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Aged Care SIRS: How to Manage Psychological and Emotional Incidents

30/11/21
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As mentioned in a previous Aged Care Essentials article, the Serious Incident Response Scheme (SIRS) is a national framework for incident management and reporting of serious incidents in residential aged care. Under the SIRS, aged care providers are obliged to report certain incidents to the Aged Care Quality and Safety Commission (ACQSC).

In some cases, aged care providers must report incidents that have psychological or emotional elements. These elements can be difficult to identify and assess. In this article we explain what the SIRS says about psychology and emotion, and give you some tips on how to manage SIRS incidents that have a psychological or emotional element.

 

The SIRS – A Quick Recap

There are eight types of “reportable incidents” under the SIRS, meaning that if any of these incidents occurs in your aged care home, you must report it to the ACQSC:

  • unreasonable use of force against a consumer
  • unlawful sexual contact, or inappropriate sexual conduct, inflicted on a consumer
  • psychological or emotional abuse of a consumer
  • unexpected death of a consumer
  • stealing from, or financial coercion of, a consumer by a staff member of the provider
  • neglect of a consumer
  • use of a restrictive practice in relation to a consumer (other than in the circumstances set out in the Quality of Care Principles)
  • unexplained absence of a consumer from the service.

Further, if any of these reportable incidents occurs, it must be categorised as “Priority 1” or “Priority 2”. Priority 1 are more serious incidents and must be reported to the ACQSC within 24 hours. Priority 2 are less serious incidents and must be reported to the ACQSC within 30 calendar days.

 

Psychology and Emotion in the Context of the SIRS

Psychology and emotion feature in two separate parts of the SIRS:

  • “Psychological or emotional abuse of a consumer” is one of the eight reportable incidents listed above. This means that if one of your consumers is psychologically or emotionally abused, you must report it.
  • “Psychological injury” is part of the definition of a Priority 1 reportable incident. This means that any reportable incident that causes the consumer “psychological injury or discomfort that requires medical or psychological treatment to resolve” will qualify as Priority 1 and must be reported to the ACQSC within 24 hours.

Let’s take a close look at each of these points.

 

Psychological or Emotional Abuse as a Reportable Incident

“Psychological or emotional abuse of a consumer” is a reportable incident. If a consumer within the facility where you work is psychologically or emotionally abused, you must report it.

But what is “psychological or emotional abuse”? According to the Quality of Care Principles, this type of abuse includes conduct that “has caused, or that could reasonably have caused, the consumer psychological or emotional distress”, including actions such as:

  • taunting, bullying, harassment or intimidation
  • threats of maltreatment
  • humiliation
  • unreasonable refusal to interact with the consumer or acknowledge the consumer’s presence
  • unreasonable restriction of the consumer’s ability to engage socially or otherwise interact with people
  • repetitive conduct or contact which does not constitute unreasonable use of force but the repetition of which has caused, or could reasonably have caused, the consumer psychological or emotional distress.

 

The SIRS Guidelines lists these examples of what is not psychological or emotional abuse:

  • a person raising their voice to attract attention or speak with a consumer who has hearing difficulties
  • minor disagreements between consumers
  • making reasonable requests of a consumer to enable the safe and effective delivery of care and services (for example, asking a consumer to cooperate or encouraging a consumer to eat their dinner).

 

“Psychological Injury” as Part of the Definition of a Priority 1 Reportable Incident

If any of the eight reportable incidents occurs, it must be categorised as “Priority 1” or “Priority 2”. A Priority 1 reportable incident is defined as a reportable incident:

  • that caused, or could reasonably have been expected to have caused, a consumer physical or psychological injury or discomfort that requires medical or psychological treatment to resolve; or
  • where there are reasonable grounds to report the incident to police; or
  • that is a consumer’s unexpected death or a consumer’s unexplained absence from the service.

This means that any reportable incident that causes the consumer “psychological injury or discomfort that requires medical or psychological treatment to resolve” must be classified as Priority 1 and reported within 24 hours.

 

Priority 2 Reportable Incidents

A Priority 2 incident is defined as any reportable incident that does not qualify as Priority 1.

 

Psychological or Emotional Impact is Key

In summary, these are our questions and answers so far:

  • How do you decide if an incident constitutes “psychological or emotional abuse of a consumer”? By determining if it has caused the consumer psychological or emotional distress.
  • How do you decide if a reportable incident qualifies as Priority 1? By determining (among other things) if the incident has caused the consumer “psychological injury or discomfort that requires medical or psychological treatment to resolve”.

In both cases, the key determiner is the psychological or emotional impact on the consumer. This is why it is crucial that aged care providers have the capacity to identify and assess consumers’ psychological and emotional state, in particular their levels of psychological discomfort, injury or distress.

 

Assessing and Reporting Emotional and Psychological Impact

Unfortunately, neither the ACQSC nor the Department of Health provides a simple tool for assessing a consumer’s level of emotional or psychological impact. In part, this may be because the task is inherently complex and situation specific. However, there are some tips that might help you to simplify the task:

  • Focus on person-centred care. Seek help from those staff who know the consumer well. They will be in the best position to assess the consumer’s level of injury, discomfort or distress.
  • Refer to the examples we’ve cited above under “Psychological or Emotional Abuse as a Reportable Incident”.
  • Ask: did the psychological injury or discomfort require medical or psychological treatment to resolve? If the answer is yes, then the incident will qualify as Priority 1. If the answer is no, the incident may qualify as Priority 2 or may not be a reportable incident at all.

Psychological and emotional impact will be different for each individual consumer, which is why understanding consumers is so essential. Remember, different consumers will express their psychological or emotional distress in different behaviours. Further, the same consumer may express their distress in different behaviours at different times.

Finally, there are some things to keep in mind when reporting incidents that have an emotional or psychological element:

  • Classify the incident carefully: is it Priority 1, or a Priority 2 or neither? If in doubt about whether an incident is Priority 1 or 2, report it as Priority 1.
  • Use precise language: ACQSC assessors will look closely at the words used in your records. Some of these words have the power to trigger a more in-depth assessment or even a finding of not-met. Say, for example, that you record a benign event where a staff member raised their voice to alert a consumer to a minor hazard, but your choice of words is subjective and expresses emotions that includes the term “yell” or “shout”. In the absence of precise detail, an assessor reading this record may interpret the event as a potential incidence of psychological or emotional abuse and may challenge you on why you did not report it.

 

Further Resources

 

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About the Author

Mark Bryan

Mark is a Legal Content Consultant at CompliSpace and the editor for Aged Care Essentials (ACE). Mark has worked as a Legal Policy Officer for the Commonwealth Attorney-General’s Department and the NSW Department of Justice. He also spent three years as lead editor for the private sessions narratives team at the Royal Commission into Institutional Responses to Child Sexual Abuse. Mark holds a bachelor’s degree in Arts/Law from the Australian National University with First Class Honours in Law, a Graduate Diploma in Writing from UTS and a Graduate Certificate in Film Directing from the Australian Film Television and Radio School.

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