Dr Neil Coventry is currently the Chief Psychiatrist for Victoria working within the Department of Health and Human Services. Dr Coventry has worked in both public and private mental health facilities for over 35 years. Previously he was Clinical Director of the Child and Adolescent Mental Health Services at Austin Hospital and has worked in health administration, as Deputy Chief Psychiatrist for Children & Youth, and more recently as Chief Psychiatrist.
Dr Coventry has special interests in trauma, family therapy, eating disorders and suicide prevention services. Dr Coventry has worked closely with consumer and carer groups to improve safety and quality of our public mental health services. He was involved in the implementation of the new Mental Health Act in 2014.
Dr Coventry responds to questions on major trauma and mental health recovery:
Q1. How do Victorian healthcare services respond to the mental health needs of major trauma patients and their families? What services are available?
The Victorian healthcare system has a range of services which aim to meet the changing needs of Victorians at any given time in their lives. Most Victorians with mental health issues access mental health services through their general practitioner or primary care provider. Some may access a mental health professional through the private system. For those who only need a few sessions a Mental Health Plan may be a good option. This provides a limited number of sessions with a mental health professional through Medicare and is available through a GP.
However, some Victorians who experience a significant trauma may require specialist mental health services. Generally the impact or severity of the condition, rather than a specific diagnosis, triggers access to specialist mental health services.
Specialist mental health services in Victoria are divided into two service delivery types: clinical and non-clinical. Both clinical and non-clinical services operate within geographically defined catchment areas.
Clinical services focus on assessment and treatment of people with a mental illness. They are available 24 hours a day, 7 days a week through a centralised triage telephone number. Each region in Victoria has access to specialist mental health services for children and adolescents, adults and older Victorians.
Non-clinical services are called Mental Health Community Support Services (MHCSS). These focus on activities and programs that help people manage their own recovery and maximise their participation in community life.
Q2. What are common mental health issues arising from experiencing a major trauma event?
It is normal to experience strong emotional, physical and behavioural reactions to a trauma event. However, some people may develop more serious conditions or the trauma event may trigger or exacerbate existing conditions. Some examples may include; Post Traumatic Stress Disorder (PTSD), major depressive disorder, anxiety disorder, substance abuse disorders, or pathological gambling.
Q3. How do you know what is ‘normal’ and a short term mental health problem and what is a mental health issue requiring support from a mental health professional?
It’s important to recognise that it is normal to experience strong emotional, physical and behavioural reactions to a trauma event. This distress can temporarily disrupt a person’s ability to function normally to day-to-day life. However, if these symptoms persist and are impacting on a person’s ability to cope with day-to-day activities, and on their relationships, then it may be useful to seek professional advice.
Q4. What advice would you give to people about to go through a long phase of recovery from a major trauma event?
Be kind to yourself and remember that it’s normal to experience strong reactions to a trauma event. Give yourself time to recover and don’t rush into major life-changing decisions. Try to resume a normal routine, as much as possible, and schedule at least one meaningful activity each day. Surround yourself with a good support network and communicate your support needs to them. Gradually confront what has happened and identify someone who you can talk to about your feelings. Look after your yourself by getting enough rest, eating a balanced diet, relaxation (i.e. yoga, meditation, gardening, listening to music). Avoid using drugs, alcohol or gambling to cope with difficult emotions.
Q5. How does a major trauma incident impact on families and friends?
Most people who experience a significant trauma will experience some emotional, physical and behavioural distress. However some people will go on to experience more serious ongoing mental health issues and/or substance misuse. This can lead to the person not being able to fulfil their previous roles and responsibilities within the family and can place strain on relationships. At times family and friends can recognise that a person requires mental health support, however this may not be what their loved one wants at this time. A person may be trying to avoid memories of their trauma experience and may even emotionally “shut down” from family and friends. This can also lead to frustration and put further strain on relationships. It is important that family and friends, as well as the trauma survivor, develop a good support network.
Q6. How does a major trauma patient speak to others about their injuries and the impact it has had on their lives?
There is a large body of evidence which recognises the importance of confronting feelings and not bottling them up following a major trauma event. Avoiding memories of the event and associated emotions is recognised as a negative coping strategy. If someone is struggling, it is important that they identify someone to which they can talk to about their experience and their feelings. This may be a friend or family member, or they may require professional support. This can be a very difficult and emotional process but an important part of the recovery journey.
Q7. What is the importance of returning to social and/or work activities?
It is important to return to a normal routine, as much as possible, and to plan meaningful activities. Being connected to social supports, employment or other meaningful activities are all important in the recovery process. Often the longer the person is away from these activities, the more socially isolated they become and the harder it is to return in the future.
Q8. Why is it important to reach out to others and ask for help?
As discussed above, talking about your feelings is important for people who have experienced a trauma event. For many people, talking to family and friends is enough. However, for those who continue to experience problems associated with the trauma event, support from a mental health professional may be required. For example, those who develop Post Traumatic Stress Disorder (PTSD) should be offered evidence-based trauma-focussed psychological interventions.
Q9. What is a typical psychological journey of a major trauma patient from impact to recovery?
There is no typical psychological journey of a major trauma patient. Everyone has a different response to trauma depending on a range of factors which may include; the severity of the trauma event, personality, social stressors, history of trauma, access to support and their personal resilience. For those who experience ongoing problems associated with their trauma, factors including; getting appropriate help, self-care and maintaining routines and meaningful activity may also influence their recovery journey.
Q10. Overall, what can major trauma patients expect from the Victorian healthcare system and the role of the Department of Health and Human Services?
From a mental health perspective, all Victorians should expect that there is an accessible and responsive service available to them at every stage of their journey. A patient’s needs may change over time and services need to be flexible to accommodate this. They should expect effective communication to occur between patients, their family members and/or carers, and multiple professionals. These professionals may include; GPs and primary healthcare, private mental health professionals, specialist public mental health services and mental health community support services. When accessing Victorian Mental Health Services, patients should expect to be assessed and treated by a multi-disciplinary team which operates within a trauma-informed care framework. They should also expect that specialist child and adolescent services are involved when assessing and treating children.
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