Displaying items by tag: treatment

Quick facts

• Peer support involves people or groups supporting one another based on shared experiences of mental health challenges. 
• Intentionally and safely sharing stories can promote mental health recovery and increase hope and connection.   
• Professional Peer Support Workers are trained to use their experience of mental health issues or caring for someone to support others safely.    
• Peer support has benefits for quality of life and can increase skills and confidence in managing mental health issues.   

• What is peer support?

  Peer support is when people give or receive support based on shared experiences of mental health concerns. Peer support relationships are different from traditional clinician-patient relationships and are not based on medical models. Instead, peer support provides mental health benefits through empathy, acceptance, and skill-sharing that comes from dealing with similar lived experiences.   

• Benefits of peer support

  There is limited evidence that peer support reduces mental health symptoms. However, it can still be an important tool in recovery. Receiving peer support has a range of possible benefits for people with mental health issues, including (1-3):  

  • Increased knowledge, skills, and confidence to manage mental health and treatment  
  • Improved quality of life and emotional resilience  
  • Feelings of hope and empowerment  
  • Increased sense of connection and less loneliness 
  • Less self-stigma around mental health  
  • Greater self-reported recovery  
  • Fewer hospital admissions  
  • Reduced substance use issues. 

  The person giving peer support can also be helped by the process. People providing peer support describe:  

  • Greater self-esteem through making a positive impact on others  
  • More feelings of equality in relationships  
  • Gaining helpful knowledge from peers  
  • Social approval and connectedness with others.   

• What does peer support involve?

  A peer support relationship can be one person supporting others emotionally, socially, or through their shared lived experience. It can also be mutual, where each person involved is giving and receiving support.

  Peer support is often provided professionally in mental health services. However, a lot of peer support happens informally, between people who share similar experiences and connect in person or online.   

  Peer support does not replace other mental health support from psychologists, counsellors, or psychiatrists. However, it is often used alongside other mental health services, empowering people to lead fulfilling lives and manage mental health challenges.     

  People do not need to share the same mental health diagnosis for peer support to work. Instead, the benefits come from having faced similar (but not necessarily the same) challenges.

• Types of peer support

  Peer support can be delivered in a range of ways, in person, over the phone, or online. Peer support can be one, or a combination, of the two categories:  

  Informal peer support

  Informal peer support is a mutual relationship between people who have similar experiences. There are not necessarily any guidelines or trained group facilitators, and there may be no mental health services involved. This could take place on social media groups, common interest meet-ups, blogs or Forums.   

  Professional peer support

  A professional Peer Support Worker will have training in how to use their mental health experience intentionally to support others safely, in groups or one-to-one. They may have additional training in group facilitation, mental health support, and assisting people who've been through trauma.

  Peer Support Workers aim to support people wherever they are in their recovery, and to focus on a person's strengths. 

• Find out more

  To explore if peer support will be helpful, think about what would suit you best. You may feel more comfortable depending on whether you are meeting one-to-one or in a group, and whether support is face-to-face or online.  

  It is also important to think about what you feel comfortable sharing and whether hearing other peoples’ experiences will be helpful right now, or if it might be upsetting. Peer support will not suit everyone all the time, and that is normal.     

  When searching for peer support, keep your safety in mind. Look for groups, services, and communities that:  

  • Are run by trustworthy organisations or charities  
  • Are facilitated by group leaders or Peer Support Workers who have support and training  
  • Have guidelines to make sure everyone is safe   
  • Keep your information private.  

  For help finding the right support for you, contact a trusted GP, mental health professional, or helpline to talk through options.   

  Peer support can be an important part of mental health recovery, increasing hope, quality of life, and empowering people to manage their mental health.     

  To discover more ways of connecting with others with shared experience, explore SANE’s range of peer support services, for anyone with mental health challenges or concerned about someone.   

  LEARN MORE 

• Resources

  • What is peer work? - video by Peer Work Hub
  • SANE Forums Lived Experience Community  
  • SANE Forums Family, Friends & carers Community  
  • Online peer communities create hope everyday – Blog   

• References

  1. Shalaby RAH, Agyapong, VIO. Peer Support in mental health: literature review. JMIR Ment Health 2020 Jun; 7(6).   
  2. White S, Foster R, Marks J, Morshead R, Goldsmith L, Barlow S et al. The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis. BMC Psychiatry 2020 Nov; 20.   
  3. Repper J, Carter T. A review of the literature on peer support in mental health services. J Ment Health 2011 Aug; 20(4): 392-411.   

Quick Facts

Dialectical behaviour therapy (DBT) is a modified version of cognitive-behavioural therapy (CBT) designed to treat borderline personality disorder (BPD). It can also be used to treat other conditions, like suicidal behaviour, self-harm, substance use, post-traumatic stress disorder (PTSD), depression and eating disorders.

• How DBT works

  The term ‘dialectical’ means ‘working with opposites’. DBT uses seemingly opposing strategies of ‘acceptance’ and ‘change’. The therapist accepts you just as you are, but acknowledges the need for change in order for you to recover, move forward and reach your personal goals.

  During a course of DBT, the therapist works with you to help you move away from harmful coping behaviours and towards a life that you find personally meaningful and fulfilling.

  DBT involves developing two sets of acceptance-oriented skills and two sets of change-oriented skills.

• Acceptance-oriented skills

  Mindfulness

  Learning how to focus your awareness on the present moment, and to acknowledge and accept your thoughts, feelings, behaviours and bodily sensations as they occur, without the need to control or manipulate them.

  Related: Mindfulness

  Distress tolerance

  Learning how to manage and cope during a crisis, and to tolerate distress when it is difficult or impossible to change a situation. Learning to accept any given situation just as it is, rather than how you think it should be, or want it to be. Learning new skills like distraction and self-soothing, for both coping with and improving distressing moments.

• Change-oriented skills

  Emotional regulation

  Learning how to effectively manage your emotional experience, and not allow your emotions to manage you.

  Interpersonal effectiveness

  Learning assertiveness strategies to appropriately ask for what you want or need. Learning how to say no, and how to manage interpersonal conflict in a way that maintains respect for yourself and others.

  A typical course of DBT

  DBT is typically run as a 24-week program, often taken twice to create a one-year program. In its standard form, there are three ways you receive DBT during the program. There are also shorter versions of DBT such as 12 week courses depending on the setting, and some versions do not include telephone coaching. DBT has been adapted for different needs.

  DBT skills training group

  A group facilitator teaches specific skills in a classroom setting, and sets tasks for the group members to practise between sessions. The skills training group typically meets once weekly, usually for around 2½ hours, across the 24-week program.

  Individual therapy

  Running at the same time as the group, individual therapy typically occurs weekly to enhance your motivation and commitment to the program. It’s also an opportunity to discuss and apply specific DBT skills to your current everyday life.

  Between-sessions telephone coaching

  On-the-spot telephone coaching from your therapist can be available at times during the week when you’re struggling. Your therapist guides you and encourages you to apply your new DBT skills to address and manage your issues.

• How to get DBT treatment

  In most Australian states, DBT programs can be accessed through both the public and private mental health system.

  Public services

  Some hospitals may run public DBT programs. Talk to your case manager, mental health professional or GP about referral options.

  Private services

  Private DBT programs require payment. Prices will vary depending on the specific service you choose. If you have private health insurance, check that it covers psychiatric admissions.

  If you don’t have private health insurance but you’re eligible for the National Disability Insurance Scheme (NDIS), you may be able to allocate funds to access a DBT program within the private system.

  To join a private DBT program, a psychiatrist from the specific hospital or clinic can provide a referral for you.

  Finding a service near you

  To find services providing BPD treatment in Australia or New Zealand, visit Project Air Strategy’s Service Directory.

  For state-based mental health assistance:

  • Victorian Mental Health Service Directory and Spectrum
  • NSW Mental Health Line on 1800 011 511 (available 24 hours)
  • ACT Mental Health Triage Service 1800 629 354
  • QLD Health 13 43 25 84
  • SA Health Mental Health Triage Service on 13 14 65 (available 24 hours)
  • WA Mental Health Emergency Response Line 1300 555 788 (metro) or 08 9224 8888 (State Wide)
  • Tasmanian Mental Health Service Helpline 1800 332 388
  • NT Crisis Assessment Telephone Triage and Liaison Service 1800 682 288.

• References

  1. Gottman, J. M., & Levenson, R. W. (1992). Marital processes predictive of later dissolution: Behavior, physiology, and health. Journal of Personality and Social Psychology, 63, 221–233.
  2. Wegner, D. M., & Erber, R. (1992). The hyperaccessibility of suppressed thoughts. Journal of Personality and Social Psychology, 63, 903–912.
  3. Goldfried, M. R., & Davison, G. C. (1976). Clinical behavior therapy. New York: Holt, Rinehart & Winston.
  4. Roemer, L., & Borkovec, T. D. (1994). Effects of suppressing thoughts about emotional material. Journal of Abnormal Psychology, 103, 467–474.
  5. Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53, 5–13.
  6. De Mello, A. (1984). The song of the bird. New York: Image Books.
  7. Nagasako, E. M., Oaklander, A. L., & Dworkin, R.H. (2003). Congenital insensitivity to pain: An update. Pain, 101(3), 213–219.
  8. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delacorte Press.
  9. Gross, J. J., & Levenson, R. W. (1997). Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, 106, 95–103.
  10. Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362.

This SANE factsheet was reviewed by industry professionals.

This SANE resource was created with support from The Vizard Foundation.

Quick Facts

In Australia, there are circumstances where you can be legally hospitalised for a mental illness without your consent. You can also be legally compelled to receive treatment — medication and/or therapy — without your consent.

• Involuntary hospitalisation

  During an episode of mental illness, you may become sick enough to need hospital treatment. If you know you need urgent help you can ask to be hospitalised, but there are also circumstances where you may be legally hospitalised without your consent.

  This isn’t rare: in 2014–15, just under a third of all mental health-related stays in Australian hospitals with specialised psychiatric care were involuntary. That’s 48,857 hospital stays.

  The laws covering involuntary hospitalisation vary from state to state, but generally, you can only be hospitalised involuntarily if you’re judged to meet all of the following criteria:

  • you have a mental illness
  • you need treatment
  • you can’t make a decision about your own care

  and one or both of these criteria:

  • you are considered to be a danger to your own safety
  • you are considered to be a danger to someone else’s safety.

  Once you reach hospital, one or sometimes two doctors will need to assess your mental health and agree that you need to be hospitalised without your consent.

  The length of time you can be held, who can extend that time and who can review your case varies by state and territory.

• Treatment orders

  A Treatment Order (sometimes called an Involuntary Treatment Order, a Community Management Order, a Treatment Support Order or a Community Treatment Order) is a legal order making it mandatory for you to take medication and engage in therapy or other treatments, whether you’re in a mental health facility or living in the community.

  The laws for Treatment Orders vary by state, but generally speaking, a mental health professional can apply for an order, which must then be approved by a legal authority such as a magistrate or tribunal.

  There are strict requirements for the granting of a Treatment Order. They are usually only granted where there is a risk of severe decline in your health, or a risk to your or someone else’s safety.

  Treatment Orders are more common in Australia than in many parts of the world, and more common in some parts of Australia than others. For example, 99 out of every 100,000 Victorians was under a Treatment Order in 2010–11; in Tasmania it was 30 out of 100,000.

• Understanding your state’s Mental Health Act

  The laws covering involuntary treatment for mental illness are the Mental Health Acts of each state and territory. There are plain-English guides on how the Act works where you live.

  Plain-English guides to the Mental Health Act

  ACT • NSW • NT • QLD • SA • TAS • VIC • WA

• Legal rights and advocacy

  Even when you’re not making decisions for yourself, you still have legal rights. Each state and territory has legal aid and advocacy services to help you understand your rights in relation to your mental illness and treatment.

  Mental health legal aid & advocacy services

  ACT • NSW • NT • QLD • SA • TAS • VIC • WA

  This SANE factsheet is currently being reviewed by industry professionals, carers and people with lived experience of BPD.

  References

  AIHW, Specialised care characteristics, accessed 3 April 2017.

  Light, E., Kerridge, I., Ryan, C., Robertson, M. (2012), Community treatment orders in Australia: rates and patterns of use. Australasian Psychiatry. 20(6), 478-482.

Quick Facts

Treatment for mental health issues, trauma, and distressing experiences can include psychological treatments, medication, support in the community, or a combination of these.

• How does psychotherapy help?

  Psychotherapy helps by giving an opportunity to talk to a specially-trained health professional in order to understand your symptoms, and to help you adapt how you feel, think and act in response to them.

• What do we know about psychotherapy?

  You play a role in the therapy yourself

  Psychotherapy helps you to understand why you feel, think and act in ways which are distressing and affect your life, and to work towards changing these. This can be challenging but it means you play an important part in your own therapy, and this in itself is empowering.

  Real change takes time to happen

  Psychotherapy does not work quickly, but over a period of months will help you to learn new ways of thinking, behaving and even feeling. You may notice, for example, that you are better prepared to handle things that used to worry you or get you down. Eventually you may find the whole way you think of yourself and the way you perceive and respond to the world changes for the better.

  Psychotherapy often combines with other treatments

  Psychotherapy is often effective on its own for people with depression and anxiety disorders. Sometimes it is also useful to combine therapy with other treatments. For people with illnesses such as schizophrenia and bipolar disorder, for example, medication, ongoing rehabilitation, accommodation and employment support are often needed.

• What kinds of psychotherapy are there?

  There are many types of psychotherapy which are proven to be effective. These may be provided individually, as part of a group, as a couple or even as a whole family – depending on the nature of the problem.

  Some common therapies are:

  Cognitive behaviour therapy (CBT)

  CBT helps people discover how their feelings, thoughts and behaviour can get stuck in unhelpful patterns. They are encouraged to try new, more positive ways of thinking and acting. Therapy usually includes tasks to try between sessions. CBT is a well-established treatment for depression and most anxiety disorders. It can also be an effective part of treatment for other conditions, including post-traumatic stress disorder (PTSD), eating disorders, bipolar disorder and schizophrenia.

  Interpersonal psychotherapy (IPT)

  IPT looks at the way someone has related to significant people in their life, and how this may have affected other relationships and how they feel, think and act generally. It then looks at finding more positive ways of interacting with others. IPT can been especially effective in treating depression and anxiety disorders.

  Dialectical behaviour therapy (DBT)

  DBT is a form of treatment specifically for people with borderline personality disorder (BPD). DBT is based on an understanding that a key problem for people with BPD is extreme difficulty in handling emotions, and the distress associated with this. DBT helps people learn to handle their emotions better and re-learn the way they typically respond to situations and other people. DBT generally combines individual and group therapy. Read more on our factsheet about DBT here. 

  Family interventions

  These treatments aim to support families and other carers by fostering calm and constructive family relationships where a member of the family has a psychotic illness such as bipolar disorder or schizophrenia. Family intervention sessions typically focus on education about mental illness, solving of problems encountered as a result of the illness, and improving communication and relationships where these are strained or stressful. Family interventions can reduce relapse rates for people with psychotic illness while also supporting everyone involved.

• How long does therapy take to work?

  Psychotherapy varies in the length of time it takes to work, depending on the particular treatment and the person’s needs. The benefits of therapy often happen at a different rate for different people. Sessions usually last between 45 and 90 minutes. Most people receive up to ten sessions, with some attending further sessions if required.

• Who provides psychotherapy?

  General practitioners (GPs)

  A GP is always the best place to start if concerned about your physical or mental health. As well as making an assessment and diagnosis, a GP can prescribe a Mental Health Care Plan, which may include referral for psychological treatment to a psychiatrist, psychologist or other mental health professional. With a referral from a GP, the cost of this treatment is largely covered by Medicare. Health professionals at Community Mental Health Services and public hospitals do not charge fees

  Psychiatrists

  Psychiatrists are medically qualified doctors who specialise in the study and treatment of mental illness. They can therefore prescribe medication as well as provide psychological treatments.

  Psychologists

  A psychologist is a health professional trained to provide treatments to people with emotional and mental health problems.

  Other mental health professionals

  Other mental health professionals may also be able to provide psychological treatments: for example, social workers and occupational therapists who have received specialised training.

• How do I find the best help?

  Use these tips to get what you need.

  Word of mouth

  As well as your GP, ask other health professionals, local pharmacists or trusted family and friends about providers of psychotherapy they would recommend.

  Australian Psychological Society (APS)

  The APS has a referral service that gives contact details of privately-practising psychologists in your area who work with particular mental health problems.

  Ask questions

  It’s important to be engaged as much as possible yourself in the psychotherapy. When making an appointment, or during an early session, ask the provider what the goals of therapy are and what it will involve.

  Speak out

  The more you speak out and are frank with yourself as well as with the person providing the treatment, the more successful it is likely to be. If you feel concerned, confused or uncomfortable with the treatment, let the provider know, so they can work with you to address the reasons for these feelings. If you feel that they are not the right person to help you, then explain this and ask for another referral. A good therapist will want what is best for you and will not hesitate to refer you to someone more appropriate.

• How do I find out more?

  Ask your doctor about any concerns you have, or contact the SANE Helpline 1800 18 SANE (7263).

  SANE also produces a range of easy-to-read publications and multimedia resources on mental illness. For more information related to this topic see:

The facts

• Many people use complementary therapies to support medical treatment.
• Complementary therapies are not a replacement for adequate medical treatment.
• Many substances or therapies labelled ‘complementary’, ‘alternative’ or ‘natural’ are not required to undergo the same safety testing as prescribed medications.
• Complementary therapies have varying degrees of effectiveness. Consult with your doctor before using them, especially about how they with prescribed medications.

• Physical therapies

  Being physically active has many physical, mental and emotional benefits.

  • Exercise is shown by research to have a definite effect in reducing the symptoms of depression and anxiety disorders. You don’t have to join a gym – it’s enough to get brisk exercise at least three times a week, for a minimum of 30 minutes. This could include running, walking fast, or cycling, for example. Consult your doctor before starting, if you have not exercised for a while.
  • Yoga can reduce stress and worry, and this in turn can have a beneficial effect on symptoms of depression. Yoga does not suit everyone, but can be helpful for some people, such as those with anxiety disorders.
  • Massage can relax people in a similar way to yoga, and lead to reduced symptoms of depression. It should be performed by a trained professional, and only if you are comfortable with a stranger touching your body.

  Related: Healthy living • Ten tips for sleep hygiene

• Nutritional and herbal therapies

  Eating fresh, healthy food is important for our mental as well as physical health. Evidence is poor, however, that consuming herbs or other substances makes a significant difference to the symptoms of mental illnesses.
  
  

  • Omega 3 oils (found in some nuts and fish) are important for our general health and maintaining good brain function. There is no evidence that they reduce the symptoms of depression, but it is speculated they may possibly be helpful in reducing the risk of developing psychotic illnesses such as schizophrenia.
  • St John’s Wort can be effective in reducing symptoms for people with mild to moderate depression. However, it should not be taken at the same time as antidepressant medication prescribed by a doctor. St John’s Wort can interact with other medications to cause a range of problems – increasing the effects of some, while decreasing the effects of others.
  • SAMe may be helpful for some people with mild to moderate depression. People with bipolar disorder should not take SAMe, however, as it may induce a manic episode. It should not be taken at the same time as a prescribed antidepressant, because of the danger of interactions.
  • Ginkgo biloba and ginseng have no effect on symptoms of depression. There is no evidence to support its use for this purpose.

• Other therapies

  • Light therapy can be helpful for some people affected by Seasonal Affective Disorder. Discuss this with your doctor.
  • Homeopathy has no effect on the symptoms of mental illness. There is no evidence to support its use for this purpose.
  • Meditation can be helpful in reducing stress for some people. It is not recommended for people severely affected by Depression or those at risk of experiencing psychotic symptoms.

  Related: Mental health in music - Mindfulness factsheet

Quick Facts

• Mental illness can be treated.
• When you or someone you know starts to feel mentally unwell, the first step in obtaining treatment is to see a doctor or other health professional for diagnosis. 
• Treatment can involve psychological therapy, medication, community supports, and self-help strategies.

• Is mental illness treatable?

  Yes, mental illness can be treated. This means that many people who have a mental illness, and are treated, recover well or even completely. However, because there are many different factors contributing to the development of each illness, it can sometimes be difficult to predict how, when, or to what degree someone is going to get better.

• What does being diagnosed mean?

  When you or someone you know starts to feel mentally unwell, the first step in obtaining treatment is to see a doctor or other health professional for diagnosis. After a thorough assessment, a doctor can make a diagnosis based on a particular pattern of symptoms. A decision can then be made about the best treatment for these symptoms and their underlying causes.

• What does treatment really mean?

  Treatment means all the different ways in which someone with a mental illness can get help to minimise the effects of the illness and promote recovery.

  It can involve psychological therapy, medication, and various supports in the community, as well as people with the mental illness helping themselves.

  • Psychological therapy
    A doctor, psychologist or other health professional talks with the person about their symptoms and concerns, and discusses new ways of thinking about and managing them.
  • Medication
    Some people are helped by taking medication for a while; others may need it on an ongoing basis. The doctor should explain the benefits and possible side-effects of medication before it is prescribed. Medical research shows that many mental illnesses are associated with changes in our brain chemistry. Medications help the brain to restore its usual chemical balance, so that the symptoms are reduced or even eliminated.
  • Community support programs
    Support programs are especially important for people with recurrent symptoms or who have a psychiatric disability. This support may include information, accommodation, help with finding suitable work, training and education, psychosocial rehabilitation and mutual support groups. Understanding and acceptance by the community is also very important.

  Further information about these different approaches is available in the Guide (see tab above).

• Where are people treated?

  These days, clinical treatment generally takes place in the community rather than in a hospital. Anyone who has been diagnosed with a mental illness which needs treatment, should be able to receive a range of clinical services in their own community. If necessary, ongoing support can be provided by a community mental health service clinic, where there are a range of mental health professionals.
  
  

• How can people help themselves?

  There are lots of things that people with a mental illness can do for themselves, to help recover a balanced life. Healthy eating, getting plenty of sleep, and regular physical activity are all important to good mental health. Learning skills which help deal with stress, feeling down, relationships or the symptoms of the illness, are also ways in which someone with a mental illness can look after themselves.

• How do I find out more?

  If you have any concerns about your treatment speak to your doctor.

Quick facts 

• Antipsychotic medication can help manage symptoms of psychosis. 
• Antipsychotic medication can be helpful for some, but may not suit everyone. 
• It can take time to find the best medication and dose for you.  
• It is important to talk to a doctor about different options, side effects, and how to use medication. 

• About antipsychotic medication 

  Antipsychotic medication refers to a few types of medication that can reduce symptoms of psychosis, like hallucinations and delusions. They also help prevent those symptoms from returning. 

  These medications work on brain chemistry – neurotransmitters that influence thoughts, mood and emotions. 

  Antipsychotic medication is often used for the treatment of schizophrenia spectrum disorders, but can also be used as part of treatment for other mental health issues. They can be used alongside other forms of help such as psychological therapies or community support. 

• When are antipsychotic medications used? 

  Antipsychotic medication can be life-changing for some people, although it may not suit everyone. It is ok if you need, or want to try, medication for your mental health. 

  Antipsychotic medications are considered a front-line treatment for psychosis. They can be prescribed for an episode of psychosis, or as part of longer-term treatment. They help reduce symptoms such as delusions and hallucinations, and can also help with mood, memory, planning, and other thinking problems. Antipsychotic medication can also be helpful in the treatment of other mental health issues, such as bipolar disorder and depression. 

  They are not addictive, do not make you euphoric, or change your personality. All antipsychotic drugs are designed to do the same thing — reduce psychotic symptoms and keep them away. However, they’re known to affect people in different ways, so your experience of taking them will be unique to you. 

  Antipsychotic medication can be prescribed alone, or with other medications. Many people use antipsychotic medication to feel more stable and find it helps them engage with other support services. People often use them alongside other forms of help like psychological therapies, support with housing and employment, physical and occupational therapy, and more. 

• Is antipsychotic medication effective? 

  Antipsychotic medication is generally effective. Most people with psychosis have fewer symptoms after starting medication. 

• What treatment with antipsychotic medication involves 

  Initial consultation and prescription 

  Antipsychotic medication is prescribed by a medical doctor (a GP or a psychiatrist). A doctor can discuss options for you, and prescribe you a dosage that they feel matches your symptoms and circumstances.  

  Different medications work for different people; you and your doctor can talk over to help decide which is most likely to be right for you. While there is usually a period of trial and adjustment, there are some things that can be worth discussing to help decide on a treatment plan: 

  • The impact and severity of symptoms. 
  • What different types of medication are available  
  • What your doctor recommends, and why 
  • How long it might take to start working 
  • How long you will need to take it for 
  • Any side-effects and how to manage these 
  • What to do if you wish to stop taking the medication 
  • Any allergies or physical health problems you may have 
  • If you are pregnant or planning to become pregnant 
  • Any other medications that you are taking, or have taken previously 
  • How and when to take the medication  
  • How to store medication safely 
  • Other factors such as foods which may need to be avoided. 

• Taking the medication 

  There are two ways to take antipsychotic medication: by mouth or as a depot (sometimes called a ‘long-acting injectable’).  

  • Medication by mouth usually means a tablet. It is important to take medication as directed.  
  • Medication by depot is a regular injection, meaning you don’t have to remember to take it. It is a slow-release medication, so it lasts a lot longer than a tablet. 

  Depots are used if there are challenges swallowing medication. They are also used if there’s a risk of forgetting or stopping taking medication, which can lead to a rapid worsening of symptoms. You can choose to take medication by depot. There are also circumstances where a doctor can legally require someone to take medication by injection, even without consent. That’s only done rarely, and always with health and safety in mind. 

  It can take several weeks, or even a few months, after the first dose of medication before it has an effect. Checking in with your doctor over time can help keep an eye on how you’re going, and monitor any side effects.  

  If you have any challenges – such as struggling to remember to take medication – it important to raise these with your doctor. 
   
  Choosing the best medication is not always straightforward because the way people respond to medication is different. This means that finding the right one for you may involve trying one or more types, or making adjustments. 
   

  Coming off the medication 

  Antipsychotic medication is often long term. Many people with psychosis need to take medication as prescribed on an ongoing basis to ensure their symptoms don’t return. 

  When medication starts working and symptoms reduce, people can be tempted to stop taking it. Some people may also want to stop taking medication due to side effects. Others might find that memory problems, or the symptoms of psychosis interfere with their decision-making.  

  Before stopping or reducing any medication it is important that you discuss with a doctor. They can help with decisions about the best path forward. Stopping antipsychotic medication suddenly can cause problems, and lead to a return of psychosis. So any changes need to be done step-by-step under your doctor’s supervision.  

• Types of antipsychotic medication 

  There are two key types of antipsychotic medication available:  

  • A newer group known as ‘second generation’ or ‘atypical’ antipsychotics 
  • An older group, known as ‘first-generation’ or ‘typical’ antipsychotic medications. These are generally only prescribed if the second-generation medications aren’t working for you. 

• Risks and side effects of antipsychotic medication 

  If you’re taking antipsychotic medication, it’s very likely you will experience some side effects. Work is being done to improve medications, but at the moment it’s often necessary to weigh up the benefits of medication against how side effects might impact you 

  They vary from person to person, but can include: 

  • drowsiness 
  • weight gain 
  • unusually dry or watery mouth 
  • restlessness 
  • trembling, especially in the limbs 
  • muscle stiffness 
  • dizziness 
  • eyesight problems 
  • moving more slowly 
  • changed interest in sex, or problems having sex 
  • nausea 
  • constipation 
  • increased sweating 
  • pain or irregularity in menstruation. 

  It’s important to tell a doctor about side-effects as soon as possible, and discuss any concerns.  

  For some people, it can take months to find the right medication — that’s normal. 

  If the side-effects of the medication you’re taking are too severe, or if your psychotic symptoms don’t subside, it might be possible to try other options. 

• Finding out more 

  To learn more, a GP or psychiatrist can provide a personalised discussion about whether antipsychotic medication is the right option for you.  

• Resources 

  • 1300 MEDICINE (1300 633 424) – Medicines Line 
  • Schizophrenia and Psychosis (SANE Fact Sheets) 
  • The patient-psychiatrist relationship: it's a matter of trust (SANE Blog) 
  • Stopping and switching antipsychotic drugs - NPS Medicine Wise 

• References

  1. 4329.0.00.003 - Patterns Of Use Of Mental Health Services And Prescription Medications, 2011’ Abs.gov.au. Australian Bureau of Statistics, 2017. Accessed 17 March 2017.
  2. Galletly et al (2016) ‘Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.’ Aust NZ J Psychiatry, Vol. 50(5) 1-117

Quick facts: 

• Mental health issues can involve a range of challenges with mood, thinking patterns, sleep troubles, physical health, and relationships.
• Complex mental health issues are impactful, severe, enduring, or episodic. They can involve high levels of psychological distress, exposure to trauma, and/or conditions such as schizophrenia, personality disorders, and bipolar disorder.
• With the right support, people affected by complex mental health issues can live long and fulfilling lives.

• About mental health

  ‘Mental health’ involves psychological, emotional, and social wellbeing. Mental health affects thinking, moods and emotions, actions and behaviours, and relationships. 

  Good mental health involves being able to manage day-to-day stress, and to deal reasonably well with the challenges life throws at us from time to time. It means experiencing satisfaction and pleasure in everyday life. It’s also normal to feel sad, lonely, angry, disappointed, or confused at times. These feelings are part of being human. 

  

• Mental health issues

  People use different language to describe challenges with their mental health and emotional wellbeing. At SANE, we usually use the term ‘mental health issues’, but related terms include ‘mental ill-health’, ‘mental illness’ or ‘mental disorders’. We usually use ‘person with lived experience’ when referring to people who are affected by mental health issues. We acknowledge and respect that everyone has their own preferred language to describe their experiences. 

  It's estimated that around one in five Australians experience mental health issues every year (1)(1). Many people experience mental health issues like depression and anxiety disorders at some time in their life. Mental health issues can involve symptoms and experiences such as: 

  • Mood problems, such as feeling sad or low, angry, numb, or experiencing rapid changes in mood  
  • Anxiety, such as racing or catastrophising thoughts; physical symptoms such as a pounding heart and difficulty breathing; or feelings of panic 
  • Negative, self-critical, or intrusive thought patterns 
  • Sleep problems, such as trouble falling or staying asleep, oversleeping, or feeling fatigued 
  • Trouble with motivation or concentration 
  • Problems with drug or alcohol use 
  • Self-harm and suicidal ideation 
  • Problems with relationships, family and friends, work, or school. 

• Complex mental health issues

  At SANE, we focus on supporting people are affected by ‘complex mental health issues’. This includes people who are affected by: 

  • High levels of psychological distress  
  • A history of traumatic events or complex trauma 

  • Symptoms and experiences that are impactful, severe, enduring, episodic, or not well understood. 

  It’s estimated that around 800,000 Australians experience complex mental health issues, or around 3% of the population (2). 

  People who experience complex mental health issues might experience symptoms and challenges like those described above. But they might be more challenging to manage, or impact on their lives in a more significant way. They may also experience certain types of symptoms like trouble managing strong and intense emotions, unusual beliefs or behaviours, and the impacts of trauma. 

  Some people with complex mental health issues identify with one or more diagnoses such as: 

  • Schizophrenia and psychosis 
  • Bipolar disorder 
  • Borderline personality disorder (BPD) 
  • Obsessive compulsive disorder (OCD) 
  • Post-traumatic stress disorder (PTSD) and Complex PTSD 
  • Eating disorders 
  • Dissociative disorders 
  • Severe depression and anxiety disorders. 

  SANE also supports people who experience co-occurring conditions such as autism, ADHD, or intellectual disability, and who also experience mental health issues.  

• Causes of complex mental health issues

  Many mental health issues are first experienced in the late teens or early twenties, but they can also emerge later in life.  

  Most mental health issues are caused by a combination of genetics, life experiences, and lifestyle factors. It is difficult to predict who will experience mental health issues, as everyone is different. Factors can include: 

  • Genetic and neurobiological vulnerability 
  • Exposure to stress or traumatic events 
  • Relationships with parents and caregivers 
  • Drug and alcohol use 

  • Physical health problems 

• Living with complex mental health issues 

  Complex mental health issues vary in how long they affect people: sometimes people experience symptoms only once, whereas for others they can be recurring or a lifelong condition. They also vary in severity, as sometimes they can be mild and other times affect people significantly, across many areas of their life.  

  Complex mental health issues can involve long-term challenges. Many symptoms can be distressing and difficult to manage at times, and can impact on mental wellbeing, quality of life, physical health, and relationships with others. Sadly, there is also a lot of misunderstanding and stigma in the general community about complex mental health issues. Getting access to the right treatment and support, at the right time, can be difficult.  

  Still, many people living with complex mental health issues are able to thrive. With the right support, it is possible to manage symptoms well, predict or prevent flare-ups or episodes, and live a long and fulfilling life.  

• Treatment and support for complex mental health issues

  ‘Mental health recovery’ is not solely about eliminating symptoms. It’s also not about being ‘well’ versus being ‘unwell’. At SANE, we think of recovery as being about developing connections to others, feeling hopeful or optimistic about the future, and feeling a sense of empowerment.   

  Thankfully, there are many things which help people with mental health recovery. Many people learn how to manage their mental health through developing a routine, learning and practicing coping skills, and accessing information about mental health. Families, friends, and other trusted people also play a huge role in recovery. 

  Many people also benefit from accessing support from mental health professionals. Treatment and support options can include counselling and psychological therapies, peer support, medications, support in the community, and managing physical health problems. 
  
  See Facts & Guides for more information about treatments and support.

• Support and resources 

  • Lifeline – 13 11 14 
  • Suicide Call Back Service – 1300 659 467    

Sometimes a person may be showing signs of mental health issues, but chooses not to seek treatment. 

There are a variety of reasons why this happens. The symptoms of psychotic illnesses such as Schizophrenia, for example, may involve delusions, hallucinations, and disturbance to thinking processes – these can make it difficult for the person to realise or acknowledge that they have a mental illness and need help. The person may have stigmatising attitudes towards mental illness, which make it difficult to acknowledge the need for help. Or they may accept they have an illness, but not want to take medication, with the possible side-effects involved.

Whatever the reason, it may be that you are feeling concerned about their mental health, distress, or abiilty to manage their daily life. 

Encourage the person to access treatment on their own volition and with your support. Here are some strategies to make communicating your concerns easier and hopefully more effective:

• Dedicate a conversation to your concerns. Choose a time and a place that is suitable for both of you. A time when you are both calm and when you feel the person is most likely to be receptive and cooperative.
• Plan what you are going to say but prepare to be flexible.
• To set this up you might open with ‘I’d like to talk something over with you that’s been worrying me. Is this a good time or shall we talk later?’
• Do your best to speak in a calm, quiet voice. Try to avoid expressing any frustration that will interfere with the person’s ability to hear what you are saying. Do not get drawn into an argument about the content of delusions, but focus on practical help that is available.
• Emphasise talking about changes and symptoms rather than a disorder. Talking about a disorder can often feel stigmatising and prevent a person from engaging.
• It can be helpful to focus on aspects that the person feels the most comfortable talking about. For example ‘I know you’ve been having trouble sleeping and concentrating lately, can we talk about that?’
• Be patient, it may take a while for the person to process what you are saying and respond to your concerns.
• Do not underestimate the power of listening. Giving the person space to talk and letting them know that they have been heard is a valuable and supportive contribution.
• Remember that you do not have to offer immediate solutions.
• Remaining calm and supportive during this conversation will make it more likely that the person will be willing to talk again.
• Offer to make an appointment for them and suggest that you or another relative or a friend accompanies them.

What if they still won’t accept help?

If the person is still reluctant to acknowledge a problem or to see a mental health professional, ask what is stopping them. Once you know what they are worried about, work together to find solutions to overcome these barriers. For example:

• Sometimes people don’t want to see a doctor because they feel frightened, anxious or angry, that others are against them, or that they are being criticised. You can help by encouraging everyone involved to think of the doctor as someone who can help and who will not judge them.
• Sometimes people may have trouble putting their thoughts together to explain their problems, they might be reluctant to talk about how they feel, or not realise they are ill. In this case, you could discuss the situation with the doctor beforehand, writing down some notes about your concerns as clearly as possible in advance.

Remember that if at all possible it is best for the person involved to voluntarily seek help.

Don’t worry if your first attempt to talk isn’t successful. An initial conversation may plant the seed of seeking help in the person’s mind. By showing that you care and are not going to judge them, they will be more likely to come to you when they do decide to seek help.

If there is outright resistance to the idea of getting medical help, talk to the doctor yourself to work out a plan. The doctor may be able to visit the person at home to make an assessment. If this is not possible, they should still be able to tell you where to get help and support – for the person as well as others who are worried.

Someone refusing to acknowledge a problem or accept treatment can place family members and friends under significant strain, especially if the person is experiencing active symptoms. Don't think you have to deal with this situation alone, contact local mental health services, a helpline or carer organisation for advice and support.