Section 2: 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 (for example, carers)
• The client’s case file or other paperwork
• Other professionals involved in the client’s care (for example, case manager, psychologist and GP).

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 wish 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.

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.

Depression

i had a black dog, his name was depression

In this video, writer and illustrator Matthew Johnstone tells the story of overcoming the "black dog of 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 the World Health Organization (WHO) as one of the leading contributors to the global burden of disease and disability.

How to recognise perfectly hidden depression 

in this TED Talk, Dr. Margaret Rutherford, a therapist for over thirty years, shares how fostering and modeling deeper transparency can both improve and save lives. After watching the video, answer the questions that follow. 

 

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. Study the following common types of anxiety disorders.

• Generalised anxiety disorder
  This disorder 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 disorder
  This disorder 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 and fear of snakes.
• Post-traumatic stress disorder 
  This disorder 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 
  This disorder involves obsessive repetitive behaviour, (for example, obsessive hand-washing, repeatedly counting items or objects or feeling the compulsion to pray a certain number of times a day) to the extent that it interferes with work and/or relationships.

The symptoms of anxiety disorders can include physical symptoms such as rapid heartbeat, palpitations, hyperventilation, sweating, headaches, nausea, vomiting, diarrhoea, 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 behavioural symptoms can include avoidance of certain situations, distress in social situations or crowds, and obsessive or compulsive behaviour such as continuous hand washing.

Living with anxiety at 17 years old

In this short documentary, Dr Alex met with Rosie, 17, who struggled with mental health issues for some time. Since receiving support, she’s now reflecting on what helped her overcome them.

Other Mental Illnesses

While depression and anxiety are the most common mental illnesses, there are many other mental disorders. As with depression and anxiety, these vary in severity and can be very debilitating. They include the following:

Schizophrenia

This is a condition that affects the normal functioning of the brain. It is characterised by symptoms such as confused thinking, delusions, and hallucinations.

What's it like to live with schizophrenia?

In this animation, the main character talks about what it’s like to live with Schizophrenia and his experiences of existing medications.

 

Bipolar disorder

This condition is characterised by both high and overexcited behaviour followed by extremely low feelings of helplessness and depression.

Living with bipolar disorder: Maarten opens up

This short documentary discusses what it is like to live with bipolar disorder. 

 

Schizoaffective disorder

This is a disorder in which mood swings are similar to those found in bipolar disorder, together with some of the symptoms of schizophrenia including delusions, hallucinations, disorganised speech and disorganised behaviour.

Living With Schizoaffective Disorder

This short documentary follows the journey of Katrina, living with schizoaffective disorder.

 

Psychosis

Psychosis is the inability to distinguish between what is real and what is imagined. Symptoms include disordered and confused thinking, delusions, and hallucinations.

Psychiatric Interviews for Teaching: Psychosis

This short video role-plays a psychiatric interview with a patient with psychosis. 

 

Depending upon the client’s mental health issues, there may be specific considerations involved in their care needs. This is why, as a counsellor, you should never be the sole person responsible for working with a client with mental health issues as counsellors do not have the necessary training for diagnosis or care planning. If you are working with a client who you suspect has mental health issues and who has yet to seek out a qualified assessment then it is important that you encourage the client to seek out appropriate assessment and complete a referral. However, if the client already has a diagnosis, is in the care of a suitably qualified professional, and you are working with them in some form of support capacity, then it would be appropriate to obtain the client’s permission to discuss any specific needs with the primary care professional.

Only once you have sought out all relevant information from the client, their support network, and any other professionals involved in the client’s care, will you fully understand your client’s needs. From there, you will be in a position to develop your own counselling-related care plan for the client. While each individual’s needs will differ, one thing that will remain constant is the need to develop a plan that supports empowerment and recovery.

Young Man on Being Diagnosed With Psychosis

The interviewer in this short documentary, talks to Andrew, diagnosed with psychosis, and his mother Simone, about the trials he faced coming to terms with his diagnosis.

Check your understanding of the content so far!

Working with clients through the recovery approach should involve reviewing the services available to the client in terms of their strengths and support networks. As you should recall from the previous section of this module, 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-centred 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-centred care also provides emotional support to the client and ensures that there is continuity between and within services. Putting individuals 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). It is important for you 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 counsellors, our own values and biases can sometimes work their way into our helping relationships.

An example of this is outlined in the following case scenario.

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 the development of any counselling plans
• Present the client with a number of different options that they can choose from when developing any counselling plan.

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

How does Empowerment & Stigma Affect Clinical & Personal Recovery?

This video answers the questions: Does empowerment help people who are mentally ill? What is stigma and self-stigma? Can too much positivity be unhelpful when trying to recover from mental illness? What is the difference between clinical recovery and personal recovery?

Support options

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

Depending upon your role in the individual’s care, you may assist them in accessing services or you may provide them with specific services. It is important to understand the client’s goals and your role in working towards them. For example, if you were working as a case manager for a mental health support organisation you might be responsible for coordinating services, whereas if you are simply working as a counsellor as part of a larger plan you would only be responsible for assisting your client with the specified goals that have been assigned to your work together.

Regardless of your exact role, collaboration is vital. Collaboration is a vital part of working from a person-centred approach as it enables the client to be empowered to achieve their goals by receiving coordinated support from the people around them. It also empowers the client by encouraging them to develop an understanding of their own needs and supports them in making decisions. Collaborative approaches reflect respect for the client in that they give them a say in the goals that they set for themselves and the strategies developed to meet their goals. 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 develop 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
• Conduct 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 in finding employment
• Facilitate involvement in volunteering.

Empowering Others on their Mental Health Journey

In this video, Marjorie Morrison, Psych Hub CEO and co-founder, provides a powerful talk on empowering others on their mental health journey.

Informed consent

Of course, when developing any form of counselling/care plan or making a referral, it is important to obtain the client’s informed consent. As you should recall, informed consent means that a client fully understands any proposed interventions before making a decision to consent to these interventions. You have a responsibility to explain the nature of interventions, their benefits, as well as any limitations. The language in which you discuss this with the client should also be understandable and appropriate to their situation.

To recap, here are the essential aspects of informed consent in mental health intervention.

In mental health intervention, informed consent plays a vital role in preserving individual autonomy and the right to select one's treatment, aligning with the principle of self-determination. This entails informing individuals about potential benefits, risks, and treatment alternatives while respecting their decisions and promoting a collaborative care approach.

Key Elements of Informed Consent

• Information Sufficiency: Ensure adequate information on the suggested approach/intervention for informed decision-making.
• Coercion-Free Decision-Making: Enable clients to make decisions without any form of coercion or external pressure.

Within the mental health system, there are some circumstances in which clients are not able to consent to treatment due to their mental state. On these occasions, helping professionals may have a duty of care and treatment can be imposed on clients involuntarily but with an attempt to utilise the least restrictive alternatives.

For example, in some cases, clients might not have the necessary insight to cooperate with interventions and may resist help. However, if a client is clearly harming him or herself or harming others, interventions may be necessary to ensure safety. Regardless of the circumstances, the most common policy is to find a solution that is least restrictive so that undue force is not imposed on the client.

Duty of care and dignity of risk

When working with people who have mental health issues you have a duty to ensure that their safety is maintained. If, for example, a client expresses the desire to commit suicide you have a duty of care to take action to address this issue with the client. However, when working with clients with mental health issues, some counsellors can feel too compelled to ‘protect’ their clients and not allow them the dignity of making their own decisions – this can be a symptom of inappropriate professional boundaries and it actually violates the concept of ‘dignity of risk’.

The concept of dignity of risk relates to the fact that in some circumstances clients may want to take certain risks even when such risks can lead to harm. While some counsellors may want to protect clients from any harm, taking risks is part of a client’s right to self-determination. For example, a person who has mental health issues may wish to apply for jobs that the counsellor considers beyond the client’s reach (for example, outside their skill level). Although this activity does carry with it a risk that the client will be rejected and become upset and hurt, the client has a right to self-determine that they are willing to accept the potential risk of harm.

As a counsellor working with clients with mental health issues, it can be a challenge to support decisions that we feel are too risky. However, unless there are serious concerns about the client’s present state of mind, you need to remember that clients typically have the right to decide what level of risk they are comfortable with. In such cases, it might be appropriate to provide the client with appropriate information that can minimise risk, however, it would not be appropriate to restrict the client from taking their chosen action.

Rights and responsibilities

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.

Check your understanding of the content so far!

In this section of the module 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.

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