1. Mental Health CPCAB L4 Diploma in Therapeutic Counselling Unit 6: Working within a coherent framework of counselling Theory & Skills 2.1 Understand & work with common life problems & obstacles to well-being 2.2 Understand & work with common mental health problems 2.4 Reflect on different approaches to understanding mental health Mental Health CPCAB L4 Diploma in Therapeutic Counselling Unit 6: Working within a coherent framework of counselling Theory & Skills 2.1 Understand & work with common life problems & obstacles to well-being 2.2 Understand & work with common mental health problems 2.4 Reflect on different approaches to understanding mental health

2. 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)

3. Mental Health Problems?.. Identifying MHP’s may be difficult without a concept of MH, one way of considering MHP is that they exist on a continuum, each of us exist on the continuum and may be found at different points, at different times, for different reasons MHP’s often, but not always coincide with life events The term Mental Illness covers a wide spectrum of experiences from; grief, stress and sadness to severe and enduring problems where people may lose touch with reality Genetics, culture, environmental, biological, psychological & social factors may all have an influence on the existence of MHP’s It can be difficult to define & obtain physical proof of a mental disorder "About a third of my cases are suffering from no clinically definable neurosis, but from the senselessness and emptiness of their lives. This can be defined as the general neurosis of our times." Carl Gustav JungCarl Gustav Jung

4. So what is Mental Illness ?? Is it a question of degree, rather than kind. An exaggeration of feelings we all have, not different feelings? DO NOT DISTURB

5. Mental Illness ?..Mental Health Disorders Mental health represents the largest of health problems in the UK at anytime 18% of women and 10% of men will have significant psychiatric symptoms Despite their common occurrence stigma, fear and discrimination persist, (Crisp, 1999) A mental illness is generally deduced from the way a person; feels, thinks, behaves or perceives the world This requires some ‘notion’ of what is normal for that person encompassing cultural, social, educational, ethnic, sexual, religious and circumstantial considerations to aide our understanding of the person Mental illness may be suspected when a person’s behaviour is ‘abnormal’ causing them or others distress

6. 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)

7. 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) http://apps.who.int/classifications/icd10/browse/2010/en#/F30-F39 & DSM IV (APA 2000)

8. 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

9. 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

10. 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 sypmtoms 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

11. Causes - Most Mental health professionals believe that psychiatric disorders are usually the result of multiple interacting & contributing factors. Physical Causes – Biological, genetic, injury, illness, addictions & deficiencies Social & Environmental Causes – relationships, support, physical environment, wider social problems, isolation Psychological Factors – trauma, abuse, coping mechanisms, life events, perception & thought pattern www.rethink.orgwww.rethink.org (16.09.2010)

12. Treatments Talking Treatments – Psychosocial Interventions; Counselling, Cognitive Behavioural Therapy, Medications – Tranquillisers & Anxiolytics, Anti-Depressants, Anti Psychotics Electro Convulsive Therapy – ECT The Mental Health Act (2007) refers to ‘treatment’ in the broadest sense, ‘treatments’ could include attendance at a MIND centre, engagement in ‘therapeutic activity’ as well as compliance with medication regimes and care plans

13. What do CPCAB say?... Where possible TC-L4 trainees should initially be matched with clients needing counselling at service level A Moving on later in the programme, to work with clients needing counselling at service level B. This excludes clients who are in acute or chronic psychological crisis (this being service level C work), or who have deep-seated psychological needs. www.cpcab.co.uk © CPCAB 2010

14. A person’s starting point is their capacity to cope with the problems in their life - their openness to, and their resilience in the face of, relationship difficulties, life stage challenges and personal identity issues. The third part of the CPCAB model is informed by research on mental health and well-being and provides a continuum of three progressively more challenging levels of therapeutic change and associated levels of therapeutic work. This ‘Service Levels’ framework doesn’t set out to describe the complexity of individual clients and their needs but rather provides a framework for thinking about where the person is starting from, together with the level of therapeutic change that may be required to achieve their therapeutic goals. The Service Levels also provide a framework for defining the nature and limits of the service that an agency or independent practitioner is able to provide.

15. One Example – four levels of intervention: For one person, the goal of ‘handling conflicts with my partner better’ might mean working to become more open about feelings (Helping Work and Service Level A) For someone else, the same goal could mean developing the ability to care for the anxious part of herself that feels terrified whenever she gets into conflict (Service Level B1) Another person might need to work through the hopelessness and despair he feels as a result of his implicit, forgotten memories of childhood conflict (Service Level B2) whilst for someone else it could mean working on her automatic disassociation from reality when faced with conflict (Service Level C)

16. Helping Work: Support for immediate distress Some people only need the opportunity to informally explore the problems and challenges in their life in the company of a skilled helper. Currently distressed but generally able to cope with life’s problems and challenges: “Normally I’m OK - I just need some support right now.”

17. Service Level A: Working with common life problems in a more in- depth way, through a formal relationship with a counsellor. Currently finding life very difficult but generally able to cope: “Normally I’m OK, but right now I’m not coping and need help to work on the problems and challenges in my life.”

18. Service Level B: Enabling change within the self Some people need to work with a counsellor or psychotherapist3 to enable change within themselves. This Service Level consists of working to change both explicit aspects of the self (B1) and the more intractable implicit aspects of the self (B2). May also be experiencing symptoms of mild to moderate common mental health problems such as anxiety and depression: “I’ve been feeling anxious and/or depressed and that’s made it even more difficult to cope with the problems and challenges in my life.”

19. Service Level C: Enabling change within the foundations of self Some people may need to work with a psychotherapist to enable change within the foundations of themselves: symptoms of severe and complex mental health problems: “I’ve never really coped that well with the problems and challenges in my life.” Moderate mental health problems include people experiencing psychological difficulties which do not restrict or impede the person from managing their own social life and health care. For example, moderate depression where the person is able to maintain their self-care. At this level of work clients need supportive or therapeutic work for chronic, debilitating mental health problems often in relation to a fragile area of personality that has been a consistent source of difficulty throughout life. Therapeutic change might involve, for example, developing the ability to ‘represent other people’s states of mind’ or changing unstable coping styles or developing the ability to ‘regulate’ overwhelming emotions through ‘self-soothing’.

20. Activity Research & reflect on different approaches to understanding & working with people experiencing mental health issues Investigate a condition and approaches used such as; CBT, medication, how it works & its effects Research the evidence base for practice in dealing with common mental health disorders and identifying the range of treatments available. Eg NICE guidelines You may wish to discuss perspectives on mental health conditions, for example how they may be viewed differently from social or medical models or depending on the psychological perspective adopted; humanistic, psychodynamic, biological, behavioural, cognitive or social.