Category Archives: Blog

What does a Public Mental Health Service Look Like?

While developing a lecture to prepare nursing students for clinical experience in community mental health, I realised that some others may be interested to know what a public mental health service looks like. In the early 1990s I first gained mental health experience working across two aging purpose-built mental health facilities – Hillcrest Hospital and the beautiful Glenside Hospital (now being used by the South Australian Film Corporation). These facilities had started out as asylums where people were hidden away from the rest of the world behind Ha-Ha Walls and layers of misunderstanding and stigma: “the madhouse”, “the funny farm”, “the loony bin”, “the nuthouse” etc.

That’s not a very accurate (or kind) representation of a what a public mental health service looks like in Australia in 2015.

Parkside Lunatic Asylum then Glenside Hospital now SA Film Corp. Photo via http://www.weekendnotes.com/z-ward-glenside-hospital/

Parkside Lunatic Asylum then Glenside Hospital now SA Film Corp. Photo via http://www.weekendnotes.com/z-ward-glenside-hospital/

Let’s try to get our head around what a public mental health service actually looks like by deconstructing its elements. It’s not about grand old buildings any more; it’s about an array of services, most of which are community-based. I’ll deconstruct a mental health service I know a bit about, but to make it easy for myself I’m leaving out the “and Hinterland” part and some other details of the Cairns and Hinterland Mental Health Service. Hopefully this will give an overview of what components make-up a mental health service in a large regional city.

IMG_4645Red = primary intake points
Yellow = inpatient beds
Green = community (outpatient) teams

Primary Intake Points
ACT = Acute Care Team = assessment, crisis response and short-term intervention
ACT ED = as above, based in the Emergency Department of Cairns Hospital
CLPS = Consultation Liaison Psychiatry Service = mental health assessment, support and education in the general hospital setting (more about that here)

Inpatient Beds
Annex = Mental Health Unit (MHU) Annex (10 beds) = an offsite annex to the mainstream MHU for short-stay sub-acute admissions/transition to home
LDU = Low Dependency Unit of the MHU (approx 26 beds, I think, on site at Cairns Hospital) = average length of admission is about 12 days
SPA = Special Purpose Area of the MHU (4 beds on site at Cairns Hospital) = used for people with specific needs (eg: elderly, teenage, new parent)
PICU = Psychiatric Intensive Care Unit (8 beds on site at Cairns Hospital) = an area of containment for people experiencing severe symptoms and/or behavioural concerns; usually short-stay

Community (Outpatient) Teams
CCT = Continuing Care Teams (3 teams: North, Central & South) = multidisciplinary recovery-focused teams that provide medium to long-term support to people in their homes and/or in community-based clinics
MIRT = Mobile Intensive Rehabilitation Team = a multidisciplinary recovery-focused team that provides medium-term intensive support to people experiencing significant psychiatric distress and/or disability
CYMHS = Child & Youth Mental Health Service = multidisciplinary team that provides assessment, support and treatment of young people (up to age 18) experiencing significant psychiatric symptoms
Evolve = Evolve Therapeutic Services = specialist multidisciplinary team for children/young people on child protection orders in out-of-home care, with severe/complex mental health support needs
OPMHS = Older Persons Mental Health Service = multidisciplinary team catering for older persons experiencing first-presentation psychiatric disorder or psychological and behavioural symptoms associated with a cognitive disorder
ATODS = Alcohol Tobacco & Other Drugs Service = multifaceted multidisciplinary team that provides free, confidential counselling and psychology services to anyone seeking help with alcohol and other drugs
Forensic = Forensic Mental Health = multifaceted multidisciplinary team that provides mental health assessment, support and treatment of people experiencing significant psychiatric symptoms and within, or at risk of being within, the corrective services system

Session 10 Lecture Part 1
Five things I want to emphasise:

  1. People receiving inpatient care make-up about 2% of the total amount of the people receiving mental health support at any given time. Public mental health services are community-based services; most people receiving support via a public mental health service have never been a hospital inpatient because of psychiatric problems and probably never will
  2. Mental health care is not just about a public mental health services: local GPs, psychologists, social workers, occupational therapists, mental health nurses and others are working in a wide variety of private and non-government organisations to support people in their recovery.
  3. It should be obvious by the intro and daggy look of my web page that I’m not representing the Cairns and Hinterland Mental Health Service here, but just to clarify: I’m not! If you’re feeling miffed or misled, please see points 10 and 13 on the meta4RN “About” page (here) or bypass me and go straight to the webpage for the Cairns and Hinterland Hospital and Health Service (here). Sorry for the confusion.
  4. I know that there a bits I’ve left out. I acknowledged that in the intro.
  5. This blog post is just a small excerpt of info that was included in a lecture for student nurses. If you’d like to see the lecture slides, here they are below:

That’s it. Thanks for visiting.

Paul McNamara, 18th January 2015.

 

The Art of Mental Health

art

Sigmund Freud is purported to have said, “Everywhere I go I find that a poet has been there before me.” Not every nursing speciality has this advantage of being informed and sustained by artists. Can those of us interested in supporting mental health consumers and carers look to art to improve our understanding and empathy of the experiences of others? 

I have created a Prezi as a seed for others to use art as an adjunct to our other sources of learning (courses, colleagues, peer-reviewed journals, text books etc). Please see the Prezi by following the link here.

The examples I have collated in the Prezi are listed below, and credit is given to the sources that were used in the Prezi.

Veronica by Elvis Costello is a beautiful song and film clip, that improves our understanding and empathy of nursing the person with dementia. The YouTube video is here: youtu.be/zifeVbK8b-g The lyrics were sourced from this website: www.azlyrics.com/lyrics/elviscostello/veronica.html I’ve written about this previously: meta4RN.com/dementia and have self-plagarised. Again. 

Dog by Andy Bull (with vocal support from Lisa Mitchell) is a fantastic song that captures some of the difficulties of the experience of depression. In the Prezi I used this YouTube link youtu.be/bBOe660BYjI and the lyrics were sourced via www.songlyrics.com/andy-bull/dog-lyrics

Dog is a poignant, wonderful song. Listen to it here:

I had a black dog, his name was depression is written, illustrated and narrated by Matthew Johnstone. It is a very accessible way think about depression and would resonate with a broad age group, I think. Here is the YouTube video used in the Prezi:

To improve understanding and empathy for the family/carers of those who experience schizophrenia I use a song called Neighbourhoods #2 (Laika). This takes a bit of explanation. First though, lets get the credits out of the way. The lyrics were sourced here: www.azlyrics.com/lyrics/arcadefire/neighborhood2laika.html The YouTube video linked in the Prezi is from here: youtu.be/8Wq917ucGaE

Laika - First dog in Space by Belgian artist Paul Gosselin. Source: http://cultured.com/image/4063/Laika_First_dog_in_Space/#fav

“Laika – First Dog in Space” by Belgian artist Paul Gosselin. Source: http://cultured.com/image/4063/Laika_First_dog_in_Space/#fav

Laika by Arcade Fire may not have been written about mental illness at all. However, as with all art, interpretation is an individual experience. I have had a few years experience as a community mental health nurse. In that role I provided direct care and support to the person experiencing mental health problems (nearly all of my clients at the time had schizophrenia) and, when family were still around, support for them too.

Much of the word imagery of Laika fits with that experience. Carers often described their frustration at the lack of insight and empathy that their family member seemed to have. Carers would oscillate between deep concern and desperate frustration about their family member. More than a few times carers expressed a nihilistic outlook – an almost complete lack of hope. The line “Our mother should’ve just named you Laika” expresses that poignantly: Laika was the name of a stray dog in Moscow who became the first living creature to orbit earth. She was never expected to return to earth safely, and died a few hours after launch. Families I have worked with have, at times, expressed that level of despair about their family member.

I also like how Laika’s story has been taken-up by the art community. I love the Arcade Fire song, and my favourite visual representation of Laika – First Dog in Space is the painting above by Belgian artist Paul Gosselin.

The last piece of art I used in the Prezi was The Scream by Edvard Munch. The source of the picture is here: www.ibiblio.org/wm/paint/auth/munch/munch.scream.jpg I’ve read that this picture has been associated with other health problems including  trigeminal neuralgia, psychosis and depersonalisation. To my eye, The Scream looks like acute anxiety and/or a panic attack. It serves as a graphic visual reminder that the first step is to assist the person to contain their distress, to be and feel safe. It shows distress that must feel overwhelming and rallies us to help: let’s think “safety first” kids.

So, that’s it for this little weekend project: if you haven’t visited the Prezi yet please do so now: The Art of Mental Health

What songs, poems, books, music and visual art will inform and sustain your clinical practice?

Paul McNamara, 7th December 2014

art

A Nurse’s Guide to Twitter

Today Ausmed Nursing Education launched the web page “A Nurse’s Guide to Twitter”. I was very pleased when Will Egan from Ausmed asked me submit the content. Now that I’ve seen how great it looks online I’m very very pleased.

The web page looks really cool.

Check it out for yourself via www.ausmed.com.au/twitter-for-nurses or the short URL aus.md/tfn

I’m writing this blog post purely to link to Ausmed page. Yes, that’s right: this web page is about another web page. There’s that meta part of meta4RN again. :-)

While I’m at it, I want to make an acknowledgement. The process of writing for Ausmed was great. Not only did they pay for the article to be written (a first for me), but they asked for my approval to all the edits that were made (another first for me – I’ve never had that courtesy extended by other publications). To top it off, the Ausmed team made my humble text look great! Aesthetics = accessibility. A big thanks to Will Egan specifically, and the Ausmed team generally.

Ausmed_Education-Logo

That’s it. Please go have a look at aus.md/tfn now!

Paul McNamara, 21st November 2014

Short URL: meta4RN.com/ausmed

 

Movies, Myths, Mistakes

The Cairns Post, 14th August 2003:

my say 1 140803As if schizophrenia isn’t enough of a burden to those who have it, they also have to put up with the myths and misunderstandings that accompany it, and the discrimination that follows.

So, let’s try to get some of the facts about schizophrenia right.

Probably the most common myth is that schizophrenia means split personality. Comparisons to Jekyll and Hyde are commonplace, but utterly wrong.

In Latin schizophrenia means split mind. This refers to the split between perceiving the world in the way most of us do and perceiving it in other ways.

To illustrate, someone with schizophrenia may interpret everyday events as having significance beyond their intent.

In health, our jargon terms for these sorts of symptoms are delusional beliefs and/or ideas of reference.

my say 2 140803In the film Angel Baby the main character sought special meaning from a game show. I have met plenty of people with schizophrenia and haven’t heard anything quite like that, but then I don’t have to make a living by entertaining people either.

I think what the movie-makers were doing was jazzing-up and stylising the experience of perceiving the everyday in another way.

Speaking of jazzing-up and stylising, A Beautiful Mind certainly did a good job with making paranoia look exciting (it’s not).

Perhaps because movies are visual, this film gave the impression the main character was experiencing his paranoia as a visual experience.

Some people with schizophrenia do have paranoid beliefs and delusions when they are unwell. Nobody I’ve met has described this visually, although quite a few have spoken about hearing things, usually voices,.

It seems these auditory hallucinations are an intrusive and exaggerated version of what all of us experience when we have those little conversations with ourselves throughout the day.

From what I’ve heard, most people’s idea of what a mental health ward looks and functions like comes straight out of One Flew Over The Cuckoo’s Nest.

Anyone who has been inside our local mental health unit at CBH will be able to tell you that it is a modern, light-filled place where there’s direct access to fresh air from just about every room.

In my opinion, the layout and design is the best of all the wards in the hospital.

Finally there’s the violence myth. Hollywood has created a perception that schizophrenia means danger.

I don’t associate violence with schizophrenia at all. I know that on occasions tragic things have happened, but this is rare.

I’ve met dozens of people with schizophrenia who would not  hurt a fly.

I guess if you’re making movies you’re not interested in a story about an ordinary-looking person doing everyday stuff in a pretty average way, other than taking medications to control uninvited symptoms.

Final Notes

Back in 2003 a journalist from The Cairns Post invited me to submit this article for the My Say column (a daily feature presenting the views of a cross-section of the community). The article’s reference to man’s inhumanity to man is in the context of current events at the time – it was published during the second week of the war in Iraq.

As I was identified as an employee of a local hospital, at the time of publication the content of the article had to be approved by the hospital’s media department. The media department approved the article without changes to content.

In 2003 I used some phrases that I find a bit jarring now. I was tempted to correct it in this 2014 version, but decided it was more authentic to leave the original unaltered.

Anyway, I stumbled across the very-low-resolution JPG version of the article today and thought it might be worth reprising. Stigmatising representations of schizophrenia still pop-up in Hollywood, – this is a tiny, inadequate bit of counter-balance.

As always, your feedback is welcome in the comments section below.

Paul McNamara, 26th October 2014

Short URL:  meta4RN.com/movies

Originally:
McNamara, Paul (2003). Movies, myths, mistakes. The Cairns Post, 14 Aug 2003, pg 13.

Humanity to Man

The Cairns Post, 29th March 2003:

cairns post column 290303Man’s inhumanity towards man has been getting plenty of coverage lately – it might be time a good time to be reminded of men who demonstrate humanity.

Not quite 10 percent of nurses are male (please don’t call us male nurses – we’re nurses, but happen to be male).

Like our female colleagues, we’re spread across all aspects of health. Blokes nursing in Cairns include Stephen in Intensive Care; Adrian and Denis who work with elderly people; Bill the midwife; Andrew in orthopaedics; Colin who runs a medical ward; Sean who visits new parents and their babies in their homes; Greg and Clif who work with people battling mental health problems; Andy does mostly policy and administrative stuff; Steve and Scott on the local crisis team, and Nick who has spent a fair bit of time nursing out bush and is currently back in town.

There’s plenty of blokes nursing locally not mentioned (sorry fellas), but you get the picture – we pop up everywhere.

So, why nursing? I won’t presume to speak for other nurses of either gender, but I can tell you what I like about the profession – I like being useful.

It’s a peculiar privilege being a nurse. Peculiar because, for all its different guises and specialities, the basic job description is the same – try to be useful to people. It’s a privilege because nursing offers an amazing level of responsibility and intimacy.

It might sound more convincing if it wasn’t coming from a bald bloke with a bit of a beer gut, but nursing is a nurturing profession. The nature of our relationships with patients is therapeutic, but first and foremost it’s a human relationship.

We often have the privilege of being with people at very important stages of their lives, and we get the opportunity to show that nurses can be professional, skilled and caring.

I’m sure it’s not unique to nursing, and it’s certainly not unique to nurses who are male, but let’s not forget that there are daily demonstrations of man’s humanity towards man.

Final Notes

Back in 2003 a journalist from The Cairns Post invited me to submit an article for the My Say column (a daily feature presenting the views of a cross-section of the community). The article’s reference to man’s inhumanity to man is in the context of current events at the time – it was published during the second week of the war in Iraq.

As I was identified as an employee of a local hospital, at the time of publication the content of the article had to be approved by the hospital’s media department. The media department approved the article without changes to content.

In 2003 I should have used the phrase “man’s humanity towards mankind” instead of “man’s humanity towards man”. Sorry. I was tempted to correct it in this 2014 version, but decided it was more authentic to leave the original unaltered.

Anyway, I stumbled across the very-low-resolution JPG version of the article today and thought it might be worth reprising. Man’s inhumanity towards mankind is still dominating the mainstream media. This is a tiny, inadequate bit of counter-balance.

As always, your feedback is welcome in the comments section below.

Paul McNamara, 26th October 2014

Short URL:  meta4RN.com/men

Originally:
McNamara, Paul (2003). Humanity to man. The Cairns Post, 29 Mar 2003, pg 19.

 

Defending Mental Health in Nursing Education

NHS

The Guardian (UK ed), 29 Sep 2014

There was an article in The Guardian (UK edition) recently where a nurse described how ill-equipped they felt to support patients experiencing mental health difficulties. The article included the startling information that, “My nursing course, which I think was excellent, contained no more than three days structured education on caring for patients with mental health problems.”

Umm. That wasn’t an excellent nursing course. That’s a crap nursing course.

Look, us Aussies like to tease the Brits about their weather and cricket team every chance we get, but I’m not accustomed to criticising their nursing courses. The truth is, I do not know enough about nursing courses in the UK to hold any strong opinions about how good or bad they are.

That said, I wonder what the general public would think of hospitals being staffed by nurses who had undertaken, as reported, a three year nursing course that includes only three days of teaching in mental health. I am glad that doesn’t happen in Australia.

Dumbing Down is Dumb

Since July 2000 most of my work has been about supporting mental health care in the general health settings as Consultation Liaison CNC (more about that here) and as Perinatal Mental Health CNC (more about that here). These roles have direct clinical input, but also have a lot to do with supporting general nurses and midwives to feel more confident and become more skilled at providing direct clinical care to people experiencing mental health difficulties. It’s inevitable that they’ll need these skills – a significant proportion of people who access general hospitals and/or maternity services also experience symptoms of depression, anxiety etc. Dumbing-down mental health education for general nurses and midwives is dumb.

elistIn August 2012 a Mental Health First Aid (MHFA) instructor proposed using MHFA as inservice education for hospital-based nurses. I mounted my high horse to defend the depth and quality of nursing education sprouting the opinion that MHFA is not suitable training for RNs. My rant went along the lines of it’s great training for many community and professional groups, but it’s inadequate for those working in health role. Undergraduate nursing programs have more than the 12 contact hours that MHFA offers, and we should re-awaken/build-on that education. Nurses in particular need to know a bit about:

  • symptom detection
  • meanings/implications of diagnostic groups
  • medication effects and side-effects
  • the biopsychosocial model of mental health
  • social determinants of health
  • risk assessment/management
  • emotional intelligence and therapeutic use of self

confpresTo give MHFA their due, they have never claimed their training to be an alternative to formal nursing education (others have). MHFA does a good job at informing first responders, but does not address mental health in a manner suitable for a frontline clinician. There is a community expectation that nurses and midwives will have a depth of understanding of mental health beyond that of the general community, beyond basic fist aid.

This conversation started off as a discussion in the workplace, then became a topic of discussion on the Australian College of Mental Health Nurses e-lists, then morphed into a conference presentation and, more recently, was articulated as this journal article:

Happell, B., Wilson, R> & McNamara, P. (2014) Undergraduate mental health nursing education in Australia: More than Mental Health First Aid. Collegian (2014), http://dx.doi.org/10.1016/j.colegn.2014.07.003

Happell, B., Wilson, R. and McNamara, P. (2014) Undergraduate mental health nursing education in Australia: More than Mental Health First Aid. Collegian (2014), http://dx.doi.org/10.1016/j.colegn.2014.07.003

Anyway, I guess there are two points to this blog post:

One: Quality Control
Let’s make sure that we continue to defend the quality and depth of undergraduate nursing and midwifery training in Australia. We must never let it slip like the UK example of just three days training in three years. That is woefully inadequate.

Two: Speak Up 
If you’re a nurse or midwife with strong opinions about a subject, it doesn’t hurt to discuss these opinions online. As per this example, a discussion held online morphed into a conference presentation and a journal article. For me, anyway, the difference between it being a rant and a paper was the interest and input from a couple of Nursing Academics: Brenda Happell (@IHSSRDir on Twitter) and Rhonda Wilson (@RhondaWilsonMHN on Twitter).

References

Happell, B., Wilson, R. L. & McNamara, P. (2013). Beyond bandaids: Defending the depth and detail of mental health in nursing education. Paper presented at the Australian College of Mental Health Nurses 39th International Mental Health Nursing Conference Perth, Western Australia, Australia. Abstract in International Journal of Mental Health Nursing, Vol 22, Issue Supplement S1, pp 11-12 http://onlinelibrary.wiley.com/doi/10.1111/inm.2013.22.issue-s1/issuetoc

Happell, B., Wilson, R. L. & McNamara, P. (2014) Undergraduate mental health nursing education in Australia: More than Mental Health First Aid. Collegian (In Press) http://dx.doi.org/10.1016/j.colegn.2014.07.003

End

Thanks for reading this far. As always, your feedback is welcome in the comments section below.

Paul McNamara, 21st October 2014

Short URL: meta4RN.com/defend

Free Open Access Mental Health Education for General Nurses and Midwives #FOANed

If you’re a nurse or midwife, and own an internet-enabled device you have unprecedented access to information.

Information + motivation = education.

Borrowing from the very successful #FOAMed initiative, recently there has been a flurry of activity regarding Free Open Access Nursing Education (aka #FOANed).  That is:

Free
Open
Access
Nurse
education

The #FOANed hashtag makes it’s easy to share info and resources via social media. If you’re cruising Twitter, Facebook, Google+ or even Instagram, have a look for the #FOANed hashtag.

Still not sure what the #FOANed hashtag is all about? Perhaps it’s just easier to see for yourself via this Storify (click here).

Mental Health #FOANed

Anyway, in the spirit of #FOANed, here are four suggestions for free open access nursing education re mental health for general nurses and midwives (click on each picture for more info):

1. Physical and Mental Health Care via Australian College of Mental Health Nurses:

2. Mental Health Liaison in General Hospitals via New South Wales Health:

inkysmudge.com.au/eSimulation/mhl.html

inkysmudge.com.au/eSimulation/mhl.html

3. Perinatal Mental Health Training for Midwives via Monash University:

perinatal.med.monash.edu.au

perinatal.med.monash.edu.au

4. MIND Essentials via Queensland Health:

Obviously, this is not an exhaustive list of the mental health #FOANed available online, but hopefully it’s enough to get you started if you’re looking for some CPD/info.

Please feel free to add your suggestions for other free open access nursing education re mental health in the comments section below.

Paul McNamara, 20th October 2014

Short URL: meta4RN.com/FOANed