Download
1 / 106
1.06k likes | 1.25k Views
Welcome Denis Fitzgerald Executive Director Catholic Social Services Victoria. The joys and the hopes, the griefs and the anxieties of the people of this age, especially those who are poor or in any way afflicted, these are the joys and the hopes, the griefs and the anxieties of the followers of Christ. Gaudium et Spes, 1965.
E N D
1. Seeking Social Inclusion: Equipping Organisations to respond to people experiencing mental illness
A symposium
9 September 2010
3.
The joys and the hopes, the griefs and the anxieties of the people of this age, especially those who are poor or in any way afflicted, these are the joys and the hopes, the griefs and the anxieties of the followers of Christ.
Gaudium et Spes, 1965
6. Program
7. 7
8. What is a mental illness? There is no adequate definition as to what constitutes a mental illness, for example where does normal human sadness end and depression begin?
Nor are there diagnostic tests that can prove one way or another that an individual has a specific illness such as schizophrenia.
A person is said to have a mental illness if an appropriately qualified professional can elicit the necessary symptoms to meet pre-set criteria to diagnose certain conditions. (Victorian Dual Disability Service, Resource Manual in Dual Disability, 2001). 8
9. Negative public attitudes to people with mental illness (Deans &Meocivic, 2006) People with psychiatric disorders are often viewed as dangerous and unpredictable; possessing undesirable traits
Many (but not all) health professional have negative views about people with a mental illness.
65 psychiatric nurses in Australia did a 50-item survey on their reactions to people with borderline personality disorder (BPD). They saw them as
manipulative (88%), engaged in emotional blackmail (51%)
nuisances (38%) made them angry (32% ).
Relatively few felt they were:
fascinating (21%) charming (13%) fun to work with (11%)
(Corrigan, 2005) 9
10. Technical definition of an intellectual disability ? IQ of 70 or below
? deficits in adaptive functioning
? onset of the disability before age 18
(DSM IV) 10
11. How do you know how severe it is? Borderline IQ: >70, but < 85
mild ID (85 %) IQ: 50-55 to 70
moderate ID (10 %) IQ: 35-40 to 50-55
severe ID (3.5 %) IQ: 20-25 to 35-40
profound ID (1.5 %) IQ: below 20-25
unspecified ID Severity undetermined
(Victorian Dual Disability Service, Resource Manual in Dual Disability, 2001). 11
12. Dual diagnosis Dual diagnosis = at least two distinct and separate disabilities/pathologies in the same individual.
A national survey* showed that 1.25% had an ID. Of these:
1.3% had a psychotic disorder,
8% had a depressive disorder
14% had a severe anxiety disorder that had been present for at least 6 months (White et al 2004)
*The Australian Disability Ageing and Carers Survey 1998 (n=42,664) 12
13. Mental illness is difficult to diagnose in people with ID Explosive outbursts of anger could be frustration by someone who has little verbal expression & lacks control over the environment or a response to threatening auditory hallucinations associated with paranoid schizophrenia.
Self-injury such as wrist-chewing or eye-poking is as-associated with some genetic conditions, e.g. Lesch-Nyhan Syndrome, and in depression.
Need to look carefully for other causes, especially if there is a change in the pattern or intensity of such behaviours.
A careful longitudinal history, observation for psychiatric signs or symptoms or a therapeutic trial of medication or other treatment may clarify the diagnosis.
Dr Chris Perkins ,a New Zealand GP (2009) 13
14. Anxiety and Dual Diagnosis Severely disabled people may respond to psychological distress by:
becoming aggressive to others,
harming themselves,
pacing and disturbed physical and a verbal behaviour
Impaired performance for tasks
Short term memory loss
Anxiety and anger are both states of increased physiological and psychological arousal and both trigger the fight or flight response. Anger and anxiety are particularly closely related in people with ID.
14
15. Inclusion - exclusion People with mental illness are often excluded from employment, education and social services, and are at risk of unstable housing and limited or no social supports - poor or nonexistent social networks.
There have difficulty accessing social services and housing.
It is estimated that in the UK the employment level of people with a psychiatric illness rarely reaches more than 10% and when working they work few hours and for only two-thirds of the national average hourly rate.
(Huxely & Thorncraft 2003)
15
16. Social exclusion and women with ID Participants in UK study spoke about how being female led to experiences of exploitation, abuse, stigmatisation and made to feel different.
They stated that they felt different and not fitting in compared to their sister, mothers and female staff. This feeling was greater among women with a mild ID.
They focussed on not having boyfriend or husband, not having children and not having their own home and such differences can lead to problems with their self esteem and finally their mental health.
(Taggart, McMillan & Lawson, 2010).
16
17. Inclusion as a protective factor (Taggart et al, 2010) Participating in the community
Having access to a pool of friends
Having a safe place to live
Being proactive in life. This involved families, schools, primary health care personnel and services being more proactive in promotion emotional literacy skills (social skills, increased self esteem, advocacy, engaging in decision making).
17
18. Accommodation Support Initiative Stage One (HASI) (Muir et al, 2008) HASI a partnership between the NSW Departments of Health and Housing and non-government organisations.
Clients are typically men born in Australia, with a primary diagnosis of schizophrenia and a secondary diagnosis.
History of long-term hospitalisation, unstable tenancies, minimal living skills, low levels of occupational, social & psychological functioning, limited social networks, prison-time.
It provides permanent social housing, community-based clinical support, support for ADL & community participation
Receive 4-5 hours of support per day - domesticity, leisure, community, finance, education & work (goal-setting, planning, organising, transporting to & from services/activities).
$58,000 per person per year and on-going support 18
19. Accommodation Support Initiative Stage One (HASI) A participant who had severe paranoia said:
My life [before HASI] consisted of barricading myself inside my house, all the windows locked, the blinds drawn . . .
For several years I only came out once a fortnight at pay-day to get smokes and food. With the support Ive got now I live a fulfilling life and I enjoy it . . . and realise that there is a world out there and I should be a part of it. (HASI participant) 19
20. Mainstreaming health services People with an ID are often expected to use general population mainstream health services including mental health.
There is growing consensus that generally inpatient and outpatient psychiatric care is inadequate to manage the complex needs of at least some individuals with dual diagnosis.
(Lunsky et al, 2008) 20
21. Allow sufficient time.
Assure a relaxed, familiar environment i.e. persons home
Spend time interacting informally first to reduce anxiety.
Allow for visual/hearing impairments i.e. communication aids
Use visual strategies (e.g., pointing to pictures, drawing).
Ensure the persons attention before speaking.
Use eye contact.
Use open-ended questions & articulate clearly.
Use straightforward, simple language.
Take into account the tendency to please and acquiesce.
Use family or caregivers to aid understanding. (Perkins, 2007)
21
22. 22
23. Hospital Staff -
Lacked knowledge about ID
Didnt communicate effectively with residents or understand their special needs
Didnt alter routines to accommodate residents
Rejected efforts to partner with family members or group home staff
Failed to pass on information about residents health to family members and group home staff
In planning for discharge, didnt consider the context of a group home environment, - making inaccurate assumptions about available care and skills.
(Webber, Bowers, Bigby, 2010)
23
24. Interactions: Lack of knowledge about ID by hospital staff Didnt know how to care for residents:
They ignore fears/anxiety, ADLs, individual needs, communication difficulties
Try to rush them - lack of time
Lack of skills in allaying fears etc. _____________________________
Im not bagging hospital staff but they dont know our clients well and ideally Id like the hospitals to do a disability component so they do know what our clients want. (House manager)
I guess the biggest issue is that the staff in the hospital say they dont know how to care for our clients, they dont have time to care for our clients in that they dont have time to listen to what the clients saying. (Agency manager) 24
25. Interactions: Unwillingness of hospital staff to work in partnership Family and staff wanted to work in partnership with hospitals e.g.. pass on information, medical history, likes +dislikes, discharge plans
Responses
Refused out of hand
Bullied
Spoken down to railroaded
Ignored
25
26. Interactions: Unwillingness of hospital staff to work in partnership
Hes got a phobia of spaces and windows and that sort of thing.
The doctor was informed of this phobia but the information was ignored, with the doctor refusing to move away from the window to examine him.
This resulted in a violent outburst with the end result he was sent to aged care by forcing the family member to sign a consent form. 26
27. Trying to access the doctors.
If they locate a doctor, they were refused access to medical information because they were not seen to have the legal right to have it.
Even just trying to get to talk to the doctors is so hard you can never find anyone who knows anything and Im not allowed to look at her file to find out information, its very difficult when the patient doesnt speak. (Family member) 27
28. There were numerous accounts of medication oversights which included not taking account of existing medication requirements as a result of pre-existing conditions
I think even with the hospitals weve had a few problems like particularly with Walter one time he went to the hospital and I had a nurse ring me up and she said how much Hepalin is he on and I told her and I said what about the Tegretol, which is another similar like drug, and she said No I dont need to know about that. Anyway a week later when he came out of hospital we found out that he hadnt had his Tegretol which is for epilepsy for over a week and hed lost a lot of weight (House manager)
28
29. Provided medical information sheets
Crafted descriptions of how resident communicates
Family members kept medical history in car to be available at all times
Because we always send a transfer sheet, if they go to hospital. So they get that information, but then like you say if they dont follow it, if they dont read it, and they dont do it, it doesnt matter how good your information services are, if people dont read them? (Aged care manager) 29
30. 30
31. Family or staff
Stay with residents during hospitalisation
Feed and shower resident
Generally someone, if its an emergency visit, our staff stay with them the whole time but if theyre actually admitted into hospital for any length of time, we actually roster staff on to go and sit with them for a couple of hours every day. (House manager) 31
32.
Yes she has a book, saying, you know: Im, Hi, Im Mary Smith, and this is the things I like and the things I do, and if I dont like things this is what I might do, and things.
You cant just leave her food with her, especially, they would just leave hot cups of tea there and she would get them on herself, or throw them across the room, or whatever, you know, she just, she doesnt understand why shes there, she doesnt like being there, because people hurt her there and she doesnt understand why theyre doing it, and you cant explain it to her, she doesnt have any concept of it.
Shes only about two or three, intellectually. (Family member) 32
33. Negotiating the system: Advocating Lobby directly
Go to higher authority other supports
Refuse to cooperate/ stand their ground
The manager from the house, she was saying to the doctors, youve got to keep him in here whilst youre administering medicine or medical treatment because we are not trained to do that. In fact she said we are not even allowed to administer. (Family member) 33
34. Supporting family members Studies suggest that children and adolescents who have a parent with mental illness also have :
An increased risk of attentional problems (Grunebaum & Cohler, 1982)
Difficulties with social adjustment (Jacob & Windle, 2000)
Availability of social support (Stromwall & Robinson, 1998).
Feel more confused on their faith journey (Mauny & Stein, 2010)
Social anxiety, lower self-esteem (Williams & Robinson)
34
35. Coping strategies: children with parents with mental illness seeking support from friends or family
engaging in activities to temporarily escape from the pressures of living with a parent with a mental illness
personal strengths - independence, creativity, empathy, resiliency, and assertiveness
Personal faith 50% used their religious or spiritual faith to cope.
(Kinsella and Anderson 1996) 35
36. 36
39. I will be talking about 2 specific areas today.
Improving access to our area mental health service The Alfred
The role that trauma plays
I will be talking about 2 specific areas today.
Improving access to our area mental health service The Alfred
The role that trauma plays
40. Overview of Sacred Heart Mission Main client group are single adults who are homeless or at risk of homelessness 45% of whom are chronically homeless
Values underpinning our work
Services include housing, health, crisis, aged care & two high volume drop in centres (400 500 people per day)
Adopted a social inclusion framework to guide our work and service development
Values
As an organisation we put a lot of focus on the power relationships. We are very conscious of the fact that the people who use our services have very limited, if any, support networks.
One of the first steps in beginning to face the challenges in their life is to feel supported and feel that someone is one their side
Dr Bruce Perry, a US based, expert in child abuse & trauma is in Australia this week and one of the things that he has been saying is that you are much more likely to be healthy, much more likely to learn more readily, much more likely to be resilient in the face of chaos, threat and trauma if you have healthy relationships This sums up our view better than I could
Social Inclusion
The process by which individuals and groups become isolated from major societal mechanisms which produce or distribute resources
Homelessness should be seen as one expression of social exclusion and the solutions to it must be much more comprehensive than if homelessness was seen solely as a lack of housing.
We must work with people in a way that equips them with the skills and confidence to reconnect with the mainstream community.
Values
As an organisation we put a lot of focus on the power relationships. We are very conscious of the fact that the people who use our services have very limited, if any, support networks.
One of the first steps in beginning to face the challenges in their life is to feel supported and feel that someone is one their side
Dr Bruce Perry, a US based, expert in child abuse & trauma is in Australia this week and one of the things that he has been saying is that you are much more likely to be healthy, much more likely to learn more readily, much more likely to be resilient in the face of chaos, threat and trauma if you have healthy relationships This sums up our view better than I could
Social Inclusion
The process by which individuals and groups become isolated from major societal mechanisms which produce or distribute resources
Homelessness should be seen as one expression of social exclusion and the solutions to it must be much more comprehensive than if homelessness was seen solely as a lack of housing.
We must work with people in a way that equips them with the skills and confidence to reconnect with the mainstream community.
41. In 2005 we identified the need to improve our capacity to respond to the mental health needs of the people we work with
On the basis of data collected we lobbied for funding for a service model that would more effectively respond to these needs and we were successful.
We were very clear at the time that we needed to do this in partnership with the Alfred Hospital the area mental health service in our catchment
In 2005 we identified the need to improve our capacity to respond to the mental health needs of the people we work with
On the basis of data collected we lobbied for funding for a service model that would more effectively respond to these needs and we were successful.
We were very clear at the time that we needed to do this in partnership with the Alfred Hospital the area mental health service in our catchment
42. Total funding was approximately: $350k per annum split between the Alfred and SHM
Total funding was approximately: $350k per annum split between the Alfred and SHM
44. Key take out messages:
For particular client groups we need to create the opportunities to provide better access to the system even with a HOPS team it wasnt working
Funded partnerships work
Cultural challenges remain
Key take out messages:
For particular client groups we need to create the opportunities to provide better access to the system even with a HOPS team it wasnt working
Funded partnerships work
Cultural challenges remain
45. The Role of Trauma People experiencing homelessness are more likely than the general population to have experienced some form of sexual or physical abuse and repeated incidents of trauma in their lives.
Unresolved trauma can lead to behaviours that increase the risk of social exclusion:
Minimal sense of belonging / trust / permanence / future
Severe changes in affect / mood
Minimal friendships
Intermittent violence to others
Risk taking behaviour
One of the challenges in our sector is that when you refer a person to an area mental health service the answer can be there is not much we can do because it is a behavioural issue. Not a psychiatric issue.
This has got a bit better for us because of the partnership I just discussed, but it remains an issue.
The biggest issue is that when it is a behavioural issue there are limited options available
The key underlying cause of the behavioural issues we see with the people we work with relates to trauma there is often One of the challenges in our sector is that when you refer a person to an area mental health service the answer can be there is not much we can do because it is a behavioural issue. Not a psychiatric issue.
This has got a bit better for us because of the partnership I just discussed, but it remains an issue.
The biggest issue is that when it is a behavioural issue there are limited options available
The key underlying cause of the behavioural issues we see with the people we work with relates to trauma there is often
46. Trauma (cont) To break the cycle of homelessness it is necessary for the individual to address the underlying causal factors and trauma is often one on them.
We need to develop an understanding of trauma that goes beyond simple post-traumatic stress disorder.
47. Our systems frequently replicate the very experiences that have proven to be so toxic for the people we are supposed to treat. (Sandra Bloom)
Child Protection systems are complex: comprised of staff, administrators, therapists, schools, courts, families and children.
Implications for self-care. And Vicarious Trauma
Child Protection systems are complex: comprised of staff, administrators, therapists, schools, courts, families and children.
Implications for self-care. And Vicarious Trauma
48. Responding to Trauma SHM trialling a trauma informed response: J2SI
Key components of the model:
Intensive Assistance - 1 day per week
Therapeutic Response
Building Up & Developing Skills
Access to specialist services through partnerships
Of the 40 people who are receiving the service, all have experienced significant trauma in their lives.
38 have experienced extreme trauma in their childhood and their history since is characterised by incident after incident. Because we are following people so intensely we are getting to know them much more and the team can see the way in which the impact of the trauma plays out in peoples lives.
Trauma informed response:
An understanding within service that people have experienced trauma and the impact that this may have on peoples lives
Using this understanding to inform the way in which you work with people
Ensuring that the system that we are a part of do not replicate peoples traumatic experiences
Accessing specialist assistance resourcing a response. Of the 40 people who are receiving the service, all have experienced significant trauma in their lives.
38 have experienced extreme trauma in their childhood and their history since is characterised by incident after incident. Because we are following people so intensely we are getting to know them much more and the team can see the way in which the impact of the trauma plays out in peoples lives.
Trauma informed response:
An understanding within service that people have experienced trauma and the impact that this may have on peoples lives
Using this understanding to inform the way in which you work with people
Ensuring that the system that we are a part of do not replicate peoples traumatic experiences
Accessing specialist assistance resourcing a response.
49. I will be talking about 2 specific areas today.
Improving access to our area mental health service The Alfred
The role that trauma plays
I will be talking about 2 specific areas today.
Improving access to our area mental health service The Alfred
The role that trauma plays
50. Overview of Sacred Heart Mission Main client group are single adults who are homeless or at risk of homelessness 45% of whom are chronically homeless
Values underpinning our work
Services include housing, health, crisis, aged care & two high volume day centres (400 500 people per day)
Adopted a social inclusion framework to guide our work and service development
Values
As an organisation we put a lot of focus on the power relationships. We are very conscious of the fact that the people who use our services have very limited, if any, support networks.
One of the first steps in beginning to face the challenges in their life is to feel supported and feel that someone is one their side
Dr Bruce Perry, a US based, expert in child abuse & trauma is in Australia this week and one of the things that he has been saying is that you are much more likely to be healthy, much more likely to learn more readily, much more likely to be resilient in the face of chaos, threat and trauma if you have healthy relationships This sums up our view better than I could
Social Inclusion
The process by which individuals and groups become isolated from major societal mechanisms which produce or distribute resources
Homelessness should be seen as one expression of social exclusion and the solutions to it must be much more comprehensive than if homelessness was seen solely as a lack of housing.
We must work with people in a way that equips them with the skills and confidence to reconnect with the mainstream community.
Values
As an organisation we put a lot of focus on the power relationships. We are very conscious of the fact that the people who use our services have very limited, if any, support networks.
One of the first steps in beginning to face the challenges in their life is to feel supported and feel that someone is one their side
Dr Bruce Perry, a US based, expert in child abuse & trauma is in Australia this week and one of the things that he has been saying is that you are much more likely to be healthy, much more likely to learn more readily, much more likely to be resilient in the face of chaos, threat and trauma if you have healthy relationships This sums up our view better than I could
Social Inclusion
The process by which individuals and groups become isolated from major societal mechanisms which produce or distribute resources
Homelessness should be seen as one expression of social exclusion and the solutions to it must be much more comprehensive than if homelessness was seen solely as a lack of housing.
We must work with people in a way that equips them with the skills and confidence to reconnect with the mainstream community.
51. In 2005 we identified the need to improve our capacity to respond to the mental health needs of the people we work with
On the basis of data collected we lobbied for funding for a service model that would more effectively respond to these needs and we were successful.
We were very clear at the time that we needed to do this in partnership with the Alfred Hospital the area mental health service in our catchment
In 2005 we identified the need to improve our capacity to respond to the mental health needs of the people we work with
On the basis of data collected we lobbied for funding for a service model that would more effectively respond to these needs and we were successful.
We were very clear at the time that we needed to do this in partnership with the Alfred Hospital the area mental health service in our catchment
52. Total funding was approximately: $350k per annum split between the Alfred and SHM
Total funding was approximately: $350k per annum split between the Alfred and SHM
54. Key take out messages:
For particular client groups we need to create the opportunities to provide better access to the system even with a HOPS team it wasnt working
Funded partnerships work
Cultural challenges remain
Key take out messages:
For particular client groups we need to create the opportunities to provide better access to the system even with a HOPS team it wasnt working
Funded partnerships work
Cultural challenges remain
55. The Role of Trauma People experiencing homelessness are more likely than the general population to have experienced some form of sexual or physical abuse and repeated incidents of trauma in their lives.
Unresolved trauma can lead to behaviours that increase the risk of social exclusion:
Minimal sense of belonging / trust / permanence / future
Severe changes in affect / mood
Minimal friendships
Intermittent violence to others
Risk taking behaviour
One of the challenges in our sector is that when you refer a person to an area mental health service the answer can be there is not much we can do because it is a behavioural issue. Not a psychiatric issue.
This has got a bit better for us because of the partnership I just discussed, but it remains an issue.
The biggest issue is that when it is a behavioural issue there are limited options available
The key underlying cause of the behavioural issues we see with the people we work with relates to trauma there is often One of the challenges in our sector is that when you refer a person to an area mental health service the answer can be there is not much we can do because it is a behavioural issue. Not a psychiatric issue.
This has got a bit better for us because of the partnership I just discussed, but it remains an issue.
The biggest issue is that when it is a behavioural issue there are limited options available
The key underlying cause of the behavioural issues we see with the people we work with relates to trauma there is often
56. Trauma (cont) To break the cycle of homelessness it is necessary for the individual to address the underlying causal factors and trauma is often one on them.
We need to develop an understanding of trauma that goes beyond simple post-traumatic stress disorder.
57. Our systems frequently replicate the very experiences that have proven to be so toxic for the people we are supposed to treat. (Sandra Bloom)
Child Protection systems are complex: comprised of staff, administrators, therapists, schools, courts, families and children.
Implications for self-care. And Vicarious Trauma
Child Protection systems are complex: comprised of staff, administrators, therapists, schools, courts, families and children.
Implications for self-care. And Vicarious Trauma
58. Responding to Trauma SHM trialling a trauma informed response: J2SI
Key components of the model:
Intensive Assistance - 1 day per week
Therapeutic Response
Building Up & Developing Skills
Access to specialist services through partnerships
Of the 40 people who are receiving the service, all have experienced significant trauma in their lives.
38 have experienced extreme trauma in their childhood and their history since is characterised by incident after incident. Because we are following people so intensely we are getting to know them much more and the team can see the way in which the impact of the trauma plays out in peoples lives.
Trauma informed response:
An understanding within service that people have experienced trauma and the impact that this may have on peoples lives
Using this understanding to inform the way in which you work with people
Ensuring that the system that we are a part of do not replicate peoples traumatic experiences
Accessing specialist assistance resourcing a response. Of the 40 people who are receiving the service, all have experienced significant trauma in their lives.
38 have experienced extreme trauma in their childhood and their history since is characterised by incident after incident. Because we are following people so intensely we are getting to know them much more and the team can see the way in which the impact of the trauma plays out in peoples lives.
Trauma informed response:
An understanding within service that people have experienced trauma and the impact that this may have on peoples lives
Using this understanding to inform the way in which you work with people
Ensuring that the system that we are a part of do not replicate peoples traumatic experiences
Accessing specialist assistance resourcing a response.
63. Creativity can improve mood. It has long been held that people with mental illness have a higher artistic creative capacity. ( Goodwin and Jamieson Bipolar Mood Disorder 1991)
Participation in creative activities per se gives some people great enjoyment plus other residual benefits.
A mentally ill person is more likely to be creative. If we provide a vehicle for them to express that creativity it may improve their mental health.
If a mentally ill person has been denied the opportunity to express themselves creatively it may inhibit the proper management of their illness.
Prefrontal Cortex latent dishinibition
64. AIM To investigate the effects on the mood states of people with schizophrenia or a mood disorder when they engage in a public theatrical production.
65. METHOD Take five participants. All participants will have bipolar mood disorder.
All five will be on medication and are being treated for the illness.
They have all been selected at random with the only criteria being they have bipolar and are being treated for it. The selection process was to ask the first five people the investigator came in contact with who fitted the criteria.
66. PERFORMANCES Performance at the Malthouse October 2005.
Performance at Trades Hall 2006
Performance at Mildura 2006
Development at St. Kilda CCU
Video Projects from 2006 to 2007.
67. Preliminary results and observations:
Malthouse four people with bi-polar all started the activity from a very low base. Not leaving their house, unhappy, lacking focus. All gained substantially from being involved. Socially, creatively, all seemed to exhibit something that equalled a response to their being involved in a play per se.
Malthouse Downsides
68. DOWNSIDES
One of the womens husbands didnt laugh at her jokes so she left him;
There was a clear division between the professional actors, the director and the mental health consumers that made the process difficult and stressful for all.
One of the male actors became grandiose and started to compare himself to Larry Olivier.
69. Mildura.
We discovered a weeding out process. Those that get anxious pull out.
Those that put on the performance who had previously been severely depressed seemed to show great improvement.
The improvement in four women acted like a catalyst for change from their depressed state and was clearly effective.
70. TRADES HALL
Observationally combined group two people with bi-polar four with schizophrenia.
This was our best project for people with schizophrenia. They gained an enormous amount from rehearsals as well as from performance.
The two with bi-polar both went high during the performance and became quite depressed after. Both of them found it very hard to let go of the process.
71. CCU St. Kilda three people with schizophrenia.
Only two have remained.
A play would be too difficult for them to do though they could write one.
We have written, devised eight videos with them, all very funny.
72. OBSERVATIONS Creativity and mental illness is so often focused on two things:
One the manic highs deliver creativity;
The florid sympoms of schizophrenia produce certain types of works of art.
Both of these are flawed analysis of the complex problem of creativity and how it manifests itself in the mind of a mentally ill person.
Kaye Jamieson and Nancy Andreason Studies.
Touched With Fire Kay Jamieson
Iowa Writing School Nancy Andreason
Schizpophrenia Calling.
73. CONCLUSIONS OUR INITIAL REVIEWS SHOW PEOPLE GAIN A LOT.
MODEL MUST BE A PROFESSIONAL DIRECTOR AND A PROFESSIONAL ACTOR
SCHIZOPHENRIA MUCH EASIER TO WORK WITH.
IT IS HARD TO GET FUNDING.
74. CONCLUSIONS IT SHOULD BE SEEN AS A TREATMENT OPTION
OBSErVATIONALLY SOMETHING TAKES OVER THE ATTENTION AND ACTIVITY OF THE BRAIN. THIS CONCURS WITH THE LITERATURE.
IT IS CHEAP EASY AND ENJOYABLE TO DO. PARTICULALR APPLICABLE TO DIVERSE BACKGROUNDS.
75. FROM LIVED EXPERIENCE TO NOVEL AN AMALGAMATION OF THE LIVED EXPERIENCES OFPEOPLE WITH MENTAL ILLNESS INTO A ENTERTAINING NOVEL TO BE PUBLISHED AND DISTRIBUTED FOR MAIN STREAM AUDIENCES.
76. QUALIFICATIONS
77. HYPOTHESIS
PUBLICATIONS OF THE LIVED EXPERIENCE TEND TO BELIMITED IN READERSHIPBY THE GENERAL PUBLIC. WE NEED TO PRODUCE A BOOK OF FICTION BASED ON THE LIVED EXPERIENCE ABOUT MENTAL ILLNESS TO REACH MAINSTREAM AUDIENCES.
There are many publications about the lived experience.
Most of these have limited audiences and tend to be similar in content.
78. AIM
79. THE LITERATURE Home About Us Glossary Site Map TranslateWhat's NewNoticeboardSuicidePreventionResourcesAuseinettere-JournalLinksWhat'sHappeningSearch by TopicAboriginal & Torres Strait Islander infoRecovery CollectionSearch by TopicKeyDocumentsAuseinetPublicationsSettings&PopulationsResourceCatalogueMediaReportsPeak Bodies & Major ContactsDiscussion LinksSearch by TopicTopic Search > RECOVERYResults for: RECOVERY - Lived Experience59 matching recordsPublications& Products [42]Media [10]Links [7]Publications and Products [42]Reflections on recovery ?2009; Scottish Recovery Network; Glasgow, ScotlandTelling it like it is... our stories ?2009; COMIC (Children of Mentally Ill Consumers); Perth, WAEmployer tool-kit: employing peer workers in your organisation ?2008; Baptist Community Services (SA) Peer Support Project; Unley, South AustraliaRecovering mental health in Scotland: report on narrative investigation of mental health recovery ?2008; Scottish Recovery Network; Glasgow, ScotlandJourneys with the black dog: inspirational stories of bringing depression to heel ?2007; Allen and Unwin; Sydney, NSWFrom relief to recovery: peer support by consumers relieves the traumas of disasters and facilitates recovery from mental illness ?2006; National Empowerment Center; Lawrence, MAHarnessing the lived experience: formalising peer support approaches to promote recovery ?2006; Scottish Recovery Network; Glasgow, UKJourneys of despair, journeys of hope: young adults talk about severe mental distress, mental health services and recovery ?2006; NZ Mental Health Commission; Wellington, NZJourneys of recovery ?2006; Scottish Recovery Network; Glasgow, UKMental health peer supported hospital-to-home project: report on the pilot period June - August, 2006 ?2006; Flinders University. Human Behaviour and Health Research Unit; Adelaide, S. Aust.People can recover from mental illness ?2006; National Empowerment Center; Massachusetts, USARecovery from schizophrenia: a consumer perspective ?2006; Dr Barbara Tooth; Malabar, NSWRecovery: a journey of hope ?2006; Scottish Recovery Network; Glasgow, ScotlandRecovery: our thoughts on recovery and what helps us to recover from mental health problems ?2006; Highland Users Group; Inverness, Scotland, UKReflections on a pilot peer support service ?2006; Mind and Body Consultants Ltd.; Auckland, NZRaising the bar: encouraging people to take an active role in their recovery ?2005; Mental Health Association of Central Australia; Alice Springs, NTUnderstanding resolution of deliberate self harm: qualitative interview study of patients' experiences ?2005; BMJ Publishing Group; London, UKBroken open ?2004; Bantam Books, Random House; Milsons Point, NSWNine lives: personal stories of mental illness ?2004; Open Minds; Wooloongabba, Qld.Our lives in 2014: a recovery vision from people with experience of mental illness ?2004; NZ Mental Health Commission; Wellington, NZRetraining the workforce to support recovery: what is recovery? ?2004; Canadian Mental Health Association. Manitoba Division; Manitoba, CanadaStaying well with bipolar disorder: final report ?2004; Research Matters; Fitzroy North, Vic.Recovered not cured: a journey through schizophrenia ?2003; Allen and Unwin; Crows Nest, NSWThe bipolar disorder video kit ?2003; SANE Australia; Melbourne, Vic"Kia Mauri Tau!": narratives of recovery from disabling mental health problems ?2002; NZ Mental Health Commission; Wellington, NZChallenges and triumphs: a mosaic of meanings ?2002; Auseinet; Adelaide, S. Aust.Getting real: a video about recovering from psychosis ?2002; Early Psychosis Prevention and Intervention Centre (EPPIC); Parkville, Vic.Getting there: recovery from eating disorders ?2002; Eating Disorders Foundation of Victoria; Melbourne, VicThe many languages of suicide ?2002; VICSERV; North Fitzroy, Vic.Something inside so strong ?2001; Mental Health Foundation UK; London, UKFour families of people with mental illness talk about their experiences ?2000; NZ Mental Health Commission; Wellington, NZThe journey towards wellness ?2000; NAMI California; Sacramento, USAThree forensic service users and their families talk about recovery ?2000; NZ Mental Health Commission; Wellington, NZA gift of stories: discovering how to deal with mental illness ?1999; University of Otago Press; Dunedin, NZRockets and rollerblades ?1997; SANE Australia; Melbourne, Vic.A journey toward recovery: from the inside out ?1996; Center for Psychiatric Rehabilitation, USA; Boston, USARecovery and the conspiracy of hope ?1996; Institute for the Study of Human Resilience; Boston, USARecovery as a journey of the heart ?1996; Center for Psychiatric Rehabilitation, USA; Boston, USAHolding on to what is real: a teenagers courageous battle with schizophrenia ?1993; Kitaron Productions; Melbourne, Vic.Twelve aspects of coping for persons with schizophrenia ?1993; Innovations and Research in Clinical Services, Community Support and Rehabilitation; USARecovery: the lived experience of rehabilitation ?1988; Center for Psychiatric Rehabilitation, USA; Boston, USAPartyline: special issues on depression ?National Rural Health Alliance; Canberra, ACTMedia [10]Hearing voicesSome of my best friends have a mental illnessDepression, she wroteThe voices withinBeingbipolarAngels and demonsLiving with a black dog: Matthew and Ainsley JohnstoneBack from the brink: recovering from depressionJourneys to recoveryHearing voices - the invisible intrudersSite Links [7]Intervoice: The international community for hearing voicesmentalympians.tvMind Bloggling: mental wellbeing from the inside outNational Voices Forum (UK)RethinkRethink Blogs (UK)Scottish Recovery NetworkPrivacy Statement Copyright & Disclaimer Contact us
80. SPECIAL TITLES KAY REDEFIELD JAMIESON AN UNQUIET MIND
PATTY DUKE A BRILLIANT MADNESS
MARGO ORUM FAIRYTALES IN REALITY
81. METHODOLGY We conducted interviews with twenty people with mental illness mainly bipolar mood disorder.
Each interview took around two hours and we concentrated on the life story not just the history of their illness. From childhood to the time of interview.
After the interviews were completed all the information was collated to devise characters consistent with writing a novel.
82. CHARACTER AND SYMPTOMS CHARACTERS WERE DEVISED BASED ON THE LIFE STORIES. WE COULDNT USE ALL CHARACTERS BECAUSE THERE WERE TOO MANY.NO ONE PERSON WAS ACTUALLY USED FOR PRIVACY REASONS AND ALSO TO MAKE MORE INTERESTING CHARCTERS.
AN EXAMPLE IS AN INTERVIEW WITH A FORMER NUN WHO HAD LEFT THE ORDER. IN THE BOOK SHE STAYS IN THE ORDER AND IS MUCH YOUNGER. THE MANNER IN WHICH SHE HANDLED HER BIPOLAR WHILE A NUN IS EXPLORED IN THE BOOK AND WE LOOK AT HER MOTIVATION TO BECOME A NUN.
83. AUTHENTICITY OF CHARACTER AND MENTAL ILLNESS THE CHARACTERS IN THE BOOK ARE AUTHENTIC TO THE ILLNESS. THOUGH THE BOOK DOES PORTRAY THE ILLNESSES ON THE MORE OPTOMISTIC SIDE.
THIS WAS DELIBERATE TO HIGHLIGHT THE CAPACITY OF PEOPLE TO LIVE WITH THE ILLNESS AND ALSO TO EMPHASIS THE RECOVERY SIDE OF THE ILLNESS
84. THE INTERVIEWEES,THE CHARACTERS,THE ILLNESS A WAR VETERANMANIC COURAGE IN BATTLE
A SOLICITOR WHO STEALS FROM HIS TRUST ACCOUNT SPENDING IT ON PROSTITUTES AND GIVING A LOT AWAY.
A NUN WHOS AUSTERE EXISTENCE MASKS HER SYMPTOMS
A WOMAN WHO IS KNOW AS A GOOD TIME GIRL BECAUSE SHE HAS SO MUCH SEX WITH MULTIPLY MEN WHILE MANIC. AND SHE IS MANIC A LOT.
85. CHARACTERS A MAN WITH TUARETTES SYNDROME AND BIPOLAR WHO IS A HARD WORKER AND BRILLIANT ARTISAN.
A MAN WITH PARANOID SCIZOPHRENIA WHO WALKS WITH A FAKE LIMP.
A YOUNG MAN WITH BIPOLAR 2 DISORDER WHO WORKS IN DIFFERENT OFFICES JOBS.
86. THE CHARACTERS COLONEL SURRY A SOLICITOR WHO WENT TO THE SECOND WORLD WAR AND ROSE TO THE RANK OF COLONEL.
HAD MANIC COURAGE IN THE WAR.THEN AS A SOLICITOR STOLE FROM HIS TRUST ACOUNT. HE WENT TO COURT AND ARGUED HE WAS MANIC AT THE TIME AND PLEADED NOT GUILTY. HE WAS FOUND NOT GUILTY AND SENT TO A PSYCHIARIC PRISON
87. IM HEREHE IS BIPOLAR WITH TAURETTES SYNDROM HE KEEPS ON CALLING OUT IM HERE AND IS NICKNAMED IM HERE. HE IS IN PRISON FOR PUNCHING UP FOUR PEOPLE
PEG LEGHE IS IN CHARGE OF THE GOLF COURSE AT THE PRISON AND WALKS AROUND IT ALL DAY. IN SEVENTEEN YEARS THEY HAVE NEVER HAD ANYONE ACTUALLY USE THE GOLF COURSE.
88. MORE CHARACTERS OLD TIMERSTHESE ARE THREE BLOKES WHO HAVE BEEN IN THE PSYCHIATRIC PRISON AND NO ONE KNOWS WHY.
GRUMPYIS A PRISON GUARD BASED ON SOMEONE I KNEW WHO WAS VERY ENLIGHTENED
JOHN SURRYS WIFE CLARE WHO GOES ALONG WITH IT ALL BUT DOESNT BELIEVE THE ILLNESS REALLY EXISTS AS AN EXPLANATION FOR THE BEHAVIOUR.
89. SUCCESS WE HAVE A 250 PAGE BOOK.
READ BY THREE EXPERTS ALL CONSUMERS WHO APPROVED IT GOING TO PUBLISHER
WE DONT HAVE A PUBLISHER THOUGH IT IS BEING READ.
NOVELS ONLY SELL THOUSANDS IN AUSTRALIA SO THE EXERCISE OF GETTING IT INTO THE MAIN STREAM IS NOT AN EASY ONE.
90. WHAT HAPPENS IN THE BOOK I HAVE A COPY HERE TO READ
READ IT WHEN ITS PUBLISHED
92.
93. Good afternoon, its great to be here with to discuss how we can support the social inclusion of people with mental illness and you are key to this task- to realise the vision of mental health that because mental health matters put forward.
The Vision- All Victorians have the opportunities they need to maintain good mental health, while those experiencing mental health problems can access timely, high quality care and support to live successfully in the community.
Social inclusion is vital to supporting the recovery of people with mental illness.
Social inclusion has also been a significant policy driver for the mental health strategy and its implementation. Of all the themes most widely quoted by the greatest diversity of stakeholders a major theme has been the how social inclusion can be a protective mechanism to promote good mental health, and how social exclusion can be a result of how society views people with severe mental illness.Good afternoon, its great to be here with to discuss how we can support the social inclusion of people with mental illness and you are key to this task- to realise the vision of mental health that because mental health matters put forward.
The Vision- All Victorians have the opportunities they need to maintain good mental health, while those experiencing mental health problems can access timely, high quality care and support to live successfully in the community.
Social inclusion is vital to supporting the recovery of people with mental illness.
Social inclusion has also been a significant policy driver for the mental health strategy and its implementation. Of all the themes most widely quoted by the greatest diversity of stakeholders a major theme has been the how social inclusion can be a protective mechanism to promote good mental health, and how social exclusion can be a result of how society views people with severe mental illness.
94. Because mental health matters: Victorian Mental Health Reform Strategy 2009 - 2019 This figure gives an overview of the architecture of the reform strategy.
The vision, and strategy itself, requires four core elements of effort:
Prevention
Early intervention (early in life, early in episode and early in illness)
Recovery
Social inclusion
These are distinct from the guiding principles that are seen on the right hand side of the figure. These principles underpin and guide actions across the core elements.
Each of the eight reform areas represents an area where significant change and development is required. Social inclusion underpins all areas of reform.
For example, Area one focuses on promoting better mental health and well-being. One of the goals seeks to promote a socially inclusive society to strengthen recognized protective factors for mental wellbeing.
Area 5 is about building the foundations for recovery through improved care coordination for people with severe mental illness and improved support to participate in the workforce and community life. This area aims to provide a comprehensive platform for people with a mental illness to fully participate in the Victorian community.
Area 6 is about responding better to vulnerable people who may be particularly susceptible to social exclusion. This focuses on better supporting Aboriginal and CALD communities and people with a mental illness and co-existing disability. A central focus of this reform area is for mainstream services to better respond to the individual needs of these groups.
This figure gives an overview of the architecture of the reform strategy.
The vision, and strategy itself, requires four core elements of effort:
Prevention
Early intervention (early in life, early in episode and early in illness)
Recovery
Social inclusion
These are distinct from the guiding principles that are seen on the right hand side of the figure. These principles underpin and guide actions across the core elements.
Each of the eight reform areas represents an area where significant change and development is required. Social inclusion underpins all areas of reform.
For example, Area one focuses on promoting better mental health and well-being. One of the goals seeks to promote a socially inclusive society to strengthen recognized protective factors for mental wellbeing.
Area 5 is about building the foundations for recovery through improved care coordination for people with severe mental illness and improved support to participate in the workforce and community life. This area aims to provide a comprehensive platform for people with a mental illness to fully participate in the Victorian community.
Area 6 is about responding better to vulnerable people who may be particularly susceptible to social exclusion. This focuses on better supporting Aboriginal and CALD communities and people with a mental illness and co-existing disability. A central focus of this reform area is for mainstream services to better respond to the individual needs of these groups.
95. What gaps and problems is the strategy addressing? Potential to prevent mental health problems needs organised, larger scale efforts
Children and young people not receiving the focus and breadth of attention required
Access and focus of the specialist service system too frequently acute and crisis driven
Lack of integrated local systems leads to gaps between services and difficulties navigating between services
Wellness, sustained recovery and consumer/carer participation not consistently the basis of care planning
Needs of many highly vulnerable groups too often unmet due to barriers between services and ambiguity about responsibility
During the consultation process for the Strategy six key gaps and problems where identified that we needed to address. These were:
Potential to prevent mental health problems needs organised, larger scale efforts
Children and young people not receiving the focus and breadth of attention required
Access and focus of the specialist service system too frequently acute and crisis driven
Lack of integrated local systems leads to gaps between services and difficulties navigating between services
Wellness, sustained recovery and consumer/carer participation not consistently the basis of care planning
Needs of many highly vulnerable groups too often unmet due to barriers between services and ambiguity about responsibility
During the consultation process for the Strategy six key gaps and problems where identified that we needed to address. These were:
Potential to prevent mental health problems needs organised, larger scale efforts
Children and young people not receiving the focus and breadth of attention required
Access and focus of the specialist service system too frequently acute and crisis driven
Lack of integrated local systems leads to gaps between services and difficulties navigating between services
Wellness, sustained recovery and consumer/carer participation not consistently the basis of care planning
Needs of many highly vulnerable groups too often unmet due to barriers between services and ambiguity about responsibility
96. Relationship between mental health problems and social inclusion Of those who were unemployed, 29% had experienced a mental illness in the last twelve months
Over half those who reported ever being homeless had experienced a mental illness in last twelve months
Of those with a profound or severe disability 43% had experienced a mental illness in last twelve months
Of those with very high levels of psychological distress 80%, had experienced a mental illness in last twelve months
(The 2007 ABS National Survey of Mental Health and Wellbeing) There is a close and often reciprocal relationship between mental illness, social problems and social exclusion.
For example, the 2007 ABS National Survey of Mental Health and Wellbeing, found that:
of those who were unemployed, 29% had experienced a mental illness in last twelve months - compared to 20% in employed group
of those reporting ever having been homeless, over half (54%) had experienced a mental illness in last twelve months this is 3 times the prevalence in those who had never been homeless
of those who had had no contact with family in last twelve months, 23% had experienced a mental illness in last twelve months - a little higher than population average, however
of those who had had no contact with friends, the figure was 38%.
of those with a profound or severe disability 43% had experienced a mental illness in last twelve months - 3 times the prevalence of anxiety disorders and 5 times that of depression compared to those with no disability.
of those with very high levels of psychological distress, 80% had experienced a mental illness in last twelve months - and of those with high levels of distress the figure was 57% There is a close and often reciprocal relationship between mental illness, social problems and social exclusion.
For example, the 2007 ABS National Survey of Mental Health and Wellbeing, found that:
of those who were unemployed, 29% had experienced a mental illness in last twelve months - compared to 20% in employed group
of those reporting ever having been homeless, over half (54%) had experienced a mental illness in last twelve months this is 3 times the prevalence in those who had never been homeless
of those who had had no contact with family in last twelve months, 23% had experienced a mental illness in last twelve months - a little higher than population average, however
of those who had had no contact with friends, the figure was 38%.
of those with a profound or severe disability 43% had experienced a mental illness in last twelve months - 3 times the prevalence of anxiety disorders and 5 times that of depression compared to those with no disability.
of those with very high levels of psychological distress, 80% had experienced a mental illness in last twelve months - and of those with high levels of distress the figure was 57%
97. Mental illness is frequently complicated by other chronic diseases or substance use Various social problems can cause or exacerbate mental illness, and there is a vey strong likelihood that those with mental illness will experience social problems.
If we are to address the social inclusion of people with mental health problems we need to not only look for the other issues that people identified as having a mental illness have, but also to recognise the prevalence of mental illness in those with various broader psychosocial problems.
We also need to recognise that mental health problems engender other mental health problems and co-exist with physical health problems. Of the 58% of population who had mental health or physical health condition in the last twelve months, only 8.2% had only a mental health problem and 11.7% had both mental and physical health problems.
The chart here demonstrates the number of days people take out of role due to comorbid conditions. From this we can see that people with affective, anxiety and substance use disorder have the highest numbers out of role per month at 9.2 days.
(source: National Survey of Mental Health and Wellbeing 2007)
Various social problems can cause or exacerbate mental illness, and there is a vey strong likelihood that those with mental illness will experience social problems.
If we are to address the social inclusion of people with mental health problems we need to not only look for the other issues that people identified as having a mental illness have, but also to recognise the prevalence of mental illness in those with various broader psychosocial problems.
We also need to recognise that mental health problems engender other mental health problems and co-exist with physical health problems. Of the 58% of population who had mental health or physical health condition in the last twelve months, only 8.2% had only a mental health problem and 11.7% had both mental and physical health problems.
The chart here demonstrates the number of days people take out of role due to comorbid conditions. From this we can see that people with affective, anxiety and substance use disorder have the highest numbers out of role per month at 9.2 days.
(source: National Survey of Mental Health and Wellbeing 2007)
98. Vicious cycle of social exclusion Vicious cycle of social exclusion
Multiple dimensions, individual and societal, contributing to social inclusion
Poverty and mental illness-breaking the cycle of debt
Intervening to create a virtuous cycle of social inclusion
What leads to social exclusion is often multi-factorial-operating at both individual and societal levels. It is the interrelationship and compounding effect of these factors that make it hard for people experiencing social exclusion to escape it, and as we see in our social service system far too many people become trapped in a vicious cycle of social exclusion.
For example, the vast majority of people with severe mental illness and psychiatric disability experience poverty. They are on a limited income from Centrelink, experience housing stress and unavoidable costs due to transport and medication. As part of their social exclusion they are do not tend to access formal financial services, and may be vulnerable to debt through unsolicited credit card increases and tactics such as door to door sales pitches for utilities and mobile phone deals. In addition, symptoms of mental illness can affect a persons judgement regarding financial decisions.
What leads to social exclusion is often multi-factorial-operating at both individual and societal levels. It is the interrelationship and compounding effect of these factors that make it hard for people experiencing social exclusion to escape it, and as we see in our social service system far too many people become trapped in a vicious cycle of social exclusion.
For example, the vast majority of people with severe mental illness and psychiatric disability experience poverty. They are on a limited income from Centrelink, experience housing stress and unavoidable costs due to transport and medication. As part of their social exclusion they are do not tend to access formal financial services, and may be vulnerable to debt through unsolicited credit card increases and tactics such as door to door sales pitches for utilities and mobile phone deals. In addition, symptoms of mental illness can affect a persons judgement regarding financial decisions.
99. Social inclusion and mental health-its everyones business
If we are to make significant improvements in the social inclusion of people with mental illness this is going to involve many sectors working together and a joined up effort from many parts of Government, and between all levels of Government- local, state and Commonwealth.
This slide demonstrates just how common it is for people using social services to have mental health problems as well.
So it makes sense if we are going to improve the social inclusion of people with mental illness we need a holistic and coordinated approach. One that addresses a range of complexities from homelessness, substance misuse through to support to re-engage in education and employment and other community activities.
The need to create this joined up service response is a key driving force for the mental health reform strategy.If we are to make significant improvements in the social inclusion of people with mental illness this is going to involve many sectors working together and a joined up effort from many parts of Government, and between all levels of Government- local, state and Commonwealth.
This slide demonstrates just how common it is for people using social services to have mental health problems as well.
So it makes sense if we are going to improve the social inclusion of people with mental illness we need a holistic and coordinated approach. One that addresses a range of complexities from homelessness, substance misuse through to support to re-engage in education and employment and other community activities.
The need to create this joined up service response is a key driving force for the mental health reform strategy.
100. Influencing community attitudes to support social inclusion Breakdown the myths, prejudice and stigma surrounding people with mental illness:
Mental illness is just a lottery
You are either severely ill or the worried well
Social participation has to wait for full recovery
People with mental illness are often violent
To do this we need to break some myths held about people with mental illness in our communities. Whilst the days of institutions are behind us, people with severe mental illness, still face many barriers to true social inclusion. Some of these are attitudinal. These negative perceptions of people with severe mental illness impact on their capacity to gain employment, housing and participate freely in the community.
Some of these commonly held myths include:
Mental illness is just a lottery
You are either severely ill or the worried well
Social participation has to wait for full recovery
People with mental illness are often violent
To improve social inclusion of people with mental illness requires the effort of not just government, but the whole community.
Reducing stigma and prejudice requires a targeted and sustained approach between all levels of government and non-government organisations. Whilst some good work has, and continues to be done, to address these issues, the Strategy signals the need to do more in this area.
The Strategy supports the development of stronger partnerships with a range of community service to combat the social isolation of people with severe mental illness, for example- vocational/employment, recreational and PDRS agencies and HACC services.
To do this we need to break some myths held about people with mental illness in our communities. Whilst the days of institutions are behind us, people with severe mental illness, still face many barriers to true social inclusion. Some of these are attitudinal. These negative perceptions of people with severe mental illness impact on their capacity to gain employment, housing and participate freely in the community.
Some of these commonly held myths include:
Mental illness is just a lottery
You are either severely ill or the worried well
Social participation has to wait for full recovery
People with mental illness are often violent
To improve social inclusion of people with mental illness requires the effort of not just government, but the whole community.
Reducing stigma and prejudice requires a targeted and sustained approach between all levels of government and non-government organisations. Whilst some good work has, and continues to be done, to address these issues, the Strategy signals the need to do more in this area.
The Strategy supports the development of stronger partnerships with a range of community service to combat the social isolation of people with severe mental illness, for example- vocational/employment, recreational and PDRS agencies and HACC services.
101. Factoring social inclusion into mental health promotion and prevention Areas for early action:
Promoting mental health in schools and early childhood settings
Promoting mental health in workplaces
Promoting community resilience in relation to significant crises such as bushfires and drought
Suicide prevention and early intervention for Aboriginal communities and vulnerable young people
Awareness campaign on mental health risks and consequences of cannabis use and alcohol misuse
Due to the strong relationship between social inclusion and mental health, it is vital that prevention and health promotion activities incorporate this into their approaches.
The Mental Health Reform Strategy recognises the need to promote a socially inclusive society to strengthen recognised protective factors for good mental health. This will include building understanding of the mental health impacts into non-health programs as well as specific mental health promotion initiatives.
Some early areas identified for early action in the Strategy Implementation Plan 2009-2011 include:
Promoting mental health in schools and early childhood settings
Promoting mental health in workplaces
Promoting community resilience in relation to significant crises such as bushfires and drought
Suicide prevention and early intervention for Aboriginal communities and vulnerable young people
Awareness campaign on mental health risks and consequences of cannabis use and alcohol misuse
Due to the strong relationship between social inclusion and mental health, it is vital that prevention and health promotion activities incorporate this into their approaches.
The Mental Health Reform Strategy recognises the need to promote a socially inclusive society to strengthen recognised protective factors for good mental health. This will include building understanding of the mental health impacts into non-health programs as well as specific mental health promotion initiatives.
Some early areas identified for early action in the Strategy Implementation Plan 2009-2011 include:
Promoting mental health in schools and early childhood settings
Promoting mental health in workplaces
Promoting community resilience in relation to significant crises such as bushfires and drought
Suicide prevention and early intervention for Aboriginal communities and vulnerable young people
Awareness campaign on mental health risks and consequences of cannabis use and alcohol misuse
102. Consumer empowerment New approaches to how we work with people with severe mental illness:
More client centered
More client directed
More personalised packages People with severe mental illness are amongst societys most disadvantaged, disempowered and marginalised. The mental health strategy indicates that we need to change the way we work with people with mental illness. They need to be at the centre of their care and recovery, active in the driving seat of their recovery process. As part of the reform strategy, we are currently rolling out a care coordination initiative.
This initiative seeks to provide care coordinators to work closely with consumers to develop their recovery plans with multiple service providers. This way complex care arrangements with numerous health and social service providers can be driven by the clients needs.
This initiative is targeted at clients with significant areas across several life areas and histories of ingrained problems who require a coordinated, tailored, multi-agency response involving a range of health and social support services. In the absence of these packages of support these individuals are at high risk of falling through the cracks between services and continuing to be socially excluded.
We have also developed more personalised packages of support for people with severe mental illness and psychiatric disability complex needs who are homeless or at risk of homelessness. These Intensive Home Based Outreach Support packages provide an additional tier level of support to our range of home based supports.
We are also beginning to explore how we could further develop packaged care arrangements for service delivery.People with severe mental illness are amongst societys most disadvantaged, disempowered and marginalised. The mental health strategy indicates that we need to change the way we work with people with mental illness. They need to be at the centre of their care and recovery, active in the driving seat of their recovery process. As part of the reform strategy, we are currently rolling out a care coordination initiative.
This initiative seeks to provide care coordinators to work closely with consumers to develop their recovery plans with multiple service providers. This way complex care arrangements with numerous health and social service providers can be driven by the clients needs.
This initiative is targeted at clients with significant areas across several life areas and histories of ingrained problems who require a coordinated, tailored, multi-agency response involving a range of health and social support services. In the absence of these packages of support these individuals are at high risk of falling through the cracks between services and continuing to be socially excluded.
We have also developed more personalised packages of support for people with severe mental illness and psychiatric disability complex needs who are homeless or at risk of homelessness. These Intensive Home Based Outreach Support packages provide an additional tier level of support to our range of home based supports.
We are also beginning to explore how we could further develop packaged care arrangements for service delivery.
103. Attending to human rights Charter of Human Rights and Responsibilities Act (Vic) 2006, Disability Discrimination Act (Cth) 1992
Review of the Mental Health Act (Vic)1986
Reduction in the use and duration of compulsory orders, coercion and restrictive practices
Supported decision making
Improved clinical access to and understanding of consumer needs, wishes and preferences leading to higher levels of treatment with consent, and
Improved health and recovery outcomes. Attending to the human rights of people, and ensuring that the rights of people with mental illness are sufficiently protected in law is essential to supporting their recovery and social inclusion. The rights of people with mental illness are protected in Australian federal law in the Disability Discrimination Act (Cth) 1992 and in Victorian law through the Charter of Human Rights and Responsibilities Act (Vic) 2006.
In addition the Victorian Government is currently reviewing the Mental Health Act 1986. The new Act will focus on:
Reduction in the use and duration of compulsory orders, coercion and restrictive practices
Supported decision making
Improved clinical access to and understanding of consumer needs, wishes and preferences leading to higher levels of treatment with consent, and
Improved health and recovery orientated treatment planning
Attending to the human rights of people, and ensuring that the rights of people with mental illness are sufficiently protected in law is essential to supporting their recovery and social inclusion. The rights of people with mental illness are protected in Australian federal law in the Disability Discrimination Act (Cth) 1992 and in Victorian law through the Charter of Human Rights and Responsibilities Act (Vic) 2006.
In addition the Victorian Government is currently reviewing the Mental Health Act 1986. The new Act will focus on:
Reduction in the use and duration of compulsory orders, coercion and restrictive practices
Supported decision making
Improved clinical access to and understanding of consumer needs, wishes and preferences leading to higher levels of treatment with consent, and
Improved health and recovery orientated treatment planning
104. Working with families and carers Families and carers of people with mental illness may also experience social inclusion:
reduced rates of employment
social isolation
poor mental health and wellbeing
Families and carers of people with mental illness may also experience social inclusion, such as reduced rates of employment, poor mental health and wellbeing and isolation.
Whilst studies have demonstrated that outcomes for people with severe mental illness can be improved through including families and carers in their treatment and care planning, the Strategy acknowledges that specialist mental health services need to do more to provide a carer inclusive approach that addresses their support needs. For example, the social inclusion of families and carers of people with severe mental illness could be improved through greater focus on increased awareness of family/carer needs, and improved linkages and referrals to respite and counselling services within specialist mental health services.
We have restructured the Carer Brokerage Fund, providing an additional $300,00 funding for carer supports in the 2010/11 financial year. We are providing funding to mental health services to develop local Mental Health Service Carer Participation Plans that will help to address the support needs of carers. These will be monitored through accreditation process and Divisional Performance Monitoring meetings.
Families and carers of people with mental illness may also experience social inclusion, such as reduced rates of employment, poor mental health and wellbeing and isolation.
Whilst studies have demonstrated that outcomes for people with severe mental illness can be improved through including families and carers in their treatment and care planning, the Strategy acknowledges that specialist mental health services need to do more to provide a carer inclusive approach that addresses their support needs. For example, the social inclusion of families and carers of people with severe mental illness could be improved through greater focus on increased awareness of family/carer needs, and improved linkages and referrals to respite and counselling services within specialist mental health services.
We have restructured the Carer Brokerage Fund, providing an additional $300,00 funding for carer supports in the 2010/11 financial year. We are providing funding to mental health services to develop local Mental Health Service Carer Participation Plans that will help to address the support needs of carers. These will be monitored through accreditation process and Divisional Performance Monitoring meetings.
105. Access and support for sustainable housing The Victorian Mental Health Reform Strategy 2009- 2011 Strategy Implementation Plan prioritises addressing the housing insecurity of people with severe mental illness. It undertakes to:
Target flexible mental health psychosocial support to people with psychiatric disability and link them to social housing options.
Streamline access to social and direct tenure public housing for people with mental health problems experiencing entrenched homelessness.
Intervene earlier to reduce homelessness and create permanent pathways out of homelessness for people with a severe mental illness.
Access to housing and employment are central to the social inclusion of people with mental illness. The link between homelessness, psychiatric crisis and hospitalisation, low levels of community participation and unemployment is well understood.
The Mental Health Reform Strategy 2009- 2011 Strategy Implementation Plan prioritises addressing the housing insecurity of people with severe mental illness. It undertakes to:
Target flexible mental health psychosocial support services to people who are most unable to access and maintain stable housing due to the impact of their psychiatric disability, and link these individuals to a range of existing and new social housing options.
Streamline access to social and direct tenure public housing for people with mental health problems experiencing entrenched homelessness.
Intervene earlier to reduce homelessness and create permanent pathways out of homelessness for people with a severe mental illness. This will involve supporting people at critical transition points, such as when they exit bed-based clinical rehabilitation services, prisons and when family support breaks down.
Significant progress has already been made with the implementation of new intensive packages of flexible, scaled psychosocial rehabilitation support that are linked to a range of housing options for people with severe mental illness. These are targeted to people who are homeless or at risk of homelessness.
We are also progressing new models to support people with a history of homelessness and severe mental illness and other comorbid issues commencing with the Elizabeth Street supportive housing initiative.
We are also developing stronger partnerships with Housing Associations, in existing or new joint developments to identify properties where we can support people with severe mental illness.Access to housing and employment are central to the social inclusion of people with mental illness. The link between homelessness, psychiatric crisis and hospitalisation, low levels of community participation and unemployment is well understood.
The Mental Health Reform Strategy 2009- 2011 Strategy Implementation Plan prioritises addressing the housing insecurity of people with severe mental illness. It undertakes to:
Target flexible mental health psychosocial support services to people who are most unable to access and maintain stable housing due to the impact of their psychiatric disability, and link these individuals to a range of existing and new social housing options.
Streamline access to social and direct tenure public housing for people with mental health problems experiencing entrenched homelessness.
Intervene earlier to reduce homelessness and create permanent pathways out of homelessness for people with a severe mental illness. This will involve supporting people at critical transition points, such as when they exit bed-based clinical rehabilitation services, prisons and when family support breaks down.
Significant progress has already been made with the implementation of new intensive packages of flexible, scaled psychosocial rehabilitation support that are linked to a range of housing options for people with severe mental illness. These are targeted to people who are homeless or at risk of homelessness.
We are also progressing new models to support people with a history of homelessness and severe mental illness and other comorbid issues commencing with the Elizabeth Street supportive housing initiative.
We are also developing stronger partnerships with Housing Associations, in existing or new joint developments to identify properties where we can support people with severe mental illness.
106. Employment has a key role in social inclusion From this graph we can see that people with severe mental illness have extremely low rates of workforce participation. However, research tells us that there is a strong desire amongst people with severe mental illness to be employed and employment can have a beneficial impact on their recovery.
Work plays an important role for all people, with or without a mental illness. Work provides individuals with economic security, social identity, social status, activity and a sense of personal achievement. Employment participation is a key plank of social inclusion and recovery.
The costs of unemployment for people with severe mental illness are great, both at an individual and societal level. At an individual level, unemployment for people with mental illness has been linked to a greater likelihood of psychiatric crisis, including increased risk of suicide, and increased use of mental health services and hospitalisation. At a societal level, there are significant financial costs associated with the low workforce participation rate of people with severe mental illness.
The Mental Health Reform Strategy provides a range of strategies to support the workforce participation of people with severe mental illness. Some of these include:
Greater prioritisation of the employment goals of people with severe mental illness in treatment and recovery planning in the specialist mental health services.
Improved linkages between the specialist mental health and specialist employment services.
In addition a Ministerial Advisory Committee has been exploring strategies to be driven through the specialist mental health services to improve the workforce participation of people with severe mental illness. It is due to report back soon.
From this graph we can see that people with severe mental illness have extremely low rates of workforce participation. However, research tells us that there is a strong desire amongst people with severe mental illness to be employed and employment can have a beneficial impact on their recovery.
Work plays an important role for all people, with or without a mental illness. Work provides individuals with economic security, social identity, social status, activity and a sense of personal achievement. Employment participation is a key plank of social inclusion and recovery.
The costs of unemployment for people with severe mental illness are great, both at an individual and societal level. At an individual level, unemployment for people with mental illness has been linked to a greater likelihood of psychiatric crisis, including increased risk of suicide, and increased use of mental health services and hospitalisation. At a societal level, there are significant financial costs associated with the low workforce participation rate of people with severe mental illness.
The Mental Health Reform Strategy provides a range of strategies to support the workforce participation of people with severe mental illness. Some of these include:
Greater prioritisation of the employment goals of people with severe mental illness in treatment and recovery planning in the specialist mental health services.
Improved linkages between the specialist mental health and specialist employment services.
In addition a Ministerial Advisory Committee has been exploring strategies to be driven through the specialist mental health services to improve the workforce participation of people with severe mental illness. It is due to report back soon.
107. The role of the workforce in supporting social inclusion Specialist mental health and broader health and community services workforces are vital to supporting social inclusion
Psychosocial Rehabilitation and Recovery Reform and Development Plan The workforces of both the specialist mental health services and the broader health and community services have key and complementary roles to play in supporting the social inclusion of people with severe mental illness.
The Department of Health is currently developing a Psychosocial Rehabilitation and Recovery Reform and Development Plan that explores how we can further develop and support the specialist mental health workforce to support the recovery of people with severe mental illness.
The way that services are provided, the environment they are provided in, and the data requested all contribute to social inclusion/exclusion in its own right.
If we are to make significant inroads into the complex issue of social exclusion it is important that the broader health and community services have a good basic understanding of mental health impacts, and that we ensure coordinated service responses and seamless transitions between our mental health and broader health and community service system. I look forward to discussing this and other issues in our panel discussion.
The workforces of both the specialist mental health services and the broader health and community services have key and complementary roles to play in supporting the social inclusion of people with severe mental illness.
The Department of Health is currently developing a Psychosocial Rehabilitation and Recovery Reform and Development Plan that explores how we can further develop and support the specialist mental health workforce to support the recovery of people with severe mental illness.
The way that services are provided, the environment they are provided in, and the data requested all contribute to social inclusion/exclusion in its own right.
If we are to make significant inroads into the complex issue of social exclusion it is important that the broader health and community services have a good basic understanding of mental health impacts, and that we ensure coordinated service responses and seamless transitions between our mental health and broader health and community service system. I look forward to discussing this and other issues in our panel discussion.
109.
Seeking Social Inclusion: Equipping Organisations to respond to people experiencing mental illness
A symposium
9 September 2010
