2. Outline of session www.rethink.org Awareness of mental health & illness How to respond to people who are unwell or in distress/crisis What local services are available How to work constructively within 'stuck' situations with tenants with mental health problems How to align with protocols that housing have with local mental health team Looking after your own mental health By the end of the session you will have a toolbox of resources to respond

3. What is mental health?

4. www.rethink.org What is mental health?

5. www.rethink.org Mental health is: How we feel about ourselves and people around us Our ability to make and keep friends and relationships Our ability to learn from others and to develop emotionally.

6. www.rethink.org A definition from the World Health Organisation: “... a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” What is mental health?

7. What is mental illness?

8. www.rethink.org Mental illness can affect the ways we feel, act and think. There are many different types of mental illnesses, and some may be more familiar than others

9. What is mental illness? www.rethink.org Depression Anxiety Suicide Psychosis Substance misuse Self-harm Eating disorders

10. Good Poor Present Absent Mental health is on a continuum mentalillness mental health Good mental health with mental illness Good mental health without mental illness Poor mental health with mental illness Poor mental health without mental illness

11. www.rethink.org 1 in 4 people experience mental health problem in their lifetime. 1 in 6 working age adults experience a diagnosable problem at any one time. Mixed anxiety and depression most common problem – affects about 11% of population. Mental illness – key facts and figures

12. PhysicalEmotionalPsychologicalBehavioural Possible signs of mental health problems

13. Physical Constant tiredness Appetite/weight changes Increased aches and pains Sleep patterns affected Lowered immune system Emotional Mood swings Guilt, low self esteem Fear, worry, anxiety Sad, tearful Irritable, angry Psychological Changed perceptions Suspiciousness/paranoia Grandiose ideas or unusual beliefs Inability to follow train of thought Difficulties with memory, concentration and decision making Behavioural Withdrawal/isolation Reduced or unusually increased energy levels Poor self-care Lack of co-operation Increased use of drugs/alcohol Possible signs of mental health problems

14. What are the features of the difficult conversations you are having with people with a mental health problem? What is your reaction? (What do you do and say?) What is the impact on the person? What is the impact on you? Mental health problems and difficult conversations

15. What can affect my mental health?

16. www.rethink.org Recovery from mental illness – what does it mean? Not necessarily clinical recovery. Different for every person. Ongoing process rather than a finite goal. About self-worth, social connections, meaning and purpose, managing your health proactively. Culturally defined.

18. www.rethink.org Time to Change’s 2008 ‘Stigma Shout’ Survey said: 87% reported a negative impact of stigma. Many people report the effects of stigma and discrimination worse than actual symptoms. Self-stigma impacts on persons self esteem, confidence and ability to relate to others. The impact of stigma

19. www.rethink.org Source: Towards Mental Health, Health services Research at the Institute of Psychiatry, King’s College London, Issue 1 2006 The impact of stigma

20. www.rethink.org Withdrawal and rejection Unemployment Homelessness Loss of social networks Debt Worsening mental health The cycle of social exclusion

21. www.rethink.org Tackling stigma

23. www.rethink.org AAssess risk (of harm to themselves or others). LListen and respect. IInformation and reassurance. AAppropriate help and support. SSeek support for yourself. A 5-step approach to helping someone in distress: ALIAS

24. www.rethink.org How are they feeling. Thoughts of suicide or self harm? Gather information:  Do they have a plan?  Have they done something similar before?  Who could they ask for help? Ensure you are safe at all times. If you think they are at immediate risk call 999. A: assess risk

25. www.rethink.org L: listen and respect

26. www.rethink.org Hope and recovery I: information and assurance

27. www.rethink.org Remember this can be difficult for people: GP Community Services – the person may already be supported by their community mental health team Talking therapies (ICOPE – self referral – across Islington) Crisis? A&E National support helplines – Samaritans A: appropriate help and support

28. www.rethink.org Sometimes children and young people are thought to be at risk due to their own mental health or the mental health of the person that cares for them. If you are worried - Talk to your line manager/Call local social services or child line People over 18 are sometime also seen to be at risk due to their mental health – the legislation around this is quite specific – if you are worried you can call social service. Always ask a line manager first Getting support for someone – safeguarding

29. 999 if urgent and immediate risk of harm Deal with immediate needs of the client Report safeguarding concerns to Adult Social Services Access Team on 02075272299 ASAP If children at risk contact Children’s Services Consider reporting to police if a crime has been committed Inform line manager Record what you saw/heard etc and actions taken Joint protocol says….

30. www.rethink.org Talk to someone about what has happened: Line manager Samaritans S: support for yourself

31. BREAK 15mins

32. Group discussion:- What is your experience of people expressing suicidal ideas? What is difficult/challenging about these conversations? Any fears or worries about these conversations? Role play Suicidality

33. In pairs – one is the customer and one the housing officer – De-roll Rotate Discussion Role play

34. If risk…. 999 Crisis team - 020 7561 4278 Assessment and Advice Team - 020 3317 6805

35. Aggression What is your experience of people being aggressive? What is difficult/challenging about these conversations? Any fears or worries about these conversations? What do you do/say? What is the impact on you/them?

36. Ask what’s happening, use open questions Sort out confusions Use person’s name Speak clearly, say who you are, remind of existing relationship and offer your help Paraphrase and check what they have said Clarify

37. Show interest and concern Listen, hear, acknowledge feelings Don’t yell or shout over Extend self and thinking to understand viewpoint Answer all requests for information, however they are phrased. Empathise with feelings, not aggressive behaviour ‘I understand you are angry but it is not okay to…’ Respect and empathy

38. Act calmly and confidently Body language Breath deeply and concentrate on the situation Slow gentle movements Don’t corner person, threaten or make false promises Don’t judge, criticise, show irritation, anger or be retaliative (its not personal, its not about you) Don’t argue and say they are wrong and you are right Control yourself

39. Request rather than command Give reasons, explain rules, reasoning behind them, be honest, express fallibility (or even agree that its unfair) Give person opportunity to control him/herself Outline consequences of different courses of action Offer choices and options, leaving power with person Resolve

40. Move to a quiet place, ask to come aside Invite person to sit down Establish aid/support/backup Maintain distance Environment

41. 999 Crisis team - 020 7561 4278 Assessment and Advice Team - 020 3317 6805 More general concerns North recovery team 02033176378 South recovery team 02033174850 Not sure, Assessment and Advice Team as above Extreme distress or distressing behaviour

42. Telephone to relevant CIFT/IHS Team Leader or next available manager Follow up email marked urgent Contact with Housing Aid Team on 0207 5272000 to see about floating support or other support or to access temporary support to avoid homelessness. Court eviction possible

43. BREAK 15mins

44. www.rethink.org Signposting SOS booklet GP ICOPE Rethink Advice and Information Samaritans Listening with respect Be prepared – build a toolkit Encouraging someone to get help

45. Spend time with others Be active Eat and sleep well Do something you enjoy Relax Seek help Looking after yourself 45

46. www.rethink.org Build a toolkit Things to put in your tool bag are: Information, leaflets, websites, helplines. Services – local to the area. Key professional contacts. A reminder of the ALIAS approach. Support for yourself – manager, counselling, friends, GP etc. Action from today

48. www.rethink.org Please fill out a feedback form before you leave. Your opinion is important for us to improve these sessions for future audiences. Contact: Cerdic.Hall@candi.nhs.ukCerdic.Hall@candi.nhs.uk Nurse Consultant – Primary Care (Mental Health) Feedback forms