De la sociedad y la cultura

After I examined the responses provided by the mental health or service systems, I then considered what appeared beneficial and ineffective in dealing with the study participants. A summary of these responses is discussed.

3.31 Case 1 (Joe):

No mental health responses were provided to Joe. The most compassion offered him was by members of the Victoria Police, who transported him to local hospitals to receive treatment for his self-injurious behaviours. It is significant that the board member instructed the guardian to advise the local police of his involvement. I assumed that the member also believed that the police had Joe’s best interests in mind.

3.32 Case 2 (Jane):

At the time of the first hearing, the records do not suggest that in spite of Jane’s personal history, she had an assigned caseworker from the mental health services. This was in spite of her frequent voluntary and involuntary admissions to a rural hospital for her self-destructive and aggressive behaviour. When Jane was admitted to a rural unit, it would appear that she had been more stable than at any other time. She too expressed optimism and a sense of security. Sadly, this facility appeared unable to keep her, and she was relocated to “a more therapeutic environment” in the city. No psychiatric interventions appeared to have any positive effect, and it appeared that Jane developed a medication dependency whenever these were trialled. Another successful intervention was when Jane lived in a unit on the grounds of the city facility. Unfortunately, this too had to be halted, but the case files revealed both staff and Jane alike agreed that she had made some gains. Jane’s final move to true independence, i.e. living alone in the community with supports, was tragically too short lived and she succumbed to the effects of illicit and prescription drugs. This result is not surprising as all previous reports

suggested that when Jane was on prescribed medication she was unable to manage and/or would quickly develop dependence to them.

3.33 Case 3 (Bill):

It would appear that Disability Services (DS) provided appropriate responses for Bill’s behaviours. They seemed to have a very good understanding of his behaviours, and when these escalated staff introduced other strategies. These included an increase in staffing both to assist Bill and to reduce his harm to self and others. DS engaged a psychologist as well as utilizing the BIST team to tailor responses to Bill. In addition, at the suggestion of the guardian, DS commenced programs to desensitize residents to stressful situations such as going to the dentist. These programs were then implemented service wide.

3.34 Case 4 (Dave):

In the first order, DS provided a very comprehensive program to assist Dave, and gave a commitment to do so, which largely occurred. The file notes revealed that Dave sought an increase in their involvement, so he too must have been comfortable with their involvement.

Following the guardianship order, Psychiatric Services (PS) placed an importance on documentation, which included the number of medications, programs attended, challenging behaviours exhibited and visits to A & E Dept.

The second order saw a continuation of all existing programs and case meetings. Psychiatric staff still believed that the guardian could effect Dave’s compliance, which did not occur.

Approximately two years later, a third order was made together with a power to enforce order. Dave took himself to hospital and received treatment. Of benefit to Dave was the advocacy by the guardian which ensured that both RDNS and Hospital in the Home provided ongoing care of his wounds.

3.35 Case 5 (Chris):

It did not appear that any mental health services responses were effective. When professionals came into Chris’s home to assist, he regularly withheld information or deliberately provided misinformation. It would appear that his earlier experiences with psychiatric services had determined his future behaviours in dealing with any service providers.

3.36 Case 6 (Nigel):

While it is difficult to determine what was beneficial for Nigel, as he achieved 4.4 years without the need for a guardian between orders two and three, it may suggest that the interventions put in place during order two were beneficial. In addition, Nigel told the guardian that he “liked” his case manager, so perhaps being case managed by someone who is liked may also be beneficial in that it provides a more secure base. During orders three and four, it appeared that an escalation in behaviours indicated that old habits die hard, and Nigel returned to his familiar ways of repeating previous patterns of behaviour.

3.37 Case 7 (Andre):

In the first order, psychiatric and in-home services appeared to have been of assistance to Andre. At the time of the second order, some eight years later, it appeared that there were no effective mental health responses. Andre was determined not to engage with any services, and only to accept assistance when circumstances were dire. Forensic Psychiatric advice was that “…...he reacts badly when too much control is taken away from him, but left to his own devices he appears to do badly”. Perhaps advocacy for his needs in his palliative care stage was the most effective intervention that occurred.

3.4 Objective 4: To enhance our knowledge as to whether guardianship