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 • 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 impairmentSocial Model – social barriers which affect mental well-being and mental healthPsycho-social Model – Freud and Erikson – developmental influences on mental well-being and mental health


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.


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.


Main types of Mental ill-health DSM Group / ICD-10Examples

Cognitive Disorders Alzheimer's disease, Vascular

Dementia, Picks Disease

Substance-related disorders Alcohol abuse

psychotic disorders Schizophrenia, delusional disorder, dysmorphia

Mood disorders Major depressive disorder, Bipolar disorder

Anxiety disorders General anxiety disorder


Main types of Mental ill-health DSM Group / ICD-10Examples

Eating disorders Anorexia nervosa, Bulimia nervosa

Sleep disorders Insomnia

Impulse control disorders not elsewhere classified Kleptomania

Personality / behaviour disorders Obsessive compulsive disorder


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)

Concerns have also been raised over• Accuracy of descriptions used for classifications• Cultural differences and how these may affect

interpretation


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


Erikson’s Psycho-social model

ApproxAge Virtues Psycho Social

Crisis

Significant

Relationship

Existential

Question

Examples

0–2 years Hopes Basic Trust vs.

Mistrust Mother Can I Trust the World?

Feeding, Abandonment

2–4 years Will Autonomy vs.

Shame and Doubt Parents Is It Okay To Be Me?

Toilet Training, Clothing Themselves

4–5 years Purpose Initiative vs. Guilt Family

Is It Okay For Me To Do, Move and Act?

Exploring, Using Tools or Making Art

5–12 years

Competence

Industry vs. Inferiority

Neighbors, School

Can I Make It In The World Of People And Things?

School, Sports


Erikson’s Psycho-social model

Approx Age Virtues

Psycho Social Crisis

Significant

Relationship

Existential

QuestionExamples

13–19 years Fidelity

Identity vs. Role Confusion

Peers, Role Model

Who Am I? What Can I Be?

Social Relationships

20–24 years Love

Intimacy vs. Isolation

Friends, Partners

Can I Love?

Romantic Relationships

25–64 years Care

Generativity vs. Stagnation

Household, Workmates

Can I Make My Life Count?

Work, Parenthood

65-death WisdomEgo Integrity vs. Despair

Mankind, My Kind

Is It Okay To Have Been Me?

Reflection on Life



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?


THE IMPACT OF MENTAL ILL HEALTH ON INDIVIDUALS AND OTHERSIN THEIR SOCIAL NETWORK

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)


DEPRESSIONMental Health


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


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



Incidence of depression among different ethnic groups

Case studies• Depression can affect people in different ways

depending on the type and severity of the condition.


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


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

•Parkinson’s disease•stroke•heart disease•cancer•diabetes

•thyroid disorders•Vitamin B12 deficiency•dementia and Alzheimer’s disease•lupus•multiple sclerosis


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


ANXIETYMental Health and Older People


How does anxiety affect us ? • How do we feel when we become anxious?

• How can it change our behaviour?


Physical and emotional symptoms of anxiety


www.campacademia.com/blog/wp-content/uploads/2010/11/Physical-Effects-of-disorders.gif

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


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



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


Managing and treating anxiety• Medication • Talking therapies, such as counselling, Cognitive

Behavioural Therapies (CBT)• Exercise• Avoiding stimulants such as caffeine, nicotine,

alcohol



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.”


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


BI-POLAR DISORDER


Stephen Fry talking about his experience of Bi-polar disorder

EXCESSIVE ALCOHOL USE


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


DELIRIUMMental Health and Older People


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


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.


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?


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 herneeds increased the social worker was able to increase the visits.

Assessing the mental health needs of older adults: SCIE publication 1996

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.



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

Today we coveredThe main forms of mental ill health affecting

older people The impact of mental ill health on individuals and

others in their social network


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)


Documents

Understand mental well-being and mental health promotion CMH 302