3Building a Future session outline Session One - Setting the Scene - developing a framework for understanding mental illnessSession Two - RecoverySession Three – Understanding psychosis and exploring communication
4Building a Future session outline Session Four – Understanding schizophrenia and the mental health legal systemSession Five – Grief and trauma related to mental illness, understanding depression and anxietySession Six – Understanding bipolar disorder, how families can be part of the solution
5Building a Future session outline Session Seven – Understanding dual diagnosis, mental health systems and the National Disability Insurance SchemeSession Eight - Understanding borderline personality disorder and taking care of yourselfSession Nine - Advanced communication skills
6Building a Future session outline Session Ten – Acknowledging grief and gaining strategies to continue the journey as a carerSession Eleven – Managing the fear of suicideSession Twelve – Developing a Wellness Recovery Action Plan (WRAP)
7New strategy for carers Change in ThinkingSeparate the person and the illnessAcknowledge griefUnderstand recoveryChange in BehaviourImproved communication skillsRecognise own limitsSeeking appropriate cultural supportManaging change and helpful interventionsChange in ResultsRecovery & hopeImproved relationshipsLess family stressIncreased wellness
8Risk of developing psychosis Risk of having a relapse The stress-vulnerability coping modelHIGHRisk of developing psychosisandRisk of having a relapseLOWProtective Factors good coping skills, social supports, appropriate medication, safety, cultural supportRisk Factors learning difficulties, poor social skills, poor coping skills, drug/alcohol use, low social supports, major life events, family history of mental illness, no treatment, poverty, migration, cultural alienation
9Mental illness and the brain Learning about brain biology can:give information from a biological and medical perspective (and some idea of its complexity)help you understand and support treatmentassist you in dealing with the stigmas of mental illnesssupport the realisation that no one is to blame for the onset of mental illness
14Key features of a recovery process Personal growthHopeUnderstanding and acceptanceActive copingWithdrawal to engagement and active participation inlifeActive experimentationRebuilding a sense of identityConnecting and contributingRecovery is a complex journey
15Beliefs that support recovery Recovery is always possibleRecovering is a truly unifying human experienceEach person’s recovery process is uniqueRecovering is not a linear processRecovering does not necessarily mean that symptoms ceaseDeveloping a meaningful contributing life
16Internal and external resources for recovery Internal ResourcesExternal ResourcesHopeAcceptanceSelf will/responsibilitySpiritualityCoping SkillsSocial supportMeaningful activityMedicationProfessional assistance
17Peer support‘Recovery in peer support comes from seeing ourselves as human beings rather than as mental patients’.‘By building trust and sharing experiences we are able to move beyond our perceived limitations, old patterns and ways of thinking about our mental health and the mental health of others…. into a culture of health and ability’.
18Wellness Recovery Action Plans Wellness Recovery Action PlansPlans cover aspects of:Wellness toolbox (your collection of skills, habits, books & other helpful things) and daily maintenance planImportant people to contact for supportTriggers and early warning signsWhen and who to contact for medical interventionCrisis and post crisis planning
19Separating the illness from the person Provides a framework for:Not engaging with the illnessAvoiding conflict that can’t be resolvedAllows for more compassion towards a personAllows for the expression of negative feelings about the illnessAllows you to be think in terms of strategies and be in more control of your actions and emotions
21Symptoms of psychosis Positive Symptoms Negative Symptoms Positive Symptomsare experiences and behaviours that have been added to the person’s normal way of functioningHallucinations are distortions of the senses that are very real to the person.The brain hears, sees, smells, tastes or feels things that are not there in the external world, for example: hearing voices / food tastes strange / people see things that aren’t realDelusions are fixed and false beliefs, e.g. ‘I am Jesus Christ’Negative Symptomstake away from a person’s experience of the worldFeelings of emptinessLack of energy, reduced motivationFlat moodThe sense of wellbeing and self worth can be reduced
22Substance induced psychosis Positive symptoms of psychosisTriggered by use of drugs or alcohol and occurs when withdrawing from the substance or soon afterPerson recovers when substance is no longer in bodyIncreased vulnerability to psychosis in future if the drug is reusedCaused by heroin, cocaine, alcohol, marijuana, amphetamines and benzodiazepinesDiagnosis will not be altered until a significant drug free period has elapsed without symptoms abating
23Biopsychosocial treatment of psychosis Biopsychosocial treatment of psychosisMedication may be used to manage and reduce symptomsHospitalisation may occur when a person is unsafe, others are unsafe and/or to treat serious physical conditions alongside symptoms of the psychosisRehabilitation and recovery orientated services include individual support in daily living, support to identify goals and aspirations in life, support to use personal resources and community supports to achieve these goals, support with identified need such as housing, employment, peer support
24Antipsychotic medication ‘Typical’ antipsyhotics:Older form of antipsychoticsGenerally less effective in treating negative symptomsReasons for being prescribed typical antipsychotics include:Reluctance to take medication and hence a legal order binds a person to take (or be given) medicationMedication has not been reviewed in a long time
25Antipsychotic medication ‘Atypical’ antipsyhotics:Newer form of antipsychoticGenerally has better results with different side effectsMore successful in treating positive symptoms as well as negative symptoms
26Taking antipsychotic medications Trials of medication (alone or in combination) are often needed to determine what works best for each individualSymptoms can remain even after medication has been startedWaiting to see if the medication is suitable can take time and can therefore be a challenging period
27Taking antipsychotic medications Other medication (often sedating) may be prescribed for problems such as agitation, anxiety and sleep disturbanceMedication may also be prescribed to reduce the side-effects of antipsychoticsOngoing medication treatment is often recommended if a person has more than one psychotic episode or has not recovered fully from a first episode
28Why use effective communication To give clarityTo assert the rights and needs of yourself and other family membersTo reduce conflictTo enhance relationshipsTo model skillsTo develop skills which reduce stress and risk of relapse
29Values that underpin effective communication EmpathyThe ability to understand someone from the other’s perspectiveGenuinenessTo assert the rights and needs of yourself and othersRespectValuing other people for themselves
30Assertiveness The right so say ‘no’ The right to say ‘yes’ and ‘no’ The right so say ‘no’The right to say ‘yes’ and ‘no’The right to say ‘I don’t understand’ and ‘I need some time to think about that’The right to make your own decisionsThe right to change your mindThe right to hold your own opinions and beliefs
31Issues that reduce effective communication Lack of skillsStrong emotionsIndecisionUnhelpful Environment
32Communication skillsLevelling - Effective communication can only occur when both parties know all the relevant information (thoughts, feeling and facts)Listening - This skill not only involves hearing, but actively processing what others sayValidating - This skill involves communicating to the other person that you have heard their position or opinion‘I’ statements – When you communicate how you feel to someone, make a request, or say ‘no’ to a demand, begin what you say with the expression ‘I’.
33Example of effective communication ‘I feel worried and frustrated when you don’t take your medication because it is an important aspect in the management of your illness (‘I…’ statement).I understand that you may have concerns about the side-effects of the medication (validation) and I am here to support you and listen if you need someone to talk to (willingness to listen).’
34Communicating with professionals Learn as much as you can about the service and how it functionsOffer any information that seems relevantPlan your questions and what you want to sayBe familiar with confidentiality policiesBe factual and clear in your conversationsRequest meetings to help with communicationRemember to thank people for their time and effortRecovery from illness will take teamwork
35Communicating with crisis teams Describe the previous diagnosis (if any) and current symptomsDescribe the positive symptomsDescribe any suicidal thoughts or actionsTell the crisis team about medicationExplain your experience of the illness in the past
36Who to call when in crisis The police respond to events in which there is any form of danger – along with the local crisis team. When you call the local crisis team on these occasions:The local crisis team should take responsibility to engage the police if they think it is necessaryIf there is extreme danger it would be sensible to call the police directly yourselfYou might want to call the local crisis team after your call to the police to ask them to attend as well
37Understanding the crisis team response Is the response inappropriate for the symptoms?Are the symptoms not severe enough?If so, what would indicate that they were severe enough (or when would the local crisis team become involved?)What should you do in the meantime? Are there other services that could be appropriate?
38Tips for seeking service If possible call services at non-crisis times, this allows you to think more clearly, relay the symptoms and describe the situation in a calmer wayConsider visiting your GP, they are able to make direct referrals to the crisis teamConsider taking the person to the emergency department of a general hospital
39What to tell the police That there is a history of mental illness What to tell the policeThat there is a history of mental illnessOf previous times of being taken to hospital by police, how it was done and how effective it wasWhether there is any danger to the police
40If you are unhappy about your experiences with an area mental health service Document your experiences to dateRequest a meeting with the professionals involved and discuss the issuesIf the issue is still unresolved you may consider taking further action
41Home activity Think about: Think about:One area of communication that you have a problem withWhat we have learnt about communication todayWhat communication strategy might be suitableAttempt the communicationReport next week on the outcome
43Positive symptoms of schizophrenia Positive symptoms - the excess or distortion of normal functions.These can include:Hallucinations (distortions of the senses)Delusions which are fixed and false beliefsDisorganised thinking and speechDisorganised behaviour, eg. dressing in an unusual manner
44Negative symptoms of schizophrenia Negative symptoms reflect a loss of normal function.These can include:Diminished range of emotional expressiveness most of the timeReduced speech/quieterInability to initiate and sustain goal-directed activitiesFeelings of emptiness, reduced sense of self worthLack of energy and reduced motivationFlat mood (flattened affect)
45Cognitive symptoms of schizophrenia Cognitive symptoms reflect an impairment of a person’s usual level of thinking. These can include:Impaired working memoryImpaired information processingProblems with concentratingImpaired ability to regulate behaviour based on social cues.
46The pattern of schizophrenia Most commonly schizophrenia develops in the following pattern:Prodromal phase Withdrawal and social isolationIrritabilityChange in usual behaviours/interests2. Active phaseCharacterised by the development of the psychotic symptoms.3. Stable phasePeriod where psychotic symptoms begin to remit and rebuilding offunctioning occurs
47Outcomes of schizophrenia 45% have complete or partial recovery after one or more episodes20% have unremitting symptoms and increasing disability35% have varying degrees of remission and exacerbation
48Social effects of living with schizophrenia Social stigmaSocial isolationPhysical co-morbiditiesSubstance useSocio-economic disadvantageIncreased risk of suicide
49Violence and schizophrenia There is a 0.1% increased rate of violence to others.Risk factors for being violent to others include:Being maleSubstance useActive psychotic symptomsPreviously violentPrevious victim of violenceViolent acts are often committed in private against people known to the perpetrator (commonly women).
50Social impacts of schizophrenia on families Social stigma Financial strainEmotional distressPhysical illnessSocial isolation
51Treatment for schizophrenia in the acute phase SafetyNutrition and HydrationDistress Treatment can involve:Hospitalisation or intensive medical support at homeAntipsychotic and sedating medications
52Schizoaffective disorder Schizoaffective disorderSchizoaffective disorder is a disorder in which mood changes similar to those found in bipolar disorder are present together with symptoms of schizophrenia.
53Schizoaffective disorder sub-types Schizoaffective disorder sub-typesSchizoaffective bipolar type – where symptoms include manic episodes or manic and depressive episodesSchizoaffective depressive type – where the symptoms include depressive episodes only
54Legal issues covered in this session Legal issues covered in this sessionPrinciples involved in treatmentLegal concepts that relate to mental health
55Issues to consider in relation to treatment Issues to consider in relation to treatmentMore or different treatmentWhether there is a need for admission to hospital or whether the person can stay at homeIf the person goes to hospital, how long the person should stay
56Mental Health ActsMental Health Acts are the laws that govern the provision of treatment, care, rehabilitation and protection for people who have a mental illnessMental Health Acts aim to balance the rights of people with mental illness to make their own decisions with the responsibilities of the community
57Voluntary treatmentVoluntary treatment means that the person with the mental illness agrees to treatment, either in the community living privately or in a mental health facility or in hospital.Many people who have a good understanding of their mental health may proactively seek treatment or agree to treatment when needed.
58Involuntary treatment People who have a severe mental illness may lack the capacity to recognise their need for psychiatric care and refuse treatment.In this situation, people fulfilling particular roles stipulated within the Act (often doctors, police, nurses) can recommend a person for psychiatric care.
59Community ordersCommunity orders require people to receive treatment for a mental illness whilst living in the community.People are required to accept treatment including medication and other therapy. Most often these apply to people who have a history of refusing treatment and becoming seriously unwell repeatedly after discharge from hospital.
60Informed consentOccurs when the person provides formal permission for a specific treatment to occur.The following information must be provided for informed consent to be given:Procedure or treatment Risk involved with that procedure or treatmentConsequences of not having the treatmentAlternative treatments
61Cognitive abilities for informed consent Mental illness has not interrupted the person’s thinking and understanding processes enough to make them unable to do all of the aboveIn this situation if the person is deemed to need treatment they will be made involuntary and the treatment provided
62Treatment plansAn outline of the proposed treatment, counselling, management, rehabilitation and other services to be provided to implement the community order .The method by which, the frequency with which, and the place at which the services will be provided.
63Protection of the rights of people with a mental illness Review body for involuntary statusCommunity members who have a monitoring roleSenior government department officialBody that provides free mental health legal adviceGovernment body that promotes the rights and interests of people unable to administer their own interests
65New Strategy for carers Change in ThinkingSeparate the person and the illnessAcknowledge griefUnderstand recoveryChange in BehaviourImproved communication skillsRecognise own limitsSeeking appropriate cultural supportManaging change and helpful interventionsChange in ResultsRecovery & hopeImproved relationshipsLess family stressIncreased wellness
66The grief of mental illness Can relate to:The loss of the person as you knew them prior to the illnessThe losses and changes that occur within families as a result of the illness
67The grief around mental illness is often not acknowledged Survivors are not accorded the right to grieve’(Dorka, K p5)The grief around mental illness is often not acknowledged. People feel too ashamed to acknowledge that mental illness is happening and therefore others don't know and so can’t be supportive. The numerous secondary losses are also not acknowledged.
68The loss around mental illness is psychological ‘Because the loss with mental illness is psychological and not physical, the community does not perceive the family’s loss and does not join with them with expressions of sadness and pain. There are no social or religious rituals as consolation.’ (MacGregor, 1994)
69Grief can be seen as disloyal ‘If I, in any way, fully acknowledge my grief and loss experience (loss of relationship with person, their hopes, goals and dreams) I am in some way being disloyal to the person and the hope that they will overcome their mental illness.’ (O’Dowd, G., 2002)
70The grief around mental illness is often ambiguous This refers to the uncertainty concerning the loss experience – is the loss temporary or permanent?It feels like a loss, but is it really one?
71The effects of trauma Trauma can have two consequences: Trauma can have two consequences:Fight and flight response – prepares the body to get out of the situation. Expressions of this include hyperarousal, panic, defensiveness, anger and reactivenessFreeze response – examples of emotional expressions of this include passivity, being disconnected, ashamed, can’t say no
72Possible responses to trauma and grief Acknowledge and validate your own grief experience Break the silence on your grief, speak to family and friendsFind places or people where you can comfortably talk eg. counselling to work through issues of trauma and grief
73Clinical DepressionA group of illnesses that are characterised by an excessive or long-term depressed mood that affects the person’s lifeDepression is often associated with anxietyDepression is often not recognised and, as a consequence, left untreated
75Classifications of Depression The common classifications of depression are:Mild depression Moderate depressionSevere or major depression
76Internal and external factors for depression ExternalInternalFamily conflictRelationship conflictRecent losses anddisappointmentsMental illness in the familyDrugs or alcoholMigration (forced and voluntary)DiscriminationSeparation from familyHigh anxiety, nervousnessChemical changes –post- operative,menopauseInherited disposition geneticMedical illness or treatments for medicalillness, e.g. low thyroid function, heartconditionsPast bad experiences, traumaPersonality prone to worry and/orperfection
77Lived experience of depression Expressions of helplessness and hopelessnessDepressed most of the dayLoss of interest or pleasure in activitiesReduced movementFatigue and loss of energyWeight loss or gainInsomnia Feelings of worthlessness/guiltPoor concentrationRecurrent thoughts of death
78Common responses to depression ‘We thought he was lazy and just wouldn’t get out of bed.’‘Why is she so sad? She should realise how lucky she is.’‘Why can’t you just pull yourself together and get going?’The act of acknowledging that one might be depressed and that help is available can be very liberating.
80Treatments and recovery PSYCHOLOGICAL TREATMENTSDRUG TREATMENTSCHANGE BRAIN CHEMICALSSerotoninNoradrenalineDopaminePROMOTE COPINGRESOLVE LIFE STRESSFamily conflictInterpersonal conflictRecent loss and disappointmentsREDUCE ANXIETYSTOP DRUG AND/OR ALCOHOL USEBRAIN EFFECTSImprove sleepImprove concentrationIncrease energyBetter moodDecrease anxiety
81Interventions for depression Be aware of safety issuesBe aware of hydration and nutritionConnect with the emotion of the experienceReinforce your love for the personTry to sit beside and be in the person’s space
82Common reasons why depression goes untreated StigmaPeople often blame their physical and emotional state on many other things The symptoms of depression can be dismissed as personality traits A common sign in the early stages is irritability
84Hospitalisation for people experiencing severe depression Safety of the personResolving of the psychotic symptomsNeed to monitor complications from physical illness, medication interactions or changes to antidepressant medicationsAdministration of ECT in life threatening casesStabilising and monitoring people with substance use issuesRemoving a person from a situation in which they are becoming increasingly depressed
85Community care for people with depression In cases of depression that are not life threatening, care in the community is preferred.The local crisis team may provide support and treatment to people who are not experiencing life threatening symptoms
86Complementary and self-help treatments The field of complementary and self-help treatments is increasingly being seen by the community as a treatment of choiceResearch published by Beyond Blue in indicates that Cognitive Behavioural Therapy and Interpersonal Therapy are the most effective therapiesIt is important to remember that severe depression must be assessed by a medical practitioner and treated accordingly, particularly when part of ongoing treatment
87Examples of beliefs and consequences An activating experience or event..eg retrenched from a job(2) Belief about the event:Irrational belief, ‘I am a failure’Rational beliefs: ‘I need a change. I would be better suited to something else’.(3) Emotional and behavioural consequences of beliefs:‘I can never be happy’ leads to a person becoming depressed‘I feel upset but I know this is temporary’ is a more positive response
89Types of bipolar disorder Bipolar 1 Disorder– one or more manic or mixed episodes, usually accompanied by major depressive episodes.Bipolar 2 Disorder – one or more major depressive episodes accompanied by at least one hypomanic episode.Cyclothymic Disorder – at least two years of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms
91Personal account of hypomania At first when I’m high it’s tremendous… ideas are fast… like shooting stars you follow until brighter ones appear… all shyness disappears. The right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.’ - Kay Redfield Jamison
92Personal account of mania ‘The ideas come too fast and there are too many… overwhelming confusion replaces clarity… you stop keeping up with it… memory goes. Infectious humour ceases to amuse. Your friends become frightened… everything is now against the grain… you are irritable, angry, frightened, uncontrollable and trapped.’ Kay Redfield Jamison
93Medications for Bipolar Disorder Medications for Bipolar DisorderAntipsychotic medicationMood stabilisersAnti-depressantsElectroconvulsive therapy
94Responding to early warning signs Call on what you know about communicating with someone in a psychotic or manic or depressed stateStay calmIf you have had experience of this before or have had discussions with the person when they were well, put into place any plans that you developed (i.e Wellness Action Recovery Plan)
95Seeking treatmentThink beforehand about how you are going to tell the story. The more your thoughts are organized the better you will communicate.Call on what you know about positive psychotic symptoms and those of mania and depression.Where possible, use medical words when communicating with health professionals.
96Assisting RecoveryAdequate planning for discharge if the person is hospitalisedConsider psychosocial supports in the discharge planningBe compassionate about side-effects of the medicationLet the person approach life at their own paceMove from a care-taking role to a care-giving role
97Assisting recoverySupport the achievements of the person with the mental illnessBe clear about how you will contribute to the person’s recoveryCommunicate with the rest of the family about the issues involved in recoveryIdentify the indicators and agree to a plan of action if a relapse occursConsider identifying early indicatorsConsult with your family member about the benefits of friends being informedPut as much control into the hands of the person themselves
99Do drugs and alcohol cause mental illness? Drugs and alcohol can cause a drug-induced psychosis in susceptible individuals.People remain more susceptible to the development of a psychosis if they reuse that drug.Drugs and alcohol can also be the trigger (stressor in the stress-vulnerability-coping model) to the development of schizophrenia or other psychotic illnesses.
100The effects of drugs and alcohol on people with mental illness People with mental illness use drugs for the same reasons as other peopleThe issues associated with mental illness make it harder to refrain from the use of drugs and alcoholThe immediate effect of drugs and alcohol usually provides relief from the positive mental illness symptoms
101The effects of drugs and alcohol on people with mental illness People with a dual diagnosis may readily associate the reduction of symptoms with the drug usePeople with a dual diagnosis generally have difficulty following through with treatmentBehaviours associated with dual diagnosis can be extremeDependence issues compounded with mental illness symptoms can result in overbearing behaviour, reduced concern for consequences of behaviour, reduced connections with society
102Facts about violence in society generally Men are more likely to commit violence than womenWomen are more likely to be the recipients of violenceViolence is more likely to be committed in private environments (home)Recipients of violence are more likely to be known to the perpetrator than strangers
103Violence in the context of mental illness People with mental illness are more likely to harm themselves than othersPeople with mental illness are often the recipients of violenceThe factors mentioned in previous slide about societal violenceHaving a history of being a victim of violenceAged 16 – 25Having an untreated mental illness resulting in uncontrolled positive symptoms
104Models of dependence on substances Moral view, punishment rather than treatment.Pharmacological view, alcohol or drugs seen as more powerful than ability to control use. Abstinence emphasised.Disease model, addiction seen as a disease, with physiological and genetic predisposing factors.Social learning, interaction between environment, individual and drugs in order to understand the drug experience. Drug use seen as learned and functional.
105Current treatment programs Disease model - linked to the AA approach, e.g. twelve stepsSocial learning approach - harm minimisation
106Harm minimisation strategies Using drugs only in the company of othersAlways using clean needlesPredetermining a non-drinking driverEating marijuana rather than inhalingNot mixing drugsNot mixing drinks
108Stages of Change model Stage of change Helpful support Stage of changeHelpful supportPre-contemplationHarm reduction strategiesContemplationOpportunities to assess pros and consDetermined preparationReinforcement of their reasons for wanting to change and practical adviceActionProblem solving skillsGoal settingMaintenanceSupport with strategiesRelapseReflective opportunitiesSupportReview plan for high risk situations
109Messages that support change Everyone needs messages saying:You are worth itThere are benefits in reducing drug or alcohol useYou have the ability to changeReminders of the gains that have been made along the journey
110Relapse in a social learning model In the social learning model, relapse is an expected part of change and can contribute to learning.
111Principles in treating dual diagnosis Principles in treating dual diagnosisAssessment needs to occur over an extended period of timeIn-patient admissions should take into account drug use or dependencyThe treating team should offer specific dual diagnosis treatmentMonitoring risk of suicide and self-harm is extremely important
112The impact of dual diagnosis on the family StressRisk of violenceAgitationRisk of suicideRelapsesFinancial strain
113The principles of safety first Stay calm and alert Effective communicationStay safeRemove yourself from the situation
114Community based mental health services Mental Health Crisis TeamMobile Treatment ServicesCommunity Mental Health CentresEarly Intervention Teams
115Principles of good practice in psychiatric rehabilitation Self determinationCommunity integrationInterdependence and responsibilityHaving a good lifeFamily support
116Features of the design of the National Disability Insurance Scheme Aimed at those who are most in needLong term, high quality supportRecipients will have a permanent disability that significantly affects their communication, mobility, self-care or self- management.It will have a comprehensive information and referral service, to help people with a disability that need access to mainstream, disability and community supports
117How will the National Disability Insurance Scheme work? Local Area National Disability Insurance Scheme Coordinators will:Assess needsDetermine individualised budgets that ‘consumers’ can ‘spend’ on supports and services known as support packages
118The intention of the National Disability Insurance Scheme For carers and families it aims to better support families in their caring role, and to ensure that role is nurtured and can be sustained.
119The National Disability Insurance Scheme for people with disabilities It aims to empower people with disabilities to make choices for themselves and have greater control over their own lives through designing of their own support package.
120For the National Disability Insurance Scheme to be effective people need to: Be clear about their recovery and life goalsHave access to information and advice that enables them to make choicesHave the ability to effectively communicate their preferences and needs
121Outline of the NDIS assessment and planning process Referral into the schemeAssessment by the NDIS Local Area CoordinatorPlanning and choosing services and supportsReview process
122What does ‘Reasonable and Necessary’ mean? Supports and Services:Should support the individual to achieve their goals andmaximise their independence;Should support the individual’s capacity to undertake activitiesof daily living to enable them to participate in the community and/or employment;Are effective, and evidence informed;Offer value for money;Should reflect community expectations, including what is realistic to expect from the individual, families and carers;Are best provided through a National Disability Insurance Scheme provider and not more appropriately provided through other systems of service delivery and support
123How families can help the person take control Knowing what helps them manage their illnessKnowing what they want from life and what they need so they can reach their goalsHelping to find information about different optionsAssisting the person to clearly communicate their choices
124Assessment and planning during acute illness Listen to what the person is communicating, both verbally and non-verballyWhenever possible, attend to the person’s preferencesDraw on plans that were developed while the person was less unwellCarers and family may need to take a more active and assertive role if the person’s insight and judgement is affected
125Assessment and planning during post acute illness phase of recovery Ask the person how they would like you to support them in the processAssist the person to access information about their rights and the options that are available to themEncourage the person to access advice or support from peersResist the urge to expect too much or too little: give the person space to set their own goals and articulate their own needsOffer messages of hope and encouragement
126Assessment and planning when recovery is well established Encourage the person to take the lead in the process: ask if they would like your supportRespect the person’s autonomyOffer positive feedback
127What makes a good life? Good Health Nutritious food and exercise Good HealthNutritious food and exerciseGainful employmentAdequate, secure, affordableaccommodationStrong family supportGood friendships and relationshipsA positive vision of the future lifeFinancial support to sustain a good life
128Recovery Factors Acceptance of illness Hope and courage Acceptance of illness Hope and courage Managing symptoms Education Reconstructing identity and purpose Supporting others Choice, responsibility, control and empowerment Meaningful activity Advocacy- Pat Deegan
130Borderline personality disorder Borderline personality disorder (BPD) is diagnosed on the basis of a cluster of:Long-standing problems with relationships, identity or sense of self, and theDifficulty with control of emotions and behaviourRecurrent suicidal impulses and self-harm are generally seen as a core problem area
131Borderline personality disorder Compare to someone with third degree burns - they become hypersensitive to any slight changes in the air temperature or being touched can be very painful. In the same way, someone with BPD becomes emotionally hypersensitive to what other people might say, experiencing real emotional pain and a sense of rejection over minor relational difficulties.
132The experience of borderline personality disorder People often experience problems with: Emotions and moodsAngerDepressionSelf damaging behaviourRelationships
133Risk factors for the development of borderline personality disorder Being female, 75% of people in hospitals with Borderline Personality Disorder are femaleHistory of abuse, neglect and invalidation
134Protective factors for borderline personality disorder Extended and connected familyValidating environmentGood coping skillsEmotional supportSocial inclusion and achievement
135Focus of treatment and support The major focus of the treatment is assisting people to:Understand the emotions triggering their behaviourChoose more adaptive behavioursTake responsibility for themselves and their behaviourAssociated symptoms such as depression or anxiety are treated with appropriate medication
136What can friends and family do? In addition to the general guidelines for supporting someone with a mental illness specific issues to consider in relation to BPD include:Take threats of harm seriously – talk with professionals about theseDevelop your communication and assertiveness skillsBe confident in your gut reaction – safety first every time!
137Carer financial support schemes Compensation for people who need to use their time caring for the person with a mental illness and so are unable to workCompensation for some of the costs associated with being the primary carer of someone with a mental illnessEach state or territory may also have a state based financial support program for families and carers.
138New Strategy for Carers Change in Thinking- Separate the person and the illness- Acknowledge grief- Understand recoveryChange in Behaviour- Improved communication skills- Recognise own limits- Seeking appropriate cultural support- Managing change and helpful interventionsChange in Results- Recovery & hope- Improved relationships- Less family stress- Increased wellness
139Looking to the futureInformation is power. Keep up with the task of learning about mental illnessConsider the emotional impact on yourself and seek supportConsider further developing your communication and problem solving skillsContinue the interests and activities in your lifeSeek support through available financial and practical schemes
141Aims of this session Examine assertiveness as a concept Examine assertiveness as a conceptLook at barriers to effective communicationRe-examine the four basic communication skillsExamine how to implement the four communication skillsPractice these skills by role-play related to real issues in your lives at present
142Assertiveness The right so say ‘no’ The right to say ‘yes’ and ‘no’ The right so say ‘no’The right to say ‘yes’ and ‘no’The right to say ‘I don’t understand’ and ‘I need some time to think about that’The right to make your own decisionsThe right to change your mindThe right to hold your own opinions and beliefs
143Applied communication skills Levelling – Why level? Examples of levelling...Listening – Why listen? Examples of listening...Validation – Why validate? Examples of validating....‘I’ Statements – Why ‘I’ statements? Examples of ‘I’ statements...
145Aims of this session To develop an understanding of the nature of grief in relation to mental illnessTo normalise grief and loss as a response to a changed situationTo create a safe and supportive environment in which to explore and express grief and lossTo develop a framework to provide support to one another
146Assumptions that may be challenged by loss That we are invaluableThat the world is meaningfulThat things happen for a good reasonThat bad things don’t happen to good people
147Positive ways to acknowledge grief Attending grief support programs in your area Counselling Keeping a journal - writing is catharsis for many Eating well Exercise Getting enough rest Seeking or creating comforting rituals Allowing emotions - tears can be healing Seeking out people who are able to sit with yoursadness Avoiding major changes in residence or jobs Participating in a volunteer capacity
149Aims of this session To increase knowledge about suicide as it relates to mental illnessTo develop a framework to examine our personal attitudes and how these form our view of suicideTo gain knowledge of risk factors relating to suicideTo increase knowledge of the suicide intervention model
150What behaviours indicate that someone might be about to attempt suicide? Talking about it Having a detailed plan about how they might go through withit Having someone close to them commit suicide Depression Substance use Not being committed to anything Having the means to carry out the plan A previous attempt at suicide Giving away possessions
152Aims of this session Increased knowledge about how best to equip yourself andyour family for the journey of mental illness Increased skills in forward planning to reduce the ‘dilemmasof caring’Familiarity with the rationale for a Wellness Recovery ActionPlan Increased understanding of the underlying principles for aWRAP Skills to develop a WRAP for themselves and or their familymember
153Benefits of a WRAPAim to increase people’s experience of independence and self-management of symptomsFamilies can use the principles of WRAP in assisting their loved one with a mental illnessRecognises the particular difficulty of decision-making at the point of relapse
154Components of a WRAPStep One - Notice Early Warning Signs or Relapse SignatureStep Two - Notice stress triggersStep Three - Develop action planNominate helpful coping strategiesDevelop a medication strategyWrite an essential contact listAgree steps for others to help
155WRAP principles Keep it simple Make it yours Keep it simpleMake it yoursWork with others, eg. Other family members, doctors, case managersKnow your plan - rehearse, adjust, write it down, have it handy