Slides of my 2015 lecture

1. Nursing the person with a mental
health problem in the community
Paul McNamara
RGN (RAH), RPN (SAMHS), BN (Flin.), MMHN (USQ), Cert IMH (WCHN), CMHN, FACMHN
@meta4RN
#NS3360

2. Acknowledgements
Tanya Park @Tanya_M_Park
Elizabeth Emmanual via @SCUonline
+ Nurses 1988-2015

3. Learning Outcomes
 Role of the community mental health nurse
 Therapeutic relationships
 Community mental health services
 Mental health legislation in the community
 Self care

4. Today’s Presentation
 Context of Community Mental Health Care
 Therapeutic Relationships vs Involuntary
Treatment
 Roles of the Community Mental Health Nurse
 Models of Community Mental Health Care

5. Today’s Presentation
 Context of Community Mental Health Care
 Therapeutic Relationships vs Involuntary
Treatment
 Roles of the Community Mental Health Nurse
 Models of Community Mental Health Care

6. 17th-19th centuries
Lunatic Asylums
1950s
Chlorpromazine
1960s-1990s
Deinstitutionalisation
Mainstreaming
Human rights

7. Deinstitutionalisation

8. Principles:
1. Consumer and carer
participation
2. Resilience and recovery
3. Social inclusion
4. Collaboration and
partnerships
5. Promotion, prevention
and early intervention
6. Evidence - based

9. Community
Mental Health
GP, NGOs etc
Carers
Person
Inpatient
Mental Health

12. Cairns
Mental
Health
ACT
ACT ED
CLPS
Annex
LDU
SPA
PICU
CCT x3
MIRT
CYMHS
Evolve
OPMHS
ATODS
Forensic

13. Inpatient Community
~50
~2450
Cairns & Hinterland Mental Health
Consumers

14. Today’s Presentation
 Context of Community Mental Health Care
 Therapeutic Relationships vs Involuntary
Treatment
 Roles of the Community Mental Health Nurse
 Models of Community Mental Health Care

15. “someone who has the lived experience of
mental distress and who has received care from
mental health professionals”
Elder, Evans & Nizette (2013) page 524
A patient client consumer is…

16. “…a balance between the personal self, offering human
closeness and professional distance”
“…an enabling relationship that supports the needs of
the client”
“…based on rapport - establishing a connection with the
person and developing trust”
Usher & Foster (2013) page 454
A therapeutic relationship is…

18. “any power or function exercised under the Act
must be exercised so that a person’s liberty and
rights are affected only if there is no less
restrictive way to protect the person’s health
and safety or to protect others”

19. Today’s Presentation
 Context of Community Mental Health Care
 Therapeutic Relationships vs Involuntary
Treatment
 Roles of the Community Mental Health Nurse
 Models of Community Mental Health Care

20. Midwives General Nurses
Mental Health Nurses

21. Multidisciplinary
Team
Mental
Health Nurse
Social
Worker
Occupational
Therapist
Psychiatrist
Psychiatric
Registrar
Psychologist

22. Case Management
“is a delivery of care that coordinates and links
various health care and social services to clients
and their families who have complex health
needs that involve ongoing care”
Funnell, Koutoukidis & Lawrence (2005)

23. Case Management
“is about participation in the consumer’s
environment”
“believing unconditionally in the person’s
ability to recover and work as if their recovery
is a reality “
Glover (2005)

24. Community MHN Roles
Assessment
e.g. mental state assessment, risk assessment
Planning
e.g. goal setting
Linking
e.g. joining in with social/sporting or… activities
Monitoring & Advocacy
e.g. ongoing assessment,
Evaluation
e.g. checking on goals and plans

25. establish, build and maintain a therapeutic
relationship with consumer
“phatic chat” & mental state assessment
administration of medication – efficacy + side
effects
counselling
therapy
Community MHN Roles

26. linking consumer with services & social
activities
advocating for consumer
assisting with life style choices
education
linking with families/carers
Community MHN Roles

27. Today’s Presentation
 Context of Community Mental Health Care
 Therapeutic Relationships vs Involuntary
Treatment
 Roles of the Community Mental Health Nurse
 Models of Community Mental Health Care

28. Recovery Model
Self empowerment
Sense of being in control
Maintaining hope
Abandoning the ‘victim’ role
(Muntez & Frese III,2001)

29. www.secretsquirrelbusiness.com.au

30. Creating relationships of safety
Encouraging the person to have a sense of control
Engaging with curiosity
Attending to self-esteem and self-identity
Attending to language and meaning
Tapping into the person’s own capacity for self-knowing
Facilitating self-help and personal responsibility
External environments that facilitate recovery
Essentials of recovery-
informed practice
Elder, Evans, & Nizette (2013) pp 21-25

31. Strengths Model
Consumer strengths
Consumer abilities and resources
Consumer and community potentials
(Fossey, cited in Dowling et al,2001)

32. Psychosocial Rehabilitation
The goal is
“to facilitate and support people with mental
illness to live, learn, work, play and relate to
others within their local community”
(Farhall etal,2001)

33. Comparison of Approaches to Care
Aspect of Care Psychosocial Rehabilitation Medical Model
Focus wellness, health disease, disorder,
illness
Basis abilities disabilities
Setting nature, familiar institutions
Relationship adult-adult expert-patient
Decision making partnership expert prescribes
treatment
(Table adapted from Sundeen 2001)

36. Today’s Presentation
 Context of Community Mental Health Care
 Therapeutic Relationships vs Involuntary
Treatment
 Roles of the Community Mental Health Nurse
 Models of Community Mental Health Care