Anna experiences severe impacts of schizophrenia and is highly cautious about interacting with people and accepting help. She was unaware of how hazardous her circumstances were. For example, Anna was pathologically paranoid about accessing and accepting financial support from Centrelink resulting in her being without an income for years and becoming severely malnourished. Her mental illness also caused extreme isolation and long-term homelessness. The most concerning factors were that she had no awareness of or insight into her illness and its impacts. The support she received from CNB needed to strike the right balance of urgency and gentleness in approach. Trust was established by working with Anna over a significant period of time, as she was initially resistant to any support and didn’t believe she required assistance.
Her mental illness did not meet the criteria for involuntary admission to the hospital for assessment, but being so dangerously malnourished led to a blackout, fall, head injury and hospitalisation. The hospital called the manager at the backpackers’ accommodation (where Anna fell), who knew she was in contact with the homeless outreach workers at CNB. We were then able to connect with the treating team. The clinicians had identified that Anna was affected by mental illness. However, the additional observations provided by CNB about how this impacted her out in the community helped them escalate care for her both during her hospital admission and upon discharge.
Multiple visits by us to Anna in the hospital helped with building the critical levels of trust that resulted in her engagement with applying for a Centrelink payment. This was the tipping point. Once she entrusted CNB to help with Centrelink, she also accepted our offer to apply for a community housing property where she now safely resides, with support from the Northern Beaches Community Mental Health Service.
CNB continues to play a critical role in Anna’s care, given we were the first people she was able to trust to help her. The next challenge was to facilitate her recognising her need for ongoing support through the NDIS. This process was complicated because Anna does not understand that she has a psychosocial disability. However, the services provided under the NDIS are critical to her ability to sustain her tenancy. Through our advocacy, Anna was granted the highest amount available in her NDIS support package (equivalent to paying for full-time care). She now requires further assistance from our team to facilitate implementing this support package and engaging care providers (CNB does not receive any of these funds).
The complexity of Anna’s circumstances and our involvement demonstrates the out-of-scope support (beyond dealing with the presenting issue of homelessness) that was necessary from CNB. Without it, she would still be homeless, at great risk and missing out on vital care to which she is entitled. People as vulnerable and unwell as Anna require continuity of care.
We are committed to respecting and promoting our clients’ self-determination and dignity of choice. The practical application of these essential principles is not always straightforward. Individuals like Anna, who are significantly impacted by mental illness, but are not deemed to be sufficiently at risk to require involuntary mental health care, can easily fall through the cracks because access to critical support is contingent on their capacity or willingness to engage with service providers. We invest significant time with such clients to empower them to get to a place of voluntarily accepting the help they need and empowering them to make informed choices about their future.
