Section 3: Working with People with Mental Health Issues

Supporting clients to work towards and achieve their goals is an important part of working with people who have mental health issues. This process should be facilitated using a team approach applying collaboration between the client, their support network, and all professionals involved.

As you learned in CHCCSM005 Develop, Facilitate and Review All Aspects of Case Management and CHCCCCS015 Provide Individualised Support, it is important to focus on making the best use of the client’s strengths and resources when facilitating their progress towards goals. When planning actions with the client you should consider the following:

• Their goals
• Their current strengths and resources
• Activities/strategies that can be implemented to help them meet their needs
• Supports they might require to implement activities/strategies
• How the activities/strategies will be monitored.

When working with clients with mental health issues, these considerations are useful. However, the National Standards for Mental Health Services 2010 also highlights a range of additional considerations for mental health professionals to keep in mind when working with people with mental health issues. These are outlined in the following extract. While, as a counsellor, you may not be working directly to treat clients with mental health issues, it is still useful for you to be aware of the standards that all mental health professionals should comply with.

While these standards are written for mental health professionals, the theme of these standards can be applied in any work with clients with mental health issues. For example, these standards highlight the importance of adopting a holistic approach to care when working with clients with mental health issues. Such clients will typically be working towards multiple goals that address all of their needs, not just the needs related to mental health issues. This means that the client’s care network is interested in meeting the client’s physical, emotional, psychological, social, economic, environmental, and spiritual needs. Therefore, as a counsellor, you should not solely focus on the client’s mental illness but look at the aspirations and goals of the individual and work towards supporting them to achieve these. The holistic approach to mental health care includes recognising that people have experiences and issues that are not necessarily related to their mental illness. These are issues that can affect anyone regardless of their mental health problems and need to be addressed in a way that might not refer to the person’s mental health problems.

Case Study

Marissa has a diagnosis of schizophrenia. She has been living with her mother for the past twenty years. Last week her mother passed away and she has had to attend the funeral, start looking for a new place to live, and start looking for an alternative income all at once. Janet, Marissa’s mental health worker, realises that this is a difficult situation and is one that would lead to stress regardless of any mental health problems. As such, Janet amends Marisa’s care plan to provide her with counselling and additional practical support to help her deal with these issues.

When working with clients with mental health issues, it is important to monitor your service delivery. As the client’s circumstances change, you may need to adapt your approach based on changing needs and goals, or factors such as changes in the client’s life situation (for example, accommodation issues or financial status). Review the following examples of some of the possible changes to client circumstances.

• The client’s mental health may improve or deteriorate. This change might have an effect on the way in which you deliver services to your client in that some services may no longer be relevant if your client’s mental health has improved. If their condition worsens or they develop new conditions they will need increased support.
• The client may need to change accommodation which could impact their support network and their access to public facilities such as transport. Moving houses can be stressful for most people and the process could aggravate mental illness symptoms.
• Financial circumstances may change, especially if your client is employed and becomes unemployed. They may require assistance in gaining access to the disability pension or unemployment benefits. On the other hand, you may find that your client is no longer eligible for social security benefits, in which case you will need to assist them with budgeting their funds.
• The client’s goals and objectives may change and require increased levels of service or services that your organisation is not able to provide. You may need to refer a client to an alternative organisation or specialist assistance.

Any decisions relating to changes in service delivery should be made in collaboration with the client as well as their wider care network.

Case Study

Maria is a young single mother with a five-year-old child. She has been diagnosed with depression and sees her support worker, Louise, regularly. Louise provides Maria with support, encourages her to take her medication, and helps her find social outlets in the community to develop friendships.

Maria has a part-time job at a local supermarket. She drops her son off at school in the morning and goes to her job from 10am until 2pm. This job suits her schedule perfectly as it allows her to work around her son’s school schedule. However, this morning Maria’s manager told her that due to a downturn in the business, her position is being made redundant.

Maria is very upset and worried about how she will support herself and her son. Louise realises that Maria requires support in finding an alternative source of income. Initially, this means referring Maria to the Centrelink office to apply for unemployment benefits. Louise is also mindful that if Maria doesn’t find a new job soon she may have to find alternative accommodation as her current rent is too high for Maria to afford on unemployment benefits alone. Louise makes a mental note that Maria may also need support in applying for social housing. With Maria’s permission, after the session, Louise contacts Maria’s case manager to advise him of Maria’s altered circumstances and schedules a case management meeting to address these changed needs.

How To Support Someone Who Is Experiencing Mental Ill-Health

This video provides advice on how to support mental health patients.

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Other key aspects of working with clients with mental health issues are:

• facilitating social justice
• facilitating social inclusion.

Social justice is about the way in which wealth, opportunity, and privilege are distributed in society. The principle of social justice requires that everyone has equal access to social resources regardless of whether they have a mental illness.

In a similar vein, the principle of social inclusion involves working with the client to find ways to enable them to feel connected to the community and participate at any point within the recovery process. Social exclusion occurs when people experience discrimination, unemployment, poverty and family breakdowns, which leads to their inability to participate in community life. People with a mental illness who experience significant barriers to accessing social and recreational activities or obtaining resources that people need to engage with the community (such as transport) are socially excluded. It is important to develop an understanding of this principle in order to work with people with mental health issues who are commonly isolated from the mainstream community. Indeed, part of your role may involve providing clients with specific supports to facilitate their social inclusion.

It is also important to ensure that all work conducted fulfils your legal and ethical responsibilities by upholding the client's rights. Upholding client’s rights involves ensuring that the client is aware of their rights at all junctures during service provision. Reminding the client that they have choices and encouraging them to express their thoughts and opinions on a regular basis is an integral part of working effectively with people with mental health issues. Clients should feel that their views are going to be heard from a non-judgemental stance and that their opinions and decisions are valued at all times. Other steps you can take to ensure that you are upholding client rights include:

• Checking in with the client regularly to ensure that they are satisfied with the service(s) they are being provided
• Providing the client with access to information and resources required to uphold their rights
• Ensuring that the client has decision-making powers
• Encouraging the client to be assertive about their rights
• Facilitating social inclusion.

There are also a number of programs within the mental health sector in which clients are encouraged to become involved in the managerial and review aspects of mental health organisations. This includes being part of interview panels for mental health jobs, developing and reviewing policies and procedures, advocating for other people with mental health issues, and being part of education and mental health promotion activities. There are also research projects that look into issues such as improvement of services and access and equity. By encouraging client participation in such activities you would not only be protecting their rights but also empowering them to take an active involvement in the sector.

Upholding a client’s rights sometimes involves making necessary adaptations to your service in order to meet the client’s needs. Mental health legislation and organisational policies and procedures call for the need for flexible service delivery. When working with clients with mental health issues you should always consider whether any adaptations are needed to your approach to better meet the client’s needs. This might involve making amendments such as adapting your approach, including members of the client’s support network in the counselling process, working more closely with other service providers, or maximising support services. Of course, when adapting your service delivery, it is always important for you to consider your organisation’s policies and procedures and work within them. If you are ever in doubt as to what adjustments are suitable then it would be important for you to seek the advice of your workplace supervisor.

Throughout your practice, it is vital that you comply with all relevant organisational policies/procedures and legislative requirements. While most of these requirements are the same regardless of your client, there are a few additional legislative considerations that are particularly important when working with clients with mental health issues. We will explore these now.

Economic Content and Impact on Individuals

The economic context significantly influences the mental health sector, impacting service provision and individuals seeking support. Economic downturns, such as recessions or financial crises, often increase demand for mental health services. Job losses, financial stress, and uncertainty can contribute to heightened levels of anxiety and depression in the population.

Reduced government funding during economic downturns can strain mental health resources, limiting the availability of services. Individuals may face challenges accessing affordable or timely mental health care. The economic context also affects mental health professionals, as budget constraints may impact staffing levels, training opportunities, and overall service quality.

Counsellors must understand the implications of the economic context recognising the potential surge in mental health needs during challenging economic periods. Being attuned to the economic climate allows counsellors to adapt their approaches, advocate for necessary resources, and effectively support individuals navigating mental health challenges exacerbated by economic factors.

Mental Health Laws

Each State and Territory has a Mental Health Act that governs how mental health is assessed and treated and safeguards the rights of people with mental health needs. In addition to the state-based Mental Health Acts, as you learned in the first section of this module, the Commonwealth Government has implemented the National Standards for Mental Health Services 2010 (NSMHS). This document outlines standards that aim to improve the quality of mental health care in Australia.

When working with clients with mental health issues it is vital that you comply with this legislation. Reading F outlines specific implementation standards that can be used to ensure compliance.

Mandatory Reporting

In Australia, the laws on mandatory reporting for people with mental health issues vary across states and territories. However, a common thread in most jurisdictions is the obligation to report situations with a serious risk of harm to an individual or others.

Below is a general overview, but it's crucial to consult the specific legislation in your jurisdiction for accurate and up-to-date information.

National and Common Principles

At the national level, Australia has common principles that guide mandatory reporting. Generally, mental health professionals are obligated to report situations involving serious threats of harm, self-harm, or harm to others. These principles prioritise the duty of care while recognising the importance of maintaining client confidentiality where possible.

State and Territory Legislation

Each state and territory in Australia has its own legislation regarding mandatory reporting for mental health issues. For example:

• New South Wales (NSW): The Mental Health Act 2007 outlines provisions for mandatory reporting in situations where a person is at risk of serious harm.
• Victoria: The Mental Health Act 2014 stipulates circumstances under which disclosure may be required, emphasising the duty to protect individuals from harm.

Child Protection Laws

In addition to general mental health legislation, child protection laws often include provisions for mandatory reporting of child abuse or neglect. This is particularly relevant when working with individuals who are parents or caregivers.

Health Practitioner Regulation

Health practitioners, including mental health professionals, are also subject to national registration and accreditation standards. These standards may include obligations related to reporting concerns about a practitioner's health or conduct.

Confidentiality and Informed Consent

Australian laws recognise the importance of confidentiality in mental health care. However, the duty to report may override confidentiality in situations with an immediate risk of harm. Mental health professionals typically work within ethical frameworks that emphasise obtaining informed consent.

Mental health professionals need to familiarise themselves with the specific legislation in their state or territory and stay updated on any changes. Additionally, seeking legal advice or consultation with professional bodies can guide navigating the complex landscape of mandatory reporting in mental health contexts.

Work Health and Safety

The work health and safety issues associated with working with clients with mental health issues can be complex. It is important to understand the issues associated with work health and safety in order to protect your own safety as a worker, the safety of your coworkers, and the safety of your clients.

Employers and workers at counselling services, community services, and mental health services have a legal obligation to take reasonable steps to keep themselves and other people who are accessing the service safe. This includes:

• Clients of the service
• Families and carers of the clients
• Visitors (including children)
• Co-workers in the service.

The term ‘safe’ refers to both physical and psychological (or emotional) safety, which means that steps should be taken to minimise the risk of individuals being exposed to unsafe, traumatic, or emotionally stressful events. The work health and safety procedures and regulations that apply to your State or Territory will provide you with instructions on how to deal with situations where harm does occur including procedures such as applying first aid, calling an ambulance, or providing support.

Working in a safe manner means that you need to assess the risks associated with the work. Assessing risk involves understanding the nature of the harm that could be caused by the risk, identifying how serious harm could be, and the likelihood of it happening. The level of risk is determined by asking yourself questions such as:

• What could go wrong?
• What is the likelihood of something going wrong?
• What are the consequences of something going wrong?

When you identify possible risks it is important to use your organisation’s risk management procedures or discuss the matter with your supervisor.

One aspect of work health and safety that most organisations will have specific policies and procedures for is the presence of children in the workplace. These policies refer to the children of workers or clients who are present in the workplace because they are accompanying their parents, not children who are clients themselves (for which there will be other specific policies and procedures that must be followed). Essentially, community service organisations have policies and procedures that help ensure the safety and well-being of children while they are in the workplace. These policies usually include the need for children to be supervised and details about areas of the workplace in which there are too many risks to allow children to be present. When working with a client who brings along their own children you will need to consider issues of risk. For example, children cannot be left unsupervised while you work with your client. In some instances, you might need to arrange for specific supervision of children, in which case you will need to gain a parent's or guardian's consent.

As in any aspect of your work, when working with clients with mental health issues it is important for you to comply with all relevant legislation. If you are ever in doubt as to how to act in a specific situation then you will need to seek the advice of your supervisor.

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As with all your work, it will be important for you to clearly and accurately document your work with clients with mental health issues as per your organisation’s policies and procedures. While each organisation will have their own expectations relating to note-taking and record-keeping, all documentation should be detailed, accurate, and professional. Some key considerations that you should keep in mind when documenting client contact include:

• Write the date, time, location and names of people present at the interaction.
• Record who said what and use inverted commas when indicating direct quotes.
• Ensure that your records are objective and accurate.
• Record facts rather than your opinions.
• Record the client’s actions and behaviours using objective terms.
• Make sure that you are writing facts not inference – identify what actually happened, not what you thought might have happened.
• Record the reasons why you made certain decisions.
• Use short sentences and be concise.
• Use plain language.
• Use appropriate headings and set out the information in a logical manner.
• Make sure that you sign all of the notes you record.

In the mental health sector, many organisations use specific documentation standards called the SOAP principles, which are outlined in the following extract. If you are providing counselling as part of a larger case management plan in the mental health sector, it might be appropriate to also use such an approach.

It is also important to ensure all notes and documentation about a client are treated with the highest levels of care and filed securely according to your organisation’s policies and procedures.

There may be times when you have to respond to a client with mental health issues who is in a state of distress or crisis. On these occasions, it is important to respond in the best way to meet the immediate needs of the person experiencing distress and keep work health and safety considerations in mind.

Introduction to Crisis Intervention

This video provides an excellent introduction to crisis intervention.

Some of the types of distress or crisis situations that you might come across include:

• Clients threatening to harm themselves
• Clients being at risk of harm from others
• Clients threatening to harm others
• Significant/sudden changes to the client’s situation.

When a client expresses distress, regardless of the nature of the crisis, it is important to respond promptly and supportively. One commonly used approach that can help counsellors and other community service workers respond appropriately in such situations is the ALGEE approach:

A – Approach, assess and assist with any crisis. This involves assessing any immediate risks of suicide or harm, signs of trauma, or high anxiety.

L – Listen to the client’s full story and concerns in a non-judgemental manner.

G – Give the client reassurance, support and information.

E – Encourage the client to seek appropriate professional help.

E – Encourage the client to seek other support strategies.

In such situations, as a counsellor, you have a duty of care to respond supportively to the client in crisis and ensure that their immediate needs are resolved (this might involve providing crisis counselling or making a referral to an appropriate support service to help meet the client’s immediate needs) as well as ensure that any appropriate amendments are made to their ongoing care plan.

5 Do's and Dont's of Dealing with Other's Mental Illness

This video discusses the five do's and don'ts of mental illness.

When working with any client it is important to ensure that you work within the limits of your own knowledge, abilities, and work role. However, these considerations are particularly important when working with clients with mental health issues due to the complex nature of such work. Always remember to ensure that you have a realistic understanding of your limitations in terms of:

• Resources available to you
• Your level of skills and knowledge
• The formal roles and the associated responsibilities assigned to you.

There will be times when the client requires assistance that is beyond the limits of your skills, knowledge, or work role. This can include requiring the specialist knowledge/skills of GPs, nurses, social workers, occupational therapists, psychiatrists, psychologists, drug and alcohol workers, and employment agencies. Depending upon the circumstances of the client’s care you may be required to make this referral yourself or discuss this need with the client’s case manager.

In situations where you need to make the referral yourself, you will need to consider the client’s specific needs and make an appropriate referral based on your organisation’s policies and procedures. When referring a client with mental health issues, it is particularly important that the referral is completed effectively.

The following table outlines a few different types of referrals.

^{(Australian Government, Attorney-General’s Department, 2015)}

While you will need to comply with your organisation’s policies and procedures, in general, some form of ‘warm referral’ is usually most appropriate for clients with mental health issues. This ensures that the referral is most effectively made and that the client’s needs will be most effectively met.

When working with clients with mental health issues it is important to remember that, as a counsellor, you are essentially only completing one part of the client’s wider care plan. Be sure to complete your role effectively and work collaboratively with other service providers.

The following videos provide examples of counsellor's working with clients with mental health issues.

How to Assess for Suicide: Role Play Counselling

A role play involving a professional counsellor and a volunteer. After watching the video, answer the questions that follow.

Cognitive Behavioural Therapy Techniques for Psychosis

A role play involving a professional counsellor and a volunteer. After watching the video, answer the questions that follow.

Assessment and Intervention with Suicidal Clients

A role play involving a professional counsellor and a volunteer. After watching the video, answer the questions that follow.

Behavioural Therapy Counselling Role-Play - Client with Symptoms of Narcissistic Personality Disorder

A role play involving a professional counsellor and a volunteer. After watching the video, answer the questions that follow.

In this section of the module you learned about some of the critical considerations that you should keep in mind when working with clients with mental health issues. Specifically, you learned about the importance of engaging in collaborative, adaptive practice that promotes client rights while still conforming to your organisational and legislative requirements.

Australian Government. (2010). National Standards for Mental Health Services 2010. Barton, ACT: Commonwealth of Australia.

Australian Government Attorney – General’s Department. (2015). Referral Guidelines for Family Relationship Centers and the Family Relationship Advice Line. Retrieved from https://www.ag.gov.au/FamiliesAndMarriage/Families/FamilyRelationshipServices/Documents/Referral%20Guidelines.doc

Mental Health Coordinating Council. (2015). Mental Health Rights Manual. Retrieved from http://mhrm.mhcc.org.au/chapter-2/2c.aspx