Canberra Hospital and Health Services
OperationalProcedure
Multi-agency Response Guide (MHJHADS)
Contents
Contents
Purpose
Alerts
Scope
Section 1 – Development and Implementation of MARG
1.Discussion with team and General Practitioner (GP)
2.Consent
3.MARG Coordination
4.Contact details
5.MARG Meeting
6.Documentation Requirements
7.Review period and register
8.Problem resolution
Implementation
Related Policies, Procedures, Guidelines and Legislation
Definition of Terms
Search Terms
Attachments
Attachment 1: Consent to Release and or Share Personal Information
Attachment 2: Declaration of Confidentiality
Attachment 3: Multi-agency Response Guide template
Purpose
To provide clinicians from Mental Health, Justice Health and Alcohol & Drug Services (MHJHADS) with a procedure for the facilitation and development of a Multi-Agency Response Guide (MARG) for persons receiving on going care from MHJHADS. Oversight of MARGs is part of the Mental Health Community Policing Initiative (MHCPI) and governed through the MHCPI Committee.
MARGs are defined as ‘collaborative management guides for persons with a mental illness or mental disorder, and whom, because of their illness pose a serious and imminent risk to themselves or others, and who regularly come into contact with multiple stakeholders including emergency services’.
MARGs are designed to reduce risks to the clinically managed person by providing coordinated and practical guidance for service providers when interacting with high risk clinically managed persons. The overarching aim of a MARG is to help reduce the number and intensity of clinically managed person’s crisis contacts with community, Government andemergency services and to support least restrictive care practices.
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ScopeAlerts
Privacy and Consent
The ACT Health Records (Privacy and Access) Act 1997, dictates that an individual’s health information cannot be released to third parties unless:
1.The information is being shared between members of a treating team for the consumer only to the extent necessary to improve or maintain the consumer’s health or manage a disability of the consumer
2.The consumer is reasonably likely to have been aware, or to have been made aware under principle 2, that information of the kind disclosed is usually disclosed to the entity. The consumer has consented to the disclosure
3.The record keeper believes, on reasonable grounds, that the disclosure is necessary to prevent or lessen a serious and imminent risk to the life or physical, mental or emotional health of the consumer or someone else
4.The disclosure is required or allowed under—
(i)a law of the Territory (including this Act)
(ii)a law of the Commonwealth
(iii)an order of a court, or
5.The disclosure of the information is necessary for the management, funding or quality of the health service received, or being received, by the consumer.
Notably, under the Commonwealth Privacy Act (1988) personal information can be released by an entity where:
(a)It is unreasonable or impracticable to obtain the individual's consent to the collection, use or disclosure, and
(b)The entity reasonably believes that the collection, use or disclosure is necessary to lessen or prevent a serious threat to the life, health or safety of any individual, or to public health or safety.
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Scope
This procedure relates specifically to clinicians in MHJHADS who provide clinical services for persons with mental illness. However, the procedure also has broader implications for all of the participatingagencies, including ambulance, police and community services.
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Section 1 –Development and Implementation of MARG
1.Discussion with team and General Practitioner (GP)
The decision to request a MARG is made by the Clinical Manager or key worker and ConsultantPsychiatrist or Senior Medical Officer. The treating team should review the clinically managed person’s treatment and care and make a decision if the clinically managed person is, because of their illness:
- Posing a potentially serious and imminent risk to themselves or others
- Are regularly coming into contact with multiple stakeholders including emergency services.
As part of this process, the clinically managed person’s GP must be contacted and invited to participate. The invitation should be provided to the person’s GP in writing and with sufficient notice to enable their attendance at meetings. Consideration should be given to scheduling meetings associated with the MARG process at the start or the end of the day to assist with GP participation. To allow for Medical Benefits Scheme (MBS) billing, GPs (and other health professionals as requested) will be provided with a copy of the meeting minutes, including start and finish times and a copy of the client consent form (or other authority as indicated).
TheClinical Manager may contact the MHCPI Clinical Lead and request information about the person’s contact with emergency services as part of this process. The outcome of the multi-disciplinary team review (MDTR)should be documented on the e-health recordand the file note labelled MDTR – MARG. The Clinical and Operational Director of the relevant program should also be advised.
2.Consent
If the Treating Team’s decision is that a MARG is recommendedthen the clinically managed personmust be contacted and the MARG processexplained.The clinically managed personand/or their nominated representativemust be offered the opportunity to participate in the process. The person or carer and/or family may also be sent an information sheet produced by the Australian Federal Police (see Attachment 1).
Written consent to release information must be obtained from the clinically managed person or theirlegal guardian. If an individual is under 18years a parent/legal guardianmust sign prior to the process proceeding(see Attachment 2).The outcome of the discussion with the clinically managed person or legal guardian should be documented in the individual’s e-health recordand a copy of the consent form attached to the persons e-health record file.
Note:all individuals/agencies that are seeking to have permission to have access to thefinal MARGmustbe listed on the consent form.
If the clinically managed person declines to provide consent for information exchange under the MARG process, a further MDTR must occur at the treating team level. If the treating team determines that a MARG is necessary in order to lessen the risk of harm to the consumer or others, in line with MHJHADS Standard Operating Procedure Confidentiality, Privacy and access to Mental Health and Alcohol and Drug Services clinical records,a writtenrequest for approval to proceed without consentshould be made to the MHJHADS Executive Officer. This should be done in the form of a Minute to the Executive Director via the Program Operational Directoroutlining on what grounds the information will be released without consent.
The MARG process can not proceed without written consent from the consumer/legal guardian or signed minute from the Executive Director of MHJHADS.
3.MARG Coordination
The next step is for the Clinical Manager to make contact with the MHCPI Clinical Lead and recommend that a MARG be developed. Mental health services will usually take the lead in the facilitation and developmentof the MARG, including arranging a MARG Meeting. The Clinical Manager is responsible for co-ordinating the MARG meeting, drafting the MARG document for dissemination to the contributory agencies and collating and incorporating feedback. The Clinical Lead of the MHCPI can assist in this process or may, in some circumstances take carriage of drafting the MARG.
Members of the MHCPI will provide the Treating Team with contact details for those representatives from police and ambulance who have been appointed to manage the MARG. A key principle is for there to be inter-agency agreement that a MARG be developed, and treating medical professional and/or psychiatrist to be supportive and involved in the process. As part of this process the person’s GP is to be invited to contribute to the MARG process and can attend any meetings related to development of the MARG.
Police, ambulance and hospital staff may also refer persons they consider in need of a MARG directly to the MHPCI for consideration. If the referred persons are not clinically managed, but a MARG is deemed necessary, then the individual must also be accepted by MHJHADS for clinical management. The MARG process will then proceed as previously described.
4.Contact details
The MHCPI members can be contacted through or via the ACT Policing switchboard 0262561763
5.MARG Meeting
The lead agency will convene a MARG Meeting with all stakeholders invited. The stakeholders can include the clinically managed person and their GP, family and carer and the participatory agencies. Attendance of clinically managed person’s family or carers in the initial MARG Meeting is to be discussed and agreed uponby stakeholders priorto the meeting.
Those attending the MARG Meeting will be reminded of their obligations under privacy legislation and will sign a Declaration of Confidentiality sign in sheet at the start of the meeting (see Attachment 3).
Attendees of the MARG meeting and outcomes of discussions should be documented on the electronic clinical record.
6.Documentation Requirements
The Clinical Manager will draft the MARGin accordance withthe decisions and actions agreed upon inthe MARG Meetings and distribute the draftMARGto agreed stakeholdersfor their feedback and comments. The Clinical Manager will incorporate the feedback and comments from stakeholders. A final copy of the MARG in PDF format will be sent to all stakeholders for electronic endorsement.
It is the responsibility of eachparticipating agency to uploadthe final MARG onto their respective databases. For MHJHADS the document will be uploaded on to the electronic clinical record and an Alert placed on the system noting the location of the MARG (see Attachment 4).
7.Review period and register
An electronic register of MARGs is maintained and reviewed by the MHCPI.
MARGs are to be reviewed at least annually by the Treating Team. The Treating Team will evaluate whether the MARG has had an impact on reducing crisis contacts, and that the clinical information is accurate. The MHCPI team will assist in reminding clinicians when a review is due. The clinically managed person’s feedback must be sought as part of the review process.
8.Problem resolution
Any disputes about MARG content or processthat cannot be resolved at the treating team level can be referred to the MHCPI committee for discussion and arbitration.
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Implementation
This procedure will be implemented and communicated via team meetings and in-services.
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Related Policies, Procedures, Guidelines and Legislation
Policies
- ACT Health Person and Carer Participation Policy Suicidal Behaviour - Risk Assessment, Treatment and Care of Consumers
- Memorandum of understanding between MHJHADS, the ACT Ambulance Service, the Australian Federal Police, the Canberra Hospital, Calvary Health Care ACT for People Requiring Mental Health Care (each agency is responsible for making this available to staff)
Guidelines
- ACT Health Charter of Rights for people who experience mental health issues
- Australian Charter of Healthcare Rights endorsed in July 2008
Procedure
MHJHADS Standard Operating Procedure Confidentiality, Privacy and access to Mental Health and Alcohol and Drug Services clinical records.
Legislation
- Carers Recognition Act 2010
- Human Rights Commission Act 2005
- Mental Health Act 2015
- Children and Young Persons Act 2008
- Children and Young Persons (Care and Protection) Act 1998
- Privacy Act 1988(Cth)
- Information Privacy Act 2014 (ACT)
- Health Records (Privacy and Access) Act 1997 (ACT)
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Definition of Terms
ACTAS – ACT Ambulance Service
AFP - Australian Federal Police
ACT POL – ACT Policing
CiOPS – Clinician in Police Operations
GP – General Practitioner
MARG – Multi-Agency Response Guide
MDTR – Multi-Disciplinary Team Review
MHCPI – Mental Health Community Policing Initiative
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Search Terms
MARG, Multi-Agency Response Guide, Mental Health, MHCPI, Mental Health Community Policing Initiative, Clinician in Police Operations, CiOPs
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Attachments
Attachment 1: Consent to Release and or Share Personal Information
Attachment 2: Declaration of Confidentiality
Attachment 3: Multi-Agency Response Guidetemplate example
Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.
Date Amended / Section Amended / Approved ByEg: 17 August 2014 / Section 1 / ED/CHHSPC Chair
Attachment 1: Consent to Release and or Share Personal Information
(Can be obtained from the Clinical forms Register)
Attachment 2: Declaration of Confidentiality
DECLARATION OF CONFIDENTIALITY MARG MEETING
Persons Name: / Clinical TeamMeeting START: Date/Time / Meeting END: Date/Time
The contents of this meeting are strictly confidential
By signing below you are indicating you understand that information disclosed during this Multi-Agency Response Guideline meeting may be of a sensitive clinical and/or operational nature and you agree to abide by Territory and Commonwealth Law relating to Privacy and Information sharing.
Name / Organisation / SignatureAttachment3: Multi-agency Response Guide template
/ / / Multi-AgencyResponse Guide
NOTE: MARGs are response plans, not clinical treatment plans. The purpose of a MARG is to provide information that will assist responders successfully assist a person when they are in crisis. MARG’s promote the need for a consistent and professional approach from responding Agencies when dealing with persons with complex and high level needs.
NAME: DOB:A MARG does not replace the need for situational assessment or override the judgement of persons responding to or assessing the situation.
NOTE: Brief statement of reasons why a MARG has been developed and whether the person is aware of the MARG and if they participated in the development.
(Client name and DOB)
Introduction & key points:
Overview including
Outside of crisis contacts Positive Statement about the person, their lives and meaning outside crisis contacts (reminder for services this person is more than their crisis interactions).
Diagnosis:
Risk:
Factors that may escalate risk;
Supports:
Legal status:Brief description of diagnosis:
Common symptoms experienced by individuals with this diagnosis:
Usual presentation:
Involved clinicians/carers:
Other Agencies:
Current medication and dose:
-
Risk Issues:
Suggested Approach:
Overriding approach:BuildingRapport:
Crisis presentation:
What is unlikely to work:
Response Guide by Agency/Area
Clinical Team
AFP
ACTAS
MHS Triage and CATT.
TCH ED / ED CL/ MHSSU /AMHU
Calvary ED
(add others as necessary)
Author Signature: / Author printed name:
For further advice available 24/7, contact Mental Health ACT Triage on 02) 62442380 or 1800 629 354
Doc Number / Version / Issued / Review Date / Area Responsible / PageCHHS17/218 / 1 / 08/09/2017 / 01/07/2020 / MHJHADS / 1 of 14
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register