The mental health jigsaw MHBiz 14 October 2015 The mental health jigsaw Dr. Leanne Craze, Sydney, Australia

What we will cover today What is mental health & mental illness Common mental illness Facts & stats Effects Causes, risks and prevention Emphases in mental health care, support and treatment Overview of mental health services and how they work

What is mental health?

What is mental health? Good mental health is a sense of wellbeing, confidence and self-esteem.  It enables us to enjoy and appreciate other people, day-to-day life and our environment. eg form positive relationships use our abilities deal with life’s challenges chill

What is a mental illness?

What is a mental illness? Is a medically diagnosable health condition Significantly affects how a person thinks, acts and interacts with other people It is diagnosed according to standardised criteria.

Mental health and mental illness Dr Mike explains the difference https://www.youtube.com/watch?v=aNQBd IMM3mQ

Other terms used Mental illnesses may also be referred to as: mental disorder or disturbance psychiatric disorder mental impairment or psychiatric disability Psychological and behavioural disorder

What is a mental health problem? A mental health problem also affects how a person thinks, feels, and behaves, but to a lesser extent than a mental illness.

What are the effects of mental illness? Mood and feelings Thinking Perception Concept of self – self image & self confidence Behaviour – what we do Physical health – many physical impacts Communication Relationships Personal development & milestones

Mental illness is common One in 5 Australians will experience a mental illness in any given year  Nearly half of Australians will experience a mental disorder in their life One third of young people will have had a mental illness by age 25

Common mental illnesses anxiety (¼ total; 1/3 women; 1/5 men) depression (1/5 total; ¼ women; 1/6 men) schizophrenia (1/100; 3% annually; more men) bipolar mood disorder (1/50; more women) personality disorders (varies) eating disorders (3/20; more common in women but increasing in men) drug and alcohol related conditions (5% annually)

Some other facts Most mental illnesses commence before the age of 25 1/3 of young people experience an episode of mental illness prior to 25 2/3 of people with a mental illness do not receive any treatment Possibly up to 85% of homeless people have a mental illness Mental illness, physical illness, drug & alcohol problems frequently co-exit

Some facts about suicide in Aust Around 2,500 people die by suicide each year or 7 people a day 2x the number of the road toll Men are at least 3x more likely to die by suicide Women are more likely to think about, plan and attempt suicide For every completed suicide, as many as 30 people attempt

Whose most at risk of suicide? Indigenous Australians are twice as likely to die by suicide than non-Indigenous Australians Gay, lesbian, bisexual, transexual, intersex people are at increased risk People with mental illness 15 times more likely to die by suicide Suicide is the leading cause of death for young people aged 15-24.

Causal contributors to mental illness Complex interactions between mind, body, environment and culture.  long-term & acute stress biological factors eg genetics, chemistry and hormones use of alcohol, drugs and other substances thinking patterns & personality traits eg constant negative thoughts and low self esteem social factors e.g. isolation, financial problems, family breakdown or violence, disasters etc

Mental health and culture – an example from Australia’s first people

Social determinants Social Determinants of Health (WHO) http://www.socialdeterminants.org.au/

Social determinants “the social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” 2011 World Conference on the Social Determinants of Health

What prevents or reduces the risk of mental illness? Enhancing things that help protect people eg a sense of belonging, supportive relationships and good physical health Reducing factors that put them at risk e.g., childhood trauma, abuse, social isolation Addressing social factors that reduce adversity and promote a sense of security, eg stable housing, stable income, personal safety

Emphases in mental health care Promotion & prevention Mental health literacy Self-management Holistic care – physical, mental health, social and emotional wellbeing Early and effective responses to reduce ongoing impacts Recovery Stepped care

Promotion and prevention Mental health promotion with all people - enabling people and communities to increase control over the determinants of wellbeing and thereby improve their mental health Targeting at risk groups to prevent illness Targeting key life cycle transition points Action on social determinants of health and wellbeing

Mental health literacy – absolutely everybody Every person, every home, every community understanding Davo’s & Dr Brian’s man therapy https://www.beyondblue.org.au/?&utm_source=google&utm_medium=cpc&utm_campaign=&ut m_term=beyond%20blue&gclid=CNSBoOvVtMgCFQcAvAodjAwLmA Brains are weird – have a mind of their own https://www.youthbeyondblue.com/understand-what's-going-on/the-brain-quiz

Everyone understanding mental illness and knowing how to help

Self-management Helping people with a mental illness or a mental health problem to Understand it Know how to manage it Be an expert on it Know how to remain well Know how to regain health Help their family to understand and help

Holistic This requires significant shift from a primary focus on reducing symptoms to: Wellbeing – emotional, interpersonal, physical, social, cultural & spiritual Challenges traditional thinking about what is a mental health service and who is a mental health professional Reinforces importance of GPs, range of counsellors, dietitians, exercise physiologists, occupational therapists, rehabilitation specialists

Early and effective As early as possible in the development of a mental illness The earlier, the better the prognosis Earlier effective professional help can prevent further episodes Earlier effective help reduces impacts and disruption Earlier effective help reduces impact on family and friends

Recovery Helping a person to get on with their life Helping people to row their own boat A focus on what’s important to the person A focus on a person’s strengths A focus on naturally occurring supports Peer support

Stepped-care Step 1 Prevention and Promotion Step 2 Recognition in Primary Health Care Step 3 Assessment and Primary Health Care Interventions Step 4 Comprehensive Specialist Services Step 5 Intensive Specialist Services

What is primary health care? Primary health care is our first points of contact with the health care system Incorporates personal care with health promotion and education and the prevention of illness and community development Includes community health centres (eg womens, Aboriginal, youth, migrant, mens, LGBTI), GPs, Health Clinics/Medical Centres, Medicare Locals/Primary Health Networks, antenatal and postnatal care, maternal and child care programs

What are specialist mental health services Staffed by people with mental health training eg nurses, psychologists, social workers, psychiatrists, other medically trained doctors, occupational therapists, welfare workers, peer workers, family support workers and increasingly health educators, exercise physiologists and dietitians Provided in hospitals, community and people’s homes Provided on a sessional, inpatient and outpatient Can be brief or more intensive Include public, private and nongovernment services Include assessment, treatment, follow-up, recovery support, rehabilitation and care coordination

Stepped Care: Step One Prevention and Promotion Support - before approaching either health or social  services: eg Friends, family & neighbours; Self-help, self-help groups & support groups Spiritual advice Advice & info eg telephone  helplines, internet Housing, legal, family support & employment assistance, leisure & recreation etc.

Stepped Care: Step Two Recognition in Primary Health Care - ‘Watchful waiting’…with further assessment and referral self-help guided self-help expert advice short-term brief intervention e-mental health information & resources signposting to/mobilising resources of Step One

Stepped Care: Step Three Primary Health Care Interventions GPs & MH Assessment short term psychological interventions physical health checks & medicine review computerised CBT social prescribing eg activities in the community caseworker support signposting to/mobilising resources of Step One Referral – whole of life

Stepped Care: Step Four . Comprehensive specialist services early intervention, crisis assessment & treatment, assertive outreach & family support assessment & treatment – hospital & community-based – both health & mental health specialist psychosocial, recovery support interventions & peer support care coordination & risk/relapse plans stable housing, income, education, employment, relationship support & participation

Stepped Care: Step Five Working with people at high risk and with complex needs in-patient and intensive clinical support in community and at home In partnership with primary health care eg GP Intensive recovery support, psychosocial rehabilitation & peer support family & relationship support high level care coordination & relapse management

What are psycho-social rehab and recovery support services? Put simply: Services and programs that support people to get on with their lives eg: Living skills Communication skills Budgeting and managing money Developing strategies to manage effects of symptoms on day to day life Getting back to work or study Healthy living Getting active & doing things in the community

Overview of evidence-based care, support & treatment Skills for living eg resilience Family, friends, neighbours & social networks – naturally occurring supports Lifestyle & healthy living Self help & self management Medical treatments - both health & mental health Psychological treatments & therapies Specialist peer support Recovery support & psychosocial rehabilitation

Local Public Mental Health Services Macarthur area - http://www.dow.catholic.edu.au/MSSD/Resources/Mental%20Health/Macarthur%20 Directory%20of%20MH-Support%20Services.pdf In Fairfield Liverpool - http://www.swslhd.nsw.gov.au/MentalHealth/LivFF.html Bankstown - http://www.swslhd.nsw.gov.au/MentalHealth/bankstown.html Parramatta - http://www.wslhd.health.nsw.gov.au/Mental-Health- Services/Our-Services

Helpful service directories HSNET - https://www.hsnet.nsw.gov.au/ Wayahead - http://directory.wayahead.org.au/ No Wrong Door Access ‘App’ – easy access to info about mental health services in South Western Sydney www.nowrongdoorsws.com.au

Useful sources of information Beyondblue - www.beyondblue.org.au Blackdog Institute - www.blackdoginstitute.org.au/ SANE – www.sane.org/ Indigenous mental health - http://aboriginal.telethonkids.org.au/kulunga-research-network/working-together- 2nd-edition-(1)/ Multicultural Mental Health Australia - www.mhima.org.au Other translated resources - http://www.mhima.org.au/resources-and-information/Translated- information/translated-mental-health-information-resources Youth mental health - www.headspace.org.au/

Contacts Leanne Craze – Leanne.craze@humecha.com.au; M 0408 869 051 Patrick Parker - District Manager, Community Mental Health & Partnerships Level L1, Mental Health Centre, Liverpool Hospital Tel 02 9616 4070 | Mob 0409 920 125 | patrick.parker@sswahs.nsw.gov.au