People mental health and their impact on daily life

1. MENTAL HEALTH IS
EVERYONE'S
RESPONSIBILITY.
Delivered by
Simone Taylor
RMN

2. Aims of this session
■ To help you understand what is meant by “mental health”.
■ To give knowledge that instils confidence when assisting with the treatment of, or
leading the treatment of someone with a mental illness.
■ To use what you know now, and the experiences you’ve had to inform the
development of your knowledge and application of skills.
■ To improve the treatment of those with a mental illness while under the care of a
physical health practitioner in acute and community settings.

3. You
■ What do you know about mental health
■ What do you worry about when treating someone with a mental health problem?
■ What do you want gain from today?

4. What experiences have you had?

5. What is Mental Health?
■ Mental health is defined as a state of well-being in which every individual realizes his or
her own potential, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to her or his community (WHO, 2018)
■ Our mental health affects how we think, feel, act and interpret the world around us. We
are all vulnerable to having our mental health becoming fragile at one point or another in
life. The stress vulnerability model is one of the easiest ways to explain how we may
become increasingly vulnerable to our mental health breaking down.
■ Mental health is something we all have. It is a continuum and can change depending on
our individual vulnerabilities, life and social stressor.
■ Our mental health is considered to be poor when our ability to function in daily tasks is
affected or altered.
■ 1 in 4 people will suffer poor mental health
The World Health Organisation, 2018

6. Causes of Mental Health Illness
■ Trauma
■ Life event
■ Stress
■ Predisposed – genetic
■ Breakdown of marriage/loss of job
■ Bereavement
■ Substance abuse
■ Homelessness

7. Stress vulnerability model
Stress bucket
Tap
Zubin J and Spring B: (1977). Vulnerability; a new view of Schizophrenia. Journal of Abnormal Psychology, 86, 103-126.
Work
Relationship
Money Family
Relationships
Intrinsic Predisposed
Vulnerabilities
Substance
Abuse Life
Crisis

8. What are the different types of
mental health illness’s, how do
they affect people and what are
there symptoms

9. Schizophrenia
■ 1 in 100 people live with a diagnosis of schizophrenia,
■ Life long illness / SMI – Serious Mental Illness
■ Characterised by a cluster of negative and positive symptoms.
■ Positive symptoms: things that people without this illness do not experience;
hallucinations – 5 types, delusions, thought disorder, poverty of speech
■ Negative symptoms: things that a person has ceased to do. self neglect, social
withdrawal, poverty of speech, flattened affect.
■ Antipsychositc medications that may be used in treating the symptoms of
schizophrenia – Clopixol , Paliperidone, Olanzapine, Aripiprazole, Clozapine, Haldol,
Halperidol.
■ CBT is also part of the NICE pathway, along with family interventions and physical
health monitoring and interventions.

10. Psychosis
■ 0.07% or 4,6000 of the UK population have psychosis .
■ 70% of the British public have had a ‘hearing voices’ experience.
■ Prodromal period – before a psychotic episode
■ A blip – 1-4 day episode
■ A psychotic episode – a prolonged period of both negative and positive symptoms effecting the
individuals daily function.
■ A recurrent psychotic disorder – more than one episode
■ Characterised by positive and negative symptoms
■ May not be life long illness.
■ Symptoms of psychosis may also be seen in Bipolar disorder, Borderline personality disorder and
obsessive compulsive disorder.
■ Medications to treat are much the same as schizophrenia. A mood stabiliser or anti-depressent may
be added if there is a depressive presentation that would benefit from a mood stabiliser or SSRI.
■ CBT is also part of the NICE pathway, along with family interventions and physical health monitoring
and interventions.

11. What’s it like to hear voices?
■ https://www.youtube.com/watch?v=0vvU-Ajwbok

12. Bipolar disorder
■ 1 in 100 people live with this diagnosis
■ Once known as Manic Depression
■ Characterised by prolonged periods of extremely low mood and with comparably
shorter periods of elation and mania.
■ Bipolar type 1 – severe mania
■ Bipolar type 2 – hypomania
■ Usually a pattern to manic episode – mixed cycle and rapid cycle. Some OTCs such as
St Johns wart can have a negative effect on Bipolar, and may cause hypomania in
untreated Bipolar.
■ Medications used to manage Bipolar – antipsychotics such as ; risperidone,
quetiapine, olanzapine, aripiprazole. Mood stabilisers such as; lithium and valproate

13. Personality disorder
■ 1 in 10 people live with this diagnosis
■ The ICD 10 reports 10 types of personality disorder;
■ Suspicious – paranoid, schizoid, schizotypal and antisocial.
■ Emotional and impulsive – borderline, histrionic and narcissistic.
■ Anxious – avoidant, dependent and obsessive compulsive.
■ No single medication is used to manage the disruptive symptoms of a personality
disorder.
■ Borderline Personality Disorder is most common in women, around 70% of those with the
diagnosis are female.
■ Diagnostic criteria for BPD has 9 characteristics, 5 must be present along with – a real or
perceived fear of abandonment and marked impulsivity from early adulthood – risk.

14. Anxiety and Depression
■ 17.8% of the population in the UK – live with these conditions
■ Some symptoms of anxiety often include; physiological symptoms, panic, avoidance,
catastrophising, withdrawal, self neglect in severe cases.
■ 5 types of anxiety – GAD, Phobias social anxiety, panic disorder and PTSD
■ Some symptoms of depression may include; low mood persistent consistently for 2 weeks,
self neglect, social withdrawal, hopeless and or helpless.
■ First line medical treatment may be in the form of an undepression or an anti-anxiety
medication.
■ Antidepressants may take up to 6 weeks to reach therapeutic effect.
■ Once therapeutic effect has been reach, this is when a person needs extra monitoring.
■ Antidepressants – duloxetine, fluoxetine, venlafaxine, sertraline , citalopram.
■ Anti-anxiety medications – all the pams! Clonazepam, diazepam, lorazepam.
■ CBT, psychoeducation group therapy, and IAPT pathways are recommended therapies for
depression and anxiety types.

15. Obsessional Compulsive Disorder [OCD]
■ 12 in ever 1000 people live with this condition
■ A obsession
■ A compulsion
■ Medication/therpy to treat/manage;
■ Antidepressant, Anti-anxiety medication, , Antispychotics, Beta Blockers
■ CBT , Exposure and Response Prevention [ERP]

16. Eating disorders
■ Anorexia nervosa
■ Bulimia
■ Binge eating disorder
■ ‘Other specified feeding or eating disorder’
■ Orthorexia – preoccupation with ‘clean/healthy’ foods
■ Avoidant/Restrictive Food Intake Disorder – foods limited due to
appearance/taste/texture/brand etc
■ Diabulimia – restriction of insulin for the purpose of weightloss
■ In the UK we have 1.6 million people with a diagnosed ED
■ No one medication or treatment is used to treat an eating disorder.
■ Supplements, strict eating regime (inpatient), weekly weigh ins, psychological
interventions.

17. Child and Adolescence Mental Health Services
■ Suicide
■ Depression
■ Self harm
■ Anxiety
■ Eating disorder
■ OCD
■ Psychosis
■ ADHD & ADD.
■ 284,599 young people are in contact with MH service under age of 19

18. Self harm and suicidal thoughts
■ Around 20% of adults experience suicidal thoughts
■ 6.7 % of those attempt to take their life
■ 6133 suicides record in 2014 age 10 and above
■ 7.3 % self harm – 1 in 15 people
■ 66.9% do not seek help for self harm
■ Under 19s – 12.1% had self harmed at some point
■ Accurate figures?
■ Types of self harm : cutting , burning, ligitures, swallowing foreign objects , inserting
foreign objects , punching , restricting food or food groups , alcohol and drug abuse ,
self exposed sexual vulnerability.
Figures taken from the Fundamental facts about mental health (2016) from www.mentalhealth.org.uk

19. What is A&E like for a Mental Health
service user?
“You are told to sit on a chair or if your lucky a bed, then you are left
there for ages, no one popping over every so often to check if your ok
like they do those are in with a physical illness. Is it any wonder we
either don’t want to attend A&E and have to be dragged there. I have
run off at times and had to be brought back by the police or security”
“A&E makes you very anxious and the staff don’t get that. A&E is not
a nice place to go when your struggling with your mental health,
everyone makes you feel like your just wasting their time “
Pseudonyms have been used to protect the identity and retain anonymity of the individuals throughout this presentation, in line with NMC confidentially requirements.
(NMC, 2015)

20. Scenario
A 14 year old comes into the A&E department with ongoing
stomach pain. You are the nurse in charge of their care after
triage. Parents are around but have stepped out to call
family/work. The 14 year old then discloses to you that they have
recurrent thoughts of harming themselves.
So now think about how you would deal with this situation, what skills you
may need to apply, and what you may need to consider in you care of this
minor.

21. Points to consider:
o Do you want to deal with this situation?
o What is your gut telling you?
o Admission to paediatric ward for psychiatric assessment?
o Disclosing information to parents who are not present?
o Safeguarding referral ?
o Risk ?
o How comfortable do you feel with dealing with this patient?
– Very comfortable, comfortable, unsure, uncomfortable, very
uncomfortable.

22. Non-prescriptive answer to scenario 1
o Take a minute to digest the information , reflect and speak to colleagues
o Validate the disclosure
o facial expressions and body language.
o confidentiality
o Find out more about the girls current life
o Intent behind thoughts
o Explore current risk - have they already self harmed?
o Call CAMHs front line worker
o Encourage the young person to speak to their parents
o Safeguarding ?
o Admission to paediatric ward for psychiatric assessment??
o Stomach pain?

23. How comfortable do you feel now
approaching this scenario?

24. Scenario
During a community visit to a 27 year old female and 6 month old baby,
you notice a open bottle of vodka on the table and several packets of
paracetamol. The mother tells you she has taken 32 paracetamol with
a glass of vodka 1 hour ago. The baby is asleep in the cot upstairs.
So now think about how you would deal with this situation, what skills you may
need to apply and what you may need to consider in you care of this situation.

25. Points to consider:
o Do you want to deal with the situation?
o What is your gut telling you?
o Risk
o Safeguarding?
o How comfortable would you feeling with dealing with this patient?
- Very comfortable, comfortable, unsure, uncomfortable, very
uncomfortable

26. Non-prescriptive answer to Scenario 2
■ Where is baby now
■ Call 999 and ask for ambulance
■ Find out exactly how many paracetamol and quantity of
vodka taken
■ Give her reassurance
■ Call base and inform them of the situation
■ Call next of kin to take care of baby
■ Report to safeguard (babies DOB and full name)

27. How comfortable do you feel now
approaching this scenario?

28. Scenario
A 32 year old man presents at A&E, having been brought there by
the police due to him stating that he has been followed by the
government and fears he may have been abducted by aliens. This
man has large cuts down his legs and the police commented that he
was found in the woods. How do you respond?
So now think about how you would deal with this situation, what skills you may
need to apply and what you may need to consider in you care of this situation.

29. Points to consider:
o Do you want to deal with the situation?
o What is your gut telling you?
o Risk
o Safeguarding referral ?
o How comfortable would you feeling with dealing with this patient?
- Very comfortable, comfortable, unsure, uncomfortable, very
uncomfortable

30. Non-prescriptive answer to Scenario 3
o Visual assessment
o Validate his experience
o He’s a human in need of care
o Communicate
o Safety and trust
o Explore his current life situation
o Speak to liaison psychiatry for reassurance
o Risk

31. How comfortable do you feel now
approaching this scenario?

32. Scenario
A 42 year old women has presented at A&E with fleeting suicidal thoughts
and you can see she has already self harmed today. Your colleagues are
telling you that they believe she has a personality disorder and is wasting
time.
So now think about how you would deal with this situation, what skills you may
need to apply and what you may need to consider in you care of this situation.

33. Points to consider:
oDo you want to deal with the situation?
oWhat is your gut reaction when you hear a person is ‘PD’?
oWhat is your gut telling you?
oRisk
oSafeguarding referral ?
oLiaison psychiatry referral?
oHow comfortable would you feeling with dealing with this patient?
- Very comfortable, comfortable, unsure, uncomfortable, very uncomfortable

34. Non-prescriptive answer to Scenario 4
o Do your research
o Visual assessment
o She a human being in need of compassionate care – validate her experience
o Communicate
o Trust
o Explore her current life situation
o Explore her suicidal intent
o Speak to liaison psychiatry for reassurance
o Risk
o Safeguarding

35. How comfortable do you feel now
approaching this scenario?

36. Final words from Mental Health Service
user:
Pseudonyms have been used to protect the identity and retain anonymity of the individuals throughout this presentation, in line with NMC confidentially
requirements. (NMC, 2015)
“Don’t judge me for my scars,
or my reason for seeking out help.
Treat me like you would expect
to be treated if you felt vulnerable
and scared”.

37. Remember ..
Mental health is everywhere and not just on mental health wards, so
we need to ensure that our friends and colleagues feel empowered in
facing theses situations as they arise.
o Remain calm and ask your colleagues for support
o Its ok to be anxious when dealing with situations
o Listen to your gut, its usually not wrong

38. Thank you

39. Reference’s
• Biskin, R. S., & Paris, J. (2012). Diagnosing borderline personality disorder. CMAJ : Canadian Medical
Association journal = journal de l'Association medicale canadienne, 184(16), 1789-94.
• BEAT eating disorder. (2018). https://www.beateatingdisorders.org.uk/types
• British Medication Journal. (2018). Obsessive-compulsive disorder.
https://bestpractice.bmj.com/topics/en-gb/362
• Mental Health Foundation. (2017). Fundamental facts about mental health. www.mentalhealth.org.uk
,
• Frith, C. D. (1987). The positive and negative symptoms of schizophrenia reflect impairments in the
perception and initiation of action. Psychology Medicine, 17, 631-648
• Joint Commissioning Panel For Mental Health (2017)
www.jcpmh.info/wp-content/uploads/10keymsgs-eatingdisorders.pdf
• Joint Commissioning Panel For Mental Health Eating Disorders (2017)
• Office For National Statistics (2018)
https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/measuringnationalwellbein
gdomainsandmeasures

40. Reference’s
• Public Health England. (2016). Psychosis Data Report : Describing variation in numbers of
people with psychosis and their access to care in England.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_d
ata/file/611422/Psychosis_data_report.pdf
• National Collaborating Centre for Mental Health (UK).(2014). Psychosis an d Schizophrenia in
Adults: Treatment and Management. https://www.ncbi.nlm.nih.gov/books/NBK333029/
• Mind. (2018). Personality Disorders.
https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-di
sorders/types-of-personality-disorder/#.XBK4tC-cbsE
• The Royal College of Nursing. (2017). Child and Adolescent Mental Health Key facts.
https://www.rcn.org.uk/-/media/royal-college-of-nursing/.../may/pub-006021.pdf