Understand mental well being and mental health promotion cmh 302
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Understand mental well-being and mental health promotion CMH 302. Jacqui Ramus. 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. Medical Model – classification systems – individual impairment

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Understand mental well being and mental health promotion cmh 302

Understand mental well-being and mental health promotion CMH 302

Jacqui Ramus


Today we shall cover

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


Different views on mental well being and mental health

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


Four models have been proposed over the past 100 years

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


Medical model classification of mental health

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


Understand mental well being and mental health promotion cmh 302

Understand mental well-being and mental health promotion


Understand mental well being and mental health promotion cmh 302

Understand mental well-being and mental health promotion


What do you feel are the key strengths and limitations of a classification system in relation to

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


Concerns have also been raised over

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


Can social influences influence mental health and well being

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


Erikson s psycho social model

Erikson’s Psycho-social model

Understand mental well-being and mental health promotion


Erikson s psycho social model1

Erikson’s Psycho-social model

Understand mental well-being and mental health promotion


Evaluating the models

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


The impact of mental ill health on individuals and others in their social network

the impact of mental ill health on individuals and othersin their social network

Understand mental well-being and mental health promotion


What undermines mental health in later life

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


Depression

Mental Health

Depression

Understand mental well-being and mental health promotion


Signs symptoms and treatment of depression

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


Depression in older people the facts

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


Understand mental well being and mental health promotion cmh 302

Incidence of depression among different ethnic groups

Understand mental well-being and mental health promotion


Case studies

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


Risk factors for depression in older people

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


Certain medical conditions can directly or indirectly cause depression in the elderly

Certain medical conditions can directly or indirectly cause depression in the elderly

Understand mental well-being and mental health promotion


Depression in older people the facts1

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


Anxiety

Mental Health and Older People

Anxiety

Understand mental well-being and mental health promotion


How does anxiety affect us

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


Physical and emotional symptoms of anxiety

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


What leads to anxiety disorder

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


Signs of anxiety disorder

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


Some people describe the following as the most common symptoms

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


Managing and treating anxiety

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


If you suspect an older adult you know might have a problem with anxiety

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


When talking with an older adult who has an anxiety problem

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


Bi polar disorder

Bi-polar disorder


Stephen fry talking about his experience of bi polar disorder

Stephen Fry talking about his experience of Bi-polar disorder

Understand mental well-being and mental health promotion


Excessive alcohol use

Excessive Alcohol use

Understand mental well-being and mental health promotion


Research has shown that there are different drinking rates among various ethnic groups

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


Delirium

Mental Health and Older People

Delirium

Understand mental well-being and mental health promotion


Delirium or dementia

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


Video the importance of housing on mental well being

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


Services in the community

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


Accepting help case study

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


What you can do to help

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


Other sources of reference for cmh 302

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


Today we covered

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


Evaluation flipcharts

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


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