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I have attached the lecture notes after the case study and I need quality 15 references Assessment #1 – Case study Assignment 1 ? Choose only one case study from the three provided in the Assessment Guide on the course website. This assignment requires you to describe the key factors you would take into account in making a social work assessment and in planning for case management with the client. You are not being asked to present a plan – only to identify the key factors to be considered in light of the academic literature on the mental health problems presented in the case. You are asked to draw on a recovery-oriented approach to mental health assessment and case management in social work as outlined in the course text book, Bland, Renouf and Tullgren (2015). This should include the following: 1. A brief explanation of a recovery-oriented approach to assessment and case management in mental health social work – what is distinctive about these? 2. The key factors in this case that should be taken into account in undertaking a recovery-oriented assessment and planning for case management, drawing on the relevant life domains outlined in the text book (i.e. you are not being asked to refer to all 12 domains but those that are most relevant to the case). This will include discussion of existing mental health research literature relevant to the case. For example, in the case of Justine, you could outline what is known about the effects of racism on mental health, the effects of sexual abuse on mental health and how this knowledge might further enhance understanding of Justine?s situation. Again, you are not being asked to present a case management plan but to speak to the factors you would consider in planning for case management; 3. The social work theory or theories that would also guide your approach to assessment and case management with this client and why (e.g. strengths approach, empowerment approach, feminist social work approach); 4. Potential ethical and legal implications of the case – this can be brief – refer to the text book chapter on legal aspects of mental health and the AASW code of ethics. Chapters 6 & 7 of the course text are a good place to start for this assignment. The case study assignment can be presented in the format of a report, and you can use the above dot points as headings. However, you need to draw on the relevant mental health and social work literature throughout. Please note ? as a social worker or human service worker, you are not being asked to make a psychiatric diagnosis. You can nevertheless comment on the condition(s) you think are likely based on your reading of the literature and the implications for practice. . This is my Case Study Jennifer is in her late 50s. She was the fifth child in a family of six. Her father was a labourer and her mother was not in the paid work force. She missed a lot of school because her mother was not well ? she implies her mother struggled with poor mental health and alludes to domestic violence from her father to her mother. Jennifer was an extremely shy child and rarely had friends to play with. She is not particularly close to her siblings, saying that they see her as ?weak? and ?unstable? like her mother. Jennifer was often singled out for physical and emotional abuse at the hands of her father, who called her ?stupid? and ?away with the fairies?. She often blamed her mother for not protecting her and for not making the home a happy one. Jennifer says that because she felt unloved in her family, she married young, yearning for closeness. She wanted to escape her family and fill the void she experienced in her own childhood. She had three children soon after. Jennifer thought that if she had children, that she could make the loving family that she missed out on. Her husband was about 20 years her senior. He had very strong expectations about marriage and gender divisions within the relationship. It was considered natural for Jennifer to tend to household chores, to cook and look after him and to take care of the children. He was the decision-maker and Jennifer had to do as she was told. Although Jennifer was originally looking for love, care and support, her husband was cold, controlling and emotionally abusive. Over time, Jennifer progressively became anxious, distressed and eventually had a nervous breakdown. Her children were still young. Jennifer often forgot to pick up the older children from school. She started to leave her younger children at home and go wandering during the day. When Jennifer went wandering, she would become disorientated and forget how to get home. One day, the police picked up Jennifer in her disoriented state and took her Glenside. At first, she was detained for three days under the Mental Health Act, which was extended a number of times over a lengthy period. Jennifer was diagnosed with schizophrenia and medicated with anti-psychotic drugs. Eventually, she was released and allowed to return home. However, Jennifer?s husband kicked her out with nowhere to go. This is when Jennifer started living on the streets. As a homeless person, Jennifer was in and out of shelters continuously. But, more often than not, she roughed it out-doors. She had numerous involuntary admissions to Glenside under the Mental Health Act over the next few years and she lost touch with her children. Since marrying and moving away more than ten years ago, Jennifer has not kept in contact with any of her family. She doesn?t even know if her parents are still together, whether any of her siblings have families of their own and where they might be living now. Jennifer has been referred by a women’s centre to a supported community housing program. The vision is to offer Jennifer a unit of her own and to implement continual supervision and support. You are her social worker. Assessment feedback Psychology, Social Work and Social Policy Mental Health and Mental Wellbeing WELF 2019 Student: Assignment 1: Case Study ? 2,250, Key components of this assignment Mark Comment by marker Demonstrated ability to apply knowledge about mental health and social work assessment and case management to the case. /25 Evidence of critical thinking and problem-solving. /10 Demonstrated understanding of the ethical and legal implications of the case /5 Written in a clear and understandable way that meets formatting/referencing requirements /10 Summary comment The Graduate qualities being assessed by this assignment are indicated by an X: GQ1: operate effectively with and upon a body of knowledge X GQ5: are committed to ethical action and social responsibility GQ2: are prepared for lifelong learning GQ6: communicate effectively X GQ3: are effective problem solvers GQ7: demonstrate an international perspective X GQ4:can work both autonomously and collaboratively Grade Textbook and referneces Please could you use quality references? Bland, R., Renouf, N. & Tullgren. (2015) Social Work Practice in Mental Health: An Introduction, Allen and Unwin, Crows Nest. Australian Association of Social Workers Australian Bureau of Statistics Law Online Australian Mental Health Consumer Network Beyond Blue: The National Depression Initiative Dept of Health, Mental Health Links Institute for Mental Health Research Centre for rural and remote mental health Commonwealth Department of Health and Aged Care 2000. Promotion, prevention and early intervention for mental health: a monograph, Commonwealth Department of Health and Aged Care 2000. National action plan for the promotion, prevention and early intervention for mental health, Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, Canberra. of Health National Mental Health Strategy 2015 (including National Mental Health Policy, National Mental Health Plan and Mental Health Statement of Rights and Responsibilities) Headspace, Youth and mental health foundation International Society for Mental Health Online Mental Health Coalition of South Australia Health First Aid Health Institute Mental Health Association of NSW Mental Health Association (Qld) Mental Health Australia, Mental Health Matters Mind Matters Health in Multicultural Australia National Institute of Mental Health (United States Department of Health and Human Services SANE Australia World Health Organisation ? ? References ? Australian Bureau of Statistics (2007) National mental health and wellbeing survey. ? Australian Institute of Health and Welfare (2016) ? Bland, R., Renouf, N. & Tullgren, A. (2015) Social Work Practice in Mental Health, Crows Nest: Allen & Unwin. ? Goffman, E. (1963) Stigma; notes on the management of spoiled identity. Englewood Cliffs, N.J. Prentice-Hall. ? Meadows et al (2007) Mental Health in Australia: Collaborative Community Practice. Melbourne: Oxford University Press. ? References ? Raphael, B. (2000) Promoting the mental health and wellbeing of children and young people discussion paper : key principles and directions. Canberra, ACT : Department of Health and Aged Care. ? Rogers, A. & Pilgrim, D. (2005) A Sociology of Mental Health and Illness. Maindenhead: Open University Press. (2006 version is an e-boo Lecture notes History ? Before 1800s, mentally ill thought to suffer because they had a “disease of the soul” (Meadows, et al, 2007). ? Harsh treatment of mentally ill (Meadows et al, 2007). ? Early Asylums People often kept in cages with straw for bedding, like animals Emphasis on ?moral? treatment ? correction and punishment (Meadows et al, 2007). ? Growth of asylums ? 18thC and Enlightenment – rise of science – idea of mental illness as disease or pathology (Meadows et al, 2007). ? 19thC – increased incarceration ? this is the Old Adelaide Gaol ? Enlightenment emphasis on rationality – ?mad seen as ?irrational? and a challenge (Meadows et al, 2007) ? Women and Madness ? Linking of women with madness in 19th C. What social factors in play? ? Women?s lives highly constrained in Victorian era ? Women?s movement active (Ussher, 1992) Linking madness with femininity ? Frail ? Sickly ? Weak ? Dependent ? Emotional ? Non-sexual ? Overly sexual ? The idea of the ?wandering womb? ? Reform of Asylums: Glenside in the 19th Century ? Glenside today ? Freudian Psychoanalysis ? Recent history ? 1960s-1970s ? De-institutionalisation ? ?a trend in mental health treatment whereby individuals are admitted for short periods of time rather than undergoing lifetime hospitalisations?.? (Anleu, 2005 in Meadows et al, 2007). Most care provided in the community not institutions ? Advantages of community care? ? Visibility ? Opportunities for social connectedness ? Greater family support ? Normalisation and reduction of stigma ? Employment ? Education and other opportunities ? Multidisciplinary treatment and care ? Self-management ? Hope ? Disadvantages of community care? ? Visibility ? Risk of increased stigma ? Risk of homelessness ? Burden of care on family ? Lack of acute care when it is needed ? Inadequate services and funding ? Isolation ? Unmanaged medications ? Risk of self-harm/harm to others ? Risk of prison ? Contemporary models of mental health ? Medical model ? Bio-psycho-social model ? Social and population health models What is the medical model? The medical model involves: ? A biological emphasis; ? An illness framework; ? The identification of sick individuals (diagnosis); ? Predicting the course of illness (prognosis) ; ? Speculating about cause (aetiology); ? Prescribing a response (treatment) . (Rogers and Pilgrim, 2005) Bio-psycho-social model ? Biological factors social factors psychological factors ? Population Approaches ? Health as ?a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity? ? Mental health as a public health issue ? Prevention ? stopping problems emerging ? Mental health promotion – process of enabling people to increase control over, and to improve their health? (WHO, 2002) Social Models of Mental Health ? Social causes ? Social context ? e.g. family, support networks, culture, community, class, gender, housing, employment. ? Social consequences ? impact on individual, family, relationships, community, employment, housing, economic security. ? Social justice ?stigma & discrimination, human rights, access to support, client & carer rights. (Bland, Renouf and Tullgren, 2015) ? Indigenous Mental Health I just look at my son today who had to be taken away because he was going to commit suicide because he just can?t handle it; he just can?t take any more of the anxiety attacks that he and Karen have. Have I passed that on to my kids because I haven?t dealt with it? How do you sit down and go through all those years of abuse? Somehow I?m passing down negativity to my kids. (Human Rights and Equal Opportunity Commission, 1997, p.222, cited in Gray & Saggers, 2005) ? Effects of the Stolen generations ? Intergenerational nature of trauma and grief (Swan and Raphael, 1995). Recovery approach ? National Mental Health Strategy ? Consumer movement – WHO study i
n 1960s ? An attitude that informs practice – not about causation ? Client-centred, strengths and systems-oriented ? Challenges history of paternalism and hopelessness (see Bland et al, 2015) So what is a recovery orientation???? ? ? ? ? So what is a recovery orientation???? ? Personal stories ? ? Summary ? High prevalence of mental health problems ? Early brutal treatment, fear and stigma ? Shift from asylums to community-care ? Social model of mental health and social work ? Shift to a recovery orientation and importance of lived experience ? References ? Australian Bureau of Statistics (2007) National mental health and wellbeing survey. ? Bland, R., Renouf, N. & Tullgren, A. (2015) Social Work Practice in Mental Health, Crows Nest: Allen & Unwin. ? Courtney, M. & Moulding, NT. (In press) Beyond balancing competing needs: embedding involuntary treatment within a recovery approach to mental health social work. Australian Social Work. ? Glover, H. (2005) Recovery Based Service Delivery: Are We Ready to Transform the Words into a Paradigm Shift? The Australian e-Journal for the Advancement of Mental Health, Vol 4. ? Goffman, E. (1963) Stigma; notes on the management of spoiled identity. Englewood Cliffs, N.J. Prentice-Hall. ? Gray, D. & Saggers, S. (2005) Indigenous health: the perpetuation of inequality. In Germov, J. (2005) Second Opinion? Melbourne: Oxford University Press. ? References ? Meadows et al (2007) Mental Health in Australia: Collaborative Community Practice. Melbourne: Oxford University Press. ? National Mental Health Strategy ? see course web site ? Ramon, S., Healy, B. & Renouf, N. (2007). Recovery from mental illness as an emergent concept and practice in Australia and the UK. International Journal of Social Psychiatry, 53(2), (108-122). ? Rogers, A. & Pilgrim, D. (2005) A Sociology of Mental Health and Illness. Maindenhead: Open University Press. (2006 version is an e-book) ? Swan, P. & Raphael, B. (1995) “Ways forward” : national consultancy report on Aboriginal and Torres Strait Islander mental health. Canberra : Australian Govt. Publishing Service c1995. ? Ussher, J. (1992) Women?s Madness: Misogyny or Mental Illness? University of Massachusetts Press. ? World Health Organisation (WHO, 2002) Prevention and Promotion of Mental Health, Geneva. Recovery Approaches to Mental Health Care ? What is recovery? ?A deeply personal, unique process of changing one?s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one?s life as one grows beyond the catastrophic effects of mental illness.? (Anthony, 1993,p.15 cited in Bland, Renouf and Tullgren, 2015, p.43) ? What is recovery? ?Recovery is the journey toward a new and valued sense of identity, role and purpose outside the parameters of mental illness; and living well despite any limitations resulting from the illness, its treatment, and personal and environmental conditions.? Queensland Health (2005) Sharing responsibility for recovery. ? Recovery ? Living well in spite of limitations and symptoms. ? Radically different to deficit model. ? Strong evidence people recover (WHO, 1967 cited in Bland et al, 2015). ? Mental illness often does not result in inevitable ?deterioration? (WHO, 1967 cited in Bland et al, 2015). . ? Total restoration of functioning possible for most people (WHO, 1967 cited in Bland et al, 2015). ? Increasing numbers of personal stories of recovery (eg Deegan, 1996). ? The most basic foundation is?.. ?Hope lays the ground- work for the process of healing to begin.? (Jacobson and Curtis, 2001, in Queensland Health, 2005). Five elements of recovery include??. ? Hope ? Active Sense of Self ? Personal Responsibility ? Discovery ? Remaining Connected (Glover, 2005) Recovery approach to practice ? No one formula – a personal journey. ? No one version in the literature – ? O?Hagan (2012) – against all involuntary treatment or detention. ? Courtney and Moulding (2014) ? their research shows social workers using recovery approaches in involuntary treatment settings. ? So what might a recovery orientation look like in practice? ? Acknowledging lived experience. ? Respectful curiosity and hopeful attitude. ? Engaging an active sense of self, agency & responsibility. ? Encouraging connection with self, relationships and community. ? Participation and collaboration. ? Deep listening. ? Not necessarily focusing on a particular view on causation ? why? (based on Bland, Renouf and Tullgren, 2015) What might a recovery orientation look like in practice? ? Focus on socio-cultural context of mental health practice. ? Focus on strengths and positive outcomes. ? Reducing professional distance and authority ? i.e. reducing POWER relation. (based on Bland, Renouf and Tullgren, 2015) Person-centred language ? From a service user perspective, workers should? ? Explore concerns, interests and aspirations to develop relationship. ? Reframe meanings. ? Notice effort and exceptions – point them out ? Describe concrete examples ? Measure, notice and sustain change ? Share power (from Anne Tullgren in Bland, Renouf and Tullgren, 2015) ? Recovery and involuntary treatment: reconciling the irreconcilable? ? What if clients stop taking medication, become very unwell & are at risk? ? Involuntary treatment ? community treatment orders (CTOs) ? Courtney and Moulding (2014) – how social workers manage tensions between recovery approach and involuntary treatment ? Recovery and involuntary treatment: reconciling the irreconcilable? ? Social workers described ethical tensions. ? BUT they embedded involuntary treatment in recovery approach by: ? Enabling client choice and agency within constraints ? Building calculated risk into treatment planning ? Advocating with other colleagues about client choice ? Advocating for clients? rights to support and challenging use of recovery rhetoric about ?client responsibility? to deprive clients of services ? (Courtney & Moulding, 2014) ? Findings Enhancing client choice : ? ?This is a good opportunity to try something different ? let?s look at making some changes to medication regimes. So rather than sticking with an injection, which ensures that it?s on board but the person doesn?t like it, let?s look at what else we can do. You?ve got the CTO there so if things start going wobbly we know we can act quickly.? (Clare) ? Findings Advocating for clients? rights to services : ?Once a CTO is in place you actually have a responsibility for this department to provide treatment for the client, and as a department we?re then obliged to assist them in getting those services, and they have a legal right to access those services.? (Andrew) ? Findings ? Social workers focused on relationship between worker-client ? Personal growth, client as expert & other relationships in clients? lives not mentioned ? May reflect narrow job roles or lack of deep knowledge about recovery approaches ? Beyond the client-worker HOUSING WORK INCOME (Queensland Health, 2005) Summary ? Recovery as an individual journey based on hope ? Fits well with social work values and purpose ? All social worker mental health practice can be guided by recovery principles – even in involuntary settings ? Recovery extends beyond worker-clie
nt to wider social engagement in the community References ? Anthony, W.A. (1993). Recovery from mental illness: the guiding vision of the mental health service system in the 1990?s. Psychosocial Rehabilitation Journal, 16(4), 11?23. ? Bland, R., Renouf, N. & Tullgren, A. (2015) Social Work Practice in Mental Health, Crows Nest: Allen & Unwin. ? Courtney, M. & Moulding, NT. (2014) Beyond balancing competing needs: embedding involuntary treatment within a recovery approach to mental health social work. Australian Social Work. ? Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19(3), (91-97). ? Glover, H. (2005) Recovery Based Service Delivery: Are We Ready to Transform the Words into a Paradigm Shift? The Australian e-Journal for the Advancement of Mental Health, Vol 4. ? References (Continued) ? O?Hagan, M. (2012). Legal coercion: the elephant in the recovery room. Retrieved from ? Queensland Health (2005) Sharing Responsibility for Recovery: Creating and Sustaining Recovery Oriented Systems of Care for Mental Health. Understanding Common Mental Health Problems ? Diagnostic and Statistical Manual of Mental Disorders – DSM Centrepiece of psychiatric diagnosis and treatment ? Based on medical model; ? Ongoing revisions & disagreements (Meadows et al, 2007); ? Presented as ?truth?; ? Embedded in cultural assumptions (Bland et al, 2015); ? Social workers need working knowledge of DSM. ? Strengths of Medical Model ? Logical; ? Empirical; ? Biological evidence; ? Pharmoco-therapy. (Rogers and Pilgrim, 2005) ? Weaknesses of Medical Model ? Mostly no proven biological causes; ? Little attention to social context; ? Over-reliance on pharmacotherapy; ? Labelling & stigmatising; ? Pathologising & paternalistic; ? Universalising explanations & treatments. (Rogers and Pilgrim, 2005) ? Bio-psycho-social model ? Biological factors ? Social factors ? Psychological factors (Meadows et al, 2007) DSM Definition of Mental Disorder ?A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning? (APA, 2013). (Bland, Renouf and Tullgren, 2015). Definition of schizophrenia ?A serious condition characterised by distortions of thinking and perception, disorganisation of thought and behaviour, cognitive problems, problems with interpersonal communication and social and functional restrictions? (Bland, Renouf and Tullgren, 2015). ? Schizophrenia ? A form of psychosis; ? 12 types – schizophrenia the most common; ? 3-5 in 1000 people in Australia (NMHS, 1997); ? Some loss of contact with reality; ? Includes delusions, hallucinations, disordered thinking, disorganised behaviour & depression. (APA, 2013) Schizophrenia – overview ? First described in 1400BC; ? Found in all cultures; ? Equal in women and men – symptom content can differ; ? Historically defined as ?chronic and deteriorating?; ? Idea of ?no hope of recovery? ? iatrogenic effects? ? 25-65% of people recover (WHO, 1967); ? People can live satisfying lives even with symptoms (Deegan, 1992; 1996; Bland et al, 2015). ? DSM diagnostic criteria and symptoms for schizophrenia ? see extra slides for Week 4 on course web site ? Social risk factors for schizophrenia ? Childhood social adversity e.g. trauma and abuse (Herman, 1997; Muesser et al, 1998); ? Negative association with socio-economic status (Rogers & Pilgrim, 2005). ? Migration (Toyokawa et al, 2012); ? Social triggers e.g. low socio-economic status, abuse, stress and racism. (Meadows et al, 2007) Social consequences ? Violence; ? Homelessness ? 30-50% of homeless population have had schizophrenia; ? Parenting – one third of people with schizophrenia have children; ? Reduced opportunities e.g. study and work; ? Stigma and victimisation. (Meadows et al, 2007) Comorbidity ? Substance abuse; ? Post-traumatic stress disorder (Muesser et al, 1998); ? Depression; ? Other mental health problems e.g. OCD; ? Physical disorders – antipsychotic drugs can cause obesity, diabetes, heart disease. (Meadows et al, 2007) Therapeutic interventions ? Anti-psychotic medication; ? Recovery approach – relationship-based case management focused on social factors, strengths, risks, goal setting, partnership; ? Psychosocial interventions e.g. cognitive-behavioural therapy, psycho-education; ? Working with families/carers. (Bland et al, 2015) Anxiety ? Most common mental health problem in developed countries (WHO, 2012); ? Can be masked by physical symptoms ? somatisation (WHO, 2012); ? Western individualism/pressure to succeed vs hopelessness/poverty (Bland et al, 2015; Barton et al in Meadows et al, 2007)n. ? Anxiety ? Anxiety is normal ? flight, fight, freeze response (Bland et al, 2015). ? Anxiety becomes a problem when no longer adaptive (Bland et al, 2015); ? Excessive fear and related behaviour disturbances (APA, 2013); ? Two to three times more common in women (APA, 2013). ? Anxiety is characterised by??. ? Excessive feelings of dread; ? Persistent worry; ? Panic or fear; ? Obsessive thoughts; ? Compulsive behaviours; ? Avoidance behaviours. (SANE, 2005 ) ? DSM on types of anxiety disorders and diagnostic criterial ? see extra slides on course web site for week 4 ? Depression ? Sadness is a common emotion; ? Problematic if major change in emotional state; ? Characterised by severity, persistence, duration; ? Feelings of worthlessness, hopelessness, extreme guilt ? Twice as many women experience depression. ? DSM on types of depression and diagnostic criterial ? see extra slides on course web site for week 4 ? Causes of anxiety and depression ? Multiple ? Triggers can include: ? Therapeutic interventions ? – anxiety and depression ? Cognitive-Behavioural Therapy (CBT) ? ? Thoughts, feelings and behaviour; ? Psycho-education, cognitive re-structuring; ? CBT with Mindfulness Therapy; ? Self-Compassion Therapy; ? Narrative Therapy (Morgan, 2007); ? Psychodynamic Therapies; ? Pharmacotherapy. BUT listening, respect, connection, empathy and non-judgemental approach most important. (from Barton et al, in Meadows et al 2007 unless otherwise indicated) Risk assessment ? Suicidal ideation and attempts common in many mental health problems. Risks – ? Young, male and unemployed; ? Isolated; ? Drug and alcohol use; ? After discharge; ? Not taking medication (for schizophrenia). ? Represents loss of hope. (Bland et al, 2015; Meadows et al, 2007) ? Summary ? Knowledge of ?conditions? in DSM necessary and important; ? Lived experience is central; ? Various therapies helpful BUT????. listening, respect, connection, empathy and non-judgemental approach most important References ? Australian Bureau of Statistics (2007) National mental health and wellbeing survey ? American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders ? DSM-5. Arlington: APA. ? Barton et al (2007) Anxiety Disorders, in Meadows et al Mental Health in Australia, South Melbourne: Oxford University Press. ? Bland, R., Renouf, N. & Tullgren, A. (2015) Social Work Practice in Mental Health, Crows Nest: Allen & Unwin. ? Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19(3), (91-97). ? Deegan, P. (1992) The Independent Living Movement and People with Psychiatric Disabilities: Taking Back Control over Our Own Lives, Psychosocial Rehabilitation Jou
rnal: 3: 15. ? References (Continued) ? Herman, J.L. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror ((Previous ed.: 1992) ed.). Basic Books. ? Meadows et al (2007) Mental Health in Australia: Collaborative Community Practice. Melbourne: Oxford University Press. ? Morgan, A. (2000) What is Narrative Therapy? An Easy to Read Introduction. Adelaide: Dulwich Centre Publications. ? Mueser, K T, Goodman, L B, Trumbetta, S L, Rosenberg, S D, Osher, F C, Vidaver, R, Auciello, P & Foy, D W, 1998, ?Trauma and posttraumatic stress disorder in severe mental illness?, Journal of Consulting Clinical Psychology, 1998, Jun 66(3), pp 493?9 ? References (continued) ? Rogers, A. & Pilgrim, D. (2005) A Sociology of Mental Health and Illness. Maindenhead: Open University Press. (2006 version is an e-book) ? SANE web site (2005) ? Toyokawa, S., Uddin, M., Koenen, K.C. and Galea, S. (2012) ?How does the social environment get into the mind??: epigenetics at the intersection of social and psychiatric epidemiology, Social Science and Medicine, 74, 67-74. ? World Health Organisation (2012) Depression. Recovery based practice To understand and achieve successful service delivery and improved outcomes for both the mental health service and consumer care, we need to consider the following To understand consumers and provide better care we need to consider how we would like to be treated and how it feels to be a consumer: Put ourselves in the consumers shoe?s: ?How does it feel to be on the other side of the door?? Always remember Consumer Rights and encourage meaningful participation. How do we engage consumers in therapeutic client centred care. Can we provide effective clinical care while still building rapport and being client focused? Can we ask clinical questions in a client centred way? Recovery the general definition Recovery 1. the act or process of recovering, especially from sickness, a shock, or a setback; recuperation 2. restoration to a former or better condition 3. the regaining of something lost Recovery in Mental Health Recovery is defined my many people and in many different ways. Recover is really about a strength based consumer focused model that helps consumers achieve their goals. Recovery is about moving away from ?do this and you will get better? to a partnership with the consumer where we as a health service and as clinicians work together with the consumers on their goals and helping them achieve what they want. People with a mental health diagnosis (regardless of what this is) want what everyone wants which is a happy life, meaningful activities, good friendships and relationship and being able to achieve there dreams. ?We want what you have? Recovery We don?t own recovery the consumer does. It is their journey and we are there to aid them in this process. Clinical recovery Clinical recovery is related to symptom management, amount of medication and contact with a health service Personal recovery Is based on their experience and their recovery and on their overall happiness and wellbeing Clinical Recovery ? Clinical recovery are the ideas that have emerged from the expertise of mental health professionals and is about reduction of symptoms, getting back to social functioning and getting back to normal. ? Most mental health services are currently geared towards clinical recovery and moving closer to personal recovery framework is a goal of many mental health services (Slade, 2009). ? Slade (2009) describes clinical recovery as being about professional accountability, as being control oriented and based on a relationship of power of the service over the individual. Clinical Recovery ? In terms of the knowledge base of clinical recovery the focus is randomised control trials guiding practice, systematic reviews and is decontextualized in terms of practice. ? Clinical recovery is scientific based and focussed on psychopathology, diagnosis, treatment and clinical expertise Personal Recovery ? Personal Recovery is an idea which has emerged from the expertise of people with lived experience of mental illness and means something different to clinical recovery. ? It is described as a deeply personal and unique experience which is about changing and shifting attitudes, values, goals with satisfaction and hope (Robert & Wolfson, 2004; Slade, 2009). ? Personal recovery is, however, said to be based upon being value centred, geared towards choice and more empowerment based than traditional clinical approaches (Slade, 2009). Personal Recovery The personal Recovery Framework is about promoting wellbeing rather than treating illness. There are four domains of recovery that have been developed from the actual lived experience or expertise of people who have experienced mental illness these are (Slade, 2009): Hope Self identity Meaning Personal responsibilities Hope The little engine that could ?I think I can I think I can? Looking forward to your future, having goals and dreams. Believing things will get better and not losing inspiration for your future Positive Emotions Happiness, Joy, Courage and Empowerment Self-identity Identifying yourself as the person you are instead of the illness you have. Being happy with who you are Finding your identity Seeing mental illness as a small bit of your life that at time you experience symptoms of and not being something that defines you and your future Focusing on your strengths not your weaknesses Meaning Developing new meaning and purpose in ones life Having goals to aim for Finding out who you really are Seeing your future as something to look forward to and not to be scared of Defining yourself by the person you are and the life you live not by the illness your experience. ?If you own your story you get to write the ending? Brene? Brown Personal responsibilities Being the driver in your life Working with and in partnership with your health workers. Taking conscious control to the events in your life Having the courage to accept responsibility for your decisions Learning from your mistakes Taking the time to learn from your experience and help it guide your future. Personal Recovery It is about rekindling hope for a productive present and a rewarding future and believing that one deserves it. Recovery involves people having a personal vision of the life they want to live, seeing and changing patterns and discovering symptoms can be managed and doing it. Recovery is about claiming the roles of a ?healthy? person rather than a ?sick person?. Recovery is about getting there. Therapist role in Clinical vs. Personal recovery Clinical Recovery You are the driver (clinician/ worker) Based on clinical improvements and outcomes Reduction in symptoms Time away from treatment Symptom management Social functioning benchmarked against illness Personal Recovery Consumers are the driver you are a co-driver Based on their goals, hopes and aspirations Social function measured by them Self management Positive identity How does recovery based practice look Seeing the real person Understanding a consumers experience Put yourself in their shoes Seeing them a person and not an illness Moving from outcomes based on clinical improvement to outcomes based on where the consumers see?s themselves Inspiring hope and encouraging them to see a future where goals and dreams are possible, not a future defined by their diagnosis How does recovery based practice look Coaching model vs. a treatment model, Acknowledging achievement Encouraging hope, aspiration and dreams Walking beside instead of mapping the path Focusing on strengths and not weaknesses Seeing a relapse not as a step back but asking what can be learned from today that they didn?t know yesterday and not suggesting a this is a step back in their journey. Learning from the Consumer Getting to know the real person Ack
nowledging there journey not minimizing the experience. It may be symptoms but its their experience Being empathic instead of sympathetic Guiding internal learning instead of teaching Consumers have the answers, its your role to aid them in discovering this themselves People learn more and take more ownership if they have discovered themselves, walk beside them. How Does a Consumer Feel? Think about how you would feel and how a mental illness could impact on you or someone you care for Think about how you would like to be treated Think about what approach would help you in these situations Think about what you would like to know How do you feel when you are first diagnosed with a Mental Illness? Denial Fear Rejection Self Doubt Lack of Self worth Different (not normal) (Crazy) These are just some of the feelings that consumers in general may experience when first diagnosed with a mental illness What does it feel like being in a psychiatric ward? Feeling trapped Feel like you have lost all freedom and rights Just want to get out Feel ashamed Afraid what people would think if they knew they had been in a psych ward (stigma) Hide their real feeling as you just want to get out Have problems accepting that they have a Mental Illness What is it like taking Medication? And why consumers often don?t want to take it Feel drained and no energy at first Might say they feel like a zombie Scared of side effects They don?t know enough about the medication they are prescribed. Don?t want to take or think you need medication Sometimes when unwell people may think that medications is trying to control them or limit them How does stigma effect a consumer? Crazy Dangerous Out of control Life is over No real future No one will like them Freak These are just some of the ideas a person may think when diagnosed, because of stigma, stigma can come from the community or a person can have their own ideas based on stigma. Stigma How can Mental Health effect your lifestyle? Isolation Confidence Self ?destructive? behaviour Effects work, study and social life May resort to drugs & alcohol to self medicate or cover up their real feelings ?Life isn?t about waiting for the storm to pass, its about learning to dance in the rain? Working together with the consumer Engaging consumer as partners in their care . Building rapport Removing the us and them (thoughts of consumers) Building a therapeutic client centred relationship. ?what do they want and how can we help them get there? Finding out early warning signs and history of current presentation. Benefits and fears (compliance of treatment) of previous and/or current treatment Planning goals Engaging consumers as partners in their care, examples in mental health care planning Ulysses Agreement This is a great starting point to engage consumers as you can talk about what they would like to happen if they get unwell Ask consumers what happen this time they got unwell and how they would like it different next time, ask them questions about there treatment, what was helpful, what are some things that they worried about, who they wanted involved. Ulysses agreement a plan for the consumer and help them think about what worked well and what could be done differently in their opinion Engaging consumer in mental health care planning ? Employment and education status, ? This is good to find out if they are working or studying. ? The follow up questions should be how is work or study going at the moment, are they areas they need assistance with, do they need doctors certificates, do they need support from the university/tafe ? If they are not working what work or study are they interested in, what have been some barriers they may have hit ? Do they need Centrelink forms completed Engaging consumer in mental health care planning Consumer wellbeing This is a great area to really explore how their mental illness effects them and what support they may need What my mental illness doesn?t stop them doing? This could be study, Caring for their family Working Exercising Caring for themselves This can be anything that they still feel confident doing when unwell Things that impact on my wellbeing, This is really triggers and what can make their wellbeing and mental health worse Ask questions about drugs and alcohol Ask question about how family and friends can impact or assist Increased stress my impact Financial issues Exam stress Increased work load Anything you think may cause stress is worth asking about Think about what makes you stressed Understanding of Mental Health This section explores the person and their families understanding of mental health Think about Medication Treatment Symptoms Diagnosis Triggers Early warning signs Stigma This leads on to early warning signs and things that help make them feel better Ask them what they noticed before becoming unwell, How was their sleep Temper Isolation Concentration Eating habits Motivation Confidence Anxiety Try to normalize as much as possible everyone notices some things that change prior to becoming unwell What helps Anything thing that makes them feel better, think outside the square Sleep Exercise Family/friends Pets The beach Good food Music Yoga Walking What helps Think about what treatment they are receiving how has this helped? Medication; how has this helped? Extra support What supports have helped Psychological therapies; how has this helped? Past and Present (what has helped in the past) What do they do to stay well? Goals What is a goal? Goals can be anything Getting up earlier Exercising Study/Work Seeing more of their family A holiday What’s one thing they want to change? What is one thing they would like to try? What are their strengths to help with this? What is the action they need to do? How is involved/responsible? Goals they have already achieved at anytime? Importance of goals Medications What medications are they taking, you prescribed and others How has the medication helped them Ask open ended questions and explore Are they sleeping better, less stressed, calmer Have other medications helped? What have they used before What is their understanding of the medication? This may be the thing impacting on compliance Medications What side effects have they experience or thought they have experienced What side effects are they scared of? Do they know how to manage these and when they should seek help? Are side effects stopping them being compliant What medications haven?t helped or they want to avoid? Why? Engaging consumers There are a number of things that you may notice from these examples. They are not making assumptions They are involving the consumer in their care. They show interest They give you a good way to assess a number of areas. Not Giving in. Recovery isn?t an easy journey sometimes its harder than the illness itself because you have to know yourself so well and plan for good times and bad times. We can?t force a person to recover, it is their journey however we can be a partner in a part of the journey and aid them with skills and knowledge we have. Its hard but its worth it and with help, personal investment and goals everyone regards of illness can have a life they want!! Consumer Centred Care Today I have discussed service delivery from a consumers view, what works well for me working in mental health and how to change practice to focus on consumers as the experts in there care. As health professional there are many ways that services can be run from very restricted practice providing little rights and freedoms to a more inclusive model that includes the consumer in there care. The outcomes of more inclusive client centred care benefits not only the consumer but reduces stigma and improves outcomes for a service as a whole. When developing a service model it is import to consider how this effects consumer care, what outcomes we are aiming for and how to provide care that concentrates on strengths and how to enable a consumer with skills on self-management. Case Management and Assessment in Mental Health Social Work Case management Developed from case work A type of planning, implementation and evaluation; Arose from expansion of community mental
health services; Assessment is early phase but occurs beyond this. Case management in mental health social work *?Case management? implies control Better thought of as partnership Complex needs = purposeful coordination Shared, inter-disciplinary responsibility Key role of social workers Recovery approach ?focus on person-in-situation/relationship (Bland, Renouf and Tullgren, 2015) What is the purpose of case management? To support clients? recovery Oriented towards the vision of recovery, social participation and social inclusion; Active and planned vs monitoring and reactive to crises. (Bland, Renouf and Tullgren, 2015). What does case management involve? Assessment of client needs; Individual service plans – key life domains, strengths & problems/risks; Monitoring & review of how client is feeling, situation & progress; Planning for case closure & discharge. (Bland, Renouf and Tullgren, 2015). Individual service plans ? 12 domains Emotional and mental wellbeing; Dealing with stress; Personal response to mental health problem; Personal safety and safety of others; Friendships and social relationships; Work, leisure and education; Daily living skills; Family?s response to a relative?s mental health problem; Income; Physical health; Housing; Rights and advocacy (Bland, Renouf and Tullgren, 2015). Levels of case management Point of contact between clients and mental health system; Internal coordination within the mental health system; Internal and external coordination; Specialist intensive case management ? most effective. (Bland, Renouf and Tullgren, 2015). Relationship and roles of a case manager Relationship is paramount ? getting to know the person (Solomonetal 2005, in Bland et al, 2015) Roles ? clinician, psychotherapist, coordinator of continuity of care, designer of strategies for achieving goals with clients, consultant team member, advocate and care planner. Focus on strengths and risks Skills (gardening); Talents (cooking); Personal virtues (patience or humour); Interpersonal skills (kindness); Interpersonal and environmental resources (family or good neighbours); Cultural knowledge; Family stories or narratives (eg migration); Occupational knowledge (caring for others); Spirituality or faith (meaning beyond the self); Hopes and dreams (a better future). *What are the challenges? Managing large workloads; Difficulty of engaging with clients who have had negative experiences in the past; Working with involuntary clients. (unless specified above, based on Bland, Renouf and Tullgren, 2015) What are the challenges? Balancing risk so there is a place for positive risk taking; Balancing accountability; Working in complex settings; Working in teams where a medical model prevails. (unless specified above, based on Bland, Renouf and Tullgren, 2015) Assessment Assessment first step in case management; Assessment = process + product; An ongoing collaborative process throughout the worker-client relationship. Mental state examination (MSE) Appearance distinctive features clothing grooming hygiene Behaviour facial expression body language and gestures posture eye contact response to the assessment itself rapport and social engagement level of arousal (e.g. calm, agitated) anxious or aggressive behaviour psychomotor activity and movement (e.g. hyperactivity, hypoactivity) unusual features (e.g. tremors, or slowed, repetitive, or involuntary movements) See course website for more dimensions of MSE Thoughts Content: delusions (rigidly held false beliefs not consistent with the person?s background) overvalued ideas (unreasonable belief, e.g. a person with anorexia believing they are overweight) preoccupations depressive thoughts self-harm, suicidal, aggressive or homicidal ideation Process: Thought process refers to the formation and coherence of thoughts and is inferred very much through the person?s speech and expression of ideas. highly irrelevant comments (loose associations or derailment) frequent changes of topic (flight of ideas or tangential thinking) *What is the flavour of the MSE? Medical Symptom-oriented Professional gaze Client passivity Objectifying Reductionist Use of mystifying language Single assessment made based on worker?s view Unequal power relations It nonetheless contributes to diagnosis Assessment in mental health social work Ongoing process of evaluating problems and strengths, including those of the environment; Focus on social context and social consequences; Focus on the relationships; Person-in-situation; Contrast with MSE; Bio-psycho-social perspective is important. (Bland et al, 2015) Strengths and Problems Strengths and problems = recovery approach. Strengths might include: Functioning in the face of distress; Bouncing back from trauma; Use of external challenges; Talents and skills; Use of social supports; Interpersonal skills; Strong intimate relationships; Extended family; Good neighbours; Use of local community services. Types of assessment Procedural and formulaic (e.g. MSE); Questioning models – a format of questions; Exchange model – most sophisticated. (Bland, Renouf and Tullgren, 2015) Exchange model Most sophisticated; More difficult; Clients have expertise; Worker?s expertise is process of problem-solving ; Can form the basis for an ongoing RELATIONSHIP; Conversational, language of the client, at client?s pace, ordinary community setting; Attitude of respectful curiosity; Systematic and draws on multiple sources? e.g. files, family etc; Numerous understandings of the person?s situation. (Bland et al, 2015) Steps Preparation ?who to see, what data, what the purpose is, limits of the task; Gathering information ?with respectful uncertainty and a research mentality?; Weighing up the data; Analysing the data; Making use of the data. (From Bland et al 2015 adapted from Milner and O?Brien, 2002) Life Domains Emotional and mental wellbeing; Dealing with stress; Personal response to mental health problem; Personal safety and safety of others; Friendships and social relationships; Work, leisure and education; Daily living skills; Family?s response to a relative?s mental health problem; Income; Physical health; Housing; Rights and advocacy (Bland, Renouf and Tullgren, 2015). Assessing risks Part of assessment and includes whether there is: Danger to self through self-harm of suicide; Danger to self through self-neglect; Dangers arising from lack of treatment; Dangers arising from offensive or provocative behaviour; Danger of exploitation by others; Danger to others through assault, exploitation or abuse or neglect of children or dependent adults. See Courtney and Moulding (2014) ? research into how social workers manage risk using a recovery approach. References Bland, R., Renouf, N. & Tullgren, A. (2015) Social Work Practice in Mental Health, Crows Nest: Allen & Unwin. Courtney, M. & Moulding, NT. (2014) ?Reconciling the irreconcilable? An exploration of how social workers manage tensions between involuntary treatment and the recovery model of mental illness?. Australian Social Work, 67(2). Practice skills in mental health social work ? Overview ? Preparation and planning ? Getting started ? Listening ? Empathic responses ? Probes ? Summarising ?people may forget what you said, they may forget what you did, but they will not forget how you made them feel???. ? Planning and preparation ? The person seeking assistance may be??.. ? Anxious – not knowing what is going to happen ? Resentful/hostile at recent diagnosis ? Annoyed e.g. trouble finding your agency, getting kids to school ? Wary/suspicious ? past experiences/stories in media ? Preparation – the interview room ? Planning & preparation ? Partnerships with other services ? Getting Started – Body language ? Awareness of body language ? SOLER Sit squarely Open posture Leaning in Eye contact Relaxed posture (Cameron, 2008 pp. 26-28) ? G
etting Started – remembering the non-verbals ? eye contact ? facial expressions ? body movements e.g. hand gestures/nodding ? focussed attention ? Listening ? stillness ? intent ? interest ? respectful ? curious ? genuine ? Listening is not? ? offering simplistic advice, platitudes or clich?s ? making internal critical judgements ? minimising the story listening requires our full attention ? changing the subject ? trying to fix it or solve it ? asking too many questions ? filling in the silences ? doing most of the talking ? Empathic Reflections ? Reflecting feelings e.g. ?You sound really stressed?? ? Reflecting situational elements e.g. ?Sounds like you have had a really tough week?? ? Reflecting behavioural elements e.g. ?Sounds like you tried really hard to manage the anxiety this week?? ? Paraphrasing e.g. ?Sounds like you?ve been pretty stressed because you?ve had a really tough week and you tried hard to manage your anxiety? ? Lead-ins to paraphrasing e.g. ?Let me see if I understand what you have been saying?.? OR ?Your main concerns seem to be that ?? ? Case example Young female client states the following 10 minutes into a first session:- ?I can?t go back to work after They saw me meltdown last week. I will never get over these panic attacks. I don?t know what to do. How do I make them stop?? ? Understandable but inappropriate responses ? ? clich?/moving along ?Everything will be OK. You?ll find that you will be able to go back to work. Let?s make a list of all the reasons you should go back to work.? ? minimising ?At least you?ve got a job. Lots of people have more difficult issues than this and they cope.? ? advice giving ?If I were you, I?d look for a new job and a fresh start.? Best not to think about your panic attacks ? it only makes them worse.? ? More appropriate empathic responses? ? ?Sounds like you are having a hard time right now and it is hard to imagine returning to work.? ? ?It?s clearly been a hard time for you. Can you tell me a little bit more about what happened at work?? ? ?Sounds as if your job means a lot to you. Can you tell me more about how you feel about work?? ? Probes ? Subtle and effective ways of gathering. Four types of probes: ? Statements ? e.g., ?I?m not sure what you mean when you say you ?lost it?? – can clarify meaning ? Requests/suggestions ? e.g., ?Can you tell me a bit more about feeling scared?? – a more direct way of asking for further information but with curiosity and interest ? Repeating a word or phrase – e.g. ?go off the deep end?? – using a suitably quizzical tone may prompt elaboration ? Non-verbal prompts ? e.g., leaning forward and/or raising your eyebrows – as in, tell me more ? Probes Helping to prioritise concerns: ? ?Jill, from everything you have said so far, what is concerning you the most?? ? ?My work situation. I mean, I?m going to lose my job if I can?t manage this anxiety and get back to work. I won?t have enough money to pay the bills, and if I have to go back to Centrelink, it will take ages before I get a payment. The kids need new school uniforms, new shoes, and books because school goes back soon ?? ? ?So you feel worried about your job because of the anxiety but you are also anxious about the time it would take to get your first payment from Centrelink ? is that what you are saying?? ? ?Yes I really need help to manage this anxiety , otherwise I don?t know what I will do? ? ?Can you tell me a bit more about how you managed your anxiety before this and how you managed to hold down the job you currently have?? ? Probes ? ?Well, I saw a counsellor for a while which seemed to help, and then I found this job with a friend in her shop and I haven?t had as much of a problem with my anxiety since then.? ? ?So by the sounds of it, things were going well, what do you think has happened since then? ? ?I don?t know, I did have a fight with my boyfriend and I was pretty upset, but we sorted it out the next day, but I noticed the anxiety sort of started about then.? ? ?A fight?? ? ?Yeah, he didn?t call me back all day and I was angry with him, but it turns out he left his phone at home. We had a bit of a yelling match at my place. We don?t fight very often, so it was pretty upsetting for me? ? ?Sounds like you felt pretty churned up and that your relationship is very important to you? ? ?Yeah, we are good mates and have fun together? ? Summarising ? attempts to tie together main themes of a client’s story ? provides feedback on what we have heard and opportunity to check if we have heard correctly? ? can help regulate the conversation , especially if the client is feeling overwhelmed ? helps review where the session is going for client and for the worker ? Summarising ? An example ?It sounds like this is a really hard time and we?ve talked about a lot of things, so I would just like to summarise what we?ve talked about so far. The anxiety appears to be your main concern at the moment, and its impact on your job and the effect this could have on being able to pay your bills. You think that it might be the fight with your partner that has set it off again. You also talked about managing your anxiety in the past and the key thing was some counselling you received at the time. You were clearly able to make use of this to manage, which is great. Before we finish our session today, I wonder if we can talk a bit about where to from here, what would you like to do ?? Next, the worker could explore aspects of a possible plan of further work together) ? Client Strengths Focusing on client strengths involves seeking strengths-based information AND emphasizing it?s significance ? Client Strengths ? Everyone has qualities that can be built on so they can reach their goals ? Not always be apparent, particularly in times of hardship and crisis ? We need to enquire C = character, courage, capacities, competencies P = possibilities, promise, positive expectations and hopes, purpose R = resilience, resourcefulness, reserves, relationships, resolve Saleeby, D. (2006). The Strengths Perspective in social work practice (p.10) ? Interviews ? ? ? Summary of skills ? Preparation ? Empathic listening ? Probes ? Summarising ? Strengths Population Approaches to Mental Health School of Psychology, Social Work and Social Policy, ? Overview ? Population approaches to mental health ? Mental health policy and strategy ? Sociology of mental health ? Stress vulnerability model ? Population Approaches Health is ?a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity? (WHO, 2002) ? Population Approaches ? Mental health as a public health issue ? Prevention ? stopping problems emerging ? Mental health promotion – process of enabling people to increase control over, and to improve their health? ? Mental health strategy ? The Mental Health Policy (2008); ? The Mental Health Plan (2009-2014); ? The Mental Health Statement of Rights and Responsibilities; ? The Medicare Agreements. ? Mental Health Policy (2008) ? Promote the mental health & wellbeing of the Australian community; ? Reduce the impact of mental health problems; ? Promote recovery; ? Assure the rights of people with mental health problems and meaningful participation in society. It is based on a population health framework. (National Mental Health Policy, 2008). ? The National Mental Health Policy (2008) recognises the need for??? ? a connected care system – consumer focused and recovery-oriented; ? attention
to promotion, prevention and early intervention across the life span that will benefit the whole community; ? collaboration and for a skilled workforce. (The National Mental Health Policy (2008) ? Prevention ? Growing attention to prevention ? Primary ? health promotion, prevention before problems start; ? Secondary ? early detection and intervention; ? Tertiary ? rehabilitation. ? Population and recovery models 1. Macro population health level But how do the two relate? 2. Individual recovery level Population models do not map out these connections well (Tew, 2005) ? Inner and outer worlds There are limited understandings of how people?s inner worlds relate to their outer worlds (Tew, 2008). ? Sociology of Mental Health ? Sociology focuses on relationship between individual & society; ? Challenges ?taking things for granted? & ?common-sense? views; ? Common sense views of mental illness are often individualistic and biological. ? Sociology of Mental Health Instead, we can ask???? ? Why is it like this? ? Why do certain mental health problems disproportionately affect particular groups of people? ? How does social context influence mental health experience? ? How does social context affect individuals? experience of mental health care? ? Four Aspects of the Sociological Imagination ? Sociological imagination ? Historical – enormous impact on who we are as individuals and societies; ? Cultural – non-biological aspects of society; ? Critical – being reflexive about the social world e.g. ?how do you know?? ? Structural ? organisation of society and impact on mental health. (Mills, 1959; Willis, 2004) ? Sociological questions Anxiety is increasing in Australia???. ? What historical shifts might help to explain this? ? What is it about the structure (organisation) of our society that causes anxiety? Which groups are most affected? ? What is it about western culture that causes anxiety? ? How do we know anxiety is increasing (critical)? What could be done differently? ? Sociological questions Suicide has increased???. ? What historical shifts might help to explain this? ? What is it about the structure (organisation) of our society that causes suicide? Which groups are most affected? ? What is it about western culture that causes suicide? ? How do we know suicides have increased (critical)? What could be done differently? ? Sociological questions Eating disorders have been increasing over four decades???. ? What historical shifts might help to explain this? ? What is it about the structure (organisation) of our society that causes eating disorders? Which groups are most affected? ? What is it about western culture that causes eating disorders? ? How do we know eating disorders have increased (critical)? What could be done differently? ? How do we bring these insights to helping individuals? By understanding the social context of mental health as the everyday contexts in which people live (Bland, Renouf and Tullgren, 2015) ? Bronfenbrenner?s ecological systems model ? Mental distress & problems of living ? ?Mental distress? is really ?the problems of living? (Tew, 2008); ? Helping people make stronger connections between inner & outer aspects of experience to make sense of distress is the foundation for recovery (Tew, 2008). ? Social factors & mental distress ? Abuse ? Social disadvantage and discrimination ? Family dynamics and communication ? Resilience ? Social Capital ? Current stress ? Stigma and social exclusion (from Tew, 2008) ? Stress-vulnerability model ? Social experiences lead to vulnerability to stress (Tienari et al, 1994, cited in Tew, 2008); ? Abuse and neural pathways for trust not being laid down; ? BUT more positive social experiences may lay down useful neurological pathways later (including therapy). (Tew, 2008) ? Abuse and mental health Powerlessness ? Individual is unable to negotiate their relationships and boundaries with others. ? ?This may be seen to construct the social aspect of a traumatic experience, and may have a profound impact on a person?s sense of self and how they negotiate relationships with others? (Tew, 2008, p. 237). ? Childhood emotional abuse & mental health ? My research question ? why do women seem to struggle more after these experiences than men? ? Gender, race & class were relevant. (Moulding, 2016) ? Childhood emotional abuse & mental health Nature of abuse???. ? Abuse of women ? being for others, body weight & appearance, sexual behaviour versus social expectations of also ?being a person?; ? Abuse of men ? achievement in sports, work, studies and ?being manly?. (Moulding, 2016) ? Childhood emotional abuse & mental health Impact of abuse????. ? Women ? lost sense of self, self-blame, guilt, shame, ED, PTSD, anxiety ? internalisation; ? Men ? blamed abusers, used violence to stop abuse, prevailed over abusers, became ?better men? – some anxiety, PTSD and ?sociopathy? but also externalisation; ? Blaming internal rather than external factors related to poorer mental health. (Moulding, 2016) ? Social approach to recovery ? Recovery in social terms = gaining control over life; ? Social circumstances than treatment or therapy; ? Stigma-busting; ? Harnessing power in relations with others; ? Interconnected-ness; ? The social as an area for change (including inside people?s heads). (Tew, 2008) ? Implications of social models for practice ? Promotion of positive mental health; ? Prevention with potentially vulnerable groups; ? Identifying vulnerability, stress, resilience in mental health assessments; ? Strategies to reduce vulnerability; ? Strategies to promote resilience; ? Promoting social inclusion and challenging discrimination; ? Working with relationship and communication issues. (from Tew, 2008) ? Summary ? Population health ? Mental health policy ? Ecological models ? Sociology of mental health ? Stress-vulnerability model ? joining the dots ? Understanding the legal context of mental health ? Session Outline ? Legislation ? Legislative principles ? Office of the Public Advocate ? Rights based approach for vulnerable older people ? Guardianship Board ? Criminal law and mental illness ? Disability legislation ? Advance care directives ? Relevant Legislation ? Mental Health Act 2009 (SA) ? Guardianship and Administration Act 1993(SA) ? Advance Care Directives Act 2013 ? Powers of Attorney and Agency Act 1984 ? Criminal Law Consolidation Act 1935 (SA) ? Equal Opportunity Act 1984 ? Disability Discrimination Act 1992 (Cth) ? Definition of Mental Health (MH Act 2009 – s3Act ) ? Mental illness is defined as any illness or disorder of the mind. ? This definition includes reasonably common conditions such as depression, other mood disorders (such as mania), schizophrenia and dementia. ? Schedule 1 ? not mental illness merely .. The definition is specific to the act ? Mental Health Act 2009 Objects s6 (a) to ensure that persons with serious mental illness? (i) receive a comprehensive range of services of the highest standard for their treatment, care and rehabilitation with the goal of bringing about their recovery as far as is possible; and (ii) retain their freedom, rights, dignity and self-respect as far as is consistent with their protection, the protection of the public and the proper delivery of the services; and (b) for that purpose, to confer appropriately limited powers to make orders for community treatment, or inpatient treatment, of such persons where required. Guiding principles s7 ? Involuntary treatment -Mental Heath Act 2009 SA ? Can only occur when an authorised medical practitioner or psychiatrist concludes that: ? (a) the person has a mental illness; and ? (b) because of the mental illness, the person requires treatment for the person’s own protection from harm (including harm involved in the continuation or deterioration of the person’s condition) or for the protection of others from
harm; ? Involuntary treatment – Mental Heath Act 2009 SA In the case of Community Treatment Orders: there are facilities and services available for appropriate treatment of the illness and there is no less restrictive means than a community treatment order of ensuring appropriate treatment of the person’s illness; in the case of Detention and Treatment Orders: there is no less restrictive means than an inpatient treatment order of ensuring appropriate treatment of the person’s illness ? Inpatient Detention and treatment orders- Mental Heath Act 2009 SA Level 1 ? maximum 7 days Can be made initially by a psychiatrist or a medical practitioner, nurse, social worker, psychologist or occupational therapist with advanced mental health training. Order must be reviewed within 24 hours Level 2 ? maximum 42 days Can be made by a psychiatrist or authorised medical practitioner before the expiry of a level 1 order. Can be revoked at any time during the order. Level 3-maximum 12 months ? Can only be made by SACAT upon application from the Director of an approved treatment centre for a person on a current level 2 or level 3 order or by the Public Advocate ? GB can on application vary or revoke an order while the order is in force. ? Community treatment orders- Mental Heath Act 2009 SA Level 1 ? maximum 28 days ? Can be made by same professionals as listed on earlier slide ? Must be reviewed within 24 hours ? Orders can be varied or revoked at any time during the 28 days. The Board must review these orders within 28 days. Level 2 ? maximum 12 months. ? Made by SACAT on application from the Public Advocate, a medical practitioner, a mental health clinician, a guardian, a medical agent, relative, friend, carer, any other person with a ?proper interest? in the matter. ? Office of the Public Advocate The role of the Office of the Public Advocate (OPA) is to promote and protect the rights of people with mental incapacity in South Australia. Responsibilities ? Guardian of last resort ? Investigation ? Education ? Advocacy ? Guardianship and Administration Act 1993 ? Recognises that people who are not able to make decisions for themselves may need additional support and assistance to ensure that a certain quality of life is maintained. ? provisions to protect a person from the risk of neglect, abuse or exploitation. ? allows SACAT to make certain orders in relation to a person with a mental incapacity. Source – SA Office Public Advocate website ? Mental Incapacity ? Guardianship and Administration Act S3 Mental incapacity means the inability of a person to look after his or her own health, safety or welfare or to manage his or her own affairs, as a result of? ? (a) any damage to, or any illness, disorder, imperfect or delayed development, impairment or deterioration, of the brain or mind; or ? (b) any physical illness or condition that renders the person unable to communicate his or her intentions or wishes in any manner whatsoever; The causes of mental incapacity can include dementia, intellectual disability, brain damage, mental illness, coma or being in a moribund state, and this must affect the person’s ability to make his or her own decisions. ? What is mental incapacity? ? Not being able to make some decisions even after the necessary information, advice and support has been given. Capacity to make a particular decision will be in doubt if a person- ? does not understand the information given or ? does not remember that information long enough to be able to make a decision or ? cannot consider the main issues, options and likely consequences involved in making that decision or ? cannot communicate the decision to others ? Alternative terms used to describe mental incapacity include ?mental impairment? and ?decision making incapacity?. ? Mental incapacity is decision specific ? It may be temporary or ongoing or may only affect certain decisions ? Capacity to make a decision can change depending on what the decision is, the complexity of the issues involved and when the decision is to be made ?E.g. a person may have a mental illness which temporarily affects their ability to manage their finances when they are unwell ? Formal assessment by GP, neurologist, geriatrician or psychiatrist ? others can provide input ? LEGISLATIVE PRINCIPLES s5 ? GAA 1. what the wishes of the person would have been if he or she had not become mentally incapacitated (where this can be determined); 2. the present wishes of the person, if these can be expressed 3. Adequacy of existing informal arrangements for the treatment and care of the person 4. Least restrictive alternative whilst still ensuring his or her proper care and protection. ? Additional Practice Guidelines ? the OPA supports the addition of two other practice guidelines in its work ? the presumption of capacity ?i.e. – there needs to be evidence that an individual cannot make their own decisions before substitute decision making is used and ? incapacity is decision specific- i.e.- there needs to be evidence that an individual cannot make a particular decision at a particular time before substitute decision making is used ? Orders ? GAA Guardianship Orders ? lifestyle and medical treatment decisions for a person with a mental incapacity. Administration Orders ? manage the financial, property and legal affairs of a person with a mental incapacity. Protected person – A person under a guardianship or administration order ? Orders as a last resort? GAA No need to apply if the person with the mental incapacity is; ? coping in the community; ? being adequately cared for by family members and/or other people; If ? there are no personal or financial problems affecting the person’s wellbeing; ? there is no conflict ? INFORMAL ARRANGEMENTS ? s 5(c) of the Guardianship and Administration Act 1993 Consideration must, in the case of the making or affirming of a guardianship or administration order, be given to the adequacy of existing informal arrangements for the care of the person or the management of his or her financial affairs and to the desirability of not disturbing those arrangements. ? Health Decisions The health practitioner is responsible for informing the person about the treatment and obtaining consent. Where a person is assessed as not being able to give consent for a particular treatment, consent must be sought from a substitute decision maker who can be: ? A substitute decision?maker appointed under an advance care directive or ? A person responsible as outlined in Section 14 of the Consent to Medical Treatment and Palliative Care Act 1995.2 in the following legal order of hierarchy. (a) guardian appointed by the Guardianship Board to make health care decisions (b) an adult domestic partner or prescribed relative with a close and continuing relationship with the person (c) an adult friend who has a close and continuing relationship (d) someone charged with the person?s ongoing day to day care and well?being (such as a Director of Care in aged or supported care) ? Substitute Decision Making-applying past wishes, values and attitudes ? Means ?standing in the shoes? of the person with the mental incapacity and trying to make the decision that the person would have made for themselves if they were still able to make that decision ? Differs from making ?best interest decisions?. Requires the decision maker to understand the person?s history, values and past lifestyle so that the best fit decision can be made ? Many decisions will require balancing competing considerations of risk and protection ? Making Decisions for Others ? Knowing how to make decisions on behalf of another person requires an understanding of: ? the rights of adults to be autonomous and in control of their own decision making ? how to facilitate adults making their own decisions ? when it is appropriate for adults to be assisted with decisio
n making or to have decisions made on their behalf ? SACAT Hearings Procedural Fairness The person the application is about has rights – ? to notice of the application and the hearing ? to know what information is before the Board ? to present evidence ? to put their views about the evidence of others ? to ask questions of anyone presenting evidence They may have advocate or support person. ? Prescribed treatment ? Prescribed treatments for a person with a mental incapacity can only be authorised by SACAT which includes: ? Under the Guardianship and Administration Act, 1993 sterilisation and termination of pregnancy ? Under the Mental Health Act, 2009 ECT (electroconvulsive therapy) and psychosurgery ? What are human rights? ? The Office of the High Commissioner for Human Rights states:- ?Human rights are rights inherent to all human beings, whatever our nationality, place of residence , sex, national or ethnic origin, colour, religion, language, or any other status. We are all equally entitled to our human rights without discrimination?. United Nations Universal Declaration of Human Rights: This means that Individuals who live with some form of mental incapacity are entitled to enjoy similar rights to every other human being. ? Rights Based Approach for vulnerable older people 1. UN principles 2. Rights of older people 3. Comparison with existing system 4. Vulnerability and capacity ? Criminal Law Consolidation Act 1935 (SA) mental illness means a pathological infirmity of the mind (can be temporary), section 269A and includes? (a) a mental illness; or (b) an intellectual disability; or (c) a disability or impairment of the mind resulting from senility but does not include intoxication. ? Mentally incompetent to commit an offence Section 269C of Criminal Law Consolidation Act 1935 (SA) states a person is mentally incompetent to commit an offence if, at the time of the alleged conduct to give rise to the offence, the person is suffering from a mental impairment and as a consequence of the mental impairment- (a) Does not know the nature and quality of the conduct, or (b) Does not know that the conduct is wrong; or (c) Is unable to control the conduct. Presumption of competence ? CLCA – Sexual Offences ? Cognitive Impairment ? In force from March 30 ? 2015 ? 2 new offences ? Sexual exploitation of a person with a cognitive impairment ? Applies to people who provide a service ? Extra deterrence S51 Criminal Law Consolidation Act ? Disability Discrimination Act 1992 Cth Covers all types of disability including mental illness Discrimination can include treating the person unfavourably because of their disability, or because of assumptions made about people with that type of disability.; Disability Discrimination Act 1992 (Cth) ? Equal Opportunity Act 1984 – SA ? Promote equality of opportunity ? And (in part) to prevent certain kinds of discrimination based on ? disability; to facilitate the participation of citizens in the economic and social life of the community; disability, in relation to mental functions includes ? total or partial loss of the person’s bodily or mental functions ? a disorder, illness or disease that affects a person’s thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour ? Advance Care Directives and other arrangements Advance Care Directives Act 2013 Act commenced on July 1st 2014 ? Creates a single advance care directive ? Enables a person to make decisions and give directions in relation to their future health care, accommodation arrangements and personal affairs ? Provides for the appointment of substitute decision-makers to make such decisions on behalf of the person if he or she is not able to make them due to impaired decision-making capacity ? Ensures that health care is delivered to the person in a manner consistent with their wishes and instructions ? Facilitates the resolution of disputes relating to advance care directives ? Provides protections for health practitioners and other persons giving effect to an advance care direction ? video ? Powers of Attorney and Agency Act 1984 ? Some questions? ? As future human service workers, how will you balance client-centred practice against the demands of risk management and involuntary treatment in everyday practice? ? How will you not become preoccupied with risk management rather than promoting and enabling client recovery? ? How will you balance the client?s right to choose or refuse treatment with the need to protect the client from a relapse? ? Acknowledgement Website of the Office of the Public Advocate, Law Handbook, Magistrate?s Court Diversion Program, Website of the Equal Opportunity Commission, Website of Australian Human Rights Commission,