My first experience witnessing advocacy in action was watching my parents advocate for me when talking to my psychiatrist and case manager. Plenty of times I was too doped up on medication to speak for myself so my parents had to act on my behalf. This is an important time for carers and consumers to develop advocacy awareness and skills.
Advocacy with treating teams has two stages: Preparation and consultation. The best consultations I have had as a consumer and working as a peer practitioner with clients are meetings that I or we have prepared for.
There are three pillars of any consultation with a psychiatrist and case managers. They are:
1. Medication
If medication is not well tuned, it can be a huge obstacle for clients recovery
2. Rights
A client is to understand their rights under the Mental Health and Wellbeing Act 2022
3. Communication
Honest communication
Question, assert, and be respectfully vocal to your psychiatrist
It is so important to ask plenty of questions in these meetings. Have questions prepared, consumers and carers should not just accept the treating team's hypothesis if they don't agree with it.
MEDICATION
It’s important to have some idea of the medication you are on or medication the treating wants to propose. Some common medications are listed below.
Anti-psychotics
Olanzipine (Zyprexa)
Clozapine (Clozaril)
Quetiapine (Seroquel)
Mood stabilisers
Lithium Bicarbonate (Lithium)
Valproate (Epilam)
Lamotrigine (Lamictal)
Anti-depressants - Selective serotonin reuptake inhibitors (SSRIs)
Escitalopram (Lexapro)
Zoloft (Sertraline)
Citalopram (Celexa)
THINGS FOR CARERS TO CONSIDER
In my time working as a peer practitioner and advocating for clients at treatment meetings I’ve noticed key elements that can affect the trajectory of the meeting. These are:
Deficit of cognition
Power imbalance
Institutionalised compliance
We can acknowledge these and prepare for them. I myself have been affected by all three in the past.
THINGS FOR CLIENTS TO CONSIDER
This is ‘your’ brain. The treated person can remind the clinical team of that. It needs very careful consideration. Repeatedly go back to the psychiatrist if a medication is not suited. There are always more options in regards to fine tuning medication. This medication is altering your brain chemistry so it may take some time or changes in your lifestyle to get used to it.
STATEMENT OF RIGHTS
A statement of rights must be provided to a person at key points during their assessment and treatment. Statements of rights set out a person’s rights when receiving mental health services from a mental health service provider.
A statement of rights includes information about patients’ right to:
communicate lawfully
apply to Mental Health Tribunal at any time for a revocation of a compulsory treatment order
choose a nominated person
seek a second opinion
make a complaint to the Mental Health Complaints Commissioner
be legally represented and be supported by an advocate carer, family member or friend at a hearing of the Mental Health Tribunal
seek the assistance of the Independent Mental Health Advocacy (IMHA) service and community visitors.
A number of other people must also be given a copy of the statement of rights. This includes a nominated person, a guardian, a carer if the decision will directly affect the carer and the care relationship, a parent of a person aged under 16 or the Secretary to the Department of Health and Human Services if the person is on a family reunification order or care by Secretary order.
MENTAL HEALTH ACT & WELLBEING ACT - SECT 2.2
Statement of rights must be explained
Clauses 37 – 40 state the importance of rights under the Act:
37) Requirement to provide a statement of rights A registered medical practitioner, authorised mental health practitioner, authorised psychiatrist or psychiatrist (as the case may be) must take all reasonable steps to ensure that a person in circumstances referred to in section 36 is given a statement of rights.
39) Explanation of statement of rights A registered medical practitioner, authorised mental health practitioner, authorised psychiatrist or psychiatrist (as the case may be) must take all reasonable steps to ensure that a person specified in section 36 who receives a statement of rights understands their rights as set out in the statement.
40) Statement of rights to be given to support persons If a statement of rights is given to a person under this Act, the registered medical practitioner, authorised mental health practitioner, authorised psychiatrist or psychiatrist (as the case may be) must take all reasonable steps to ensure that a statement of rights is also given to the following persons— (a) if the person is a patient, any nominated support person of the patient; (b) any guardian of the person; (c) any carer of the person if the carer has been notified of any of the following because it directly affects the carer and the care relationship
OUTCOME
Establish the outcome you’d like in the preparation stage. During the consultation, consumers may need to keep themselves and the meeting on track, that is, towards this outcome. Derailing can happen because it can be an emotional setting for oneself and the carer. The aim is to assert your choice and control for a beneficial compromise.
ADVOCACY EMPOWERING
Every person that gets admitted to the mental health system has rights backed by the mental health and wellbeing Act 2022. This means you are backed by law to be respectfully vocal to reach a resolution that works for you. Being responsible for your rights can be very empowering. I had to be given my rights 3 times before I understood I was backed by law. Once I 'owned' this reality I had far better treatment outcomes because I could shift the power imbalance I had with the psychiatrist. I went from passive to assertive over my mental health.
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