Page 2681 - Week 08 - Thursday, 24 August 2006
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People with mental illnesses can live messy lives and do not fit neatly into the segmented programs of well-intentioned officials.
Our current models focus resources heavily on the time of crisis rather than on a long-term plan for maintaining mental health and providing resources for recovery. The approach taken during a time of crisis can also make recovery more difficult and reduce the trust that people with mental illness and their families have in the system. And because the system is illness focused, people often do not get help early enough.
The traditional way of working with people with mental illness did not include the idea of recovery, particularly in the case of illnesses which involve psychosis. However, in the 1990s, a broader discussion of recovery from mental illness commenced. The scope of a recovery focused system is much more holistic than much of the medical model. It covers not only physical and mental health and psychological wellbeing, such as self-esteem, hope, coping and confidence but also the social domains of life such as economic matters, social interrelationships, purposeful activities, leisure and housing. The aim of the system must be to stimulate recovery rather than encourage lifelong dependence on social services.
There are examples in the world where recovery focused models have been put in place, and these have shown promising results. The longest running example of this kind arose in Italy in the province of Trieste, which has a population of around 300,000, similar to Canberra. This model of care and treatment is one which relies strongly on the development of respectful and non-hierarchal relationships which focus on the person and not the sickness. It works towards recovery and maximising independence, while maintaining the supportive network of relationships, so people can pass through this service when they need its help without having to wait for crisis to develop.
As much as possible, they seek to maintain the person in their ordinary world and support them there, helping them to develop resilience through support in the community. Families and supporters are provided with specific assistance and often are put in touch with other families experiencing similar problems so that they have peer support. Access to secure and safe housing is a necessary basis of this model.
Importantly, there is no use of seclusion or restraint, and none of the community mental health services are locked. Bars are on the outside of the ground floor windows to keep burglars out, but the upper-storey windows are open to let in the sun and air. This should be contrasted with the frequency of use of seclusion in the ACT, 88 in the first three-quarters of 2005-06, and the status of the psychiatric services unit at the Canberra Hospital, which is a locked ward.
The use of involuntary treatment orders in Trieste is also rare—seven per 100,000 residents. This should be contrasted with the ACT where the Community Advocate reports 810 orders for voluntary detention of either three or seven days and 213 psychiatric treatment orders for 2004-05. Converting this to a comparison with Trieste, the ACT uses 341 orders per 100,000 residents, compared to seven.
Finally, Trieste has been found to be much more cost effective than our traditional models of mental healthcare. The paper does not go into the costs involved, but I would be happy to provide separate papers dealing with this issue if members are interested.
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