Australasian Psychiatry 28(5)

The Community Collaboration Committee: a cross-Tasman partnership The RANZCP Community Collaboration Committee (CCC) is a cross-Tasman partnership of consumers, carers, and RANZCP Fellows and trainees. Since its establishment in 1996, the CCC has contributed to setting standards for the assessment and accreditation of psychiatrists, helped to set mental health policy directions and contributed to the internal business of the RANZCP. It acts as a conduit between the needs of the community and psychiatry, and advocates for better participatory mental healthcare. The term “patient-centred care” has become an important part of conversations around what constitutes best practice in patient care and medical treatment across all medical specialties. But what does this term actually mean for psychiatry? What would the practice of psychiatry be with the absence of a participatory approach with its consumers and carers? One could argue that it wouldn’t be very effective. The participatory approach aims to improve the way mental health care is experienced, moving away from the exclusive priorities of medical specialists to a more collaborative journey of care with the patient and their family/wha¯nau. Slowly, the tide is shifting towards this model. The informal support given by family and friends is often the single most important factor in supporting mental wellbeing, yet these supporters are often overlooked and not fully resourced in our mental health systems.1 This is a problematic state of affairs when you consider that statistically speaking, one-in-five Australians experience some form of mental illness in any given year.2 The work of the CCC is centred on an acknowledgement that when someone is diagnosed with a mental illness it not only directly affects them, but it also affects their family/ 612

wha¯nau. The RANZCP has incorporated this concept of “healing in partnerships” into its governance structure by encouraging community member positions on a wide range of College committees. “Community members” who sit on the CCC are exactly that – they are members of the community who are committed to positively influencing the practice of psychiatry by providing an opportunity to Fellows and trainees to listen to the insightful voices of those with lived experience who share their stories of the mental health system. The aim of the partnership is to seek continuous improvement of mental health care. Community members are individuals who live with a diagnosis of mental illness. They are family members, friends, partners and colleagues whose lives have all, in some way, been deeply impacted by an array of experiences of mental illnesses, and they are committed to improving the journey of care. Narratives of personal experience underpin the work and deliberations of the CCC and illuminate the need for a collaborative approach. They are also an essential part of ensuring the College realises its purpose to advance the profession, support the needs and expectations of members, and to improve the mental health and wellbeing of communities. Over the years, the histories of those involved in the CCC have become as diverse as the work of the CCC itself. These have involved mothers whose children have been diagnosed with schizophrenia, who have suddenly had to take on the role of carer as well as parent; ambitious students who were suddenly overwhelmed by a psychotic illness and unable to complete their “Plan A”; family members who have had to navigate the trauma of losing a loved one to suicide. These individuals have used their experience as a means to

express their passion to make a difference to the lives of others. The diverse experience and expertise of the members of the CCC is evidenced by the work they have undertaken to date and the work planned for the future. The CCC has ownership of a number of position statements on topical issues such as “acknowledging and learning from past mental health practices”,3 “supporting carers in the mental health system”,4 “recovery and the role of the psychiatrist”,5 “the contribution to practice made by psychiatrists who have a personal experience of mental illness”,6 as well as a number of other projects on topics allied to the participatory model of care. It is an ongoing goal of the CCC to develop policy, advice and resources with respect to involving carers, family and wha¯nau in mental health care, as well as increasing awareness of community voices in the training of psychiatrists and building relationships with other mental health organisations. CCC members, both past and present, describe the rich experience that comes from sharing views and insights and seeking to understand differing perspectives. The work of the CCC and its community members, who are willing to offer up their expertise and experiences for the benefit of others, is itself a clear indication of the benefits of a participatory approach. To learn more about the Community Collaboration Committee, please visit ranzcp.org/about-us/governance/ committees/practice-policy-partnerships-committee/community-collaboration-committee References 1. RANZCP Position Statement 73: Mental health for the community https://www.ranzcp.org/news-policy/policy-and-advocacy/position-statements/mental-healthfor-the-community

College Affairs 2.  Australian Institute of Health and Welfare 2018. Mental health services – in brief 2018. Cat. no. HSE 211. Canberra: AIHW. https://www.aihw.gov.au/get media/0e102c2f-694b-4949-84fb-e5db1c941a58/ aihw-hse-211.pdf.aspx?inline=true 3. RANZCP Position Statement 84: Acknowledging and learning from past mental health practices https://www. ranzcp.org/news-policy/policy-and-advocacy/position-

statements/acknowledging-and-learning-from-pastmental-health

policy-and-advocacy/position-statements/recoveryand-the-psychiatrist

4. RANZCP Position Statement 76: Supporting carers in the mental health system https://www.ranzcp.org/newspolicy/policy-and-advocacy/position-statements/ supporting-carers-in-the-mental-health-system

6. RANZCP Position Statement 85: the contribution to practice made by psychiatrists who have a personal experience of mental illness https://www.ranzcp. org/news-policy/policy-and-advocacy/position-statements/the-contribution-to-practice-made-by-psychiatrists

5. RANZCP Position Statement 86: Recovery and the role of the psychiatrist https://www.ranzcp.org/news-policy/

Qualified Privilege Q & A Peer Review Groups (PRGs) have been a cornerstone of the RANZCP Continuing Professional Development Program since the 1980s. Members use PRGs to discuss cases, management and issues in a supportive and safe environment. For many years, RANZCP Peer Review Group meetings have been formally declared as an activity which has the protection of qualified privilege. What is qualified privilege? Qualified privilege provides immunity to a legal action for acts or statements that are made in the performance of a legal or moral duty. In this case the legal or moral duty is the critical appraisal of the delivery of health care services. Examples of these types of critical appraisals include mortality and morbidity meetings, critical incident reviews, root cause analyses and any other critical review of one’s practice. Health professionals may have concerns that participating in this type of critical review of their practice may leave them open to legal action and may be reluctant to fully engage. The protection of qualified privilege is a means of encouraging full and frank participation, in the interests of improving health care. What does this mean to you in your PRG? It means that information that might identify a person cannot be disclosed outside the PRG meeting, nor can a record be made of that information. In Australia disclosing identifying information or making a record that includes identifying information is a

criminal offence that can have a penalty of imprisonment. What are the laws governing qualified privilege in New Zealand and Australia? In New Zealand qualified privilege is governed by the Quality Assurance Activities (QAA) provisions of the Health Practitioner Competence Assurance Act (HPCAA). In Australia there are provisions in state and Commonwealth law. The RANZCP has qualified privilege under the Commonwealth Qualified Privilege Scheme (QPS) which is governed by Part VC of the Health Insurance Act 1973. Hospital mortality and morbidity meetings are usually protected by the relevant state law. What should and should not be disclosed under qualified privilege? In practical terms, any notes, or records of a PRG should not include any detail that might identify a patient. It is against the law to document in a patient’s clinical record that you have consulted with your PRG colleagues regarding an individual patient and that they agree (or not) with your treatment plan. This action identifies your colleagues and your patient to other health professionals who may have permission to access that record. If you need a formal second opinion, arrange for another psychiatrist to conduct an independent assessment of the patient. The usual conventions regarding patient consent apply to PRGs. If the patient is not identifiable, their case

can be discussed within the PRG. Bringing a patient file and passing it around to your colleagues is not permissible without first gaining the patient’s consent to you sharing their file with others. What does the RANZCP have to do to maintain qualified privilege for PRGs? The RANZCP must provide information annually to the New Zealand Ministry of Health and the Australian Department of Health about the activity of PRGs, specifically, how they influence the quality of health care service. PRG coordinators complete a survey that collects data on how their PRG operates, what issues have been raised within the PRG, and what actions have been taken. While individual PRGs may feel that they are not able to influence the improvement of the health care system, data collected from all PRGs over time can give a picture of many smaller actions that collectively make a difference to the way health care is delivered. Where can I find out more about qualified privilege? The legislative instrument protecting Australian PRGs: www.legislation.gov.au/Details/F2020L00609 The Commonwealth QPS operating in Australia: www1.health.gov.au/internet/ main/publishing.nsf/Content/qps-info QAA provisions of the HPCAA: www. health.govt.nz/our-work/regulationhealth-and-disability-system/healthpractitioners-competence-assurance-act/ quality-assurance-activities-under-act 613

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Australasian Psychiatry 28(5) The Community Collaboration Committee: a cross-Tasman partnership The RANZCP Community Collaboration Committee (CCC) is...
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