Specialist Training
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Mental Health
Specialist Training
Welcome…
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Welcome to this web based knowledge session on Mental Health. It
should take you approximately 25 minutes to complete this material.
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Aims & Objectives…
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By the end of this session you will have knowledge of:
What a mental disorder is
What causes mental disorders
Who has mental disorders
Diagnosis of mental disorders
Depression
Bipolar Disorder
Anxiety
Schizophrenia
Self harm
Eating Disorders
Suicide
Challenging Behaviours
Support from Care Workers
The Mental Health Act
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Introduction…
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One of the service user groups that you may become involved with
while working for Prestige Nursing is people with Mental Health
issues. Did you know that it is estimated that 1 in 4 of us will at some
point in our lives have a Mental Health issue? It is more common than
you might think. For most people the issues are resolved relatively
easily, but some require more help as their problems are more severe.
This module will introduce you to the
legislation around Mental Health,
different types of disorders and the
things to look out for if you are
providing care to somebody with a
mental disorder.
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Introduction…
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Before we look at any Mental Health problems, let‟s first consider
what good mental health actually is. You probably have an idea of
what this means but would you be able to describe a definition of it?
In fact, the World Health Organisation (WHO) has stated that there
is no official definition of the term, however, it has provided this
description:
“Mental Health is a state of well-being in which the individual
realises his or her own abilities, can cope with the normal stresses
of life, can work productively and fruitfully, and is able to make
a contribution to his or her community.”
Good mental health is therefore much more than simply the absence
of a mental illness!
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Introduction…
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Positive mental health includes some of these factors of life:
Healthy thinking Healthy emotional health
our ability to think clearly, our ability to experience,
to solve problems and to understand and express
make sound decisions. feelings.
Healthy perception
making sense of events
and the world around us
Being able to function in Being able to cope with the
everyday society ordinary demands of life
being able to make and sustain our ability to deal with
relationships and participate in setbacks, difficult experiences
the wider society. and stress – our „resilience‟.
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Introduction…
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So people with mental health issues are people who are unable to
function in everyday society, are unable to cope with the ordinary
demands of life, who do not have healthy perception or thinking and
who do not have good emotional health.
There are several levels of severity of this and
you may hear the terms Mental Illness and
Mental Disorder being mentioned.
Both are often used interchangeably and for
the purposes of this module we will use the
term Mental Disorder to include a wide
spectrum of severity of Mental Health issues.
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What is a Mental Disorder…
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As this is such a wide area, how would you define the term Mental
Disorder? Have a think and then compare your answer with the
definition given in the Mental Health Act (MHA):
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“Mental Disorder” means any disorder or disability of the mind.
Originally the Mental Health Act gave 3 levels of Mental
Disorders, however, these were replaced with the above
definition in the 2007 amendments of the act.
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What is a Mental Disorder…
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This definition covers a wide area, so here is a list of types of mental
disorders to give you some understanding of what we are looking at:
Depression
Bipolar Disorder/Manic Depression
Anxiety
Schizophrenia
Self Harm
Eating Disorders
Suicide
Each of these will be covered in more detail later on. Let‟s first have a
look at some of the general points around Mental Disorders.
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What causes Mental Disorders…
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It is difficult to pinpoint exactly what causes a Mental Disorder and
often it is a series of events that triggers it. Studies of the significant
causes and processes involved in the development of mental illness
have found that there can be physical, social, environmental and
psychological causes for mental illness.
Physical causes
This means our individual genetic make-up can make some people
more prone to Mental Health issues than others. There is evidence,
although it‟s hotly debated, that some people may be genetically more
prone to problems such as schizophrenia or depression.
Sometimes physical injuries, such as severe head injuries can change a
person‟s personality, and in some cases they may begin to experience
schizophrenia and psychotic type symptoms.
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What causes Mental Disorders…
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Also substance or alcohol abuse can have an impact on a person‟s
mental state. Additionally substance abuse or illness of mothers
during pregnancy, can lead to changes in their baby's development
which may ultimately effect the child‟s mental health.
Social and environmental causes
These are factors such as where we live, whether we have strong
support networks, our place of work and how and where we can
relax. When we face difficult times the
support of our family and friends can help
to provide a sense of strength and
security. Where a person does not have
such support they can feel vulnerable and
isolated and less able to cope.
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What causes Mental Disorders…
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Physical environments such as where you live can be very stressful,
particularly when there are problems with neighbours or high crime
rates. In addition, if people are unable to find employment or hold
down a job it can put pressure on their mental well-being. Being in
work can promote a feeling of self worth, satisfaction and social
inclusion. It can also provide a level of financial security, without
which people can struggle to cope.
However, some jobs can also put a high
level of stress and pressure on a person,
which can again increase their risk of
anxiety and depression. Therefore, a good
work-life balance is always important.
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What causes Mental Disorders…
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Psychological factors
Your psychological state influences your mental and emotional
state, particularly if you are are coping with a traumatic and abusive
past. Negative childhood experiences can make people more prone
to developing mental health problems. For example, post-traumatic
stress disorder (PTSD), anxiety and in more extreme cases
Dissociative Identity Disorder (DID – in the past referred to a
multiple personality disorder) are all mental health conditions that
are commonly found in people who have been abused.
Equally current experiences of significant life events such as
bereavement or divorce can leave people struggling to cope.
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Who has Mental Disorders…
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We have just looked at the factors that may contribute to triggering
Mental Disorders and from that you have probably realised that
Mental Disorders can affect people from all walks of life. Life
events, stress and the strength of our support networks, together with
our age or gender, all combine in determining our mental health. That
is why anyone can potentially develop a mental health problem.
However, some people do seem to be more at
risk than others. For example, experiences
during childhood such as trauma or abuse can
increase the risk of mental illness by
changing someone's behaviour and thinking
patterns.
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Who has Mental Disorders…
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In Scotland a consultation called „Towards a Mentally Flourishing
Scotland‟ (TAMFS) was carried out, which found these broad groups
of people may be more prone to Mental Health issues than others:
People in institutional settings, such as those in secure care or
subject to detention, or people living in care homes or long-term
nursing care settings.
People in non-health care settings, such as veterans or the
homeless, who may not otherwise be reached by traditional
health care or health improvement approaches.
People with alcohol problems, people misusing drugs, people who
are victims of violence and abuse, people who are perpetrators
of violence and abuse.
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Who has Mental Disorders…
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Looked after and accommodated children, children whose
parents have problems with drugs and/or alcohol, children
whose parents have a mental illness.
People without access to key assets or resources.
People and groups who experience discrimination.
When you consider all of these groups it becomes clear that a lot of
them are potentially the types of service users we would look after.
Therefore, even if we look after them for reasons other than their
mental health, it is worth knowing what might help them not to
develop any problems in the first place. You may well be a little part
of their support network that can help them cope.
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Diagnosis of Mental Disorders…
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A diagnosis of a mental disorder will usually be made by an
experienced psychiatrist working with other health professionals.
Initially, the person will be observed for symptoms, and the doctor
will check through a 'diagnostic schedule' to find out how the person
functions day to day. After this initial interview, the individual will be
monitored over a period of time.
People respond to the diagnosis of a mental disorder in different
ways. Some will welcome it as it gives meaning to the way they have
been feeling. For others it can be a label that brings with it stigma,
discrimination and prejudice.
However, a diagnosis will often have to be made before the most
appropriate treatment can be authorised.
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Depression…
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Let‟s now look in more detail at the different types of mental health
disorders we listed earlier so you get an understanding of how they
manifest themselves – starting with Depression.
Most people will have some times in their lives when they are feeling
„down in the dumps‟ and low. This is a normal part of life and doesn‟t
automatically mean that the person suffers from depression.
Depression does incorporate these feelings, however, they are much
more severe and longer lasting.
Depression is increasingly common and
people of all ages, backgrounds, lifestyles
and nationalities can experience it.
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Depression…
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People suffering from depression may display the following signs
and symptoms:
Feelings of overwhelming sadness, guilt, worthlessness or
hopelessness. People may also feel anxious, tense, irrationally
worried and irritable. They may lose interest and pleasure in the
things they normally enjoy. One person puts it like this:
“It was hard to get out of bed in the morning. I just wanted to hide
under the covers and not talk to anyone. I didn‟t feel like eating and
lost a lot of weight. Nothing seemed fun anymore. I was tired all the
time, and I wasn‟t sleeping well at night. But I knew I had to keep
going because I‟ve got kids and a job. It just felt so impossible, like
nothing was going to change or get better.”
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Depression…
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People that do not understand depression often feel that sufferers
should just pull themselves together. Or they may ask what the person
has to be depressed about, especially if they are young and have their
lives ahead of them. This attitude is not helpful and can actually
reinforce the sufferers feeling of guilt and worthlessness. Depression
is an illness that needs to be treated and is not a sign of weakness.
“People think that when you‟re depressed, you‟re depressed about
something. But I‟m not. I just feel terrible. It‟s not about record
sales or media or family. The real root of it all is, actually, I suffer
with an illness that‟s called depression.” (Robbie Williams, pop star)
So even people who we think have it all can be affected!
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Depression…
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There are many treatments for depression, from medication to
complementary therapies to talking treatments. Often a combination
of things works at different times.
The key to recovery is finding what works, with
the support of professionals. Often, talking
treatments like counselling or therapies that help
focus on positive achievements are a first step to
recovery. You may be able to play your own role
in supporting a service user recovering from depression by displaying
good listening skills and being part of their support network.
Recovery means different things to different people though and no
two individual journeys of recovery will be the same.
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Bipolar Disorder…
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You may have heard Bipolar Disorder referred to as Manic
Depression – the two describe the same mental health disorder.
People go through phases of extreme mood swings, leaving them
either highly elated or very depressed.
When the person goes through a high their mind will
race, they may talk very quickly, seem full of energy,
not sleep very much, or at the extreme, begin to
believe they have special powers. They are prone to
excesses of spending money, extreme religious
beliefs, sleeping around or other risk taking behaviour.
The depression experienced in bipolar disorder is very similar to that
experienced in other kinds of depression.
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Bipolar Disorder…
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About 1 in 100 people will suffer bipolar disorder during their
lifetime. It affects both men and women equally, and most commonly
starts when people are in their twenties.
Bipolar often occurs when work, studies, family or emotional
pressures are at their greatest. In women it can also be triggered by
childbirth or during menopause. There is some evidence pointing to a
genetic link to bipolar disorder. However, science has yet to find clear
evidence of exactly which genes might be responsible and what the
consequences for treatment may be.
The diagnosis is given when somebody has experienced significant
periods of depression, and at least one significant period of mania.
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Bipolar Disorder…
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Because diagnosis is made difficult by the complex symptoms, proper
treatment can sometimes be delayed for up to a decade following first
symptoms! (ICD10, WHO, (1992)) This can have tragic consequences as between
10 – 20% of people with bipolar disorder will take their own life and
up to 1/3 will make a suicide attempt.
Treatment of the disorder can include medication, such as mood
stabilisers like Lithium or antidepressants, and a range of talking
treatments.
Early diagnosis and treatment are very important as severe and/or
untreated episodes of bipolar disorder can be very damaging for the
person and their relationships and can negatively affect employment,
family and social relationships.
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Bipolar Disorder…
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People with bipolar disorders often experience stigma as a result of
people‟s impressions of them when they are unwell. People frequently
lose their jobs and go through relationship break ups and when they
recover find it hard to regain employment or make up with their loved
ones because things said or done when they were unwell have
damaged those relationships.
As a care worker you will be able to support
your service users during times of elation
and depression by listening and supporting
them. This may take the form of practical
help if the person is depressed and unable to
carry out certain tasks for themselves or it
may be that you balance their elation by making them aware of the
consequences of some of the risks they may think about taking.
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Anxiety…
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Anxiety or fear is something that we all feel at some point if we are
threatened or overwhelmed. It can even be a helpful feeling in that it
can help us avoid dangerous situations, make us alert and give us the
motivation to take action. However, anxiety in the context of mental
health issues is a feeling that is incredibly strong, goes on for a long
time and sometimes is triggered by ordinary things that don‟t pose
any risk to us at all. Anxiety can stop us from doing the things we
want to and can make somebody‟s life miserable.
Estimates say 1 in every 10 people experience anxiety or a phobia at
some point in their lives. Phobias have intense symptoms of anxiety
and arise when people are confronted with something that frightens
them. They can be triggered by something that poses a real risk, e.g.
heights, but they can also be quite illogical, e.g. a fear of clowns.
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Anxiety…
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Anxiety can be due to a person‟s genetic make up or may be triggered
by external factors such as stress or financial worries. Also using
drugs like amphetamines, LSD or Ecstasy can sometimes cause
anxiety. Often, however, anxiety is triggered by a mixture, i.e. a
person‟s personality combined with events that have happened.
There are a range of anxiety disorders, which can include:
Panic disorder – person suffering from panic attacks.
Obsessive Compulsive Disorder (OCD) – this includes obsessive
thoughts that are repetitive, unwanted and obtrusive. These thoughts
lead to compulsive behaviour i.e. acts or rituals carried out to stop the
obsessive thoughts.
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Anxiety…
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Post traumatic stress disorder (PTSD) – this occurs in people who
have experienced some kind of horrific event(s). This could be a car
crash, mugging, rape and often soldiers coming back from war areas
can suffer from this. The person often experiences flashbacks,
nightmares and „feeling out of contact‟ with their life.
Social Phobia – This is characterised by a fear of doing things in front
of other people and making a fool of oneself.
Generalised anxiety disorder (GAD) – This is much more than the
normal anxiety people experience. It‟s chronic and fills the person‟s
day with exaggerated worry and tension, even though there is little or
nothing to provoke it. People constantly anticipate disaster, often
worrying excessively about health, money, family or work.
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Anxiety…
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The signs and symptoms of these anxieties tend to manifest
themselves both in the mind and body and can include:
Mind
Feeling worried all the time
Feeling tired
Unable to concentrate Body
Feeling irritable Irregular heartbeats (palpitations)
Sleeping badly Sweating
Muscle tension and pains
Breathing heavily
Dizziness
Faintness
Indigestion
Diarrhoea
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Anxiety…
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To control anxiety or recover fully from it it is usually very helpful to
participate in stress relieving activities. These can vary between
people but may include things like exercise, listening to music or
practicing Yoga. Having a good support network in one‟s family and
friends or other support workers, which may include you as a care
worker, is also helpful. Talking about fears can help to diminish them.
If any of these are inappropriate there is also
medication that can help to alleviate anxiety.
Their drawback is that they can be very addictive,
so coming off the medication can mean having to
deal with unpleasant withdrawal symptoms.
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Schizophrenia…
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Schizophrenia is a complex mental health problem which affects
thinking, feeling and behaviour. Each individual will experience a
range of symptoms, not everyone will have them all. Symptoms may
include:
Hallucinations – seeing, hearing, feeling, smelling or tasting
something that does not exist, as if it were real. Hearing voices is the
most common hallucination experienced with schizophrenia.
Delusions – the person my hold false and often unusual beliefs with
unshakeable conviction. For example, somebody might fear that he or
she is being watched or followed by another who wants to control or
do them harm.
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Schizophrenia…
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A person with schizophrenia may appear to show little emotion or
express it out of context, e.g. crying at a joke. They may become
withdrawn and avoid the company of family and friends or even
become uncharacteristically hostile to members of the family.
Often their way of thinking, acting and speaking
becomes muddled and illogical, conveying little
meaning.
Schizophrenia is one of the most widely misunderstood
and stigmatised mental health problems. There is widespread
misconception that people with the disorder are dangerous and
unstable. The media, who often use terms like “schizo” to describe
people who commit violent acts, can reinforce this impression.
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Schizophrenia…
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Schizophrenia, however, is not a split personality, nor does the
behaviour of people with this diagnosis swing dramatically between
normal and dangerous. Violence is not a symptom of schizophrenia.
The disorder can affect people from all walks of
life and for some it starts very quickly, whereas
for others it can develop slowly over a period of
time. The changes in behaviour can be very
difficult to understand for people around the
individual, especially if they are not aware that the person is ill.
It is not fully known what causes schizophrenia, but a combination of
factors such as stress, hereditary factors and drug abuse, have been
shown to increase the risk of developing it.
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Schizophrenia…
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At times, some people with schizophrenia may require hospital care
however, most live in their own homes in the community. The disorder
is commonly managed with medication and with the addition of good
support from friends, family and/or professionals many people can
and do lead productive lives.
There is a belief that having schizophrenia
leaves a person completely unable to
function and permanently unable to make
rational decisions.
However, in reality, most people with schizophrenia are able to take
control of their lives, some with and some without assistance from
support or advocacy.
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Self Harm…
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Did you know that according to the MHF/Camelot Foundation
National Enquiry into Self Harm in Young People 2004, 1 in 15 young
people have self harmed? The same enquiry describes self harm as “a
wide range of things that people do to themselves in a deliberate and
usually hidden way, which are damaging”. It includes these actions:
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Cutting
Burning and scalding
Banging heads & body parts against walls
Hair pulling
Biting
Swallowing or inserting objects
Self Poisoning
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Self Harm…
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Self Harm is always a sign of emotional distress and that something is
seriously wrong.
For some people, self harm provides the means to cope with
overwhelming emotions and it‟s a way to control feelings of
helplessness and powerlessness. The self harm gives these people a
feeling of control. For others, it temporarily combats feelings of
emotional numbness, as the pain involved in self harming confirms
that they are still able to feel something.
Because of the complex feelings involved, people
often keep self harm well hidden from friends and
family and may go to great length to avoid showing
the area of their body that they harm.
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Self Harm…
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Of course self harm is damaging and may be dangerous, but for many
people it provides a method of coping with life. It is important to
recognise the level of distress that has led the person to taking up self
harm and that it provides a coping mechanism.
What do you think will happen if this coping
? mechanism is taken away?
It‟s important to realise that although friends and family will want the
person to stop self harming, taking away that coping mechanism can,
in the short term, increase their emotional distress and make the
situation worse. It‟s therefore important to tackle the root cause of the
distress, not just the symptoms.
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Self Harm…
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There are a lot of myths and misconceptions about self harm. Test
your own understanding with the statements below and find out if
you‟re right or wrong by clicking each of the three statements:
1. People who self harm are 2. People who self harm are
attention seeking attempting suicide
Young people often feel Suicide is often a last resort for
embarrassed or guilty about their people to make their emotional
self harm and actually keep it distress stop. Self harm can
secret. It‟s not trivial „attention actually help people in emotional
seeking‟, but it can of course be a distress go on living with the pain
serious cry for help. they feel.
3. You know if someone is self harming if they have cuts on their arms.
Cutting is only one form of self-harm, others include burning, hitting, bruising or
poisoning.
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Self Harm…
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Giving up self harm can be a long and difficult process and no two
journeys of recovery are likely to be the same.
Some use self help groups or online
support communities, others seek
help from their GP, who may refer
them for psychological therapies.
Therapies can help to build new,
healthier coping mechanisms to
replace the self harm and also
address the feelings that led to the self harm in the first place.
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Self Harm…
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People who self harm can face stigma when others notice their scars.
They may stare, point or make comments as for many people the
thought of somebody wilfully hurting themselves is very unsettling
and incomprehensible.
One of the most commonly reported areas where self harm results in
stigma is when accessing medical help. Openly displayed prejudice
here can lead to people not completing
their treatment or being deterred from
seeking future treatment. So people that
self harm do need help and support from
medical professionals as well as their
friends and family around them.
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Eating Disorders…
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There has been a lot of media coverage about eating disorders in the
last few years and some people say that the whole debate about size 0
catwalk models is to blame for an increase in eating disorders. And it
very probably is responsible for more and more people being much
more body conscious and wanting to be thin.
Clinically significant eating disorders were, however, first described
by Physician and Minister John Reynolds in 1669 and Philosopher
Thomas Hobbes in 1688. But it may be the case that it is much more
common these days. When the feeling of wanting to lose a little bit of
weight or comfort eating a little becomes a major part of somebody‟s
life, they may have an eating disorder.
The two most common ones are anorexia nervosa and bulimia nervosa.
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Eating Disorders…
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Anorexia Nervosa Bulimia Nervosa
People with anorexia avoid People with bulimia go
eating and often feel very fat through cycles of binge
even though some are 15% eating and purging by then
under their ideal body weight. making themselves sick or
They may exercise vigorously taking laxatives to get rid of
and not accept the fact they the food. They may look a
need a balanced diet because healthy body shape but find
their view of food and their it very difficult to control
own body is extremely their eating habits, sometimes
distorted. being on strict diets and
sometimes bingeing.
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Eating Disorders…
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The lines between anorexia and bulimia can be blurred and some
people may display symptoms of both. Anybody can develop an eating
disorder, although it will most likely occur in young women aged 15
and 25. Girls and women are 10 times more likely to suffer from
anorexia or bulimia than boys! An eating disorder can leave a person
with low self esteem and a distorted body image. It can lead to
depression and even place somebody at risk of self harm or suicide.
Eating disorders can also do great physical harm to the
body. Regular vomiting can lead to dehydration, bad
breath and serious damage to teeth. Regular use of
laxatives can lead to severe bowel disease and serious
imbalances of the body‟s essential minerals can result
in organ failure and even death.
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Eating Disorders…
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It is important to understand that eating disorders
are not just about food or weight issues. Often
people with eating disorders are emotionally
distressed, suffer from depression or anxiety.
Eating disorders can also develop when people
feel they are not in control of their life and
therefore instead control the food they consume.
People with eating disorders are often prone to facing prejudice and
are viewed negatively by the people around them. Other people may
harbour feelings of disgust and may make comments on the sufferer‟s
appearance. Hurtful comments can reinforce a negative body image as
well as people‟s feeling of guilt and shame and reinforce the problem.
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Eating Disorders…
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Eating disorders can develop relatively slowly with the behaviours
involved becoming ingrained over time. Therefore, the sooner the
person can get support the better. Recovery can take a long time and
often the person will experience setbacks before achieving full
recovery. Nevertheless, many people do recover completely.
Treatment can include hospital care, treatment from
GPs and support in the community with dieticians and
occupational therapists forming part of the care team.
Some people also find self help groups useful. Also,
family, friends and any additional support networks
can really help the person‟s recovery. As a care worker,
you may well be part of that support network that can
provide encouragement and moral support.
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Suicide…
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Suicide is the formal term for taking one‟s own life. It is often
described as being something that happens when a person‟s painful
circumstances exceed their resources for coping with that pain.
Strangely enough, the people that attempt or
commit suicide often don‟t actually want to die.
They simply want the emotional distress they are
feeling to stop and sometimes they conclude that
suicide is the only way to make that happen.
Every lost life to suicide is a tragedy – for the lost life, talent, mother,
father, brother, sister, son or daughter but it is also a tragedy for the
people left behind. People suffering from mental illness can be at risk
of suicide, so when looking after a service user you can be helpful in
spotting the potential signs.
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Suicide…
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So how can you spot the potential warning signs? Although it‟s a
difficult subject to talk about, the only way to really find out is to ask.
Talking about suicide does not increase the risk of it happening, it may
actually decrease the risk as the person is given a chance to express
their feelings and distress and this can provide relief.
Some of the signs given below may give you an indication that
somebody is considering suicide. This is not an exhaustive list and
some people may display these signs and be coping well, whereas
others may commit suicide without ever having displayed any of the
signs. However, they may focus your attention:
Change in Personality: The person may not seem themselves and be
distracted, sad, distant or lacking in concentration.
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Suicide…
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Recent loss or trigger: A person may be at risk due to a significant life
event, such as a bereavement or trauma. Also, anniversaries of these
life changes can be a trigger.
Hopelessness: The person may believe that things will never change or
get better. They may also talk about future events being irrelevant, as
they may believe they won‟t be here for them.
Talking about death: The person may talk about dying, disappearing
or going away, about suicide methods or funerals. Often, the more
detailed a person‟s plan for suicide is, the more at risk they may be.
Putting affairs in order: The person may be at risk if they have been
talking about suicide and suddenly arrange their will, sort out pets or
childcare and giving away precious possessions.
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Suicide…
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Also be aware of situations where a person displayed these signs and
suddenly they have lifted and the person appears calm and happier.
Rather than it being a sign that the person‟s troubles have gone away,
it may actually be the case that they have decided on their suicide and
this has given them a feeling of calmness and being in control.
There is a lot of stigma around suicide, it is
one of the last taboos of society. It is
inconceivable to most people why
somebody would want to take their own
life, so people find it difficult to talk about
the subject.
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Suicide…
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Once a person has committed suicide many people are at a loss as to
what to say to the family.
But of course the family needs much
support as suicides are often harder to deal
with than other types of bereavements. This
is due to not fully understanding the reasons
or feeling guilt of not being able to spot the
signs and prevent it.
You may be able to provide some of this
support, by listening and being reassuring.
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Challenging Behaviours…
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Although we‟ve stressed that Mental Disorders do not automatically
make a person aggressive or dangerous, we should spend a little time
looking at challenging behaviours. How would you describe what
„challenging behaviours‟ are?
Show Me
Behaviours are described as "challenging" when they
break fundamental social rules, e.g. that it is wrong to
hurt others, hurt yourself, destroy property or
otherwise disrupt other people's lives.
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Challenging Behaviours…
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Common examples of challenging behaviour
are aggression, self-injuries, property
destruction, oppositional behaviour, stereotyped
behaviours, socially inappropriate behaviour,
and withdrawn behaviour.
Note how the term „challenging behaviour‟ is used as a way to label the
behaviours as challenging, rather than label the person as the problem.
Don‟t forget that often the behaviour is caused by a condition and it‟s
not the person themselves that is „bad‟.
There are many reasons why someone might show these behaviours
including frustration, conflict with others, lack of significant
relationships or a history of inappropriately learned behaviours.
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Challenging Behaviours…
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Certain challenging behaviours are common in particular mental
disorders:
Depression may Schizophrenia may
present as withdrawn be indicated by
behaviour, irritability Manic depression aggression that has
and aggression may present as no clear reasons and
directed at people absconding, may be a reaction to
trying to motivate boisterousness and hallucinations or
the person. disinhibition. paranoia.
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Challenging Behaviours…
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It is useful to remember that we all apply behaviours in order to
achieve or avoid something and challenging behaviours are no
different. If the person achieves their goal, the challenging behaviours
will be maintained. What do you think these goals could be?
Show Me
Getting attention
Avoidance of demands
Gaining access to activities or objects
Sensory feedback, e.g. hand flapping, eye poking
Pursuit of power and control over own life
Reduction of arousal and anxiety
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Challenging Behaviours…
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Now that you understand some of the reasons why challenging
behaviours are displayed you can probably already guess some of the
triggers that can set them off. These could be things like:
Trying to get own way or attention
Too much noise or too many people
Intrusion of personal space
Frustration due to change of routine
Lack of communication
Lack of impulse control
The need to have control
Hiding an inability with accusations
But challenging behaviours can also be triggered by a reaction to
medication or if a person is unable to appropriately voice pain.
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Challenging Behaviours…
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So what can you do if you are met with challenging behaviour? Try to
defuse the situation by being non-confrontational, and do not take
personal offence. Avoid reacting to any abuse and don‟t try to make
the person do something that they don‟t want to do. If they feel
threatened for any reason, avoid hurrying or crowding and raising
your voice, as this can increase their feelings of threat and alarm.
As difficult as it is, try to stay calm and keep a sense
of humour. Reassure the person and respect their
personal space. It may be helpful to refocus them by
changing the subject, the surroundings or offering a
positive treat. Don‟t put the person under pressure
by asking them to make decisions, they might just
not be able to cope at that point.
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Image: Michal Marcol / FreeDigitalPhotos.net
Challenging Behaviours…
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Allowing for flexibility of routines and finding purposeful activities
and exercises may help with avoiding challenging behaviours in the
first place.
If things ever do get out of hand and you, as a care worker, feel
uncomfortable or threatened you should remove yourself from the
situation. Never put yourself at risk! You may need to walk away
from the situation and try again later.
You can also refer to the „Dealing with harassment, violence and
aggression‟ section of the Prestige Nursing Health & Safety
handbook for more information. Depending on the service user, you
may also need to attend practical training in breakaway techniques.
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Support from Care Workers…
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You have already learnt about a variety of mental health disorders and
you can probably already see how your job as a care worker can play a
vital role in enabling a service user to get better.
What do you think you can do as part of your role to help a person
suffering from a mental disorder get better?
Show Me
Provide empowering and adaptable assistance
Promote a sense of hope
Be a source of information
Involve and support the person’s family and friends
Be proactive in spotting signs
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Support from Care Workers…
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You should be aware though that getting better can be a tough
journey and you may be faced with resistance. This can be purely
down to the fact that getting better involves changing one‟s life and
change can seem scary and threatening.
Therefore the person has to commit to
making that change happen before they can
get better. Pushing them with comments
like „Do you really want to live your life
like this‟ is not helpful if they are not yet
ready to face the challenge. However once
they are you can support them by being
a good listener, providing information and letting the service user
express their fears.
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Support from Care Workers…
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Be aware how fear can express itself sometimes. How would you react
when somebody says to you „I‟d really like to, but…‟
Would you jump in straight away with helpful suggestions of how
they can make the „but‟ go away? It‟s very tempting and what a lot of
us would naturally do. However, the „but‟ might be an expression of
worry, so saying something like „I can see you are worried about this,
what is it that concerns you?‟ you can uncover their fears and really
get to the bottom of the issue.
You should always offer praise and encouragement and if there are
any setbacks in the process, make sure the person is realistic about
their goals and let them know that a simple setback does not mean
they have failed. Sometimes the learning experience is very useful.
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The Mental Health Act…
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Let‟s now have a look at the legislation around Mental Health.
Although many people with Mental Health Disorders go on to live a
full and successful life, there are also others that need intervention to
ensure their own health and safety and that of others.
Many people with mental health disorders
recognise their need for help and
voluntarily admit themselves to hospital,
however, some need to be detained.
Nearly fifteen thousand people, or well
over a third of patients who were in
mental health hospitals in England or
Wales on the 31 March 2006, were detained under the Mental Health
Act.
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The Mental Health Act…
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Most patients are detained for the treatment of mental illness, which
includes a wide range of diagnoses, often involving psychotic illness,
but also depression and dementias.
More than half (55%) of mental illness patients are detained in general
mental health wards; 20% are in low secure wards; another 20% in
medium secure wards, and about 5% in the three High Security
Hospitals (Ashworth, Broadmoor and Rampton).
Key findings about the use of the Mental Health Act
Taken from the Commission’s
Twelfth Biennial Report 2005-2007
Risk, Rights, Recovery
The length of hospital stay for detained patients varies considerably
from two weeks to one year. The longest hospital stay recorded in
March 2006 was more than 70 years! Patients can be detained through
a civil route or via the criminal justice system. This decision is not
undertaken lightly and indicates an illness of some severity.
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The Mental Health Act…
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Let‟s have a look now at what the Mental Health Act covers. The
1983 Act is largely concerned with the circumstances in which a
person with a mental disorder can be detained for treatment for that
disorder without his or her consent.
It also sets out the processes that must be followed and the safeguards
for patients, to ensure that they are not inappropriately detained or
treated without their consent.
The main purpose of the act is to ensure that people
with serious mental disorders which threaten their
own safety or that of the public can be treated
irrespective of their consent where it is necessary to
prevent them from harming themselves or others.
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The Mental Health Act…
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In 2007 the 1983 Mental Health Act was amended and this also had an
impact on the Mental Capacity Act 2005 as the Deprivation of Liberty
Safeguards were introduced. We have a separate eLearning module
available on the Mental Capacity Act, please refer to this for more
information.
The main changes that were introduced in the 2007 amendments are:
New criteria for detention: it will not be possible for patients to
be compulsorily detained or their detention continued unless
appropriate medical treatment is available.
Professional roles: a wider group of practitioners can take on
the functions currently performed by the approved social worker
(ASW) and responsible medical officer (RMO).
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The Mental Health Act…
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… continued:
Nearest relative: it gives patients the right to displace their
nearest relative and enables county courts to displace a
nearest relative where there are reasonable grounds for doing
so.
Supervised community treatment (SCT): for patients following
a period of detention in hospital. A small number of patients
will be able to live in the community whilst subject to certain
conditions under the 1983 Act as amended, to ensure they
continue with their medical treatment.
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The Mental Health Act…
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… continued:
Age-appropriate services: hospital managers must ensure that
under 18s admitted to hospital for mental disorder are
accommodated in an environment that is suitable for their age.
Advocacy: to make arrangements for help to be provided by
independent mental health advocates.
The Mental Health Act also has a Code of Practice which provides
guidance to doctors and nurses on how they should fulfill
their duties under the Mental Health Act. The Code of
Practice includes 5 Guiding Principles, which are listed
on the next pages.
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The Mental Health Act…
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The 5 guiding principles which must be considered when any
decisions are being made under the Mental Health Act
are:
1. Purpose principle: all decisions should be made with the
aim of minimising the undesirable effects of mental
disorder.
2. Least restrictive principle: restrictions of a patient’s
freedom should be kept to a minimum.
3. Respect principle: the needs and values of each patient
should be recognized and respected. This includes
their race, religion, culture, gender, age, sexuality
and any disability they may have. The patient’s views,
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wishes and feelings should be taken into account and
The Mental Health Act…
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4. Participation principle: patients should be involved as
much as possible in the planning of their care and
treatment. The involvement of care workers and
family members should be encouraged unless there
are particular reasons why this should not happen.
5. Effectiveness, efficiency and equity principle: resources
should be used in an effective, efficient and equitable
way.
After discharge from compulsory hospital admission
(section 3)
some people with severe mental illness will be on section
117
aftercare. This means that the local authority and the
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Review…
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This module has covered the contributing factors to mental health
problems, who is likely to develop these problems and how they are
diagnosed.
It also covered a range of mental health issues including disorders such
as depression, bipolar disorder, schizophrenia and eating disorders.
There was a section on how, as a care worker, you can support service
users with mental health disorders. Finally, the module covered the
Mental Health Act 1983 with the 2007 amendments including its 5
guiding principles. There was reference to the Mental Capacity Act,
however, we have a separate eLearning module for this that you can
refer to.
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Well done!
You have completed this web based package on Mental Health.
Please now complete the assessment on Mental Health.
Reference:
http://www.seemescotland.org.uk/
http://www.rethink.org/
http://www.dwp.gov.uk/publications/specialist-guides/medical-
conditions/mental-health-act.shtml
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