Student name: Susann Treston, Jennifer Zoet & Kerry Clancey - - PDF document

Student name: Susann Treston, Jennifer Zoet & Kerry Clancey Student number: S0158048 S0134362 & S0197295 Course code: SOWK12009 Assignment: Assessment 2 Topic: In-service Presentation Mental Health Act 2000 Involuntary Patients Word count: 1578 Lecturer: Darren de Warren Due date: 7 May, 2010

SOWK12009 Page 1 of 8 How social work scholars and Practitioners have analysed and approached the engagement, contracting and assessment of involuntary clients.

• Psychiatric hospital admission almost always a crisis.
• Engagement a challenging process
• Also opportunity to work with client in the moment with what matters to client.
• Comprehensive assessment requires attention to specifics of involuntary situation

(Moore 2009)

• Flowchart: Involuntary treatment and Assessment under the Mental Health Act 2000

(Qld) (Queensland Public Interest Clearing House 2009). Evidence based practice model:  ‘Practice based on scientific knowledge about what works’ ( Chaffin, Friedrich 2004, cited in Trotter 2006, p. 9).  Process involves practice question; search for best evidence, critical evidence appraisal and action based upon client preferences, practice experience and best evidence’ (Schlansky & Gibbs, 2004, cited in Trotter 2006. p. 9).  Research findings are a primary source of information for practice. (Trotter 2006) Relationship between the case manager and client Engagement  Engagement is an ongoing, evolving process, not just the first phase of contact.  Start where the client is, paying close attention to the clients own understanding perceptions, who the client is as a person and what their needs are (Moore 2009).  In direct practice client engagement is comprised of 2 activities; establishing a collaborative relationship base on trust and rapport and establishing the client in the role

• f the client (Ivanoff et al, 1994 p. 20)

 Relationship facilitation with involuntary clients will not follow the same voluntary engagement process as client perceptions about treatment and the practitioner are initially negatively weighed.  Enhancers of voluntary relationships can be a negative; empathy and genuineness may be overwhelming in early stages of treatment for clients suffering from major mental disorders and anti social personality disorder (Strasberger 1986, cited Ivanoff et al 1994). To hostile, non compliant resistant clients: displays of closeness and warmth by practitioner may be aversive (De Voge and Beck 1978, cited Ivanoff et al 1994)

SOWK12009 Page 2 of 8 Approaches that work  Easily understood, honest and frequent discussions concerning the role of the client and the role of the worker, the dual role of the worker, the aims and purpose of the intervention and issues of confidentiality. When mental health clients are assisted in their understanding of each person’s respective roles, outcomes are improved (Trotter 2006).  Pro social actions and values are those which are supportive, tolerant and caring of

• thers (non sexist, non racial comments etc.), and employing the concept has been

related to improved outcomes. Worker models pro social values in their own behaviours and purposefully uses praise and other rewards to encourage the client when they are seen to be acting pro socially (Trotter 2006).  Collaborative problem solving: identifying and working with the client’s definition of problems, developing client strategies for modest goal achievement. In the case of some mental health patients, working with the client’s definition of the problem may be unsuitable: cognitive behavioural interventions often have strategies to address distorted and unproductive thinking assisting client to redefine goals (Trotter 2006).  Dual optimism (believing client can change and the client believes worker helpful) good listening skills, openness and selective use of humour. Reflective listening; inappropriate paraphrasing of clients comments can cause responses of client anger, anxiety, depression: better to offer alternative interpretations rather than merely reflect content (Nugent & Halvarson 1995, cited Trotter 2006). Contracting  Involuntary clients difficult to negotiate a contract with: either they don’t see there is a problem or don’t see that the practitioner can help.  The terms of legal arrangement must be distinguished from the terms of the worker/client contract.  By emphasising client choice and fostering client control, some feeling of personal autonomy over the change process may mitigate involuntariness (Rooney 2009).  Through an informed consent strategy, involuntary clients may choose not to comply with the legal and non negotiable requirements of their treatment and accept the repercussions of their choices. (Rooney 2009)

SOWK12009 Page 3 of 8 Assessment  Initial assessment usually in context of pressured contact; client behaviour in these conditions is indicative of behaviour under pressure. (Rooney 2009, p.135).  Negative response predictable in situations involving a threat to valued freedoms.. Avoid premature labelling, these are normal responses; can be reduced by expressing empathy.  Employ selective confrontation around non negotiable items. Indigenous Involuntary Patients and issues to be aware of prior to contact  Many studies have shown very little information is available in relation to mental health and Aboriginal and Torres Strait Island culture, and little support is available to workers. Advocacy and research is currently being conducted to help provide a model for mental health care workers to ensure a more appropriate, culturally sound plan is used in treatment for these minority groups.  Mental health workers should keep in mind Indigenous mental health has been affected by past experiences caused by colonialisation and ‘unfinished business’ which has impacted many aspects of indigenous lives (Baily n.d.).  An Involuntary Treatment Order (ITO) does not necessarily mean a client is deemed to be an inpatient. However, if an ITO is made, it is legally enforceable and attendances to appointments are required regardless of whether the client is an inpatient or outpatient and little regard is shown for client’s cultural backgrounds.  When an indigenous mental health client is advised of a tribunal hearing, issues can and do arise as many indigenous clients identify the tribunal with court systems, intimidation and authoritarianism. Geography also hinders clients contact as many indigenous people live in rural areas. Furthermore, a lack of Indigenous Mental Health Workers (IMHW) or support persons to assist in getting the client to hearings creates further problems (Fisher et.al (2009). Gaining cultural knowledge  Understanding of kinship relations is paramount in evaluating psychotic crisis as psychological organisation process must be understood in terms of culture due to ‘dreaming’. Dreaming is seen as an alternate reality, culturally determined and can confirm beliefs or have an individual or group meaning which maintains group cohesion (Petchcovsky et.al 2003, p.16,17).

SOWK12009 Page 4 of 8  Valuing indigenous community and family when treating individuals rather than focusing

• n the individual is imperative. Further knowledge of links to the land, spirituality and

myth are also vital in developing compassionate thoughtfulness in treating a client in self determination and recognising when it is appropriate to be available to consult and when it is appropriate to step aside (Petchcovsky et.al 2003, p.233) How to communicate with Indigenous and Torres Strait Islander clients  Have a ‘yarn’ with the client to begin with. Use clear, simple language and awareness of body language and eye contact is also important. Be aware that indoors may be confining and an outdoor arrangement may be more comfortable for the individual. Keep in mind the individual should feel comfortable, respected and cared for when communicating with indigenous people, rather than following rules and doing all the ‘right’ things (Mental Health First Aid, 2008).  Be aware of issues such as shame with the client or community, furthermore do not to undermine Aboriginal healing, as this may hinder communication and cause alienation. Instead, talk in terms of feelings and behaviours as labelling illnesses may bring a shame (Mental Health First Aid, 2008).  Cultural sensitivity is imperative when dealing with mental health and Indigenous people. For example, when indigenous persons suffer the loss of a family member, it is tradition to cut one’s self. If a client of aboriginal decent presents in this circumstance, it is important to clarify the circumstances relating to the injuries. If this cultural difference is not identified, the client may be seen as self harming and treated accordingly. Further misconceptions can be made if a worker is culturally unaware. Prevalent issues with CALD populations Overview of Culturally and Linguistically Diverse (CALD) clients within Gold Coast community mental health services  In a 2007/08 analysis of inpatient databases, Gold Coast mental health statistics identified 93 CALD consumers, including 26 consumers who did not state their country of

• birth. (

 CALD consumers were largely born in Asian (N=30) and European countries (Western Europe N=24, Eastern Europe N=23). (Gold Coast Mental Health Rehabilitation Services 2010).

SOWK12009 Page 5 of 8 Culturally Sensitive Clinical Practice  Awareness of your own attitudes and how attitudes may affect service delivery.  It is critical, therefore, for practitioners to attend to (a) their attitudes and feelings about clients (b) their clients’ attitudes and feelings toward them, and (c) the degree of synergy that results when these are expressed within the clinical setting (Ridley et al., 1998 quoted MCMH 2002, p. 19).  Obstacle: medical ethnocentrism: biomedical beliefs dominate to the exclusion of others manifested in responses of laughter, surprise, incomprehension, anger and shock and resulting in a client perception of threat or reluctance to disclose information. An adoption

• f practitioner cultural relativism promoting mutual understanding and negotiation

requires and understanding of the client within the clients culture rather than the clinicians culture (MCMH 2002).



Awareness of specific cultural issues that are being experienced by your clients  Culture influences the way individuals label illness, identify normality, symptoms, seek help, define expectations for therapists and clients, create personal identity and states of

• consciousness. (Ridley et al., 1998, MMHA 2002)

 There are often common characteristics resulting from cultural differences, which may impact upon the clinical interaction and treatment. The individual must be treated within the context of their cultural influences; some common issues are:  Western individualistic medicine versus holistic cultural knowledge systems.  Importance of family inclusion in consultations  Value differences: pride, self reliance, and emotion control versus submission, conformity or emotional displays.  Gender issues, role changes and status  Refugee stress from intolerable suffering, reticence to open discussion, shame, loss and grief, fear of authority figures.  Competing desires of western culture versus traditional.  Stigma of mental illness, differing terminology of symptoms and attitudes to medical treatment, suspicion of talk based therapy.(MMHA 2002, Payne 2005)

SOWK12009 Page 6 of 8 Culturally competent health practitioners:  Understand the concept of culture in interactions.  Willingness to explore other perspectives.  Identify culturally appropriate work strategies. (Fitzgerald et al., 1996, MMHA 2002). Specific Areas of Cultural Competence: Acceptance of Diversity  Open to cultural differences  Respecting diverse practices and requests. Equity and Access  Recognising CALD clients require equality of care.  Accommodating clients’ care choices.  Awareness of the sources of extra social support, community organisations and resources available to CALD clients to overcome barriers facilitate access. Communication  Non reactance to accent.  Simple language use, avoiding terminology, jargon, colloquialisms, slang and metaphors.  Interpreter used when English proficiency is inadequate and aware of liability for non use when one is necessary.  Encouraging the interpreter to refrain from inserting his interpretations, or omitting information.  Checking understanding and accuracy of the translation.  Looking and speaking in the first person directly to the client.  Noticing nonverbal communication indicating associated emotion. (MMHA 2002) . .

SOWK12009 Page 7 of 8 References Bailey, J n.d., You’re not listening to me!! Aboriginal mental health is different – Don’t you understand??, James Cook University, Townsville, viewed May 7, 2010, http://www.abc.net.au/rural/events/ruralhealth/2005/papers/8nrhcfinalpaper00495.pdf Gold Coast Mental Health Rehabilitation Services 2010, CALD Statistics, Author, Queensland

Health and Multicultural Coordinator, Southport.

Ivanoff, A, Blyth, B & Tripodi,T 1994, Involuntary clients in social work practice: a research based approach, Aldine de Gruyter, New York. Mental Health First Aid, 2008, Cultural considerations & communication techniques: guidelines for providing mental health first aid to an Aboriginal or Torres Strait islander person, viewed May 7, 2010, http://www.mhfa.com.au/documents/guidelines/8307_AMHFA_Cultural_guidelinesemail.pdf Moore, E 2009, Case management for community practice, Oxford University Press, South Melbourne. Multicultural Mental Health Australia 2002, Cultural assessment tool, viewed 22 April 2010 http://www.mmha.org.au/mmha-products/books-and-resources/cultural-awareness-tool-cat Payne, M 2005, Modern Social Work Theory, Lyceum Books, Chicago. Petchcovsky, L & San Roque, C & Beskow, M 2003, ‘Jung and the dreaming: analytical psychology’s encounters with Aboriginal culture’, Transcultural Psychiatry, vol.40, no.2. pp. 208-238. Queensland Public Interest Clearing House 2009, Factsheet Involuntary Assessment, viewed 22 April, 2010, http://www.qpilch.org.au/resources/factsheets/Involuntary_Assessment.htm Rooney, R.H. 2009 Strategies for working with involuntary clients , Columbia University Press, New York. Trotter, C 2006. Working with involuntary clients: a guide to practice, Allen & Unwin, Crows Nest. .