Case management "absolutely" saves lives
By Susie Hill
Improving the care of people who make non-fatal suicide attempts is one of the seven goals in the New Zealand Suicide Prevention Action Plan. One of the outcomes is to improve collaboration between mental health service providers, consumers and family advisors.
Peter Gillan is an example of that collaboration in action. He has helped support nearly 500 people in his three years as primary mental health co-ordinator in South Auckland (Manukau city, pictured above) Not one has died by suicide.
“I wouldn’t say I have directly stopped someone from suicide, but we haven’t had anyone complete suicide yet,” Peter is quick to add.
He describes his role as unique, working as a vital go-between: a link for patients moving between secondary and primary mental health services.
A former emergency department nurse, Peter advocates on behalf of people with mental illness. The process, he says, is pretty simple.
“If a patient overdoses, our doctors get sent an automatic discharge summary from emergency departments. They forward me this to follow up and check to see if the patient is seen by either secondary mental health services or is coming in to have a review by our GPs.
“Or, if the patient gets referred to acute mental health services, I will contact triage and just find out the plan and step back while acute services manages the patient. Then, when the patient gets discharged back to the GP, I assist in the case management and support service role.”
Peter case manages mild to moderate mental illness, in conjunction with GPs, mostly handling patients experiencing depression or bipolar disorder.
“If they have major Illness, they stay in the mental health service. I will occasionally throw myself in there if I know them, but [if I don’t know them] the last thing they need is yet another person complicating things.”
Peter feels his role supports his GPs, who commonly have patients present in a puddle of tears, but who don’t make the criteria for free mental health service.
“So I case manage: I sort, listen, plan, review… I’m like a box in the middle.”
He says it is very much about working proactively.“If JK can do it, so can I.”
“I will often ring the mental health crisis team and ask ‘do you know about this person?’ or ‘have you seen this patient yet?’. It’s all very much a wrap-around, integrated service approach.”
Peter works across two different primary health care services in South Auckland. Both are quite different, but the issues are not very different for people who report not being well.
“It comes down to very low income, poor housing, illicit drug and alcohol usage. When all of the above issues combine, things start to get complicated,” he says. “Nothing is ever impossible, it just takes time, and gaining patient trust.”
When people become unwell, he refers them back to mental health services, but it works both ways.
“An acute mental health service will contact me, and discharge patients back to the primary health service knowing they are better supported by the service we are able to provide.”
Mental illness has “come out of the closet” over the past ten years, Peter believes, thanks to the work of service providers and others willing to share their stories publicly, many of these through the Like Minds, Like Mine programme.
He makes special note of former All Black John Kirwan’s campaign to help those with depression.
“He is a truly inspirational man; I would personally like to shake his hand one day. It’s about keeping it simple and showing you care for what’s going on in patients' lives.”
Peter says there is only a handful of primary care mental health coordinators across Auckland. His role is indirectly funded by Counties Manukau DHB, which has committed to the role “in earnest and gone places with it”, and is bravely funded by the clinics he works for.
“I have been doing this for three years and it is fundamentally working; I believe it has absolutely saved lives,” Peter says.
Liaison role gives support like no other
Paul Butler is one of Peter Gillan’s clients. He is a man who knows the “black demon” that is chronic pain and depression. He has experienced both at the same time and describes it as a different beast from experiencing one or the other.
“You walk a fine line, and it’s a horrible place,” he says.
Paul, who has had mental health issues all his life, developed pain problems in the 90s following 15 operations to rebuild his right leg.
“At one stage of my life I couldn’t get out of bed, I lost my sense of taste and stopped showering. I was on ACC and under the mental health service, I was on meds for depression and pain, and in and out of some pretty dark places,” he recalls.
For three years, Paul tried his best to get back to work but his physical and mental frailty was not understood by his employers and none of the jobs worked out. It was a recipe for disaster.Over those three years, Paul had three self-described “meltdowns” and had to rely on a sickness benefit.
Things came to a head for Paul last December. “I had an utter breakdown… I had had enough and came close to checking out.”
He attended a South Auckland clinic that sent him straight to a counseling programme, a mental health provider and primary mental health coordinator Peter Gillan.
“If JK can do it, so can I.”
“Peter was just brilliant. He’s a very straight talker and he’s been there done that so he knew where I was coming from.
“I have had years of counseling but Peter really listens and gives you knowledge that works. I read a lot and I listen and I know what works… and Peter works.
“He doesn’t give you sympathy, he didn’t lecture, he is not patronising, there are no undertones or innuendo. He just says it like it is: “Where are you today and where are you going to be tomorrow?”
“When I was wanting to check out I rang him up, he didn’t panic, he just said “ok how are you? I think we need to talk’. So I popped in and I never felt dumb and stupid [for doing what I did], I felt normal and he gave me realistic scenarios.”
Peter sees Paul once or twice a week now, and has written a letter for Paul to return to work through a WINZ programme where he builds his hours up gradually and no secret is made of his difficulties.
Without Peter’s liaison role, Paul believes he wouldn’t get that sort of support.
“I can’t admire him enough for the load he takes off my GP and I have really moved forward a lot because of that.”
Paul says the role takes a massive load off other providers who either haven’t got the time or don’t want to hear about or deal with his problems.
“Peter puts clarity around things and doesn’t go into theory.. I like that.”
That sounds a lot like the John Kirwan messages that Paul also truly values. “I have taken tools out of that book to stop me falling into black holes,” he says.
One of those tools is to be up front about his mental unwellness and use his own name in this article.
“If JK can do it, so can I.”
