Alex is on an inpatient treatment order (in the hospital) and wants to change their psychiatrist. Alex wants to change psychiatrist because the psychiatrist is not listening to Alex nor supporting their goals.
Step 1 – Alex identifies the issue
What is the issue(s) Alex is concerned about?
Alex has multiple concerns about the psychiatrist. Including that the psychiatrist:
- keeps interrupting and talking over Alex during the meetings
- does not understand Alex’s point of view
- does not respect Alex’s life decisions, strengths and experiences
- is breaching Alex's rights to be involved in treatment decisions
- is not helping Alex move towards the goal of working in the community.
Who is the decision maker? Who can help Alex?
Alex knows the hospital's clinical director makes decisions about someone's psychiatrist. The quickest way to communicate with them is by first talking with the nurse.
Step 2 – Alex learns their rights
What are Alex’s rights?
- be supported to make or participate in decisions about treatment – even where those decisions involve a degree of risk
- receive treatment and support that helps Alex’s recovery and connection to community
- having their individual needs respected and responded to, such as culture, communication, age, disability, gender, religion, and sexuality
- their dignity and autonomy being respected and promoted.
What resources can help Alex?
Alex gets the following information to help with self-advocacy:
- fact sheet and video. If they are not available on the ward, Alex calls IMHA so that they can send it to the hospital
- the statement of rights document that the mental health staff were required to give Alex. This document also explains Alex's rights and options
- information and advice from other consumers who are on the ward.
Who may be able to assist?
Alex asks the nurse for rights information. Alex later calls an IMHA advocate to make a plan about what to do.
Step 3 – Alex thinks about solutions
What is the main (preferred) solution?
Alex prioritises what is most important. Alex’s clear solution is a change of psychiatrist.
Are there alternative solutions?
Alex is willing to compromise if the service will not change psychiatrists. Alex is willing to stay with the current psychiatrist if there is a clear change in their behaviour and they address Alex’s concerns.
How will Alex know if they were successful?
Alex knows that success means better treatment and that their rights are respected. This could be through a different psychiatrist, or if the current psychiatrist changes their behaviour.
Step 4 – Alex makes a plan
How will Alex express their views?
Alex will ask for a meeting to discuss their concerns with the nurse and ask them to raise it with the clinical director.
Alex will make a list of concerns, rights, and the reasons why they want to change psychiatrist.
Alex will also make a list of questions, such as 'What are the hospital's policies about changing psychiatrists?' if the nurse or clinical director says no to the request.
Who will Alex communicate to, and when?
Alex will go to the primary nurse and ask for a meeting with the manager.
Who may support Alex (if they want support)?
If Alex needs support, they can ask a close family or friend, nominated person, or an advocate. Alex decides to have the meeting without support at this stage.
Step 5 – Alex enacts the plan
Alex organises the meeting
Alex asks the primary nurse for a meeting later that day. Alex doesn't know exactly when, so writes some notes for the meeting to be prepared.
Alex attends the meeting
Alex asks at the beginning to speak first without interruption.
Alex highlights the concerns about the psychiatrist. Next, Alex outlines consumer rights under the Mental Health Act, and that the service must follow this. Finally, Alex tells the nurse the reasons for wanting to change the psychiatrist.
The nurse initially waited, then thanked Alex for raising the concerns. The nurse said that there were limited staff and that this was not possible. Alex reminded the nurse that the request was made to the clinical director and asked the nurse to provide the written policy if this was not possible. The nurse appeared uncertain and agreed to go away and talk to the clinical director for changes.
Alex asked when to expect an answer, and the nurse said lunch time the following day after the psychiatrists had met.
Alex and the service make an agreement
The nurse and Alex agreed that if they cannot change the psychiatrist, the nurse will organise a meeting together to discuss Alex's concerns.
Step 6 – Alex reviews the process
Alex reflects – what happened, what worked, what didn’t work
Alex is satisfied with the process but is waiting for an answer on the change of psychiatrist. Alex thinks that having the notes prepared and asking about the processes was helpful.
Alex reflects that having a conversation about their rights and expectations when starting with a new psychiatrist is important.
What are the next steps?
If the clinical director does not decide to change psychiatrist, Alex will ask for a meeting with the psychiatrist to talk about their concerns.
Reviewed 20 November 2022