eMental health toolkit

Shakil, 32, was brought to the emergency department by his brother who found him in a nearby suburb by accident. Shakil was covered in blood and feathers and had been missing from home for several years. Shakil was found by chance by his brother who had seen him walking down the road and followed him home. Home turned out to be a ramshackle flat above an empty shop. His brother had been shocked to find the remains of a partly plucked, un-gutted pigeon that Shakil explained was leftover from his dinner. Shakil said he had put the bird in the oven for half-an-hour to cook it, but since the electricity supply had been discontinued, the attempt had been pointless. Shakil was not receiving unemployment benefits, because he said the money should be sent to the third world instead. Shakil said that a God (called Abu-Lafram) lived in his bathroom and told him to deny himself for the benefit of the third world. Shakil had little furniture and food but an abundance of aluminium tin foil. Shakil explained he used the tin foil to line the walls of the flat to protect Abu Lafram from the evils that seeped through the walls. Shakil mimicked Abu Lafram’s voice that he said was telecast through his head, announcing in a low melodramatic tone “I send you the purest pure thoughts Shakil”. His brother had been most upset when he had told Shakil the bad news that his mother had died whilst Shakil had been away from home. Shakil’s only response was to smirk and then laugh.

Shakil was assessed, hospitalised and treated for schizophrenia and has been discharged on an Involuntary Treatment Order due to his poor insight and to ensure compliance with medication moving forward. He is currently stabilising and living back with his brother.

Shakil’s medication management is via his GP and care coordination through the Credentialed Mental Health Nursing Service.

Given the complexity of this patient, the use of eMental Health tools may need to be delayed until Shakil is further stabilised and is able to engage. An outcome tool such as the Recovery Star could be useful to ascertain where Shakil sits in his recovery journey and to identify Shakil’s health priorities, acceptance of treatment and readiness for change.

The clinician could consider using the phone app ConnectMe to encourage Shakil to communicate with his practitioner using secure means.

Chris is a 21-year-old male who was referred to the Lifeline Macarthur Crisis Support Aftercare Program on discharge from hospital following a suicide attempt.

Leading up to the suicide attempt, Chris had multiple psychosocial stressors including a relationship breakdown, job insecurity, financial issues and an ill mother. He had no past mental health history or diagnosis. There was history of anabolic steroid use.

Chris maintained that the suicide attempt was impulsive, as he had broken up with his girlfriend that morning. He reported no history of past suicide attempts or suicidal ideation.

As well as being supported by the Aftercare Program, Chris received face-to-face clinical support through SWSPHN’s Clinical Suicide Prevention Program.

Aftercare provided phone crisis support to Chris, initially three times a week, then weekly. Chris acknowledged that he was reluctant to reach out to others for support as he didn’t want to burden them or appear ‘weak’. A safety plan was developed that included reaching out to his sister or friends if he had thoughts of suicide, or phoning Lifeline 13 11 14 if he was unable to contact them. Regular exercise was also an important part of his self-care.

Chris was exited from the Aftercare Program after nine weeks as he no longer had thoughts of suicide and he felt he was able to cope with life’s stressors without regular phone crisis support.