Understand mental well-being and mental health promotion CMH 302

1. Understand mental well-being and mental health promotion CMH 302 Jacqui Ramus

2. Today we shall cover The main forms of mental ill health The impact of mental ill health on individuals and others in their social network Understand mental well-being and mental health promotion

3. Medical Model – classification systems – individual impairment Social Model – social barriers which affect mental well-being and mental health Psycho-social Model – Freud and Erikson – developmental influences on mental well-being and mental health Different views on mental well-being and mental health Understand mental well-being and mental health promotion

4. Four Models have been proposed over the past 100 years Psycho-social / psycho-analytic model (Erikson and Freud) – Freud believed that childhood experiences and unconscious desires influenced behaviour, and conflicts during these stages caused mental ill health. Erikson eight-stage theory of psychosocial development describes growth and change throughout the lifespan, focusing on social interaction and conflicts that arise during different stages of development. Biological model - The basic idea is that mental disorders are rooted in physical problems and that they require physical treatments to alleviate them (drug therapy/ECT/lobotomy). Social model - the social model is interested in the way that society at large reacts to people. It places responsibility for people’s problems as much in the lap of society as it does in the lap of the person themselves. Understand mental well-being and mental health promotion

5. Medical Model - Classification of Mental Health There are two main International Statistical Classification of Diseases, Injuries and Causes of Death (ICD). First published in 1900 and adopted by the World Health Organisation in 1949 since 1994 ICD-10 is currently in use and any updates due 2015 DSM Classification of mental health first occurred in 1952 when the Diagnostic and Statistical Manual of Mental Disorders was first published DSM produced by the American Psychiatric association - DSM-IV-TR - (2000) is the current version. Understand mental well-being and mental health promotion

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8. What do you feel are the key strengths and limitations of a classification system in relation to: Diagnosis Treatment Research Social implications (what do friends and family think?) Economic implications ( impact on work / benefits etc) Understand mental well-being and mental health promotion

9. Concerns have also been raised over Accuracy of descriptions used for classifications Cultural differences and how these may affect interpretation Understand mental well-being and mental health promotion

10. Can social influences influence mental health and well being? Think of older people you know, for example, relatives, neighbours and friends. Now consider ways in which the following can contribute to the person’s good / poor mental health: A sense of well-being The person’s living circumstances Being able to make, and keep, relationships with other people Coping with the challenges which life brings Understand mental well-being and mental health promotion

11. Erikson’s Psycho-social model Understand mental well-being and mental health promotion

12. Erikson’s Psycho-social model Understand mental well-being and mental health promotion

13. Evaluating the models Compare and contrast the strengths and limitations of each model? Does each model apply equally to all forms of mental ill health? Is there a place for a mix of models? Understand mental well-being and mental health promotion

14. the impact of mental ill health on individuals and othersin their social network Understand mental well-being and mental health promotion

15. What undermines mental health in later life? Depression Dementia (covered in a separate session) Alcohol abuse Problems caused by medication Other mental health problems (such as anxiety, delirium, late onset schizophrenia, Bi-polar disorder) Understand mental well-being and mental health promotion

16. Mental Health Depression Understand mental well-being and mental health promotion

17. Signs symptoms and treatment of depression Video outlining key issues for people living with depression Note down the key points that you wish to clarify / discuss or learn from this video Discuss in pairs Understand mental well-being and mental health promotion

18. Depression in older people – the facts One in four older people have symptoms of depression that require treatment Fewer than one in six older people with depression discuss their symptoms with their GP and only half of these receive adequate treatment Physical illness increases the risk of depression Untreated depression is the leading cause of suicide among older people, with men living alone at particularly high risk Understand mental well-being and mental health promotion

19. Incidence of depression among different ethnic groups Understand mental well-being and mental health promotion

20. Case studies Depression can affect people in different ways depending on the type and severity of the condition. Understand mental well-being and mental health promotion

21. Risk factors for depression in older people Receiving high levels of care Recent bereavement Social isolation and loneliness Excessive alcohol use Poverty Regular sleep problems Dementia Understand mental well-being and mental health promotion

22. Certain medical conditions can directly or indirectly cause depression in the elderly Understand mental well-being and mental health promotion

23. Depression in older people – the facts There is good evidence for the effectiveness both of counselling and antidepressants for the treatment of depression in older people Referral to an Old Age Mental Health Team should be considered if the person is considered to be at risk or not responding to treatment Increased exercise, opportunities to socialise, continued learning and volunteering, and financial help and advice can prevent or minimise depression, particularly in older people Understand mental well-being and mental health promotion

24. Mental Health and Older People Anxiety Understand mental well-being and mental health promotion

25. How does anxiety affect us ? How do we feel when we become anxious? How can it change our behaviour? Understand mental well-being and mental health promotion

26. Physical and emotional symptoms of anxiety www.campacademia.com/blog/wp-content/uploads/2010/11/Physical-Effects-of-disorders.gif Understand mental well-being and mental health promotion

27. WHAT LEADS TO ANXIETY DISORDER? A number of things can contribute to an anxiety disorder: • Extreme stress or trauma • Bereavement and complicated or chronic grief • Alcohol, caffeine, drugs (prescription, over-the-counter, and illegal) • A family history of anxiety disorders • Other medical or mental illnesses or • Alzheimer’s or other dementias Geriatric Mental Health Foundation Understand mental well-being and mental health promotion

28. SIGNS OF ANXIETY DISORDER • Excessive worry or fear • Refusing to do routine activities or being overly preoccupied with routine • Avoiding social situations • Overly concerned about safety • Racing heart, shallow breathing, trembling, nausea, sweating • Poor sleep • Muscle tension, feeling weak and shaky • Hoarding/collecting • Depression • Significant use of alcohol Geriatric Mental Health Foundation Understand mental well-being and mental health promotion

29. Some people describe the following as the most common symptoms Dizziness Unsteadiness Feeling terrified Feeling like you are choking Flushed face or feeling “heat in the head” Stomach pains Feeling faint http://www.mysahana.org/2010/12/anxiety Understand mental well-being and mental health promotion

30. Managing and treating anxiety • Medication • Talking therapies, such as counselling, Cognitive Behavioural Therapies (CBT) • Exercise • Avoiding stimulants such as caffeine, nicotine, alcohol Geriatric Mental Health Foundation Understand mental well-being and mental health promotion

31. If you suspect an older adult you know might have a problem with anxiety, Notice and ask about any changes in: • Daily routines and activities. Is the person avoiding situations and activities he or she once enjoyed? • Worries. Does he or she seem to worry excessively? • Medication. Is he or she taking a new medication, either prescription or over-the-counter? Or has the dosage changed for one of the medications? • Is he or she drinking more alcoholic drinks than previously? • Mood. Is the older adult tearful, lacking emotion, or “just doesn’t feel right.” Understand mental well-being and mental health promotion

32. When talking with an older adult who has an anxiety problem Be calm and reassuring Acknowledge their fears but do not play along with them Be supportive without supporting their anxiety Encourage them to engage in social activities Offer assistance in getting them help from a physician or mental health professional Understand mental well-being and mental health promotion

33. Bi-polar disorder

34. Stephen Fry talking about his experience of Bi-polar disorder Understand mental well-being and mental health promotion

35. Excessive Alcohol use Understand mental well-being and mental health promotion

36. Research has shown that there are different drinking rates among various ethnic groups • High abstinence, low drinking rates among many non-white minority ethnic groups • Irish people report frequent & heavy alcohol use • South Asians have lowest rates of alcohol use, but high rates among some drinkers • Black Caribbean, Black British, Black African people consume less than general population • People of Mixed ethnicity drink more than non-white minority ethnic groups • Low rates of consumption among Chinese people • Less variation in heavy drinking by age among Black Caribbean and Indian and Sikh men • Ethnicity and alcohol: a review of the UK literature, MIDDLESEX UNIVERSITY Understand mental well-being and mental health promotion

37. Mental Health and Older People Delirium Understand mental well-being and mental health promotion

38. Delirium or dementia? Delirium • Suddenly starts with a clear, identifiable time of onset • Cause is usually treatable such as infection, constipation, • Usually reversible Attention impaired • Consciousness ranges from lethargic to very alert • Effect on memory varies • Medical attention usually required immediately (usually ceases once source of infection is treated) Dementia • Slow, gradual changes. Typically notice changes over months • Due to chronic disorder such as Alzheimer’s • Progressive process • Attention not affection until late stages • No effect on consciousness until late stages • Loss of memory especially for recent events • Medical attention required, less urgently Understand mental well-being and mental health promotion

39. Video: the importance of housing on mental well-being • There is an important link between housing and mental wellbeing. • Cultural or language barriers may prevent people accessing services providing repairs or adaptation. • Poverty can mean that some older home owners and private tenants are unable to repair or maintain their property. Sources of charitable funding or grants may be available to help. • Disrepair and maintenance can affect not only physical health but can lead to anxiety and stress. It can also cause social isolation as older people may feel embarrassed to invite friends and family. Understand mental well-being and mental health promotion

40. Services in the community Make links with the specialist services in your area for older people with mental health needs. Find out their criteria for referrals. Ask for their help or advice if you feel you need it. Try to put yourself in the position of the older person – how would these symptoms make you feel? Would you be frightened, worried? How would you want to be treated? Understand mental well-being and mental health promotion

41. Accepting help– case study Mrs W had been persuaded to accept a regular home care visit as it was clear she was neglecting herself, but she found the visits tiresome and could not see why she needed help. On a number of occasions she wrote to the Director of Social Services politely asking for the care to be withdrawn. On each occasion the social worker from the community mental health team for older people came to see her and persuaded her to continue. He understood and sympathised with her irritation, but he also knew from previous discussions with her that it was important to her not to feel a burden on her family. He was able to convince her that the home care visits stopped her family worrying about her, and she was prepared to accept them on this basis. Gradually the home carers became trusted by Mrs W, and as her needs increased the social worker was able to increase the visits. Assessing the mental health needs of older adults: SCIE publication 1996 Understand mental well-being and mental health promotion

42. What you can do to help Recognise that family carers may have difficulty recognising or pinpointing what is wrong with their relative, particularly if the onset of the problem has been gradual. Being able to suggest support organisations / information can be helpful, for instance the Alzheimer’s Society, which may be able help them with support, information and advice. Recognise that some carers are reluctant to accept help because they fear that they will be excluded and that services will ‘take over’, although it is important that they receive appropriate support, otherwise it may affect their own mental health and well-being. Understand mental well-being and mental health promotion

43. Other sources of reference for CMH 302 BBC Website Health ( Emotional health) http://www.bbc.co.uk/health/emotional_health/mental_health/stigma.shtml#research_on_mental_health_stigma SCIE Introduction to adult mental Health Services http://www.scie.org.uk/publications/introductionto/adultmentalhealthservices/mentaldisorders.asp and http://www.scie.org.uk/topic/careneeds/mentalhealth MIND - http://www.mind.org.uk Understand mental well-being and mental health promotion

44. Today we covered • The main forms of mental ill health affecting older people • The impact of mental ill health on individuals and others in their social network Understand mental well-being and mental health promotion

45. Evaluation flipcharts How can you put this learning into your work? Can you think of any service users in particular who might have poor mental health and for whom your increased awareness may be useful? (Don’t record names of people – just the person’s situation) Understand mental well-being and mental health promotion