Making a statement on mental health

People can experience deterioration in their mental state in any healthcare setting. An acute deterioration in a person’s mental state is an adverse outcome in itself. It can also be associated with other adverse outcomes, including self-harm, suicide and aggression. Early recognition can mean that the person experiencing deterioration in their mental state has the greatest capacity to participate in shared decision-making, and may minimise the use of restrictive interventions. To ensure early recognition and response to deterioration in a person’s mental state, all members of the healthcare workforce need to be alert for its signs.

National Consensus Statement

The Australian Commission on Safety and Quality in Health Care (the Commission) has developed the ‘National Consensus Statement: Essential elements for recognising and responding to deterioration in a person’s mental state’ (the Consensus Statement). It will support health service organisations as they implement new actions in the National Safety and Quality Health Service Standards (second edition).

The Consensus Statement is an adaptation of the successful model for recognising and responding to acute physiological deterioration. What makes that model successful is a systematic approach to recognising signs of physiological deterioration, documenting these and escalating care through agreed and available pathways. Standardised processes do not replace or dilute clinical judgement but support it, and the capacity to escalate care solely on the basis of clinical concern is built into the system.

Deterioration in a person’s mental state is a process experienced by an individual person and the language of the new Consensus Statement reflects that. It is a complex phenomenon, and the signs may be different for different people, or different for the same person at different times. Because of this complexity, there is not a set list of objective observations that healthcare workers can rely on to identify deterioration in a person’s mental state. This means that an effective response relies on collaboration with the person to identify what they are experiencing, and to develop a response that reduces their distress, and keeps them and other people safe.

The Consensus Statement describes the essential elements to ensure safe and effective recognition and response to deterioration in a person’s mental state. These are divided into three parts:

• Processes of Care, which sets out the actions that members of the workforce take to safely and effectively recognise and respond to deterioration in a person’s mental state.
• Therapeutic practice, which describes the collaborative approach members of the workforce adopt with consumers and carers, and with each other. This section includes the values that underpin the approach.
• Organisational supports, which sets out the structural and organisational factors that support the workforce to implement the approach.

While the guiding principles of the Consensus Statement apply in all healthcare settings, the ways in which they are implemented must be tailored to local resources, including the skills of members of the workforce. A frontline worker may not have the expertise or experience to manage all aspects of the response should a person for whom they are providing health care experience deterioration in their mental state. Under the Consensus Statement, every worker will be expected to be alert to the potential for deterioration, and know how to initiate response using their local escalation protocol.

The Consensus Statement is available on the commission’s website: https://www.safetyandquality.gov.au/our-work/mental-health/.

The commission is undertaking further consultation with stakeholders about ways in which local services can implement the essential elements described in the Consensus Statement.

Image credit: ©Australian Commission on Safety and Quality in Health Care.

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