Carers identified?

Answers to some common questions

Page last updated: 2010

For many years mental illness was not discussed openly in the community because of fear, ignorance or stigma. Most people can easily recognize when someone has a physical illnesses or disability and is happy to seek treatment from a GP or a specialist. This is not often the case with mental illness, particularly when it develops during the teenage years. We have all heard comments such as:

" He was moody and irritable, but we thought it was just being a teenager" " I just thought I was so stressed I could not think straight" "I know I drink too much, but it blocks out all the bad thoughts I am having"

It is common for people not to discuss what may be symptoms of mental illness with family or friends. Negative views, or stigma about mental illness, are often due to lack of information or experience, misunderstandings, or cultural beliefs.

Some people from different cultures or Indigenous people feel okay about accessing normal services however some may need to be referred to specialized services where their specific language and/or cultural needs are able to be given particular attention.

What if I am worried that my relative or friend is becoming unwell?

It is important to encourage the person to seek help. Talking with someone about the situation is also important for you. If the person is being treated by a mental health service then speak with their Case Worker.

If the person is being treated by their local GP then this may be a good place to start.

Advice, information and assistance can also be obtained from the State/Territory Mental Health Service. Other options for help include Private Psychiatrists and community organisations (see contact details section on page insert number).

What information will services need to know?

Asking questions is how services find out what is happening and how they might be able to help. Being prepared for these questions will help you feel less anxious and enable the services to assess the situation better. Some questions that you may be asked include:
  • Is the person talking about hurting themselves or other people?
  • Has the person already been diagnosed with a mental illness?
  • If yes, which one? Who diagnosed the illness? When?
  • Are they currently under the care of a Doctor or other services?
  • Is the person willing to accept help?
  • Does the person have any medical conditions?
  • Is the person on any medication? If so what?
  • Does the person misuse substances? (alcohol, illegal drugs, inhalants)
  • What is happening that is worrying you and for how long has it been happening?
  • What has prompted you to seek help now? Top of page

What can I do if the person refuses help?

Sometimes people don't feel they need help or refuse to accept help. Everyone is an individual and there may be many reasons for refusing help such as:
  • What will people think?
  • I live in a small town - everyone will know
  • Men are strong, they don't get sick
  • I am too anxious to talk to anyone
  • I am not unwell
In other cases denial that anything is wrong may be one of the characteristics of the illness.

This can be a difficult situation for families and friends who are concerned about the person. In circumstances where the person is very unwell and refusing to acknowledge this, the Mental Health Act can be used to get help for the person even if they do not agree. Talk with your GP or your local MHS for information and advice about getting help for your relative or friend under the Act. Top of page

What do I do if I'm concerned someone needs help urgently?

If the person is talking or behaving in a way that suggests they are going to hurt themselves or another person, help needs to be obtained urgently. If you feel:
  • Afraid for the person you care for
  • Afraid for yourself or another person
  • Helpless or despairing
  • That you cannot keep on caring
  • That you do not know what to do
Don't be afraid to contact someone and ask for help, even if you are not sure if it's the right person. If they cannot help they should be able to tell you who can.

Before you call:

  • Take a few deep breaths
  • Stay as calm as possible
  • Stay safe
  • Decide who might be the best person to contact
When you call:
  • Say who you are and what is wrong
  • Say what is needed
  • Trust what they say to you
  • Say if there is any reason why you cannot do what they say
Your local mental health service can provide you with information, advice and assistance in most cases.

However, if you feel that you, or anyone else is in real danger, dial 000 and ask for the Police. The police are authorised under legislation to take a person to hospital to have a psychiatric assessment. Top of page

What happens after the person has been assessed?

This depends on individual circumstances and how unwell the person is. Sometimes the person may need to be admitted to hospital, sometimes the person can get treatment and support in the community from the mental health service, private mental health practitioners, other community services or their GP.

In some situations you may notice that the person you care for has become more upset or anxious after their assessment or appointment. They may have been talking about issues they find difficult, or their relationship with you. Listen quietly and calmly to what they have to say without becoming defensive.

Sometimes people just want to talk about their concerns. They are not necessarily looking for answers. Make it clear they have your full attention and you are listening properly. You might like to save any suggestions for a later conversation.

If your conversation becomes difficult or the person you are talking to gets angry, stay calm, be firm, fair and consistent, admit if you are wrong and don't lose control.

Often just spending time with the person lets them know you care and can help you understand what they are going through. Top of page

What will happen when my friend or family member is admitted voluntarily to hospital?

When your family member/friend first comes into the hospital a doctor will examine them and decide whether they need treatment and if so, whether this should happen in hospital or in the community. If the doctor thinks they would benefit from treatment from the service, they will also make sure that they agree to admission and that they know what that means for them. They will be given a consent form to sign, which they should only complete if they understand and agree to the admission and the treatment offered.

What if my friend or family member wants to stop their treatment?

Voluntary patients have the right to stop treatment whenever they wish, this includes leaving the hospital or deciding to stop attending community mental health services and they have the right to refuse any treatment offered to them. However, if they do decide they would like to leave the hospital or stop attending appointments at a community mental health service they should talk to someone from their treating team to discuss their plans.

Can my family member/friend who is a voluntary patient be made an involuntary patient?

Yes. If your family member/friend changes their mind about staying in hospital and wants to leave against all the advice of the treatment team then a doctor will examine the person again. If the doctor feels that your family member/friend are so unwell that there are risks to the health and safety of themselves or other people then they have the power to keep them in hospital for their own good. This means they become an involuntary patient. Top of page

What will happen when my family member or friend is admitted involuntarily to hospital?

When your friend or family member first comes into the hospital for admission, a doctor will examine them to determine whether they need to stay in the inpatient unit. In some situations where the person with the mental illness is very unwell or may feel like hurting themselves, or another person, it may be necessary for a short period of time for the doctor to make a decision that this person must be admitted to hospital. This is called an involuntary admission. The legislation that enables this to occur is called the Mental Health Act.

In this situation the person with the mental illness will, within a short period of time be examined by a second doctor. If the second doctor agrees with the first doctor then the involuntary admission will continue for a further time.

If this situation occurs the doctor will also have to decide how much information he or she is able to discuss with you. Once the person with the mental illness is feeling better they will be able to decide how much information they want to share with you.

It is important during this period that staff listen to your concerns and explain as much as they are legally allowed to do.

Legal orders are only allowed to be used in cases where a person does not understand how unwell they are and refuses to have any treatment, or in cases where because of their illness they may pose a risk to themselves or another person. The order usually stays in place until the person is well again. However during this time the person with the mental illness, or you, as the person who cares for them may challenge the legal order if you think it is unfair.

If either the first or second doctor decides that they don't need to be admitted as an involuntary patient, they may consider admitting them as a voluntary patient or consider involuntary or voluntary treatment in the community. Top of page

Can my friend or family member who is an involuntary patient leave the hospital?

While they are being detained as an involuntary patient your friend or family member cannot leave the inpatient unit unless their doctor says they can. If they are given leave it will be for a specific purpose and they must comply with the conditions of their leave.

If they do leave the hospital without permission, a police officer or someone else authorised by their doctor may pick them up and take them back.

If they want to leave the hospital to see someone, or attend an appointment, they can ask their doctor for permission. If the doctor thinks that the leave is for a good reason and will be good for them then they may be given permission. The doctor may cancel your friend or family members leave if they believe that they are likely to come to harm, harm someone else or become more unwell, or if they have not done what they agreed to while on leave. Top of page

What does this public or private mental health service do?

The service assesses and helps people with mental illness. Our goal is to provide you and your loved one with a service that is based on each person's individual needs. We have experienced staff who have expertise in helping people with all types of mental illness as well as helping parents, carers and other family members. Our aim is to help people with a mental illness to get well quickly and to return to live in the community as soon as possible.

There is a lot of paperwork that needs to be completed when a person with a mental illness is admitted to a public or private mental health service. This is also a time when you can tell staff about your relationship with the person and what you do to support them.

Part of this process may involve asking the person you care for, for permission for the staff to talk with you about your experience of living with them, or supporting them. Sometimes the person you care for may be so unwell that they say that they do not want staff to talk with you. Whilst staff have to respect their wishes at that time it is important for you to understand that the staff will keep discussing this matter with the person as they become well as their feelings about this issue are likely to change as time goes by.

Staff recognise how important carers are in the ongoing support of a person with a mental illness. They will therefore be working with the person to encourage them to include you in their care and planning for their discharge.

You will also be given information about the Carer Consultant/Family Support Worker who will contact you within the next couple of days. You may also make contact with this person at any stage to obtain extra information to help you to understand what is happening. Top of page

Being discharged from the hospital/clinic

The person you care for may only be in hospital for a short period until their illness has been stabilised. They may be referred to a less intensive level of service such as a community service or private psychiatrist.

Discharge planning will start from the moment your friend or family member starts receiving treatment from the mental health service. The treating team will also involve you in these discussions wherever possible and appropriate.

When your friend or family member leaves the hospital they will have a discharge plan that contains arrangements for:

  • The level of on-going care necessary
  • Who will be available to provide this care?
  • Where the person will live?
  • Who will be responsible for medication?
  • Provision of information and support to everyone involved
  • Development of a relapse prevention plan
It is important that you feel fully involved at all stages of care, including the decision to discharge the person. This is a process of handing over care and carers are critical partners in this process. Ideally, time should be allowed for you to make choices about:
  • Taking on, or continuing to fulfil the role of carer
  • How much and what type of care you are prepared to provide taking into consideration your other family commitments, work, health education and social activities.
Some people feel they have no choice in this matter even when their personal and physical resources have been exhausted, where they are afraid of the person with the illness, or where that person will not allow you to have enough information to provide proper care. This is an extremely difficult situation for carers who want to help. Services must listen to your concerns and provide you with information regarding people and services that can help you. Top of page

What is a community management /treatment order and when are they made?

Community Management/Treatment Orders are made where a person is unwilling or unable to follow a treatment plan on a voluntary basis but can be treated involuntarily in the community rather than admitted to a hospital. If your friend or family member is on a Community Management/Treatment Order they can live in a hostel, at home with you or independently, but they have to follow a treatment plan that is developed for them.

The treatment plan will include things like:
  • Who is responsible for your friend or family member's treatment
  • Where the treatment or care is to take place e.g. home
  • How often the person treating or caring for your friend or family member must visit them or vice versa
  • Medication and/or other treatments your friend or family member will need to receive under the order.
The mental health team will work with your family member/friend during the period of this Order to help them develop insight, understanding and knowledge of the mental illness and its management. You, as their carer should also have input at this time. Top of page

Dealing with difficult behaviour

Much of the care of people with a mental illness takes place in the community with brief visits to hospital only if essential. It is therefore possible that you may, from time to time, need to deal with some difficult behaviour. This will depend on the nature of the illness and will vary from person to person. There is a lot of misunderstanding about mental illness but generally people find it uncomfortable to be with people who might be behaving strangely or are withdrawn and unhappy. Often when someone becomes distressed they seem to be like a different person. Some of you may become angry about what appears to be laziness or disinterest. Most people do not realize that some mental illnesses and medications can make people unable to motivate themselves or to see how they affect other people.

Those people with severe illnesses who experience hallucinations or delusions may not be able to understand how their illness affects them; the voices they hear and beliefs they have are real to them, and therefore they think their actions are entirely appropriate. You may find that at first you try to prove to them that their beliefs are wrong, but it is a pointless exercise. It may be more helpful to explore their feelings and plan how to cope with them, or to distract their attention. Sometimes when a person is recovering they may remember what was going on inside their head, but often they cannot.

Medication may make people drowsy and unable to think quickly and clearly; some medication can affect sleep or make people more anxious. You are often in the best position to notice if behaviour is worsening, or if medication is having an adverse affect. If the person also uses alcohol or drugs it may prevent medication working effectively. Top of page

Dealing with unusual thoughts or behaviour

Unusual thoughts or behaviour often cause problems for families, friends and carers. The problems that can arise include:
  • Disordered thinking and speech which may indicate paranoia and delusions
  • Social withdrawal
  • Loss of motivation
  • Depression, attempts at self harm or suicide
  • Aggression (usually verbal)
  • Risky behaviour (see below)
Some suggestions for managing these situations:
  • Respond calmly and with tolerance
  • Communicate clearly, simply and without undue emotion
  • Be patient, give time and space to let coping begin again
  • Be realistic in your expectations
  • Be clear and consistent in what you say and do
  • Avoid letting their pessimism influence your thinking and feelings
  • Take action in small steps

Disordered thinking and speech

It is important to avoid going along with or humouring the person you care for by agreeing with their perceptions or beliefs. You can say that you do not see or hear the things they do, and that 'delusions' are part of their illness - which you can help via distraction, talking about how they feel, encouraging them to ignore voices etc.

Try to avoid:
  • Confronting or laughing at their expressed thoughts
  • Undermining them by telling them they are 'stupid' or 'mental'
  • Ignoring them by remaining silent Top of page

Risky behaviour

Aggressive or risky behaviour is often a response to a feeling of losing control. It will help you if you can try to:
  • Understand the person's response: although the response may be extreme, real problems have usually triggered it.
  • Recognise the triggers: what are the situations that make them fear losing control? Learn to recognize the early warning signs.
  • Have realistic expectations of what the person you care for can achieve, and give plenty of encouragement. Try to avoid criticism or nagging. However let your personal knowledge of what works guide you.
  • Give them space and time. The person you are caring for needs to regain control and learn to cope again. If there is no risk to the person or other people, you could leave the room or go out for awhile until the emotional temperature has cooled.
  • Provide reassurance. The person you care for needs to know that you support them fully as they regain control over the situation and cope again.
  • If the person you care for is saying that they want to die, or to kill themselves, it may help to encourage them to talk about why they feel like this. They may be afraid of being alone, of being unwell forever or they may be overwhelmed by feelings of paranoia or guilt. It can also help to let them know that you understand why they may feel so desperate but that you will help them get through it. Discussing such feelings rarely makes them worse. It will help if you can keep calm and discuss how you can support them during this time. Try to give them hope that it will pass.
Know whom you should contact and how to do this if you have real fears for your safety.

If the behaviour of the person you are caring for is causing you concern, speak to the mental health team involved, they should be able to help you with this.