In this section you will learn to:
- Work in a way that reflects and prioritises the person’s right to self define and direct their own recovery
- Communicate in a way that develops and maintains respect, hope, trust and self-direction
- Recognise and respect the person’s social, cultural and spiritual differences
- Support the person to understand and exercise their rights
- Maintain confidentiality and privacy of the person within organisation policy and protocols
Supplementary materials relevant to this section:
- Reading A: National Standards for Mental Health Services 2010
It is important for a community support worker to know how to work effectively with people with mental health issues. Even though, in your role, you would not be the sole practitioner working with clients with mental health issues, you may be working with them as part of their larger case management plan or you may assist individuals with mental health needs to seek out appropriate services. As such, it is important for you to have a good understanding of the key principles and processes of the mental health sector. In this section of the Study Guide you will learn more about the key values and principles of working in the mental health sector and how these can be applied in your work.
Historical Context of The Mental Health Sector
The way we view and treat mental illness has undergone major changes over the last 50 years. In particular, there has been a trend towards increased respect for the human rights of clients, more client-centred decision-making, and a focus on the principles of recovery.
Early attitudes towards and treatment of mental illness in Australia reflect its foundation as a penal colony. Mental illness was essentially treated the same as criminality, and sufferers were locked away and subjected to the same harsh, regimental attitudes as convicts, and in many cases the mentally ill were locked up in the same jails as criminals. Mental illness was not considered to be a medical condition by many in authority until the early 19th century. In religious communities, it was sometimes thought to be a manifestation of demonic possession, while some social reformers and philosophers thought it was a sign of social degeneracy. Australia’s first purpose-built facility for the treatment and protection of the mentally ill was Tarban Creek asylum, built in Sydney in 1838.
While misunderstanding and mistreatment of mental illness continued, in 1843 the Lunacy Act was introduced in Victoria, showing a growing awareness of the need to treat mental illness as a medical condition and for governments to protect and provide care for the mentally ill. The 19th century saw the development of the new discipline of psychiatry in Europe, with its most famous practitioners including Sigmund Freud and Carl Jung. Treatments like electroshock therapy, lobotomy, hydrotherapy (ice baths) and hypnosis were practised into the late 20th century in many countries, including Australia. Dream interpretation, regression therapy, rebirthing, and primal scream therapy were just a few of the non-invasive therapies experimented with throughout the last century. Psychoanalysis is one of the most enduring therapies and is still practised.
The following extract provides an overview of the history and evolution of mental health services. While it focuses on Queensland, the changes discussed are applicable to all of Australia.
From Institution to Community
In the early days of Queensland’s history, it was assumed that people with mental illness had no capacity to look after themselves and should be separated from the rest of society.
In the 1950s, new ideas about the organisation of psychiatric care shifted the emphasis from custodial care in large, closed institutions to supporting patients to live in the community. Increasing numbers of patients were discharged and fewer admitted, and allied health professionals became involved in preparing patients for life beyond the walls of the institution.
Today, it is recognised that many risk factors for mental illness lie beyond the health system, and relate to aspects of our everyday lives. These aspects include material well-being, housing, education, community inclusion and acceptance and employment. There is growing recognition that a whole-of-government, whole-of-community approach is necessary to reduce the prevalence and impact on the mental health of individuals, their families, carers and communities.
In response, Queensland Health, as part of the Queensland Plan for Mental Health 2007-2017, committed $4.77 million over the four years to 2011 to strengthen the capacity to coordinate care for consumers with complex needs living in the community.
Changing Community Attitudes
Despite increasing awareness about mental health issues in the community, there are still many misconceptions about mental illness that create barriers that sufferers are constantly coming up against in the community, in their relationships and in employment. The mental illness label marks people as ‘other’. It creates a stigma, where people with mental illness may feel shame, disgust, isolation, and a sense of otherness. This stigma can lead to them believing that they are not normal, and therefore do not deserve to be treated with the same dignity and respect as everyone else. Stigmatisation in the community can lead to discrimination. People with mental illness are seen by others through a lens of fear or misunderstanding. Labels like dangerous, unstable, unreliable, morbid, or morose, lazy, crazy, and unpredictable, all create barriers to understanding the real person behind the label, their abilities, their uniqueness and potential. This is particularly the case for those living with a disability and older people. Not only do they face the challenges of everyday life, but there are several stereotypes, myths and stigmas that surround them and can negatively affect their mental health issues.
Widespread social attitudes and values of colonial Australians influenced how people suffering from mental health issues were perceived by the community. Hard work, individual effort and virtuous living promised to bring success and security to individuals able to live up to these ideals. People who did not, particularly those considered ‘insane’, were seen to be responsible for their illness due to moral weakness and personal deficiency.
Psychiatrists and other health professionals tried to influence the public perception of mental illness so it was regarded as an illness like any other. Recommendations for changes including those relating to opening mental health units in general hospitals and introducing the concept of voluntary admissions were specifically directed at reducing the stigma attached to individuals with mental illness. When the first ward of this type was opened in at the Brisbane General Hospital in Queensland in 1918, Dr Henry Byam Ellerton commented:
This ward was built to meet a long-felt need – namely, to supply suitable accommodation where patients with impending mental breakdown, or even acute mental cases in their initial stages, might receive all the advantages of medical treatment and skilled nursing without the stigma of certification as insane.
People who live with mental illness still experience stigma and discrimination. The results of stigma can often be worse than the illness itself, particularly when people face discrimination finding employment, a place to live, satisfactory health care and connections to other people. This stigma has tragic consequences. Many people with mental health problems fail to seek treatment because of the shame associated with their illness.
Here is a brief overview of the myths and facts surrounding mental illness:
Myth: Mental illness is indicative of personal weakness.
Fact: Mental illnesses are medical conditions resulting from a blend of biological, genetic, environmental, and psychological factors. They are not a reflection of personal weakness.
Myth: People with mental illnesses are inherently violent and dangerous.
Fact: The majority of individuals with mental illnesses are not violent; in fact, those facing mental health challenges are more likely to be victims of violence than perpetrators.
Myth: Mental illnesses are not real medical conditions.
Fact: Mental illnesses are legitimate medical conditions with biological, neurological, and psychological components. They can be diagnosed, treated, and effectively managed.
Myth: Only specific demographics are affected by mental illness.
Fact: Mental illness can affect anyone, irrespective of age, gender, race, socioeconomic status, or background. It is a widespread and diverse health concern.
Myth: People with mental illnesses cannot lead fulfilling lives.
Fact: With appropriate treatment and support, many individuals with mental illnesses can lead productive, fulfilling lives. Recovery is possible, allowing people to achieve their goals and aspirations.
Myth: Mental illnesses are rare and uncommon.
Fact: Mental illnesses are common, affecting a significant portion of the population. According to the World Health Organisation (WHO), one in four people will experience a mental health issue at some point in their lives.
Myth: Mental health is separate from physical health.
Fact: Mental and physical health are interconnected. Mental illnesses can impact physical health, and vice versa. For example, conditions like depression can contribute to physical health challenges.
Myth: Once diagnosed, individuals cannot recover from mental illness.
Fact: Many people with mental illnesses recover fully or manage their conditions effectively with appropriate treatment, support, and self-care. Recovery is a dynamic and achievable process.
Myth: people are either mentally healthy or mentally ill.
Fact: Mental health exists on a continuum, and everyone experiences fluctuations in their mental well-being. Mental health is not an all-or-nothing concept, and seeking support is a positive step for everyone.
These myths often leads to the following barriers that people with mental illness commonly face:
- Prejudice and discrimination: Prejudice leads to negative stereotypes, fear, and discrimination against individuals with mental health illnesses. This can result in social isolation, limited opportunities, and a reluctance to seek help.
- Barriers to access services: Barriers such as financial constraints, lack of awareness, and limited mental health resources often limit access to timely and appropriate mental health services.
- Social isolation: Stigmatisation may lead to social withdrawal and isolation, impacting an individual's social support network and exacerbating feelings of loneliness and alienation.
Advocacy and Consumer Participation
While there have always been critics of asylums and institutions, advocacy for patients with mental health issues was formalised in Queensland in the 1940s with the formation of the Relatives of the Mentally Ill Association. The Association made frequent approaches to government over conditions at the Goodna Mental Hospital and raised issues such as increasing the quality of meals and clothing for patients, improving recreation facilities and establishing an ‘after-care home’ for patients who resided in the institution because they had nowhere else to go.
The civil rights movement of the 1960s and 1970s raised awareness of the rights of minority groups, including people with mental illness. In 1977, the Queensland Department of Health established the Office of the Patients’ Friend to advocate for individual rights including the right to be consulted about treatment, the right to be protected from abuse, and the right to be free from unnecessary controls.
Various non-government organisations have also been established to advocate and support people with mental illness and their families and carers.
As the human rights movement gained momentum, the voices of patients themselves emerged as a force for change. One objective was to shift the balance of power to place mental health service users on an equal footing with professionals. In recognition of the expertise that mental health consumers have in their knowledge of mental illness, current health policy in Queensland supports the active participation of consumers, families and carers in all aspects of policy, planning and services.
Summary of historical, social,political and economic impact - mental health sector
The mental health sector in Australia, like in any other country, is influenced by a complex interplay of historical, social, political, and economic factors. Understanding these influences is crucial for developing effective mental health policies and services. Here's an overview of how each of these factors impacts the mental health sector in Australia:
Historical Impact: Stigma and Discrimination: Historical stigmas associated with mental health issues have influenced public perceptions and attitudes. Efforts to combat stigma and discrimination have been ongoing, but historical prejudices can still affect how individuals with mental health conditions are perceived and treated. Institutionalization: Australia, like many other countries, had a history of institutionalizing people with mental illnesses. The shift towards community-based care and deinstitutionalization has influenced the current mental health landscape.
Social impact: Increasingly, people are recognizing and embracing the importance of mental health as an essential component of overall well-being, with initiatives promoting this gaining momentum. Advocacy groups play a crucial role in diminishing stigma, fostering comprehension, and pushing for policy reforms to enhance mental health assistance. Modern perspectives underscore the importance of destigmatization, awareness campaigns for mental health, and the promotion of inclusivity. Approaches that prioritize the individual and emphasize recovery have become more prominent.
Political Impact: Policy and Funding: Government policies and funding decisions have a direct impact on the mental health sector. Adequate funding and effective policies are crucial for the development and maintenance of mental health services. National Mental Health Strategy: Australia has implemented various national mental health strategies to guide policy and service development. The political commitment to mental health at the national and state levels greatly influences the sector's effectiveness.
Economic impact:Access to Services: Economic factors can affect access to mental health services. Socioeconomic disparities may result in unequal access to quality mental health care. Employment and Mental Health: Economic downturns and job insecurity can contribute to increased stress and mental health challenges. Conversely, supportive workplace policies and mental health programs can positively impact mental well-being.
Values and principles in mental health
Recovery
The concept of ‘recovery’ is an emerging paradigm in mental health services that focuses not on a patient being ‘cured’, but of individuals living meaningful lives with mental illness. Recovery acknowledges that having a mental illness does not necessarily mean life long deterioration, but focuses on an individual’s journey toward a sense of identity, role and purpose beyond the boundaries of mental illness. The recovery approach focuses on the person experiencing improved quality of life and higher levels of functioning despite their illness, rather than solely on reduced symptoms or the need for treatment.
Patient Rights
The Queensland mental health system is based on a framework which encompasses fundamental rights and responsibilities for all people who have a mental illness, including the following:
People with a mental illness are entitled to respect for their basic human rights, confidentiality, and must be able to participate in decisions made about them.
The specific cultural, religious and language needs of individuals must be respected.
Treatment should only be provided where it promotes or maintains the person’s mental health, and should impose the least restriction on their rights possible with due regard for the safety of the person and others.
(Queensland Health, 2009)
Principles of Recovery and Empowerment
The above extract highlights the importance of the concept of ‘recovery’ to modern mental health services. The concept of recovery oriented practice is central to working effectively with clients with mental health issues. This is explained in the following extract.
Principles of Recovery Oriented Mental Health Practice
From the perspective of the individual with mental illness, recovery means gaining and retaining hope, understanding of ones abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self.
It is important to remember that recovery is not synonymous with cure. Recovery refers to both internal conditions experienced by persons who describe themselves as being in recovery— hope, healing, empowerment and connection—and external conditions that facilitate recovery—implementation of human rights, a positive culture of healing, and recovery-oriented services.
Jacobson and Greenley, 2001 p. 482
The purpose of principles of recovery oriented mental health practice is to ensure that mental health services are being delivered in a way that supports the recovery of mental health consumers.
1. Uniqueness of the individual
Recovery oriented mental health practice:
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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
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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
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empowers individuals so they recognise that they are at the centre of the care they receive.
2. Real choices
Recovery oriented mental health practice:
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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
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supports individuals to build on their strengths and take as much responsibility for their lives as they can at any given time
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ensures 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:
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involves listening to, learning from and acting upon communications from the individual and their carers about what is important to each individual
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promotes and protects individual’s legal, citizenship and human rights
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supports individuals to maintain and develop social, recreational, occupational and vocational activities which are meaningful to the individual
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instils hope in an individual’s future and ability to live a meaningful life.
4. Dignity and respect
Recovery oriented mental health practice:
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consists of being courteous, respectful and honest in all interactions
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involves sensitivity and respect for each individual, particularly for their values, beliefs and culture
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challenges discrimination and stigma wherever it exists within our own services or the broader community.
5. Partnership and communication
Recovery oriented mental health practice:
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acknowledges 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
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values the importance of sharing relevant information and the need to communicate clearly to enable effective engagement
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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:
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ensures and enables continuous evaluation of recovery based practice at several levels
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individuals and their carers can track their own progress
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services demonstrate that they use the individual’s experiences of care to inform quality improvement activities
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the mental health system reports on key outcomes that indicate recovery including (but not limited to) housing, employment, education and social and family relationships as well as health and well being measures.
(Department of Health, 2010)
Here is the summary of the key values and principles in mental health sector:
- Recovery: Acknowledges that individuals with mental health challenges can regain a fulfilling life beyond the limitations of their condition. It prioritises hope, resilience, and personal growth, fostering a belief in the capacity for recovery.
- Recovery oriented practice: Approaches mental health care with a focus on supporting individuals in their recovery journey, emphasising collaboration and person-centered care. It recognises the individual's agency, strengths, and goals, promoting self-determination and autonomy.
- Health promotion and prevention: Aims to enhance mental well-being and prevent mental health issues through proactive measures, education, and awareness. It emphasises the importance of early interventions and community initiatives to improve overall mental health.
- Holistic approach: Considers the interconnectedness of physical, psychological, social, and environmental factors in addressing mental health. It advocates for comprehensive and integrated care that attends to the diverse aspects of an individual's life.
- Empowerment and disempowerment: Empowerment involves supporting individuals to make decisions and take control of their lives. Disempowerment refers to processes that limit autonomy. This encourages practices that empower individuals, involving them in decision-making, and avoids actions that diminish autonomy.
- Access and equity: Ensures that mental health services are accessible to all, regardless of socio-economic status, ethnicity, or geographical location. It strives for fairness and inclusivity, addressing barriers to access and promoting equal opportunities for mental health care.
- Early intervention: Involves timely and proactive measures to address mental health issues at their early stages, preventing escalation. It recognises the significance of early identification and intervention to enhance outcomes and reduce the impact of mental health challenges.
- Rights: Upholds the human rights of individuals with mental health issues, including the right to dignity, privacy, and participation in decision-making. It advocates for the protection of fundamental rights, ensuring individuals are treated with respect and without discrimination.
- Social justice and inclusion: Promotes fairness and equality in the distribution of resources and opportunities, advocating for the inclusion of individuals with mental health challenges in all aspects of community life. It works towards dismantling stigma and discrimination, fostering a society where everyone has equal access to social, economic, and educational opportunities.
- Citizenship: Recognises individuals with mental health issues as active members of society with the right to participate fully in community life. It encourages the integration of individuals with mental health challenges into the broader community, emphasising their roles as citizens with rights and responsibilities.
As you can see, there is now an increasing focus on assisting individuals with mental health issues to understand their abilities, have a positive sense of self, develop their autonomy, and engage with the community. In fact, this focus is highlighted in the National Standards for Mental Health Services. The full Standards are provided in Reading A; however, the following extract provides a good outline of the key principles of these Standards.
Reading
Reading A – National Standards for Mental Health Services 2010
Reading A provides a copy of the National Standards for Mental Health Services 2010 which outlines the key principles and standards underpinning mental health service provision.
Key principles that have informed the development of the Standards include:
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Mental health services should promote an optimal quality of life for people with mental health problems and / or mental illness.
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Services are delivered with the aim of facilitating sustained recovery
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Consumers should be involved in all decisions regarding their treatment and care, and as far as possible, the opportunity to choose their treatment and setting.
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Consumers have the right to have their nominated carer(s) involved in all aspects of their care.
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The role played by carers, as well as their capacity, needs and requirements as separate from those of consumers is recognised.
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Participation by consumers and carers is integral to the development, planning, delivery and evaluation of mental health services.
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Mental health treatment, care and support should be tailored to meet the specific needs of the individual consumer.
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Mental health treatment and support should impose the least personal restriction on the rights and choices of consumers taking account of their living situation, level of support within the community and the needs of their carer(s).
Finally the Standards describe care that will be delivered in accordance with each of the nine (9) domains from the Key Performance Indicators for Australian Public Mental Health Services (2005) as follows:
Effectiveness: care, intervention or action achieves desired outcome in an appropriate timeframe.
Appropriateness: care, intervention or action provided is relevant to the client’s needs and based on established standards.
Efficiency: achieving desired results with the most cost-effective use of resources.
Accessibility: ability of people to obtain health care at the right place and right time irrespective of income, physical location and cultural background.
Continuity: ability to provide uninterrupted, coordinated care or service across programs, practitioners, organisations and levels over time.
Responsiveness: the service provides respect for all persons and is client orientated. It includes respect for dignity, cultural diversity, confidentiality, participation in choices promptness, quality of amenities, access to social support networks, and choice of provider.
Capability: an individual’s or service’s capacity to provide a health service based on skills and knowledge.
Safety: the avoidance or reduction to acceptable limits of actual or potential harm from health care management or the environment in which health care is delivered.
Sustainability: system or organisation’s capacity to provide infrastructure such as workforce, facilities, and equipment, and be innovative and respond to emerging needs.
(Australian Government, 2010)
When working with clients with mental health issues, all helping professionals are required to apply an appropriate approach so that the client’s individual, legal, citizenship, and human rights are upheld. This involves treating clients with dignity and respect and allowing them to direct their own recovery by seeking their input about each step of the treatment process. Involving a person with mental health issues to direct their own recovery can be a challenging process. Some of the mechanisms that are commonly adopted to facilitate this process include:
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Encouraging the client to identify his or her own goals and objectives.
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Working with the client to develop plans of action.
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Identifying areas of interest and preferences and drawing on these in development of plans.
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Supporting the client to reflect on their past and review issues that require improvement.
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Presenting the client with a number of different options that they can choose from when deciding upon a way forward.
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Encouraging the client to undertake activities independently (such as becoming involved in community groups and functions).
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Ensuring that the client feels that they have a say at all junctures of the recovery process.
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Undertaking evaluations of the recovery process in collaboration with the client.
While each of these components of care are equally important, they all start with establishing a respectful relationship with the client. This is particularly important because people with mental health issues often face a number of barriers to recovery, many of these related to the way in which others, even helping professionals, behave towards them. They often face discrimination, prejudice and the effects of social stigma which can impact upon their feelings of self-worth and desire to seek assistance. For example, experiences of discrimination, prejudice, and stigma can:
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Create social isolation.
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Discourage people from seeking treatment.
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Limit recreational, educational, and employment opportunities.
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Impact self-esteem and allow negative perceptions to be internalised.
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Result in individuals blaming themselves for their issues and not believing that they have the same rights as others.
Discrimination against people with a mental health issues is often the result of a number of socially accepted myths about mental illness. These myths include that:
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Mental illness is caused by personal weakness.
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People with a mental illness can “pull themselves out of it”.
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People with a mental illness are violent.
These myths are all without foundation. The facts are that mental health issues are caused by genetic, biological, social and psychological factors, many of which are beyond the control of the individual. Furthermore, people with mental health issues are more likely to harm themselves or be harmed by others than they are to be violent towards others (Government of Western Australia Mental Health Commission, 2010).
As a community support worker, it is important for you to understand the realities surrounding mental health and the common experiences of individuals experiencing mental health issues. This will enable you to work effectively with people with mental health issues.
Reflection
Self-Reflection
Consider your own attitudes towards people with a mental health issues. Do the myths outlined above resonate with you?
Do you think that you need to learn more about the facts of mental illness in order to allow you to work effectively with individuals with mental health issues?
When working with people who have mental health issues, it is also very important to develop a respectful relationship that promotes trust, hope, and a sense of self-direction. While there are a number of steps that you will take to do this (which you will learn about throughout this Study Guide), it all begins with respectful communication.
Key concepts when providing care:
Following code of practice: A code of practice in community services is a set of guidelines that outline the best practices and standards for delivering community services. It provides a framework for the delivery of quality services that meet the needs of clients and are in line with ethical and legal requirements. Consequences for breaching these guidelines may range from disciplinary action to criminal charges depending on the breach.
Discrimination: Discrimination is the unfair treatment of an individual or group based on certain personal characteristics, such as race, gender, age, religion, sexual orientation, disability, or any other protected attribute. Discrimination can take many forms, including exclusion, harassment, and differential treatment. Employees in the community services and health industry have a responsibility to prevent discrimination and promote diversity and inclusion in their workplaces. By doing so, they can create safe, respectful, and inclusive environments that promote the health and well-being of all individuals. Anyone found in breach of discrimination-based legislation is liable to face legal consequences and penalties.
Dignity of risk: Dignity of risk is based on the belief that all individuals should have the opportunity to make their own decisions and take risks in order to lead fulfilling lives. However, this concept also recognises that individuals may require support and guidance to make informed decisions and manage potential risks.This may seem in contradiction to other legal and ethical responsibilities health and community services workers must comply with, so it is recommended that they conduct thorough risk assessments, develop supportive strategies and consult with colleagues/ supervisors as needed to ensure the right outcome is achieved.
Duty of care:In the community services and health industry, employees have a duty of care to ensure the safety, well-being, and rights of the individuals they support.The duty of care is based on the principle that individuals have a right to be protected from harm, and that those who are in a position to do so have a responsibility to take action to prevent harm from occurring. A breach of a duty of care may result in legal and disciplinary consequences, such as lawsuits, loss of professional license, or termination of employment.
Informed consent: Informed consent outlines an individual's right to receive and understand information about their care or treatment options, including any potential risks or benefits, and to make an informed decision about their care. It must also be determined that the client has the capacity to provide informed consent.Failure to obtain informed consent or to uphold an individual's right to make their own decisions can result in legal and ethical consequences for employees, including lawsuits and disciplinary action.
Mandatory reporting: Mandatory reporting requires workers to report suspected cases of abuse or neglect of children, elderly, or vulnerable individuals to the relevant authorities. The purpose is to protect those who may be at risk of harm and ensure that appropriate interventions can be implemented to prevent further harm.Failure to report suspected cases of abuse or neglect can result in legal and ethical consequences for employees, including fines, disciplinary action, and criminal charges.
Human Rights Based Approach
The Human Rights-Based Approach (HRBA) to work in the community services and health industry emphasises the principles of dignity, equality, participation, and accountability. It integrates human rights standards and principles into all aspects of service delivery, policy development, and decision-making. It ensures that services and interventions are designed and implemented in a manner that respects and upholds each persons basic human rights.
A short summary of the 6 key principles and rights captured in the Universal Declaration of Human Rights (UDHR).
UDHR KEY PRINCIPLES & RIGHTS SUMMARY
- Equality and non-discrimination: All individuals are born free and equal in dignity and rights, without any distinction based on race, color, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status. It promotes equal treatment, opportunities, and protection for all, fostering inclusive and diverse societies.
- Right to life, liberty, and security: Every person has the right to life, liberty, and security of person. This includes protection from arbitrary deprivation of life, unlawful imprisonment, and physical or psychological harm. It ensures individuals are free from torture, slavery, and other forms of cruel or inhumane treatment.
- Freedom of thought, expression, and religion: This right encompasses the freedom to hold opinions, express ideas, and seek, receive, and impart information and knowledge through any medium. It also guarantees the freedom of religion or belief, including the freedom to worship, practice, and manifest one's religion individually or in community.
- Right to fair treatment: This principle guarantees that everyone is entitled to a fair and public hearing by an independent and impartial tribunal when facing legal issues or disputes. It includes the right to be presumed innocent until proven guilty, the right to legal counsel, and protection against arbitrary arrest, detention, or exile.
- Right to education, health, and social security: This right ensures that every individual has access to education, including free and compulsory primary education, and the opportunity to develop their full potential. It also encompasses the right to the highest attainable standard of physical and mental health and social security, including access to medical care, social assistance, and social services.
- Right to work, just wages, and labor protections: Everyone has the right to work, free choice of employment, and just and favorable conditions of work. This includes fair remuneration for work, equal pay for equal work, and the right to form and join trade unions to protect and promote their interests. It also safeguards against exploitation, forced labor, child labor, and unfair treatment in the workplace.
You have learned about respectful communication throughout your course. You will need to utilise these skills when working with clients with mental health issues. At a basic level, when communicating with people with mental health issues, you will need to ensure that you:
- Minimise distractions (e.g., ensure that communication is occurring in a suitable environment with minimal background noise and distractions).
- Demonstrate that you are paying attention (e.g., demonstrate active listening skills).
- Use effective questioning skills to develop an understanding of the client’s needs without making them feel interrogated.
- Pay attention to both what the person is saying and what is being revealed through body language.
- Maintain a culturally appropriate level of eye contact.
- Acknowledge the client’s feelings (e.g., reflections of feeling).
- Do not interrupt the client unnecessarily.
- Do not make assumptions.
- Mirror the client’s verbal and body language where appropriate.
In a nutshell, you need to remember that clients with mental health issues deserve the same levels of respect and individualised attention as all other clients. You should not make assumptions about them or infer disrespect on any level, and depending upon the client’s previous experiences, you may find that you need to spend more time establishing a respectful helping relationship, particularly if the client has previously had negative experiences as a result of discrimination, prejudice, or stigma. In such cases, it can also be useful to work from a strengths-based perspective in order to help demonstrate respect for the client and help facilitate the development of hope, trust, and self-direction.
Throughout your interactions with clients with mental health issues, the process of communication should be empathetic, engaging, and hope giving. It should involve listening and responding in a non-judgmental and sensitive manner based on valuing the uniqueness of each person. Respecting the person’s own understanding of their experience is also vital as this provides them with an opportunity to find their own voice in expressing their experiences.
The following case scenarios provide some examples of respectful communication.
Case Study
Cynthia
Cynthia a support worker, visits her client, Martin, in his home every week as part of a mental health outreach program. Knowing that she is a guest in his home, Cynthia always asks Martin if the visit is convenient and does not let herself into his home unless he invites her to come in. Today Martin is angry because of a dispute he had with his neighbor about loud noise coming from his apartment next door. Martin gets so excited telling Cynthia about the fight he had with his neighbor that he waves his arms about in the air and begins to shout. Rather than telling Martin to lower his voice, Cynthia responds by nodding her head and making understanding facial expressions while reflecting his story in a lowered tone and asking some clarifying questions. Cynthia’s communication techniques help Martin calm down as he realises that she is listening to him intently. Throughout this interaction, Cynthia has demonstrated respectful communication.
Case Study
Sarah
Sarah, a support worker in a community mental health organization, has been assigned to assist John, a client living with schizophrenia. John experiences periods of intense paranoia and social withdrawal, making effective communication challenging. One day, Sarah arrives at John's residence to discuss his upcoming therapy appointments and medication schedule. John appears agitated and avoids eye contact, exhibiting signs of heightened anxiety. Recognizing the need for careful communication, Sarah adopts a person-centered approach.
Communication Strategies:
Establishing Trust: Sarah begins by creating a safe and non-judgmental environment. She sits at eye level with John, maintains a calm demeanor, and uses open body language to convey her approachability. Acknowledging John's feelings, Sarah assures him of confidentiality and respect.
Active Listening: Sarah listens attentively to John's concerns without interrupting. She acknowledges his emotions and repeats key points to demonstrate understanding. By mirroring his feelings, she validates his experiences and fosters a sense of being heard.
Clear and Simple Language: Recognizing the potential for confusion or misinterpretation, Sarah uses clear and simple language. She avoids jargon and provides information in small, digestible chunks. Visual aids, such as a written schedule or medication chart, help reinforce key points.
Non-Verbal Cues: Understanding that verbal communication might be challenging, Sarah utilizes non-verbal cues. She uses gestures, facial expressions, and body language to convey empathy and reassurance. This assists in building a connection beyond words.
Empowering Choices: To promote autonomy and control, Sarah involves John in decision-making. She offers choices regarding appointment times, medication preferences (within medical guidelines), and activities. Empowering John in these decisions helps build a collaborative and respectful relationship.
Regular Check-ins: Sarah establishes a routine of regular check-ins to monitor John's well-being. This involves both formal discussions about appointments and informal chats to gauge his emotional state. Consistent communication fosters a trusting relationship over time. Outcome:
Through these communication strategies, Sarah successfully engages John in discussions about his treatment plan and addresses his concerns. Over time, John becomes more comfortable communicating with Sarah, leading to improved collaboration in his mental health care. This case study illustrates the significance of tailored communication approaches in supporting individuals with mental illness and highlights the positive impact of a person-centered communication strategy.
Reflection
Reflect on Case Studies
Can you think of any other ways support workers could demonstrate respectful communication in the above scenarios?
When working with people with mental health issues it is also important to respect their social, cultural, and spiritual differences. Such differences can impact not only the way in which individual clients wish to work with services but it can also impact what services are required.
It is important to take the time to understand your client’s values and core social, cultural, and spiritual practices and ensure that you demonstrate respect for them. While you can improve your understanding of other cultures through professional development and research, it is important to avoid stereotyping or making assumptions. There is often great diversity within cultural groups due to regional, class, family, and individual differences. Therefore, it is always important to take the time to explore your client’s individual values and practices and make appropriate amendments to your practice to respect these. For example, some individuals may celebrate specific religious holidays and it would be appropriate to facilitate the client’s celebration of these dates.
The following case scenario demonstrates another way in which diversity can be respected.
Case Study
Fatima is a 22-year-old woman who was born in Lebanon and came to Australia with her family when she was six years old. She has been diagnosed with bipolar disorder and is undergoing treatment at the local mental health clinic. Fatima attends her appointments accompanied by her family, which includes her mother, father, and older brother. In her culture the value of family involvement in her treatment and other aspects of her life is high. She consults her parents before she makes any significant decision and does not wish to engage with community workers unless her family is present. The support workers accommodate Fatima’s wishes by ensuring that there are always enough seats for each of Fatima’s family members to attend any meetings. They also make eye contact with everyone in the room and demonstrate inclusive practice in relation to Fatima’s family.
Clients from diverse backgrounds can also have different perspectives of mental illness and differing needs.
- Generally immigrants, refugees and asylum seekers have lower rates of mental health service utilisation than the Australian-born population. Barriers to access include greater stigma about mental illness in some CALD communities, language barriers, cultural misunderstandings, and limited knowledge of mental health and available services when compared with the Australian-born population. These barriers make it harder for people from CALD backgrounds to access mental health services when needed, resulting in higher acute and involuntary admissions.
- People from CALD backgrounds are overrepresented in involuntary admissions and acute inpatient units and are more likely to be exposed to quality and safety risks. These risks include misunderstandings and misdiagnosis and they are often a result of language and cultural barriers.
(Mental Health in Multicultural Australia 2014)
When considering the presence of mental health concerns, you also need to consider cultural and spiritual factors. Just because a client has a belief that seems unusual to you, this does not necessarily mean that they have a mental illness. If an individual’s beliefs and practices are common and accepted within their own community then there may be no issue. As a support worker, you may be required to assist clients to better understand their needs, the services that they may require, and help them to exercise their rights to effective service provision.
People with mental health issues are often marginalized in society and are seeking assistance from a position of lowered power. It is important to support these individuals to understand and exercise their rights. While you should be aware of the general rights of clients, the following extract provides a good summary of client rights.
Respect
Clients have the right to
- Be treated with respect
- Have your individual human dignity valued.
- Be free from unlawful discrimination.
- Ask to have a staff member of your own gender when receiving treatment.
- Have your individual needs respected in relation to your age, culture, language, disability, gender and sexuality.
Safety
Clients have the right to
- Be safe when receiving treatment and care.
- Receive high quality treatment and care.
- Be treated in the least restrictive environment appropriate to your individual needs.
- Receive appropriate and comprehensive information about your treatment, including the side effects, in a timely manner.
- Obtain a second opinion about your treatment and care.
Communication
Clients have the right to
- Be heard.
- Have a safe environment created that supports information exchange between you and your health care providers.
- Be informed about services, treatments, options and costs throughout your care.
- Ask questions regarding your care and have them answered in a clear and understandable manner.
- Communicate your views and preferences about your treatment and care options by using an Advance Agreement.
Access
Clients have the right to
- Timely access to health and human services.
- Care that promotes independence and recovery.
- Choose if, and when, family, friends and other supports are included in your care.
- Access mental health care that is equivalent to care available in the community, if you are subject to the criminal justice system.
Participation
Clients have the right to
- Live, work and participate in your community with equitable access to human services.
- Participate in decisions and choices about your care throughout all stages of your care and recovery.
- Receive information in a form and language that you understand.
- Have your Advance Agreement inform your care.
- Participate in mental health legal proceedings.
- Access independent advocacy and legal advice regarding your treatment, care and social needs.
Privacy
Clients have the right to
- Protection of your personal privacy.
- Privacy and confidentiality of your personal information.
- Access your own health records in accordance with the law.
Comment
Clients have the right to
- Comment on your care and to have your concerns addressed.
- Receive information on mechanisms of complaint and redress
(ACT Government Health 2016)
As a support worker, you must not only uphold your client’s rights in your own interactions with them, you should also empower your clients to understand and exercise their rights. In many cases, this might involve explaining rights to a client so that they understand where they stand on issues as they arise. The following case study provides an example of such a situation.
Case Study
Jennifer is a client of a mental health clinic. She is socially isolated and has very few support networks as her parents have both passed away and her older brother lives far away in another state. Jennifer has made a friend at one of the recreational functions that was coordinated by the mental health clinic. Her new friend, Simone, has also been diagnosed with a mental illness. Simone has very protective parents who want to know everything about her social interactions. They have met Jennifer and want to know more about her, including her diagnosis and where she lives, before they permit her to socialise any further with Simone. They have approached the mental health clinic for information about Jennifer. As they have been quite aggressive in their requests, the support worker, Mary, decides to meet with Jennifer to explain to her that she has rights that include confidentiality. Mary tells Jennifer that the mental health clinic will not divulge any information about her to anyone who asks without Jennifer’s permission. She explains to Jennifer that she is under no obligation to disclose information to Simone’s parents and that both Simone and Jennifer are permitted to socialise with whoever they want during their visits to the mental health clinic.
If a person with a mental health issue feels that a community services provider has treated them unfairly they have the right to have their complaint heard and acted upon. Most organisational policies will have procedures where the client can complain directly to the individual staff members concerned or escalate the matter if they are not satisfied with the outcome of the complaint process. Outside the relevant service provider there are two places that a person with a mental illness can complain to if they feel that they have been treated unfairly. These include the Human Rights Commission that investigates complaints related to discrimination according to sex, disability (this includes temporary and permanent disability), medical conditions (including mental health), race, and age. There are also state-based Mental Health Commissions that can provide information about the Health Care Complaints Commission in the relevant state or territory.
The privacy of all clients is protected by the Privacy Act 1988 (Cth) and various other relevant State and Territory based legislation – clients with mental health issues are not exempt from this. Mental health services will have privacy and confidentiality policies that set out procedures for managing personal health information held by the service. These policies explain how personal health information is collected and used within the service and the circumstances in which it may be disclosed to third parties. These procedures typically include that:
- Collection of personal health information should be conducted in a setting that protects the information from been accessed by unauthorized people and provides privacy to the client.
- Health information should be collected where possible directly from the individual concerned.
- Security exists to prevent loss of data
- Personal information is protected from unauthorised access
- Care is taken to prevent unauthorised access during the transfer of information
- The individual’s consent is obtained to use personal health information for the purpose of research or quality assurance and improvement.
Regardless of whether the information is recorded in the client’s file or even stored in your head, it is considered protected information and cannot be shared with anyone unless the client gives permission to share this information. There are some exceptions to this rule in relation to people who are experiencing involuntary treatment where information that is considered to prevent harm to the client, harm to another, or harm from another, is considered sufficient to breach client confidentiality.
When working with clients with mental health issues you may be required to make a referral. In such cases you should follow your organisation’s standard procedures and codes of practice.
Throughout your work you must ensure that you maintain your client’s rights. This will help you to establish a respectful and appropriate relationship that will allow you to best work to meet their needs. You will learn more about how to do this in the following sections of the Study Guide.
In summary, privacy refers to an individual's right to control the collection, use, and disclosure of personal information. Confidentiality refers to the obligation to protect and keep confidential any information that a client shares. This involves obtaining informed consent, maintaining accurate and secure records, minimising information sharing, complying with legal requirements, etc. Failure to maintain privacy and confidentiality can result in legal and ethical consequences for employees, including disciplinary action, loss of licensure or certification, and legal liability.
In this section of the Study Guide you were introduced to the key practice principles involved in working with people with mental health issues. You also learned about some of the key considerations involved in establishing a respectful relationship that demonstrates respect for the individual and their diversity, their needs, and their rights.
Now its your turn!
Australian Government. (2010). National Standards for Mental Health Services 2010. Barton, ACT: Commonwealth of Australia.
ACT Government Health. (2016). Charter of rights for people who experience mental health issues. Retrieved from http://www.health.act.gov.au/our-services/mental-health/charter-rights
Government of Western Australia Mental Health Commission. (2010). Common myths about mental illness. Retrieved from http://www.mentalhealth.wa.gov.au/mental_illness_and_health/Myths_mental_illness.aspx
Mental Health in Multicultural Australia (2014). Framework for mental health in multicultural Australia: Towards culturally inclusive service delivery. MHIMA.
Queensland Health. (2009). The road to recovery: A history of mental health services in Queensland 1859-2009. Queensland Government.
