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BORE DA - GOOD MORNING. FACTS AND MYTHS ABOUT MENTAL ILLNESS Jayne Anderson / Bleddyn Lewis. Facts and Myths about Mental Illness. 1.Mental health problems only happen to other people

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slide2

FACTS AND MYTHS ABOUT MENTAL ILLNESS

Jayne Anderson / Bleddyn Lewis

facts and myths about mental illness
Facts and Myths about Mental Illness

1.Mental health problems only happen to other people

  • Fact: 1 in 4 of the adult population will suffer from mental health problems in any one year, and one in six experiences this at any given time. - The Office for National Statistics Psychiatric Morbidity report (2001). It is estimated that approximately 450 million people worldwide have a mental health problem- World Health Organisation (2001)

2. People with mental illness are violent and dangerous

  • The risk of being killed by a stranger with a severe mental health problem is roughly 1:10,000,000, about the same probability as being hit by lightning*. The number of homicides by people with schizophrenia is around 30 per year. This is 5% of all homicides, the prevalence of schizophrenia in the population being 1% or less – Avoidable Deaths, Five year report of the national confidential inquiry into suicide and homicide by people with mental illness (December 2006).
facts and myths about mental illness1
Facts and Myths about Mental Illness

3. People with mental illness are poor and/or less intelligent

  • Mental illness, like physical illness, can affect anyone regardless of intelligence, social class or income level. Celebrities such as Stephen Fry, Nick Drake, Paula Yates, Kurt Cobain, Virginia Woolfe, Brooke Shields and Winston Churchill have all experienced mental illness.

4. People who self-harm are attention-seekers

  • This is untrue. Most people who self-harm do it in secret and it’s only when they need to seek medical attention, that they come to the attention of others
facts and myths about mental illness2
Facts and Myths about Mental Illness

5. People with poor mental health are weird

  • Everyone suffers from low mood and 1 in 4 of the population will experience mental ill health at some point in their lives. Think of 12 people you know. Are 3 of them rocking in the corner muttering to themselves? Thought not.

6. Mental illness is caused by emotional weakness

  • People do not choose to become mentally ill. As with other medical conditions, like heart disease or diabetes, it has nothing to do with being weak or lacking will-power.
facts and myths about mental illness3
Facts and Myths about Mental Illness

7. Once you’ve had a mental illness, you never recover

  • People can and do recover from mental illness. Medications, psychological interventions, a strong support network and alternative therapy treatments from cognitive behavioural therapy to improved diet and exercise habits are also very effective in leading to a complete recovery

8. Since ‘care in the community’ was started, people with mental health problems have been left to roam the streets

  • Even before the closure of the old large scale psychiatric hospitals, around 95% of people received care and treatment for mental illnesses in the community. What has changed is the type of accommodation and treatment available. For example, people requiring long term care in a hospital are usually no longer in the same building as those requiring short term admissions.
facts and myths about mental illness4
Facts and Myths about Mental Illness

9. All people who suffer from depression are suicidal

  • Suicide is not a mental illness. Not everyone who is depressed will consider suicide. It is as inaccurate as saying that all football fans are hooligans. However it is true to say that individuals experiencing a mental health problem are, generally, associated with a higher risk of suicide. If you suspect someone is feeling suicidal ask them – it could help save their lives.

10. If I seek help for my mental health problem, others will think I am "crazy"

  • Early treatment can assist with a faster recovery. If you broke your arm would you delay getting a cast applied incase people thought you were weak? Not likely!
slide8

Risk Factors: Certain factors can indicate an increased risk of physically violent behaviour . The following lists are not intended to be exhaustive and these risk factors should be considered on an individual basis.

demographic or personal history indicators
Demographic or personal history indicators
  • History of disturbed / violent behaviours
  • History of misuse of substances or alcohol
  • Carers reporting service user’s previous anger or violent feelings
  • Previous expression of intent to harm others
  • Evidence of rootlessness or ‘social restlessness’
  • Previous use of weapons
  • Previous established dangerous acts
  • Severity of previous acts
  • Known personal trigger factors
  • Evidence of recent severe stress, particularly a loss event or the threat of loss
  • One or more of the above in combination with any of the following:
  • Cruelty to animals
  • reckless driving
  • History of bed wetting
  • Loss of parent before the age of 8 years D(GPP)
clinical variables
Clinical variables
  • Misuse of substances and / or alcohol
  • Drug effects (disinhibition, alcathisia)
  • Active symptoms of schizophrenia or mania in particular
  • Delusions or hallucinations focused on a particular person
  • Command hallucinations
  • Preoccupation with violent fantasy
  • Delusions of control (especially with a violent theme)
  • Agitation, excitement, overt hostility or suspiciousness
  • Poor collaboration with suggested treatments
  • Antisocial, explosive or impulsive personality traits or disorder
  • Organic dysfunction D(GPP)
situational variables
Situational variables
  • Extent of social support
  • Immediate availability of potential weapon
  • Relationship to potential victim (for example, difficulties in relationship are known)
  • Access to potential victim
  • Limit setting (for example, staff members setting parameters for activities, choices, etc.)
  • Staff attitudes D(GPP)
slide12

Reference:Violence - The short-term management ofdisturbed/violent behaviour inpsychiatric in-patient settingsand emergency departmentsNICE 2005

slide13
These were just a few of the most common misconceptions surrounding mental health and mental illness.

Unfortunately, there

are many more!

slide15
There is now a considerable amount of evidence about the factors that promote and protect mental health and wellbeing and those which are associated with risk of poor mental health.
  • Improve Your Mental Health: No matter how old or young you may be, mental health is there in everyday life – in how we think and how we feel, how we react to others and how we are with ourselves. We all need to look after it, just as we do with our physical health.
top tips for positive mental health
Top Tips for Positive Mental Health
  • Staying mentally healthy isn't just about treating illness – far from it! There are lots of things we can do to help prevent ourselves getting ill in the first place, and plenty more we can try if we (or those around us) do encounter problems.
  • So, to get you started, we've put together these Top Tips for Positive Mental Health. Don't keep them under your hat either – tell your family, friends and colleagues. Everyone should know this stuff!
top tips
Top Tips
  • Talk about your feelings
  • Write it down
  • Keep active
  • Eat well
  • Sleep well
  • Drink sensibly
  • Keep in touch with friends and loved ones
  • Get the knowledge, take control
  • Get professional help
  • Look beyond drug therapies
  • Change the scene
  • Time for another cuppa?
  • Hold that thought
  • Go for green
  • Let there be light
  • Listen up!
  • Improve your coping skills
  • Set realistic goals
  • Keep an eye on personal stress
  • Three good things...
  • Get involved
  • The long way
  • Find a hobby
  • Do good
  • Ask for help
  • http://www.wellscotland.info/top-tips.html
media entertainment or information how balanced is this
Media – Entertainment or Information: How balanced is this?
  • Some programmes and media outlets are seen as being significantly more helpful than others. In a surveys regional newspapers, regional TV news and regional radio news programmes were all felt to be fairer or more mixed in their coverage than national media.
  • The Big Issue, The Guardian and EastEnders were all highlighted as fair and balanced reporters of mental health issues.
  • Sue Baker of Mind said: "Really, it is tabloid coverage which gives us most cause for concern. They are looking for snappy headlines which will sell papers and they inevitably go for 'psycho' angles.
slide20

Bonkers Bruno Locked Up

On Tuesday 23 September 2003, The Sun published the offensive headline "Bonkers Bruno Locked Up". For later editions, this was toned down to "Sad Bruno in mental home". The coverage was roundly condemned by the main groups in the mental health field. At SANE, chief executive Marjorie Wallace said it was "ignorant reporting" and that "it did both the media and the public a huge disservice".

slide21

Brit, don’t end up like your Gran

THE life of troubled BRITNEY SPEARS appears to be unravelling before the eyes of the world. On the surface it seems the pressures of fame have pushed the former Pop Princess to the brink. But today The Sun can reveal that the seeds of the star’s dramatic downfall may well have been sown in her troubled childhood.

The demons of suicide, mental and emotional instability, addiction, homelessness and violence all lurk within the multi-millionairess’s dark past. Even her great-uncle, Earnest, has said of Britney: “She didn’t have a hope of turning out normal.” In a chilling parallel to her situation, The Sun can today reveal that Britney’s own GRANDMOTHER committed suicide aged just 31, after her baby son died.

And some fear sad Britney’s own sad life could come to a tragic end, just like her poor grandmother’s.

slide22

I'd kick Britney off the bi-polar express

Britney Spears appears to be locked in a downward spiral which, we're reliably informed, is a result of bipolar disorder. Strangely enough Kerry Katona is also a sufferer.

This, apparently, accounts for the way these young mothers end up in desperate domestic brawls splashed all over the front pages.

The path to self-destruction is not, as we might have imagined, due to an excess of mind-bending drugs, alcohol or general self-indulgence, but in Britney and Kerry's case, the mental disorder, bipolar.

So much sexier and hip than manic depression - as it was called until it became trendy.

slide23

KNIFE THREAT TO COPS

Addict slashes own throat after police zap him with Taser.

A mental patient slit his own throat after being shot by police with a 50,000-volt Taser.

Disturbed Justin Perry suffered massive blood loss which led to a heart attack and he died despite efforts to save him.

The drama happened after officers rushed to the home of crack addict Perry when he threatened to kill his mum June.

slide24

'Gascoigne thought aliens were coming to abduct him'

Paul Gascoigne, pictured here in 2006, has been arrested and sectioned after his allegedly menacing behaviour at the Malmaisonhotel in Gateshead.

He became wired and unpredictable and would flip and turn violent over nothing. He was uncontrollable.

slide26
Rethink calls for urgent national attention to prevent another Taylor tragedy

14 December 2007

  • Spokesperson for Taylor family says they are “vindicated but destroyed”
  • Mental health charity Rethink today (December 14) called for national action to prevent the catalogue of failings that led to Garry Taylor killing his friend.
slide27
Rethink call for action on report from the Disability Rights Commission

27 September 2007

  • Leading mental health charity Rethink today (September 27) called for immediate government action to save the lives of thousands of people with schizophrenia after a damning report on health inequalities from the Disability Rights Commission.
slide28
NEWS RELEASE

Monday December 4 2006

  • OVER 50 HOMICIDES PER YEAR BY MENTAL HEALTH PATIENTS
  • National study finds 1 in 20 homicides committed by people with schizophrenia; many are preventable.
avoidable deaths 2006
Avoidable Deaths (2006)
  • Over 50 homicides are committed each year in England and Wales by mental health patients, according to a new report by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI).
  • Many follow poor recognition of risk by mental health services. However, the number of cases is not increasing, and the risk of random killings by mentally ill people has not risen in the last 30 years.
  • The NCI examined all suicides and homicides by mental health patients over a 5-year period. Of the 600 homicide convictions per year in England and Wales, it found that 30 (5%) were committed by people with schizophrenia, although only half were known patients.
avoidable deaths 2006 cont
Avoidable Deaths (2006) Cont.

Key findings and recommendations from the study on homicide (data collected from April 2000 to December 2003) include:

  • The Inquiry investigated 249 cases of homicide by people with a history of mental illness – 9% of all homicides in England and Wales during this period.
  • In the week prior to homicide 71 (29%) patients were seen by services; only 9% were thought to be of short-term moderate or high risk of violent behaviour.
  • Stranger homicides, i.e. random attacks on members of the public by people with mental illness, have remained at five per year indicating that community care has not increased the risk to the general public.
  • Services should ensure that high risk patients receive enhanced CPA, backed up by peer review in the most high risk cases.
the way forward
The way forward !

We all have a duty to:

  • KEEP AN OPEN MIND
  • BE INFORMED
  • PROMOTE GOOD MENTAL HEALTH
  • TACKLE STIGMA
slide32

STEPPING STONES.

ONE STEP AT A TIME …

Richard Jones

what is mental health
What is Mental Health?
  • The concept of ‘madness’ is one which is accepted globally across many different cultures.
  • In modern Western culture it is viewed as an ‘illness’ or ‘disease’.
  • Because people are viewed as ill they are generally relieved of their usual responsibilities and their support becomes the domain of professionals.
slide36
The mentally ill person is often seen as an ‘other’.
  • A distinct class of person.
  • Different and apart from ‘normal’ people.
  • They become the illness that they are deemed to have ‘schizophrenic’, ‘manic depressive’, ‘anorexic’.
slide37
“Is it possible to restore these people to full humanity when we actually fear their difference so much and when they themselves secretly feel less than human?”

Campbell (1998)

the difference between the medical view and the person s experience

The difference between the medical view and the person’s experience

beyond symptoms and deficits…

the person
The person

“Today I wanted to die. Everything was hurting. My body was screaming. I saw the doctor. I said nothing. Now I feel terrible. Nothing seems good and nothing seems possible.”

Written in a patient’s diary

the doctor
The Doctor

Flat. Lacking in motivation, sleep and appetite good. Discussed aetiology. Cont. LiCarb 250mg qid. Levels next time.

Written in medical notes

from Repper & Perkins (2003)

slide42
Choice
  • Accessibility
  • Advocacy
  • Equal opportunities
  • Income and employment
  • Self help
  • Self organisation

Read (1996)

slide44
Adequate income
  • Intimacy
  • Privacy
  • Meaningful work
  • A satisfying social life
  • Happiness
  • Adequate resources
  • Warmth

Estroff (1993)

slide47

“A personal process of overcoming the negative impact of a psychiatric disability despite its continued presence.”

it involves
It involves
  • personal development and transformation
  • acceptance of the illness
  • a sense of responsibility or control over one’s life
  • hope
  • the support of others
  • and working collaboratively with others on treatment and rehabilitation.
what matters
What matters?
  • Are we living the life we want to be living?
  • Are we achieving our personal goals?
  • Do we have friends?
  • Do we have connections with the community?
  • Are we contributing or giving back in some way?
slide50

Recovery is a process, not a place.Looking at where we want to be and what we want to achieve. Not where we came from.

recovery is about
Recovery is about
  • recovering what was lost: rights, roles, responsibilities, decisions, potential and support
  • involving people in having a personal vision of the life they want to live
  • discovering symptoms can be managed and doing it
  • doing more of what works and less of what doesn’t
  • reclaiming the roles of a ‘healthy’ person and not a ‘sick’ person.
  • getting there.
what we know
What we know
  • People can and do recover.
  • Recovery is a process or a journey rather that an end point.
  • Recovery means much more than an absence of symptoms
  • Attitudes and values can have a powerful impact.
  • Recovery is a common human experience.
  • Different things help different people recover.
main ingredients
Main ingredients
  • Belief by the person experiencing mental illness/distress that they can and will recover
  • Belief by people supporting them
  • Commitment by the person experiencing mental distress to recover
  • A personal strategy for recovery
  • Resources to enable the person to recover
  • Personal growth is shared with others seeking to recover.
what people say helps them
What people say helps them
  • Having hope.
  • A belief in change.
  • Being ready to lead their own recovery.
  • Self management and coping skills development.
  • Being optimistic yet realistic.
  • Having a chance to contribute or give back.
  • Finding meaning and purpose.
  • Supportive relationships.
  • Becoming engaged and involved.
  • Supportive and accessible services and treatments.
  • Patience
  • Creativity.
slide56
Mental Health Policy
    • The Care Programme Approach (England & Wales)
    • National Service Framework (Equity, Empowerment, Effectiveness, Efficiency)
      • Standard 1 - social inclusion, health promotion, tackling stigma
      • Standard 2 - service user and carer empowerment
      • Standard 3 - promotion of opportunities for a normal life
slide58
The care plan does not only address health needs.
  • It must cover aspects of social care and functioning.
  • A psychosocial approach is used.
  • The care coordinator links in with other agencies, both statutory and non-statutory, to promote social inclusion and recovery.
slide60
Tackle stigma and discrimination
  • Ensure advocacy services are available
  • Provide and maintain good quality housing
  • Help access educational and training opportunities
  • Help find supportive networks which include opportunities for friendship.
slide62
The process of recovery is a journey traveled by a service user and those closest to them.
  • It encompasses all aspects of life to help provide a meaningful and happy life without fear and prejudice.
  • It does not replace the medical model of care but works with it.
slide63
Service users are offered a greater degree of input into their care.
  • They agree a care plan, and a way forward that suits their individual circumstances, with their care coordinator.
  • The people closest to them are offered a carers assessment and input into the service user’s care. They are recognised as key individuals to recovery.
further information
Further information
  • Rethink - mental health charity

www.rethink.org

  • Julie Repper / Rachel Perkins
slide67

A PERSONAL AND PROFESSIONAL VIEW OF

‘THE GAP’

Kathy Giles

slide68
WHY ?
  • I am someone’s brother, sister, father, mother
  • I don’t always act like this
  • I really don’t feel quite myself
  • Will someone ask me WHY?
  • As children we drive adults to distraction
  • With what and where and why and when
  • Surely as adults we should not make assumptions
  • But ask the question WHY?
  • To all those who profess to care
  • Look beyond what you can see and
  • Try to find the person who is me
  • To do that, ask the question WHY?

Heads are shaking

People tutting

Yes, I am behaving strangely

But have they asked me WHY?

No-one will come near me

They all seem so afraid

Yes, I know that I am shouting

But no-one asks me WHY?

I am really hot and bothered

My head it hurts like hell

I feel disorientated

I want to know the reason WHY?

unscheduled care project
UNSCHEDULED CARE PROJECT
  • Some facts
  • About the project
  • Work we have done
  • What this means to you
slide71
Unscheduled care is defined as when someone seeks treatment or advice for a health problem without arranging to do so more than a day in advance.

O’Caithan et al 2007

some facts
Some facts
  • It is estimated that up to 5% of those attending an Emergency Department have a primary diagnosis of mental ill health .
  • A further 20-30% of attendees have co-existing physical and psychological problems, with much of the latter remaining undetected.
  • In January 2004, a Department of Health audit suggested that up to 10% of emergency departments’ four hour breaches involved patients with mental ill health. In addition, a third of patients with mental ill health wait longer than four hours compared to 10% of all patients.

Improving the management of patients with mental ill health in emergency care settings. Department of Health Checklist 2004

slide73
People with mental health problems are:
  • more likely to leave the Emergency Department before being seen,
  • are associated with a higher number of serious incidents,
  • more likely to report their experience of the emergency department as negative.

Managing urgent mental health needs in the Acute Trust. Academy of Medical Royal Colleges 2008.

slide74
Self-harm is one of the top five reasons for admission to hospital for emergency medical treatment, accounting for up to 170,000 admissions in the UK each year.

NICE 2004

  • Over a quarter of the 682 adult service users surveyed in the Royal College of Psychiatrists’ Self-Harm Project (2006/07) rated staff poorly in terms of their attitude and understanding.
  • Mental health is a major issue for acute hospital inpatients, for example 60% of patients over 65 years of age will have a mental health problem and such patients have higher levels of physical morbidity and longer lengths of stay.

Who Care Wins, RCPsych, 2005.

core values
Core values
  • The same standard of urgent assessment, diagnosis and intervention should be provided for mental health care as is expected for physical health care.
  • Good management of mental health problems can make a significant contribution to the effectiveness and efficiency of acute hospitals and improve the outcome for patients.
  • There should not be any discrimination against an individual because of mental health problems.
main aims
Main aims
  • To develop an Integrated Care Pathway for unscheduled mental health assessment and treatment
  • To produce proposals for service development and improvement
  • To link in with the wider unscheduled care developments across the three counties
  • To provide the optimal conditions to deliver mental health interventions.
need for the project
NEED FOR THE PROJECT

There were concerns about current out of hours unscheduled care arrangements from the following stakeholders:

PATIENTS

Delays in accessing

Treatment.

Confusing procedures.

Conflicting advice.

ON DUTY

PSYCHIATRIST

Unnecessary assessments.

Lack of skills / support.

Patients not clerked in to

A+E.

Lack of clinical/risk info.

A+E STAFF

Having to care for patients

waiting for MH assessment.

Feeling under skilled.

Delays in accessing

Assessment.

OUT OF HOURS GP

Having to manage

single –handedly until MH

assessor arrives.

Delays.

Exposure to risks related to

Above points.

CRHT SERVICE

Poor clinical risk

Information.

Lack of medical access for

Joint decision making /

Prescribing.

baseline review
BASELINE REVIEW

The “out of hours service” activities of the mental health services across the three counties of Carmarthenshire, Ceredigion and Pembrokeshire.

  • Audits
  • Questionnaires
  • Engaged widely
  • Leg work
findings
FINDINGS

The main findings summarised:

  • Unacceptable delays in accessing assessment (5 hours+).
  • Confusing procedures and conflicting advice
  • Proportion of unnecessary assessments / admissions
  • Lack of skills/ lack of support
  • Patients not clerked / booked / registered into A+E
  • Concerns about contact with service being recorded
  • Lack of clinical or risk information
issues
ISSUES
  • History taking
  • Assessment
  • Record keeping
  • Managing individuals with complex needs
  • Medical prescribing
  • Physical health examination
  • Fitness for assessment
  • Safety
  • Child Protection Legislation
  • Knowledge & Application of MHA s.12 MHA Approval
the agreed plan
THE AGREED PLAN

Implement a care pathway, assessment tool and comprehensive training programme:-

  • Introducing a central referral point (Divisional screening / discussion )
  • Develop role of initial assessor
  • Assessments by CRHT , MH Practitioner based on acute ward
  • Divisional on-call doctor only
    • Problems resolved
    • Equity
    • Resource implications
slide82

MHLD

BASELINE

REVIEW

BUSINESS

CASE

IMPLEMENTATION

PLAN

IMPLEMENTATION

EVALUATION

0CT ‘07 OCT ‘08FEB ‘09

slide83

MULTI FUNCTIONAL MULTI DISCIPLINARY PROVISION FOR UNSCHEDULED CARE

24 HOURS OF CARE

00.00HRS 24.00HRS

09.00 CMHT 17.00

MH PRACTITIONER 08.30

16.30 MH PRACTITIONER

08.30 CRHTT 22.00

09.00 LIAISON PRACTITIONER 17.00

INPATIENT UNITS 24HRS

slide84

TRAINING

  • Baseline review
  • Tender specification
  • Closing date
  • Filming @ WWGH
  • Launch date
  • All practitioners
slide87

ALL MY HEALTH NEEDS

Jayne Anderson

all my health needs
All my health needs

Definition of the concept of health

‘A state of complete physical, mental and social well being and not merely an absence of disease.’ – WHO (1991)

policy etc
Policy etc.
  • Health services should adopt a holistic view of the assessment and development of care plans for mental health service users (DoH, 1990)
  • Recommendations for the physical health care of people with SMI (DoH, 2005,2006)
  • Guidelines for the treatment of schizophrenia in primary and secondary care (NICE, 2002)
  • CNO’s review of mental health nursing (DoH, 2006)
  • ‘Designed for Life’, the WAG’s 10 year vision for Health, states that there is to be a Revised Health Inequalities Strategy to be published in 2009
  • Closing the Gap (DRC Report, 2006)
six key priorities for health improvement
Six key priorities for health improvement
  • Tackling health inequalities
  • Reducing the numbers of people who smoke
  • Tackling obesity
  • Improving sexual health
  • Improving mental health & well being
  • Reducing harm and encouraging sensible drinking

(DoH, 2005)

what physical health problems do people with smi ld experience
What physical health problems do people with SMI / LD experience?
  • People with SMI have higher morbidity and mortality rates
  • It is estimated that the life expectancy of people with schizophrenia is reduced by 10 years (Newman & Bland, 1991) or more recently 25 years (Parks et al., 2006)
  • People with intellectual disabilities have an increased risk of early death compared to the general population (Hollins et al., 1998; McGuigan et al., 1995).
  • People with Down's syndrome have a shorter life expectancy than people with intellectual disabilities generally, although the life expectancy of this group is increasing particularly quickly (Puri et al., 1995).
higher rates of major diseases
Higher rates of major diseases

The analysis of data on people with learning disabilities in Wales shows that –

  • • There is a much higher rate of obesity amongst people with learning disabilities (35%, as compared with a general population figure of 22%). The figure for women with learning disabilities is particularly high at 40%.
  • • 9% of people with learning disabilities have diabetes, compared with 4% in the general population.
higher rates of major diseases1
Higher rates of major diseases

People with bi-polar disorder, depression or schizophrenia have higher rates of:

  • Diabetes – more than 10% higher than the general population (Holt & Peveler, 2006, Busche & Holt, 2004)
  • Cardiovascular disease – 2-3 times higher than the general population (Brown et al., 2000; Osby et al., 2000)
  • Respiratory disease – more likely to suffer asthma, chronic bronchitis and emphysema (Sokal et al., 2004)
  • Obesity– Increasing evidence of higher rates of upper body obesity (Ryan & Thakore, 2001)
  • Stroke
  • Cancers – higher rates of digestive & breast cancer (Schoos & Cohen, 2003)
higher rates of major diseases2
Higher rates of major diseases

People with schizophrenia:

  • Twice as likely to have bowel cancer as other citizens (new finding internationally)

(Disability Rights Commission Formal Investigation Report 2006)

causes
Causes ?
  • Health behaviours – Smoking, diet, physical inactivity, alcohol & substance misuse, sexual behaviour
  • Illness – Symptoms, poor spontaneous reporting of physical health problems
  • Services not geared to meet peoples needs … - Lack of knowledge, lack of training, attitudes, confidence, lack of integrated care
  • Adverse effects of medication – Extrapyramidal side effects, weight gain, glucose intolerance & diabetes, cardiovascular effects, sexual dysfunction, neuroleptic malignant syndrome
  • Environment – Poverty, poor housing, social exclusion
  • Difficulties recognising symptoms
  • Barriers to accessing primary care
  • Communication barriers
  • Inequalities in screening & treatment
recommendations from the drc closing the gap report 2007
Recommendations from the DRC ‘Closing the gap’ Report 2007
  • All professionals and organisations with a role in the provision of primary care health services to people with learning disabilities and/or mental health problems must act now to tackle the inequalities in physical health and primary health care services they experience
  • The planning and commissioning of primary care services for people with learning disabilities and/or mental health problems need to take greater account of their physical health care needs
  • Urgent and positive action is needed to ensurethat people with learning disabilities and/or mental health problems and their carers (and other support workers) where relevant know their rights in relation to physical health and the services to support this, and are able to take part or receive appropriate help in programmes geared to supporting them in managing their physical health conditions
recommendations from the drc closing the gap report 20071
Recommendations from the DRC ‘Closing the gap’ Report 2007
  • People with learning disabilities and/or mental health problems have a right to be registered with a GP and this needs to be made a reality
  • Everyone with learning disabilities and/or mental health problems under the active care of a psychiatrist should also have their physical health monitored by regular review from primary health care services, including a GP or other primary care practitioner
  • People with learning disabilities and/or mental health problems living in residential or nursing homes, in ‘supported living’ arrangements, in prisons or in secure accommodation for young people should have equal access to a GP and access to options for healthy living
  • Services and equality schemes need to be put in place to ensure that people with learning disabilities and/or mental health problems who do not have easy access to a GP or experience exclusion on multiple grounds receive full and proper primary health care services
recommendations from the drc closing the gap report 20072
Recommendations from the DRC ‘Closing the gap’ Report 2007
  • GP practices and primary care centres need to make ‘reasonable adjustments’ to make it easier for people with learning disabilities and/or mental health problems to get proper access to the services offered by the practice
  • People with learning disabilities and/or people with enduring mental health problems should be offered an annual check on their physical health by a primary care specialist and access to health interventions that fit the level of their health needs regardless of age
  • We recommend that people with learning disabilities and/or mental health problems should be offered accessible and appropriate support to encourage healthy living and overcome any physical health disadvantages which come with their condition or treatments administered for the condition including information, advice and support, in an accessible, relevant and targeted form, on how to quit smoking, on good diet, on sexual health, on alcohol, on street drugs and on physical exercise
  • There should be a comprehensive programme of evidence based training and information resources (the design and at least some of the delivery of which involves users and user groups) for primary health care staff
initiatives
Initiatives

National Developments:

  • Incentivised GP contract
  • Direct enhanced learning disability health check
  • WAG Department of Health and Social Services Equality Group

Local Developments: (amongst others)

  • Embedded into Service philosophy – ICM Policy – Developed & Reviewed in 2006
  • Physical health protocol development – Developed in 2006
  • Well-being support programme – 2 cohorts in 2007 and a further 2 cohorts 2008 & a further 2 planned for early 2009
  • Care Co-ordinator training - ongoing
  • Unscheduled Care Project – commenced mid 2007
  • Nutritional screening audit - 2007
  • Physical health protocol audit - 2007
jan batty development worker mind your heart jan batty@nphs wales nhs uk tel 01570 423957

Jan BattyDevelopment WorkerMind Your Heartjan.batty@nphs.wales.nhs.uktel. 01570 423957

true or false
True or False?

People with mental health problems are not interested in their physical health

“Health promotion is not a priority in a 10 minute GP appointment with people with mental health problems. Getting by day to day is often a major challenge for the people and support regarding this is a priority.”

(Quoted in the Disability Rights Commission Report ‘Equal Treatment: Closing the Gap’ 2006)

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“People with severe mental illness want to look and feel well, no matter how long they have been ill and are not willing to compromise on either aspect”

(‘Neuroleptic Weight Gain’, Tweedell, Sutter, Dolan 2004)

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“Efforts directed at increasing activity levels, making healthier lifestyle choices and managing weight gain are highly valued by clients and they identify these efforts as important in their recovery.”

(‘Mum I used to be good looking, look at me now’, Dean, Todd, Morrow, Sheldon 2001)

potential obstacles
Potential Obstacles
  • Lack of motivation
  • Effects of medication
  • Lack of money
  • Boredom
  • Mental health culture
  • Attitudes and beliefs of health staff
mind your heart programme
Mind Your Heart Programme

Our aim is to improve the physical health of mental health service users in Ceredigion by

  • Engaging people in activities that reduce their risks of illness
  • Removing obstacles
  • Raising awareness
what did we do
What did we do?
  • Training for staff and volunteers
  • Small grants supported engagement in activities
  • Presentations and networking to raise awareness
  • Worked with Mental health voluntary organisations, Community Mental Health Teams and Afallon ward, Bronglais Hospital
what did we find
What did we find?
  • Training led to changes in personal health behaviour of staff
  • Changes in culture

“We introduced no smoking on our premises even before the ban was introduced and would not have done it without Mind Your Heart”

(Staff member at drop-in)

what did we find1
What did we find?
  • Gave authority and legitimacy

“I could back up information I was giving with facts…I felt sure of what I was saying”

(Staff member after Food and Mood training)

conclusions
Conclusions
  • An effective, sustainable and efficient intervention
  • Promoting mental and physical health together is helpful
  • Working in partnership is crucial
summary
Summary
  • People with mental health problems are interested in their physical health
  • Expectations of staff and lack of opportunities can hold them back
  • People can use healthier lifestyles to aid recovery
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POSTER PRESENTATIONS

Caroline Oakley

making a difference
Making a difference !

10 minutes:

  • key points from today that have made you think differently
  • 3 things that you will do differently