The Australian Integrated Mental Health and Palliative Care Task (IMhPaCT) project aimed to improve the quality of palliative care for people with a severe and persistent mental illness and those who develop mental health issues as a response to their diagnosis of a life-limiting illness. These patients and families are generally cases of high complexity and require strong collaboration and cooperation across various service sectors. Education across both palliative care and mental health services was identified as a key objective in improving palliative care service delivery in this patient population. This article specifically addresses one aspect of the project-the education strategy. The processes of development, implementation, and evaluation of outcomes are discussed.
People with severe mental illness (SMI) are widely reported to be at an increased risk of morbidity and premature death due to physical health conditions. Mental health nurses are ideally placed to address physical and mental health comorbidity as part of their day-to-day practice. This study involved an audit of hardcopy and electronic clinical case-notes of a random sample of 100 people with SMI case managed by community mental health service in metropolitan South Australia, to determine how well physical health conditions and risk factors, screening, and follow-up are recorded within their service records. Every contact between 1 July 2015 and 30 June 2016 was read. One-way ANOVA, Scheffe's test, and Fisher's exact test determined any significant associations across audit variables, which included gender, age, income, living arrangement, diagnosis, lifestyle factors, recording of physical health measures, and carer status. A focus on physical health care was evident from everyday case-note records; however, because this information was 'buried' within the plethora of entries and not brought to the fore with other key information about the person's psychiatric needs, it remained difficult to gain a full picture of potential gaps in physical health care for this population. Under-reporting, gaps and inconsistencies in the systematic recording of physical health information for this population are likely to undermine the quality of care they receive from mental health services, the ability of mental health service providers to respond in a timely way to their physical healthcare needs, and their communication with other healthcare providers.
The potential for growth within a relationship between individuals experiencing “psychotic” and “nonpsychotic” realities in based in acceptance of a shared human vulnerability. Through the human-to-human relationship, acceptance of the mutual experience of ontological insecurity and fear of nihilation can facilitate the emergence of a “nonpsychotic” reality. Interconnectedness, that occurs through the process of growth within a loving, nongoal–orientated relationship, leads to a negation of the need for an altered state to exist to defend the threat of nihilation in the person experiencing “psychosis,” and the person in a “nonpsychotic” state to resist the attempt to change the legitimate reality the other person is experiencing. The ensuing changes to the liminal space occupied by a person said to be in a “psychotic” state, when being together in a coexisting same experience, can lead to mutual growth and the evaporation of the so labelled “psychotic” state. This demonstrates the “psychotic” experience is more consistent with a dissociative response to threat in relationship and could be reframed as a “Dissociachotic”—a form of dissociation that has been mislabelled as a unique condition of “psychosis” due to its specific representation of creating safety for a person experiencing threat in relationship.
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