2. 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
3. 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
4. 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
5. 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
6. Recovery Program
Groups provide an opportunity to
observe within a more informal setting
client skill level and
abilities, motivation, memory, concentrati
on, ability to plan, to organise, to
judge, decision-making skills, self
control, social skills, motor skills, insight
into current admission, social
interactions, etc
7. 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
8. 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
9. 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 Index
Brookvale Living Skills Assessment
CAM
ACLS
LOTCA
10. 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
13. Mental State Assessment
Part of „everyday‟ practice in mental
health
Useful in any direct client care role
Important for client sensitive practice
14. Mental State Assessment
Comprehensive initial assessment
includes case history plus mental state
examination
Many different formats - key elements
remain the same
15. Considerations
Cultural issues
Culture specific
phenomena
Legal issues
Confidentiality
Mental Health
Act
Capacity
Documentation
16. 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.
17. Interview and communication
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”
18. Interview and communication
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
19. Case 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 complaint
Question: “How long has this been happening for you?”
Medical history
Include: Past and present medications.
Psychiatric history
Question: “Have you ever seen any one in mental health before?”
Family history
Include: Medical and Psychiatric histories
20. Case 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.
21. Risk Assessment
On initial assessment importance in 2
key areas.
- Self harm/Suicidal ideation
Include: history of self harm/suicidal ideation, current
acts/ideation, plans for the future.
- Violence/Homicidal ideation
Include: history of aggressive/violent behaviour, current aggressive
behaviour/ideation.
22.
23. 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.
24. 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.
25. 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.
27. 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?
28. 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
29. Thought Content
Assessed through interviewing
Describes themes a person is thinking
Delusions
Paranoia
Preoccupation
Obsessions
Compulsions
Phobias
Suicidal Ideation
31. MSE –Insight, Judgement
Insight
Knowledge of
medications, experiences, effects of
substance use
Judgement
Ability to sift through information
Impulsive
???Capacity to organise and understand???
35. 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