Handout 1: What is the Difference Between Mental Health, Mental Illness, Psychiatric Disorder and Psychiatric Disability?

Transcription

1 Handout 1: What is the Difference Between Mental Health, Mental Illness, Psychiatric Disorder and Psychiatric Disability? Personality We all have a personality type. Our personality comes from our biology, our experience, culture, and family environment. There is a range of personality types. A person may be shy, extroverted, over achieving, suspicious, angry or a variety of other characteristics. Mental health The capacity of individuals within groups and the environment to interact with one another in ways that promote subjective well-being, optimal development and use of mental abilities and achievement of individual and collective goals consistent with justice. A mental health problem is: A minor disruption in the interactions between the individual, the group and the environment, which causes some distress. All people have the potential to experience a mental health problem at some time in their lives. This may arise from: Within the individual due to physical illness, stress, or a lack of coping skills External causes harsh environment, family conflict, trauma, social problems such as unemployment, retrenchment, and poverty. Mental illness/mental disorder Mental disorders are considered to be significant behavioural or psychological problems or patterns that occur in an individual. These may be associated with: distress (painful symptoms) disability (impairment in one or more important areas of functioning) a significant increased risk of death, pain, or disability or in the loss of freedom. A syndrome or pattern of behaviour means that the disorder is: Observable and medically diagnosable Resulting in an impairment of the person s abilities to think, feel and relate to others. Serious mental illness or disabling mental disorder Requires the delivery of specialist mental health services. Handouts for Job Provide Support to People with Mental Health Issues Page 1 of 35

2 Psychiatric disability Proportions of people with mental illness/disorder experience a disability. The psychiatric disorder or illness becomes disabling when there are problems in 3 or more areas of major life activity. These areas include: self-care receptive and expressive language learning mobility self-sufficiency. The disability may be caused by the: direct manifestations of the illness eg hearing voices all the time impact of the illness on everyday life and activity additional restrictions placed on the individual by society s response to the illness. Mental illness includes a wide range of disorders and is prevalent in the community. The majority of people who experience mental illness are not disabled. Only minorities of those experiencing mental illness have severe chronically disabling disorders. Causes of psychiatric disorders Most mental health workers now subscribe to a bio-psycho-social model which recognises that there are many causes of psychiatric disorders. The causes of a mental illness include: Biological factors Arising from the physiology and biochemistry of bodily systems or from genetic inheritance. Psychological factors Usually derived from upbringing, emotional experience and interaction with people. Social factors Arising from the person s cultural environment and current life situation. Any or all of these can be seen as predisposing factors or vulnerabilities and an event from any of these same areas can become a precipitating or trigger event. Handouts for Job Provide Support to People with Mental Health Issues Page 2 of 35

3 Classification of mental disorders The most widely used system for diagnosis of a mental disorder in Australia is the DSM IV or the Diagnostic and Statistical Manual of Mental Disorders published by American Psychiatric Association, 4 th edition Handout 2: Understanding Psychotic Illness A Psychosis refers to a state where a person looses contact with reality. The word is derived from the Latin words Psyche meaning mind and osis meaning illness. Some commonly used expressions to describe this state are: Out of touch with reality Spinning out, Going off the planet. There are four main types of symptoms in psychosis. These are: Disorders of perception - hallucinations Disorders of Thinking delusions and thought disorders Disturbances in behaviour Disturbances in feelings and emotions (affect). A hallucination refers to when a person may hear, see, feel, taste, smell or taste things, which are not there. Hallucinations may be: auditory (hearing) eg hearing voices visual (seeing) eg seeing spiders crawling on the floor tactile (touch) eg feeling something on your skin olfactory (smell) eg smelling gas gustatory (taste) eg strange tastes. Delusions are falsely held fixed ideas not shared by peers. They are falsely held in that there may be some truth in the idea but the reason for believing the idea is base on irrational thinking. They are fixed because generally the person can t be talked out of the idea. Some examples of delusions: A paranoid delusion or a feeling of being persecuted, thinking people are following you, watching you. Guilt or an sense of worthlessness, or that you have done great harm. Somatic (means bodily) delusion an idea that there is something wrong or strange about your body. Grandiose delusion or thinking that you are specially chosen, have special powers, have special connections. Handouts for Job Provide Support to People with Mental Health Issues Page 3 of 35

4 Disorders of thinking There are a number of disorders of thinking. These include: Thought Disorder thoughts are jumbled up, thoughts just stop, thoughts are off the point Ideas of reference believing that things refer to you personally eg thinking that the TV News relates to you Thought insertion believing that thoughts can be put into your head by someone Thought broadcasting believing that your thoughts can be heard by everyone. What are some of the disturbances in behaviour and feelings? Changed feelings: A person experiencing a psychotic episode may feel strange and cut off from the world with everything moving in slow motion. Emotions may seem dampened and the person may feel less emotion than before, or show less emotion to those around or may withdraw socially. Anxiety/Agitation: Very often emotions are in turmoil. Things seem in some way not right or normal. This can be a time of great fear and stress when a person s usual methods to calm him or herself don t seem to work. This leads to much anxiety and fear about what is happening. Changed behaviour: A person experiencing psychosis may have differently from the way they usually do. You may be extremely active or lethargic. Often, changes in behaviour are associated with the other symptoms of psychosis. What are the causes of psychosis? Drugs and alcohol Physical illness Organic cause How long does psychosis last? Psychosis is time-limited. Generally a psychotic episode lasts less than one month. Or May be part of an ongoing psychotic illness. Psychotic Illnesses Schizoaffective disorder symptoms of both schizophrenia and bipolar disorder. People with schizoaffective disorder are generally treated for the particular symptoms they have. Schizophreniform disorder Schizophreniform disorder is diagnosed if psychotic symptoms last more than one month but less than six months. Symptoms are similar to those of schizophrenia. Drug induced psychosis Drug induced psychosis is brought on solely by the use of drugs in someone who is predisposed to a psychotic episode. With a drug induced Handouts for Job Provide Support to People with Mental Health Issues Page 4 of 35

5 psychosis the symptoms appear quickly and last a relatively short time, hours to days, until the effects of the drug wear off. Disorientation, memory problems and visual hallucinations are the most common symptoms. Delusional disorder If you have delusional disorder you may hold strong beliefs in things, which are not true. You may have delusions of being persecuted, that people are out to get you; or that you are someone famous. Major depression Someone who has major depression has a type of depression, which is so intense it causes loss of interest and enjoyment, loss of appetite, severe insomnia and even psychotic symptoms- such as delusions. Post-partum psychosis Post-partum psychosis can be brought on by hormonal changes after childbirth, and often resembles schizophrenia or bipolar disorder. Postpartum psychosis happens to about 1 in 500 pregnant women. Other illnesses Other physical illnesses altogether can affect the brain- causing psychotic symptoms. Some of these illnesses include AIDS, thyroid disorder, brain tumour, Huntington s disease and viral infection. Schizophrenia What does schizophrenia mean? An ongoing psychotic illness which interferes with a person s ability to think, feel and act Not split personality schizophrenia is thought to be a splitting of the personality from reality. A person with schizophrenia is not inhabited by two personalities he or she has one personality but may be affected by disordered thinking which could lead to unusual and out of character behaviour Its name is derived from, the Latin Schizos = Fractured/broken and Phrenos = Mind or Brain. What are the symptoms of schizophrenia? There are two kinds of symptoms in schizophrenia: Positive (active) symptoms o Delusions o Hallucinations o Thought disorders And Negative (passive) symptoms a failure to respond to stimuli (internal or external) o Flatness of affect - blunted emotions o Poverty of ideas o Loss of interest o Lack of motivation/drive/initiative o Poverty of speech Handouts for Job Provide Support to People with Mental Health Issues Page 5 of 35

6 o Diminished expressive behaviour, self-care and personal function Is psychosis the same as schizophrenia? Schizophrenia is a psychotic illness but a person can have a psychotic episode without having schizophrenia. For a person to be given a diagnosis of schizophrenia the person will: Exhibit disturbed thinking this means the person has experienced psychotic symptoms Have had a decline in functioning ie they will perform below their previous level of achievement Have the condition for at least 6 months What is the incidence of schizophrenia? Schizophrenia affects 1 in 100 Australians this means that it is a very common disorder in medical terms. How old are people when they develop schizophrenia? Generally the age of onset (i.e when the person first gets sick) is: For Men years. For Women years. Schizophrenia is a disorder of young people it usually begins in late adolescence. What are the causes of schizophrenia? It s not yet completely known May be different causes for different forms of schizophrenia Genetics and environment both contribute People inherit a predisposition to the illness Stress is a precipitant, not the cause. If you would like more information try What is the outcome for people with schizophrenia what happens to people with the illness? 25% - 30% have a complete recovery 35% - 40% have recurrent episodes of illness 30% - 35% have chronic (ongoing) symptoms, disability. 10% suicide rate this is a much higher rate than for the general population. Handouts for Job Provide Support to People with Mental Health Issues Page 6 of 35

7 Is schizophrenia an illness? Schizophrenia is generally thought to be a brain disease or group of brain diseases. A disorder in the way that information is processed in the brain Information is transmitted from one neuron to another by chemicals called neurotransmitters Schizophrenia is believed to be caused by chemical changes that cause a breakdown in those systems People with schizophrenia are thought to have too much of a chemical called dopamine. What are some of the interventions which help people with schizophrenia: Medication Peer support contact with other people who have had similar experiences Optimism and Support for recovery Community-based support individual support plan Crisis intervention when needed Practical support - housing, employment, accommodation. What are some of the problems of people with a mental illness Stigma Family response Discrimination Isolation Employment, finances, accommodation Drugs and alcohol Medication and side effects Dealing with the symptoms of an illness And Everything else that happens in life to everyone. Are people with a mental illness aggressive? Mental illness in itself does not always cause aggression. People can have different reasons for behaving in an aggressive manner. They pay present as aggressive because: May be the person is angry Of how the person is being treated because of the mental illness The person has an aggressive personality of the illness. Handouts for Job Provide Support to People with Mental Health Issues Page 7 of 35

8 Are people with a mental illness sick all the time? No. People have episodes of mental illness. An episode of illness may be: mild - minor or major severe An acute episode means that the person is having a lot of symptoms. What does schizophrenia feel like? When I had my first breakdown I felt like an egg that had been dropped on the kitchen floor. Part of the shell is still intact but part of it is shattered and the egg-white is leaking out of it. The egg-white is my personality, and I can not get it together again. From the audio-cassette of ABC Science Show Schizophrenia. Produced by Anne Deveson. It s like all the electric wires in the house are plugged into my brain and everyone has a different voice. So, I can t think. Some of the voices tell me things like what to do, and that people are watching me. I know that there are really not any voices, but I feel as though there are, and that I should listen to them, or something will happen to me. I see thongs.in crowds. I see people looking at me, and talking about me. Sometimes I hear them planning to kill me. I don t want to die. I want to be like everyone else. From the film on Schizophrenia Promise. Handout 3: Mood Disorders Mood disorders are called affective (emotional) disorders There are two categories of mood disorders: 1. Depressive Disorders 2. Bipolar Affective Disorders Depressive Disorders Minor Depression This is what we all experience from time to time: Normal ups and downs, the blues Normal human response to bereavement, relationship break up, financial worries, loss or sadness or rejection or other situations Gets better with support, change of environment, time. Handouts for Job Provide Support to People with Mental Health Issues Page 8 of 35

9 Major Depression Major depression is a regular or ongoing depression, called a depressive illness. Depressive illness is depression that doesn t go away for several weeks or months. Depression is a very common mental illness and is significantly different from unhappiness or sadness. It is a long lasting, often recurring illness as real and debilitating as heart disease. There may be feelings of oppressive sadness, fatigue and guilt. The person who is depressed feels lonely and isolated, helpless, worthless and lost. There is usually a combination of physical and psychological symptoms involved in a depressive episode. Melancholia is the terrible sadness that never lifts. Common symptoms of depression The main two symptoms of depression are: Lack of energy, Loss of interest in life s activities Depressed mood. Other symptoms of depression: Eating too much or too little, appetite loss leading to weight loss, or sometimes weight gain Sleep disturbances Sleeping too much or too little, difficulty going to sleep (insomnia), waking up in the night, early morning wakening is common Change in self-image feelings of worthlessness or guilt Restlessness, agitation and irritability or physically slowed down Difficulty concentrating, remembering Slowed thinking, Inability to make decisions Thoughts of death or suicide Inability to function at work or school Headaches, digestive disorders, nausea with no other cause Excessive crying Persistent feelings of sadness, anxiety and hopelessness Feelings of inappropriate guilt or worthlessness. The types of depression There are different types of depression. Major (Clinical) Depression Major depression is diagnosed if a person has experienced at least 2 weeks of depressed mood with at least 4 other symptoms of depression. Dysthymic Disorder This is diagnosed if a person has experienced at least 2 years of depressed mood more days than not and has additional symptoms of depression. Some common symptoms Handouts for Job Provide Support to People with Mental Health Issues Page 9 of 35

10 noticed with this disorder are feelings of inadequacy, loss of interest or pleasure, dwelling on the past, feelings of guilt and social withdrawal. It differs from Major Depression in that major depression consists of one or more episodes whereas dysthymic disorder may begin early in life, be less severe but is more or less continuous over the life span (unless treatment is sought). Adjustment Disorder with Depressed Mood Depression can be triggered by situations in your life that are stressful; such as moving house, loss of a job or relationship break-up. Even positive changes can be difficult to adjust to such as marriage, new job, birth of a baby etc. Change at any level can cause your stress levels to rise. Depression is more intense and lasts for much longer than the unhappiness experienced in daily life. Treatment is generally necessary and often very effective. Psychotic depression Sometimes depression becomes so severe that the person is psychotically depressed this means that the person has the symptoms of psychosis such as delusions, and hallucinations and can become very withdrawn. What causes depression? Depression is almost always caused by a combination of factors environmental, personality, genetics. Sometimes it is possible to point to a specific event that seems to have triggered a depression. At other times it comes on for no apparent reason even for individuals whose lives are going well. External events Losses Loneliness resulting from relationship difficulties Financial Worries Retirement Other stresses Life cycles issues Depression is closely associated with stress and can occur at certain stages of life, such as puberty, middle age or retirement. Stress resulting from personal tragedies, family breakdown and unemployment, for example, can all contribute. Personality Some personality types are more prone to depression. People who set very high standards for themselves and others may be easily depressed if they are let down. Past depressive episodes: Once a person has experienced an episode of major depression, you may be more likely to develop another depression in the future. Genetics People can inherit a predisposition to develop depression. Having close relatives who have had depression increases the risk of developing depression. Handouts for Job Provide Support to People with Mental Health Issues Page 10 of 35

11 The body s chemistry Current research suggests that an imbalance of brain chemicals called neurotransmitters, can be a factor in depression. Depression is thought to be a deficiency in a chemical called norepinephrine. An imbalance in the chemicals in the brain, which regulate mood and activity, can alter someone s thoughts, emotions and behaviour. This can be corrected with the use of antidepressants. Other causes: Medical illnesses Some Medications Alcohol and other substances What are the interventions for depression? Counselling and therapy: Counselling and therapy involve a process of talking about concerns, working through possible solutions and learning problem solving, communication skills and coping strategies. Medication: Medication such as antidepressants can be effective in the treatment of depression. These medications are non habit forming and are helpful in reducing the severity, frequency and duration of depressive episodes. Electroconvulsive therapy (ECT) for severe depression How common is depression? Estimates vary from 5%to 15% of Australians having experience of a major depressive illness at some point in their lives. What is the outcome? Most people recover from depressive illness. Some people have numerous episodes of depression. People with depression have a high rate of suicide and suicide attempts. Bipolar affective disorder This is also a mood disorder but a person with bipolar disorder has both depression and mania. It is a disorder of mood and of energy level with swings from high to low. It used to be called manic-depressive illness. What does mania mean? Mania means an increase in mental and physical activity. Hypomania is a mild form of mania where there is an upswing in mood. A manic episode is when the mood change is more marked and severe and persistent. The person may no longer be connected with reality they may be psychotic. What are the common symptoms of mania? Feeling high everything seems wonderful to the person Irritability Not wanting to sleep Fast flow of ideas and speech _pressure of speech Increased sexual activity (out of character for the person) Feeling that one is great or significant or specially chosen Handouts for Job Provide Support to People with Mental Health Issues Page 11 of 35

12 Increased religious/spiritual feelings (out of character for the person) Reduced sense of danger Spending too much money (out of character for the person). How common is bipolar disorder? About 1% of the population have bipolar disorder. When do people develop bipolar disorder? Between the ages of 18 and 25 is the most common time for people to have their first episode of bipolar disorder. What is the outcome? Some people have only one episode of mania and one episode of depression. Other people have frequent swings between mania and depression. What does bipolar disorder feel like? I went into a fantastic high, my mind was speeding with an unreal sense that all limits were off; I could set up grandiose schemes, be brilliantly creative, order people around because I was a genius, spend money with abandon. I didn t need to sleep or eat. I rode a motorbike the wrong way up a freeway. I plugged myself into a power point with a fork to hear messages from God and mercifully survived both. From being a non-religious person, my psychotic delusions grew and I believed I was the Virgin Mary and talked incessantly about my special mission, and rang people in the middle of the night. Anyone who didn t agree with my brilliant ideas was treated with scorn. Meg Smith Good Weekend Handout 4: A Guide To Who s Who In Mental Health Some of the names of different worker in the mental health field can sound confusingly similar- for example, psychiatrist, and psychologist and yet these job titles may indicate quite different roles and approaches to mental health problems. Advocate An advocate is someone who represents their own or someone else s interest and speaks out on their behalf. There are many forms of advocacy in mental health. A Consumer Advocate is generally a person who has had personal experience of mental health problems. A Legal Advocacy in the field of mental health encompasses a broad range of activities from advice to representation. Lawyers can act as legal advocates at hearings related to the Mental Health Act - Review Tribunals or Hospital hearings that consider whether a detained person should be released. Handouts for Job Provide Support to People with Mental Health Issues Page 12 of 35

13 Case Manager (Also called Case Coordinator, Services Coordinator, Key Worker). Case management is provided for consumers and carers whose needs are high priority or complex and who are likely to require support from a range of different agencies to enable them to live at home or continue caring. The person who takes on the role of coordinating care or providing support is the Case Manager. Their role includes: Making an assessment of the client s needs Designing an Individual Support Plan with the consumer and with relevant agencies Monitoring with the consumer the effectiveness of the plan. The Case Manager can be a nurse, social worker or other mental health worker. Carer A carer is a person who provides support to someone with a mental illness. They are often family members of friends. Community Mental Health Nurse/Psychiatric Nurse Community Mental Health Nurses are registered nurses with specialist training who work in the community and are generally employed by the Area Health Service community mental health team. The role of the Community Mental Health Nurse role can be very wide and can include: Offering counselling or anxiety management or exploring different coping strategies with people with acute short term difficulties; Working with people who have had severe mental health problems for many years and who need long term support to live in the community; Administering psychiatric drugs. Consumer This term is often used to describe a person who receives or has received a mental health service. There is not universal acceptance of this term and some people prefer other words such as survivor, service-user, client. The term was developed to convey the sense that a consumer is a person who has rights, including a right to complain if not satisfied with a service. General Practitioner (GP) Between a quarter and a third of a GP s workload will be concerned with emotional or psychological difficulties. GPs can talk through problems, prescribe medication or make referrals as they see fit. Many mental health problems are dealt with by GPs without referral elsewhere. Handouts for Job Provide Support to People with Mental Health Issues Page 13 of 35

14 Mental Health Act Each State has a Mental Health Act which is the law which defines the criteria for people to be taken to and detained in a hospital and treated against their will, or treated in the community on an order. Each Mental Health Act also outlines the rights of people detained under the Mental Health Act. Occupational Therapist Occupational therapists work in psychiatric units, day hospital and in the community. Their role is to help people with mental health problems to build up confidence and skills needed for personal, social, domestic, leisure or work activities. They focus on the learning of specific skills or techniques, including, arts, crafts, drama, dance, writing, group work (such as anxiety management assertion training), individual counselling and training activities in daily living. Psychiatrist Psychiatrists are medically qualified doctors who have taken further training and specialised in mental illness. The consultant psychiatrist is the most senior member of the team with overall responsibility for patient assessment and care, but the psychiatric patient usually has more contact with the Psychiatric Registrar. Psychiatrists are not only hospital based. Others work in community mental health centres or multi-disciplinary teams. They work closely with a number of different mental health professionals, such as psychologists, social workers and mental health nurses. Psychiatry is generally influenced by biochemical explanations for mental illness. Treatments within psychiatry therefore tend to be predominantly physical, such as drugs and ECT. Psychologist Clinical psychologists have a first degree in psychology (the study of mental phenomena) and a Masters degree in clinical psychology with a minimum of one year s experience. Their training centres on the application of scientific principles to the understanding of human experience and action, including thoughts, feelings and behaviour. Clinical psychology has developed from its early reliance on behavioural theory and methods to a much broader approach. It is possible to find clinical psychologists offering a wide range of treatments to assist people to change the circumstances in which they are experiencing distress. Treatment interventions include behaviour therapy, cognitive therapy and psychotherapy. Cognitive therapy can help people identify patterns of thinking and logic that can influence their ideas and behaviour and perpetuate mental health problems. Psychotherapist, Psychoanalyst and Counsellor There are three main types of talking treatment psychotherapy, psychoanalysis and counselling. Although the distinctions between them are blurred at the edges, there are differences in the methods used, the intensity and length of treatment and in the training the therapist receive. Other professionals also sometimes offer talking treatments. For example a community psychiatric nurse, psychologist, occupational therapists, and social worker. Handouts for Job Provide Support to People with Mental Health Issues Page 14 of 35

15 Self-Help Groups People may support themselves and each other in self-help groups on numerous issues, such as eating distress and sexual abuse. Social Worker Social workers may be involved in mental health in a number of ways and work in a variety of settings. Social workers offer advice on practical matters, accommodation or financial benefits, can make referrals to appropriate services, and provide advocacy. Some may offer counselling, family support and education. Handout 5: Information for Carers of a person with a mental illness How to help your relative or friend some tips Information - Get to know as much as possible about the illness or disability to increase your understanding of what the person is going through. Learn about the cause, the treatments, and the outcomes. Take great care of yourself address your own needs because a carer who cares for him/herself is better able to care for their loved one. It is important to maintain and establish friendships, activities and hobbies. Avoid Blame relatives do not cause mental illness. Realistic expectations It is normal to feel the loss of what your loved one was able to do before they developed a mental illness. He or she may also be experiencing similar feelings of loss and sadness. Some people recover completely, others may have ongoing symptoms. If expectations are too high this may mean that the signs of progress are overlooked. Expectations of employment, or schooling may simply be inappropriate at certain periods, while a possibility at other times. Some realistic signs of progress could simply be when your relative starts eating with the family, or having daily showers. Positive outlook One of the most important ways a carer can help is by instilling hope of a more positive future for their loved one. Often the person experiencing the mental illness may not be able to foresee better days. Seek help Get to know the services and resources in your area Consider joining a self-help group. Communication Can be difficult but can also be improved by learning new communication skills. For more details see the references listed below. Pay attention to the needs of other family members caring for someone with a mental illness can affect the dynamics of the family. Handouts for Job Provide Support to People with Mental Health Issues Page 15 of 35

16 References: 1. Caring for Someone with a mental illness Fact Sheet produced by the Mental Health Association NSW Inc, 2. A Caregivers Guide to Living with Mental Illness 3. A SANE Guide for Carers: a guide for family and friends of people with a mental illness. From Sane Australia, NAMI National Alliance for the mentally ill Coping Tips for Siblings and Adult Children of Persons with a mental illness 5. Woolis, R (1992) When Someone You Love has a Mental Illness: A handbook for Family, Friends and Caregivers. Handout 6: Mental Health Rights The rights of people with disabilities are protected by a number of international conventions, Federal (Commonwealth) and State laws (often called Acts). There have been a number of International Conventions outlining the human rights of all people 1. Universal Declaration of Human Rights (1948) Paragraph 63 if the Vienna Declaration and Program of Action at the 1993 World Conference on Human Rights states: The World Conference on Human Rights reaffirms that all human rights and fundamental freedoms are universal and thus unreservedly include persons with disabilities. Every person is born equal and has the same rights to life and welfare, education and work, living independently and active participation in all aspects of society. 2. The Declaration of the Rights of Disabled Persons (1975) Article 3 Disabled persons have the inherent right to respect for their human dignity. Disabled persons whatever the origin, nature and seriousness of their handicaps and disabilities, have the same fundamental rights as their fellow-citizens of the same age, which implies first and foremost the right to enjoy a decent life, as normal and full as possible. Handouts for Job Provide Support to People with Mental Health Issues Page 16 of 35

17 3. The National Statement of Rights and Responsibilities (1991) Australian Commonwealth Law 1. Human Rights and Equal Opportunity Commission Act (1986) 2. Disability Services Act (1986) 3. Disability Discrimination Act (1992) State Laws For example in NSW - 1. Disability Services Act (1993) 2. Anti-Discrimination Act (1977) Part 4A 3. Mental Health Act National Mental Health Statement of Rights and Responsibilities (Adopted by Australian Health Ministers in March 1991). This Statement of Rights and Responsibilities aims to ensure that consumers, carers, advocates, service providers and the community are aware of their rights and responsibilities and can be confident in exercising them. Consumer rights and responsibilities The key rights which affect individuals seeking promotion or enhancement of mental health or care and protection when suffering mental health problems or mental disorders are: The right to respect for individual human worth, dignity and privacy The right equal to other citizens to health care, income maintenance, education, employment, housing, transport, legal services, equitable health and other insurance and leisure appropriate to one's age The right to appropriate and comprehensive information, education and training about their mental health problem or mental disorder, its treatment and services available to meet their needs The right to timely and high quality treatment The right to interact with health care providers, particularly in decision making regarding treatment, care and rehabilitation The right to mechanisms of complaint and redress The right to refuse treatment (unless subject to mental health legislation); The right to advocacy The right to access to relatives and friends The right to have their cultural background and gender taken into consideration in the provision of mental health services The right to contribute and participate as far as possible in the development of mental health policy, provision of mental health care and representation of mental health consumer interests Handouts for Job Provide Support to People with Mental Health Issues Page 17 of 35

18 The right to live, work and participate in the community to the full extent of their capabilities without negative discrimination. All members of Australian society have responsibilities in relation to health care. Specifically, mental health consumers have a responsibility: To respect the human worth and dignity of other people; and To participate as far as possible in reasonable treatment and rehabilitation processes. Handout 7: Dealing with Loss Loss is a universal experience but its consequences can have adverse effects. Stress, loss and grief are common themes for people presenting for help and particularly for people with mental health problems. Psychotic illnesses are thought to be exacerbated by stress and depression. People who have a diagnosis of mental illness often experience a sense of loss and grief. Their carers often describe feelings of loss in relation to the person who is now affected by the illness. This handout explores the relationship between stress, loss and grief and some of the effects that stress, loss and grief can have. Key messages: People react differently to a loss experience There are strategies which help people cope with their own and others loss experience Everyone needs to be able to identify sources of help People from different cultural/ethnic/religious backgrounds may cope with loss in different ways. Categories of Loss: Loss can be grouped into 4 major categories: 1. The loss of a significant person 2. The loss of a part of the self 3. The loss of external objects 4. Developmental loss. While these losses are listed in various categories, there is considerable overlap and one loss often impinges on another; as a result the distinctions between categories tend to blur. Handouts for Job Provide Support to People with Mental Health Issues Page 18 of 35

19 1. Loss of a significant person Death of a loved one - the ultimate loss, final and complete; also desertion, separation, divorce, abortion, stillbirth. 2. Loss of part of the self a. Physical - structural and functional. Structural loss includes the loss of a limb, loss of an organ, disfigurement, loss of hair, loss of teeth, any outward change, loss of body image (through surgery, burns, accident). Functional loss includes loss through stroke, paralysis, deafness, blindness, arthritis, infertility. b. Psychological-loss of memory, judgement, pride, control, status, usefulness, independence, esteem, values, ideas. c. Social-loss of roles, employment, friends; geographic moves, travel. d. Community and cultural-loss through immigration, urban renewal, refugee experience. 3. Loss of external objects Loss of possessions-money, jewels, property, and symbols of identity - such as photographs and artefacts, through burglary, robbery and natural disasters such as floods and fire. 4. Developmental loss Birth trauma, weaning, growing up, school, exam failures, school to-work transition, leaving home, new relationships, marriage, old age, multiple cumulative losses. Normal Grief Reactions 1. Emotions Anxiety and fear Sad Guilt Angry Inadequacy Hurt Relieved Loneliness 2. Physical Sensations Hollowness in stomach Tightness in chest Oversensitivity to noise A sense of depersonalisation Breathlessness Weakness of muscles Lack of energy Dry mouth 3. Cognitions Disbelief Handouts for Job Provide Support to People with Mental Health Issues Page 19 of 35

20 Confusion Preoccupation Sense of presence of bereaved Hallucinations 4. Behaviours Sleep disturbances Appetite disturbances Absent-minded behaviours Social withdrawal Dreams of the deceased Avoiding reminders of the deceased Searching and calling out Sighing Restless overactivity Crying Visiting places and carrying objects that remind the survivor of the deceased Treasuring objects that belonged to the deceased The above are all common, normal reactions to grief. Handout 8: Suicide Risk Factors Risk factors associated with suicide International data and recent Australian experience highlight several groups at higher risk of suicide. As suicide rates have fluctuated over the years, these cycles seem to be related to economic cycles and other social and structural changes factors. The following table shows international estimates of suicide risk for high risk groups related to three categories of risk factors: Individual Family Peer and community factors including education and work related risk factors. Handouts for Job Provide Support to People with Mental Health Issues Page 20 of 35

21 Estimates of suicide risk factors for high risk groups Individual risk factors for suicide Sex Age Rural Aboriginal Culturally and linguistically diverse backgrounds Current or former mental health clients People within four weeks of discharge from a psychiatric hospital Previous suicide attempts Substance use/misuse People with serious physical illness or disability Males are 3-4 times more likely to die from suicide than females. Young and older males are specifically at risk. Suicide rates are higher for young males living in non-urban settings. Suicide rates of year old males living in remote Australia are close to twice those of males living in capital cities. Suicide rates in Aboriginal males between the ages of years are 4 times higher than for non- Aboriginal young people. There is great diversity in the risk of suicide to migrants. While migrants of non-english speaking backgrounds up to the age of 64 years had lower or similar rates of suicide than the overall community, migrants aged 65 years and over had significantly higher rates. Higher risks were also found for migrants from English-speaking countries, Western, Northern and Eastern Europe, the former USSR and Baltic States. Current or former mental health clients have a suicide risk 10 times that of the general population. Where people have been discharged from a psychiatric facility, the suicide risk in the first four weeks after discharge increases to times. People who have made previous suicide attempts have a fold increased risk of suicide. Substance use/misuse People who misuse substances (alcohol and other drugs) have a suicide risk 20 times that of the general population. People who have a serious physical illness or disability are also at higher risk; people who have AIDS have a 36-fold higher risk of suicide. Handouts for Job Provide Support to People with Mental Health Issues Page 21 of 35

22 Family risk factors Child sexual abuse Medically serious suicide attempts were reported 4 times more commonly in young people who have been sexually abused. Not living with the original family; communication problems with parents Stressful life events Relatives and peers of people who have died by suicide Children and young people who are not living with their original family, and also those children who have communication problems with parents, carried a 2-fold higher risk of suicide. Young people experiencing stressful life events such as disciplinary crisis, the loss of a parent or relative or a relationship break-up, may experience a 6-fold increase in suicide risk. A recent suicide or suicide attempt by a relative or peer is also associated with a higher suicide risk (up to 5-fold). Social, community and peer risk factors for suicide Occupational groups Certain occupational groups are at higher risk of suicide such as farmers and doctors which both have a 2 fold risk. Homeless people People in custody Gay or lesbian young people Unemployed people Gun ownership People who are homeless or living in refuges have higher rates of mental health problems compared to the general population. People in prisons have a 5-fold risk of suicide. Studies of gay and bisexual young people consistently report high attempted suicide rates. People who are unemployed have twice the risk of suicide compared to the general community. Having a gun in the home is associated with a higher likelihood of shooting as the method of suicide. Source: NSW Department of Health Suicide: We can all make a difference Warning Signs of Suicide Suicide is a permanent solution to a temporary problem When in doubt check it out. Handouts for Job Provide Support to People with Mental Health Issues Page 22 of 35

23 Most people who think about suicide do give some warning or clue to their intentions. If you think that a person is feeling suicidal ask them if they are. It will not encourage them to do it. It will give an opportunity for the person to talk about how they are feeling and allow the listener to offer hope and support. Some general warning signs that may mean that the person is having thoughts of suicide are: Previous attempts at suicide or self-harm Verbal warnings Getting affairs in order - Saying goodbye to people, Giving away possessions Changes in behaviour Depression, sad, empty mood Chronic fatigue Changes in sleep and eating patterns Talking or joking about suicide Talks of hopelessness, helplessness or worthlessness Preoccupation with death Loss of interest in things previously enjoyed Self destructive behaviour (eg. Alcohol and drug abuse) Risk taking behaviour (eg. Reckless driving) Obsession with guns/knives. Each person is an individual and they will have their own individual reaction to loss and stress and depression. There may be other signs that someone is feeling suicidal or contemplating suicide. There is no formula for suicide. Handout 9: Guidelines for Assessment and Management of Depression and Suicide in Elderly People Risk factors for suicide Being physically unwell Elderly males Social isolation Depressive disorder diagnosed or suspected Recent losses or bereavements Personal history of suicide attempts Family history of suicide attempted or completed Handouts for Job Provide Support to People with Mental Health Issues Page 23 of 35

24 Precipitating Factors Poor impulse control Alcohol/substance abuse Availability of means Protective factors Religious beliefs Concern for impact on others Cultural practices Assigning a Level of Risk Prefer not to wake in the morning Feel life is not worth living Occasional thoughts of ending one s life RISK Thoughts of a means Provisional detailed plan if things get so bad Actual plan Low risk Moderate risk High Risk Need regular Review Establish safety net contact person Make a keeping safe contract Establish a convincing set of steps that a patient would take if suicidal impulsesbecame overwhelming. Review at leastdaily with set contact time. Patient not to be left alone Seek urgent specialist help Consider transfer to Hospital. Action Plan Don t keep it to yourself Always be active Identify who you will call for assistance in your area Source: NSW Health: Consensus Guidelines for Assessment and Management of Depression in the Elderly. Handouts for Job Provide Support to People with Mental Health Issues Page 24 of 35

25 Handout 10: Interviewing Skills 1. Preparation What is the purpose of the interview? Consider the effects of the setting Identify possible areas of concern and strategies to deal with them. 2. Introduction It is very important that you clearly introduce yourself to the person you are about to interview and are as clear as possible about the purpose of the visit/ interview and what you hope to achieve. Failure to do this can create confusion in the mind of the client and lead to misunderstandings. 3. Attending Physical attending is a sign to the client that the interviewer is actively present and working with him/her and assists the interviewer to actively listen. You need to be aware of verbal, non-verbal and paralinguistic cues to what is being communicated. Paralinguistic means: tone of voice, loudness, pitch, pacing of words, stumbling over words etc. Non-verbal and paralinguistic cues either. 1) Confirm, punctuate, emphasise, modulate or modify the verbal message of the speaker or 2) Contradict the verbal message of the speaker and thus contain the real message. S O L E R Face the other person squarely Adopt an open posture Lean toward the other Keep good eye contact Try to be at home or relatively relaxed in this position. 4. Active Listening 5. Accurate Empathy The goal is to communicate to the client that the helper understands his world from the client s perspective. Such empathy deals both with feelings and with the behaviours and experiences underlying these feelings Such empathy helps establish trust and rapport and increases the level of the client s self exploratory behaviour. ( see the bottom of this handout for some common problems with accurate empathy) 6. Response/summary/where to from here? Identifying issues and checking back with the client Feedback from client Handouts for Job Provide Support to People with Mental Health Issues Page 25 of 35

26 Client s expectations. 7. Terminating the interview Making a statement to the effect that the interview time is drawing to a conclusion Reviewing briefly what has been achieved, and where the interview has reached (summarizing) Any decisions which have been made in terms of tasks agreed to for both interviewer and interviewee Possible discussion of follow-up, next appointment, or what the follow-up process will be Recognition of interviewee s feelings at end of interview Emphasis on positives achieved (no matter how meagre). Some Common problems with communicating primary-level accurate empathy The cliché: If you respond to another s self-disclosure with a cliché, this is usually worse than no response at all. It can be perceived as demeaning and can put distance between those trying to communicate. Premature advanced accurate empathy Making in-depth, inept interpretations of what the client is saying before having gained a full understanding of the issues. Inaccuracy Accurate empathy needs to be exactly that-accurate. If your understanding of another is inaccurate, he or she will probably let you know by stopping or going off on a new tangent, or may say that s not exactly what I meant. Being inaccurate can be a sign that the interviewer is pursuing his/her own agenda rather than listening to and responding to the other. Accurate empathy is a sign of mutuality and cooperation rather than control. Feigning understanding It may be difficult to understand what the client is saying, especially if he or she is confused, distracted or in a highly emotional state. On the other hand, the counsellor might become distracted and fail to follow the client. At such times the counsellor should not feign understanding. Genuineness demands that the counsellor admit he or she is lost and works to get back on track again- I think I ve lost you. Could we go over that again? If the counsellor is confused it is alright to admit confusion- I m sorry. I m a bit confused about what you just said. Could we go through it again? Parroting Accurate empathy is not parroting. The counsellor should look for the core of what is being expressed by the client and reflect it back to the client. The counsellor tries to communicate understanding rather than just regurgitate what the client has said. Jumping in too quickly or letting the other ramble Most beginners have to practice waiting when the client pauses, allowing both to think about where they are up to. Jumping in too quickly conveys awkwardness. During the pause, the counsellor might ask him/herself What are the real issues here? This does not mean the counsellor Handouts for Job Provide Support to People with Mental Health Issues Page 26 of 35