AOD and Mental Health Networking Presentation

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AOD and Mental Health Networking Presentation

• Gregory Goodluck
• 12/8/08

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SW Mental Health Counselling
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SW Mental Health Counselling

• Who or What is SW Mental Health Counselling?

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SW Mental Health Counselling is
A Bulk Billing Mental Health Counselling Service
operated by Gregory Goodluck and Rebecca Orr
recognised and assisted by the AASW, Top End
Division of General Practice (now GPNNT) and NT
Carers to provide specialised mental health
counselling and focussed psychological strategies
under the DHAs Enhanced Primary Care Better
Access Medicare Items.
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SW Mental Health Counsellors work in consultation
with General Practitioners and other relevant
services, to help people diagnosed with mental
health disorders achieve their best possible
levels of psycho-social well-being.
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All our practitioners are specialist mental
health workers accredited by the Australian
Association of Social Workers (AASW).
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All referrals must come through a General
Practitioner or Psychiatrist using a Mental
Health Care Plan, to enable us to see the client
free of charge for up to 12 sessions per year.
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SW Mental Health Counselling is working from
offices located at NT Carers Corner of Caryota
Court, and Dick Ward Drive. Practitioners may
also be available to see clients in offices
sponsored by other non-governmental services, or
by home visits in special circumstances.
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SW Mental Health Counselling

• SW Social Workers
• AASW Australian Association of Social Workers.
• Accredited Mental Health Social Workers

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SW Mental Health

• AASW
• Competencies
• Referee
• Minimum two years experience in MH
• Mental Health Subcommittee of the AASW

• DHA
• Cth Department of Health and Aging
• Medicare items
• Focussed Psychological Strategies

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Better Access to Mental Health

• Medicare Items
• Focussed Psychological Strategies (FPS) to Mental
  Health Patients who can now claim rebates for
  services under the new Medicare items for FPS
  (allied mental health items 80100 to 80020), when
  managed under a GP Mental Health Care Plan (item
  2710 -2712) or under a Psychiatrist assessment
  and management plan (item 291 or 293).

• Foccussed Psychological Strategies
• Cognitive Behaviour Therapy
• Relaxation
• Narrative Therapy
• Interpersonal

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Focussed Psychological Strategies

• A range of acceptable strategies has been
  approved for use by allied health professionals
  utilizing the FPS items. These are  
• 1. Psycho-education 
• 2. Cognitive-behavioural Therapy including   
• 3. Relaxation strategies 
• 4. Skills training   
• 5. Interpersonal Therapy  
• 6.There is flexibility to include narrative
  therapy for Aboriginal and Torres Strait Islander
  people.   

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1. Psycho-education 

• Providing insight and understanding on what to
  expect from conditions such as depression and
  anxiety. It can sometimes help clients to relax
  and to view things differently if they can
  attribute certain symptoms or problems to a
  condition. E.g. abiding sense of hopelessness and
  pessimism as a symptom of depression (not
  reality!).

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2. Cognitive-behavioural Therapy

• Behavioural interventions  
• -          Behaviour modification  
• -          Exposure techniques  
• Activity scheduling
• Cognitive interventions
• Cognitive therapy  

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3. Relaxation strategies

• -          Progressive muscle relaxation 
• -          Controlled breathing  

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4. Skills training       

• -       Problem solving skills and training  
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• -          Anger management  
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• -          Social skills training  
•  
• -          Communication training  
•  
• -          Stress management  
•  
• -          Parent management training 

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5. Interpersonal Therapy

• (especially for depression)  

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Narrative Therapy

• There is flexibility to include narrative therapy
  for Aboriginal and Torres Strait Islander
  people. 
• The above was a direct quote from DHA material.
• Narrative approaches can be effective for
  non-indigenous folk as well. 

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Outreach and Home visits

• professional attendances at places other than
  consulting rooms would be provided where
  treatment in other environments is necessary to
  achieve therapeutic outcomes. (M.7.5) 

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Holistic Mental Health Work

• My Personal Professional Framework is an holistic
  Bio-Psycho-Social-Cultural-Spiritual paradigm.
• Not really separate pieces, but whole.
• Indigenous and non-Western world-views dont
  necessarily divide experience/existence or reduce
  it.
• CBT and Narrative focus on the subjective inner
  life of the person and how it translates into
  attitudes, intentions and behaviours.

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PsychoSocioCulturoTherapy

• CBT and Narrative both deal with underlying
  beliefs
• Culture is a set of beliefs and practices or
  behaviours
• CBT and Narrative are both interested in the deep
  structures of belief systems and how they affect
  thinking choices, behaviours and emotions.

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The Biological and the Spiritual bits of a
Holistic Paradigm.

• Spiritual orientations, existential, ethical and
  interpersonal influences on attitudes and
  behaviours interweave strongly with social,
  cultural and psychological factors.
• And we are what we eat.
• Poor diet and exercise lower the spirits
• Positive spirits improve all other matters.
• Clients big picture worldviews and sense of
  their place and relationship to existence, life
  and humanity can have a huge bearing on
  motivation and behaviour and therefore must be
  taken into account and worked with.

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AOD clients and SW Mental Health

• Referral Paths and Processes
• Relationship with GPs

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Referral Paths

• All referrals must come through a General
  Practitioner or Psychiatrist using a Mental
  Health Care Plan, to enable us to see the client
  free of charge for up to 12 sessions per year.

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Relationship with GPs

• SW mental health counsellors are members of the
  Top End Division of General Practice now merged
  and renamed General Practice Network NT
  http//www.gpnnt.org.au/
• SW Mental Health has a good working relationship
  with GPs.

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SW Mental Health and GPs

• Soon after receiving a referral which may contain
  a K10 and starting with a client The GP practice
  is notified.
• In the middle and/or at end of the first six
  sessions a letter is sent to the GP by way of
  progress report which may include new K10 data.

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SW Mental Health and GPs

• Clients may be referred for a further six
  sessions if necessary with a new mental health
  care plan generated by the General Practice in
  consultation with the client.
• Communication occurs at the beginning and end of
  the next six sessions and during as needed.

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SW Mental Health and GPs

• Currently 12 sessions is the maximum available
  under Medicare for any 12 month period.
• In very special circumstances a third block of
  six sessions may be referred by the GP.

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Reporting back to the referring medical
practitioner. On completion of the course of
treatment, the allied health professional must
provide a written report to the referring medical
practitioner. The written report provided to the
referring medical practitioner should include
information on assessments carried out on the
patient treatment provided and
recommendations on future management of the
patients disorder. DHA
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SW Mental Health and Medicare Items

• For provision of FPS services by a social worker.
• 80150 20 to 50 min office consultation
• 80155 20 to 50 min out of office consultation
• 80160 50 min office consultation
• 80165 50 min out of office consultation
• 80170 group therapy of 60 mins or more
• with 6 to 10 clients.

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Item 8060 Professional attendance for the
purpose of providing focussed psychological
strategies services for an assessed mental
disorder by a social worker registered with
Medicare Australia as meeting the credentialing
requirements for provision of this service -
lasting more than 50 minutes - where the patient
is referred by a medical practitioner, as part of
a GP Mental Health Care Plan or a referred
psychiatrist assessment and management plan or
referred by a specialist or consultant physician
in the practice of his or her field of psychiatry
or paediatrics. (Professional attendance at
consulting rooms) Fee 79.40 Benefit 85
67.50  DHA
Item 8060  
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Further information For further information about
Medicare Benefits Schedule items, please go to
the Department of Health and Aging website at
www.health.gov.au/mbsonline
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More about SW Mental Health Counselling? Try our
Website

• http//www.swmentalhealth.com.au

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AOD clients and SW Mental Health

• Examples of Clients referred
• Example of a first session
• Example of types of interventions
• Prognostication
• Limitations

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Hypothetical Example of AOD type client

• Anglo Male, early 40 years old.
• Referred with Anxiety and Depression suffering
  poor physical immunity and chronic infections.
• Context of chronic THC use and intermittent
  withdrawal and relapse.
• Anger issues
• Interpersonal problems at home and at work.

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SW Mental Health AOD client

• Initial session going through Care Plan and
  assisting the client to articulate his wants for
  counselling.
• Setting tentative goals for therapy
• Anger management basic orientation
• Reviewing Goals each session
• Social Isolation and
• Grief and Loss Issues emerge as core foci
• Cognitive therapy regarding expectations of self
  and others.
• Relaxation strategies.
• Emerging issues with world view, cynicism and
  anger towards his concept of God.
• Exploration of his beliefs and compatibility with
  strategies
• Referral to 12 step programs and support groups.

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SW Mental Health AOD client

• History of physical abuse in Criminal Justice
  contexts due to oppositional behaviour.
• Behaviour Therapy including increased physical
  exercise, eating and relaxation regimes
• Cognitive Therapy including disputing negative
  attributions with self generated evidence to
  break down and replace schemas about self in
  relation to others and life.
• E.G. The ABC of CBT

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The ABC of CBT (E.g.)

• Adversity bus didnt stop
• Belief driver hates me
• Consequence feel depressed
• Disputation driver didnt see me
• Energised optimism/empowerment

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Example AOD Mental Health client continued

• Outcome More assertive communication with house
  mate(s)
• Change of employment to more suitable level of
  autonomy
• Decreased Drug Abuse
• Improved Mood
• Anger managed better
• Physical Health Improved K10 lower.

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Relaxation Strategies Controlled Breathing

• Abdominal Breathing / Belly Breathing
• Calm Breath
• Normal Breath in through the nose
• Breath out saying Calm or Relax
• Count to four before inhaling
• Repeat for five minutes.

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Prognostications

• In our counselling professions we are often faced
  with the harsh reality that many of the problems
  our clients come to us with have been with them
  for years or decades and as such may take some
  time to overcome.
• However, we believe that we can sow the seeds of
  recovery with skill-full interventions that
  empower clients to continue to work towards
  change long after their allotted time of therapy
  has concluded.

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Limitations

• In many cases it would be far more efficacious to
  have more sessions as it may take up to 12
  sessions to begin to get into the deeper core
  business. However, transferable skills can be
  taught in earlier sessions that the clients can
  choose to apply throughout their lives.
• The MBS rebate is too small to cover report and
  letter writing, no-shows administration and
  other overheads. Charging clients a gap makes it
  less attractive.
• There is an element of charity in this type of
  practice. The government underpay for these
  items. Many private practitioners cant afford
  bulk-billing

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Gregory Goodluck

• BA Hon, BSW, MAASW(Acc), Assoc MAPS
• Gregory is an experienced Mental Health Social
  Worker, Psychosociotherapist, and conditionally
  registered Psychologist in the Northern
  Territory. Gregory has broad experience including
  cross-cultural mental health work with indigenous
  people and clients from refugee backgrounds.
  Gregory has experience in mainstream mental
  health services, community health, indigenous
  community services mental health education,
  relationship counselling and mens work. Gregory
  counsels men, women and children with a variety
  of troubles including depression, anxiety,
  trauma, psychoses, personality disorders,
  adjustment disorders and dual diagnoses including
  issues with Alcohol and other Drugs. Gregory uses
  an holistic, bio-psycho-socio-cultural-spiritual
  framework of practice, including Cognitive
  Behaviour Therapy, Narrative Therapy, Mindfulness
  Techniques and Relaxation strategies.