The Continuing Care Program is a multidisciplinary team providing case management for clients with a severe mental illness. This includes people with schizophrenia and other psychotic disorders, mood disorders, severe anxiety disorders and personality disorders (generally borderline personality disorders) and dual diagnosis.

The teams at Murnong Clinic and Chandler House (adult) are made up of

• Psychiatric Nurses
• Psychologists
• Social Workers
• Occupational Therapists
• Consultant Psychiatrists
• Psychiatric Registrars/medical Officers
• Administration Staff

A rostered duty worker receives referrals for non-urgent assessments and case management. They are received from Outer East triage and other mental health services where a client is currently case managed and needs to be transferred.

The duty worker will present the case to the multidisciplinary team at the daily intake meeting at 9am the following day. (Monday - Friday)

All referrals for non-urgent assessment or for case management from other agencies are received by the psychiatric triage service.

If a referral is appropriate a case manager is generally allocated at the daily intake meeting. At the intake meeting the multidisciplinary team may decide that a prospective client should be given an appointment for case management assessment depending on the needs of the individual.

Case Management

Case management should be considered when the needs of the client cannot be met by other more generic services and where assertive follow up made be required. Clients on a CTO and those who are on clozapine will generally receive automatic case management. Case management does not mean that you have a case manager for life. Case managers and medical staff (treating team) continually review their role in the care of clients. It is a fluid process where it is anticipated that clients will move through the service once the identified needs have been met. It is a process by which the client is moved from a point of entry into the service, to a point of exit.

In general, the process of case management can be more or less effective depending on a number of factors including:

• The development of rapport between the client and the case manager
• Willingness of the client to engage in the process
• The ability of the service to provide supports
• Availability of other ancillary services within the system and within the community
• Family supports
• The client’s socio-economic circumstances

Discharge from the continuing care service will occur once the targeted goals have been achieved.

Why refer for case management?

It is a needs identification process. A client with a mental illness does not constitute someone requiring case management. Issues such as symptom instability that is not indicative of an acute crisis, poor compliance with medication, or a mental illness that may effect the individual’s ability to participate in social, vocational or other similar characteristics of daily living, are issues which may benefit from case management.

Two example reasons to refer for case management…

Client has a mental illness impacting on their ability to function in aspects of their life. Case management may be particularly helpful in establishing or promoting links with rehabilitative options.

The symptoms of the illness experienced by the client remain of continuing concern, i.e. symptom instability, medication compliance, etc., but in the absence of acute client risk concerns.

Contact

Monday - Friday   9am - 5pm

Via Triage Service - Phone 1300 721 927 or 9847 4700