Navigating Mental Health

1. Navigating Mental Health

2. Rebecca Turpin • Edge Employment Solutions • (BA Psychology Honours) • Conditionally registered psychologist

3. Aims of this seminar • To provide information and education about psychiatric disabilities • To enable individuals to understand what is needed to provide effective services to people with a psychiatric disability • To enhance individuals ability to work together between organisations, and to develop effective networks in working with people with a psychiatric disability.

4. Mental Illness – The basics • Mental health issues constitute one of the most serious and perplexing problems we face in today’s society. • Mental illnesses touches all of us at some time during our lives. If we are not the ones afflicted, then it will be a family member, a loved one, a friend and in our case, a client we are supporting within the agency.

5. Some famous and historically important people who claimed they heard voices • Socrates (philosopher) Charlemagne (Emperor) • Moses (prophet) Caeser (Emperor) • Jesus (prophet) Alexander the Great (Emperor) • Mohammed (prophet) Teresa of Avila (religious mystic) • Joan of Arc (martyr) Columbus (discoverer) • Luther (religious leader) Calvin (religious leader) • Swedenbourg (philosopher/politician) William Blake (artist) • John Welsely (founder of Methodism) Jonathan Swift (writer) • Carl Jung (psychologist) Ghandi (politician/ pacifist) • Evelyn Waugh(writer) Anthony Hopkins (actor) • Malcolm Lowry (writer) Charles Dickens (writer) • Zoe Wannamaker (actress) Sylvia Plath (poet) • Philip K. Dick (writer) John Paul Sartre (writer) • Beethoven (composer) Virginia Woolf (writer)

6. Abnormal Behaviour • Society has explained and treated abnormal behaviour in different ways in different times. • How a particular society reacts to abnormality depends on the society’s values and assumptions about human life and behaviour. • For example during the Middle Ages, when a religious point of view was predominant, abnormality was usually explained in terms of supernatural causes such as demons, and treatment involved prayers and various forms of exorcism. • Contrast this with current trends in Western society to which science is important and in which people have a great deal of faith in the miracles of modern medicine, abnormal behaviour is considered evidence of mental illness and is often treated with drugs.

7. Classification of abnormal behaviour • So what is the line between normality and mental illness? • There is no single definitive widely accepted truth about what constitutes psychological abnormality. • However there are guidelines for defining abnormality and practical standards for the formal diagnosis of disorders. • As you saw earlier, today’s definitions have evolved over the centuries and have changed even more so within the last few years with the recovery movement gaining momentum. • To examine the question of what defines abnormal behaviour let us pose a number of questions

8. Does infrequency define Abnormality?

9. Does Suffering Define Abnormality

10. Does Strangeness Define Abnormality?

11. Does the Behaviour Define Abnormality?

12. Is normality a guideline?

13. So what is defined as abnormal behaviour • Professionals generally use two practical guidelines to define abnormal behaviour. • Firstly they take into account the persons behaviour, the context in which it occurs, and the appropriateness for that context. In other words they consider whether the persons behaviour causes impaired functioning. • Secondly they consider whether the person displays a consistent set of maladaptive feelings or behaviours that have been defined by mental health professionals as constituting mental dysfunction.

14. Diagnostic Systems There are two major classification systems of mental illness/disorders in use in Australia: • The current edition (DSM IV) is the most widely accepted system in the world for classifying psychological problems and disorders. • WHO (World Health Organisation) publishes another manual worldwide, The International Classification of Diseases (ICD) which in many respects is similar to the DSM. • To be diagnosed with a disorder the person must exhibit multiple behaviours that fit a defined pattern, their behaviour must cause dysfunction, it must be present for a specific amount of time, and it must not be due to some other explanation or physical disorder.

16. So what are we to conclude? • Although most serious behaviour disorders are universally recognized many others are culture specific. • This is why there is no single, universally accepted definition of abnormal behaviour. • Instead we have some guidelines (DSM) which vary in their applicability depending on the case. • According to these guidelines abnormal behaviour is unusual, maladaptive, and causes distress. • It also typically violated social norms.

17. The Disease Analogy and Medical Model of Mental Illness • This analogy can help scientists apply the scientific methods that have worked so well in medicine. • Yet the Illness analogy can obscure the social nature of much abnormal behaviour.

19. Criticisms of the DSM Sometimes the personal and cultural points of view concerning what is abnormal come into conflict. Some psychologists allege that if we take environmental circumstances into account then mental disorders are not medical illnesses.

20. David Rosenham’s study (1973) Other criticisms have been made regarding the validity of diagnostic categories.

21. Diagnostic Labels also become a self-fulfilling prophecy Once a person begins to behave abnormally a second force comes into play, society’s reaction. People diagnosed as mentally ill are stigmatized and socially disadvantaged. To adapt they withdraw from social contacts and may behave violently or act out towards a society that has shunned them. Eventually diagnostic labels even begin to affect how people think about themselves. They may lose faith in their ability to control their own life and become dependent on mental health professionals. They may view themselves as nothing more than “a schizophrenic”.

22. Should mental health professionals be using the DSM This does not mean that everything contained in the DSMIV is uncritically accepted. Mental health, psychology and psychiatry is a rapidly moving field in which there are still more questions than answers. Neither the current DSM nor any DSMs in the foreseeable future can or will claim to be definitive. New information on mental health is constantly being accumulated and no single research study is likely to be the last word on any issue.

23. What causes mental illness? Most mental illnesses are caused by the interaction of a number of factors including: Biological predisposition (genetic or acquired) Adverse early life experiences (eg abuse, neglect, death of parents or other losses and traumas) Individual psychological factors (self-esteem, thinking style) Current social circumstances (financial, work, relationship or family stress, or adverse life events) A “single” cause is highly unlikely. Rather an episode of illness appears to occur in a biologically and psychologically predisposed individual, under the trigger of social/environmental stress.

24. Depression The word depression is used in many different ways. Everyone can feel sad or blue when bad things happen. However everyday blues or sadness is not depression. People with the blues may have a short-term depressed mood but they can manage to cope and soon recover without treatment. The depression we are talking about is clinical depression which lasts for at least two weeks and affects a persons ability to carry out their work or to have satisfying personal relationships. Clinical depression is a common but serious illness and is often recurrent (that is people recover but develop another episode later on).

25. Mental Status Indicators Emotions Sadness, anxiety, guilt anger, mood swings, lack of emotional responsiveness, Anhedonia (e.g. lack of pleasure) helplessness, of unrelentless hopelessness (e.g., I can’t take one more day of this. I just cant do it. Things are never going to change, no matter what I do). Thoughts Frequent self-criticism, self-blame, worry, pessimism, impaired memory and concentration, indecisiveness and confusion, tendency to believe others see you in a negative light, suicidal ideation, idyllic thoughts of death as a release (e.g. I’ll be up in heaven, no-one will be able to hurt me anymore) Behaviour Crying spells, withdrawal; from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation Physical Chronic fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, irregular menstrual cycle, loss of sexual desire, unexplained aches and pains.

26. What causes Depression Depression has no single cause and often involves the interaction of many diverse biological, psychological and social factors

27. ANXIETY DISORDERS Everybody experiences anxiety at some point in their lives Anxiety can be quite useful in helping a person to avoid dangerous situations and motivate them to motivate them to solve everyday problems. Anxiety can vary in severity form mild uneasiness through to a terrifying panic attack. Anxiety can also vary in how long it lasts, from a few moments to many years. An Anxiety Disorder differs from normal anxiety in the following ways: It is more severe It is long lasting It interferes with the persons work or relationships

28. General symptoms of Anxiety Anxiety can show in a variety of ways: physical, psychological and behavioural Physical Cardiovascular: palpitations, chest pain, rapid heartbeat, flushing Respiratory: hyperventilation, shortness of breath Neurological: dizziness, headache, sweating, tingling and numbness Gastrointestinal: choking, dry mouth, nausea, vomiting, diarrhoea Musculoskeletal: muscle aches and pains (especially neck, shoulders, and lower back), restlessness, tremor, and shaking Psychological Unrealistic and/or excessive fear and worry (about past or future events), mind racing or going blank, decreased concentration and memory, indecisiveness, irritability, impatience, anger, confusion, restlessness or feeling on edge or nervousness, tiredness, sleep disturbances, vivid dreams Behavioural Avoidance of situations, obsessive or compulsive behaviour, distress in social situations, phobic behaviour

29. Anxiety Disorders Generalized Anxiety Disorder (GAD) Panic Disorder Phobic Disorders Agoraphobia Social Phobia Specific Phobia Acute stress disorder and post-traumatic stress disorder (PTSD) Obsessive Compulsive Disorder

30. Compulsive behaviours are repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession in order to reduce anxiety e.g. washing, counting, checking

31. PSYCHOSIS What is psychosis? Psychosis is a general term to describe a mental health problem in which a person has lost some contact with reality. There are severe disturbances in thinking, emotion and behaviour. Psychosis severally disrupts a persons life. Relationships, work and self-care are difficult to initiate and/or maintain. The main psychotic illnesses are schizophrenia, bipolar disorder, psychotic depression, schizoaffective disorder, and drug-induced psychosis.

32. Schizophrenia Schizophrenia is nothing to do with split personality. This is a common misconception, which is often confused with dissociative identity disorder (formerly known as multiple personality disorder) The term schizophrenia means fractured mind, and refers to changes in mental function where thoughts and perceptions become disordered. when first affected.

33. The major symptoms of schizophrenia are defined as either positive or negative. Symptoms such as hearing voices no-one else can are positive as they are added to normal experience by the illness. When the illness causes things to be missing from a persons normal experience and behaviour, this is called negative symptoms e.g. lack of motivation, withdrawing from people.

34. The symptoms of schizophrenia include: Delusions These are false beliefs held by the person, which is not held by others of the same cultural background. The person is so convinced of their delusion, that the most logical argument against it is useless.

35. Delusions take various forms: Paranoid delusion - a belief that you are being watched and singled out for some harmful purpose Grandiose delusion - a belief that you have special powers – that you are an important religious leader, politician, scientist Depressive delusion – a belief that you are guilty of some terrible crime or responsible for horrific world events

36. Hallucinations These are false perceptions. Hallucinations most commonly involve hearing voices, but can also involve seeing, feeling, tasting or smelling things. These are perceived as very real by the person with schizophrenia but are not actually there.

37. While the voices are unpleasant for some people for others they provide companionship or reassurance. Visual hallucinations are less common however they most commonly occur when the psychosis is drug induced. Hallucinations of taste and smell can also occur so that what seems to be the peculiar taste of food can cause someone who feels paranoid to believe they are being poisoned.

38. Confused thinking The everyday thoughts that let us lead our daily lives become confused and don’t join up properly. Some even believe their thoughts are being interfered with or that they can influence the thoughts of others, or that everybody else can read their thoughts. These disturbances in thinking mean that the person often has difficulty concentrating, following conversation or remembering things. Thoughts are all jumbles up Thinking Difficulties There may be difficulties in concentration, memory and ability to plan. These make it more difficult for the person to reason, communicate and complete daily tasks.

39. Loss of drive/motivation A secondary symptom often associated with psychosis is low motivation. Sometimes we under-estimate or forget about this. It can be genuinely difficult for the brain to translate a thought or wish into actual action.

40. Diagnosing Schizophrenia Schizophrenia is only diagnosed if the symptoms last over 6 months. A diagnosis of schizophreniform disorder is made if the psychotic symptoms last more than one month but less than 6 months. Brief Reactive Psychosis is the diagnosis if symptoms last for less than one month and may be a temporary reaction by the brain to a very stressful event.

41. Bipolar Disorder People suffering from Bipolar Disorder have extreme mood swings, fluctuating between periods of depression, mania and normal mood. Common symptoms in mania include: Increased energy and overactivity Elated mood The person will feel high, happy, full of energy, on top of the world, invincible Need less sleep than usual The person can go for days with little sleep Irritability This may occur if others disagree with a manic persons unrealistic plans or ideas Rapid thinking and speech The person may talk too much, too fast, and keep changing topics Lack of inhibitions The person may disregard risks, spend money extravagantly or be very sexually active Grandiose delusions These involve very inflated self esteem such as a belief that the person is superhuman, especially talented, or an important religious figure Lack of insight The person is so convinced that their manic delusions are real that they do not realise they are ill

42. Psychotic Depression Sometimes depression can be so intense it causes psychotic symptoms. E.g. the person may have delusions involving guilt, severe physical illness or hopelessness. Schizoaffective Disorder Sometimes its not possible to tell the difference between schizophrenia and bipolar disorder as the person has symptoms of both illnesses. Schizoaffective disorder just means a form of psychosis which falls midway between diagnosis of schizophrenia and bipolar disorder. Drug-induced Psychosis This is a psychosis brought on by the use of drugs. The symptoms usually appear quickly and last a short time (from a few hours to a few days) until the effects of the drug wear off. The most common symptoms are visual hallucinations, disorientation, and memory problems. Drugs that can cause psychosis are marijuana, cocaine, ecstasy, amphetamines.

43. The jigsaw – you, your client and the system

44. Crisis Intervention • A crisis is a situation when a person feels completely overwhelmed or defeated by the problems they are facing. • Crisis intervention is immediate person to person assistance. It helps restore self-determination in people who have exhausted their usual coping resources. • The intervener aids in the search for solutions by encouraging the individual to consider and to clarify thoughts, feelings and options.

45. Relating to a person who is experiencing a crisis Be warm, respectful and matter of fact. The situation varies from one individual to another. Recognise that the experience is real for this person at this time and that they may have difficulty paying attention to you. Keep sentences short: stick to one thing at a time.

46. Be honest but not argumentative. It can be useful to ask the person what they want right now Ask about friends, relatives, therapists or psychiatrists If the person is doing things which annoy or anger you ask them firmly to stop. Don’t make generalised criticisms.

47. If the person is violent or if you feel unsafe, make it clear that you are not going to harm the person, but you will not tolerate violence. If the person does not calm down, ring the police for your own protection. Remember that not everyone who experiences active symptoms of mental illness will be in a state of crisis,

48. What to do for someone experiencing depression and suicidal thoughts • People often disclose information to employment consultants that they would not disclose to even a spouse or family member due to the rapport built and the trust that has been instilled in the relationship. These disclosures may include feelings of hopelessness or despair or frank suicidal thoughts. • A suicidal patient may evoke significant strong emotions for an individual, such as anger toward the person or fear of losing the person, of personal failure in preventing suicide. However, despite these emotions, employment consultants have tremendous potential to respond to this call to action by arming themselves with the knowledge of risk factors for potential suicide

49. Risk Assessment A number of suicide risk assessment tools have been devised.

50. Depression is a major risk factor for suicide, but there are others as listed below (http://www.capefearpsych.org/documents/SADPERSONS-suiciderisk.pdf) • The SAD person’s risk assessment TOOL • Sex: males kill themselves more than 4 times more often than females • Age: certain age groups are more at risk • Depression: Depressed persons are more at risk • Previous attempt: more likely to attempt in the future • Ethanol: alcohol abuse very often implicated in suicide • Rational thought: more prone to suicide if psychotic • Social network: the less social support, the greater the risk • Organised Plan: greater risk if suicide plans are organised • No spouse: greater risk of suicide if there is no partner • Sickness: a chronic physical illness makes suicide more likely