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Session One Slides
Building a Future session outline
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Session One - Setting the Scene - developing a framework
for understanding mental illness
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Session Two - Recovery
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Session Three – Understanding psychosis and exploring
communication
Building a Future session outline
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Session Four – Understanding schizophrenia and the mental
health legal system
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Session Five – Grief and trauma related to mental illness,
understanding depression and anxiety
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Session Six – Understanding bipolar disorder, how families
can be part of the solution
Building a Future session outline
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Session Seven – Understanding dual diagnosis, mental
health systems and the National Disability Insurance
Scheme
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Session Eight - Understanding borderline personality
disorder and taking care of yourself
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Session Nine - Advanced communication skills
Building a Future session outline
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Session Ten – Acknowledging grief and gaining strategies
to continue the journey as a carer
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Session Eleven – Managing the fear of suicide
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Session Twelve – Developing a Wellness Recovery Action
Plan (WRAP)
New strategy for carers
Change in Thinking
• Separate the person and the illness
• Acknowledge grief
• Understand recovery
Change in Behaviour
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Improved communication skills
Recognise own limits
Seeking appropriate cultural support
Managing change and helpful interventions
Change in Results
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Recovery & hope
Improved relationships
Less family stress
Increased wellness
The stress-vulnerability coping model
HIGH
Protective Factors good coping skills, social
supports, appropriate medication, safety, cultural
support
Risk of
developing
psychosis
and
Risk of
having a
relapse
LOW
Risk Factors learning difficulties, poor social
skills, poor coping skills, drug/alcohol use, low social
supports, major life events, family history of mental
illness, no treatment, poverty, migration, cultural
alienation
Mental illness and the brain
Learning about brain biology can:
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give information from a biological and medical perspective
(and some idea of its complexity)
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help you understand and support treatment
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assist you in dealing with the stigmas of mental illness
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support the realisation that no one is to blame for the onset
of mental illness
Neurotransmitters & Synapses
The brain
Cycling forward
TIME
Session Two Slides
Key features of a recovery process
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Personal growth
Hope
Understanding and acceptance
Active coping
Withdrawal to engagement and active participation in
life
Active experimentation
Rebuilding a sense of identity
Connecting and contributing
Recovery is a complex journey
Beliefs that support recovery
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Recovery is always possible
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Recovering is a truly unifying human experience
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Each person’s recovery process is unique
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Recovering is not a linear process
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Recovering does not necessarily mean that symptoms cease
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Developing a meaningful contributing life
Internal and external resources for recovery
Internal Resources
Hope
Acceptance
Self will/responsibility
Spirituality
Coping Skills
External Resources
Social support
Meaningful activity
Medication
Professional assistance
Peer support
‘Recovery in peer support comes from seeing ourselves
as human beings rather than as mental patients’.
‘By building trust and sharing experiences we are able
to move beyond our perceived limitations, old patterns
and ways of thinking about our mental health and the
mental health of others…. into a culture of health and
ability’.
Wellness Recovery Action Plans
Plans cover aspects of:
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Wellness toolbox (your collection of skills, habits, books &
other helpful things) and daily maintenance plan
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Important people to contact for support
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Triggers and early warning signs
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When and who to contact for medical intervention
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Crisis and post crisis planning
Separating the illness from the person
Provides a framework for:
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Not engaging with the illness
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Avoiding conflict that can’t be resolved
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Allows for more compassion towards a person
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Allows for the expression of negative feelings about the illness
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Allows you to be think in terms of strategies and be in more
control of your actions and emotions
Session Three Slides
Symptoms of psychosis
Positive Symptoms
are experiences and behaviours that have
been added to the person’s normal way of
functioning
Hallucinations are distortions of the senses
that are very real to the person.
The brain hears, sees, smells, tastes or feels
things that are not there in the external world,
for example: hearing voices / food tastes
strange / people see things that aren’t real
Delusions are fixed and false beliefs, e.g. ‘I
am Jesus Christ’
Negative Symptoms
Feelings of emptiness
take away from a person’s experience of
the world
Lack of energy, reduced motivation
Flat mood
The sense of wellbeing and self worth can be
reduced
Substance induced psychosis
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Positive symptoms of psychosis
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Triggered by use of drugs or alcohol and occurs when withdrawing from
the substance or soon after
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Person recovers when substance is no longer in body
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Increased vulnerability to psychosis in future if the drug is reused
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Caused by heroin, cocaine, alcohol, marijuana, amphetamines and
benzodiazepines
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Diagnosis will not be altered until a significant drug free period has
elapsed without symptoms abating
Biopsychosocial treatment of psychosis
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Medication may be used to manage and reduce symptoms
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Hospitalisation may occur when a person is unsafe, others are
unsafe and/or to treat serious physical conditions alongside
symptoms of the psychosis
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Rehabilitation and recovery orientated services include
individual support in daily living, support to identify goals and
aspirations in life, support to use personal resources and
community supports to achieve these goals, support with
identified need such as housing, employment, peer support
Antipsychotic medication
‘Typical’ antipsyhotics:
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Older form of antipsychotics
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Generally less effective in treating negative symptoms
Reasons for being prescribed typical antipsychotics include:
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Reluctance to take medication and hence a legal order binds
a person to take (or be given) medication
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Medication has not been reviewed in a long time
Antipsychotic medication
‘Atypical’ antipsyhotics:
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Newer form of antipsychotic
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Generally has better results with different side effects
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More successful in treating positive symptoms as well
as negative symptoms
Taking antipsychotic medications
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Trials of medication (alone or in combination) are
often needed to determine what works best for
each individual
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Symptoms can remain even after medication has
been started
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Waiting to see if the medication is suitable can
take time and can therefore be a challenging
period
Taking antipsychotic medications
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Other medication (often sedating) may be prescribed
for problems such as agitation, anxiety and sleep
disturbance
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Medication may also be prescribed to reduce the
side-effects of antipsychotics
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Ongoing medication treatment is often recommended
if a person has more than one psychotic episode or
has not recovered fully from a first episode
Why use effective communication
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To give clarity
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To assert the rights and needs of yourself and other
family members
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To reduce conflict
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To enhance relationships
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To model skills
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To develop skills which reduce stress and risk of
relapse
Values that underpin effective communication
Empathy
The ability to understand someone
from the other’s perspective
Genuineness
To assert the rights and needs of
yourself and others
Respect
Valuing other people for themselves
Assertiveness
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The right so say ‘no’
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The right to say ‘yes’ and ‘no’
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The right to say ‘I don’t understand’ and ‘I need some time to
think about that’
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The right to make your own decisions
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The right to change your mind
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The right to hold your own opinions and beliefs
Issues that reduce effective communication
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Lack of skills
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Strong emotions
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Indecision
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Unhelpful Environment
Communication skills
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Levelling - Effective communication can only occur when both
parties know all the relevant information (thoughts, feeling and
facts)
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Listening - This skill not only involves hearing, but actively
processing what others say
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Validating - This skill involves communicating to the other person
that you have heard their position or opinion
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‘I’ statements – When you communicate how you feel to
someone, make a request, or say ‘no’ to a demand, begin what
you say with the expression ‘I’.
Example of effective communication
‘I feel worried and frustrated when you don’t take your
medication because it is an important aspect in the
management of your illness (‘I…’ statement).
I understand that you may have concerns about the side-effects
of the medication (validation) and I am here to support you and
listen if you need someone to talk to (willingness to listen).’
Communicating with professionals
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Learn as much as you can about the service and how it functions
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Offer any information that seems relevant
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Plan your questions and what you want to say
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Be familiar with confidentiality policies
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Be factual and clear in your conversations
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Request meetings to help with communication
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Remember to thank people for their time and effort
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Recovery from illness will take teamwork
Communicating with crisis teams
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Describe the previous diagnosis (if any) and current symptoms
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Describe the positive symptoms
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Describe any suicidal thoughts or actions
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Tell the crisis team about medication
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Explain your experience of the illness in the past
Who to call when in crisis
The police respond to events in which there is any form of danger –
along with the local crisis team. When you call the local crisis team on
these occasions:
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The local crisis team should take responsibility to engage the
police if they think it is necessary
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If there is extreme danger it would be sensible to call the police
directly yourself
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You might want to call the local crisis team after your call to the
police to ask them to attend as well
Understanding the crisis team response
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Is the response inappropriate for the symptoms?
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Are the symptoms not severe enough?
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If so, what would indicate that they were severe enough (or when
would the local crisis team become involved?)
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What should you do in the meantime? Are there other services that
could be appropriate?
Tips for seeking service
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If possible call services at non-crisis times, this allows you to
think more clearly, relay the symptoms and describe the
situation in a calmer way
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Consider visiting your GP, they are able to make direct referrals
to the crisis team
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Consider taking the person to the emergency department of a
general hospital
What to tell the police
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That there is a history of mental illness
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Of previous times of being taken to hospital by police,
how it was done and how effective it was
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Whether there is any danger to the police
If you are unhappy about your experiences with
an area mental health service
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Document your experiences to date
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Request a meeting with the professionals involved and
discuss the issues
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If the issue is still unresolved you may consider taking
further action
Home activity
Think about:
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One area of communication that you have a problem
with
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What we have learnt about communication today
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What communication strategy might be suitable
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Attempt the communication
Report next week on the outcome
Session Four Slides
Positive symptoms of schizophrenia
Positive symptoms - the excess or distortion of normal functions.
These can include:
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Hallucinations (distortions of the senses)
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Delusions which are fixed and false beliefs
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Disorganised thinking and speech
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Disorganised behaviour, eg. dressing in an unusual
manner
Negative symptoms of schizophrenia
Negative symptoms reflect a loss of normal function.
These can include:
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Diminished range of emotional expressiveness most of the time
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Reduced speech/quieter
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Inability to initiate and sustain goal-directed activities
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Feelings of emptiness, reduced sense of self worth
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Lack of energy and reduced motivation
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Flat mood (flattened affect)
Cognitive symptoms of schizophrenia
Cognitive symptoms reflect an impairment of a person’s usual level
of thinking. These can include:
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Impaired working memory
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Impaired information processing
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Problems with concentrating
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Impaired ability to regulate behaviour based on social cues.
The pattern of schizophrenia
Most commonly schizophrenia develops in the following pattern:
1.
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Prodromal phase
Withdrawal and social isolation
Irritability
Change in usual behaviours/interests
2. Active phase
• Characterised by the development of the psychotic symptoms.
3. Stable phase
• Period where psychotic symptoms begin to remit and rebuilding of
functioning occurs
Outcomes of schizophrenia
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45% have complete or partial recovery after
one or more episodes
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20% have unremitting symptoms and
increasing disability
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35% have varying degrees of remission and
exacerbation
Social effects of living with schizophrenia
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Social stigma
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Social isolation
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Physical co-morbidities
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Substance use
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Socio-economic disadvantage
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Increased risk of suicide
Violence and schizophrenia
There is a 0.1% increased rate of violence to others.
Risk factors for being violent to others include:
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Being male
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Substance use
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Active psychotic symptoms
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Previously violent
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Previous victim of violence
Violent acts are often committed in private against people known to the
perpetrator (commonly women).
Social impacts of schizophrenia on families
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Social stigma
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Financial strain
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Emotional distress
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Physical illness
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Social isolation
Treatment for schizophrenia in the acute phase
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Safety
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Nutrition and Hydration
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Distress
Treatment can involve:
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Hospitalisation or intensive medical support at home
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Antipsychotic and sedating medications
Schizoaffective disorder
Schizoaffective disorder is a disorder in which mood changes
similar to those found in bipolar disorder are present together
with symptoms of schizophrenia.
Schizoaffective disorder sub-types
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Schizoaffective bipolar type – where symptoms include
manic episodes or manic and depressive episodes
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Schizoaffective depressive type – where the symptoms
include depressive episodes only
Legal issues covered in this session
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Principles involved in treatment
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Legal concepts that relate to mental health
Issues to consider in relation to treatment
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More or different treatment
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Whether there is a need for admission to hospital or
whether the person can stay at home
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If the person goes to hospital, how long the person
should stay
Mental Health Acts
Mental Health Acts are the laws that govern the provision of
treatment, care, rehabilitation and protection for people who
have a mental illness
Mental Health Acts aim to balance the rights of people with
mental illness to make their own decisions with the
responsibilities of the community
Voluntary treatment
Voluntary treatment means that the person with the mental
illness agrees to treatment, either in the community living
privately or in a mental health facility or in hospital.
Many people who have a good understanding of their mental
health may proactively seek treatment or agree to treatment
when needed.
Involuntary treatment
People who have a severe mental illness may lack the
capacity to recognise their need for psychiatric care and
refuse treatment.
In this situation, people fulfilling particular roles stipulated
within the Act (often doctors, police, nurses) can recommend
a person for psychiatric care.
Community orders
Community orders require people to receive treatment for a
mental illness whilst living in the community.
People are required to accept treatment including
medication and other therapy. Most often these apply to
people who have a history of refusing treatment and
becoming seriously unwell repeatedly after discharge from
hospital.
Informed consent
Occurs when the person provides formal permission for a
specific treatment to occur.
The following information must be provided for informed
consent to be given:
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Procedure or treatment
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Risk involved with that procedure or treatment
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Consequences of not having the treatment
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Alternative treatments
Cognitive abilities for informed consent
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Mental illness has not interrupted the person’s thinking
and understanding processes enough to make them
unable to do all of the above
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In this situation if the person is deemed to need
treatment they will be made involuntary and the
treatment provided
Treatment plans
An outline of the proposed treatment, counselling,
management, rehabilitation and other services to be provided
to implement the community order .
The method by which, the frequency with which, and the
place at which the services will be provided.
Protection of the rights of people with a mental
illness
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Review body for involuntary status
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Community members who have a monitoring role
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Senior government department official
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Body that provides free mental health legal advice
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Government body that promotes the rights and interests
of people unable to administer their own interests
Session Five Slides
New Strategy for carers
Change in Thinking
• Separate the person and the illness
• Acknowledge grief
• Understand recovery
Change in Behaviour
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Improved communication skills
Recognise own limits
Seeking appropriate cultural support
Managing change and helpful interventions
Change in Results
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Recovery & hope
Improved relationships
Less family stress
Increased wellness
The grief of mental illness
Can relate to:
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The loss of the person as you knew them prior to
the illness
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The losses and changes that occur within families
as a result of the illness
The grief around mental illness is often
not acknowledged
Survivors are not accorded the right to grieve’
(Dorka, K. 2002 p5)
The grief around mental illness is often not
acknowledged. People feel too ashamed to acknowledge
that mental illness is happening and therefore others
don't know and so can’t be supportive. The numerous
secondary losses are also not acknowledged.
The loss around mental illness is psychological
‘Because the loss with mental illness is psychological and
not physical, the community does not perceive the family’s
loss and does not join with them with expressions of
sadness and pain. There are no social or religious rituals
as consolation.’ (MacGregor, 1994)
Grief can be seen as disloyal
‘If I, in any way, fully acknowledge my grief and loss
experience (loss of relationship with person, their hopes,
goals and dreams) I am in some way being disloyal to the
person and the hope that they will overcome their mental
illness.’ (O’Dowd, G., 2002)
The grief around mental illness is often
ambiguous
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This refers to the uncertainty concerning the loss
experience – is the loss temporary or permanent?
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It feels like a loss, but is it really one?
The effects of trauma
Trauma can have two consequences:
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Fight and flight response – prepares the body to get
out of the situation. Expressions of this include
hyperarousal, panic, defensiveness, anger and
reactiveness
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Freeze response – examples of emotional
expressions of this include passivity, being
disconnected, ashamed, can’t say no
Possible responses to trauma and grief
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Acknowledge and validate your own grief experience
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Break the silence on your grief, speak to family and
friends
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Find places or people where you can comfortably talk
eg. counselling to work through issues of trauma and
grief
Clinical Depression
A group of illnesses that are characterised by an excessive or
long-term depressed mood that affects the person’s life
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Depression is often associated with anxiety
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Depression is often not recognised and, as a
consequence, left untreated
The Mood Graph
Classifications of Depression
The common classifications of depression are:
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Mild depression
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Moderate depression
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Severe or major depression
Internal and external factors for depression
External
Internal
• Family conflict
• High anxiety, nervousness
• Relationship conflict
• Chemical changes –post- operative,
menopause
• Recent losses and
disappointments
• Mental illness in the family
• Inherited disposition genetic
• Drugs or alcohol
• Medical illness or treatments for medical
illness, e.g. low thyroid function, heart
conditions
• Migration (forced and voluntary)
• Past bad experiences, trauma
• Discrimination
• Personality prone to worry and/or
perfection
• Separation from family
Lived experience of depression
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Expressions of helplessness and hopelessness
Depressed most of the day
Loss of interest or pleasure in activities
Reduced movement
Fatigue and loss of energy
Weight loss or gain
Insomnia
Feelings of worthlessness/guilt
Poor concentration
Recurrent thoughts of death
Common responses to depression
‘We thought he was lazy and just wouldn’t get out of bed.’
‘Why is she so sad? She should realise how lucky she is.’
‘Why can’t you just pull yourself together and get going?’
The act of acknowledging that one might be depressed
and that help is available can be very liberating.
Physical impacts of depression
Treatments and recovery
PSYCHOLOGICAL
TREATMENTS
PROMOTE COPING
DRUG
TREATMENTS
CHANGE BRAIN
CHEMICALS
Serotonin
Noradrenaline
Dopamine
RESOLVE LIFE
STRESS
Family conflict
Interpersonal conflict
Recent loss and
disappointments
REDUCE ANXIETY
STOP DRUG
AND/OR ALCOHOL
USE
BRAIN EFFECTS
Improve sleep
Improve
concentration
Increase energy
Better mood
Decrease anxiety
Interventions for depression
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Be aware of safety issues
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Be aware of hydration and nutrition
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Connect with the emotion of the experience
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Reinforce your love for the person
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Try to sit beside and be in the person’s space
Common reasons why depression goes
untreated
Stigma
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People often blame their physical and emotional
state on many other things
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The symptoms of depression can be dismissed as
personality traits
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A common sign in the early stages is irritability
Recovery from depression
Biological
Psychological
Environmental
Acute
Medication / ECT
Safety
Security
Hospital
Intensive support
Recovery
Medication / ECT
Talking therapy
Communication skills
Support
Friendship
Inter-dependence
Employment
Housing
Responsibility
Hospitalisation for people experiencing severe
depression
• Safety of the person
• Resolving of the psychotic symptoms
• Need to monitor complications from physical illness,
medication interactions or changes to antidepressant
medications
• Administration of ECT in life threatening cases
• Stabilising and monitoring people with substance use
issues
• Removing a person from a situation in which they are
becoming increasingly depressed
Community care for people with depression
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In cases of depression that are not life
threatening, care in the community is preferred.
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The local crisis team may provide support and
treatment to people who are not experiencing life
threatening symptoms
Complementary and self-help treatments
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The field of complementary and self-help
treatments is increasingly being seen by the
community as a treatment of choice
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Research published by Beyond Blue in 2008
indicates that Cognitive Behavioural Therapy and
Interpersonal Therapy are the most effective
therapies
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It is important to remember that severe
depression must be assessed by a medical
practitioner and treated accordingly, particularly
when part of ongoing treatment
Examples of beliefs and consequences
(1) An activating experience or event..eg retrenched from a job
(2) Belief about the event:
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Irrational belief, ‘I am a failure’
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Rational beliefs: ‘I need a change. I would be better suited to something
else’.
(3) Emotional and behavioural consequences of beliefs:
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‘I can never be happy’ leads to a person becoming depressed
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‘I feel upset but I know this is temporary’ is a more positive response
Session Six Slides
Types of bipolar disorder
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Bipolar 1 Disorder– one or more manic or mixed
episodes, usually accompanied by major depressive
episodes.
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Bipolar 2 Disorder – one or more major depressive
episodes accompanied by at least one hypomanic
episode.
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Cyclothymic Disorder – at least two years of
numerous periods of hypomanic symptoms and
numerous periods of depressive symptoms
Review of the Mood Graph
Personal account of hypomania
At first when I’m high it’s tremendous… ideas are fast… like
shooting stars you follow until brighter ones appear… all
shyness disappears. The right words and gestures are
suddenly there… uninteresting people, things become
intensely interesting. Sensuality is pervasive, the desire to
seduce and be seduced is irresistible. Your marrow is infused
with unbelievable feelings of ease, power, well-being,
omnipotence, euphoria… you can do anything… but,
somewhere this changes.’ - Kay Redfield Jamison
Personal account of mania
‘The ideas come too fast and there are too many…
overwhelming confusion replaces clarity… you stop keeping
up with it… memory goes. Infectious humour ceases to
amuse. Your friends become frightened… everything is now
against the grain… you are irritable, angry, frightened,
uncontrollable and trapped.’ Kay Redfield Jamison
Medications for Bipolar Disorder
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Antipsychotic medication
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Mood stabilisers
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Anti-depressants
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Electroconvulsive therapy
Responding to early warning signs
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Call on what you know about communicating with
someone in a psychotic or manic or depressed state
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Stay calm
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If you have had experience of this before or have had
discussions with the person when they were well, put
into place any plans that you developed (i.e Wellness
Action Recovery Plan)
Seeking treatment
Think beforehand about how you are going to tell the
story. The more your thoughts are organized the better
you will communicate.
Call on what you know about positive psychotic
symptoms and those of mania and depression.
Where possible, use medical words when
communicating with health professionals.
Assisting Recovery
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Adequate planning for discharge if the person is
hospitalised
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Consider psychosocial supports in the discharge planning
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Be compassionate about side-effects of the medication
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Let the person approach life at their own pace
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Move from a care-taking role to a care-giving role
Assisting recovery
• Support the achievements of the person with the mental
illness
• Be clear about how you will contribute to the person’s
recovery
• Communicate with the rest of the family about the issues
involved in recovery
• Identify the indicators and agree to a plan of action if a
relapse occurs
• Consider identifying early indicators
• Consult with your family member about the benefits of friends
being informed
• Put as much control into the hands of the person themselves
Session Seven
Do drugs and alcohol cause mental illness?
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Drugs and alcohol can cause a drug-induced
psychosis in susceptible individuals.
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People remain more susceptible to the development
of a psychosis if they reuse that drug.
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Drugs and alcohol can also be the trigger (stressor
in the stress-vulnerability-coping model) to the
development of schizophrenia or other psychotic
illnesses.
The effects of drugs and alcohol on people
with mental illness
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People with mental illness use drugs for the same
reasons as other people
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The issues associated with mental illness make it
harder to refrain from the use of drugs and alcohol
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The immediate effect of drugs and alcohol usually
provides relief from the positive mental illness
symptoms
The effects of drugs and alcohol on people
with mental illness
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People with a dual diagnosis may readily associate the
reduction of symptoms with the drug use
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People with a dual diagnosis generally have difficulty following
through with treatment
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Behaviours associated with dual diagnosis can be extreme
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Dependence issues compounded with mental illness
symptoms can result in overbearing behaviour, reduced
concern for consequences of behaviour, reduced connections
with society
Facts about violence in society generally
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Men are more likely to commit violence than
women
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Women are more likely to be the recipients of
violence
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Violence is more likely to be committed in private
environments (home)
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Recipients of violence are more likely to be known
to the perpetrator than strangers
Violence in the context of mental illness
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People with mental illness are more likely to harm themselves
than others
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People with mental illness are often the recipients of violence
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The factors mentioned in previous slide about societal violence
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Having a history of being a victim of violence
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Aged 16 – 25
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Having an untreated mental illness resulting in uncontrolled
positive symptoms
Models of dependence on substances
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Moral view, punishment rather than treatment.
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Pharmacological view, alcohol or drugs seen as more
powerful than ability to control use. Abstinence emphasised.
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Disease model, addiction seen as a disease, with
physiological and genetic predisposing factors.
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Social learning, interaction between environment, individual
and drugs in order to understand the drug experience. Drug
use seen as learned and functional.
Current treatment programs
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Disease model - linked to the AA approach, e.g.
twelve steps
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Social learning approach - harm minimisation
Harm minimisation strategies
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Using drugs only in the company of others
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Always using clean needles
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Predetermining a non-drinking driver
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Eating marijuana rather than inhaling
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Not mixing drugs
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Not mixing drinks
Stages of change model
Stages of Change model
Stage of change
Helpful support
Pre-contemplation
Harm reduction strategies
Contemplation
Opportunities to assess pros and cons
Determined preparation
Reinforcement of their reasons for wanting to
change and practical advice
Action
Problem solving skills
Goal setting
Maintenance
Support with strategies
Relapse
Reflective opportunities
Support
Review plan for high risk situations
Messages that support change
Everyone needs messages saying:
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You are worth it
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There are benefits in reducing drug or alcohol use
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You have the ability to change
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Reminders of the gains that have been made along the journey
Relapse in a social learning model
In the social learning model, relapse is an expected part
of change and can contribute to learning.
Principles in treating dual diagnosis
•
Assessment needs to occur over an extended period of
time
•
In-patient admissions should take into account drug use or
dependency
•
The treating team should offer specific dual diagnosis
treatment
•
Monitoring risk of suicide and self-harm is extremely
important
The impact of dual diagnosis on the family
•
Stress
•
Risk of violence
•
Agitation
•
Risk of suicide
•
Relapses
•
Financial strain
The principles of safety first
•
Stay calm and alert
•
Effective communication
•
Stay safe
•
Remove yourself from the situation
Community based mental health services
•
Mental Health Crisis Team
•
Mobile Treatment Services
•
Community Mental Health Centres
•
Early Intervention Teams
Principles of good practice in psychiatric
rehabilitation
•
Self determination
•
Community integration
•
Interdependence and responsibility
•
Having a good life
•
Family support
Features of the design of the National
Disability Insurance Scheme
•
Aimed at those who are most in need
•
Long term, high quality support
•
Recipients will have a permanent disability that significantly
affects their communication, mobility, self-care or selfmanagement.
•
It will have a comprehensive information and referral service,
to help people with a disability that need access to
mainstream, disability and community supports
How will the National Disability Insurance
Scheme work?
Local Area National Disability Insurance Scheme
Coordinators will:
•
Assess needs
•
Determine individualised budgets that ‘consumers’ can
‘spend’ on supports and services known as support
packages
The intention of the National Disability
Insurance Scheme
For carers and families it aims to better support families in
their caring role, and to ensure that role is nurtured and
can be sustained.
The National Disability Insurance Scheme
for people with disabilities
It aims to empower people with disabilities to make
choices for themselves and have greater control over their
own lives through designing of their own support package.
For the National Disability Insurance
Scheme to be effective people need to:
•
Be clear about their recovery and life goals
•
Have access to information and advice that enables
them to make choices
•
Have the ability to effectively communicate their
preferences and needs
Outline of the NDIS assessment and
planning process
•
Referral into the scheme
•
Assessment by the NDIS Local Area Coordinator
•
Planning and choosing services and supports
•
Review process
What does ‘Reasonable and Necessary’
mean?
Supports and Services:
• Should support the individual to achieve their goals and
maximise their independence;
• Should support the individual’s capacity to undertake activities
of daily living to enable them to participate in the community
and/or employment;
• Are effective, and evidence informed;
• Offer value for money;
• Should reflect community expectations, including what is
realistic to expect from the individual, families and carers;
• Are best provided through a National Disability Insurance
Scheme provider and not more appropriately provided through
other systems of service delivery and support
How families can help the person take
control
•
Knowing what helps them manage their illness
•
Knowing what they want from life and what they need so
they can reach their goals
•
Helping to find information about different options
•
Assisting the person to clearly communicate their
choices
Assessment and planning during acute illness
•
Listen to what the person is communicating, both verbally
and non-verbally
•
Whenever possible, attend to the person’s preferences
•
Draw on plans that were developed while the person was
less unwell
•
Carers and family may need to take a more active and
assertive role if the person’s insight and judgement is
affected
Assessment and planning during post acute
illness phase of recovery
•
Ask the person how they would like you to support them in the
process
•
Assist the person to access information about their rights and the
options that are available to them
•
Encourage the person to access advice or support from peers
•
Resist the urge to expect too much or too little: give the person
space to set their own goals and articulate their own needs
•
Offer messages of hope and encouragement
Assessment and planning when recovery is
well established
•
Encourage the person to take the lead in the process:
ask if they would like your support
•
Respect the person’s autonomy
•
Offer positive feedback
What makes a good life?
•
•
•
•
Good Health
Nutritious food and exercise
Gainful employment
Adequate, secure, affordable
accommodation
• Strong family support
• Good friendships and relationships
• A positive vision of the future life
• Financial support to sustain a good
life
Recovery Factors
•
•
•
•
•
•
•
Acceptance of illness
Hope and courage
Managing symptoms
Education
Reconstructing identity and purpose
Supporting others
Choice, responsibility, control and
empowerment
• Meaningful activity
• Advocacy
- Pat Deegan
Session Eight Slides
Borderline personality disorder
Borderline personality disorder (BPD) is diagnosed on the basis
of a cluster of:
•
Long-standing problems with relationships, identity or
sense of self, and the
•
Difficulty with control of emotions and behaviour
•
Recurrent suicidal impulses and self-harm are generally
seen as a core problem area
Borderline personality disorder
Compare to someone with third degree burns - they become
hypersensitive to any slight changes in the air temperature or
being touched can be very painful. In the same way, someone
with BPD becomes emotionally hypersensitive to what other
people might say, experiencing real emotional pain and a sense
of rejection over minor relational difficulties.
The experience of borderline personality
disorder
People often experience problems with:
•
Emotions and moods
•
Anger
•
Depression
•
Self damaging behaviour
•
Relationships
Risk factors for the development of
borderline personality disorder
•
Being female, 75% of people in hospitals with Borderline
Personality Disorder are female
•
History of abuse, neglect and invalidation
Protective factors for borderline personality
disorder
•
Extended and connected family
•
Validating environment
•
Good coping skills
•
Emotional support
•
Social inclusion and achievement
Focus of treatment and support
The major focus of the treatment is assisting people to:
•
Understand the emotions triggering their behaviour
•
Choose more adaptive behaviours
•
Take responsibility for themselves and their behaviour
•
Associated symptoms such as depression or anxiety are
treated with appropriate medication
What can friends and family do?
In addition to the general guidelines for supporting someone with a
mental illness specific issues to consider in relation to BPD include:
•
Take threats of harm seriously – talk with professionals
about these
•
Develop your communication and assertiveness skills
•
Be confident in your gut reaction – safety first every time!
Carer financial support schemes
•
Compensation for people who need to use their time caring
for the person with a mental illness and so are unable to
work
•
Compensation for some of the costs associated with being
the primary carer of someone with a mental illness
•
Each state or territory may also have a state based financial
support program for families and carers.
New Strategy for Carers
Change in Thinking
- Separate the person and the illness
- Acknowledge grief
- Understand recovery
Change in Behaviour
- Improved communication skills
- Recognise own limits
- Seeking appropriate cultural support
- Managing change and helpful interventions
Change in Results
- Recovery & hope
- Improved relationships
- Less family stress
- Increased wellness
Looking to the future
•
Information is power. Keep up with the task of learning
about mental illness
•
Consider the emotional impact on yourself and seek support
•
Consider further developing your communication and
problem solving skills
•
Continue the interests and activities in your life
•
Seek support through available financial and practical
schemes
Session Nine Slides
Aims of this session
•
Examine assertiveness as a concept
•
Look at barriers to effective communication
•
Re-examine the four basic communication skills
•
Examine how to implement the four
communication skills
•
Practice these skills by role-play related to real issues in
your lives at present
Assertiveness
•
The right so say ‘no’
•
The right to say ‘yes’ and ‘no’
•
The right to say ‘I don’t understand’ and ‘I need some time to
think about that’
•
The right to make your own decisions
•
The right to change your mind
•
The right to hold your own opinions and beliefs
Applied communication skills
•
Levelling – Why level? Examples of levelling...
•
Listening – Why listen? Examples of listening...
•
Validation – Why validate? Examples of validating....
•
‘I’ Statements – Why ‘I’ statements? Examples of ‘I’ statements...
Session Ten Slides
Aims of this session
•
To develop an understanding of the nature of grief in
relation to mental illness
•
To normalise grief and loss as a response to a changed
situation
•
To create a safe and supportive environment in which to
explore and express grief and loss
•
To develop a framework to provide support to one another
Assumptions that may be challenged by
loss
•
That we are invaluable
•
That the world is meaningful
•
That things happen for a good reason
•
That bad things don’t happen to good people
Positive ways to acknowledge grief
Attending grief support programs in your area
• Counselling
• Keeping a journal - writing is catharsis for many
• Eating well
• Exercise
• Getting enough rest
• Seeking or creating comforting rituals
• Allowing emotions - tears can be healing
• Seeking out people who are able to sit with your
sadness
• Avoiding major changes in residence or jobs
• Participating in a volunteer capacity
Session Eleven Slides
Aims of this session
•
To increase knowledge about suicide as it relates to mental
illness
•
To develop a framework to examine our personal attitudes
and how these form our view of suicide
•
To gain knowledge of risk factors relating to suicide
•
To increase knowledge of the suicide intervention model
What behaviours indicate that someone might
be about to attempt suicide?
• Talking about it
• Having a detailed plan about how they might go through with
it
• Having someone close to them commit suicide
• Depression
• Substance use
• Not being committed to anything
• Having the means to carry out the plan
• A previous attempt at suicide
• Giving away possessions
Session Twelve Slides
Aims of this session
• Increased knowledge about how best to equip yourself and
•
•
•
•
your family for the journey of mental illness
Increased skills in forward planning to reduce the ‘dilemmas
of caring’
Familiarity with the rationale for a Wellness Recovery Action
Plan
Increased understanding of the underlying principles for a
WRAP
Skills to develop a WRAP for themselves and or their family
member
Benefits of a WRAP
•
Aim to increase people’s experience of independence and
self-management of symptoms
•
Families can use the principles of WRAP in assisting their
loved one with a mental illness
•
Recognises the particular difficulty of decision-making at the
point of relapse
Components of a WRAP
•
Step One - Notice Early Warning Signs or Relapse
Signature
•
Step Two - Notice stress triggers
•
Step Three - Develop action plan
− Nominate helpful coping strategies
− Develop a medication strategy
− Write an essential contact list
− Agree steps for others to help
WRAP principles
•
Keep it simple
•
Make it yours
•
Work with others, eg. Other family members, doctors, case
managers
•
Know your plan - rehearse, adjust, write it down, have it
handy