Stigma and common misconceptions surrounding mental illness often result in consumers not accessing mental health services until episodes have reached a more severe level (Meadows et al, 2009). No matter when a consumer presents to services it is important that we view the consumer as sitting within a continuum of care, with an understanding that treatment involves several phases of care with the view to providing a recovery based service (Australian Health Ministers, 2003).
Generally individuals fit within a continuum in the following manner:
(Commonwealth Department of Health and Ageing, 2000)
The arrows in this diagram point both ways because it is not a linear process. Many consumers move in both directions from the community to inpatient acute care and then back to community based intervention and so on. Some stages of illness require acute care whereas others don’t. When working in a recovery-focused way, clinicians should always bear in mind that recovery is the main goal of intervention.
But what do we really mean by recovery?
Read the relevant pages of your Meadows text about recovery and supporting recovery in Chapter 17
What is your definition of recovery? How do you envisage your role in helping the consumer with their recovery process?
Recovery can be viewed as a journey through differing types of care (Meadows et al, 2012). It often starts with the mental health issue being diagnosed and care being offered to the consumer within the community, if at all possible.
If this is not sufficient, the consumer may receive acute care in hospital as an inpatient. Following a period of acute care, there needs to be a period of rehabilitation which may involve both inpatient and outpatient care. This is then followed up by community support, with a focus on relapse prevention.
It is important during all these stages that clinicians work closely within their treating teams and make clear the role they are playing in the recovery process. Clear consistent messages are important during the whole treatment process, as relapse prevention work towards the end is reliant on consistent messages throughout the treatment process.
Community based intervention
Assuming for a moment that the assessment stage suggests that care within the community is appropriate for the consumer, there are two main types of intervention that are possible:
• Therapy or the use of suitable focused psychological strategies
• Advocacy and social support
These two main types of intervention are conducted within the context of interdisciplinary collaboration and planning.
When planning therapy it is important to consider the client in their entirety (Meadows et al, 2012). The following should be considered prior to planning any therapy with a consumer:
• Is the consumer willing to continue with therapy for the time required?
• What psychosocial issues may prevent therapy from succeeding? (eg. geographical isolation and low income preventing travel)
• Is the client sufficiently safe and secure in order to reduce stress to the point where therapy can succeed?
• Does your service have the resources to provide the therapy needed for the period it is required?
Quite often these issues create barriers to treatment and provide many clinicians with a very difficult decision: what do you provide to a client when the most obvious evidence-based intervention is not a viable option?
When therapy is unable to progress for one of these reasons, a mental health practitioner can do two things. First, they can work to mitigate risk and build rapport with the client. Rapport is often the greatest indicator of successful outcomes, more so than the type of therapy used (Hernandez et al, 2007).