A person walking alongside brings security

When psychiatric nurse Janica Laine goes to see a client, she encounters the person as a human being, with respect. Interaction is essential in creating mutual understanding and trust in the situation.

“When providing support to a mental health and substance abuse client, it is important to understand that the client is the expert on their own life. I accept that what the client wants and considers good is sufficient, and that is what we will then work towards,” says Janica Laine.

Treating home care clients with mental health and substance abuse problems presents its own challenges and requires specific expertise. Some clients may not have any recognition of their illness, their relationships with their loved ones may have been severed for one reason or another, or their financial challenges may be so complicated that they take away the clients’ will to live. They also often already have such poor functional capacity that it is very challenging for them to leave home.

Care work professionals have called for more knowledge and skills on the subject to be able to better meet the needs of clients with substance abuse and mental health problems during home visits. 

“Home care staff experience powerlessness and even hopelessness with clients who have significant mental health challenges or use substances excessively. These clients demonstrate varying levels of commitment to home care visits and services. The visiting psychiatric nurse assesses the clients’ overall situation and mood, provides, for example, guided self-care for the clients and engages in multidisciplinary cooperation, which is usually required to improve the clients’ overall situation. Janica also provides the staff with specific skills for working with the clients,” says Project Manager Tiina Hovila.

When home care professionals have deemed it necessary to involve a psychiatric nurse in the treatment of a client, Janica contacts the clients selected by the carers and enquires about the their need for a visit.

“I may also go and see the client at home together with a practical carer. At first, I introduce myself and ask about how the client is doing. The client’s need for my visits often becomes apparent already during this conversation, and we can then initially discuss and agree on the objectives. The aim is to improve the client’s own life management and empower them to take independent action in their daily life.”

Once the client has agreed to start on a common path and given their consent, Janica takes an in-depth look at the client’s situation: she reads the records in the client and patient information system and interviews family members and the support network.

The clients may have a heavy burden on their shoulders, and the first home visits are often spent unloading it. Janica listens, taking her time.

“I go to meetings without haste and with time. I usually spend at least an hour with the client, but occasionally I have taken up to three hours. On those occasions, we have, for example, gone to the geropsychiatry outpatient clinic for an appointment.”

“A relationship of trust is usually established quickly. It may have an impact when I say that I am a psychiatric nurse, but it is also important to adapt your own interaction in these situations. When trust is established, the client opens up about even the most painful issues. It may put them in a state of mind where they think: ‘all right, I will now let it all come out,’” Janica says.

Once the client has been able to unburden themselves, Janica discusses with them what could bring relief from their dejection or powerlessness and create the kind of hope for the future that would empower them. Finding and reinforcing the client’s resources is also at the core of the work.