’t get hurt. It also includes emotional safety: creating a welcoming environment free from stigma and judgement, and ensuring that people feel comfortable, validated and respected. For Aboriginal and Torres Strait Islander people, services need to be culturally safe. Ensuring sexual safety within services is also essential.

See Section 3 for cultural safety principles.

Quality means providing the best possible services for a person’s individual needs and circumstances, with the goal of supporting personal recovery in a culture that feels safe, comfortable and respectful. Quality includes providing services that are evidence based and cost effective—but also providing care that is tailored to a person’s individual needs and ensures that the people who use a service have a positive experience. Quality is underpinned by the principles of human rights.

Diverse perspectives

Different people have different perspectives about what is most important for safety and quality. If you’ve used mental health services, you have probably developed your own ideas about safety and quality.

Many consumers see safety in terms of what they will go through when using services. They may have concerns about the legal issues regarding inpatient treatment orders, or they may worry about medicines and their own power to make choices about treatment. They may wonder about the safety of other people on the ward. Feeling safe might include being listened to by doctors, nurses and other health professionals.

Many carers see safety in similar ways, or they might think quality concerns the timely availability of care and the ways in which treatment, support and discharge occur. They might want to be involved in care decisions and receive follow-up phone calls from services. The nature and quality of engagement are vital.

It’s important to understand that carers cannot speak on behalf of consumers, and vice versa. Even if a carer also has lived experience as a consumer, they must be clear about what hat they are wearing when speaking up or speaking out.

Consumers, carers, family and kinship groups may all experience frustrating and traumatising gaps in services, or have concerns about how mental health services relate to general practitioners and other community services and supports. They may experience situations where cultural identity and preferences are not taken into account. And the experience of crisis and police involvement is often difficult.

Mental health professionals are aware of the range of experiences that consumers and carers regularly face when seeking services. They also observe how services operate, and see both positive and negative patterns in the availability of mental health care and how it is provided. Health professionals also have professional, organisational and clinical perspectives that affect their safety and quality priorities. Concerns about risk and security can dominate how professionals relate to consumers and carers. Perspectives of people with lived experience of mental ill-health acknowledge the importance of safe and high-quality health care from the conventional perspective. However, they stress that the process of determining what is safe and high-quality care must be informed by, and meaningful for, their lived experience.

This process goes beyond valuing subjective points of view: it’s about recognising life context, culture, identity, risks and opportunities—it’s about working together in partnership to identify what’s appropriate for consumers, carers, families and kinship groups, and then acting on this. Safe, quality care that acknowledges lived experience perspectives requires structural competency, conceptual competency and relational recovery. This is embodied in the principles of recovery, dignity of risk, trauma-informed care, cultural safety and co-production.

Person-centred care and personal recovery

The definitions of safety and quality used in this guide are underpinned by the recognition that our right to health is a fundamental part of our human rights, and is informed by the concepts of person-centred care and personal recovery. Participating in governance is an opportunity to ensure that the human rights of individuals are protected—respect for human rights is fundamental to supporting the recovery of people living with mental health problems.

Person-centred care is about providing the services and support that are right for each person, taking into account their unique needs, circumstances, preferences and recovery goals. Person-centred care focuses on what each person needs and what works for them. It requires service providers to work in partnership with consumers to understand their personal preferences, establish trust and mutual respect, and plan and make decisions about care.1 We encourage all services to employ a person- centred and family-centred approach. This approach involves working with the consumer and their family or kinship group, as appropriate.

Person-centred care is related to the concept of personal recovery, which focuses on achieving the goals and outcomes that a person considers important and meaningful for their recovery. Personal recovery is guided by each person’s goals and priorities, rather than relying only on diagnostic criteria or what a clinician or service provider thinks is a ‘good’ outcome.

Person-centred care and personal recovery play an essential role in ensuring safety and quality in mental health care. According to the Australian Commission on Safety and Quality in Health Care, person-centred care is “widely recognised as a foundation to safe, high-quality health care”.²

Safety and dignity of risk

Recovery and steps in personal growth can occur outside a person’s comfort zone. The principle of ‘dignity of risk’ is also important. Service environments and interactions between consumers, carers and health professionals need to provide opportunities for positive risk-taking. The balance between risk and safety and the tensions around this should be discussed and worked through with mutual respect and personal integrity.

Trauma-informed care

This approach recognises that many people accessing mental health care have experienced significant adverse life events, particularly during their childhood. These events include experiencing or witnessing such things as war, violence, natural disasters, accidents and loss. In addition, the approach recognises that many people experience traumatic events while receiving mental health care. Others have experienced trauma in the context of cultural, gender or sexual discrimination and marginalisation.

National standards

This guide introduces the two sets of national standards that apply to a framework for providing mental health services. The standards guide healthcare systems to deliver safe care and continually improve the quality of their services.

The first set is the National Safety and Quality Health Service (NSQHS) Standards. The eight NSQHS Standards were developed by the Australian Commission on Safety and Quality in Health Care, and are designed to provide a nationally consistent statement about the level of care that people can expect from health services. All public and private hospitals, day-procedure services and public dental practices in Australia must be accredited for the eight NSQHS Standards.

The second set is the National Standards for Mental Health Services. These standards are managed by the Australian Government Department of Health to guide continual quality improvement throughout all mental health services across Australia, from general practice to community mental health services to acute hospital-based services. They also apply across all sectors—public, private and non-government.

See Appendix 2 for further details on these standards.

A partnership approach

This guide supports a partnership approach for improving safety and quality in mental health services. In a partnership approach, the people who provide services and the people who use services come together as equals to help make mental health services the best they can be.

A partnership approach recognises that people who have lived experience of mental health challenges and personal recovery, or who have been a carer or family member of someone with lived experience, have unique knowledge and expertise that is essential to the delivery of safe and high-quality mental health services. Planning and producing services together at the local level helps to ensure that services are relevant and meaningful for the recovery needs and wishes of consumers, carers, families and kinship groups.

This is a key reason why the NSQHS Standards encourage all public and private health services to develop and maintain local partnerships and activities. Genuine person- centred care and recovery cannot be achieved through top-down, bureaucratic activities; they must involve relationship-based activities generated by local meetings and interactions between service providers, consumers, carers, families and kinship groups. Discussions and planning are thus grounded in the context of local lives, aspirations and opportunities.³