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Session One Slides Session One - Setting the Scene - developing a framework for understanding mental illness Session Two - Recovery Session Three – Understanding.

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Presentation on theme: "Session One Slides Session One - Setting the Scene - developing a framework for understanding mental illness Session Two - Recovery Session Three – Understanding."— Presentation transcript:


2 Session One Slides

3 Session One - Setting the Scene - developing a framework for understanding mental illness Session Two - Recovery Session Three – Understanding psychosis and exploring communication Building a Future session outline

4 Session Four – Understanding schizophrenia and the mental health legal system Session Five – Grief and trauma related to mental illness, understanding depression and anxiety Session Six – Understanding bipolar disorder, how families can be part of the solution Building a Future session outline

5 Session Seven – Understanding dual diagnosis, mental health systems and the National Disability Insurance Scheme Session Eight - Understanding borderline personality disorder and taking care of yourself Session Nine - Advanced communication skills Building a Future session outline

6 Session Ten – Acknowledging grief and gaining strategies to continue the journey as a carer Session Eleven – Managing the fear of suicide Session Twelve – Developing a Wellness Recovery Action Plan (WRAP) Building a Future session outline

7 New strategy for carers Change in ThinkingSeparate the person and the illness Acknowledge grief Understand recovery Change in BehaviourImproved communication skills Recognise own limits Seeking appropriate cultural support Managing change and helpful interventions Change in ResultsRecovery & hope Improved relationships Less family stress Increased wellness

8 HIGH Risk of developing psychosis and Risk of having a relapse LOW Risk Factors learning difficulties, poor social skills, poor coping skills, drug/alcohol use, low social supports, major life events, family history of mental illness, no treatment, poverty, migration, cultural alienation Protective Factors good coping skills, social supports, appropriate medication, safety, cultural support The stress-vulnerability coping model

9 Learning about brain biology can: give information from a biological and medical perspective (and some idea of its complexity) help you understand and support treatment assist you in dealing with the stigmas of mental illness support the realisation that no one is to blame for the onset of mental illness Mental illness and the brain

10 Neurotransmitters & Synapses

11 The brain

12 Cycling forward TIME

13 Session Two Slides

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

15 Beliefs that support recovery Recovery is always possible Recovering is a truly unifying human experience Each person’s recovery process is unique Recovering is not a linear process Recovering does not necessarily mean that symptoms cease Developing a meaningful contributing life

16 Internal and external resources for recovery Internal ResourcesExternal Resources Hope Acceptance Self will/responsibility Spirituality Coping Skills Social support Meaningful activity Medication Professional assistance

17 ‘Recovery in peer support comes from seeing ourselves as human beings rather than as mental patients’. ‘By building trust and sharing experiences we are able to move beyond our perceived limitations, old patterns and ways of thinking about our mental health and the mental health of others…. into a culture of health and ability’. Peer support

18 Wellness Recovery Action Plans Plans cover aspects of: Wellness toolbox (your collection of skills, habits, books & other helpful things) and daily maintenance plan Important people to contact for support Triggers and early warning signs When and who to contact for medical intervention Crisis and post crisis planning

19 Separating the illness from the person Provides a framework for: Not engaging with the illness Avoiding conflict that can’t be resolved Allows for more compassion towards a person Allows for the expression of negative feelings about the illness Allows you to be think in terms of strategies and be in more control of your actions and emotions

20 Session Three Slides

21 Symptoms of psychosis Positive Symptoms are experiences and behaviours that have been added to the person’s normal way of functioning Hallucinations are distortions of the senses that are very real to the person. The brain hears, sees, smells, tastes or feels things that are not there in the external world, for example: hearing voices / food tastes strange / people see things that aren’t real Delusions are fixed and false beliefs, e.g. ‘I am Jesus Christ’ Negative Symptoms take away from a person’s experience of the world Feelings of emptiness Lack of energy, reduced motivation Flat mood The sense of wellbeing and self worth can be reduced

22 Substance induced psychosis Positive symptoms of psychosis Triggered by use of drugs or alcohol and occurs when withdrawing from the substance or soon after Person recovers when substance is no longer in body Increased vulnerability to psychosis in future if the drug is reused Caused by heroin, cocaine, alcohol, marijuana, amphetamines and benzodiazepines Diagnosis will not be altered until a significant drug free period has elapsed without symptoms abating

23 Biopsychosocial treatment of psychosis Medication may be used to manage and reduce symptoms Hospitalisation may occur when a person is unsafe, others are unsafe and/or to treat serious physical conditions alongside symptoms of the psychosis Rehabilitation and recovery orientated services include individual support in daily living, support to identify goals and aspirations in life, support to use personal resources and community supports to achieve these goals, support with identified need such as housing, employment, peer support

24 Antipsychotic medication ‘Typical’ antipsyhotics: Older form of antipsychotics Generally less effective in treating negative symptoms Reasons for being prescribed typical antipsychotics include: Reluctance to take medication and hence a legal order binds a person to take (or be given) medication Medication has not been reviewed in a long time

25 Antipsychotic medication ‘Atypical’ antipsyhotics: Newer form of antipsychotic Generally has better results with different side effects More successful in treating positive symptoms as well as negative symptoms

26 Taking antipsychotic medications Trials of medication (alone or in combination) are often needed to determine what works best for each individual Symptoms can remain even after medication has been started Waiting to see if the medication is suitable can take time and can therefore be a challenging period

27 Taking antipsychotic medications Other medication (often sedating) may be prescribed for problems such as agitation, anxiety and sleep disturbance Medication may also be prescribed to reduce the side-effects of antipsychotics Ongoing medication treatment is often recommended if a person has more than one psychotic episode or has not recovered fully from a first episode

28 Why use effective communication To give clarity To assert the rights and needs of yourself and other family members To reduce conflict To enhance relationships To model skills To develop skills which reduce stress and risk of relapse

29 Values that underpin effective communication Empathy The ability to understand someone from the other’s perspective Genuineness To assert the rights and needs of yourself and others Respect Valuing other people for themselves

30 Assertiveness The right so say ‘no’ The right to say ‘yes’ and ‘no’ The right to say ‘I don’t understand’ and ‘I need some time to think about that’ The right to make your own decisions The right to change your mind The right to hold your own opinions and beliefs

31 Issues that reduce effective communication Lack of skills Strong emotions Indecision Unhelpful Environment

32 Communication skills Levelling - Effective communication can only occur when both parties know all the relevant information (thoughts, feeling and facts) Listening - This skill not only involves hearing, but actively processing what others say Validating - This skill involves communicating to the other person that you have heard their position or opinion ‘I’ statements – When you communicate how you feel to someone, make a request, or say ‘no’ to a demand, begin what you say with the expression ‘I’.

33 Example of effective communication ‘I feel worried and frustrated when you don’t take your medication because it is an important aspect in the management of your illness (‘I…’ statement). I understand that you may have concerns about the side-effects of the medication (validation) and I am here to support you and listen if you need someone to talk to (willingness to listen).’

34 Communicating with professionals Learn as much as you can about the service and how it functions Offer any information that seems relevant Plan your questions and what you want to say Be familiar with confidentiality policies Be factual and clear in your conversations Request meetings to help with communication Remember to thank people for their time and effort Recovery from illness will take teamwork

35 Describe the previous diagnosis (if any) and current symptoms Describe the positive symptoms Describe any suicidal thoughts or actions Tell the crisis team about medication Explain your experience of the illness in the past Communicating with crisis teams

36 The police respond to events in which there is any form of danger – along with the local crisis team. When you call the local crisis team on these occasions: The local crisis team should take responsibility to engage the police if they think it is necessary If there is extreme danger it would be sensible to call the police directly yourself You might want to call the local crisis team after your call to the police to ask them to attend as well Who to call when in crisis

37 Understanding the crisis team response Is the response inappropriate for the symptoms? Are the symptoms not severe enough? If so, what would indicate that they were severe enough (or when would the local crisis team become involved?) What should you do in the meantime? Are there other services that could be appropriate?

38 Tips for seeking service If possible call services at non-crisis times, this allows you to think more clearly, relay the symptoms and describe the situation in a calmer way Consider visiting your GP, they are able to make direct referrals to the crisis team Consider taking the person to the emergency department of a general hospital

39 That there is a history of mental illness Of previous times of being taken to hospital by police, how it was done and how effective it was Whether there is any danger to the police What to tell the police

40 Document your experiences to date Request a meeting with the professionals involved and discuss the issues If the issue is still unresolved you may consider taking further action If you are unhappy about your experiences with an area mental health service

41 Think about: One area of communication that you have a problem with What we have learnt about communication today What communication strategy might be suitable Attempt the communication Report next week on the outcome Home activity

42 Session Four Slides

43 Positive symptoms - the excess or distortion of normal functions. These can include: Hallucinations (distortions of the senses) Delusions which are fixed and false beliefs Disorganised thinking and speech Disorganised behaviour, eg. dressing in an unusual manner Positive symptoms of schizophrenia

44 Negative symptoms reflect a loss of normal function. These can include: Negative symptoms of schizophrenia Diminished range of emotional expressiveness most of the time Reduced speech/quieter Inability to initiate and sustain goal-directed activities Feelings of emptiness, reduced sense of self worth Lack of energy and reduced motivation Flat mood (flattened affect)

45 Cognitive symptoms of schizophrenia Cognitive symptoms reflect an impairment of a person’s usual level of thinking. These can include: Impaired working memory Impaired information processing Problems with concentrating Impaired ability to regulate behaviour based on social cues.

46 The pattern of schizophrenia Most commonly schizophrenia develops in the following pattern: 1.Prodromal phase Withdrawal and social isolation Irritability Change in usual behaviours/interests 2. Active phase Characterised by the development of the psychotic symptoms. 3. Stable phase Period where psychotic symptoms begin to remit and rebuilding of functioning occurs

47 Outcomes of schizophrenia 45% have complete or partial recovery after one or more episodes 20% have unremitting symptoms and increasing disability 35% have varying degrees of remission and exacerbation

48 Social effects of living with schizophrenia Social stigma Social isolation Physical co-morbidities Substance use Socio-economic disadvantage Increased risk of suicide

49 Violence and schizophrenia There is a 0.1% increased rate of violence to others. Risk factors for being violent to others include: Being male Substance use Active psychotic symptoms Previously violent Previous victim of violence Violent acts are often committed in private against people known to the perpetrator (commonly women).

50 Social stigma Financial strain Emotional distress Physical illness Social isolation Social impacts of schizophrenia on families

51 Treatment for schizophrenia in the acute phase Safety Nutrition and Hydration Distress Treatment can involve: Hospitalisation or intensive medical support at home Antipsychotic and sedating medications

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

53 Schizoaffective disorder sub-types Schizoaffective bipolar type – where symptoms include manic episodes or manic and depressive episodes Schizoaffective depressive type – where the symptoms include depressive episodes only

54 Legal issues covered in this session Principles involved in treatment Legal concepts that relate to mental health

55 Issues to consider in relation to treatment More or different treatment Whether there is a need for admission to hospital or whether the person can stay at home If the person goes to hospital, how long the person should stay

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

57 Voluntary treatment Voluntary treatment means that the person with the mental illness agrees to treatment, either in the community living privately or in a mental health facility or in hospital. Many people who have a good understanding of their mental health may proactively seek treatment or agree to treatment when needed.

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

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

60 Informed consent Occurs when the person provides formal permission for a specific treatment to occur. The following information must be provided for informed consent to be given: Procedure or treatment Risk involved with that procedure or treatment Consequences of not having the treatment Alternative treatments

61 Cognitive abilities for informed consent Mental illness has not interrupted the person’s thinking and understanding processes enough to make them unable to do all of the above In this situation if the person is deemed to need treatment they will be made involuntary and the treatment provided

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

63 Protection of the rights of people with a mental illness Review body for involuntary status Community members who have a monitoring role Senior government department official Body that provides free mental health legal advice Government body that promotes the rights and interests of people unable to administer their own interests

64 Session Five Slides

65 New Strategy for carers Change in Thinking Separate the person and the illness Acknowledge grief Understand recovery Change in BehaviourImproved communication skills Recognise own limits Seeking appropriate cultural support Managing change and helpful interventions Change in ResultsRecovery & hope Improved relationships Less family stress Increased wellness

66 Can relate to : The loss of the person as you knew them prior to the illness The losses and changes that occur within families as a result of the illness The grief of mental illness

67 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. The grief around mental illness is often not acknowledged

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

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

70 This refers to the uncertainty concerning the loss experience – is the loss temporary or permanent? It feels like a loss, but is it really one? The grief around mental illness is often ambiguous

71 Trauma can have two consequences: Fight and flight response – prepares the body to get out of the situation. Expressions of this include hyperarousal, panic, defensiveness, anger and reactiveness Freeze response – examples of emotional expressions of this include passivity, being disconnected, ashamed, can’t say no The effects of trauma

72 Possible responses to trauma and grief Acknowledge and validate your own grief experience Break the silence on your grief, speak to family and friends Find places or people where you can comfortably talk eg. counselling to work through issues of trauma and grief

73 Clinical Depression A group of illnesses that are characterised by an excessive or long-term depressed mood that affects the person’s life Depression is often associated with anxiety Depression is often not recognised and, as a consequence, left untreated

74 The Mood Graph

75 Classifications of Depression The common classifications of depression are: Mild depression Moderate depression Severe or major depression

76 External Internal Family conflict Relationship conflict Recent losses and disappointments Mental illness in the family Drugs or alcohol Migration (forced and voluntary) Discrimination Separation from family High anxiety, nervousness Chemical changes –post- operative, menopause Inherited disposition genetic Medical illness or treatments for medical illness, e.g. low thyroid function, heart conditions Past bad experiences, trauma Personality prone to worry and/or perfection Internal and external factors for depression

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

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

79 Physical impacts of depression

80 Treatments and recovery DRUG TREATMENTS PSYCHOLOGICAL TREATMENTS PROMOTE COPING CHANGE BRAIN CHEMICALS Serotonin Noradrenaline Dopamine RESOLVE LIFE STRESS Family conflict Interpersonal conflict Recent loss and disappointments REDUCE ANXIETY STOP DRUG AND/OR ALCOHOL USE BRAIN EFFECTS Improve sleep Improve concentration Increase energy Better mood Decrease anxiety

81 Interventions for depression Be aware of safety issues Be aware of hydration and nutrition Connect with the emotion of the experience Reinforce your love for the person Try to sit beside and be in the person’s space

82 Common reasons why depression goes untreated Stigma People often blame their physical and emotional state on many other things The symptoms of depression can be dismissed as personality traits A common sign in the early stages is irritability

83 Recovery from depression Biological Psychological Environmental AcuteMedication / ECTSafety Security Hospital Intensive support RecoveryMedication / ECTTalking therapy Communication skills Support Friendship Inter-dependence Employment Housing Responsibility

84 Safety of the person Resolving of the psychotic symptoms Need to monitor complications from physical illness, medication interactions or changes to antidepressant medications Administration of ECT in life threatening cases Stabilising and monitoring people with substance use issues Removing a person from a situation in which they are becoming increasingly depressed Hospitalisation for people experiencing severe depression

85 In cases of depression that are not life threatening, care in the community is preferred. The local crisis team may provide support and treatment to people who are not experiencing life threatening symptoms Community care for people with depression

86 The field of complementary and self-help treatments is increasingly being seen by the community as a treatment of choice Research published by Beyond Blue in 2008 indicates that Cognitive Behavioural Therapy and Interpersonal Therapy are the most effective therapies It is important to remember that severe depression must be assessed by a medical practitioner and treated accordingly, particularly when part of ongoing treatment Complementary and self-help treatments

87 (1)An activating experience or retrenched from a job (2) Belief about the event: -Irrational belief, ‘I am a failure’ -Rational beliefs: ‘I need a change. I would be better suited to something else’. (3) Emotional and behavioural consequences of beliefs: -‘I can never be happy’ leads to a person becoming depressed - ‘I feel upset but I know this is temporary’ is a more positive response Examples of beliefs and consequences

88 Session Six Slides

89 Types of bipolar disorder Bipolar 1 Disorder– one or more manic or mixed episodes, usually accompanied by major depressive episodes. Bipolar 2 Disorder – one or more major depressive episodes accompanied by at least one hypomanic episode. Cyclothymic Disorder – at least two years of numerous periods of hypomanic symptoms and numerous periods of depressive symptoms

90 Review of the Mood Graph

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

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

93 Antipsychotic medication Mood stabilisers Anti-depressants Electroconvulsive therapy Medications for Bipolar Disorder

94 Call on what you know about communicating with someone in a psychotic or manic or depressed state Stay calm If you have had experience of this before or have had discussions with the person when they were well, put into place any plans that you developed (i.e Wellness Action Recovery Plan ) Responding to early warning signs

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

96 Assisting Recovery Adequate planning for discharge if the person is hospitalised Consider psychosocial supports in the discharge planning Be compassionate about side-effects of the medication Let the person approach life at their own pace Move from a care-taking role to a care-giving role

97 Assisting recovery Support the achievements of the person with the mental illness Be clear about how you will contribute to the person’s recovery Communicate with the rest of the family about the issues involved in recovery Identify the indicators and agree to a plan of action if a relapse occurs Consider identifying early indicators Consult with your family member about the benefits of friends being informed Put as much control into the hands of the person themselves

98 Session Seven

99 Do drugs and alcohol cause mental illness? Drugs and alcohol can cause a drug-induced psychosis in susceptible individuals. People remain more susceptible to the development of a psychosis if they reuse that drug. Drugs and alcohol can also be the trigger (stressor in the stress-vulnerability-coping model) to the development of schizophrenia or other psychotic illnesses.

100 People with mental illness use drugs for the same reasons as other people The issues associated with mental illness make it harder to refrain from the use of drugs and alcohol The immediate effect of drugs and alcohol usually provides relief from the positive mental illness symptoms The effects of drugs and alcohol on people with mental illness

101 People with a dual diagnosis may readily associate the reduction of symptoms with the drug use People with a dual diagnosis generally have difficulty following through with treatment Behaviours associated with dual diagnosis can be extreme Dependence issues compounded with mental illness symptoms can result in overbearing behaviour, reduced concern for consequences of behaviour, reduced connections with society The effects of drugs and alcohol on people with mental illness

102 Men are more likely to commit violence than women Women are more likely to be the recipients of violence Violence is more likely to be committed in private environments (home) Recipients of violence are more likely to be known to the perpetrator than strangers Facts about violence in society generally

103 People with mental illness are more likely to harm themselves than others People with mental illness are often the recipients of violence The factors mentioned in previous slide about societal violence Having a history of being a victim of violence Aged 16 – 25 Having an untreated mental illness resulting in uncontrolled positive symptoms Violence in the context of mental illness

104 Moral view, punishment rather than treatment. Pharmacological view, alcohol or drugs seen as more powerful than ability to control use. Abstinence emphasised. Disease model, addiction seen as a disease, with physiological and genetic predisposing factors. Social learning, interaction between environment, individual and drugs in order to understand the drug experience. Drug use seen as learned and functional. Models of dependence on substances

105 Disease model - linked to the AA approach, e.g. twelve steps Social learning approach - harm minimisation Current treatment programs

106 Using drugs only in the company of others Always using clean needles Predetermining a non-drinking driver Eating marijuana rather than inhaling Not mixing drugs Not mixing drinks Harm minimisation strategies

107 Stages of change model

108 Stages of Change model Stage of changeHelpful support Pre-contemplationHarm reduction strategies Contemplation Opportunities to assess pros and cons Determined preparation Reinforcement of their reasons for wanting to change and practical advice Action Problem solving skills Goal setting MaintenanceSupport with strategies Relapse Reflective opportunities Support Review plan for high risk situations

109 Messages that support change Everyone needs messages saying : You are worth it There are benefits in reducing drug or alcohol use You have the ability to change Reminders of the gains that have been made along the journey

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

111 Assessment needs to occur over an extended period of time In-patient admissions should take into account drug use or dependency The treating team should offer specific dual diagnosis treatment Monitoring risk of suicide and self-harm is extremely important Principles in treating dual diagnosis

112 Stress Risk of violence Agitation Risk of suicide Relapses Financial strain The impact of dual diagnosis on the family

113 Stay calm and alert Effective communication Stay safe Remove yourself from the situation The principles of safety first

114 Mental Health Crisis Team Mobile Treatment Services Community Mental Health Centres Early Intervention Teams Community based mental health services

115 Self determination Community integration Interdependence and responsibility Having a good life Family support Principles of good practice in psychiatric rehabilitation

116 Aimed at those who are most in need Long term, high quality support Recipients will have a permanent disability that significantly affects their communication, mobility, self-care or self- management. It will have a comprehensive information and referral service, to help people with a disability that need access to mainstream, disability and community supports Features of the design of the National Disability Insurance Scheme

117 Local Area National Disability Insurance Scheme Coordinators will: Assess needs Determine individualised budgets that ‘consumers’ can ‘spend’ on supports and services known as support packages How will the National Disability Insurance Scheme work?

118 For carers and families it aims to better support families in their caring role, and to ensure that role is nurtured and can be sustained. The intention of the National Disability Insurance Scheme

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

120 Be clear about their recovery and life goals Have access to information and advice that enables them to make choices Have the ability to effectively communicate their preferences and needs For the National Disability Insurance Scheme to be effective people need to:

121 Referral into the scheme Assessment by the NDIS Local Area Coordinator Planning and choosing services and supports Review process Outline of the NDIS assessment and planning process

122 Supports and Services: Should support the individual to achieve their goals and maximise their independence; Should support the individual’s capacity to undertake activities of daily living to enable them to participate in the community and/or employment; Are effective, and evidence informed; Offer value for money; Should reflect community expectations, including what is realistic to expect from the individual, families and carers; Are best provided through a National Disability Insurance Scheme provider and not more appropriately provided through other systems of service delivery and support What does ‘Reasonable and Necessary’ mean?

123 Knowing what helps them manage their illness Knowing what they want from life and what they need so they can reach their goals Helping to find information about different options Assisting the person to clearly communicate their choices How families can help the person take control

124 Listen to what the person is communicating, both verbally and non-verbally Whenever possible, attend to the person’s preferences Draw on plans that were developed while the person was less unwell Carers and family may need to take a more active and assertive role if the person’s insight and judgement is affected Assessment and planning during acute illness

125 Ask the person how they would like you to support them in the process Assist the person to access information about their rights and the options that are available to them Encourage the person to access advice or support from peers Resist the urge to expect too much or too little: give the person space to set their own goals and articulate their own needs Offer messages of hope and encouragement Assessment and planning during post acute illness phase of recovery

126 Encourage the person to take the lead in the process: ask if they would like your support Respect the person’s autonomy Offer positive feedback Assessment and planning when recovery is well established

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

128 Acceptance of illness Hope and courage Managing symptoms Education Reconstructing identity and purpose Supporting others Choice, responsibility, control and empowerment Meaningful activity Advocacy - Pat Deegan Recovery Factors

129 Session Eight Slides

130 Borderline personality disorder (BPD) is diagnosed on the basis of a cluster of: Long-standing problems with relationships, identity or sense of self, and the Difficulty with control of emotions and behaviour Recurrent suicidal impulses and self-harm are generally seen as a core problem area Borderline personality disorder

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

132 People often experience problems with: Emotions and moods Anger Depression Self damaging behaviour Relationships The experience of borderline personality disorder

133 Being female, 75% of people in hospitals with Borderline Personality Disorder are female History of abuse, neglect and invalidation Risk factors for the development of borderline personality disorder

134 Extended and connected family Validating environment Good coping skills Emotional support Social inclusion and achievement Protective factors for borderline personality disorder

135 The major focus of the treatment is assisting people to: Understand the emotions triggering their behaviour Choose more adaptive behaviours Take responsibility for themselves and their behaviour Associated symptoms such as depression or anxiety are treated with appropriate medication Focus of treatment and support

136 In addition to the general guidelines for supporting someone with a mental illness specific issues to consider in relation to BPD include : Take threats of harm seriously – talk with professionals about these Develop your communication and assertiveness skills Be confident in your gut reaction – safety first every time! What can friends and family do?

137 Compensation for people who need to use their time caring for the person with a mental illness and so are unable to work Compensation for some of the costs associated with being the primary carer of someone with a mental illness Each state or territory may also have a state based financial support program for families and carers. Carer financial support schemes

138 New Strategy for Carers Change in Thinking- Separate the person and the illness - Acknowledge grief - Understand recovery Change in Behaviour- Improved communication skills - Recognise own limits - Seeking appropriate cultural support - Managing change and helpful interventions Change in Results- Recovery & hope - Improved relationships - Less family stress - Increased wellness

139 Information is power. Keep up with the task of learning about mental illness Consider the emotional impact on yourself and seek support Consider further developing your communication and problem solving skills Continue the interests and activities in your life Seek support through available financial and practical schemes Looking to the future

140 Session Nine Slides

141 Examine assertiveness as a concept Look at barriers to effective communication Re-examine the four basic communication skills Examine how to implement the four communication skills Practice these skills by role-play related to real issues in your lives at present Aims of this session

142 Assertiveness The right so say ‘no’ The right to say ‘yes’ and ‘no’ The right to say ‘I don’t understand’ and ‘I need some time to think about that’ The right to make your own decisions The right to change your mind The right to hold your own opinions and beliefs

143 Applied communication skills Levelling – Why level? Examples of levelling... Listening – Why listen? Examples of listening... Validation – Why validate? Examples of validating.... ‘I’ Statements – Why ‘I’ statements? Examples of ‘I’ statements...

144 Session Ten Slides

145 To develop an understanding of the nature of grief in relation to mental illness To normalise grief and loss as a response to a changed situation To create a safe and supportive environment in which to explore and express grief and loss To develop a framework to provide support to one another Aims of this session

146 That we are invaluable That the world is meaningful That things happen for a good reason That bad things don’t happen to good people Assumptions that may be challenged by loss

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

148 Session Eleven Slides

149 To increase knowledge about suicide as it relates to mental illness To develop a framework to examine our personal attitudes and how these form our view of suicide To gain knowledge of risk factors relating to suicide To increase knowledge of the suicide intervention model Aims of this session

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

151 Session Twelve Slides

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

153 Aim to increase people’s experience of independence and self-management of symptoms Families can use the principles of WRAP in assisting their loved one with a mental illness Recognises the particular difficulty of decision-making at the point of relapse Benefits of a WRAP

154 Step One - Notice Early Warning Signs or Relapse Signature Step Two - Notice stress triggers Step Three - Develop action plan −Nominate helpful coping strategies −Develop a medication strategy −Write an essential contact list −Agree steps for others to help Components of a WRAP

155 Keep it simple Make it yours Work with others, eg. Other family members, doctors, case managers Know your plan - rehearse, adjust, write it down, have it handy WRAP principles

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