Understanding Mental Health Needs Training Presentation This set of slides provides a basic introduction to the promotion of service users’ mental health. It contributes to the knowledge components of Care Certificate Standard 9, Mental Health, Dementia and Learning Disabilities. Further background information can be found in the Understanding Mental Health topic.

Learning Aims and Outcomes To be more aware of service users’ mental health needs To introduce basic information about mental health matters To understand how care staff can notice and report changes in service users’ mental health To understand how care staff can promote positive mental health

Key Questions What do we mean by mental health or mental wellbeing, mental health problems and mental illness? What affects mental health and wellbeing? Is there a difference between being mentally ill and physically ill? Have social attitudes to people with mental health problems changed? Are they continuing to change? The presentation will cover these issues.

Introduction: What Is Mental Health? Mental health and wellbeing can be taken for granted So we notice only signs of mental ill health Mental health “problems” cover a wide spectrum from daily worries to complex illnesses Physical and mental wellbeing often go together But physical disability does not necessarily result in mental ill health It is important to promote mental health and wellbeing to prevent mental ill health or mental health “problems” Key Learning Points We do not usually think about our mental health except when there is a problem. In other words, we think more in terms of mental ill health and mental illness than we do of good mental health. Mental health is usually thought of as a state of emotional and psychological wellbeing when we feel positive about ourselves, thinking clearly and in control of our actions (as discussed further in next slide). “Mental health problem” covers a very wide spectrum, from the worries and grief we all experience as part of everyday life, to the most bleak, suicidal depression or complete loss of touch with everyday reality. A mental health problem only becomes a serious problem when it interferes with the ability to cope on a day-to-day basis or when behaviour becomes a concern for others. The more extreme forms of mental distress are disturbing for the person experiencing it and for those around them. Mental distress can be highly disruptive but people do find ways of managing their problems and carrying on with their lives. Usually, good physical health and mental health go hand in hand and physical ill health can affect mental health, but it would be unfair to suggest that everyone with a physical illness or disability may not achieve good mental health. Many people with disabilities, for example, experience good mental health as they adjust to their personal situations. It is important to encourage positive mental health because this can prevent mental distress and to help deal better with mental health problems if they arise. (Next slide follows this last point up.)

Mental Health and Wellbeing: What Makes You Feel Good and Not So Good About Yourself? Do you agree that the following can contribute to a sense of mental wellbeing? Self-identity; [Are you happy (or unhappy) with who you are?] Self-concept; [Are you positive (or negative) about yourself?] Self-image; [Are you confident (or worried) about how you appear to other people?] Self-esteem; [Do you feel good (or bad) about yourself?] Abilities to cope with and manage stress; [Are you resilient or not?] Behaviour patterns; [Can you adapt easily (or not) to different situations?] Key Learning Points A person’s mental health or wellbeing can be influenced by several factors such as these described above, which can be used as discussion points in terms of “do you agree or disagree with this statement?” Learners might want to comment from their experiences without going into them too deeply. “You” should be seen as people in general.

Discussion Points Mental health and wellbeing is often based on what society thinks is “normal” for its members Different societies and cultures have different ideas about what is “normal” and, therefore, what is “healthy” and unhealthy Mental distress can be seen as a sign of personal weakness There is a lot of shame and stigma to the idea of being mentally unwell, which does not apply to physical ill health Key Learning Points Ideas of a healthy and unhealthy “self” are based on what a society finds appropriate, acceptable or normal and these ideas differ according to society and culture. People who appear different or behave differently from the normal can often be thought to be “mentally ill” — to be excluded from normal society as they were once shut up in asylums. Mental distress can also be looked at judgmentally as personal weakness and something to be ashamed about. There is still a huge stigma attached to being mentally as opposed to being physically unwell, which must be challenged. (Allow time to discuss the idea of stigma, eg do you agree? Why is it? What should be done about it? So how should we approach our service users who appear to be mentally distressed or unwell? (Leads on to next slide.)

What Makes Service Users Feel Good or Not So Good About Themselves? Examples: The underlying reasons for them becoming service users and having to be cared for Their difficulties in coming to terms with their situation, eg loss of independence because of increasing disability The direct effects of illness on emotional wellbeing and mental health The above points can be used to prompt discussion about what might affect the mental wellbeing of the people using their service, eg older people, etc which can be related to their current situation. The list can be expanded from the ensuing discussion and continued into the next slide.

What Can Affect Service Users’ Wellbeing? Difficulties in coming to terms with permanent disability, producing frustration, bitterness, anger, depression Poor self-concept, self-esteem and self-identity (as discussed above) Loneliness, especially for those living alone in the community For care home residents, the effects of moving from a familiar family and community environment to an unfamiliar care home environment The effects of losing people who they were close to as a result of bereavement or separation The fact that they may already be receiving mental health services before they start to access domiciliary care services or before admission to a care home Learners should be encouraged to reflect from their experiences of working with their service users on how being a service user is likely to affect their mental health and wellbeing (also, how being a carer of a service user, eg someone with dementia can affect the carer’s mental health and wellbeing). Emphasis that everyone’s problems are personal to them and must be dealt with on an individual basis. However, learners should also be aware of some facts about mental ill health (next slide).

Facts About the Causes of Mental Health Difficulties Mental health problems can result from a range of adverse factors associated with social exclusion and can also be a cause of social exclusion, for example: unemployed people are twice as likely to have depression as people in work children in the poorest households are three times more likely to have mental health problems than children in well- off households half of all women and a quarter of all men will be affected by depression at some period during their lives people who have been abused or been victims of domestic violence have higher rates of mental health problems These points show that there are many social factors that affect an individual’s mental health and wellbeing. The list might be expanded from discussion to include more recent influences such as social media on young people‘s mental health.

Psychiatric Classifications Mental health disorders can be discussed in the following terms Organic (where there is identifiable brain damage, eg from a brain tumour or dementia) or Functional (where there is no obvious brain damage but some form of breakdown as found in, for example, schizophrenia) Neurosis (severe forms of normal experiences, eg anxiety or compulsive disorders) or Psychosis (severe distortion of a person’s perception of reality as in schizophrenia) ICD-10 Classification, which lists major groups of disorders in related families, eg mood disorders, which includes depression and manic depression This slide deals with the idea of mental illness as a set of conditions that might, but might not be directly related to the social factors described in the previous slide. Diagnosis of any condition is usually complex and difficult. Learners here should just be aware of how mental illness is addressed by professionals, psychiatrists, etc. Further information is available in the Mental Health Foundation Factsheet 2 (www.mentalhealth.org.uk).

Observing Mental Health and Wellbeing in Practice You should be observing and reporting on any significant changes that suggest a decline in their mental health, including: mood and attitudes behaviour and conduct physical and mental energy signs of distress, worrying and anxiety intellectual abilities confusion, disorientation and forgetfulness losing track of time and place preoccupation with illness and own thoughts, eg of dying sleeping and waking patterns Here, the discussion switches to how care staff might help to promote mental health and wellbeing by observing and reporting signs and symptoms, and changes in the people to whom they are providing a service.

Summary of Key Learning Points Mental health is not just a matter of mental illness, but is everyone’s concern Our mental health may suffer in minor or major ways and the difficulties may be temporary or longer lasting Many minor mental health difficulties may resolve themselves without specialist help Some mental health difficulties may be treated by self-help Some mental health difficulties may need to be treated through a GP Other mental health difficulties may need specialist psychiatric help Some people whose poor mental health results in behaviour that remains a concern to others or to society at large may need continuing support and supervision from the relevant statutory services This slide can be used to summarising the different approaches to people with mental health difficulties. Use factsheets from, eg Rethink (www.rethink.org), MIND (www.mind.org.uk) and NHS Choices (www.nhs.uk) to add to the information.