4 March 2014 Delivered by: Aly Anderson

1. Supporting patients in mental distress – awareness and good practicea PLT programme for:Practice Nurses and HCA’s 4 March 2014 Delivered by: Aly Anderson

2. Objectives As a result of this session, you will: • Understand what is meant by the term ‘mental health’ • Be able to recognise symptoms of mental health problems (specifically in relation to depression, anxiety disorders and psychosis). • Be able to respond appropriately to someone in mental distress • Have a basic understanding of how to assess the risk of suicide • Understand the importance of looking after your own mental wellbeing.

3. Work in pairs: Come up with a definition and/or list of words that you think of when you think of the term ‘mental health’. What is mental health?

4. “Mental health influences how we think and feel about ourselves and others and how we interpret events. It affects our capacity to learn, to communicate and to form, sustain and end relationships. It also influences our ability to cope with change, transition and life events: having a baby, moving house, experiencing bereavement.” (Mental Health Improvement ‘concepts and definitions’, Friedli, L. 2004) Everyone has mental health What is mental health?

5. World Health Organisation definition: A positive sense of well being A belief in one’s own worth and the dignity and worth of others The ability to deal with the inner world of thinking, feeling, managing life and taking risks The ability to initiate and sustain mutually satisfying personal relationship The ability of the mind to recover from shock and trauma

6. A mental health problem is a disturbance in the way in which a person thinks, feels and behaves.  Mental ill-health can happen to anyone – and it’s on a continuum Most of us go through periods where we feel ‘down’ and/or anxious A diagnosable mental health problem is where symptoms tend to be more severe, are longer lasting and affect our ability to function Wide range of diagnosable conditions What is a mental health problem?

7. Depression Anxiety – including OCD, phobias, PTSD and Panic disorder Psychotic disorders – bipolar disorder, schizophrenia Some mental health conditions

8. The Mental Health Continuum Optimal Mental wellbeing Optimal mental wellbeing with diagnosable mental health issue Optimal mental wellbeing without mental health issue Serious diagnosable mental health Issue No symptoms of mental heath issue Poor mental wellbeing without a diagnosable mental health issue Poor mental wellbeing with diagnosable mental health issue Poor Mental wellbeing

9. Mental Health Facts • 1 person in 4experiences some form of mental health issue every year and, right now, 1 in 6 workersis dealing with a mental health related problem such as anxiety, depression or unmanageable stress Source: ONS (2009) • This week, in England, approximately 80people will take their own lives. Three quarters of them are likely to be men (based on ONS figures 2009) • £30.3 billion is the estimated annual loss of output within workplaces (England) due to mental ill-health Source: Centre for Mental Health (2009)

10. Prolonged exposure to stress Traumatic life events Physical health problems Isolation Genetic predisposition Lack of support Bereavement Drug/alcohol misuse . . . Risk factors for mental health issues

11. Disability Poor housing/homelessness Abuse Unemployment Homelessness Discrimination Risk factors for mental health issues

12. Protective Factors • Supportive social networks • Physical exercise • Positive coping strategies • Communication skills • Emotional literacy • Problem solving abilities • Arts and culture • Confidence/self-belief . . .

13. Protective Factors • Balanced diet • Respectful relations • Values and beliefs • Tolerant, supportive community • Rest and reflection

14. TrueorFalse? Mental health myths

15. Signs and symptoms of anxiety and depression Group Exercise - identifying symptoms: - Physical - Behavioural - Psychological (thoughts and feelings)

16. Persistent sadness, Loss of interest, difficulty concentrating Irritability, negativity Mood swings Loss of confidence/self esteem Undue feelings of guilt, hopelessness/worthlessness Thoughts of suicide and/or self harm Depression

17. Depression cont’d. . . • Persistent tiredness • Unexplained aches and pains • Gaining/losing weight. • Sleeping too much, too little • Loss of libido • Avoiding others • Stopping enjoyable interests/hobbies • Eating too much/too little • Self harm. . .

18. Palpitations Chest pain Stomach problems, nausea muscle aches Headaches, dizziness Feeling ‘on edge’ Panic attacks Anger, confusion Excessive fear & worry Unwanted repetitive thoughts Anxiety

19. Anxiety cont’d . . . • Mind racing • Irritability • Sleep difficulties • Difficulties with decision-making • Avoidance • Repetitive behaviours • Phobic behaviours (discomfort &urge to escape)

20. Panic attack symptoms Symptoms may include: • Chest pain/discomfort • Nausea • Fear of dying • Numbness/pins & needles • Sweating • Feelings of detachment • Increased awareness of heart beat • Trembling/shaking

21. Psychosis Psychosis is an umbrella term used to describe conditions which affect the mind, where there has been a distortion of reality involving: • Hallucinations(false perceptions) such as hearing voices or seeing people who aren’t there • Delusions – false beliefs, possibly including paranoid thoughts. • Disordered thinking Violence is not a symptom of psychosis Psychosis is a significant risk factor for suicide

22. Schizophrenia • Not ‘split personality’ • A psychotic illness in which the changes in behaviour or symptoms have been present for at least 6 months • Many people with schizophrenia lead full and happy lives • Many people with schizophrenia make a full and sustained recovery

23. Bipolar Disorder • Extreme highs (mania) alternate with lows (depression). • Bipolar disorder may be psychotic or non-psychotic • When psychosis occurs it is in context of general mood disturbance. • Symptoms of mania include: lack of inhibitions, grandiose delusions, elated mood, needing less sleep that usual.

24. Supporting someone in distress Group activity – case study

25. Suicide warning signs • Expressions of hopelessness or helplessness • Feeling trapped – like there is no way out of a situation • Overwhelming sense of shame or guilt • A lack of interest in the future • Written or spoken notice of intention to end own life • Withdrawing from family/friends • Giving away possessions, putting affairs in order • Sudden unexplained ‘recovery’

26. Suicidal thoughts • Suicidal behaviour is on a continuum • It is a myth that if someone talks about suicide they are less likely to complete suicide • Don’t be afraid to ask about suicide – it’s good practice and you won’t do any harm by asking/listening • Confidentiality never applies to suicide

27. Being supportive • Encourage the person to talk – and listen to them • Silence – can be very supportive • Ask what you can do to help • Be encouraging, hopeful and reassuring • Offer support rather than solutions • Refer to other professionals as appropriate

28. Non-judgemental listening Non-judgemental listening is about: • Accepting people exactly as they are • Genuinely making no moral judgement about their situation • Empathically trying to get on their wavelength

29. Empathy Putting oneself in the other person’s shoes and seeing what the world looks like and feels like; conveying this understanding to the other person.

30. How would you feel if . . . • You were really upset about something but people kept telling you to stop worrying about it? • You were in unbearable pain and nobody wanted to help you. • You went somewhere where the people around you kept talking about you behind your back and writing things down about you. • People kept telling you, over and over again, that you were bad, ugly and a waste of space.

31. Empathy While you may not always understand what is going on for an individual, you can demonstrate empathy by reflecting back the feelings that the individual is expressing.

32. Next steps for patients in distress • If you believe that a patient is suicidal, refer them to a doctor as soon as possible. Ensure that someone stays with them until that appointment. • If you think someone is having a panic attack, treat as an emergency and call doctor. • If patient is showing signs of psychosis, call doctor for immediate assessment.

33. Recovery from mental health problems • With the right support, most people recover from mental health problems. • For some, recovery may not about a total absence of symptoms but is more about the individual building a personally meaningful and satisfying life. • Individuals manage their symptoms in a variety of different ways. There is no ‘one size fits all’. • Hope is crucial to recovery.

34. Looking after yourself • Supporting someone in distress can impact on your own wellbeing • Prolonged, unsupported workplace stress is a risk factor for mental ill-health • Be sure to look after your own mental health . . .

35. Looking after yourself Five Ways to wellbeing . . . 1. Connect 2. Be active 3. Take notice 4. Keep learning 5. Give

36. Evaluation We are always keen to hear how our training can be improved, so please complete the evaluation sheet. Copies of today’s powerpoint slides will be sent to you by Sheona Dalton- Workforce development. Thank you!