MOSBY’S POCKETBOOK OF

mental health
         Eimear Muir-Cochrane
              Patricia Barkway
                Debra Ni...
MOSBY’S POCKETBOOK OF

mental health
MOSBY’S POCKETBOOK OF

mental health

               Eimear Muir-Cochrane
                 Patricia Barkway
              ...
Mosby
                        is an imprint of Elsevier

                        Elsevier Australia. ACN 001 002 357
     ...
Foreword

In the everyday practice of health, public safety and other human
services, mental healthcare has been an import...
vi   ■   Foreword


be employed in the field. Importantly, the pocketbook format will help
to ensure that current research ...
Contents
Foreword                                               v

Preface                                               i...
viii   ■   Contents


Appendix 3            Prescription abbreviations      141

Appendix 4            Top 10 tips for peo...
Preface

It is estimated that approximately 450 million people worldwide
have a mental health problem, with one in four pe...
x   ■   Preface


professionals without formal mental health qualifications. We think
this is what we have achieved and tru...
Authors and reviewers

AUTHORS
Eimear Muir-Cochrane BSc(Hons) RN MHN GradDipAdultEdu-
cation MNS PhD FACMHN
Professor and ...
xii   ■   Authors and reviewers


Julie Sharrock RN MHN BEd MHSc (PsychNurs) AdvDipGestalt-
Therapy FACMHN MRCNA
Mental He...
1
                 Working in a recovery
                            framework

INTRODUCTION
A recovery-oriented approach ...
2    ■   Mosby’s Pocketbook of Mental Health



    Box 1.1 Protective factors
    Individual
    Individual protective fa...
CHAPTER 1    Working in a recovery framework   ■      3



• People need to reclaim their personal story of mental distres...
4   ■   Mosby’s Pocketbook of Mental Health


 9. Know that change is constant. Although change is inevitable,
    growth ...
CHAPTER 1    Working in a recovery framework   ■   5


only working with the consumer to manage the symptoms of mental
ill...
6   ■   Mosby’s Pocketbook of Mental Health


They can provide a buffer against stress, as well as be a set of resources
t...
CHAPTER 1   Working in a recovery framework   ■    7



Table 1.2 The 4As recovery framework
 Element to
 recovery        ...
8   ■   Mosby’s Pocketbook of Mental Health



• assists people in the context of their whole lives, not just their illnes...
CHAPTER 1   Working in a recovery framework   ■   9


 7. acknowledges the different cultures of Aotearoa/New Zealand
    ...
10   ■   Mosby’s Pocketbook of Mental Health


3. Recognition as partners in care, rehabilitation and recovery.
   Develop...
CHAPTER 1    Working in a recovery framework   ■   11


Commonwealth Department of Health and Aged Care (CDH&A) 2000b
   P...
12   ■   Mosby’s Pocketbook of Mental Health


Richmond Fellowship: www.richmondnz.org. The Richmond Fellowship
   is esta...
Mosby's Pocketbook Of Mental Health Sample Chapter
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Mosby’s Pocketbook of Mental Health is a convenient, user-friendly resource for all health professionals. The potency of this text is in its easily accessible format which offers clear, concise guidance to students on clinical placements and practitioners.

In sum a ‘one stop shop’ for essential knowledge and skills backed up by the latest scientific evidence. The text is consumer centred and context specific with practical advice supported by internationally accepted standards of evidence. Dot points, diagrams and tables are used to provide straightforward, readable, accessible, hands on material.

Mosby’s Pocketbook of Mental Health will complement a core text and offer a quick reference in clinical practice.

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Mosby's Pocketbook Of Mental Health Sample Chapter

  1. 1. MOSBY’S POCKETBOOK OF mental health Eimear Muir-Cochrane Patricia Barkway Debra Nizette
  2. 2. MOSBY’S POCKETBOOK OF mental health
  3. 3. MOSBY’S POCKETBOOK OF mental health Eimear Muir-Cochrane Patricia Barkway Debra Nizette Sydney Edinburgh London New York Philadelphia St Louis Toronto
  4. 4. Mosby is an imprint of Elsevier Elsevier Australia. ACN 001 002 357 (a division of Reed International Books Australia Pty Ltd) Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067 © 2010 Elsevier Australia This publication is copyright. Except as expressly provided in the Copyright Act 1968 and the Copyright Amendment (Digital Agenda) Act 2000, no part of this publication may be reproduced, stored in any retrieval system or transmitted by any means (including electronic, mechanical, micro- copying, photocopying, recording or otherwise) without prior written permission from the publisher. Every attempt has been made to trace and acknowledge copyright, but in some cases this may not have been possible. The publisher apologises for any accidental infringement and would welcome any information to redress the situation. This publication has been carefully reviewed and checked to ensure that the content is as accurate and current as possible at time of publication. We would recommend, however, that the reader verify any procedures, treatments, drug dosages or legal content described in this book. Neither the author, the contributors, nor the publisher assume any liability for injury and/or damage to persons or property arising from any error in or omission from this publication. National Library of Australia Cataloguing-in-Publication Data Muir-Cochrane, Eimear. Mosby’s pocketbook of mental health / Eimear Muir-Cochrane; Patricia Barkway; Debra Nizette. 9780729539319 (pbk.) Includes index. Bibliography. Mental health--Handbooks, manuals, etc Other Authors/Contributors: Barkway, Patricia. Nizette, Debra. 616.89 Publishing Manager: Luisa Cecotti Developmental Editor: Larissa Norrie Publishing Services Manager: Helena Klijn Editorial Coordinators: Sarah Botros/Amanda Simons Edited by Ruth Matheson Proofread by Pam Dunne Indexed by Jon Jermey Cover design by Toni Darben Internal design and typesetting by TNQ Books and Journals Printed by China Translation and Printing Services
  5. 5. Foreword In the everyday practice of health, public safety and other human services, mental healthcare has been an important and often poorly understood element. Frequently, better knowledge of mental health and practical strategies to support the mental health of consumers would assist in providing appropriate and effective responses to the needs of people in crisis or people with longer term mental health needs. In extreme circumstances, when people are confronted, for example, by death, terminal illness or violence, and in the more mun- dane circumstances of routine care wherein, for example, confusion, misinformation and unfamiliarity may challenge both consumers and staff to make sense of their situation, the focus on mental health should equal the attention given to the support of physical health. Changes in the provision of healthcare, including greater focus on community- based care and subacute care, which are being introduced as strategies to alleviate the increasing costs and overloading of services experienced in the acute hospital setting, will heighten the need for good basic men- tal health knowledge and practical skills among our health and human service workforce. Mosby’s Pocketbook of Mental Health provides a text that is espe- cially relevant for those at the forefront of these changes and who will increasingly require a good practical knowledge and skill set in mental health. The text provides a broad overview and because of its utility, contemporary approach and focus on practical care, it will be useful for mainstream health practitioners and others such as police, social and human services workers, and emergency services workers. The authors bring to the text their extensive experience in real- world mental healthcare, and this is evident from both the breadth of the content and the practical information provided. The pocketbook is straightforward and readable, providing easy access to the sort of information that practitioners require when working in the field. At times, it will be used to review knowledge and, at other times, it will be used as a quick reference to clinical signs and interventions that can v
  6. 6. vi ■ Foreword be employed in the field. Importantly, the pocketbook format will help to ensure that current research evidence and best practice are brought into play in the clinical setting. Professor Paul Arbon AM Dean, School of Nursing and Midwifery, Faculty of Health Sciences, Flinders University President Elect, World Association for Disaster and Emergency Medicine (WADEM) Chief Commissioner, St John Ambulance Australia
  7. 7. Contents Foreword v Preface ix Authors and reviewers xi Chapter 1 Working in a recovery framework 1 Chapter 2 Essentials for mental health practice 13 Chapter 3 Mental state assessment 25 Chapter 4 Culture and mental health 37 Chapter 5 Common mental illnesses and associated disorders 48 Chapter 6 Psychiatric emergencies 69 Chapter 7 Managing medications 82 Chapter 8 Contemporary talking therapies 99 Chapter 9 Co-occurring medical problems 103 Chapter 10 Loss and grief 109 Chapter 11 Law and ethics 120 Chapter 12 Settings for mental healthcare 128 Appendix 1 Surviving clinical placement 137 Appendix 2 Working with people with challenging behaviours 139 vii
  8. 8. viii ■ Contents Appendix 3 Prescription abbreviations 141 Appendix 4 Top 10 tips for people taking psychiatric medication 142 Further reading and resources 143 Glossary 147 Index 165
  9. 9. Preface It is estimated that approximately 450 million people worldwide have a mental health problem, with one in four people experiencing some kind of mental health problem in the course of a year. Following the reform of mental health services, including mainstreaming and the delivery of care within a recovery framework, all health workers now need a range of mental health skills and knowledge in order to practise effectively in their work with mental health consumers and their carers/families. For this reason, we decided to put such a text together, originally devised over dinner in Chinatown in Brisbane in April 2008. This handy, readable text is intended to provide easy access to immediate advice for a range of health professionals, including gen- eral nurses, general practitioners, paramedics, police, mental health workers, drug and alcohol workers, and allied health professionals who encounter people with mental health problems in their daily work. We have endeavoured to distil the core elements of engaging and work- ing with people with mental health problems into practical skills and approaches that can be applied to a range of settings for care. At the core of mental health practice is a focus on social inclusion and recovery, culture, and respect for and promotion of consumer rights in mental healthcare. Accordingly, we have included chapters that reflect these foci and associated ‘hands on’ strategies. We have used text boxes to provide practical tips about what to do in commonly encountered situations. The appendices serve as an aide memoire or checklist for quick reference in relation to, inter alia, working with consumers with challenging behaviours, tips in regard to undertaking a successful clinical placement and guidance to those taking psychi- atric medications. We have included extensive web-based resources to provide the latest bibliography of reliable electronic resources for ease of access. In writing this book we set out to ‘cut to the core’ in terms of what practical, doable and helpful strategies would be of use to health ix
  10. 10. x ■ Preface professionals without formal mental health qualifications. We think this is what we have achieved and trust readers will find this book to be a practical and useful adjunct to their clinical practice. Eimear Muir-Cochrane Patricia Barkway Debra Nizette
  11. 11. Authors and reviewers AUTHORS Eimear Muir-Cochrane BSc(Hons) RN MHN GradDipAdultEdu- cation MNS PhD FACMHN Professor and Chair of Nursing (Mental Health Nursing), School of Nursing and Midwifery, Flinders University Patricia Barkway BA MSc(PHC) RN MHN FACMHN Senior Lecturer, Stream Coordinator, Mental Health Nursing Programs, School of Nursing and Midwifery, Flinders University Debra Nizette RN MHN DipAppSc(NrEd) BAppSc(Nursing) MNrSt FRCNA FACMHN Mental Health Nurse Advisor, Office of the Chief Nurse, Queensland Health REVIEWERS Ruth DeSouza DipNurs GradDipAdvNursPractice MA Senior Research Fellow, Centre for Asian and Migrant Health Research, National Institute for Mental Health and Public Health Research, AUT University, Auckland Kim Foster PhD MA BN DipAppSc RN MRCNA FACMHN Associate Professor, Mental Health Nursing; Coordinator, Mental Health Programs, Faculty of Nursing and Midwifery, University of Sydney Jem Masters MN(Hons) MMgt GradDipNursMgt RN (RGN, RSCN UK) PyschCert FACMHN Registered Nurse, St Vincent’s Hospital, Sydney; former Mental Health Lecturer, Faculty of Nursing and Midwifery, University of Sydney xi
  12. 12. xii ■ Authors and reviewers Julie Sharrock RN MHN BEd MHSc (PsychNurs) AdvDipGestalt- Therapy FACMHN MRCNA Mental Health Nurse; Coordinator, Consultation–Liaison Psychiatry, St Vincent’s Mental Health Anthony O’Brien RN BA MPhil(Hons) FNZCMHN Senior Lecturer, School of Nursing, Faculty of Medical and Health Sciences, University of Auckland; Nurse Specialist, Liaison Psychiatry, Auckland District Health Board
  13. 13. 1 Working in a recovery framework INTRODUCTION A recovery-oriented approach to mental healthcare aims to facilitate mental health, minimise the impact of mental illness and manage the symptoms of mental illness. The recovery model emerged in the latter part of the twentieth century amid worldwide reform of mental health services. It is a person-centred approach, underpinned by principles of social justice and equity, which challenges an exclusive biomedical model of focusing mainly on symptom identification and treatment. This chapter examines recovery as a philosophy and as a framework within which to deliver mental health services, from the perspective of the consumer, the mental health professional and mental health services. RECOVERY Recovery is a philosophical and practical approach to care in which the emphasis is on a person’s potential to lead their lives as they wish. Recovery is not just about reducing or eliminating symptoms; it is about an individual’s journey living with a mental illness. Recovery in this context has many meanings, and it is an individual and a dynamic experience, not a static process. A recovery-based model is underpinned by an emphasis on a num- ber of protective factors that can be harnessed to reduce the sever- ity and impact of the experience of mental illness. Protective factors serve a number of purposes. They can buffer risk factors and provide a cushion against negative effects. Also, they may interrupt the pro- cesses through which risk factors operate. For example, a community program that helps young men learn conflict resolution may interrupt a potential path to delinquency. Protective factors can be grouped into three areas: individual; family and peers; and community (see Box 1.1). 1
  14. 14. 2 ■ Mosby’s Pocketbook of Mental Health Box 1.1 Protective factors Individual Individual protective factors include: • resilient characteristics, such as effective coping skills and being able to manage stress • a sense of one’s own spirituality • effective interpersonal skills • problem-solving skills • a perception of social support from family and peers • a healthy sense of self and a sense of belonging • positive expectations/optimism for the future, and • meaningful activities in which to engage. Family and peers Protective factors in the area of family and peers include: • good relationships and regular contact with family members • a stable family involvement with positive peer group activities and norms, and • friends to socialise with. Community Community protective factors include: • an economically sustainable community • a safe and health-promoting environment • active community centres, and • neighbourhood cohesion. In the past, the phenomenon (i.e. the lived experience of the person with a mental illness) was at the core of care for people with mental ill- ness. However, throughout the twentieth century, the focus shifted and the biomedical model dominated psychiatric care and concentrated on symptoms identification and reduction, primarily through medi- cation, with the subjective experience having less emphasis. Recent decades, however, have seen a shift towards a recovery approach in which ‘person-centred’ care is central. Table 1.1 provides a comparison of biomedical and recovery-focused understandings. THE TIDAL MODEL Developed by Professor Phil Barker in the United Kingdom in the late 1990s, the Tidal Model is a philosophical approach to the provision of mental healthcare with the following core values:
  15. 15. CHAPTER 1 Working in a recovery framework ■ 3 • People need to reclaim their personal story of mental distress and mental illness in order to reclaim their lives. • The role of health professionals is to assist people realise what they want in relation to their lives. The following 10 commitments guide the Tidal Model approach to mental health clinical practice (Barker 2009): 1. Value the voice of the person: their voice of experience is central, not the professional medicalised account. 2. Respect the language: the words people use to describe their experience is vital. 3. Develop genuine curiosity: listen to the person, be interested in what they have to say, not just ‘what is wrong with them’. 4. Become an apprentice: the person with a mental illness is the expert. Learn from the person. 5. Use the available toolkit. What resources does the person have? What has worked before? 6. Craft the step beyond. What needs to be done now? 7. Give the gift of time: take time! 8. Help the person reveal their personal wisdom. The person knows themselves best. Table 1.1 Comparison of biomedical and recovery-focused understandings Biomedical approach to understanding mental Person-centred recovery illness framework A linear process of illness and A cyclical process of trying and wellness trying again Focus on treatment and medication Focus on meaningful relationships management and leading an ‘ordinary life’ Spirituality and meaning are not Spirituality is important in developing viewed as important meaning and understanding Relapse is viewed as a failure Relapse is viewed as an opportunity for growth and learning The experience of mental illness is The experience of recovery from a a negative one mental illness has positive aspects The nature of mental illness is Having a mental illness is an predetermined individual and unique process Relinquishing roles and Maintaining roles and responsibilities is accepted responsibilities is promoted
  16. 16. 4 ■ Mosby’s Pocketbook of Mental Health 9. Know that change is constant. Although change is inevitable, growth is optional. The task of the professional helper is to develop awareness with the person of when change occurs and to support the person making decisions about what course to take. 10. Be transparent. Be honest and upfront. Use the person’s language in their care and assessment plans. THERAPEUTIC RELATIONSHIPS In clinical practice the relationship a mental health worker has with a consumer and their family is the cornerstone of effective mental health practice, and requires the establishment of trust and effective commu- nication. The purpose of the relationship is to: • engage with the person in order to complete a full assessment and care plan • encourage the person to define their problems and perceptions of their distress • facilitate the development of learning and coping skills by the person, and • resolve or minimise existing problems or symptoms. The role of health professionals in mental health promotion is to: • facilitate a healthy lifestyle through education about diet and nutrition, rest, sleep and exercise • support individuals in accessing employment services, housing, education and health services, and • provide mental healthcare early and provide continuing intervention programs. WORKING IN A RECOVERY FRAMEWORK Recovery as a concept and approach emerged alongside the reform of mental health services that occurred in Western countries towards the end of the twentieth century. As an approach to mental health service delivery, recovery challenges traditional biomedical model approaches and empowers consumers as they work in partnership with mental health professionals to manage a life lived with mental illness. A recov- ery approach has subsequently become an integral component of men- tal health service delivery (Rickwood 2006). Recovery for consumers and carers refers to living well with an ongoing mental illness, having hope and setting goals for the future— not just symptom management. It encompasses learning about the illness and factors which trigger episodes, and making necessary life- style changes. Recovery for the mental health professional means not
  17. 17. CHAPTER 1 Working in a recovery framework ■ 5 only working with the consumer to manage the symptoms of mental illness, but also working with the person to enable them to lead a full and meaningful life, despite the illness. A recovery approach acknowledges that some factors increase risk of relapse of mental illness, while others are protective of mental health. Hence, a recovery approach encompasses more than merely treating or managing the symptoms of the illness. It includes recognition of and attention to the social and economic aspects of people’s lives, as well as their mental illness or disability. The mental health professional who utilises a recovery framework works in partnership with the consumer (and carer) to maximise the quality of life for the person living with mental illness (Barkway 2009). Rickwood (2006) distinguishes protective and risk factors for the development of and recovery from mental illness, and states that pro- tective factors for mental illness reduce the likelihood that a disorder will develop by reducing the exposure to risk, and by reducing the effect of risk factors for individuals exposed to risk. Protective factors also foster resilience in the face of adversity and moderate against the effects of stress, whereas risk factors increase the likelihood that a disorder will develop, exacerbate the burden of an existing disorder and can indicate a person’s vulnerability. Both protective and risk factors include genetic, biological, behav- ioural, sociocultural, and demographic conditions and characteristics (Rickwood 2006), with some factors being internal to the person, while others are external. Internal factors include genetics, disposition and intelligence, while external drivers comprise the social determinants of health related to social, economic, political and environmental factors, including the availability of opportunities in life and access to health services (Commonwealth Department of Health and Aged Care 2000a, World Health Organization 2008). Risk factors increase vulnerability to mental illness and mitigate against recovery from mental illness. Risk factors for mental illness in children, for example, have been identified as: family discord and vio- lence; low family income; parental unemployment; parental substance misuse and mental health problems; a coercive parenting style; poor monitoring and supervision at home and school; inconsistent behav- iour management; poor peer relations; and school alienation (Com- monwealth Department of Health and Aged Care 2000b, p 118). Protective factors assist the individual to maintain emotional and social wellbeing, and to cope with life experiences—including adversity.
  18. 18. 6 ■ Mosby’s Pocketbook of Mental Health They can provide a buffer against stress, as well as be a set of resources to draw upon to deal with stress (Commonwealth Department of Health and Aged Care 2000a, p 53). Factors that have been identified as pro- tective against mental illness in children, for example, include: family harmony; a positive school environment; school achievement; a sense of self-worth; self-efficacy; coping skills; social skills; having a personal con- fidante; belonging to a positive peer group; and leading an active lifestyle (Commonwealth Department of Health and Aged Care 2000b, p 118). RECOVERY-ORIENTED MENTAL HEALTH SERVICES In 2006, a framework for recovery-oriented mental health services in Australia was proposed by the National Mental Health Promotion and Prevention Working Party following an extensive consultation process with consumers, carers and service providers. The framework consists of four essential elements to recovery and relapse prevention called the ‘4As’—awareness; anticipation and planning; alternatives and oppor- tunities; and access and early intervention (Rickwood 2006). The 4As framework describes ways to promote mental wellness and to reduce future episodes of mental illness for people who have been seriously affected by mental illness. It is designed to guide the development of local implementation plans by the mental health- care system—including all those people and services (government, private and non-government organisations) that support people who have experienced mental illness, and to reorient services towards recovery approaches. Implementing the framework requires four basic activities: plan- ning; adequate resourcing; allocating responsibility; and evaluation and monitoring the implementation and outcomes (Auseinet 2006, Rick- wood 2006). Table 1.2 summarises key components of the framework. According to the Western Australian Government (2004), mental health services can adopt a recovery framework by establishing part- nerships with the consumer which empower the person, assure their rights, increase their control over their mental health and wellbeing, assist individuals to reach the best possible outcomes and enable them to fully participate in society. A recovery-focused mental health service, therefore, is one which: • is accessible and enables people to find the right help at the right time, for as long as it is needed • gives people the best help available, whoever they are and wherever they are
  19. 19. CHAPTER 1 Working in a recovery framework ■ 7 Table 1.2 The 4As recovery framework Element to recovery Components Awareness Acceptance and recognition of the mental illness by the consumer, family and carers Awareness of vulnerability for relapse Recognition of early warning signs of illness Knowledge of personal risk and protective factors Positive attitudes towards mental illness by the wider community to enable self-acceptance and a sense of self-worth Anticipation and Consumer-centred care to empower consumers to planning make the decisions they choose, rather than have decisions made for them Planning and management on many levels: daily plans; crisis plans; and longer term wellness and relapse-prevention plans Involvement of all relevant people (i.e. the consumer, their family and carers, clinical service providers, and providers of psychosocial and psychiatric rehabilitation services) Regular reviews of relapse-prevention plans to ensure they continue to meet the person’s needs, taking into account their age, personal circumstances, cultural background and mental illness experience Alternatives and Support services to mitigate against mental illness risk opportunities factors and strengthen protective factors for mental health Addressing the clinical, social, emotional, physical and spiritual needs of the person Ensuring a range of supported accommodation, employment, recreational options and follow-up services are available within the community Recognition of the role and importance of peer support Access Services that are responsive to early warning signs, and early not just acute crises intervention Ensuring consumers and their families and carers have developed effective coping skills to recognise and respond to early warning signs ‘Step-up’ and ‘step-down’ facilities which respond quickly and effectively to changing mental health needs, as recognised by consumers and their families and carers Source: Auseinet (2006) and Rickwood (2006).
  20. 20. 8 ■ Mosby’s Pocketbook of Mental Health • assists people in the context of their whole lives, not just their illness • protects consumers’ and carers’ rights and treats them with respect and equality • enables people with mental illness to take on competent roles • supports people in using mental health services only when necessary, and • looks outward to assist people to find and use available community services, supports and resources. Furthermore, to facilitate recovery, mental health services must be staffed by people who support the core values of recovery policy and are competent to assist consumers in their recovery journey (Western Australian Government 2004). RECOVERY COMPETENCIES FOR MENTAL HEALTH WORKERS The New Zealand Mental Health Commissioner, Mary O’Hagan, describes a competent mental health worker as one who: Understands recovery principles and experiences, supports service users’ personal resourcefulness, accommodates diverse views on mental health issues, has self-awareness and respectful communica- tion skills, protects service users’ rights, understands discrimination and how to reduce it, can work with diverse cultures, understands and supports the user/survivor movement, and understands and supports family perspectives (O’Hagan 2004, p 2). This is exemplified in the ‘Recovery competencies for New Zealand mental health workers’, which were developed by the Mental Health Com- mission of New Zealand (2001). The competencies outline the knowledge, skills and disposition required by mental health workers to enable them to work within a recovery framework. A competent mental health worker: 1. understands recovery principles and experiences in the Aotearoa/ New Zealand and international contexts 2. recognises and supports the personal resourcefulness of people with mental illness 3. understands and accommodates the diverse views on mental illness, treatments, services and recovery 4. has the self-awareness and skills to communicate respectfully and develop good relationships with service users 5. understands and actively protects service users’ rights 6. understands discrimination and social exclusion, its impact on service users and how to reduce it
  21. 21. CHAPTER 1 Working in a recovery framework ■ 9 7. acknowledges the different cultures of Aotearoa/New Zealand and knows how to provide a service in partnership with them 8. has comprehensive knowledge of community services and resources, and actively supports service users to use them 9. has knowledge of the service user movement and is able to support their participation in services, and 10. has knowledge of family/whānau perspectives and is able to support their participation in services (Mental Health Commission of New Zealand 2001, p 7). WORKING WITH INDIVIDUALS When working with individuals to facilitate recovery, ‘Rethink’ (the leading United Kingdom mental health charity) challenges an exclusive biomedical model approach of focusing on illness and symptom man- agement, and advocates a model in which mental wellness is the goal. Rethink recommends an approach which: • focuses on goals, not problems • values the strengths the person brings to their personal recovery • respects the person’s self-direction, and • creates an environment which supports personal recovery and values small steps (Rethink 2009). In summary, the Rethink model is person centred and directed, and proposes working with the person’s strengths, and addressing issues of everyday living—as well as managing the symptoms of men- tal illness. WORKING WITH FAMILIES In Canada, the Family Mental Health Alliance (2006) is a collaboration between consumers, carers and health services, which works in part- nership to develop a stronger voice for families in the mental health and addiction system, to strengthen the supports provided to families and to raise awareness of issues from a family perspective. The alliance has identified four needs of families and caregivers of people with men- tal illness and/or addictions as: 1. Services for families: educating, supporting and caring for the caregivers. Provide psychoeducational programs for families, carers and friends of people with a mental illness, aimed at increasing the capacity for carers to care for themselves, other family members and their relative living with a mental illness. 2. Peer support: families helping families. Provide support and funding for peer-support initiatives and facilitate access for consumers.
  22. 22. 10 ■ Mosby’s Pocketbook of Mental Health 3. Recognition as partners in care, rehabilitation and recovery. Develop organisational policies and provide training that assists clinicians to work with families. Include family members in policy development and the delivery of education for clinicians. 4. Families as system partners. Recognise and involve family members as key stakeholders of mental health services (e.g. as members of advisory committees and boards of mental health services) (Family Mental Health Alliance 2006). Addressing the needs of families and caregivers recognises the sig- nificant role they play in caregiving and, importantly, that they too have needs as a consequence of their caregiving role. CONCLUSION Recovery is the journey undertaken by the person with mental illness (often in collaboration with a mental health professional) as the consumer rethinks their identity, goals and hopes (Slade 2009). For mental health professionals, working within a recovery framework involves working with the consumer’s strengths, and addressing issues of everyday living—as well as managing the symptoms of mental illness. Finally, as a guiding framework for clinical practice, recovery is an approach to achieving mental health, which involves more than merely treating the symptoms of mental illness. It includes notions of empowerment of consumers and their carers, the delivery of person-centred care and the establishment of a partnership between consumers, carers and mental health professionals in attaining the goal of mental health. Importantly, there is a focus on the consumer’s strengths, rather than the deficits that may be a consequence of the mental illness. References Auseinet 2006 Pathways of recovery: framework for preventing further episodes of mental illness summary sheet. Online. Available: www.auseinet.com/files/ recovery/4a_summary.pdf 29 Apr 2009 Barker P 2009 The Tidal Model: reclaiming stories, recovering lives. Online. Available: www.tidal-model.com 1 Aug 2009 Barkway P 2009 Psychology for health professionals. Elsevier, Sydney Commonwealth Department of Health and Aged Care (CDH&A) 2000a National action plan for promotion, prevention and early intervention for mental health. Mental Health and Special Programs Branch, CDH&A, Canberra
  23. 23. CHAPTER 1 Working in a recovery framework ■ 11 Commonwealth Department of Health and Aged Care (CDH&A) 2000b Promotion, prevention and early intervention for mental health: a mono- graph. Mental Health and Special Programs Branch, CDH&A, Canberra Family Mental Health Alliance 2006 Caring together: families as partners in the mental health and addiction system. Family Mental Health Alliance, Ontario Mental Health Commission of New Zealand (MHC) 2001 Recovery competen- cies for New Zealand mental health workers. MHC, Wellington O’Hagan M 2004 Recovery in New Zealand: lessons for Australia? Guest edito- rial, Australian e-Journal for the Advancement of Mental Health 3(1):1–3 Rethink 2009 Recovery and self management. Online. Available: www.rethink. org/living_with_mental_illness/recovery_and_self_management/index. html 20 Apr 2009 Rickwood D 2006 Pathways of recovery: preventing further episodes of mental illness (monograph). Commonwealth of Australia, Canberra Slade M 2009 100 ways to support recovery: a guide for mental health profes- sionals. Rethink Recovery Series, Vol 1, London Western Australian Government 2004 A recovery vision for rehabilitation: psychiatric rehabilitation policy and strategic framework. Department of Health Office of Mental Health, Perth World Health Organization (WHO) 2008 Closing the gap in a generation: health equity through action on the social determinants of health. WHO, Geneva WEB RESOURCES Auseinet recovery online collection: http://auseinet.flinders.edu.au/toolkit/index. php. The collection aims to assist jurisdictions, service providers, consumers and carers to implement a recovery approach. Auseinet interprets recovery as maximising wellbeing for a person with a mental illness or disorder. It encom- passes many of the same principles as mental health promotion, including quality of life, wellbeing and positive mental health. Canadian Mental Health Association: www.ontario.cmha.ca/policy_positions. asp?cID=7138. The monograph ‘Caring together: families as partners in the mental health and addiction system’ was produced by the Family Mental Health Alliance in partnership with the Centre for Addiction and Mental Health, Canadian Mental Health Association, Ontario, and the Ontario Federation of Community Mental Health and Addiction Programs. Recovery Competencies for New Zealand Mental Health Workers: www.mhc. govt . nz / users / Image / Resources / 2001 % 20Publications / RECOVERY _ COMPETENCIES . PDF . This paper describes the competencies men- tal health professionals require to be able to work within a recovery framework in their clinical practice. Rethink (UK): www.rethink.org. Rethink is the largest severe mental illness char- ity in the UK. It is dedicated to improving the lives of everyone affected by severe mental illness, whether they have a condition themselves, care for others who do, or are professionals or volunteers working in the mental health field.
  24. 24. 12 ■ Mosby’s Pocketbook of Mental Health Richmond Fellowship: www.richmondnz.org. The Richmond Fellowship is established in most Australian states and territories. It was founded in Richmond, England, in 1957 and has since grown into a worldwide network of support services for people with mental illness. It promotes mental health and recovery for people living with mental illness by providing community- based rehabilitation within an accommodation support framework. Tidal Model: www.tidal-model.com. The Tidal Model is the first mental health recovery model developed conjointly by mental health nurses and people who have used mental health services.

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