Defining Mental Health … Mental Health is the emotional and spiritual resilience which enables us to enjoy life and to survive pain, disappointment and sadness. It is a positive sense of well-being and underlining belief in our own and others’ dignity and worth Health Education Authority (1997) Mental Health Programme Good mental health is not just the absence of disorder but includes a positive sense of well-being, individual resources; self esteem, optimism, a sense of mastery and coherence, the ability to initiate, sustain and develop mutually satisfying personal relationships and the ability to cope with adversity Jenkins (2001, Developing a national mental health policy) Mental Disorder ‘any disorder or disability of the mind’ (MHA 1983, amended 2007)

Prevalence of Mental Health Disorders Up to 40% of patients attending their GP practice will have a mental health problem, in 20-25% of cases the sole reason for attending will be mental health problem, typically anxiety or depression. Major depression is expected to be the world’s most debilitating disease by 2020, however between 30-50% of presentations go undetected (DoH, 2001) An average GP surgery with 2,000 patients is likely to have: 200 diagnosed with depression 100 yet to be diagnosed 500 consultations PA specific to depression 25 patients with chronic low grade depression (dysthmia) 25 patients with recurrent brief depression 12 patients with major depression 2 patients admitted to hospital as a result of severe depression 1 patient committing suicide in every 5 year period Most common MHP: Alzheimer’s & Dementia, Alcohol & Substance misuse, Mood or ‘affective’ disorder, anxiety, schizophrenia, anorexia & bulimia (Cross, 2003 in BACP 2008)

What BACP say... “ Therapists with limited time or resources should have some knowledge of the most commonly seen mental health problems. Ideally though they should aim for a wide-ranging and thorough knowledge of mental health problems in order to be familiar with the clinical features commonly presented by clients....” Understanding terms used makes communication more effective & efficient and helps avoid confusion, commonly used terms and descriptions can be found in manuals such as ICD 10 (WHO 1992) & DSM IV (APA 2000)

Recognising signs & symptoms The ability to recognise signs & symptoms will vary according to the therapists skill in observing the client Signs & Symptoms may occur in recognisable patterns e.g in relation to depression: Neglected appearance, poor eye contact, reduced gestures, pessimistic speech The client may describe symptoms such as loss of interest, disturbed sleep pattern, feelings of hopelessness or presenting with high levels of distress Discriminating symptoms relate to those specific to a MH condition eg the delusion that thoughts are being inserted into one’s mind are a DS for Schizophrenia, whereas suicidal thoughts are a Characteristic Symptom as they may occur in several MHP’s Identification of MHP is best conducted in a systematic way; Mental State Examination Tool is useful to be aware of but NOT to diagnose

Human Mental State & The Mental State Examination The Domains in which the mind functions: Thoughts – ideas, thoughts, internal dialogue Feelings – Subjective emotional states Perceptions – sensory modalities; touch, taste etc Cognitions – abilities of intelligence, attention, concentration, memory, calculation, language Behaviour – actions and manifestations of internal mental state Assessment of the state of mind at the time of interview: Appearance & Behaviour – eye contact, self care, presentation, expression, posture, movement Speech – content, rate, pattern, continuity Thought – preoccupations, obsessions, delusion, suicidal ideation Mood – as expressed verbally / non verbally, evidence of congruence / incongruence Affect observed expression of emotion; smiling etc Abnormal Experience – depersonalisation, feeling unreal, Beliefs – false beliefs & delusions, fixed, rigid, Perception – false perception or hallucinations Cognition – organisation of time, attention, concentration, focus, memory Insight – awareness of what / how they are presenting

Other Considerations... Precipitating factors – events occurring shortly before onset Predisposing factors – early life events, genetics, family dynamics, socio-economics, personality Perpetuating factors – these prolong the course of the problem Severity – intensity of the symptoms Duration – how long the client has been experiencing symptoms Form & Content – eg form; auditory hallucination content; voices say ‘you are bad’ We all experience distress at some point, not all will have a mental health problem as a result, knowing about mental health will enhance the practitioners confidence and capabilities in recognising what conditions may require intervention from a therapist with specialist skills

Research approaches to understanding & working with people experiencing a specific mental health issue Research the evidence base for practice in dealing with common mental health disorders identifying the range of treatments recommended (see NICE guidelines) including medication, how it works & its effects You may wish to discuss perspectives on mental health conditions and how they may be viewed differently from social or medical models or the psychological perspective adopted; humanistic, psychodynamic, cognitive etc Activity: Short Presentation-

‘ Interesting Reading’ Grant A (2010) Cognitive Behavioural Interventions for Mental Health Practitioners, Learning Matters Pilgrim D (2009) Key Concepts in Mental Health, Sage Redstone J (2008) Working With Clients With Addictive Behaviours BACP information leaflet G15 Reeves A (2010) Counselling Suicidal Clients, Sage Reeves A & howdin J (2008) Considerations When Working with Clients Who Self Harm BACP information leaflet G12 Reeves A & Seber P (2007) Working with the suicidal client BACP information leaflet P7 Rundle K, in Tolan J & Wilkins P (2012) Client Issues in Counselling & Psychotherapy, Sage Ch7 Person Centred Approaches to Different Realities Russello A (2008) Recognising Mental Health & Mental Health Problems BACP information leaflet G7 Warner M, in Cooper et al (2013) The Handbook of Person Centred Psychotherapy & Counselling, Palgrave Macmillan pt3,ch23 Difficult Client Process