This chapter provides an overview of the common medicines prescribed within mental health care and explores the ways in which personal narratives and social expectations can influence the experience of taking medicines. The chapter also looks at concepts and practices that influence the management of medicines and encourage safe and high-quality use of medicines. These concepts include consumer experience, concordance, and shared decision-making. Facilitating a positive experience of medicinal use requires quality communication and team work, whereby nurses, psychologists, occupational therapists, dietitians, medical practitioners and pharmacists work in partnership with the consumer and carer.

Assessment in the mental health field is a dynamic process of learning, using experience and applying multiple sources of knowledge and evidence. This chapter presents an overview of assessment practices and processes undertaken within formal mental health care and discusses these within the context of consumer–health practitioner partnerships. We start by considering how assessment practices are a prominent feature of understanding a person’s situation and life context, and how these need to be based on the principles of person-centred, trauma-informed care and cultural safety. We discuss the importance of engagement and therapeutic relationships skills in ensuring consumers, carers and family members are meaningfully connected within a process for identifying the mental health problems the person is experiencing. Part of this awareness is reflecting on what it is like for a person to be assessed, and the power dynamics involved in naming experience, symptoms and diagnosis. The chapter then looks at the paradigm of comprehensive assessment, with specific discussions about strengths-based assessment, mental state examination and the roles of different health professionals.

Readers of this book will have thought deeply about how to collaborate with and support people with a mental illness, their families and carers. The preceding chapters have given considerable emphasis to a narrative approach. This final chapter discusses leadership, particularly for new entrants into mental health settings.Effective clinical care is person and family centred. It seeks to understand and involve consumers, carers and families in rich discussions about their needs, preferences and values. This understanding and involvement is combined with evidence-based practice to support consumers in their treatment and recovery goals.At the heart of the decision to take this approach has been the fundamental belief in human connectedness. By working through this text, readers have been challenged to think about how and when to move in new ways when working with resilient and vulnerable people, which is helpful across a range of practice settings when seeking to make a difference in the lives of people experiencing a mental illness. While this is important in providing a theoretical and practical basis for care, it is at the point of care that effective leadership is required.

This chapter introduces the concept of mental illness, how it is diagnosed, and the main diagnostic classification systems used in health practice. The experiences and symptoms of people living with mental illness – according to criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 – are reviewed. It is emphasised that diagnostic criteria can be considered within an overall framework for conversation and engagement between practitioners, consumers, and carers, with the overarching aim of exploring and understanding the best response to distress and treatment approach to promote recovery processes. Criticisms towards diagnostic classification systems are also summarised. Finally, potential effects of the COVID-19 pandemic and its implication for people’s mental health are presented.

By now readers of this book would have been thinking quite deeply about the topic of mental health and the practical ways in which they might collaborate with and support people with a mental illness, their families and carers. The preceding chapters have given considerable emphasis to a narrative approach. This final chapter is orientated towards a discussion of leadership – particularly for new entrants into mental health settings.

Effective clinical care is person and family centred. It seeks to understand and involve consumers, carers and families in rich discussions about their needs, preferences and values. This understanding and involvement is also combined with evidence-based practice to support consumers in their treatment and recovery goals.

At the heart of the decision to take this approach in this book has been the fundamental belief in human connectedness. Each of the chapters contained within this book has set about encouraging discovery and learning by making sensitive revisions regarding the ways in which nursing, health and human services practices can be made more meaningful in the lives of those who need them.

By working through each of the chapters, readers will have been challenged to think about how and when to move in new ways when working with resilient and vulnerable people, which might be helpful across a range of practice settings when seeking to make a difference in the lives of people experiencing a mental illness. And while this is important in providing a theoretical and practical basis for care, it is at the point of care that effective leadership is required.

A message of leadership

What we say, do, think and feel as nurses and health professionals can be an expression of leadership. This approach speaks directly to the process of making sense of what people around us are doing together and how best to understand, engage and, as far as possible, be committed to support each other (Holm & Severinsson, 2010). Why is this important? Because there have been and continue to be reports of people with a mental illness not accessing any kind of mental health care. Some are being turned away. Others are being left behind.

Introduction

This chapter provides an overview of the common medicines prescribed within mental health care and explores the ways in which personal narratives and social expectations can influence the experience of taking medicines. The chapter also looks at concepts and practices that influence the management of medicines and encourage safe and high-quality use of medicines. These concepts include compliance, adherence and concordance, shared decision-making, quality use of medicines, monitoring and review. The associated practices draw attention to the context of mental health care in the current era, in which health practitioners, including nurses, operate as a team. Facilitating a positive experience of medicinal use requires quality communication and team work, whereby nurses, psychologists, occupational therapists, dietitians, medical practitioners and pharmacists work in partnerships with the consumer and carer. The roles of the mental health practitioner are discussed in terms of supporting the experience of consumers and families with the use of medication, providing information and guidance, advocating for the expressed wishes of consumers and assisting in solving problems, monitoring safety and health promoting activities. Reflective exercises help readers to consider the engagement and communication skills required for the promotion of a positive experience for consumers, and encourage them to be involved in their medicine-related care.

Why do I need to know about the use of medicines?

Psychotropic medicines are at the centre of treatment for many forms of mental illness. Most health practitioners come into contact, on a daily basis, with people taking psychotropic medicines. Providing safe and high-quality health care requires you to understand the concepts and themes expressed within the learning objectives. This learning will help you to understand why the prescription of psychotropic medicines is linked to community attitudes and stigma towards mental illness and why many consumers may be hesitant to take these medicines or may wish to discuss their experience of them. From a safety perspective, in this chapter you will also learn about the side effects of psychotropic medicines and how you can assist in identifying adverse events and health risks for consumers. The chapter also introduces the concept of shared decision-making, which is a framework that includes consumers and carers in treatment planning and helps them to understand and express their wishes and preferences regarding treatment.