NSW Family Focused Recovery Framework 2020-2025 - NSW
NSW Family FocusedRecovery Framework2020-2025A framework for NSW Health services
NSW Ministry of Health1 Reserve RoadSt Leonards NSW 2065Tel. (02) 9391 9000Fax. (02) 9391 9101TTY. (02) 9391 9900www.health.nsw.gov.auProduced by: Mental Health BranchThis work is copyright. It may be reproduced in wholeor in part for study or training purposes subject to theinclusion of an acknowledgement of the source. It may notbe reproduced for commercial usage or sale. Reproductionfor purposes other than those indicated above requireswritten permission from the NSW Ministry of Health. NSW Ministry of Health 2020SHPN (MH) 200518ISBN 978-1-76081-466-3 (print)ISBN 978-1-76081-467-0 (online)Further copies of this document can be downloaded fromthe NSW Health website www.health.nsw.gov.auOctober 2020
NSW HealthContentsForeword4Overview8The case for early intervention15Family focused recovery practice24Family focused recovery practice in Child and Adolescent Mental Health Services (CAMHS)and Youth Mental Health Services (YMHS)29Family focused recovery practice in Perinatal and Infant Mental Health Services (PIMHS)33Family focused recovery practice in Adult Mental Health Services (AMHS)36Goal 1: Holistic, person-centred care40Goal 2: Safe, high quality care42Goal 3: Connected care44References46Appendix 1: Mental Health Rights and Responsibilities50Appendix 2: Glossary and Acronyms51Appendix 3: Families where a Parent has a Mental Illness (FaPMI) Practice Standards52Appendix 4: Policy context55List of tablesTable 1: The Framework at a glance12Table 2: Snapshot of mental health issues for children, young people and parents18Table 3: Goal 1 – Holistic, person-centred care40Table 4: Goal 2 – Safe, high quality care42Table 5: Goal 3 – Connected care44List of figuresFigure 1: The Family Model263
NSW Family Focused Recovery Framework 2020-2025ForewordTara’s story demonstrates the significant difference that NSW Health workers can make toa person’s recovery journey and their family’s positive experiences of care.Tara’s story“Family recovery and resilience was essential to my recovery and having thatacknowledged and addressed was the only way for me to work my way back to recovery.”Parenting with Obsessive Compulsive DisorderSix weeks in hospitalI was the mother who was always trying to be theperfectionist and bake cupcakes for the class anddress-up for Book Week and hat parades for mychildren. I also have a lived experience of mentalhealth issues. I’ve had Obsessive Compulsive Disorder(OCD) issues and anxiety issues since I was a teenagerand for the most part I’ve dealt with it myself.The first day I tried to go to hospital I couldn’tbecause my routines weren’t right. The second day,after starting at 10am, I finally made it to Admissionsat 2pm. My husband had to go because it was schoolpick-up time. So there I was, alone, defeated bymy OCD and anxiety and unable to function. I wasassessed and stayed as an inpatient for six weeks.Worries about losing my childrenLosing my parenting roleIn 2013 my father died and I lost the only remainingfamily member from my family of origin. The OCDand anxiety began to invade my life to the pointwhere I needed to see my GP. The fear of the stigmaof mental health and the albeit irrational worry thatI may lose custody of my children stopped me fromcontinuing to seek help. I worried that if I didn’t do it‘just right’.something would happen to my children.My anxiety to fulfil my parental role as perfectly aspossible contributed to my condition. My self-esteemwas very low and my whole sense of identity and selfworth centred on me being there for my family to thebest that I could. When I was admitted to hospital, Ifelt that was taken away from me and I had even lesscontrol. My anxiety was increasing, my mental statedecreasing, all of which was exacerbated when I wasin hospital by this sense of losing my parental role. Myfamily did not know how to deal with a mental healthadmission which added to our stress.Early in 2015, I was having panic attacks. I becameobsessed with exact routines. I just kept gettingworse. I was barely eating dry crackers and I spenthours trying to get things ‘just right’, so as to protectmy family. I thought if I didn’t do everything ‘justright’. something would happen to my children.My GP put me on medication but I started to feelworse. I wasn’t sure if it was due to the medication butas my GP had gone on leave I didn’t know where toturn. I got to the point that I begged my husband toget me help, but we didn’t know where to get it from.The only help I could find was the mental health line.They said I should go to the local psychiatric hospitalas there’s always a local psychiatrist on duty who canreview the medication I was taking.4My anxiety to fulfil myparental role as perfectlyas possible contributedto my condition.
NSW HealthMy family needed helpAdd to that - my family had no rule book on howto cope. There was stress placed on my family, andparticularly on my husband, who did not have a clearprocedure for what to do when visiting with children,let alone how to explain a mental health admission tothem. A major stressor was that our youngest childdidn’t know about my mental health issues, and wedidn’t want him to know. They knew I was in hospitaland they visited me but they were not told specificdetails.Being separated from my childrenThis was also the first time I’d been separated frommy youngest child. He had special dietary needsthat I was always in charge of. How would he havehis dietary needs met? How would he get to school?How would he sleep overnight? How would he copewithout me?How health workers made a differenceThey acknowledged my role as a parent and talkedwith me about my family and any concerns I hadHaving a clinician who was understanding andacknowledged me as a parent helped me to expressmy fears and I really felt she wanted to help us.So from that point on I was happy and confidentto involve my son and husband in conversationsregarding mental illness and plan supports for eachof us.They helped us use the family friendly visiting areaWhilst I was in the hospital we were fortunate enoughto have access to the family room - a dedicated areafor families to feel safe, comfortable, to connectand spend time together. Given that this was ourfirst separation it was important for us to have asafe, child-friendly visiting space on a locked mentalhealth unit where we could feel comfortable and haveregular contact.They gave us resources, information and helped usdevelop a family care planWe as parents were given resources that includedcarer information and together we developed afamily plan. Talking gave us answers, helped usto understand, and gave us hope and alleviatedconfusion and fears. It helped us to get past thestigma of mental health.They valued our own knowledge about what weneededWe were actually listened to and our insight into ourown family was valued. It helped us to be able tocommunicate with each other better.5
NSW Family Focused Recovery Framework 2020-2025Jessica’s story - a story of a young carerBecoming a young carerI was recognised as being part of the processI always like to preface my story with, my dadis a really great parent. He has been loving andsupportive my whole life.We had a lot of conversations, within groups, aboutwhat was going on for us, and what we could do. Itwas very age-appropriate. I was recognised as beingpart of the process, I was considered a factor in it,more than just collateral information, which I reallyappreciated. It is really difficult, when a medicalprofessional is sitting there telling you what to do,versus when you’re with that person 24/7.I’m 23 years old, I live in a small rural community, thesame community I grew up in. I grew up on a farmwith my parents and my brother. When I was aboutseven or eight, the drought started to affect ourfamily business, and affect our whole community.During that time, my father developed depression,which was a very confusing time for the whole family.He also had a workplace accident around that time,which really exacerbated that situation, from thatexperience, I became a young carer.Acknowledging there was a problem and gettinghelpI started noticing he was withdrawing from doingthings with us, we used to go on bike rides aroundthe farm, he used to help me with my horses, he wasfinding those interactions a lot more difficult, and hewas very unmotivated.In my mind, I was thinking that I’d done somethingwrong. But my mum was the one that recognisedthat it was a problem within himself, that he neededto address.The first step was for him to go and speak to his GP.Saying it out loud, and addressing it with people.From there, he became involved with some mentalhealth services, where he saw a psychologist, foundsome medication that worked for him.It definitely wasn’t a complete upward trajectoryfrom there. There was a lot of really tough times,especially in the beginning of the medication, tryingto find what was the best fit for him. In that period,he voiced that he wanted to end his own life, whichwas very confronting. I was present for that.The importance of seeking helpWithout seeking help, I believe that my father maynot have lived. He was in a very, very difficult place,where he did want to end his own life. So, it’s madethe world of difference to our family. I’ve got to growup with my dad, my mums got to have her husband,but it’s also impacted us, in the sense that, he hasbecome well. He’s been able to make strides in hiscareer, and be a supportive father, and give back tothe community. We’ve been able to see someone,really, rise up against that adversity, and say, “I’mman enough to recognise that I need help, to seekthat help, and then to grow from that, and helpothers.” And, he’s been a really big example for allof us. So, yeah, not just having him, but then to seehim flourish, as well, on top of that, has been a reallygreat experience.It is very difficult, but we do have a really goodrelationship now. I suppose, that’s part of that familyfocused recovery, those relationships don’t have tobe permanently damaged, and early intervention canmaybe stop some of those bridges from burning.AcknowledgementThe NSW Ministry of Health would like thank Taraand Jessica for allowing their true stories to beshared to help those reading the NSW Health FamilyFocused Recovery Framework 2020-2025. Thestories highlight the positive impact services makefor parents with lived experience of mental healthissues and their children and families.The first step was for him to go andspeak to his GP. Saying it out loud,and addressing it with people.6
TheFramework7
NSW Family Focused Recovery Framework 2020-2025OverviewThis Framework replacesthe NSW Children of Parentswith a Mental Illness (COPMI)Framework for MentalHealth Services 2010-2015(PD2010 037).ScopeVisionOver the past decade change to incorporate familyand parent focused practice has occurred but is yetto become fully embedded into mental health servicesin NSW.All members of families where parents live withmental health issues are safe, well and supported.This Framework builds on ‘COPMI’ learning to dateand provides a fresh way forward to guide servicesin improving support to families where a parent liveswith mental health issues and has dependent childrenthrough implementing a family focused approach.ObjectivesAn overview of the Framework is presented in Table 1– the Framework at a Glance.It is acknowledged that people have many and oftenmultiple interpersonal dependences and that theserelationships may be of great personal significance toeach person. Whilst the family focused nature of thisframework relates to parents and dependent children,the overarching importance of all relationships isrecognised, including diverse caring relationships.To improve outcomes for families impactedby parental mental health issues, theFramework outlines three objectives formental health services. These are to:Purpose3. Coordinate treatment and supportFamily focused recovery practice is sometimes notwell understood. This Framework explains familyfocused recovery practice, outlines the underpinningprinciples and describes how a person-centred andfamily focused approach can be implemented.Actions in the Framework are designed to improveoutcomes in the immediate and longer term forinfants, children, young people, parents/carers andfamilies through expanding the family focusedaspect of person-centred assessment, treatmentand support.81. Embed a family focused approach2. Deliver evidence informed interventionsto meet the needs of familiesImplementation of the Mental Health Statementof Rights and Responsibilities 2012, and the NSWHealth CORE values underpin family focused recoverypractice (Appendix 1).
NSW HealthVisionAll members of familieswhere parents live withmental health issues aresafe, well and supported.Strategic alignmentThe person-centred and family focused preventionand early intervention approach promoted in thisFramework embeds the strategic directions ofNSW Health’s The First 2000 Days Framework andIntegrated Prevention and Response to Violence,Abuse and Neglect Framework.This Framework is also an action under theNSW Strategic Framework and WorkforcePlan for Mental Health 2018-2022:Objective Six: Intervene early for childrenand young people and guides action inline with the three goals of the StrategicFramework and Workforce Plan which are:This Framework promotes best outcomes forvulnerable children and families in line withrecommendations of NSW Ombudsman BiennialReport of the deaths of children in NSW 2016 and2017 (June 2019) and the NSW Forecasting FutureOutcomes Stronger Investment Unit (2018 InsightsReport).1 The Insights report identifies two vulnerablegroups prioritised for investment under the NSWGovernment Their Futures Matter (TFM) Reform:1. Holistic person-centred care ulnerable children 0-5 years (includes childrenVwith parents who have mental health issues as arisk factor) hildren and young people affected by mentalCillness (their own mental health issues or parentalmental health issues).2. Safe, high quality care3. Connected careA strong emphasis of this framework is aboutintegrating care for vulnerable and at-risk familieswho often have complex health and social needs.Implementing this Framework therefore supportsthe vision of the NSW Health Strategic Frameworkfor Integrating Care.This Framework is aligned with the National ActionPlan for the Health of Children and Young People2020-2030, which prioritises support for parenting,parental mental health and prevention and earlyintervention for children, with a particular focus onthe first 2000 days.9
NSW Family Focused Recovery Framework 2020-2025AudiencePrinciplesThis Framework guides the work of NSW Healthservices that provide clinical and non-clinical servicesimpacting the mental health and wellbeing of families.The principles underpinning the Framework are:This Framework will directly inform the work of thefollowing clinical services: erinatal and Infant Mental Health ServicesP(PIMHS) hild and Adolescent Mental Health ServicesC(CAMHS) Youth Mental Health Services (YMHS), and Adult Mental Health Services (AMHS)It also calls on Mental Health and general healthservices to develop coordinated and integrated careprocesses including through: i ntervening early for infants, children and youngpeople living in families where a parent hasmental health issues can positively impact theirhealth, wellbeing and life outcomes ental health and wellbeing outcomes formparents, children and family members areinterrelated and can be interdependent ffering parents with mental health issues supportoin their parenting role can improve their personalrecovery as well as deliver prevention and earlyintervention benefits to their children r ecovery involves a social process occurringthrough relationships, particularly those of family onnection to country and culture play a crucialcrole in recovery and wellbeing s ervices play a critical role in improving outcomesfor children, parents and families s afety and risk, including child abuse and neglectand domestic and family violence (DFV), areprimary considerations requiring a sensitive butproactive approach Maternity Services Paediatrics Child and Family Health Services Youth Health Emergency Departments Alcohol and Other Drug Services eneral medical and psychosocial/social supportGservices including specialty clinics for childrenand young people and f amily-focused care recognises and respects thepivotal role of the family and the uniqueness ofeach consumer and family group Violence, Abuse and Neglect (VAN) Services. s ervices apply evidence based and traumainformed practice that involves recovery oriented,person-centred, family focused and culturally anddevelopmentally appropriate care i nter-agency and cross-sector communication,engagement, collaboration and partnership areessential to meet the needs of various familymembers s ervices use a co-design approach including peoplewith mental health issues, families and carers whendeveloping, planning, delivering and evaluatingfamily focused mental health services.2, 3Non-clinical services may for example providemanagement and oversight, develop policy, guidanceand/or education and training materials.Recovery involves a social process occurringthrough relationships, particularly those of family.10
NSW HealthImplementationA high-quality service that incorporates a familyfocused recovery approach is one where:Making family focused recovery a reality raisespractical, professional and organisational challengesfor services, but if we wish to value the family life ofclients it is incumbent on services to help meet theneeds of parents with mental health problems andtheir families. hildren and young people flourish despite theirCown or their parents’ mental illness arents get the support they need to cope andPparent well despite their own or their children’smental illness ental health services have a stronger familyMfocus I ndividuals and families increase control overtheir own mental health.The Framework includes a set of actions. The keytask for all services is to decide which actions tofocus on depending on local needs and formulate animplementation plan accordingly.Everyone who works in the health service has a partto play. This will vary depending on your role, but weshare overall responsibility. Substantial change canbe achieved, albeit requiring significant dedication,commitment and determination from those involved.The indicators of success listed here can be used byservices to assess impact locally and in evaluatingthe impact of the framework overall.Everyone whoworks in the healthservice has a part to play.11
Framework at a GlanceThe goals, objectives and framework scope are outlined in Table 1, the ‘Framework at a Glance’. The objectives willbe achieved through embedding the priority actions outlined in Tables 3, 4 and 5.Table 1: The Framework at a glanceVisionAll members of families where parents live with mental health issuesand have dependent children are safe, well and supportedGoalsHolistic,person-centred careObjectivesSafe, highquality careConnectedcareEmbed a family focusedapproachDeliver evidence basedinterventions to meetthe needs of familiesCoordinate treatmentand supportPopulationsLocationsService providers Pregnant women andpartners and parentswith mental health issues Hospitals Mental Healthincluding PIMHS,CAMHS, YMHSand AMHS Children of parents withmental health issues Community includingcommunity healthsettings Schools and TAFE People with increasedvulnerabilities* Maternity, Paediatrics,Child and FamilyHealth Youth HealthScope EmergencyDepartments Alcohol and OtherDrug Services General medical andpsychosocial/socialsupport services Violence, Abuseand Neglect (VAN)servicesActionAreas Service Planning andDevelopment Quality
Appendix 1: Mental Health Rights and Responsibilities 50 Appendix 2: Glossary and Acronyms 51 Appendix 3: Families where a Parent has a Mental Illness (FaPMI) Practice Standards 52 Appendix 4: Policy context 55 List of tables Table 1: The Framework at a glance 12 Table 2: Snapshot of mental health
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