The Mental Health Act 2014 (MHA 2014) s.542 gives the Chief Psychiatrist the responsibility to make a recommendation to the Governor of Western Australia for the authorisation of a hospital. The set of standards that need to be met for this to occur is published as The Chief Psychiatrist’s Standards for Authorisation of Hospitals under the Mental Health Act 2014 (the Standards) October 2019.
The COVID-19 pandemic changes the everyday business of inpatient mental health care and poses significant challenges to mental health services in ensuring a high standard of care is maintained. There is much to consider including the provision of safe, suitable and therapeutic environments. Importantly, once a facility is Authorised there are statutory requirements in terms of reporting to the Chief Psychiatrist and legal requirements of receiving and treatment (including the use of restrictive practices) of a patient under the Mental Health Act 2014.
Given the dynamic nature of COVID-19 response there may be the need for the authorisation of a facility to be expedited to meet the impact of the virus on services. Consideration has therefore been given as to how to appropriately translate standards for authorisation during COVID-19. The values and priorities of the Chief Psychiatrist during this time remain the same: facilities must be safe, they must be suitable, they must be appropriate for the intended cohort, and the functionality of the environment must be therapeutic.
Safety in Authorised Hospitals has these three principles at its core:
- Infrastructure safety (e.g. ligature points and line of sight)
- Operational safety (e.g. robust policy and procedures)
- Relational safety (e.g. staff culture and philosophy of care)
Different cohorts or settings may require different balances between infrastructure and operational focus, whereas relational safety is always required for safe care.
In the COVID-19 context, the service must have a focus on providing;
- physical health assessments and management of physical health issues including the robust monitoring and management of COVID-19 in people admitted for mental health indications
- a safe environment that minimises potential harm and is informed by the Chief Psychiatrist’s Sexual Safety Guidelines
- a therapeutic environment that includes appropriate access to outdoor areas
- a trauma informed and contemporary approach to care
The Chief Psychiatrist regards every request for authorisation of a mental health facility with due consideration to Australia’s obligations as a signatory to the Optional Protocol to the Convention Against Torture, and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT) and the rights of individuals. Services are still required to address the Standards and where gaps are identified my office will work closely with the health service. We are seeking to be as flexible, nimble and prompt as possible to assist and meet the needs of the WA community during this period.
To seek an expedited authorisation assessment, services should consider these issues in advance:
- Are there existing Authorised Hospitals that can be more rapidly reconfigured to meet community needs and service requirements?
- Is authorisation required for this unit, or can/should it operate as a non-authorised unit?
- Has this been considered as part of a broader state emergency mental health planning process (other service providers who may be affected consulted)
- Is there likely to be funding, resources, staffing to enable this unit to realistically function as an authorised unit?
Under the COVID-19 circumstances, the Chief Psychiatrist will prioritise this discussion regarding authorisation to clarify the matter urgently. Although the nature of the process required under the MHA 2014 means there are steps which sit outside the remit of the Chief Psychiatrist, my office will respond, advise and assist services throughout.
Questions can be directed to Cate Wray, Consultant, Statutory Authorisations and Approvals, telephone 65530000 or email firstname.lastname@example.org
Dr Nathan Gibson