A centre where treatment, education and rehabilitation are provided by staff specially trained in adolescent mental health should include:
- Mental Healthcare Nurses
- Teachers/Teacher Aides
- Occupational Therapists
- Social Workers and
- Administrative, Maintenance and Catering personnel
Additional visiting/external professionals providing training in a range of areas will predominantly be organised through the school for weekly/monthly inclusion in the education program. These could include development of skills in the areas of independent living, self-defence, cooking, creative/artistic expression (including writing, music, art, etc.), sporting or physical pursuits etc. A number of activities held off-site provides access to appropriate facilities/experts but also establishes and maintains connections to the wider community wherever possible. (Participation in any of these activities would be according to the clinical assessment of individual appropriateness.)
In this kind of centre, young people who are high risk can be under very close 24hr supervision when required. And, at the same time, they will be accessing ongoing intensive treatment. This is not possible in any other youth mental health service i.e.
ACUTE WARDS in hospitals are where patients in crisis can be under constant supervision, usually while medication is adjusted. Once the critical phase has been navigated, patients are then released to seek long-term treatment though other services. The staff in acute wards are not in a position to provide extensive treatment programs, rehabilitation and other therapeutic services. The demands and needs of acute patients are such that ensuring their safety and restoring stability are the primary goals.
YOUNG PEOPLE ACCESSING TREATMENT AND EDUCATION IN THEIR LOCAL COMMUNITY must do so in the environment from which many have withdrawn. Psychiatric appointments are typically once a fortnight/month and other services like occupational therapy and social work aren’t always easily accessible in every Queensland community. Day programs too are not available throughout the state and housebound young people are unable to attend even when there is a local service. Even mobile services like Assertive Mobile Youth Outreach Service (AMYOS) can fail to engage those suffering severe and complex issues, particularly those who have lost trust in practitioners and services. Some special education options may exist close to some young people’s homes but the likelihood of the teachers having a comprehensive understanding and experience of severe and complex adolescent mental health issues is slim. And for many young people, the local state school or home schooling may be the only options.
(So, following the closure of the Barrett Adolescent Centre in January 2014, those experiencing pervasive and debilitating mental health issues in Queensland were left without a service that can make a difference to suffering that is at the severe end of the spectrum –suffering that will only increase if the right kind of intervention isn’t available. And that impacts on the family, friends and carers of the sufferer as well.)
It shouldn’t be overlooked that a residential service provides respite for families/carers as well as therapeutic and learning experiences for the young people admitted. Severe and complex mental health issues in adolescents affect whole families, not just individuals. But an inpatient extended service where comprehensive treatment, education and rehabilitation are provided by a multidisciplinary team of clinical, education and allied health staff specially trained in adolescent mental health can make a significant positive difference to lives that have already experienced years of suffering. A purpose-built centre of this kind can provide intensive treatment in an environment that incorporates a level of safety that can’t be achieved in family homes without stretching carers far beyond their limits BUT within a design/layout that is far more conducive to daily living for the young people in residence than a hospital ward would be. With the right balance between the needs for security and privacy but also allowing for flexibility, approachability and community, such a centre can facilitate physical activity and a range of outdoor experiences and include space for a garden and inviting community areas. Some peace and tranquillity not only helps to balance the difficulty of confronting mental health issues but provides the essentials of daily living for every person and especially, every teenager – for whom personal space is so important. So to have such opportunities within an setting with expert supervision and comprehensive treatment meets safety, developmental and individual needs in the best way possible.
In such a centre, patients receive individualised treatment – in one-one-one (and occasionally group) therapeutic experiences as appropriate. The expertise of staff in an extended inpatient service goes beyond that existing in an acute ward of a hospital (where the focus must be on stabilising patients who are at high risk) as treating and rehabilitating patients on a long-term basis requires a specific skill set and depth of knowledge. In an extended treatment facility with an ON-SITE SCHOOL, young people can have personal learning plans devised by the expert teachers according to the level of education and developmental ability the student has reached thus far. This allows each of the adolescents to begin to experience success – through not being compared to anyone else – and to gain a greater understanding of their own challenges, skills and responsibilities in a safe and understanding atmosphere.
One of truly unique aspects of an inpatient extended treatment and rehab centre is the fact that the collaborative multidisciplinary team of professionals and the adolescents together create a micro-community that enables young people to observe and form functional relationships in a reassuring environment. The trust on which these relationships are based then provides a foundation for a young person to develop resilience and self-esteem as well as the forum in which to test and develop newly acquired skills in social interaction – which they can then practise during the regular excursions in the wider community when those are deemed clinically suitable. So a key element of the effective functioning of a ‘Tier 3’ facility is the continual collaboration of staff i.e. although health and education specialists have clear responsibilities, the sharing of appropriate information relating to each patient/student ensures a integrated approach which not only means consistency of care but is more likely to achieve progress sooner.
And, of course, having an on-site school enables students to re-connect to and/or maintain their education – an area that often suffers in young people with severe mental health issues – with the specially trained staff incorporating life-skill development and vocational training into the flexible, student-focussed program. The mere existence of the physically self-contained school (i.e. not within the residential and treatment areas of the facility but clearly a cohesive part of the functioning of the centre as a whole) encourages an adjustment to a more ‘normalised’ daily routine. ‘Patients’ become ‘students’ and interaction leads to the development of peer relationships – a key element of life but quite often something that young sufferers of severe mental illness have rarely experienced.
Although a criticism of inpatient care can be the learning of negative behaviours, that concern is uppermost in the minds of staff. And it should be acknowledged that the experience can present positive revelations to newly admitted adolescents in that there are other teenagers experiencing challenges of the same level or type as those they’re dealing with i.e. with a common trait of mental health issues being to feel separate and unique in your suffering (and the stigma of mental illness still evoking totally inappropriate feelings of shame), discovering that others have had similar experiences and are progressing/have progressed can be incredibly reassuring. (In contrast, being allocated a longer term/ ‘swing’ bed in an acute ward and watching other patients with less severe/complex issues come and go can only serve to add to the despair and isolation already prevalent in those whose suffering is pervasive.) And, observing others learn to replace negative behaviours with productive tools for handling challenging situations is not only valuable in the case of mental health issues but in life in general. So overall, the experience of those who’ve had access to treatment provided by this kind of facility is that it is inherently a positive one.
The micro-community of the centre is clearly always part of the wider community, however. With regular connections to activities at other locations and young inpatients given leave to visit/stay with friends and family whenever appropriate, there are no opportunities for the development of the institutionalised behaviours seen in previous generations for whom long stays in mental health units were permanent and harmfully restrictive. Young people who start as full-time residents of the centre are always on a path to gradually transitioning back to their own communities – but this must keep pace with their progress and their ability to achieve success within changed arrangements. So when a patient moves to staying some nights at the centre and some at home/in the community; and then when they become solely a day patient depends on each individual case. To allocate a finite length of stay to every individual upon admission is to deny the premise of patient-focussed treatment. And a ‘one size fits all’ approach to mental healthcare will never be a solution promoted by anyone with even the slightest interest in the field.
The aim of a contemporary inpatient extended treatment facility should be, wherever possible, to champion young people as independent, productive, functioning adults-to-be … preparing them for their lives in society by assisting them in developing the skills to accomplish whatever they’re able while ensuring that mental health issues are treated/managed in the best way possible.
So, an extended inpatient centre is a place of hope. Of acceptance and encouragement. It is a bridge to the life that always existed in potential but remained barricaded by mental health issues and the impediments those issues spawned. No one should deny young people the opportunity to, one day, cross that bridge.