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.
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.
Red = 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)
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
Five things I want to emphasise:
- 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
- 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.
- 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.
- I know that there a bits I’ve left out. I acknowledged that in the intro.
- 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.