Me, Myself and My Tribunal

Aim

To increase patients’ satisfaction with their engagement levels during Justice Health & Forensic Mental Health Network (JH&FMHN) Tribunals by 70%, by December 2016.

Benefits

Improves patient preparation for Tribunals.
Increases patient engagement and self-efficacy in Tribunals.
Improves patients’ level of satisfaction with their engagement in their Tribunals.
Helps patients advocate for themselves during Tribunals.
Reduces the risk of anxiety and stress in patients during the Tribunal process.

Background

The Forensic Hospital is located in Sydney and treats people in the justice system who have been found not guilty due to mental illness or are unfit to plea under the Mental Health (Forensic Provisions) Act. As part of their treatment, patients are housed involuntarily in The Forensic Hospital and are required to attend a Mental Health Review Tribunal every six months. The treating multidisciplinary team also attends each Tribunal and provides an update on the patient’s progress. The Tribunal is a specialist body constituted under the Mental Health Act 2007. It was established to protect the rights of patients and has a wide range of powers that allow members to conduct mental health inquiries, as well as make and review orders. It also oversees the care and treatment of patients with a mental illness.

Prior to the project, there was anecdotal evidence that suggested Tribunals had a negative impact on patients’ mental health. This presented in a number of ways, including a deteriorating mental state, confusion about the Tribunal process, lack of confidence and fear of saying the wrong thing. These factors hindered patients’ ability to engage in the Tribunal to their satisfaction. In this case, the satisfaction of patients is more important than their level of engagement, as each Tribunal requires a varying level of engagement and patient satisfaction has a greater impact on their mental health. It was determined that improving patients’ satisfaction with their engagement in Tribunals would enhance their mental health and therefore their recovery.

Implementation

Consultation was undertaken with consumer participants and JH&FMHN Research and Practice Development Units, to develop a pre-implementation survey.
The pre-implementation survey was conducted in September 2016, with patients in the Clovelly and Eloura Units of The Forensic Hospital. The survey asked how they felt before the Tribunal, how confident they were when speaking at the Tribunal and how satisfied they were with their level of engagement during the Tribunal.
A preparation tool was developed to help patients prepare for their Tribunal. It was adapted from an existing tool in use by the Mental Health Review Tribunal and comprised four questions, as follows.
- Do you know what order your treating team is applying for? What is your understanding of this order?
- Do you have any comments about the progress you’ve made with your mental health recovery?
- Would you like to tell the tribunal about your plans for the future?
- Is there anything else you’d like to add that you think will help the Tribunal make its decision?
The tool was implemented in the Clovelly and Eloura Units in November 2016.

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

Project start: June 2016
Project evaluation: December 2016
Planning for implementation across The Forensic Hospital: January 2017

Implementation sites

Clovelly Unit (sub-acute), The Forensic Hospital, JH&FMHN
Elouera Unit (rehabilitation), The Forensic Hospital, JH&FMHN

Partnerships

NSW Mental Health Review Tribunal
Legal Aid

Results

The patient satisfaction survey was conducted in November 2016, with the same patient cohort as the pre-implementation survey. There was a 70% increase in patients’ satisfaction with their engagement in Tribunals, with results also showing a positive response to the preparation tool itself.
Staff feedback was collected in November 2016 and showed a positive response to the implementation of the tribunal preparation tool in the two trial units. Plans are now underway to roll out the project across all units in The Forensic Hospital.
There were a number of solutions that were not implemented as part of the project, due to time constraints. Recommendations have been made for The Forensic Hospital to implement these moving forward. These include:
- family and carer education on the Tribunal process
- development of a family and carer Tribunal preparation tool
- increased access for family and carers to Tribunals
- increased staff awareness of their role in Tribunals, as well as awareness of policies and procedures to support patients, families and carers
- clarification of all internal and external roles involved in the Tribunal process
- a consistent, hospital-wide approach to Tribunals.

Lessons learnt

It’s important to find common ground and create a shared vision – if everyone disagrees it’s difficult to get buy-in and find a solution.
If team members are unhappy about the project leader’s final decision, it’s important to ensure they feel confident approaching Clinical Leadership Program facilitators and project sponsors for support.
Regular communication and consultation with team members before making important decisions or changing the scope of the project is vital.
There was resistance from staff which was minimal but did affect morale.
It’s important to motivate others, challenge the process and keeping trying.
Team members were all on secondment from other areas in the JH&FMHN , which made it difficult to find time to meet and work collaboratively on the project.