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World Mental Health Day 2008 BORE DA - GOOD MORNING.

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1 World Mental Health Day 2008 BORE DA - GOOD MORNING

2 World Mental Health Day 2008 FACTS AND MYTHS ABOUT MENTAL ILLNESS Jayne Anderson / Bleddyn Lewis

3 World Mental Health Day 2008 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).

4 World Mental Health Day 2008 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 its only when they need to seek medical attention, that they come to the attention of others

5 World Mental Health Day 2008 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 World Mental Health Day 2008 Facts and Myths about Mental Illness 7. Once youve 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 World Mental Health Day 2008 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!

8 World Mental Health Day 2008 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 World Mental Health Day 2008 Demographic or personal history indicators History of disturbed / violent behaviours History of misuse of substances or alcohol Carers reporting service users 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 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)

10 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 Reference: Violence - The short-term management of disturbed/violent behaviour in psychiatric in-patient settings and emergency departments NICE 2005

13 World Mental Health Day 2008 These were just a few of the most common misconceptions surrounding mental health and mental illness. Unfortunately, there are many more!

14 World Mental Health Day 2008 WHAT AFFECTS MENTAL HEALTH AND WELLBEING ?

15 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 Top Tips Talk about your feelings Write it down Keep active Eat well Sleep well Drink sensibly Keep in touch with friends and loved ones Keep in touch with friends and loved ones Get the knowledge, take control 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 Keep an eye on personal stress Three good things... Get involved The long way Find a hobby Do good Ask for help

18 World Mental Health Day 2008 MEDIA – ENTERTAINMENT OR INFORMATION: HHOW BALANCED IS THIS?

19 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 Brit, dont 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 stars 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- millionairesss dark past. Even her great-uncle, Earnest, has said of Britney: She didnt have a hope of turning out normal. In a chilling parallel to her situation, The Sun can today reveal that Britneys own GRANDMOTHER committed suicide aged just 31, after her baby son died. And some fear sad Britneys own sad life could come to a tragic end, just like her poor grandmothers.

22 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 '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 World Mental Health Day 2008 A more balanced approach?

26 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 The way forward ! We all have a duty to: KEEP AN OPEN MIND BE INFORMED PROMOTE GOOD MENTAL HEALTH TACKLE STIGMA

32 World Mental Health Day 2008 STEPPING STONES. ONE STEP AT A TIME … Richard Jones

33 World Mental Health Day 2008 Recovery

34 World Mental Health Day 2008 A process of recovering from a mental health problem

35 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 The difference between the medical view and the persons experience beyond symptoms and deficits…

39 World Mental Health Day 2008 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 patients diary

40 World Mental Health Day 2008 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 World Mental Health Day 2008 What do people want from mental health services?

42 World Mental Health Day 2008 Choice Accessibility Advocacy Equal opportunities Income and employment Self help Self organisation Read (1996)

43 World Mental Health Day 2008 What do they feel are their unmet needs?

44 World Mental Health Day 2008 Adequate income Intimacy Privacy Meaningful work A satisfying social life Happiness Adequate resources Warmth Estroff (1993)

45 World Mental Health Day 2008 So… What is recovery?

46 World Mental Health Day 2008 It is not a cure

47 World Mental Health Day 2008 A personal process of overcoming the negative impact of a psychiatric disability despite its continued presence.

48 World Mental Health Day 2008 It involves personal development and transformation acceptance of the illness a sense of responsibility or control over ones life hope the support of others and working collaboratively with others on treatment and rehabilitation.

49 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 doesnt reclaiming the roles of a healthy person and not a sick person. getting there.

52 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 How have mental health services adapted to assist the recovery process?

56 World Mental Health Day 2008 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 World Mental Health Day 2008 How does this work?

58 World Mental Health Day 2008 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 World Mental Health Day 2008 Services should combine and…

60 World Mental Health Day 2008 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 World Mental Health Day 2008 In Summary…

62 World Mental Health Day 2008 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 World Mental Health Day 2008 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 users care. They are recognised as key individuals to recovery.

64 World Mental Health Day 2008 Further information Rethink - mental health charity Julie Repper / Rachel Perkins

65 World Mental Health Day 2008 Refreshments.

66 World Mental Health Day 2008 Hassen Joomraty

67 World Mental Health Day 2008 A PERSONAL AND PROFESSIONAL VIEW OF THE GAP Kathy Giles

68 World Mental Health Day 2008 WHY ? 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 someones brother, sister, father, mother I dont always act like this I really dont 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 World Mental Health Day 2008 A CO-ORDINATED APPROACH TO CARE Bleddyn Lewis

70 World Mental Health Day 2008 UNSCHEDULED CARE PROJECT Some facts About the project Work we have done What this means to you

71 World Mental Health Day 2008 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. OCaithan et al 2007

72 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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. A+E STAFF Having to care for patients waiting for MH assessment. Feeling under skilled. Delays in accessing Assessment. ON DUTY PSYCHIATRIST Unnecessary assessments. Lack of skills / support. Patients not clerked in to A+E. Lack of clinical/risk info. 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 MHLD BASELINE REVIEW BUSINESS CASE IMPLEMENTATION PLAN IMPLEMENTATION EVALUATION 0CT 07 OCT 08 FEB 09

83 World Mental Health Day 2008 MULTI FUNCTIONAL MULTI DISCIPLINARY PROVISION FOR UNSCHEDULED CARE 24 HOURS OF CARE 00.00HRS 24.00HRS CRHTT MH PRACTITIONERMH PRACTITIONER CMHT INPATIENT UNITS 24HRS LIAISON PRACTITIONER 17.00

84 World Mental Health Day 2008 TRAINING Baseline review Tender specification Closing date WWGH Launch date All practitioners

85 World Mental Health Day 2008 Lunch break

86 World Mental Health Day 2008 Closing the Gap Disability Rights Commission (2006)

87 World Mental Health Day 2008 ALL MY HEALTH NEEDS Jayne Anderson

88 World Mental Health Day 2008 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 World Mental Health Day 2008 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) CNOs review of mental health nursing (DoH, 2006) Designed for Life, the WAGs 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 Physical health protocol development

101 World Mental Health Day 2008 Well-being Support Programme

102 World Mental Health Day 2008 Supporting Health Promotion for Mental Health Service Users Jan Batty

103 World Mental Health Day 2008 Jan Batty Development Worker Mind Your Heart tel

104 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 Potential Obstacles Lack of motivation Effects of medication Lack of money Boredom Mental health culture Attitudes and beliefs of health staff

108 World Mental Health Day 2008 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 World Mental Health Day 2008 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 World Mental Health Day 2008 Mind Your Heart Toolkit

111 World Mental Health Day 2008 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 World Mental Health Day 2008 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) What did we find?

113 World Mental Health Day 2008 Conclusions An effective, sustainable and efficient intervention Promoting mental and physical health together is helpful Working in partnership is crucial

114 World Mental Health Day 2008 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 World Mental Health Day 2008 POSTER PRESENTATIONS Caroline Oakley

116 World Mental Health Day 2008 MAKING A DIFFERENCE !

117 World Mental Health Day 2008 Making a difference ! 10 minutes: key points from today that have made you think differently 3 things that you will do differently

118 World Mental Health Day 2008 QUESTION TIME

119 World Mental Health Day 2008 Closing Remarks


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