1. BORE DA - GOOD MORNING

2. FACTS AND MYTHS ABOUT MENTAL ILLNESS Jayne Anderson / Bleddyn Lewis

3. Facts and Myths about Mental Illness
1.Mental health problems only happen to other people
Fact: 1 in 4 of the adult population will suffer from mental health problems in any one year, and one in six experiences this at any given time. - The Office for National Statistics Psychiatric Morbidity report (2001). It is estimated that approximately 450 million people worldwide have a mental health problem- World Health Organisation (2001)
2. People with mental illness are violent and dangerous
The risk of being killed by a stranger with a severe mental health problem is roughly 1:10,000,000, about the same probability as being hit by lightning*. The number of homicides by people with schizophrenia is around 30 per year. This is 5% of all homicides, the prevalence of schizophrenia in the population being 1% or less – Avoidable Deaths, Five year report of the national confidential inquiry into suicide and homicide by people with mental illness (December 2006).
Myth . The actual fact that is that brain disorders, like heart disease and diabetes, are legitimate medical illnesses. Research shows there are genetic and biological causes for psychiatric disorders, and they can be treated effectively.
Myth. The truth is that the incidence of violence in people who have a brain disorder is not much higher than it is in the general population. Those suffering from a psychosis such as schizophrenia are more often frightened, confused and despairing than violent.
Fact. Most experts agree that a genetic susceptibility, combined with other risk factors, leads to a psychiatric disorder. In other words, mental illness have a physical cause.
Fact. Some people think that depression is a result of character flaws or personality weaknesses, and that depressed people could just snap out of it if they really wanted to. We know now that depression has nothing to do with being lazy or weak. It results from changes in brain chemistry or brain function, and medication and /or psychotherapy often help people to recover.
Myth. Schizophrenia is often confused with multiple personality disorder. Actually, schizophrenia is a brain disorder that robs people of their ability to think clearly and logically. Symptoms range from social withdrawal to hallucinations and delusions. Medication has helped may to lead fulfilling and productive lives.

4. Facts and Myths about Mental Illness
3. People with mental illness are poor and/or less intelligent
Mental illness, like physical illness, can affect anyone regardless of intelligence, social class or income level. Celebrities such as Stephen Fry, Nick Drake, Paula Yates, Kurt Cobain, Virginia Woolfe, Brooke Shields and Winston Churchill have all experienced mental illness.
4. People who self-harm are attention-seekers
This is untrue. Most people who self-harm do it in secret and it’s only when they need to seek medical attention, that they come to the attention of others

5. Facts and Myths about Mental Illness
5. People with poor mental health are weird
Everyone suffers from low mood and 1 in 4 of the population will experience mental ill health at some point in their lives. Think of 12 people you know. Are 3 of them rocking in the corner muttering to themselves? Thought not.
6. Mental illness is caused by emotional weakness
People do not choose to become mentally ill. As with other medical conditions, like heart disease or diabetes, it has nothing to do with being weak or lacking will-power.
6. Fact. It is not normal for older adults to be depressed. Signs of depression in older people include loss of interest in activities, sleep disturbances and lethargy. Depression in the elderly is often undiagnosed, and it is important that family and carers recognise the problem and seek professional help.
7. Children and adolescents can develop severe mental illnesses, left untreated these problems can get worse..
8. Fact. You can’t just make a mental illness go away because you want it to. Ignoring it doesn’t make it go away either. Serious mental illnesses require professional help, therapeutic interventions / medication
9. Myth. Modern ECT has given a new lease of life to people who suffer from severe and debilitating depression. It is used when other treatments such as psychotherapy or medication fail or cannot be used. Patients who receive ECT are asleep under anaesthesia, so they do not feel anything

6. Facts and Myths about Mental Illness
7. Once you’ve had a mental illness, you never recover
People can and do recover from mental illness. Medications, psychological interventions, a strong support network and alternative therapy treatments from cognitive behavioural therapy to improved diet and exercise habits are also very effective in leading to a complete recovery
8. Since ‘care in the community’ was started, people with mental health problems have been left to roam the streets
Even before the closure of the old large scale psychiatric hospitals, around 95% of people received care and treatment for mental illnesses in the community. What has changed is the type of accommodation and treatment available. For example, people requiring long term care in a hospital are usually no longer in the same building as those requiring short term admissions.

7. Facts and Myths about Mental Illness
9. All people who suffer from depression are suicidal
Suicide is not a mental illness. Not everyone who is depressed will consider suicide. It is as inaccurate as saying that all football fans are hooligans. However it is true to say that individuals experiencing a mental health problem are, generally, associated with a higher risk of suicide. If you suspect someone is feeling suicidal ask them – it could help save their lives.
10. If I seek help for my mental health problem, others will think I am "crazy"
Early treatment can assist with a faster recovery. If you broke your arm would you delay getting a cast applied incase people thought you were weak? Not likely!
6. Fact. It is not normal for older adults to be depressed. Signs of depression in older people include loss of interest in activities, sleep disturbances and lethargy. Depression in the elderly is often undiagnosed, and it is important that family and carers recognise the problem and seek professional help.
7. Children and adolescents can develop severe mental illnesses, left untreated these problems can get worse..
8. Fact. You can’t just make a mental illness go away because you want it to. Ignoring it doesn’t make it go away either. Serious mental illnesses require professional help, therapeutic interventions / medication
9. Myth. Modern ECT has given a new lease of life to people who suffer from severe and debilitating depression. It is used when other treatments such as psychotherapy or medication fail or cannot be used. Patients who receive ECT are asleep under anaesthesia, so they do not feel anything

8. Risk Factors: Certain factors can indicate an increased risk of physically violent behaviour . The following lists are not intended to be exhaustive and these risk factors should be considered on an individual basis.

9. Demographic or personal history indicators
Evidence of recent severe stress, particularly a loss event or the threat of loss
One or more of the above in combination with any of the following:
Cruelty to animals
reckless driving
History of bed wetting
Loss of parent before the age of 8 years D(GPP)
History of disturbed / violent behaviours
History of misuse of substances or alcohol
Carers reporting service user’s previous anger or violent feelings
Previous expression of intent to harm others
Evidence of rootlessness or ‘social restlessness’
Previous use of weapons
Previous established dangerous acts
Severity of previous acts
Known personal trigger factors

10. Clinical variables Misuse of substances and / or alcohol
Drug effects (disinhibition, alcathisia)
Active symptoms of schizophrenia or mania in particular
Delusions or hallucinations focused on a particular person
Command hallucinations
Preoccupation with violent fantasy
Delusions of control (especially with a violent theme)
Agitation, excitement, overt hostility or suspiciousness
Poor collaboration with suggested treatments
Antisocial, explosive or impulsive personality traits or disorder
Organic dysfunction D(GPP)

11. Situational variables
Extent of social support
Immediate availability of potential weapon
Relationship to potential victim (for example, difficulties in relationship are known)
Access to potential victim
Limit setting (for example, staff members setting parameters for activities, choices, etc.)
Staff attitudes D(GPP)

12. Reference: Violence - The short-term management of disturbed/violent behaviour in psychiatric in-patient settings and emergency departments NICE 2005

13. Unfortunately, there are many more!
These were just a few of the most common misconceptions surrounding mental health and mental illness.
Unfortunately, there
are many more!
6. Fact. It is not normal for older adults to be depressed. Signs of depression in older people include loss of interest in activities, sleep disturbances and lethargy. Depression in the elderly is often undiagnosed, and it is important that family and carers recognise the problem and seek professional help.
7. Children and adolescents can develop severe mental illnesses, left untreated these problems can get worse..
8. Fact. You can’t just make a mental illness go away because you want it to. Ignoring it doesn’t make it go away either. Serious mental illnesses require professional help, therapeutic interventions / medication
9. Myth. Modern ECT has given a new lease of life to people who suffer from severe and debilitating depression. It is used when other treatments such as psychotherapy or medication fail or cannot be used. Patients who receive ECT are asleep under anaesthesia, so they do not feel anything

14. WHAT AFFECTS MENTAL HEALTH AND WELLBEING ?

15. There is now a considerable amount of evidence about the factors that promote and protect mental health and wellbeing and those which are associated with risk of poor mental health.
Improve Your Mental Health: No matter how old or young you may be, mental health is there in everyday life – in how we think and how we feel, how we react to others and how we are with ourselves. We all need to look after it, just as we do with our physical health.

16. Top Tips for Positive Mental Health
Staying mentally healthy isn't just about treating illness – far from it! There are lots of things we can do to help prevent ourselves getting ill in the first place, and plenty more we can try if we (or those around us) do encounter problems.
So, to get you started, we've put together these Top Tips for Positive Mental Health. Don't keep them under your hat either – tell your family, friends and colleagues. Everyone should know this stuff!

17. Top Tips Talk about your feelings Go for green Write it down
Keep active
Eat well
Sleep well
Drink sensibly
Keep in touch with friends and loved ones
Get the knowledge, take control
Get professional help
Look beyond drug therapies
Change the scene
Time for another cuppa?
Hold that thought
Go for green
Let there be light
Listen up!
Improve your coping skills
Set realistic goals
Keep an eye on personal stress
Three good things...
Get involved
The long way
Find a hobby
Do good
Ask for help

18. MEDIA – ENTERTAINMENT OR INFORMATION:
HHOW BALANCED IS THIS?

19. Media – Entertainment or Information: How balanced is this?
Some programmes and media outlets are seen as being significantly more helpful than others. In a surveys regional newspapers, regional TV news and regional radio news programmes were all felt to be fairer or more mixed in their coverage than national media.
The Big Issue, The Guardian and EastEnders were all highlighted as fair and balanced reporters of mental health issues.
Sue Baker of Mind said: "Really, it is tabloid coverage which gives us most cause for concern. They are looking for snappy headlines which will sell papers and they inevitably go for 'psycho' angles.

20. Bonkers Bruno Locked Up
On Tuesday 23 September 2003, The Sun published the offensive headline "Bonkers Bruno Locked Up". For later editions, this was toned down to "Sad Bruno in mental home". The coverage was roundly condemned by the main groups in the mental health field. At SANE, chief executive Marjorie Wallace said it was "ignorant reporting" and that "it did both the media and the public a huge disservice".

21. Brit, don’t end up like your Gran
THE life of troubled BRITNEY SPEARS appears to be unravelling before the eyes of the world. On the surface it seems the pressures of fame have pushed the former Pop Princess to the brink. But today The Sun can reveal that the seeds of the star’s dramatic downfall may well have been sown in her troubled childhood.
The demons of suicide, mental and emotional instability, addiction, homelessness and violence all lurk within the multi-millionairess’s dark past. Even her great-uncle, Earnest, has said of Britney: “She didn’t have a hope of turning out normal.” In a chilling parallel to her situation, The Sun can today reveal that Britney’s own GRANDMOTHER committed suicide aged just 31, after her baby son died.
And some fear sad Britney’s own sad life could come to a tragic end, just like her poor grandmother’s.

22. I'd kick Britney off the bi-polar express
Britney Spears appears to be locked in a downward spiral which, we're reliably informed, is a result of bipolar disorder. Strangely enough Kerry Katona is also a sufferer.
This, apparently, accounts for the way these young mothers end up in desperate domestic brawls splashed all over the front pages.
The path to self-destruction is not, as we might have imagined, due to an excess of mind-bending drugs, alcohol or general self-indulgence, but in Britney and Kerry's case, the mental disorder, bipolar.
So much sexier and hip than manic depression - as it was called until it became trendy.

23. KNIFE THREAT TO COPS
Addict slashes own throat after police zap him with Taser.
A mental patient slit his own throat after being shot by police with a 50,000-volt Taser.
Disturbed Justin Perry suffered massive blood loss which led to a heart attack and he died despite efforts to save him.
The drama happened after officers rushed to the home of crack addict Perry when he threatened to kill his mum June.

24. 'Gascoigne thought aliens were coming to abduct him'
Paul Gascoigne, pictured here in 2006, has been arrested and sectioned after his allegedly menacing behaviour at the Malmaison hotel in Gateshead.
He became wired and unpredictable and would flip and turn violent over nothing. He was uncontrollable.

25. A more balanced approach?

26. Rethink calls for urgent national attention to prevent another Taylor tragedy
14 December 2007
Spokesperson for Taylor family says they are “vindicated but destroyed”
Mental health charity Rethink today (December 14) called for national action to prevent the catalogue of failings that led to Garry Taylor killing his friend.

27. Rethink call for action on report from the Disability Rights Commission
27 September 2007
Leading mental health charity Rethink today (September 27) called for immediate government action to save the lives of thousands of people with schizophrenia after a damning report on health inequalities from the Disability Rights Commission.

28. NEWS RELEASE
Monday December
OVER 50 HOMICIDES PER YEAR BY MENTAL HEALTH PATIENTS
National study finds 1 in 20 homicides committed by people with schizophrenia; many are preventable.

29. Avoidable Deaths (2006)
Over 50 homicides are committed each year in England and Wales by mental health patients, according to a new report by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI).
Many follow poor recognition of risk by mental health services. However, the number of cases is not increasing, and the risk of random killings by mentally ill people has not risen in the last 30 years.
The NCI examined all suicides and homicides by mental health patients over a 5-year period. Of the 600 homicide convictions per year in England and Wales, it found that 30 (5%) were committed by people with schizophrenia, although only half were known patients.

30. Avoidable Deaths (2006) Cont.
Key findings and recommendations from the study on homicide (data collected from April 2000 to December 2003) include:
The Inquiry investigated 249 cases of homicide by people with a history of mental illness – 9% of all homicides in England and Wales during this period.
In the week prior to homicide 71 (29%) patients were seen by services; only 9% were thought to be of short-term moderate or high risk of violent behaviour.
Stranger homicides, i.e. random attacks on members of the public by people with mental illness, have remained at five per year indicating that community care has not increased the risk to the general public.
Services should ensure that high risk patients receive enhanced CPA, backed up by peer review in the most high risk cases.

31. The way forward ! We all have a duty to: KEEP AN OPEN MIND BE INFORMED
PROMOTE GOOD MENTAL HEALTH
TACKLE STIGMA

32. STEPPING STONES. ONE STEP AT A TIME …
Richard Jones

33. Recovery

34. A process of recovering from a mental health problem

35. What is Mental Health?
The concept of ‘madness’ is one which is accepted globally across many different cultures.
In modern Western culture it is viewed as an ‘illness’ or ‘disease’.
Because people are viewed as ill they are generally relieved of their usual responsibilities and their support becomes the domain of professionals.

36. The mentally ill person is often seen as an ‘other’.
A distinct class of person.
Different and apart from ‘normal’ people.
They become the illness that they are deemed to have ‘schizophrenic’, ‘manic depressive’, ‘anorexic’.

37. “Is it possible to restore these people to full humanity when we actually fear their difference so much and when they themselves secretly feel less than human?”
Campbell (1998)

38. The difference between the medical view and the person’s experience
beyond symptoms and deficits…

39. The person
“Today I wanted to die. Everything was hurting. My body was screaming. I saw the doctor. I said nothing. Now I feel terrible. Nothing seems good and nothing seems possible.”
Written in a patient’s diary

40. from Repper & Perkins (2003)
The Doctor
Flat. Lacking in motivation, sleep and appetite good. Discussed aetiology. Cont. LiCarb 250mg qid. Levels next time.
Written in medical notes
from Repper & Perkins (2003)

41. What do people want from mental health services?

42. Choice Accessibility Advocacy Equal opportunities
Income and employment
Self help
Self organisation
Read (1996)

43. What do they feel are their unmet needs?

44. A satisfying social life Happiness Adequate resources Warmth
Adequate income
Intimacy
Privacy
Meaningful work
A satisfying social life
Happiness
Adequate resources
Warmth
Estroff (1993)

45. So… What is recovery?

46. It is not a cure

47. “A personal process of overcoming the negative impact of a psychiatric disability despite its continued presence.”

48. It involves personal development and transformation
acceptance of the illness
a sense of responsibility or control over one’s life
hope
the support of others
and working collaboratively with others on treatment and rehabilitation.

49. What matters? Are we living the life we want to be living?
Are we achieving our personal goals?
Do we have friends?
Do we have connections with the community?
Are we contributing or giving back in some way?

50. Recovery is a process, not a place
Recovery is a process, not a place. Looking at where we want to be and what we want to achieve. Not where we came from.

51. Recovery is about
recovering what was lost: rights, roles, responsibilities, decisions, potential and support
involving people in having a personal vision of the life they want to live
discovering symptoms can be managed and doing it
doing more of what works and less of what doesn’t
reclaiming the roles of a ‘healthy’ person and not a ‘sick’ person.
getting there.

52. What we know People can and do recover.
Recovery is a process or a journey rather that an end point.
Recovery means much more than an absence of symptoms
Attitudes and values can have a powerful impact.
Recovery is a common human experience.
Different things help different people recover.

53. Main ingredients
Belief by the person experiencing mental illness/distress that they can and will recover
Belief by people supporting them
Commitment by the person experiencing mental distress to recover
A personal strategy for recovery
Resources to enable the person to recover
Personal growth is shared with others seeking to recover.

54. What people say helps them
Having hope.
A belief in change.
Being ready to lead their own recovery.
Self management and coping skills development.
Being optimistic yet realistic.
Having a chance to contribute or give back.
Finding meaning and purpose.
Supportive relationships.
Becoming engaged and involved.
Supportive and accessible services and treatments.
Patience
Creativity.

55. How have mental health services adapted to assist the recovery process?

56. Mental Health Policy The Care Programme Approach (England & Wales)
National Service Framework (Equity, Empowerment, Effectiveness, Efficiency)
Standard 1 - social inclusion, health promotion, tackling stigma
Standard 2 - service user and carer empowerment
Standard 3 - promotion of opportunities for a normal life

57. How does this work?

58. The care plan does not only address health needs.
It must cover aspects of social care and functioning.
A psychosocial approach is used.
The care coordinator links in with other agencies, both statutory and non-statutory, to promote social inclusion and recovery.

59. Services should combine and…

60. Tackle stigma and discrimination
Ensure advocacy services are available
Provide and maintain good quality housing
Help access educational and training opportunities
Help find supportive networks which include opportunities for friendship.

61. In Summary…

62. The process of recovery is a journey traveled by a service user and those closest to them.
It encompasses all aspects of life to help provide a meaningful and happy life without fear and prejudice.
It does not replace the medical model of care but works with it.

63. Service users are offered a greater degree of input into their care.
They agree a care plan, and a way forward that suits their individual circumstances, with their care coordinator.
The people closest to them are offered a carers assessment and input into the service user’s care. They are recognised as key individuals to recovery.

64. Further information Rethink - mental health charity
Julie Repper / Rachel Perkins

65. Refreshments.

66. Hassen Joomraty

67. A PERSONAL AND PROFESSIONAL VIEW OF
‘THE GAP’
Kathy Giles

68. WHY ? I am someone’s brother, sister, father, mother Heads are shaking
People tutting
Yes, I am behaving strangely
But have they asked me WHY?
No-one will come near me
They all seem so afraid
Yes, I know that I am shouting
But no-one asks me WHY?
I am really hot and bothered
My head it hurts like hell
I feel disorientated
I want to know the reason WHY?
I am someone’s brother, sister, father, mother
I don’t always act like this
I really don’t feel quite myself
Will someone ask me WHY?
As children we drive adults to distraction
With what and where and why and when
Surely as adults we should not make assumptions
But ask the question WHY?
To all those who profess to care
Look beyond what you can see and
Try to find the person who is me
To do that, ask the question WHY?

69. A CO-ORDINATED APPROACH TO CARE
Bleddyn Lewis

70. UNSCHEDULED CARE PROJECT
Some facts
About the project
Work we have done
What this means to you

71. Unscheduled care is defined as when someone seeks treatment or advice for a health problem without arranging to do so more than a day in advance.
O’Caithan et al 2007

72. Some facts
It is estimated that up to 5% of those attending an Emergency Department have a primary diagnosis of mental ill health .
A further 20-30% of attendees have co-existing physical and psychological problems, with much of the latter remaining undetected.
In January 2004, a Department of Health audit suggested that up to 10% of emergency departments’ four hour breaches involved patients with mental ill health. In addition, a third of patients with mental ill health wait longer than four hours compared to 10% of all patients.
Improving the management of patients with mental ill health in emergency care settings. Department of Health Checklist 2004

73. People with mental health problems are:
more likely to leave the Emergency Department before being seen,
are associated with a higher number of serious incidents,
more likely to report their experience of the emergency department as negative.
Managing urgent mental health needs in the Acute Trust. Academy of Medical Royal Colleges 2008.

74. Self-harm is one of the top five reasons for admission to hospital for emergency medical treatment, accounting for up to 170,000 admissions in the UK each year.
NICE 2004
Over a quarter of the 682 adult service users surveyed in the Royal College of Psychiatrists’ Self-Harm Project (2006/07) rated staff poorly in terms of their attitude and understanding.
Mental health is a major issue for acute hospital inpatients, for example 60% of patients over 65 years of age will have a mental health problem and such patients have higher levels of physical morbidity and longer lengths of stay.
Who Care Wins, RCPsych, 2005.

75. Core values
The same standard of urgent assessment, diagnosis and intervention should be provided for mental health care as is expected for physical health care.
Good management of mental health problems can make a significant contribution to the effectiveness and efficiency of acute hospitals and improve the outcome for patients.
There should not be any discrimination against an individual because of mental health problems.

76. Main aims
To develop an Integrated Care Pathway for unscheduled mental health assessment and treatment
To produce proposals for service development and improvement
To link in with the wider unscheduled care developments across the three counties
To provide the optimal conditions to deliver mental health interventions.

77. NEED FOR THE PROJECT
There were concerns about current out of hours unscheduled care arrangements from the following stakeholders:
PATIENTS
Delays in accessing
Treatment.
Confusing procedures.
Conflicting advice.
ON DUTY
PSYCHIATRIST
Unnecessary assessments.
Lack of skills / support.
Patients not clerked in to
A+E.
Lack of clinical/risk info.
A+E STAFF
Having to care for patients
waiting for MH assessment.
Feeling under skilled.
Delays in accessing
Assessment.
OUT OF HOURS GP
Having to manage
single –handedly until MH
assessor arrives.
Delays.
Exposure to risks related to
Above points.
CRHT SERVICE
Poor clinical risk
Information.
Lack of medical access for
Joint decision making /
Prescribing.

78. BASELINE REVIEW
The “out of hours service” activities of the mental health services across the three counties of Carmarthenshire, Ceredigion and Pembrokeshire.
Audits
Questionnaires
Engaged widely
Leg work

79. FINDINGS The main findings summarised:
Unacceptable delays in accessing assessment (5 hours+).
Confusing procedures and conflicting advice
Proportion of unnecessary assessments / admissions
Lack of skills/ lack of support
Patients not clerked / booked / registered into A+E
Concerns about contact with service being recorded
Lack of clinical or risk information

80. ISSUES
History taking
Assessment
Record keeping
Managing individuals with complex needs
Medical prescribing
Physical health examination
Fitness for assessment
Safety
Child Protection Legislation
Knowledge & Application of MHA s.12 MHA Approval

81. THE AGREED PLAN
Implement a care pathway, assessment tool and comprehensive training programme:-
Introducing a central referral point (Divisional screening / discussion )
Develop role of initial assessor
Assessments by CRHT , MH Practitioner based on acute ward
Divisional on-call doctor only
Problems resolved
Equity
Resource implications

82. MHLD 0CT ‘07 OCT ‘08 FEB ‘09 BASELINE REVIEW BUSINESS CASE
IMPLEMENTATION
PLAN
IMPLEMENTATION
EVALUATION
0CT ‘ OCT ‘ FEB ‘09

83. MULTI FUNCTIONAL MULTI DISCIPLINARY PROVISION FOR UNSCHEDULED CARE
24 HOURS OF CARE
00.00HRS HRS
CMHT
MH PRACTITIONER
MH PRACTITIONER
CRHTT
LIAISON PRACTITIONER
INPATIENT UNITS 24HRS

84. TRAINING Baseline review Tender specification Closing date
WWGH
Launch date
All practitioners

85. Lunch break

86. ‘Closing the Gap’ Disability Rights Commission (2006)

87. ALL MY HEALTH NEEDS
Jayne Anderson

88. All my health needs Definition of the concept of health
‘A state of complete physical, mental and social well being and not merely an absence of disease.’ – WHO (1991)

89. Policy etc.
Health services should adopt a holistic view of the assessment and development of care plans for mental health service users (DoH, 1990)
Recommendations for the physical health care of people with SMI (DoH, 2005,2006)
Guidelines for the treatment of schizophrenia in primary and secondary care (NICE, 2002)
CNO’s review of mental health nursing (DoH, 2006)
‘Designed for Life’, the WAG’s 10 year vision for Health, states that there is to be a Revised Health Inequalities Strategy to be published in 2009
Closing the Gap (DRC Report, 2006)

90. Six key priorities for health improvement
Tackling health inequalities
Reducing the numbers of people who smoke
Tackling obesity
Improving sexual health
Improving mental health & well being
Reducing harm and encouraging sensible drinking
(DoH, 2005)

91. What physical health problems do people with SMI / LD experience?
People with SMI have higher morbidity and mortality rates
It is estimated that the life expectancy of people with schizophrenia is reduced by 10 years (Newman & Bland, 1991) or more recently 25 years (Parks et al., 2006)
People with intellectual disabilities have an increased risk of early death compared to the general population (Hollins et al., 1998; McGuigan et al., 1995).
People with Down's syndrome have a shorter life expectancy than people with intellectual disabilities generally, although the life expectancy of this group is increasing particularly quickly (Puri et al., 1995).

92. Higher rates of major diseases
The analysis of data on people with learning disabilities in Wales shows that –
• There is a much higher rate of obesity amongst people with learning disabilities (35%, as compared with a general population figure of 22%). The figure for women with learning disabilities is particularly high at 40%.
• 9% of people with learning disabilities have diabetes, compared with 4% in the general population.

93. Higher rates of major diseases
People with bi-polar disorder, depression or schizophrenia have higher rates of:
Diabetes – more than 10% higher than the general population (Holt & Peveler, 2006, Busche & Holt, 2004)
Cardiovascular disease – 2-3 times higher than the general population (Brown et al., 2000; Osby et al., 2000)
Respiratory disease – more likely to suffer asthma, chronic bronchitis and emphysema (Sokal et al., 2004)
Obesity– Increasing evidence of higher rates of upper body obesity (Ryan & Thakore, 2001)
Stroke
Cancers – higher rates of digestive & breast cancer (Schoos & Cohen, 2003)

94. Higher rates of major diseases
People with schizophrenia:
Twice as likely to have bowel cancer as other citizens (new finding internationally)
(Disability Rights Commission Formal Investigation Report 2006)

95. Causes ?
Health behaviours – Smoking, diet, physical inactivity, alcohol & substance misuse, sexual behaviour
Illness – Symptoms, poor spontaneous reporting of physical health problems
Services not geared to meet peoples needs … - Lack of knowledge, lack of training, attitudes, confidence, lack of integrated care
Adverse effects of medication – Extrapyramidal side effects, weight gain, glucose intolerance & diabetes, cardiovascular effects, sexual dysfunction, neuroleptic malignant syndrome
Environment – Poverty, poor housing, social exclusion
Difficulties recognising symptoms
Barriers to accessing primary care
Communication barriers
Inequalities in screening & treatment

96. Recommendations from the DRC ‘Closing the gap’ Report 2007
All professionals and organisations with a role in the provision of primary care health services to people with learning disabilities and/or mental health problems must act now to tackle the inequalities in physical health and primary health care services they experience
The planning and commissioning of primary care services for people with learning disabilities and/or mental health problems need to take greater account of their physical health care needs
Urgent and positive action is needed to ensure that people with learning disabilities and/or mental health problems and their carers (and other support workers) where relevant know their rights in relation to physical health and the services to support this, and are able to take part or receive appropriate help in programmes geared to supporting them in managing their physical health conditions

97. Recommendations from the DRC ‘Closing the gap’ Report 2007
People with learning disabilities and/or mental health problems have a right to be registered with a GP and this needs to be made a reality
Everyone with learning disabilities and/or mental health problems under the active care of a psychiatrist should also have their physical health monitored by regular review from primary health care services, including a GP or other primary care practitioner
People with learning disabilities and/or mental health problems living in residential or nursing homes, in ‘supported living’ arrangements, in prisons or in secure accommodation for young people should have equal access to a GP and access to options for healthy living
Services and equality schemes need to be put in place to ensure that people with learning disabilities and/or mental health problems who do not have easy access to a GP or experience exclusion on multiple grounds receive full and proper primary health care services

98. Recommendations from the DRC ‘Closing the gap’ Report 2007
GP practices and primary care centres need to make ‘reasonable adjustments’ to make it easier for people with learning disabilities and/or mental health problems to get proper access to the services offered by the practice
People with learning disabilities and/or people with enduring mental health problems should be offered an annual check on their physical health by a primary care specialist and access to health interventions that fit the level of their health needs regardless of age
We recommend that people with learning disabilities and/or mental health problems should be offered accessible and appropriate support to encourage healthy living and overcome any physical health disadvantages which come with their condition or treatments administered for the condition including information, advice and support, in an accessible, relevant and targeted form, on how to quit smoking, on good diet, on sexual health, on alcohol, on street drugs and on physical exercise
There should be a comprehensive programme of evidence based training and information resources (the design and at least some of the delivery of which involves users and user groups) for primary health care staff

99. Initiatives National Developments: Incentivised GP contract
Direct enhanced learning disability health check
WAG Department of Health and Social Services Equality Group
Local Developments: (amongst others)
Embedded into Service philosophy – ICM Policy – Developed & Reviewed in 2006
Physical health protocol development – Developed in 2006
Well-being support programme – 2 cohorts in 2007 and a further 2 cohorts 2008 & a further 2 planned for early 2009
Care Co-ordinator training - ongoing
Unscheduled Care Project – commenced mid 2007
Nutritional screening audit
Physical health protocol audit

100. Physical health protocol development

101. Well-being Support Programme

102. Supporting Health Promotion for Mental Health Service Users
Jan Batty

103. Jan Batty Development Worker Mind Your Heart jan. batty@nphs. wales
Jan Batty Development Worker Mind Your Heart tel

104. True or False?
People with mental health problems are not interested in their physical health
“Health promotion is not a priority in a 10 minute GP appointment with people with mental health problems. Getting by day to day is often a major challenge for the people and support regarding this is a priority.”
(Quoted in the Disability Rights Commission Report ‘Equal Treatment: Closing the Gap’ 2006)

105. “People with severe mental illness want to look and feel well, no matter how long they have been ill and are not willing to compromise on either aspect”
(‘Neuroleptic Weight Gain’, Tweedell, Sutter, Dolan 2004)

106. “Efforts directed at increasing activity levels, making healthier lifestyle choices and managing weight gain are highly valued by clients and they identify these efforts as important in their recovery.”
(‘Mum I used to be good looking, look at me now’, Dean, Todd, Morrow, Sheldon 2001)

107. Potential Obstacles Lack of motivation Effects of medication
Lack of money
Boredom
Mental health culture
Attitudes and beliefs of health staff

108. Mind Your Heart Programme
Our aim is to improve the physical health of mental health service users in Ceredigion by
Engaging people in activities that reduce their risks of illness
Removing obstacles
Raising awareness

109. What did we do? Training for staff and volunteers
Small grants supported engagement in activities
Presentations and networking to raise awareness
Worked with Mental health voluntary organisations, Community Mental Health Teams and Afallon ward, Bronglais Hospital

110. Mind Your Heart Toolkit

111. What did we find?
Training led to changes in personal health behaviour of staff
Changes in culture
“We introduced no smoking on our premises even before the ban was introduced and would not have done it without Mind Your Heart”
(Staff member at drop-in)

112. What did we find? Gave authority and legitimacy
“I could back up information I was giving with facts…I felt sure of what I was saying”
(Staff member after Food and Mood training)

113. Conclusions An effective, sustainable and efficient intervention
Promoting mental and physical health together is helpful
Working in partnership is crucial

114. Summary
People with mental health problems are interested in their physical health
Expectations of staff and lack of opportunities can hold them back
People can use healthier lifestyles to aid recovery

115. POSTER PRESENTATIONS
Caroline Oakley

116. MAKING A DIFFERENCE !

117. Making a difference ! 10 minutes:
key points from today that have made you think differently
3 things that you will do differently

118. QUESTION TIME

119. Closing Remarks