Members of the St Vincent de Paul Society and the general public can learn how to help create a mutually beneficial relationship with someone who is living with a mental illness. It is also helpful to know how to act in the advent of a risk situation.
PETER SCHAECKEN (Consumer consultant, Sydney South West Area, Mental Health Service, Eastern Zone): It is very important to have someone to come to your place or meet somewhere, and just to have some friendship and some normal conversation is very important.
LYNNE (Living with a mental illness): Be compassionate and respectful and treat the person like you would anybody else.
GREG HOGAN (Co-ordinator, Ozanam Institute of Spirituality): The philosophy of the Society and the spirituality of the Society is to help people where they’re at, and it’s not about running away just because we get thrown a curve ball.
LYNNE: Not be fearful you know, because that’s something that’s going to make them feel worse straight away. So don’t be fearful around different behaviour because there’s probably a good reason for that different behaviour.
JOHN KONRADS (Former Olympic swimmer): We used to advise these people just get yourself together, pull your socks up, and that’s the worst thing you can tell a depressive because they can’t pull their socks up, so that makes them feel more helpless still.
JOHN CAMPBELL (President State Council St Vincent de Paul Society Queensland): So as a Vincentian visitor, if you think they have got some form of a mental illness don’t be frightened to ask them. “Are you on medication?” “Are you taking medication for anything”? Nine times out of 10 they would tell you, yes I have depression, or yes I’m suffering from anxiety or I’ve got bi-polar or something of that nature.
LYNNE: You know, asking them about mental health issues like you would physical health issues. You know and don’t make a huge differentiation between the two.
JOHN O’NEIL (President State Council ST Vincent de Paul Society NSW/ACT): And showing that we’re respectful in the very first instance is the right way to start an interview. It’s absolutely essential.
PETER SCHAECKEN: To treat the person with respect. If it’s obvious a person is unwell, not to yell at them, not to criticise them.
MYREE HARRIS RSJ (President, NSW State Advisory Committee on Mental Health): If I opened a back door and I found a guy really agitated, talking to himself, seemingly when I hear people doing that I think their probably hearing voices. My response would be to just respond calmly to him, say “hello Joe you don’t seem the best today, seem to be worried about something”. And it could be if he is genuinely unwell, he may not be very clear in what he wants to say to me. I just continue speaking calmly to him and I’d say “Joe, listen you don’t seem real well to me today, you seem a bit upset about things” and often if you do it that way they’ll agree with you that they’re not very well. “And Joe I’d like to contact your case worker, would you be ok about that? I think your case worker would be concerned to realise you just aren’t feeling the best today and you might be able to use some help he can give you. So when I leave here Joe I might just call your case worker and ask him to look in on you, is that ok with you?”
JOHN O’NEIL: You also have to recognise that their privacy is also to be respected.
PROFESSOR GORDON PARKER (Executive Director at The Black Dog Institute): I hear many stories about your organisation, where people say to me: “Look my visitor was my only friend. That person helped me through a difficult time, I was really quite suicidal but this person kept me”. And how did it work? “Well I didn’t really see them as my friend, I just felt they were on my wave length and they were prepared to spend time with me. Just even buying me a cup of coffee was an indicator that they were prepared to do something practical”. So this level is very important, but it’s not enough… I think there are stages that follow. Many of these people are without structure, so maybe giving them some guidance about how to get some structure across the day.
LYNNE: It’s good for people to have a management plan and the person you’re seeing may have one of those. That might be who to contact in terms of friends and family if they aren’t doing too well, if they’re not travelling too well that day.
PROFESSOR PARKER: A lot of these people have had bad experiences with health professionals. That doesn’t mean you should give up. They should then be encouraged to think about going back and seeing another health professional.
LYNNE: So I swapped to a psychiatrist, who believed me and supported me in my story and that made a really big difference for me.
PETER SCHAECKEN: And I think what else can be very important is that engagement process. When your meeting a person with a mental illness for the first time and you’re going to be seeing them on a regular basis, if you can build up a rapport with that person over a period of time, there’s a good chance that person with a mental illness will trust you. And once you’ve gained their trust you’ve got the basis for a relationship or a friendship.
LYNNE: Trying to be positive and giving hope.
PETER SCHAECKEN: So some of the strategies for engaging the person might be to share a hobby with the person.
GREG HOGAN: It’s not about turning around and walking away just because it’s something new for us. It’s about getting in there and helping people where there at, and providing whatever support we can.
PETER SCHAECKEN: There are some things that people with mental illness do find difficult, for example some people find it very hard to watch the news and knowing what’s going on because it’s so distressing to them because they might be feeling depressed and isolated and they really feel what’s happening on the news and it really affects them. So there are some things that may not be good to talk about such as politics.
LYNNE: Consistency is really important and being motivating is really important as well.
JOHN KONRADS: Making encouragement statements can be a bit of a double ended sword, so some people might want to say “she’s just trying to make me feel good,” but I think that the key thing in terms of improvement is that for the Vincentian themselves, they get the sense of satisfaction that the things that I’m doing are actually working and I can see an improvement in that place. And I think that if your volunteers your good people anyway and good people get their thanks, their pay from feeling good inside themselves. They’ve actually helped another human being.
High Risk Situations
PROFESSOR PARKER: People with acute psychotic conditions can at times be very dangerous. And therefore forewarned is forearmed.
JOHN O’NEIL: You cannot under any circumstances put a question direct to a person who is antagonistic.
PROFESSOR PARKER: The way in which we professionally handle it is we always work out where we are going to interview somebody or where we are going to be with them. If we are in a dangerous situation we allow a lot of distance between ourselves and the other person, we sit closer to the door than the other person so if anything happens we can run. We don’t have the doors locked and we try to keep the door open. If there’s any other concerns we would always have a second or a third person present and you would maintain authority, but you would not want to override or crowd or pressure the person. Given those rules then most of the time you can control and prevent the high risk situations.
DR BOB SERICH (Chair, National Mental Health and Homelessness Advisory Committee): If a person was angry and hostile and wasn’t settling down despite whatever you tried to do to make things better, offering to do the cup of tea, a smoke, then you would be sort of moving outside making the call, same thing.
JOHN CAMPBELL: In all the years I’ve been doing visitations I’ve never really had an episode where I’ve been worried. Usually once you tell them you’re from St Vincent de Paul they respect that and they usually stay calm.
JOHN O’NEIL: We’re really here to help you and we really want to help you. We’re volunteers, we’re not paid people. We’re volunteers.
PROFESSOR PARKER: At times, particularly when people are acutely psychotic it may be quite inappropriate for a whole range of reasons, not only your own safety, but particularly because you’re unlikely to be seen as particularly helpful and at those times it would be quite inappropriate to approach that person.
MYREE HARRIS RSJ: And if you had someone, who really off his face, aggressive, threatening obviously you’d call the police.
PROFESSOR PARKER: And even in those difficult situations, how to proceed. One example for instance is the space that one leaves between you and the other person. Most human being prefers about a meter if they’re in a close relationship, but if you were with an acutely psychotic person you’d probably allow a minimum of two to three metres. So there are a whole range of very simple strategies where you don’t crowd the person. Where you don’t talk over them, where you don’t cut them off, where you maintain eye contact, where you maintain your natural sense of authority but you’re not authoritarian. And these nuances, which can be natural to some people, still need to be sharpened up I think in dealing with psychotic people. So I would argue very much for some professional training.
PETER SCHAECKEN: The more we all know about mental illness and about people with mental illness the easier it is to communicate and interact with people with mental illness.