Transcript Slide 1

BORE DA - GOOD MORNING
World Mental Health Day 2008
FACTS AND MYTHS ABOUT MENTAL
ILLNESS
Jayne Anderson / Bleddyn Lewis
World Mental Health Day 2008
Facts and Myths about Mental Illness
1.Mental health problems only happen to other people
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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
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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).
World Mental Health Day 2008
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
World Mental Health Day 2008
Facts and Myths about Mental Illness
5. People with poor mental health are weird
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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
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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.
World Mental Health Day 2008
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.
World Mental Health Day 2008
Facts and Myths about Mental Illness
9. All people who suffer from depression are suicidal
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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"
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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!
World Mental Health Day 2008
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.
World Mental Health Day 2008
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)
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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)
World Mental Health Day 2008
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)
World Mental Health Day 2008
Reference:
Violence - The short-term management
of
disturbed/violent behaviour in
psychiatric in-patient settings
and emergency departments
NICE 2005
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These were just a few of the most common
misconceptions surrounding mental health
and mental illness.
Unfortunately, there
are many more!
World Mental Health Day 2008
WHAT AFFECTS MENTAL HEALTH AND
WELLBEING ?
World Mental Health Day 2008
 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.
World Mental Health Day 2008
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!
World Mental Health Day 2008
Top Tips
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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
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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
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http://www.wellscotland.info/top-tips.html
World Mental Health Day 2008
MEDIA – ENTERTAINMENT OR
INFORMATION:
HHOW BALANCED IS THIS?
World Mental Health Day 2008
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.
World Mental Health Day 2008
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".
World Mental Health Day 2008
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 multimillionairess’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.
World Mental Health Day 2008
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
World Mental
Health
Day 2008disorder, bipolar.
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.
World Mental Health Day 2008
'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 Malmaison
hotel in Gateshead.
He became wired and unpredictable and would flip and turn violent
over nothing. He was uncontrollable.
World Mental Health Day 2008
A more balanced approach?
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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.
World Mental Health Day 2008
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.
World Mental Health Day 2008
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.
World Mental Health Day 2008
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.
World Mental Health Day 2008
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.
World Mental Health Day 2008
The way forward !
We all have a duty to:
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KEEP AN OPEN MIND
BE INFORMED
PROMOTE GOOD MENTAL HEALTH
TACKLE STIGMA
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STEPPING STONES.
ONE STEP AT A TIME …
Richard Jones
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Recovery
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A process of recovering from
a mental health problem
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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.
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 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’.
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“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)
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The difference between the medical view and
the person’s experience
beyond symptoms and deficits…
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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
World Mental Health Day 2008
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)
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What do people want from
mental health services?
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Choice
Accessibility
Advocacy
Equal opportunities
Income and employment
Self help
Self organisation
Read (1996)
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What do they feel are their unmet needs?
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Adequate income
Intimacy
Privacy
Meaningful work
A satisfying social life
Happiness
Adequate resources
Warmth
Estroff (1993)
World Mental Health Day 2008
So…
What is recovery?
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It is not a cure
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“A personal process of overcoming the negative
impact of a psychiatric disability despite its
continued presence.”
World Mental Health Day 2008
It involves
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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.
World Mental Health Day 2008
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?
World Mental Health Day 2008
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.
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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.
World Mental Health Day 2008
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.
World Mental Health Day 2008
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.
World Mental Health Day 2008
What people say helps them
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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.
World Mental Health Day 2008
How have mental health services adapted to
assist the recovery process?
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 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
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How does this work?
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 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.
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Services should combine and…
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 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.
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In Summary…
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 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.
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 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.
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Further information
 Rethink - mental health charity
www.rethink.org
 Julie Repper / Rachel Perkins
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Refreshments.
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Hassen Joomraty
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A PERSONAL AND PROFESSIONAL VIEW OF
‘THE GAP’
Kathy Giles
World Mental Health Day 2008
WHY ?
Heads are shaking
People tutting
Yes, I am behaving strangely
But have they asked me 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?
No-one will come near me
They all seem so afraid
Yes, I know that I am shouting
But no-one asks 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?
I am really hot and bothered
My head it hurts like hell
I feel disorientated
I want to know the reason 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?
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A CO-ORDINATED APPROACH TO CARE
Bleddyn Lewis
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UNSCHEDULED CARE PROJECT
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Some facts
About the project
Work we have done
What this means to you
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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
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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
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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.
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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
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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.
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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.
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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.
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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.
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NEED FOR THE PROJECT
There were concerns about current out of hours unscheduled care
arrangements from the following stakeholders:
PATIENTS
ON DUTY
PSYCHIATRIST
Delays in accessing
Treatment.
Confusing procedures.
Conflicting advice.
Unnecessary assessments.
Lack of skills / support.
Patients not clerked in to
A+E.
Lack of clinical/risk info.
A+E STAFF
OUT OF HOURS GP
CRHT SERVICE
Having to care for patients
Having to manage
Poor clinical risk
waiting for MH assessment. single –handedly until MH
Information.
Feeling under skilled.
assessor arrives.
Lack of medical access for
Delays in accessing
Delays.
Joint decision making /
Assessment.
Exposure to risks related to
Prescribing.
Above points.
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BASELINE REVIEW
The “out of hours service” activities of the mental health services
across the three counties of Carmarthenshire, Ceredigion and
Pembrokeshire.
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Audits
Questionnaires
Engaged widely
Leg work
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FINDINGS
The main findings summarised:
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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
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ISSUES
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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
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THE AGREED PLAN
Implement a care pathway, assessment tool and comprehensive
training programme:
Introducing a central referral point (Divisional screening /
discussion )
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Develop role of initial assessor
Assessments by CRHT , MH Practitioner based on acute ward
Divisional on-call doctor only
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Problems resolved
Equity
Resource implications
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MHLD
BASELINE
REVIEW
BUSINESS
CASE
IMPLEMENTATION
PLAN
0CT ‘07
IMPLEMENTATION
OCT ‘08
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FEB ‘09
EVALUATION
MULTI FUNCTIONAL MULTI DISCIPLINARY PROVISION FOR UNSCHEDULED CARE
24 HOURS OF CARE
00.00HRS
24.00HRS
09.00
MH PRACTITIONER
CMHT
08.30
17.00
16.30
08.30
09.00
CRHTT
LIAISON PRACTITIONER
INPATIENT UNITS 24HRS
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MH PRACTITIONER
22.00
17.00
TRAINING
Baseline review
•Tender specification
•Closing date
•Filming @ WWGH
•Launch date
•All practitioners
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Lunch break
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‘Closing the Gap’
Disability Rights Commission (2006)
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ALL MY HEALTH NEEDS
Jayne Anderson
World Mental Health Day 2008
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)
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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)
World Mental Health Day 2008
Six key priorities for health
improvement
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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)
World Mental Health Day 2008
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).
World Mental Health Day 2008
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.
World Mental Health Day 2008
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)
World Mental Health Day 2008
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)
World Mental Health Day 2008
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
World Mental Health Day 2008
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 ensure
that 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
World Mental Health Day 2008
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
World Mental Health Day 2008
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
World Mental Health Day 2008
Initiatives
National Developments:
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Incentivised GP contract
Direct enhanced learning disability health check
WAG Department of Health and Social Services Equality Group
Local Developments: (amongst others)
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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
World Mental Health Day 2008
Physical health protocol
development
World Mental Health Day 2008
Well-being Support Programme
World Mental Health Day 2008
Supporting Health Promotion for
Mental Health Service Users
Jan Batty
World Mental Health Day 2008
Jan Batty
Development Worker
Mind Your Heart
[email protected]
tel. 01570 423957
World Mental Health Day 2008
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)
World Mental Health Day 2008
“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)
World Mental Health Day 2008
“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)
World Mental Health Day 2008
Potential Obstacles
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Lack of motivation
Effects of medication
Lack of money
Boredom
Mental health culture
Attitudes and beliefs of health staff
World Mental Health Day 2008
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
World Mental Health Day 2008
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
World Mental Health Day 2008
Mind Your Heart Toolkit
World Mental Health Day 2008
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)
World Mental Health Day 2008
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)
World Mental Health Day 2008
Conclusions
 An effective, sustainable and efficient
intervention
 Promoting mental and physical health
together is helpful
 Working in partnership is crucial
World Mental Health Day 2008
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
World Mental Health Day 2008
POSTER PRESENTATIONS
Caroline Oakley
World Mental Health Day 2008
MAKING A DIFFERENCE !
World Mental Health Day 2008
Making a difference !
10 minutes:
 key points from today that have made you
think differently
 3 things that you will do differently
World Mental Health Day 2008
QUESTION TIME
World Mental Health Day 2008
Closing Remarks
World Mental Health Day 2008