MENTAL HEALTH AWARENESS TRAINING FOR PROBATION WORKERS ’

1. MENTAL HEALTH AWARENESSTRAININGFOR PROBATION WORKERS’

2. Trainer and Group Introductions • Housekeeping • Ground Rules: Confidentiality • Take time out and seek further support if needed • Respect yourself and each other • Allow each other time to talk • Look after our own and each others wellbeing • Ice Breaker Exercise

3. CONTENTS Course Structure Defining mental health and coping What is mental illness The mental health continuum Mental Illness and Stigma Mental disorders The Offender with Anxiety The Offender with Depression The Offender with Eating Distress The Offender with Bi-Polar Disorder The Offender with Schizophrenia The Offender with a Personality disorder Young Offenders and Mental Health Mental health in Older Offenders Self injury and Suicidal Behaviour The Offender with Dual Diagnosis Communication Working with risk Diversity and Equality

4. MENTAL HEALTHGroup activity • How would you definegoodmental health? • How would you definepoormental health?

5. MENTAL ILLNESS AND STIGMA • 25% of us may experience mental distress at some point in our lives. • We can all have positive and negative ‘life experiences’ which have an impact on how we think, feel and engage with the world. • Certain circumstances increase the risk of mental illness. The stigma surrounding mental illness adds to the distress and isolation felt by offenders who experience mental health problems

6. COPING MECHANISMSGroup activity • What ‘coping mechanisms’ do you use to maintain or improve your mental health? • What resources might offenders use to help themselves cope?

7. HOW WOULD YOU DEFINE MENTAL HEALTH? “Mental health is the emotional and spiritual resilience which enables us to enjoy life and to survive pain, disappointment and sadness. It is a positive sense of well-being and an underlying belief in our own, and others “dignity and worth.” Mental Health Promotion 2006

8. MENTAL DISORDER What are the causes of mental disorder?

9. WHAT FACTORS COULDCAUSE MENTAL DISTRESS Many theories, many factors, complex reasons

10. THE MENTAL HEALTHCONTINUUM Where are you on the continuum at the moment?

11. THE MAIN CATEGORIES OF MENTAL DISORDERS

12. WHAT IS ANXIETY? Anxiety is physiological sense of unease we experience in response to environmental stressors. • More prevalent amongst offenders. • Often associated with other mental illnesses, such as depression and Post Traumatic Stress Disorder. • Considered a mental health problem when it is prolonged, severe and interferes with everyday activities. • If left unmanaged may develop into other problems such as panic attacks, phobias and obsessive compulsive disorders.

13. ANXIETY • What are the physical and psychological effects of anxiety? • How can we recognise it?

14. THE EFFECTS OF ANXIETY

15. PANIC ATTACKS Anxiety may take the form of a panic attack.. Panic attacks are a rapid build-up of powerful sensations generally associated with physical feelings Pounding and sometimes irregular heartbeat Chest pains, inability to breathe Feeling faint and/or sick, sweating Shaky limbs, legs turning to jelly Feelings of losing control • Offenders fear that they are going mad, blacking out or having a heart attack. • It can be a terrifying experience.

16. WHAT IS DEPRESSION? Symptoms of depression vary from offender to offender but may include: Low mood & low energy – neglect of personal hygiene. Disturbed sleep or appetite. Withdrawing from social situations. Loss of interest in usual activities. Low self-worth • Depression can be a long-term illness or may last for just one episode. • The severity and effect it has on the offender varies significantly

17. DEPRESSION • Make a list of some of the symptoms of depression

18. HOW DO YOU THINK AN OFFENDER WITH DEPRESSION MIGHT BEHAVE?

19. EATING DISTRESS Eating disorders are treatable medical conditions. • Although eating disorders are experienced predominantly by women men can be also be affected • Offenders with an eating disorder may also have other mental health problems such as generalised anxiety or depression. • In severe cases eating disorders can lead onto physical health problems including heart conditions and kidney failure.

20. EATING DISTRESS • How would you define eating normally? • Is it the same for everyone?

21. UNDERSTANDING OFFENDERS WITH BIPOLAR DISORDER Bipolar illness (manic depression) is a mood disorder which can involve extreme swings of mood ranging from severe depression to severe mania (‘lows’ to ‘highs’). • There may be long periods of stability in between. • Each individual will have a unique pattern of severity and duration. • The most common types of Bipolar disorder are known as Bipolar I and Bipolar II…

22. BIPOLAR I AND BIPOLAR II

23. HOW DOES MANIAAFFECT INDIVIDUALS • Incoherent, rapid or disjointed thought • Paranoia • Hallucinations affecting vision, hearing or perception • Grandiose delusions or ideas • Psychosis – losing touch with reality

24. HOW DOES HYPOMANIAAFFECT INDIVIDUALS Hypomania is a less severe form of mania. • Self confident and euphoric but may also react with sudden anger, impatience, or become irritable. • More ideas than usual, very creative. • More reckless, more talkative or more challenging.

25. THE DEPRESSIVE PHASE IN BIPOLAR DISORDER IS SIMILAR TO DEPRESSION… Severe depression usually follows an episode of mania. • Feelings of emptiness or worthlessness. • Loss of energy and motivation for many or all day-to-day activities. • Pessimism and negativity about most things (or everything). • Thoughts of death and suicide can be common but may be hard to discuss.

26. WHAT IS SCHIZOPHRENIA? “Schizophrenia is a severe mental disorder, characterized by profound disruptions in thinking, affecting language, perception, and the sense of self. It often includes psychotic experiences, such as hearing voices or delusions. It can impair functioning through the loss of an acquired capability to earn a livelihood, or the disruption of studies”. (W.H.O. 2009).

27. STIGMA AND SCHIZOPHRENIA • It’s important to say that Schizophrenia is not: • Split or Multiple Personalities • Caused by parents or the way someone was brought up • Untreatable • A guarantee that a person will be in hospital for life. • A guarantee that the offender will be dangerous. • People with Schizophrenia are more likely to: • Harm themselves • Be passive • Withdraw

28. SCHIZOPHRENIA Generally 1 in 100 people experience Schizophrenia • The highest incidence is in the late teens and early twenties • It affects men and women equally • Onset of illness is earlier in men than women • 25-50% of sufferers make a full recovery • 25% may experience long lasting problems

29. HOW ARE INDIVIDUALS AFFECTED BY SCHIZOPHRENIA? • Hallucinations • Delusions • Agitation • Disorganised thinking • Slowness to move, think, speak, react • Social withdrawal • Apathy • These experiences may occur separately, together or alternately.

30. UNDERSTANDING HALLUCINATIONS • Hallucinations are when a person hears,sees, smells or feels things that others do not. • The most common type are auditory hallucinations - i.e. hearing voices. • To the person experiencing them the voices are very real. • These experiences can be very frightening.

31. DELUSIONS Delusions happen when a person has a belief that seems very real to them but others do not share. Examples include: • Having special powers - e.g. the ability to read other peoples minds. • Believing that people are against them. • Thinking that people may be trying to harm them. • Their thoughts are being broadcast out loud. • Everybody knows what they are thinking. • It is important to bear in mind the cultural context – strange behaviour in our culture may not be considered strange in other cultures.

32. PERSONALITY DISORDERS An offender with a personality disorder may show some of the following traits: • Aggression and sudden outbursts of inappropriate anger. • Signs of anxiety or depression. • Deliberate acts of self harm. • Signs of eating distress. • Provocative and antagonistic behaviour. • Pre-occupation with routine. • Lack of emotion and remorse and/or taking everything personally. • Constantly seeking approval. • Dependence on others, deceitfulness, bullying and disregard for others.

33. OLDER PROBATION SERVICE USERSGroup activity • Why might older adults in the criminal justice system be more vulnerable than younger adults? • What particular problems do older adults face within the criminal justice services?

34. SELF HARM AND SUICIDEGroup activity • What are the causes of self harm?

35. DUAL DIAGNOSIS • The term ‘dual diagnosis’ can be defined in a number of ways but for the purpose of this publication it will be taken to mean the co-existence of severe mental health and substance misuse problems. • It is generally accepted that individuals with dual diagnosis suffer poorer health outcomes and present significant challenges to both health and criminal justice services.

36. HOW ARE MENTAL DISORDERS TREATED? • Prescribed medication • Self and advocacy groups • Talking therapies • Advocacy • Complementary therapies Some people find prescription medicine helpful, while others find that talking treatments are better. For some people find that a combination works best. Everyone is different and what works for one offender may not work for another.

37. REFERRING ON… • When would you need to refer to Mental Health services? • Where do you refer to? • Is there a single entry to Mental Health services? • Are you aware of local care pathways? Group to discuss…