Module 3: Mental health Awareness

Objectives To be aware of the range of mental health problems To be aware of the signs and symptoms of mental health problems To be aware of the prevalence of mental health problems

Dual Diagnosis Capabilities Education and Health Promotion: Be able to offer basic but accurate and up to date information and advice about effects of substances on mental and physical health and vice versa. Dual Diagnosis Capability 8 level

Mental Health Problems Mental health is in a constant state of flux and is affected by a variety of things such as life- events, stress, environmental factors (like being in prison), relationships, losses, financial problems, and physical health problems. mental health problem: severe and prolonged stress and an underlying vulnerability. Manifested in a number of ways: mood problems, anxiety problems, or psychosis (loss of reality). Affects almost 20% of the population.

Recovery Model of Mental Health Comes from the growing force of the service user movement Changing from a negative view to a more positive view which includes rebuilding, reclaiming and taking control. Recovery is not about a “cure” but more about achieving an optimum quality of life, and learning something from ones own experiences of mental illness. Focus on the individual and place them and their views at the centre. Emphasize strengths rather than focus on problems, educate the public to combat stigma. Foster collaboration between those who need support and those who provide it rather than using coercion.

Types of Mental Disorders Mental disorders Disorders of Mood Depression anxiety Organic brain Disease Dementia Head injury Disorders related to Psychoactive Substance use Alcohol dependence Developmental Disorders Autism Schizophrenia And delusional disorders Neurotic Anxiety disorders Personality Disorders Borderline Anti-social

Depression Lowering of mood, and reduction in energy and activity Symptoms include: –tearfulness –loss of appetite –loss of libido –feelings of guilt and worthlessness, –loss of interest in things –poor sleep (either too much or too little), –sleep disturbances including early morning waking –negative view on life both past and present –Social withdrawal. Treatment includes talking therapies, anti-depressant medication, and rarely ECT.

Anxiety Symptoms: –extreme restlessness and agitation –complaining of physical symptoms such as palpitations –sweating –breathlessness –shaking –diarrhoea and indigestion –problems sleeping –problems concentrating –constant worrying. Panic attacks: extreme anxiety response with no apparent cause. Sudden onset and difficult to predict. –Feeling of terror, difficulties breathing (hyperventilation) dizziness, heart pounding and a sense of doom.

OCD, Phobias, and PTSD Obsessive compulsive disorder –Obsession: an unwanted or unpleasant idea that the person can’t stop thinking about (e.g. thoughts of harming a loved one); –Compulsion is a behaviour that a person can’t stop doing e.g. hand washing, counting etc. A phobia is an “unreasonable” fear and the person copes by avoiding the trigger at all costs. Both OCD and phobias in their extreme form can be very disabling as they prevent people from doing their normal activities. OCDs and phobias are treated with cognitive behavioural therapy, support and sometimes medication such as anti-depressants

PTSD Post-traumatic stress disorder Occurs immediately or delayed reaction to a traumatic experience above and beyond normal experiences e.g. major disaster, military combat, childhood abuse Symptoms include: –intrusive (often very intense and real) memories (also known as “flashbacks”), –dreams and nightmares about the traumatic experience, –a sense of numbness and detachment from those around them, –anhedonia (which means inability to experience pleasure) –“hyperarousal” and “hypervigilance” –Substance misuse –Suicidal and aggressive behaviours –Treated with anti-depressants, and specialist counselling

Schizophrenia Schizophrenia is a disorder of thinking and perception and affects (feelings and emotions) that are inappropriate or blunted. Serious and enduring mental illness characterised by “psychosis” (difficulty separating what is real from imaginary happenings). Positive symptoms (things that are present) include: –Odd or unusual beliefs that they hold with very strong conviction (or “delusions”). –Strong convictions that some external force is controlling their thoughts and behaviour (delusion of control, influence) and may feel powerless over this. –auditory hallucinations –Thought insertion or withdrawal, thought broadcast, and thought echo Negative symptoms (things that are absent) include: –being socially withdrawn, –lacking motivation to do things –not experiencing pleasure from anything Treatment includes anti-psychotic medication, support, psychosocial interventions such as CBT and family work

Bi-polar affective disorder This causes extreme mood swings, so people may have episodes of extreme happiness or mania, and then plummet to despair and depression. Some people will experience psychotic symptoms at either end of the spectrum as well. Someone who is elated will have pressure of speech (talking fast and incessantly), restless and agitated, flight of ideas (having lots of ideas), little or no sleep, disinhibition (may take off clothes, or act sexually), feel powerful or famous. When depressed they will exhibit symptoms as described in the depression section. When people are stable they function very well. People are treated with mood stabilisers and psychosocial interventions.

Personality Disorders Severe disturbances of personality and behavioural tendencies of individuals Usually manifest during childhood and adolescence and continue through into adulthood. They may develop as a result of traumatic experiences in early childhood and are most common in people who have been abused sexually or violently. Many people with PD have co-morbid mental health and substance use problems Antisocial PD: –Difficulty coping with boredom. –Difficulties holding down a job or stay in a long-term relationship. –Act impulsively and recklessly, often without considering the consequences. Borderline PD: –Problems controlling their emotions. –Extreme fear of abandonment by others. –Over-dependent and demanding which in turn pushes others away. –Impulsive acts of self-harm and suicide attempts. –NO LONGER A DIAGNOSIS OF EXCLUSION- should get access to help from mental health services.

Prevalence of Mental Disorders. Psychiatric morbidity of adults in private households survey 2000 (ONS) Adults rates per 1000 population General anxiety44 Depression26 Phobias18 OCD11 Panic7 Any PD44 ASPD6 BPD7 Psychotic disorders5 More than one disorder4 Alcohol dependence74 Drug dependence: –Cannabis31 –Cocaine2 –Heroin1 –Cannabis only25

Prevalence of Mental Disorders. Psychiatric morbidity of adults in private households survey 2000 (ONS) One year prevalence