Determining Needs and Preferences

Clients with mental health issues often face a range of issues and in order to work effectively with them it is important to comprehensively understand their needs. This usually involves gathering and interpreting information from a variety of sources. This might include:

• The client themselves.
• The client’s family and support network (e.g., carers).
• The client’s case file or other paperwork.
• Other professionals involved in the client’s care (e.g., case manager, psychologist, GP, etc.).

Of course, it is important to remember that clients with mental health issues have the same rights to privacy and confidentiality as other clients, so if you are wishing to obtain information by speaking to other people, it is important to first obtain permission from the client and to make sure that you do so via your organisation’s standard practices.

Case Study

Janet works for a disability support agency and she is meeting with new client, Marisa, today. Marisa tells Janet that she was diagnosed with a mental illness and has been attending a local mental health clinic for case management and support. Janet would like to help Marisa find part-time employment but is unsure of how many hours a week Marisa is capable of working. As such, Janet would like to speak to Marisa’s case manager at the mental health clinic. Janet first asks Marisa if she will allow her to contact her case manager (to which Marisa readily agrees) and then asks Marisa to sign a consent form that allows her to collect information about her ability to work from the mental health clinic. Marisa signs the form which Janet then sends to the mental health clinic as evidence that she has Marisa’s permission to collect information from them.

When gathering and interpreting information for the purpose of determining a client’s needs, you must make sure that you develop a full understanding of the client’s needs and strengths. This usually involves learning more about their mental health needs.

While each client will have different needs, it can be useful for you to have a basic understanding of some of the most common types of mental illnesses – let’s take a look at these now.

Common types of mental illness:

Depression

An individual who experiences depression can have clinically significant symptoms such as a prolonged and unusually sad mood, loss of interest in activities they previously enjoyed, tiredness, and lack of energy. Depression can also include difficulty sleeping, loss of confidence and low self-esteem, and difficulty in concentrating and making decisions. Depression is considered by World Health Organization (WHO) as one of the leading contributors to global burden of disease and disability.

Anxiety Disorder

Most anxiety is normal and is not considered a disorder. However when anxiety lasts a long time and disrupts an individual’s work or social relationships the anxiety is considered to be significant. Some common types of anxiety disorders include:

• Generalized anxiety disorder – a disorder that is characterised by excessive anxiety about aspects of life such as social relationships, work or financial matters.
• Panic disorder – panic disorders are characterised by repeated panic attacks. Panic attacks are a sudden surge of overwhelming anxiety and fear including rapid heartbeat and difficulty breathing.
• Phobic disorders – a disorder, which involves a persistent and irrational fear including avoidance of situations, or objects that induce these fears. Fears can include a variety of things such as social interaction, fear of flying, fear of snakes, etc.
• Post-traumatic stress disorder – a disorder which involves mental and emotional stress that occurs as a result of severe psychological shock (such as from an injury) which involves disturbance of sleep and vivid recall of the experience that caused the shock.
• Obsessive-compulsive disorder – a disorder which involves obsessive repetitive behaviour such as obsessive hand-washing, repeatedly counting items or objects, or feeling a compulsion to pray a certain number of times a day to an extent that it interferes with the work and/or relationships.
• Eating Disorder:For example: Anorexia Nervosa it involves restrictive eating, an intense fear of gaining weight, and a distorted body image.Bulimia Nervosa: Characterised by binge eating followed by compensatory behaviours like vomiting or excessive exercise.

The symptoms of anxiety disorders can include physical symptoms such as rapid heartbeat, palpitations, hyperventilation, sweating, headaches, nausea, vomiting, diarrhea, and muscle aches and pains. Psychological symptoms can include a racing mind, unrealistic and/or excessive fear, blankness, memory and concentration problems, irritability or being on edge, confusion, and sleep disturbance. The behavioral symptoms can include avoidance of certain situations, distress in social situations or crowds, and obsessive or compulsive behavior such as continuous hand washing.

Other Mental Illnesses

While depression and anxiety are the most common mental illnesses, there are many other mental disorders that helping professionals should expect to meet people with. As with depression and anxiety, these vary in severity and can be very debilitating. They include:

• Schizophrenia – a condition that affects the normal functioning of the brain. Characterised by symptoms such as confused thinking, delusions, and hallucinations.
• Bipolar disorder – a condition that is characterised by both high and overexcited behaviour followed by extremely low feelings of helplessness and depression.
• Schizoaffective disorder – a disorder in which mood swings are similar to those found in bipolar disorder, together with some of symptoms of schizophrenia including delusions, hallucinations, disorganised speech and disorganised behaviour.
• Psychosis – the inability to distinguish between what is real and what is imagined. Symptoms include disordered and confused thinking, delusions, and hallucinations.
• Borderline Personality Disorder (BPD): Features instability in relationships, self-image, and emotions, as well as impulsive behaviour. Antisocial Personality Disorder (ASPD): Involves a persistent pattern of disregard for the rights of others and a lack of empathy.
• Attention-deficit/ hyperactivity disorder (ADHD):ADHD, Predominantly Inattentive Type Characterised by difficulty sustaining attention and organising tasks. ADHD, Predominantly Hyperactive-Impulsive Type: Involves hyperactivity and impulsive behaviour.
• Autism Spectrum Disorder (ASD): Impacts social interaction, communication, and behaviour, often diagnosed in childhood.

As a support worker, your primary responsibility is to encourage clients with suspected mental health issues to seek professional assessment. When working with clients who already have a diagnosis and are under the care of qualified professionals, your role shifts towards a supportive capacity. Obtaining permission to collaborate with the primary care professional allows you to gather comprehensive information about the client's needs. This collaborative approach aligns with the holistic care model prevalent in community services, ensuring a well-rounded understanding of the client's circumstances.  By incorporating insights from various sources, including the client, their support network, and other professionals, you can tailor your support interventions to promote empowerment and recovery. In a community services setting, this approach aligns with the broader goal of fostering resilience and independence among individuals facing mental health challenges.

Responding to clients changing needs:

In community services, responding to changes in a client's mental health, mental distress, and crises is paramount for providing effective support and fostering well-being.

Here are some examples of managing and responding to clients changing mental health conditions:

1. Change in Mental Health:

   • Scenario: Client shows early signs of depression.
   • Response: Identify and openly discuss early signs to prevent escalation. Encourage seeking professional mental health support.
   • Justification: Trained professionals offer accurate assessments and tailored interventions for improved outcomes.

2. Change in Mental Distress:

   • Scenario: The client experiences increased anxiety.
   • Response: Assess immediate safety concerns. Apply de-escalation techniques in crisis situations to promote a calmer environment.
   • Justification: De-escalation techniques effectively manage tension and contribute to a supportive atmosphere.

3. Crisis:

   • Scenario: Teenage client unable to cope, threatening to run away.
   • Response: Apply psychological first aid principles for practical and emotional support. Provide information on crisis hotlines and emergency services.
   • Justification: Psychological first aid aids in immediate stress coping, while crisis hotlines offer accessible support in urgent situations.

Working with clients and responding to there changing needs should involve reviewing the services available to the client in terms of their strengths and support networks. Effective practice involves the use of person-centred care in which the client’s preferences are central and they are treated with respect and dignity. Person centered care seeks a partnership between the family, the worker, and the person with a mental illness, ensuring that the support services provided revolve around the client rather than funding models or the worker’s interests. Person centered care also provides emotional support to the client and ensures that there is continuity between and within services. Putting the individual with mental health issues at the centre of their care is a way of ensuring that they receive a quality service and get the help they need when they need it, as well as promoting the ability of the client to be more active in looking after themselves.

When discussing options, you should reflect on what the client identifies as important in their lives (such as their preferences, life goals, and lifestyle choices, as well as their responsibilities and their rights). You need to allow the client to express their own opinions without judgement and without imposing your own values and beliefs. One way to prevent imposing your values and beliefs on your clients is to ensure that you recognise your feelings and beliefs when they differ from your client and that you demonstrate the self awareness to avoid imposing your own beliefs when they differ from your client’s. Self-awareness involves understanding that everything we do is informed by our values. These values are often shaped by our cultural upbringing and regardless of how well-meaning we are as support workers, our own values and biases can sometimes work their way into our helping relationships.

An example of this is outlined in the case scenario

Case Study

Emily, a community support worker, is assigned to assist Daniel, a client with schizophrenia, in his daily activities and community integration. Emily holds strong personal beliefs around independence and self-sufficiency, valuing autonomy highly.One day, Emily notices Daniel struggling to complete a task independently due to his mental health challenges. Instead of providing the support he requires, Emily insists that he should manage the task alone, aligning with her value of promoting self-reliance.

Impact of helping:

Deterioration of Trust:Daniel perceives Emily's insistence as a lack of understanding of his struggles, leading to a breakdown in trust. Emily's imposition of her values erodes the foundation of a collaborative and empathetic helping relationship.

Increased Anxiety for the Client: Daniel, already coping with the challenges of schizophrenia, experiences heightened anxiety due to the pressure to meet Emily's expectations. Emily's approach unintentionally exacerbates Daniel's mental health issues, contradicting the primary goal of support.

Strained Communication: The value conflict leads to strained communication between Emily and Daniel. Open dialogue, crucial for effective mental health support, diminishes as Daniel feels misunderstood and unsupported.

Risk of Disengagement: Daniel, feeling unsupported and misunderstood, may disengage from the support services altogether. Emily's values negatively impact the client's willingness to participate in the assistance offered.

Resolution and Learning: Recognizing the detrimental impact of her values on the helping relationship, Emily undergoes reflective supervision and training. She learns to balance her commitment to autonomy with the client's specific needs and the principles of person-centered care. Emily's growth in understanding the importance of aligning support with the client's preferences and capabilities helps rebuild trust and enhance the quality of the helping relationship.

This case underscores the need for community support workers to continually reflect on and manage their own values to ensure they do not impede the well-being and progress of clients with mental health challenges.

When working with clients with mental health issues, you should, wherever possible:

• Encourage the client to identify his or her own goals and objectives.
• Identify areas of interest and preferences and draw on these in development of individualised plans.
• Present the client with a number of different options that they can choose from.

It is likely that clients with mental health issues will require a range of support options including:

• Practical support – this may include assistance with managing their symptoms, managing tasks of everyday living, finding employment, etc.
• Emotional support – this may include facilitating contact with support network, facilitating social involvement, etc.
• Financial support – This may involve facilitating access to community services or government benefits, etc.

In the dynamic field of community services, especially in mental health support, the role of a support worker is pivotal in facilitating access to services and providing targeted assistance. The nature of the support worker's role may vary, from coordinating comprehensive services as a case support worker to offering specific services tailored to clients needs and condition. Regardless of the specific role, collaboration is at the heart of effective community-based mental health support.

Understanding Client Goals: A support worker in mental health within community services must first comprehend the client's goals, aspirations, and challenges. This understanding forms the basis for tailoring support to meet individual needs.

Role Clarity: Depending on the specific position, the support worker may have different responsibilities. A case support worker might coordinate a range of services, while a counselor focuses on assisting the client with predefined goals. Clarity in roles ensures efficient and targeted support.

Collaboration as a Cornerstone: Collaboration is emphasized as a vital element, aligning with a person-centered approach. This collaborative effort empowers the client by providing coordinated support from various stakeholders, fostering a holistic and integrated approach to mental health care.

Empowering Clients through Decision-Making: Collaboration empowers clients to actively participate in decision-making regarding their care. This involvement not only respects their autonomy but also encourages a deeper understanding of their needs and aspirations. Respecting

Client Autonomy: Collaborative approaches reflect a profound respect for the client's autonomy. Clients are given agency in setting their own goals and contributing to the development of strategies to meet those goals. This person-centered approach places the client at the forefront of decision-making.

Effective Communication: Clear and open communication is fundamental when working collaboratively with clients and their care networks. Transparent discussions ensure that everyone involved is informed and engaged in the decision-making process.

Cultural Sensitivity: A support worker in community services must be culturally sensitive, acknowledging and respecting diverse perspectives within the collaborative network. This approach ensures that services are tailored to meet the unique cultural needs of the client.

In conclusion, the support worker's role in community services within the realm of mental health is characterized by a collaborative and person-centered approach. By understanding client goals, clarifying roles, and fostering collaboration, support workers contribute significantly to empowering individuals on their mental health journey within the community. When working collaboratively with clients and their care networks it is important to:

• Ensure the client understands the decisions that need to be made.
• Work with the client to discuss options or alternatives.
• Encourage the client to think about their future and how they want it to be shaped.
• Ask the client prompting questions about their preferences.
• Participate in regular meetings with the client’s care networks to discuss issues.
• Seek input from the client’s care network about any key decisions.
• Encourage the client’s care network to be involved with the recovery activities.

When assisting the client to set specific goals it is also important to discuss options that best meet the client’s desires as well as facilitate empowerment and recovery. For example, it could be beneficial to discuss strategies that:

• Meet the client’s specific needs.
• Encourage social interaction.
• Facilitate access to training and education.
• Assist the client to find employment.
• Facilitate involvement in volunteering.

In community services, the support worker's role in assisting clients with mental health issues is multifaceted, focusing on ensuring informed consent, promoting safety, and respecting the concept of dignity of risk.

Informed Consent: You must have the informed consent of your client before you disclose any information about their health status to any potential employers or service providers. Many people who suffer from mental illness fear stigma and discrimination and, more likely than not, have already suffered some form of discrimination, harassment or bullying related to their mental health status. When asking your clients to make decisions that will impact on their lives, such as disclosing their mental health status, you must make sure that they understand what they are consenting to, and the possible outcomes of that decision. People who are under the influence of intoxicating drugs may not be able to give informed consent because their judgment may be impaired. People experiencing a psychotic episode may not have the capacity to make informed decisions and choices. In situations where clients lack the capacity to consent due to their mental state, support workers have a duty of care to ensure the well-being and safety of the individual, seek collaboration with mental health professionals, and adhere to legal and ethical standards. The overarching goal is to provide care that is respectful, least restrictive, and supportive of the client's dignity and rights.

In terms of promoting client safety, upholding the safety of clients with mental health issues is a primary responsibility of a support worker. For instance, if a client expresses suicidal thoughts, the support worker has a duty of care to address the issue. However, it's crucial to avoid overprotectiveness that infringes on the client's dignity of risk – their right to make decisions, even if they involve some level of risk.

Remember, individuals with mental health issues have the same rights as other clients. Of course, they also have the same responsibilities. For example, if a client with mental health issues is threatening or abusive they can be asked to leave the service. Similarly, legislative requirements apply equally to people with mental health issues. For example, mandatory reporting applies regardless of whether the victim or perpetrator has mental health issues.

In essence, the support worker in community services embraces a client-focused approach, balancing safety measures with the promotion of individual autonomy and dignity. Through clear communication, respect for informed consent, and adherence to legal standards, support workers contribute to the holistic well-being of clients with mental health issues within the community.

In this section of the Study Guide you learned about the processes involved in determining the needs and preferences of clients with mental health issues. In the next section you will learn more about how to use this information in order to work effectively with them.

Now its your turn

Mental Illness Fellowship Victoria. (2011). Understanding psychosis. Retrieved from http://www.mifellowship.org/sites/default/files/styles/Fact%20Sheets/Understanding%20Psychosis.pdf