Brock Cook

Occupational TherapistTownsville Integrated Mental Health Service

Overview of my Acute Mental Health Unit 34 Bed inpatient unit

○ 8 HDU Beds○ 26 Open Beds

Located adjacent to main hospital Multidisciplinary Team

○ OT, OT Assistant, Social Worker, ATSI Worker, Nurses, Psychiatrists, Doctors

OT Role

To assist individuals to maximise independence in their daily occupations and life roles

To assess how an individual’s mental illness impacts on their ability to function in their everyday occupations and roles

So what do I do?????? Clinical reviews

○ Discuss as a multidisciplinary team each clients progress○ Clients requiring OT assessment identified○ Treatment plans, assessments, therapy programme input and

discharge planning

Occupational Therapy Assessment○ ADL’s○ Meal Preparation○ Reports completed & discussed at clinical review

Individual Intervention○ As per recommendations from assessment○ Eg. Visual Prompting for self care, graded exposure○ Referral to other agencies eg. SOLAS, Queensland Lifestyle

Services

Weekly Recovery (Group) programme

Recovery Programme

Provides a structure to the clients day Supports the client in recovery by the

utilisation of group work Staff involved in the program include

○ OT, OT Assistant, NGO’s○ Consumer consultant

Recovery Program

Groups provide an opportunity to observe within a more informal setting client skill level and abilities, motivation, memory, concentration, ability to plan, to organise, to judge, decision-making skills, self control, social skills, motor skills, insight into current admission, social interactions, etc

Therapy/Recovery Groups

Psycho educational Self esteem Goal setting, Social skill groups Anger management Relaxation techniques Stress Management

Health Promotion Alcohol and drugs in your

life Healthy life style choices Healthy eating Community Support

Information Group

Recreational Community Meetings Exercise- Gym, morning

walks Pool Competitions Pamper Time Activity based groups

utilising volunteers Art & Craft

Practical Skills Based groups that support existing and/or focus on developing new skills Cooking group BBQ

Non standardised Assessments Observation skills Practical activities eg BBQ, cooking Social activities eg, Sussex on Quinn Liaison with treating team Case notes Feedback from client & family Feedback from community case

managers

Standardised Assessments

OTENT-Occupational Therapy Evaluation of Needs and Treatment which focuses on ADL’s, Task Organisation skills, Interpersonal abilities and motor tasks

Modified Barthel IndexBrookvale Living Skills AssessmentCAMACLSLOTCA

Example Role for Occupational Therapy

Build rapport Consumer Screening Tool

○ Explore interests, strengths, goals

Involvement in recovery programme○ Healthy Promotion Groups○ Goal Setting○ Self Esteem○ Relaxation○ Community Support Information Group○ Recreational Groups

Assessment ○ ADL’s○ Meal Preparation○ Seek family support/collateral

Referral to other agencies○ ATODS, GROW, ROADS, Sussex On Quinn○ Family Support- Mental Illness Fellowship

OT and Mental Health

Any Questions

MentalMental StateState AssessmentAssessment

Part of ‘everyday’ practice in mental health

Useful in any direct client care role

Important for client sensitive practice

MentalMental StateState AssessmentAssessment

Comprehensive initial assessment includes case history plus mental state examination

Many different formats - key elements remain the same

ConsiderationsConsiderations

Cultural issues

Culture specific phenomena

Legal issues

Confidentiality

Mental Health Act

Capacity Documentation

Rapport

Think about the individual person, not the mental illness.

Treat a person with a mental illness like anyone else, with the same respect and individuality.

Even when acutely psychotic, a person can communicate and interact rationally if interviewed skillfully.

Interact directly and openly with the person, using simple, clear language.

Do not talk about the person behind their back.

Interview and Interview and communicationcommunication Adoption of an attentive and unhurried

appearance and attitude.

Observation of the client for non-verbal cues.

Effective questioning techniques including: Open Ended Questioning e.g. “ tell me what has

been happening”, “tell me more about that”, “how have you been feeling recently”

Interview and Interview and communicationcommunication

Effective questioning techniques including:Listening For Verbal Cues e.g. “I don’t care what

happens”, “I’ve given up”, “I can’t cope”Clarifying Questions e.g. “ what do you mean when

you say you feel strange/weird/out of it?”Specific Directed Questioning to identify key

symptoms of psychiatric illness Screening questions for risk of self-harm in high risk

groups

Case HistoryCase History Demographic information Presenting complaint/problem

Question: “ What has been happening for you that brings you here today..How can I help?”

History of the presenting complaintQuestion: “How long has this been happening for you?”

Medical historyInclude: Past and present medications.

Psychiatric historyQuestion: “Have you ever seen any one in mental health before?”

Family historyInclude: Medical and Psychiatric histories

Case HistoryCase History Substance Usage

Include: Illicit substances, Prescription medications, alcohol and tobacco. Quantities and frequencies of use.

Personal history Development- Milestone achievement

Education- Grades, enjoyment

Relationships- Past relationships/bonding,? Abuse.

Forensic- Past and current charges, offences Premorbid personality

Question: Do you think, or has anyone else commented that you have changed since this all started?”

Current situation Can include: Current residence, current relationships/supports, level

of functioning at work, school, home.

Risk Assessment

On initial assessment importance in 2 key areas.

- Self harm/Suicidal ideationInclude: history of self harm/suicidal ideation, current acts/ideation, plans for the future.

- Violence/Homicidal ideationInclude: history of aggressive/violent behaviour, current aggressive behaviour/ideation.

Mental State Examination: MSE Systematic approach to evaluating a consumer’s

mental state at a particular point in time. Important part of a comprehensive mental health

assessment. Commences an MSE immediately by observing

the consumer and continuing to do so throughout the contact.

Broken into 9 components.

Written MSE

Professional and objective manner using terminology that is non-prejudicial of the consumer in a moral or ethical sense.

Structured format helps clinicians avoid oversights and ensures the MSE is readable and coherent.

Utilising specific and conventional terminology helps in communicating to others, but be aware of misinterpretation.

MSE- Appearance and Behaviour

Detailed description of what you see

Clothing

Hygiene

Physical features

Behaviour

Rapport

Whoever reads your notes should be able to have mental picture of how the client presented.

MSE- Speech

Volume Rate Tone Coherence Succinct? Over inclusive? Content

MSE - Mood and Affect

Mood = subjective: what the client states Affect = objective: what do you see?

Mood: “I feel sad”Affect: client appeared teary, low range of

emotional reactivity

Congruent? Does what is stated match watch you see?

Thought Form / Process

Assessed through observations It reflects the persons pattern of

thought Loosening of association Flight of ideas Racing thoughts Tangentiality Circumstantiality Word salad/incoherence Neologisms Clang/associations Thought blocking

Thought Content

Assessed through interviewing Describes themes a person is thinking

Delusions Paranoia Preoccupation Obsessions Compulsions Phobias Suicidal Ideation

MSE - Perception

Hallucinations Gustatory= taste Auditory Visual Somatic Tactile Olfactory= smell Vestibular= sensation of movement

Heightened or Dulled Perception Illusions Depersonalisation Derealisation

MSE –Insight, Judgement

Insight Knowledge of medications, experiences,

effects of substance useJudgement Ability to sift through information Impulsive

???Capacity to organise and understand???

MSE – Cognition

Alertness / consciousness Memory Orientation Abstract thought Concentration

MSE – Neurovegatative

Sleep quantity, quality, circadian rhythmsEat quantities – lack of or too much, patterns,

dietary balanceMotivationEnergyLibido

Performing an MSE

http://www.youtube.com/watch?v=ZB28gfSmz1Y

Discussion & Write Up

Break into groups If this is going to be your

assessment piece to hand in, fill in the MSE blank form.

Ask questions if your unsure of how to describe what you observed

Questions…