Introduction
Clinical mental health services are managed by public hospitals and provide assessment, diagnosis, treatment and clinical case management to people with a serious mental illness. Psychiatric disability rehabilitation and support services are provided by community service organisations (CSOs).
Specialist clinical mental health services in Victoria are provided on an area basis, and are often referred to as area mental health services (AMHS). They include adult mental health services, child and adolescent mental health services, and aged persons mental health services. Each of these service categories provides inpatient psychiatric services, in addition to a range of residential and other community-based services.
Priority access to mental health services for children and youth in out-of-home care
Policy guidelines issued by the Chief Psychiatrist set the framework for arrangements for mental health services to give weighted and preferential consideration to infants, children and young people (to the age of 18) who are in out-of-home care as a result of child protection intervention. It does so by directing area mental health services (child, youth and adult streams) to establish a service response that ensures the most appropriate and timely assistance is either provided or facilitated for this client group.
Referrals are flagged by the triage or intake service and a streamlined service response is provided to best meet their needs.
See Mental health protocol.
Child and adolescent mental health services (CAMHS) / Child and youth mental health services (CYMHS)
Target population
Specialist child and adolescent mental health services are provided for children up to the age of 18 years with serious emotional disturbance. This includes young people with a diagnosable psychiatric disorder whose condition is considered seriously detrimental to their growth or development or where there are substantial difficulties in the person’s social or family environment.
Emotional disturbance in childhood and adolescence may present in a variety of ways. While symptoms may include impaired reality testing, hallucinations, depression and suicidal behaviour, emotional disturbance in childhood presents more often in other ways. Hyperactivity, nightmares, fearfulness, bed-wetting, language problems, refusal to attend school, and stealing are among the behaviours that may indicate distress or disturbance. Young people from 16 to 18 years of age may receive a service from either child and adolescent mental health services or adult area mental health services depending on their needs.
Service components
Crisis assessment and treatment
Intensive mobile youth outreach support services (IMYOS)
IMYOS provide intensive outreach mental health case management and support to adolescents who display substantial and prolonged psychological disturbance, and have complex needs that may include challenging, at risk and suicidal behaviour. These services work with young people who have been difficult to engage using less intensive treatment approaches.
Continuing care case management services, clinical and consultancy
These teams provide a range of services starting with initial intake to provide advice, information and screening. They undertake assessment and treatment of children and young people experiencing significant psychological distress or mental illness and their families. Services include crisis assessment, case management, multi-modal treatments, individual, family and group therapy and parent or carer support. They also provide consultancy services to other community agencies and service providers. Child and adolescent mental health services work extensively with other service sectors including schools, general practitioners, paediatricians, youth and family services, child protection and welfare agencies.
School early intervention programs (conduct disorder program)
Conduct disorder is the most severe type of disruptive behaviour in children and young people, with such behaviours as extreme aggression, truancy, lying, stealing, lack of empathy, or running away. Programs offering multilevel early intervention and prevention designed to reduce the prevalence and impact of conduct disorder are currently being piloted in Victoria, and are not currently available in all catchment areas.
Acute inpatient services
These services provide short-term inpatient assessment and/or inpatient treatment for children and adolescents who have a severe emotional disturbance that cannot be assessed satisfactorily or treated safely and effectively within the community. They are usually located within general hospitals. Links with metropolitan inpatient services exist for the admission of consumers from rural services.
Day programs
Child and adolescent mental health services' adolescent day programs offer an integrated therapeutic and educational program for young people with behavioural difficulties; emotional problems such as severe depression and/or anxiety; emerging personality difficulties or a severe mental illness such as early psychosis. Issues such as relationship and/or social difficulties and non-attendance of an educational or vocational setting are addressed through intensive group therapy. These programs are not currently available in all health catchment areas.
Adult specialist mental health services (16 to 64 years)
Target group
Adult specialist mental health services are aimed primarily at people with serious mental illness or mental disorder who have associated significant levels of disturbance and psychosocial disability due to their illness or disorder. Commonly these will be people with a diagnosis of a major mental illness, such as schizophrenia or bipolar disorder, but will also include some people with other conditions such as severe personality disorder, severe anxiety disorder, or those who present in situational crisis that may lead to self-harm or inappropriate behaviour toward others. The distinguishing factor is the level of severity of the disturbance and impairment. Increasingly, adult mental health service consumers have more than one disorder, with drug and alcohol related disorders (dual diagnosis) being most prevalent.
Service components
All specialist mental health services are required to provide a range of components so that consumers have access to similar service responses and functions wherever they live. However the health services and hospitals deliver their public specialist mental health services differently depending on the local service environment and catchment area. Some services have separate teams for each component function. Others operate 'integrated teams' which perform a number of functions by rostering staff to undertake the required activities for a given period. The critical factor is that all area mental health services provide the full range of functions.
Specialist services are usually provided on a divisional or statewide basis.
Crisis Assessment and Treatment Teams (CATT)
These services operate 24 hours a day and provide urgent community-based assessment and short-term treatment interventions to people in psychiatric crisis. CATT services have a key role in deciding the most appropriate treatment option and in screening all potential inpatient admissions. CATT services provide intensive community treatment and support, often in the person’s own home, during the acute phase of illness as an alternative to hospitalisation. CATT services also provide a service to designated hospital emergency departments through an on-site presence.
Mobile support and treatment services (MSTS)
These services provide intensive long-term support to people with prolonged and severe mental illness and associated high-level disability. They utilise an assertive outreach approach and operate extended hours seven days a week. MSTSs differ from continuing care services in the frequency and intensity of intervention offered and work more closely with psychiatric disability rehabilitation and support services.
Continuing care, clinical and consultancy
These are the largest component of adult community-based services. These services provide non-urgent assessments, treatment, case management, support and continuing care services to people with a mental illness in the community. The length of time case management services are provided to a person varies according to clinical need. Continuing care services may be involved with people for extended periods or may provide more episodic care. Continuing care clinicians frequently liaise with, and refer to, generalist services including general practitioners for ongoing support and provision of services to people with a mental illness.
Clinical residential rehabilitation services (Community Care Units)
Community care units provide medium to long-term accommodation, clinical care and rehabilitation services for people with a serious mental illness and psychosocial disability. Located in residential areas, they provide a 'home like' environment where people can learn or re-learn everyday skills necessary for successful community living. While it is envisaged that people will move through these units to other community residential options, some consumers require this level of support and supervision for a number of years.
Prevention and Recovery Care services (PARC)
PARC is a supported residential service for people experiencing a significant mental health problem but who do not need or no longer require a hospital admission. In the continuum of care, they sit between adult acute psychiatric inpatient units and a client's usual place of residence. PARC aims to assist in averting acute inpatient admissions and facilitate earlier discharge from inpatient units. They are not a substitute for an inpatient admission; rather they provide clinical treatment and short-term residential support. PARC services are usually a partnership between PDRSS and clinical services. PARCs are not currently available in all catchment areas.
Early intervention services
These teams support and enhance the capacity of primary care providers, especially general practitioners and community health services, to recognise and respond to mental disorders more effectively. They provide consultation, liaison, education and training services to primary care providers for both low and high prevalence disorders. The teams have a particular focus on disorders such as depression and anxiety and also provide some short-term direct care treatment and assessment for these high prevalence disorders.
Early Psychosis Program
Early psychosis services focus on providing service to young people between 16-25 years who are experiencing a first episode of psychosis. They aim to provide for earlier and more intensive treatment as well as minimising disability associated with psychosis, including the impact of distress/trauma on both the young person and their family. These services are sub-specialty programs within the specialist clinical adult area mental health service with close links to child and adolescents mental health services, primary care services and other community services and organisations. Early psychosis services are not currently available in all catchment areas.
Acute inpatient services
These services provide voluntary and involuntary short-term inpatient management and treatment during an acute phase of mental illness, until the person has recovered enough to be treated effectively and safely in the community. These units are located within acute general hospitals. People admitted to an inpatient unit from the community are usually assessed by a CATT service to see if a less restrictive option is possible.
Secure extended care inpatient services
These services provide medium to long-term inpatient treatment and rehabilitation for consumers who have unremitting and severe symptoms of mental illness, together with associated significant disturbance, that inhibit their capacity to live in the community. These services are provided on a regional basis and are gazetted to take involuntary consumers. They are typically located on hospital sites with acute mental health units or other extended care bed-based services. They represent the highest level of care on the continuum of mental health services and provide extended clinical treatment, supervision and support.
Homeless outreach services
Homeless outreach psychiatric services (HOPS) provide a specialist clinical and treatment response for people who do not engage readily with mental health services. HOPS work in partnership with homelessness services and use assertive outreach to locate and engage with their clients to create a pathway out of homelessness by providing early and appropriate treatment. HOPS link clients into the mental health service system, including access to long-term housing augmented with outreach support, and improve the coordination and working relationships between mental health and homelessness services. HOPS also provide assessment and secondary consultation to homelessness services and other mental health workers. HOPS are not currently available in all catchment areas.
Youth program – early psychosis services
The Youth Early Psychosis (YEP) program provides an early intervention service for young people between 16 and 25 who are experiencing, or at risk of, a first episode of psychosis.
YEP services provide treatment and support over the crucial three-year period after psychotic symptoms first emerge, when relapse is most likely to occur. Interventions are multi-modal, phase-specific and evidence-based. Lower caseloads enable YEP clinicians to deliver more intensive case management and to provide consultation, education and training to other services.
Consultation and liaison services
Consultation and liaison psychiatry is the diagnosis, treatment and prevention of psychiatric morbidity among physically ill patients who are patients of an acute general hospital. This includes the provision of psychiatric assessment, consultation, liaison and education services to non-psychiatric health professionals and their clients or patients. This service is not currently available in all general hospitals.
Considerations for good practice
In some cases, mental health issues may be closely related to experiences of abuse or neglect.
Presentation in childhood and adolescence
Emotional disturbance in childhood and adolescence may present in a variety of ways. While symptoms may include impaired reality testing, hallucinations, depression and suicidal behaviour, emotional disturbance in childhood presents more often in other ways. Hyperactivity, nightmares, fearfulness, bed-wetting, language problems, refusal to attend school, and stealing are among the behaviours that may indicate distress or disturbance. See advice Suicide and self-harming and specialist practice resource Child development and trauma.
Working with other professionals
Protecting children is a responsibility of the whole community and one specifically shared by those government and non-government agencies which provide any form of care for children and families or which come into contact with them in the course of their work.
In order to provide a more integrated service for children and families, child protection services need to invest energy and resources to strengthening and forming dynamic partnerships between professionals. Key to building trust and relationships is a commitment to managing differences and resolving any conflict that arises.
Impact of a parent's mental illness
Episodes of a mental illness can come and go periodically through people’s lives. Some people experience mental illness only once and fully recover. For others, mental illness recurs for a period of time or throughout their lives. Children, however, have a right to a safe and secure home in which to grow. Their physical and psychological development cannot be put on hold. Balancing these factors represents a key issue for all child protection practitioners. See Parental mental illness assessment tool.
Learn more about mental illness
Useful information about mental illness can be found on the Victorian Government's Mental Health Services website and at Beyond Blue. Take the opportunity to learn about this area, or refresh your memory, when you have a client who has a mental illness or who has a family member with a mental illness.
Find out about local protocols
Local protocols may have been developed. Find out what exists in your area.
Referral
Referral of individuals and families to other professionals and agencies in the service network for assistance is a core skill for child protection practitioners. See Making effective referrals.