Only when lower order needs have been met can we be concerned with the higher order needs. When you reach self-actualization you may exhibit the following characteristics: keen sense of reality, objective judgment, see problems in terms of challenges and solutions not just complaints and excuses, independent, socially compassionate, accepting others as they are, spontaneous and natural, creative, inventive and original. Story of Ethan and his mom- Ethan having trouble with constipation & pediatrician is not helpful. Ethan is uncomfortable & unhappy. Stresses mom out. Mom needs help but doesn’t know where to get it. If HV helps her what would happen? mom will have energy to devote to Ethan and his intervention Ethan will be more receptive because he will feel better & be healthier Mom will see professional as invested. Will trust more. Will listen more. Mom will feel better about herself because she got Ethan the help he needs. She was effective.
*Parents need to know that we care before they care what we know. Boundaries What you can do & aren’t prepared to handle If problem is beyond your expertise-REFER Professional distance is the boundary we, as the professionals, set with each family To be successful at HV we need good boundaries When we do not have appropriate professional boundaries we lose our objectivity Without objectivity we can’t use proper judgment and fully serve the families Don’t expect families to set the boundaries Building on strengths Recognize/acknowledge parent as expert on the child Sharing one’s own family life Appropriate if related to family’s life Communicates understanding & support Validates the parent’s experience/feelings Trust the power of the process of developing the relationship Relationship is dynamic, varies in nature & effect Development occurs through relationship Relationships are patterns of interaction over time All relationships involves mutuality Each person influences the other at the moment and in important ways over time Shared Delight Korfmacher Article 1190 EHS mothers from 17 sites around the US How moms rated HR correlated with how their involvement was viewed by professionals Parent-report measures tend to be positively biased…rated very highly even when qualitative reports suggest much more variability in the relationship HR should not be static, should change over time as the child matures and needs change and families and prof get to know each other more This study showed relationships went down from first (6 months) to second eval (15 months) and leveled off at third (26 months)
Communication=process by which families and professionals exchange messages that influence, facilitate and define the purposes of EI Help parents strive for realistic optimism Don’t assume you know more about the child than the parent Start with something where parents can be successful Use “door openers” which invite them to say more about the incident or their feelings. Such as “I see” “oh” “tell me more” “No kidding Speak in plain, everyday language Generalizations about parents of children with disabilities will influence your actions, so don’t label Brady Article Identifying and describing types and patterns of talk during interactions b/w 15 families of ycwd and EI prof Video-taped and then analyzed with computerized coding system What amt & type of talk are used by prof & families? Prof talked 50% of the total visit time-23% direct to families, 27% to child Families talked 44% of the time-1/2 to child, ½ to professional Considerable variability-Prof 33-70% & Family 25%-63% Professionals give info (direct) and praise (indirect) most often Families initiates (direct) and responds (indirect) most often Lots of variability here also Is there a rel. b/w amt & types of professional talk and the amt & types of family talk? Positive correlation b/w total indirect prof and total family talk (& family initiates) The more prof praised, encourages, and accepted families’ ideas the more involved families were in the ix Younger prof less likely to give info and more likely to direct families What sequential patterns of talk are most common? Older prof give info more (gave it in a f-c way) but prof give info and then tend to give more info indicating lack of ix by family. When major focus is prof giving info that wasn’t requested by families power and control in the relationship are likely not being shared. Following a family member’s expression of feelings prof tended to react to content and not to expression of feelings…tendency to rush in , offer solutions, and try to “fix” the problem Key tenet of family-centered tx is to listen actively, acknowledge, and address families concerns and needs Need to reflect feelings (a microskill in active listening) allows families to identify and clarify their concerns and accept their feelings as valid
Empathy seeing things from the other person’s perspective Respect belief in the worth of all human beings and acting on those beliefs Perseverance & resilience commitment and conviction that enable professionals to continue in the face of obstacles, set backs, and lack of progress Passion need to have a strong drive to know more regardless of current knowledge or skill. Lifelong learner! Don’t be afraid to say “I don’t know” but then find out! Don’t be guided by “traditional” expectations…won’t know until we try or let’s try another way
MENTAL HEALTHASHRAF TANTAWY Professor of Psychiatry Suez Canal University Ismailia, Egypt.
OVERVIEW PART I MENTAL HEALTH PART IIMENTAL HEALTH ISSUES PART III CAREGIVERS BURDEN
DEFINITION OF HEALTH “A state of complete(Physical, Mental & Social) well-being”(World Health Organization)
The 10 Health Indicators 1- Physical Activity. 2- Overweight and Obesity. 3- Tobacco Use. 4- Substance Abuse. 5- Responsible Sexual Behavior. 6- Mental Health. 7- Violence and Injury. 8- Environmental Quality. 9- Immunization. 10- Access to Health Care.
MENTAL HEALTHThe successful performance ofMental Functions.Resulting in Productive activities& Fulfilling relationships. The ability to adapt to change &cope with stressors. The successful adaptation tostressors are evidenced by
MENTAL ILLNESSA Clinically Syndrome, marked byDistress, Disability, Suffering orLoss of freedom.Maladaptive Responses tostressors evidenced by thoughts,feelings & behaviors, interfere withthe individual’s physical, social or
Mental Health/ Mental Illness Concept Must Be Clear Mental Health Mental IllnessContinuum - Not Static(Introversion → Avoidant Personality → Social Phobia → Schizophrenia)
MENTAL HEALTH Maslow identified: A “Hierarchy of Needs”:Self-actualization as fulfillment of one’s highest potential
Aspects of Mental HealthEmotional Intelligence: Emotions are skills for living. Have emotional self control. Recognize emotions in others. Handle relationships.Resiliency:Emerge and grow from negative life events.Spirituality:That part of us that deals with relationships, values andaddresses questions of purpose and meaning in life.
Common & SeriousMental Health ProblemsCommon Problems: – Depressive Disorders. – Anxiety Disorders.Severe & Enduring Problems: – Schizophrenia. – Bipolar disorder. – Major depression. – Dementia.
Problems of Mental Disorders Lifespan vs. Health span. Physical Burden. Poly-Pharmacy. Psychosocial Burden.Biological Basis of Psychiatric Disorders.
Lifespan vs. Health spanLifespan: Length of life increased.Health span: Length of healthy life before Disability.Factors affecting lifespan and health span:1. Exercise: Improves mood andcognition.2. Sleep pattern.3. Eating pattern.4. Social networks: Protective against
Physical BurdenComorbid Physical Diseases:NS, IS, CVS, RS, US & GIT.Disability: Physical & Mental.Side Effects: Psychotropic Drugs.
Physical ComorbiditySchizophrenia: Obesity, Hypertension & Smoking. Hepatitis C & HIV. Drug related Movement Disorders. Cancer Colon. Rheumatoid Arthritis.Bipolar Disorder As for schizophrenia. + Drug Related Thyroid Diseases. Drug Related Renal Diseases (Lithium).Causes of Death among Mental Patients: Cardio-Respiratory Disease & Infectious disease.
Psychosocial BurdenSocial Isolation.Physical & Cognitive Dysfunctions.Loss of Social & Occupational Status.Loss of Friends.Lack of Adequate Health Care.Financial Insecurity.Death Preoccupation.Dependency on Their Families.
CAUSES OF MENTAL ILLNESSThe concept of multiplefactors in the causation ofpsychogenic disorders hasbecome generally accepted.The factors are consideredto involve the individual, thefamily & the community.
Biological Basis of Psychiatric DisordersNerves EnvironmentHormones BrainAction Endocrine Glands Immune System Physiology & Behavior
The Biological Basis of Psychiatric Disorders Brain Mind Biopsychosocial ModelPsychoneuro- Medically Immunology Unexplained Physical Symptoms Body
Diathesis-Stress Model Diathesis Stress “Predisposing Causes” “Precipitating Causes”(Hereditary Predisposition) (Situational Factors) Bio-Psycho-Social Approach Disorder “Maintaining Causes”• Emphasizes Interaction of Physical ConditionsBiological and Social Factors Recovery
Quality of LifeWell-being: Physical, Psychological, Social & Spiritual. Physical Psychological Functional Ability Anxiety Strength/Fatigue Depression Sleep & Rest Enjoyment/Leisure Nausea Pain Distress Appetite Happiness Constipation Fear Pain Quality of Cognition/Attention Social Life Spiritual Financial Burden Hope Caregiver Burden SufferingRoles & Relationships Meaning of Pain Affection Religiosity Sexual Function Transcendence Appearance
How Does The Public View The Mentally Ill?They are fearful.There is a big stigma.The mentally ill are labeled.Care is rationed.People oppose care by using laws.The mentally ill are losers when itcomes to the budget for care.
What are The Costs of Mental Illness? Police costs. Public health costs. Safety costs. Court costs. Business costs. Social costs. Jail costs.
Psychiatrists handle littlenumber of real psychiatricpatients, WHY?There are 5 levels and 4 filters.
L1:Community (30%). F1 : Illness behavior.L2:Mental morbidity in primary care (25%). F2: Ability to detect.L3:Mental morbidity by doctors (10%). F3: Referral.L4:Morbidity in mental health services (2.5%). F4: Admission.L5: Psychiatric inpatients (0.5%).
The Provider- Caregiver Relationship– Expectations.– Establish & Maintain Boundaries.– Building on Strengths.– Sharing One’s Own Family Life.– Reciprocal & Positive Feelings.
Talking with CaregiversBe Positive.Be Flexible.Be a Good Observer.Work as Partner.Listen Actively.Begin Where The Caregiver Is.Ask Leading Questions.Make Comments Thoughtfully.Answer Personal Questions.
MENTAL HEALTH APPROACHESPrimary Prevention.Secondary Prevention.Tertiary Prevention.
PSYCHIATRY STRATEGIESIntegration of mental health withprimary health care throughthe national mental health program.Provision of tertiary care institutions fortreatment of mental disorders.Eradication stigmatization of mentally illpatients.Protecting patient rights through regulatoryinstitutions like the central mental healthauthority.
Numbers of People Affected Globally 450 million people with mental disorders:– 150 million with Depression.– 90 million with Alcohol or Drug Use Disorder.– 40 million with Epilepsy.– 25 million with Schizophrenia.– 10 million Attempt Suicide every year.– 1 million Commit Suicide every year.
Did You Know?4 of the 10 leading causes of disability aremental disorders:- MD, Schizophrenia, Dementia & OCD.6% of the population suffers from Severe &Persistent Mental Illness:- Dementia, Schizophrenia, BAD & MD. 13 % of the population has a diagnosis of:- Dysthymia, Panic Disorder, Phobia & Antisocial Personality Disorder.
Psychiatry by Numbers25% of the population has a mentaldisorder.15% of patients in population havedepressive illnesses.90% of the 10 most commoncomplaints in psychiatric settinghave no organic basis.50% of mental health care can bedelivered by Non-Psychiatrists.
Relationship Between Psychiatry & MedicineA- Medical Conditions that have psychiatric symptoms.B- Psychosomatic Disorders.C- Medically Unexplained Physical Symptoms.D- Mental Disorders that may have physical symptoms.
A- Medical Conditions That Have Psychiatric Symptomatology1- Neurological Diseases: Brain tumors, Epilepsy, MS, Parkinsonism,...2- Endocrine Syndromes: Thyroid, Suprarenal, Ovaries, Pancreas,…3- Infectious Diseases & Autoimmune Syndromes.4- System Failures: Renal, Hepatic, Cardiac, Respiratory,...5- Chronic Disability: Blindness, Deafness, Muteness, Loss of limb,...6- Blood Diseases: Anemia, Leukemia, Hemolytic diseases,...
B- Psychosomatic DisordersThe physical condition must show eitherdemonstrable organic pathology or aknown patho-physiologic process.They can influence not only the cause ofthe illness but can also worsen thesymptoms & affect the course of thedisorder.Examples: Angina, Hypertension,Bronchial asthma, Rheumatoid arthritis,Duodenal ulcers, IBS, Eczema, Psoriasis& Urticaria.
C- Medically Unexplained Physical SymptomsSometimes psychological factors can cause ill health without actually causing a disease.As a result of unhappiness, anxiety or stress due to personal problems, physical symptoms may develop. A- Somatoform disorders. B- Factitious disorders. C- Malingering.
CAREGIVERS BURDEN Physical Burden. Financial Burden. Time Burden. Role Burden. Emotional Burden. Others.
Caregiving Burden Signs of Caregiver Burnout1- Physical Burden: Weight Change: Gain or Loss. Unexplained Somatic Complaints: (Chronic headaches, backaches orothers). Caregiver’s Syndrome: (Fatigue from physical strain & sleep lack ). Osteoporosis and Arthritis.
Caregiving Burden Signs of Caregiver Burnout3- Time Burden: Caregiving is time-consuming. Less time for other tasks. Activities can be stressful.4- Role Burden: Feelings of being pulled in differentdirections. Family responsibilities. Pressure and tension.
Caregiving Burden Signs of Caregiver Burnout5- Emotional Burden:Common feelings: Being overwhelmed, Anger,Frustration, Guilt, Exhaustion, Loneliness andSocial withdrawal.Cognitive disturbances: Lack of concentrationand finding it difficult to complete complex tasks.Sleep disorders: Sleeplessness / stressful dream.Anxiety: about facing another day and what thefuture holds.Depression: feeling sad and hopeless.Adjustment disorders.
Psychiatric Disorders Among CaregiversDepression.Anxiety disorders.Unexplained SomaticComplaints.Adjustment disorders.
ConclusionsMental disorders among patients & theircaregivers are frequent, associated withincreased medical & functional morbidity.Attention to physical, psychological & spiritualconcerns are necessary.Use of medication, psychotherapy orcounseling in an integrated manner results inbest outcomes.The good physician will treat the disease butthe great physician will treat the patient.Mental health means enhancing physicaltreatment & promoting mental health.
Nursing Is Of Paramount ImportanceAmong Mental Patients