The role of the Accredited Person in the Bowral Mental Health Service

To be able to understand the role of the Accredited Person one must also understand the place of the NSW Mental Health Act 2007 in the function of any mental health service. In earlier Mental Health Acts there was always a place for someone who substituted for medical practitioners in the initial assessment of persons with a mental illness or a mental disorder. Previous Acts had often designated a special Welfare Officer who could detain (or cause to be detained) a person with a mental illness or mental disorder. Over the passage of years the role of this special person was used less, often due to the willingness of general practitioners and other medical staff who were specialists in Psychiatry, to legally detain persons under the Mental Health Act. During the final stages of the 1990 NSW Mental Health Act, the Department of Health trialled the Accredited Person's Training Program through the NSW Institute of Psychiatry. The initial program saw a number of clinical staff undertake a rigorous training program developed by the Institute of Psychiatry. Not only were the applicants for this program exposed to face to face lectures about the Act and the legal and clinical requirements required by the Act, but they were assessed on their knowledge and clinical skill by the educators at the Institute. Those who successfully completed this initial training course were then authorised by the Minister and the Director General of NSW Health to perform a function that had traditionally been one for a registered medical practitioner. By writing a Schedule on a mentally ill or mentally disordered person the Accredited Person can legally detain an individual who has met the criteria as outlined in the Act and, if necessary, impose a requirement that the detained person is transported to the nearest declared mental health inpatient facility for further assessment and, if again deemed necessary by another medical practitioner, admitted for treatment. Naturally, the Accredited Person seeks to ensure that the person they assess is able to obtain their treatment in the least restrictive environment, so detaining a person is never contemplated unless there is clear evidence that the person will get worse or more unsafe if left untreated, or may avoid treatment if they remain in the community. In some circumstances it might prove very difficult for the Accredited Person to be able to properly assess the person who is mentally ill or mentally disordered. In this event the Accredited Person may rely on their observations or that of others to be able to make the determination to have the person detained. Generally, the information provided by the carer or family of the patient may also be important to the Accredited Person when the person with the mental illness is unable to do so due to their illness or disorder. Such information as is provided by a third party is able to be recorded by the Accredited Person on the documentation often called the "Schedule". It is important for carers and family members to understand that while they, the family, have had a very personal experience with the person and their mental illness, the Accredited Person must be confident that the patient does meet the criteria for enforcing the schedule. If there is any doubt about the person's status, the Mental Health Act requires the admitting doctor at the receiving unit to offer the patient voluntary admission or to discharge them from the inpatient Unit.What can be said then about the role of the Accredited Person in the Bowral Mental Health Service? Well it is known that the training of the Accredited Persons has been exceptionally rigorous and useful. The first trained Bowral clinician has had his Schedules validated by specialist medical practitioners at the mental health inpatient units. He has now been joined by four Bowral colleague who also have an unblemished record for ensuring that persons detained under the Mental Health Act receive timely treatment for their illnesses or disorders. Due to the success of the Accredited Persons program, and a reluctance now by some of our local general practitioners to damage the therapeutic relationship between themselves and their patients, the Bowral Mental Health Service has seen the successful training of another four staff members as Accredited Persons. What this has meant for the local community is that persons with a mental illness or mental disorder are now more likely to be provided with earlier treatment, attain quicker stability, and be returned to their families or the community more quickly.