As a concept The Recovery Model inspires hope.


In response to a professional blog regarding The Recovery Model that implies that the model is dangerous and should be dumped.

There is a disconnect between the model and it’s proper integration and delivery. Issues raised in the blog focused on the anti-psychiatry movement and some blame was laid at the models door. Below is my response to this blogger, whom I have great respect for and I empathise with in regards to delivery of the model and the dynamic of scapegoating psychiatry as an evil within our society.

As a concept The Recovery Model inspires hope. It must be noted though that this recovery is in fact personal not clinical. I would caution you not to make the same mistake that you are accusing others of doing. The Recovery Model is a very helpful and useful tool. The twin pillars of person centered and strength based practice are vital in supporting the model as used by a person’s support network, both clinical and nonclinical and the person themselves. It recognises that a person is not simply mentally ill but is a person whose life is affected by the experience of a mental illness. Semantics? No! Truly the second interpretation is more accurate than the former.

Is it become a tool to fund inappropriate interventions? Well yes it can be. When applied by incompetent services or clinicians. The model allows a person to identify their strengths rather than focus on the weakness. This , if done well, improves the quality of the life lived and recognises that while the life experience of illness is fundamentally difficult it does not have to be the entire focus of that person’s life which is the majority experience. So, a personal recovery is a powerful thing on its own.

There are many flaws of delivery to be worked out. But an all-encompassing rejection of the model is unwise and potentially damaging to those who need the perspective it offers.

 Anyone saying differently is deluded or is too rigid in their thinking. The model empowers the individual. Would you take that from a person whose life is complicated and often dominated by the experience of their illness?

When first introduced to the idea I was gobsmacked. Improvement of personal circumstances and the daring concept of hope was an enormous change of perspective. . I know that this recovery is independent of my symptomatology.

Unfortunately as there has always been, there are groups and individuals who rage against psychiatry and psychopharmacology. The agenda for the groups is based around paranoid fantasies and the short comings of medications and therapies. And there are shortcomings. Psychiatry is a science based art. It requires a skill in delivery that really can only be developed over time through experience with patients. That experience is not science. It is rarely repeatable or transferable from one patient to another. Being an interpersonal discipline the effectiveness of the psychiatry is based mainly in the understanding of the individual’s experience of the effects of illness in their lives and how treatment options will or won’t work for them.

Of course individuals have claimed a negative stake in psychiatry as well. This is simply a reflection of the shortcoming of the discipline. Many of us in conjunction with our clinicians strive to find effective treatments. It is quite often the case that the appearance of trial and error is at work within that treatment dynamic. This is a real experience. Because of this many people feel let down and look for a scapegoat. There is also the idea that everything is treatable. If a patient presents without improvement,then that patient might after several changes in treatment, find such a promise as disingenuous.

In my experience with complex PTSD, I was not promised any kind of cure or treatment that would “fix me right up”, there was no magic wand. I knew that and my clinician reinforced that. I am now on an unusual combination of meds that appear at this point to be working, but it’s been 14 years of trial and error.

It doesn’t help that side effects to many drugs are simply too much to bear. I might well argue that we should direct our ire at Big Pharma, for putting patent based profits before better developed medications, rather than the discipline of psychiatry. But if psychiatry rails against this most useful model, it shows itself as being no better than the conspiracy theorists. I suggest we should all work toward making both kinds of recovery (clinical and personal) an experience that helps the individual grow and achieve quality in the lives lead.

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THE LAST SCRAPE OF THE BARREL MIGHT WELL BE THE BEST SCRAPE


Foreword- Is it possible to achieve a clinical recovery directed by a personal recovery? Below is a lyrical description of a person’s experience of a new psychological and personal paradigm. …

Source: THE LAST SCRAPE OF THE BARREL MIGHT WELL BE THE BEST SCRAPE

The Reality and Worth of the Lived Experience.


The Reality and Worth of the Lived Experience.

 

Consumer is a political term used to describe a population who have who access services and have high service needs. The human element is completely erased. But this is the term we are currently using. This may not always be the case in the future.

For those who work the role of consumer companion a more accurate title might well be a professional personal companion. This is far from being a new concept. Many of the world’s finest artists, composers, writers, thinkers and politicians throughout history have employed the services of a paid companion. In the majority of cases these relationships were completely platonic. So what did a companion do? Quite simply they were there. There to help with tasks, to provide company, conversation, intellectual stimulation, advocacy and emotional and physical care. This was all done within a platonic framework or boundary. In the corporate world these people are called personal assistants and often work well outside of the standard job description. This is a transferrable archetype.

Even Peer Support lacks certain humanism. It reduces both the Peer and the Person to tightly defined roles without the obvious boundaries. The Peer experience, the lived experience as it stands right now, will not be the panacea that many hope for. The reason is very simple.

Any experience is limited to how that experience is interpreted and then how it is utilised. How it is utilised is limited by the experiences a person has which once again are interpreted and utilised by earlier experiences. Life is experience, its interpretation and its utilisation is a linear process defined and limited in and by time.
You may have a lived experience of Bi-Polar. The person you support has a lived experience of Bi-Polar, without adding any other variables these experiences are not shared homogenously. The experiences themselves will differ immensely. The interpretation will be exponentially different. How each experience is utilised will differ yet again at an even greater order of magnitude.

So what is the point of a job that requires the worker to have a lived experience? Your lived experience gives you an emotional insight which those without such a background cannot hope to emulate. Just that, in and of itself makes any peer program worthwhile, as long as that person receives good training and is able to learn new skills. One of those skills is self- directed learning. It is extraordinarily helpful when supporting a person to actually understand the diagnosis. Become familiar with the symptomology. A small amount of clinical knowledge can make the difference when interpreting a person’s behaviour.

 

 

 

With mental illness few things are simple. But by having a base level understanding of your client’s illness, you will be more aware of potential barriers and challenges in communication. For the Peer worker communication is the life and soul of the job. Having a little clinical knowledge along with the wisdom gained from interpreting your own lived experience allows for a special skill. That skill is empathy.

Empathy is kind of like the fifth element in supporting someone. Though you may be able to draw on your own experience, you may find it difficult to identify with another’s experience simply because their experience is theirs alone and therefore alien to you, so you may not identify with it nor understand the behaviour it has engendered. You though, have lived a life full of challenges that parallel with the person and it is that which allows you empathy which in turn allows to understand another’s intrinsic being as they live their lives.

With empathy comes understanding. With understanding comes patience, and patience or the lack of it is the key to a continuity of quality of care. Let’s remember we are care givers, not care takers.

Lived experience workers could well be the game changer in mental health care. This can only happen though if we combine our understanding of your own experience, a basic clinical knowledge of mental illness and disorders and be open to understanding the experience of the person you are working with. So when we work with a person we must get to know as much of them as they will allow. This will carry you and the person you are working with a lot further than has been possible in the past. This will also allow the person you are working with to increase their own understanding of the illness. As stated before with understanding comes patience and the person you work with needs to have patience with themselves also.How it is uti;liHaH

Asylum seekers and complex PTSD in Australia.


In Australia we have a “Turn back the boats” policy in regard to refugees. This is lawded by so many in my country because they have been told that this legislation actually targets smugglers. The truth of the matter is that humanitarianism is the last thought in the minds of our political parties, who are in bi partisan agreement on this policy.

So when people actually make it here we deport them to an off shore facility and keep them imprisoned for a very long time. The processing of asylum seekers can and does takes years. And we do not discriminate between adults and children. All are treated the same.

The terrible truth is that asylum seekers are seeking rescue from traumatic, life threatening situations in the home lands. They come here more often then not, heavily traumatised by the lives they have been forced to live in their homelands and what do we do? We traumatise them again. The most fundamental of which is the very simple- People looking for help or rescue are rejected and then imprisoned which not only reinforces previous trauma but retraumatises. The outcome being a population of people who develop severe and com[lex mental disorders who are then traumatised again by the staff of the detention centres. There have been so many reported rapes and accusations of sexual misconduct by detention centre staff that the immigration minister the dishonourable Peter Dutton has recently had a rape victim flown secretly out of the Nauru detention centre and attempted to send this young woman to Papua New Guinea for an abortion. The High Court in Australia has rule as of Friday the 4/5/16 that it was an illegal action. Since then the minister has refused admittance to Australia for this poor person and noone at this point now knows what the next step has been.

Australia. An humanitarian nation? I think. We damage the damaged and do not care what happens to them and we cover up the abuse done to these folk. Australia is as culpable as the countries these people have fled from, for causing severe mentsl illness and hopelessness which has lead to numerous suicides, including self immolation.

If God judges then Australia will be judged most harshly and ignorance is no defence against the crime.

 

NO SAFE PLACE- Just another mental health disaster


OPENING STATEMENT

I am not here today to make friends. I am not here to network nor to make good impressions in an effort to get work. Neither am I here to show boat! So, why am I here?

Locked wards? No, I talk about this subject a lot and nobody including Qld’s current health minister wants to even engage the subject.

Is it because, like prisoners we have our tobacco taken away from us and it is only returned on a persons discharge? No. No one seems to give a rats about that either. Or I simply hear a lot of nanny nation comments.

So like prisoners we are locked in without our privileges. This is for voluntary patients by the way not involuntary. Involuntary patients are treated the same they just acquire more paper work.

GUTS OF THE ISSUE

So let me reflect to you another uncomfortable truth.

A truth that, perhaps the public health sector particularly, may not wish to hear.  People with severe and persistent psychiatric illness / disorders have no safe place within the public mental health system to go when acute or at risk. If you want confirmation of that outrageous statement join a lived experience forum. The scores of forum members I have come to know all tell a frighteningly similar tale and which inevitably ends with a person back at home still distressed, still at risk. Don’t ask staff with a lived experience, I already have and what they say is not the same as what those forum members are saying.  Since being popular is probably not a viable outcome for me after this presentation, I would put forth the idea that perhaps actually being paid to work within a set model influences one’s critical capacity to be objective and informed about other peoples’ experiences within that model. Lived experience workers are a boon to the care of their peers but the model they are working within is incomplete and they remain totally unaware of this. As it stands with current modelling the therapeutic section of the model, which would count as the infrastructure is not actually there. For more than a decade I have heard the rallying cry of no hospitalisation! The rationale? Being in hospital, leads to institutionalisation. Bollocks! Very long term hospitalisation may lead to this but if you use the NGO support models in conjunction with a solid discharge plan, this is accounted for and the patient is supported through a transition from public health to the NGO sector. Pretty simple really!

So what do we have? We have a partial working therapeutic model. We have satellite services that provide day to day support for people managing a mental illness/disorder.  This almost has the appearance of a help line model but with the social and therapeutic benefits only an ongoing interpersonal relationship and regular visits can provide. This is good. We have services whose sole purview is to connect clients/patients with the satellite services they require, be that mental health plan support, crisis support, access to general medicine and pharmaceutical support/ intervention, support and advocacy with other public departments. We have excellent new training for new workers who have a desire to add a positive influence into the lives of others by seeking their own recovery and in so doing support the facilitation of another’s. This is a fast growing workforce. And as such can support a true model.

A true model is not much different from current NGO modelling for service provision. It simply requires a real infrastructure. There is no public health infrastructure to base this model on. Without short – medium term hospitalisation (1 week to 12 months) there is a hole in the current model which not only means people are at the highest risk and suffering the symptoms of their illness alone. There is also a hole where properly trained and educated psyche nurses should be, (adding mental health to a nurses degree does not actually give them the knowledge or practice attributes required to be effective psyche nurses), because the goal of short to medium term hospitalisation is to stabilise and to begin and establish treatment for the patient, the person has more options to find and then maintain stability. And what do mentally ill people want more than gold?

 Stability.  Resilience then, is a backup tool not the primary coping mechanism.

It is a word which has so much meaning for so many people. Few others are even able to conceive of the benefits of this stability. Without that kind of care with that kind of outcome, all other service provision models are as a scent on the wind. They can have an enormous influence on a person’s recovery but without the whole model the satellites end up doing band aid work. This leads to service providers trying to provide services they are neither funded for nor are qualified to supply. As they are distracted by acute psychiatric issues, the longer term goals and outcomes recede further away and become pointless distractions, in and of themselves.

Let me begin with a telling of an event in the last year which has opened my eyes to the true nature of our Public Psychiatric Services system. I don’t often personalise when writing for professional readers or audiences. When I do it’s generally because I want to impart a message so strongly that actually making such a disclosure strengthens not only my resolve but hopefully also the message itself. So indulge me.

On the Monday the 7th of September, last year, I presented myself to the Prince Charles Hospital admission team.  This had been organised by my private psychiatrist and the hospitals treating psychiatrist and the acute care team.  It was agreed from the first words of conversation that I was a voluntary patient seeking admission to be weaned from a particularly inter-reactive and dangerous medication. As going into a locked ward troubles me, and brings back very painful and traumatic memories the idea was to make this a smooth and collaborative experience.

 Within a few minutes the young registrar informed me of a new hospital policy that stated that all patients must hand over their cigarettes or other smoking materials. My response?

“You are fucking kidding, right?” In the same way you turn to a mate and say WTF? Incredulous and yet still seeing the humour.

And that is where things went off script in a major way. I looked at the door to see four extremely large and extremely intimidating security guards, a nurse from the acute care team walked in, told me that all conversation was now at an end I would be accompanying them to the ward. We entered the isolation cells and stood there for a count of 130. At this point I was then crowded into the PICU ward. Patient Isolation Care Unit.   I tried explained to them that they had made a major error of judgement and that they should look to my file notes as to the nature of my admission. This was ignored. Obviously because I’m a nuttier!

A day and a half later, a doctor showed up. He is one of the senior doctors in charge of the unit.

He stated that the process by which I was admitted was hugely flawed that day, and that the assessment team had made some serious errors. I explained I had been completely miss-assessed, regarded as a threat and isolated all for no evidential reason. He agreed that I would be placed in an open ward ASAP, and that I would have double the smoking privileges. This felt to me like a cheap and tawdry bribe. I was asked to “keep it quiet, or the patients would riot”. After many hours I was relocated to west wing.  I found out I was under an ITO only the day before it had run its course. So, to add insult to injury, not only had a voluntary patient been ITO’d but was not informed of it until its end. Now I was to begin the detox.

 A so called treatment team suggested cold turkey at home was the best course rather than wean over a two week period in a safe place.

Just in reference to that point

 My Doctor, Dr George Bruxner states that he never agreed to my discharge and was in fact outraged by the treatment I received from the acute care team.  It was only later I considered the possibility that they simply wanted me off ward.

 Tranylcypromine is a drug that takes two weeks minimum to withdraw from. It is a highly reactive compound and requires constant supervision as hypertension and tachycardia are major side effects of coming off the drug. Acute compulsive suicidality is also a major side effect of withdrawal. As I live alone and have no family, I was at grave risk. The withdrawal itself was physically harrowing and traumatic to deal with alone. It was never recommended by my own psychiatrist to detox this way and to be perfectly frank I was at dire risk the entire time.

The same three words kept going around and around in my head

NO SAFE PLACE TO GO!

I was desperately ill and the mental health unit which should be a sanctuary or to use a very loaded word, a place of asylum, was actually detrimental to my health.

And that’s when it struck me. There would probably never again be a safe public hospital system for psychiatric care again. Why?  THERE IS NO SHORT TERM MONEY IN IT!!!!

As a younger person during the late 1980’s and early 90’s, I had accessed the same hospitals’ psyche unit.  6 open wards, one closed ward and admissions that ran for as long as was necessary for the wellbeing, safety and best treatment outcomes for the patient.

Yes there were issues, abuses, and systemic failures. But instead of salvaging the care and treatment portion of the hospital model the whole system was pulled down.

In its place we now have what amounts to little more than a triage unit that send it’s (frankly) doubtfully assessed Patients/CONSUMERS into the poorly integrated NGO models of mental health service for observation, care and treatment. Services that are not available in the NGO sector at any public level.

 

When speaking with people living with complex mental illness/disorders, the sense of hopelessness is palpable. With any complex diagnosis people require regular care from a clinician. What is provided by the state essentially covers twelve weeks of care and treatment with a clinician who may or may not even be knowledgeable about your particular disorder. Because of that fact, just on its own, people are suffering and people are in fact dying.

And why?

No Safe Place To Go!

Somehow, some way it’s been figured to be more cost effective to use the current half- model. And if it’s cheaper; then selling the idea to the sector is the last step. And they do this by calling, excitedly, for submissions of Expression of Interest into new modelling practices, for a better healthcare outcome no just for today for also for tomorrow.

What most people don’t seem to get is that “tomorrow”? is pretty close to literal. Short term economics has been the economic model since Bob Hawke’s last term as Prime Minister. In those days it was called economic rationalism. The rationalism lay seemingly exclusively within a 3-5 year period which coincidentally was also falls within the same time between elections.  I don’t consider myself in any way a cynic, but it has been illustrated over and over by successive governments regardless of partisan politics; The ideologies of both major parties are as one in the practise of short stop economics.

What this says about the leadership in Australia is not for me to comment on here.  But the practicalities are very simple. Twice in six months I needed a safe place to be assessed, observed, cared for. The simple fact is that a suicidal but voluntary patient was discharged by a system, so easily, and with no thought as to follow up care and then put that distressed person at extreme risk both medically and psychiatrically. That this is supposed a place of health and safety speaks volumes as to the disintegration of the entire public mental health system and to the lack of real commitment to Good Mental Health and suicide prevention. And the continuing isolation and mental distress, in many ways condemns the NGO sector’s ability to not only be effective advocates but more importantly illustrates the services required by people experiencing acute psychiatric distress cannot be met by the NGO mental health sector. They cannot provide a safe place. A 24 hr hotline is not a safe place. This is not only unreasonable to the extreme but is also terribly, terribly dangerous.

If you had kidney failure and were unable to receive the necessary treatment to survive, it would be considered unconscionable. People in mental distress are at the same mortal risk, so why the difference? I cannot answer that.

I do though have an idea for a pathway. At this point it is one man’s idea. A man’s idea who himself has little solid understanding of economics.

 

 

 

Now since so many psychiatrists claim to be frustrated with the current system and since too as a body they have a certain level of influence in regards to legislation and policy making, perhaps the Royal Australian and New Zealand College of Psychiatrists, The Australian Psychological Society along with the Australian Medical Association and even the Pharmacists Guild if they worked together, might actually help to facilitate real treatment modelling options.  All have vested interests in better public psychiatric care. Alone each body has a certain political clout. Not overwhelming by any means but individually it’s there. Together with the NGO sector? It could be a big hammer.

Can you say the word COOPERATION? I have been lamented at by psychiatrists and psychologists for quite some time now about how impossible it is for them to actually practice their art and to help sick people feel better. They all complain, but it would appear, that is all they do. I am just a man with complex mental illness problems to do deal with; I simply can’t and won’t also carry the weight for the well paid professionals who are struggling. Boo Hoo! I must advocate for myself and I have no loaded dice but you guys? Well the only real impediment I see is apathy.

If you want to do your job well, take a stand. Take it in unity with your PEERS ! There are enough of you together to push the therapeutic point home.

Can you see the combined resources of just these four bodies? Just imagine this group with a political will to make mental health a state of being rather than a description of a service sector. I guarantee that if the political will is there, the NGO sector,( who are solely motivated to support people who experience psychiatric illness/ disorders), will march in step to help shape a proper paradigm of health.

Or are you too scared to even try? You have far, far less to lose than I do. Like so many others I could very well die because there is no safe place.

Imagine psychiatrists and psychologists if you look beyond your own short term economics and take on just two patients to bulk bill; the benefit for those who are in need of weekly or fortnightly appointments ( even if it’s simple maintenance) will be immeasurable. You will also being doing a thing. Taking an action which is truly morally good. I know that most of you actually care about your fellow humans. You chose your field of endeavour based upon that care and the desire to at the very least ease pain. Take “Cause No Harm” to its logical end and bring comfort where for so many for so long there has been none. Me, I’ve forgotten how to hope. Do you even care?

But hey just say it can’t be done and it won’t be.

And we will just continue to undergo the lived experience of having a mental illness as we have it this very day. That’s the choice, folks. It’s really that simple.

As for the economic benefits the basics are easy. With a healthier population you have increased work engagement and productivity. With greater economic independence comes a higher level of consumer spending which in turn adds to the nation’s GDP. To go just a tad deeper, with increased productivity leading to greater profits, national and international investment is encouraged.

This is of course based on long term economics. And therein lies the rub.

Us against them? This is a negative starting point. We must convince those who need convincing of the worth of providing real and meaningful psychiatric care for its own sake.

FINAL STATEMENT.

Either way mentally ill people are suffering greatly for no other reason than economic ones. This is in a first world economy, by the way.

I would like to pose a question. What is a government is elected to do? It is elected to provide essential services for its citizens and to oversee the making and application of law, policy and build on past strengths to make a greater and more prosperous nation going on into the future.

Since when, did health and education become nonessential services? We are a first world economy. We are wearing Big Boy pants. It’s time to act like it.

Look, I am not pretending to have the answers; I don’t Do economics. I’m not even pretending I know what all the questions are. But we do have experts in economics, legislation and policy and the attendant procedures regarding all these things.

We come back and the word is still cooperation.

The word is cooperation.

But hey just say it can’t be done and it won’t be.

And we will just continue to undergo the desperate lived experience of having a mental illness as we have it to this very day.

It is only through uniting and pooling our resources and knowledge and drive that we can affect change. If we don’t, at best the suffering will continue, and not only will people continue to die but it will happen more often. If it happens often enough (and we know this through our prison models, and we know through homelessness modelling), people just stop giving a goddamn. That’s the people. The public, they’ll just stop giving a damn. This apathy has been modelled throughout Europe, The U.S. and Great Britain. And if we can succeed in this then surely we can succeed in working with these other disadvantaged and endangered people. Just because people are poor doesn’t mean they stop having worth. I’m poor. I live in poverty. What am I worth?

I am complexly mentally ill. My disorder is extreme in its treatment resistance. Do I matter?

If I matter, doesn’t everyone else?

 

our blessed Australia


when i was growing up I saw little in my closest circle that resembled love, faith, kindness, social and personal empathy or any family loyalty. Instead I saw brutality, torture, favouritism, ignorance, bigotry, hate, violence, and abandonment.
I was not agreeable to any of those things. Instinctively I knew what was morally good and what was morally bad. Simple terms yes, but in the reduction of behaviour simple terms are more honest and easier to grasp.
Good and bad.
I knew in my soul that my father’s blind prejudice, and his inability to rescue his child were indicators of his cowardice. He had no backbone and died the same way.
Sandra (a mother in name only) was vicious, perverse, violent, egomaniacal, and a liar and deciever. She still lives that way.
I knew again, in my soul that both of these people were intrinsically wrong and in his case passively and in her case actively evil.
I would and could not be like that. I did not know how to be like that.

Sadly I see our country, our blessed Australia acting in both forms of evil.
This behaviour is not partisan but practised by both sides of politics. And we the people, allow it.
We the people facilitate it.
Imprisoning the hopeless and the children of those is the blackest mark against not the govt, but us as Australians.
Stopping the boats? my God what has become of us when we use fear to justify the imprisonment and torture of a desperate people.
We Australians support these policies.
It lessens us. It makes us tolerant of evil practise. We judge other nations so very harshly and yet we tolerate evil. Who are we?
I am not Austalian, I am a citizen of humanity. As we all are. But so many many practise passive evil.
There is only Good and Bad. There is no grey here. You either stand for good and act in that manner or you stand for bad and act in that manner. To allow evil to happen? that is bad.
The strong minority is glad handed by the passive majority and we end up locking small children into prisons where they become so damaged that they attempt to kill themselves. 5 and 6 year olds attempting and some completeing  suicide. Is this the mark of a nation of good people?

no

not even a little, God help us

THE TRUE PURPOSE IS SO THE CLIENT/PATIENT CAN IDENTIFY WITH YOU.


 

LET US FIRST REMEMBER THAT LIVED EXPERIENCE IS NOT JUST FOR YOU THE PEER, TO IDENTIFY WITH THE CLIENT/PATIENT. THE TRUE PURPOSE IS SO THE CLIENT/PATIENT CAN IDENTIFY WITH YOU.

 So many people begin the navigating of the mental health sector initially through hospitalisation.

 A Peer understands that this experience, whilst being unique for each patient has certain similarities. We are succoured by a mental health hospital system that is severely under-resourced. There is a lack of beds for people needing stays longer than seventy two hours. There is a chronic understaffing of specialist nursing staff, minimal engagement of nursing staff to patients causing an aloofness that can be interpreted as being non- caring. That is not to say that staff do not care, it is simply an object lesson that fewer resources beget tighter time management, leading to a prioritising of duties that may not be in the best therapeutic interest of the patient.  This is simply one of the roles Peer workers can be deployed to, filling those resource breaches for the best outcomes of the patients.

So what is peer work? What is a Peer? How does a Peer support filling the needs of the client/patient.

Peer work is a distillation of the workers own lived experience of mental illness that informs empathy and reflects the trials and triumphs of that lived experience. Coupled with that experience is a sound understanding of clinical and service models, knowledge of the mental health sector and the resources and processes that exist within the service sector. The purpose of all this is to role model positive behaviours, practical and non- threatening interventions ( often forgotten), identification of unconventional skills, attributes and their application to goal setting and discovering and sharing pathways to attainment.

A Peer is someone who has lived with and managed (to a greater or lesser extent) a mental illness or disorder. A Peer provides an example of successful integration into the community and society as a whole. A Peer is much more than the sum of their lived experience. One cannot be a Peer if one has not embraced the responsibility of living, trying, failing and succeeding.

The Peer fills a role in a client’s life. That role is reinforced by empathy which leads to compassion which in turn leads to patience. Patience is the one commodity that the non-peer and clinical sectors have in very short stock. A Peer works within a framework designated by the employer but informed by the Peer’s experience. The Peer is well aware that anything is possible. Not only anything damaging (which is a universal experience) but anything that promotes growth in confidence, skills, self-knowledge, self-management, self-esteem (if possible, but sometimes is not), problem management (not solving), goal setting and acquisition. A Peer accepts themselves. A Peer then role models that acceptance.

The success or failure of any project hinges on the input received to inform design, planning and execution. Without the right information a project is doomed to failure, which is the history of mental health rehabilitation. This is one of the many roles that Peers fill with the mental health sector, both service and clinical. Peers consult with peak bodies to improve communication, to clarify needs, to draw attention to outmoded paradigms and input into service model design and application.

The word rehabilitation has needed to be re-quantified when working with clients who experience severe and long-term mental illness. The Recovery Model gives us that re-quantification. Success is defined not by a service model or a workers definition. It is woven over time by the client/patient and reinforced through reflection and challenge by the Peer. The direction and the end point/s are conceived by the client and can be identified by both client/patient and Peer.

Peer employment is a relatively new concept in Australia. As such it has been and still is to an extent resisted by the old status quo. The concerns most commonly raised by those with a vested interest have been the anxiety around Peers taking on clinical roles. Of course this could only happen if the person was in fact qualified as a clinician but still identified with the lived experience of mental illness/disorder. What the Peer is able to do is to pick up service slack and empathetically (through being Peers) deliver a caring and informed support to patient’s needs. This support with the mental health hospital system can be caring outreach, a role once delivered by nursing staff, information and advocacy when a patient is not satisfied with clinical intervention, referral to services before and during the discharge process.

The real meat of the Peer work begins in the community.

Nurse Engagement and Patient Distress


Consumer engagement is far from a simple issue.  In fact engagement can be divided into at least two categories. There is the engagement of consumers into sector service providers and the engagement of service providers with consumers.

Let us in this case, look at service providers engaging with the “consumer”. The public mental health system is an interesting dynamic to kick this off with.

Have you ever been admitted to a mental health unit? I don’t mean a private hospital format but it’s diametric opposite, the public hospital system.

Imagine you are fly that has hitched a ride in the luggage of a person presenting to the acute care team of any of our public mental health units.  There you, Mr Fly, washing your legs and grooming your wings, sat high on a wall in a so-called open ward (we’ll get back to another time). As you look around you notice a fair number of consu……, look let’s drop the offensive and depersonalised language and call them patients.  You observe from your lofty vantage point a superfluity of patients walking around the ward with little purpose and seemingly no direction. Tis strange, you think, that as you observe these actions all day that the only time you see a nurse leave the strangely shaped gold fish bowl is to either hand out patients cigarettes or to watch them walk a patient down the hall to open the locked door that leads out of this open ward. Disturbingly, you also witness the occasional patient presenting with the obvious signs of distress, simply slumping into a corner or outside the locked, heavy door of the nurses’ station. Merely to witness such distress is in itself a disturbing thing, but more so, is the fact that no one seems to notice. Well, that’s not entirely accurate. You do observe that some of the nursing staff glance at the frazzled wreck of an individual in distress but then turn back to colleagues to laugh, perhaps at a well told joke or anecdote. Puzzled you take flight and land unnoticed (much like the patient) high on the surface of the glass that guards the nursing and clinical staff. Coffee cups are half full, someone has brought in pastries and everyone is having a grand old morning tea and still the patient, who obviously must be an “attention seeker”, shrinks further to the floor and makes sounds that, even as an insect you know characterise a person who is not having a very good day. Eventually, to your enormous surprise you spy another patient actually approach this sad wreck of humanity, slowly dissolving to paste, and lo! and Behold! This patient actually sits next the poor unfortunate and introduces herself. Barely able to believe your multi-faceted eyes you see the woman scooch a little closer and you hear her ask

“Hey what’s going on? Are you o.k.?”

The quivering wreck of humanity looks up and though you cannot make out his words you see the other patient take the man’s hand and hold it and you can hear the tone of comfort coming from her voice.

Again you switch your gaze to the “goldfish bowl”. It would appear as if, once having seen the distressed man, there is obviously no need to look in that direction again.

Comparatively quickly, you see the male patient rise to his feet and escorted by the female patient they try to gain the attention of staff. They patiently wait for what seems to be an inappropriately lengthy time to simply get the attention of anyone with the bowl. From your point of view it almost appears like the nursing staff is looking in every other direction but where the patients are standing.

They wait and they wait until, releasing an audible sigh of what sounds suspiciously like irritation, a nurse materialises in a puff of magic smoke. The female patient then explains how she found the man stuffed into a corner, weeping and shaking and was very concerned because she felt that his obvious distress and pain needed the attention of someone far more qualified than she. This Good Samaritan (strangely apt if you know your cultural history) is then directed back to whatever she was doing and the man in distress is directed to the medication window. Several minutes later a small paper cup containing a tiny round tablet is handed to the man along with a small paper cup of water. After swallowing this tablet he is directed back to his room to lie down. The nurse then returns to the main cabin of the bowl and sits down to type at a computer. It is obvious, even to a semi-educated fly, that she is updating the patient’s file to include the dosage of medication.

You see the ward door open and you make a “bee-line” for it. Ain’t no chance in hell you’re gonna stick around a joint like this, where people are less noticeable than a flying insect.

The issue described here is one of staff engagement with patients. I know for an absolute fact that this situation is hardly a rare occurrence. How do I make this claim? Well the wonders of the internet have brought such devices of support such as lived experience forums. In Queensland alone I am a member and contributor on four such forums. People offer each other support, resources, networking and general socialisation. They are also a deep well of distilled experience. All I’ve ever had to do was to ask folk what their experience of hospitalisation was like and the stories poured forth. Disturbingly, I have seen a terrible, frightening consistency of details with these stories. To be quite frank, their tales mirror my own.

For reasons I don’t yet quite grasp, nurse engagement with patients is the lowest I’ve seen in 30 years of accessing hospitalisation for acute mental illness.

The reasons are immaterial. The rationalisation, however specious, matter not all. What does matter is that patients in mental health units are not getting the acute care they require when either upset or in serious distress.

I say the reasons don’t matter, simply because changing a professional paradigm is along , tedious and more often than a resisted process. There is a resource available that addresses this issue. That resource is beautiful in its simplicity. Hire and allow Peer Support Workers to help support people during patient admissions and discharge within the public health system. Now I know apparently that is already happening. Unfortunately many of the lived experience people I’ve spoken to have never seen one. Peer Support Workers and Consumer Carers have taken on a myth-like quality. People are told they exist but few have ever photographed one. 

So think, if you will , that even if the reasons/excuses given for the paucity of nurse to patient engagement are true, there is a perfect resource available to do the very simple but vital work of comforting. This solution is cost effective and easily manageable.

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