Showcasing: Consumer and Carer Council
Nepean Blue Mountains
Nepean Blue Mountains Local Health District (NBMLHD) Mental Health Service
Living Well Domain
Putting people first
The Consumer and Carer Council (The Council) is made up of people with lived experience of mental ill-health and of mental health carers as voting members, together with mental health staff in non-voting positions. The CCC aim is to embed co-design with consumers and carers, moving beyond consultation. Its purpose is to improve mental health services through input in service planning, policy development, setting priorities, training and evaluation, and addressing quality issues in the delivery of services. The council consists of six consumers and six carers and receives recurrent funding from the NBMLHD to cover members’ remuneration, capacity building and projects.
The Council is formalised through a Charter, endorsed by NBMLHD Chief Executive that recognises the Council as an equal partner in improving mental health care and operations. Council members believe that the Charter represents one of the state’s more advanced mutual partnerships between consumers, carers and mental health staff as it demonstrates an institutional foundation whereby consumers and carers are embedded in the organisation and co-design is routine.
The key challenge was to develop an advanced mutual partnership between consumers, carers and mental health staff to embed co-design in mental health service improvement. Such an approach would recognise and formalise the lived experience of people with mental health issues and their carers, families and kinship groups as contributing valuable information, expertise and insights into mental health service improvement processes.
In early 2015, a Consumer and Carer Advisory Committee was established as a consultative mechanism. By late 2017, the Committee began recognising the limitations of its consultative role which, by tending to occur too late in improvement processes, failed to maximise the potential of members’ lived experience, knowledge and skills.
The Nepean Blue Mountains Mental Health Service Consumer and Carer Council is an active partnership between mental health consumers and carers and mental health staff to ensure mental health lived experience is routinely embedded in the NBMLHD Mental Health Service through co-production and co-design.
To strengthen its role, the Council, with the Charter, replaced the Consumer and Carer Advisory Committee. The initiative is among the first of its kind in New South Wales and was developed to ensure that local services were person-centred and responsive to local community needs.
The Council meets monthly to help define policy, procedures and offer direction to the NBMLHD with the aim of ensuring that the lived experience voice is heard and acted upon.
The initiative has 12 core members, including two co-chairs and a liaison officer who provides formal communications between the Council and the NBMLHD Mental Health Service. The Council co-chairs aim to also regularly meet with other mental health consumer advocacy groups in other districts around NSW to ensure best practice.
The NBMLHD Mental Health Service also provides administrative support for Council activities, while recurrent funding covers project costs and payment for members.
This initiative is innovative due to the strong collaboration between the NBMLHD and mental health consumers and carers. The Council demonstrates that genuine and authentic co-design is a superior way forward for local health districts to better support their local communities.
A key achievement of the Council is its involvement in the development of the NBMLHD Mental Health Service’s new five-year strategic plan, with the service adopting all Council suggestions.
In other projects, the Council co-designed a new Transfer of Care procedure over a 12-month period that is now a model for other services. The Council is supporting implementation of a co-produced Advance Statement, a tool for communicating a person’s treatment preferences in the event of a mental health crisis. It also offered valuable input into the design process and funding application to improve the therapeutic environment of the Nepean Hospital and Blue Mountains Mental Health Units.
The Charter signing underpins community confidence in ongoing genuine collaboration. The Council hopes to continue to strengthen and expand its networks and that the program’s ongoing success will lead to similar models being followed by others.
For more information, visit https://www.nbmlhd.health.nsw.gov.au/.
Showcasing: Therapeutic Environments Capital Works Program at Nepean Hospital
Nepean Blue Mountains
Nepean Blue Mountains Local Health District
Living Well Domain
Putting people first
Reducing and eliminating seclusion and restraint in hospital settings requires several quality and practice improvements, of which one is improving the therapeutic environment of the ward. By improving the environments of mental health inpatient units, spaces are created that are safer and more welcoming, and which encourage positive relationships between patients and staff.
The NSW Government funded a Mental Health Therapeutic Environments Minor Capital Works Program to assist Local Health Districts to undertake capital works upgrades to improve the design of their mental health inpatient units and to support the reduction of the use of seclusion and restraint. Seclusion is where an admitted patient is placed in a room, alone, from which they cannot freely exit, and restraint is where a person’s freedom of movement is restricted through chemical or physical means.
The Nepean Blue Mountains Local Health District (NBMLHD) project began in July 2018 and was co-designed with people with lived experience of mental health issues and people in caring roles. The project’s aim was to design improvements to the Acute and High Dependency Mental Health Units at Nepean Hospital, and the Blue Mountains Mental Health Unit at Katoomba, to create a more engaging and therapeutic environment.
A $1.5 million grant was provided by the Ministry of Health as part of the 2018/19 Mental Health Therapeutic Environments Minor Capital Works Program. The project is due for completion in late 2019.
Eliminating or reducing practices that are not therapeutic and contribute to the trauma experienced by patients is well-recognised challenge. Most people admitted to mental health units have a history of trauma. Secluding people or restraining them while they are in hospital adds to this trauma and makes the journey to recovery more challenging.
The mental health sector in NSW is working towards eliminating the use of seclusion and restraint, which has been reflected in changes to legislation, policy and clinical practice.
To assist the Mental Health Units to reduce and eliminate the use of seclusion and restraint, extensive work and resources are needed to ensure the physical space better meets the mental health and wellbeing needs of people with lived experience of mental health issues, people in caring roles and staff.
Co-design principles were fundamental to the project, where people with lived experience of mental health issues and those in caring roles were key partners in guiding and shaping the proposed designs. A project users group was established for the co-design process including people with lived experience of mental health issues, peer workers, nursing staff and managers and allied health staff.
Key features designed for the units include:
- A transition space designed to ease the fear people may feel when entering the mental health units at Nepean Hospital.
- Well-resourced sensory rooms containing weighted toys and blankets and access to music. The rooms will provide a comforting and calm environment purposefully designed to help people self-regulate strong emotions and manage their distress.
- Other features, such as a dedicated television spaces, redecorated family rooms, an active courtyard and a passive garden space designed to provide opportunities for meaningful activity and social connection.
The renovations underway are informed by the participation of people with lived experience of mental health issues and those in caring roles through the co-design process. By providing a more therapeutic environment the NBMLHD mental health service anticipates it will be better able to provide a more positive inpatient environment and meet the needs of the local community who require hospital admission.
It is also hoped that the project will serve as a best practice model for other mental health units once complete.
i. Kezelman, C., & Stavropoulos, P. (2012). Practice guidelines for treatment of complex trauma and trauma informed care and service delivery. Retrieved from https://www.blueknot.org.au/resources/Publications/Practice-Guidelines
ii. Cusack, P., Cusack, F. P., McAndrew, S., McKeown, M., & Duxbury, J. (2018). An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings. International Journal of Mental Health Nursing, 27 (3), 1162-1176.
iii. Van Der Kolk, B. A. (2015). The body keeps the score. London: Penguin Books.