Module I Defining a Mental Health Crisis Roles and responsibilities

1. Multidisciplinary Responses to Mental Health Crises Module IDefining a Mental Health CrisisRoles and responsibilities

2. Multidisciplinary Responses to Mental Health Crises Module IVideo 1 Double click on the movie to start

3. Module I Outline Multidisciplinary Responses to Mental Health Crises By the completion of this module, students should be able to: • Define the terms mental illness and mental health crisis. • Compare and contrast the role and responsibilities of key stakeholders involved in mental health crises • Identify appropriate contacts for patients at times of crisis.

4. Definitions Multidisciplinary Responses to Mental Health Crises • How would you define “mental illness”? • What about a “mental health crisis”? • Consumers...patients or clients? • Provide illustrations from your clinical experience.

5. Stakeholders Multidisciplinary Responses to Mental Health Crises What agencies/personnel would typically be involved in a Mental Health Crisis?

6. Referral Pathways Multidisciplinary Responses to Mental Health Crises Field Event GP Person behaving abnormally Ambulance ED Police CATT Bystander or Family Member 000

7. Guiding Principles Multidisciplinary Responses to Mental Health Crises When any agency attends a mental health crisis, their collective aims should be to: • Prevent harm to the person and any others present, including attending staff. • Respond in ways that are supportive and minimise restrictions to the person’s freedom. • Maintain the dignity and rights of the person.

8. Are We Doing That? Multidisciplinary Responses to Mental Health Crises In Nov 2009 The Victorian Auditor-General assessed the coordination, preparation and effectiveness of police, ambulance and mental health triage and CAT service responses to mental health crises • The report identified the following concerns: • DOH lacks useful data to determine responses and the effectiveness of responses to mental health crises

9. Are we doing that? Multidisciplinary Responses to Mental Health Crises • Victoria Police needs to address their standard training in the management of mental illness. • Significant training gaps exist for CATT clinicians and Paramedics, particularly with regards to de-escalation and interagency liaison. • Police, AP’s and CATT lack opportunities for interagency learning and exposure to consumer experience.

10. Victorian Auditor-Generals Report Multidisciplinary Responses to Mental Health Crises • There is a lack of clear communication about expectations and limitations of CAT services. • The sites used to conduct mental health assessments and modes of transport do not reflect existing protocols and the principles of the Mental Health Act 1986. This program aims to address some of these issues.

11. Roles and Responsibilities of Key Stakeholders Multidisciplinary Responses to Mental Health Crises

12. General Practitioners Multidisciplinary Responses to Mental Health Crises • Often primary healthcare provider and as such, maintaining the longstanding relationship is important. This is important to note in Module IV. • GP’s have a responsibility to care for the patient, practice staff and other people in the environment at that time, so safety is pivotal

13. Ambulance Victoria Multidisciplinary Responses to Mental Health Crises Primary role is the transport of mentally ill persons. DOH and AV protocol (2002) states the ambulance service is the lead agency for transport and an ambulance should be called when: • A person cannot be safely transported in any other way. • Medical treatment is urgently needed. • An involuntary patient has been sedated by oral, intramuscular or intravenous medication to transport them to an approved mental health service. • A person needs to be mechanically restrained.

14. Transport Options Multidisciplinary Responses to Mental Health Crises There are however, some alternatives to ambulance transport that should be considered if appropriate. These include: • A private vehicle driven by a family member, carer or friend. • Taxi accompanied by a family member, carer or friend. • Agency driven vehicle driven by a mental health professional with either another mental health professional or if required, a police officer to accompany them. • Police as last resort.

15. Discussion Point Multidisciplinary Responses to Mental Health Crises • What are the benefits of ambulance facilitated transport? • What are the drawbacks of ambulance facilitated transport? 000?

16. Police Multidisciplinary Responses to Mental Health Crises • Police objectivesinclude preserving the peace, maintaining public safety and helping those needing assistance and detecting and apprehending offenders. This is also the case during a mental health crisis. • Their role when mental health practitioners are available is to preserve the peace, maintain safety and only if absolutely necessary, transport the patient; as well as acting on any criminal offences.

17. Police Multidisciplinary Responses to Mental Health Crises Under Section 10 of the Mental Health Act, police may apprehend a person who appears mentally ill, based on their appearance and behaviour, for the purposes of arranging for a mental health assessment or examination. Police will generally do so either by contacting triage or attending a hospital Emergency Department. This will be discussed further in Module IV.

18. Discussion Point Multidisciplinary Responses to Mental Health Crises Why is there now an emphasis on minimising the use of police vehicles as the primary means of transporting the mentally ill, to include other alternatives?

19. Police and Mental Health Services Multidisciplinary Responses to Mental Health Crises • When Police and CAT are in attendance: • Mental health clinicians are responsible for the Ax, treatment and care of people with a MI and for providing advice about matters relating to MI; and • Police remain responsible for incident control and the safety of all persons present at the scene; although mental health service personnel can provide information and assistance, they cannot act as negotiators. • Keep this in mind for Module III.

20. CAT Multidisciplinary Responses to Mental Health Crises • Crisis Assessment and Treatment Teams which are a part of area mental health services. They operate 24/7. • Service eligible to people between 16-64 years during business hours and all ages after hours. • During business hours those under 16 years and over 64 years have specific services designed to manage crises. • CAT are staffed by multidisciplinary teams including social workers, nurses, OT’s, psychologists and medical staff.

21. CAT Multidisciplinary Responses to Mental Health Crises Community-based outreach service for assessing and treating people suffering from serious mental illness. Roles: • Assessment of people in acute phase of a mental illness. • Intervention for people in psychiatric crisis to identify problems and alleviate risks. • Short-term intensive treatment of people with an acute mental illness, in their usual residence, as an alternative to admission to an inpatient service.

22. CAT Multidisciplinary Responses to Mental Health Crises • Despite their name, most CAT services do not have the capacity or resources to respond immediately to crises. • General guidelines suggest they should respond within 24 hours. This may change region to region and is a cause of great confusion amongst clinicians and the general public.

23. Emergency Department Multidisciplinary Responses to Mental Health Crises When patients arrive in the ED the goal is to: • Exclude life threatening disorders. • Identify and treat organic disorders. • Determine whether the behavioural disorder is functional (such as schizophrenia or mania). • It is usually not possible to arrive at a specific psychiatric diagnosis in the emergency setting.

24. Emergency Department Multidisciplinary Responses to Mental Health Crises • As a general rule the management strategy utilised will be the least invasive possible to ensure the safety of the individual patient and all others within the ED. • Referral teams are available and larger ED’s have specialist mental health nurses on staff. • It is vital that you do not make promises to the patient regarding what will happen when they reach the ED except to reassure them that they will be safe.

25. Interagency Roles in Mental Health Crisis

26. Multidisciplinary Responses to Mental Health Crises Module I Video 2 Double click on the movie to start

27. Resources Multidisciplinary Responses to Mental Health Crises The locations and contact numbers of area mental health services can be accessed via: http://www.health.vic.gov.au/mentalhealth/services/adult/index.htm

28. References Multidisciplinary Responses to Mental Health Crises • Cameron, P., Jelinek, G., Kelly, A., Murray, L., & Brown, A. (Eds.). (2009). Textbook of Adult Emergency Medicine (3rd ed.). Sydney:Churchill Livingstone. • Center for Mental Health Services (2009). Practice Guidelines: Core Elements for Responding to Mental Health Crises. HHS Pub. No. SMA-09-4427. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. • Department of Human Services (2002). Ambulance transport of people with a mental illness. Victoria, Melbourne: Victorian Government Department of Human Services, Metropolitan Health and Aged Care Services. • Mental Health Act 1986 (Vic). Retrieved April 28th, 2010, from http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubLawToday.nsf/2184e627479f8392ca256da50082bf3e/408CAB28203FBAA7CA257695000683EF/$FILE/86-59a096.pdf • Springvale Monash Legal Service Inc. (2005). Police training and mental illness – A time for change. Retrieved April 28th, 2010, from http://www.smls.com.au/pdfs/publications/2005/PTMI%202005.pdf • Springvale Monash Legal Service Inc. (2007). Crisis Assessment and Treatment (CAT) Services in Victoria. Retrieved April 28th, 2010, from http://www.smls.com.au/pdfs/publications/2007/cat_service_booklet.pdf • Victorian Auditor-General. (2009). Responding to Mental Health Crises in the Community. (PP No 245). Victorian Government Printer: Victoria.