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.

 

One thought on “What does a Public Mental Health Service Look Like?

  1. Debi Klages

    Hi Paul, I think that an improved focus on strengths and recovery is the way our mental health care system is desperately needed. As health care providers we could be providing care in a different manner. At the moment we ( in Queensland) have a structured way of providing care care review summary plans ( you know the ones) , in addition to all of the other required suite of bits of paper that we need to complete (MHA related stuff).
    We all have been trained to function within these parameters. What has not happened is we have not been trained/mentored/educated/supported in a model of recovery based care despite the fact that the health care system within which we both function has bits of paper (recovery plans etc). Curious n’est pas?
    There has been an increase in the hearing voices movement as well as the open dialogue initiative which both focus less on the medical model ( meaning psychopharmacology).
    It is my belief that we ( the big we) could take advantage and learn from other states ( countries ) and implement the Strengths Model of Case Management ( Rapp and Goscha) and the Wellness Recovery Action Plan ( Copeland) into our core practice. I know we have the bits of paper floating around but to me its like have a cheat sheet for MSE without the education bit.
    I admit that I am a bit biased having been part of the implementation/mentoring/teaching team for both of the above components when I worked in Victoria and I have attached a little document below with some of the outcomes.
    http://docs.health.vic.gov.au/docs/doc/FB0BB89C4DF9567ECA257A70000D0CAF/$FILE/hyperlink%2013%20-%20st%20v%27s.pdf

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