If family or friends think this may be the case, they can visit a GP themselves to discuss what can be done to help. In some circumstances a team from a community mental health service can visit you at home or other place where you feel comfortable to make an assessment. The public health system includes treatment in public hospitals and community mental health services.
Advantages of using the public health system are that there is no direct charge, and that — at its best — it will provide access to a range of support services in the community such as rehabilitation and supported accommodation. Public mental health services are also more evenly distributed across the country, although there are still not enough, particularly in rural areas. It is possible to visit a psychiatrist working in private practice rather than in the public system. A GP can provide a referral to a psychiatrist as they would to any other specialist.
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It is also possible to be an in-patient at a private clinic or hospital. This would be expensive, however, unless you are covered by private health insurance. As well as making an assessment and being able to refer to a psychiatrist, GPs also provide ongoing care to many people who have a mental illness. Training and support are now available to help them in this role. Some areas operate a shared care system where a GP provides the medical treatment and a case manager provides the ongoing support and coordination of care. It is important to look after your physical health too, and regular visits to a GP can play an important role in maintaining good general health.
Most people diagnosed with a mental illness will have contact with a psychiatrist at some stage, though people more seriously affected will have regular contact. Other doctors also work at community mental health services and are often responsible for treatment too. It is important to feel comfortable with this treating doctor, and to feel able to communicate with them about all aspects of the illness and treatment. When you have been diagnosed with a mental illness which needs specialist ongoing treatment such as Bipolar disorder or Schizophrenia, for example , you should be able to receive a range of clinical services from a community mental health service while continuing to live at home.
Mobile Crisis Teams and Support Teams are often based at community mental health services. Some parts of the country have transcultural psychiatric services, with mental health professionals able to provide help in a number of languages. The case manager should be able to tell you if such a service exists in your State or Territory. All community mental health services should also have access to interpreters. If assessed as needing ongoing treatment and support you should be allocated a case manager or other key contact person in the mental health service.
This is a very important role. Where a service is well run and properly funded, the case manager should be able to provide a range of services, including:. Crisis teams — sometimes called Crisis Assessment and Treatment CAT Teams or Psychiatric Emergency Teams PET — are groups of mental health professionals who provide assessment and treatment for people seriously affected by mental illness. In some parts of the country crisis teams are available around the clock, seven days a week though this is not the case everywhere. Crisis teams can assess people in their own home and then arrange treatment, including visits from a support team or hospitalisation where necessary.
They should also provide information and support to family and any other carers. Support Teams provide intensive, long-term treatment and support to people seriously affected by mental illness unlike Crisis Teams which focus on crisis situations. Support Teams have a variety of names in different parts of the country. Support Teams try to reduce the number of hospitalisations a person may need and help them maintain a treatment plan and reasonable quality-of-life. They normally provide an extended-hours service, ideally for seven days a week.
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A generation ago, it was common for an episode of mental illness to lead to many months in a psychiatric hospital. Nowadays you are likely to be admitted to hospital only if you are acutely ill and require intensive care for a while. There is also a trend to treat people in psychiatric wards in general hospitals rather than stand-alone psychiatric hospitals — treating mental illness just like any other medical condition, in fact.
If a psychiatrist or other treating professional recommends that you need psychiatric treatment, and you do not agree, it is possible to be treated involuntarily in certain circumstances. The exact circumstances vary between different States and Territories, but in general people receive treatment in this way to ensure their own health or safety, or that of others.
There are legal limits on how long you can be treated involuntarily before a review is held by a Mental Health Review Board or similar body. These facts should be explained to anyone receiving involuntary treatment.
In some States and Territories it is possible to be treated involuntarily either as a hospital in-patient or while living in the community. If you are treated involuntarily in the community, the treatment team has extra responsibilities and obligations in relation to things such as medication and regular check-up visits. This type of arrangement may be subject to a court order sometimes called a Community Treatment Order and is legally binding. The range of treatments provided as part of clinical care can include medication and psychological therapy covered in the following sections , often in combination.
As well as these, a further form of treatment is electroconvulsive therapy ECT. This can be highly effective in treating severe Depression, especially when other treatments have not been helpful. It may occasionally be recommended for other forms of mental illness too. ECT involves giving a general anaesthetic and muscle relaxant, after which an electrical current is passed through the brain. Any side-effects, such as a headache or mild loss of memory are usually temporary and pass after a few hours.
ECT should be administered only after the treatment has been fully explained to you, and any questions have been satisfactorily answered. ECT is usually given only with the consent of the person being treated. If the psychiatrist does not believe that you are able to give informed consent, then the psychiatrist can consent for you, but only after notifying and discussing the issue with the primary carer.
In some parts of Australia the agreement of two doctors is required. Many mental illnesses are associated with changes in the natural chemistry of the brain. Certain medications help the brain to restore its usual chemical balance — reducing symptoms so that the person feels better. These include antidepressants for Depression , antipsychotic medications for psychotic illnesses such as Schizophrenia and mood stabilizers for Bipolar disorder. Medications are usually taken as tablets, sometimes by injection, in a syrup or wafer.
The size of dose is not necessarily an indication of how severe symptoms are. Some people have depot injections. This means that the medication releases slowly from a muscle over a period of time, usually between a week and a month. Some people prefer injections because they are not good at remembering to take tablets, or just because it makes life simpler. We all react differently to medications, and body mass and rate of metabolism can affect the amounts needed to be helpful.
Age, gender, whether we smoke, and other factors may also mean that we react differently to the same dosage. If you have any concerns about the unwanted side-effects of medication, make sure you discuss them with your doctor. Doctors have a responsibility to prescribe the most effective medication at the lowest effective dose, so that any unwanted side-effects are kept to a minimum. They can only do this, though, if told as clearly as possible how well you feel the current medication is working.
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This is an important contribution that you and family and other carers can make to the effectiveness of the treatment. Once the best medication and dosage have been established, a maintenance dose will be determined from then onward, to help avoid a return of symptoms. This may be needed for some months or longer, depending on need. If a doctor considers that it is absolutely essential for you to take medication — for your own safety or that of others, for example — then you can be legally required to take it.
This may mean a support team supervising the medication to help you remember to take it.
It may mean asking you to take it as an injection. When someone has been diagnosed with major Depression, they will probably be treated with antidepressant medication. The symptoms of Depression are associated with changes in a particular brain chemical called serotonin. Antidepressant medications assist the brain to restore its usual chemical balance. This helps reduce or get rid of some of the symptoms. Sixty to seventy percent of people with major Depression respond to initial appropriate antidepressant treatment. Antidepressants may also be helpful in combination with psychological treatments in the treatment of anxiety disorders.
There is a range of antidepressants available and it is generally thought that they have similar effectiveness. However antidepressant drugs differ in their likely side-effects and their safety in overdose. These are key considerations for a doctor when deciding which one to prescribe.
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In some cases, where the Depression is particularly severe, the newer antidepressants may not be as effective as the older tricyclic and MAOI antidepressants, such as amitriptyline Endep, Tryptanol and imipramine Tofranil , for example. Side-effects such as dry mouth, blurred vision, constipation, urinary retention, sedation, and weight gain have been associated with the tricyclic antidepressants.
Once again, it is important to discuss any side-effects immediately with the doctor.
It may take between one and four weeks from beginning to take the antidepressant before it starts to have an effect. Newer antidepressants have fewer side-effects and are safer in overdose than the older antidepressants. Some people may experience side-effects with the newer antidepressants, especially when starting — for example: nausea, reduced sexual function, agitation, diarrhoea, headache, insomnia and in some cases restlessness and agitation.
Not everyone will experience these side-effects but if you do, then discuss this with your doctor. Antipsychotic medication works to minimise the symptoms of Psychosis — such as thought disturbance, delusions and hallucinations — and to minimise the risk of having another episode.
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Others have since been developed, and they have become an important part of treatment for psychotic illnesses. Before the development of antipsychotic drugs also known as neuroleptics , there was no effective treatment for psychotic symptoms. Psychotic symptoms are associated with changes in a particular brain chemical called dopamine. Antipsychotic medications assist the brain to restore its usual chemical balance. It can take some weeks before the medication starts to work. There are two types of antipsychotic medication: typical older and atypical newer.
While no single antipsychotic medication is totally effective for everyone, they are improving. If you are not comfortable about the medication you are taking, it is important to discuss this with the treating doctor so that action can be taken without the risk of symptoms returning.
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