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Information on Getting an Assessment from Mental Health:

Assessment - What Happens?

(Please note that procedures can vary from State to State)

If someone you know is showing signs of depression or psychosis or you think they may be suicidal, you can arrange for an assessment by the Government Mental Health service. There are two ways of doing this:

Non-Urgent Referral:

If the patient is not in any immediate danger or does not present an immediate danger to others and you are unsure what the problem is, your GP can provide you with a referral and you can contact Mental Health to arrange an appointment.

A carer, family member or individual may also make a referral. The consent of the person being referred or their family/guardian (in cases where the person is unable to give consent) is preferred before a referral is accepted.

Assessments can be conducted at home or some other suitable venue. During the assessment it is usual to be interviewed by a two Mental Health Professionals. This could include a doctor, psychologist, a therapist or psychiatric nurse. They will discuss the patients symptoms and obtain a history of the patients behaviour.

If it is deemed that the patient requires case management it is likely a further appointment will be made to see a Mental Health Psychiatrist who will make recommendations regarding ongoing treatment. An individual service plan will also be developed in consultation with the patient and their family/carer.

Urgent/Crisis Referral:

If the patient is violent, psychotic or suicidal then it is obviously not sensible to wait for a future appointment. Getting the patient into a hospital emergency ward via ambulance is the quickest and safest strategy for all concerned. The police will also attend if violence or aggression is an issue, this is for the protection of all concerned and nothing to be worried about, the police are well trained for these situations and will conduct themselves in a sympathetic, understanding and non-threatening manner.

The Hospital will arrange for an assessment team from Mental Health to see the patient. There may be some wait depending on the time of day the patient is admitted.

Mental Health staff will talk with the patient to ascertain their level of disability and whether they can be treated as an out-patient. The assessment team will (after consultation with the patient and family) recommend the best option for the safety of the patient. If the person is psychotic or suicidal and a danger to themselves or others they will admit the patient to a psychiatric hospital for treatment until they are stabilised.

Why You Should Seek Assessment/Treatment for Someone in Crisis:

While it can be extremely difficult to make the first call, when you consider the consequences of leaving a person untreated it is important for you to take courage and do what is necessary for the well being of the sufferer and those who live with them.

Delaying treatment of psychiatric illness is directly linked to longer recovery times. In the case of someone suffering psychotic episodes every episode suffered causes accumulated damage. At best this will prolong recovery time, at worst it can reduce the likelihood of the patient making a complete recovery. Your action in seeking help will always be in the best interests of the sufferer.

Sometimes the patient will not recognise that there is anything wrong with them. They may become abusive and angry with their family or the person who arranged the admission. This is nothing unusual and once they receive the required treatment, are in control of themselves and can recognise their behaviour was out of control they will understand why you had to have them assessed.

Admission:

Visiting a Psychiatric ward for the first time can be a very confronting experience. Other patients suffering a variety of illnesses and displaying unusual behaviours can be difficult to cope with for both the patient and their family.

Often the patient will use emotional blackmail against loved ones in an attempt to coerse them into 'getting them out'. This can be extremely distressing and hurtful for family members because there is little that the sufferer will not say in order to get what they want.

As difficult as it is and unless you observe some factual reason why the patient should be removed from the hospital, it is best to try to ignore their demands. If you succumb to unfounded demands there is a 100% chance you will regret having done so and you will also face the very unpleasant task of having to admit them a second time which can be very difficult.

These days there is little danger of a patient being kept in too long, it is more likely they will be sent home too soon!

Take heart and remember that if the patient was thinking sensibly they would understand the reason they should remain in the hospital. You will notice as the treatment takes effect that the patient will stop this behaviour. They will slowly come to a realisation that the hospital is where they need to be.

The Benefits of In-Patient Treatment:

Psychiatric Hospitals by nature are not very pleasant places, but they are very necessary. If you have experienced the stress of coping with someone who is suicidal or not responsible for their actions the hospital is a safer alternative for the sufferer than trying to 'go it alone'.

The in-patient situation also gives medical staff access to the patient at all hours of the day so they can gain a first hand understanding of the cycles involved in the patient's illness, the pattern of symptoms, their reaction to medication and their general behaviour.

Other benefits include helping the patient to form good habits with regard to sleep patterns, diet and regular meals, medication compliance and personal hygiene.

Psychiatric wards are very structured in their approach to patient freedoms (of course they have to be). It follows that patients can feel restricted in what they are allowed to do compared with the freedoms at home.

At times, a reminder of consideration for others in their environment is relevant and the inability to follow every whim is necessary.

A very positive benefit of this structured environment is that it limits the amount of thinking a patient has to do to look after themselves, further it reduces the stress and worry of every day functioning, this aids recovery.

It is important to remember that adherance to learned healthy behaviours and routines should be maintained when the patient comes home.

Aid Recovery - Be Actively Involved:

Ask questions and take an active role in the treatment of the patient. Some hospital staff may discourage this or not be forthcoming with information.

It is essential that you are not discouraged from asking questions.

You have the right and must insist on being fully informed about diagnosis and proposed treatments at all times.

Your family and/or carer (with your consent) has the same right to receive information about your care and treatment and to be involved in the process and discussions with your mental health provider.

Good psychiatric care will always actively involve those closest to the sufferer. The best outcomes are always achieved in close consultation with supportive family.

It should be expected that observation of a patient for extensive periods would result in better treatment outcomes and certainly a better understanding of the patients particular illness.

It is simply not acceptable in a hospital environment (which provides the opportunity to make a detailed analysis) that staff be reticent in advising the results of their observations.

When you consider that a GP has about 15 minutes in which to assess someone's mental state, it is obvious that an in-patient situation has the potential to (and should) deliver far more.

Feeling Shut Out?

Many of you will have experienced practitioners with exclusionary attitudes towards consulting anyone other than the patient.

There are people in the system who have an aversion scrutiny. Stand your ground. Speak up. Demand answers. Never settle for a second-rate, lazy or incompetent attitude in patient care.

If you are still not satisfied then report these individuals (in writing) and hopefully we will have them and their type eventually removed from the system.

Practitioners who are competent and confident in their abilities never have any difficulty keeping the patient and their family fully informed. They know that sharing of information provides a more complete understanding of the patients condition which ultimately leads to better results.

Power of Attorney:

Unless the patient specifically does not want family involved in their treatment based on a rational decision, discuss the possibility of the granting of a 'power of attorney' so you can look after their interests when they are not able to do so themselves.

Not only will this save a lot of angst if things don't go the way they should, it makes treating professionals answerable to persons other than the patient.

Medications dull a persons thinking abililty and make them overly 'compliant' to suggestion. While the patient may seem 'calmer' and more easy going the downside to this is that they can lack the ability to question or analyse what is being proposed.

This is a very unsatisfactory situation wherever a patients long term wellbeing is concerned. In particular, when so called 'last resort' treatments such are ECT are being proposed without adequate further second or third tier investigation of the patients condition, someone needs the power to intervene on the patients behalf.

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Coming Home:

When the time comes to leave the hospital this can present new challenges for the patient. While being very happy to be 'getting out', in the rush to get home there is often not a great deal of thought about how they will manage once they are home.

The hospital should be able to assist in this regard prior to the patients release. One would expect that a psychiatric hospital would cover this as a matter of course however often the patient or family will have to request assistance in this regard.

If the patient is case managed arrangements should be put in place prior to discharge with regard to frequency of visits and when the first visit will take place.

If the patient was admitted due to suicidal thinking or attempt it is very important that they receive adequate support on their return home. There have been far too many cases of patients attempting or completing suicide within the first week or two of coming home, most of these because of lack of follow up support.

It is best not to rely on mental health services to support you. Some areas offer better service than others but as a general rule they are under funded or for whatever reason lack the ability to offer the high level of support required.

Most hospitals can provide you with a list of support services but you would be well advised to check on waiting lists and get references from those who have used these services well prior to having to rely on them. While things may look promising on paper and it may appear there is a plethora of help out there, in reality many services are over booked, not available, or have guidelines which restrict the type of support they can give and the manner in which they facilitate it.

Make your own plans for adequate supervision and support of the patient well in advance, that way you know they are properly supported and any other support you receive is a bonus.

Having a good support base is crucial to continuing recovery. A list of people that the person can contact in case of crisis and regular visits and some activities to occupy the time at home are essential.

Having formed good habits while in the hospital these can quickly disappear once returning to the home environment, especially if this environment is a centre for stress and other life problems.

Coming from a structured environment where everything is taken care of and run to a schedule, to a completely unstructured environment where the person may have to take care of all their basic needs can be daunting and at times overwhelming.

Coming Home Handy Hints List:

Listed below are some things you or your family should consider to ease the transition and continue on the path to recovery:

These are just a few measures that can be put in place to ease the transition from hospital to home.

There are other ideas in our 'Hot Tips' page put forward by people who have found what works for them.

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Quick Link on This Page Handy Hints for when you come home

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