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SWN005 Mental Health Landscape and Social Work Practice

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Title: SWN005 Mental Health Landscape and Social Work Practice


1
SWN005 Mental Health Landscape and Social Work
Practice
  • Dr Niki Edwards

2
AIMS
  • QUIZ appreciate the role that stigma and
    discrimination play in the management of mental
    illness and mental health problems (self
    reflection).
  • Awareness of key definitions of mental illness,
    mental disorders and mental health problems.

3
Quiz
  • Please write down TRUE or FALSE to following
    questions.
  • We will come back to these at the end of the
    presentation.
  • This presentation will address many of the issues
    raised.

4
True or False 1
  • Mental health is a life long process. It
    involves a sense of harmony and balance for the
    individual, family, friends, their community and
    more broadly society.

5
True or False 2
  • Mental illness is a single rare disorder that is
    uncommon. It only affects a small number of
    people.

6
True or False 3

Being treated for a mental illness means an
individual has in some way "failed" or is weak.
7
True or False 4
  • People with mental illness are violent and
    dangerous so should be approached with caution,
    and fear.

8
True or False 5
  • People with mental illness have childlike
    perceptions of the world (they lack intelligence)
    and will always need to be taken care of.

9
True or False 6
  • Mental illness is not a true medical diagnosis
    eg. people with depression should (and could)
    really just snap out of it, get a job, and get
    on with life.

10
True or False 7
  • Depression and other illnesses, such as anxiety
    disorders, do not affect children or adolescents.
    Any emotional problems they have are just a part
    of growing up ie. they just grow out of it.

11
True or False 8
  • People with severe mental illness should really
    be cared for in hospital. (They are best cared
    for in hospital)

12
True or False 9
  • Mental illness is NOT a life sentence ie.
    recovery IS possible for people with mental
    illness.

13
True or False 10
  • No individual or cultural group is immune from
    mental illness.
  • It is a global phenomenon.

14
True or False 11
  • People living with mental illness expect to be
    rejected by the community and are therefore
    reluctant to engage with others.

15
True or False 12
  • The effects of stigma and discrimination may
    have a greater impact on an individual than the
    actual mental illness.

16
Introduction
  • Mental Health Social Work
  • SWN005

16
17
Introduction
  • Mental illness is common, effects 15 people
    during their lifetime.
  • Universal mental health problems and mental
    illness is experienced by people of all
    countries, by women and men of any age and
    socioeconomic status, and in urban and rural
    environments.
  • Global phenomenon and global health priority eg.
    not just in developed countries.

18
Introduction
  • "Mental illness is Australia's great invisible
    epidemic. Of all the diseases in our community,
    it exhibits the grossest mismatch between the
    cost of the disease, the disease burden, and the
    amount that is spent collectively by the
    community to address that cost."
  • Commonwealth of Australia (2006) A national
    approach to mental health from crisis to
    community. www.aph.gov.au/Senate/committee/mentalh
    ealth_ctte/report/index.htm

19
Introduction
  • As with many diseases, mental illness can be
    severe for some people and mild in others.
  • People with a mental illness dont necessarily
    look like they are sick, particularly if their
    illness is mild.

20
Introduction
  • No objective tests only subjective assessment.
  • Other individuals may show more explicit symptoms
    such as confusion, agitation, or withdrawal.
  • Often others first notice something is wrong,
    rather than the person.
  • Cascade effect individual, those around them and
    society.

21
Introduction
  • Social workers have a key role to play in working
    with people living with mental illness.
  • Work at micro, mezzo and macro levels.
  • Roles in assessment, diagnosis, treatment and
    interventions.
  • Roles in advocacy (individual and systemic) and
    policy and program review and development (local
    through to national/international).

22
Legislation and Service Delivery Guidance
  • Policy and Services

22
23
Mental health system
  • OKits a BIG problem
  • How does society respond?
  • How do Australian governments rise to the
    challenge of providing appropriate services to
    people living with mental illness?...or carers
    supporting people with psychosocial disability?

24
Queensland mental health system
  • Far more than acute inpatient mental health beds
    or community mental health services (clinics and
    outreach assessment teams) provided by Queensland
    Health.
  • NB role for general practitioners
  • (gatekeepers/ usually first
  • point of call).
  • Psychiatrists, social workers,
  • psychologists other clinicians in private
    practice (Medicare Better Outcomes initiative).
  • Non-clinical mental health services/psychosocial
    disability support provided by non-government
    organisations (NGOs).

25
Queensland mental health system
  • Public and private, government and
    non-government, and hospital and community
    services comprise the Queensland mental health
    system.
  • Cross-sectoral responsibility everyones
    business.
  • Queensland Government (Queensland Health) is the
    major provider of acute services for people with
    serious mental illness.
  • Hospital and Health Services provide based
    community mental health services and hospital
    based beds.
  • QH oversees the provision of authorised mental
    health services, as per the Mental Health Act
    (Qld) 2016.

25
26
Queensland mental health system
  • Most common way of seeing a private psychiatrist
    is through a referral from a GP, which allows the
    Medicare rebate to be claimed.
  • Notably in rural areas, private psychiatrists may
    not be available.
  • Private psychiatrists mainly provide outpatient
    services from their consulting rooms or inpatient
    services to private hospitals.
  • Some may have specialist interests (eg. working
    with particular age groups or disorders, and
    specific therapies).

27
Queensland mental health system
  • Psychiatric Disability and Psychosocial
    Rehabilitation Support Services (non-clinical
    mental health services)
  • A range of services provides employment
    placement, support, information, day and
    residential programs and family respite.
  • Many are NGOs with government funding.

28
Non-government sector
  • Non-government service providers in Queensland
    deliver/implement a range of programs including
  • community awareness and education
  • early intervention
  • family and peer support
  • independent living and support
  • non-clinical counselling services
  • building sector capacity through training and
    organisational development activities.
  • Queensland Alliance for Mental Health is a NGO
    that supports over 240 community organisations
    working in mental health in Queensland
    www.qldalliance.org.au/

29
National Mental Health Strategy
  • Mental Health Statement of Rights and
    Responsibilities 1991
  • National Mental Health Policy 1992
  • National Mental Health Plan, 199298
  • Second National Mental Health Plan,199803
  • National Mental Health Plan 200308
  • COAG National Action Plan for Mental Health
    2006-11
  • National Mental Health Policy 2008
  • Fourth National Mental Health Plan 2009-14
  • Fifth National Mental Health Plan
  • States and Territory mental health policies,
    plans and strategies

30
National Mental Health Policy (2008)
  • Principles underpinning future mental health
    reform
  • To promote the mental health and wellbeing of the
    Australian community and, where possible, prevent
    the development of mental health problems and
    mental illness
  • To reduce the impact of mental health problems
    and mental illness, including the effects of
    stigma on individuals, families and the
    community
  • To promote recovery from mental health problems
    and mental illness and
  • To assure the rights of people with mental health
    problems and mental illness, and to enable them
    to participate meaningfully in society.

31
National Standards for Mental Health Services
(2010)
  • The first National Standards for Mental Health
    Services were developed in 1996, focused on
    raising the quality of acute mental health
    services.
  • The key changes to the 2010 Standards are
  • Addition of a Recovery Standard and
  • Expansion of the applicability of the 2010
    Standards.
  • The 2010 Standards are now applicable to
  • The public health system (inpatient,
    rehabilitation and community) and private
    hospitals
  • Private office based providers and
  • NGOs.

32
Fourth National Mental Health Plan 2009-2014
Set an agenda for collaborative government action
in mental health for five years from 2009, offers
a framework to develop a system of care that is
able to intervene early and provide integrated
services across health and social domains, and
provides guidance to governments in considering
future funding priorities for mental health.
33
Fourth National Mental Health Plan 2009-2014
  • 5 priority areas for government action in mental
    health
  • Social inclusion and recovery
  • Prevention and early intervention
  • Service access, coordination and continuity of
    care
  • Quality improvement and innovation and
  • Accountability - measuring and reporting
    progress.
  • Robust accountability framework and governments
    must report annual progress to the Council of
    Australian Governments.
  • Includes indicators for monitoring change in the
    way the mental health system is working for
    people living with mental illness as well as
    their families and carers.

34
Fifth National Mental Health and Suicide
Prevention Plan?
  • http//www.health.gov.au/internet/main/publishing.
    nsf/content/mental-fifth-national-mental-health-pl
    an
  • Seeks to establish a national approach for
    collaborative government effort from 2017 to 2022
    across eight targeted priority areas
  • Achieving integrated regional planning and
    service delivery.
  • Effective suicide prevention.
  • Coordinated treatment and supports for people
    with severe and complex mental illness.
  • Improving Aboriginal and Torres Strait Islander
    mental health and suicide prevention.
  • Improving the physical health of people living
    with mental illness and reducing early mortality.
  • Reducing stigma and discrimination.
  • Making safety and quality central to mental
    health service delivery.
  • Ensuring that the enablers of effective system
    performance and system improvement are in place.

35
Critique
https//croakey.org/magical-realism-and-the-draft-
fifth-national-mental-health-plan/
36
Roadmap for National Mental Health Reform
2012-2022
  • COAG initiative that outlines directions for all
    governments over next 10 years - 2.2 b
    investment.
  • Our long term aspiration is for a society that
    values and promotes the importance of good mental
    health and wellbeing maximises opportunities to
    prevent and reduce the impact of mental health
    issues and mental illness and supports people
    with mental health issues and mental illness,
    their families and carers to live contributing
    lives.
  • Indicators and accountability.
  • Mixed responses consider looking at
  • http//theconversation.com/five-views-of-the-roadm
    ap-for-national-mental-health-reform-11216

37
Roadmap for National Mental Health Reform
2012-2022
  • Priority 1 Promote person-centred approaches.
  • Priority 2 Improve the mental health and social
    and emotional wellbeing of all Australians.
  • Priority 3 Prevent mental illness.
  • Priority 4 Focus on early detection and
    intervention.
  • Priority 5 Improve access to high quality
    services and supports.
  • Priority 6 Improve the social and economic
    participation of people with mental illness.

38
  • http//www.mentalhealthcommission.gov.au/our-repor
    ts/our-national-report-cards.aspx
  • The National Mental Health Commissions 2017
    National Report on Mental Health and Suicide
    Prevention.
  • Reporting on the outcomes of engagement with
    stakeholders and the work of the Commission to
    help shape a mental health system that can
    respond to peoples needs more effectively.
  • In the process of developing a new monitoring and
    reporting framework which will guide future
    reports.
  • This framework will also assist national reform
    in mental health and suicide prevention through
    the lens of consumers and carers, and their
    experiences.

39
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40
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41
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42
  • Queensland Mental Health Commission
  • http//www.qmhc.qld.gov.au/work/queensland-mental-
    health-and-drug-strategic-plan/

https//www.qmhc.qld.gov.au/wp-content/uploads/201
7/02/Discussion-Paper_A-renewed-plan-for-Queenslan
d_Feb-2017.pdf
43
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44
Challenges
  • Positive mental health outcomes for people living
    with mental illness depends on much more than
    mental health policy.
  • Good mental health and wellbeing depends as much
    on things like housing, employment, education,
    personal and family support (cross-sectors) ie.
    people are primarily social relational beings.
  • Need to adopt a life course approach (needs
    change over time).

Its not an individual problem everyone is
responsible and has an NB role to play.
45
Challenges
  • Tension between funding for mental health
    hospital beds and community options (eg. step
    down/step up services).
  • BUT funding allocated to mental health still does
    not reflect the prevalence of mental health
    problems and associated psychiatric disability in
    the community.
  • No national infrastructure for mental health
    promotion, prevention and early intervention.
  • Contemporary services continue to focus on
    chronic illness.

46
Challenges
  • Health system still focuses on low prevalence
    disorders and high prevalence disorders left to
    GPs and private sector.
  • Specialised mental health services cluster around
    hospitals, acute mental health services, jails.
  • Growth in the non-government sector (outsourcing
    by government to save) and allegations of
    de-professionalisation of mental health.
  • Mental health needs of minority groups
    neglected eg. dual disability, refugees, people
    with mental illness in rural communities etc.

47
Conclusion
  • Shift over time from institutionalisation to
    community care, noting resourcing issues for a
    good life in the community.
  • Mental health is a now a major focus of
    Government policy and increased funding.
  • Evidence that mental health and wellbeing is
    closely linked to social determinants of health
    including low income, unemployment, poor housing.
  • Promotion, prevention and early intervention in
    mental health and wellbeing is acknowledged.
  • Emphasis in policy and programs on equity,
    access, equality and participation .
  • Increasing focus on recovery and consumer and
    care involvement.

48
Key references
  • Australian Bureau of Statistics (2007). National
    Survey of Mental Health and Wellbeing Summary of
    Results. ABS Cat No. 4326.0. Canberra ABS.
  • Begg S, Vos T, Barker B, Stevenson C, Stanley L,
    Lopez AD, 2007. The burden of disease and injury
    in Australia 2003. PHE 82. Canberra AIHW
    www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id644
    2459747
  • Forbes, M., Barker, A. and Turner, S., 2010, The
    Effects of Education and Health on Wages and
    Productivity, Productivity Commission Staff
    Working Paper, Melbourne.
  • Fourth National Mental Health Plan 2009-2014
    www.health.gov.au/internet/main/publishing.nsf/con
    tent/mental-pubs-f-plan09
  • Mental Health Council of Australia Mental Health
    Fact Sheet Definitions of Mental Illness
    www.mhca.org.au/documents/Definitionsofmentalhealt
    h.pdf
  • http//www.mentalhealthcommission.gov.au/our-repo
    rt-card.aspx
  • Queensland Health. The Health of Queenslanders
    2010. Third Report of the Chief Health Officer
    Queensland. Brisbane 2010 http//www.health.qld.g
    ov.au/cho_report/
  • Roadmap for National Mental Health Reform
    2012-2022
  • https//www.coag.gov.au/sites/default/files/The2
    0Roadmap20for20National20Mental20Health20Refo
    rm202012-2022.pdf.pdf

49
Resources
  • National help lines
  • Lifeline 24 hour counselling and referral 13 11
    14
  • Kids helpline counselling for people under 18
    years 1800 55 18 10
  • Just Ask rural mental health info 1300 13 11 14
  • Mens Line Australia 24 hour counselling for men
    1300 78 99 78
  • National web sites
  • BeyondBlue www.beyondblue.org.au
  • Black Dog Institute www.blackdog.org.au
  • depressioNet www.depressionet.com.au
  • Mental Health Council www.mhca.org.au
  • SANE Australia www.sane.org
  • Government
  • Federal Government Mental Health
    www.mentalhealth.gov.au
  • Queensland Health www.health.qld.gov.au

50
Mental health landscape
  • ANSWERS TO THE QUIZ

50
51
True or False 1
  • Mental health is a life long process. It
    involves a sense of harmony and balance for the
    individual, family, friends, their community and
    more broadly society.

TRUE but everyone is potentially vulnerable to
mental health problems and mental illness. Risk
factors for mental illness include recreational
drug use, smoking, alcohol misuse and dependence,
socioeconomic disadvantage and life events such
as trauma, stress, bereavement, and unemployment
etc.
52
True or False 2
  • Mental illness is a single rare disorder that is
    uncommon. It only affects a small number of
    people.

FALSE There are multiple types of mental illness,
each with its own features and underlying causes.
Some symptoms are shared across different
diagnoses. Saying mental illnesses are all the
same is just like saying that all cancers are the
same. Just like cancer, causes and treatments all
differ. Mental Illness is common, with over a
one year period, 15 of Australians experiencing
mental illness.
53
True or False 3

Being treated for a mental illness means an
individual has in some way "failed" or is weak.
FALSE A mental illness is not a character flaw.
It is a diagnosable medical illness, and it has
nothing to do with being weak or failing in some
way. It has been suggested that society is
failing people with mental illness and that the
best way of judging a society is how it treats
its most vulnerable people.
54
True or False 4
  • People with mental illness are violent and
    dangerous so should be approached with caution
    and feared.

FALSE Most violent people have no history of
mental disorder and most people with mental
illness have no history of violent behaviour.
Research indicates that people receiving
treatment for a mental illness are no more
violent or dangerous than the general population.
The use of drugs or alcohol has a stronger
association with violence than does mental
illness. People living with a mental illness are
more likely to be victims of violence, especially
self-harm. When it does occur, violent behaviour
usually happens in the context of distressing
hallucinations or treatment that has not been
effective.
55
True or False 5
  • People with mental illness have childlike
    perceptions of the world, lack intelligence and
    will always need to be taken care of.

FALSE Many studies show that most people with
mental illness have average or above-average
intelligence. Mental illness, like physical
illness, can affect anyone regardless of
intelligence, social class or income level. What
support is required will differ significantly
between individuals and depend upon their unique
circumstances and experiences.
56
True or False 6
  • Mental illness is not a true medical diagnosis
    eg. people with depression should (and could)
    really just snap out of it, get a job, and get
    on with life.

FALSE Although people with mental illness can
play a big part in their own recovery, they did
not choose to become ill, and they are not lazy
because they cannot just "snap out of it." Mental
illness cannot be willed away. Ignoring the
problem does not make it go away, either. It
takes courage to seek professional help.
57
True or False 7
  • Depression and other illnesses, such as anxiety
    disorders, do not affect children or adolescents.
    Any emotional problems they have are just a part
    of growing up eg. they just grow out of it.

FALSE Children and adolescents can develop mental
illness, including severe mental illness. Since
World War 2 there has been a substantial increase
in psychosocial disorders among young people. The
incidence of mental illness in young people is
now well documented and shown to be the highest
of any age group. In Australia, the prevalence is
approximately 14 in children aged 4-12 years
19 13-17 and up to 27 for 18-24 years . Many
young people do not access services. Left
untreated, these problems can get worse. Talk
about suicide should be taken very seriously.
58
True or False 8
  • People with severe mental illness should really
    be cared for in hospital.
  • FALSE Most people can recover from mental
    illness, especially if they receive help
    early. Some people will only experience one
    episode of mental illness and recover fully,
    others may be well for long periods with
    occasional episodes, and a minority of people
    will experience ongoing psychiatric disability.
    Most people with mental illness will be treated
    while living in the community. Some people may
    require admission to hospital but will return to
    supported community accommodation. There is
    overwhelming advice from people with mental
    illness and their families and friends that
    living in the community with appropriate support
    and assistance, is the preferred option.

59
True or False 9
  • Mental illness is a life sentence ie. recovery
    is not possible for people with mental illness.

FALSE Most people can and do recover from mental
illness although early treatment is key. Recovery
is described as a deeply personal, unique
process of changing ones attitudes, values,
feelings, goals, skills, and/or roles. It is a
way of living a satisfying, hopeful, and
contributing life even with limitations caused by
illness. Recovery involves the development of new
meaning and purpose in ones life as one grows
beyond the catastrophic effects of mental
illness (Anthony, 1993) Recovery-oriented
services are essential to mental health treatment
and community care.
60
True or False 10
  • No individual or cultural group is immune from
    mental illness. It is a global phenomenon.

TRUE People from any background can develop
mental illness. Cultural background affects how
people experience mental illness and how they
understand and interpret the symptoms of mental
illness. Many Aboriginal and Torres Strait
Islander peoples carry a significant burden of
grief and loss from an early age, due in part to
the high rates of mortality, illness,
incarceration, and deaths in custody.
Pre-migration experiences and the process of
resettlement in a foreign land can impact on the
mental health of people from culturally and
linguistically diverse backgrounds and their
children.
61
True or False 11
  • People living with mental illness expect to be
    rejected by the community and are therefore
    reluctant to engage with others.

TRUE Stigma has 2 major components public
(reaction of general public to people with mental
illness) and self-stigma (prejudice that people
with mental illness tend to turn towards
themselves (Goffman, 1963). The more visible the
stigmatizing mark or condition, the more society
believes the individual should be able to control
it and the greater the negative impact of not
being able to do so. Stigma creates a culture of
us and them. Stigma hinders help-seeking
behaviours.
62
True or False 12
  • The effects of stigma and discrimination may
    have a greater impact on an individual than the
    actual mental illness.

TRUE It is human nature to fear what is not
understood. Therefore mental illness is feared by
many people and, unfortunately, still carries a
stigma (defined as a mark or sign of disgrace)
which results in negative discrimination at
school, at work, in relationships etc. Because of
stigma and discrimination, many people hesitate
to get help for a mental health problem for fear
of being looked down upon. It is unfortunate that
this happens because effective treatment exists
for almost all mental illnesses. Worse, the
stigma experienced by people with a mental
illness can be more destructive than the illness
itself.
63
Resources
  • National help lines
  • Lifeline 24 hour counselling and referral 13 11
    14
  • Kids helpline counselling for people under 18
    years 1800 55 18 10
  • Just Ask rural mental health info 1300 13 11 14
  • Mens Line Australia 24 hour counselling for men
    1300 78 99 78
  • National web sites
  • BeyondBlue www.beyondblue.org.au
  • Black Dog Institute www.blackdog.org.au
  • depressioNet www.depressionet.com.au
  • Mental Health Council www.mhca.org.au
  • SANE Australia www.sane.org
  • Government
  • Federal Government Mental Health
    www.mentalhealth.gov.au
  • Queensland Health www.health.qld.gov.au

64
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