Peter Bewert & Tracey Garratt, Salvation Army -Inspiring hope in mental illness
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Peter Bewert & Tracey Garratt, Salvation Army -Inspiring hope in mental illness
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Peter Bewert & Tracey Garratt, Salvation Army -Inspiring hope in mental illness
- 2. Our purpose Inspired by the message of Christ, our mission is to serve all Australians in practical and tangible ways. Each of us has a heart for people - a deep and powerful need to care for others. We understand accepting care is an emotional and challenging time. We welcome, support and guide all people and their families through - to become part of our family – where they have freedom and can be themselves. The care we provide goes beyond the physical to ensure our residents and clients are healthy, comfortable and above all, loved. We respect each individual and the rich lives that they have led, so our care is centred around their needs and preferences, not ours.
- 3. For the love of Christ Compels us 2 Corinthians 5:14
- 4. We have an uncompromising commitment to all Australians – to create a loving home and family environment which enhances their health and spiritual well-being.
- 5. Uncompromising Commitment Focuses on what is important for the individual in respect to their journey past, journey present and journey future. Shared Journey – we are all part of a community Celebrates individuality, purpose, meaning and fosters the uniqueness that is who we are as people
- 7. Building Contentment : a wellness alliance Emotional awareness Emotional connectivity Contentment
- 8. Behaviour Support Planning Wellness Wellness Regressive experience Regressive experience Crisis Crisis 10% 25% 65% Carpenter Court (2006) Carpenter Court (2012)
- 9. Presenting Circumstances Frequent re-admission to Acute Psychiatric Hospital Failed attempt at long term Psychiatric rehabilitation Failed admission to mainstream aged care facility Estrangement from family Case study of model in action: Peter Causal Factor Regressive Experience Feeling Strategy Outcome • Delusion he is being beaten by “others” inside him • Unable to stop the assault • Verbal Aggression • Screaming • Pacing • Fear • Disempower- ment • Staff respond to fear • Staff assist with identification of emotional response • Staff ask how they can help • Decreased verbal aggression • Screaming has stopped • Pacing has decreased • Decreased occurrence of delusion • Increased self control • Increased emotional awareness • Increased dignity • Peter has regained power over “the others” (fear)
- 10. A hope for a new tomorrow Your true self is pure, infinite spirit. Spirit isn’t something outside you, but intertwined in everything you feel, think and do (Chopra: 2013) Ultimately meaning in life is central to who we are as individuals It includes finding intimacy with the concept of “god”, people around us, it transcends loss and disability, focuses on finding meaning and hope within our everyday existence. (MacKinlay: 2001)
- 11. If we are to better the future, we must disturb the present. (Catherine Booth)
Editor's Notes
- Aged Care Plus is part of The Salvation Army within Australia and provides aged care services across the Australian Eastern Seaboard.18 Residential Aged Care Centres which provide a mixture of High Care, Low Care and Dementia Care Services. There are over 1300 Residential Aged Care Beds in our Centres combined.8 Retirement Villages for independent livingWe currently have 50 Community Aged Care Packages providing care services into the homes in local communities and have recently been successful in acquiring an additional 31 Community based care packages.2 Day Therapy CentresHACC Counselling Service for Carers caring for their loved ones in the home environment.TSAACP provides a unique and diverse service to our community and our demographic at some Centres is very different to the profile mostly associated with aged care services in Australia. Our mission is to meet the needs of persons practically and without prejudice. Many of our consumers come from backgrounds such as alcohol recovery services, homeless lifestyle and persons from a low socioeconomic background. Whilst this shapes some of our internal demographics our care centres are available to all persons from all walks of life.The freedom to be oneself is fundamental to our ethos, we value the individuality and the life experience of each person who comes into our care and we foster this as a part of community which focuses not only on inclusion but belonging. The value of each individuals experience is what makes our care environments unique
- The Australian StoryLike most countries, Australia has an ageing population. Older people (those aged 65 years and over) currently make up 13.6 per cent of the population. Compared with 8.3 per cent in 1971, it is estimated that by 2015 older people will comprise 16.4 per cent of the population, increasing to 26 per cent in 2050. Over the next two decades, Australia’s population is expected to rise by 29 per cent, with the number of people aged 65 and over rising by 90 per cent. Our ageing population is diverse and varied and the needs are only going to continue to change particularly as we span the generations.There is a distinct change in the ageing profile entering into residential aged care services. The Australian Government focus in part has been about promotion of wellness and care services in the community setting for as long as possible and considerable federal funding has been put into community based aged care services for care provision within the home setting. As a result of this the admission profile to residential services has changed dramatically:Increased frailty and higher physical dependence – this has had implications for what were typically known as low care environments and has resulted in specialisation of service types within TSAACP (this will be discussed in more detail shortly)Palliative CareIncreased need for high and low care dementia servicesPsychogeriatric needs / Mental HealthCare provision is continually changing and not one size fits all. This provides us with challenges and we are continually required to reinvent ourselves in order to meet the needs of our changing consumer cohort. The importance of individuality, connectedness and the comfort of being a community is paramount in ensuring we meet the wellbeing and spiritual needs of our residents.Definition of Healthy ageingThere are many definitions of healthy ageing, a term which is often used interchangeably with terms such as active ageing, successful ageing, positive ageing and productive ageing. Although there is no universal definition, there is general acceptance that healthy ageing involves more than justphysical or functional health. Quality of life is fundamental to ensuring our individual stories continue to be heard, considered and respected for the uniqueness they provide. In essence these stories are the fabric of who we are.WHO defines active ageing as ‘the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age’ allowing people to ‘realize their potential for physical, social and mental well-being throughout the life course’.
- Being part of a community contributes to well-being throughout our lives. People living in residential aged care are recognised as being at greater risk of social isolation and disconnection from their experience of community. Our aim is to inspire hope which in turn promotes well-being and quality of life. This can be a challenge as our resident demographic often comes from an environment where there is hopelessness, particularly those with homeless backgrounds and where life’s circumstances have resulted in some tragic and negative outcomes. The literature indicates Social inclusion strategies are essential to ensure that people living in residential aged care services are supported to be involved and connected. Many people who come from a homeless background or suffer with mental illness can feel isolated. This isolation results in significant outward displays of what is perceived by many as “difficult behaviour”Our approach aims to improve and integrate connectivity in a community setting by:adopting a strong person-centred approachbetter understanding the complexity of older people’s health care needs, specifically the relationship between the physical and the emotional components of a persons illness; andimproving outcomes by fostering individuality and providing hope in individual circumstances.Each of our Centres provide a unique service to a unique group of older Australians. Our staff and residents frequently tell us of the importance of a family environment in our care settings. We have realised that to foster this type of environment is essential in achieving a person centeredness and wellness.
- Uncompromising Commitment is our Person Centred Care Approach within TSAACP. It is based upon our values and provides a framework for our individual service types. It is based around the definition articulated by the Victorian Department of Health Services which states that the aim of a person centred care framework is“Treatment and care provided by health services [that] places the person at the centre of their own care and considers the needs of the older person’s carers.” (Victorian Department of Human Services: 2003)Uncompromising Commitment’ – focuses on the person’s capabilities, not their deficits;fosters a shared understanding about what is important to the person in their day-to-day life and in the future they desire; and seeks to develop a better, shared understanding of the person and their situation. A person-centred plan is developed which will describe the balance between what is important to the person, their aspirations, and what supports they require.A collaborative and respectful relationship between the consumers and care provider.The framework is not a prescriptive model of care for centres as one size does not fit all. The Framework is applied practically based upon the individual needs of the care service and the people who are a part of that community.We have three very specific services within our group that cater for the needs of people with mental illness and people from homeless backgrounds. One of our greatest challenges in this area is achieving contentment in a group of individuals that often have significant behavioural challenges as a result of their mental illness. Carpenter Court is one of our services that meets the needs of this unique group of individuals and succeeds in achieving wellness and ultimately providing a hope, meaning and purpose for residents.
- Traditional behaviour management strategies are focussed on the actual behaviour being presented by the person. Traditional methodologies are not usually focussed on the underlying emotional and well-being factors associated with the outward demonstration of the behaviour. The focus in main stream behaviour management approaches is to identify the trigger and resolve this for the individual rather than with the individual. This is focussed on the physical components of health.There is often a lack of recognition for emotional or spiritual awareness and interventions are focussed on the exhibiting problem often stereotyped as a behaviour. The intervention is reactive and often focussed on the behaviour being exhibited with the ultimate aim of modification– often there is little insight to the underlying impacts that result in the behaviour being exhibited initially. This results often in frequent recurrence and an increase in anxiety, agitation and decreased spiritual well-being for the individual. Feedback from our resident cohort indicates this typical approach results in the reinforcement of feelings with a negative impact, specifically “I’m a bad person”. A traditional approach does not necessarily focus on the wellbeing of the individual – rather it is focussed on ceasing the behaviour being exhibited. This does not foster a person centred approach where spiritual contentment and well-being is enhanced, the focus is on the trigger for the demonstrated behaviour.
- In order to achieve wellbeing and spiritual contentment within the resident cohort at Carpenter Court an experiential model has been implemented based on the emotional awareness behind the behaviour being exhibited by the individual resident.Emotional Awareness – A persons experience will often dictate their outward expression – Experience is based upon an individuals emotions and how they interpret the situation or circumstance they are in. Persons with a mental Illness are unable to identify or be aware of the links between their actions (or the behaviour) and their emotional and spiritual state.Emotional Connectivity – When we focus on the expression of the individuals experience this allows the care giver to identify specific interventions to address the emotional and spiritual component based on the experience. It is a focus not on the management of the behaviour, but the emotional connections that provides significance to the person. Contentment – the outcome is not focussed on a specific behaviour strategy, but rather on their contentment. The interventions implemented results in achieving contentment for the individual and this in turn increases their spiritual and emotional awareness.The model gives the person a supportive framework to address their feelings and emotions. The focus is on providing a dignified environment to address underlying aetiology of emotional disturbances which often results in significant internal turmoil for the individual. Behavioural support planning allows the person the opportunity to respond to their feelings in a way that provides meaning which is specific to their individual needs.Deepak Chopra states that ones spirit can be altered by the “continuous cascade of thoughts, sensations and emotions. The mind can get mired in a conditioned pattern of thinking, returning again and again to thoughts of anxiety, stress, depression and limitation”
- In 2005 it was recognized that referrals for people with Mental Illness plus/minus homelessness (of all levels) were increasing. It was also noted that referring agencies were having increasing difficulties placing these people into aged care. Aged Care was and is experiencing a surge of aged applicants and consequently the marginalized were/ are the least attractive to accommodate. In response to the changing resident community it was decided to change the service profile, this involved all internal and external stakeholders. Focus groups were held with staff which led to a comprehensive literature reviews.This reflected our experience that Challenging behaviors are increasing and that these are mostly associated with dementia. However older people with long term mental illness present with behaviors not associated with cognitive decline. The challenge of providing care and accommodation to this population is immense, as implications/ repercussions of behavior impact care and the workforce- as well as the person themselves.It was obvious that whilst approaching this issue from WHS, social, medical and clinical models The overwhelming expressed need by residents was a need for them to understand their place in the world- they had a desire to develop self-awareness and self-control, the residents saw us as partners in assisting this to occur. Underpinning this was a feeling that they were not good enough, and had never been recognized as a whole person throughout their entire lives- that is a physical, social and spiritual part of society and the core community.
- In 2012 Peter was admitted to Carpenter Court on a trial basis. Peter was immediately assessed and a BSP was initially developed.The aim was to address the emotional discord rather that the presenting behavior.Peter was diagnosed with Schizophrenia- chronic treatment resistant in 1973. Peter had repeated admissions into the regions Acute Mental Health Unit every year to late 2010 with length of stay ranging from 4- 18 weeks. In 2010 Peter was admitted into a long term rehabilitation facility which was unsuccessful resulting in admission to a locked psychiatric facility. In 2012 Peter was transferred into a locked aged care dementia unit which also failed and was again admitted into the acute Mental Health Facility. Peter has long standing fixed delusions which are resistant to treatment, many of the delusions have significant impact on how he is viewed publicly. Some Peters delusions are: there a people inside of him who beat him, he is a 15 year old girl, he frequently receives electric shocks from outer space, he owns an orphanage, He has been kidnapped and is held against his will, he is in goal. The resultant behavior ranges from verbal aggression, physical aggression, screaming, threatening to kill people, refusal to speak to his mother who is still alive. Response to one delusionThe most apparent presenting emotion was fear- when I discussed this with Peter he was immediately taken aback and could be seen to be re-evaluating . The delusions remained however recognition of his feeling allowed him freedom to take action to resolve the fear. We simply provide the environment and support for this to occur. For example Peter is fearful of “others” inside of him as they beat him regularly 2-3 time a week. When asked how we can help he asked that they be told they must not beat him. I asked Peter if I could speak to one of the others and proceeded to tell them they are not to beat Peter any more- Peter now tells staff he has been beaten by the “others” inside of him, but not like before- in fact he asked a staff member to put a bandage on his hand as he had hurt it defending himself. We have noticed that the frequency of the beating is now 1-2 month, and Peter is beginning to develop his own strategies to manage this fear- one of those being he will tell the others not to beat him himself. This slide represents the background work completed with Peter, this forms the basis for a joint development of the Behavior support plan.
- Meaning is centric to all individuals. The Model presented in action at Carpenter Court identifies that the individualised approach to each person is critical in ensuring their individual meaning, purpose and hope in life is identified and actualised. When the causal factors that result in an outward expression as a behaviour are identified and individuals are provided with the opportunity to explore these in a safe environment, there is a hope and freedom that is found ultimately resulting in improved well-being and quality of life. Spirituality is the personal quest for understanding answers to ultimate questions about life, meaning and about relationships. Contentment is key to achieving spiritual well-being.