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Topic 1: Recovery Types of recovery: Personal, clinical, social, relational, family Personal recovery “The process of personal recovery has at its very heart, the reclamation of personal power which is a liberating experience that occurs through the politicisation of the self within wider societ...

Topic 1: Recovery Types of recovery: Personal, clinical, social, relational, family Personal recovery “The process of personal recovery has at its very heart, the reclamation of personal power which is a liberating experience that occurs through the politicisation of the self within wider society” “Recovery involves living as well as possible”  Moving away from ‘illness’ towards wellbeing/living a good or meaningful life (changes to identity)  Self-(re)discovery  Self-determination  Choosing the life I want to live (not one other prescribes or decide for me) Components of personal recovery Mike Slade (2009) – CHIME Connectedness To self and others. Recovery does not happen in isolation – it happens in relationships and communities of belonging. Hope Held by the person, communicated constantly by other people, including professionals. Identities Moving away from the identity of ‘ill’ (and related constructions such as ‘incompetent’, ‘unreliable’, ‘dangerous’) to identities meaningfully chosen by the person. Ascribed identities are rejected. Meaning and purpose Self-defined, not limited by diagnosis or ideas about the limitations associated with the diagnosis Empowerment Self-empowerment sits alongside self-determination Link to practise AASW Code of ethics Trauma informed care Client centred care Walking along side client Clinical recovery Clinical recovery refers to the absence of symptoms, either because of them being eradicated by treatment, or because the treatment is suppressing or controlling them. The essential concept of clinical recovery is that the recovery process occurs because of the effectiveness of the clinical treatment. cure and symptom remission which is observed and categorised by clinicians. primarily defined by mental health professionals pertains to a reduction or cessation of symptoms Social recovery or psychosocial/psychiatric rehabilitation “Social recovery views the recovery process as the person’s ability (or lack of) to interact in a particular way within society”  There is a focus is on ‘functionality’ in the face of illness  assumption that there are gaps in living skills evident and these are addressed through rehabilitation  Focus is community integration and participation in ‘mainstream’ activities  Assessing people’s functional capacity and implementing skills training to improve capacity (e.g. living skills, budgeting, cooking, cleaning, catching public transport, becoming job ready) The focus of social recovery Economic - Education, employment and training Housing - Accept available options, shared housing, supported housing Behavioural - Modifying behaviours to avoid impact on others, ‘realistic’ expectations, mainstream presentation and behaviour, impacts of medications is considered in relation to behavioural goals, adaptation Lifestyle - Planning for relapse/preventing relapse, nutrition, exercise, sleep hygiene, hobbies, spirituality, medication or other treatments, adaptation, and acceptance Relationships and connections - Support systems, relationships, friendships, professional relationships Relational recovery All change happens in relationship, and that our attachments to others are both the most meaningful and at times the most challenging parts of our lives A way of conceiving recovery based on the idea that human beings are interdependent creatures. Family recovery   Families also experience significant and often prolonged distress, particularly if they provide long-term support for a loved who experience mental distress/illness  Recovery process is viewed as occurring in the family context Recovery extended Functional recovery Focus is on gaining / regaining functionality – activities of daily living, community participation, engagement in employment / education ‘Recovery’ - alcohol and other drug area Abstinence (as distinct from harm minimisation) Family Systems Theory Is a concept of looking at the family as a cohesive emotional unit. A family functions as an emotional system within which each person plays a specific role and must follow certain roles. Patterns develop within the system. Depending on the specific system, a member’s actions/behaviours can either balance or cause imbalance of the system at various points in time. Topic 2: Understanding and responding to trauma and mental distress What makes social work different from other disciplines in mental health contexts? Focus on both individual and societal wellbeing Underpinned by socially inclusive communities Emphasis on principles of social justice, respect for human dignity and human rights Dual focus on the individual AND external issues that impact wellbeing Critical social work in mental health Examination of how power dynamics operate to understand the processes by which inequalities are reproduced  Recognises the “iterative relationship between the personal and political dimensions of life” The United Nations Convention on the Rights of Persons with Disabilities (CRPD) To promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. Critical and rights-based social work practice in mental health Types of traumas Public trauma: war, disasters and sudden/traumatic death Private trauma: domestic and family violence, child abuse, sexual violence and abuse Singular trauma: one off event Complex trauma experiences Vicarious trauma: The emotional residue of exposure to traumatic stories and experiences of others through work; witnessing fear, pain, and terror that others have experienced (secondary trauma) Most likely to affect service providers and front-line workers Historical trauma and transgenerational effects: “subjective experiencing and remembering of events in the mind of an individual or the life of a community, passed from adults to children in cyclic processes as collective emotional and psychological injury over the life span and across generations” Trauma survival strategies Experiences: Survival strategies Abuse Hearing voices Betrayal Self-harm Neglect Eating disorder Denial Resourcefulness Blame Creativity Threats Sense of justice Symptoms and trauma Voices, visions and disturbing beliefs often represent memories, experiences and the perpetrator. This means people who hear voices may: Feel watched or monitored Believe what the voices say (they are evil) Have distorted body image (reflective or perpetrator messages and actions) Voices may Call people names (often representative of the abuse experiences or impacts) Commands people to harm or kill themselves Reinforce guilt, shame, and responsibility (you asked for it) Convince them they are a perpetrator Eating disorders and self-harm Evidence suggests a relationship between trauma experiences and eating disorders. Two Australian studies reported: Women described purging and starvation as forms of self-harm in response to sexual trauma Negative emotions of abuse linked to eating disorders including binge eating for emotional comfort and relief, using purging and starvation as punishment for abuse Substance use and self-harm Substances such as drugs and alcohol, actions such as self-harm, over or under eating, or gambling can be functional ways to cope with traumatic experiences Bring temporary relief Numbing Unconscious strategies to manage and cope with internal distress arising from traumatic experiences Self-harm can be an expression of inward pain Delusions Trauma informed and personal recovery approach The experience of persecution and surveillance can often be grounded in experience (being followed prior to an assault or living with long term danger) Delusions often reference often symbolise unexpressed thoughts and feelings – there can often be a meaning and code to be understood Meaning and sense-making Meaning making can be a useful approach for some people Finding the meaning requires deep listening and engaging with a person’s (or one’s own) story Trauma informed practise A strengths-based approach, which seeks to understand and respond to the impact of trauma on people's lives. The approach emphasises physical, psychological, and emotional safety for everyone and aims to empower individuals to re-establish control of their lives. Five key principles: 1. Safety 2. Trustworthiness 3. Choice 4. Collaboration 5. Empowerment Principle 1: Safety Safety first and do no harm Be mindful, thoughtful, sensitive, empathic and caring in all your interactions Consider the physical environment (where you meet, doors, positioning of self and person, soothing spaces, security, self-awareness) o Safety in body o Safety in social network, relationships, services o Safety in environment Principle 2: Trustworthiness Reliability, consistency and transparency Professional boundaries or safe connections – balancing the tension between care, compassion and relationship Clear information (provided in multiple formats) explains what happens and why it happens. Explaining consent, duty of care and confidentiality while considering issues related to safety and trust Clear explanation of processes, practices, principles and values associated with service delivery Principle 3: Choice What choices are available to the consumer in relation to the types of services they receive, how often they receive them and who provides them? Is the person choosing or involved in their treatment plan?  Is the person making decisions – involved in decision-making? Build in ‘small choices’ – finding balance between offering choice and overwhelming a person Principle 4 – Collaboration Offer opportunity for input Provide support to enable collaboration Who leads – deciding what is on the agenda, what is discussed, how it is discussed? How can you address power and share power? Principle 5 – Empowerment Self-empowerment (you cannot empower another person; however, you may be able to provide resources, hold space for the person, listen and bear witness) Create the conditions collaboratively with the consumer so that they can engage in empowering activities of their own choosing Key concepts in trauma Dissociation, hyper/hypo-arousal, intrusion 1. Dissociation Helps people to survive unbearable situations Dissociation can become problematic and have negative impacts if it is a long-term coping strategy It is also a part of normal adaptive psychological processes and can be powerfully protective 2. Hyper and hypo-arousal Hyperarousal and hypervigilance: Prolonger alertness and arousal Easily startled Terror Usual capacities and coping abilities overwhelmed  Visible distress and agitation Hypo arousal: Shutting down, distress not as visible 3. Intrusion Frequent, intractable and repeated intrusive memories and thoughts (flashbacks, nightmares, panic, anxiety, somatic responses) The traumatic moment becomes encoded in … memory, which breaks spontaneously into consciousness, both as flashbacks during waking states and as traumatic nightmares during sleep Personality disorders Personality Disorders: Antisocial PD Known as sociopathic, psychopathic and dissocial in the past Chronic & pervasive disregard for others Manipulative, deceitful, callous and hostile Problematic relationships (exploitation, violence, aggression) Abuse histories Treatments have little impact (CBT and psychotherapy) Personality Disorders: Borderline Personality Disorder  Emotional vulnerability – sensitivity Difficulties with intimacy or connections Fear of abandonment Impulsivity Self-harm Histories of abuse, neglect and invalidation (particularly in formative years) Experiences of abandonment make interpersonal interactions and relationship significantly unsafe Types of ‘Psychotic Disorders’ Schizoaffective disorder Schizophrenia Delusions Psychotic disorder due to mental illness Brief Substance induced Schizophreniform Clinical definitions of psychosis Psychosis is a general term used to describe experiences which involve losing some contact with reality Disturbances in thinking, emotions and behavior Negative and positive symptoms Emotional withdrawal Sleep disturbances Impacts relationships, work, self-care, activities of daily living Personal recovery explanations of psychosis Complex and contextual understandings of the whole person Trauma is considered to include at least the following: Loss  Bullying Communication and attachment patterns and experiences Domestic and family violence Childhood physical, emotional and sexual abuse Childhood neglect Adult sexual assault, exploitation and abuse Torture and other experiences related to war Heightened sensitivity to environmental factors Oppression and discrimination Clinical definition of depression Low mood is something we all experience. Depressive disorder is distinguished from normal unhappiness or sadness when the mood state: Is severe and persistent Lasts for two weeks or more Interferes with our ability to function at home or work Symptoms of depression are associated with most other mental disorders and frequently with chronic physical illness... Anxiety and depression often coexist (and can be difficult to unravel). Impacts of depression Cognitive Behavioural Affective Hopelessness Increase or decrease in Ambivalence Negative and impaired activity levels Little joy or gratification sense of self Increased crying Compromised self Suicidal ideation, intent Suicide attempt esteem and action Slow speech Inadequacy Focus on self Substance use changes Worthlessness Limited concentration Impulsive Apathy span Sadness Guilt  Exaggeration or Behaving in ways Powerlessness diminishment inconsistent with past Reactivity and values Loss of motivation Compulsive Psychomotor changes Giving up Perfectionism Responses to depression Individual experience/journey– who am I? Exploration of sense of self and identity Support, connection and acceptance Acceptance and commitment therapy (ACT): accepting what cannot be controlled, committing to the life of one’s choosing Connecting to the self, one’s body, one’s environment Therapy, counselling, group support CBT and Mindfulness - Recent studies indicate mindfulness meditation helpful in reducing recurrence; awareness of how we construct thoughts and this then constructs our interactions/behaviors. Clinical treatments and medication - a personal recovery framework recognizes that clinical treatments can be useful; however, a medication only approach is questioned Clinical explanation for Bipolar Affective Disorder Persistent, recurring illness, and the pattern of cycling between high and lows – distinct for each individual Subgroups of bipolar disorder- Bipolar I and Bipolar II Anxiety Disorders Generalised anxiety disorder Obsessive Compulsive Disorder  Agoraphobia Panic disorder Post-traumatic stress disorder Specific phobia Explanations for anxiety disorder Psychological symptoms of anxiety Recurring fears (of death, losing control, embarrassment or humiliation) Worry Sense of foreboding or impending harm Disruptive thought patterns (catastrophic or obsessive thinking) Tension, restlessness and agitation Hyper-vigilance Depersonalization (distortion of sense of self) Derealization (the world does not seem real or is experienced as strange) Impaired concentration, attention and thinking patterns Complex and Post Traumatic Stress Disorder (C/PTSD) Re-experiencing the phenomena Being triggered by associated events or phenomenon to re-experience the event The need to avoid triggers, events or reminders Disassociating or numbing of responses to triggers, reminders or similar events. Hyper-arousal - the need to remain hyper-vigilant about one’s safety or surroundings, disturbed sleeping, impaired thinking and concentration and lability of mood.  Depressive features or presentation Topic 3: Lived experience participation and involvement Why is consumer and family involvement and participation necessary and important? Consumers and families have expertise due to their direct understandings or observations Research says partnerships and collaboration improve outcomes for individuals and families accessing the mental health system Consumers are the key stakeholders in the mental health system, being directly impacted by the quality of services Spectrum of Participation and Engagement Participation and Engagement can occur across various levels 1. Individual level Direct treatment, care and support Feedback and complaints process Provision of information 2. Service level Consumer and community advisor committees/ groups Clinical and professional advisor committees Peer workforce 3. Sector level Peak bodies Advocacy organisations Mental health commission 4. System level Mental health networks System clinical policy groups Peak bodies and advocacy organisation Primary health networks Mental health commission Guiding principles  Safety Authenticity Humanity Equity diversity Principles of Co-production (NDTi) (Checklist) 1. People are involved throughout the process- from beginning to end 2. People feel safe to speak up and are listened to 3. We work with the issues which are important to people 4. It is clear how decisions are made 5. People’s skills and experiences are used in the process of change 6. Meetings, materials and venues are accessible to people- they can get there, prepare, be heard and follow progress 7. Progress is evaluated by looking at actual change in people’s lives Topic 4: Risk and safety/ Suicide and self-harm Empowerment: Collaboration People set their own goals ‘Having a go’ creates the conditions for people to experience empowerment Empowerment occurs in relationship and in community Power relations rather than power being held over/on/under … Self-determination Consumers having the right to choose freely Self-harm “Self-harm is a form of communication, an expression of frustration, a metaphor, many things to many people, the common feature being it is a real response to real feelings. To recover, people must be supported to explore the experience, to understand what they are doing and why, to accept it as part of themselves and to make decisions about how to go on to live lives with or without self-harm.” Death is not intended Alleviation or experience of pain Dissociative state often induced Principles for supporting people in relation to suicide (attempts and/or ideas) Reflective of personal recovery goals such as: Hope, connectedness and choice Meaning making Healing and transformation Opportunities Self-empowerment Self-determination Safety factors to consider – vulnerabilities / ‘risks’ Previous suicide attempts Problematic substance use Sexual/physical abuse Financial stress/poverty Racism & discrimination Stigma Mental distress/’mental illness’ Access to lethal means Isolation  Recent release from institutions (prison, hospital) Recent admission to institution (prison, hospital) The goal is not to simply force someone to stay alive from moment to moment. Rather, it is to support them to create meaning and a life that they want to live. Not killing oneself is simply a side-effect of all that. Topic 4: Substance use and harm reduction Types of drug use Recreational use Intensive use Experimental use Situational use Dependent use Abstinence-based models Abstinence models include the following ideas: Addiction is a disease which people have no control over There are often genetic predetermining factors There is no ‘cure’ It is a progressive disease which means the only response is abstinence Abstinence is required to engage with mental health treatment Example of abstinence treatment approaches: 12 step programs (AA, NA) Structured and uniform program– involve ideas such as giving oneself up to one’s ‘higher power’, acknowledging one’s powerlessness in the face of addiction, complete abstinence and regular attendance at groups  Alternative medications or pharmacotherapies Detoxification Harm minimisation According to the 2017 -2026 National Drug Strategy: Harm reduction strategies encourage: Safer behaviours Educe preventable risk factors Contribute to a reduction in health and social inequalities among specific population groups “Building safe, healthy and resilient communities through preventing, responding and reducing alcohol, tobacco and other drugs related health, social and economic harms Harm reduction Humanistic Approach: a non-judgemental approach to working with people– dignity, compassion and respect Recognises the autonomy of people to make choices Provides practical and immediate evidence-based strategies to prevent and reduce drug-related harm (physical, social, mental health) Focus and commitment to human rights Recognition of social and health determinants and the social factors that influence vulnerability to drug-related harms Topic 5: Working with Aboriginal and Torres Strait Islander people (in a mental health context) Building bridges program Socio-cultural holistic model Working in an indigenous context Intergenerational trauma (trauma informed practice) Social and emotional wellbeing model Acting with cultural awareness, safety, and security Engage in critical self-reflection on own culture, cultural boundaries and limitations Develop an understanding of key barriers to Aboriginal and Torres Strait Islander people accessing mainstream mental health services Identify the relationship between history, colonization, current and past legislation, racism and mental distress Develop an understanding of the Noongar Work Practice Model for Aboriginal Youth Mental Health (Culbong et al., 2022) Working with and value families Risk and safety Suicide and self-harm Practice scenarios Anthony is 28 years old and has been in and out of mental health services for ten years as an inpatient and outpatient. He has acquired a number of diagnoses including ‘psychosis’ and ‘schizoaffective disorder’. Anthony was admitted as an inpatient to Grayland's Hospital two days ago after an incident that resulted in Police taking Anthony to the Emergency Department. Members of Anthony’s extended family have been in contact with you and the multidisciplinary team. They told you that Anthony’s voices have been getting worse and Anthony has been finding them increasingly distressing the past two weeks. They tried to get some help for Anthony, but all the services had a waiting list of two weeks or more. You met with Anthony briefly this morning and he told you that his voices include voices of ancestors, spirits and cultural entities. What would you do? You are working within a multidisciplinary team at Grayland's Hospital including: Social work team (yourselves), Aboriginal mental health worker, Psychiatrist, Nurses, and Occupational therapist How would you approach working with Anthony? In your discussion, please consider: The multidisciplinary team – how might each profession view the situation? ‘Symptoms’ of ‘schizophrenia’ and the spiritual and cultural experience of hearing voices Cultural healing Family and community All domains of social and emotional wellbeing