What happens when you are feeling unwell?

If you call the psychiatric triage service, you may have to wait in a queue at high peak times but rest assured, you will get to talk to a qualified mental health clinician. They will ask you some questions to determine what they can do to provide the best outcome for you. They may simply offer support, advice or even a visit from the Crisis Assessment and Treatment (CAT) team if required. They may also direct you to attend your nearest Emergency Department or ask you to call an ambulance in an emergency.

If the CAT team visit you at home, they will conduct a mental state examination and carry out a risk assessment to enable them to assess your situation quickly and efficiently. They may offer to visit you at home over a period of time to ensure that you are receiving the best possible treatment for the best possible outcome. You may also request phone support if you do not feel it is necessary for them to visit you at home. In an emergency, The CAT team may be required to utilise the Mental Health Act (MHA) to bring you into hospital. This would only happen in a scenario where they feel that you are at risk of harm to yourself or others, or if you are not able to care for yourself and they deem that leaving you at home could lead to further deterioration in your mental health. This would only happen if you were unwilling or unable to make the decision to go to hospital yourself.

If you attend the Emergency Department (ED), you will be seen by triage and they will liaise with the mental health clinicians in ED. You will then be seen by a mental health clinician who will carry out a mental state examination and a risk assessment. They will work with you to try and find the most appropriate solution for your situation. This may involve referral to the CAT team, an admission to the mental health inpatient service or linking in with the ALERT team to support you in finding safe accommodation. If you are not presenting at your local ED, staff may liaise with the closest hospital to where you live with a view to transferring you there. The idea of this is for continuity of care and to allow friends and family to easily visit should you wish them to.

If you are admitted to the mental health inpatient service from ED, you will usually be escorted to the ward with a nurse and sometimes security staff to ensure your safety. On the inpatient unit, you will be welcomed by a mental health nurse who will usually take down some details, check your vital signs and orientate you to the ward. You will usually be asked to show all of your belongings when you first arrive. This is to ensure the safety of everyone in the ward including you. You will usually be asked to provide a urine sample and to consent to your bloods being taken as standard procedure. This allows your doctors to ensure you are physically well and look for any underlying indicators which may explain why you are unwell. You will usually meet your Treating Consultant Psychiatrist and/or treating registrar (a qualified doctor training to be a psychiatrist) the day following your admission, they will discuss lots of things with you including treatment options such as medications. Most mental health wards run group programs on a daily basis where you can keep yourself busy during your stay. It is normal practice to remain on the ward for at least 24 hours before you may be allowed to leave. This is so that staff can ensure you are physically and mentally well enough to leave the ward and return safely. Your doctors may also ask you to invite your family to the ward for a meeting to ensure they are able to support and understand what you are going through and to ensure they receive the support they need.

Being in hospital can be a difficult time for anyone, especially if you are unsure of what to expect. Most wards have a gender sensitive area which is usually secure, this is for those who have been through difficult times and would feel safer and assured within such an environment. There is also the Extra Care Unit (ECU) which is known by various different names depending on where you are staying. It can also be referred to as the High Dependency Unit or the Mental Health Intensive Care Area. The ECU is a secure area with fewer beds and more nurses to ensure you receive more intensive support. This can be a difficult place to stay because you are generally more restricted by the areas you can access. This is not intended as a punitive measure, but rather to allow nurses and doctors to provide a higher level of care with the ability to assess you closely for the most suitable treatment. You will be seen by a doctor at least once every day that you are in the ECU so that they can assess the need for you to be there. If they no longer feel that you need to be in a secure area, they may decide to transfer you to the open ward or low dependency unit.

If you are in hospital under the Mental Health Act (2014) you will be provided with your rights according to the type of order you are on. An assessment order (AO) lasts for 24 hours from the time you arrive in hospital and means you must be assessed by a Consultant Psychiatrist within that 24hour period. Based on their assessment, they will decide whether to revoke you AO or extend it by 24 hours for the purpose of further assessment. They can only extend it twice. They may also decide you need further longitudinal assessment to ensure you are receiving the most appropriate support and treatment, in this case they may utilise a Temporary Treatment Order (TTO) A TTO lasts for up to 28 days but may be revoked before that if you are well enough. Within 28 days you will be provided with the opportunity to sit before a mental health tribunal (a panel of independent people consisting of a Psychiatrist, a lawyer and a community member). You will be offered legal assistance through legal aid before your hearing; they will visit you on the ward and discuss your options with you and then represent or assist you in the hearing.

If you disagree with your status under the mental health act, your diagnosis or your current treatment plan, you are entitled to request a second opinion. You can contact the second psychiatric opinion service. You can request that this opinion is from another doctor from within the same service, or a doctor who is independent of the hospital where you are staying.

Independent Mental Health Advocacy (IMHA): You can contact IMHA at any time for information about your rights. If you are placed under the mental health act, you can contact them for support, advice or assistance and they will come and visit you on the ward. They are an independent body who can advocate for you and make sure that your treating team are hearing what you have to say. This can be a very useful resource if you are feeling unsupported, even if it is to clear up a misunderstanding and get you and your team on the same page.

If you have any concerns during your stay on the ward, you can escalate them to your contact nurse, treating team or even to the Nurse Unit Manager (NUM). They will be happy to discuss any compliments or complaints you may have around your treatment or your stay in general and are a good source of support.

Discharge planning should start from day one. This is to ensure that you are readily receiving the care, treatment and assistance that you need, meaning that you do not have to stay on the mental health ward any longer than you need to. Discharge planning may include contact with lots of other professionals like social worker, pharmacist, occupational therapist, psychologist, neuropsychologist, carer consultant, consumer consultant, and peer support. Your doctor will meet all of these professionals each week to present your case and make referrals to the appropriate people. This ensures you get the most appropriate help and support as soon as possible. For example, Social worker may assist with housing, finances and legal concerns among other things. Your treating doctors will work with you to achieve the best possible outcome, helping you to return home as soon as possible. This may include referral to: the CAT team to support you at home following your admission; a community mental health clinic where you may receive ongoing care in a community setting for as long as necessary; private psychiatrists and psychologists; general practitioners; drug and alcohol services among others.

On discharge you will usually be provided with a prescription or 1-2 weeks worth of medications to allow ample time for you to book in with your GP for ongoing mediation supplies. It is important that you feel ready for discharge and that the appropriate supports are put in place for you when you leave hospital. This can sometimes cause a delay when your treating team is attempting to coordinate various different services to support you at home but they will work hard to keep any complications to a minimum. Whether you are receiving follow up from the CAT team, Case Management, Peer support or your GP health professionals will continue to support you in your recovery journey.

When you have been referred for case management, whether you are doing so voluntarily or in line with the Mental Health Act, you will be supported along your recovery journey to achieve your personal goals as well as educated around any changes in lifestyle, diet, medications etc. that may help you to reach the best possible outcome. You can do all of this with the support of your case manager – a mental health professional and a community consultant psychiatrist. Sometimes the community team will have a shared care arrangement with your GP as it is likely that you already have a strong relationship with them.

If you have ever experienced or are experiencing thoughts of harming yourself or ending your life you may be referred to the Hospital Outreach Post suicide Engagement (HOPE) team for more intensive, focussed case management. This team also work with family and carers to help them understand what you are going through and provide better support at a difficult time.

When you already have a case manager, you will have regular appointments with them to make sure that you are happy with your treatment and that it is adequate. If you are receiving your medication in the form of an injection you can request to have this at home or attend your local community mental health clinic, this will usually be given by your case manager or an available nurse. You will also have appointments with the community psychiatrist to review your medications, treatment and mental state to ensure you are staying well. If you or the staff have concerns that you are feeling unwell, your case manager may recommend you have an admission to hospital. They may escort you to ED or in some cases directly to the Mental Health ward for admission. This depends whether you have any physical health concerns that need to be investigated in the general ward before you are admitted to Mental Health.

If you have private health insurance, you may wish to utilise a private mental health clinic for your treatment. You may already have a private psychiatrist and want to go to the same clinic they work in for consistency of care. However, you can also ask your doctor or nurse to contact Bed brokers – a service that will find you a bed quickly and efficiently but still take your preferences into consideration. You can also seek a private bed if you have been admitted to a public hospital in emergency circumstances; once a private bed is available you will be transferred.

PARC Prevention and Recovery Care can be used for step down (from hospital) or a step up (from home) care. When you ‘step down’ from hospital, you can stay at PARC for 2-4 weeks as a transition back home. You can learn new skills, work on your recovery goals and attend group sessions with people in similar situations to you. To access PARC you will need to have a case manager who will continue to engage in your recovery whilst you are there.

You may also be able to utilise PARC as a ‘step up’ from your home environment in order to receive a little extra support than you otherwise would at home, or to give your loved ones an opportunity for respite. You can be referred to PARC by your case manager or from the mental health ward.

Community Care Units (CCU) CCU’s are recovery focussed rehabilitation units within a community setting for people with complex needs. Here you will be helped to learn/develop daily living skills and work on your recovery goals with the support of a multidisciplinary clinical team. You will be supported to re-integrate into the broader community upon completing rehabilitation.

Secure Extended Care (SECU) SECU provides medium to long term-treatment and rehabilitation to people with severe and enduring mental illness. SECU’s are inpatient units in a hospital setting and provide rehabilitation up to and including transition and discharge to an appropriate accommodation in the community. This can sometimes be a CCU.

COPES (Carer Offering Peers Early Supports) program) COPES works with your loved ones (friends and family) to provide support and education about services available to ensure they in turn can best support you during your recovery.

Community follow up arrangement/ Continuing Care Team:

• Case manager When you are referred for case management you will be allocated a specific clinician to provide support to you and your loved ones (when required) in the community. You can have appointments to see them in your local mental health clinic and they may also visit you at home. Your case manager will work with you to coordinate your ongoing recovery efforts to ensure that you stay well at home, provide education, administer medications, support you with employment goals, finances, accommodation, assess your mental state and risks as well as things like NDIS and Centrelink. Your case manager may recognise when you need increased supports and refer you to various services to ensure you can maintain your independence and life in the community.
• Mobile Support & Treatment Services (MST) MSTs case management is similar to regular case management, but the clinicians here have fewer clients to provide care for which means they can deliver more intensive outreach. This means they are available to see you on a more regular basis to make sure that you are well supported in maintaining your recovery, particularly when your needs are complex. You may be referred back to regular case management if you no longer need intensive support.
• Homeless Mental Health Services Homeless mental health services deliver mental health assessments, treatment and support to people who are homeless or at risk of homelessness. They work closely with homeless services to link people with ongoing support around accommodation, finances and healthcare to ensure you the best opportunities for recovery.