Transcript Mental Health Awareness - Queen's Nursing Institute

Opening Doors
There are many people working in the
field of homelessness who have had no
formal or informal training in mental
health.
It is recognised that that close working
between voluntary agencies and mental
health care providers has proved
invaluable.
Mental Health Awareness
It is also recognised (Meddings and Levey
(2000), that the training of hostel workers
and others involved in homelessness
work, is a component of best practice.
I was recently asked to produce Mental
Health Guidelines for people working with
homeless people by QNI Opening Doors.
Homelessness & Mental Health
A Guide for Practitioners Working in the
Field of Homelessness
Peter Melvin BSc(Hons), RMN, QN
Aims:
 To
provide an understanding of mental health
problems.
 Develop
knowledge of helping people with
mental health problems within your
environment.
 To
provide a brief overview of interventions and
services available.
What is Mental Health?
“Mental health is not just the absence
of disorder. It is a state in which a
person is able to fulfil an active
functioning role in society, interacting
with others and overcoming difficulties
without suffering major distress or
disturbed behaviour.”
(Donaldson and Donaldson 2003)
Ronnie O’Sullivan,
Snooker Player
People are quite ignorant
about mental illness. They
think “you moany old sod,
why don’t you just cheer up.”
Sometimes I think, "yes I am
a moany old sod" and I play
that character and get a
sense of happiness out of it.
The worst thing someone
can say is “jack yourself out
of it”; in the end I tell them
“do you think I enjoy being
like this”.
Paul Merton, 44,
Comedian
“People shouldn’t feel
ashamed for having a
mental illness. We don’t
feel ashamed for having
a broken leg, so why a
mental illness”?
Mental Health Prevalence
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1 in 4 adults in any year will experience some form of mental
health problem.
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25% general population (WHO 2006).
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80 million working days lost per year due to anxiety and
depression.
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The current cost of mental health problems £105 billion.
(Guardian 2010)
Mental Health Prevalence Amongst
Homeless People
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50% + of homeless population suffer from some form of mental
illness.
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60% + of those homeless people suffering from mental illness
have a co-morbid substance misuse problem.
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Mental illness and co-morbid substance misuse amongst
homeless population is up to 5 times higher than the general
population.
Homelessness and Access to Mental
Health Care
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Homeless people can still find it difficult to register with a local
Primary Care Practice in the 21st century!
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Access to Primary Care is paramount for effective healthcare –
Homeless Link (2011) reported that 41% of homeless people
attended an A&E department during a 6 month audit period.
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Access to Secondary Mental Health Care for people suffering
from psychotic illnesses nigh on impossible without a primary
care referral.
Influential factors
•Genetic
•Lifestyle
•Environmental
•Economic / Social
•Access to services
Typical Mental Illnesses;
OCD
Self Harm
Suicide
Dementia
Mental
illness
Depression
Bi-Polar
Psychosis
Anxiety
and
Panic
Attacks
SMI
Mild - Moderate
•Schizophrenia
•Anxiety
•Bi-Polar Disorder
•Depression
•Depression
•Obsessive/compulsive
•Personality Disorder
•Personality disorders
•Dual diagnosis
•Drug / alcohol misuse
Symptoms of Schizophrenia:
Positive Symptoms Hallucinations:
 any of the 5 senses
 auditory (voices) most common - derogatory/
commentary/command
Delusions:
 false belief not in keeping with culture /background
common theme e.g. persecution, grandiosity,
controlled by other people.
Thought disorder:
 fluency /flow /neologisms (new words)
Negative symptoms;
 Self
neglect
 Social withdrawal /isolation
 Apathy
 Poverty of speech
 Lack of motivation
 Retarded movement
 Inability to function
 Low mood
 Lack insight
What helps Psychotic Disorders?
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Concordance with prescribed medication (Anti
psychotics)
Minimise stress
Avoid alcohol & substance misuse.
Adequate sleep
Healthy diet & regular exercise
Regular social contact & positive relationships
Employment
Adequate finances & Housing
Depression;
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Hopelessness
desperation
Poor motivation
Reduced self esteem and self confidence
Disturbed sleep
Poor appetite
Feelings of guilt and worthlessness
Suicidal thoughts and ideas
Bipolar disorder:
Mania:
elated mood, increased activity, well- being,
grandiose, disinhibited, Extravagant, irritable,
aggressive
Depression:
decreased mood, decreased activity, loss of
interest, lack of enjoyment, negative thoughts, low
self worth, hopelessness, suicidal thoughts, social
withdrawal
What helps Bipolar Disorder?
Mania:
Decreased stimulation, calm environment, non
confrontational, distraction techniques, protect dignity,
sleep / appetite
Depression:
Increase stimulation, encourage activity, encourage
routine, support, goal setting, diary planner, ? suicidal
thoughts, sleep / appetite
Anxiety:
Disorders:
Phobias – social, agoraphobia, general,
Generalised Anxiety Disorder, Obsessive Compulsive
Disorder (OCD), Post Traumatic Disorders (PTSD).
Symptoms:
Physical response - palpitations, dry mouth, “butterflies” in
stomach, altered breathing, sweating.
Psychological - negative thoughts, feeling of impending danger,
“Fight or Flight” reaction, poor concentration, constant worry,
racing thoughts.
Behaviour- can’t relax, pace up and down, snappy and irritable,
drink/smoke more, can result in a “Panic Attack”.
What Helps Anxiety?
 Adequate
 Good
sleep
diet
 Learn to relax
 Recognise signs - plan
 Distraction
 Controlled breathing
 Challenge the negative thoughts
 Self Help Books
 Cognitive Behaviour Therapy (CBT)
Personality Disorder;
 Diagnosed
over period of time, often
retrospectively.
 Characteristics and enduring patterns of
thought processes, emotions and behaviours
differ markedly from a culturally expected and
accepted range
 10 different personality disorders classified
 Estimate 10% population
(Mental Health Foundation 2003)
Borderline Personality Disorder:
Characteristics:
 pattern of instability of interpersonal
relationships,
 impulsive, damaging behaviour
 unstable self image
 feelings of emptiness
 inappropriate anger
 fear of abandonment
 manipulative behaviour
 self harm /threats of suicide
Self Harm - Cutting
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Injury to self including cutting are not suicidal
behaviours and are not associated with
serious danger. (Gerson & Stanley 2005)
The Purpose of cutting is to relieve negative
emotions. (Linahan 2002)
Cutting provides short term relief from intense
negative emotion by substituting physical for
mental suffering – Distraction.
Self Harm - Repetition
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have done it before
have a personality disorder
have been in psychiatric treatment
are unemployed
are in social class V – unskilled workers
Misuse alcohol and/or drugs
have a criminal record
Aged between 24 and 35
Single, divorced or separated
A Coping Mechanism
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“Paradoxically, the purpose of some acts of
self harm is to preserve life. Professionals
sometimes find this a difficult concept to
understand”
( NICE Self-Harm Guideline, 2004)
Self Harm
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Carers may relieve their own disappointment
and frustration with the client by stigmatising
them as bad, attention seeking or
manipulative, terms which have no
explanatory value but subtly devalue the
clients distress and can sometimes be used
to justify either harsh or indifferent treatment.
NICE Guidelines
“People who have self-harmed should be
treated with the same care, respect and
privacy as any patient. In addition,
healthcare professionals should take full
account of the likely distress associated with
self harm.”
What Helps?
 Understanding
why people self harm:
-feelings of worthlessness/be in control
 Agreed one to one time
 Calm, objective approach
 Boundaries
 Collaboration
 Consistency
 Communication /support
 Risk /responsibility balance
 Environment should feel safe and supportive.
Mental Health & Substance Misuse
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Substance misuse can make existing mental
health problem much worse, poor outcomes.
Can trigger the onset of mental illness.
Recent research has established clear link
between cannabis use and the development
of psychosis/schizophrenia.
Increased risk of infections, hepatitis, HIV.
Can lead to increased criminal activity and
contact with criminal justice service.
Drug Misuse and Mental
health
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Stimulants: (ecstasy, speed, LSD) shown to have an effect
on depression, anxiety and paranoia. Can have devastating
effect on sufferers of schizophrenia.
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Cocaine & Crack: can effect mood, anxiety and cause
paranoia. Can be the cause of relapse in people suffering
with schizophrenia.
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Cannabis: can trigger psychotic illnesses
Any Questions?