Mental health nurses in the community

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The Adelaide Clinic provides an invaluable nursing service to patients in South Australia

The Adelaide Clinic is in the unique position of being one of the few standalone mental health sites from which a community nursing service has operated for the last 15 years.

The mental health team has seven members: two designated enrolled nurses, three clinical nurses, one clinical nurse consultant and an occupational therapist. This service operates Monday to Friday from 8am to 4.30pm and averages between 150 to 180 patients at any one time. It covers the metropolitan Adelaide area plus surrounding areas. Each team member operates in a specific area so that they build up their knowledge base of available private, public, non-government organisation and council facilities.

A patient-centred recovery based approach is used, focussing on early identification of mental health problems. Collaboration between patient and their carer, treating psychiatrist and the community mental health nurse is essential.

The community mental health team at the Adelaide Clinic

The community mental health team at the Adelaide Clinic

Access

The community mental health team aims to dispel patient anxiety connected to discharge by visiting them whilst still in the inpatient setting. They are given an outline of the service, a contact phone number and the date of first visit. This is scheduled in the first week post discharge thus setting up a safety net to allay the patient’s concerns regarding the lessening of support when returning home. The first week post discharge has the highest risk of relapse/readmission.

The community mental health nurse aims to help patients feel at ease during home visits, which allows for a more therapeutic relationship. Patients can present differently in their own environment away from the formal hospital setting. A more accurate assessment of how patients function on a daily basis can be observed, as well as any obstacles towards recovery.

The nurse encourages dialogue about areas the patient may be struggling with. Goals need to be obtainable, realistic and meaningful for the patient. The patient receives a personal recovery plan with a timeline.

At the next appointment the goal recovery plan is reviewed to track the patient’s progress. The goal may be broken down to smaller steps if it is not achieved. The main objective is to give the patient a sense of achievement. When the patient has times of self-doubt, the personal recovery plan is an accurate way to reflect on past achievements, building up their self-esteem.

A behavioural activation plan is a more general look at the patient’s week ahead. A blank seven-day timetable is given to the patient to write in certain activities. A starting point can be getting the patient to write in their healthcare appointments. The timetable is an essential part of the recovery process and is used to plot psychological, physical and social components of daily living – this is especially good for people who lack in motivation, find decision making hard and lack time management skills.

Relapse prevention plan

An integral part of the recovery process is increasing the patient’s awareness of strategies to prevent a future relapse. The community mental health nurse looks at the individual’s early warning signs and works with the patient to document these on a prevention plan

The nurse’s role is to encourage the patient to have a conversation with their carer or others listed in the plan so the contacts have an awareness of their expected role. Patients are given a contact list for access to out of hour support services in South Australia.

Given the hours of operation, it is necessary to provide patients numbers to access in times of crisis. Early intervention service Adelaide Clinic formalised its early intervention service 18 months ago. A community team member is available on a daily basis to respond to urgent referrals either via the treating psychiatrist or from the admissions co coordinator who oversee the bed availability. The treating psychiatrist may ask for community intervention whilst the patient is awaiting admission.

This can have the desired effect of sustaining the patient in their own environment and sometimes prevent admission altogether. Over the last five months the clinic has prevented 25 admission episodes using this model.

By Georgina Smith

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