Articles, Blog

4. Interviewing Clients with Mental Illness

December 11, 2019

First, I think it’s important to remember that as lawyers, we aren’t medical specialists, we aren’t… we don’t have expertise in mental health, and we shouldn’t expect ourselves to… appreciate, or… or have a thorough or detailed understanding of different diagnoses and the different medications, of different symptoms that individuals might experience if they have a mental illness. And certainly, we shouldn’t expect… consider ourselves not fully equipped or trained to assist an individual just because we don’t have a thorough understanding of the different types of mental illness; for example, a general understanding is, more than enough is generally appropriate to assist an individual and a general understanding of… how mental illness can impact on individual, the fact that different individuals can experience mental illness in different ways hence, that mental illness and medication can fluctuate quite significantly over time as well. Second is, I think it’s also important, very important to remember to treat the individual not as, an individual as a mentally-ill person, but rather, as any other individual who may be experiencing symptoms of a mental illness that are beyond of their control. It’s important not to consider or to view the individual, or anything that they’re saying through the lens of mental illness. It’s also important of course to be conscious of capacity issues so, the lawyer should be remembering that a mental illness might impact on individuals’ capacity to make certain decisions or, to give instructions about certain matters so, it’s important for the lawyer to remember their fundamental ethical duties and of course, start from the assumption that the individual does have capacity. Lawyer should of course, also… remember that they can and should, take steps to maximize the individuals’ capacity. when assisting the individual. There are a lot of factors that can be taken in into account when considering capacity issues and these are outlined in more detail; for example, in the… Queensland Handbook for Practitioners on Legal Capacity. Of course, the Queensland laws are these ethics and they can also provide guidance on these matters. In setting aside time to interview the client, it’s important that, that is a real time also, that realizing it might take more than one interview of certain head other lawyers who work regularly say look, it need to set up say about two-and-a-half times the amount of time you would ordinarily expect. It might… if, you feel that you’re going around in circles it’s better to stop the interview even early and and reschedule for another day rather than be frustrated with your client because that is so counterproductive and we’ll build a barrier between you and your client that shouldn’t exist. You are asking very neutral open-ended questions today, you seem… very… anxious about talking about that or noticed that you’re not very clear you your answers just wondering if there’s a better time that we can make to talk but sometimes people can get quite distressed quite readily and as lawyers, we may not have the skills to… to inquire terribly much about…those issues so you better off a bit a lot of inquiries is someone else who I can call you know, seems to getting distressed at the moment to assist you, or to assist us in… what we have to achieve today. what we have to achieve today. Someone who the person trusts, could be a family member, or a friend or it could be a professional. Medications and side effects are very individual. To what affects one person you might have had previous client who had bad reaction to a particular medication may not apply to the next person that you see so you can’t carry over learnings from… from one client to the other. So, it’s important to… to just ask… straightforward and have a… not have a negative or an overly positive view of medications just neutral fact-finding… questions. What are they on? What medications? What’s the name? How did they take that medication? because I can very considerately and give you a lot of information for example, are either an injection or depot, or waiver, or just tablet form of medication can give you a lot of information – What are the doses? – there’s morning and night How does that affect you? How do you find taking that medication? Another useful question is: How long have you been on this medication? because it might have been fairly settled and being on it a long time they might have just started it a month ago. Asking you know when’s the best time of day to meet you. You want to… get instructions when clients feeling most… you know… comfortable and confident and get the most information from them and also, you can find out if the question of capacity comes up along the track that you’ve interviewed them at their best time. So, factors that can impact on capacity for example, some people take very heavy not time doses of medication so the mornings are really difficult for them to wake up and they’re a bit groggy in the mornings. Sometimes, people might be on a course of ACT (Acceptance and Commitment Therapy) so, it’s best to leave a couple of days after a dose of ACT. Some people may or may not be comfortable to talk around the time that have a depot. It might… cause them a lot of anxiety or, or they may have some side effects around that so, just asking when’s the best time and also date, if they have sort of fortnightly… treatment events. Sometimes… the person themselves, or the referring person such as, Harry or that the health professional can identify the legal issue. However, the research shows that, that’s quite often not the case that… that something’s not working well for the person and maybe a lawyer can help; can sometimes be the best way the problems articulated. So that, therefore… we can utilize great tools such as, the legal health check when the referrals unclear, to help identify what might be the issues for the client. So, the legal health check will cover a range of common legal problems and we’ll go through and it’s also written in very much plain English because… if it’s written in legalese, all the questions are in legalese you know, it’s so… over everyone’s heads and we won’t be terribly helpful and meaningful so, legal health check is quite a good too, when there’s a non-specified referral. If this is specific referral and people that look out really want help with my pension that should be reinstated. You don’t want to irritate people by asking a lot about the questions first. So that, at that point the legal health check might be used when the first legal issue is addressed to check that there’s no other outstanding ones. One of the things I do when I’m talking with somebody who I think he’s anxious or is having difficulty retaining the information, is to give them small pieces of information at the time and then discuss it with them so that I can have them repeat back to me in their own words have I understood what I said and then as we build on the conversation and get further down you… you’re making the topic sort of broader and broader and then at the end, you can ask them to summarize what you’ve said over the session so, that way you have a better idea that they’ve actually understood what you’ve said. If they have a support personal care thats with them and that person is really anxious, it’s time well spent to… the term which use as “de-escalate”, or to calm that person and just spend some time talking about what they’re anxious about so that, they’re calmed and settled because that’s going to help the client be calmed and settled. Anxiety is really contagious if the lawyers anxious about it, if somebody else in the room is anxious about it, it’s going to be really difficult to have a calm and smooth interaction with everybody. The family and the carers are often there on the frontline so involving them is so important I think to getting positive outcome here. Having said that, you really do need to, get the permission of the patient in order to do that thing, to have full consent and… and for everyone to be participating in this conversation because often very personal information that is being shared that… that with ordinary and should be kept confidential. So they need to be comfortable with that sharing of information But also, they need to be having an opportunity to be able to talk to me, to talk to Karen, and the people on the clinic on the run as well, because sometimes… sometimes even while meeting families and carers can be part of the issue – point of the underlying issue behind whatever that social or medical-legal problem is. It’s probably more usual for… for the lawyers to meet one on one with the client and so, on ordinary practices as you know getting client authority you know, who is allocated for us to contact and who is it, you don’t want us to have contact with and just… in relation to fluctuating capacity issues and level of comfort and confidence that clients will have over time. It’s important just to check in. Is it still okay for… for the support worker to come in or you know, shall we just do this interview? It’s important as Harry talk about the sixth sense you know, to… to listen to yourself and your own reaction something is…it’s different about this presentation today and so you… you just might… might ask a few different questions before you get going, or you know, if you’re not sure if it’s not clear – the information that’s coming from your mother is it ‘s still okay to give, you know your mom a call, or or your case manager a call about this, so i get the… the full picture and… and think I just need to clarify so, when… was i might have given permission beforehand you just want to… develop that working alliance and not be working against your client so, it’s very, very important.

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