Opening Doors

There are many people working in the field of homelessness who have had no formal or informal training in mental health.

It is recognised that that close working between voluntary agencies and mental health care providers has proved invaluable.

Mental Health Awareness

It is also recognised (Meddings and Levey (2000), that the training of hostel workers and others involved in homelessness work, is a component of best practice.

I was recently asked to produce Mental Health Guidelines for people working with homeless people by QNI Opening Doors.

Homelessness & Mental Health

A Guide for Practitioners Working in the Field of Homelessness

Peter Melvin BSc(Hons), RMN, QN

Aims:

 To provide an understanding of mental health problems.

 Develop knowledge of helping people with mental health problems within your environment.

 To provide a brief overview of interventions and services available.

What is Mental Health?

“Mental health is not just the absence of disorder. It is a state in which a person is able to fulfil an active functioning role in society, interacting with others and overcoming difficulties without suffering major distress or disturbed behaviour.” (Donaldson and Donaldson 2003)

Ronnie O’Sullivan, Snooker Player

People are quite ignorant about mental illness. They think “you moany old sod, why don’t you just cheer up.” Sometimes I think, "yes I am a moany old sod" and I play that character and get a sense of happiness out of it. The worst thing someone can say is “jack yourself out of it”; in the end I tell them “do you think I enjoy being like this”.

Paul Merton, 44, Comedian

“People shouldn’t feel ashamed for having a mental illness. We don’t feel ashamed for having a broken leg, so why a mental illness”?

Mental Health Prevalence

 1 in 4 adults in any year will experience some form of mental health problem.

 25% general population (WHO 2006).

 80 million working days lost per year due to anxiety and depression.

 The current cost of mental health problems £105 billion. (Guardian 2010)

Mental Health Prevalence Amongst Homeless People

 50% + of homeless population suffer from some form of mental illness.

 60% + of those homeless people suffering from mental illness have a co-morbid substance misuse problem.  Mental illness and co-morbid substance misuse amongst homeless population is up to 5 times higher than the general population.

Homelessness and Access to Mental Health Care

 Homeless people can

still

find it difficult to register with a local Primary Care Practice in the 21 st century!

 Access to Primary Care is paramount for effective healthcare – Homeless Link (2011) reported that 41% of homeless people attended an A&E department during a 6 month audit period.  Access to Secondary Mental Health Care for people suffering from psychotic illnesses nigh on impossible without a primary care referral.

Influential factors

•

Genetic

•

Lifestyle

•

Environmental

•

Economic / Social

•

Access to services

Typical Mental Illnesses;

OCD Self Harm Suicide

Mental illness

Bi-Polar Psychosis Anxiety and Panic Attacks Dementia

Depression

SMI

•Schizophrenia •Bi-Polar Disorder •Depression •Personality Disorder •Dual diagnosis

Mild - Moderate

•Anxiety •Depression •Obsessive/compulsive •Personality disorders •Drug / alcohol misuse

Symptoms of Schizophrenia

:

Positive Symptoms -

Hallucinations:   any of the 5 senses auditory (voices) most common - derogatory/ commentary/command Delusions:  false belief not in keeping with culture /background common theme e.g. persecution, grandiosity, controlled by other people.

Thought disorder:  fluency /flow /neologisms (new words)

Negative symptoms;

 Self neglect  Social withdrawal /isolation  Apathy  Poverty of speech  Lack of motivation  Retarded movement  Inability to function  Low mood  Lack insight

What helps Psychotic Disorders?

       Concordance with prescribed medication (Anti psychotics) Minimise stress Avoid alcohol & substance misuse.

Adequate sleep Healthy diet & regular exercise Regular social contact & positive relationships Employment  Adequate finances & Housing

Depression;

        Hopelessness desperation Poor motivation Reduced self esteem and self confidence Disturbed sleep Poor appetite Feelings of guilt and worthlessness Suicidal thoughts and ideas

Bipolar disorder:

Mania:

elated mood, increased activity, well- being, grandiose, disinhibited, Extravagant, irritable, aggressive

Depression:

decreased mood, decreased activity, loss of interest, lack of enjoyment, negative thoughts, low self worth, hopelessness, suicidal thoughts, social withdrawal

What helps Bipolar Disorder?

Mania:

Decreased stimulation, calm environment, non confrontational, distraction techniques, protect dignity, sleep / appetite

Depression:

Increase stimulation, encourage activity, encourage routine, support, goal setting, diary planner, ? suicidal thoughts, sleep / appetite

Anxiety:

Disorders: Phobias – social, agoraphobia, general, Generalised Anxiety Disorder, Obsessive Compulsive Disorder (OCD), Post Traumatic Disorders (PTSD).

Symptoms: Physical response palpitations, dry mouth, “butterflies” in stomach, altered breathing, sweating.

Psychological - negative thoughts, feeling of impending danger, “Fight or Flight” reaction, poor concentration, constant worry, racing thoughts.

Behaviour can’t relax, pace up and down, snappy and irritable, drink/smoke more, can result in a “Panic Attack”.

What Helps Anxiety?

 Adequate sleep  Good diet  Learn to relax  Recognise signs - plan  Distraction  Controlled breathing  Challenge the negative thoughts  Self Help Books  Cognitive Behaviour Therapy (CBT)

Personality Disorder;

 Diagnosed over period of time, often retrospectively.

 Characteristics and enduring patterns of thought processes, emotions and behaviours differ markedly from a culturally expected and accepted range  10 different personality disorders classified  Estimate 10% population (Mental Health Foundation 2003)

Borderline Personality Disorder:

Characteristics:

 pattern of instability of interpersonal relationships,  impulsive, damaging behaviour  unstable self image  feelings of emptiness  inappropriate anger  fear of abandonment  manipulative behaviour  self harm /threats of suicide

Self Harm - Cutting

 Injury to self including cutting are

not

behaviours and are

not

suicidal associated with serious danger. (Gerson & Stanley 2005)  The Purpose of cutting is to relieve negative emotions. (Linahan 2002)  Cutting provides short term relief from intense negative emotion by substituting physical for mental suffering – Distraction.

Self Harm - Repetition

 have done it before  have a personality disorder  have been in psychiatric treatment   are unemployed are in social class V – unskilled workers  Misuse alcohol and/or drugs  have a criminal record  Aged between 24 and 35  Single, divorced or separated

A Coping Mechanism

 “Paradoxically, the purpose of some acts of self harm is to preserve life. Professionals sometimes find this a difficult concept to understand” ( NICE

Self-Harm Guideline, 2004)

Self Harm

 Carers may relieve their own disappointment and frustration with the client by stigmatising them as

bad, attention seeking or manipulative

, terms which have no explanatory value but subtly

devalue

the clients distress and can sometimes be used to justify either harsh or indifferent treatment.

NICE Guidelines

“People who have self-harmed should be treated with the same care, respect and privacy as any patient. In addition, healthcare professionals should take full account of the likely distress associated with self harm.”

What Helps?

 Understanding why people self harm: -feelings of worthlessness/be in control  Agreed one to one time  Calm, objective approach  Boundaries  Collaboration  Consistency  Communication /support  Risk /responsibility balance  Environment should feel safe and supportive.

Mental Health & Substance Misuse

 Substance misuse can make existing mental health problem much worse, poor outcomes.

 Can trigger the onset of mental illness.

 Recent research has established clear link between cannabis use and the development of psychosis/schizophrenia.

 Increased risk of infections, hepatitis, HIV.

 Can lead to increased criminal activity and contact with criminal justice service.

Drug Misuse and Mental health



Stimulants:

(ecstasy, speed, LSD) shown to have an effect on depression, anxiety and paranoia. Can have devastating effect on sufferers of schizophrenia.



Cocaine & Crack:

paranoia. Can be the cause of relapse in people suffering with schizophrenia.

can effect mood, anxiety and cause 

Cannabis

: can trigger psychotic illnesses

Any Questions?