9:06am, 14 Jan 2010 empoweranger

I am a consumer support worker and advocate. I hear many concerns from people about attending the emergency department due to the lack of privacy and negative attitude, lack of empathy and understanding from ED staff about what they are going through. A 24hr rapid response outreach team to support people in crisis is a much better system as people will be seen by staff with mental health knowledge and skills and greater empathy.

A reaon for diverting people to the ED was to ensure physical health care was provided as these untreated health problems may be contributing to the mental health deterioration. I believe that this is an important aspect of care, but it is not necessarily in the persons best interest to be maintained in a threatening (perceived or real) environment that will potentially make the situation worse. Medical practitioners to reveiw physical health care could be part of the admission process at appropriate facilities. If people needed to be transferred to a general health facility then this could be arranged.

I would like to see a complete overhaul of the mental health inpatient facilities. I believe many are more like prisons and not health promoting environments. I have seen a unit in Western Australia that had rooms, furnishing (indoor and outdoor) that were more like a holiday resort. There was no seclusion room as it was not needed. There was a waiting list for staff - as everyone wanted to work there. The patients commented this was the best place they had ever been.

Another factor that can support people in crisis is there element of control and decision making. There are many forms of early intervention plans (eg NSW MHOAT Wellness Plan, Ullysees Plan, etc) that enable the person when well to identify their early warning signs and support team (carer, family, friends, psychiatrist, care coordinator, GP etc). The plan would include the persons wish and needs from their support team with contact details. The plans also include early intervention strategies such as medication options, increased appointments, and admission wishes if inpatient services are required. Another important part of the plan is to identify who is going to ensure bills/ rent is paid, children & animals cared for, house secured, plants watered, employer and/or education facility contacted.

As an example my best friend is on my plan, he has a copy and he calls my care coordinator if he has concerns about my mental health. As all of the people on my plan have a copy of the plan (which I wrote and update) they will always take the call and respond appropriately. As my wishes for care are respected I am more likely to respond and participate in the care plan being enacted.

it is important if these plans are to be successful that they are respected by all the support team and impemented as much as possible to the person's wishes.

Crisis care also requires effective and efficient care post the crisis. People need to feel confident that they will be supported to return to their homes, families and lifestyle.

12:44pm, 19 Oct 2009 coniconi

Hi i' m worried about my grand father, in fact, is in a retirement home and every time i go to see him he don't do nothing, is social live is not really ecxiting and he is becoming angry! I've heard about Play Therapy but do you have any forum that talk about this and do you know if it could be good for him to participate to one these therapy?

What do you think of this!

8:26pm, 13 Oct 2009 RachM

I am concerned about the ability of mental health services to cater for acutely ill individuals in areas where drug detoxification is not a separate system. Unfortunately in our area I have spoken to individuals who were unable to access hospital care during periods of serious mania and depression due to limited resources being overwhelmed with drug patients. I am not sure if this is the case in all areas, but I think that it needs to be addressed in those areas where it is set up like that.

6:12pm, 12 Oct 2009 sherree

As an aged and disability ECA with Day Centre, Respite and Community experience, it is common to see people with various health issues; both physical and mental. Early on in my workplace training I participated in a course' Mental Health First Aid''The course enabled me to recognise the early indicators of mental health issues and what to do. I would highly recommend wide access to such a course for all people. Helping people with these problems should not be just confined to the health industry, as it encompasses all walks of life and the observant and informed could arrest the issue early. The main skill focused on was active listening!

2:05pm, 30 Sep 2009 rotraut123

I feel that mental health is everyone's business and we need to accept grater social responsibility for ourselves and others. At a professional and para-professional level services need to be integrated across primary, secondary and tertiary levels so we are not wasting resources by duplicating each others efforts.

Governments could create positions for para professionals and facilitate their growth towards full professional status this would increase the resource pool to meet the needs of many unseen clients and incorporate services.

Big picture aside creating environments of hope and affording respect and dignity by matching people with real opportunities for social inclusion and community integration seem desirable and in the long-term more productive.

9:37pm, 24 Sep 2009 Rosemary

As a nurse currently working under the mental health nurse incentive program, I believe the government has finally got it right. Ok the program has it's flaws but it is finally a step in the right direction to provide quality mental health care to our clients in the community. I currently employ 8 mental health nurses and we work under the initiative and provide outreach services to clients for GP's and private psychiatrists. I run our service as a client focused crisis resolution service and provide outreach case management.We treat clients in a wholistic manner and believe we function as a cross between a cat team, cct team, msts team and disability support service. Our clients respond extremely well to the consistant care and develop a very good working relationship with their nurse. We are available to our clients out of hours and find by dealing with issues before they develop into major problems there is a better outcome for all concerned. We have had some excellent results working in this way and the same nurse works with the client from referral through to discharge. We have the flexibility of visiting clients daily if required to keep them out of hospital and develop strong links with the clients local health network. It is so good to see a client who would normally be admitted to a psychiatric facility being well managed in their own environment by the people who care for them the most and have seen many times the impact this has upon their recovery. It is good to be able to empower families to be more actively involved in caring for family members. It reinforces the understanding they have an important role to play in clients recovery and recognises their contribution, whilst at the same time providing them with support,education and respite options. I believe the mental health nurse incentive program should be more accessible for clients and they should be able to choose to access a nurse of their choice as they can a psychologist . Nurses are skilled therapists within their own right and need to value their own worth.

11:40pm, 23 Sep 2009 School Counsellor

I work as a School Counsellor and also provide part-time private practice psychology services in Central West NSW. I am particularly concerned at the lack of easily accessible mental health services for children and adolescents in my region. While well-resourced families can and do access mental health services for their children through Medicare provisions, a very large number of families do not have the necessary resources to do this. For example, they do not have transport to get to a GP to get a Mental Health Care Plan and do not have the financial resources to pay the gap to the psychologist who provides counselling services. This will most likely sound ridiculous to anyone who has the skill and resources to effectively manage their own life, but many children / adolescents in my region live in dysfunctional families who do not effectively self-manage. I was thrilled when 'headspace' centres were established around Australia and especially when one was opened in Bathurst. These walk-in, easy access shopfront health providers are a highly effective method for young people to access mental health services. Their fomat suits the client group I am describing as it is no cost to them, walk-in, easy access and non-confrontational. I was hopeful that headspace centres would be established in other regional centres in my region. But alas, funding is being pulled from the Bathurst headspace and I was told by Dept of Health officers that there will be no more centres established. To further disadvantage children of primary school age and below, my local Community Health Centre Family Therapy team has lost half of its psychologists due to cutbacks, so their service has been greatly reduced and long waiting lists limit access to services. Parent in NSW Regional areas need to be able to readily access free mental health services for their children and teenagers need to access services themselves when their families won't / don't assist them. There are many students in the 5 schools I service as a School Counsellor who would benefit from mental health counselling, but have no access. This is short-sighted and leads to long-term mental health conditions that are expensive to treat. I plead with our Federal government to establish headspace services in all major regional centres and provide a regular youth mental health outreach service into the surrounding rural/remote townships. This will be extremely proactive and save buckets of money in the long-term.

10:29am, 23 Sep 2009 Toni Anderson of Arafmi Queensland

In the last 15 years or so, the message is starting to get through to certain quarters of the Australian community, (through the implementation of the Mind Matters Curriculum in schools around the country and the higher profile of organizations like SANE.org and Mental Health Carers ARAFMI) , that taking care of your mental health and promoting well-being is important.

This has led to more pastoral care providers in schools and parents of adolescents seeking help earlier for emerging mental health problems. Sadly, our system for providing mental health care and treatment for adolescents is woefully understaffed and under-resourced given the level of need that exists in the community today.

Given that we ALL know from a huge body of research evidence - (The Medical Journal Of Australia has many sources for this issue)- that early intervention and support from medically trained professionals working in partnership with families establish a more promising trajectory in terms of 1) the long term management of mental health issues and 2) reducing the financial and emotional costs to society, it is vital that we close the gap in the provision of treatment available for these ‘at risk’ adolescents who have been diagnosed with a mental health problem.

This is the REAL crisis facing us today.

Putting a young person under the age of 18 in a mental health unit with hard cord adult mental health patients creates a whole new set of problems and families and carers feel less confident in the value of using the system for support. The concept of Kids In Mind as a program to address mental health breakdown in young people is brilliant but there are just too few available for those in need.

With the rising number of teenagers accessing recreational drugs and binge drinking, we need to ensure that a loud and clear message is sent to our young Australians that they need to care for their bodies AND their minds. The Australian Bureau of Statistics latest report on mental health issues in our country today lists anxiety and self harm as the top concerns facing us today and we are doing so little to tackle these key reasons for mental health breakdown.

If we are going to reduce mental health crises, we need to tackle the problems at an earlier age and mandate that it is part of the school curriculum to raise awareness amongst teenagers about positive strategies for taking care of our nation’s mental health and well-being. In this way, we also support families, carers and educators who are at the coalface and dealing with young adolescents who may otherwise be vulnerable to making poor choices about the management of their own mental health.

According to Dr Michael Carr-Gregg, this is when they are questioning their identity and wondering where they fit in to the world at large, and it is also when they are most ‘at risk’ if they cannot find a place to belong. In my opinion, suicide should not be an option for so many of our young people in 2009, yet it is…

As leaders in the field of mental health we need to stop the talkfest and ACT NOW. If we are totally honest, we ALREADY know that this problem exists and that there are strategies in place to deal with these issues – we just need to train more staff, empower families and fund more capable organizations who have proven skills in the field so that we can get the job done!

In my opinion, Australia is a wonderful country in which to live and we have the capacity as a nation to lead the way in the management and treatment of mental health issues if we put our minds to it. I am proud to say I have seen a change in the last few years and am looking forward to the seeing further improvements to the mental health system in the very near future … we are so close to being great…together we can make a difference.

8:44pm, 21 Sep 2009 barbieq

Admission to an acute care unit is a wild ride. Being confronted with all types of mad people when you are feeling crazy youself is no joke.

I was very concerned also about being thrown out to the sharks (community), especially with the lack of professionals in rural areas, but thankfully found Grow.

Grow is not for the acutely ill, but is a fantastic community support and teaches you the importance of & how to become an ordinary everyday decent human being instead of a precious spoilt brat, wallowing in illness.

Too much mental health care is pandering to the preciousness of maladjusted people who can and should learn how to be "normal". I seriously believe many mental health patients thrive on the attention they get from being childish and inadequate, and from scaring people.

After all if society shuns you because you're mad, you are likely to isolate yourself & make up all sorts of excuses why you stay that way.

Grow challenges our crazy thinking. It encourages people away from isolation and into friendships with others who are there or have been there, & encourages us to help others in similar need. In helping others we actually help ourselves get better.

Why are mental health patients not routinely encouraged / referred to go to Grow?

I have met some people through Grow that are awe inspiring. They began their journey through mental illness as a crazy slobbering uncoperative mess under a doona, and ended up as responsible community citizens because they went to Grow. Proof indeed that you can recover, and that Grow does work. But it does not work for those who don't want to get better. And there are plenty of people who have beconme addicted to & consumed by their mental illness.

Everyone knows about AA for recovering alcoholics. Why doesn't everyone know about GROW for those recovering from mental illness???

Care & support for acute episodes should be based in the community, not in hospital.

The handling of mentally ill patients by hospitals is ghastly and dehumanising. Like puttng criminals all in together so they can learn better how to be a criminal.

Our Mental Health System is paternalistic and very medication oriented. It needs to be more community based & normality focused, and set to challenge patients to recover, not just medicating them and supporting them and in their state of inadequacy, maladjustment & dependence.

10:47am, 21 Sep 2009 Janet Austin

Early intervention for mental health treatment will reduce the distress and disability experienced by a person. The term 'mental health crisis' may be unhelpful to those considering early assistance for mental health issues as the individual may delay seeking assistance until he or she meets the criteria of a 'crisis'. Consider reducing the emotional language used in relation to mental health isssues. The 24 hour response issue assumes that most mental health issues are 'crises'. Consider carefully whether most mental health services could be met during business hours in a more cost effective manner, when more highly trained professionals are available to attend to the person's needs. After hours treatment may be better limited to managing immediate risk of harm to the person or others until usual working hours.

Research shows that best results are achieved when treatment provided to a person is specific to the disorder or problem. The most effective treatment requires that the therapist is competent to provide a thorough psychological assessment, develop a plan with the person, and provide treatment to meet the needs identified by the person experiencing a mental health problem. Research is clear that whilst some intervention may be useful to relieve the immediate emotional needs of a person, the person will recover fully when treatment addresses the specific underlying psychological causes of the problem. This requires that the therapist has extensive skill and training and can provide the necessary treatment at the pace that the client is capable of working through the cognitive and emotional changes that need to occur in order for a full and lasting recovery. The mental health services have the resources for this work but may not, in all instances have clinicians trained in specific interventions required for treatment. The Medicare system provides some assistance for those who can afford the 'gap' however those on a low income have limited access to mental health assistance through private psychologists due to the cost. The current system of University postgraduate training does not guarantee high quality training and experience, although there is an assumption that those successfully completing postgraduate training have achieved this level of competence. An Australia wide system of assessing the competence of individuals offering assistance through Medicare would ensure the high standard required and this is essential.

12:10pm, 18 Sep 2009 emma b

I wonder if having well-trained telephone mental health counsellors (24/7) for people and their families would be useful in this situation. I agree with many of the other comments about the lack of services, facilities and staff to meet the needs of people experiencing a mental health crisis, and I don't think it's going to get any better! I think that key issues are timely action, eg. not waiting until things are really dire before seeking help, and skilled assistance, to help the person deal with the situation. I wonder if many 'crises' arise simply because the person is 'not sick enough' to warrant the services of an overstretched system, and so they get no help until things are very bad.

11:33am, 18 Sep 2009 mentalhealthnurse

As a nurse with almost 20 years experience within the Mental Health Sector (both public and private), I welcome these Reforms. I am particularily interested in the recommendations regarding improvements to Medicare Rebates and PBS items, as the community should be able to have greater access to care from a nurse, without having to fund this themselves, as they are often already very vulnerable and experiencing hardship as a result of the mental illness. With regards to the hours clinical services are available, I agree the community should be able to access Specialist Mental Health Services 24 hours a day. It has been an ongoing frustration, shared with my colleagues. Both professionals and the community have been constrained by inadequate funding. I can honestly say, that the professionals I work with do the very best they can, but we do not hold the purse strings. If the government is serious about providing 24 hour outreach teams, some boosts to the professional workforce will be required. It will be critical to ensure that 'rapid response outreach teams' are staffed by qualified nurses, doctors and allied health staff to ensure that they truly can make a difference. With regards to the setting of care, it has been my experience that having a range of options is best. These ideally include outreach options (including community settings, workplaces/schools and homes), community health clinics, Divisions of GPs; psychiatric consultation and liaison services (for people within acute health and aged care beds) sub acute residential beds - with professionals on staff; emergency departments; short stay units and acute psychiatric inpatient beds . Not all consumers will require, or want to be seen in the same setting. For some, they prefer to come to an emergency department, and believe it a quicker and safer option. The quote regarding EDs, in my experience, may be more reflective of the ones that are not adequately designed or staffed to respond to people with mental illness presentations. I accompanied a close family member to a major emergency department (at 2am in the morning) as he was acutely depressed and had thoughts of wanting to end his life. The ED was one that had a specialist Mental Health Nurse working, not on-call, but on shift at the ED. My whole family believes this was the best response for my brother. A thorough assessment was undertaken, plan formulated and then a brief counselling session occured. He was given an appointment to come back to see the mental health nurse practitioner in two days time. He ended up seeing the Nurse Practitioner at the ED 5 times over a period of about 6 weeks, who worked with the GP for followup. I advocate for keeping EDs (that are set up well) as an option, alongside the 24 hour rapid response outreach teams.

In regards to the focus on intervening early, this is reflective of the evidence base. More than a decade of my nursing practise has been within Specialist Child and Adolescent Services. It has been rewarding to care for, and see the children and their families health and well being improve, ultimately reaching recovery. This was in contrast to some of the adults I cared for. Some of the adult clients would discuss problems they experienced during their childhood and adolescence, which with the benefit of hindsight, were contributers or indicators of untreated mental illness. Unfortunately, often by the time they were accessing the Specialist Adult Mental Health Service, their lack of previous care effected the recovery outcomes as an adult, which is not acceptable. Raising Mental Health literacy may go some way to addressing this situation. However, it can not be done in isolation. As the community becomes more aware, they will rightly expect that if they or a loved one presents with a mental illness, they will be able to receive appropriate care. With this is mind, it is essential for exisitng Mental Health Services to receive improved funding and be expanded.

This will need to include a specific focus on increases to the numbers of professioanls within the sector. Being a nurse, I can speak from this perspective. We need more support for new nurses entering the sector to be provided with nursing clinical supervision and preceptorship from exisitng, experiences nurses. Having manageable and safe workloads helps keep nurses working within the sector, and it is true that this can be improved. Making sure enrolled nurses can be assisted to become registered nurses is an area for further consideration. Looking at strengthening the professional career pathways will be important for some nurses, and I understand that the government is trying to improve options for Nurse Practitioners. Ultimately, I hope that these reforms do allow my colleagues and I to be able to continue to work in the Clinical Mental Health Sector, allow us to provide more care to more people, to improve the mental health and well being for people.

7:11am, 18 Sep 2009 pharmacist1975

I have a friend who was suicidal at Christmas time. Christmas tends to be a very stressful time for people with mental health problems. He tried to access his usual hospital service and was told that it was not a good time for hospitalisation as the psychiatrists were on leave. The mental health services should be staffed to meet the needs of people with mental health problems rather than those of the medical staff.

The other problem is that there is little continuity of care once a person has had a mental health crisis. A person will be stabilised with a psychiatrist/psychologist team in hospital and will then be discharged to the community to find another psychiatrist - often with little assistance to do so.

7:32pm, 17 Sep 2009 Sharon

As a mental health nurse I see the difficulty people have accessing the system. It is definitely not user friendly. There's so much red tape and beauracracy, it seems the patient/client often ends up feeling that they are the least important piece of the puzzle. I've worked on an acute inpatient unit and in the community, and honestly, despite the best efforts of clinicians, it's so hard for the consumer to even get a foot in the door. I know it costs and, no I don't know where the money would come from, but we have got to make the system more accessible to the huge numbers of people who need it.

1:39pm, 17 Sep 2009 stephen niemiec

There is considerable evidence in the literature that crisis resolution teams which offer 24/7 home based treatment as an alternative to inpatient admission are largely successful and that patients and carers who receive treatment from these multidisciplinary teams prefer them to other modes of treatment.

The NHS developed these teams as a national strategy based upon the evidence that had been collected up until 1999 and subsequent to that there is additional evidence to support these teams but also proves that these teams are cost effective, reduce overall admission rates by around 45%, are preferred by service users and allow specialist inpatient teams to focus their care and treatment on those whose risk to themselves or others is too great to safely manage within the community.

What is important to note in the establishment of these teams is the concept of model fidelity, ie there are certain factors that guarantee success if implemented correctly. These factors include:

1) a 24/7 availability

2) multidisciplinary working

3) the team gatekeeps admission beds, and

4) they offer alternatives to admission ie home based treatment until the crisis is resolved. These teams are not crisis intervention teams but crisis resolution teams.

12:49pm, 17 Sep 2009 Paul K

I am a credentialed mental health nurse working in a busy 5 doctor general practice under the mental health nurse incentive program, there are only 500 of us MHN's in the country and I'm not sure what percentage of us work in GP settings.

We all do great work on the coal-face of mental health issues and there needs to be more of us and more incentive (fiancially) to enable us to achieve more for those experiencing debilitating mental health issues. I would like to work more than three days a week in this role but because of the bizzare mediacre scheduling fee I cannot.

It's a great start DoHA - but with a little more negotiating and a review of the reality of setting up and fiancially maintaining private practice for nurses we could have many more mental health nurses in TRUE early intervention roles - saving the system money by intervening BEFORE a person requires hospitalisation. Yes these nursng positions can AVOID the need for hospitalisation!

I have collegues who would 'come over' to private practice, but compared to the financial safety and security of a goverment job there is currently not much incentive. DoHA, Medicare and colleges of mental health nurses and GP's need to 'get it together' to enable quality primary mental health care to be available to ALL Australians - from the health provider most Australians access first - the GP.

The process already exists in the Mental Health Nurse Incentive Program - Lets use it - and make it better than it already is!

Paul K

2:34pm, 16 Sep 2009 maria teresa

I think the best thing for emergencies is the understanding of family members or a near friend of the patient that can listen and understand the problem the patient is having.

Sometimes the emergency staff members are a little rude with the patients,and the patients become aggressive in response. The best help is the understanding and care of a person known by the patient.

12:32pm, 15 Sep 2009 juneyf

Having had a close relative suffer severe Post-natal depression, the worst thing was her being in a facility with people suffering all levels of psychosis, depression, young girls with severe anorexia. I took my young children to see her and there was blood on the floor, a man banging his head on a wall, swearing, everyone smoking etc. Here there was also a nursery with innocent, little babies in close proximity to all this. I found it one of the most disturbing experiences and my 11yr old daughter was quite shaken. Can we not have separate facilities for post-natal depression units? They simply should not be mixed in with all kinds of mental disorders.

8:22am, 15 Sep 2009 duecomment

Rapid response outreach teams need to be multi-disciplinary. It should be mandated that all who work in the health & helping professions spend 3% of their time annually in the crisis team (with appropriate training).

7:54am, 15 Sep 2009 KathrynK

As someone who has experienced severe anxiety and depression coupled with a PSTD (BPD) and spent months circling in and out of hospital; and now about to be a registered nurse, with friends who have worked in the public mental health system, I have seen how little there is besides over medication and detainment to actually treat the people. I was lucky enough to have services involved who linked me with further appropriate services, however during that time the number of people repeatedly in hospital, often so drugged they fell asleep with hot cups of tea in their hands, was shocking.

It depends on the type of crisis, but actually having crisis teams who will actually visit 24/7 instead of the acute care teams that don’t have the staff to visit overnight most of the time would definitely be of benefit. Perhaps also outreach teams who are funded and staffed enough that they can call and visit newly discharged patients for the first days to weeks to help them adjust. In hospital there is nothing to do but smoke, and now NSW has banned that (feedback from nurses I have spoken to is that patients on a relatively even keel considering their illness have lost the plot to the point of needing chemical sedation/restraint) there is little for them to do. Perhaps also setting up daily programs, optional but daily, where there are groupwork, DBT, CBT, music, self-esteem building, craft/drawing/painting, and counselling that can continue once discharged. My problem was when I was admitted I couldn’t see my outside counsellor as they didn’t have the funds/facilities to visit me as an inpatient, and then when discharged, the psychologists I saw inside couldn’t see me as an outpatient. There needs to be more coordination so that there is continuity of care and people can continue seeing a counsellor (hopefully one they resonate with) both whilst inpatient and as outpatient.

Another issue is the number of sessions people can have per year for psychotherapy. I was able to make use of 20 sessions through VCT, however I went through years of therapy, often 2-3times weekly. Granted it didn’t all help, but even when it didn’t it led to another therapist who perhaps could help. It was very hard to be able to continue with one or two therapists I resonated with and who could reach me as there simply weren’t enough sessions (20 sessions to deal with years of abuse and build so kind of self-esteem???...it’s not enough). This was also before Medicare started its 6 sessions, and again, that’s not enough.

Work on preventing the crisis and having services to support the people and check on them in the early days after discharge, and then attend the person upon receipt of a call instead of telling them to go to the hospital, just calling an ambulance, or not doing anything bar talking with them. Also, particularly as there’s nothing for them to do, have areas within the psychiatric inpatient units where patients can smoke, often they can’t work and have limited circles of friends and smoking helps them, majority will go back to it once discharged and it helps them cope better when their freedom is taken away (granted usually for their safety and that of those around).

Put more funds in and allow continuity of care, more available care, and more options for rehabilitation programs, as suggested above.