Adv Mh Participant Bklet3


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Adv Mh Participant Bklet3

  1. 1. Advanced Mental Health Training Presented by: Minds Eye 5 Fairfax Mews, Off Fairfax Road London N8 0NN Tel: 0208 347 7225/6 Fax: 0208 881 2477 Email: 1
  2. 2. Advance Mental Health Course Programme Time Session 09.30 Session 1 Welcome Introduction to course Expectations 09.45 Session 2 How to identify mental health problems and support service users develop positive mental health Including From Stress to Psychosis Use of mental health legislation 11.00 Tea Break 11.15 Session 3 Person Centred Approach Principles of Psychosocial intervention Use of medication 1.00 Lunch 2.00 Session 4 Case study – Depression Practice skills – Motivation Practice skills - Psychotherapy strategy 3.00 Tea Break 3.15 Practice skill – Working with difficult behaviour 4.10 Bringing it together 4.20 Course Evaluation 4.30 Close 2
  3. 3. How to identify mental health problems and support the service user develop positive mental health What is good mental health? Ladder of functioning A good way to identify mental health problem is to look at our ladder of functioning N o lim it p e r s o n G o o d fu n c tio n in g le v e l A n g ry A n x io u s M e n ta lly ill Good level of functioning Angry: 3
  4. 4. Anxious Mentally ill No limit person Wyne Dyer (1995) suggests that 5% of the population is in this category. 4
  5. 5. Functional areas affected by mental health problems • Physical appearance, health and hygiene • Biological functions: sleep, feeding, bowels, bladder • Activity, energy, movements • Verbal and non-verbal communications • Mood and emotional reactions • Perceptions of others, objects and environments • Relationships and sexuality • Self perception, insight and esteem • Repertoire of adaptive and maladaptive behaviours • Attention, thinking and learning • Memory and attention • Perceptions/attitudes to health and needs How many people experience mental health problems? On average 1 in 4 people will experience some kind of mental health problem in the course of a year. However, of these, only a relatively small number will be diagnosed with a serious and enduring mental health problem. Statistics How many people experience mental health problems? Mental health problems are found in people of all ages, regions, countries and societies. • 1 in 4 British adults experience at least one diagnosable mental health problem in any one year, and one in six experiences this at any given time. • Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of people who experience more than one mental health problem (this is known as ‘co-morbidity’). What are the main types of mental health problems? • Mixed anxiety & depression is the most common mental disorder in Britain, with almost 9 percent of people meeting criteria for diagnosis. • Between 8-12% of the population experience depression in any year • About half of people with common mental health problems are no longer affected after 18 months, but poorer people, the long-term sick and unemployed people are more likely to be still affected than the general population. 5
  6. 6. Who develops mental health problems? • Women are more likely to have been treated for a mental health problem than men (29% compared to 17%).This could be because, when asked, women are more likely to report symptoms of common mental health problems. • Depression is more common in women than men. 1 in 4 women will require treatment for depression at some time, compared to 1 in 10 men. The reasons for this are unclear, but are thought to be due to both social and biological factors. It has also been suggested that depression in men may have been under diagnosed because they present to their GP with different symptoms. • Women are twice as likely to experience anxiety as men. Of people with phobias or OCD, about 60% are female. • Men are more likely than women to have an alcohol or drug problem. 67% of British people who consume alcohol at ‘hazardous’ levels, and 80% of those dependent on alcohol are male. Almost three quarters of people dependent on cannabis and 69% of those dependent on other illegal drugs are male. • In general, rates of mental health problems are thought to be higher in minority ethnic groups than in the white population, but they are less likely to have their mental health problems detected by a GP. • One in four unemployed people has a common mental health problem What about mental health problems among children and young people? • One in ten children between the ages of one and 15 has a mental health disorder • Estimates vary, but research suggests that 20% of children have a mental health problem in any given year, and about 10% at any one time. • Rates of mental health problems among children increase as they reach adolescence. Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged 11-15 6
  7. 7. What is the prevalence of mental health problems in older people? o Depression affects 1 in 5 older people living in the community and 2 in 5 living in care homes. • Dementia affects 5% of people over the age of 65 and 20% of those over 80. About 700,000 people in the UK have dementia (1.2% of the population) at any one time. How common is suicide? • In 2004, more than 5,500 people in the UK died by suicide • British men are three times as likely as British women to die by suicide. • Suicide remains the most common cause of death in men under the age of 35 • The suicide rate among people over 65 has fallen by 24% in recent years, but is still high compared to the population overall How common is self-harm? • The UK has one of the highest rates of self harm in Europe, at 400 per 100,000 population. • People with current mental health problems are 20 times more likely than others to report having harmed themselves in the past. What is the relationship between mental health problems and offending? • More than 70% of the prison population has two or more mental health disorders. Male prisoners are 14 times more likely to have two or more disorders than men in general, and female prisoners 35 times more likely than women in general • The suicide rate in prisons is almost 15 times higher than in the general population. In 2002 the rate was 143 per 100,0001 compared to 9 per 100,000 in the general population.2 7
  8. 8. From Stress to Psychosis Stress-Vulnerability Model of Psychosis There are multiple causative factors in the development of psychosis but most research suggests that the Stress-Vulnerability model of psychosis is the most dominant. This model suggests that a vulnerability to psychosis is acquired through a genetic predisposition or as a result of an environmental insult to the brain (e.g. head injury). This vulnerability, however, is not considered to be sufficient to manifest the disorder and must be 'triggered' by environmental processes. The environmental component can be biological (i.e. an infection, or even drugs and alcohol) or psychological (stressful living situation, school exams, travel etc.). • vulnerability to psychosis is acquired through a genetic predisposition, or as a result of an environmental insult to the brain. • to manifest, the disorder must be 'triggered' by environmental processes • the amount of environmental stress needed to 'trigger' psychosis likely differs from person to person, as does the amount of vulnerability that at risk people have for psychosis. The 'stress' component of the model may take many forms, including: • Traumatic life events. • Use of drugs and alcohol. • Stressful living conditions (e.g., low socioeconomic status; high levels of family conflict). DECREASED STRESS TOLERANCE There is also some agreement that people with psychosis handle stress poorly. It seems that they have a low tolerance for stress - things that would have not been stressful for someone who does not have psychosis can prove too much for those who do have it. There is also a lower tolerance of intense emotions from others, e.g. anger, criticism, conflict or extremes in positive concern or over involvement. Clearly this makes knowing how far to push or encourage someone to do something a difficult decision. On the one hand too much pushing may lead to problems and even relapse, whereas no encouragement to do things may see someone sink into apathy and withdrawal. Certain factors can also reduce the risk that an at-risk person will develop psychosis: • Use of appropriate prescription medication. • Use of stress management techniques. • Reliable support systems (e.g., family, a hospital day program). 8
  9. 9. Use of Mental Health Legislation Mental Health Act 1983 and Mental Health Act 2007 is primarily Civil Rights Legislation used to manage people with Mental Illness in 3 settings, namely, 1. In the Community 2. In Hospital 3. In Criminal Justice System In a nutshell MHA 1983 and 2007 enable people with mental illness to get treatment when they need it with minimal infringement of their civil liberties. • It outlines when a person can be detained. • How the person should be treated by Hospitals. • What support mechanisms should be in place for after care of the service used on discharge from hospital The MHA also establishes how people who commit offences when mentally ill should be treated and supported via the health system working along side the Criminal Justice System In the Community • Voluntary admission • Compulsory admission • After Care Support Discharge into community • CTO • Sec 117 discharge • Housing • Money • Supporting People • output linked • services • CPA • Maintenance • Relapse prevention In the Hospital Hospital treatment • Category 1 - Medication 9
  10. 10. • Category 2 – ECT and Hormonal • Category 3 – More invasive treatment • Talking therapy Rights in hospital • To MHRT In Criminal Justice System Similar to the Civil System with more controls and mandatory orders Other Legislation: Mental Capacity Act 2005 European Human Rights Act 1998 NHS and Community Care Act 1991 The Human Rights Act 1998 furthers the Civil Rights of people with mental illness by further defining additional rights that people with mental illness have such as rights to establish a family, right to choose e.g. nearest relative. The Mental Capacity Act establishes the principle that everyone has mental capacity. It outlines processes by which it can be confirmed that the person’s capacity is diminished due to mental illness, how he/she can be supported to make decisions that enhance their own best interest. The funding for mental health services comes from a number of sources such as the NHS and Community Care Act 1991, the National Service Framework of Mental health, National Service Framework for Elders, Supporting People Funding, Housing related funding. This funding working alongside the legislation creates a climate for safe service provision which is further boosted by Care Standards Act 2000 and CSCI inspectorate which inspects and reinforces service standards. The rights of Minority Ethnic community is also protected by the Race Relations Act 1976 and its Amendments in year 2000. 10
  11. 11. Person Centred Approach This approach puts the person at the centre and enable/supports the person to develop a picture of quality of life the person wants to lead by exploring the following areas with the person and then supporting the person achieve their aspirations in these areas. Key area Objectives 1. Relationships 2. Fun 3. Health • Physical Health • Mental Health 4. Occupation 5. Personal Development 6. Community 7. Money 8. Home 9. Emotional Regulation 10. Drugs use 11. Alcohol use 12. Support Network 13. Employment 11
  12. 12. 14. Education 15. Day Care 16. Leisure 17. Parenting 18. Other 12
  13. 13. Principles of psychosocial intervention The term psychosocial intervention has come to refer to any programme that aims to improve the psychosocial well-being of the service user Psychosocial interventions support the service user to cope with their mental health condition, and help the quality of life. (Slade and Haddock 1996) These interventions are also beneficial to relatives, and are effective in improving the quality of family environment (Penn and Mueser 1996) Key working is generally a key component of delivering psychosocial intervention in mental health care. Research suggests that establishing a therapeutic alliance is essential to the success of psychosocial interventions. The interventions are made up of: • Information and advise giving • Harm reduction interventions e.g. support the person get appropriate medication, supporting the person get housing, help person reduce chaos in their life created by mental health difficulties • Service user education to take reduce chaos in their life, manage their mental health symptoms and relapse prevention. • Cognitive-behaviour interventions to manage mental health symptoms • Social skills development/support/training • Family intervention A typical protocol for using psychosocial intervention is: • Take referral • Carry out risk assessment • Develop a collaborative working relationship with service user • Enable harm reduction • Support the person through recovery • Empower the person to take control over their life • Provide support to remain independent in the community • Help the person to participate in contributing to community life • Support the person establish their relapse signature and empower them to use the care system effectively to remain well in the community 13
  14. 14. Commonly Prescribed Mental health medications: Mental health medications are used to provide relief from mental health symptoms. Listed below are two tables of commonly prescribed psychotropic mediations. The first table is a listing of medications based on their psychiatric use. This table includes brand names and their generic form in parentheses. The second table provides a cross-reference by generic name. As with all questions about medication, be sure to consult with your prescribing physician or pharmacist for any specific questions you may have about dosage, drug interactions, or side effects. Schizophrenia Typical Haldol (haloperidol), Haldol Decanoate antipsychotics Loxapac (loxapine) Mellaril (thioridazine) Moditen (fluphenazine), Prolixin Decanoate Stelazine (trifluoperazine) Largactil (chlorpromazine) Fentazin (perphenazine) Atypical Clozaril (clozapine) antipsychotics Risperdal (risperidone) Seroquel (quetiapine) Zyprexa (olanzapine) Bipolar disorder Epilim (valproic acid) Lithonate (lithium carbonate) *Lamictal (lamotrigine) 14
  15. 15. *Neurontin (gabapentin) *Tegretol (carbamazepine) *Topamax (topiramate) Depression Tricyclics *Anafranil (clomipramine) Asendin (amoxapine) Tegretol (amitriptyline) Allegron (nortriptyline) Sinequan (doxepin) Surmontil (trimipramine) Tofranil (imipramine) Concordin (protriptyline) SSRIs Cipramil (citalopram) Faverin(fluvoxamine) Seroxat (paroxetine) Prozac (fluoxetine) Lustural (sertraline) MAOIs Nardil (phenelzine) Parnate (tranylcypromine sulfate) Others Molipaxin (trazodone) Effexor (venlafaxine) Zispin (mirtazapine) Dutonin (nefazodone) Anxiety disorders 15
  16. 16. Ativan (lorazepam) BuSpar (buspirone) *Inderal (propranolol) *Klonopin (clonazepam) Librium (chlordiazepoxide) (oxazepam) (Generic only) *Tenormin (atenolol) Tranxene (clorazepate) Valium (diazepam) Xanax (alprazolam) *Antidepressants, especially SSRIs, are also used in the treatment of anxiety. Anti-panic Agents Rivotril (clonazepam) Seroxat (paroxetine) Xanax (alprazolam) Lustural (sertraline) *Antidepressants are also used in the treatment of panic disorder. Anti-obsessive Agents Anafranil (clomipramine) Faverin (fluvoxamine) Seroxat (paroxetine) Prozac (fluoxetine) Lustural (sertraline) Stimulants (used in the treatment of ADD/ADHD)(Attention Deficit Hyperactive Disorder) 16
  17. 17. Dexedrine (dextroamphetamine) Ritalin (methylphenidate) *Antidepressants with stimulant properties, such as Norpramin and Wellbutrin, are also used in the treatment of ADHD. Generic Name Brand Name Current Uses alprazolam Xanax anxiety, panic amitriptyline Triptazol, Lentizon depression amoxapine Asendin depression atenolol Tenormin anxiety buspirone BuSpar anxiety carbamazepine Tegretol bipolar disorder chlordiazepoxide Librium anxiety chlorpromazine Thorazine schizophrenia citalopram Cipramil depression, panic, anxiety clomipramine Anafranil OCD, depression clonazepam Rivotril panic, anxiety clorazepate Tranxene anxiety clozapine Clozaril schizophrenia dextroamphetamine Dexedrine ADHD diazepam Valium anxiety doxepin Sinequan depression fluoxetine Prozac depression, OCD, panic, anxiety fluphenazine Moditen schizophrenia fluvoxamine Favrin OCD, depression, panic, anxiety gabapentin Neurontin bipolar disorder haloperidol Haldol schizophrenia imipramine Tofranil depression, panic 17
  18. 18. lamotrigine Lamictal bipolar disorder lithium Priadel bipolar disorder lorazepam Ativan anxiety loxapine Loxapac schizophrenia methylphenidate Ritalin ADHD mirtazapine Zispin depression nefazodone Dutonin depression nortriptyline Pamelor, Allegron depression olanzapine Zyprexa schizophrenia oxazepam Generic Only anxiety paroxetine Seroxat depression, panic, OCD, anxiety perphenazine Trilafon, Fentazin schizophrenia phenelzine Nardil depression propranolol Inderal protriptyline Concordini depression quetiapine Seroquel schizophrenia risperidone Risperdal schizophrenia sertraline Lustural deprssion, panic, OCD, anxiety thioridazine Mellaril schizophrenia topiramate Topamax bipolar disorder tranylcypromine Parnate depression trazodone Molifaxin depression trifluoperazine Stelazine schizophrenia trimipramine Surmontil depression valproic acid Epilim bipolar disorder venlafaxine Effexor depression Side Effects 18
  19. 19. 1. ANTIPSYCHOTIC MEDICATIONS Typical Side effects Sedation, dry mouth, muscle stiffness, muscle cramping, tremors, EPS or Extrapyramidal symptoms (akinesia - inability to initiate movement and akathisia - inability to remain motionless)and weight-gain. Atypical Side effects Weight gain and diabetes 2. ANTIMANIC MEDICATIONS Used for Bipolar. Lithium. Side effects of lithium. Initially, the person may have slight nausea, stomach cramps, diarrhea, thirstiness, muscle weakness, and feelings of being somewhat tired, dazed, or sleepy. A mild hand tremor may emerge as the dose is increased. These effects are normally minimal and usually subside after several days of treatment. But some of the initial side effects may carry over into long-term therapy and others may emerge. Some patients continue to have a slight hand tremor. Many drink more fluids than usual-without always being aware of it--and urinate more frequently, while still others may gain weight. Weight gain often can be controlled with proper diet. Anticonvulsants. Anticonvulsants used for bipolar disorder include carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). The other anticonvulsant valproic acid (Depakote, divalproex sodium) is the main alternative therapy for bipolar disorder. Dizziness, drowsiness, unsteadiness, nausea, and vomiting. Skin rashes may occur.ide effects 3. ANTIDEPRESSANT MEDICATIONS Side effects Side effects of antidepressant medications. Antidepressants may cause mild, and often temporary, side effects (sometimes referred to as adverse effects) in some people. Typically, 19
  20. 20. these are not serious. However, any reactions or side effects that are unusual, annoying, or that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are as follows: • Dry mouth—it is helpful to drink sips of water; chew sugarless gum; brush teeth daily. • Constipation—bran cereals, prunes, fruit, and vegetables should be in the diet. • Bladder problems—emptying the bladder completely may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be at particular risk for this problem. The doctor should be notified if there is any pain. • Sexual problems—sexual functioning may be impaired; if this is worrisome, it should be discussed with the doctor. • Blurred vision—this is usually temporary and will not necessitate new glasses. Glaucoma patients should report any change in vision to the doctor. • Dizziness—rising from the bed or chair slowly is helpful. • Drowsiness as a daytime problem—this usually passes soon. A person who feels drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and to minimize daytime drowsiness. • Increased heart rate—pulse rate is often elevated. Older patients should have an electrocardiogram (EKG) before beginning tricyclic treatment. The newer antidepressants, including SSRIs, have different types of side effects, as follows: • Sexual problems—fairly common, but reversible, in both men and women. The doctor should be consulted if the problem is persistent or worrisome. • Headache—this will usually go away after a short time. • Nausea—may occur after a dose, but it will disappear quickly. • Nervousness and insomnia (trouble falling asleep or waking often during the night)—these may occur during the first few weeks; dosage reductions or time will usually resolve them. • Agitation (feeling jittery)—if this happens for the first time after the drug is taken and is more than temporary, the doctor should be notified. • Any of these side effects may be amplified when an SSRI is combined with other medications that affect serotonin. In the most extreme cases, such a combination of medications (e.g., an SSRI and an MAOI) may result in a potentially serious or even fatal "serotonin syndrome," characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems. The small number of people for whom MAOIs are the best treatment need to avoid taking decongestants and consuming certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles. The interaction of tyramine with MAOIs can bring on a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the individual should carry at all times. Other forms of 20
  21. 21. antidepressants require no food restrictions. MAOIs also should not be combined with other antidepressants, especially SSRIs, due to the risk of serotonin syndrome. 4. ANTIANXIETY MEDICATIONS Side effects Both antidepressants and antianxiety medications are used to treat anxiety disorders. Antianxiety medications include the benzodiazepines, which can relieve symptoms within a short time. They have relatively few side effects: drowsiness and loss of coordination are most common; fatigue and mental slowing or confusion can also occur. These effects make it dangerous for people taking benzodiazepines to drive or operate some machinery. Other side effects are rare. The only medication specifically for anxiety disorders other than the benzodiazepines is buspirone (BuSpar). Unlike the benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an antianxiety effect and therefore cannot be used on an "as-needed" basis. Beta blockers, medications often used to treat heart conditions and high blood pressure, are sometimes used to control "performance anxiety" when the individual must face a specific stressful situation—a speech, a presentation in class, or an important meeting. Propranolol (Inderal, Inderide) is a commonly used beta blocker. 5. Medications to manage side effects Procyclidine hydrochloride is used in patients with schizophrenia to reduce the side effects of antipsychotic treatment, such as parkinsonism and akathisia MEDICATIONS FOR SPECIAL GROUPS Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing. 21
  22. 22. Working with challenging behaviour Mental illness in a person can lead to behaviour in a service user which from time to time is difficult to deal with by service providers e.g. Non engagement with service providers, over use of alcohol and illicit substances, demotivation, sleep disturbance, eating patterns and so on. This means that organisations that provide services to people with mental illness have to provide guidelines on how to work safely and effectively with service users. Any guideline in working with people with mental illness needs to be underpinned by duty of care which is made up of: Welfare – whatever the staff do has to promote the long term welfare of the service user Support – staff need to provide support now that enables to person to cope with their situation and address disadvantages brought on by mental illness and Protection – ensure that the person with mental illness is supported to protect themselves from abuse In providing services to a person with mental illness who may have complex needs and present challenging behaviour, evidence based practice suggests that staff should use good practice protocols. These protocols need to address individual’s service uses unique needs and situation. A typical protocol would be made up of: • Comprehensive assessment • Risk assessment • Care management arrangement • With key working practice • Appropriate medication • Harm reduction practice • Recovery from mental illness • Rehabilitation • Re-engagement of the community • Relapse prevention The practice in all these areas would be guided by organisations policy and practice as well as knowledge base developed by practitioners and legislation. 22
  23. 23. How to do effective counselling? Practice skills • Listening • Supporting the person take responsibility • Enabling the person to solve their own problems • Empowering the person to take control of their own life 23
  24. 24. Protocol for supporting recovery Case study 1. Identify issues 2. Risk assessment 2.1 Motivation comes from pain or pleasure 3. Reducing chaos and enabling recovery 3.1.Increase energy to change - Sleep 3.2 Addressing the internal demotivator - Increasing enjoyment 4.1 Activating the Person 4.1 Addressing persons moods using thought patterns 4.2 Enaging person’s schemas – Downward arrow technique 5, Rehabilitation 5.1 Engaging person in daily life • Housing • Money • Health • Physical • Mental health • Relationships • Network • Emotional regulation • Alcohol • Drugs • Day activity • Fun • Personal development 6.Relapse Prevention Next 6 months • Issues from past • Issues in present • Issues from future 7. Working with difficult behaviour 24
  25. 25. • Success formula • Role modelling • New Associations • New habits 25
  26. 26. Case study: Key Issues Risk (High, Medium, Low) 26
  27. 27. Thought Record 1. Situation 2. How did you feel? 3. What Thoughts came to your head? 4. Evidence for the strong thought 5. Evidence against 6. What fuelled your behaviour? Is it information from 4 or 5 7. Action plan Support mechanisms © Mind Eye 2008 27
  28. 28. Other intervention tools 28
  29. 29. Booklist COGNITIVE THERAPY BOOK LIST COGNITIVE THERAPY OF SUBSTANCE ABUSE by Aaron T. Beck, Fred D. Wright, Cory F. Newman, and Bruce S. Liese (Paperback - 30 April 2001) COGNITIVE THERAPY - BASICS AND BEYOND by Judith S. Beck. (1995) Library index 616.89'14 COGNITIVE BEHAVIOURAL THERAPY: RESEARCH, PRACTICE AND PHILOSOPHY. by Brian Sheldon (Routledge, 1995) £12.95 COGNITIVE BEHAVIOUR THERAPY IN ACTION by P. Trower, A. Casey, W. Dryden (Sage, 1986) £10.99 COPING WITH DEPRESSION by Dr Ivy-Marie Blackburn MIND OVER MOOD (Patients' and Therapists' Manuals) by Dr D. Greenburgh and Dr Christine Padesky COGNITIVE THERAPY AND THE EMOTIONAL DISORDERS by Aaron T. Beck, M.D. (Meridian, USA. 1976 ) COGNITIVE THERAPY OF PERSONALITY DISORDERS by Aaron T. Beck, Arthur Freeman and Associates (The Guilford Press, USA. 1990) 29