The Victorian Mental Health Reform Strategy, the Crisis Assessment and Treatment, and the Ambulance Transport of Patients Who Are Mentally Ill - Coursework Example

Name Institution Statement of Objectives Examine "Ambulance transport of people with a mental illness protocol 2010" of The State Government of Victoria To comprehensively assess the protocol’s strengths and weaknesses against the National Standards for Mental Health Workforce and other relevant frameworks like the Recovery Principles and Trauma Informed Care To illustrate the rural focus of the above mentioned guidelines and protocols with emphasis on their strengths and weaknesses Make a conclusion on the basis of this review of any matters that could be improved in the protocol and how this would be formulated. Introduction Mental illness refers to any form of behavior or mental activity which either presents some suffering to the subject or makes the person not lead a normal life and most significantly the patterns shown don’t occur as a normal feature in a population (Schutt and Goldfinger, 2011). A persons is affected in thought, emotions, actions and perception thus fails to lead a normal life. Stigma and discrimination are key features that mental patients face everyday. The Mental Health Council of Australia (MHCA) and other bodies have been on the forefront in addressing the false perceptions that are rife in society concerning mental illness. Today many reforms have been put in place to address issues that been brought forward by human rights activists and other stakeholders in the Mental Health fraternity (Chappell, 2013). Background Information There has been a rapid shift from a practitioner based therapy to a more tailored patient based system. The Victorian mental Health Reform Strategy 2009-2019 has been released in March 2009 and which is now addressing critical areas like ambulance transport of mentally ill patients and how various parties like family, police, the mental health officer and hospital staff as a whole approach and provide services to the mentally ill patient. National Standards of Mental Health Workforce on the other hand provides guidelines to the key mental health practitioners which includes psychologists, the social workers, occupational therapists, psychiatrists and nurses. This defines their values (e.g. respect, excellence) attitudes (e.g. Professionalism, cultural consciousness) and responsibilities like professional development and health promotion. Trauma informed care authoritatively outlines the management of patients who have suffered some horrifying incident and are traumatize (Slate and Johnson, 2013). This is achieved through containing shame, humiliation, violence that the patient may be associated with especially where the patient survived an incident. Recovery Principles is a holistic approach that still echoes the importance of respect, acceptance, individualized based therapy and empowerment all of which are directed to a mentally ill patients to help in the quick recovery process and should therefore be accorded to them by society, family and mental health practitioners. The Mental Health Act (2007) on the other hand supports all the protocols above by providing a list of provisions to be accorded to the patient, core of which include care and treatment in chapter 4, voluntary admission in chapter 2 and chapter 3 that shows when involuntary treatment has to be embraced. It has nine chapters with chapter 9 indicating limits to holding office positions etc. (The Mental Health Act, 2007). Discussion The ambulance transport of mental illness patient’s protocol 2010 has various strengths when compared to the other guidelines. However it also suffers some limitations. The following are the key strengths of this protocol over the others Well defined emergency categories This Protocol 2010 has categorized ambulance responses to various requests. Code 1 involves lights and sirens and the nearest emergency point is highly considered with code 2 having no lights and sirens and is common with the apprehended under section 10. The National Standards for Mental Health Workforce does not categorize response of the medical staff to the various categories of mentally ill patients and thus fails to fully tailor the needs of the patients. Trauma Informed Care on the other hand just appreciates the empathetic nature that should be accorded to the patients in cases where the victims calls through the hotlines but does not provide us with these categories. The mental health triage Mentally ill patients may have unfamiliar patterns of mental dysfunction even at weird hours like midnight (Slate and Johnson, 2013). This protocol’s key on this is to assess the patient first and this assessment forms the basis of the kind of response, urgency or even if the patient needs mental health services. This is usually done by the mental health practitioner. It’s possible because the Victoria’s area mental health services provide these services 24 hours a day 7 days a week and telephone triages predominate involving all ages. Trauma Informed Care also has similar provisions but is mainly directed to the patient, victim or the close caregivers. In trauma the need to contain the situation like prevent suicide is key for victims, however the Victorian Protocol 2010 will categorize the emergency and respond accordingly to the site. The crisis assessment and treatment services and allowance of carers to provide service The Crisis Assessment and Treatment (CAT) has been recognized in the 2010 protocol and its main aim is to rich out to the larger community especially rural areas. This directive is aimed at intervening in a crisis by assessing people within certain timelines as specified by legislations of the state and moreso providing support to the people in the community so that they can avoid being admitted. It’s like a prophylactic measure aiming to reduce cases of admission (Slate and Johnson, 2013). In addition to this we have an out of hours support to the aged, children and adolescents. This is a key step in clinical care and is in line with the patient oriented system that is being realized in this era. These services definitely encourages the patients and changes the general view of the population regarding mental health. The Mental Health Act (2007) does not clearly indicate this and it only accepts the community based therapy and not detailing what kind of support is to be given. The National Standards for Mental Health Workforce on the other hand supports this. Under health and prevention promotion by implementing and intervention of any unusual behavior sited in a community. Emergency services liaison committees This is a key strength in this protocol as various parties are usually involved in the mental illness management. The police, the representatives of ambulance services, the consumers and carers all discussing developments in the mental illness sector. This is key in avoidance of disorganized labor. The roles of the various parties are revised so that all the parties work in harmony for the betterment of the health of the patient. Aspects like the use of force by the police are reviewed and measures put in place to avoid this in the wake of constrain free delivery of a patient to a mental health facility (Slate and Johnson, 2013). National Standards for Mental Health Workforce mainly involves the main workforce that has been stated earlier. The roles of the police are not clearly defined in the guideline. MHA 2007 has supported this Protocol by also defining the areas where police have to be called in. The Protocol on the other hand has suffered the following limitations Disorganized labor The idea of several parties being involved in the transit of the patient to the health facility may cause disorder especially in cases where all the parties are involved. The police will want to play there role, nurses want to administer sedatives, the family and care givers may oppose this and all this will cause a messy scene at the expense of the patient. National Standards for Mental Health Workforce mostly confines to the medical and psychological practitioners. Empathetic listening Regardless of the 24/7 mental health triage the issue of empathetic listening to a victim or a family requiring assistance is key. This protocol hold response through ambulances at heart without considering fact of containing the situation before reaching the area. The Trauma Informed Care is the one of choice when it comes to this with clearly defined process of communication. Restraining the patient The restrainment of patients’ clause should be revised since in this era the use of such methods contradicts with many human rights indications. Some ambulance personnel will avoid the idea of calming down the patient and empathetic conversations by restrainment which may be irrelevant. The National Standards for Mental Health Workforce objective is to avoid these methods. Ambulance fees This may be unacceptable in cases where the victim has no immediate breadwinners and has no support from anybody. It’s the right of the patient to receive such services and any costs met should be paid by authorities. Rural focus The strengths of this Protocol is that on emergency the Code 3 is tailored to respond to ambulance request from areas far away. This is because in this case the person will need to be transported to the closest facility as opposed to the catchment area service that the person would have been admitted. The aspect of distance of the ambulance to the area and the same ambulance heading back may cause aggravation of symptoms to the patient and further medical treatment may be irrelevant due to damage caused. National Standards for Mental Health Workforce does not have such provisions of categorizing. A variety of transport modes is possible for the patient. This hence doesn’t necessarily restrict the patient to ambulance. The protocol hence considering the long distance from rural places has recognized the use of private vehicles, taxis, agency vehicles and even Non-emergency patient transport (NEPT) as authorized to transport the patient. This helps to remove delays. The MHA 2007 doesn’t outline such provisions but recognizes ambulances and police vehicles as the only transport means available. The procedure for handover of the patient to the ambulance personnel agrees that a mental health professional can accompany the person in the ambulance when variations in ambulance crewing present. This is good because the rural patient receives optimum care from both the ambulance team and the medical health officer. These provisions are not outlined in National Standards for Mental Health Workforce and the guidelines only work when the patient is now in the health facility. The crisis assessment and treatment services (CAT) is a focus on the community especially the rural dwellers. This is to ensure that there is assessment and intervention when needed to patients of various age sets. As discussed earlier, it’s prophylactic and mainly contains a given mental illness before reaching hospitalization levels. Costs are saved and a healthy relationship between the mentally ill, the community and the health practitioners develops. National Standards for Mental Health Workforce also agrees to this but the MHA 2007, the Trauma Informed Care don’t have such provisions. Ambulance Victoria The Rural ambulance Victoria and Metropolitan Ambulance Victoria restructuring and merging has been a key issue as this has encouraged service delivery. This is because there is shared advanced facilities from the metropolitan sector. The rich resources now available are meant to enhance quick recovery and also enhance clinical care for the patient. Community Mental Health services These are services that have been customized for the community. Main objective is to provide acute psychiatric assessment and treatment functions in the community. It is approved and region specific. The rural areas have found this benefiting as services have been brought to their doorstep (Slate and Johnson, 2013). The shortcomings of this Protocol in rural focus cannot be ignored and were identified as follows Cultural awareness The rural parts have intense cultural factors in place and should be considered. National Standards for Mental Health Workforce standard 4 defines culture with reference to the Aboriginal and Torres Strait Islander. Such provisions are not in the protocol. The impacts of colonization, grief, loss, trauma has been embraced by the guideline thus largely showing the weakness of this Protocol The diverse needs of the patients are not fully met in this protocol though most sections have the interests of the patient at heart. Standard 3 of National Standards for Mental Health Workforce acknowledges social, linguistic, spiritual, cultural, diversity of people as powerful influence on service provision and as core elements in a patient oriented system. These provisions are not detailed in this Protocol. Roles and responsibilities may also conflict in cases where health officers have to accompany patients in ambulances from rural areas as the Protocol says they should agree in such cases without elucidating what happens when they don’t agree. However National Standards for Mental Health Workforce clause on partnership and integration clearly overpowers this protocol as this partnership and integration is aimed at harmonious existence and cooperation within parties involved in patient care. Recommendations and improvements The ambulance transport of patients with mental illness Protocol 2010 has been a blessing in many ways to the patients. However despite the recognition of the traits of this Protocol some malpractices cannot be avoided. The following are the altered practices and the necessary improvements The use of force Mental illness disorders can sometimes be difficult to contain due to the violent nature of the presenting symptoms. In this case human rights violation can be pronounced. The police on the other hand have been known to use some force when executing their tasks. Thus strict penalties should be imposed to such breach of human rights. A well-defined system should be put in place to punish such individuals. The police should also be trained differently on how to manage the mentally ill patients Sexual assault and exploitation Mentally ill patients have altered cognitive, perceptions, emotions and actions thus are a target of sexual exploitation by the very authorities who have to offer services to them (Schutt and Goldfinger, 2011). The protocol should have a provision of female ambulance personnel, female health practitioners managing and providing services to female patients and vice versa where possible to avoid any forms of sexual exploitation imposed to the patient. Restraint The protocol clearly illustrates that the use of restraint should be avoided where alternatives are present. This may not be the case as the providers of services in reality will find it better to restrain the patient than engage in empathetic listening and care at the expense of their time and money. Thus the whole mental illness management team need to be trained on their language, communication skills and the law (Slate and Johnson, 2013). Human rights should be emphasized in such settings so that they can realize that patients are human beings and should be treated so (Schutt and Goldfinger, 2011) Harmonization with the law (Mental Health Act, 2007) The act for instance gives the right to any patient to discharge himself or herself in a facility (section 8). This should be amended to coincide with the National Standards for Mental Health Workforce authority of efficient service provision (Chappell, 2013). Such patients may harm the population as they may discharge themselves but may still be very unfit. The use of sedative hypnotics The various issues like force, restraint could be addressed by allowing the ambulance team to give sedative hypnotics. The protocol states that there has been a controversy whether to allow the ambulance team use these sedatives. It should be allowed because it will greatly avoid conflicts between various professionals and avoid human rights violations. Where possible the team should be taught on the various doses to administer and should also be taught on the varieties of sedative hypnotics to use. Cultural diversity Policies should be put in place to ensure that patients are treated fairly regardless of their cultures or races (Chappell, 2013).The protocol has very little bearing on this. Hence this should be included in the revised protocol. On the issues of disbursement of the ambulance teams to respond to a crisis, such should be done carefully such that the parties doing this are familiar with the cultures or beliefs held in that region so that as they perform their duties they get along with the people in the area. Employment of such staff should also be equal and diverse to encourage quick help and understanding from the people receiving the services (Chappell, 2013) Conclusion Thus this protocol concerning the ambulance transport of patients who are mentally ill adds greater changes to the view people have on the mentally ill. The idea of urgency and categorization of emergencies is welcoming and directly benefits the patient. The protocol is also beneficial to the rural community especially through the Crisis assessment and treatment services which has brought the services closer to the patients and significantly functions as prophylactic. The police roles and limits have been clearly stated in this protocol despite their omission in National Standards for Mental Health Workforce and the Trauma Informed Care. The emergency liaison committees can never be overlooked as it has integrated the workforce, bringing them together at one table so that they can discuss the way forward and updates on mentally ill patients. This is in line with National Standards for Mental Health Workforce on partnerships and integration. The law has also been incorporated in the act with reference to the MHA 2007 that outlines the treatment, hospitalization, transport and the rights of the patient whether in custody or free. Where discrepancies exist the recommendation bit outlines how the sectors involved including the law, this protocol 2010, the Trauma Informed Care and National Standards for Mental Health Workforce can harmonize their guidelines to work together for the betterment of the patient’s health References Slate, R & Johnson, W. (2013). The criminalization of mental illness: crisis and opportunity for the justice system. Durham, North Carolina: Carolina Academic Press. Chappell, D. (2013). Policing and the mentally ill international perspectives. Boca Raton: CRC Press. Schutt, R. & Goldfinger, S. (2011). Homelessness, housing, and mental illness. Cambridge, Mass: Harvard University Press. The Mental Health Act (1983, revised 2007). (2010).The Victorian Protocol 2010. Big Print, 45 Buckhurst Street, South Melbourne 3205 Victoria Government Department of Health (2013).The National Practice Standards for the mental health workforce 2013 Big Print, 45 Buckhurst Street, South Melbourne 3205 Mental Coordinating Council (2013) Trauma informed care .Glover streets publishers. Rozelle NSW 2039 Read More