Mental Health Resource 4 Carers

1. Mental Health Resource 4 Carers

2. Mental Health Resources 4 Carers • Carers Qld Inc. would like to acknowledge the funding provided by the Country to Coast Primary Health Network in the development of the following carer education resource.

3. Mental Illness

4. Mental Illness • Approximately 1 in 5 Australians will experience a mental illness. • Mental illness is a general term which refers to a group of illnesses, just as heart disease refers to illnesses and disorders relating to the heart. • A mental illness is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people. • Mental illness diagnosed according to a standard criteria (DSM –V or ICD-10). • Most of us will experience a mental health problem at some time in our lives

5. Mental Health Problems • Mental health problem(s) also interfere(s) with how a person thinks, feels, and behaves, but to a lesser extent. • Mental health problems are more common and include the mental ill health that can be experienced temporarily due to the stresses of life.

6. Mental Health System

7. Mental Health System • Mental health care is delivered by a range of providers operating within and across different sectors. • Clinical assessment and treatment services are provided by public (Queensland Health) and private sector mental health services and health practitioners. • A variety of other interventions to support mental health and recovery are provided by other government and non-government sectors. Services including those such as housing, employment or personal care. • All sectors are involved in identifying and intervening early with people who are at risk of developing mental illness and facilitating timely and effective recovery-orientated pathways.

8. Mental Health Act 2016Rights of Family, Carers and Other Support Persons • Mental Health Act 2016 (MHA 2016) acknowledges the role of family, carers and support persons play when the person is unwell, and through all stages of treatment, care and recovery. • Support persons are recognized throughout the MHA 2016 and are afforded a number of important rights and responsibilities.

9. Rights of Family, Carers and Other Support Persons The principles of the Act provide that: To the greatest extent practicable, family, carers and other support persons … are to be involved in decisions about the person’s treatment and care, subject to the person’s right to privacy. (Mental Health Act 2016).

10. What role does a support person play The MHA 2016 expressly states the role of the support person is: • To contact the person while they are undergoing treatment and care. • To participate in treatment decisions. • To receive information about the person’s care, treatment, rehabilitation and recovery. • To arrange other support services for the person, such as respite care, counselling and community care facilities.

11. Family, carers and support persons responsibilities • To respect the person’s dignity and humanity. • To consider the opinions and skills of health practitioners who provide treatment and care. • To co-operate with reasonable programs of assessment, treatment, care, support, rehabilitation and recovery.

12. Support person’s rights Nominated support person’s, family, carers and other support persons have rights, including the right to: • Visit a person at any reasonable time of the day/night, provided the support person is not excluded from visiting … (if the visit may adversely affect the person) and the person wishes to be visited. • Ask a health practitioner to visit and examine a person, and consult with an authorized doctor about the person’s treatment and care. • Communicate with a person by post, phone or electronically, unless prohibited by the administrator as being detrimental to the person or others. • Request a second opinion on behalf of the person. • Request a copy of the Statement of Rights.

13. Mental Health Treatments & Interventions

14. Treatment Modalities • Psychological Therapy • Medication • Community Support Programs

15. Common Terminology in Treatment • Recovery • Wellness Recovery Action Plan

16. Recovery • What is Recovery? • Refers to a person’s improved capacity to live a fulfilled life that is not dominated by illness and treatment. • Does not focus on reduced symptoms or treatment alone, but on the person experiencing improved quality of life and higher levels of functioning. • Individual journey towards a new and valued sense of identity, role and purpose outside boundaries of mental illness. • Recovery means over time, individuals come to terms with their illness, learn how to accept and move beyond it. • Person learn to believe in themselves, identify strengths as well as limitations and find purpose and enjoyment in their life. Source: the Queensland Plan for Mental Health 2007-2017)

17. WRAP • Wellness Recovery Action Plan • Developing a Wellness Toolbox (daily maintenance plan). • Understanding triggers and what can be done about them. • Identifying early warning signs and an action plan. • Signs things are breaking down and an action plan. • Crisis planning. • Post Crisis Planning. http://mentalhealthrecovery.com/wrap-is/

18. Self CareStrategies for supporting and sustaining yourself as a carer

19. How are carers affected by Mental Illness? • Mental Illness often has a “ripple effect”. • Carers may take on role of day-to-day care. • Carers are often not acknowledged or listened to by health professionals. • Carers often provide long term, complex care with little to no support.

20. How are carers affected by Mental Illness? • Educational and vocational opportunities are more difficult to manage. • Social and recreational opportunities can be unmanageable at times. • Family breakdown due to stress and communication issues. • Carers often experience emotions related to losses and unrecognized grief reactions.

21. How are carers affected by Mental Illness? • Carers also report that caring for loved one is an incredibly enriching experience. • A unique, powerful and positive experience, if the right support, education and information is available and accessible.

22. What is Self-Care • Self care is any intentional actions you take towards caring for your; physical, emotional, intellectual (thinking) and spiritual wellbeing. • Self care is not : • An “emergency response plan” to be activated when impacted by stress . • Self Care is not about being selfish. • Is not about doing more, or adding more tasks to an already overwhelming task list.

23. Why is Self-Care important? • Enhancing capacity to maintain caring role. • Whilst caring is rewarding, it can also be stressful. • Carers are at greater risk than the general population to experience stress, depression and anxiety. • To minimize personal stress and the impact on the human body and emotional wellbeing.

24. Barriers to Self-Care • Thinking you’re selfish if you take time out for your needs. • Fear – can be frightening to think about own care needs. • Difficulty asking what it is you need. • Feelings of inadequacy asking for help. • Perceived lack of time.

25. Self Care Strategies Enhancing Health and Wellbeing • Reducing personal stress. • Setting goals that are achievable. • Negotiating appropriate boundaries in relationships. • Seek solutions to issues. • Asking for and accepting help. • Developing a Self Care Maintenance Plan.

26. Self Care Maintenance Plan Activities that incorporate the general principles to: • Take care of physical health. • Manage your stress & reduce where possible. • Recognize and honor your emotional, psychological, physical, creative, and spiritual needs. • Nurture your relationships where possible. • Find balance between caring role and other aspects of your life.

27. Self Care Maintenance Plan Important questions to ask your self when developing your Self Care Maintenance Plan. • How do I cope now? Identifying what you presently do to manage stress and assess if these strategies are working. • What it is you would like to do? Brainstorm activities you would like to add to your routine. • Outline your plan. Develop a Self Care Maintenance Plan. • Identify obstacles. • Make a commitment to yourself. • Share intentions. • Follow your plan.

28. Self- Care Maintenance Plan: example

29. Self- Care Maintenance Plan: example

30. Warning Signs – when to seek help Identifiable signs - • Feeling tired most of the time. • Feeling overwhelmed and irritable. • Sleep disturbance - too much or too little sleep. • Poor eating habits. • Gaining or losing weight. • Ignoring own health. • Loss of interest in activities you used to enjoy. • Social isolation.

31. Loss and Grief

32. Change = Loss = Grief (Adapted from Worden)

33. Loss • We experience loss across our life-span • Loss of a loved one/friends (bereavement), relationship, pets, job/career or way of life, children leaving home, dreams, goals and aspirations. • For Carers many of the changes and losses experienced can come quickly and often. • One loss can lead to another loss or trigger memories of previous losses in life.

34. Ambiguous Loss • ‘Ambiguous Loss’ is what carers experience when someone is still “there”, physically present but also not “there”, psychologically and emotionally different .( G. Betz, J. Thorngreen, 2006). • Ambiguous loss is experienced in witnessing the person ‘s losses due to consequences of mental illness – that could include independence, employment, financial, friends and relationships, losses of joy and pleasure, dreams, hopes and aspirations. • Carers/family members supporting a loved one, may themselves experience many losses that go unrecognized by others or themselves.

35. Loss • Common losses experienced by carers: Identity Family Relationships Relationship roles Health Dreams, Goals, Wishes & Aspirations Companionship Time Friends Expectations Self Esteem Lifestyle Sense of Self Freedom Communication Life’s Meaning Privacy Choice Future Bereavement Intimacy Personal Space Opportunities – educational & career

36. What is Grief? • Grief is a natural response to a painful loss. • The more significant the loss, the more intense the grief is likely to be. • Grief is like a roller coaster.

37. DisenfranchisedGrief • Disenfranchised grief is the “invisible” or “unrecognized” grief. • Disenfranchised grief is when a grief cannot be openly acknowledged, publicly mourned or socially supported. • No public rituals to celebrate the unique ness of an individual’s life. • There may be sense of frustration or even anger that no one really understands what you are going through. • A carer’s reflection. • “I had lost the wife I knew with out the luxury of having a funeral.” ( Carer Victoria -2011)

38. Signs of Grief

39. Stages of GriefKubler-Ross model 1 Denial- “ this isn’t happening” , “ I don’t need any help” 2 Anger “ this isn’t fair” , “ how can this happen to me?” 3 Bargaining – “ I would do any thing to change this” 4 Depression- “ what’s the point?” – “ there is no hope” 5 Acceptance- “ It is what it is” (E. Kubler-Ross “On Death and Dying -1969)

40. Worden’s Tasks • Accept the reality of the loss. • Process your pain and grief. • Adjust to the environment in which the person you once knew is missing. • Find connections – Reinvest your emotional energy by welcoming the person they have become.

41. Grieving • People grieve a loss or losses in their own way. • No right or wrong way. • No set timetable. • Two distinct grieving styles • Intuitive grievers. • Instrumental grievers.

42. What Helps? • Allow yourself to grieve • Take care of yourself • Engage in activities you enjoy • Let other’s know how they can help • Accept and be open to offers of support • Stay connected • Honor your loss • Express grief in creative ways • Seek out support • Recognize and value your growth as a person

43. Planning for life in the Future • Prepare for life after caring • Maintaining and nurturing meaningful relationships • Maintaining/developing interests • Engage in learning – University 3rd Age • Self Care • Return to paid employment

44. When to Seek Help • You don’t feel able to cope with overwhelming emotions or daily life • The intensity of emotions not subsiding • Your not sleeping • Extreme anger or bitterness over loss • Feeling life is empty and meaningless • Avoiding things that remind you of your loss • Intense longing and yearning for the deceased • Intrusive thoughts and images of your loved one

45. Supporting a Loved One with Mental Illness

46. Know the Illness • Learn about the symptoms. • Theories of causes. • Treatments. • Medications.

47. Communicating with a person who has a Mental Illness • Practice reflective listening. • Focus attention on the person. • Try to understand person’s experience. • Avoid reactive listening. • Remain calm. • Set limits.

48. Communication • The DESC approach: • Describe the behaviour that is concerning you objectively. • Express how you feel about it • Specify the behaviour you want • State the Consequences

49. Communication • The LEAP approach: • LEAP is an effective sustem for communicating and collaborating to solve problems – • Listen: Listen to try to understand what it is the person is telling you. Reflect back what you have heard, without your opinion/ideas. • Empathise: empathise with how the person feels about their experience and symptoms, without necessarily agreeing with their reality – e.g. “that sounds scary. Do you feel friegtened. • Agree: Find areas of agreement, especially goals you both want (e.g. Stay out of hospital). • Partner: Collaborate to work towards agreed upon goals.

50. Living With Black Dog • https://www.youtube.com/watch?v=2VRRx7Mtep8