Part 1 Section C: About the NSW mental health system
Part 1 Section C: About the NSW mental health system
This section provides an introduction to:
- Private mental health care and treatment in NSW
- Public and community mental health care and treatment in NSW
- The dominant model of public mental health care and treatment in NSW
- 'Recovery oriented practice' in community-managed mental health care services
On other pages, the Manual has information about services that provide legal advocacy and advice, non-legal advocacy and advice and information about how to make a complaint in relation to aspects of the mental health system in NSW.
1C.1: Private mental health care and treatment in NSW
If you want private assistance for the range of conditions from emotional problems to mental illness, you can access:
- services provided by General Practitioners (GPs);
- services provided by psychiatrists, who are doctors specialising in psychiatry, usually on referral from a GP;
- services provided by psychologists or social workers qualified in a variety of specialities, usually on referral from a GP;
- services provided by counsellors or psychotherapists trained and accredited by state and national bodies (not government), without need for a referral;
- services in private psychiatric hospitals and out-patient clinics, usually accessed with financial support from private health insurance cover and arranged by private psychiatrists and psychologists;
- health services (including counselling for mental health and drug and alcohol issues) provided to young people through HeadSpace
Most treatment for mental illness, particularly for people with a diagnosis provided by a private doctor, is based on the use of psychotropic or anti-depressant medication. It is unusual to find private doctors or psychiatrists who do not use medication as a central part of their treatment of diagnosed mental illness.
Generally people with other mental health problems (such as anxiety disorders, depression and compulsive disorders) get help through referral from their GP to a combination of services that includes medication and/or psychotherapy from a psychiatrist and counselling or psychotherapy from a psychologist or social worker.
1C.2: Public and community mental health care and treatment in NSW
If you cannot afford private health care or want to access non-private health care, the following options are available to you:
- care in the community through community mental health units usually attached, sometimes physically, to public psychiatric hospitals or units;
- inpatient care in public psychiatric hospitals or units run by the NSW Government;
- counselling services provided by various organisations, hospitals and community health providers in particular areas such as drug and alcohol counselling, grief counselling, relationship counselling, rape crisis counselling, and trauma counselling;
- referral to private health providers, usually psychologists, who may or may not 'bulk bill' (that is, not ask for an upfront payment).
Under the Mental Health Act 2007 (NSW), you can be forced to have care and treatment in hospital and sometimes forced to take medication in the community through Community Treatment Orders (CTOs). Both are types of involuntary treatment.
1C.2.1: The dominant model of public mental health treatment and care in NSW
In all public mental health care services in NSW, except counselling and psychological services, the care and treatment you will receive will be:
- based on the medical model, that is treating your emotional/mental problem as an 'illness'; and
- with very limited exceptions, the administration and monitoring of medication only.
Therapies, such as behaviour modification that do not use medication or that complement drug treatments, are not generally provided in NSW public mental health facilities, whether you are a voluntary or involuntary patient.
Counselling is sometimes a component of public mental health community-based treatment but treatment with medicine remains the main focus of that treatment as well.
Social workers, often working in or linked to public hospitals, can provide a variety of advice and assistance in areas other than about direct treatment, such as accommodation, employment issues, arranging services such as occupational therapy, as well as giving advice about how the mental health system works. Social workers can also be accessed through community services.
Mental health community services often provide support in the areas of case management, supported accommodation, living skills training and also help to make contact with employment and social supports. Referral to such programs is generally through clinical services.
1C.2.2: The dominant model of care and support in community-managed mental health services in NSW: 'Recovery Orientated Practice'
In NSW, many services are delivered by non-government organisations (NGOs). Community-managed mental health organisations offer a wide range of holistic treatment, care and support programs in which the model of care is described as 'Recovery Orientated Practice'. Services in community-managed mental health organisations are provided by a range of allied health care professionals including: mental health professionals; social workers and case managers; support and peer support workers and volunteers; drug and alcohol and other counsellors and psychologists; and other community workers.
You may access some of these services through a referral from a public facility, a psychiatrist or GP, or a psychologist or other health professional. However, as a general rule, you can self-refer direct to community services. Some of these services are listed in the Appendix B.
Recovery is described as a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life, even with the limitations caused by mental illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the challenging effects of mental illness. Recovery in a broad sense is about finding a way to get back on track after experiencing illness.
Community-managed mental health organisations embrace principles of recovery in order to enhance a person's very individual recovery journey. Recovery Orientated Practice is a holistic approach to illness that addresses all aspects of a person's life, including psychological and physical needs, as well as social, economic, education, employment, housing and other needs at the same time, whilst maximising the ability to live in the community independently. The focus is on the individual and their needs first, and on the illness, which is only one part of the person, second.
What you can expect from a community-managed organisation is a service that will support you through your individual recovery journey. This is at an organisational as well as individual level. Their role is to help you meet your goals rather than determine the direction. The principles of recovery on an individual level include, but are not limited to:
- Hope
- Meaning, purpose and direction
- Rights and personal responsibility
- Equality and respect
- Empowerment and self-determination
- Social inclusion and connectedness
The role of the service provider is to aid the process of recovery, rather than decide its direction, by for example:
- helping natural support systems;
- helping you to access a range of other community services, supports and networks;
- enabling access to services such as drug and alcohol, trauma and other counselling services;
- providing access to opportunities for employment, education and training, and acquiring new skills; and
- securing long-term housing.
By including every aspect of recovery in service delivery, organisations provide opportunities for participating in self-advocacy, consultation and involvement in the development of how services are run and policy is developed, and peer support and self-help.
Disclaimer
- The legal and other information contained in this Section is up to date to 13 September 2010.
- This Manual only refers to the law and practices applying to the Australian state of New South Wales (NSW).
- MHCC does not guarantee the accuracy nor is responsible for the content or the currency of the content of external documents and websites linked to this Manual.