Student Guide CHCMHS003-CHC53315-MH SPECIALISATION
Student Guide CHCMHS003-CHC53315-MH SPECIALISATION
Student Guide CHCMHS003-CHC53315-MH SPECIALISATION
MENTAL HEALTH
CHCMHS003 PROVIDE RECOVERY-
ORIENTED MENTAL HEALTH SERVICES
Student Guide
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UNIT INFORMATION
Qualifications and units of competency
ALG offers programs that are national qualifications from the vocational education and training (VET) sector in
Australia.
Each qualification contains the required number of core and elective units of competency that need to be
achieved.
The unit of competency define the skills and knowledge to operate effectively and how they need to be applied to
perform effectively in a workplace context.
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LEARNING PROGRAM
1. SHARE AND COLLECT INFORMATION TO COLLABORATIVELY
INFORM THE PLAN FOR RECOVERY
Learning outcomes
Upon completion of this topic, you will have learned to:
§ Work in a recovery-oriented framework that respects the person’s experience, culture and unique
recovery journey and the agreed recovery alliance relationship
§ Use a collaborative approach to discuss and determine information to be collected and sources of
information to be accessed
§ Explain any organisation or program requirements including the commitment to access and equity,
and limits to confidentiality
§ Obtain consent from the person according to organisation policy and procedure
§ Gather and document information from the person and other agreed sources to explore and clarify
the person’s preferences, meanings and needs
§ Apply best practice principles, if formal assessment is to be conducted, and work within
organisation policy and procedures relating to assessment protocols
§ Together identify the range and potential effects of social and other barriers that are impacting on
the person
This unit will provide you with all the knowledge required to perform the role of a mental health worker that
provides recovery-oriented health services. Throughout this unit the following legislation should remain prominent
in your mind.
WHAT IS RECOVERY?
§ Recovery is personal, individual and unique
§ People can and do recover from mental illness
§ ‘Recovery’ and ‘cure’ do not mean the same thing. People can and do live well with the presence of symptoms
of mental illness
§ Recovery is supported by collaborative partnerships in which key partners develop facilitative relationships to
meet the individual consumer’s needs
§ Health workers must embrace the potential for recovery in their approach to practice
§ There is no time frame set for an individual’s recovery journey. Everyone’s recovery journey is unique
§ Recovery is not an intervention and professionals cannot ‘do’ recovery ‘to’ people
Recovery is a uniquely personal process and is directed and owned by the individual. A recovery orientation is the
philosophical framework within which services should embed their models and tools, including rehabilitation tools
in mental health service delivery, in partnership with consumers to facilitate positive consumer outcomes.
Given that recovery is a deeply personal experience, it is not possible to provide a simplistic definition. ‘Recovery’
is a concept that is values-based and focuses on the inherent value and capacity of each individual to engage in a
personalised journey of growth in living a meaningful life. The term ‘recovery’, as informed by people who have a
lived experience, infers a process whereby a person constantly utilises their ability to influence the things that
stand in the way of living a good life.
Research has identified that consumers commonly identify the following to be key themes for their recovery:
§ Finding hope
§ Feeling safe, secure and valued
§ Re-defining identity
§ Developing, strengthening and renewing relationships
§ Finding meaning in life
§ Having choices
Recovery is not the same thing as being cured. Recovery is a process not an end point or a destination. Recovery
is an attitude, a way of approaching the day and facing the challenges. Being in recovery means recognising
limitations in order to see the limitless possibilities. Recovery means being in control. Recovery is the urge, the
wrestle, and the resurrection.
This approach to recovery emphasises that everyone who experiences mental illness, including those seriously
affected by mental illness, can achieve an improved level of wellbeing and a renewed sense of identity, purpose
and meaning in life in the presence or absence of symptoms of illness.
The ideas expressed by Dan Fisher’s Empowerment Model reflect the broader concept of the Recovery Model -
that recovery from mental illness is possible.
The values of the Recovery Model are empowerment, hope, self-determination, meaningful role and cultural
competence.
Communication difficulties
When communicating with individuals with mental illness, there are certain difficulties which may present
themselves depending upon the nature of their illness. These might include:
§ Extraneous noise levels
§ Multilingual staff
§ Medication levels
When faced with these types of difficulties it is important to apply the appropriate strategies to overcome them.
These strategies might be relatively simple in their application. For example:
§ Provide a quiet environment where possible
§ Speak in the language best understood by the client
§ Speak slowly and clearly, facing the person you are speaking with
§ Be prepared to take the time to listen. It may take longer for a person on medication to think about what they
are trying to tell you
When you are trying to convey a message to a person with a mental illness, it is important that they have a firm
grasp on what you are trying to tell them. If they appear to be perplexed by what you are saying, then the
information may need to be paraphrase or use analogies in order for them to interpret the intended meaning.
MEETING GOALS
In all cases your role will be to identify the goals of the client and then set about implementing strategies to meet
the goals. For goals to be achievable they will need to meet certain criteria which includes being:
§ Flexible, regularly reviewed and changed
§ Formally or informally negotiated
§ Generated in accordance with consumer's wishes and aspirations
The first step is to address issues around language and communication. Effective communication ensures the
provision of accurate and appropriate care, facilitates client participation and helps to establish a meaningful
relationship between staff and clients.
The cultural and spiritual needs of clients must also be identified and supported across all services. Culturally
appropriate care requires an awareness of the cultural and religious factors that can influence the way clients
respond to illness and health care.
Although; as with all care services, it is always important to identify individual needs and preferences.
A range of language and interpersonal skills will be required by the community services worker in order to correctly
communicate with the client and ascertain their individual needs.
Language and interpersonal skills include:
§ Means for communicating with people with disabilities or where English is not the first language
§ Means for communication with people in particular communities
§ Communication with different age and gender groups
The community services sector and, in fact our greater community are becoming more and more divers all the
time. It is essential that the community services worker has an adaptable and flexible communication style that
can be changed when the need is recognised. Specific communication needs may arise from individual and
cultural differences, and it is important that these are recognised and responded to correctly to ensure effective
communication and respect for all involved.
There are many different factors which may cause a need for adapted communication including:
§ Gender
§ Race
§ Age
§ Language
§ Literacy level
§ Disability
§ Critical situations
§ Emotional situations
It is important that all of these needs are responded to in a fair and non-judgmental manner. There are many
different appropriate methods that communication can be altered in order to meet these needs. These include:
§ Written materials in multiple languages
§ Facial expressions and body language
§ Practical demonstrations
§ Cultural advisors
§ Interpreters
§ Brail machines
§ Speaking machines
§ Signs and symbols
It is important to conduct all communication in a sensitive and empathetic manner in order to protect the right of
all clients and colleagues for respect and understanding.
Once the worker has used the appropriate skills to communicate with the client, and gather information, the
information then needs to be analysed.
It is essential that all of the information that can be collected from clients is checked for accuracy and cross
checked against multiple pieces of information to ensure that a comprehensive assessment of client needs can
be made.
These needs will then need to be prioritised, and a plan of action and services recommended will need to be
drawn up.
It is extremely important that the benefits of each available service are then matched carefully to the clients’
needs to ensure that the services provided match the needs of the client directly.
The information that has been collected about the clients’ needs will need to be assessed for complexity, urgency
and eligibility so that service delivery priorities and needs can be determined and responded to.
Complexity: The complexity of a client’s needs will be determined by the number of needs that the client has and
the number of different services that the client will require in order to meet their needs.
Clients may be considered to have complex needs if they have two or more of the following factors:
§ Physical
§ Social
§ Economic
§ Personal factors
Complex needs must be determined and assessed as these types of issues with clients may require an integrated
approach and with coordinated assistance from a variety of different institutions. There are some organisations
which will be better equipped to dealing with clients with certain complex needs and at times clients may need to
be referred on to these organisations.
URGENCY
Urgency will be assessed on an assessment tool that will categorise different levels of risk that the client is being
exposed to and without referral to the correct service will continue to be exposed to until correct services may be
accessed by the client. Assessing risk is a complex issue as at times when a client is exposed to a particular risk
over long period of time they may become at a heightened risk of new issues. The urgency of a clients’ situation
will depend on the type of risk, and the type of damage exposure to that risk could cause to the client. Risk levels
will be decided on within the client’s risk profile and will be a major factor when determining the level of urgency
that a client has in regards to what will be considered a reasonable time frame for access to the services that are
required by that client. In some instances, a heightened level of risk may also change the amount of services that
a client is eligible for. In some instances, the urgency of a clients’ situation may allow the client eligibility for
access to emergency or special priority services.
ELIGIBILITY
Each different service provider and each different service will have a number of eligibility criteria that the client
must meet in order for them to be able to be granted access to each particular service. It will be necessary to
access all of the client’s information to ascertain their eligibility for each service. In some instances, may not meet
all of the eligibility requirements in this instance the client may be granted access due to their urgent or complex
needs or may need to conduct a series of other steps prior to them being able to access the service required.
When analysing client information and planning services for the client, community service workers need to ensure
that the process is performed in line with their organisational requirements.
CONFIDENTIALITY
Confidentiality in regards to community service work is viewed to in legal terms as the protection of personal
information. In order for one to comply legally with regulations surrounding confidentiality, an individual is not
permitted to share a client’s personal information with coworkers, third parties or even friends and family of the
client. The legal exception to this rule is when sharing the information could prevent harm being done to the client
or anyone in the greater community.
It is essential that all of the rules of confidentiality are followed at all times and information shared over
organisations does not reveal any of the following information regarding clients. The following is a list of types of
client information that would need to be kept confidential:
§ Name, date of birth, age, sex and address
§ Current contact details of family, guardian, etc.
§ Bank details
§ Medical history or records
§ Personal care issues
§ Service records and file progress notes
§ Individual personal plans
§ Assessments or reports
§ Guardianship orders
§ Incoming or outgoing personal correspondence
§ Race
§ Philosophical belief
In order to ensure confidentiality when sharing information within organisations, it is important that appropriate
confidentiality measures are taken. These are not only to protect the clients but also other workers and
organisations within the organisation. Names and any identifying information should be removed from all
information shared and general or statistical information should be used as much as possible. If information
regarding a particular situation is disclosed, then it will be important to change any information which may
compromise the privacy of the people involved.
If any paperwork is shared, then any personal information will need to be removed from the document prior to
sharing. Remember confidentiality is both a legal and ethical concern and must be maintained correctly at all
times.
Read more
More information on the Federal Register of Legislation can be found here:
https://www.legislation.gov.au/
Remember, you are bound by law to comply with The Privacy Act 1988 and its subsequent amendments, by
maintaining the privacy and confidentiality of your client, their carer and their information.
You can achieve this by:
§ Not discussing the client's information with anyone you are not authorised to. This includes relatives and
friends of the client not identified in the care plan
§ Taking care to secure any written information you have regarding the client and their care as per your
organisation's policies and procedures
§ Checking with your supervisor and the client when you have concerns about who to give information to
§ Maintaining the carer's information with the same respect as that of the client
§ Documenting any concerns or observations of the carer that could indicate they may require more assistance
There is no standard access and equity policy. Most organisations have their own policy drafted.
The policy should outline how the principles of access to services for all who qualify and fair treatment of all
community members applies to all functions of the organisation.
This policy statement should be made available to all staff, affiliated organisations and members of the public.
All organisational staff should be familiar with the policy and put it into practice in all of their work functions.
These are ethical obligations. Without the client’s full consent, assessment should not take place. Consent must
be voluntary, and the client must be given sufficient information about assessment to make a decision. This is
known as informed consent.
Any consent from a client must be in writing. Your organisation will have a templated version of a consent form
that your client must sign prior to any assessment commencing. The record of assessment must be detailed
sufficiently with the client’s details, who the information will be provided to and the reason for sharing the
information. The record of consent must then be filed according to organisational policies.
Every client has the right to their privacy and dignity. This includes demonstrating the utmost respect for the client,
their belongings, their information and their body. Your organisation will have strict policies the storage of client
information and who the case can be discussed with. At times you may need to share aspects of the client's
health status or care needs with others in the health care team. At all times this must be done in a respectful
manner and only the relevant facts revealed.
Where family members or other clients make enquiries about a client be polite but do not reveal personal
information. Consider your own position and how you would feel about your personal information being shared
with your family and friends without your consent.
If you meet with difficulties in refusing to pass on to a person information about a client in your care, then refer
them to a senior member of staff in your organisation to handle the enquiry.
Gather and document information from the person and other agreed
sources to explore and clarify the person’s preferences, meanings and
needs
To effectively gather, document and explore information to clarify the preferences, meanings and needs of the
client, it is necessary to be able to accurately interpret any observations or tests that may take place during the
assessment process.
Observations should be noted and recorded and feedback actively sought. Your organisation may have a formally
established procedure for the monitoring/feedback system. This may well include template evaluations that are
given to the client and significant others to compile their responses at regular intervals.
There are several methods of gathering information to assess the needs of a client. Your organisation will have
preferred methods and procedures for gathering client information but here are a few that could be used.
Reviewing a care plan has benefits as most of the information has already been gathered by another colleague.
This method can give you excellent information about a client prior to developing a plan for them. It does not
however give room for alternative or additional questioning.
Observation of clients can give a great deal of information on their abilities, however, does not leave room for
eliciting information on preferences of strengths outside of the specific activity being observed.
Readings, test and observations may be in relation to:
§ Emotional issues
§ Psychological profiling
§ Literacy
§ Social issues
§ Economic status
§ Medical and health issues
§ Mental health status
§ Cultural issues and requirements
§ Developmental issues such as developmental and intellectual disabilities
§ Family issues
Standard proforma give a great deal of information and usually have a section that allows for additional
questioning relevant to the individual. You organisation may use a combination of methods over a period of time
to gather information about a client. This will give the best-rounded information in the end.
A standard proforma will have information that is personal to each client and it will prompt you to ask the
questions that will provide you with the information you need to assess clients effectively. Over the page is a
standard proforma that you might use to gather information from your first meeting with a client:
Note: If some of the following information is not known about the child or young person when completing this
form, write ‘unknown at this stage’ in the relevant box.
Date completed
Completed by
Placement type
Family group home care Supported independent living Emergency respite care
Duration of placement
Level of need
If ‘high’ is selected, provide reasons (below) for determining that this child or young person has high needs or
requires a high needs or fee-for-service placement:
Name
Cultural background
Religion
Address Phone
Health
Describe all ongoing physical or mental health issues (note challenging behaviours are further on). Include any
known allergies. If a diagnosis is made include who made it and when. List ALL medications the child/young
person takes:
General
practitioner
Psychiatrist
Psychologist
Paediatrician
Dentist
Other
Other
Medicare card/number
Healthcare card/number
When assessing observations and tests that are included in the assessment of the client, it is important for the
community services worker to recognise what normal readings are so that they have a benchmark to compare the
client’s results with. If the results and observations of the client significantly deviate from the norm, this will
provide information about what actions might need to be implemented. Significant deviations may serve to
indicate the urgency of the required actions.
Many people working in the community services sector, such as caseworkers have a comprehensive knowledge
base which enables them to provide accurate and detailed assessments about the needs of the client. They are
able to use their knowledge and observational skills to identify significant variations from the norm when
analysing client information.
All of the information regarding a client will need to be accessed and analysed in order to correctly identify all of
their needs and then be able to prioritise their needs in order of importance.
It is essential that all of the information that can be collected from clients is checked for accuracy and cross
checked against multiple pieces of information to ensure that a comprehensive assessment of client needs can
be made.
These needs will then need to be prioritised, and a plan of action and services recommended will need to be
drawn up.
It is extremely important that the benefits of each available service are then matched carefully to the clients’
needs to ensure that the services provided match the needs of the client directly.
To do this you may need to ask some very pointed questions such as:
§ What is the purpose of assessment?
§ What services do you think are required?
§ Why are they required?
§ How urgent is assistance required?
§ Is the person living at home?
- If so, are they alone or do they have a partner?
The answer to these questions will determine not only the need for assessment but the urgency of the request.
Once this is determined, you can arrange for a time to meet with the person to perform the assessment.
Together identify the range and potential effects of social and other
barriers that are impacting on the person
No matter what program or service you develop or offer there will always be some people who have barriers to
participation. Types of barriers experienced by clients may include:
§ Cultural – there may be people who cannot or do not participate based on cultural factors such as “girls don’t
do this” or “boys don’t do this”
§ Religious – religious factors can contribute to lack of participation sometime as prayer time for Muslims may
clash with activities, programs or appointments
§ Physical – some people may have physical disabilities that prevent or hinder participation
§ Intellectual – some people may have intellectual disabilities that prevent or hinder participation
§ Psychological – some people may have psychological conditions that may hinder or prevent participation
§ Time and resource constraints – some people may have problems fitting in an activity/service/appointment
into a busy lifestyle or may not have transport to get to the activity/appointment
There could be many more barriers to participation so you will need to discuss this with your client’s so that you
can work around these barriers when possible.
There are various goods and services that can help a person overcome the challenges that come with having a
disability. These challenges limit them from fulfilling independent living, as well as participating in daily, cultural,
political, social and economic activities.
Below are examples of supports that can address the requirements of people with disability:
§ Personal help/attendant care
§ Personal planning supports
§ Homemaker services
§ Brokerage services
§ Technical aids and devices
§ Respite and training for family caregivers
§ Specialized features at home and in work and learning environments
§ Medications, developmental/therapeutic services
§ Transportation supports specific to a disability
§ Accessible community infrastructure
§ Human capacity at the community level to include people with disabilities
Supports are required of different kinds and in different forms, at all stages of the lifespan: children, youth, adults
and seniors.
OVERCOMING BARRIERS
The principles and best practice of inclusion are reliable basis for identifying and overcoming barriers to
participation. The approach may include the following:
§ Applying a person-centred process - It is because the overall welfare and personal preferences of the
individual are the key considerations.
§ Building partnership with the community and encouraging cooperation
§ Involving the family of the person with disability
§ Providing open options and opportunities specifically for the individual based on the person’s goals, strengths,
abilities and interests
§ Peer support: it views the mutual support of a person’s peers in recovery as being invaluable and the need for
valued roles and community inclusion to be recognised and promoted.
§ Respect: community, service system, family and friend’s acceptance of the person as a person first and
foremost, elimination of discrimination and stigma, are seen as being crucial to recovery as is the self-
acceptance of the person and the regaining of self-belief along with respect for others. Respect ensures the
inclusion and full participation of the person in all aspects of their lives.
§ Responsibility: it entails the person taking personal responsibility for their own self-care and journey of
recovery and taking the (often) difficult steps to achieve their own goals.
§ Hope: believing in themselves and that they can overcome any barriers and obstacles that are in their path.
Hope is the catalyst for recovery. It is internalised and needs to be fostered and promoted by the person’s
family, peers, friends and services.
‘Person-centred care planning’ involves a collaborative process between the person and his or her supporters
(including the clinical practitioner) that results in the development and implementation of an action plan to assist
the person in achieving his or her unique, personal goals along the journey of recovery. Such a ‘plan’ is always
‘goal oriented’ and needs to:
§ Promote recovery rather than only try to minimize illness
§ Be based on the person’s own goals and aspirations
§ Articulate the person’s own role and the role of both paid and natural supports in assisting the person to
achieve his or her own goals
§ Focus and build on the person’s capacities, strengths, and interests
§ Emphasize the use of natural community settings rather than segregated program settings
§ Allow for uncertainty, setbacks, and disagreements as inevitable steps on the path to greater self-
determination
Person-centred care planning for any person with a mental illness does not require professionals/practitioners or
service providers to do whatever the person wants. Ideally, person-centred care planning evolves within a
collaborative relationship in which decision-making is viewed as shared between the person with mental illness
and professionals/practitioners and service providers. Within the context of such a partnership, each party has its
respective role to play.
Professionals/practitioners assess, evaluate, diagnose, educate, inform, and advise the person and his or her
supporters about the possible courses of treatment and rehabilitation available for whatever ails or is disabling
the person, including the relative benefits and drawbacks of each approach. Professionals/practitioners then
provide and even deliver what they are competent to provide based on the nature of the person’s situation and
circumstances. The person, in conjunction with his or her supporters (to whatever degree he or she wishes) makes
decisions about what treatments, interventions, services, and supports make the most sense within his or her life
context, given his or her values, needs, preferences, and goals. It is no more appropriate for the person to assume
the role of professional/practitioner than it is for the professional/practitioner to assume the authority to make
the person’s decisions for him or her. It is the right, and ethical responsibility, of professionals/practitioners to
offer the best assistance and support that they can. Yet it is also the person’s right, except in few exceptional
circumstances to make his or her own decisions about what recommendations, interventions, services, or
supports he or she will use in his or her recovery.
Person-centred planning emphasizes the need for the professional/practitioner and person to enter into a
collaborative process of exploring and identifying the goals and objectives that will promote the person’s recovery
and increase his or her quality of life. The person-centred plan is a roadmap for pursuing the person’s valued life
goals, and the milestones which are achieved along the way (i.e., short-term objectives) serve to give both the
professional/practitioner and the individual the critical experiences of success and forward momentum needed to
continue on the road ahead. In this sense, the plan becomes a useful tool that has direct relevance in guiding the
work of the team over time.
It can be consulted as needed in order to ensure that all parties stay on course, and revised as often as needed if
the person encounters barriers or roadblocks along the way or reaches certain landmarks and wants to set a new
destination.
A quality person-centred plan not only depicts the short and long-term destinations, but also explicitly identifies
the role of all team members in contributing to the process. Supports are thought of broadly and include specific
action steps for the professionals/practitioners involved as well as for the person in recovery and his or her
natural supports. Thus, the person-centred plan is an important tool that promotes accountability among all
stakeholders as both tasks and timelines are clearly spelled out. The potential impact and value of the written
planning document is further magnified when this document is offered in hard copy to the person in recovery (an
essential practice in person-centred planning). This is not only an important symbolic gesture offered in the spirit
of partnership and transparency; it also serves to activate the person in the day-to-day work of his or her recovery
process. The written plan, while a valuable tool for setting a course and reflecting on progress, is only one piece of
the picture. Equally, if not more, important is the process behind the development of the plan.
Person-centred planning does not mean simply giving a person whatever he or she wants. Instead, it requires
professionals/practitioners to take into account, and to base the services they provide, on a collaborative
decision-making process in which the person plays a central role. Rather than being in conflict with evidence-
based practice, this emphasis on the person’s own values, goals, and preferences is perfectly in accordance with
the principles of evidence-based approaches, that all adults have the right to make their own decisions. It is for
this reason that evidence-based research and basic human rights explicitly includes the person’s role as decision-
maker (including his or her needs, cultural values, and preferences, including the right to defer decision-making to
others) as one of the three components that the professional/practitioner has to consider (the other two being the
available scientific evidence and the professional’s/practitioner’s accumulated knowledge base and clinical
experience.
Since the person is free to (and in one way or another, will, except in very limited situations) ultimately make his or
her own decisions, it behoves professionals/practitioners to accept this fact and to communicate with the person
and his or her family in as accurate, informative, culturally and personally responsive, and perhaps even
persuasive, a way as possible so as to maximize outcomes.
The apparent contradiction between person-centred planning and evidence-based practice is due to confusion,
currently prevalent in the field, between evidence-based medicine or practice, on the one hand, and evidence-
based practices, on the other. As described above, evidence-based medicine or practice is based on the available
scientific evidence, the professional’s/practitioner’s accumulated knowledge and experience, and the person’s
choice. Evidence-based practices, on the other hand, are those interventions for which scientific evidence exists
attesting to their effectiveness for certain conditions or populations. Evidence-based practices may (or may not)
be used within the context of evidence-based medicine, depending on the practitioner’s clinical judgment, the
person’s particular conditions and circumstances, and the person’s informed choice. Somewhere along the way,
evidence-based practice (i.e., what practitioners do) became confused with evidence-based practices (those
interventions which have been shown to be effective), leading some in the field to suggest broad-scale and
indiscriminate adoption of evidence-based practices for everyone with a select condition (regardless of other
evidence and other relevant factors).
The planning tools used by your organisation will have guidelines for you to follow to help ensure that each area of
the client's life is adequately addressed. The following is an example of questions that could be asked around
employment/community participation.
§ What types of community jobs could you see the person doing?
§ Does the vision reflect an individualised job, based on the person’s interests and gifts, versus an enclave?
§ If a job would not be the right expression for the person, are there meaningful activities described that support
the person in contributing their unique gifts and talents and supports them in being seen as a valued
community member?
Source: 'Increasing person-centred thinking; Improving the quality of person-centred planning. A facilitator's guide to the planning process’, by
Angela Novak Amado, Ph.D. and Marijo McBride, M.Ed.
If this is the first contact the client has had with your organisation then their initial interaction will likely form their
future impression about your service. Tone of voice, style, approach, language, time taken to explain the process,
listening to concerns and offering choices will inform their perception.
It is critical that their impression of your organisation is one of caring, professional staff who are working with the
client to achieve common goals and improve the circumstances of the client and their family.
You will need to be familiar with your organisation's requirements for conducting and recording planning meetings
before you commence the process. Use the appropriate planning tools and record the information as required.
Using cross-cultural skills is an effective way to enhance the engagement of clients within the community to share
information and thus support the established networks.
In order to deliver the highest standard of service the needs, expectations and preferences of the client will need
to be identified and accommodated.
With the move from a medical model of care to a person-centred approach the need for individualised plans, that
address all aspects of a client's life, became significant. Tools have been developed for use by service providers to
encourage clients to identify areas in which they already have skills and areas where assistance is required to
help them meet their full potential.
A planning session is to ensure that the interests of the client are met and using a collaborative approach helps
clarify the roles of all concerned.
By explaining the purpose of the planning process all stakeholders can provide input of information in a manner
that can then be collated and developed into a meaningful approach to life for the client. It provides the
opportunity to identify and address any shortfalls in training, resource application, the monitoring and evaluation
timeframes and methods and the expected outcomes to be achieved.
There are a number of planning options available. Your organisation will instruct you in their preferred methods.
These planning options may include:
§ Informal plans
§ Person-centred planning processes including maps, path or personal futures planning
§ Organisational planning processes that include:
- Individual program plan
- Care plan
- Treatment plan
- Education plan
- Rehabilitation plan
- Employment plan
- Recreation and access plan
Always follow your organisation's policies, procedures and protocols when using planning tools to collect and
record information.
Different planning options should be discussed with client’s every step of the way. When considering options for
your client you should consult them. Remember, you can make suggestions but at the end of the day if the client
doesn’t agree there will be no benefit for them. Involve your client in the decision-making process to ensure
maximum participation and minimum rejection.
INDIVIDUALISED PLANS
People who have a mental illness have a capacity for physical, emotional, social and intellectual development.
They are entitled to the same conditions of everyday living as anyone else in the community.
Clients require an individualised approach to deal with their unique issues, needs, abilities and character traits.
Asking questions to confirm the plans of the client enables you to find the best care options for your client's
particular needs.
Questions should be delivered in a way that will encourage clients to share relevant information with you, that is,
current and past history, including physical, intellectual or psychological health.
Providing the client with open ended questions enables you to assess the reasons consequences and evidence for
their responses. It provides the worker with a perspective on the client’s view of the world.
When gathering information from clients, it is useful to:
§ Use simple words and short sentences
§ Speak with the client in a manner that is age appropriate
§ Be respectful of all their concerns
§ Provide a quiet and private environment, free of distractions
§ Address the person by their preferred name
§ Allow enough time for the client too respond to your questions
§ If the client appears to be struggling for words, gently suggest words that may assist them according to the
context of the conversation, but do not assume that you know what they want to say
§ Try to frame questions and instructions in a positive way
Your organisation should have well-designed systems and procedures for case/ care plans. The types of
information you will require from your clients will include:
§ Client’s history
§ Currents wants
§ Preferences
§ Expectations
§ Future intentions
Physical wellness encompasses all aspects of a sound body and fitness, including:
§ Body size/shape
§ Sensory responsiveness
§ Body functioning
§ Strength, flexibility and endurance
§ Disease resistance
§ Ability to recuperate
Social wellness is being able to have satisfying interpersonal relationships and maintain social connectedness.
Intellectual wellness is being able to think clearly, reason objectively, analyse, and use your intelligence effectively
to solve problems and meet challenges.
Emotional wellness being able to control your emotions and express them appropriately at the right times.
Environmental wellness is cultivating an appreciation for the environment and your role in preserving, protecting,
and improving it. It also includes having access to a safe and healthy workplace.
Spiritual wellness is experiencing a deep sense of purpose, meaning, or value from personal beliefs. It may
include religion, belief in a supreme being, and/or a feeling of unity with others and with nature.
Occupational wellness is having fulfilling and meaningful work in which you nurture your gifts, skills and talents. It
is the ability to get personal fulfilment from our jobs or our chosen career fields while still maintaining balance in
our lives. Our desire to contribute in our careers to make a positive impact on the organisations we work in and to
society as a whole leads to Career/Livelihood Wellness.
Financial wellness is how you understand and handle your money in ways that provide for you now, as well as
prepare you for financial changes.
DEVELOPMENT OF SELF-EFFICACY
Self-efficacy beliefs begin to form in early childhood as the child deals with a variety of experiences, tasks and
situations. The development of self-efficacy beliefs continues throughout life as people learn, experience and
develop into more complex human beings.
There are four major sources that contribute to the development of self-efficacy beliefs:
§ Performance accomplishments: The experience of mastery influences your perspective on your abilities.
Successful experiences lead to greater feelings of self-efficacy. However, failing to deal with a task or
challenge can also undermine and weaken self-efficacy.
§ Vicarious experience: Observing someone else perform a task or handle a situation can help you to perform
the same task by imitation, and if you succeed in performing a task, you are likely to think that you will
succeed as well, if the task is not too difficult. Observing people who are similar to yourself succeed will
increase your beliefs that you can master a similar activity.
§ Verbal persuasion: When other people encourage and convince you to perform a task, you tend to believe that
you are more capable of performing the task. Constructive feedback is important in maintaining a sense of
efficacy as it may help overcome self-doubt.
§ Physiological states: Moods, emotions, physical reactions, and stress levels may influence how you feel about
your personal abilities. If you are extremely nervous, you may begin to doubt and develop a weak sense of self-
efficacy. If you are confident and feel no anxiety or nervousness at all, you may experience a sense of
excitement that fosters a great sense of self-efficacy. It is the way people interpret and evaluate emotional
states that is important for how they develop self-efficacy beliefs. For this reason, being able to diminish or
control anxiety may have positive impact on self-efficacy beliefs.\
CULTURAL REQUIREMENTS
Australia has a community rich in diversity. Many of your clients and colleagues may come from a cultural
background different to your own. It is important that you are familiar with the cultural preferences of your clients
in terms of communication and personal care. For example, some female clients from a Muslim background
require a female carer to attend to their personal needs. Preferences such as these should be identified during
development of the care plan but where concerns arise alert your supervisor immediately.
Avoid applying your own personal preferences to the client. Some people from other cultural backgrounds prefer
not to wear deodorant, others do not cut their hair. Women of some Asian backgrounds do not fully bath or shower
for weeks after having a baby but sponge themselves with hot water and keep warm, believing this will lead to
better health in old age.
Some cultures have very strict rules about the preparation of food and clients will refuse to eat if these are not
adhered to.
Research a little of the cultural background of your client before you start work with them. Ask if they prefer tasks
performed a particular way and how they wish to be addressed. By showing respect for a person's beliefs you will
soon establish a good working relationship with them.
Remember, you are a professional providing personal care to the client according to their preferences.
§ Developing individual action plans with the person with a mental illness that address their changing needs
§ Referrals to specialist services appropriate to their needs
§ Involve significant others as appropriate in helping people identify their options and ways they might be able
to achieve their goals. Significant others may include:
- Carers
- Advocates
- Family members
- Case workers
- Friends
Self-advocacy is the ability to speak-up for yourself and the things that are important to you. Self-advocacy means
you are able to ask for what you need and want and tell people about your thoughts and feelings. Self-advocacy
means you know your rights and responsibilities, you speak-up for your rights, and you are able to make choices
and decisions that affect your life. The goal of self-advocacy is for YOU to decide what you want, then develop and
carry out a plan to help you get it. It does not mean you can’t get help if you need or want it, it just means that you
are making the choices and you have to be responsible for the choices you make.
It is important to learn self-advocacy skills because it helps you decide what you want and what is possible for you
to expect. When you have good self-advocacy skills you can have more control and make the life decisions that
are best for you. Self-advocacy helps to empower you, to speak-up for yourself and make decisions about your life.
SMART GOALS
When assisting the client to set goals, it is important to ensure that the goals are:
§ Specific - The desired outcome should be stated in specific terms. This enables both the client and the worker
to focus on specific achievements and outcomes.
§ Measurable - Ideally, the goal should be broken down into smaller steps. This allows for the objectives to be
more easily measured. Being able to achieve small steps and measure progress, assists the motivation of the
client as they progress toward achieving their ultimate goal.
§ Attainable - When setting goals, it needs to be ensured that they are not beyond the reach of the client. If
goals are set too high, and the client feels that they will not be able to achieve them, then they are likely to
lose motivation. At the same time, the goals need to be set sufficiently high for the client to feel that they have
something challenging to work toward.
§ Realistic - Goals need to be realistic so that the client feels they have something to work toward. The goal
needs to be relevant to the needs of the client so that they see the goal as being worthwhile.
§ Timely - Goals should be set with specific timelines in place. Having a timeline in place provides a ‘finish line’
for the client, and motivates them to pursue their goal with a specific date in mind.
If clients identify any aspects of the service that are not meeting their needs, you will need to modify the service
and their goals to meet those needs.
Identify possible barriers or risks with the person and the strategies
and/or other people who can assist in responding to or overcoming
these challenges
There are many barriers that a person diagnosed with a mental illness can experience. They range from the social
barriers to the financial or employment barriers. Some of these barriers include:
§ The impact of clinical symptoms
§ Side effects of medications
§ Community stigma and resulting ‘stigmatic thinking’ by the person with mental health conditions
§ Discrimination
§ Low expectations of health professionals
§ Lack of access to services especially in rural and remote locations
§ Lack of collaboration within programs and between agencies
§ As well as factors associated with social and economic marginalisation such as:
- Family breakdown
- Social isolation
- Homelessness
- Drug and alcohol problems
These barriers can negatively impact on a person’s sense of identity, mental wellbeing, economic security, social
skills, and value in society.
The barriers that people with a mental health diagnosis suffer can impact on them in ways that are sometime
difficult to understand.
The effects can range from feeling of self-loathing, hatred of the world in general to self-destructive behaviours.
The impact is much greater on person with mental illness than someone who has not. For example: a person with
depression has lost her family and friends and is now even more depressed and has discussed suicide because
she feels worthless.
This is fairly typical of the level of impact that social isolation, lack of employment and lack of support can cause
on a person with depression.
There are some strategies that you can try in order to assist a person with mental illness to cope better and
overcome the barriers they face. Possible strategies to respond to barriers may include:
§ Focusing on strengths - this can assist a person to see that they have particular strengths that can be used to
overcome barriers to participation
§ Solution finding - this can assist by challenging the person to find ways of solving the barriers they face every
day
§ Cooperative effort - this will assist by offering assistance to achieve goals by cooperating with others. This can
aid in encouraging the person to achieve with other rather than alone
§ Information - providing information in detail can often help if the person has all the details of a social activity
or task then they can often approach the task with a better attitude
§ Providing choices and options - providing options can assist by enabling the person to choose what they want
to do rather than just giving one option where they may feel forced to do something they may not want to do
Neighbours might take the person shopping each week when they go shopping. And co-workers may look out for
the person in the workplace to ensure stress levels aren’t getting too high.
There are many ways that others can be engaged in the support processes and your organisation will have its
preferred methods.
If you are at all unsure about this process please check with your supervisor to ensure you are following workplace
procedures for engagement.
As you can see the short-term goals revolve around the longer-term plan for recovery. Once the end result of
intervention is clear the short-term goals can be determined and set in place.
§ Information sharing and planning: There should be a strategy in place for how information will be shared and
plans laid out for how the case management plan will proceed.
§ Appropriate conflict resolution techniques to be employed: Appropriate conflict resolution techniques will need
to be explained to the client, and decided on prior to the commencement of case management planning
processes.
Once the client has been advised of all the above information you will be in a position to develop and document
their wellness and risk plans.
The following points are an example of what may be incorporated into policy and procedure in relation to the duty
of care.
§ All employees need access to orientation training and induction that includes information about duty of care
§ Employees need to seek advice and support from internal or external professionals to deal with issues that
challenge duty of care and dignity of risk
§ Appropriate documentation relating to daily duty of care responsibilities should be maintained at all times (e.g.
case notes)
§ Information should be given to clients, staff, volunteers and significant others about considerations involved in
evaluating duty of care issues. This should include information identifying duty of care obligations and the
client’s right to experience and learn from risk taking
§ Ensure that clients participate in decisions regarding their care arrangements and lifestyle choices
§ Issues relating to duty of care must be discussed with a manager or supervisor
As you can see, the thrust of duty of care policy is to collaborate with the relevant people involved and to be
mindful of accountability and client rights.
Identify and document the person’s and worker’s roles and timelines
for action
During the initial planning stage, roles and goals need to be established. These will include timeframes for
achievement, level of participation and strategies to measure the success of aspects of the individualised support
plan.
Variations in the client's circumstances may impact the success of the plan. Changing health status, the
degenerative nature of some conditions, improvements in a client's condition may all result in the plan no longer
being viable or being unable to meet the client's needs and aspirations. The review process will provide
information used to implement a more effective plan.
Where a client's situation has improved as a result of the strategies previously put in place to meet their needs
and identified risks, then comment should be recorded on the effectiveness of the plan. The client should be
encouraged to establish new goals and these incorporated into the plan.
During the review process the following points need to be considered:
§ Do the intervention strategies meet the needs of client now and in the future?
§ Are there alternative services that could assist the client?
§ Have priorities been outlined?
§ Have all goals and objective been worked into the plan?
§ Have timelines been set?
§ Has the client been consulted throughout the process?
§ Have all parties designated roles been defined?
§ Have contingency plans been established?
§ Have cultural considerations been integrated into the plan?
§ Have the client’s needs changed?
§ Have the clients living arrangements changed?
§ Have these been factored into the changing service plan?
Reviewing service plans enables you as the service provider and the client to assess whether the goals set in the
original plan are still current and/or have been met and if any goals or service need changing in order to meet the
new needs of the client.
Typical teams based in Community Mental Health Centres, or provide services for the area, are:
§ Community Rehabilitation Team: The service provides a range of individual and group programs including
social and leisure activities, vocational assessments and work training programs for people requiring
assistance with community living. Referral to the Rehabilitation Service would normally be made through a
clinician at the Community Health Centre.
§ First Episode Psychosis Services: This service provides specialist treatment for young people under 25 years
of age with first onset psychosis.
§ Adolescent Community Mental Health Services: The Adolescent Community Mental Health Service is a
specialised and mobile service for young people aged from 13 to 18 years who are experiencing:
- Changes in moods or ways of thinking
- Behaviours reflecting mental health concerns
- Issues around relationships
- Problems with schooling or conduct
The team offers acute assessment, support and counselling and help with links to other specialist services. The
team helps young people with mental health problems in the community stay safe and well. The team also
provides preventative and educational programs as well as a consultation to other health professionals.
There are also teams which only cover specific areas:
§ Mobile Assertive Treatment Team (MAT Team): The MAT Team provides assertive case management for
adults aged 18 to 65 who have been assessed and referred from mental health services through the
hospitals (Rozelle and Missenden Unit) and Community Mental Health Centres (Camperdown, Marrickville
and Redfern) The MAT Team operates 7 days a week from 8am to 10pm Monday to Friday and Saturday
from 12:30pm to 9:00pm on weekends.
§ Aboriginal Mental Health Service: The Aboriginal Mental Health Service works in partnership with other
service providers such as The Aboriginal Medical Services at Redfern. The Team offers initial assessment,
referral, consultation and liaison.
§ Boarding House Teams: works with residents who require mental health interventions and are living in
private boarding houses (Licensed Residential Facilities). These boarding Houses are generally located in the
inner West of Sydney (for the Sydney South West Area). Boarding house residents with mental health issues
have been identified as a "special-needs" group. They are primarily a population with mental health problems
approaching senior years, whose problems are often increased by physical illness/disability, poor nutrition,
socioeconomic disadvantage and the stigma associated with mental illness. The BHT liaises with a range of
services to ensure that clients with a mental illness are linked with the mental health & related services they
require.
CARERS ROLES
Many people care for their family members, who are dealing with mental health issues. These carers also need
support and care.
They can struggle with the changing relationships they experience as carers for example:
§ A child now becomes the carer for a mentally ill parent
§ The parent now cares for a mentally ill child who has become an adult
These relationships must be formed again in a different manner. Whilst the person they are caring for is an adult,
they are often unable to manage as an adult would, this can sometimes mean they are treated more as children
and not adults.
These changing relationships can often affect the carer greatly and in this case they really need assistance to
manage this changing relationship. This assistance can come in many roles but you should never underestimate
the positive aspect that a variety of people and services can have on a mentally ill person.
This assistance may not only be for the client but may also extend to the carer as well. They may also need
counselling or medical assistance but there are some things that you can do to encourage both parties to begin to
enjoy the changing relationship.
Try to get both parties to focus on the positive aspects of their lives. Things such as:
§ The closeness they now share
§ The time they can spend together
§ The feeling that the child can now assist the parent rather than the other way around
In all circumstances, if you believe there is a problem in relation to the mental health of either the carer or the
person being cared for you should report this to your supervisor or refer them to a G.P. or counsellor.
Caring for a mentally ill person can be a drain on any person and none so much as the child of the person. The
main thing is that they are encouraged to use the supports that are available to them. Supports may include:
§ Respite – Respite care can give the carer a well-earned break and the person they care for variety and extra
social opportunities.
§ Counselling – counselling can provide all parties with a means to talk openly about their feelings and can give
everyone the release they need to just feel free to talk without offending or burdening others.
§ Home care – can offer services to assist with cleaning, cooking and shopping.
§ Meals on wheels – provides daily meals for people in need when they are unable to cook them for themselves.
§ Home nursing – can provide assistance with medications, wound management, showing, personal care.
Each of these services provide a different support and can be utilised in order to give the client, the families and
friends a break from the day-to-day care of the person.
Many carers see themselves as a family member who looks after a person they love, not as a carer. This means
that they may not think to look for, or ask for help. There are a wide range of services available to help them in
their caring role. Whatever the service, whether it’s short-term respite or counselling, it is designed to lend them
the support and assistance they may need. It’s things like having some extra help and support that may mean
they can stay in their caring role for longer.
Discuss with the person their interest and readiness to initiate their
plan for recovery
Undertake service actions as agreed in the plan in a timely manner
People who are dealing with mental health issues have a capacity for physical, emotional, social and intellectual
development. They are entitled to the same conditions of everyday living as anyone else in the community.
Clients require an individualised approach to deal with their unique issues, needs, abilities and character traits.
Asking questions to confirm the plans of the client enables you to find the best care options for your client's
particular needs.
Questions should be delivered in a way that will encourage clients to share relevant information with you, that is,
current and past history, including physical, intellectual or psychological health.
Providing the client with open ended questions enables you to assess the reasons consequences and evidence for
their responses. It provides the worker with a perspective on the client’s view of the world.
When gathering information from clients, it is useful to:
§ Use simple words and short sentences
§ Speak with the client in a manner that is age appropriate
§ Be respectful of all their concerns
§ Provide a quiet and private environment, free of distractions
§ Address the person by their preferred name
§ Allow enough time for the client too respond to your questions
§ If the client appears to be struggling for words, gently suggest words that may assist them according to the
context of the conversation, but do not assume that you know what they want to say
§ Try to frame questions and instructions in a positive way
Your organisation should have well-designed systems and procedures for case/ care plans. The types of
information you will require from your clients will include:
§ Client’s history
§ Currents wants
§ Preferences
§ Expectations
§ Future intentions
§ Design and implement plans that will enable clients to live in a manner as closely aligned with their previous
comfort needs as possible
§ Take into consideration the original diagnosis, appropriate and necessary medical treatments, adherence to
the treatment plan, and the presence of co-existing conditions
§ Allow for the client to do as much as they can for themselves
§ Provide support around independence and self-help
Clients require an individualised approach to deal with their unique issues, needs, abilities and character traits.
When working with a client, you must ensure you:
§ Are aware of the varying levels of support that clients need at different times
§ Take into consideration case histories and family or representative contributions
§ Utilise inclusive assessments that are based on client needs, abilities and readiness for care
§ Design and implement plans that will enable clients to live in a manner as closely aligned with their previous
comfort needs as possible
§ Take into consideration the original diagnosis, appropriate and necessary medical treatments, adherence to
the treatment plan, and the presence of co-existing conditions
PROVIDE CHOICES
All clients should be provided with choices in the provision of their care. How care workers respond to the choices
the clients make is important. Having choices creates a sense of quality in the life of the client.
Working in the community services sector, you’re likely to encounter situations where the client does not want to
make choices about the provision of their care. How you support individual's choices will vary according to the
nature of the choice involved and the person's previous experience in making choices.
In situations where people may want to make choices that are obviously not in their best interest it is important
that you maintain their self-esteem with your response or so that they will not become withdrawn and stop making
choices. Some people with an intellectual disability who are withdrawn or passive have their behaviour incorrectly
interpreted as part of their disability, when, in fact, the behaviour is often the direct result of low self-esteem.
In order to maintain the self-esteem of the clients who avoid the decision-making process, it is important that you
acknowledge their choice to do so and respect their decision. Acknowledging their decisions, can help them to
focus upon the things that they feel they can influence.
It is important to ensure that you have access to the required information, resources and education options that
will allow you to continue to assist the clients towards their goals. These resources must be identified, accessed
and then allocated according to the availability of the services. There are a number of different types of resources
that may be required. These resources may be internal or external to your department’s jurisdiction and
organisation.
CLIENTS RESOURCES
One of the most important aspects of dealing with clients is managing their expectations and aspirations. The
current commitments in time and resources of the client, as well as the service providers, must be checked to
ensure that the capacity to reach the goals that the worker and the client agree upon is present.
CLIENT CAPACITY
Clients must have the capacity to undertake the actions that are to be undertaken or else they will not engage
fully in or simply fail to be present for the activities. They must be committed and confident that their goals can be
reached before they begin the process of creating a plan, or the plan will have a high chance of not being
successfully completed.
The worker should assist the client in finding flexibility in their current commitments in regards to time and
resources such as money and mental fortitude. As with most all other aspects of working with young clients and
their families, it is paramount that the client allocates their own resources and time in a way that suits them while
still allowing for their goals to be reached.
CLIENTS RESOURCES
One of the most important aspects of dealing with clients is managing their expectations and aspirations. The
current commitments in time and resources of the client, as well as the service providers, must be checked to
ensure that the capacity to reach the goals that the worker and the client agree upon is present.
CLIENT CAPACITY
Clients must have the capacity to undertake the actions that are to be undertaken or else they will not engage
fully in or simply fail to be present for the activities. They must be committed and confident that their goals can be
reached before they begin the process of creating a plan, or the plan will have a high chance of not being
successfully completed.
The worker should assist the client in finding flexibility in their current commitments in regards to time and
resources such as money and mental fortitude. As with most all other aspects of working with young clients and
their families, it is paramount that the client allocates their own resources and time in a way that suits them while
still allowing for their goals to be reached.
DECISION-MAKING
There are a number of ways to support clients who need to be motivated, to make decisions for themselves, and
to have the confidence to act on those decisions.
Methods by which the client may be encouraged include:
§ Asking their opinion on how to handle situations rather than instructing them on how to do it
§ Asking the client to consider options that may have worked for them in the past
§ Providing assistance to select options, as opposed to directing them
If the client has an established plan, it is important to support them in the decision-making process regarding
issues that relate to the plan. At the same time, whilst supporting the client, it is important to ensure that you
operate within the boundaries of organisational policies and procedures and meet the requirements of decisions
made by other authorities. Court orders would be one such example.
SELF-ADVOCACY
Self-advocacy is the practice of standing up for one’s own rights. Encouraging and assisting a person with a
mental illness to self-advocate is essential in ensuring self-determination, empowerment, independence and
control. It is important that a person with a mental illness is aware of their own rights and is provided with the
support, information and assistance that they require in order to self-advocate effectively.
If subject to a state/territory Mental Health Act, a duty of care exists to ensure that the above care is delivered,
and that:
§ Consumers are treated with respect and dignity
§ Consumers’ rights are protected and respected
§ The standards of care and treatment are equal to that of patients in the general health care system
§ Clinical compliance with all the provisions outlined under Mental Health Act
Federal, state and territory governments have a responsibility to establish legislation that ensures a high standard
of duty of care and provide sufficient funding to allow for compliance and accountability of their legislation,
policies and practices.
Delivering a proper duty of care requires the provision of a transparent level of accountability. Accountability
means being responsible for your actions or inactions.
You will need to determine your level of responsibility in relation to a duty of care in line with your job role and
description. If you are unsure, please ensure you ask your supervisor about your responsibilities.
Dignity of risk is the legal requirement to ensure that all persons with a disability have the legal right to choose
their own medical treatments, take positive risk and choose resilience building, even if the professionals involved
feel that this is not the correct choice for them.
DIGNITY OF RISK
The Dignity of Risk acknowledges that life experiences come with risk, and that we must support people in
experiencing success and failure throughout their lives. However, it can be a challenge to support decisions that
we feel are risky, or with which we don’t agree, without our safety-oriented health care culture.
You will need to provide each client with their dignity of risk. This means that each client will need to be free to
make choices for themselves and take certain risks that we are all free to do.
In most cases you will not be able to stop them from this because it is their right. This right does not extend to
physical harm to self or others in any situation.
The dignity of risk project outlines the following:
The UK, Australia and Canada have many similarities in their understanding of the issue of decision making for
older adults. We have summarized these perspectives into four principles that we believe best inform our view
on the Dignity of Risk in older adults.
1. Adults have the right to make their own decisions, and to be assumed to have capacity to do so unless
shown otherwise – and capacity should be viewed as decision-specific.
2. A person should be offered all reasonable support and assistance in making and following through on their
decisions before others step in to make decisions for them.
3. People have the right to make decisions that others feel are unwise or disagree with, the right to have a
different tolerance for the risks associated with a decision, and the right to fail after making a decision.
4. When others are involved in decision making with person, any decisions must be made with the person’s
best interest and preferences at the forefront, and must strive to infringe the least upon their basic rights
and freedoms.
Of course, understanding the impact of these four statements in relation to care of older adults, and then
working to embed these principles into a balanced approach to care is a complex issue that may often be
dependent on the setting in which the care occurs. For this reason, we have designed – and are implementing
and evaluating – participatory workshops, that allow health care personnel to explore these issues and then
create the methods for embedding them in their practice.
Both the duty of care and the dignity of risk are rights that each client has. You will need to ensure you work within
the boundaries of these so that client’s rights have been met.
Using each of the above strategies you can build a trusting and helpful relationship with client that will allow them
to trust you and use your assistance to benefit them.
§ Legal
§ Mental health
§ Physical
§ Problematic alcohol and other drugs use
§ Sexuality
§ Social
§ Spiritual
§ Trauma informed care
Once you have a list of the client’s needs you can begin suggesting options that will assist in meeting their needs.
For example: you have a client who has expressed a wish to have assistance with grief and loss as they have just
had a close family member pass away. You could suggest grief counselling or group support.
Whatever the outcome, give the client a choice. It is always best to provide more than one option so they have the
choice rather than just having one and feeling like they have no choice in their pathway to recovery.
Record keeping
Information is shared within the bounds of confidentiality, and wherever possible, with the consent and knowledge
of a consumer, with people such as:
§ Care network
§ Case managers
§ Consumers
§ Family members
§ Other services
§ Other staff
§ Supervisor
Recordkeeping: Ideally all records should be developed in collaboration with the consumer.
Records of service provision may include:
§ Advanced directive
§ Advocacy letters
§ Assessment records
§ Care and service plans
§ Complaints
§ Consent letters
§ Consumer's own records of their recovery
§ Evaluation forms
§ Feedback and satisfaction forms
§ File notes
§ Individual program plans
§ Individual service plans
§ Initial contact forms
§ Personal records
§ Recovery wellness plans
§ Referral letters
You must always ensure that all policies and procedures are adhered to strictly and that you report any issues in
relation to variances of expected behaviours.
You will need to use these policies and procedures when providing services to mental health clients and all your
provisions must be delivered and adapted in line with the policies and procedures.
If you are unsure about what you can and can’t do for a client, please refer to your policies and procedures or as
your supervisor or manager.
Determine with the person who else they choose to involve in their
recovery process and the roles they want them to play
Determining if the person would like to have other people involved in their recovery process and what roles they
want them to play is a very important part of the person’s recovery.
Finding other people that can help the person with mental illness to overcome barriers is vital to the provision of
the services. People that may be able to assist may include:
§ Family
§ Carer/s
§ Friends
§ Neighbours
§ Social network
§ Co-workers
§ Employers
Each one of these people can play an important role in assisting in their recovery process, to overcome or break
down barriers to recovery.
Ensuring that you maintain and develop effective consultation with the person’s care support network so that you
have all the information you need to assist the client to the best of your ability in order to meet their needs.
ALLOCATION OF ROLES
When allocating roles, it is important to give team members as much information as possible about the work you
require them to do and to make sure they understand and accept the delegation you are giving them. People are
not mind readers; therefore, they cannot be expected to meet your expectations unless you fully brief them in a
clear and unambiguous way.
The support term must not only be well informed about the specific nature of the work you wish them to undertake
and its overall objective, but also the timeframe in which the work must be completed and any other special
conditions or requirements of the work.
Establishing a channel of clear and open communication is also essential if you want your people to be committed
to, and excited about, achieving their own particular objectives and the client’s goals. A policy of open and honest
communication on all issues relating to care plans and strategies will enable each team member to know exactly
what he or she is meant to be doing at any given time, and why, and encourages interaction and constructive
problem solving.
Being ‘available’ for the client and the team is extremely important, as is keeping them ‘in the loop’ about any
important decisions made, why they are making them and how they might affect the team.
When you give instruction and allocate roles and tasks, make sure the individuals to whom you assign the role are
realistically in a position to commit to the task and not simply taking on too much responsibility because they
don’t know how to say no to the client.
In your role, there will be many situations where you need to consult with other individuals and groups in order to
successfully implement the recovery process.
respite in a care facility can help provide the carer with the break they need while still providing for the needs of
the client. This can give the carer the opportunity to participate in employment or social opportunities.
IDENTIFY ISSUES
Family, carer/s and friend’s issues may include:
§ Emotional well-being
§ Exhaustion, lack of sleep
§ Financial difficulties due to loss of income or expense of meeting care needs
§ Feelings of grief and loss, resentment, depression
§ Breakdown of other family relationships
§ Physical health and well-being, the carer's own medical issues
§ Withdrawal from social participation by choice or due to carer obligations
§ Destructive behaviour such as drug or excessive alcohol consumption used to address stress
As identified previously, the support the primary carer provides is vital in economic terms for the government and
to the wellbeing of the client. It is therefore critically important to maintain the health and wellbeing of the primary
carer. You can meet the needs of families and carers by:
§ Providing carer respite
§ Providing access to counselling and psychology services
§ Providing additional practical support
§ Making referrals to services and organisations that could meet their needs
The support you offer in this regard cannot be understated. As the care worker you will be in a unique position to
identify when a carer is experiencing ill health, injury or stress related to, or impacting on, their role as the primary
carer for your client. It is important to record your concerns and observations and report to your supervisor as
soon as practicable.
Carer burnout is a real concern in the support of those who are ageing or living with a disability. There are many
carer support groups and networks available to provide information and assistance to carers at risk.
Trust – This is the foundation of every good relationship. When you trust your team and colleagues, you form a
powerful bond that helps you work and communicate more effectively. If you trust the people you work with, you
can be open and honest in your thoughts and actions, and you don't have to waste time and energy "watching
your back."
Mutual respect – When you respect the people that you work with, you value their input and ideas, and they
value yours. Working together, you can develop solutions based on your collective insight, wisdom and creativity.
Mindfulness – This means taking responsibility for your words and actions. Those who are mindful are careful
and attend to what they say, and they don't let their own negative emotions impact the people around them.
Welcoming diversity – People with good relationships not only accept diverse people and opinions, but they
welcome them. For instance, when your friends and colleagues offer different opinions from yours, you take the
time to consider what they have to say, and factor their insights into your decision-making.
Open communication – We communicate all day, whether we're sending emails and IMs, or meeting face-to-face.
The better and more effectively you communicate with those around you, the richer your relationships will be. All
good relationships depend on open, honest communication.
In the information age, we have to send, receive, and process huge numbers of messages every day. But effective
communication is about more than just exchanging information; it's about understanding the emotion behind the
information. Effective communication can improve relationships at home, work, and in social situations by
deepening your connections to others and improving teamwork, decision-making, and problem-solving. It enables
you to communicate even negative or difficult messages without creating conflict or destroying trust. Effective
communication combines a set of skills including non-verbal communication, attentive listening, the ability to
manage stress in the moment, and the capacity to recognise and understand your own emotions and those of the
person you’re communicating with.
While effective communication is a learned skill, it is more effective when it’s spontaneous rather than formulaic.
A speech that is read, for example, rarely has the same impact as a speech that’s delivered (or appears to be
delivered) spontaneously. Of course, it takes time and effort to develop these skills and become an effective
communicator. The more effort and practice you put in, the more instinctive and spontaneous your
communication skills will become.
Simply effective communication includes these things:
§ Active listening – Active listening is a communication technique which requires the listener to feedback what
they hear to the speaker, by way of re-stating or paraphrasing what they have heard in their own words, to
confirm what they have heard and moreover, to confirm the understanding of both parties.
§ Reflecting feelings – Mirroring the client’s emotions back to them, to help them clarify how they feel.
§ Open and closed questioning or probing – Open questions are those that do not invite a specific response, but
give the person the opportunity to discuss their thoughts and feelings. Closed questions are questions that
require a specific, brief answer.
§ Summarising – Summing up what a person has told you, by selecting key points and ideas and repeating
them back to the client.
§ Reframing – Providing the person with an opportunity to see things from a different perspective, or to shift or
reshape their point of view. For example, a person may be distressed because their partner doesn't respond to
their text messages straight may. You may assist the person to reframe the situation by explaining that their
partner may be busy at work (or otherwise) and that they may not always be able to respond immediately.
§ Exploring options – Discussing and analysing all possible options, so as to help the person to make an
informed decision.
§ Normalising statements – Statements which validate the person’s feelings and remind them that what they
are feeling is understandable and not unusual.
§ Appropriate communication aids – A communication aid helps a person to communicate more effectively with
those around them; these aids range from simple letter boards to sophisticated pieces of computer
equipment.
§ Appropriate modes of communication – There are 4 main types of communication they are as follows;
dialogue or verbal communication, nonverbal communication, visual communication and other types of
communication.
§ Appropriate tone and presentation – Communicated through gesture, body language or posture; facial
expression and eye contact, object communication such as clothing, hairstyles or even architecture, or
symbols and infographics, as well as through an aggregate of the above, such as behavioural communication.
§ Observation – Observation helps understand the effectiveness of communication, this is because body
language (part of non-verbal communication) is instinctive and more reliable than verbal communication in
many cases.
§ Providing appropriate and accurate information – The ability to communicate information accurately, clearly
and as intended, is a vital life skill and something that should not be overlooked.
The way you interact with your clients and staff will determine how your clients perceive you, your business and
your products or services. It is imperative that you promote your company at every turn, and this doesn’t
necessarily only involve times when you are meeting clients. When consulting or interacting with clients you need
to take into account the cultural and personal factors that may be involved. Communicating across cultures is
challenging. Each culture has set rules that its members take for granted. Few of us are aware of our own cultural
biases because cultural imprinting is begun at a very early age. And while some of a culture's knowledge, rules,
beliefs, values, phobias, and anxieties are taught explicitly, most of the information is absorbed subconsciously.
We are all individuals, and no two people belonging to the same culture are guaranteed to respond in exactly the
same way. However, generalisations are valid to the extent that they provide clues on what you will most likely
encounter when dealing with members of a particular culture.
There are certainly many communication skills that are essential to be learned and developed for working with
people with a mental health condition, however, true empathy and encouragement are skills that cannot be
‘faked’.
Developing strength-based approach and person-centred communication revolves around seeing a person with a
mental health condition as a real person. It involves seeing them in the context of their ability, rather than their
disability. It involves not putting a set of standards, preconceived ideas or negative connotations on a person with
a mental health condition. It required that you respect the rights, dignity, choices and confidentiality of the person.
To develop these skills, a worker needs to start with the foundation of treating everyone as an individual. This
involves making a true effort to get to know their clients as an individual, not as a collective with a shared mental
health issues or set of shared character traits. Using appropriate communication skills, the worker should
endeavour to learn about their clients as people – their hopes, aspirations, likes, dislikes, hobbies. This sets a
foundation for building a professional working relationship and fosters trust between the worker and the client.
This may involve a level of appropriate self-disclosure. Person-centred communication is a two-way street. You
cannot expect a client to be comfortable with you if you are not willing to engage the client with your life. Through
conversation, you may find a shared interest, hobby or activity.
Strength based communication techniques include:
§ Reframing
§ Asking solution-focused questions
§ Using inspirational metaphors
§ Enhancing empathy and the need to avoid pejorative labelling
§ Self-esteem building
§ Creative self-management strategies
§ When and how to use incentives
§ Respectful limit-setting
§ Helping people
Building on a foundation of trust will help foster genuine empathy and encouragement. Have you ever had some
‘encouragement’ from a stranger? It can be hard to take seriously, and you may not fully believe the message, as
there is no pre-existing relationship between you and the stranger. This is the same between a worker and a
client. If there is no genuine professional relationship, any efforts you put in to encourage or empower the client
will not be as effective. It is integral to remember that for many clients, and indeed in past times, people with a
mental health conditions did not have a ‘voice’, with many of their actions being controlled or limited. Your clients
may not have had a worker who has demonstrated a caring, professional relationship, and may find it hard to
adapt to a worker that is simply there to manage practicalities of their lives.
Respecting your client involves respecting their thoughts, beliefs, practices and preferences. Just because your
client has a disability, it does not preclude them from engaging in all manner of activities, a faith or religious
belief, from cultural activities, even personal likes or dislikes. You may have differing opinions on a range of the
clients thoughts or beliefs. However, this must not prevent you from undertaking the client relationship with
respect and dignity. You must never criticise a client’s belief system, preference or opinions – these will destroy a
professional-client relationship, disempower them and disengage them from any program or strategy that you try
to implement.
Your professional working relationship with your client must be built on supportive communication, true empathy
and an ethos of encouragement and engagement.
Outside your organisation, you, or your client may have a range of other support mechanisms. These may include:
§ The client's friends or family
§ Any treating medical practitioners, such as their treating GP
§ Any vocational workers
§ Any disability support workers in the community
Each support person or group will often have a specific responsibility and be able to offer specific assistance or
support. An example of this may be the client’s treating GP, who is responsible for the client’s overall health,
medicinal and pharmaceutical needs and ongoing health monitoring. They would not take an active role, however,
in the client’s plans for social engagement or involvement. Alternatively, the client may be involved with vocational
activities, such as craft or pottery. The vocational support workers will not be involved with prescribing medication
or specifically supporting the clients social plans. They will, however, be involved supporting the client in managing
any vocational activities they undertake.
Working with your client, you may need to both support, and seek support from these various support partners.
These support partners will provide a wealth of information (considering any privacy requirements, confidentiality
or restrictions) in assisting you with supporting the person.
2. Identify a way that you can support someone to communicate effectively with you. This could be
body language, effective listening techniques etc.
DEBRIEFING
A debrief is a vital part of your role in community services that enables you and your team to self-correct, gel as a
team, and enhance your performance. It also provides you with the mechanism for “unloading” the actions of the
day, particularly if it has been a strenuous one.
During debriefs, team members reflect upon a recent experience, discuss what went well and identify
opportunities for improvement. They attempt to build a common understanding—by clarifying roles; priorities and
goals—remove obstacles to collaboration, and reach agreements about how to ensure future success.
Debriefing will allow you to discuss any problems you may be having with particular client’s or issues relating to
work, and to get advice from another person on how best to help a client.
There will always be times where it doesn’t seem to matter what you do you cannot help someone, so getting
advice from other people is vital to keeping your mental health in check.
Debriefing can be done in a team environment or can be done on a one-to-one basis. Whatever works to keep you
mentally healthy is what you need to be doing. Regular debriefing should be arranged no matter what your role or
the challenges you face.
"Clients, by virtue of their need for help, are in a dependent, less powerful, and more vulnerable position."
(Herlihy & Corey, 2006, p. 13)
In some cases, there will be a need to address the obvious power issues in the relationship between you and your
client. This will mean you will need to establish a professional working relationship with the person who has a
mental illness or disorder including:
§ Listen respectfully to the person
§ Provide the setting for an emotionally supportive, therapeutic relationship
§ Maintain an empathic, supportive and hope inspiring approach
§ Value the lived experience of mental illness and consequences for the person and significant others, such as
carers and family
§ Give due regard to the person’s age and cultural background, sensitive to ethnicity, race, socio economic
standing and gender as variables that might affect the working relationship
§ Work in partnership with the person and relevant others and ensures mutuality in assessment and action
planning. Partnership and mutuality are values that extend to working with professional colleagues
§ Communicate mutuality in the relationship by using inclusive language, avoiding terms that emphasise
differences in experience, power and person hood between the person and the worker
§ Gather and provide information in a way that respects the person’s experience, beliefs and feelings
§ Welcome and invite feedback from the person
§ In all aspects of work, encourage maximum levels of the person’s participation in decision-making,
emphasising self-determination over day-to-day activities
§ Have the ability to accommodate the needs language and understanding relevant to working with different
age groups: children, young people, adults and older people
§ When working with families and groups, recognise and sees to accommodate the different experiences and
perspectives of different family members and other relevant people
The national practice standards for the mental health workforce highlight power differentials in the client-worker
relationship. Standard 13 states:
In all cases ensuring you address the obvious power differentials between yourself and the client means that you
will have a better more therapeutic relationship with your clients where power is not an issue. It is vital to ensure
your clients do not feel as though they are not as powerful as you are. This can end up damaging the relationship
of hope and trust between you and your client and rendering this relationship ineffective.
At all times you will need to ensure that you take your lead from the person, not insisting on certain aspects of
care. They need to be in charge of their own recovery process and they need to be listened to in order to give them
the charge that they deserve over their own lives.
It is very important to remain calm and speak in reassuring tones to settle a distressed or anxious client, it is also
important to recognise when your personal safety, or the safety of others, is at risk and then take action to avoid
any harm. Most organisations will have a procedure that outlines how you are to respond to a crisis and other
client emergencies. The procedure should also advise on prioritising the steps to take.
All organisations will have a contingency plan to deal with each situation. Each organisation will have very clear
Workplace Health and Safety guidelines in place to ensure that you are practising in a safe manner and so you
know what you need to do in a situation that is potentially dangerous for you and/or others.
Establishing the time frame under which you need to operate is a major consideration. This means that after
identifying the level of risk you may need to respond immediately or you may need to proceed more slowly. Factors
that may require immediate response may be:
§ Removing the client from their environment
§ Seeking urgent medical attention
§ Finding an interim place to stay
The policies and procedures in your organisation, your supervisor and your own assessment skills are what you
will need to use in the moment and use response strategies appropriate to each crisis situation that presents
itself in your work with distressed clients.
For people at more urgent risk, additional action may be needed to facilitate professional help seeking. If you
believe the suicidal person will not stay safe, seek their permission to contact their regular doctor or mental
health professional about your concerns. If possible, the health professional contacted should be a professional
the suicidal person already knows and trusts.
If the person has a specific plan for suicide, or if they have the means to carry out their suicide plan, call a
mental health centre or crisis telephone line and ask for advice on the situation.
At all times you must report the suicidal behaviours/thoughts to your supervisor. You must never agree to keep a
plan for suicide or risk of suicide a secret. If the person doesn’t want you to tell anyone about their suicidal
thoughts, you should not agree but give an explanation why (for example, “I care about you too much to keep a
secret like this. You need help and I am here to help you get it”). Treat the person with respect and involve them
in decisions about who else knows about the suicidal crisis.
If the person refuses to give permission to disclose information about their suicidal thoughts, then you may need
to breach their confidentiality in order to ensure their safety. In doing so, you need to be honest and tell the
person who you will be notifying.
Keep in mind that it is much better to have the person angry at you for sharing their suicidal thoughts without
their permission, in order to obtain help, than to lose the person to suicide.
If the suicidal person has a weapon, contact the police. When contacting the police, inform them that the person
is suicidal to help them respond appropriately. Make sure you do not put yourself in any danger while offering
support to the suicidal person.
Be prepared for the suicidal person to possibly express anger and feel betrayed by your attempt to prevent their
suicide or help them get professional help. Try not to take personally any hurtful actions or words of the suicidal
person.
There may be times when the behaviours become such a high risk that a crisis response might involve the need
for restrictive practices. These behaviours might include:
§ Aggressive behaviours – verbal abuse and threatening behaviours towards staff or community members
§ Inappropriate sexualized behaviour – sexual assault, unsafe and indiscriminate sexual behaviour
§ Socially inappropriate behaviour – urinating, defecating in public
§ Deliberate self-harm
§ Suicide attempts
§ Risk taking – train surfing, unsafe drug taking, dangerous driving
§ Violent crime
§ Arson
Of course some of these behaviours will also involve contact with the police and/or court system.
If a restrictive practice is felt necessary, then the following principles will need to be considered and used:
§ Least restrictive way – impose the minimum limits to freedom that are required for everyone’s safety
§ Implementing positive strategies – the restrictive practice must be used for the minimum amount of time that
is needed then positive strategies must be resumed
§ Consultation with significant others
§ Review of the restrictive practices – to avoid misuse and abuse
§ Transparency and accountability – the team should be open to discuss and question the validity of the
restrictive practice
§ Ongoing support – the need to provide care and support after the incident to ensure the behaviour is not
repeated
If confronted with an aggressive person, the worker is only able to use enough force to defend themselves to risk
prosecution for assault. When considering reasonable force, a court, for example, would look at:
§ The balance of power between the people involved
§ The environment where the incident happened
§ Availability of additional resources
§ Optional courses of action
At all times it is best to work diligently with the support plan to reduce the risk of negative client behaviour.
EMERGENCY ASSISTANCE
When working with people who are dealing with mental health issues there will be occasions when you will be
required to seek emergency assistance.
Emergency assistance may be sought from:
§ Ambulance
§ Clinical mental health services
§ Cultural consultants
§ Hospitals
§ Other organisations
§ Peer workers
§ Person's care network
§ Police
§ Workers within the organisation
Always ensure you follow organisational policies and procedures when you are contacting emergency services and
where possible ensure the confidentiality and privacy rights of the client are adhered to.
Of course there are times when your care for them will override their privacy especially in the case of suicidal
behaviour, when to keep them safe you will have to intervene and provide information to people outside their
normal care range.
Reviewing service plans enables you as the service provider and the client to assess whether the goals set in the
original plan are still current and/or have been met and if any goals or service need changing in order to meet the
new needs of the client.
The principles of recovery-oriented mental health practice ensure that mental health services are delivered in a
way that supports the recovery of mental health consumers.
They are:
1. Uniqueness of the individual
Recovery oriented mental health practice: recognises that recovery is not necessarily about cure but is about
having opportunities for choices and living a meaningful, satisfying and purposeful life, and being a valued
member of the community accepts that recovery outcomes are personal and unique for each individual and go
beyond an exclusive health focus to include an emphasis on social inclusion and quality of life empowers
individuals so they recognise that they are at the centre of the care they receive.
2. Real choices
Recovery oriented mental health practice: supports and empowers individuals to make their own choices about
how they want to lead their lives and acknowledges choices need to be meaningful and creatively explored
supports individuals to build on their strengths and take as much responsibility for their lives as they can ensure
that there is a balance between duty of care and support for individuals to take positive risks and make the most
of new opportunities.
3. Attitudes and rights
Recovery oriented mental health practice: Involves listening to, learning from and acting upon communications
from the individual and their carers about what is important to the individual.
promotes and protects an individual’s legal, citizenship and human rights supports individuals to maintain and
develop social, recreational, occupational and vocational activities which are meaningful to them instils hope in
an individual about their future and ability to live a meaningful life.
4. Dignity and respect
Recovery oriented mental health practice: Involves being courteous, respectful and honest in all interactions
involves sensitivity and respect for each individual, especially for their values, beliefs and culture challenges
discrimination wherever it exists within our own services or the broader community.
5. Partnership and communication
Recovery oriented mental health practice: acknowledges that each individual is an expert on their own life and
that recovery involves working in partnership with individuals and their carers to provide support in a way that
makes sense to them values the importance of sharing relevant information and the need to communicate
clearly involves working in positive and realistic ways with individuals and their carers to help them realise their
own hopes, goals and aspirations.
6. Evaluating recovery
Recovery oriented mental health practice ensures and enables continuous evaluation at several levels:
Individuals and their carers can track their own progress. Services demonstrate that they use the individual’s
experiences of care to inform quality improvement activities. The mental health system reports on key outcomes
that indicate recovery. These outcomes include housing, employment, education, social and family relationships,
health and wellbeing.
Interactions with clients with a mental health issue can be a little strained at times due to the nature of the issue
however there are some things that should always remain the same. They include at all times showing clients:
§ Warmth – Showing warmth just basically means showing kindness
§ Openness – An honest way of talking or behaving in which you do not try to hide anything
§ Care – Looking after and providing for the needs of your client
§ Authenticity – Simply means don’t be false. Make sure you are genuine at all times
This will assist with the regular review of the recovery plan and with the alliance and communication with the
person, ensuring continued support, relevance and effectiveness of the plan.
There are two main types of feedback data that can be collected, and these are:
§ Quantitative feedback: Collects data in the form of numbers. This means that aspects can be measured and
expressed in numbers as percentages or ratios. Quantitative Research tells us ‘how many’, ‘how much’, ‘to
what extent’ or ‘what size’ something is.
§ Qualitative feedback: Collects exploratory data, it asks a variety of carefully planned questions that seek the
underlying reasons, opinions and motivation behind different actions and situations.
All the information will need to be compiled into workable sections and measured against the organisations goals
and objectives in relation to client service. This information is critical in the design and creation of appropriate
policies and actions plans that suit the clients and meets the purpose that they were designed for.
Successful analysis on the feedback that you have gathered will inform on different aspects of the client service
delivery platforms and can assist in determining what about the services offered and clients suits the needs of the
clients as intended.
It is also important that your target audience understands the purpose of the consultation and feedback process
to ensure that information collected during the review is in a manageable and useful format.
It is essential that the results from the feedback collection are used to make positive change and ensure that the
community services organisations are continuously improving the services that are supplied to clients in line with
the feedback collected.
Identify new directions and areas for change in the recovery plan and
amend plans and transition strategies
Continue implementation and review cycle for the recovery plan until
outcomes have been achieved and no further service or support is
required
The person’s willingness and ability to direct the processes relating to the provision of their care may be attributed
to both how well informed they are and a recognition that they have the right to refuse services.
In order to exercise choice and maximise independence, people require access to accurate information that will
help them manage their own lives, understand their options and engage with and actively participate in their
community.
The client has the power to determine the direction that their care takes. Those providing support services should
not presume the direction their care will take. As it is the person who makes the ultimate decision regarding the
provision of their care and services, they are the person who is providing direction to the support worker.
Whilst the support person can provide the client with information and suggestions which they feel may be
beneficial to their care, the client has the right to refuse these suggestions and choose the path they wish to take.
They may wish to determine their ongoing care on a daily basis or institute planning for their needs in the future.
In the case where the support worker identifies potential issues in the way the care in being planned or instituted
then they may wish to raise this with the client, but ultimately they need to respect the client’s decision.
Providing information to the client, may assist them in making decisions about how they may improve their
lifestyle. The information needs to be relevant to their needs and lifestyle, how improvements might be made, and
should identify the services that could be of assistance to them in meeting their needs. This information may be in
relation to issues such as the provision of health care services, equipment that might be beneficial to them,
financial services or perhaps referrals that might provide them with further information they need. Providing this
information will enable the individual to gain a better sense of control over their life.
If the client is not given the responsibility of directing their own care then there is a risk that they will become
compliant with the direction of the support worker or organisation providing the services. Subsequently, this can
negatively impact upon their independence. In this situation the provision of care and services is directed by the
provider and the client risks losing their sense of empowerment. Whilst the support worker may be compliant with
respect to the provision of care and services, the overall effect may be detrimental to the client in that they can
become reliant on others making decisions for them.
There may be compliance issues arise when the support worker, who is in a position of influence promotes what
they see as being beneficial to the client. If the worker promotes their ideas in such a way that they are perceived
to be insistent or intimidating to the client, then this may result in the client feeling disempowered and having to
do what they are told.
A more appropriate way of approaching the client regarding the way in which they utilise a particular service would
be to explain not only what services are available to them but how they might be beneficial. i.e. there should be
reasoning behind the suggestions given.
If the support worker identifies the need for an intervention which will be of benefit to the client, and the client
subsequently refuses, then there should be supporting documentation outlining the refusal as well as the
reasoning behind the refusal. Instances of non-compliance without the appropriate supporting reasoning can
sometimes be viewed as the client being merely obstinate or irrational. Providing the reasoning behind their
choice to refuse the implementation of services can assist in validating their decision.
The client may wish to consult with an advocate before making a decision based on the suggestions of a support
worker.
Advocacy services support people to actively participate in decision-making processes and conversations that
impact on their lives.
Advocates will listen and act in the best interests of the individual and support people with the aim to increase
independence and confidence to represent their own interests, and help them to be aware of the different ways
they can have a say.
PRINCIPLES OF EMPOWERMENT
Gaining independence is a very important aspect of empowerment for people living with a mental illness and this
is a very important aspect of working with people with a mental health condition. It is essential that a range of
steps are taken that will assist in guiding and enabling choice and self-determination in a positive and supportive
manner for the client at all times.
Notes
RESOURCES
Any relevant resources for CHCMHS003 Provide Recovery-Oriented Mental Health Services are outlined below.
Additional information
Title/Author Details
APPENDICES
Any relevant appendices for CHCMHS003 Provide Recovery-Oriented Mental Health Services are outlined below.
The codes were developed after extensive consultation with industry, employers, employees, governmental
agencies and the community to provide greater certainty about what constitutes compliance under the OHS Act.
Other states will have similar compliance codes – refer to your relevant state for further information.
MANDATORY REPORTING
What is mandatory reporting?
The legal requirement to report suspected cases of child abuse and neglect is known as mandatory reporting. All
jurisdictions possess mandatory reporting requirements of some description. However, the people mandated to
report and the abuse types for which it is mandatory to report vary across Australian states and territories.
Who is mandated to make a notification?
The groups of people mandated to notify their concerns, suspicions or beliefs to the appropriate statutory child
protection authority range from a limited number of specified persons in specified contexts (Western Australia,
Queensland) through to every adult (Northern Territory).
The relevant Acts and Regulations in the Australian Capital Territory, New South Wales, Queensland, South
Australia, Tasmania, Victoria and Western Australia contain lists of particular occupations that are mandated to
report. Some states have a limited number of occupations listed, such as Queensland (doctors, departmental
officers, and employees of licensed residential care services) and Victoria (police, doctors, nurses and teachers).
Other jurisdictions have more extensive lists (Australian Capital Territory, South Australia, Tasmania) or use
generic descriptions such as “professionals working with children.”
POLICY FRAMEWORKS
The Australian Government is committed to developing a more effective and efficient mental health system that
improves the lives of Australians with, or at risk of, mental illness. On 26 November 2015, the Australian
Government Response to Contributing Lives, Thriving Communities - Review of Mental Health Programmes and
Services was announced.
The Government tasked the National Mental Health Commission with conducting a national review of mental
health programmes and services. The focus of the review was on assessing the efficiency and effectiveness of
programmes and services in supporting individuals experiencing mental ill-health and their families.
The Australian Government also established a Mental Health Expert Reference Group (ERG) to provide advice to
inform the response to the Review of mental health programmes and services.
Policy frameworks will also be available through your relevant state or territory authority.
RECORD KEEPING/MANAGEMENT
Information is shared within the bounds of confidentiality, and wherever possible, with the consent and knowledge
of a consumer, with people such as:
§ Care network
§ Case managers
§ Consumers
§ Family members
§ Other services
§ Other staff
§ Supervisor
Recordkeeping: Ideally all records should be developed in collaboration with the consumer.
Records of service provision may include:
§ Advanced directive
§ Advocacy letters
§ Assessment records
§ Care and service plans
§ Complaints
§ Consent letters
§ Consumer's own records of their recovery
§ Evaluation forms
§ Feedback and satisfaction forms
§ File notes
§ Individual program plans
§ Individual service plans
§ Initial contact forms
§ Personal records
§ Recovery wellness plans
§ Referral letters
You must always ensure that all policies and procedures are adhered to strictly and that you report any issues in
relation to variances of expected behaviours.
You will need to use these policies and procedures when providing services to mental health clients and all your
provisions must be delivered and adapted in line with the policies and procedures.
HISTORICAL CONTEXT
Below is a timeline briefly describing the historical context of mental health work in Australia, which reflects the
changing attitudes to mental health and approaches to working with people with mental health issues
1811
§ Opening of Australian Lunatic Asylum Castle Hill NSW
§ Mental illness viewed as madness and related to ‘bad blood’ or character flaws rather than illness
§ Management was custodial and by physical restraint, isolation and control
§ Little emphasis on treatment
§ Staffed by untrained care assistants
1867
§ Act of Parliament sends people with mental illness to asylum rather than prison
1900
§ Separation of mental illness and ‘mental retardation’
§ Male attendants remain untrained
§ Medical superintendents start training staff
§ Introduction of female staff considered
1950 to 1980s
§ Expanded nursing curricula
§ Commencement of specialisation in nursing
§ Illness approach to mental health problems
§ Curative focus
§ Major tranquilisers developed
§ Pharmaceutical management rather than physical restraint possible
§ Beginning of nurses working therapeutically with clients individually and groups
1970s to 1980s
§ Scaling down/closing of psychiatric institutions
§ Smaller units in general hospitals
§ Increase in community-based care
§ Reduction in length of stay in inpatient units
§ Significant numbers of people never admitted to hospital yet well managed
Current
§ Significant numbers of people never admitted to hospital yet well managed
§ People receiving care within own family and community setting
§ Least restrictive environment possible
§ Mainstreaming
HOLISTIC APPROACH
For a worker to respond holistically to a client’s issues, they need to:
§ Appreciate the complexity of the person’s situation/issues and the environment in which that situation/issue
occurs
§ Understand how this issue/situation affects the client in all aspects of their functioning – physical, emotional,
spiritual, and mental
§ Establish an effective and trusting relationship with the client to explore their options with them so they can
resolve their issues
§ Liaise with other significant people or organisations in the client’s life to facilitate the client’s goals and action
plans
Holism is a term from the Greek word ‘holos’ meaning whole. Thousands of years ago Aristotle encapsulated the
principle of holism when he wrote, ‘The whole is more than the sum of its parts’ (from Aristotle’s Metaphysics).
When we apply this concept to human beings, it brings awareness that we cannot really know a person without
learning about all aspects of their life and understanding the impact of the interrelationships between those
aspects.
This has been most clearly seen in the area of health care, where the concept of holistic health care has replaced
the more traditional medical model. The traditional approach of treating the illness and not the person failed
miserably to improve the overall wellness of patients. In addition, the medical model raised the status of the
medical profession to that of a divinity and effectively removed the right and responsibility of the patient to be a
decision maker or even a participant in their own care.
However, the concept of holistic care is not restricted to the field of medicine and health care. It is now the guiding
principle in all forms of community and disability service work. Workers in all sectors (e.g. domestic violence work,
youth work, and disability services work) need to adopt an approach that emphasises the need to look at the
whole person and consider their physical, environmental, emotional, social, spiritual and lifestyle situation. To
achieve this, you attempt to understand the interplay of personal, relationship and social factors that affect the
current situation for each client. This approach recognises that people need resources, support and knowledge so
they can make choices that will better enable them to function in their environment (Berger, RL, McBreen, JT, &
Rifkin, MJ 1996).
Hence holistic care focuses on educating the person so that they can take responsibility for achieving balance and
wellbeing in their life. It promotes a belief in the ability of clients to control or at least participate in the planning of
their lives if given the necessary knowledge, skills and support.
Working with clients in an holistic approach requires you to look at the person from a whole-of-life perspective,
including:
§ Emotional support
§ Education
§ Work
§ Recreation
§ Health and mental health
§ Finances
§ Accommodation/housing
§ Networks/community/family
§ Culture/religion
§ Legal issues
People and the situations in which they find themselves are very complex. Clients are likely to present with
multiple issues. They may be referred to the agency you work for, or contact the agency themselves, because of
one presenting problem but it is very likely that this presenting problem is only one issue relating to a broader
range of problems that the client is experiencing. A client’s social, emotional, spiritual and physical wellbeing
needs to be seen within the broader context of their world.
SOCIAL JUSTICE
Social justice refers to the idea of creating a society based on principles of equality and solidarity that
understands the values of human rights and that recognises the dignity of every human being.
A healthy community brings substantial personal, community and national benefits…Health and wellbeing is
influenced by social determinants – the conditions in which people are born, grow, live, work and age. In Australia,
the higher your income and education level, the better your health will tend to be, creating health inequality.
People on low incomes, people in rural and remote areas and Aboriginal people have on average poorer health,
die earlier and receive less healthcare than other Australians. There is currently a significant gap in life expectancy
between wealthier and poorer people in Australia. Social issues are also the primary cause of chronic health
problems, including cardiovascular disease, diabetes and obesity.
CITIZENSHIP
Concepts of citizenship relevant to people with mental health issues include:
§ Self-determination: This has been an important concept for both the independent living and self-advocacy
movements. Within the wider citizenship debates, there is an assumption that individuals have capacity for
free choice and, particularly within the liberal tradition, full citizenship involves the exercise of autonomy
§ Participation: This concept is often used by disabled people when engaging with the debate on social
exclusion
§ Contribution: The value of our contribution to economic and social life
REFERENCES
Any relevant references for CHCMHS003 Provide Recovery-Oriented Mental Health Services are outlined below.