Topic: Mental health

We’re putting the spotlight on mental health in this new monthly feature. Learn more about SWSPHN commissioned services, projects and events, and find guidance on navigating the mental health system.

This month we spoke to Dokotela about the SWSPHN-funded Consultant Psychiatry Service. 

 

What services and supports does your service provide?

The Consultant Psychiatry Service commissioned by South Western Sydney PHN provides brief intervention and care planning by a psychiatrist for people with severe and persistent mental illness who face barriers accessing a psychiatrist.

There are two equally important objectives of the service:

• Provide psychiatry services for those with severe and persistent mental illness who live, study or work within South Western Sydney.
• Support and advice to GPs to build capacity in managing the long-term mental healthcare of these consumers.

 

What are your service location/s and service hours?

9am to 5pm, Monday to Friday

The service offers flexible delivery including:

• Face-to-face at select general practices in Bankstown, Fairfield, Liverpool and Campbelltown. A list of face-to-face general practices can be found here.
• Telehealth through secure Zoom video conferencing available to any general practice in South Western Sydney or the telehealth hubs in East Hills and Tahmoor.

 

What is the eligibility criteria to access your service and are there any targeted supports to specific population groups?

Services are available to people aged 12 years and over with a severe and persistent mental illness who need support from a psychiatrist but are unable to access a psychiatrist due to barriers. In addition, the service is available to GPs requiring support in the treatment and management of this cohort.

This service is not designed for Court Reports, NDIS or Disability Support Pension Assessments, RTA Forms or Workers Compensation. Additionally, this service is not for the assessment or treatment of neurodevelopmental or behavioural disorders as a primary reason for referral – such as ADD/ADHD or Autism Spectrum Disorders.

 

Does your service provide support to people who don’t speak English as a first language?

Yes

 

If so, what supports are available?

Dokotela utilises the TIS interpreting service. Our preferred method of the interpreting service is face-to-face but in some circumstances the interpreter service is also available via telehealth.

 

How can people be referred?

Referrals can be made by GPs only. GPs can refer by completing the SWSPHN Mental Health Referral Form and faxing it to 4623 1796 or  via the Online Referral Form.

The following information is required, and if not submitted the referral may not be accepted:

• Current medication summary and response to past medications
• Patient medical history
• Patient psychiatric history including past admission discharge summaries or not there has been no admissions
• Correspondence from previous psychiatrists, or note there has been no previous psychiatric assessment

 

Please provide a case study/example of a client journey when accessing your services, including:

• Why they were referred
• How they were supported
• Who else was engaged and how (eg GP, family etc)?
• What was the outcome

 

Background

This young man was referred by his GP for ongoing psychotic symptoms despite being on antipsychotic medications. He was reportedly discharged to the care of the GP following two inpatient admissions to a mental health facility at the local teaching hospital.

This young man aged 18 lives with his mother, older brother and younger sister. He is currently single and working in a warehouse in casual employment. He presented for consultation with his mother, who was active in the consultation and assessment process.

 

Provisional diagnosis and risk assessment

FEP – First Episode Psychosis with a prodrome from high school, with ongoing symptoms despite being on antipsychotic medication for the past six months. No suspected non-adherence, no illicit substance use over the past six months.

Genetic loading of Schizophrenia – paternal aunty

 

Management plan

Treatment

Increase Aripiprazole to 15mg mane

Continue the Quetiapine for the time being

 

Investigations

Requested the following investigations be carried out by the GP.

FBC, EUC, LFT’s, TFT’s including Thyroid antibodies, ECG, Vitamin B12 and D, iron studies.

Urine drug screen

 

Outcome

A detailed assessment/ report was sent to the Early Psychosis Intervention Program (EPIP) psychiatrist after a discussion with the patient and his mother. The patient was discussed with the EPIP psychiatrist at Liverpool Hospital and was accepted into the program. This is a specialised team-based program which provides support to young persons with First Episode Psychosis.

 

A Day in the life of Dr Samira Bhuiyan

Psychiatrist Specialist with the Consultant Psychiatry Service

 

Day-to-day role

My day for PHN starts bright and early, usually at the location by 7.30am to get some coffee (give me a few months and I’ll have tried all of the cafes in Western Sydney!). I’m in the clinic by 8am to get set up and review patient files before my first appointment starts. My first patient usually comes in around 9am and they keep coming until 5pm. It’s a pretty busy day until 7pm, especially as I try to get all of the patient notes and reports done before the day ends.

 

What do you find most challenging about your role?

At the moment the most challenging thing is trying to manage patient expectations while ensuring a good rapport and implementation of a workable management plan. Some patients have waited years or even decades to see a psychiatrist and many have a belief the appointment will ‘fix’ all of their problems. 

 

What you find most rewarding about your role?

Patients are generally grateful to have someone listen to their issues and explain options to them in a collaborative way. It is always nice to see people working to get better. I truly enjoy being able to see the difference good mental health treatment makes on their lives.

 

What do you enjoy doing outside of your job?

Currently my life is chock full of baby-related events like swimming lessons, grandparent visits and playdates, so there’s little time for much else. In the time I do get for personal activities, I enjoy being able to catch up with friends, being crafty (origami and crochet are my favourites) and going to the movies with my family. 

Lifeline Macarthur and Western Sydney have a number of suicide prevention programs available to people needing support.

These include:

• Aftercare program – offers phone-based crisis support for those over 18 who have survived a suicide attempt or are at heightened risk of suicide. Contact Anne Rogers on 4645 7212 or rogersa@lifelinemacarthur.org.au.
• Eclipse Support Group – support group for survivors of a suicide attempt or those who are at heightened risk of suicide. The group is an eight-week closed group running face-to-face or online and provides psychoeducation around suicidal thoughts and safety planning, triggers, and resilience. For referrals and intake contact Jenny Holmes on 4645 7216 or holmesj@lifelinemacarthur.org.au.
• Suicide Bereavement Support Groups – an eight-week closed group or monthly open group, which gives those who have lost a loved one to suicide the opportunity to share thoughts and feelings around their loved one’s suicide. Topics discussed include guilt, shame and the ‘why’ questions that can arise. Groups are delivered face-to-face or online. Contact Jenny Holmes on 4645 7216 or holmesj@lifelinemacarthur.org.au.

For more information on these programs, visit www.Lifelinemacarthur.org.au.

You in Mind

 

Erin – Female

I have been extremely impressed with the service I received from PHN South Western Sydney, from the moment I was put in touch with a clinician, and throughout the process thereafter. In the past, I have been hesitant to seek professional advice for personal concerns, however a major change in my life made me realise I require the help of health professional.

The clinician I was referred to, Martin (Community Links), was fantastic from the first consultation. He showed empathy, understanding, and left me leaving my first appointment feeling extremely empowered. 

A feeling that was vital for me moving forward with the next challenges I was to face in my situation. Throughout our consultations he was able to put so many of my existing feelings and concerns into words and helped me to understand my strengths, values and understand my situation on a different level.

He did all of this with an extremely ‘down to earth’ approach. Like chatting to a friend! Looking back on the extremely difficult time I was going through, I honestly believe I couldn’t have gotten through it near as well, without the support and guidance of Martin. I highly recommend the services of Martin and the team at PHN South Western Sydney and strongly hope others find the experience as nurturing and helpful as I did.

You in Mind – Provisional Referral

 

Fred – Male – Age 55

 

Fred is a 55-year-old married man with three adult sons who all live independently, two who live interstate. Fred’s wife was diagnosed with a degenerative physical illness ten years ago which has confined her to a wheelchair. She needs in home support as Fred works and is also managing his own chronic physical illness. Fred’s parents were German migrants post WW2. He grew up in the Wollondilly/Wingecarribee region and left school to learn the trade of building. He has no family history or previous experience of mental health issues, however reports deteriorating mood and increasing feelings of hopelessness over the last few years. To date, he has not spoken of his parent’s experiences during the war. His children are all managing well and have no evidence of ill health.

Fred was referred to the You in Mind service through the local Community Mental Health team (a nominated referring agency of You in Mind) who sought Fred’s consent to share his contact details and passed them onto the You in Mind service provider – Community Links.

A You in Mind mental health professional contacted Fred to meet for the first of three sessions without having to obtain a Mental Health Treatment Plan. Fred chose to meet at a convenient time and location in a local park, and he explained how he came to seek support via the Community Mental Health team.

Over the course of two sessions, Fred decided to continue to attend therapy with the You in Mind Clinician and made an appointment with his GP to have a Mental Health Treatment Plan developed. The You in Mind clinician also spoke with Fred’s GP in preparation of the appointment and offered follow up support to walk through the referral process if needed.

Fred continues to see the You in Mind clinician fortnightly for office based therapy, he has noticed an improvement in his mood and reduction in symptoms.

You in Mind – Provisional Referral

 

Sue – Female – Age 23

 

Sue is a 23-year-old female living in the Southern highlands with her mother.

Sue has a family history of mental illness, including depression and anxiety. Over the past four years, Sue had been travelling overseas and has spent time attending spiritual retreats and self-help groups. Since returning home, Sue has resumed work in cafes, and works long hours. On her two days’ off, Sue usually meets friends in Sydney or stays local. She has maintained some friendships from school, however describes high school as a source of distress due to targeted and sustained bullying at 14 years of age. Sue believes it was during this time that she became depressed and experienced chronic suicidal thoughts, but did not receive treatment.

Sue became a client of You in Mind after spending a weekend in Sydney. During this time Sue was consuming alcohol and stimulants, and whilst driving home became overwhelmed with memories, causing a panic attack and disorientation. Following this, Sue visited a local GP practice she had never been to before and was seen by the doctor immediately. The doctor assessed her mental state, noting Sue’s uncertainty about receiving mental health treatment. Sue agreed to meet a You in Mind mental health professional under a ‘provisional’ referral, meaning she would be able to attend up to three sessions without a Mental Health Treatment Plan, during which time a therapeutic relationship may be developed between Sue and the clinician and questions around therapy could be answered. Ultimately this option for soft entry, empowered Sue to take control of her health while being provided a quick and responsive service.

After the three sessions were complete, Sue agreed to return to the GP to have a Mental Health Treatment Plan developed so that she could access the remaining nine sessions under You in Mind.

Sue is regularly attending therapy and is making positive progress.

People with a mental illness often have differences in their thinking, mood or behaviour associated with significant distress and impaired functioning.

 Examples include mood disorders like: 

• Major depression 
• Bipolar disorder
• Schizophrenia
• Anxiety
• Personality and eating disorders

In South Western Sydney more than 102,000 people aged 15- 85 years can be diagnosed with a common mental illness in any one year. 

These include: 

• 44 ,155 with any mood disorder (including depression)
• 36,321 with any substance disorder,
• 142,437 with any common mental disorder, and another 
• 3,560 with a psychotic disorder

South Western Sydney PHN commission a range of free mental health service providers to help people dealing with mental illness. Visit our Mental Health page for details on all commissioned services providers.

The Blackdog Institute, with funding from SWSPHN, is holding free workshops for health professionals in South Western Sydney.

Depression Dilemmas will be held on Sunday, 16 February at Liverpool Catholic Club. Topics covered will include: depression and alcohol; late life depression; and difficult to treat. Register online or at education@blackdog.org.au.

Managing Bipolar Disorder will be held on Sunday, 3 May at Campbelltown Catholic Club. Topics covered will include: assessment and diagnosis; pharmacological management; recovery and wellness; and diagnostic dilemmas. Register online or at education@blackdog.org.au.

Dealing with Anxiety Disorders will be held on Sunday, 14 June at Mercure Liverpool. Topics covered will include: understanding anxiety; assessing anxiety; behavioural strategies; the anxious mind; and pharmacological treatments. Register online or at education@blackdog.org.au.