2FACTS AND MYTHS ABOUT MENTAL ILLNESS Jayne Anderson / Bleddyn Lewis
3Facts and Myths about Mental Illness 1.Mental health problems only happen to other peopleFact: 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 dangerousThe 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.
4Facts and Myths about Mental Illness 3. People with mental illness are poor and/or less intelligentMental 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-seekersThis 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
5Facts and Myths about Mental Illness 5. People with poor mental health are weirdEveryone 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 weaknessPeople 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 / medication9. 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
6Facts and Myths about Mental Illness 7. Once you’ve had a mental illness, you never recoverPeople 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 recovery8. Since ‘care in the community’ was started, people with mental health problems have been left to roam the streetsEven 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.
7Facts and Myths about Mental Illness 9. All people who suffer from depression are suicidalSuicide 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 / medication9. 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
8Risk 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.
9Demographic or personal history indicators Evidence of recent severe stress, particularly a loss event or the threat of lossOne or more of the above in combination with any of the following:Cruelty to animalsreckless drivingHistory of bed wettingLoss of parent before the age of 8 years D(GPP)History of disturbed / violent behavioursHistory of misuse of substances or alcoholCarers reporting service user’s previous anger or violent feelingsPrevious expression of intent to harm othersEvidence of rootlessness or ‘social restlessness’Previous use of weaponsPrevious established dangerous actsSeverity of previous actsKnown personal trigger factors
10Clinical variables Misuse of substances and / or alcohol Drug effects (disinhibition, alcathisia)Active symptoms of schizophrenia or mania in particularDelusions or hallucinations focused on a particular personCommand hallucinationsPreoccupation with violent fantasyDelusions of control (especially with a violent theme)Agitation, excitement, overt hostility or suspiciousnessPoor collaboration with suggested treatmentsAntisocial, explosive or impulsive personality traits or disorderOrganic dysfunction D(GPP)
11Situational variables Extent of social supportImmediate availability of potential weaponRelationship to potential victim (for example, difficulties in relationship are known)Access to potential victimLimit setting (for example, staff members setting parameters for activities, choices, etc.)Staff attitudes D(GPP)
12Reference: Violence - The short-term management of disturbed/violent behaviour in psychiatric in-patient settings and emergency departments NICE 2005
13Unfortunately, there are many more! These were just a few of the most common misconceptions surrounding mental health and mental illness.Unfortunately, thereare 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 / medication9. 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
15There 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.
16Top 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!
17Top Tips Talk about your feelings Go for green Write it down Keep activeEat wellSleep wellDrink sensiblyKeep in touch with friends and loved onesGet the knowledge, take controlGet professional helpLook beyond drug therapiesChange the sceneTime for another cuppa?Hold that thoughtGo for greenLet there be lightListen up!Improve your coping skillsSet realistic goalsKeep an eye on personal stressThree good things...Get involvedThe long wayFind a hobbyDo goodAsk for help
18MEDIA – ENTERTAINMENT OR INFORMATION: HHOW BALANCED IS THIS?
19Media – 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.
20Bonkers 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".
21Brit, 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.
22I'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.
23KNIFE THREAT TO COPSAddict 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.
26Rethink calls for urgent national attention to prevent another Taylor tragedy 14 December 2007Spokesperson 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.
27Rethink call for action on report from the Disability Rights Commission 27 September 2007Leading 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.
28NEWS RELEASEMonday DecemberOVER 50 HOMICIDES PER YEAR BY MENTAL HEALTH PATIENTSNational study finds 1 in 20 homicides committed by people with schizophrenia; many are preventable.
29Avoidable 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.
30Avoidable 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.
31The way forward ! We all have a duty to: KEEP AN OPEN MIND BE INFORMED PROMOTE GOOD MENTAL HEALTHTACKLE STIGMA
32STEPPING STONES. ONE STEP AT A TIME … Richard Jones
34A process of recovering from a mental health problem
35What 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.
36The 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)
38The difference between the medical view and the person’s experience beyond symptoms and deficits…
39The 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
40from Repper & Perkins (2003) The DoctorFlat. Lacking in motivation, sleep and appetite good. Discussed aetiology. Cont. LiCarb 250mg qid. Levels next time.Written in medical notesfrom Repper & Perkins (2003)
41What do people want from mental health services?
42Choice Accessibility Advocacy Equal opportunities Income and employmentSelf helpSelf organisationRead (1996)
47“A personal process of overcoming the negative impact of a psychiatric disability despite its continued presence.”
48It involves personal development and transformation acceptance of the illnessa sense of responsibility or control over one’s lifehopethe support of othersand working collaboratively with others on treatment and rehabilitation.
49What 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?
50Recovery 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.
51Recovery is aboutrecovering what was lost: rights, roles, responsibilities, decisions, potential and supportinvolving people in having a personal vision of the life they want to livediscovering symptoms can be managed and doing itdoing more of what works and less of what doesn’treclaiming the roles of a ‘healthy’ person and not a ‘sick’ person.getting there.
52What 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 symptomsAttitudes and values can have a powerful impact.Recovery is a common human experience.Different things help different people recover.
53Main ingredientsBelief by the person experiencing mental illness/distress that they can and will recoverBelief by people supporting themCommitment by the person experiencing mental distress to recoverA personal strategy for recoveryResources to enable the person to recoverPersonal growth is shared with others seeking to recover.
54What 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.PatienceCreativity.
55How have mental health services adapted to assist the recovery process?
56Mental Health Policy The Care Programme Approach (England & Wales) National Service Framework (Equity, Empowerment, Effectiveness, Efficiency)Standard 1 - social inclusion, health promotion, tackling stigmaStandard 2 - service user and carer empowermentStandard 3 - promotion of opportunities for a normal life
58The 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.
60Tackle stigma and discrimination Ensure advocacy services are availableProvide and maintain good quality housingHelp access educational and training opportunitiesHelp find supportive networks which include opportunities for friendship.
62The 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.
63Service 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.
64Further information Rethink - mental health charity Julie Repper / Rachel Perkins
67A PERSONAL AND PROFESSIONAL VIEW OF ‘THE GAP’Kathy Giles
68WHY ? I am someone’s brother, sister, father, mother Heads are shaking People tuttingYes, I am behaving strangelyBut have they asked me WHY?No-one will come near meThey all seem so afraidYes, I know that I am shoutingBut no-one asks me WHY?I am really hot and botheredMy head it hurts like hellI feel disorientatedI want to know the reason WHY?I am someone’s brother, sister, father, motherI don’t always act like thisI really don’t feel quite myselfWill someone ask me WHY?As children we drive adults to distractionWith what and where and why and whenSurely as adults we should not make assumptionsBut ask the question WHY?To all those who profess to careLook beyond what you can see andTry to find the person who is meTo do that, ask the question WHY?
70UNSCHEDULED CARE PROJECT Some factsAbout the projectWork we have doneWhat this means to you
71Unscheduled 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
72Some factsIt 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
73People 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.
74Self-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 2004Over 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.
75Core valuesThe 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.
76Main aimsTo develop an Integrated Care Pathway for unscheduled mental health assessment and treatmentTo produce proposals for service development and improvementTo link in with the wider unscheduled care developments across the three countiesTo provide the optimal conditions to deliver mental health interventions.
77NEED FOR THE PROJECTThere were concerns about current out of hours unscheduled care arrangements from the following stakeholders:PATIENTSDelays in accessingTreatment.Confusing procedures.Conflicting advice.ON DUTYPSYCHIATRISTUnnecessary assessments.Lack of skills / support.Patients not clerked in toA+E.Lack of clinical/risk info.A+E STAFFHaving to care for patientswaiting for MH assessment.Feeling under skilled.Delays in accessingAssessment.OUT OF HOURS GPHaving to managesingle –handedly until MHassessor arrives.Delays.Exposure to risks related toAbove points.CRHT SERVICEPoor clinical riskInformation.Lack of medical access forJoint decision making /Prescribing.
78BASELINE REVIEWThe “out of hours service” activities of the mental health services across the three counties of Carmarthenshire, Ceredigion and Pembrokeshire.AuditsQuestionnairesEngaged widelyLeg work
79FINDINGS The main findings summarised: Unacceptable delays in accessing assessment (5 hours+).Confusing procedures and conflicting adviceProportion of unnecessary assessments / admissionsLack of skills/ lack of supportPatients not clerked / booked / registered into A+EConcerns about contact with service being recordedLack of clinical or risk information
80ISSUESHistory takingAssessmentRecord keepingManaging individuals with complex needsMedical prescribingPhysical health examinationFitness for assessmentSafetyChild Protection LegislationKnowledge & Application of MHA s.12 MHA Approval
81THE AGREED PLANImplement a care pathway, assessment tool and comprehensive training programme:-Introducing a central referral point (Divisional screening / discussion )Develop role of initial assessorAssessments by CRHT , MH Practitioner based on acute wardDivisional on-call doctor onlyProblems resolvedEquityResource implications
82MHLD 0CT ‘07 OCT ‘08 FEB ‘09 BASELINE REVIEW BUSINESS CASE IMPLEMENTATIONPLANIMPLEMENTATIONEVALUATION0CT ‘ OCT ‘ FEB ‘09
83MULTI FUNCTIONAL MULTI DISCIPLINARY PROVISION FOR UNSCHEDULED CARE 24 HOURS OF CARE00.00HRS HRSCMHTMH PRACTITIONERMH PRACTITIONERCRHTTLIAISON PRACTITIONERINPATIENT UNITS 24HRS
84TRAINING Baseline review Tender specification Closing date WWGHLaunch dateAll practitioners
88All 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)
89Policy 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 2009Closing the Gap (DRC Report, 2006)
90Six key priorities for health improvement Tackling health inequalitiesReducing the numbers of people who smokeTackling obesityImproving sexual healthImproving mental health & well beingReducing harm and encouraging sensible drinking(DoH, 2005)
91What physical health problems do people with SMI / LD experience? People with SMI have higher morbidity and mortality ratesIt 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).
92Higher 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.
93Higher 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)StrokeCancers – higher rates of digestive & breast cancer (Schoos & Cohen, 2003)
94Higher 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)
95Causes ?Health behaviours – Smoking, diet, physical inactivity, alcohol & substance misuse, sexual behaviourIllness – Symptoms, poor spontaneous reporting of physical health problemsServices not geared to meet peoples needs … - Lack of knowledge, lack of training, attitudes, confidence, lack of integrated careAdverse effects of medication – Extrapyramidal side effects, weight gain, glucose intolerance & diabetes, cardiovascular effects, sexual dysfunction, neuroleptic malignant syndromeEnvironment – Poverty, poor housing, social exclusionDifficulties recognising symptomsBarriers to accessing primary careCommunication barriersInequalities in screening & treatment
96Recommendations 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 experienceThe 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 needsUrgent 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
97Recommendations 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 realityEveryone 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 practitionerPeople 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 livingServices 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
98Recommendations 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 practicePeople 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 ageWe 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 exerciseThere 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
99Initiatives National Developments: Incentivised GP contract Direct enhanced learning disability health checkWAG Department of Health and Social Services Equality GroupLocal Developments: (amongst others)Embedded into Service philosophy – ICM Policy – Developed & Reviewed in 2006Physical health protocol development – Developed in 2006Well-being support programme – 2 cohorts in 2007 and a further 2 cohorts 2008 & a further 2 planned for early 2009Care Co-ordinator training - ongoingUnscheduled Care Project – commenced mid 2007Nutritional screening auditPhysical health protocol audit
102Supporting Health Promotion for Mental Health Service Users Jan Batty
103Jan Batty Development Worker Mind Your Heart jan. batty@nphs. wales Jan Batty Development Worker Mind Your Heart tel
104True 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)
107Potential Obstacles Lack of motivation Effects of medication Lack of moneyBoredomMental health cultureAttitudes and beliefs of health staff
108Mind Your Heart Programme Our aim is to improve the physical health of mental health service users in Ceredigion byEngaging people in activities that reduce their risks of illnessRemoving obstaclesRaising awareness
109What did we do? Training for staff and volunteers Small grants supported engagement in activitiesPresentations and networking to raise awarenessWorked with Mental health voluntary organisations, Community Mental Health Teams and Afallon ward, Bronglais Hospital
111What did we find?Training led to changes in personal health behaviour of staffChanges 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)
112What 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)
113Conclusions An effective, sustainable and efficient intervention Promoting mental and physical health together is helpfulWorking in partnership is crucial
114SummaryPeople with mental health problems are interested in their physical healthExpectations of staff and lack of opportunities can hold them backPeople can use healthier lifestyles to aid recovery