Mental Health Care: An Introduction for Health Professionals, 4th Edition

About the authors ix

Chapter 1 Mental health care in Australia 1

Introduction 2

1.1 Definitions 2

Mental health and mental illness 4

1.2 Stigma 8

Community attitudes 9

Attitudes of health professionals 10

1.3 A focus on caring 12

History of caring 12

Definitions of ‘care’ and ‘trauma-informed care’ 13

Aims of care and trauma-informed care 14

1.4 Caring in the health context 15

Current policy directions 17

Current service frameworks 18

Current service approaches 20

1.5 The prevalence of mental illness in Australia 23

Prevalence of suicide in Australia 24

Issues for young people 25

1.6 Common mental health issues 26

Summary 34

Key terms 34

Review questions 36

Discussion and debate 36

Project activity 37

Websites 37

References 38

Acknowledgements 43

Chapter 2 Assessment in the mental health context 44

Introduction 45

2.1 Mental health assessment of adults 45

2.2 Approaches to assessment 45

Reflection 48

Relationship 50

Recording 57

Reporting 58

2.3 Assessment tools 59

The comprehensive mental health assessment 60

2.4 Diagnostic manuals 66

ICD-11 67

DSM-5 67

2.5 Young people and mental health assessment 68

Young people presenting for assessment 69

Assessment frameworks for young people 70

2.6 Communicating with young people 72

The need to avoid ‘labelling’ young people 73

Summary 75

Key terms 75

Review questions 76

Discussion and debate 76

Project activity 76

Websites 77

References 77

Acknoweldgements 83

Chapter 3 The legal and ethical context of mental health care 84

Introduction 85

3.1 The legal and ethical context 85

Legal requirements 86

Ethical requirements 87

Confidentiality and privacy 88

Professional requirements 90

3.2 Challenges for health professionals 90

Legal and ethical frameworks 91

3.3 Capacity and competence 95

Principles of capacity and competence 95

Incapacity 96

Different types of consent 97

Power of attorney 97

3.4 Advance care agreements 99

Legal issues 99

Information required to make an informed decision 100

3.5 Duty of care 100

Reasonable and unreasonable 102

Least restrictive environment 103

3.6 State and territory mental health legislation 105

Sectioning and scheduling 106

3.7 Forensic mental health care 108

Summary 110

Key terms 110

Review questions 111

Discussion and debate 111

Project activity 111

Websites 112

References 112

Acknowledgements 115

Chapter 4 Culturally appropriate mental health care 116

Introduction 117

4.1 The pervasive nature of culture and subculture 117

Culture and subculture 117

4.2 Cultural constructions of mental illness 119

Alternative views to mental health care 119

4.3 Mental health and Indigenous cultures 120

What is meant by ‘indigenous’? 120

The Indigenous view of ‘health’ 122

The mental health and wellbeing of Indigenous Australians 123

Issues to consider when supporting the mental health and wellbeing of Indigenous Australians 127

‘How would you like us to help you?’ 128

4.4 Mental health and rural and remote cultures 131

What is a ‘rural’ or ‘remote’ culture in Australia? 131

Major issues for people living in rural and remote areas 132

Ongoing loss 134

Systemic issues 135

Addressing the issues in rural and remote areas 136

4.5 Mental health and multiculturalism 138

The language of multiculturalism 139

Individualism and collectivism 141

Gender roles 142

Cultural diversity, stigma and mental illness 144

4.6 Supporting people who are members of subcultures or minority groups 144

Definitions of LGBTQIA people 145

LGBTQIA culture 145

Risk factors for the mental health of LGBTQIA people 145

Major mental health issues faced by LGBTQIA people 146

4.7 Towards providing culturally appropriate mental health care 147

Cultural proficiency 148

Culturally appropriate approaches to treating mental illness 149

Information and education 150

Actively supporting culturally appropriate services 151

Working with families and communities 152

Summary 154

Key terms 154

Review questions 155

Discussion and debate 156

Project activity 156

Websites 157

References 157

Acknowledgements 165

Chapter 5 Common reactions to stressful situations 166

Introduction 167

5.1 Stress reactions 167

5.2 Physical, emotional and behavioural reactions 169

Physiological reactions 170

Emotional and behavioural reactions 170

Fear 175

Reactions of families and carers 176

5.3 Factors that influence stress reactions 178

Age 178

Background 179

Coping style 180

Context and setting 182

Locus of control 185

Resilience 186

Type of support received 187

5.4 Priorities when supporting people through stressful situations 188

Engagement and collaboration 188

Therapeutic alliance or relationship 189

Care plans 189

Referral 191

5.5 Providing information 191

Understanding information in stressful situations 192

Preparing information 192

5.6 Self-care 195

Reflective practice 195

Clinical supervision 196

Time out 197

Summary 199

Key terms 199

Review questions 200

Discussion and debate 200

Project activity 201

Websites 201

References 201

Acknowledgements 207

Chapter 6 People displaying challenging behaviours 208

Introduction 209

6.1 The nature of challenging behaviours 209

6.2 Reasonable and unreasonable behaviour 210

Challenging behaviours in children 212

The ‘difficult patient’ 212

Outcomes of labelling 214

Defence mechanisms 214

Control and power 216

The influence of health professionals 217

6.3 Causes and triggers of challenging behaviour 218

Communication and challenging behaviours 219

General assessment 219

Older people and challenging behaviours 221

6.4 Challenging behaviours exhibited by health professionals 222

6.5 Addressing challenging behaviours 223

Organisational responses 223

Education and training 225

6.6 Risk assessment 226

Working with people with challenging behaviours 227

Summary 235

Key terms 235

Review questions 236

Discussion and debate 236

Project activity 236

Websites 237

References 237

Acknowledgements 240

Chapter 7 Depression, anxiety and perinatal mental health 241

Introduction 242

7.1 Depression 242

Symptoms of depression 242

Causes of depression 243

Depression and physical illness 244

Types of depression 246

7.2 Approaches to the care of depression 249

Interpersonal skills 250

Comprehensive approach 251

Psychoeducation 252

Treatment options 253

7.3 Perinatal mental health issues 258

Policy context 260

Types of perinatal mental health issues 260

Caring for mothers with perinatal mental health issues 261

Supporting the partner 262

7.4 Caring for children, adolescents and young people with depression or psychosis 263

Nature versus nurture 263

Assessment issues to consider for children and adolescents 264

Common childhood diagnoses 265

Common interventions used with children and adolescents 266

Youth mental health 267

Neurobiological influences 268

Practice principles 268

7.5 Anxiety 271

Types of anxiety 271

Hypochondriasis 275

Approaches to care for anxiety 276

Summary 278

Key terms 278

Review questions 279

Discussion and debate 280

Project activity 280

Websites 281

References 281

Acknowledgements 284

Chapter 8 Caring for a person who has self-harmed 285

Introduction 286

8.1 Definitions 286

8.2 Incidence of self-harming 288

Suicide rates 288

Rates of self-harm 289

Indigenous populations 290

Methods of self-harm 290

8.3 ‘Causes’ of self-harming behaviour 291

Other risk factors 293

8.4 Attitudes towards self-harm 300

8.5 National Suicide Prevention Strategy 302

Groups ‘at risk’ 303

8.6 Assessment of risk 308

The ‘why’ of risk assessment 308

The ‘who’ of risk assessment 309

The ‘how’ of risk assessment 310

Risk assessment tools 310

8.7 Caring for the person who has self-harmed 313

Effective interpersonal communication 314

Managing short-term high risk 315

Psychological therapies 316

Medication 317

The role of family and carer(s) 317

Postvention 318

Summary 320

Key terms 320

Review questions 321

Discussion and debate 321

Project activity 321

Websites 322

References 323

Acknowledgements 327

Chapter 9 Caring for a person with a serious mental illness 328

Introduction 329

9.1 Definitions 329

Schizophrenia 330

Bipolar disorder 336

9.2 Comorbidities in people with serious mental illness 338

Factors that contribute to poor physical health 338

Common physical illnesses 339

When is a mental health assessment required? 343

Comorbidity and assessment 343

Comorbid treatment options 344

9.3 Carers 345

Roles 346

Providing information 347

Information sharing 347

9.4 Treatments for serious mental illness 348

Pharmacological therapies 348

Psychological therapies 352

9.5 Recovery 355

Summary 357

Key terms 357

Review questions 358

Discussion and debate 358

Project activity 359

Websites 359

References 359

Acknowledgements 361

Chapter 10 Substance use disorders 362

Introduction 363

10.1 Substance use and substance misuse 363

Prevalence of substance use 363

Adverse effects of substance use 365

Attitudes to substance use 365

10.2 Attitudes of health professionals 367

Language use 367

10.3 Health promotion and disease prevention 370

Harm minimisation 371

10.4 Categories of substances 371

Stimulants 371

Depressants 372

Hallucinogens 372

10.5 Substance use disorders 373

Substance-induced disorders 373

Reward pathways 374

10.6 Commonly misused substances 375

Alcohol 375

Amphetamines 380

Benzodiazepines 381

Cannabis 382

Medicinal cannabis 383

Cocaine 383

Ecstasy 383

Hallucinogens and GHB 384

Opiates and opioids 384

Tobacco 388

10.7 Assessment of substance use 390

Standardised substance screening tools 390

Assessment of alcohol and drug use 391

Referrals 392

10.8 Caring for family members 392

Support and education 392

Parents and children 393

Homelessness 393

10.9 Motivation for behaviour change 393

Cycle of Change 393

Stages of treatment 397

Motivational interviewing 398

Brief interventions 402

10.10 The stress–vulnerability model 403

What can be helpful? 404

What things are unhelpful? 405

Summary 407

Key terms 407

Review questions 408

Discussion and debate 409

Project activity 409

Websites 409

References 410

Acknowledgements 412

Chapter 11 Caring for an older person with a mental illness 413

Introduction 414

11.1 Caring for older people 414

11.2 The impact of ageism 415

Culture and attitudes 416

Discrimination 417

11.3 Assessing the older person 417

A biopsychosocial approach 417

Thinking biopsychosocially 420

Cognitive assessment 421

11.4 Dementia 422

Dementia and ageing 423

Types of dementia 424

Assessment of dementia 425

Ethical and legal considerations 426

Dementia and medication 426

11.5 Depression in older people 427

What constitutes depression? 427

What does depression look like? 428

Assessment of depression 428

Risk factors 431

Suicide 432

11.6 Delirium 433

Assessment of delirium 433

Characteristics of a delirium 434

Types of delirium 434

Responding to a delirium 435

Summary 437

Key terms 437

Review questions 438

Discussion and debate 438

Project activity 439

Websites 439

References 439

Acknowledgements 442

Chapter 12 Mental health service delivery 443

Introduction 444

12.1 Approaches to mental health service delivery in Australia 444

National standards for health services 444

State or territory variations 446

12.2 Primary health care services 446

Mental health promotion and disease prevention 446

Consumer and carer networks 456

Not-for-profit organisations 457

Better Access to Mental Health Care Initiative 459

Disaster services 459

Online mental health services 460

Practice nurses 460

Primary Health Networks 460

12.3 Secondary health care services 461

Child and adolescent mental health services 461

Community mental health teams 462

Consumer and carer consultants 463

Inpatient services 464

Mental health consultation liaison services 465

Perinatal mental health services 469

Older person’s mental health services 469

12.4 Tertiary health care services 471

Forensic mental health services 471

Dual disability services 472

Summary 476

Key terms 476

Review questions 477

Discussion and debate 477

Project activity 478

Websites 478

References 479

Acknowledgements 484

Index 485