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Mental Health and Addictions Program

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Taitamariki Oranga Whanaketanga


Youth Wellness Development

Mental Health and Addictions

7737.6104

Nadia Withers and Rachel Herbert

2011000181 / 2008004064

Objective:

'Creating positive changes for lifelong wellness, utilizing a holistic, multi dimensional program to facilitate a journey of healing and transformation to enable a person to live a worthwhile life of their choice while striving to reach their full potential.'

Table of Contents


About us

Addictions

Mental Health

Services

Duration

referral system

programme overview

In House Support

Transitioning back home

Models informing practice

models of intervention

References

About Us:


Studies have shown a prevalence of mental health and addiction problems amongst youth in Aotearoa, with access to primary and secondary mental health services an ongoing problem. Early intervention for emerging mental health and addiction issues such as problem drinking is necessary but lacking [1].

 We offer residential and outpatient intervention programs for youth aged between 11 and 19 years struggling with Mental Health  and/or Addiction issues. Tangata Whaiora live on-site in one of six housing facilities with 24 hour support, in a nurturing environment.



Addiction/substance misuse

Addiction occurs when a person uses a substance or engages in activity (such as gambling) seen as pleasurable but which becomes compulsive, resulting in interference in ordinary life, affecting school, work, relationships, even health. A person with an addiction or substance abuse problem may not realize they are behaving in an out of control manner.

Signs of recent use:

Sense of euphoria

heightened sense of perception - visual, auditory and taste

increased heart rate and blood pressure

red or glassy eyes

dry mouth

decreased coordination

difficulty in concentration

increased appetite

slow reaction time

paranoia

sudden change in behaviour 



Symptoms For mental Health Assessment (DSM-5)[2]

Depression 

Loss of interest and pleasure in usual activities
Persistent low, sad mood with empty feelings/hopelessness
  • Significant weight loss or gain or decrease/increase in appetite
  • Agitation and restlessness or feeling slowed down
  • fatigue or energy loss
  • feeling worthless or excessively guilty
  • unable to think or concentrate and/or indecisive
  • recurrent thoughts of death, suicidal ideation, suicide attempt, or plan to attempt suicide


  • Anxiety
  • Excessive worry or apprehension about numerous events or activities which is 
  • difficult to control, combined with any of the following:
  • Restlessness or feeling on edge
  • being easily fatigued 
  • difficulty concentrating
  • irritability
  • muscle tension
  • sleep disturbance


  • Symptoms For mental Health Assessment (DSM-5)[2] Cont.

  • Bipolar Disorder
  • Characterized by extreme highs (mania) and extreme lows (depressive episodes)
  • Mania usually includes:
  • euphoric feelings
  • feeling rested after less sleep
  • exceptionally talkative 
  • easily distracted
  • agitation and increase in goal-directed activity
  • racing thoughts
  • risky activities
  • Depressive episodes include symptoms for clinical depression as above


  • schizophrenia
  • Delusions
  • Hallucinations
  • disorganised speech (e.g. incoherence)
  • grossly disorganised or catatonic behaviour
  • diminished emotional expression

  • Services

Health and Fitness (Taha Tinana)

It has been proven that physical activity improves mental health dramatically and is essential to maintain an overall healthy well being. At Taitamariki Oranga Whanaketanga we will be offering physical activity in all forms including sports facilities, personal training services, yoga, meditation and exercise programs, swimming, boxing, martial arts and hiking experiences. Residents will be expected to participate in at least one half hour activity a day [3].

Life Skills

Having a healthy sense of self and being motivated is also an important part in maintaining a healthy well-being. At Taitamariki Oranga Whanaketanga, we are aware that some youth have not had the opportunity or have been affected by mental health in ways that may have prevented them being able to further their life skills and give them a sense of achievement. Practical skills classes will be available at Taitamariki Oranga Whanaketanga such as cooking, building, sewing, horticulture and agriculture to ensure whaiora have all the opportunities needed to succeed with their goals.

Education Services

At Taitamariki Oranga Whanaketanga In house schooling will be provided so that service users can continue with their education despite living with a mental illness. 

Whanau Support (Taha Whanau)

Whanau evenings will be hosted once a week to incorporate family and caregiver support. This will give Whaiora the chance to share their progress and talk about any struggles they may be experiencing. It also allows them to still be included in their family unit and provide a sense of belonging.

Services continued

Spiritual Support (taha Wairua)

Studies have shown that people with positive spiritual beliefs have a healthier mental health and a better response to recovery. At Taitamariki Oranga Whanaketanga we aspire to encourage whaioras spiritual growth by having in house mentors available to help guide and support clients with their spiritual needs [4]. 

Weekly Activities (Taha Hinengaro)

Our facility also incorporates out of agency experiences weekly to participate in activities such as the beach, movies, hiking trips and community involvement such as youth events, sports tournaments and noho marae. 

Whakapapa Support (Taha Whanau/Wairua)

At Taitamariki Oranga Whanaketanga we give our clients the chance to learn about their whakapapa from whatever culture they are from. This helps support Whaiora to have a healthy sense of self and identity and gather connections to their heritage. This opens up pathways for Whaiora to become involved in traditions specific to their culture for example, Waka Ama and Kapa Haka

Whanau Education (Taha Whanau/Hinengaro)

Living with a mental illness and/or addiction can take a toll, not only on the client, but also on those supporting them. At Taitamariki Oranga Whanaketanga we offer ongoing counselling, support and education for whanau/caregivers that are assisting Whaiora in everyday life. We offer this service to help raise awareness and destigmatize mental health and/or addiction issues for whaiora. This will be imperative in assisting clients as they integrate into everyday life. If whanau are given tools for supporting their young person living with mental health or addiction issues, they will be more likely to spot the warning signs of relapse, thereby being more effective in assisting them back to wellness. 


Duration
In order to establish healthy habits and a balanced well-being, we recommend a minimum of a 12 week stay in our residential Unit which includes ongoing assessments to document the clients progress and/or regression. This would determine how long a client will remain in residential care or if they are showing signs of independence and self management that could result in discharge. Once discharged, clients and their whanau are supported by their social worker and mental health professional, to transition into everyday life and prevent possible relapse.

Referral System 
At Taitamariki Oranga Whanaketanga we require a referral from an outside mental health agency working with whaiora, where the methods of treatment have not been successful in managing the clients mental health challenges thus far.
We also accept self referrals where an in-house mental health professional will assess and diagnose where appropriate, in order to put a treatment plan in place. 
Residential care will be provided to those that are experiencing mental health and/or addiction issues which are resulting in life becoming unmanageable, thereby needing additional support and intervention.  

Programme Overview

The 12 week programme structure consists of life-skills workshops, management skills workshops, reflection, group work and therapy, outings, specialised groups, counselling sessions, whanau days, and more. Each person will be assessed and given their own individual intervention programme reflecting their needs and goals. For example, utilising the Te Pou assessment model, a person presenting with depression or anxiety who has not responded to earlier levels of treatment may best be supported with a higher intensity level of therapies such as CBT, group therapy, and medication.

Management skills

5 x week for six weeks, 3 x week thereafter

The 12 week programme consists of workshops expanding on the basics of recovery, including negative and positive self-talk, triggers, addictive thinking, withdrawal, attending behaviours, ownership, the addiction cycle, and more. Having knowledge about mental health and addiction issues makes the pathway to wellness smoother, enabling whaiora to have an active role in their recovery. 

Run by psychologist and social worker.

Life Skills

Daily

Cooking, home maintenance, vehicle maintenance, time management, computer skills, self-defence, first aid, etc. While unwell, it is easy to put important life skills on the back burner, however these are imperative to building self confidence and easing integration back into society.

Run by Kaitiaki, Mental Health Support Workers

Reflection - Wairua Development

Daily

Reflect on thought/feeling/reading and how they feel affected personally. Spiritual discussion, workshops - discovering spirituality and what it means to you. This is vital to ensure the strength of the individual's wairua, encompassing that cornerstone to balance well-being. 

Run by Kaitiaki, Mental Health Support Workers




Programme continued

Complementary Programme

Daily

includes sports and fitness, art therapy, music therapy, animal therapy, yoga etc. Physical health is imperative to holistic well-being, another cornerstone of Te Whare Tapa Wha. Utilising other therapies such as art and music can encompass wairua as well, helping to create balance. 

Run by Occupational Therapist

Counselling 

Daily for first six weeks, gradually decreases as needed thereafter

One on one counselling sessions

Run by Counsellor/psychiatrist/psychologist depending on individual intervention programme

Group Therapy

Weekly

Peer support, discussion of challenges faced. Group therapy also encourages whanaungatanga, forming strong bonds between individuals, whereby people can continue to support each other even once they have left the facility. 

Run by Social worker/counsellor/mental health worker

Whanau/Family Therapy

Weekly

Opportunity for Whaiora and Whanau to discuss any challenges and how to overcome these. This is vital to allow whanau to share their stories, as well as put support in place at home and in the community.

Run by Social Worker or Psychologist


Program continued


Whanau Days

Weekly

Whaiora implement their knowledge of Manaakitanga by preparing the whanau days, including preparing meals and entertainment for their whanau and family

Community Involvement

Weekly

Trips, tournaments, festivals, other community events

Run by Mental Health Support Worker


Other educational and goal-driven activities are incorporated into each individual treatment plan, utilising a client-centred approach

In House Support


In house Kaitiaki
Placed in each home to provide 24 hour live in support, guardianship and fostering to whaiora, giving clients a sense of stability and the opportunity to build trusting and nurturing relationships.

Psychiatrist
Whaiora will have access to an in house psychiatrist to accommodate any diagnosis', medications, hospital visits and any other medical care related to mental health and addictions.

Psychologist
Psychologists are available to whaiora as part of their treatment plans to help them use evidence based methods to learn how to manage life with a mental illness, cope in stressful situations and break past the barriers that prevent a person reaching their goals.

Counselors 
Counselors will be available at Taitamariki Oranga Whanaketanga to help guide clients find methods of coping with every day life challenges, how to manage in stressful situations and assist clients with their goals such as their career or education.

Addiction specialists
Poor mental health and substance misuse have a tendency to go hand in hand. Addiction specialists will be available at Taitamariki Oranga Whanaketanga to provide the skills of  prevention, screening, intervention, and treatment for substance use and addiction. Their role will include the psychological and physical effects that substances can complicate.


In House Support Continued


Social Workers
The role of the Social worker involvement will be to follow and record progress/challenges in whaiora, change therapies to suit client needs, provide information for community support available and foster integration back into the community, including working closely with whanau. 

Occupational therapist
Occupational therapists focus on client centered,  intervention movements that promote healthy life activities and lead to productive daily routines. They help to address and overcome the barriers that may occur when living with mental illness and/or addictions. Their main role at Taitamariki Oranga Whanaketanga is to team clients up with productive activities that will add value to their life, increase independence and endorse habits that can be maintained when integrating back into the community.

Mental Health Support Workers 
Multiple support workers will be available to assist whaiora with everyday living in residential care. This may include setting up rosters for cleaning and cooking, aid in getting around the centre, and providing emotional and mediation support for any in house challenges between clients.

transitioning back home

On completion of the 12 week residential programme, transitioning back into "normal" life takes place. 

A level of wellness and balance deemed sufficient by the multi-disciplinary team at Taitamariki Oranga Whanaketanga will need to be achieved before transitioning can begin, as well as suitable whanau support within the home.

During the first three months of leaving residential care, a social worker will make a minimum of one visit per week, with counselling sessions taking place twice a week with a mental health professional (mental health professional is dependent on each individual intervention programme). This ongoing support will be provided by Taitamariki Oranga Whanaketanga. 

After the first three months, if deemed appropriate by mental health professionals, counselling sessions will decrease to weekly, and continue as such until they are no longer needed, a decision to be made with input from the client and their whanau. Ideally, Whaiora will continue with mental health support for a minimum of 12 months after leaving the residential programme. They are able to access further support, or return to the residential programme, as and if needed. Social worker visits will continue weekly until no longer needed. 

Taitamariki Oranga Whanaketanga will work collaboratively with Whaiora to ensure their wellness plan is followed, and encourage clients to continue with their plan once leaving the residential programme. This includes incorporating both physical and spiritual health while utilising whanau and professional support to live a well-balanced life with a healthy state of mind.


Models informing practice 

Te Pou

Te Pou is a stepped care assessment tool used to match different therapies and intensities to the needs of the client. It has five tiers of service that do not need to be accessed in any specific order. It takes factors into consideration such as cultural issues, levels of distress, presenting problems, mental health and addiction assessments, strengths, choices and goals to inform therapy practice. It also provides assessment forms adapted by Te Whare Tapa Wha and the Maihana model as a way to document clients individual goals, beliefs, values, whanau support and overall wellbeing. Te Pou provide Therapy Review forms to help determine if the therapy needs to be changed or adapted to suit the clients ever changing needs [5].




Models Informing Practice cont.

Te Whare Tapa Wha

At Taitamariki Oranga Whanaketanga we believe in a holistic, balanced approach to well-being, therefore Te Whare Tapa Wha is utilized as an assessment tool. 

Te Whare Tapa Wha is a Maori Health model developed by Professor Mason Durie in 1982, depicting four cornerstones to health and well-being. If any of these cornerstones should become damaged or unwell, the whole person can become unbalanced or unwell [6].

The areas of well-being fundamental to good health are Taha Tinana (physical health), Taha Hinengaro (mental health), Taha Wairua (spiritual health), and (Taha Whanau representing the importance of whanau support). Combined, each of these represents a person's need to grow and develop while being sustained in mind, body and spirit, with the support of those around them. We believe that having these areas well balanced is essential, therefore prioritising the balance between them will give us a better understanding and ability to respond in ways that encompasses the person as a whole [7].




Models Informing Practice cont.

Strength Based

The strengths-based approach encourages the support worker to ignore stereotypes and see the capabilities of whaiora to move towards a promising future. We believe that promoting inherent strengths can help ensure the person's full potential to live a promising life can be reached. Every person and community has strengths that can be utilised to help whaiora achieve their goals and make positive changes. Difficult life events may be harmful however opportunity and positive challenges may also arise, therefore it is imperative to promote those strengths in order to encourage whaiora to have a healthy and positive sense of self to help achieve their goals [8]. 

At Taitamariki Oranga Whanaketanga we believe that having a healthy sense of self, believing in your abilities, and breaking down the negative stigma attached to mental health, can bring about improvements and positive well-being in every day life. Every person has strengths, however life events can prevent them from seeing these at times. While working with whaiora we will endeavour to bring their strengths to the forefront - whether it is an inherent strength such as sporting ability, artistic talent, musical prowess, or even an empathetic nature; or a strength represented by something else such as strong whanau or community support. 

Models of Intervention

Cognitive Behavioural Therapy (CBT)

CBT focuses on making connections between thoughts, feelings with a persons behavior and actions.  It works as a combination of how you think and how that results in the way you behave. CBT aims to help a person become aware of their thoughts and behavior processes and work on alternative ways of thinking and behaving in order to reduce psychological distress and learn positive coping strategies to deal with stressful situations. CBT suggests behaviour is learned through observation of others, therefore when applied to substance use, for example, CBT proposes individuals first learn about the use of drugs or alcohol by observing those around them using them. Therefore, CBT assesses addictive behaviours as learned habits shaped by learning, thereby maintaining habits can be replaced through developing behavioural skills and cognitive strategies [9]. 

We will deliver CBT in both individual and group sessions. The individual sessions will be tailored to the specific needs of whaiora, while the group sessions will allow for further sharing of strategies and ideas with immediate implementation of new skills.


Mindfulness-based Cognitive Therapy (MBCT)

Mindfulness-based Cognitive Therapy was originally developed as an approach to avoid relapse and prevent the onset of depression. It works as a combination of mindfulness techniques and cognitive therapy to help break the negative thought processes that can become a habit when experiencing depression. It teaches clients to be aware of their own triggers and warning signs when experiencing a possible relapse, to enable them to seek treatment earlier. Mindfulness focuses on awareness of thoughts and feelings, being accepting of them without reacting or attaching to them. This decentering process promotes disconnecting from self-criticism and distress that can emerge when reacting to negative thought patterns [10]. 

MBCT is utilised as an intervention with the goal of interrupting automatic thought processes and coach whaiora to notice when these are taking place, and focus on acceptance and reflection instead of reaction. Studies show that MBCT results in improved mindfulness, suggesting an increase in self awareness and acceptance, as well as a decrease in self-judgement and reaction.



Models of Intervention cont.


Dialectical Behaviour therapy (DBT)

DBT Therapy is a highly effective treatment for individuals with intense emotions, disrupted relationships, and impulsive behaviors. It is proven to help clients experiencing suicidal thoughts or difficulty managing emotions. DBT helps to reduce anxiety in stressful situations and shift negative thinking into positive behaviors.  Increased self compassion, acceptance and a sense of self worth and purpose in individuals is a goal worked towards during DBT sessions and is part of the recovery process [11]. 


Models of Intervention cont.

Individual Family Therapy

We believe our whaiora are better understood as part of their whanau than in isolation from one another. At Taitamariki Oranga Whanaketanga we believe in restoration and preservation of whanau involvement in the clients life. Individual Family therapy will be available to whaiora at least once a week to address any family wide conflicts or stresses that may distort a healthy family dynamic.  This is also an opportunity for whaiora to discuss challenges they may be experiencing and for whanau to ascertain and understand what life is like for the family member living with a mental illness. Family may also use this time to talk about challenges they experience as a whanau supporting someone living with a mental illness and/or addiction. 


Group Therapy

Group Therapy will take place at Taitamariki Oranga Whanaketanga where one or more therapists will work with a group of around seven individuals. This is a process that works well for individuals to form trust and communicate openly about the challenges they may be facing with one another. This also helps whaiora practice listening and empathy skills while having the opportunity to share their thoughts and feelings, which in turn allows clients to feel well supported, both by professionals and peers. This assists the individual to not feel like they are facing their challenges alone.



References


  1. Child and Youth Mental Health And Addiction; 2011; NZ Mental Health Commission; 978-0-478-29231-2
  2. Diagnostic And Statistical Manual of Mental Disorders Fifth Edition; Arlington, VA, American Psychiatric Association; 2013; 978-0-89042-555-8
  3. Physical Activity for Mental Well Being; Mental Health Foundation NZ; 2017;https://www.health.govt.nz/system/files/documents/topic_sheets/physical-activity-mental-wellbeing-english_0.pdf
  4. The Impact of Spirituality on Mental Health; Mental Health Foundation UK; 2017; https://www.mentalhealth.org.uk/sites/default/files/impact-spirituality.pdf
  5. Te Pou - Let's Get Talking; 2017;                                                                   https://www.tepou.co.nz/uploads/files/resource-assets/lets-get-talking-assessment.pdf 
  6. Te Whare Tapa Wha; Ministry of Health; 2017; http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha
  7. Oranga Tamariki Practice Centre - Ministry of Social Development; 2017; https://practice.mvcot.govt.nz/policy/assessment-and-decision-making/resources/working-with-maori.html 
  8. Applying Social Work Theories and Methods; B. Teater; 2014; 978-0-33524-763-9
  9. Evidence-Based Addiction Treatment; P.M. Miller; 2009; 978-0-12-374348-0
  10. Mindfulness-Based Cognitive Therapy Vs. Cognitive Behaviour Therapy as a Treatment for Non-Melancholic Depression - Journal of Affective Disorders; Manicavasgar, Parker, Perich; 2011; 130
  11. Dialectical Behavior Therapy in a nutshell, The California Psychologist; Linehan & Dimeff; 2001; 34, 10-13