Hope Springs




			MEDICAL SERVICES AVAILABLE A comprehensive range of public mental health services is available for children, adolescents, adults and aged persons. DO YOU NEED ASSISTANCE FROM A SPECIALIST MENTAL HEALTH SERVICE? Sometimes it is difficult to know whether there is a mental health problem. Most people at some time may feel anxious, irritable or depressed; experience mood swings, loss of energy or motivation; and may sense that things around them have changed. These feelings and changes in behaviour will probably pass with time and reassurance. However, if they persist for some weeks or disrupt a person's life or cause distress, assistance or advice can be sought from their local doctor or a mental health service. Getting help early is very important. If you are unsure about contacting a mental health service, you can discuss your problem with the person's local doctor. HOW TO GET ASSISTANCE FROM A SPECIALIST MENTAL HEALTH SERVICE If help is needed, you should first contact the local general practitioner or the community mental health centre in your area. Outside normal business hours, contact the psychiatric inpatient service at the nearest General Hospital. Professional staff will be on duty at these services and will ask the person in need about the problem, including questions about why they have contacted the service and whether they have used public mental health services before. This information will help staff decide which service is most useful to them, what can be done and when. There are a number of options available for treatment, care and rehabilitation. Each of these is described below. WHAT SERVICES ARE AVAILABLE? Child and Adolescent Services · Community-based assessment and treatment · Inpatient Adult Services · Continuing care · Crisis assessment and treatment · Mobile support and treatment · Acute inpatient · Residential rehabilitation · Non-residential rehabilitation · Secure/extended care inpatient · Residential and non- residential disability support Aged Persons' Services · Psychogeriatric assessment and treatment · Acute inpatient · Extended care inpatient Continuing Care - Treatment and Consultancy The majority of people who use the public mental health services are seen by Community Mental Health Service staff. These highly trained, professional staff provide assistance, treatment and ongoing support. When you seek help, your first contact will generally be here. A case manager will be given the responsibility for coordinating the services provided to you by the public mental health services. A case manager could either be a social worker, a psychiatric nurse, an occupational therapist, a psychologist, a doctor or a psychiatrist. People who phone or visit their nearest Community Mental Health Service will speak with the duty worker to determine a course of action. An appointment to see a member of staff at the Service will be arranged or a referral given to another service that may be more able to meet the person's needs. Crisis Assessment and Treatment Services When there is a crisis, people are frequently seen by a professional from a Crisis Assessment and Treatment (CAT) service. CAT services offer assessment and intensive community-based treatment as an alternative to being admitted to hospital. When people are very ill, CAT services staff may visit daily over a number of weeks. Some clients may be visited several times a day. Mobile Support and Treatment Services People who have a serious mental illness and require intensive ongoing support are seen by Mobile Support and Treatment (MST) services. Operating seven days a week, MSTs provide continuing care and treatment to people in their own surroundings. This mobile service provides the community support needed by people and reduces the likelihood of repeated hospital admissions. Acute Inpatient Services Sometimes people need to be cared for in hospital. Acute inpatient units provide treatment for people with a serious mental illness on a short-term basis. Many of these units are located with general hospitals near to where you live. These services provide short-term, inpatient treatment and support until the person is well enough for effective, community-based treatment. Prior to being admitted to an inpatient service, the person will be assessed by a CAT service member. Secure / Extended Care Inpatient Services Unfortunately, some people with a serious mental illness have behaviour that might put themselves or others at risk. They need a safe, supportive place to live where they receive the best care and treatment available. Secure/extended care inpatient services provide the intensive treatment and support required. Psychogeriatric Assessment and Treatment Service Psychogeriatric assessment and treatment (PGAT) services make an initial assessment and arrange the necessary follow-up. This may involve providing information to the elderly person and his or her carer or relatives as to the nature of the illness and the proposed treatment. The PGAT staff may also assist other agencies involved with the consumer. Finally, the staff may provide treatment in the home, where this is possible, or arrange access to facilities where the consumer can be treated. Psychogeriatric Residential Services Psychogeriatric nursing homes are nursing homes in the community which specialise in caring for elderly persons with a mental illness. These psychogeriatric nursing homes are light, airy and purpose-built. Residents generally have their own room with their own bathroom. These psycho-geriatric nursing homes are designed to have a familiar, home-like atmosphere, and residents can participate in cooking and other supervised activities. ADULT MENTAL HEALTHCARE Click here for a printable version of this chart ADULT MENTAL HEALTHCARE It is a very complicated chart. It reflects the difficulty that people have in navigating the system of Mental Healthcare in Victoria. The person with a mental health crisis may already be seeing his/her own general practitioner and the GP mainly seek admission for his patients into hospital as a psychiatric patient. Admission into a private Psychiatric Hospital, such as Melbourne Clinic is simpler, but for admission into the Area Mental Health Service as an inpatient the person must be firstly be assessed by the Crisis Assessment and Treatment Service (CATS). This assessment may take place either in the home or at the Hospital Emergency Department, or the Community Mental Health Service, or wherever seems best. Three courses are open following the assessment. 1. If the person is in danger of harming themselves or other people or has unmanageable behaviour issues they could be admitted into the Acute Psychiatry Unit of the Hospital. 2. The person be referred to the Community Mental Health Service for Psychiatric consultation and community-based treatment.(Mobile Crisis Assessment & Treatment, or Mobile Support & Treatment Service) 3. The person could be referred back to their general practitioner. From hospital the person is discharged to either their own Psychiatrist or General Practitioner, or to the Community Mental Health Service, with its Continuing Care and Case Management possibilities. At home the person who may use various forms of support and treatment to aid their recovery. These include the Community Mental Health Service, or their GP or Psychiatrist. They may have social support from relatives and friends, and community resources such as Psychiatric Disability Support Services, Mutual Support / Self Help groups and support from Church or other community organizations. At this stage the person may consolidate their learning about their own illness and its treatment and management, including self-management. To help this education various sources of information are available and should be pursued. CASE MANAGEMENT WHAT IS A CASE MANAGER? A case manager is a staff member with professional training in a community mental health service. A case manager could either be a social worker, a psychiatric nurse, an occupational therapist, a psychologist, a doctor or a psychiatrist. A case manager is responsible for looking after the interests of consumers of public mental health services. They are the central point of contact for a consumer and will act as a guide to help them towards recovery. This means making sure that they are helped by public mental health services, including disability support services, by advocating on their behalf and by linking them with the appropriate services. The case manager will work with a consumer for as long as it takes for them to receive the best services necessary for their recovery. If they have to go into hospital, the case manager will keep in contact with them during their stay. This may involve talking to hospital staff on their behalf to make sure that they are aware of the previous treatment and support that the consumer has received from the community mental health centre. If a consumer moves into another area, their case manager will help to make contact with the right service, find out who will be seeing them, and possibly arrange to be part of a joint meeting with the new case manager. HOW CAN A CASE MANAGER HELP ME? A case manager is responsible for looking after the interests of consumers whilst they are within public mental health services. This means making sure that they receive a full assessment of their mental and physical state as well as an assessment of their needs for services. Not only are case managers there to help consumers to make the best use of services, but they are also there to make sure that these services respond to them quickly and efficiently. Part of the working relationship between a consumer and their case manager involves looking at the range of areas which may lead to stress and how a consumer can manage these areas in their daily life. So, a 'needs of service' assessment includes: · Emotional and mental wellbeing · Dealing with stress · Personal response to illness · Personal safety and safety of others · Friendships and social relationships · Work, leisure and education · Daily living skills · Family response to illness · Income · Physical health · Housing · Rights and advocacy The reason for exploring these areas is to find out what is going to be most useful for recovery and a better quality of life. Consumers may not want to discuss all of these areas straight away as some may be more important than others. A case manager will respect a consumer's privacy except when they think that someone else may be at risk. One of the best ways a case manager can help a consumer with any problem areas is through an Individual Service Plan (ISP). WHAT IS AN INDIVIDUAL SERVICE PLAN? An ISP is a working plan that is put together by a consumer and The reason for exploring these areas is to find out what is going to be most useful for recovery and a better quality of life. Consumers may not want to discuss all of these areas straight away as some may be more important than others. A case manager will respect a consumer's privacy except when they think that someone else may be at risk. One of the best ways a case manager can help a consumer with any problem areas is through an Individual Service Plan (ISP). WHAT IS AN INDIVIDUAL SERVICE PLAN? An ISP is a working plan that is put together by a consumer and their case manager. It is a written summary of what a consumer is working towards (their goals) and how they are going to get there (strategies that will be used). This plan will be written in a way which is easily understood by the consumer and their family or carer. Changes to the plan might occur along the way and this should happen with a consumer's consent. Their family, carer or advocate may also have some input into the plan with the consumer's permission. If the consumer or their family disagree with parts of the plan then they should let the case manager know immediately so that a compromise can be worked out. The plan is usually reviewed at least every six months so further changes can be made at this time. A consumer can have their family, carer or advocate present at the review meetings. It is important to know that the ISP is a tool to help a consumer work towards recovery. It is not an end in itself because a consumer's needs may change over time. CARRYING OUT THE INDIVIDUAL SERVICE PLAN The case manager will work with a consumer to look at: · Their current situation · What goals are needed to improve the situation · What strategies are going to be used to achieve these goals · Who will be involved in carrying the strategies out · A date for the review of the ISP A case manager will usually be in contact with other professionals and services to make sure that a consumer's needs and goals are looked after quickly and appropriately. It is the case manager's responsibility to make sure an ISP is carried out in the best possible way. WHAT HAPPENS AT THE REVIEW OF AN INDIVIDUAL SERVICE PLAN? The review will cover three areas: · Check to see whether the goals and strategies of the ISP are working as intended · Review the original goals in the ISP, looking at other ways for meeting them, and making any needed changes · Decide whether all the ISP goals have been met and whether a consumer still needs to use public mental health services. ENDING INVOLVEMENT The decision to end involvement with public mental health services is made by the consumer and their family, carer or chosen advocate. This will also involve any other professional staff the consumer has been working with in the services. A consumer's involvement with public mental health services will finish when they no longer require such services or the ones they have been using are no longer appropriate. Of course, if a consumer needs help at some point in the future, they can contact the service again. It is important to know that a consumer's involvement will not finish until all the tasks listed below have been carried out by their case manager: · The consumer has been appropriately referred to other agencies (for example, a disability support service, family support service or a general practitioner) with their consent. · The case manager has explained the reasons why the consumer's involvement in public mental health services is no longer necessary. · A letter has been sent to the consumer confirming in writing that their involvement with public mental health services has been completed. · The case manager has informed the consumer's family or carer and other professionals that the consumer is finishing their involvement with the services. · The case manager has let the consumer, family, carer, and others know how the consumer can use public mental health services again, if they need to. SERVICES FOR CARERS THE CRITICAL ROLE OF FAMILIES AND OTHER CARERS The experience of mental illness affects not only the individual but also those concerned for their welfare. The impact will vary according to the severity, course and outcomes of the illness as well as the life circumstances of individuals and their families or carers. Research into the support and care of people with mental illness confirms the critical role that families and other carers can play, the demands of care giving and the importance of family and carer satisfaction with services. Support for families and carers is enhanced through Victoria's Strategy for Carers policy. The programs funded are listed below. CARER CRISIS SUPPORT PROGRAM Each Mental Health Service has a Carer Crisis Support Program which can be used to help families and carers in crisis, or to avoid a potential crisis. Where families and carers experience difficulties in their ability to care for their relative or friend, funds from this initiative can help in getting extra help or covering costs. PLANNED RESPITE CARE Psychiatric disability support services provide respite care which allows for a short term break from usual care arrangements for families and carers and people with serious mental illness. Planned carer respite care services can also provide respite when a family or carer has a need for immediate respite, such as unexpected hospitalisation. INFORMATION AND SUPPORT FOR FAMILIES AND CARERS A number of organisations provide support, advocacy, and information to families and other carers of people with serious mental illness. See the Directory for details about · Statewide organisations. · Psychiatric Disability Support Services - eg day programs, and home-based outreach support. The Community Mental Health Service has information about respite care in your area, and other carer support services. The information on Assessment and Treatment, Case Management and Services for Carers was provided by the Mental Health Branch of the Victorian Government Dept. of Health SUGGESTIONS ON HOW TO RESPOND TO THE UNFAMILIAR BEHAVIOUR OF A PERSON WITH A MENTAL ILLNESS The difficult behaviours of people with a mental illness are usually symptomatic of the illness, not a personality problem. Seek information from reliable sources about what you're dealing with. Symptoms Confusion about what is real, difficulty in concentrating, agitation, excitability, fearfulness, marked distrust, insecurity, irritability and withdrawal from normal activities and relationships may be among the symptoms of a mental illness. The symptoms of mental illness rarely present danger to others. Careful Responses · Accept and value the person; accept that illness is present. Respect the dignity of the other. Being there as an informed listener is important. · Never be consumed by self-blame. · Don't argue with what is said to you, especially on topics that are highly emotional. The thinking behind it may be delusional. · Communication should be calm, clear and direct. · You may invite the person to join you in simple activities. Don't be tempted to take over the things they are able to do - let them do the best they can. Encourage the breaking of bigger tasks into smaller ones. Praise the achievement of small steps. Reduce the intensity of inter-personal engagement. · If you are unfamiliar with the behaviour, ask what the person is doing. If it relates to delusional thinking it is probably best not to pursue the content. Instead, calmly advise the person of the consequences of his or her behaviour (if danger or police intervention is likely). If the behaviour is relatively innocuous, try to divert them to something constructive or more practical. · If the behaviour in ways is unacceptable to you, calmly tell them specifically what they can and cannot do and state the consequences. Behaviour limits are best if communicated beforehand. · It is often wise to pay as little attention as possible to the bizarre behaviour, focusing instead on positive, healthy activity and behaviour. Coping with Mental Illness - 14 Principles for the Relatives Ken Alexander 1. M.I. not uncommon 9. Limit self-sacrifice 2. Learn about the illness 10. Managing time demands 3. Avoid the guilt trap 11. Maintain social life, 4. Get good help and support interests, hobbies 5. Community self-help groups 12. Set independence goals 6. The need for training (both parties) 7. Learn about the pressures 13. Change way of seeing on carers things, leading to coping 8. Needs of other family 14. Take great care of members yourself THE WAY MENTAL HEALTH SERVICES INVOLVE FAMILIES AND CARERS Most workers would admit to having sometimes been anxious when approaching carers or families, especially when there are strong emotions or tensions present. It is not uncommon for workers to feel: outnumbered that they may say the wrong thing that they may open up a can of worms' they will not be able to handle the outpouring of strong emotions. You will have noted that 'externalising' the trauma of mental illness diminishes the potential for personal blame, hurt, anger and resentment. This technique will help you not take it personally when a family expresses frustration, anger or grief but allow you instead to see these expressions as a normal (and even a healthy) response to the trauma of mental illness. Acknowledging positive intentions and validating pain often leads to a respectful and direct discussion about what is helpful and what is not. The following is a brief checklist of practical guidelines which are often helpful in dealing with carers and families: Setting the scene for respectful meetings may include: · Indicating that you value the carer's or family's willingness to meet with you. · Indicating how much time you can spend with the family. · Clearly stating your agenda for the meeting. · Asking what each family member would like to achieve from the meeting. Set small, achievable goals for any meeting, for example, to acknowledge how difficult it must be for the family. Enquire about successful approaches - what has worked in the past and exceptions. Don't focus only on problems. Feedback from carers and consumers suggests that workers who are authentic and open are valued and usually effective. Provide comfort, support and debriefing rather than trying to change or fix the family. Ask how you can help. Be curious about what it is like for families. Try to 'step into the shoes' of each family member and acknowledge their particular situation. Arrange a follow-up meeting. MAKING CONFIDENTIALITY WORK FOR EVERYONE In many cases confidentiality is not a major issue, but in others it becomes a stumbling block to establishing an effective partnership among workers, carers and clients. The key to making confidentiality work for everyone is to broaden the concept from a concern primarily with short-term individual rights to a consideration of the sort of longer-term relationship that is wanted. Focusing on the style of communication you would like to promote between consumers, carers and yourself may be more productive than exclusively focusing on confidentiality. Start assisting effective communication to develop as soon as possible. Don't think of confidentiality as a blanket concept. Typically a consumer or carer (or worker) may feel comfortable sharing some information and not other information. Also think of confidentiality as dynamic: both consumers and carers are likely to want to communicate productively in the longer term, even if they are currently in conflict. . For example, during an acute crisis, such as involuntary admission, a consumer may not want any information shared but as the crisis settles, may be ready to communicate more openly. A NON-BLAMING APPROACH Both mental health workers and carers may be vulnerable to using blame as part of their personal survival scheme to combat feeling overwhelmed, uncertain or powerless. Identifying a culprit (preferably someone blameworthy and close at hand) helps us to regain a sense of mastery but unfortunately also leads to oversimplification of the problem and to premature closure. There are a number of techniques available to diffuse blame, for example externalising, identifying shared goals and pointing to the problem of blame itself. The following discussion summarises some techniques which may be useful in adopting a non-blaming approach: · Expect to be blamed by carers from time to time, and be aware of the temptation to blame back. · Approach carers and other family members with a compassionate curiosity, wanting to understand their perspective, rather than judging or trying to seek a cause for the mental illness. Externalise the problem by thinking of families facing problems rather than problem families. · Join with each family member's hopes for a good outcome; you will often find everyone has similar goals, although different ways of going about achieving them. · Don't wait for blame to affect relationships. Make any covert blame overt and normalise it: talk about it and even try joking about it. · Ask yourself, 'What is the least blaming and least pathological way of explaining a carer's actions?' Utilising this technique will require you to understand the context in which people are operating, including their previous experiences, hopes and fears. For example, a father is seen as overly controlling of his son until it is discovered that the man's brother suffered from a mental illness and suicided. · Blame the patterns that lead to vicious cycles rather than the people involved. For example, a mother tries to protect her vulnerable daughter from the outside world, but the girl aims for independence by escaping her mother's restrictions, thus putting herself at risk and further eliciting her mother's protectiveness. · Separate intentions and actions. Family members may have good intentions despite acting in unhelpful ways. Acknowledging good intentions can be the first step to challenging unhelpful behaviours. · Turn your diagnostic skills toward searching out strengths and positive intentions in your clients and their carers. You will need to be tenacious, because problems and difficulties tend to be privileged in the psychiatric context. Embrace competency models (NB. This is deceptively difficult to do, and workers may want to access some professional development about using this approach.) Start talking about what a better situation would look like, and collaborate on taking small steps toward that goal. Acknowledge any steps already taken, no matter how small. A focus on solutions can circumvent the problem talk which often invites blaming. A SIMPLE GUIDE TO DEBRIEFING A trauma framework tends to encourage a normalising and supportive attitude to carers, and debriefing is the response of choice to assist people experiencing a major trauma. One of the great advantages of debriefing is that it is not seen as counselling or therapy but as a way of assisting normal people adjust to an abnormal or traumatic situation. Debriefing has a high community acceptance for bank tellers, police, ambulance officers and firefighters. For mental health workers, debriefing is a useful framework within which to apply their existing skills as well as to build new ones. Mental health workers already utilise many of the relevant techniques without labelling them as debriefing. Debriefing carers and consumers is what often takes place when mental illness first hits the family, as well as in response to intermittent crises such as an involuntary admission, suicide attempts, absconding or dystonic reactions to medication. During calmer periods, debriefing can take the form of talking with the family, listening to their feelings, helping them to gain information about the illness and relevant services, facilitating carers making contact with support groups and other carers, fostering acceptance of the situation and encouraging those involved to look after themselves. The acronym 'N.E.W.S.' can be used to describe the basic steps of debriefing: Normalise Provide information about common responses to a trauma or the ongoing stresses caused by mental illnesses; point out that the feelings the carer or consumer is experiencing are normal responses to a traumatic situation. Educate Provide information and details about the illness, the mental health system and your treatment approach. Provide information in small amounts and in ways the person can understand. Repeat the information. Education about the trauma helps the person put their pain and suffering into context. Warmth and emotional support Help carers or consumers cope with their anxiety and fears (i.e. provide emotional support but don't try to change them). Remember that debriefing is not therapy. Simply acknowledging how hard it must be for them or showing some appropriate comforting gesture goes a long way toward developing a supportive rapport. Strengths Pointing out strengths, such as resilience or persistence, or partial successes can help people develop a more balanced account of themselves, which typically leads to greater empowerment and greater ability to fight the mental illness and its effects. In practice, this can be as simple as pointing out that, given what someone has been through, they are doing a very good job. From the Workers Booklet accompanying the Fa.S.T. Video Series produced by The BOUVERIE Centre, Flemington.. 1997 To come: PIECING THINGS TOGETHER Recovery/ Rehabilitation Support (PDSS) Housing Options Employment Financial Legal Community - Social and Recreational