Page Section: Centre Content Column

Mental Health

Referral to another service

Unfair mental heath treatment

Problems with a mental health case manager's communication

Getting a new case manager

A long wait for an apology

Contact from a mental health provider

Not quite the right response

Achieving a cultural success story

Getting a new case manager

No family Involvement for up to eight weeks

Failure of mental health plan during a crisis

The importance of up-to-date records

A consumer writes about the advocates who helped them

The importance of good communication

Mental illness history leads to staff ignoring physical concerns

Interpreter needed

Restoring important mental health support

Reducing methadone to best meet a consumer's need

Deteriorating health from lack of interpreters

A mother advocates for her son with advocacy mentoring

Lack of co-operation leads to frustration

Problems with a Deaf Mental Health Service

Sorting out an incorrect clinical record

When fear immobilises

Respect and mental health issues

Finding a system of care that works

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

Counselling confusion

Sorting out a consumer-centered mental health plan

Support is important

 

 

Referral to another service

While it was clear from the outset that the consumer's issues were outside of the work of a Health and Disability Advocate of the Nationwide Service, the consumer advised he had been to a number of other agencies prior to contacting advocacy. He had just arrived in town and was a consumer of mental health services. He became agitated when the advocate advised that advocacy could not help with accommodation, food and money.

The first agency contacted advised they did not have the resources to help and he needed to contact Baptist Ministries. The consumer advised he had already been there and to a number of other agencies. After many suggestions the consumer finally agreed to go to the local police station and speak with someone from victim support. He readily accepted that suggestion. 

With the consumer's agreement the advocate contacted victim support and explained the situation to the co-ordinator who agreed to try to find accommodation for the consumer.

The action the advocate took ensured the safety of a vulnerable consumer.

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Unfair mental heath treatment

Mental Health ~ Right 2 ~ fair treatment ~ Right 5~ effective communication

A consumer contacted an advocate for support to complain regarding her "unfair "treatment from a mental health provider. The consumer advised she had previously made a complaint about a person who hadsince been employed by the provider organisation and that when she encountered this person in the waiting room had become distressed.

As a result of the upset the providers felt the best option was for the consumer to be seen elsewhere. The consumer advised she had issues around trust and access to other people at the service when she required it. In the past she had been able to access assistance even if not scheduled for an appointment.

After considering the advocacy options the consumer chose to have advocacy support to write a letter to the provider requesting a meeting to discuss her concerns.

As had been agreed, the advocate accompanied the consumer to the meeting. After outlining her concerns at the meeting the consumer became distressed and left the room. She returned a few minutes later with the advocate's support. 

The provider provided a verbal apology for the distress the situation was causing and stated a written apology would follow. It was also agreed the consumer should return to the previous venue for follow-up. If she required the support of the team outside scheduled appointments, the consumer should call ahead. These agreements were recorded on the advocacy resolution form.

Following the meeting the advocate contacted the consumer who advised she now had her appointments at the old venue with her psychiatrist. She had been given information about who she would see when he was away and was very happy about this. 

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Problems with a mental health case manager's communication

Right 1 ~ respect ~ Right 5 ~ effective communication ~ community mental health team

A consumer arranged to meet with an advocate. At the meeting she said she had been receiving care from mental health services for many years and had previously had good support from her case manager. They had recently "fallen out" because of poor communication and lack of support resulting in a lack of trust by the consumer.

At this point the consumer was unsure about complaining as she considered how she was feeling may be part of her unwellness.

The advocate and consumer spoke of the Maori model for health, Te Whare Tapa Wha. The consumer advised that her hinengaro was poor, her whanau support was strong, her tinana and wairua were wavering. She had come to the advocacy service because she felt lost and did not know what to do. The consumer wanted to share her story to help her to see her way clear to resolve her situation.

The consumer advised she felt her case manager was focussed on herself, rather than the consumer. She found their conversations confusing and felt the case manager had made judgements about her and passed those on to her clinicians.

The consumer said she wanted to be happy again and needed a case manager who would assist her to live a good quality of life. She said she was feeling very anxious about the whole situation.  

After discussing a range of options the consumer decided the best way forward was to meet, and requested the advocate assist in arranging a meeting with the case manager's team leader. The team leader suggested that the case manager be present at the meeting as the consumer needed to resolve her issues with the case manager, regardless of whether the consumer retained her or not. The advocate relayed the information to the consumer who agreed, although somewhat reluctantly. The advocate reminded the consumer that she would have family present and the support of the advocate at the meeting. 

The consumer and her whanau met with the advocate prior to the meeting to go over the format of the meeting, discuss the issues that would be raised and confirm the consumer's desired outcome.

The consumer went in to the meeting feeling positive and was able to express her issues in a positive way. The case manager was able to respond in a way that the consumer accepted and it was agreed that the providers present would meet with the clinicians involved to discuss a way forward for the consumer's care and treatment. Following that meeting they would meet with the consumer to discuss a proposed care plan. The consumer was happy with these proposed actions. 

Following the discussions with the clinicians and with the consumer's agreement she was admitted to hospital to have her health needs reassessed. She was able to participate in the development of her new care plan. She now has support from the community mental health team. and no longer requires the assistance of a case manager.

The consumer reports that her Tinana, Wairua and Whanau supports are intact and her hinengaro is kapai. She is very grateful for the advocacy support she received.

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Getting a new case manager

DHB ~ Mental Health Service ~ Right 1 ~ Respect 

A mental health consumer contacted the advocacy service with serious concerns about the relationship with her case manager. The consumer said that her case manager had said some very inappropriate and unprofessional comments about her as a person and her mental health status. The consumer said that she felt very disrespected and doubted their relationship could be restored to a point that would continue to positively meet her needs.

The consumer considered the options available and decided she would like a meeting with the manager of the service. 

At the meeting, with the advocating supporting, the consumer had the opportunity to express her concerns and felt she was listened to.  

A new case manager was appointed and the consumer said she was very relieved as the situation had caused her a lot of undue stress. The consumer said that she was very grateful for the support of the advocate.

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A long wait for an apology

DHB ~ Community Mental Health Service ~ Right 1 ~ Respect ~ Right 2 ~ Harassment & discrimination ~ Right 10 ~ Complaint

A consumer was bullied and spoken to disrespectfully by a community mental health service key worker at a support meeting.  At the conclusion of the meeting the key worker followed the consumer out into the street and continued the conversation in public where anyone could hear.  

The consumer made a written complaint directly to the Community Mental Health Service. The consumer went overseas for a while.  

When they returned they had not received a response from the Community Mental Health Service. The consumer then decided to make an on-line complaint to HDC. HDC wrote to the Community Mental Health Service recommending they respond to the consumer either in writing or arrange to meet with the consumer, where they are able to have a support person at the meeting with them if they so choose.  The consumer initially thought to receive a written response, however, they decided to meet with the community mental health team.  The consumer contacted an advocate for support at the meeting.

The consumer said that they would like the meeting to be held at a neutral venue, and contacted the Community Mental Health Service to advise they would like to meet to resolve their concerns. They also mentioned that an advocate would be attending the meeting to support them.  

At the meeting the consumer was able to express how they felt about what had occurred. Members of the Community Mental Health Service apologised for the delay in responding to the consumer's complaint.

They also apologised for the way the key worker had spoken to the consumer.  They informed the consumer that steps have been put in place so an incident like this does not happen again to anyone by any member of the Community Mental Health Service staff.

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Contact from a mental health provider

DHB ~ Mental Health Facility ~ Right 4 ~ Appropriate standards ~ Right 5 ~ Effective communication ~ Medication  

A service manager at a home for consumers with mental health issues contacted the advocacy service to ask if an advocate would visit a resident who had a concern he wished to raise.

The resident had been with the service for over 20 years and hadalways been on medication. He felt he was improving and wanted to eventually come off medication and leave the service. As English was his second language the advocate asked him if he could fully comprehend the information and if he would like an interpreter. He was very proud of his English and said he did not need an interpreter.

He wanted support for a review of his medication and status at his next review with the local DHB mental health team. He felt that he needed to have the support of an advocate as he didn't think the psychiatrist was listening to him.

Discussion with the service manager resulted in the date of the appointment being brought forward. 

The meeting was attended by the service manager, psychiatrist, social worker, advocate and student social worker. The consumer spoke about wanting to come off his medication and eventually go back to the country of his birth. He said he was a voluntary patient and was able to stop his medication whenever he chose. The psychiatrist explained to him her concerns about his coming off the medication and the long term effect and consequences that this would probably cause.

She talked about the possibility of enacting the Mental Health Act by evoking a compulsory treatment order. The consumer didn't seem to understand this. 

The consumer's social worker explained the situation to him as best he could but made a further time to visit him outside of the meeting, to discuss the situation in more detail. He was also given written information of the decision made by the DHB to pass to the resident. The service manager had a good relationship with the resident and would notice if there were any concerns. 

The consumer was happy with this outcome and felt that he had been heard and supported.

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Not quite the right response

Mental Health ~ Right 4 ~ Appropriate standards ~ Psychiatrist ~ Assessment

A consumer contacted an advocate as she had recently been assessed by her psychiatrist and disagreed with the assessment. She had also been taken off her medication and was having side effects related to withdrawal.

The consumer and advocate discussed her desired outcomes and the options she had in making a complaint about her assessment. The consumer said that she wanted to be re-assessed at a time when she was not affected by withdrawal symptoms, and to have a new treatment plan. The consumer decided to write a letter to express her concerns and the advocate provided her with support to do so. 

She received a response from the provider explaining the assessment process and suggesting she phone the relevant person in order to discuss a new treatment plan and assessment. The consumer discussed the response with the advocate advising she was not happy with it, but would, if necessary, phone the person suggested.

The advocate discussed further options with the consumer, such as writing a response or requesting a meeting. However the consumer decided that at that stage she wanted to leave it, advising if she felt the need in the future she would contact the advocate again. 

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Achieving a cultural success story

Mental health Services ~ Right 5 ~ Effective communication ~ Right 6 ~ Fully informed ~ Right 7 ~ Choice and consent ~ Cultural support ~ Translation ~ Interpreter

A consumer required support from the advocacy service. She was discharged from the service because she did not speak English and needed a psychotherapist who couldspeak her own language.

She was supported to contact the advocacy service by a local cultural support service as they were able to assist with a translation for her. An advocate met with the consumer and the cultural support service to discuss her concerns and to provide resolution options for her.   

As a result of the discussion the consumer said she would like to meet with the Community Mental Health Team Manager, with the support of the advocate, cultural support service Team Leader and a qualified interpreter. The advocate was asked to arrange the meeting. This included providing an outline of the issues the consumer wanted to discuss with the manager.  

At the meeting the consumer was able to share her concerns and say what would bring about resolution for her including remaining with the Community Mental Health Team and having a psychotherapist who spoke her own language. The meeting concluded with the Mental Health Manager saying she needed to speak with the team and that another meeting would be called once that had occurred. At the second meeting, which occurred within two weeks of the first, the consumer was advised that the provider was able to meet her request.  

The consumer and her husband were very grateful for the assistance of the advocate in achieving their goals. The cultural support Team Leader also shared her thanks with the advocate and has subsequently asked for training for her team about the advocacy service and the Code of Rights.

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No family Involvement for up to 8 weeks
Mental Health ~ Right 5 ~ Effective Communication ~ Right 8 ~ Support
A family contacted an advocate for help. They had previously been caring for their daughter/sister with limited support from a vocational service. Due to a recent illness and the consumer's subsequent hospitalisation a decision had been made to transfer her to an out of town facility for assessment. Despite the fact that during her hospitalisation they had been present 24 hours a day to help her communicate, the family had been told they would not be able to see her for up to eight weeks.
With the assistance of the advocate they arranged to meet the new provider via video-link. Prior to the meeting the advocate assisted them to document the questions they felt they needed to put to the new provider. Once the new provider heard the family explain the communication challenges their sister has, she thought it absolutely necessary for them to accompany her.  The provider explained that the "no family involvement for up to eight weeks" was a guideline only to ensure a smooth transition into the assessment process.
The family told the advocate that despite days of trying to explain their concerns about new environments and added stresses for their sister/daughter, that "no-one seemed to hear them".  They said that they had run out of steam and were surprised how easy the communication was once the advocate had become involved in assisting them. 
 
The consumer successfully transferred to the new assessment unit with support from her sisters and after seven days they left her in the care of the new provider confident that they now knew something about her and can at least make basic communication signs that can be understood.  The family feels confident that this assessment will bring their daughter/sister home with a programme that better suits her needs and the changing needs of elderly parents.

Getting a new case manager

Community Mental Health Team ~ Right 1 ~ Respect ~ Right 4 ~ needs met

A consumer receiving care from a Community Mental Health Team contacted the advocacy service after many altercations with her case manager. She felt disrespected, talked over and not listened to. This had caused her to become very anxious and angry as she felt her needs were not being met.

The consumer had initiated numerous meetings to discuss this issue and to request a new case manager but no action had ever been taken in response to the meetings.

In considering the options the consumer stated she was not willing to have any further contact with her case manager as with every contact her anxiety increased and she was left feeling "revolted and disgusted".

She gave the advocate consent to ring the case manager's supervisor to request a change of case manager. The call was made in the consumer's presence and resulted in an agreement that the consumer would be allocated a new case manager the following day.

The advocate rang the consumer the following day to ensure that this had been followed through. The consumer advised that she had been assigned a new case manager. She was very grateful and thanked the advocate for advocating on her behalf adding that she felt "a whole lot less stressed and angry".

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No family Involvement for up to eight weeks

Mental Health ~ Right 5 ~ Effective Communication ~ Right 8 ~ Support

A family contacted an advocate for help. They had previously been caring for their daughter/sister with limited support from a vocational service. Due to a recent illness and the consumer's subsequent hospitalisation a decision had been made to transfer her to an out-of-town facility for assessment. Despite the fact that during her hospitalisation they had been present 24 hours a day to help her communicate, the family had been told they would not be able to see her for up to eight weeks.

With the assistance of the advocate they arranged to meet the new provider via video-link. Prior to the meeting the advocate assisted them to document the questions they felt they needed to put to the new provider. Once the new provider heard the family explain the communication challenges their sister has, she thought it absolutely necessary for them to accompany her.  The provider explained that the "no family involvement for up to eight weeks" was a guideline only to ensure a smooth transition into the assessment process.

The family told the advocate that despite days of trying to explain their concerns about new environments and added stresses for their sister/daughter, that "no-one seemed to hear them".  They said that they had run out of steam and were surprised how easy the communication was once the advocate had become involved in assisting them. 

The consumer successfully transferred to the new assessment unit with support from her sisters and after seven days they left her in the care of the new provider confident that they now knew something about her and ccould at least make basic communication signs that can be understood.  

The family felt confident that this assessment would bring their daughter/sister home with a programme that better suited her needs and the changing needs of elderly parents.

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Failure of mental health plan during a crisis

Mental Health Crisis Team ~ Right 4 ~ Services consistent with needs

A consumer's mother contacted an advocate for support with a complaint about the refusal of assistance by the Crisis Team to help when her daughter was threatening to end her life. The complainant called the ambulance and her daughter was admitted to an acute Mental Health Unit.

After considering her options, the complainant decided a written letter of complaint was the best way to proceed. When she had previously raised her concerns about the lack of care, she had been advised by the provider that a plan would be implemented to ensure the provider responds in an appropriate time and manner, yet that had not happened.

The complainant received a response in which the provider acknowledged their lack of appropriate care, and agreed to consult with both the consumer and complainant regarding future care.

They put in place strategies for the future, and both the consumer and her family were happy with the outcome.

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The importance of up-to-date records

The mother of a consumer contacted the advocacy service about the local Community Mental Health Service. She was concerned that:

1. Her son had not been receiving his medication when it was due, from the community mental health nurse.

2. The Community MH Service had failed to record their new address which resulted in the nurse going to the wrong place on two occasions and going to the wrong house on a third occasion.

3. She was unable to access the medication for her son from either of the two Community Mental Health Services or the mental health ward at the hospital after hours.

4. As a result of not receiving his medication, her son became increasingly unwell and had a violent episode which required his admission to the mental health unit where he is still an inpatient.

After considering the options she decided to write to the manager of the mental health services to request they look in to the matter and provide an explanation at a meeting with her.

The advocate supported the complainant at a meeting with the community mental health nurse and the manager of the mental health service.

The manager acknowledged and apologised for the systemic errors which included out-of-date address records. She explained the service was under review and that she would follow up with the ward to remind them about the importance of recording all calls from family members.

The complainant was happy with the outcome of the meeting.

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A consumer writes about the advocates who helped them*

Mental health ~ Crisis team ~ Inpatient ~ Right 4 ~ Appropriate standards ~ Right 7 ~ Informed consent versus power over

My partner and I have both had to use the community mental health crisis team at the local hospital as well as experiencing admissions to the inpatient unit.

A number of issues arose from these experiences, some which showed serious malfunctions and neglect in clinical practice, and some which reflected the "power over" attitude of some members of mental health staff and management.

Our local advocates have been fantastic. I truly don't know how we would have coped without them. We are still resolving some issues, with their assistance, so that the ongoing care of my partner in particular is safe and helpful.

We have been consulted by the advocates about everything, given choices, supported when we were both too unwell to cope with fighting to get proper care. The outcome is a great feeling of empowerment around collaborating with these people. It really works - of "containment" in a tricky situation and a feeling of not being alone.

I take my hat off to these people, they have given unstintingly of their time and efforts and I would thoroughly recommend them if people are experiencing difficulty with services. They understand the meaning of working alongside people, and they are aware of "power and control" issues for want a better phrase, so they actually understood our dilemma when services used power over us instead of informed consent. They really understand the phrase "nothing about me, without me."

* This article first appeared in Psychwatch New Zealand. December 14, 2008 and has been edited for the website

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The importance of good communication

DHB ~ Mental health ~ Voluntary patient ~ Right 4 ~ Meeting needs ~ Right 5 ~ Effective communication ~ Right 6 ~ Dully informed

The family of a man receiving voluntary psychiatric inpatient care contacted an advocate regarding concerns he had with medication changes and with the service generally. He told the advocate that even though he was a voluntary patient the doctor would not allow him to go on leave from the hospital unless a guardian was available.

After considering his options, the consumer chose to have a meeting with those involved in making the decisions about his care.

He was supported at the meeting by some family members as well as the advocate. The meeting provided a forum for the consumer and his family to get answers to things that had been bothering them. The medication changes were explained and other treatment options discussed. When the issue of being able to leave the unit was raised all were able to have input into a plan that would first see the consumer experience a supported living environment prior to his transition home.

The consumer and his family were happy with the outcome as not only had they had the opportunity to discuss their concerns but they were also able to assist with developing future plans.

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Mental illness history leads to staff ignoring physical concerns

DHB ~ Mental health unit ~ Self-harming ~ Diagnostic tests ~ Right 5 ~ Effective communication

A consumer who had been admitted to the mental health unit for self harming contacted an advocate because staff wouldn't listen to him.

He felt continually weak and unwell and had raised his concerns with doctors at the unit. He believed that because of his mental health history the doctors were not taking his concerns seriously and as a result had not ordered any diagnostic tests to find out what was wrong with him. He felt very stressed about his health and wanted to meet with all the practitioners involved in his care to get an explanation about why he wasn't being taken seriously.

At his request the advocate arranged and supported him during the meeting. Due to the preparation before the meeting, the consumer was able to voice his concerns and discuss a plan for his care. Following the meeting the consumer said that having the support of the advocate had made him feel empowered to speak for himself.

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Interpreter needed

DHB ~  Mental Health Service ~ Interpreter ~ Medication ~ Side effects ~ Right 5 ~ Effective communication

A consumer with English as a second language contacted an advocate with concerns about her medication. She wasn't sure if she was taking it correctly and wanted to know the possible side effects. She had been unable to discuss this with clinical staff as they did not provide an interpreter at her consultations.  She said she felt she was becoming unwell and despite contacting the service a number of times to request a home visit by a nurse visit she had not been given any attention.

After considering a range of options the consumer elected to meet with the provider and to ask the provider to have an interpreter present for the meeting.

The advocate supported the consumer at the meeting where an interpreter was also present. The consumer received an explanation about her medication, possible side effects and her care plan. There was an agreement that an interpreter would be provided for future consultations. The consumer was very satisfied with this outcome.

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Restoring important mental health support

Community mental health crisis team ~ Right 4 ~ consistent with needs ~ Right 5 ~ effective communication

A woman rang the advocacy service desperate to receive help for her 19-year-old son. He had a long history of mental illness and was receiving care from community mental health services. His mother became concerned when he stopped taking his medications and was becoming progressively unwell. In the past when he had stopped his medication he had become violent toward his parents, resulting in police involvement and the consumer being put in a secure facility under the Mental Health Act for 10 days - before being placed in a rest home for respite care. His family felt this was not the right place for him, even for a few days, so he was discharged home.

At her wits end and wanting to avoid this happening again the mother rang the advocacy service for help.

The advocate spoke with the son who said he was not receiving the care he needed. No follow-up visits or phone calls had been made and the isolation was affecting his wellbeing. Both he and his mother were desperately worried he would relapse if he didn't receive immediate help. They both wanted the community mental health team to keep appointments, establish dialogue with them, as well as having a key worker and a plan of action to help prevent any further acute admissions to hospital.

After considering the options, they asked the advocate to organise a face-to-face meeting with the mental health crisis team. This happened very quickly with the son being seen soon after by the team's doctor and his new key worker. The consumer received an apology for the break down in communication. Both mother and son believe the advocacy support and prompt actions of the advocate saved the consumer's life.

He is finally getting the support he needs from the mental health team and is once again taking an interest in his own health issues and participating in a range of activities.

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Reducing methadone to best meet a consumer's need

Alcohol and drug service ~ methadone reduction ~ Right 4 (3) ~ consistent with needs

A consumer on the methadone treatment programme was very concerned that his dose was being reduced too rapidly, particularly since he was experiencing high levels of anxiety about his personal life. He was also concerned that he had been labelled a safety risk after making desperate comments at his last treatment session. Even though they weren't intended to be, he believed the doctor had interpreted his comments as threatening.

He asked an advocate to support him at a meeting with alcohol and drug service staff to discuss the speed of his medication reduction and to dispel concerns about his earlier comments. Although the advocate was clear that the dose prescribed was ultimately a clinical decision, the consumer felt he would be calmer in the way he presented himself with an advocate present providing support.

The advocate supported the consumer at a meeting with key clinical staff where he addressed his issues in a calm and rational manner. He was really pleased that the staff listened to what he had to say and agreed to slow the reduction of his methadone dose.

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Deteriorating health from lack of interpreters

DHB ~ Mental health ~ English as a second language ~ Interpreter ~ Right 5 ~ Effective communication ~ Medication side effects

A woman approached an advocate at an education session. English was her second language so she often had difficulty understanding what was being said. She had been taking antidepressant medicines for many years without any instructions on how to take the medication. This made it almost impossible for her to follow the treatment process as she didn't know how much to take and when. She was also concerned about possible side affects from the medication. She was also upset that despite a number of requests, no-one had visited her at her home.

Her limited comprehension of English made it difficult for her to indicate to the hospital staff that she didn't always understand. On occasions her daughter was present to interpret for her but she felt she should have been offered an interpreter at all consultations with psychiatrists, other doctors and nurses. She felt her health had deteriorated as a result of this lack of information and support from the Mental Health Service.

After considering the options, the consumer felt the best approach was to meet face to face with the staff from the mental health service. She wanted an interpreter who spoke her language to be present. The advocate assisted by liaising with the service to arrange the meeting with an interpreter present so the consumer could learn how to take the medication and the possible side effects.

The family doctor also attended along with DHB staff and the advocate. Having an interpreter present made a big difference for the consumer who was able to ask her questions and receive the response in a language she understood. It was agreed that an interpreter would be engaged for all scheduled consultations in the future to avoid any misunderstanding. The consumer was very happy with this outcome.

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A mother advocates for her son with advocacy mentoring

DHB ~ Mental health service ~ Eating disorder ~ Mentoring ~Right 4(3)(5) ~ Consistent with needs ~ Cooperation ~ Right 5 ~ Effective communication

A mother spoke with an advocate about hospital staff not listening to her or her teenage son. The poor communication also happened between key hospital staff involved in his care. She was very upset that this often resulted in unfair loss of privileges for her son who had an eating disorder. She had just attended a meeting with hospital staff and wished to continue "hands-on" advocating for her son, with assistance from the advocate should it be required. She was also keen to get the staff to try newer models of care than the antiquated regime they were using.

The advocate spoke with the mother about her son's right to the provision of services consistent with his needs as well as his right to co-operation amongst hospital personnel involved in his care. After considering the various options, the boy's mother chose to request regular meetings with key hospital staff to ensure better communication between those involved in his care. She was also keen to use these meetings to provide information on a newer, improved model of care.

Telephone mentoring between the mother and advocate provided support for her ongoing efforts which resulted in improved consistency of care and better communication between hospital staff involved in her son's treatment. She was also delighted at their decision to implement a newer model of care.

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Lack of co-operation leads to frustration

DHB ~ Maori Health ~  Mental Health ~Right 4(5) ~ Co-operation ~ Right 5 ~ Effective communication

A woman and her whanau were frustrated and confused by inconsistencies between the Maori health and mental health services the consumer was using for her treatment. They approached an advocate for help. After considering the options the consumer opted for a meeting with the two providers. She wanted her whanau present, as well as the advocate for support. The advocate assisted by arranging the meeting, helping the consumer prepare her questions as well as discussing the meeting process.

Due to this preparation and support the consumer was able to address all of her concerns and receive responses to them. The woman and her whanau felt the meeting went very well and appreciated the role of the advocate to enable them to find their own solutions. Since the meeting the woman and her whanau have found significant improvements with the communication and both departments are working cooperatively.

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Problems with a Deaf Mental Health Service

Deaf Mental Health Service ~ Right 4 ~ Consistent with needs ~ Right 6 ~ Fully informed

A Deaf consumer, who spoke fluently as well as using NZSL, required the assistance of Advocacy. When her regular support worker from the Deaf Mental Health Service (DMHS) left she was advised that someone would take over until a new support worker was appointed. Three months later she still had not seen anyone, was concerned that she may become unwell without any support, and accessed a counsellor at her own expense. She had already attempted to contact the temporary support worker by fax and text as well as visiting the office, leaving numerous messages requesting contact. Her GP also tried to contact the support worker without success and in the end referred the consumer to the general Community Mental Health Service.

The consumer had attended an advocacy education session so was aware of her rights. After making contact with HDC and advocacy, she received an immediate response from the manager of the mental health service. The manager explained they had encountered great difficulty recruiting a suitable person for the role and apologised for the delay. Although she claimed to have responded to the GP's voicemail message, the GP had not received any messages from the manager.  The consumer found the response from the manager unacceptable and decided to discuss the situation with her GP, and use the support of the advocate to pursue her complaint.

Although the consumer accepted the apology, she wanted to meet with the manager to discuss the delay in receiving a response to her concerns.  The manager agreed to meet and to organise an interpreter for the meeting. In the meantime the consumer continued to receive support through the team organised by her GP.

Before the agreed date for the meeting a new support worker was appointed and made contact with the consumer. The consumer chose to continue with her complaint as she was concerned about how other Deaf consumers had been affected and felt the provider needed to address how the service is provided when they are short staffed. Prior to the meeting the manager contacted the consumer to seek permission for the two new support workers to attend as she felt they could learn something from the process. The consumer denied the request on the basis she wanted to discuss issues pertaining to previous staff and management.

At the meeting the consumer began with a prayer and went on to speak of her experience of not having support; how she felt she was left in the dark not knowing what was going on. She said they had failed to update her despite repeated messages requesting information. The consumer said she was surprised that the standard of care and management were not the same as for other health services.

The manager apologised for the lack of support and said she ought to have more actively supervised the team throughout that period. She was based at a different location to the Deaf Mental Health Service. As a result of the complaint she had advised her Manager that she was finding it difficult to effectively manage the two services. She also acknowledged the difficulty dealing with the sudden resignation of the former support worker. The consumer accepted what the manager had said and was happy and relieved that she had finally been heard. She ended the meeting with a prayer.

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Sorting out an incorrect clinical record

Incorrect documentation ~ Clinical record ~ Public hospital

A consumer was stunned to discover during a hospital admission for a minor procedure that his clinical record referred to a mental health diagnosis which had been disputed many years ago.

The consumer believed the information to be incorrect and that it should not be on the file. He contacted the local advocate who suggested the concerns be taken in the first instance to the privacy officer at the District Health Board. The consumer did this but was very unhappy with the response and sought assistance from the advocate. The advocate supported the consumer at a meeting with the DHB's Chief Medical Officer to discuss the information either being removed or to have a statement from the consumer placed on the file

The consumer was very pleased to be told at the meeting that the Board had had the file independently reviewed and agreed that the old diagnosis was inaccurate. The hospital agreed to start a new file, with the consumer's statement and the review letter to be placed on the old file to deal with the historical issues. The consumer was delighted with this result, and also appreciative of the doctor on the ward who had first drawn the consumer's attention to the old information on file.

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When fear immobilises

A man with a needle phobia contacted advocacy after he attended a pre-anaesthetic clinic where the specialist nurse and anaesthetist did not take his phobia seriously, even though the DHB had been advised of the phobia by his GP. They tried to joke and jolly him through the appointment, and insisted he watch a video on anaesthetics saying it would be beneficial for him. He was traumatised by the pre-anaesthetic procedure.

This experience left the consumer in extreme distress and unable to go ahead and have the scheduled operation two days later.

As he was so traumatised, he asked the advocate to contact the DHB and raise his complaint. The DHB wrote a letter of apology but the man did not think this fully addressed his problem, so he wrote another letter to his consultant and the manager of surgical services reiterating his concerns.

This resulted in a very positive and professional pre-anaesthetic appointment and his operation was scheduled for the following week. The man was very pleased with the outcome and thanked the Advocacy service for their assistance.

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Respect and mental health issues

An advocate was contacted by a friend of a consumer who was receiving treatment at the local hospital for fractures after falling from a building. The friend had concerns about her care in the orthopaedic ward and was keen for the advocate to visit the consumer.

When the advocate arrived at the ward she was told the consumer was being specialled because of behavioural problems. The staff nurse said that the consumer was "subnormal" and that when she misbehaved they made her lie on a mattress on the floor. The nurse then looked at his watch, said that her punishment time was over and the advocate could go and see her. When the advocate commented that the consumer was not being treated with much respect she was told by the staff nurse "She doesn't treat us with much respect".

After spending some time talking with the consumer it was clear she would prefer to be in the familiar surroundings of the psychiatric ward, where she had previously been an inpatient.

A review of the consumer's care was undertaken with input from mental health services. As the appropriate clinical support for her orthopaedic injuries would not be available in a psychiatric ward, the consumer accepted that the best place for her was the orthopedic ward with changes to her management plan. 

She was also happy that there would be education provided to staff on the orthopaedic ward on mental illness and managing challenging behaviour.

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Finding a system of care that works

A consumer said that when her key worker went on long-term leave, the new key worker appeared overloaded and seemed rushed about everything. The first time the key worker visited she came in and sat down without asking or being invited, she didn't take her shoes off or ask if it was okay to leave them on. On a number of occasions she made appointments to visit the consumer and did not show up. When the consumer rang the office, they told her that the keyworker would not be able to come that day and would reschedule.

With the advocate's support the consumer wrote to the manager of the community mental health unit. As a result of her letter the manager advised there were no other keyworkers available, but he would arrange for the nurse manager to attend an appointment with her psychiatrist, where they would be able to discuss the consumer's concerns. The consumer requested the advocate's support at the appointment.

At the meeting, they agreed that the nurse manager would oversee the administrative side of the key worker's role. The consumer would trial having her care managed by a GP, and that it would be up to her to decide if the trial was a success.

The consumer was very happy with the outcome of the meeting.

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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. 

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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 Māori 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 Māori 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 Māori 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.

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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.

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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.

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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.

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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.

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Sorting out a consumer-centered mental health plan

Mental health service ~ Voluntary inpatient ~ Medication ~ Supervision requirements ~ Resolution meeting ~ Communication ~ Information ~ Care planning ~ Rights 5, 6

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.

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Support is important

Psychiatrist ~ Case manager ~ Resolution meeting

A woman had issues with her mental health team after a previous meeting had not gone well.  She had written a letter to her psychiatrist and case manager and was planning to give each of them a copy at her next appointment.  She approached the advocacy service and asked if an advocate could attend this meeting with her as she was feeling extremely anxious about it.

At the meeting, the doctor acknowledged how positive it was that she had both written her experience down and organized to have an advocate present to support her.  The doctor also acknowledged that the previous meeting had not gone well.  A full discussion took place about her new diagnosis and where to from here. Having an advocate there gave her the confidence to tell her story and ask questions.  The woman felt it had been a very good meeting and was happy and relieved.

 

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