1. The mental health jigsaw
MHBiz
14 October 2015
The mental health jigsaw
Dr. Leanne Craze,
Sydney, Australia

2. What we will cover today
What is mental health & mental illness
Common mental illness
Facts & stats
Effects
Causes, risks and prevention
Emphases in mental health care, support and treatment
Overview of mental health services and how they work

3. What is mental health?

4. What is mental health?
Good mental health is a sense of wellbeing, confidence and self-esteem. 
It enables us to enjoy and appreciate other people, day-to-day life and our environment. eg
form positive relationships
use our abilities
deal with life’s challenges
chill

5. What is a mental illness?

6. What is a mental illness?
Is a medically diagnosable health condition
Significantly affects how a person thinks, acts and interacts with other people
It is diagnosed according to standardised criteria.

7. Mental health and mental illness
Dr Mike explains the difference IMM3mQ

8. Other terms used Mental illnesses may also be referred to as:
mental disorder or disturbance
psychiatric disorder
mental impairment or
psychiatric disability
Psychological and behavioural disorder

9. What is a mental health problem?
A mental health problem also affects how a person thinks, feels, and behaves, but to a lesser extent than a mental illness.

10. What are the effects of mental illness?
Mood and feelings
Thinking
Perception
Concept of self – self image & self confidence
Behaviour – what we do
Physical health – many physical impacts
Communication
Relationships
Personal development & milestones

11. Mental illness is common
One in 5 Australians will experience a mental illness in any given year 
Nearly half of Australians will experience a mental disorder in their life
One third of young people will have had a mental illness by age 25

12. Common mental illnesses
anxiety (¼ total; 1/3 women; 1/5 men)
depression (1/5 total; ¼ women; 1/6 men)
schizophrenia (1/100; 3% annually; more men)
bipolar mood disorder (1/50; more women)
personality disorders (varies)
eating disorders (3/20; more common in women but increasing in men)
drug and alcohol related conditions (5% annually)

13. Some other facts Most mental illnesses commence before the age of 25
1/3 of young people experience an episode of mental illness prior to 25
2/3 of people with a mental illness do not receive any treatment
Possibly up to 85% of homeless people have a mental illness
Mental illness, physical illness, drug & alcohol problems frequently co-exit

14. Some facts about suicide in Aust
Around 2,500 people die by suicide each year or 7 people a day
2x the number of the road toll
Men are at least 3x more likely to die by suicide
Women are more likely to think about, plan and attempt suicide
For every completed suicide, as many as 30 people attempt

15. Whose most at risk of suicide?
Indigenous Australians are twice as likely to die by suicide than non-Indigenous Australians
Gay, lesbian, bisexual, transexual, intersex people are at increased risk
People with mental illness 15 times more likely to die by suicide
Suicide is the leading cause of death for young people aged

16. Causal contributors to mental illness
Complex interactions between mind, body, environment and culture. 
long-term & acute stress
biological factors eg genetics, chemistry and hormones
use of alcohol, drugs and other substances
thinking patterns & personality traits eg constant negative thoughts and low self esteem
social factors e.g. isolation, financial problems, family breakdown or violence, disasters etc

17. Mental health and culture – an example from Australia’s first people

18. Social determinants
Social Determinants of Health (WHO)

19. Social determinants
“the social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” 2011 World Conference on the Social Determinants of Health

20. What prevents or reduces the risk of mental illness?
Enhancing things that help protect people eg a sense of belonging, supportive relationships and good physical health
Reducing factors that put them at risk e.g., childhood trauma, abuse, social isolation
Addressing social factors that reduce adversity and promote a sense of security, eg stable housing, stable income, personal safety

21. Emphases in mental health care
Promotion & prevention
Mental health literacy
Self-management
Holistic care – physical, mental health, social and emotional wellbeing
Early and effective responses to reduce ongoing impacts
Recovery
Stepped care

22. Promotion and prevention
Mental health promotion with all people - enabling people and communities to increase control over the determinants of wellbeing and thereby improve their mental health
Targeting at risk groups to prevent illness
Targeting key life cycle transition points
Action on social determinants of health and wellbeing

23. Mental health literacy – absolutely everybody
Every person, every home, every community understanding
Davo’s & Dr Brian’s man therapy
m_term=beyond%20blue&gclid=CNSBoOvVtMgCFQcAvAodjAwLmA
Brains are weird – have a mind of their own

24. Everyone understanding mental illness and knowing how to help

25. Self-management
Helping people with a mental illness or a mental health problem to
Understand it
Know how to manage it
Be an expert on it
Know how to remain well
Know how to regain health
Help their family to understand and help

26. Holistic
This requires significant shift from a primary focus on reducing symptoms to:
Wellbeing – emotional, interpersonal, physical, social, cultural & spiritual
Challenges traditional thinking about what is a mental health service and who is a mental health professional
Reinforces importance of GPs, range of counsellors, dietitians, exercise physiologists, occupational therapists, rehabilitation specialists

27. Early and effective
As early as possible in the development of a mental illness
The earlier, the better the prognosis
Earlier effective professional help can prevent further episodes
Earlier effective help reduces impacts and disruption
Earlier effective help reduces impact on family and friends

29. Recovery Helping a person to get on with their life
Helping people to row their own boat
A focus on what’s important to the person
A focus on a person’s strengths
A focus on naturally occurring supports
Peer support

30. Stepped-care Step 1 Prevention and Promotion
Step 2 Recognition in Primary Health Care
Step 3 Assessment and Primary Health Care Interventions
Step 4 Comprehensive Specialist Services
Step 5 Intensive Specialist Services

31. What is primary health care?
Primary health care is our first points of contact with the health care system
Incorporates personal care with health promotion and education and the prevention of illness and community development
Includes community health centres (eg womens, Aboriginal, youth, migrant, mens, LGBTI), GPs, Health Clinics/Medical Centres, Medicare Locals/Primary Health Networks, antenatal and postnatal care, maternal and child care programs

32. What are specialist mental health services
Staffed by people with mental health training eg nurses, psychologists, social workers, psychiatrists, other medically trained doctors, occupational therapists, welfare workers, peer workers, family support workers and increasingly health educators, exercise physiologists and dietitians
Provided in hospitals, community and people’s homes
Provided on a sessional, inpatient and outpatient
Can be brief or more intensive
Include public, private and nongovernment services
Include assessment, treatment, follow-up, recovery support, rehabilitation and care coordination

33. Stepped Care: Step One
Prevention and Promotion Support - before approaching either health or social  services: eg
Friends, family & neighbours;
Self-help, self-help groups & support groups
Spiritual advice
Advice & info eg telephone  helplines, internet
Housing, legal, family support & employment assistance, leisure & recreation etc.

34. Stepped Care: Step Two
Recognition in Primary Health Care - ‘Watchful waiting’…with further assessment and referral
self-help
guided self-help
expert advice
short-term brief intervention
e-mental health information & resources
signposting to/mobilising resources of Step One

35. Stepped Care: Step Three
Primary Health Care Interventions
GPs & MH Assessment
short term psychological interventions
physical health checks & medicine review
computerised CBT
social prescribing eg activities in the community
caseworker support
signposting to/mobilising resources of Step One
Referral – whole of life

36. Stepped Care: Step Four.
Comprehensive specialist services
early intervention, crisis assessment & treatment, assertive outreach & family support
assessment & treatment – hospital & community-based – both health & mental health
specialist psychosocial, recovery support interventions & peer support
care coordination & risk/relapse plans
stable housing, income, education, employment, relationship support & participation

37. Stepped Care: Step Five
Working with people at high risk and with complex needs
in-patient and intensive clinical support in community and at home
In partnership with primary health care eg GP
Intensive recovery support, psychosocial rehabilitation & peer support
family & relationship support
high level care coordination & relapse management

38. What are psycho-social rehab and recovery support services?
Put simply: Services and programs that support people to get on with their lives eg:
Living skills
Communication skills
Budgeting and managing money
Developing strategies to manage effects of symptoms on day to day life
Getting back to work or study
Healthy living
Getting active & doing things in the community

39. Overview of evidence-based care, support & treatment
Skills for living eg resilience
Family, friends, neighbours & social networks – naturally occurring supports
Lifestyle & healthy living
Self help & self management
Medical treatments - both health & mental health
Psychological treatments & therapies
Specialist peer support
Recovery support & psychosocial rehabilitation

40. Local Public Mental Health Services
Macarthur area - Directory%20of%20MH-Support%20Services.pdf
In Fairfield Liverpool -
Bankstown -
Parramatta - Services/Our-Services

41. Helpful service directories
HSNET -
Wayahead -
No Wrong Door Access ‘App’ – easy access to info about mental health services in South Western Sydney

42. Useful sources of information
Beyondblue -
Blackdog Institute -
SANE –
Indigenous mental health nd-edition-(1)/
Multicultural Mental Health Australia -
Other translated resources - information/translated-mental-health-information-resources
Youth mental health -

43. Contacts Leanne Craze – Leanne.craze@humecha.com.au; M 0408 869 051
Patrick Parker - District Manager, Community Mental Health & Partnerships Level L1, Mental Health Centre, Liverpool Hospital Tel | Mob |