Disorganised
community mental health service
Restoring
important relationships
20
years in the mental health service
Meeting with a
provider to ask questions
Improved care on admission to hospital
Making a
difference with the resolution agreement form
Mental
health support in prison
Counselling
confusion
Sorting out a
consumer-centered mental health plan
The importance of good
communication
Support is
important
Disorganised
community mental health service
The mother of a consumer believed her son
received poor care from the community mental health service, and
contacted an advocate to complain that:
- her son not receiving his medication from the community mental
health nurse when it was due'
- the service did not record their new address which resulted in
the nurse visiting the wrong address on two occasions and going to
the wrong house on the third occasion'
- she was unable to access medication for her son from
either of the two community mental health services or the mental
health ward at the hospital after hours.
As a result of not receiving his medication, her son became
increasingly unwell and eventually had a violent episode resulting
in his admission to the mental health unit where he is still a
patient.
After considering the options, and with the assistance of the
advocate, the consumer's mother wrote to the manager of the mental
health service outlining her concerns and requesting a meeting.
This was attended by the manager and the mental health nurse who
had tried to visit the consumer to administer his injection. She
acknowledged that because they did not record the new address she
visited the wrong address then the wrong house.
The manager said a new 0800 mental health line was in the
process of being set up for all mental health calls. The manager
agreed to remind the inpatient ward of processes for recording
calls from consumers and those acting on their behalf. The manager
also acknowledged the systemic errors that had taken place and said
the community mental health service was already under review with a
report due at the end of the year.
The mother of the consumer felt her concerns had been addressed
and was pleased with the outcome of the meeting.
Go to top
Restoring important
relationships
A mental health consumer phoned an advocate in a distressed
state. He had been prescribed different medication by another
psychiatrist. A week later, he had then been told to stop
taking this medication by his usual psychiatrist who made an
appointment to see him in a couple of days. The consumer was
now suffering side effects from what he believed were the changes
to his medication. The relationship with his case manager had also
broken down.
He talked through the options with the advocate and chose to
contact his GP immediately. The GP sorted out his medication and
made sure he was alright. The advocate then offered to attend
the meeting as his support person to discuss these matters with his
psychiatrist and case manager.
At the meeting he talked about the issues with his medication
and his concerns that arranged meetings and phone calls were not
always being carried out by staff. This was acknowledged, and
those present assured him that they would keep to arranged
meetings/phone calls in the future. The consumer was happy
with the outcome and said the meeting had gone better than in the
past. The providers also thanked the advocate as they had
found it helpful to discuss these issues in a constructive
setting.
Go to top
20 years in the
mental health service
This is a story of a very long journey for me in the mental
health service and the discovery of the advocacy service.
I have been under the mental health service for the past 20
years, being moved from institution to institution. My hometown was
in the lower part of the North Island and when I was in that area I
felt close to my ancestry and my roots. I was moved further north a
few years ago into a secure environment and was on heavy psychotic
medication which made me feel worse and the long-term result was,
it had a severe adverse effect on my body resulting in my being
taken to hospital for emergency surgery. I very nearly died as a
result of a perforation and spent ten days in the intensive care
unit recovering. The long-term result was that I now have to have a
permanent colostomy which I have come to terms with.
I contacted the advocacy service in 2006 as I wanted support to
address the issues which led me to have emergency surgery and as a
result a meeting was set up with the head of clinical services, the
service manager and people from the unit in which I was housed. The
outcome of this meeting was that the mental health service would
support me in my application to lodge a claim with ACC. At this
meeting I was given both a verbal and written apology for the
medical error which had caused my life to be turned upside down.
After this meeting I felt that I could put the events of the past
to one side and try to move on with my recovery from both physical
and mental aspects.
The advocate continued to visit me every six weeks to ensure
that I was supported and this for me was the one single thing that
made me believe someone cared about my welfare. I felt I had a
purpose in carrying on and I decided that if I wanted to be
released, I would have to comply with taking medication and abiding
by the rules of the establishment. I asked the advocate to come
with me to my next clinical meeting which is attended by the
psychiatrist, psychologist, key workers and with the support of the
advocate I made my application to be transferred to the Mäori unit.
I felt that being immersed in my culture would help me to become
well. It took several months until this happened and during this
time I became depressed and had some lapses in behaviour, but my
advocate kept saying to me to have faith and it would happen.
I am now living in the Mäori unit and have made a lot of
progress, so much so that I was encouraged to apply for escorted
home leave to my hometown. This took place earlier in 2007 and to
visit family and relatives over a two-day visit was a great healing
for me. I returned to the unit full of hope for the future and at
my last clinical meeting my advocate supported me in my request for
unescorted leave to go up to the local shops once a week with a
leave pass of four hours. This was granted and the joy, the
freedom, after 20 years of being incarcerated to just be able to
walk along a public road, look at the flowers in the gardens, see
children riding bikes to school and to watch people shopping, was
something that 12 months previously I would have thought would be
impossible. My heart was light; the very essence of my being was at
last full of hope for the future and I was sure I was well on the
road to becoming well.
The next hurdle for me was to request that I be allowed to move
into the self-contained flat which was adjacent to the Mäori unit.
This was a giant step towards being transitioned out of a secure
environment and once more I sought the support of the advocate at
my clinical meeting as I saw this step as a positive move to living
back in the community. I knew that I was becoming well and while I
was a little frightened about leaving the security of the unit and
having to cook my own meals and look after myself the advocate
encouraged me to be positive and said she would support me and
would continue to come to my clinicals whenever I had a special
request to make.
Life for me now is so different from 12 months ago and I never
would have believed that I am now just one step from what I call
freedom. To have someone believe in me and support me during times
of difficulties and to not give up on me when I fell by the
wayside. There were times during the past 12 months where
depression took over and I lost faith and at those times I just
made a phone call to the advocate and we talked things through. The
advocate encouraged me to seek help and support from the local
Kaumatua which I did and now I have a group of people whom I can
contact for support.
My last step is to move into supported living in the community
and this may be achieved by Christmas. What a wonderful Christmas
present for me on my journey of discovery.
Go to top
Meeting with a
provider to ask questions
The man resident in a mental health facility was concerned that
his medication had been changed without any follow-up, the provider
had not communicated with him about a change in plan for a hospital
admission, and that he was not taken on outings.
After discussion with an advocate, the man decided he wanted to
meet with the provider with advocacy support. He was seeking
improved communication and daily services that met his needs.
The manager responded with an apology and agreed that their
communication could be improved, as could the support they
provided. The manager outlined what they could provide and the man
was happy that the services offered would meet his needs.
The man was pleased to have had advocacy support as he said he
would not have been able to address the concerns alone.
Go to top
Improved care on
admission to hospital
A consumer, who usually received care from community mental
health, was been acutely admitted to hospital. She had concerns
relating to the manner in which she was admitted, and asked an
advocate to help her to address her complaint. She hoped the
provider would acknowledge and learn from the complaint, as she
relied on the provider for care and support when she became
unwell.
Initially, with support from the advocate, she wrote and
explained that the behaviour and overreaction of some staff had
caused a deterioration in her condition. The provider responded
saying that some staff were not fully aware of the consumer's
symptoms and acknowledged their response could have been different.
There was no explanation of what would be done to prevent the
consumer and staff from finding themselves in the same situation if
the consumer required readmission, so the consumer requested a
further response to address this issue.
The provider then advised that the consumer's treatment had been
reviewed with the care team involved, and the learning from that
process had been documented. He offered an apology for the way the
consumer had been treated, and advised she would be involved in any
care plans in the future. She was happy with the response and
reported that she had already seen improvements in the service
provided.
Go to top
Making a difference with the
resolution agreement form
Community Mental Health ~ Chronic pain ~ Self harm ~
Depression ~ Resolution agreement form ~ Rights 1, 2, 3, 4(3),
4(5), 5
Following a major accident a consumer suffered from chronic pain
and chronic depression with suicidal thoughts. She was upset by
disrespectful comments made when seeking help from the Community
Mental Health service and felt she was being discriminated against
because of her history of self harm.
She was also concerned that there was no communication between
the Pain Clinic, the Community Mental Health service and the Crisis
Team, which was compromising her care. She also complained that as
an in-patient she had suffered unnecessary pain due to pain relief
not being administered at the prescribed time.
After discussing the options with the advocate, she chose to
write to the provider requesting a meeting, outlining her concerns
and her expectations. The advocate supported the consumer at the
meeting where it was agreed that her care plan would be updated. In
addition, generic information would be shared between Community
Mental Health, the Crisis Team Mental Health and the Pain Clinic,
prescribed medication would be administered at the times specified
and staff would receive training on Effective Communication and the
Code of Rights.
These were all documented on the advocacy complaint resolution
agreement form for ongoing actions. The consumer was happy with the
outcome as all the agreed actions were completed. She said
the use of the form at the meeting had given her confidence that
what had been agreed to would actually happen.
Go to top
Mental Health Support
in Prison
A prisoner contacted the advocacy service saying the judge who
sentenced him had said he was to have help from the local forensic
mental health team. However, nothing seemed to be happening and he
was becoming quite stressed about it. He had seen someone on one
occasion earlier on in his sentence, but they had not come back as
promised, and he couldn't remember who they were. He had asked
within the prison what was happening but had been unsuccessful in
getting an answer.
The advocate spoke with the prisoner and described what he could
do. It was agreed the advocate would email the team leader of the
medical unit to search out the information he needed and arrange
for him to be seen.
The nurse emailed back saying there was meant to be an
arrangement for the forensic mental health service to come back and
see him. She set up a new appointment for him and he was happy
about that.
Go to top
Counselling
confusion
Counselling ~ Coordinating agency ~ Effective
communication
A consumer arranged his own counsellor but because he had not
sought permission from the agency co-ordinating this service they
cancelled his appointments. The consumer expressed concern that he
was not aware of this process or the repercussions.
The advocate supported the consumer at a meeting with the
co-ordinating agency. An explanation was provided to the consumer
on the processes which the agency follows. As a result of
this meeting, the agency restarted the counselling sessions for the
consumer who was pleased with this outcome.
Go to top
Sorting out a consumer-centered
mental health plan
Mental health ~ Voluntary inpatient
~ Medication ~ Resolution meeting
Family members contacted an advocate about a consumer receiving
voluntary psychiatric inpatient care. He was concerned about
medication changes and the hospital's insistence that a guardian be
available when he goes on leave. A meeting was arranged with the
psychiatrist, consumer and family members with advocacy support
following a discussion with the consumer of his rights and the
options to resolve his concerns.
The consumer and his family members were pleased with the
meeting outcome. They received answers to their questions and
medication changes were explained along with the different
treatment options available. The consumers leave was also addressed
and a plan put in place to transition him to a supported living
situation in the community that he and his family were happy
with.
Go to top