Dual Diagnosis of mental illness (MI) and acquired brain injury (ABI): Making positive changes towards rehabilitation and recovery.

Aims and Rationale
The aim of this exploratory study was twofold. It sought to describe some of the challenges faced by people with dual diagnosis of ABI and MI; and secondly, from these findings make recommendations on service practices and policies that would be required for an effective post discharge rehabilitation and recovery pathway.

Methods
This phenomenological study used in-depth interviews to obtain an insider perspective from eight individuals and/or their families, and case managers. Interviews were transcribed and the researchers used qualitative analysis to identify key themes that reflected the experiences of participants.

Findings
Participants faced a lack of appropriate supports available which reflected a deficiency of expertise in understanding the complex intersection of disability and mental illness. This created confused pathways towards recovery and improved quality of life. Participants were either categorized as having ABI or MI leading to inappropriate accommodation, social isolation, and lack of engagement in meaningful activities such as leisure activities and employment. Commonly, participants with ABI/MI fell “between the cracks”.

Implications for policy and practice
The rehabilitation and recovery of people with ABI/MI requires services that have knowledge and expertise in each condition and the implications of dual diagnosis. Improved integration of disability and mental health services will be an important strategy to achieve this.

Mrs Annalise O'Callaghan, Lecturer, School of Occupational Therapy and Social Work, Centre for Research into Disability and Society, Curtin University will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast.

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Preventing obesity and poor physical health through assessment and ongoing monitoring

Dr Susanne Stanley aims to highlight the poor physical health of the mentally ill, paying particular attention to the high incidence of obesity, which can lead to complications such as type 2 diabetes and cardiovascular disease.

Whilst obesity is of great concern in the general population, people with a mental illness face additional factors. For example, psychotropic medication effects such as weight gain can lead to obesity in the mentally ill, highlighting the need for vigilance with physical health examination and ongoing monitoring.

The Clinical Guidelines for the Physical Care of Mental Health Consumers: Assessment and Monitoring Package will be outlined, assisting clinicians in the overall care of their patients through the direction of evidence-based procedures and tools to prevent poor physical health, and aide in the recovery process for all mental health patients.

Dr Susanne Stanley, Senior Research Officer, The University of Western Australia will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast. 

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Talk is Cheap: The Role of a Speech Pathologist in Mental Health Services

It has been shown that language (e.g. understanding other people, or expressing yourself effectively), social interaction, and literacy disorders are strongly correlated with behavioural and emotional difficulties, and that often these communication disorders are undiagnosed and untreated.

For example, a high profile study in 1996 (Emerson and Enderby) found the prevalence of communication disorders in a mental health service to be 75%. Once in the psychiatric care and/or the criminal justice psychiatric system, people are expected to engage with a variety of interventions, but they are often unable to benefit fully from these without the necessary comprehension, expression and empathy skills.

Ms Woodward will recap the communication difficulties commonly associated with different mental health conditions, then briefly outline the benefits of Speech Pathology input within this field, both direct and indirect interventions.

A Speech Pathologist enables effective communication between patients and peers, staff, families, other professionals and the wider community by assessing, diagnosing and treating communication (speech, language and social interaction/communication) and swallowing difficulties/disorders and providing advice and training to other staff to ensure that the patients’ environment is modified in order maximise effective communication. Input is therefore a combination of direct work with patients, resource making (e.g. supporting written information visually), and liaison/training with other professionals to ensure effective communication throughout the patients’ care, thereby enhancing good practice throughout the service.

This has an impact on the individual, their community, and the efficacy of their rehabilitation, therefore with implications for national policy of healthcare.

Ms Mary Woodward, Specialist Speech Pathologist, Concord Centre for Mental Health will present at the:

13th International Mental Health Conference, "Positive Change - Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast. 

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Carer Appraisal Scale - A Carer-Based Assessment of Patient Functioning

Measurement of patient outcomes is an integral part of mental health service evaluation, as well as guiding clinical practice to ensure best outcomes for patients. Despite there existing numerous tools for quantifying patient functioning based on clinician assessments or self-reports, there is a serious paucity of tools available for the carers of patients to appraise their functioning.

Collateral information is well recognised as being integral for assessments of patients, but there are very few structured systems for assessing patients based on the perceptions of carers. This is despite the usually greater lengths of time carers spend with patients than clinicians.

Dr Neil Jeyasingam describes a tool developed for use in a community aged care psychiatric service, which involves four sections:

• a global impression of patient progress,
• a scorable checklist of patient functioning in multiple domains,
• a qualitative section for identifying the most pressing concerns from the carer's perspective, and
• an open-ended feedback on treatment to date.

In this pilot study, Dr Jeyasingam validated the tool against multiple well-recognised clinician assessment tools, and found good correlation in most domains. In addition, there was extensive positive feedback from carers themselves regarding our use of this tool in regular clinical practice.

Dr Jeyasingam feels this tool has the potential for use in other community aged care psychiatric services, as it provides a framework for communication of concerns, assists in prioritising care and adds value to clinician treatment plans, as well as providing another dimension to assessment of the patient.

Practical implications of its use, limitations and potential for modifications to suit other settings will be also discussed.

Dr Neil Jeyasingam, Old Age Psychiatrist, Northern Sydney / Central Coast Area Health Service will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast. 

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

The Integration of Resolution with Recovery Principles for the Ageing Person

The “Australian National Standards for Mental Health Services 2010”, in conjunction with the “Implementation guidelines for Public Mental Health Services and Private Hospitals” both inform and guide the development and application of appropriate practices across the lifespan.

Embedded within these standards are the principles of recovery which include “gaining and retaining hope, understanding of one’s abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life and a positive sense of self.”

Several developmental theorists present conceptual frameworks that describe stages or developmental tasks that arise during the life spectrum and which characterize stages of maturity. The descriptive “Integrity versus Despair” period of Erikson neatly conceptualizes the dilemma faced by the ageing client of successful integration of life challenges and achievements contrasted against the despair of meaninglessness and failure.

Jonathan and Joan address the specific adaptation of recovery principles to the challenge of the resolution of life meaning for the older person.

Applying the principles of recovery for the older person (65 years and older) suffering from mental illness, is a challenge for clinicians at a time when the generative activities of life are often on the wane and at a time when they may begin to dwell on inevitable mortality.

In Western cultures death is not integrated fully into the fabric of life.

Failure to recognize the importance and influence of dying can distort and warp adaptive maturation, giving rise to anxiety disorders, depression and an all pervading sense of hopelessness, thwarting attempts by the mental health worker to engage meaningfully.

A complementary theoretical framework of resolution is presented which integrates principles of recovery into a holistic approach to the unique and complex challenges that present in the later stages of the lifespan. Meaning and self determination are emphasized in this approach, and resolution of life issues is addressed in three domains, namely; resolution of focus, priorities and meaning.

Mr Jonathan Smith & Joan Gavan, Older Persons Mental Health Community Team  will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast.

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Empowering Peer Support Workers in Mental Health Service Delivery

Moving away from a deficits-approach, scholars have described recovery as a journey, in which a person:

(1) makes sense of their experience;
(2) learns to manage their illness;
(3) regains psychological and emotional well-being; and
(4) takes on socially valued roles.

Some authors argue that recovery is best seen in terms of social interaction. It is suggested that peer support is a key component of recovery as it holds negligible assumptions about a person’s capacities and limitations, and avoids hierarchical relationships between health care providers and patients, thus allowing people living with a mental illness to move away from their disability to attempt new, health-enriching behaviours with one another.

Recent mental health policy and funding further reflects the rising importance of the role of Peer Support Workers (PSWs) in addressing the needs of mental health consumers in Western Australia. However, studies on peer support in Australia have been scarce.

Grace presents findings from the first phase of a larger study designed to investigate how peer support facilitates recovery for people with mental illness in Western Australia. Ten interviews were conducted with managers, policy makers, educators and supervisors of peer support workers, from government and non governmental service providers to:

(1) explore the role of peer support in the organisation;
(2) examine how peer support workers are prepared for and supported in their roles and
(3) investigate their perspective of the peer support relationship.

The following themes emerged from the interviews:

(1) working with and through the lived experience of mental illness;
(2) the characteristics of successful PSWs;
(3) recruiting and developing PSWs;
(4) developing peer support as a profession;
(5) embracing PSWs as colleagues in the workplace.

Addressing these issues warrant the attention of policy makers and management, as the establishment of Peer Support services in Western Australia advances.

Mrs Grace Zeng, Lecturer, Curtin University will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast.

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Life values, active procrastination, and psychological wellbeing

Prof Richard Hicks

People's life values are thought to be inherently positive forces for decision making and giving direction to life. Some values may clash with society or workplace environments. But decision making is not always easy in complex and confusing times. This can lead to delay of decision making, or what many people would call procrastination.

Procrastination in the workplace and among students is thought to be associated generally with negative wellbeing. However, according to recent studies procrastination may be either passive (the 'old-style' procrastination) or active. Little is known about the new approach or whether active procrastination is healthy-- nor is much known about whether purposeful life values (such as those proposed in Acceptance and Commitment Therapy- ACT) are related to active procrastination and/or psychological wellbeing.

Richard will present information on the relationships among life values, active procrastination and wellbeing from a survey of 120 university students. The survey package involved use of the new ACT Values Questionnaire, the 2004 Active and Passive Procrastination Scales, and the Ryff Psychological Wellbeing Scale.

Results show generally positive relationships. Essentially findings suggest traditional (passive) procrastination is unhealthy; and active procrastination may be healthy: strongest relationships are found between life values, meaning and psychological wellbeing. Use of the Values
Questionnaire as part of counselling and psychotherapy to help re-orient decision making and direction may be helpful for many in their personal and work lives.

Prof Richard Hicks, Professor of Psychology, Bond University will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast.

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

'Surviving and Thriving' - a new culture in co-location

Who are Stepping Up?

Stepping Up is an awarding winning consortium that consists of four not-for-profit agencies: Interact Australia, Odyssey House Victoria, Task Force and Youth Projects who came together to delivery a number of programs including forensic, mental health, alcohol and other drug treatment services.

Recently Stepping Up have acquired a new therapeutic counselling service ( x3 locations) that celebrates Psychologists, MSW's, RN's Psych and AOD Generalist on an innovated program that is housed inside Match Works employment services.

This has presented itself with many layers of challenges. The marriage of employment and complex behaviours. The staff have many years of experiences however they have never physically sat in a open office shared space with the employment staff.  Let the fun begin.

The Surviving:

• How to build and new service with professional and clinical integrity?
• How to attract and retain highly skill and qualified staff?
• How to create an environment of mentally healthy staff in foreign environment?
• Support is a language not ever heard in Employment Services - for the staff have only to obtain numbers.

The Thriving:

• Talking.
• Breathing.
• Self Reflection.
• Education.
• Preventative approaches - this is before we actually had any face to face sessions with the consumer.
• Attendance at combined staff meetings.
• Providing training and education from a non policing.
• Staff feeling it is their role to embrace a collaboration with a people focused approach.

How can we best service the community from a population approach.

• External Supervision monthly.
• Peer Reviews.
• Individual supervision.
• Coaching and regular discussion about what is working and what are our growth areas.

Ms Shelley Cross, General Manager, Stepping Up Consortium will present at the: 13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast.

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Treatment decision making for young people diagnosed with major depressive disorders: The case for shared decision making

Shared decision making (SDM) is a model of medical or treatment decision making that involves collaboration between a clinician and client. One way of implementing SDM is with the use of decision aids (DA), which have demonstrated effectiveness for non-psychiatric conditions and emerging evidence for adults diagnosed with mental disorders.

A theoretical basis for SDM for young people has been made, yet work in this area is in its infancy.

The aim is to develop an online, evidence-based, preference sensitive DA to support young people facing a choice about treatment for moderate to severe depression.

The DA was based on systematic reviews and semi-structured qualitative interviews that were conducted with clients (n=10), caregivers (n=5) and clinicians (n=22) about their experiences and beliefs about treatment decision making for young people diagnosed with major depressive disorders.

Further consultations were held with medical, consumer and caregiver experts and pilot testing completed the development process.

Data from interviews demonstrated that client preference for involvement in treatment decision making for depression is not static and may vary with different clients and at different times for the same client. Caregiver involvement was seen as optional.

All participants voiced a preference for interactive, evidence-based information to support decision making. Based on this and consultations with expert groups, a DA was developed and pilot tested. Clients and clinicians found the DA to be acceptable and useful, and their feedback was used to refine the DA.

Treatment decision making in this area is a complex process that can be supported with the use of an evidence-based, preference-sensitive DA. The development of this DA contributes to the emerging field of youth SDM and can now be further tested for effectiveness. Approaches such as this DA hold the potential to improve client satisfaction, adherence and clinical outcomes.

Ms Magenta Simmons,  Research Fellow Headspace Centre of Excellence in Youth Mental Health will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast.

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Elyn Saks: A tale of mental illness -- from the inside

Improving Employment Outcomes for People with a Mental Illness: Progress in the Hunter New England Region of NSW

Engagement in employment has been associated with significant financial, social and health benefits for people with a mental illness. However, as a population, people with mental illness experience high levels of unemployment and often have difficulty accessing services to support them.

Literature indicates that people with a psychotic illness have the worst employment outcomes of any disability group. Given the onset of mental illness often occurs in late adolescence, there is much to be done to prevent the disruption to employment and career trajectory that may occur with this illness experience.

Emma will discuss the progress of the implementation of evidence based employment services within the Hunter New England region mental health services in NSW. This region has been the leader in the state of NSW in the implementation of the Individual Placement and Support Model of supported employment.

Emma will describe the background to this model and its close alignment with the delivery of recovery based mental health services. Outcomes of the implementation of this model across nine different metropolitan and rural sites will be highlighted and compared to international benchmarks in this field.

Ms Emma Robson & Emma Smith, Occupational Therapists, Vocational Education Training and Employment Service, Hunter New England Mental Health will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast. 

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Let’s Talk About Children: Dissemination of a family focused intervention

Improved outcome for children of parents with mental illness has been demonstrated through family focused interventions. Despite this, there are many barriers to family focused intervention in mental health service delivery.

Let’s Talk about Children was developed for use with families in which a parent has a mental illness. It focuses on improving communication surrounding mental illness, identifying children’s needs and linking the family with additional support or interventions. It has been used with parents with a range of diagnoses. It involves two to three sessions with parents. Let's Talk was developed in Finland by Prof Tytti Solantaus and was disseminated throughout the Adult Mental Health Service.

Through collaboration between the adult and child and youth mental health service, training in Let’s Talk has been offered. The feasibility of dissemination of an intervention such as this in the local context needed to be established.

Mary will focus on the response to offering training in the intervention to clinicians from a range of services. The results of a focus group discussion of barriers and enablers to a family focused intervention will be explored. Initial feedback with regard to the training offered and applicability to practice was positive.

There are particular issues related to the local context which need to be understood to assist in dissemination of a family focused intervention such as Let’s Talk.

Dr Mary Jessop, Child and Adolescent Psychiatrist, Children's Health Services, Royal Children's Hospital will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast.  

Web: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Expert warns against child mental health checks

Professor Allen Frances

One of the most influential psychiatrists in the United States says the Federal Government's program to screen three-year-olds for mental health problems is "ridiculous" and potentially dangerous.

By Eleanor Hall -  ABC Radio

Australian preschoolers are set to be screened for early signs of mental illness as part of the Government-funded Healthy Kids Check, which would be voluntary for families.
The Australian Medical Association (AMA) supports the initiative but says the evaluations must focus on broad-based problems rather than individual things like fear of the dark or fear of monsters.

The Healthy Kids Check will be predominately conducted by GPs who will refer children with troubling behaviour to psychologists and paediatricians.

The program will cost $11 million over five years and is expected to identify about 27,000 children who would benefit from extra support.

But Professor Allen Frances, an Emeritus Professor at the Duke University, has raised concerns about the scheme... more