session one slides session one - setting the scene - developing a framework for understanding mental...

Session One Slides

• Session One - Setting the Scene - developing a framework for understanding mental illness

• Session Two - Recovery

• Session Three – Understanding psychosis and exploring communication

Building a Future session outline

• Session Four – Understanding schizophrenia and the mental health legal system

• Session Five – Grief and trauma related to mental illness, understanding depression and anxiety

• Session Six – Understanding bipolar disorder, how families can be part of the solution

Building a Future session outline

• Session Seven – Understanding dual diagnosis, mental health systems and the National Disability Insurance Scheme

• Session Eight - Understanding borderline personality disorder and taking care of yourself

• Session Nine - Advanced communication skills

Building a Future session outline

• Session Ten – Acknowledging grief and gaining strategies to continue the journey as a carer

• Session Eleven – Managing the fear of suicide

• Session Twelve – Developing a Wellness Recovery Action Plan (WRAP)

Building a Future session outline

New strategy for carersChange in Thinking • Separate the person and the illness

• Acknowledge grief• Understand recovery

Change in Behaviour • Improved communication skills• Recognise own limits• Seeking appropriate cultural support• Managing change and helpful interventions

Change in Results • Recovery & hope• Improved relationships• Less family stress• Increased wellness 

HIGH

Risk of developing psychosis

and

Risk of having a relapse

LOW

Risk Factors learning difficulties, poor social skills, poor coping skills, drug/alcohol use, low social supports, major life events, family history of mental illness, no treatment, poverty, migration, cultural alienation

Protective Factors good coping skills, social supports, appropriate medication, safety, cultural support

The stress-vulnerability coping model

Learning about brain biology can:

• give information from a biological and medical perspective (and some idea of its complexity)

• help you understand and support treatment

• assist you in dealing with the stigmas of mental illness

• support the realisation that no one is to blame for the onset of mental illness

Mental illness and the brain

Neurotransmitters & Synapses

The brain

Cycling forward

TIME

Session Two Slides

Key features of a recovery process  

• Personal growth• Hope• Understanding and acceptance• Active coping• Withdrawal to engagement and active participation in life• Active experimentation• Rebuilding a sense of identity• Connecting and contributing• Recovery is a complex journey 

Beliefs that support recovery

 • Recovery is always possible

• Recovering is a truly unifying human experience

• Each person’s recovery process is unique

• Recovering is not a linear process

• Recovering does not necessarily mean that symptoms cease

• Developing a meaningful contributing life

Internal and external resources for recovery

Internal Resources External Resources

HopeAcceptanceSelf will/responsibilitySpiritualityCoping Skills

Social supportMeaningful activityMedicationProfessional assistance

‘Recovery in peer support comes from seeing ourselves as human beings rather than as mental patients’.

‘By building trust and sharing experiences we are able to move beyond our perceived limitations, old patterns and ways of thinking about our mental health and the mental health of others…. into a culture of health and ability’.

Peer support

Wellness Recovery Action Plans

Plans cover aspects of:

• Wellness toolbox (your collection of skills, habits, books & other helpful things) and daily maintenance plan

• Important people to contact for support

• Triggers and early warning signs

• When and who to contact for medical intervention

• Crisis and post crisis planning

Separating the illness from the person

Provides a framework for:

• Not engaging with the illness

• Avoiding conflict that can’t be resolved

• Allows for more compassion towards a person

• Allows for the expression of negative feelings about the illness

• Allows you to be think in terms of strategies and be in more control of your actions and emotions

Session Three Slides

Symptoms of psychosisPositive Symptomsare experiences and behaviours that have been added to the person’s normal way of functioning

Hallucinations are distortions of the senses that are very real to the person.

The brain hears, sees, smells, tastes or feels things that are not there in the external world, for example: hearing voices / food tastes strange / people see things that aren’t real

Delusions are fixed and false beliefs, e.g. ‘I am Jesus Christ’

Negative Symptomstake away from a person’s experience of the world

Feelings of emptiness

Lack of energy, reduced motivation

Flat mood

The sense of wellbeing and self worth can be reduced

Substance induced psychosis• Positive symptoms of psychosis

• Triggered by use of drugs or alcohol and occurs when withdrawing from the substance or soon after

• Person recovers when substance is no longer in body

• Increased vulnerability to psychosis in future if the drug is reused

• Caused by heroin, cocaine, alcohol, marijuana, amphetamines and benzodiazepines

• Diagnosis will not be altered until a significant drug free period has elapsed without symptoms abating

Biopsychosocial treatment of psychosis

• Medication may be used to manage and reduce symptoms

• Hospitalisation may occur when a person is unsafe, others are unsafe and/or to treat serious physical conditions alongside symptoms of the psychosis

• Rehabilitation and recovery orientated services include individual support in daily living, support to identify goals and aspirations in life, support to use personal resources and community supports to achieve these goals, support with identified need such as housing, employment, peer support

Antipsychotic medication

‘Typical’ antipsyhotics:

• Older form of antipsychotics

• Generally less effective in treating negative symptoms

Reasons for being prescribed typical antipsychotics include:

• Reluctance to take medication and hence a legal order binds a person to take (or be given) medication

• Medication has not been reviewed in a long time

Antipsychotic medication

‘Atypical’ antipsyhotics:

• Newer form of antipsychotic

• Generally has better results with different side effects

• More successful in treating positive symptoms as well as negative symptoms

Taking antipsychotic medications

• Trials of medication (alone or in combination) are often needed to determine what works best for each individual

• Symptoms can remain even after medication has been started

• Waiting to see if the medication is suitable can take time and can therefore be a challenging period

Taking antipsychotic medications

• Other medication (often sedating) may be prescribed for problems such as agitation, anxiety and sleep disturbance

• Medication may also be prescribed to reduce the side-effects of antipsychotics

• Ongoing medication treatment is often recommended if a person has more than one psychotic episode or has not recovered fully from a first episode

Why use effective communication

• To give clarity

• To assert the rights and needs of yourself and other family members

• To reduce conflict

• To enhance relationships

• To model skills

• To develop skills which reduce stress and risk of relapse

Values that underpin effective communication

Empathy The ability to understand someone from the other’s perspective

Genuineness To assert the rights and needs of yourself and others

Respect Valuing other people for themselves

Assertiveness

• The right so say ‘no’

• The right to say ‘yes’ and ‘no’

• The right to say ‘I don’t understand’ and ‘I need some time to think about that’

• The right to make your own decisions

• The right to change your mind

• The right to hold your own opinions and beliefs

Issues that reduce effective communication

• Lack of skills

• Strong emotions

• Indecision

• Unhelpful Environment

Communication skills

• Levelling - Effective communication can only occur when both parties know all the relevant information (thoughts, feeling and facts)

• Listening - This skill not only involves hearing, but actively processing what others say

• Validating - This skill involves communicating to the other person that you have heard their position or opinion

• ‘I’ statements – When you communicate how you feel to someone, make a request, or say ‘no’ to a demand, begin what you say with the expression ‘I’.

Example of effective communication

‘I feel worried and frustrated when you don’t take your medication because it is an important aspect in the management of your illness (‘I…’ statement).

I understand that you may have concerns about the side-effects of the medication (validation) and I am here to support you and listen if you need someone to talk to (willingness to listen).’

Communicating with professionals • Learn as much as you can about the service and how it functions

• Offer any information that seems relevant

• Plan your questions and what you want to say

• Be familiar with confidentiality policies

• Be factual and clear in your conversations

• Request meetings to help with communication

• Remember to thank people for their time and effort

• Recovery from illness will take teamwork

• Describe the previous diagnosis (if any) and current symptoms

• Describe the positive symptoms

• Describe any suicidal thoughts or actions

• Tell the crisis team about medication

• Explain your experience of the illness in the past

Communicating with crisis teams

The police respond to events in which there is any form of danger – along with the local crisis team. When you call the local crisis team on these occasions: 

• The local crisis team should take responsibility to engage the police if they think it is necessary

• If there is extreme danger it would be sensible to call the police directly yourself

• You might want to call the local crisis team after your call to the police to ask them to attend as well

Who to call when in crisis

  Understanding the crisis team response

• Is the response inappropriate for the symptoms?

• Are the symptoms not severe enough?

• If so, what would indicate that they were severe enough (or when would the local crisis team become involved?)

• What should you do in the meantime? Are there other services that could be appropriate?

  Tips for seeking service

• If possible call services at non-crisis times, this allows you to think more clearly, relay the symptoms and describe the situation in a calmer way

• Consider visiting your GP, they are able to make direct referrals to the crisis team

• Consider taking the person to the emergency department of a general hospital

• That there is a history of mental illness

• Of previous times of being taken to hospital by police, how it was done and how effective it was

• Whether there is any danger to the police 

What to tell the police

• Document your experiences to date

• Request a meeting with the professionals involved and discuss the issues

• If the issue is still unresolved you may consider taking further action

If you are unhappy about your experiences with an area mental health service

Think about:

• One area of communication that you have a problem with

• What we have learnt about communication today

• What communication strategy might be suitable

• Attempt the communication

Report next week on the outcome

Home activity

Session Four Slides

Positive symptoms - the excess or distortion of normal functions.

These can include: 

• Hallucinations (distortions of the senses)

• Delusions which are fixed and false beliefs

• Disorganised thinking and speech

• Disorganised behaviour, eg. dressing in an unusual manner

Positive symptoms of schizophrenia

Negative symptoms reflect a loss of normal function. These can include:

Negative symptoms of schizophrenia

• Diminished range of emotional expressiveness most of the time

• Reduced speech/quieter

• Inability to initiate and sustain goal-directed activities

• Feelings of emptiness, reduced sense of self worth

• Lack of energy and reduced motivation

• Flat mood (flattened affect)

Cognitive symptoms of schizophrenia

Cognitive symptoms reflect an impairment of a person’s usual level of thinking. These can include: 

• Impaired working memory

• Impaired information processing

• Problems with concentrating

• Impaired ability to regulate behaviour based on social cues.

The pattern of schizophreniaMost commonly schizophrenia develops in the following pattern:

1. Prodromal phase •  Withdrawal and social isolation• Irritability• Change in usual behaviours/interests

2. Active phase• Characterised by the development of the psychotic symptoms.  3. Stable phase• Period where psychotic symptoms begin to remit and rebuilding of functioning occurs

 Outcomes of schizophrenia

• 45% have complete or partial recovery after one or more episodes

• 20% have unremitting symptoms and increasing disability

• 35% have varying degrees of remission and exacerbation

Social effects of living with schizophrenia   

• Social stigma

• Social isolation

• Physical co-morbidities

• Substance use

• Socio-economic disadvantage

• Increased risk of suicide

Violence and schizophrenia  

 There is a 0.1% increased rate of violence to others.

Risk factors for being violent to others include:

• Being male

• Substance use

• Active psychotic symptoms

• Previously violent

• Previous victim of violence

Violent acts are often committed in private against people known to the perpetrator (commonly women).

  • Social stigma 

• Financial strain

• Emotional distress

• Physical illness

• Social isolation

Social impacts of schizophrenia on families

Treatment for schizophrenia in the acute phase

• Safety

• Nutrition and Hydration

• Distress

 Treatment can involve:

• Hospitalisation or intensive medical support at home

• Antipsychotic and sedating medications

Schizoaffective disorder  

Schizoaffective disorder is a disorder in which mood changes similar to those found in bipolar disorder are present together with symptoms of schizophrenia.

Schizoaffective disorder sub-types  

• Schizoaffective bipolar type – where symptoms include manic episodes or manic and depressive episodes

• Schizoaffective depressive type – where the symptoms include depressive episodes only

Legal issues covered in this session  

• Principles involved in treatment

• Legal concepts that relate to mental health

Issues to consider in relation to treatment  

• More or different treatment

• Whether there is a need for admission to hospital or whether the person can stay at home

• If the person goes to hospital, how long the person should stay

Mental Health Acts

Mental Health Acts are the laws that govern the provision of treatment, care, rehabilitation and protection for people who have a mental illness Mental Health Acts aim to balance the rights of people with mental illness to make their own decisions with the responsibilities of the community

Voluntary treatment 

Voluntary treatment means that the person with the mental illness agrees to treatment, either in the community living privately or in a mental health facility or in hospital.

Many people who have a good understanding of their mental health may proactively seek treatment or agree to treatment when needed. 

Involuntary treatment  

People who have a severe mental illness may lack the capacity to recognise their need for psychiatric care and refuse treatment.  In this situation, people fulfilling particular roles stipulated within the Act (often doctors, police, nurses) can recommend a person for psychiatric care.  

Community orders 

Community orders require people to receive treatment for a mental illness whilst living in the community.  People are required to accept treatment including medication and other therapy. Most often these apply to people who have a history of refusing treatment and becoming seriously unwell repeatedly after discharge from hospital. 

Informed consent 

Occurs when the person provides formal permission for a specific treatment to occur.  The following information must be provided for informed consent to be given:

• Procedure or treatment 

• Risk involved with that procedure or treatment

• Consequences of not having the treatment

• Alternative treatments

Cognitive abilities for informed consent 

• Mental illness has not interrupted the person’s thinking and understanding processes enough to make them unable to do all of the above

• In this situation if the person is deemed to need treatment they will be made involuntary and the treatment provided

Treatment plans  

An outline of the proposed treatment, counselling, management, rehabilitation and other services to be provided to implement the community order . The method by which, the frequency with which, and the place at which the services will be provided.  

Protection of the rights of people with a mental illness 

• Review body for involuntary status

• Community members who have a monitoring role

• Senior government department official

• Body that provides free mental health legal advice

• Government body that promotes the rights and interests of people unable to administer their own interests  

Session Five Slides

New Strategy for carers

Change in Thinking • Separate the person and the illness• Acknowledge grief• Understand recovery

Change in Behaviour • Improved communication skills• Recognise own limits• Seeking appropriate cultural support• Managing change and helpful interventions

Change in Results • Recovery & hope• Improved relationships• Less family stress• Increased wellness 

 Can relate to:

• The loss of the person as you knew them prior to the illness

• The losses and changes that occur within families as a result of the illness

The grief of mental illness

Survivors are not accorded the right to grieve’(Dorka, K. 2002 p5) The grief around mental illness is often not acknowledged. People feel too ashamed to acknowledge that mental illness is happening and therefore others don't know and so can’t be supportive. The numerous secondary losses are also not acknowledged.

The grief around mental illness is oftennot acknowledged

‘Because the loss with mental illness is psychological and not physical, the community does not perceive the family’s loss and does not join with them with expressions of sadness and pain. There are no social or religious rituals as consolation.’ (MacGregor, 1994) 

The loss around mental illness is psychological

‘If I, in any way, fully acknowledge my grief and loss experience (loss of relationship with person, their hopes, goals and dreams) I am in some way being disloyal to the person and the hope that they will overcome their mental illness.’ (O’Dowd, G., 2002) 

Grief can be seen as disloyal

• This refers to the uncertainty concerning the loss experience – is the loss temporary or permanent?

• It feels like a loss, but is it really one?

The grief around mental illness is oftenambiguous

Trauma can have two consequences: 

• Fight and flight response – prepares the body to get out of the situation. Expressions of this include hyperarousal, panic, defensiveness, anger and reactiveness

• Freeze response – examples of emotional expressions of this include passivity, being disconnected, ashamed, can’t say no

The effects of trauma

Possible responses to trauma and grief   

• Acknowledge and validate your own grief experience 

• Break the silence on your grief, speak to family and friends

• Find places or people where you can comfortably talk eg. counselling to work through issues of trauma and grief

Clinical Depression

A group of illnesses that are characterised by an excessive or long-term depressed mood that affects the person’s life

• Depression is often associated with anxiety

• Depression is often not recognised and, as a consequence, left untreated

The Mood Graph

Classifications of Depression

The common classifications of depression are:

• Mild depression 

• Moderate depression

• Severe or major depression

  External Internal

 • Family conflict • Relationship conflict

• Recent losses and disappointments

• Mental illness in the family

• Drugs or alcohol

• Migration (forced and voluntary)

• Discrimination

• Separation from family

 • High anxiety, nervousness

• Chemical changes –post- operative, menopause

• Inherited disposition genetic • Medical illness or treatments for medical illness, e.g. low thyroid function, heart conditions

• Past bad experiences, trauma

• Personality prone to worry and/or perfection

Internal and external factors for depression

  • Expressions of helplessness and hopelessness• Depressed most of the day• Loss of interest or pleasure in activities • Reduced movement• Fatigue and loss of energy• Weight loss or gain• Insomnia • Feelings of worthlessness/guilt• Poor concentration• Recurrent thoughts of death

Lived experience of depression

Common responses to depression

‘We thought he was lazy and just wouldn’t get out of bed.’ ‘Why is she so sad? She should realise how lucky she is.’ ‘Why can’t you just pull yourself together and get going?’ The act of acknowledging that one might be depressed and that help is available can be very liberating. 

Physical impacts of depression

Treatments and recovery

 DRUG TREATMENTS

PSYCHOLOGICAL TREATMENTS

PROMOTE COPINGCHANGE BRAIN CHEMICALS

SerotoninNoradrenalineDopamine

RESOLVE LIFE STRESS

Family conflictInterpersonal conflictRecent loss and disappointments

REDUCE ANXIETY

STOP DRUG AND/OR ALCOHOL USE

BRAIN EFFECTSImprove sleepImprove concentrationIncrease energyBetter moodDecrease anxiety

Interventions for depression

• Be aware of safety issues

• Be aware of hydration and nutrition

• Connect with the emotion of the experience

• Reinforce your love for the person

• Try to sit beside and be in the person’s space

Common reasons why depression goes untreated

  Stigma

• People often blame their physical and emotional state on many other things  

• The symptoms of depression can be dismissed as personality traits 

• A common sign in the early stages is irritability

Recovery from depression  

   Biological

 Psychological

 Environmental

Acute Medication / ECT Safety Security

HospitalIntensive support

Recovery Medication / ECT Talking therapyCommunication skills

Support Friendship

Inter-dependenceEmployment

HousingResponsibility

• Safety of the person• Resolving of the psychotic symptoms• Need to monitor complications from physical illness,

medication interactions or changes to antidepressant medications

• Administration of ECT in life threatening cases• Stabilising and monitoring people with substance use

issues• Removing a person from a situation in which they are

becoming increasingly depressed

 Hospitalisation for people experiencing severe depression

• In cases of depression that are not life threatening, care in the community is preferred.

• The local crisis team may provide support and treatment to people who are not experiencing life threatening symptoms

 Community care for people with depression

• The field of complementary and self-help treatments is increasingly being seen by the community as a treatment of choice

• Research published by Beyond Blue in 2008 indicates that Cognitive Behavioural Therapy and Interpersonal Therapy are the most effective therapies

• It is important to remember that severe depression must be assessed by a medical practitioner and treated accordingly, particularly when part of ongoing treatment

 Complementary and self-help treatments

(1) An activating experience or event..eg retrenched from a job

(2) Belief about the event:

- Irrational belief, ‘I am a failure’

- Rational beliefs: ‘I need a change. I would be better suited to something else’.

(3) Emotional and behavioural consequences of beliefs:

- ‘I can never be happy’ leads to a person becoming depressed

- ‘I feel upset but I know this is temporary’ is a more positive response

 Examples of beliefs and consequences

Session Six Slides

Types of bipolar disorder  

    • Bipolar 1 Disorder– one or more manic or mixed

episodes, usually accompanied by major depressive episodes.

• Bipolar 2 Disorder – one or more major depressive episodes accompanied by at least one hypomanic episode.

• Cyclothymic Disorder – at least two years of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms

Review of the Mood Graph  

  At first when I’m high it’s tremendous… ideas are fast… like shooting stars you follow until brighter ones appear… all shyness disappears. The right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.’ - Kay Redfield Jamison 

Personal account of hypomania

  ‘The ideas come too fast and there are too many… overwhelming confusion replaces clarity… you stop keeping up with it… memory goes. Infectious humour ceases to amuse. Your friends become frightened… everything is now against the grain… you are irritable, angry, frightened, uncontrollable and trapped.’ Kay Redfield Jamison 

Personal account of mania

• Antipsychotic medication

• Mood stabilisers

• Anti-depressants

• Electroconvulsive therapy

Medications for Bipolar Disorder

 • Call on what you know about communicating with

someone in a psychotic or manic or depressed state

• Stay calm

• If you have had experience of this before or have had discussions with the person when they were well, put into place any plans that you developed (i.e Wellness Action Recovery Plan)

Responding to early warning signs

  Think beforehand about how you are going to tell the story. The more your thoughts are organized the better you will communicate. Call on what you know about positive psychotic symptoms and those of mania and depression. Where possible, use medical words when communicating with health professionals.

Seeking treatment

Assisting Recovery

• Adequate planning for discharge if the person is hospitalised

• Consider psychosocial supports in the discharge planning

• Be compassionate about side-effects of the medication

• Let the person approach life at their own pace

• Move from a care-taking role to a care-giving role

Assisting recovery

• Support the achievements of the person with the mental illness

• Be clear about how you will contribute to the person’s recovery

• Communicate with the rest of the family about the issues involved in recovery

• Identify the indicators and agree to a plan of action if a relapse occurs

• Consider identifying early indicators• Consult with your family member about the benefits of friends

being informed• Put as much control into the hands of the person themselves

Session Seven

Do drugs and alcohol cause mental illness?

• Drugs and alcohol can cause a drug-induced psychosis in susceptible individuals.

• People remain more susceptible to the development of a psychosis if they reuse that drug.

• Drugs and alcohol can also be the trigger (stressor in the stress-vulnerability-coping model) to the development of schizophrenia or other psychotic illnesses.

• People with mental illness use drugs for the same reasons as other people

• The issues associated with mental illness make it harder to refrain from the use of drugs and alcohol

• The immediate effect of drugs and alcohol usually provides relief from the positive mental illness symptoms

The effects of drugs and alcohol on people with mental illness

• People with a dual diagnosis may readily associate the reduction of symptoms with the drug use

• People with a dual diagnosis generally have difficulty following through with treatment

• Behaviours associated with dual diagnosis can be extreme

• Dependence issues compounded with mental illness symptoms can result in overbearing behaviour, reduced concern for consequences of behaviour, reduced connections with society

The effects of drugs and alcohol on people with mental illness

• Men are more likely to commit violence than women

• Women are more likely to be the recipients of violence

• Violence is more likely to be committed in private environments (home)

• Recipients of violence are more likely to be known to the perpetrator than strangers

Facts about violence in society generally

  • People with mental illness are more likely to harm themselves than others

• People with mental illness are often the recipients of violence

• The factors mentioned in previous slide about societal violence

• Having a history of being a victim of violence

• Aged 16 – 25

• Having an untreated mental illness resulting in uncontrolled positive symptoms

Violence in the context of mental illness

• Moral view, punishment rather than treatment.

• Pharmacological view, alcohol or drugs seen as more powerful than ability to control use. Abstinence emphasised.

• Disease model, addiction seen as a disease, with physiological and genetic predisposing factors.

• Social learning, interaction between environment, individual and drugs in order to understand the drug experience. Drug use seen as learned and functional.

Models of dependence on substances

 • Disease model - linked to the AA approach, e.g.

twelve steps

• Social learning approach - harm minimisation

Current treatment programs

   • Using drugs only in the company of others

• Always using clean needles

• Predetermining a non-drinking driver

• Eating marijuana rather than inhaling

• Not mixing drugs

• Not mixing drinks

Harm minimisation strategies

Stages of change model

 Stages of Change modelStage of change Helpful support

Pre-contemplation Harm reduction strategies

Contemplation Opportunities to assess pros and cons

Determined preparation Reinforcement of their reasons for wanting to change and practical advice

Action Problem solving skills Goal setting

Maintenance Support with strategies

Relapse Reflective opportunities

SupportReview plan for high risk situations

Messages that support change

Everyone needs messages saying: 

• You are worth it

• There are benefits in reducing drug or alcohol use

• You have the ability to change

• Reminders of the gains that have been made along the journey

Relapse in a social learning model

In  the social learning model, relapse is an expected part of change and can contribute to learning.

• Assessment needs to occur over an extended period of time

• In-patient admissions should take into account drug use or dependency

• The treating team should offer specific dual diagnosis treatment

• Monitoring risk of suicide and self-harm is extremely important

Principles in treating dual diagnosis

 • Stress

• Risk of violence

• Agitation

• Risk of suicide

• Relapses

• Financial strain

The impact of dual diagnosis on the family

 • Stay calm and alert 

• Effective communication

• Stay safe

• Remove yourself from the situation

The principles of safety first

• Mental Health Crisis Team

• Mobile Treatment Services

• Community Mental Health Centres

• Early Intervention Teams

Community based mental health services

• Self determination

• Community integration

• Interdependence and responsibility

• Having a good life

• Family support

Principles of good practice in psychiatric rehabilitation

• Aimed at those who are most in need

• Long term, high quality support

• Recipients will have a permanent disability that significantly affects their communication, mobility, self-care or self-management.

• It will have a comprehensive information and referral service, to help people with a disability that need access to mainstream, disability and community supports

Features of the design of the National Disability Insurance Scheme

Local Area National Disability Insurance Scheme Coordinators will:

• Assess needs

• Determine individualised budgets that ‘consumers’ can ‘spend’ on supports and services known as support packages

How will the National Disability Insurance Scheme work?

 For carers and families it aims to better support families in their caring role, and to ensure that role is nurtured and can be sustained. 

The intention of the National Disability Insurance Scheme

It aims to empower people with disabilities to make choices for themselves and have greater control over their own lives through designing of their own support package.

The National Disability Insurance Scheme for people with disabilities

• Be clear about their recovery and life goals

• Have access to information and advice that enables them to make choices

• Have the ability to effectively communicate their preferences and needs

For the National Disability Insurance Scheme to be effective people need to:

• Referral into the scheme

• Assessment by the NDIS Local Area Coordinator

• Planning and choosing services and supports

• Review process  

Outline of the NDIS assessment and planning process

Supports and Services: • Should support the individual to achieve their goals and maximise their independence;• Should support the individual’s capacity to undertake activities of daily living to enable them to participate in the community

and/or employment;• Are effective, and evidence informed;• Offer value for money;• Should reflect community expectations, including what is

realistic to expect from the individual, families and carers; • Are best provided through a National Disability Insurance

Scheme provider and not more appropriately provided through other systems of service delivery and support

What does ‘Reasonable and Necessary’ mean?

• Knowing what helps them manage their illness

• Knowing what they want from life and what they need so they can reach their goals

• Helping to find information about different options

• Assisting the person to clearly communicate their choices

How families can help the person take control

• Listen to what the person is communicating, both verbally and non-verbally

• Whenever possible, attend to the person’s preferences

• Draw on plans that were developed while the person was less unwell

• Carers and family may need to take a more active and assertive role if the person’s insight and judgement is affected

Assessment and planning during acute illness

• Ask the person how they would like you to support them in the process

• Assist the person to access information about their rights and the options that are available to them

• Encourage the person to access advice or support from peers

• Resist the urge to expect too much or too little: give the person space to set their own goals and articulate their own needs

• Offer messages of hope and encouragement

Assessment and planning during post acute illness phase of recovery

• Encourage the person to take the lead in the process: ask if they would like your support

• Respect the person’s autonomy

• Offer positive feedback

Assessment and planning when recovery is well established

 What makes a good life?

• Good Health• Nutritious food and exercise• Gainful employment• Adequate, secure, affordable accommodation• Strong family support• Good friendships and relationships• A positive vision of the future life• Financial support to sustain a good

life

• Acceptance of illness•  Hope and courage•  Managing symptoms•  Education•  Reconstructing identity and purpose•  Supporting others•  Choice, responsibility, control and

empowerment•  Meaningful activity•  Advocacy

      - Pat Deegan 

Recovery Factors

Session Eight Slides

Borderline personality disorder (BPD) is diagnosed on the basis of a cluster of:  

• Long-standing problems with relationships, identity or sense of self, and the

• Difficulty with control of emotions and behaviour

• Recurrent suicidal impulses and self-harm are generally seen as a core problem area

Borderline personality disorder

Compare to someone with third degree burns - they become hypersensitive to any slight changes in the air temperature or being touched can be very painful. In the same way, someone with BPD becomes emotionally hypersensitive to what other people might say, experiencing real emotional pain and a sense of rejection over minor relational difficulties.   

Borderline personality disorder

People often experience problems with: 

• Emotions and moods

• Anger

• Depression

• Self damaging behaviour

• Relationships

The experience of borderline personality disorder

• Being female, 75% of people in hospitals with Borderline Personality Disorder are female

• History of abuse, neglect and invalidation

Risk factors for the development of borderline personality disorder

• Extended and connected family

• Validating environment

• Good coping skills

• Emotional support

• Social inclusion and achievement

Protective factors for borderline personality disorder

The major focus of the treatment is assisting people to: 

• Understand the emotions triggering their behaviour

• Choose more adaptive behaviours

• Take responsibility for themselves and their behaviour

• Associated symptoms such as depression or anxiety are treated with appropriate medication

Focus of treatment and support

In addition to the general guidelines for supporting someone with a mental illness specific issues to consider in relation to BPD include: 

• Take threats of harm seriously – talk with professionals about these

• Develop your communication and assertiveness skills

• Be confident in your gut reaction – safety first every time!

What can friends and family do?

• Compensation for people who need to use their time caring for the person with a mental illness and so are unable to work

• Compensation for some of the costs associated with being the primary carer of someone with a mental illness

• Each state or territory may also have a state based financial support program for families and carers.

Carer financial support schemes

New Strategy for CarersChange in Thinking - Separate the person and the illness

- Acknowledge grief- Understand recovery

Change in Behaviour - Improved communication skills- Recognise own limits- Seeking appropriate cultural support- Managing change and helpful interventions

Change in Results - Recovery & hope- Improved relationships- Less family stress- Increased wellness 

• Information is power. Keep up with the task of learning about mental illness

• Consider the emotional impact on yourself and seek support

• Consider further developing your communication and problem solving skills

• Continue the interests and activities in your life

• Seek support through available financial and practical schemes

Looking to the future

Session Nine Slides

• Examine assertiveness as a concept

• Look at barriers to effective communication

• Re-examine the four basic communication skills

• Examine how to implement the four communication skills

• Practice these skills by role-play related to real issues in your lives at present 

Aims of this session

Assertiveness

• The right so say ‘no’

• The right to say ‘yes’ and ‘no’

• The right to say ‘I don’t understand’ and ‘I need some time to think about that’

• The right to make your own decisions

• The right to change your mind

• The right to hold your own opinions and beliefs

Applied communication skills

• Levelling – Why level? Examples of levelling...

• Listening – Why listen? Examples of listening...

• Validation – Why validate? Examples of validating....

• ‘I’ Statements – Why ‘I’ statements? Examples of ‘I’ statements...

Session Ten Slides

•  To develop an understanding of the nature of grief in relation to mental illness

• To normalise grief and loss as a response to a changed situation

• To create a safe and supportive environment in which to explore and express grief and loss

• To develop a framework to provide support to one another

Aims of this session

• That we are invaluable

• That the world is meaningful

• That things happen for a good reason

• That bad things don’t happen to good people

Assumptions that may be challenged by loss

 Attending grief support programs in your area•  Counselling•  Keeping a journal - writing is catharsis for many•  Eating well•  Exercise•  Getting enough rest•  Seeking or creating comforting rituals•  Allowing emotions - tears can be healing•  Seeking out people who are able to sit with your sadness•  Avoiding major changes in residence or jobs•  Participating in a volunteer capacity

Positive ways to acknowledge grief

Session Eleven Slides

•  To increase knowledge about suicide as it relates to mental illness

• To develop a framework to examine our personal attitudes and how these form our view of suicide

• To gain knowledge of risk factors relating to suicide

• To increase knowledge of the suicide intervention model

Aims of this session

•  Talking about it•  Having a detailed plan about how they might go through with it•  Having someone close to them commit suicide•  Depression•  Substance use•  Not being committed to anything•  Having the means to carry out the plan •  A previous attempt at suicide•  Giving away possessions

What behaviours indicate that someone might be about to attempt suicide?

Session Twelve Slides

•  Increased knowledge about how best to equip yourself and your family for the journey of mental illness•  Increased skills in forward planning to reduce the ‘dilemmas of caring’• Familiarity with the rationale for a Wellness Recovery Action Plan•  Increased understanding of the underlying principles for a WRAP•  Skills to develop a WRAP for themselves and or their family member

Aims of this session

• Aim to increase people’s experience of independence and self-management of symptoms

• Families can use the principles of WRAP in assisting their loved one with a mental illness

• Recognises the particular difficulty of decision-making at the point of relapse

Benefits of a WRAP

• Step One - Notice Early Warning Signs or Relapse Signature

• Step Two - Notice stress triggers

• Step Three - Develop action plan

−Nominate helpful coping strategies−Develop a medication strategy−Write an essential contact list−Agree steps for others to help

Components of a WRAP

• Keep it simple

• Make it yours

• Work with others, eg. Other family members, doctors, case managers

• Know your plan - rehearse, adjust, write it down, have it handy

WRAP principles