Working with People with Mental Health Issues

Submitted by Ruchi.Makkar@e… on Mon, 12/04/2023 - 16:12

In this section you will learn to:

  • Provide support that facilitates progress towards the person’s goals in collaboration with the person and their care network
  • Work in ways that uphold the person’s rights
  • Adapt service delivery within organisation policies and procedures to meet the person’s specific needs and requirements
  • Document interactions and services according to organisation policy and procedures
  • Respond promptly and supportively to people experiencing distress or crisis
  • Work within the limits of own knowledge, abilities and work role and make referrals to other services as indicated by the person’s needs

Supplementary materials relevant to this section:

  • Reading F: Implementation Guidelines for Non-Government Community Services

Now that you have an understanding of the important considerations involved in establishing a working relationship with a client with mental health issues and how to work with them to determine their needs and preferences, we will explore how to work effectively with them in order to help them to meet their needs. The information included in this section will provide you with a good overview of how to work effectively in your own practice, however, you should also read through Reading F, which provides a more comprehensive overview of how to implement the National Standards for Mental Health Services in a community services organisation.

Reading

Reading F – Implementation Guidelines for Non-Government Community Services

Companion implementation guidelines were created in order to support community services organisation to appropriately implement the National Standards for Mental Health Services 2010, which is included as Reading F.

Sub Topics
women on craft

Supporting clients to work towards and achieve their goals is an important part of working with people who have mental health issues. This process should be facilitated using a team approach applying collaboration between the client, their support network, and all professionals involved.

 It is important to focus on making the best use of the client’s strengths and resources when facilitating their progress towards goals. When planning actions with the client you should consider:

  • Their goals.
  • Their current strengths and resources.
  • Activities / strategies that can be implemented to help them meet their needs.
  • Supports they might require to implement activities/strategies.
  • How the activities / strategies will be monitored.

When working with clients with mental health issues, the above considerations are useful, however, the National Standards for Mental Health Services 2010 also highlight a range of additional considerations for mental health professionals to keep in mind when working with people with a mental health issue. These are outlined in the following extract. While, as a support worker you may not be working directly to treat clients with mental health issues, it is still useful for you to be aware of the standards that all mental health professionals should comply with.

To meet the needs, goals and aspirations of people and their families and carers, mental health practitioners deliver quality, evidence-informed health and social interventions.

The mental health practitioner:

  1. Advises the person and their family or carer of their right to informed consent for treatment and of their right to refuse treatment
  2. Discusses the range of treatment, care and support options available with the person and, where appropriate, their families and carers, identifying potential benefits and risks pertaining to experimental or controversial treatment and care, or treatment and care with an undeveloped evidence base
  3. Plans, implements and monitors a range of engaging, evidence-informed, safe and effective intervention strategies chosen with the person and family or carers, and consistent with experience, professional background and roles within the interdisciplinary team
  4. Identifies a range of culturally and developmentally appropriate interventions that may derive from but not be limited to the following approaches
    • cognitive
    • behavioural
    • interpersonal
    • attachment-based
    • motivational
    • systemic
    • psychoeducation
    • psychodynamic
    • psychopharmacological
  5. Articulates an understanding of common interventions, including medications, commensurate with role and experience
  6. Delivers treatments and interventions using a recovery and family-focused approach, along the spectrum from prevention through to tertiary treatment
  7. Recognises when to ask senior practitioners or peers for assistance in working with people and families; operates within their own scope of practice; and refers on when needed
  8. Delivers treatments, interventions and support work in the most appropriate formats, which may include
    • sessions with individuals
    • group work
    • family or systems interventions
  9. Enquires about, recognises, works with and develops the person’s and family or carer’s strengths and experience of what works and what does not work
  10. Works flexibly at the person’s pace and with their priorities and schema, facilitating engagement throughout the course of intervention
  11. Assists people and families or carers to see things from the other’s perspective, and to develop shared understandings
  12. Supports the person in parenting or caring roles where relevant, promoting effective parenting or care strategies relevant to the needs of dependents
  13. Monitors people for evidence of appropriate and sufficient response to treatment interventions including medication, and for symptoms of possible side-effects, then communicates the results to the team or medical practitioner as appropriate
  14. Observes the dynamics of transference and countertransference processes and uses these to guide practice, seeking supervision and support if required to facilitate positive outcomes
  15. Provides or facilitates management, including self-management, of the person’s physical healthcare needs including detrimental use of licit or illicit substances
  16. Reviews the person’s status and updates their individual care plan with the person and family or carers as appropriate, consistent with progress and changing needs

(National Standards for Mental Health Services 2010)

While these standards are written for mental health professionals, the theme of these standards can be applied in any work with clients with mental health issues. For example, these standards highlight the importance of adopting a holistic approach to care when working with clients with mental health issues. Such clients will typically be working towards multiple goals that address all of their needs, not just the needs related to mental health issues. This means that the client’s care network is interested in meeting the client’s physical, emotional, psychological, social, economic, environmental, and spiritual needs. Therefore, as a support worker, you should not solely focus on the client’s mental illness but look at the aspirations and goals of the individual and work towards supporting them to achieve these. The holistic approach to mental health care includes recognising that people have experiences and issues that are not necessarily related to their mental illness. These are issues that can affect anyone regardless of their mental health problems and need to be addressed in a way that might not refer to the person’s mental health problems.

Case Study
woman burrying head on pillow

Marissa has a diagnosis of schizophrenia. She has been living with her mother for the past twenty years. Last week her mother passed away and she has had to attend the funeral, start looking for a new place to live, and start looking for an alternative income all at once. Janet, Marissa’s support worker, realises that this is a difficult situation and is one that would lead to stress regardless of any mental health problems. As such, Janet, recommends changes to amend Marisa’s care plan to provide her with a referral for counselling services and additional practical support to help her deal with these issues.

When working with clients with mental health issues, it is important to monitor your service delivery. As the client’s circumstances change, you may need to adapt your approach based upon changing needs and goals, or factors such as changes in the client’s life situation (e.g., accommodation issues or financial status). For example, changes to client circumstances could include:

  • The client’s mental health may improve or deteriorate. This change might have an effect on the way in which you deliver services to your client in that some services may no longer be relevant if your client’s mental health has improved. If their condition worsens or they develop new conditions they will need increased support.
  • The client may need to change accommodation which could impact on their support network and their access to public facilities such as transport. Moving houses can be stressful for most people and the process could aggravate mental illness symptoms.
  • Financial circumstances may change, especially if your client is employed and becomes unemployed. They may require assistance in gaining access to the disability pension or unemployment benefits. 
  • The client’s goals and objectives may change and require increased levels of service or services that your organisation is not able to provide. You may need to refer a client to an alternative organisation or specialist assistance.

Any decisions made relating to changes to service delivery should be made in collaboration with the client as well as their wider care network and health professionals.

Case Study
mother sitting next to son on bed

Maria is a young single mother with a five-year-old child. She has been diagnosed with depression and sees her support worker, Louise, regularly. Louise provides Maria with support, encourages her to take her medication, and helps her find social outlets in the community to develop friendships.

Maria has a part-time job at a local supermarket. She drops her son off at school in the morning and goes to her job from 10am until 2pm. This job suits her schedule perfectly as it allows her to work around her son’s school schedule. However, this morning Maria’s manager has told her that due to a downturn in the business her position is being made redundant.

Maria is very upset and worried about how she will support herself and her son. Louise realises that Maria requires support in finding an alternative source of income. Initially this means referring Maria to the Centrelink office to apply for unemployment benefits. Louise is also mindful that if Maria doesn’t find a new job soon she may have to find alternative accommodation as her current rent is too high for Maria to afford it on unemployment benefits alone. Louise makes a mental note that Maria may also need support in applying for social housing. With Maria’s permission, after the session, Louise contacts Maria’s case manager to advise him of Maria’s altered circumstances and schedules a case management meeting to address these changed needs.

visiting psychologist

Other key aspects of working with clients with mental health issues are facilitating social justice and social inclusion. Social justice is about the way in which wealth, opportunity, and privilege is distributed in society. The principle of social justice requires that everyone has equal access to social resources regardless of whether they have a mental illness. In a similar vein, the principle of social inclusion involves working with the client to find ways to enable them to feel connected to the community and participate at any point within the recovery process. Social exclusion occurs when people experience discrimination, unemployment, poverty and family breakdowns, which leads to their inability to participate in community life. People with a mental illness who experience significant barriers to accessing social and recreational activities or obtaining resources that people need to engage with the community (such as transport) are socially excluded. It is important to develop an understanding of this principle in order to work with people with mental health issues who are commonly isolated from the mainstream community. Indeed, part of your role may involve providing clients with specific supports to facilitate their social inclusion.

It is also important to ensure that all work conducted with your clients fulfills your legal and ethical responsibilities. Upholding client’s rights involves ensuring that the client is aware of their rights at all junctures during service provision. Reminding the client that they have choices and encouraging them to express their thoughts and opinions on a regular basis is an integral part of working effectively with people with mental health issues. Clients should feel that their views are going to be heard from a non-judgmental stance and that their opinions and decisions are valued at all times. Other steps you can take to ensure that you are upholding client rights include:

  • Checking-in with the client regularly to ensure that they are satisfied with the service(s) they are being provided.
  • Providing the client with access to information and resources required to uphold their rights.
  • Ensuring that the client has decision making powers.
  • Encouraging the client to be assertive about their rights.
  • Facilitating social inclusion.

There are also a number of programs within the mental health sector in which clients are encouraged to become involved in the managerial and review aspects of mental health organisations. This includes being part of interview panels for mental health jobs, developing and reviewing policies and procedures, advocating for other people with mental health issues, and being part of education and mental health promotion activities. There are also research projects that look into issues such as improvement of services and access and equity. By encouraging client participation in such activities you would not only be protecting their rights but also empowering them to take an active involvement in the sector.

Upholding a client’s rights sometimes also involves you making necessary adaptations to your service in order to meet the client’s needs. Mental health legislation and organisational policies and procedures call for the need for flexible service delivery. When working with clients with mental health issues you should always consider whether any adaptations are needed to your approach to better meet the client’s needs. This might involve working more closely with healthcare team members, or maximising support services. Of course, when adapting your service delivery, it is always important for you to consider your organisation’s policies and procedures and work within them. If you are ever in doubt as to what adjustments are suitable then it would be important for you to seek the advice of your workplace supervisor.

Throughout your work, it is vital that you comply with all relevant organisational policies/procedures and legislative requirements. While most of these requirements are the same regardless of your client, there are a few additional legislative considerations that are particularly important when working with clients with mental health issues – we will explore these below.

Legal and Ethical Considerations

woman sorting papers

There are various applicable legal and ethical consideration which must be taken in consideration when working with mental health issues. These include applicable Internation, National, Local and state and territory laws.

Children in the workplace: The UNCRC is an international human rights treaty that sets out the civil, political, economic, social, and cultural rights of children. Australia ratified the UNCRC in 1990. Nationally, the Child Protection (Working with Children) Act 2012 establishes a framework for screening individuals who work or volunteer with children, including requiring a Working with Children Check, Child Wellbeing and Safety Act 2005 sets out the legal obligations of organisations to protect the safety and wellbeing of children in their care, including requirements for reporting child abuse and neglect. State/ Territory Child Protection Act (varies by state/territory) This may include: - Child Protection Act 1999 (Qld) - Children and Young Persons (Care and Protection) Act 1998 (NSW) - Children and Young People Act 2008 (ACT) - Child Employment Act 2003 (VIC) - Children, Young Persons and Their Families Act 1997 (TAS) - Child Safety (Prohibited Persons) Act 2016 (SA) - Children and Community Services Act 2004 (WA) - Care and Protection of Children Act 2007 (NT) Each state and territory has its own child protection legislation that sets out the legal obligations and requirements for organisations and individuals working with children, including mandatory reporting requirements for child abuse and neglect.

Discrimination: The United Nations Universal Declaration of Human Rights (UDHR) This prohibits discrimination on the basis of race, color, sex, language, religion, political or other opinion, national or social origin, property, birth, or other status. Internationally, Labour Organisation (ILO) Convention 111 on Discrimination in Employment and OccupationRequires member states to eliminate discrimination in the workplace. Nationally in Australia the following are applicable laws:

  1. Australian Human Rights Commission Act 1986: This Act establishes the Australian Human Rights Commission (AHRC) and gives it the power to investigate and resolve complaints of discrimination and breaches of human rights.
  2. Disability Discrimination Act 1992: This Act prohibits discrimination against people with disabilities, including children with disabilities, in employment, education, access to premises, and the provision of goods and services.
  3. Sex Discrimination Act 1984: This Act prohibits discrimination based on sex, gender identity, and intersex status, including in employment, education, access to premises, and the provision of goods and services.
  4. Racial Discrimination Act 1975: This Act prohibits discrimination based on race, colour, ethnicity, and national origin, including in employment, education, access to premises, and the provision of goods and services. State/ Territory Each Australian state and territory have their own anti-discrimination laws such as: - Anti-Discrimination Act 1977 (NSW) - Victorian Charter of Human Rights and Responsibilities Act 2006 It is unlawful to discriminate on the grounds of race, sex, age, sexual orientation, marital or domestic status, disability, transgender status, and other factors.Local Inclusion (Anti-Discrimination) Policy Outlines the City of Sydney council's commitment to promoting a safe and inclusive community for all residents and visitors.

Dignity of risk: United Nations Convention on the Rights of Persons with Disabilities (CRPD) Recognises the right of persons with disabilities to enjoy the same rights and freedoms as others, including the right to make their own choices and take risks. Nationally, Aged Care Quality Standards Promotes and supports individual autonomy and decision-making. The National Disability Insurance Scheme (NDIS) Practice Standards Promotes and supports individual autonomy and decision-making. State/ Territory Some states provide individual decision-making legislation including: - Guardianship and Administration Act 2019 (Qld) - Mental Health Act 2014 (Vic) Provide frameworks for decision-making and capacity assessments for individuals who may require support.

Duty of care: At the international level, the United Nations Convention on the Rights of the Child (UNCRC) and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) both include provisions related to duty of care for vulnerable individuals. At the national level in Australia, the Work Health and Safety Act 2011 (Cth) imposes a duty of care on employers to ensure the health and safety of workers and others in the workplace. The Aged Care Act 1997 (Cth) and the National Disability Insurance Scheme Act 2013 (Cth) also impose duties of care on providers of aged care and disability services, respectively. State/ Territory Health Records and Information State and territory laws also impose a duty of care on community services and health industry professionals. For example, the Health Records and Information Privacy Act 2002 (NSW) and the Privacy and Data Protection Act 2014 (Vic) require health practitioners to maintain the confidentiality and security of patient information.

Informed consent: The principle of informed consent is recognised in various international declarations and guidelines, such as: - World Medical Association's Declaration of Helsinki - UNESCO Universal Declaration on Bioethics and Human Rights. These documents emphasise the importance of obtaining voluntary and informed consent from individuals involved in research or medical procedures. Nationally, the National Health and Medical Research Council (NHMRC) National Statement on Ethical Conduct in Human Research. It provides guidelines for research involving humans, including requirements for obtaining informed consent. State/ Territory Each Australian state and territory has its own laws and regulations that govern informed consent in the healthcare context. These include: - Health Records and Information Privacy Act 2002 (NSW) - Health Records Act 2001 (VIC) - Consent to Medical Treatment and Palliative Care Act 1995 (SA) These outline the requirements for obtaining and documenting informed consent in healthcare settings. Local (Organisation level) Hospice policies or research ethics guidelines. These policies aim to ensure compliance with relevant legislation and ethical standards.

Mandatory reporting: The applicable National laws include: Family Law Act 1975 This legislation requires certain professionals, such as doctors, psychologists, and social workers, to report child abuse or neglect if they have reasonable grounds to suspect it during their work. Crimes Act 1914 This Act imposes a general obligation on all individuals to report offenses they believe have been committed against children. National Disability Insurance Scheme Act 2013:This legislation establishes mandatory reporting obligations for registered NDIS providers in relation to serious incidents or abuse against participants. State/ Territory Child Protection Act (varies by state/territory) Each state and territory has its own child protection legislation that sets out the requirements and processes for reporting child abuse and neglect. These laws typically outline who is required to report, what should be reported, and the procedures to be followed. State/ Territory Domestic Violence Protection Act (varies by state/territory):Legislation relating to domestic violence often includes provisions for mandatory reporting in situations where children are at risk or witnessing domestic violence.

Privacy, confidentiality and disclosure: The General Data Protection Regulation (GDPR) This applies to organisations that handle the personal data of individuals in the European Union. It sets out requirements for the collection, use, and protection of personal information, including the rights of individuals regarding their data. Nationally Privacy Act 1988 The Privacy Act establishes a national framework for the handling of personal information. It includes Australian Privacy Principles (APPs) that apply to most private sector organisations and government agencies. The APPs govern the collection, use, disclosure, and storage of personal information. State/ Territory Health Records and Information Privacy Act (HRIPA) (varies by state/territory) Each Australian state and territory has its own HRIPA or similar legislation that specifically addresses privacy and confidentiality in the healthcare sector. For example, in New South Wales, the Health Records and Information Privacy Act 2002 (NSW) governs the handling of health information by health service providers.

Mental health legislation: The State/ Territory Mental Health Act (varies by state/territory) This may include: - Mental Health Act 2007 (NSW) - Mental Health Act 2014 (Vic) - Mental Health Act 2016 (Qld) - Mental Health Act 2014 (WA) - Mental Health Act 2009 (SA) - Mental Health Act 2013 (Tas) - Mental Health Act 2015 (ACT) - Mental Health and Related Services Act 1998 (NT) Each Australian state and territory has its own MHA that specifically governs the assessment, treatment, and rights of people with mental illness.

Work health and safety The ILO's: - Occupational Safety and Health Convention - Occupational Safety and Health Recommendation The International Labour Organisation (ILO), set standards and guidelines that influence national legislation. Nationally, Work Health and Safety Act 2011 (Cth)The model legislation establishes the framework for work health and safety across Australia, emphasising a duty of care, risk management, and worker consultation. State/ Territory Work Health and Safety Act (varies by state/territory) This may include: - Work Health and Safety Act 2011 (NSW - Occupational Health and Safety Act 2004 (Vic) - Work Health and Safety Act 2011 (Qld) - Occupational Safety and Health Act 1984 (WA) - Work Health and Safety Act 2012 (SA) - Work Health and Safety Act 2012 (Tas) - Work Health and Safety Act 2011 (ACT) - Work Health and Safety (National Uniform Legislation) Act 2011 (NT) Each Australian state and territory has its own WHS Act that adopts the model legislation, regulating work health and safety in the state/territory.

Mental Health Laws

man reading on a computer

Each State and Territory has a Mental Health Act that governs how mental health is assessed and treated and safeguards the rights of people with mental health needs. In addition to the state-based Mental Health Acts, as you learned in the first section of this Study Guide, the Commonwealth Government has implemented the National Standards for Mental Health Services 2010 (NSMHS). This document outlines standards that aim to improve the quality of mental health care in Australia.

The National Standards for Mental Health Services are standards that apply to all mental health services across Australia, including clinical services, in-patient units, and community mental health services provided by the public, private and non-government sectors. There are ten standards that deal with a range of issues which include rights and responsibilities, safety, consumer and carer participation, diversity responsiveness, and delivery of care. The Standards include recommendations about how to put the standards into effect and monitor whether or not mental health services are meeting the standards.

(Mental Health Coordinating Council, 2015)

When working with clients with mental health issues it is vital that you comply with this legislation. Reading F outlines specific implementation standards that can be used to ensure compliance.

Summary of impacts of mental health legislation on workers and potential consequences for non-compliance:

Impact on individual workers:

  • Protection of rights: Mental health legislation outlines the rights of individuals with mental health issues, ensuring they receive fair and respectful treatment. Criteria for involuntary treatment: Mental health laws typically specify criteria for involuntary treatment, emphasising the necessity of balancing the rights of individuals with the duty of care.
  • Duty of care obligations: Mental health legislation reinforces the duty of care that workers owe to individuals receiving mental health services.
  • Privacy and confidentiality requirements: Workers are bound by legal and ethical obligations to maintain confidentiality and privacy. Mental health legislation often includes provisions regarding the secure handling of sensitive information.
  • Informed consent practices: Legislation may outline requirements for obtaining informed consent before providing mental health interventions to ensure individuals have sufficient information to make autonomous decisions about their treatment.
  • Anti-discrimination measures: Mental health legislation includes provisions to prevent discrimination against individuals with mental health issues to ensure an inclusive and supportive environment.

Consequences of a breach:

  • Legal considerations: Breaching mental health legislation can result in legal actions, including fines and legal proceedings. Workers may face personal liability for their actions if they fail to comply with the law.
  • Professional disciplinary actions: Regulatory bodies and professional associations may take disciplinary actions against workers who breach mental health legislation. This can include suspension or revocation of professional licenses and memberships.
  • Damage to professional reputation: Breaching mental health laws can have long-term consequences for a worker's professional reputation. Public awareness of legal violations can undermine trust in the individual's competence and integrity.
  • Compensation claims: Individuals who experience harm due to a worker's breach of mental health legislation may pursue compensation claims. This can lead to financial consequences for the worker and their employing organisation.
  • Organisational repercussions: Employers may face consequences for workers' breaches of mental health legislation, including legal actions and damage to the organisation's reputation. This can impact the overall functioning of the mental health service.
  • Loss of employment: Breaches of mental health legislation may lead to termination of employment. Employers may take such actions to demonstrate their commitment to legal and ethical standards.

Legal and Ethical rights and responsibility of workers, employers and clients

happy team work

The legal and ethical rights of community workers, employers, and clients in mental health services in Australia are underpinned by a complex interplay of legislation, regulations, and ethical guidelines. Upholding these rights is essential for ensuring the well-being, autonomy, and dignity of all parties involved in the community services sector.

Workers: Workers have the right to a safe and healthy work environment, fair wages, reasonable working hours, protection against discrimination and harassment, and the right to join trade unions and engage in collective bargaining. Workers have a responsibility to provide high-quality services, respect client autonomy and dignity, maintain confidentiality, engage in ongoing professional development, adhere to professional codes of conduct, and advocate for the rights and well-being of clients.

Employers: Employers are responsible for providing a safe and healthy work environment, complying with employment laws and regulations, preventing discrimination and harassment, ensuring fair wages and working conditions, and providing appropriate training and support for workers. Employers have the right to expect employees to perform their duties competently and professionally, adhere to organisational policies and procedures, and act in the best interests of clients and the organisation.

Clients: Clients have the right to receive appropriate and quality services, be treated with dignity and respect, make informed decisions about their care, have their confidentiality protected, and access information about their rights and the services available to them. Clients have a responsibility to provide accurate information about their needs, actively participate in their care and decision-making, respect the rights and dignity of workers, and comply with the agreed-upon treatment plans and guidelines.

Workplace Health and Safety

team on collaboration

The workplace health and safety issues associated with working with clients with mental health issues can be complex. It is important to understand the issues associated with workplace health and safety in order to protect your own safety as a worker, the safety of your coworkers, and the safety of your clients.

The Work Health and Safety Act legally mandates a safe and healthy work environment through an organisations legal duty of care to ensure the safety and well-being of workers and clients and identifying and mitigating workplace risks. Ethically, it reflects a commitment to worker and client well-being and safety.It involves comprehensive WHS policies, regular risk assessments, and ongoing training to create a safe and ethical workplace.It empowers workers with a safe environment, promoting well-being, job satisfaction, and confidence in their roles.Potential consequences for a breach may include legal penalties, fines, and regulatory sanctions, damage to reputation, loss of trust, and compromised safety.

Employers and workers at counselling services, community services, and mental health services have a legal obligation to take reasonable steps to keep themselves and other people who are accessing the service safe. This includes:

  • Clients of the service.
  • Families and carers of the clients.
  • Visitors (including children).
  • Co-workers in the service.

The term ‘safe’ refers to both physical and psychological (or emotional) safety, which means that steps should be taken to minimise the risk of individuals being exposed to unsafe, traumatic, or emotionally stressful events. The workplace health and safety procedures and regulations that apply to your State or Territory will provide you with instructions on how to deal with situations where harm does occur including procedures such as applying first aid, calling an ambulance, or providing support.

Working in a safe manner means that you need to assess the risks associated with the work. Assessing risk involves understanding the nature of the harm that could be caused by the risk, identifying how serious harm could be, and the likelihood of it happening. The level of risk is determined by asking yourself questions such as:

  • What could go wrong?
  • What is the likelihood of something going wrong?
  • What are the consequences of something going wrong?

When you identify possible risks it is important to use your organisation’s risk management procedures or discuss the matter with your supervisor.

One aspect of workplace health and safety that most organisations will have specific policies and procedures for is the presence of children in the workplace. These policies refer to the children of workers or clients who are present in the workplace because they are accompanying their parents, not children who are clients themselves (for which there will be other specific policies and procedures that must be followed). Essentially, community service organisations have these policies and procedures that help ensure the safety and wellbeing of children while they are in the workplace. These policies usually include the need for children to be supervised and details about areas of the workplace in which there are too many risks to allow children to be present. When working with a client who brings along their own children you will need to consider issues of risk. For example, children cannot be left unsupervised while you work with your client. In some instances you might need to arrange for specific supervision of children in which case you may need to arrange a parent or guardian consent for this to occur.

As in any aspect of your work, when working with clients with mental health issues it is important for you to comply with all relevant legislation. If you are ever in doubt as to how to act in a specific situation then you will need to seek the advice of your supervisor.

crop image of woman working with computer

As with all your work, it will be important for you to clearly and accurately document your work with clients with mental health issues as per your organisation’s policies and procedures. While each organisation will have their own expectations relating to note taking and record keeping, all documentation should be detailed, accurate, and professional. Some key considerations that you should keep in mind when documenting client contact include:

  • Write the date, time, location and names of people present at the interaction.
  • Record who said what and use inverted commas when indicating direct quotes.
  • Ensure that your records are objective and accurate.
  • Record facts rather than your opinions.
  • Record the client’s actions and behaviours using objective terms.
  • Make sure that you are writing facts not inference – identify what actually happened not what you thought might have happened.
  • Record the reasons why you made certain decisions.
  • Use short sentences and be concise.
  • Use plain language.
  • Use appropriate headings and set out the information in a logical manner.
  • Make sure that you sign all of the notes you record.

In the mental health sector, many organisations use specific documentation standards called the SOAP principles, which are outlined in the following extract. 

In general, progress notes in mental health services are documented using SOAP principles (Subjective, Objective, Assessment, and Plan). While this is not the only format used to document progress notes it is considered a helpful way of organising thoughts, identifying priorities for documentation and ensuring the various elements are documented.

  • S: The subjective component of documentation describes a consumer's [client’s] view of their current condition in narrative form. Notes are taken about a consumer's thoughts, feelings, concerns, the intensity of the consumer's problems and impact they are having on others. It may include the consumer's goals or plans
  • O: The objective component includes any observable, measurable and quantifiable data about a consumer such as their appearance and behaviour, their response to the therapeutic relationship, observable strengths, and any outside data or test results
  • A: Assessment (also described as Analysis) involves a synthesis and analysis of the subjective and objective information gathered. It documents the practitioner's clinical reasoning and may include a summary of the consumer's main symptoms or issues to be addressed. Issues may be identified by a number which corresponds to actions under the next heading.
  • P: The plan refers to the proposed action or interventions. Date of next expected contact should be noted. It may also include a prognosis.

An example from a clinical file at a Community Care Unit (CCU)

23/10/08 Case management review

S.

F reports feeling “a bit down”. Concerned about tension in relationship with girlfriend since she moved out of CCU. Feels he is not making progress and wants to “get on with life, get a job”. Reports minimal auditory hallucinations and not bothered by these. Frustrated with medication side effects, nocturnal drooling and impotence. Mother has been ringing unit this week wanting update.

O.

Well kempt and highly engaged. Talked openly and is developing a clearer plan for future. Mood euthymic and sadness/frustration expressed is appropriate. Mental state stable and responding well to current medications.

A.

Currently settled with improvement in mental state and motivation. Ready for more active goal setting and intervention re future goals. Side effects persist and frustrated by these. Willing to tolerate medications in immediate future as can see benefits.

P.

  • Review ISP with emphasis on reconsidering future goals – set some clear short term goals that he is highly motivated about.
  • Discuss side effects and medication with Dr A (24/10) – may need to review in medium term if unprepared to tolerate side effects
  • Organise family meeting for 27/10. Include ISP development in this meeting.
  • To be seen 24/10.

(Mental Health Professional Online Development)

It is also important to ensure all notes and documentation about a client are treated with the highest levels of care and filed securely according to your organisation’s policies and procedures.

Records Management

Records management is the practice of creating, storing, maintaining, and disposing of records in a manner that ensures their accuracy, completeness, and security. Employees in the community services and health industry have legal and ethical obligations to maintain accurate and complete records of their interactions with clients. Failure to comply with records management policies can have serious legal and ethical consequences for employees and organisations such as legal action or loss of reputation for a breach in privacy or serious consequences for client health and well-being where mis information is recorded

male psychologist with client

There may be times when you have to respond to a client with mental health issues who is in a state of distress or crisis. On these occasions it is important to respond in the best way to meet the immediate needs of the person experiencing distress and keep work health and safety considerations in mind. Some of the types of distress or crisis situations that you might come across include:

  • Clients threatening to harm themselves.
  • Clients being at risk of harm from others.
  • Clients threatening to harm others.
  • Significant/sudden changes to the client’s situation.

When a client expresses distress, regardless of the nature of the crisis, it is important to respond promptly and supportively. One commonly used approach that are commonly applied by health professionals and  can also be applied by other community service workers is called the ALGEE approach: 

A – approach, assess and assist with any crisis. This involves assessing any immediate risks of suicide or harm, signs of trauma, or high anxiety.

L – Listen to the client’s full story and concerns in a non-judgmental manner.

G – Give the client reassurance, support and information.

E – Encourage the client to seek appropriate professional help.

E – Encourage the client to seek other support strategies.

In such situations, as a support worker, you have a duty of care to respond supportively to the client in crisis and ensure that their immediate needs are resolved (this might involve making a referral to an appropriate support service to help meet the client’s immediate needs) as well as ensure that any appropriate amendments are made to their ongoing care plan.

As such Support workers in the community play a crucial role in addressing and supporting client needs through a diverse range of services. Their responsibilities encompass a holistic approach to enhance well-being and foster independence.

Key aspects of how support workers can achieve this include referring or providing information to the clients appropriately about various available services such as:

  1. Counseling and Therapy Services: Offer emotional and psychological support within the boundary of your role; you can use strategies and techniques such as active listening, mindfulness and relaxation exercises however, the best way to support the client is to encourage them to acknowledge and validate the feelings and seek counselling or therapeutic interventions to manage any distress.
  2. Mental Health Clinics/Psychiatric Hospital: Specialized services for mental health assessment and treatment.
  3. Health Care Services, Doctors Office: Provide general health services, including preventive care and chronic condition management.
  4. Drug and Alcohol Support Services, Support Groups: Assist individuals dealing with substance abuse issues.
  5. Employment and Training Services, Job Training Programs: Support individuals in gaining and maintaining employment.

Additional Services Include

  • Disability Services, Respite Care: Support individuals with disabilities in achieving independence and inclusion.
  • Aged Care Services, Nursing Homes: Meet the needs of the elderly population.
  • Youth Services, Outreach Programs: Address the specific needs of young people.
  • Domestic Violence Support, Women's Shelters: Provide assistance and protection to those experiencing domestic violence.
  • Legal Aid Services, Legal Aid Clinic: Provide legal assistance and advice.
  • Homelessness Services, Homeless Shelters: Address housing instability and homelessness.
  • Community Centers, Council or Recreational Centre: Provide a hub for community engagement and activities.
  • Crisis Intervention Services, Crisis Hotline: Offer immediate support during crises or emergencies.
  • Advocacy and Rights Protection, Human Rights Commissions: Advocate for the rights of individuals and address social justice issues.
  • Cultural and Linguistic Support, Translation Services: Cater to the diverse needs of culturally and linguistically diverse populations.

Guidelines for Referring Clients to Health Services or Other Professionals:

Here are some situations where support workers can refer clients to health services or appropriate practitioners:

  • Suspected Serious Mental Health Issues: Indicators: Severe depression, suicidal thoughts, hallucinations, delusions, or signs of severe mental distress. Response: Refer to trained mental health professionals for thorough assessments, accurate diagnoses, and specialized interventions.
  • Risk of Harm to Self or Others: Indicators: Expressions of intent to harm oneself or others, escalating violence, or clear signs of imminent danger. Response: Immediate intervention by mental health or emergency services may be necessary to ensure safety.
  • Medical Issues Impacting Mental Health: Indicators: Physical health issues significantly impacting mental health or mental health symptoms indicative of an underlying medical condition. Response: Refer to healthcare professionals for an assessment of the interplay between physical and mental health and appropriate medical interventions.
  • Suspected Substance Abuse or Addiction: Indicators: Signs of substance abuse or addiction affecting mental well-being. Response: Refer to addiction specialists or substance abuse counselors for targeted support and intervention.
  • Specialized Therapeutic Needs: Indicators: Individuals requiring specific therapeutic modalities (e.g., trauma-focused therapy, dialectical behavior therapy). Response: Refer to specialized therapists or clinicians with expertise in particular therapeutic approaches for tailored support.
  • Legal or Criminal Justice Involvement: Indicators: Involvement with the legal system due to mental health-related issues. Response: Refer to legal professionals or court-ordered mental health services to address legal concerns.
  • Children and Adolescents with Mental Health Issues: Indicators: Mental health issues in children or adolescents requiring specialized child and adolescent mental health services. Response: Refer to child psychologists, pediatricians, or child and adolescent mental health professionals for age-appropriate interventions.
  • Lack of Progress or Deterioration: Indicators: Lack of improvement or worsening of symptoms despite community-based interventions. Response: Refer to professionals with specialized expertise for reassessment and adjustment of the treatment plan.
  • Need for Medication Management: Indicators: Individuals requiring prescription medications for mental health conditions. Response: Refer to psychiatrists or medical professionals for medication assessment and management.

By facilitating referrals, support workers contribute to a client-centered approach, promoting access to specialized care and improving overall mental health outcomes. It enhances the effectiveness of interventions and ensures that clients receive the most suitable and targeted support for their unique circumstances.

client talking to counsellor

When working with any client it is important to ensure that you work within the limits of your own knowledge, abilities, and work role, however, these considerations are particularly important when working with clients with mental health issues due to the complex nature of such work. Always remember to ensure that you have a realistic understanding of your limitations in terms of:

  • Resources available to you.
  • Your level of skills and knowledge.
  • The formal roles and the associated responsibilities assigned to you.

There will be times when the client requires assistance that is beyond the limits of your skills, knowledge, or work role. This can include requiring the specialist knowledge/skills of GP’s, nurses, social workers, counsellors, occupational therapists, psychiatrists, psychologists, drug and alcohol workers, and employment agencies. Depending upon the circumstances of the client’s care you may be required to make this referral yourself or discuss this need with your supervisor or case manager.

In situations in which you need to make the referral yourself, you will need to consider the client’s specific needs and make an appropriate referral based upon your organisation’s policies and procedures. When referring a client with mental health issues, it is particularly important that the referral is completed effectively.

The table below outlines a few different types of referral.

Possible term Characteristics Possible advantages and disadvantages
Passive referral The client is given contact information for appropriate service(s) and is left to make her/his own contact at a time that best suits the client. This process gives responsibility to the client to take action on their own behalf. However, there is a greater likelihood that the referral will not be taken up.
Facilitated referral The client is helped to access the other service, for example, the referring organisation makes an appointment with the other service on the client’s behalf, asks the other service to make contact with the client/s or a caller is transferred to the other service. The other service is made aware of the client, and the client is helped to access that other service. The client may need to wait for a response to the other service.
Active referral The referring organisation, with the client’s consent, provides the organization to which it is referring the client with information that it has collected about the client or with its professional assessment of the client’s needs. The client does not need to repeat all of their story and the agency to which the client is referred has relevant information about the client. However, there is a risk that the information is communicated out of context and therefore misinterpreted by the service which is receiving the referral, especially if not done as a ‘warm’ referral (see below).
Cold referral The client is transferred to another service, without any immediate communication between the Centre or Advice Line and the other services, for example, by putting the client into a call center queue. The other service may be unaware of the nature of the call or of any information or services that have already been provided. The client may be frustrated that they have to re-tell their story or may not communicate their needs in a way that allows the other service to see why the client has been referred.
Warm referral A ‘live’ three-way conversation in the presence of the client (whether face to face or by telephone) in which the referring organisation introduces the client, explains what has already been done to assist the client and why the client is being referred.

This provides an open and transparent process in which information can be exchanged between the Centre, the client and the other service. Issues can be clarified immediately. The client does not need to repeat all of their story.

The process relies on someone being available at the other service at the time the client is to be referred.

(Australian Government, Attorney-General’s Department, 2015)

While you will need to comply with your organisation’s policies and procedures, in general, some form of ‘warm referral’ is usually most appropriate for clients with mental health issues. This ensures that the referral is most effectively made and that the client’s needs will be most effectively met.

In summary, work role boundaries refer to the ethical and professional guidelines that govern the interactions and relationships between employees and clients in the community services and health industry. These boundaries may include: - Avoiding dual relationships - Maintaining professional distance - Respecting client autonomy - Establishing clear communications etc. Failure to maintain appropriate client boundaries can result in legal and ethical consequences for employees, including disciplinary action, loss of licensing or certification, and legal liability.

When working with clients with mental health issues it is important to remember that, as a support worker, you are essentially only completing one part of the client’s wider care plan. Be sure to complete your role effectively and work collaboratively with other service providers.

In this section of the Study Guide you learned about some of the critical considerations that you should keep in mind when working with clients with mental health issues. Specifically, you learned about the importance of engaging in collaborative, adaptive practice that promotes client rights while still conforming to your organisational and legislative requirements.

Australian Government. (2010). National Standards for Mental Health Services 2010. Barton, ACT: Commonwealth of Australia.

Australian Government Attorney – General’s Department. (2015). Referral Guidelines for Family Relationship Centers and the Family Relationship Advice Line. Retrieved from https://www.ag.gov.au/FamiliesAndMarriage/Families/FamilyRelationshipServices/Documents/Referral%20Guidelines.doc

Mental Health Coordinating Council. (2015). Mental Health Rights Manual. Retrieved from http://mhrm.mhcc.org.au/chapter-2/2c.aspx

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