How can clinicians best work with carers and the new role of the nominated person?

A useful conceptualisation of working with carers and the nominated person is to understand this as occurring in two phases. The first is an establishing phase where the clinician works with the consumer and the significant people in their life to identify who might be involved and how. The second, enabling phase, involves working with these identified people when a consumer becomes subject to compulsory care. There are important differences that apply to the roles of the nominated person, and that of the carer.

clinicians chatting around a table

The Establishing Phase

The establishing phase identifies who might be in the role of carer and nominated person, clarifies how they will be involved in the consumer’s care and specifically what role they will play in the event of the consumer being subject to compulsory treatment.

The clinician discusses with the consumer the important people in their life, who might be involved in their mental health care and how they might best be involved. They might discuss what the nominated person role will involve and what the nominated person and carer can expect in terms of communication from the treating team.

It is important to note that depending on the resources, needs and preferences of the consumer, there may be no active role for the clinician in establishing a nominated person. In other cases there may be a very active facilitation role for the clinician, including being a witness to a nomination.

Watch this video demonstrating a simple discussion in the establishing phase. [Note this is an educational video made by practitioners for training purposes only]

Processes and practice tips

Key steps in the Establishing Phase include:

  • exploring the options for the consumer to have their treatment preferences represented when they are receiving compulsory treatment
  • determining existing supports including whether the consumer has a carer and if a nominated person is desired
  • choosing a nominated person or a person to be identified as a carer
  • if desired by the consumer, making contact or meeting with the proposed nominated person
  • appointing a nominated person
  • revoking a nomination
  • declining to act as a nominated person

The link below will open a table that provides practice tips to facilitate this establishing phase. At each point in the processes that refer primarily to the nominated person, it is recommended that the clinician consider the role of the family/carer, particularly if the consumer does not elect them to be the nominated person.

You can download and print the document. It may be a useful sheet to refer to in your workplace. Establishing Phase: Processes and practice tips

The Enabling Phase

The enabling phase will occur when the consumer becomes a (compulsory) patient within the terms of the Act. At this point the role of the nominated person becomes active and the obligations of the authorised psychiatrist to consult and inform the nominated person and carer come into play. In reality, it would be expected that clinicians would include significant people (family, carer, friend) in treatment planning and decision making whether or not the treatment being undertaken is under a compulsory treatment order. Good practice for all consumers (not only those on compulsory treatment orders) requires decision making supported by the sharing of relevant information with people that the consumer determines are important in their lives.

Important elements which may contribute to the successful enabling of the nominated persons and carer provisions at various points in the patient’s treatment are

  • determining firstly whether treatment decisions will directly affect the carer and the care relationship and therefore whether they will be required to seek the views of the carer and to inform them about treatment decisions or orders complying with obligations to inform or consult the nominated person and carers
  • considering how the nominated person and carer are provided with information relevant to the patient’s treatment
  • considering how the nominated person’s and carer’s views are sought in relation to the patient’s treatment
  • explaining how treatment decisions that are not consistent with the nominated person’s views are determined and communicated to the nominated person and patient

The link below will open a table that provides practice tips to facilitate this enabling phase. It describes considerations for the consumer, family members, carers and significant people. It is important to once again note that many of the practices applying here are likely to be relevant to the role of carer. You can download and print the document. It may be a useful sheet to refer to in your workplace. Enabling the Nominated Person & Carer Roles: Processes and practice tips