Principles of recovery oriented practice are included as an appendix and glossary to the NSMHS. The Principles are a guide for services applying the NSMHS and refer to involvement in decision making, choice, participation in service planning, delivery and evaluation, and the availability of individually tailored supports.
An analysis of the NSMHS with a personal recovery framework has two important points.
Both of these concepts are not yet embedded in the NSMHS. Conference presenters alluded to the vicious cycle resulting from this compromise whereby the mental health system relies on force.
Perhaps for this reason few of the terms associated with a trauma-informed framework (Table 3) are included in the NSMHS. The Standards do not directly refer to trauma, trauma-informed services, or the prospect that consumers may be, even inadvertently, harmed in the course of receiving services.
The NSMHS do not elaborate on the need for psychological safety or relationships with service providers that are experienced as safe by consumers.
The NSMHS are also informed by the Australian Public Mental Health Services 2005 key performance indicators, one of which is safety, defined as 'the avoidance or reduction to acceptable limits of actual or potential harm from health care management or the environment in which health care is delivered.' It is an acknowledgement that practices can harm, irrespective of the intention of the practice.
While it is appreciated that the complexity of government structures and systems is such that a lag between new developments in contemporary mental health care and the translation of these into policy is inevitable, this should not preclude critical analysis of the NSMHS. The purpose of this analysis is to acknowledge these limitations, to highlight the implications of contemporary developments for policy and practice, and to contribute to ongoing developments in mental health policy and standards.
Analysing the NSMHS 2010 with the three frameworks of rights, recovery, and trauma-informed found that the Standards go some way towards recognising the imperatives of mental health support that does not rely on force.
The right to receive a service free from coercion is not assessable against the NSMHS, and other rights such as informed consent are conditional.
The NSMHS explicitly commits mental health services to providing safe support, which is a necessary precondition of trauma-informed services.