Mental Health Care

About the authors ix Chapter 1 Mental health care in Australia 1 Introduction 2 1.1 Definitions 2 Mental health and mental illness 4 1.2 Stigma 8 Community attitudes 9 Attitudes of health professionals 10 1.3 A focus on caring 12 History of caring 12 Definitions of ‘care’ and ‘trauma-informed care’ 13 Aims of care and trauma-informed care 14 1.4 Caring in the health context 15 Current policy directions 17 Current service frameworks 18 Current service approaches 20 1.5 The prevalence of mental illness in Australia 23 Prevalence of suicide in Australia 24 Issues for young people 25 1.6 Common mental health issues 26 Summary 34 Key terms 34 Review questions 36 Discussion and debate 36 Project activity 37 Websites 37 References 38 Acknowledgements 43 Chapter 2 Assessment in the mental health context 44 Introduction 45 2.1 Mental health assessment of adults 45 2.2 Approaches to assessment 45 Reflection 48 Relationship 50 Recording 57 Reporting 58 2.3 Assessment tools 59 The comprehensive mental health assessment 60 2.4 Diagnostic manuals 66 ICD-11 67 DSM-5 67 2.5 Young people and mental health assessment 68 Young people presenting for assessment 69 Assessment frameworks for young people 70 2.6 Communicating with young people 72 The need to avoid ‘labelling’ young people 73 Summary 75 Key terms 75 Review questions 76 Discussion and debate 76 Project activity 76 Websites 77 References 77 Acknoweldgements 83 Chapter 3 The legal and ethical context of mental health care 84 Introduction 85 3.1 The legal and ethical context 85 Legal requirements 86 Ethical requirements 87 Confidentiality and privacy 88 Professional requirements 90 3.2 Challenges for health professionals 90 Legal and ethical frameworks 91 3.3 Capacity and competence 95 Principles of capacity and competence 95 Incapacity 96 Different types of consent 97 Power of attorney 97 3.4 Advance care agreements 99 Legal issues 99 Information required to make an informed decision 100 3.5 Duty of care 100 Reasonable and unreasonable 102 Least restrictive environment 103 3.6 State and territory mental health legislation 105 Sectioning and scheduling 106 3.7 Forensic mental health care 108 Summary 110 Key terms 110 Review questions 111 Discussion and debate 111 Project activity 111 Websites 112 References 112 Acknowledgements 115 Chapter 4 Culturally appropriate mental health care 116 Introduction 117 4.1 The pervasive nature of culture and subculture 117 Culture and subculture 117 4.2 Cultural constructions of mental illness 119 Alternative views to mental health care 119 4.3 Mental health and Indigenous cultures 120 What is meant by ‘indigenous’? 120 The Indigenous view of ‘health’ 122 The mental health and wellbeing of Indigenous Australians 123 Issues to consider when supporting the mental health and wellbeing of Indigenous Australians 127 ‘How would you like us to help you?’ 128 4.4 Mental health and rural and remote cultures 131 What is a ‘rural’ or ‘remote’ culture in Australia? 131 Major issues for people living in rural and remote areas 132 Ongoing loss 134 Systemic issues 135 Addressing the issues in rural and remote areas 136 4.5 Mental health and multiculturalism 138 The language of multiculturalism 139 Individualism and collectivism 141 Gender roles 142 Cultural diversity, stigma and mental illness 144 4.6 Supporting people who are members of subcultures or minority groups 144 Definitions of LGBTQIA people 145 LGBTQIA culture 145 Risk factors for the mental health of LGBTQIA people 145 Major mental health issues faced by LGBTQIA people 146 4.7 Towards providing culturally appropriate mental health care 147 Cultural proficiency 148 Culturally appropriate approaches to treating mental illness 149 Information and education 150 Actively supporting culturally appropriate services 151 Working with families and communities 152 Summary 154 Key terms 154 Review questions 155 Discussion and debate 156 Project activity 156 Websites 157 References 157 Acknowledgements 165 Chapter 5 Common reactions to stressful situations 166 Introduction 167 5.1 Stress reactions 167 5.2 Physical, emotional and behavioural reactions 169 Physiological reactions 170 Emotional and behavioural reactions 170 Fear 175 Reactions of families and carers 176 5.3 Factors that influence stress reactions 178 Age 178 Background 179 Coping style 180 Context and setting 182 Locus of control 185 Resilience 186 Type of support received 187 5.4 Priorities when supporting people through stressful situations 188 Engagement and collaboration 188 Therapeutic alliance or relationship 189 Care plans 189 Referral 191 5.5 Providing information 191 Understanding information in stressful situations 192 Preparing information 192 5.6 Self-care 195 Reflective practice 195 Clinical supervision 196 Time out 197 Summary 199 Key terms 199 Review questions 200 Discussion and debate 200 Project activity 201 Websites 201 References 201 Acknowledgements 207 Chapter 6 People displaying challenging behaviours 208 Introduction 209 6.1 The nature of challenging behaviours 209 6.2 Reasonable and unreasonable behaviour 210 Challenging behaviours in children 212 The ‘difficult patient’ 212 Outcomes of labelling 214 Defence mechanisms 214 Control and power 216 The influence of health professionals 217 6.3 Causes and triggers of challenging behaviour 218 Communication and challenging behaviours 219 General assessment 219 Older people and challenging behaviours 221 6.4 Challenging behaviours exhibited by health professionals 222 6.5 Addressing challenging behaviours 223 Organisational responses 223 Education and training 225 6.6 Risk assessment 226 Working with people with challenging behaviours 227 Summary 235 Key terms 235 Review questions 236 Discussion and debate 236 Project activity 236 Websites 237 References 237 Acknowledgements 240 Chapter 7 Depression, anxiety and perinatal mental health 241 Introduction 242 7.1 Depression 242 Symptoms of depression 242 Causes of depression 243 Depression and physical illness 244 Types of depression 246 7.2 Approaches to the care of depression 249 Interpersonal skills 250 Comprehensive approach 251 Psychoeducation 252 Treatment options 253 7.3 Perinatal mental health issues 258 Policy context 260 Types of perinatal mental health issues 260 Caring for mothers with perinatal mental health issues 261 Supporting the partner 262 7.4 Caring for children, adolescents and young people with depression or psychosis 263 Nature versus nurture 263 Assessment issues to consider for children and adolescents 264 Common childhood diagnoses 265 Common interventions used with children and adolescents 266 Youth mental health 267 Neurobiological influences 268 Practice principles 268 7.5 Anxiety 271 Types of anxiety 271 Hypochondriasis 275 Approaches to care for anxiety 276 Summary 278 Key terms 278 Review questions 279 Discussion and debate 280 Project activity 280 Websites 281 References 281 Acknowledgements 284 Chapter 8 Caring for a person who has self-harmed 285 Introduction 286 8.1 Definitions 286 8.2 Incidence of self-harming 288 Suicide rates 288 Rates of self-harm 289 Indigenous populations 290 Methods of self-harm 290 8.3 ‘Causes’ of self-harming behaviour 291 Other risk factors 293 8.4 Attitudes towards self-harm 300 8.5 National Suicide Prevention Strategy 302 Groups ‘at risk’ 303 8.6 Assessment of risk 308 The ‘why’ of risk assessment 308 The ‘who’ of risk assessment 309 The ‘how’ of risk assessment 310 Risk assessment tools 310 8.7 Caring for the person who has self-harmed 313 Effective interpersonal communication 314 Managing short-term high risk 315 Psychological therapies 316 Medication 317 The role of family and carer(s) 317 Postvention 318 Summary 320 Key terms 320 Review questions 321 Discussion and debate 321 Project activity 321 Websites 322 References 323 Acknowledgements 327 Chapter 9 Caring for a person with a serious mental illness 328 Introduction 329 9.1 Definitions 329 Schizophrenia 330 Bipolar disorder 336 9.2 Comorbidities in people with serious mental illness 338 Factors that contribute to poor physical health 338 Common physical illnesses 339 When is a mental health assessment required? 343 Comorbidity and assessment 343 Comorbid treatment options 344 9.3 Carers 345 Roles 346 Providing information 347 Information sharing 347 9.4 Treatments for serious mental illness 348 Pharmacological therapies 348 Psychological therapies 352 9.5 Recovery 355 Summary 357 Key terms 357 Review questions 358 Discussion and debate 358 Project activity 359 Websites 359 References 359 Acknowledgements 361 Chapter 10 Substance use disorders 362 Introduction 363 10.1 Substance use and substance misuse 363 Prevalence of substance use 363 Adverse effects of substance use 365 Attitudes to substance use 365 10.2 Attitudes of health professionals 367 Language use 367 10.3 Health promotion and disease prevention 370 Harm minimisation 371 10.4 Categories of substances 371 Stimulants 371 Depressants 372 Hallucinogens 372 10.5 Substance use disorders 373 Substance-induced disorders 373 Reward pathways 374 10.6 Commonly misused substances 375 Alcohol 375 Amphetamines 380 Benzodiazepines 381 Cannabis 382 Medicinal cannabis 383 Cocaine 383 Ecstasy 383 Hallucinogens and GHB 384 Opiates and opioids 384 Tobacco 388 10.7 Assessment of substance use 390 Standardised substance screening tools 390 Assessment of alcohol and drug use 391 Referrals 392 10.8 Caring for family members 392 Support and education 392 Parents and children 393 Homelessness 393 10.9 Motivation for behaviour change 393 Cycle of Change 393 Stages of treatment 397 Motivational interviewing 398 Brief interventions 402 10.10 The stress–vulnerability model 403 What can be helpful? 404 What things are unhelpful? 405 Summary 407 Key terms 407 Review questions 408 Discussion and debate 409 Project activity 409 Websites 409 References 410 Acknowledgements 412 Chapter 11 Caring for an older person with a mental illness 413 Introduction 414 11.1 Caring for older people 414 11.2 The impact of ageism 415 Culture and attitudes 416 Discrimination 417 11.3 Assessing the older person 417 A biopsychosocial approach 417 Thinking biopsychosocially 420 Cognitive assessment 421 11.4 Dementia 422 Dementia and ageing 423 Types of dementia 424 Assessment of dementia 425 Ethical and legal considerations 426 Dementia and medication 426 11.5 Depression in older people 427 What constitutes depression? 427 What does depression look like? 428 Assessment of depression 428 Risk factors 431 Suicide 432 11.6 Delirium 433 Assessment of delirium 433 Characteristics of a delirium 434 Types of delirium 434 Responding to a delirium 435 Summary 437 Key terms 437 Review questions 438 Discussion and debate 438 Project activity 439 Websites 439 References 439 Acknowledgements 442 Chapter 12 Mental health service delivery 443 Introduction 444 12.1 Approaches to mental health service delivery in Australia 444 National standards for health services 444 State or territory variations 446 12.2 Primary health care services 446 Mental health promotion and disease prevention 446 Consumer and carer networks 456 Not-for-profit organisations 457 Better Access to Mental Health Care Initiative 459 Disaster services 459 Online mental health services 460 Practice nurses 460 Primary Health Networks 460 12.3 Secondary health care services 461 Child and adolescent mental health services 461 Community mental health teams 462 Consumer and carer consultants 463 Inpatient services 464 Mental health consultation liaison services 465 Perinatal mental health services 469 Older person’s mental health services 469 12.4 Tertiary health care services 471 Forensic mental health services 471 Dual disability services 472 Summary 476 Key terms 476 Review questions 477 Discussion and debate 477 Project activity 478 Websites 478 References 479 Acknowledgements 484 Index 485