There is still much confusion about what mental illness really means. Understanding the experience of mental illness, and how it is treated, means you are better equipped to handle enquiries and provide a service to those who are affected and their families.
Yes, mental illness includes a range of conditions that can be diagnosed and treated by doctors, just like other health problems.
Some people are born with an inherited vulnerability to develop a form of mental illness and then factors such as a traumatic event, the regular stresses of life, drug use, exam stress or financial problems can trigger an episode of illness.
Mental illness affects around 20% of adult Australians every year. Most of these will have some form of Anxiety disorder or Depression. A smaller proportion of around 3% will have an illness involving Psychosis, such as Schizophrenia.
Most people living with mental illness are able to get on with their lives and work in the community when there is ongoing treatment and support. However, some face challenges at times because of their symptoms, because they are not receiving effective treatment and support, or because of prejudice and lack of understanding by others.
These challenges can include:
Mental illness not only has an impact on the lives of those directly affected, it can also be confusing and distressing for family and other carers, especially when they are not receiving any education or support for their caring role.
Yes – while there is no cure for all mental illnesses, the symptoms are treatable. In most cases, a combination of psychological treatment, prescribed medication, and involvement in community programs and support can help a person living with mental illness get on with their lives. Employment can make a positive contribution to this recovery.
Mental illness is associated with only a small proportion of the violence that occurs in society, despite misleading impressions sometimes given in entertainment and news media. In fact, research indicates that people being effectively treated for a mental illness are no more violent or dangerous than the general population.
People living with mental illness are actually far more likely to be the victims of violence and of self-harm.
When people affected by mental illness are violent, this is usually when they are not receiving treatment or taking medication as prescribed, when there is drug or alcohol abuse, or where there is a history of violent behaviour.
Mental illness does not affect intelligence and intellect. People with a mental illness have the same range of intelligence as the general population, and have made many major contributions to culture and society.
However, someone who is acutely ill or who has a disabling form of illness may have problems with organising their thoughts and words, making it more difficult to communicate.
A person with an anxiety disorder feels distressed a lot of the time for no apparent reason, interfering with their ability to function and to take pleasure in life.
There are several types of anxiety disorder including: Generalised anxiety disorder, Social anxiety disorder and Obsessive-compulsive disorder.
For further information, see ‘Anxiety and related disorders’.
Depression is an illness in which people experience a significantly low mood for a long time.
While everyone feels down from time to time, people with depression experience a persistent feeling of sadness for more than two weeks, without reason, that cannot be shaken and that affects their capacity to get on with their daily lives.
For further information, see ‘Depression’.
Bipolar disorder (once called manic–depression) is an illness characterised by severe low and high moods, often with periods of normal moods in between.
For further information, see ‘Bipolar disorder’.
Schizophrenia is an illness that affects the normal functioning of the brain. It interferes with a person’s ability to think, act and feel. It is episodic, meaning the person will have periods of acute illness while feeling generally well the rest of the time.
For further information, see ‘Psychosis’.
Borderline personality disorder is characterised by distressing emotional states, difficulty in relating to other people, and self-harming behaviour.
People with bpd have persistent difficulty relating to others and to the world around them. This may include idealising or devaluing other people, difficulty making compromises, marked impulsiveness, anxiety, depression, and intense outbursts of anger. They may feel dependent on others for their identity or afraid of being left alone, and so often make frantic efforts to avoid real or imagined abandonment.
For further information, see ‘Borderline personality disorder’.
Mental illness is treated by health professionals, as with any other health issue. This treatment does not just mean the help someone gets from a psychiatrist or other doctor. It can involve a whole range of other mental health and welfare professionals, providing a range of support in the community.
A GP’s surgery is the best place for anyone to go when concerned about feeling physically or mentally unwell. After an assessment and diagnosis, the GP can then recommend the best treatment. This may include a Mental Health Treatment Plan with referral to a psychologist, psychiatrist or Community Mental Health Service if necessary, as well as ongoing treatment.
Clinical psychologists specialise in the psychological treatment of mental health problems, especially Anxiety disorders and Depression. If a referral is given by a GP, then most of the cost can be claimed under Medicare.
The Australian Psychological Society also has a referral service (1800 333 497).
A psychiatrist is a medically-qualified doctor who also specialises in the study and treatment of mental illness. Psychiatrists can prescribe medication, provide psychological treatments and refer to other services – usually after a referral from a GP.
Public mental health services are generally based in community clinics linked to mental health wards in local hospitals. They provide a range of clinical services for people severely affected by mental illness, who are usually allocated a case worker. This person is responsible for coordinating and implementing a treatment plan. If necessary, people can also be admitted to hospital if acutely unwell.
Each CMHS also operates mobile teams – sometimes called a Crisis Assessment and Treatment (CAT) Team, Psychiatric Emergency Team (PET), or Mobile Support Team (MST). These are groups of mental health professionals who can provide assessment and ongoing treatment for people in their own homes, and can arrange admission to hospital if necessary.
It was once common for an episode of mental illness to lead to many months in a psychiatric hospital. It is now more usual to admit someone to hospital only if they are acutely ill and require intensive care for a while. This is generally provided in mental health wards within general hospitals.
With good treatment and support most people with mental illness recover and live full lives. However, mental illness can recur and sometimes lead to ongoing disability, affecting the way people are able to cope in their everyday lives. Some people may only need to take medication for a few months; others may need to take it on an ongoing basis.
Community support programs aim to help people regain living, working and social skills so that they are better able to get on with life again. This may be through a day centre, a supported accommodation program, a personal helper and mentor scheme, or specialist employment service, for example. A range of legal and advocacy services is also available.
Family and other carers play an important part in supporting people living with a mental illness.
Family and carers also need support themselves, as the symptoms of mental illness can be demanding as well as distressing for them too. It is important, therefore, that family and other carers are included in discussions about treatment and support, and are referred to carer support organisations and services such as respite care, education and training.
Contact the SANE Centre on 1800 18 SANE (7263), for more information about mental illness and treatments, guidance, and referral to support services in your local area.
You probably deal with customers who have a mental illness every day, without realising it. There may be occasions, however, when someone is more severely affected by symptoms. They may seem unreasonably anxious, confused or distressed, difficult to understand, or behaving in an unusual manner. In these circumstances, it is important to know what you can do to communicate effectively in order to help them and help you do your job.
The HELP model has been specially developed to provide a simple blueprint for effective communication in these circumstances.
The HELP model consists of four simple actions:
Mental illness is greatly misunderstood, and those affected by it are often treated with less respect than is given to other people.
It is important, therefore, to listen carefully and take seriously the concerns of people with a mental illness, just as you would with other customers.
Some people with a mental illness will have a carer present, such as a family member or friend. It might be tempting to address the carer instead of the customer, but make sure you speak to the person directly. If they need help in communicating, the carer will step in, but it is important you do not ignore the customer.
Active listening is simply a way of listening that focuses attention on the speaker. It means restating, in your own language, your impression of what the customer has said. Doing this will reassure someone, who is used to being ignored, that you are taking their concerns seriously.
Another important aspect of active listening is not to interrupt. Allow the customer to explain their situation and concerns fully before you respond. Giving the customer the opportunity to ‘off-load’ their concerns will help to reduce their anxiety.
Give visual and verbal cues that you are listening and taking the customer’s concerns seriously:
Give the customer enough time to express their concerns. Listen to what they are saying, rather than be distracted by any symptoms they may have.
Remember that it’s not easy for someone to tell you that they have a mental illness. Ensure you respect the sensitivity of this.
If possible, and particularly if their concern is of a personal nature, ask the customer if they would like to move to a more private space to discuss the matter.
As well as listening to what the customer says (the presenting issue), think about what else might be making them feel concerned (any underlying issue).
People with a mental illness are just as likely to have a valid concern as anyone else, so be careful not to assume any emotional response is due to mental illness alone.
Some examples of questions you might ask:
Dealing with services can be a challenge at the best of times for many people, let alone when someone is affected by mental illness.
Handling the complexities of bureaucracy, as well as coping with the symptoms of mental illness can be profoundly frustrating. In these circumstances, it is not surprising that people may express themselves in ways that appear inappropriate to you, challenging or even angry.
Whatever their specific concerns, it is important to reflect some ‘common ground’ that you agree on. This demonstrates that you have heard and acknowledged what they are saying, and that you will do what you can to help.
Show empathy by reassuring the person that you acknowledge and understand how they are feeling because of their concerns (this is different to sympathy, where you merely feel sorry for the person without necessarily understanding their concerns and feelings).
Examples of statements you could use:
Even after you have listened to the customer and offered to do what you can, there may be times when people repeat the same point unnecessarily. This might be because they are used to being ignored or ‘passed on’. It might be because symptoms or the side-effects of medication have affected their communication and cognitive skills, and they are unaware they are repeating themselves.
On occasions like this, it may be useful to use limiting techniques:
Examples of statements you could use:
Symptoms or the side-effects of medication can affect cognitive and communication skills – how well someone can organise their thoughts and then explains them. For this reason, you may need to repeat your questions or advice a number of times or in different ways, so that the customer can understand better what is being said.
People may be unclear about what you can and cannot do. They are understandably most concerned with their own problem, and want someone to ‘do something about it’.
To save misunderstanding, make clear what your service is able to do, and what it is not able to do. Then, provide simple and accurate information about other services that are able to deal with their concern if appropriate.
Explain why you are doing this. People with mental illness often feel – and sometimes with justification – that they ‘get the run around’ so it is important to reassure the person that you are not simply ‘passing them on’.
Simple ways of how to progress are:
It is also important to know when and where to refer a customer living with a mental illness for more specialised support. This will make you more confident in communicating with and helping them.
If situations like this are regularly encountered, discuss the need for staff training in suicide intervention (call the SANE Helpline for details).
As well as using the HELP model, there are also some simple principles to remember.
People affected by mental illness often have their concerns disregarded or treated disrespectfully. Make sure that no one in your workplace behaves thoughtlessly in this way.
Body posture, gestures, facial expressions and eye movements, as well as tone of voice, all contribute significantly to the messages you give, over the phone as well as face-to-face. People are often able to pick up on even the subtlest change in tone of voice. Being aware of your body language and tone of voice will help you to communicate more effectively.
Sometimes symptoms of mental illness can make it difficult for someone to ask for help in a straightforward way. Ensure you make the effort to understand what the person’s concerns are.
If someone is acting offensively or aggressively, tell them as calmly as you can that their behaviour is unacceptable and that they need to behave politely so that you are able to help them.
Keep a few key telephone numbers and website addresses handy, such as the local mental health service, family support group, community legal centre or Ombudsman so you can put the person in touch with the appropriate service.
The tips given here are not intended to replace or conflict with your organisation’s safety procedures. Remember to take into account your organisation’s safety procedures if you feel at risk at any stage.
Avoid giving advice on dealing with mental illness. If someone has concerns related to their illness, focus on helping them to access professional support.
People affected by some mental illnesses may develop delusions – odd beliefs not shared by other people. It doesn’t help anyone to get drawn into argument about the validity of these beliefs.
Emphasise that while you do not share them, you understand these beliefs feel real to the person concerned, and move on to how you can help them.
Unfortunately, it’s all too easy for people to talk down to others who have a disability, including those with a psychiatric disability. Treat people with the respect you would expect if your positions were reversed.
Just because someone has a mental illness doesn’t mean their concerns are imagined or less valid than other people’s. Treat them with the same attention as you would any other customer’s issue.
If someone appears extremely distressed or unwell because of mental illness, use the ‘In a crisis’ principles. Familiarise yourself with these and where to call if someone needs help, such as the local mental health service or even emergency services on 000 if necessary.
It is important that you are aware of what to do if a customer expresses thoughts of suicide.
A customer might express this overtly – for example, saying something like ‘I’m going to kill myself’, or indirectly – for example, saying something like ‘It’s all getting too much for me, I can’t take this any more’.
If an overt comment is made, contact the police and local mental health service. If indirect, ask the customer to clarify before contacting emergency services or the local mental health service.
If there is no immediate threat to act, encourage the customer to call Lifeline, their doctor or other health professional to talk about these feelings.
If situations like this are regularly encountered at your service, discuss the need for staff training in suicide intervention. Contact the SANE Help Centre for details.
See also How to help in a crisis for guidance on what to do when someone experiences a mental health crisis.
See the following case studies to see the HELP model principles in action.
Jenny has depression and social anxiety disorder. She received a Centrelink letter asking her to visit the office to speak with a consultant about her Disability Support Pension.
She approaches your counter but appears very distressed and anxious. She doesn’t understand why she has had to come to the office in person. She tells you that she has felt anxious since receiving the letter, and she has been unable to sleep.
Concern about a face-to-face meeting is the issue Jenny presents, but what are the underlying issues?
From what Jenny says, she clearly experiences genuinely distressing fear and anxiety about social situations, and feels overwhelmed at having to attend the interview.
What are some of the barriers Jenny may be experiencing?
It may seem irrational that having to attend a routine interview would cause Jenny so much worry. It is important to understand, however, that there are underlying causes to Jenny’s anxiety, which need to be taken seriously.
How can you show Jenny that you understand how she feels?
Acknowledge Jenny’s feelings. Make a clear statement that you understand she is feeling very anxious at the moment and that the letter obviously caused her a lot of worry. Explain to Jenny that face-to-face appointments are part of routine practice for Centrelink.
How could you respond if Jenny continues to express anxiety and argues that she shouldn’t have to come into the office in person?
Try to limit the immediate behaviour, by saying something like, ‘I understand what you are trying to tell me. Now let’s look at what we can do in the future to make this process easier for you’.
You may be able to consider alternative methods of communicating with Jenny – for example, by phone, letter, email, or a visit to her home. Talk these options through and agree they will be considered in her case.
How do you close the interview with Jenny?
Explain to Jenny that her request to not attend face-to-face interviews at the Centrelink office for medical reasons will be considered seriously, Confirm with her you will note this request on her file, will follow it through, and that she will be informed of the decision.
Toni calls the bank call centre. She has had repeated problems with her finances and a credit card debt which has been at the limit for almost a year.
She has Bipolar disorder and her only income is the Disability Support Pension. The call is to request a large loan for a business she wishes to start, which she excitedly says will make her rich.
Toni has no security for the loan and no business plan. You tell her the bank is unable to provide the money. She is not happy. How can you HELP Toni?
As well as frustration and anger with the bank for not giving her a business loan, what other issues may be relevant?
Toni has acknowledged having Bipolar disorder in the past, after getting into financial difficulties when unwell. During an episode of illness she acts impulsively and has grandiose ideas, becoming irritated and angry when others do not see things the same way.
What are some of the barriers Toni may be experiencing?
Regardless of Toni’s mental health, she is genuinely frustrated at living on a low income and her persistent financial difficulties, and angry at her repeated failure to improve this situation.
How can you show Toni that you understand how she feels?
State clearly that you understand how frustrating it must be to have the application refused, but that it does not meet the bank’s lending criteria. Explain how these work and that you cannot contravene company policy.
How could you respond if Toni starts to insist that her proposed business will make a fortune and benefit the bank too?
Take the time to explain to Toni why her request is outside the criteria. Acknowledge her frustration, and ask if she understands the reasons for refusal of the loan even if she disagrees with them.
What other services could offer support to Tina?
Toni needs fundamental help to regain control over her finances. Only then can she have a realistic chance of raising money to start a business.
The best way to help her do this is to recommend she see a counsellor from a financial counselling service which provides free services to people from disadvantaged backgrounds.
Give Toni the details of a local service and encourage her to make an appointment, in order to realise her goal of getting her finances back on track.
James is a regular visitor to your post office. He has previously mentioned that he has Schizophrenia.
Paying his electricity bill, he appears agitated and distressed. He asks you why none of the post office assistants like him. He says they are always giving him strange looks and saying spiteful things about him. How can you HELP James ?
What is really troubling James?
Despite James’ concerns about the counter staff, you have always been within earshot, and are confident that they do not behave in the way he describes. In fact, you know they are sympathetic towards him.
An underlying issue may be that James is becoming unwell and has started experiencing symptoms of Schizophrenia such as hearing voices and paranoia.
How can you show James that you see he is distressed?
It is important that you acknowledge how James feels, even if his fears are unjustified. Don’t simply brush off his concerns; reflect them back – saying, for example,‘I can see you’re upset about how things seem to you.’
While concerned about James, you are not personally responsible for him, nor qualified to give the professional help he needs. What is the best way to help him within these limits?
A useful first step in this direction is to ask James who was able to help when he felt this way on past occasions. If he is becoming unwell, then it is important he receives help from a doctor or other health professional.
Recognise that you cannot force him to seek this help, but certainly encourage him to discuss how he is feeling with a doctor, or with someone who cares for him.
Who is it best for James to talk to about how he feels?
It is likely that, when prompted, James will tell you that he saw his doctor when he last became paranoid and convinced that others were talking about him spitefully.
Whether he mentions his doctor or not, though, it is a good idea to encourage James to see his GP, case manager or other health professional if he is ‘feeling stressed’.
He could also call the SANE Helpline for information and advice, or a crisis service such as Lifeline if he is feeling highly distressed, see ‘Contacts’ for further information.
Don’t forget that you may also benefit from debriefing after a conversation like this – talk with a manager or colleague, or call the SANE Helpline if necessary.
David is a public housing tenant. You are visiting him as a representative of the Housing Office in response to complaints lodged by neighbours about his hoarding. David has an obsessive-compulsive disorder as well as Schizophrenia, and his unit is waist-high in old papers and junk; it is infested with rodents and other pests, and the smell is spreading to other units.
David is not happy with your visit. He begins to swear loudly, insisting that what he does at home is no concern of others. How can you HELP David?
What do you think David’s real concerns are likely to be, if you look beyond the irritation with his neighbours?
David is annoyed with his neighbours for complaining about him, as well as concerned about losing his unit as a result. Understand that these feelings are in addition to underlying general anxiety and his compulsion to hoard as a way of attempting to cope with this.
How can you show David that you see how he feels?
State clearly that you understand it must be difficult for him to see why he needs to remove the hoarded items, but he also needs to understand that they create a health risk for others in the building, as well as for himself. Ask if the items also make it difficult for him to live in the unit.
How could you respond if David does not agree with you?
Tell David that the Housing Office will do what it can to help him, but he has to be willing to receive help to resolve the health and safety risk caused by the hoarding: this is the key issue. Inform him that there are services which can help him with this.
Explain that Housing Officers are legally required to evict the resident in extreme situations where a property is poorly maintained and a risk to health and safety. Reassure David that you do not want his situation to come to this, unless absolutely necessary.
Repeat that the Housing Office will do all it can to help him, but he has to be willing to receive this help.
What services could offer support to David?
Offer to link David with a service which can help people affected by hoarding, such as a community support or mental health agency. Encourage him to accept this offer as a way of dealing with problems caused by his hoarding, and to help ensure he is able to keep his home.
Ask if there is anyone that you can contact who might also be able to help David in this situation – for example, his case worker, doctor, a family member or friend.
Mary phones your call centre, worried that she is unable to pay her mobile phone bill.
She is very upset and explains at length that she has mental illness and her only income is the Disability Support Pension, that she has had to pay for unexpected car repairs and won’t be able to settle her phone bill for months, and that she has no landline and her mobile is her lifeline to friends and family. How can you HELP Mary?
What are the main issues concerning Mary?
Unable to pay her phone bills for the next few months, Mary is worried and almost hysterical at losing her only means of contact with others.
Take on board the realities of Mary’s life: that she has an illness which makes it harder to cope with life’s challenges; that she feels understandably anxious and powerless about having very little disposable income, and that her phone is especially important as a way of keeping in touch with people who care about her.
What can you do to show Mary her worries are understood?
Reflect Mary’s concerns back to her, giving reassurance that her situation is viewed sympathetically by the company, and that she has done the right thing by contacting the call centre to discuss it.
While being sympathetic to Mary’s overall situation, how can you keep the focus on the one issue you are able to help with: her unpaid mobile phone bill.
Mary sees her unpaid bill as part of a collection of worries, including keeping her car on the road, managing her finances generally, and possibly losing touch with her family and friends. It is important, nevertheless, not to be distracted into discussion of these other issues where you are unable or unqualified to provide advice.
Summarise what she has told you regarding her bill, and explain that this is what you will focus on helping her with during this call.
What services are able to help Mary?
Explain your organisation’s Financial Hardship Policy which aims to maintain service while making reasonable arrangements for payment of debt, then connect Mary with the department which handles this within the company.
Before transferring Mary, explain to her clearly what you are doing and why, so that she does not feel that she is simply being ‘passed around’.
Explain Mary’s situation to the department you transfer her to as well, so that she does not have to repeat the story all over again, causing her further unnecessary frustration and distress.
Mark, 19, has been referred to your employment service by Centrelink, for help with non-vocational barriers before finding a job. He has severe anxiety and experiences difficulty coping with new situations. After assessment, you refer him to a psychologist for treatment.
Mark, however, is reluctant to go, saying he does not want to take medication. How can you HELP Mark?
What are Mark’s main concerns?
Mark is reluctant to accept treatment for his mental health problems – creating barriers in other areas of his life, such as employment, income and socialising.
As well as having a fear of medication and of being considered a ‘mental patient’, due to misunderstanding and stigma, Mark’s concerns are also likely to be related to his general anxiety about any new situation.
What can you say to reassure Mark?
It is important to acknowledge Mark’s feelings. Being told he has a mental illness can be a shock for a young person, especially if he does not understand what this means in reality.
Make a clear statement to Mark that you understand he is feeling very unsure about receiving treatment for his anxiety, but that this will make a big difference to the rest of his life.
What are the practical limits to the help you can give Mark?
Receiving treatment for his anxiety disorder would help Mark find a job as well as improve his quality of life. However, you are only responsible for improving his employment prospects, and someone cannot be forced to accept medical treatment (except in very special circumstances where health or safety are at grave risk).
What practical help can you offer Mark?
As well as providing Mark with referral to a psychologist, it is important to give him helpful, accurate information about his mental health problem – for example, that anxiety disorders are common, that they are treatable, and that treatment usually involves talking to a psychologist rather than taking medication.
If Mark still decides against treatment, move on to enquiring about other areas where you can help, such as training courses, helping with a resumé or job applications, or finding suitable clothes for interviews.
Ensure you give Mark information about anxiety disorders and treatments to read, and remind him that he can change his mind about getting help at any time in the future.
You can also give him the SANE Helpline details – 1800 18 SANE (7263) or via sane.org –if he would like a confidential discussion about this with a health professional.