Care in Mental Health-Substance Use

David B. Cooper

• Publisher: CRC Press
• Year: 2019
• ISBN:
  9781315342948
• Edition: 1
• Topic: Medizin
• Subtopic: Medizinische Theorie, Praxis & Referenz

The Mental Health-Substance Use series provides clear guidance for professionals on this complex and increasingly recognised field. It concentrates on the concerns, dilemmas and concepts that impact on the life and well-being of affected individuals and those close to them, as well as the future direction of practice, education, research, services, intervention, and treatment. This volume is primarily about caring for individuals and families who turn to professionals at a time when their lives are unmanageable alone, but is also concerned with the care that these professions extend to their own members. It contends that these issues are closely interrelated, with appropriate communication and support being key to both. Its chapters draw from a variety of theories and treatments to provide practical advice on the challenge of providing appropriate care tailored to a wide scope of individuals and families. The volumes in this series are designed to challenge concepts and stimulate debate, exploring all aspects of the development in treatment, intervention and care response, and the adoption of research-led best practice. They are essential reading for mental health and substance use professionals, students and educators.

CHAPTER 1

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Setting the scene

David B Cooper

If I want to know what you’re thinking right now, all I have to do is care more about what you’re thinking than what I am thinking… .As soon as I care more about what you’re thinking than what I’m thinking I will give up my thoughts and I will absorb yours, and I will understand.¹

INTRODUCTION

The difficulties encountered by people who experience mental health–substance use problems are not new. The individual using substances can often encounter annoyance and suspicion when presenting to the mental health professional. Likewise, the person experiencing mental health problems, when presenting to the substance use services, can encounter hostility and hopelessness. ‘We cannot do anything for the substance use problem until the mental health problem is dealt with!’ The referral to the mental health team is returned: ‘We cannot do anything for this person until the substance use problem is dealt with!’ Thus, the individual is in the middle of two professional worlds and neither is willing to move, yet both professional worlds are involved in ‘caring’ for the individual.

For many years, it has been acknowledged that the two parts of the caring system need to work as one. However, this desire has not developed into practice. Over recent years, the impetus has changed; there is now a drive towards meeting the needs of the individual experiencing combined mental health–substance use problems by pooling expertise from both sides. Moreover, there is an international political will to bring about change, often driven forward by a small group of dedicated professionals at practice level.

Some healthcare environments have merely paid lip service — ensuring the correct terminology is included within the policy and procedure documentation, while at the same time doing nothing, or little, to bring about the changes needed at the practice level. Others have grasped the drive forward and have spearheaded developments at local and national level to meet such needs. There now appears to be a concerted international effort to improve the services provided for the individual, and a determination to pool knowledge and expertise. In addition, there is the ability of these professional groups to link into government policy and bring about the political will to support such change. However, this cannot happen overnight. Major attitudinal changes are needed — not least at management and practice level; one consultant commented that to work together on mental health–substance use problems would be too costly. Furthermore, the consultant believed it would create ‘too much work’! Consequently, there is a long way to go — but there is a driving force to succeed.

Obtaining in-depth and knowledgeable text is difficult in new areas of change. One needs to be motivated to trawl a broad spectrum of work in order to develop the sound grounding that is needed to build good professional practice. This is a big request of the hard-worked and pressured professional. There are a few excellent mental health–substance use books available. However, this series of six books, of which this is the fifth, is groundbreaking, in that each presents a much-needed text that will introduce the vital steps to the interventions and treatments available for the individual experiencing mental health–substance use concerns and dilemmas.

These books are educational. However, they will make no one an expert! In mental health–substance use, there is a need to initiate and maintain education and training. There are key principles and factors we need to bring out and explore. Some we will use, others we will adapt and others we will reject. Each book is complete. Conversely, each aims to build on the preceding book. However, books do not hold all the answers. Nothing does. What is hoped is that the professional will participate in, and collaborate with, each book, progressing through each to the next. Along the way, hopefully, the professional will enhance existing knowledge or develop new concepts to benefit the individual.

The books offer a first step, relevant to the needs of professionals — at practice level or senior service development — in a clear, concise and understandable format. Each book has made full use of boxes, tables, figures, interactive exercises, self-assessment tools and case studies — where appropriate — to examine and demonstrate the effect mental health–substance use can have on the individual, family, carers and society as a whole.

A deliberate attempt has been made to avoid jargon, and where special terminology is used, to offer a clear explanation and understanding. The terminology used is fully explained at the beginning of each book, before the reader commences with the chapters. By placing it there the reader will be able to reference it quickly, if needed. Specific gender is used, as the author feels appropriate. However, unless stated, the use of the male/female gender is interchangeable.

BOOK 5: CARE IN MENTAL HEALTH–SUBSTANCE USE

Case study 1.1

My life was good, a home, family, work. I lived for work because that provided me with the money to keep my family- my responsibility. But things were going wrong, I lost control of my perceived destiny. Ill health took control. Initially, I coped, I had hope, it will get better — no need to adapt — but the system was slow; stepped care meant that I could not get back my usual good health. I had to try this before I could try that — even though I knew ‘that’ would help me! Then I entered my ‘abyss’.

The darkness as I call it took over. It might take days, weeks, months, years, to clear - maybe never — at that time I did not know! ‘Eventually you will find a way to cope and accept’ At this stage this was just a myth put about by ‘them’. Just something your family and friends told you. Slowly they stepped back unable to cope with my behaviour and actions. I was angry, sad, despairing, unhappy, unreasonable, and obnoxious! I built a brick wall around me. Each meeting with the specialist brought initial hope — then hopelessness. I tried to recreate what I had and cocoon myself in my own safe world. My income dropped — disappeared altogether — but the bills did not! But society and state perceive people like me as scroungers — work dodgers — a burden. In my mind I was begging for money. But my income was not as it was — I needed money to keep things as they were. I created my own empire — borrowed money I could not pay back in the misguided belief that this would bring normality back to my life — and I would then pay my debts. My debtors were after me, my family wanted me to change — but there was no way out or so I believed. I felt ashamed — I hid things — my feelings — my life was a lie — because no one would understand. I sank into a hole; maybe sought thrills. I would buy something that I believed would make me happy, but I didn’t need it, and the happiness passed as soon as I bought the expensive ‘treat’! Nobody cared — or that is how I felt — I will die — indeed, I wanted to die. I acted in ways I did not understand — and again the shame, the despair — no way out — so what — who cares! Some sort of self-harm, self-gratification — all was doomed, I would get the punishment I deserved for being ill — not like normal hardworking people. I wanted to be punished — needed to be punished — punished for being weak and ill — not normal. At some point I accepted that I needed to change — to adapt — to take control of ‘it’. It cannot be in charge of me. I accepted my position in life — the illness — its potential route. Slowly I came out of my abyss. I looked around and saw the damage I had done. I was aware of the destruction — but helpless. I tried to make amends and build bridges with those I had hurt along the way. Some may forgive — others may accept - while others will never forgive or accept. The damage lives alongside my illness. But I saw a light — my own light of acceptance. I accepted the progression of my illness. Of course, many people have helped me along the way — but that goes unacknowledged. I needed to do this for myself. Now I accept the good days — and the bad. I know the damage to myself is progressive — and the damage to others cannot be corrected — but I can only accept my future. Yes, there are down days — black, cold and empty days. But I look for hope. Hang on to the hope — for that is my way forward — my way out. Until the end! Of course, this is my story — my life. We are all different — I suppose we handle things differently. But that is how it was for me — then and now.

The case study above offers an insight into the life journey of the individual experiencing mental health–substance use problems. We do not know how it is for him/ her but we listen to the individual’s story. The professionals role is to see where the individual is in his/her life. To support and steer that individual to a level of stability that is acceptable to him/her. You may not be able to ‘fix’, but may be able to encourage acceptance and bring hope — to offer care’ to the individual.

But what of the person who cares for the carer — the professional — does she/he need care? This book is primarily about caring for the individual and family who come to us for care at a time when their lives are unmanageable alone. However, we must at the same time address the issue of looking after the professional who cares for the individual/family. If we are to provide good-quality care then we need to ensure that the carers themselves (in this case the professionals) are cared for.

It is strange that a caring profession’, which cares for the ill and troubled, can turn on ill colleagues and apply rules to ensure they return to work quickly. Such as chasing up, without considering that the professional may also need care. We introduce one change after another, increasing the workload of front-line professionals, removing resources and downgrading — shortages are the norm rather than the exception — and yet we do little to support the professionals who are affected.

Change is unsettling and yet we permit rumour to spread about redundancies and demotions without meeting directly to explain what is going on — this is management by ‘fear’, sometimes bullying — and it is wrong! If communication were effective then it would be possible to bring the professional onside with change; if it were balanced and even-handed it could be achieved quickly and effectively. However, there appears to be a perception that ‘they’, the front-line professionals, do not need to know until the time is perceived to be right. Working in such a manner causes friction and directly affects the care of the individual and family.

It is imperative that we care effectively and efficiently for the professional at all levels. Robust clinical supervision, supported education and training and inclusion in decision-making are all easy to introduce and have little cost impact. Yet, we fail to consider the needs of the carer persistently, under the illusion that ‘they’ do not need to be cared for, ‘their’ job is to care for others. To improve the quality of care for the individual and family this attitude needs to change. But it will take more than a comment in a single chapter to change the philosophy of care for all people including the professional. Surely we are in the business of caring and want to achieve a good standard of care for the individual and family? To be effective in that business we need to care for the carers — so who will be first to bring about this change? Effective communication is the starting point…

It costs more to employ a new professional than to care for the professional we already have — it is more cost-effective and makes sense … so why does it not happen?

The professional’s role is to see where the individual is in his/her life, to support and steer that individual to a level of stability that is acceptable to him/her. You may not be able to ‘fix’, but may be able to encourage acceptance and bring hope. This is also the manager’s responsibility to her/his employees. There is no difference in the care that is needed for the individual, family and professional. Nor should we forget that we need to care for the manager’s well-being. It is not merely a ‘them down to us’ process but a two-way interaction of humanness in the face of what can be a very hard — but rewarding — occupation.

As we look at the role of caring in this book and how it can enhance the health and well-being of the individual and family in our care, remember to consider how this caring should be extended and applied to our professional colleagues.

‘We should judge ourselves before we judge others.’

For the individual and family it is important that we intervene in a way that is right for the individual — what works for one person may not work for another. Matching the intervention to the person leads to a more effective outcome. Working with the individual in a supportive environment, alongside others experiencing similar problems, should not be overlooked as an effective intervention.

The professional listens to and works alongside the individual as he/she moves towards their goals. Sometimes one way does not work and an alternative is tried — the good professional never gives up on the individual — no one ‘deserves it’. The door should always be open — the professional accepting of the individual at whatever point she/he enters our care (see Book 1, Chapter 7).

To achieve this, the professional needs an understanding of what is available to aid the individual in achieving his/her own goals: where he/she wants to be and what is acceptable to him/her — not what is acceptable to the professional! To do this we need the basics — then we develop that knowledge into practice and skill.

As mentioned in the Preface, the ability to learn and gain new knowledge is the way forward. As professionals, we must start with knowledge, and from there we can begin to understand. We commence using our new-found skills, and then develop the ability to examine practice, to put concepts together and to make valid judgements.² This knowledge is gained through education, training and experience, sometimes enhanced by our own life experiences.

Those we offer care to, and their family members, bring their own knowledge, skills and life experiences, some developed from dealing with ill health. Therefore, mutual understanding and respect is necessary to make interventions and treatment outcome effective.

We need to appreciate and understand the concerns and dilemmas that face the person before she/he comes for advice and treatment. We have to adapt the service to respond to those individual needs. It is important to remember that each person is unique. Yes, there may be similarities in symptoms, and specific needs relevant to sex and age. However, we must accept and acknowledge that each will have variations and specific needs that have to be considered when developing appropriate services, and when interacting with the individual. Moreover, we must be awar...

Table of contents

• Cover Page
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• About the Mental Health–Substance Use series
• About the editor
• List of contributors
• Terminology
• Cautionary note
• Acknowledgements
• Dedication
• 1 Setting the scene David B Cooper
• 2 Accessing services Kim Moore
• 3 Improving access to psychological interventions Shona McIntosh
• 4 Caring for the family Alison Sadler
• 5 Caring for Indigenous people Charlotte de Crespigny and Scekar Valadian
• 6 Early intervention with young people Ian Wilson
• 7 Engaging the individual and family David Watkins, Francis McCormick and Rosemary Cuff
• 8 Screening Brian R Rush and Saulo Castel
• 9 Assessment Michael Adams and Gemma Stacey-Emile
• 10 Brief intervention Karl V Robins and David A Hingley
• 11 Integrated motivational interviewing and cognitive behavioural intervention Michael Fitzsimmons and Christine Barrowclough
• 12 Cognitive behavioural integrated treatment (C-BIT) Derek Tobin
• 13 Pharmacological management Cynthia MA Geppert and Kenneth Minkoff
• 14 Complementary and alternative therapies: magic, mystery or fact? Je Kan Adler-Collins
• 15 Pain management Peter Athanasos, Rose Neild, Charlotte de Crespigny and Lynette Cusack
• Useful chapters
• Useful contacts Collated by Jo Cooper
• Index