Navigating Mental Health. Rebecca Turpin Edge Employment Solutions (BA Psychology Honours) Conditionally registered psychologist. Aims of this seminar. To provide information and education about psychiatric disabilities
There are two major classification systems of mental illness/disorders in use in Australia:
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.
Other criticisms have been made regarding the validity of diagnostic categories.
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”.
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.
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.
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).
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).
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)
Crying spells, withdrawal; from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation
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.
Depression has no single cause and often involves the interaction of many diverse biological, psychological and social factors
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
Anxiety can show in a variety of ways: physical, psychological and behavioural
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
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
Avoidance of situations, obsessive or compulsive behaviour, distress in social situations, phobic behaviour
Generalized Anxiety Disorder (GAD)
Acute stress disorder and post-traumatic stress disorder (PTSD)
Obsessive Compulsive Disorder
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
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.
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.
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.
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.
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
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.
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.
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
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.
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.
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.
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
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
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
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
Sometimes depression can be so intense it causes psychotic symptoms. E.g. the person may have delusions involving guilt, severe physical illness or hopelessness.
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.
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.
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.
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.
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,
A number of suicide risk assessment tools have been devised.
1 Current Plan
2 Previous attempt
Myth: People who commit suicide always give off some kind of clear warning sign or call for help
Ask the following questions
Preferably contact such services with the clients permission, but be aware of your duty of care.
• There’s no point in just telling someone with depression to get better as they cannot “snap out of it” or “get over it.”
• You should not be hostile or sarcastic when the person attempts to be responsive but rather accept these responses as the
best the person has to offer at that time.
• Avoid speaking to the person with a patronising tone of voice and do not use overly-compassionate looks of concern.
• Resist the urge to try to cure the person’s depression or to come up with answers to their problems.
There are many services available to clients which broadly fall under the heading of mental health provision. They include:
Psychiatric institutions, for residential and outpatient care
Crisis Emergency Teams - which will assist in emergencies and assess whether someone is unwell enough to warrant hospitalization
Psycho-social rehabilitation programs, which often provide assistance with daily living skills and leisure activities
Housing programs, which assist people to find suitable accommodation in the community
Mental health clinics, which may provide both counselling and medication services, along with various education programs
Support groups, which provide an opportunity for people to meet with other consumers, share experiences, and lobby for additional services
Private practitioners, including psychiatrists and psychologists
It is essential that you develop good working relationships with the staff of these other agencies.
It is simply not possible to assist someone with a serious illness in isolation from other resources – your client will need assistance beyond the boundaries of employment agency, and it is important that you are able to refer them to more appropriate services when necessary.
A GP can provide the following types of help:
Explaining a mental illness and how the person can best be helped
Prescribing medication if needed
Referring the person to a counsellor, clinical psychologist or psychiatrist
Counsellors and clinical psychologists specialise in the psychological treatment of mental health problems.
They are not medically qualified, so they cannot prescribe antidepressants or other drugs. A counsellor of clinical psychologist can provide a person with the following types of help:
An opportunity to talk about problems and to be listened to in an emotionally supportive and non-judgementally way
Specific methods for overcoming mental illness and preventing its recurrence. A counsellor will provide active listening techniques and an opportunity to discuss life problems, however a clinical psychologist is able to provide therapeutic intervention such as CBT
If a person wants help from a counsellor or clinical psychologist they can contact one themselves or get a recommendation form their GP.
Psychiatrists are medical specialities who treat mental health problems.
Psychiatrists generally only treat people who have severe or long lasting problems. They are experts on medication and can help people who are having side-effects from their medication or interactions with their other medications.
It is possible to see a psychiatrist only by getting a referral from a GP.
The person may not want to seek professional help. You should find out if there are specific reasons why this is the case.
If the person still doesn’t want help after you have explored their reasons with them, let them know that if they change their mind in the future about seeking help they can contact you. You must respect the person’s right not to seek help at all times unless you believe that they are at risk of harming themselves or others.
Admission for Psychiatric Treatment
Some rules of thumb if your client wishes to cease taking medication:
Close collaboration with the treating psychiatrist, especially if they have known the client for some time is invaluable as long as the client is happy for this transfer of information to occur.
Discuss the issue with your client. They may be unaware that you have less time to spare than they either need or want. Set boundaries on the amount of time you can spend with them and define your role more clearly