CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN …

1 CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA. CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA 01. Foreword The aim of this brochure is to inform the community about public mental health service providers in Victoria. It explains the purpose and role of CRISIS ASSESSMENT and TREATMENT (CAT) SERVICES and triage; contacting CAT. SERVICES (including an index of contact numbers, and websites, for CAT SERVICES and other relevant agencies throughout Victoria); situations where CAT service clinicians can assist; and how to make complaints. This brochure has been designed by a number of Monash University Law Students working in the Mental Health Community Development (CD) Group. Past participants of this group have conducted research into police shootings and mental illness, the role of the Coroner's Court, as well as the criminalisation of mental illness. Through our research, we ascertained that there is some confusion about the role of CAT SERVICES , among not only the community, but among related professionals as well.

2 The Springvale Monash Legal Service has made a serious commitment to improving access to justice for marginalised or disadvantaged people. We believe there is significant value in ensuring that the community is informed about mental health service provision. This Discussion Paper has been produced by the Springvale Monash Legal We have consulted many professionals and related Service Inc. and printed agencies in the production of this brochure. We would with assistance from the Danks Trust. like to thank the Mental Health Branch of DHS and various CAT service clinicians who provided valuable time, and Title: CRISIS ASSESSMENT & crucial feedback for this information brochure. TREATMENT (CAT). SERVICES in Victoria Author: Springvale Monash The following Monash law students have been involved Legal Service Inc. in the information gathering and production of this Artwork: Chris Maplestone brochure: Deborah Rea, Ariella Gery, Blake Sabo, Springvale Monash Legal Patrick Verhoeven, Simonne Kaplan, Janine Hill-Buxton, Service Inc.

3 2007 Shaun Keogh, Tammy Giouzeppos, Silvana Nastasi This material is copyright. and Jade Press. It may be reproduced for legitimate educational or Dave Taylor review purposes; copying for other purposes must Community Development Worker be authorised by express Springvale Monash Legal Service Inc. permission of Springvale Monash Legal Service Inc. p (03) 9562 3144. e 02 CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA. Introduction The public mental health system consists of clinical SERVICES that are managed by Public Health SERVICES and that provide ASSESSMENT , diagnosis, TREATMENT and clinical case management to people suffering from serious mental illness and severe mental disorder. Specialist clinical mental health SERVICES in Victoria are provided on an area basis, and are often referred to as area mental health SERVICES (AMHS). They include adult mental health SERVICES , child and adolescent mental health SERVICES , and aged persons mental health SERVICES . Each of these service categories provides inpatient psychiatric SERVICES , in addition to a range of community-based and residential SERVICES .

4 In each adult AMHS, the front end' of the mental health service system is comprised of: Mental Health triage SERVICES : Triage occurs at the first point of contact with mental health SERVICES . Triage clinicians provide initial ASSESSMENT and advice, usually over the telephone. This is expected to be a 24 hour service. CAT SERVICES : CAT is a community-based outreach service for assessing and treating people suffering from serious mental illness. CAT SERVICES have a number of functions, the foremost being: o ASSESSMENT of people in the acute phase of a mental illness;. o CRISIS intervention for people in psychiatric CRISIS to identify problems and alleviate risks; and CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA 03. o Short-term, intensive TREATMENT of people with an acute mental illness or mental disorder, in their usual residence, as an alternative to admission to an inpatient unit. Enhanced CAT (ECAT) SERVICES : ECAT is an Emergency Department-based psychiatric ASSESSMENT service.

5 The CAT service is a part of an AMHS that operates 24. hours and, in most cases, is geographically linked to a mental health inpatient service. Each CAT service may be managed differently depending on the local service environment and catchment area, but all CAT SERVICES share the same functions. For example in many rural AMHS, CAT, Mobile Support and Community Care functions are carried out by all community mental health clinicians, while in most metropolitan AMHS, CAT. is a separate team, frequently combined with ECAT. and triage. The critical factor, however, is that all CAT. SERVICES have access to the full range of mental health SERVICES , and are expected to deliver the same 1 The above information was taken from the following website: [accessed 9 June 2006]. 04 CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA. The Role of CAT CAT SERVICES : SERVICES Receive referrals from triage and attend situations where individuals are in the acute stage of their mental illness or in psychiatric CRISIS .

6 Conduct initial ASSESSMENT of problems;. develop and implement CRISIS management plans for/with the individual;. provide further short-term TREATMENT and support during the acute stage of the CRISIS ;. Facilitate all public psychiatric inpatient admission;2 and Facilitate referral to other service providers. NOTE: Definition of CRISIS . Psychiatric CRISIS describes the situation where a person with a mental illness or severe mental disorder experiences thoughts, feelings or behaviours which cause severe distress to him/her and those around him/her requiring immediate psychiatric TREATMENT to assess and manage risk and alleviate The acute stage of a mental illness is characterised by infrequent yet severely distressing symptoms that require immediate TREATMENT . This may be the person's first experience of mental illness, a repeat episode or the worsening of symptoms of an often continuing mental 2 See Psychiatric CRISIS ASSESSMENT and TREATMENT SERVICES : Guidelines for Service Provision, 1994, ' (Guidelines) for more information 3 Victorian Mental Health Website: 4 As above CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA 05.

7 Target Groups for CAT SERVICES will assist people: CAT SERVICES aged between sixteen to sixty-four years during business hours, and all age groups after hours: o in the acute phase of a mental illness, or at risk of an acute episode, who require intensive TREATMENT and support from public mental health SERVICES ;. o in psychiatric CRISIS due to mental illness or mental disorder o who require intensive community TREATMENT and support to prevent psychiatric admission Specialist mental health SERVICES are aimed primarily at people suffering from serious mental illness or mental disorder who have associated significant levels of disturbance and psychosocial disability due to their illness or disorder. This includes some people with conditions such as severe personality disorder, severe anxiety disorder, or those who present in situational CRISIS that may lead to self-harm or inappropriate behaviour towards others, the distinguishing factor being the level of severity of the disturbance and For information on the target group for adult mental health When considering referrals of persons SERVICES refer to: with personality disorder, CAT will take into account the presenting symptoms, the availability of TREATMENT , mentalhealth/ SERVICES /adult/ the involvement of alternative SERVICES , the existence of a current management plan, and the likely therapeutic benefit of specific interventions.

8 For example, clinical For information on mental health SERVICES catering for and research findings have consistently shown that those outside of the above age inpatient or compulsory TREATMENT , except for very brief bracket, see Other Victoria periods, is seldom of sustained therapeutic benefit for Mental Health SERVICES below. persons with personality disorder. 5 See guidelines, 06 CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA. Contacting CAT If you are a GP / private practitioner / police/ family SERVICES / Mental member /individual suffering from mental illness you can call a centralized mental health triage number Health Service (contact numbers vary for each region).6 A mental Providers and health practitioner will answer the call, attempt to Criteria for counsel the person suffering from mental illness who is Attendance in CRISIS and obtain all relevant information in order to decide the nature and level of response required. When deciding if a referral should involve action by the CAT.

9 Service or another part of the mental health service, triage will consider: 1. Whether the person in need appears to have a serious mental illness or a severe mental disorder 2. Whether the person in need is experiencing a psychiatric CRISIS The immediacy and severity of the situation will be considered. 3. Whether the person in need is in the acute stage of his/her illness or disorder The seriousness of the symptoms will be assessed. 4. Risk to the individual suffering from mental illness and others High risk situations will be prioritised; and In high risk situations, CAT clinicians must consider involving the police, if they are not already in 6 Refer to Contact Details below or go to 7 See . guidelines, CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA 07. 5. Risk to CAT service members In assessing risk, the on-call worker will consider a number of factors, including the following:8. o level of agitation;. o explicit acts or threat of violence;. o past history of violence.

10 O attitude of person to the referral;. o psychiatric history;. o presence of other people, including dependent children;. o role of other people (threatening or supportive);. o physical location of referred person; and o gender issues. In situations of high risk, police involvement must be considered and CAT SERVICES may either attend with police or refer the case to police. CAT clinicians and police will be guided by the 2004 Victoria Police- Department of Human SERVICES Mental Health Branch' Protocol when managing high-risk situations. Generally, police will be responsible for any activity relating to crime 8 See . guidelines, 08 CRISIS ASSESSMENT & TREATMENT (CAT) SERVICES IN VICTORIA. or threat to other people, and CAT SERVICES When contacting CAT. SERVICES it is helpful to be as will be responsible for mental health issues specific as possible about the once the situation has been made concerns, behaviours, feelings, distress, risks etc. This will assist CAT SERVICES In some situations of high risk, it may be in assessing the nature and more appropriate for the person suffering urgency of the situation.