Block 33 H&S Flashcards
How many elements are there to negligence?
- 3
- individual to be successfully sued, each must be proved.
Negligence: duty of?
- A duty of care must be proven between the health authority, individual professional and the patient.
Negligence: breach?
- A breach in the duty of care must be proven
Negligence: damage?
- There must be evidence of damage caused by the breach
When should confidentiality be broken?
- Protect children
- Protect public – e.g. from acts of terrorism
- Required by courts
- Prevent or detect a crime
- Provide care in life-threatening circumstances
- Protect the service provider in life-threatening circumstances
Right to life?
- The European court has held that the article requires hospitals to take measures to ensure steps are in place to secure an individual’s right to life = mostly relevant with
regards to suicide
Prohibition of torture (human rights act)
- Have to justify medical treatment (as side effects / process e.g. ECT) could be classified as torture
- Relevant to MHA as could give patient cheaper drug with worse side effects (can’t do this), or give drug instead of psychological thera
right to liberty and security?
cannot take away right to freedom without good reason
right to a fair trial?
:
* Everyone sectioned has the right to a mental health review tribunal hear
independent MH advocate =
Allocated worker to support pt, allow them to express their views and concerns and to defend their rights
independent mental capacity advocate =
Support people who lack capacity to make certain decisions are provided under the MCA 2005
discrediting stigma =
keeping stigmatising conditions hidden except from close family and friends
Discreditin stigma =
keeping stigmatising conditions hidden except from close family and
friends
felt stigma =
sense of fear due to ones conditions
enacted stigma =
physical act of displaying stigma
Courtesy stigma =
Stigma felt by someone who is with a person open to stigma e.g. parent
of a child w/ autism
Equality act 2010?
makes it illegal to discriminate directly or indirectly against people with
mental health problems in public services and functions, access to premises, work,
education and transport`
Crisis team?
- Support mental health crises in the community e.g. suicidal thoughts, self-harm, experiencing psychosis, severe panic attacks, putting others at risk
- Offer short term support to prevent hospital admission or can arrange for pt to go to hospital if pt is very unwell
- May offer medication, arrange regular visits, make sure pt is in touch with other services to get long term support
Early intervention in psychosis team?
Can support a pt 14-35 years old if they experience psychosis for the first time or are at risk of experiencing psychosis (primary or from drug use)
- Pts can be supported by the team for up to 3 years
what can the early intervention in psychosis teams do?
Provide self-management skills, housing and debt management, employment support, relapse prevention work, psychological and pharmacological
interventions, carer’s assessments, crisis plan, regular checks and monitoring
OAT?
- Give intensive support because of complex mental health needs who aren’t engaging effectively with mental health services
- Aim to reduce hospital admission
- Help with daily living, taking medication, psychological therapy, social support, physical health, finding suitable accommodation, access crisis support
quickly, care plan for family and carers
peak onset of depression?
- 50% of cases occur under 40
- peak onset 25-40
peak onset for depresion w psychotic features?
- 50-70
which ethnic gr has a 4x higher rate of psychosis?
afro-carribean
Carers act?
- carers act 1995
- carers have right to assessment of own needs even if the person they care for refuses
help for carers - carers assessment?
- Carers assessment - receive a community care assessment to establish how much support from social services they are entitled to
- Could mean carer is entitled to personal care assistance - e.g. having someone help pt to wash, adaptations being made to home, respite care
Carers UK?
- Provide support for carers especially those having difficulty adjusting/ coping with changes in their life
carers online support?
- online forums
- carers support groups
- carer’s direct helpline
Bed wetting?
- Normal for children <6 even if “toilet-trained”
- Exclude a physical problem
- Educate parent about appropriate toilet training methods
Temper tantrums?
- normal as a toddler
school refusal could be due to anxiety
origins of addiction - predisposing and precipitating factors?
- genetics
- learned acceptable behaviours
- occupation - high in unskilled labourers
- stressful life events
- males > females
maintenance - perpetuating factors in mental illness?
- negative reinforcement - taking drug removes negative side effects of withdrawal
- psychological - tolerance develops
Addiction =
continued repitition of a behaviour, despite adverse consequences
What is dependence?
take a substance, and your body becomes dependent
what are the symptoms of dependence syndrome?
- salience
- compulsion
- tolerance
- withdrawal upon absitnence
- resinstatement upon abstinence
Salience =
substance takes priority over other behaviours
MI 4 principles?
- express empathy by using reflective listening
- develop discepancy between pt’s values and current behaiours
- sidestep resistance with empathy and understanding
- support self effiacy by building pt’s confidence
Non NHS agencies in MH?
- MIND
- samaritans
- childline
reasons why people self harm?
- Cry for help
- Escape from intolerable situation
- Relief from state of mind
- Attempt to influence others
- Testing the benevolence of fate
higher suicide rates?
- unemployed
- uni students
- doctors
- lawyers
- farmers
- politicians
List the members of the community MH team?
- Psychiatrists
- Psychologists
- Social workers
- Occupation therapists
- Community psychiatric nurses
- Peer support workers
Roles of the community MH team?
- Psychiatrists
- Assessment and diagnosis of mental health conditions
- Prescribing meds
- Treatment planning
Psychologists?
- CBT and other psychological interventions
- Psychological assessments and evaluations
role of community psychiatric nurses?
- Ongoing support and care to indiv in the community
- Monitor symptoms and medication adherence
- Education and guidance
role of social workers?
- Assessing social and envir factors impacting MH
- Providing support with housing, finances and benefits
- Facilitate access to community resources and services
role of occupational therapists?
- Assess indiv functional ability and daily living skills
- Provide interventions to improve independence
what does the mental health act allow for?
- The mental health act (2007) allows for the compulsory detention of those who are mentally ill
section 2 of the mental health act lasts for…
- Lasts 28 days max, not renewable
section 2 allows for?
- Admission for assessment
- Treatment can be given against patient’s wishes
who applies for a section 2?
- AMHP makes the application based on the recommendations of 2 doctors
- One of the doctors should be approved under section 12(2) – usually consultant psychiatrist
what is a section 3?
- Admission for treatment
- Up to 6 months but can be renewed
- Tx can be given against ppt’s wishes
who applies for a section 3?
- AMHP along with 2 doctors
section 4 is a ?
- 72 hour assessment order
- Used as an emergency when a section 2 would involve an unacceptable delayw
who applies for a section 4?
- GP and an AHMP
what is section 4 often changed to?
- Often changed to a section 2 on arrival at hosp
section 5(2)?
- a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
section 5(4)?
- similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
Sec
section 17a?
- Supervised Community Treatment (Community Treatment Order)
- can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication
Sec
section 135?
- a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
Sec
section 136?
- someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
- can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
under which sections can people not be treated?
- section 135
- section 136
common law?
used to treat patients in emergency scenarios
MCA?
- used in patients who require treatment for physical disorders that affect brain function.
- Remember this may be delirium secondary to sepsis or a primary brain disorder such as dementia
MHA?
- used in patients who require treatment for mental disorders.
- For patients already admitted to hospital, a section 5(2) is used if there is not the time for a more formal section 2 or 3.
AMHPs?
- usually social workers
- can also be nurses, OTs, psychologists, doctors, psychiatrists
Diagnostic criteria for depression?
Key symptoms:
* persistent sadness or low mood; and/or
* loss of interests or pleasure
* fatigue or low energy
* at least one of these, most days, most of the time for at least 2 weeks
* if any of above present, ask about associated symptoms:
o disturbed sleep
o poor concentration or indecisiveness
o low self-confidence
o poor or increased appetite
o suicidal thoughts or acts
o agitation or slowing of movements
o guilt or self-blame
Not depressed =
<4 symptoms
mild depression?
4 symptoms
moderate depression =
5 -6 symptoms
severe depression?
- seven+ symptoms
- with ot without psychotic symptoms
depression symptoms should be present for?
symptoms should be present for a month or more and every symptom should be present for most of every day
GAD diagnostic criteria?
- Excessive anxiety and worry, occurring more days than not for at least six months, about a number of events or activities.
- The individual finds it difficult to control the worry.
- The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past six months):
* Restlessness or feeling keyed up or on edge.
* Being easily fatigued.
* Difficulty concentrating or mind going blank.
* Irritability.
* Muscle tension.
* Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). - The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not exclusively due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a mood disorder, psychotic disorder, or pervasive developmental disorder.
panic disorder diagnostic criteria?
- Recurrent panic attacks which are characterised by a discrete period of intense fear or discomfort, typically reaching a peak within minutes and during which time 4+ of the following symptoms occur:
- Palpitations, pounding heart, or accelerated heart rate.
- Sweating.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, lightheaded, or faint.
- Chills or heat sensations.
- Paresthesias (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control or going crazy.
- Fear of dying.
panic disorder
At least one of the attacks has been followed by one month or more of one or both of the following?
- Persistent concern or worry about individual panic attacks or their consequences
- Significant maladaptive change in behaviour related to the attacks e.g. avoidance of situations
Schizophrenia - characteristic symptoms?
- At least one of the following
- Must be present for at least a month:
- Delusions
- Hallucinations
- Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms such as avolition – lack of motivation
what to exclude w schizophrenia?
- Schizoaffective disorder and mood disorder with psychotic features have been ruled out
- Exclusion of organic causes
- One of more major areas of functioning such as work, interpersonal realtions or self care are markedly reduced
management of a violent patient - immediate safety measures?
- Ensure safety of patient and staff
- removal of weapons
management of a violent ppt - assessment and risk management?
- conduct thorough mental state assessment
- assess risk level
- create risk management plan tailored to the patient’s indivdual needs
management of a violent patient - de-escalation?
- verbal techniques to reduce agitation
- Calm and non confrontational demeanour
Medications for violent behaviour?
- IM lorazapam
- Haloperidol and other Aps
psych therapy for violent patient?
- Conselling and other therapy aimed at improving social skills and anger management
Prevalence of anxiety?
- Prevalence: Adult Psychiatric Morbidity survey – 19% of adults
- Gender differences: women > men
Worlwide: 4%
prev of depression?
- Prev: 19%
- Gender: women> men
- Worldwide: 5%
- 280 million people worldwide
prevalence =
- Proportion of people in a population who have a disease at a specific time period or over a specified period
- Measure of the total burden of disease in the population
what does prevalence include?
- Includes new and existing cases
what is prevalence influenced by?
- Influenced by duration of disease, incidence, rate of recovery or mortality
incidence =
- Rate at which new cases occur in the population
- Measures risk of developing the disease within a certain time frame
incidence is the ? per ?
- New cases per unit of population at risk
what is incidence used to study?
- Used to study risk factors of a disease
role of mental health teams in management od depression?
- Assessment and diagnosis: psychiatrists, psychologists, nurses
- Treatment planning: development of treatment plans tailored to needs and preferences
- Medication management: psychiatrists monitor medications and adjust treatment regiments
- Psychotherapy – psychologists - CBT
Relationship between cultural factors and symptoms and experience of depression?
- Cultural norms and values – in some cultures mental health problems may be stigmatized or misunderstood -> symptom concealment or symptom delay
- rCultural attititudes e.g. towards emotional expression can influence how depression is experienced
relationship between SES and depression?
- SES – income, education, housing
- Can influence prevalence, severity, and course of depression
- Lower SES -> inc stress, financial strain
relationship between ethnicity and depression?
- Discrimination and marginalisation based on race, gender, sexual orientation or immigration status -> stress, psychological distress and increasing risk of depression
- Discrimination can impact access to healthcare and treatment -> making mental health disparities worse
cultural beliefs influence a person’s….
-Cultural beliefs – influence an individual’s understanding of depression and their help seeking behaviours
cultural factors and seeking treatment for depression?
- Cultural beliefs can lead to stigma which can deter a person from seeking support due to fear of social rejection or discrimination
- Cultural acceptance and understanding can facilitate help seeking and treatment adherence
support for treatment for depression?
- Social support networks – family networks and cultural norms influence availability and effectiveness of social support networks for ppl w depression
- Strong support systems -> coping w symptoms and accessing treatment
what limits people accessing support for MH?
- Accessing help – SES, cultural beliefs, and systemic barriers can affect access to HC and treatment services for depression
- Limits ability to seek and receive mental health care
MH problems in PC?
- 1 in 3 patients presenting to PC have a MHC
- Increased demand – patients with mental health problems often have physical symptoms -> freq consultations -> inc demand
- Complexity of care – due to multifaceted nature of mental health conditions and co-morbities
MH problems present a ? challenge in primary care
- Diagnostic challenges due to overlap of physical and psychological symptoms
? of ppl w a MHP are cared for entirely witjin primary care?
- 90% of people with mental health problems are cared for entirely within primary care
- PC uses less than 10% of the total expenditure on MH
epidemiology of self harm?
- 13%
- Higher rates in females
in which age gr are self harming rates higher?
- Women: 15-24
- Men: 25-34
epidemiology of suicide?
- Higher rates in men
- Highest amongst middle aged adults, paticularly males
- Females are more likely to attempt suicide but men are more likely to die by suicide
in which age group do suicide rates peak?
-45-49 age gr is the peak
assessment of self harm?
- Assessment of self harm behaviour – including frequency, methods, triggers
- Develop a safety plan with the individual – e.g. identifying warnings signs, coping strategies, emergency contacts
Psycho
psychoeducation for self harm?
- Provide info and psychoeducation about self harm including common triggers, and potential consequences
- Alternate coping strategies such as relaxation techniques, mindfulness and problem solving skills
CBT for self harm?
- CBT or DBT for self harm
- CBT focuses on identifying and challenging negative thought patterns, learning adaptive coping skills, and developing alternative ways of responding to emotional distress.
referral for self harm?
- Includes PC, CMHTs, specialist services for self harm and suicide prevention
- Collaborate with MHPs to develop comprehensive care plans
referral to non NHS agencies for self harm?
- That offer specialized support and interventions for self harm such as counselling, peer support grs, crisis helplines
Discus
impact of ethnicity on diagnosis of psychosis - diagnostic bias?
- Diagnostic bias – ppl from ethnic minorities such as Black and Hispanic populations are more likely to be diagnosed with psychosis comp to white people
- This may be influenced by diagnostic bias, where cultural differences in expression of distress and symptoms are misinterpreted as signs of psychosis.
impact of ethnicity on diagnosis of psychosis - access to care?
- Access to care – racial and ethnic disparities in access to MH services may result in delayed or inadequate Tx for psychosis
impact of ethnicity on diagnosis of psychosis - language barriers?
-Language barriers contribute to disparities in diagnosis and Tx
culture and the diagnosis of psychosis?
- Cultural interpretation of symptoms – differences in interpretation of psychotic symptoms can influence how families and indiv perceive and attribute distressing experiences
- Cultural expression of distress – cultural norms and values influence how psychotic symptoms are expressed within different cultures
Age & diagnosis of psychosis?
- Childhood onset psychosis may present with atypical symptoms and developmental delays
- Age related RF - such as cognitive decline, medical comorbidities, and substance use, can complicate the diagnosis and management of psychosis in older adults
- Co-morbidities can mask psychotic symptoms
Give examples of the impact on carers where a person has complex mental health needs - emotional ?
- Emotional strain – feelings of stress, anxiety, sadness, frustration
- Witnessing struggle of loved ine
Give examples of the impact on carers where a person has complex mental health needs - physical?
demands of caregiving as they may neglect their own health
Give examples of the impact on carers where a person has complex mental health needs - social and financial?
- Social isolation – many carers find it difficult to maintain social activities and connections outside of caring. Can worsen feelings of loneliness
- Financial strain – reducing hours/ leaving job to care
Give examples of the impact on carers where a person has complex mental health needs - psych impact?
- Psychological impact – psych distress, depression, burnout – unpredictability and severity of loved one’s mental health symptoms
Give examples of the problems that people with sensory impairments may have accessing mental health services ?
- Communication barriers – struggling with telephone systems, GP touchscreens, lack of sign language
- Lack of accessibility – digital resources and informational materials may not be accessible
- Stigma and discrimination – deter them from accessing help
- Transportation challenges
impact of addiction on society?
- Economic burden – healthcare costs, lost productivity, social welfare costs
- Crime and violence – ASB, drug related offenses, domestic violence
- Public health crisis – HIV. AIDs, Hepatitis
Impact of addiction on family?
- Strains relationships
- Emotion distress of family members – shame, guilt, depression, low self eseteem
- Financial instability – debt, economic hardship for families
impact on indiv of addiction?
- Physical health consquences – infectious, resp, cardiovascular problems
- MH – addiction often co-occurs with MH disorders
- Social isolation – due to strained relationships and alientation
RF for drug taking?
- early aggressive factors
- lack of parental supervision
- academic problem
- peer substance use
- drug availability
- child abuse/ neglect
- poverty
individual risk factors for drug taking?
- genetic disposition
- prenatal alcohol exposure
- difficult temperament
- poor impulse control
- low harm avoidance
- lack of self regulation
- ADHD/ anxiety/ depression/ antisocial behaviour
- rebelliousness
personality traits increasing risk of drug taking?
Personality traits: including disinhibition, poor impulse control, novelty or sensation seeking may increase the risk of substance misuse.
co-morbidities increasing risk of drug taking?
Psychiatric co-morbidities (depression, anxiety, PTSD, psychosis): illicit drugs may be used in an attempt to self-medicate.
societal factors increasing risk of drug taking?
- peer pressure
- lack of family involvement
- attitudes towards drugs/ alcohol
- Social and environmental factors:
- poor school achievement, unemployment, social deprivation, history of criminal activity, peer influence, and normalisation of substance misuse in the individual’s culture or peer group.
Health promotion for reducing alcohol - education and awareness?
- Increasing public awareness
- By providing accurate information abt health consequences. Social impacts and legal ramifications of substance use ppl can make informed decisions abt drug and alcohol use
Health promotion for reducing alcohol - risk reduction strategies?
- Promotion of harm reduction strategies to minimise negative consequences
- E.g. resp drinking behaviours such as moderate alcohol consumption, avoiding binge drinking
Harm reduction strategies?
- Harm reduction strategies – needle exchange programmes, overdose prevention training, access to naloxone
Policy in reducing alcohol?
- EB policies and regulations to reduce misuse and harm at the population level
- E.g. restrictions on alcohol advertising and marketing, increasing taxes on alcohol and tobacco products, enforcing age restrictions for alcohol and tobacco sales
cycle of change model stages?
- precontemplation
- contemplation
- prep
- action
- maintenance
- termination
precontemplation?
not yet considering changing their behaviour
contemplation?
aware of the need to change and are considering taking action
preparation stage?
person has made a commitment to change and is preparing to take action
action?
ppl modify their behaviour to achieve theit goals
maintenance stage?
- ppl work to sustain the changes they have made over the long term.
- May develop strategies for managing cravings, coping and triggers and preventing relapse
termination stage?
In this stage, individuals have successfully integrated the new behavior into their lifestyle, and the risk of relapse is minimal
MI is a…
- Goal oriented approach to facilitating behaviour change by helping individuals explore and resolve ambivalence
what are the steps of MI?
- Empathetic approach – active listening
- Develop discrepancy - Practitioners help clients explore the discrepancy between their current behavior and their goals, values, or aspiration
- Avoid argumentation – practioners take a non-confrontational stance
- Support self-efficacy – improve confidence of the ppt in making positive changes
Outline how effective co-working with other NHS specialties and non-NHS agencies maintains high quality patient care?
- Co-working allows development of holistic treatment plans
- Collaborating with specialists allows HC teams to draw on diverse perspectives and knowledge
- Continuity of care – as ppts move between different HC settings and services
- Shared care planning and monitorig between different agencies
Attachment in the development of personality?
- Attachment – e.g. with primary caregivers
- Secure attachment: responsive and nurturing caregiving, fosters trust and good emotional regulation
- Insecure attachment: inconsistent or neglectful parenting -> insecurity and difficulties in forming close relationships
personality - authoritative parenting ->
warmth and support -> positive outcomes such as self confidence
authoritarian parenting- >
high control and low warmth -> anxiety, low self esteem and rebellious behaviour
how does culture shape personality?
- Cultural and environmental factors, such as cultural norms, values, and societal expectations, shape personality development by influencing the socialization process and providing context for individuals’ experience
What are personality disorders?
Personality disorders are characterized by enduring patterns of thoughts, feelings, and behaviors that deviate from cultural expectations and cause significant impairment in social, occupational, or other areas of functionin
Arguments for personality disorders?
- Clinical utility – provides a framework for understanding and diagnosing indiv with persistent maladaptive heaviours
- Helps to identify people who may benefit from interventions
- Treatment planning – allows us to addess the underlying patterns of dysfunction
- Research benefits – allows study of etiology, course and treatment outcomes of different PDs
Arguments against the concept of PD?
- Stigmatisation and labelling
- Diagnostic overshadowing
- Dimensional nature of personality – oversimplification of the complexity of personality functioning
- Limited treatment efficacy
Duty of care?
- HCPs have a duty to assess and manage the risk of violence to others
informed consent?
- Informed consent required before using interventions aimed at managing the risk of violence
- May be lack of insight
confidentiality?
- Legal exception where there is a serious risk of harm to others
- Balance of duty to maintain confidentiality with the duty to warn others
Least r
least restrictive measures?
- Least restrictive measures should be used to the level of risk – not restrict their right to liberty unnecessarily
effectcts of normal aging on health?
- Cognitive changes – concerns over memory loss -> anx and stress
- Emotional regulation – more susceptibility to depression, anx, loneliness
- Physical health conditions such as chronic pain and arthritis -> distress, functional impairment, reduced QoL
effects of physical illness on MH - distress?
Diagnosis of a physical illness, particularly chronic or life-threatening conditions, can lead to psychological distress, including anxiety, depression, and adjustment disorders
effects of physical illness on MH - uncertainty?
- Uncertainty about prognosis, treatment options, and future health outcomes can contribute to emotional distress and existential concerns.
other effects of physical illness on MH?
- Pain and insomnia -> distress, disruption of daily activities
- Medication side effects e.g. sexual dysfunction, CI, mood changes
Social
Social and family consequences of physical illness?
- Caregiver stress
- Financial strain
- Changes in family dynamic
effects of dementia on carers ?
- Emotional strain – witnessing cognitive decline
- Caregiver burden – exhaustion, burnout
- Social isolation
- Financial
- Role strain – balancing multiple roles and resp such as caregiver, spouse etc
- Loss of personal identity
Support for dementia carers?
- Dementia advisors and support workers – personalised support, info and guidance to carers and families
- Practical support with navigating the care system and accessing local support
carer support group?
- bring together individuals who are caring for someone with dementia to share experiences, advice, and practical tips for coping with caregiving challenges.
respite care services for dementia?
- temp relief for carers by providing short term care and support for the person w dementia
- allowing carers to take a break
how can respite care services be provided?
- Respite care services may be provided in various settings, including day centers, residential respite care facilities, or through home-based respite care services.
community support for patients with psychiatric disorders in old age?
- CMHTs
- day centers
- home care centers
CHMTs for older adults w psychiatric conditions?
- CHMTs provide MDT support and treatment for older adults w psychiatric disorders in the community
- Includes assessment, psych therapies, social support
day centers for older adults with psych condt?
- provide structured daytime programs
- provide social activities. cognitive stimulation, practical support
home care services for older ppl w psychiatric conditions?
- for people living in their own homes
- includes personal care, medication Mx, meal prepping, transportation and companionship
assisted living facilities offer…
- Assisted living facilities offer residential accommodation and support services for older adults with psychiatric disorders who require assistance with activities of daily living but do not require 24-hour nursing care.
what are the types of assisted living facilities?
- residential care homes
- gr homes
residential care homes?
Residential care homes provide 24-hour supervised care and support for older adults with psychiatric disorders who require more intensive assistance with personal care, mobility, and supervision
group homes?
- a.k.a as residential homes and supported housing
- offer shared accom for older ppl w psych disorders
- Residents live together in a supportive community setting and receive assistance with daily living activities, medication management, and social support.
Nursin
nursing homes for older adults w psych conditions?
- provide 24-hour nursing care and support for older adults with psychiatric disorders who have complex medical needs, functional impairments, or behavioral challenges that require skilled nursing care
- some have specialised dementia care units
features of health adjustment responses to physical illness?
- active coping
- engaging in problem solving strategies
- seeking social support
- using coping strategies
features of unhealthy adjustments to physical symptoms?
- avoiding or denying physical symptoms
- minimising significance
- refusing to acknowledge need for medical care
- delay seeking treatment, ignore warning signs
- maladaptive coping – substance abuse, self medication to provide temp relief but can exacerbate health problems
personal factors which can influence adjustment to physical symptoms?
- Individual differences in personality, coping styles, resilience, and psychological resources can influence adjustment to physical symptoms.
- Factors such as self-efficacy, optimism, and perceived control over health outcomes can promote healthy adjustment,
- while factors such as low self-esteem, learned helplessness, and negative beliefs about illness may contribute to maladaptive adjustment.
Family
family factors influencing adjustment to physical symptoms?
- Positive family support, open communication, and shared coping strategies can facilitate healthy adjustment,
- while family conflict, dysfunction, or lack of support may hinder adaptation and exacerbate distress
cultural factors affecting a person’s adjustment to physical symptoms?
- Cultural factors shape individuals’ attitudes toward seeking medical care, expressing emotions, and relying on social support.
- Cultural stigma, discrimination, and beliefs about fate, destiny, or spiritual explanations for illness may impact adjustment and help-seeking behaviors
primary HP strategies for promotion of mental wellbeing?
- Public awareness campaigns - Public awareness campaigns aim to raise awareness about mental health issues, reduce stigma, and promote positive attitudes toward mental well-being
- Education and training programs - Education and training programs provide individuals with knowledge, skills, and resources to promote mental well-being and resilience.
- Promotion of healthy lifestyle behaviours – such as regular physical activity, balanced nutrition and adequate sleep
importance of prevention in child MH ?
- Early intervention and risk reduction - Prevention efforts aim to identify and address risk factors for mental health problems in children before they escalate into more severe issues.
- By intervening early, prevention programs can reduce the likelihood of children developing chronic mental health conditions and experiencing long-term negative outcomes.
normalisation of mental health concerns in children?
Normalizing mental health concerns, such as anxiety, bedwetting, school refusal, or tantrums, helps reduce stigma and increase awareness of common childhood challenges.
early intervention and prevention can reduce the?
long term impact of mental health problems on a child’s overall QoL and school functioning
role of the school in managing child MH?
- Identification of early signs of MH concerns – teachers and staff
- Preventative interventions - may include social-emotional learning (SEL) programs, bullying prevention initiatives, stress reduction activities,
- Supportive environment for students by providing access to school counselors, school psychologists
Health visitors in the management of child MH?
- Identification of RF and screening for parental MH problems
- provide information, guidance, and referrals to appropriate services.
- Offer home visits, developmental assessments and parenting support
- Health visitors promote positive parent-child bonding and attachment by providing guidance on responsive caregiving, communication strategies, and stress management techniques
Role of social services in management of child MHP?
- develop support plans and interventions to address concerns such as parental mental illness, substance abuse
- child protection and safeguarding - identifying and responding to concerns of abuse, neglect, or exploitation.
educational psychologists in managing child MH?
- assessment and intervention - assess children’s cognitive, emotional, and behavioral functioning to identify factors that may impact their learning and well-being.
- Support for special education needs
Physiological theories of EDs - genetic factors?
higher concordance rate for eating disorders among identical twins compared to fraternal twins
Physiological theories of EDs - neurobiological?
dysregulation of neurotransmitters such as serotonin, dopamine, and norepinephrine, may contribute to the development of eating disorders
Physiological theories of EDs - endocrine?
hormonal imbalances such as disruptions in HPA axis and abn in secretion of hormones like cortisol, insulin and leptin
sociological factors in development of ED?
- Social pressures – medial portrayals of thinness and pressure to attain ideal body images
- Exposure to media images, peer pressure and societal emphasis on appearance
- Family – parental modelling of dieting behaviours, perfectionism
Cultural factors in development of ED?
- Cultural – societies that prioritise thinness may stigmatise certain body types and may contribute to internalisation of thin-ideal standards
Developmental theories in the development of EDs - early life?
- Developmental transitions, such as puberty, adolescence, and young adulthood, are critical periods for the onset of eating disorders
- Life events such as trauma or absuse
development theories in the development of EDs- insecure attachment?
- Insecure attachment styles, characterized by ambivalence, avoidance, or disorganization, may predispose individuals to develop maladaptive coping mechanisms, including disordered eating behaviors, as a way to regulate emotions and seek validation.
developmental theories of ED - personality traits?
- Individuals with perfectionistic tendencies, low self-esteem, identity confusion, or difficulties in emotion regulation may be more vulnerable to developing eating disorders
Role of the mental health act in management of an eating disorder?
- If a person with an eating disorder is deemed to be at risk of serious harm to themselves or others due to their condition, they may be detained under the MHA for assessment and treatment.
- Compulsory treatment – sectioning or use of CTOs
the MHA requires that indiv w EDs, are?
assessed for their capacity to make decisions about their treatment. If a person lacks the capacity to make informed decisions due to the severity of their eating disorder or associated mental health issues, their treatment decisions may be made by healthcare professionals
RCT is an?
- Effectiveness study. Experimental
cohort studies look at?
risk or prognosis. Can be retro or prospective
CCS look at?
risk or prognosis. Always retrospective.
issues w methodology?
- Blinding, allocation concealment?
- Administering the intervention
- Differences in population
- Biases introduced
- How was the data measured and analysed?
problems that can arise w cohort/ CCS?
- Long enough follow up?
- Biases
- Recruitment
- Measurement and analysis?
- Differences in population
Child protection act?
- set of laws aimed at safeguarding children from harm and ensuring their welfare
what does the child protection act cover?
- mandatory reporting of abuse
- child welfare assessments
- provisions of children in need of protection or care
when was the child protection act made?
1998
mandatory reporting?
- all cases of FGM under 18s
- child sexual abuse
children act was made in?
2004
Principles of the children act 2004?
- Allow children to be healthy
- Help children to be happy and enjoy life
- Allowing children to remain safe in their environments
- Help children to succeed
- Help achieve economic stability for the future - of children
- Help make a positive contribution to children’s lives
what did the children act 2004 outline?
- children’s comissioner for england
- safeguarding boards - co-ordinate efforts between organisations like social, healthcare and the police
- imp of info sharing
the children act 2004 introduced the ? framework?
The act introduced the Common Assessment Framework to provide a standardized approach for assessing the needs of children and identifying appropriate services to support them.
psychological consequences of substance misuse?
- chronic substance misuse -> cognitive impairment and memory problems
- withdrawal symptoms -> emotional instability, agitation and cravings
social consequences of addiction?
- strain on relationships w family or friends -> social isolation
- impair functioning in their job or in education
- stigma and discrimination -> alientation
economic consequences of substance misuse?
- economic burdens on HCS due to increased healthcare utilisation and productivity losses
- financial costs of substance related costs
- decreased productivity
link between substance misuse and crime?
- Substance misuse is often associated with criminal behavior, including drug trafficking, theft, burglary, and violent crime.
- may be to finance the addiction
- could be due to the increased impulsive and risky behaviour
section 135 vs 136?
- section 135 - at home
- section 136 - in a public place
Anxiety screening tool?
- GAD-2
- anxiety disorder is likely if a person answers 2 or 3 to one or both Qs (ie anxiety present > 50% time)
Clark’s CBT model for panic attacks?
- The trigger can be external (eg crowds) or internal (eg heartbeat) – ‘selective attention’/ ‘hypervigilence’
- The person misinterprets normal body sensations as meaning that a physical or mental disaster is imminent – ‘catastrophic misinterpretation’
- The ‘fight or flight’ survival response produces more symptoms - which fuel the ‘vicious cycle’ of panic
- attempts by the person to manage panic bring short term relief but make it worse in the long term (avoidance + safety behaviours)
precipitating factors in GAD?
Stressful life events eg relationship problems, physical illness, threatened loss of employment (contrast losses - which tend to provoke depression)
Maintaining factors in GAD?
- CBT theory states that in GAD worrying abour worry maintains anxiety and leads to unsuccessful attempts to control it
RF for anxiety?
- Female sex
- Family history
- Childhood abuse and neglect
- Environmental stress(e.g. redundancy, divorce)
- Emotional trauma
- Substance abuse
diagnostic criteria for anxiety?
resilience factors =
- Resilience factors (RFs) are psychological resources that buffer the potentially negative effects of stress on mental health.
examples of resilience factors?
- the ways in which individuals view and engage with the world
- the availability and quality of social resources
- specific coping strategies
problem solving and anxiety?
- anxiety (especially chronic) can hinder our ability to filter things that we think of as a threat in order for our brains to accurately concentrate on the retrieval of info necessary for problem solving
members of community MH teams?
- nurses
- occupational therapists
- psychologists
- MH support workers
- consultant psychiatrists
Community mental health teams work as part of an MDT to:
- provide medical support
- putting patients in touch with other agencies
- short term work for a specific mental health diagnosis which requires short term support
- physical health monitoring
CMHTs work as part of an MDT and can provide support with (3)?
- support w employment support
- psychological approaches
- support with day to day activities and functioning
organisiation of MH services?
- Primary care - GP
- community - MH teams
- hospitals and in specialist services
- this is primary, secondary and tertiary care
NHS LTP?
is going to create intergrated community mental health servcies
primary MH services?
GP - refer to secondary services but these can also be accessed through the single point of access
secondary MH services?
specialised, include teams like community MH teams, crisis resolution and home treatment teams and hospital care
voluntary MH services?
- Running alongside primary and secondary services are voluntary services: support provided in the community, usually by charities and other non-profits.
- You can often access these services without a referral
tertiary MH services?
highly specialised treatment like forensic MH services or specialist psychotherapy services
intergrated care systems =
- removing traditional divisions between different tiers of care
- so that people get less disjointed care
what do ICS aim to do?
- aims to remove divisions such as those between hospials and GPs, physical and mental health and the NHS & local authority
ICS are new partnerships between?
between the NHS and other health and care organisations. Such as the local authority, voluntary sector and social enterprise sector
depression epidemiology?
- 4th leading casue of disability worldwide
- point prevalence 2-5%
RF for depression?
- genetics
- Gender – twice as common in women
- Childhood experience – e.g. loss of parent, lack of parental care, abuse
- Personality – especially neuroticism
- Social environment – life stresses, lack of social network etc
- Physical illness
ICD-10 criteria for depression
levels of CBT - self help materials?
- Self-help materials – This is not a form of psychotherapy and no CBT skills or training are required by the individual reading the self-help material (e.g. books/ websites).
levels of CBT - assisted self help?
- Assisted self-help - computerized CBT, self-help material presented to a support group or individuals by a health worker, such as a graduate mental health worker or assistant psychologist
levels of CBT - CBT approaches?
- CBT approaches - Specific CBT interventions for specific problem areas, e.g. anxiety management, coping with voices etc.
levels of CBT - formulation driven CBT?
- Formulation driven CBT– This is a form of psychotherapy, the patients are not fully able to help themselves and have sought help from a trained professional.
what are the levels of CBT?
1) Self help materials
2) assisted self help
3) CBT approaches
4) formulation driven CBT
what do the therapist and patient agree on during CBT?
- Patient and therapist agree problem list and goals. Treatment is a collaborative partnership
- Focuses on ‘here and now’
Which type of questioning is used in CBT?
- socratic questioning used by the therapist
- open therapeutic process
- homework used
what is the CBT model of depression?
- Underlying beliefs centre around being helpless or unloveable
- Trigger events typically involve loss or ‘failure’
- This produces negative cognitions about self/ future/ world which reinforce underlying beliefs, and affect mood and behaviour
CBT model of depression - how are negative thoughts maintained?
- These negative thoughts are maintained by distorted information processing (e.g. overgeneralization, personalization, selective abstraction)
red flags in depression?
- Risk of suicide
- Feeling of hopelessness
- Chronic pain
- Disabling symptoms
- Severe and prolonged symptoms
How do young adults tend to present with depression?
- Young adults tend to sleep a lot, overeat, withdraw and show self-neglect.
how do older adults tend to present with depression?
- Older adults often present with insomnia, anxiety, anorexia, poor self-care and exacerbation of pre-existing physical conditions like painful arthritis, constipation, head and neck and back pain
Diagnostic criteria for depression
depression is the ? most common reason for consulting a GP
3RD
Normal grief reactions?
- shock, denial, numbness, guilt, sadness, weeping, resolutuon
- Emotional and practical support is normally sufficient.
abnormal grief reactions?
- if symptoms are more intense e.g. clinical depression or if they’re prolonged (beyond 6 months) or if they’re delayed in onset
- Counselling, “guided mourning” and occasionally medication may be needed.
socio-cultural aspects of depression - black and asian races present less ofern with?
- Black and Asian races present less often to their GP with “depression”
- Some groups are more likely to complain of physical symptoms eg Mediterranean (“nerves, headache”), China & Asia (“weak, tired”),
what are risk factors for suicide?
- migration and not speaking the local language are risk factors for suicide
- refer to specific services e.g. Refugee council and use a professional translator
for depression to be diagnosed there needs to be?
- 4+ symptoms for at least 2 weeks include at least 2 of the first 3 core symptoms
ECT monitoring - addenbrooke’s cognitive assessment?
- addenbrooke’s cognitive assessment mainly used - measures new learning, retrograde amnesia and subjective memory impairment
advantages of ECT?
- Effective when other treatments don’t work
- Most effective with most severe illness
Disadvantages of ECT?
- Multiple brief anaesthetics
- Acute confusional states
- Memory impairment: anterograde and retrograde
Acute impact of ECT on serotonin?
· increased cerebral serotonin concentration
chronic impact of ECT on serotonin?
· increase in post-synaptic 5-HT2 receptors
inform patient started on AD of:
- risks including transient increase in anxiety at the start of treatment)
- and of the risk of discontinuation/withdrawal symptoms if the treatment is stopped abruptly or in some instances if a dose is missed or, occasionally, on reducing the dose of the drug.
indications of ECT?
- treatment resistant depression
- severe major depression
- bipolar depressive and mania
- schizophrenia
side effects of ECT?
- nausea
- headache
- fatigue
- confusion
- slight memory loss
self help materials in depression?
- royal college of psychiatrists which provides patient information
- MIND
- Depression UK
- mental health foundation
depression management: improving wellbeing?
- provide advice on activities to imptove wellbeing such as
- physical activity: walking, jogging, swimming, dance
- Maintaining a healthy lifestyle through diet, alcohol intake, and sleep.
depression management: social support?
- social support for family/ carers supporting the person
CMHTs assess patients who are referred and?
patients are then allocated a key worker who co-ordinates their treatments
Crisis teams involve?
- psychiatrists
- MH nurses
- social workers
- support workers
Roles of crisis teams (4)?
- can visit the patient’s home or them in hospital if they’re being discharged
- assist with self help strategies
- administer medications
- provide practical help e.g. with money or housing
Early intervention teams can?
support you if you experience psychosis for the first time
What are EIT?
- they are MDTs set up to identify and reduce treatment delays at the onset of psychosis and promote recovery by reducing the probability of relapse following a first episode of psychosis
who are assertive outreach teams for?
- for those with complex mental health needs e.g. for those with severe long term mental illnesses and those who have been in hospital many times
- complex needs such as violent behaviour, drug or alcohol use and mental illness, those detained under the mental health act or serious self harming
AOTs are also known as?
- also known as the complex care team or programme of assertive community treatment
- AOTs review the care plan every 6 months
exposure to ? play a role in the onset of depression?
poverty and violence
Cultural factors in depression?
- cultures vary in their conceptualisation of mental health
- symptoms they recognize as signs of depression, and their openness towards discussing feelings of depression.
How may different cultures interpret the symptoms of depression?
- For instance, some cultures might interpret symptoms of depression in a more somatic or physical way, focusing on complaints like fatigue orpain, while others may focus more on the emotional or cognitive symptoms.
fear of ? may stop people from seeking help for depression
stigma
cultural factors also influence the types of ?
treatment sought by the patient, wirh some cultures relying more on traditional/ alternative medicines
cultural identifity influences the degree to which a person?
- cultural identity influences the degree to which a person shows physical symptoms of depression
- in other words, some cultures are more comfortable reporting depressive symptoms that are physical in nature rather than mental.
- For example, research shows that many depressed Chinese people complain of bodily discomfort, feelings of inner pressure, and symptoms of pain, dizziness, and fatigue
Depression and the western world?
- depressed individuals might not readily seek out psychiatric or mental health care for depressive symptoms.
- Because the public discourse regarding depression is more prevalent in Western societies, it is more socially acceptable to have depression, and more people are willing to seek help.
stigmatisation of mental illness in other cultures?
- mental illnesses may be denied out of shame of being identified as craxy
- Others may find the label “depression” morally unacceptable, shameful, and experientially meaningless
? of people w MH problems are cared for within primary care
90
PC uses ? of total expenditure on MH
10
Which proportion of GP appoinments are mental health related?
40%, has risen since the pandemic started
assessments for disturbed, suicidal or agitated people?
- psychosocial needs - social needs like home environment, recent life events, history leading to the thoughts of self harm
- psychological and physical needs - MH disorders, miuse of recreational drugs and/or alcohol
factors that increase the person’s risk of depression/ self harm?
- hopelessness
- features of depression
- features suggestive of suicidal intent - evidence of planninf, changes to will, precautions taken to prevent rescue
Features that make a person higher risk of suicide/ self harm?
- features associated with risk - male sex, physical health problems, low SES, high-risk employment (such as farmers or healthcare professionals)
management of a person at risk of suicide/ self harm?
- prevent access to means of self harm
- written and verbal info for the person and their family
- ensure all members of MDT are kept informed
what does counselling involve?
- involves the patient talking about their feelings and emotions with a trained therapist
- the therapist can help the patient gain a abetter understanding of their feelings and thought processes
counselling is ideal for people who are?
coping with a current crisis such as anger, bereavement, interftility etc
what is behavioural activation?
- talking therapy that aims to help people with depression take simple, practical steps towards enjoying life again.
- The aim is to give you the motivation to make small, positive changes in your life.
BA also involves teaching the person…
problem-solving skills to help them tackle problems that are affecting their mood
problem solving therapy is aimed at?
improving an individual’s ability to cope with stresful life experiences
what is the underlying assumption of problem solving therapy?
- The underlying assumption of this approach is that symptoms of psychopathology can often be understood as the negative consequences of ineffective or maladaptive coping.
PST aims to help individuals adopt a ?
realistically optimistic view of coping, understand the role of emotions more effectively, and creatively develop an action plan geared to reduce psychological distress
PROBLEM SOLVING THERAPY
interventions in PST?
psychoeducation, interactive problem solving exercises and motivational homework assigments
mental illness with the highest mortality rate?
EDs
women: men ratio in anorexia?
10:1
anorexia - MDT approach when?
there is comorbid physical or mental illness
feeding against will?
- last resort
- should only be done in the context of the Mental Health Act 1983 or Children Act 1989.
lifetime female prev of bulimia?
2%
bulimia occurs across all?
socioeconomic groups
Female: male ratio in bulimia?
- female:male 10:1 although incidence in men is increasing
- common in adolescent and young adulthood
RF for bulimia
core features of bulimia?
- regular binge eating, loss of control eating during binges
- attempts to counteract the binges
- BMI > 17.5kg/m2
- Preoccupation with weight, body shape and body image
- Preoccupation with food & diet.
physical symptoms of bulimia?
- bloating & fullness
- lethargy
- heartburn & reflux
- abdominal pain
- sore throat & dental problems
what is common with bulimia?
- mood disturbances, anxiety, low self esteem and self harm are common with bulimia
- depressive symptoms are more common than anorexia nervosa
Bulimia - prognosis?
80% make full recovery without Tx
? of bulimia patients go on to develop anorexia
10-15%
? has the highest mortality rate - deadliest psychiatric condition
anorexia
causes of death with EDs?
- suicide - always screen for mood disturbances and also suicide risk
- medical complications - heart failure, fatal arrhythmias, severe dehydration/ malnourishment, multi-organ failure
screening questionnaire for EDs?
SCOFF questionnaire
SCOFF questionnaire?
- do you make yourself Sick because you feel uncomfortably full?
- do you worry that you have lost Control over how much you eat?
- have you lost more than One stone in a 3-month period?
- Do you believe yourself to be Fat when others say you’re too thin?
- Would you say Food dominates your life? (2+ indicate likely case of anorexia or bulimia)
Capacity is related to a patient’s ability to:
- understand information relevant to the specific decision;
- be able to understand the nature of their illness and understand the implicationsof non-treatment
- be able to rationally weigh up the pros and cons of treatment;
- thus make an informed decision regarding their management and communicate their
decision.
new MCA (2005) means
- under the new MCA (2005) people lacking capacity may be treated if it’s in their best interest
treating people without capacity:
- needs to be the least restrictive option
- is not depriving them of their liberty
- there is no advanced refusal or objection by a done or court of protection.
anorexia and MH act?
- Treatment of people with severe anorexia nervosa who are not consenting to treatment for their mental disorder will in most cases require use of the MHA as it involves deprivation of liberty and compulsory refeeding.
for people lacking capacity, emergecy treatment can be performed under ?
- For people lacking capacity, emergency medical treatment can be performed under Common Law.
- Non-emergency treatment for a physical condition not related to the eatingdisorder may be performed under the MCA 2005.
16-18 year olds who are refusing Tx?
- treatment for 16-18 year olds who are refusing treatment - parental conset cannot be used as authority to treat
EDs in males ?
- later age of onset
- typically higher rates of obesity pre-onset
- Often a fixation on body shape or type rather thanweight. e.g. ‘to be muscular’
- More likely to see excessive exercise
3 phases of adolescent focused therapy?
- Alliance and mutual understanding of AN
- Enhancing independence from parents
- Develop strategies to deal with the tasks of adolescence
- AFT less effective and takes longer than FBT
family based therapy/ maudsley model - 4 phases?
1 - Acknowledging state of starvation, focus on refeeding, emphasis on parental control
2 – Continued focus on weight gain, starting to shift responsibility
3 – Weight maintenance, focus on family relationships, develop family strengths
4 – Relapse prevention, endings
Family therapy?
- views the problems as relational not individual
- externalisation of the ED
- non-blaming, unifies the family and shares responsibility
- family is best positioned to find their own solutions
Developmental theories of ED?
- features preceding the onset of EDs which are present in childhood
- childhood perfectionism
- individuals with both constrained (anorexia) and disinhibited (bulimia) eating share the personality trait of high harm avoidance.
- impulsivity & binge eating
- compulsivity and anorexia
Genetic predisposition in ED?
- genetic predisposition - relatives of those diagnosed with an eating disorder are up to 6x more likely to develop an ED
sociocultural theory of ED?
- Eating disorders are overwhelmingly found in Western countries where there is a heavy emphasis on thinness- a core feature of eating disorders.
- It is also found in countries where food is in abundance as in places of deprivation, round figures are more desirable
SLT in development of EDs?
- During childhood, children encode the behaviour of their role models (e.g., celebrities or parents),imitatingit.
- They do not imitate all behaviour, but if it isreinforcedor is the generally accepted opinion of society, they are likely to replicate it.
- Society and the media perceive ‘skinnier’women and ‘muscular’ men as more attractive.
family in ED?
- one of the strongest external contributors to maintaning EDs
- often family members are praised for their thiness
- maintains maladaptive eating behaviours
- Families that emphasize thinness or place a large emphasis on physical appearance are more likely to have a child diagnosed with an eating disordeR
personality in ED - perfectionism?
- Perfectionism - especially for anorexia
- perfectionism magnifies normal body imperfections, leading an individual to go to excessive (i.e. restrictive) behaviors to remedy the imperfection
Personality in ED - self esteem?
Self esteem - Low self-esteem not only contributes to the development of an eating disorder, but is also likely involved in the maintenance of the disorde
transdiagnostic model of ED?
suggests that overall low self-esteem increases the risk for over-evaluation of body, which in turn, leads to negative eating behaviors that could lead to an eating disorder
Using the MH act and compulsory treatment ?
- If a person’s physical health is at serious risk due to their eating disorder, they do not consent to treatment, and they can only be treated safely in an inpatient setting
*
Child or young person without capacity?
if physical health is at serious risk and they do not consent to treatment, ask their parents or carers to consent on their behalf and if necessary, use an appropriate legal framework for compulsory treatment (such as the Mental Health Act1983/2007 or the Children Act1989).
Causes of MCI?
- early dementia
- physical health problems like COPD
- medication side effects e.g. anti cholinergics or meds that cause drowsiness
- MH problems
Prevalence of MCI?
- between 5% and 25%
NICE - at risk groups for delirium?
- 65+
- prev history of cognitive impairment/ suspected cognitive impairment
- current hip fracture
- severe illness
STOPP criteria
- STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) aims to reduce the incidence of medicines-related adverse events from potentially inappropriate prescribing and polypharmacy.
START criteria?
- START (Screening Tool to Alert to Right Treatment) can be used to prevent omissions of indicated, appropriate medicines in older patients with specific conditions.
MHA states that (capacity?
- MHA states that a person must be assumed to have capacity unless it’s established that they lack capacity
- However, if a person is at imminent risk of suicide there may well be sufficient doubts about their mental capacity at that time.
- practitioners need to act in the patients best interests - this may involve sharing critical information
Mental capacity act 2005 ?
- a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.
MCA - a person is unable to make decisions for himself if he is unable to:
- (a)to understand the information relevant to the decision,
- (b)to retain that information,
- (c)to use or weigh that information as part of the process of making the decision, or
- (d)to communicate his decision (whether by talking, using sign language or any other means).
Effects of dementia on carers?
- guilt - losing temper, not wanting the responsibility, feelimg embarassed about the person’s off behaviour
- grief and loss - loss of the future they planned together
- anger - at the person, having to be a carer, angry at lack of support
- exhaustion
support for carers - carers assessment?
- needs assessment used by the LA to decide which support their eligible to receive
- works out your abilities and how they affect your caring role
- and your needs and which level of support is needed
support for dementia on medical issues?
- GP, social services, occupational therapists to support and advise on medical issues
local support groups for dementia carers?
- local support groups - local Alzheimer’s Society office, Age UK and Carers UK.
online discussion forums for carers?
- online discussion forums - practical suggestions and letting of steam - e.g. Talking Point
therapy for carers?
- talking therapies such as CBT
booklets for carers?
- booklets such as Caring for a person with dementia from alzheimer’s.org.uk for practical support
support that the LA can offer a carer?
- homecare visits
- adaptations to the home
- respite care
- support from professionals, such as a dementia specialist nurse
- support groups
residential homes provide accomodation and personal care such as help w:
- washing
- dressing
- taking medicines
- going to the toilet
nursing homes?
- These also provide personal care but there will always be 1 or more qualified nurses on duty to provide nursing care.
- Some nursing homes offer services for people that may need more care and support.
who are nursing homes for?
- severelearning disabilities, severe physical disabilities or both
- a complex medical condition that needs help from a qualified nurse
NHS LTP for older ppl?
- the NHS long term plan will ensure consistent access to mental health care for older adults with functional needs (i.e. depression, anxiety and severe mental illnesses).
- NHS talking therapies for anxiety and depression which need to meet the needs of older patients
NHS LTP - community based teams
- Community-based mental health crisis response teams will work closely with ‘physical health’/Ageing Well Urgent Community Response services to provide coordinated rapid response, assessment, admission avoidance, and discharge support functions for older people
what are community MH teams?
- support people w mental health problems but also their carers
community MH teams involve?
- a community psychiatric nurse (CPN), a psychologist, an occupational therapist, a counsellor and a community support worker, as well as a social worker.
- one member is appointed as a care coordinator and keeps in contact to help plan care
social/ community care?
- social care is support to carry out day to day tasks
- e.g. managing money or improving relationships
- can be referred or contacted directly
supported housing?
- if the person is finding it difficult to manage in their own home and needs more support
- can be:
- support in their own home
- supported housing and group homes
- short stay supported housing
support in ur own home
floating support?
- benefits
- budgeting
- accessing care, local activities, education, training or advocacy.
- often run by charities
community care or home help?
- social services offer them a home
- care workers might help with things like household tasks, preparing meals and taking medication.
- social services do an assessment on how much help you need
short stay supported houses - crises houses?
- They offer short-term housing and are an alternative to going into hospital
epidemiology of schizophrenia?
- one in 100
- ages 15-45, but may develop at any age
men tend to develop schiz ?
- males and females equally affected but men tend to develop it earlier at around 20 but women 30
genetics of schiz?
- Genetics- high genetic linkage to schizophrenia.
- One parent with Schizophrenia 10% lifetime(10% increased chance if you have member of family with the condition.
environmental insuts and schiz?
winter or spring births and infections, obstetric complications
personality inc schiz risk?
- Personality – person with underlying Schizotypalpersonality disorder.
stress and schiz?
- upbringing and stressful life events - increased risk of relapse rates
- social stresses - social drift hypothesis
cannabis and schiz?
- substance miuse - heavy cannabis intake at 18 associated w inc risk of psyhcosis
structural brain abn and schiz?
Decreased cortical volume,enlarged ventricles, hypo frontality (associated with negative symptoms and autism.
prognosis of schiz?
- 1/3 make complete recovery
- 1/3 experience recurrent episodes of psychosis with some degree of social disability
- 1/3 may remain chronically disabled.
features indicating good prognosis?
- abrupt onset,
- an absence of prodromal disturbances,
- onset in midlife,
- presence of identifiable life stresses,
- absence of blunting/flat affect
- and/or early treatment
schizophrenia involves disruptions in the following dopamine pathways:
- mesolimbic pathway
- mesocortical pathway
- nigrostriatal pathway
- tuberoinfundibular pathway
CBT for schiz?
- psycho-education
- family therapy
Psycho-education?
accepting the illness, addressing routine/activity scheduling, sleep hygiene, breathing techniques, mindfulness
family therapy for schiz?
- awareness of relapse symptoms, supporting structure, looking after the patient
social interventions?
- rehabiliation
- social support
rehabilitation?
- Return to education/work, re-establishing family functioning, management of substance-misuse etc.
social support for schiz?
- Housing & Accommodation Issues, Access to benefits etc.
approach for chronic enduring psychosis
CPA - Care Programme Approach
First rank symptoms of schiz?
- auditory hallucinations:
- hearing thoughts spoken aloud
hearing voices referring to himself / herself, made in the third person - auditory hallucinations in the form of a commentary
- thought withdrawal, insertion and interruption
- thought broadcasting
- somatic hallucinations
- delusional perception
- feelings or actions experienced as made or influenced by external agents
epidemiology of schizophrenia?
- 1% lifetime prevalence of schizophrenia
- incidence: around 15 new cases per 100000 per annum
onset of schiz: the prodome?
- begins in young adulthood
- Children who go on to develop schizophrenia often have subtle premorbid motor, linguistic and social dysfunction
- Gradual functional decline: fall off in school/college, loss of friends, odd behaviours, ideas, beliefs etc
- May go on for months or years
stigma =
refers to a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses.
common/ case law is ?
the development of legal standards that have been tested in a court of law over time.
statute law =
law passed by Acts of Parliament.
common law?
*A person with a mental illness is an autonomous individual, ie is presumed to have capacity to consent to or refuse treatment, unless it is shown to be otherwise.
To have capacity to give informed consent a person must be able to:
–Understand the information given
–Retain that information long enough to make a decision
–Weigh it in the balance free from either internal or external pressures
–Communicate the decision
mental capacity act?
- enshires principals of common law as regards to the treatment of persons who lack capacity into statute law
Mental Health Act (1983)?
- The MHA allows for assessment, treatment and in-patient care for persons with a mental disorder and governs the procedure by which that care is given.
- The use of the Mental Health Act is not determined by an assessment of capacity, but rather by the presence or absence of a mental disorder.
suicide risk in schiz?
- to oneself - about 10-15% suicide risk in schizophrenia
- particularly high in young, educated people early in the course of their illness.
risk to others in schiz?
- to others - risk of violence, minor aggression
other risks w schiz?
- self neglect - due to postive and negatve symptoms
- vulnerability of patients to stigma
RF for schiz?
- Family history
- Social isolation
- Migrants
- Family problems
- Heavy cannabis use in adolescence
- Intrauterine and perinatal complications
- Intrauterine infection, particularly viral
- Abnormal early cognitive/neuromuscular development
red flags in schiz - suicidal thoughts?
- Severe social problems
- Self-neglect
- Hallucinations, especially command in nature
- Passivity phenomena
For section 2, a person is unable to make a decision for himself if he can’t:
(a) to understand the information relevant to the decision,
(b) to retain that information,
(c) to use or weigh that information as part of the process of making the decision, or
(d) to communicate his decision (whether by talking, using sign language or any other means).
rehabilitation for psychosis is for thos w ?
- for those w complex psychosis
- treatment resistant psychosis
- recurrent admissions or extended stays
principles of rehabilitation for psychosis?
- recovery-orientated approach - shared ethos and agreed goals, sense of optimism and aims to reduce stihma
- deliver individualised, person-centred care through collaboration and shared decision making
rehab for psychosis - be offered the ? envir?
- be offered in the least restrictive environment and aim to help people progress from more intensive support to greater independence
- recognise need for supported accomodation
MDTs for psychosis rehabiliatation services - who is involved??
- rehabilitation psychiatrists
- practitioner psychologists
- nurses
- occupational therapists
- social workers
- support workers (including peer support workers)
- specialist mental health pharmacists.
programmes and interventions for psychosis should develop a ? and offer ? group activities?
- services should develop a culture that promotes improving daily living skills
- offer structured group activities (social, leisure or occupational) aimed at improving interpersonal skills.
interventions that can be offered for psychosis rehab?
- educational opportunities such as recovery colleges
- substance misuse interventions
managing relapse?
- Risk of harm to the person - self harm, suicide, accidental injury, command hallucinations
- level of family/ social support
- Timing — be aware that the highest risk of suicidetends to be around the time of a psychotic episode and shortly after hospital discharge.
risk - history?
- Previous violence, whether investigated, convicted or unknown to the criminal justice system
- Relationship of violence to mental state
- Lack of supportive relationships
- Poor concordance with treatment, discontinuation or disengagement
- Impulsivity
- Alcohol or substance use, and the effects of these
- Early exposure to violence or being part of a violent subculture
- stable RF or a change in them?
- evidence of recent stressors, losses or threat of loss
- Are the family/carers at risk? History of domestic violence
- Lack of empathy
risk - envir?
- risk on release from restricted settings
- Access to potential victims, particularly individuals identified in mental state abnormalities
- Access to weapons, violent means or opportunities
- Involvement in radicalisation.
risk - mental state?
- Evidence of symptoms related to threat or control, delusions of persecution by others, or of mind or body being controlled or interfered with by external forces, or passivity experiences
- Voicing emotions related to violence or exhibiting emotional arousal (e.g. irritability, anger, hostility, suspiciousness, excitement
- Specific threats or ideas of retaliation
- Grievance thinking
- Thoughts linking violence and suicide (homicide–suicide)
- Thoughts of sexual violence
- Evolving symptoms and unpredictability
- Signs of psychopathy
- restricted insight
rates of S across ethnic groups?
- rates of psychotic disorders like schizophrenia can be as much as 5x higher in some ethnic minority groups such as people of black Caribbean or African heritage in the UK.
- Ethnic minority status was associated with more than double the odds of psychotic disorders.
what can explain the inc risk of psychosis in ethnic minorties?
- Linguistic distance from the majority group, and social disadvantage, were both associated with nearly double the odds of psychosis, which appeared to mostly explain the increased risk faced by ethnic minority groups
culture and schiz diagnosis?
- variation between countries when it comes to diagnosing schizophrenia - overdiagnosis due to ethnic background
culture - acceptance of S symptoms in certain cultires?
- One issue is that positive symptoms such as the hallucination or hearing voices may be more acceptable in African cultures because of cultural beliefs in communication with ancestors, and therefore people are more ready to acknowledge such experiences - when reported to psychiatrists this is seen as abnormal, ethnocentric approach
culture - over-interpretation of symptoms?
- over-intrepretation of the symptoms of black people during diagnosis - cultural differences in language and mannerisms, difficulties in relating between black patients and white therapists,
schiz diagnosis - age?
- most commonly diagnosed between the ages 15-35
- women tend to present when older (peak in the late twenties, compared to a peak in the early twenties in men).
preventing psychosis - referral to specialist services in patients who are distressed with declining social function and:
- Transient or attenuated psychotic symptomsor
- Other experiences or behaviour suggestive of possible psychosisor
- A first-degree relative with psychosis or schizophrenia
Role of EIPs?
- EIP teams are often the first group to review patients with a new episode of psychosis or schizophrenia.
- The teams consist of psychiatrists, psychologists, community psychiatric nurses, social workers and support workers.
high vs low risk of harm w a psychotic disorder?
- high risk of harm: same-day mental health assessment by the early intervention in psychosis
- not at high risk of harm: EIP team
common law principles which may be used to provide emergency care and treatment to patients that lack capacity:
- necessity
- duty of care
common law allows?
- allows anyone to take reasonable and proportionate action to prevent immediate significant harm to others
- applies whether or not he has capacity
principles of common law?
- in an emergency, when it’s not possible to find out a patient’s wishes, you can treat them without their consent
- provided the treatment is necessary to save their life or prevent a serious deterioration of their condition
- must be the least restrictive of the patient’s future choices
under common law, it’s acceptable to act in a patient’s best interests if:
- the care and treatment is urgent and there is not time to consider the use of alternative legislation (e.g. the patient is unconsious and requires immediate treatment)
- care and treatment is necessary to save their life or prevent serious deterioration
section II?
- Admission for assessment
- 2 doctors need to make the recommendation
- lasts for a maximum of 28 days
at any time during a section 2, a patient can be put on
a section 3
section 3?
- Admission for treatment
- long term civil section
- An AMHP makes an application for admission, based on the recommendations of two medical practitioners.
duration of a section III?
- The initial period for which detention is authorised is six months, but it can be renewed by the RC for a further six months, then for further periods of 12 months.
Section IV?
- used when it is of urgent necessity for the patient to be admitted and detained under section 2
- It is similar to s2, but differences include that only one medical recommendation is required, and it lasts up to 72 hours
Section V?
- holding powers
- A nurse of the specified class may detain certain inpatients for up to 6 hours, and a doctor may detain inpatients for up to 72 hours.
SECTION 136?
- police
- allows them to take and keep a patient at a place of safety
- can do this without a warrant if:
- you appear to have amental disorder, AND
- you are in any place other than a house, flat or room where a person is living, or garden or garage that only one household has access to, AND
- you are “in need ofimmediate care or control” (meaning the police think it is necessary to keep you or others safe).
how long can police keep a person under section 136?
- police can keep the patient in a place of safety for up to 24 hrs which can be extended for another 12 hours if it was not possible to assess you in that time.
community treatment orders?
- CTO is an order made by yourresponsible clinicianto give you supervised treatment in the community.
- This means you can be treated in the community for your mental health problem, instead of staying in hospital.
- But your responsible clinician canreturn you to hospitaland give you immediate treatment if necessary
- comes with certain conditions like living in a certain place or going to appointments
how long does a CTO last?
- last 6 months from date of order
- You can only be put on a CTO if you are in hospitalunder certain sections,and ifcertain criteria are met.
when can a CTO be made?
- section 3
- section 37 hospital order
- Unrestricted transfer direction under section 47 (Notional section 37)
Who can’t be put on a CTO:
- You are under sections 2, 4 or 5
- You have already been discharged from your section.
Criteria for a CTO?
- You are suffering from amental disorderfor which you need to receive medical treatment.
- You need to receive this medical treatment for your health or safety, or for the protection of others.
- You can receive this treatment without needing to be detained in hospital.
- Your responsible clinician needs to be able to recall you to hospital if necessary.
- Appropriate medical treatmentis available for you in the community
what are the human rights?
- right to life
- right not to be tortured or treated in a inhuman or degrading way
- right to liberty
- right to respect for private and family life. home and correspondence
- right not to be discriminated against
- Right to freedom of thought, conscience and religion
- Right to peaceful enjoyment of possessions
right to life?
- If people with mental health/capacity issues have their physical health needs ignored which could risk their life
right to be free from inhuman or degrading treatment?
- neglect or lack of care leading to serious harm or suffering
- a person presenting a risk of serious self-harm or harming others including staff and others using the service
- failing to provide treatment to reduce serious harm experienced by the person
right to liberty?
- decisions preventing a person from leaving a place (such as a care home or hospital) and ensuring the correct processes are followed
- when a person requires constant supervision or monitoring and ensuring they have access to the relevant safeguards
restricting the right to liberty?
- this right can be restricted but only in specific circumstances e.g.
- detaining a person under the MA
- depriving a person of their liberty under theMental Capacity Act either where
the right to not be tortured?
- not to be treated in a way that causes intense physical or mental suffering
- This could include police violence, poor prison conditions, or neglect or abuse in a care home
which AP carry high risk of weight gain?
Olanzapine and Clozapine
when does neuroleptic malignant syndrome occur?
commonly occurs due to initiation of anti-dopaminergic medication or withdrawal of dopamine agonists. S
what is secure attachment?
Support mental processes that enable the child to regulate emotions, reduce fear, attune to others, have self-understanding and insight, empathy for others and appropriate moral reasoning
insecure attachment?
If a child cannot rely on an adult to respond to their needs in times of stress, they are unable to learn how to soothe themselves, manage their emotions and engage in reciprocal relationships.
when is attachment behaviour most prominent?
6 and 36 months
differential smiling at ? months
6 months
stranger anxiety at ? months
9 months
factors promoting attachment ?
- maternal sensitiity
- warmth
- emotional responsiveness
- involvement
- reciptocity
what is secure attachment (3)
◦Secure base effect, distressed on separation, greets positively on return
insecure attachment (4)?
◦ Difficult to settle/angry/ ignores on reunion
◦ Explores with no anxiety,
◦ Little distress on separation, ignore on reunion
◦ Fear of or for the care giver
insecure attachment is often associated w?
poor parenting/ abuse
Assessment of attachment?
- Behaviours on separation and reunion
- Patterns of comfort seeking when hurt/ upset
- Reliance on caregivers when help needed
- Affection shown to caregivers
- Exploratory behaviour in different settings
- Co-operativeness
- Controlling behaviour (seeking to control caregiver)
Factors presenting risk to the quality of attachment between child and parent:
- Poverty
- Parental mental health difficulties
- Exposure to neglect, domestic violence or other forms of abuse
- Alcohol/drug taking during pregnancy
- Multiple home and school placements
- Premature birth
- Abandonment
- Family bereavement
secure attachments constitute ?
65%
child’s behaviour in secure attachment?
- explores room
- actively distressed if mother leabes
- positive reunion and accepts comfort eaily
- more confident and with positive self esteem
mother’s behaviour in secure attachment?
- seen as available
- dependable and warm
- responsive to child’s cues, quick
anxious attachment constitutes ?
10-15%
child’s behaviour in avoidant attachment?
- not distressed by mother leaving
- avoids mother on return, focusing on environment
- has learnt to suppress behaviours normally used to alert mothers
mother’s behaviour in avoidant attachment?
- rejecting angry hostile if child makes demands in stresful situation
ambivalent/ resistant attachment constitutes?
8-10%
what is the child’s behaviour like in ambivalent/ resistant attachment?
- very distressed when mother leaves
- ambivalence on return both seeking comfort and then rejecting/ resisting on reunion
mother’s behaviour in ambivalent attachment?
- inconsistent care giving
- unresp and insentive to childs needs and demands
disorganised attachment constitutes ?
15-19%
disorganised attachment behaviours?
- contradictory behaviours strong proximity seeking and strong avoidance
- distress, anger, freezing and stereotypes
mother’s behaviour in disorganised attachment?
- frightened or frightening
- abusive
management of attachment difficulties?
- psychoeducation
- formulation of difficulties
- liason w other agencies
- systemic work w whole family
conduct disorders?
- > 6m duration
- Umbrella term, range of behavioural difficulties inc. CD and ODD
- At the most severe end will involve antisocial and criminal acts
higher rates of conduct disorders in?
adhd and autism
opositional defiant disorder?
younger children; defiant, disobedient, disruptive but not aggressive or antisocial behaviour
management of behav and conduct disorders?
- prevention
- psychoeducation
- family therapy
- parenting support via social care
- Parenting interventions have evidence for 11 and under; child-focused groups recommended for older children but often not available
emotional disorders?
- includes anxiety disorders
- depressive disorders
- mania
- bipolar
higher ates of emotional disorders in?
girls
precipitating factors for emotional disorders?
- bullying
- school transitions
- exams
- house moves
- physical illness
- parental separation
- frienship problems
- new step parents
- domestic discord
- bereavement
CBT model of anxiety
prev of self harm in adolescence?
- prev of 5-15%
- peaks in adolescent years and early 20s
- higher rates in females
RF for self harm?
- disputes - parents, peers, siblings
- difficulties w relationships
- school problems
- physical ill health
- prev history of abuse
- intercultural stresses
- depression
- bullying
- sexual problems
- alc and drug use
- awareness of self harm by friends/ family
factors associated w inc suicide risk?
- Conducted in isolation
- Timed so that intervention was unlikely
- Precautions to avoid discovery
- Preparation in anticipation of death e.g. giving things away
- Act considered for hours/days beforehand
- Suicide note
- Adolescent told others beforehand about thoughts of suicide
- Or, they did not alert others
strategies to keep self harming children safe?
- Strategies that help when upset/distressed.
- Talking with an understanding adult.
- Ringing a helpline.
- Going to see a GP/ CAMHS professional.
- Speak to parents or guardians about how they can help to keep that young person safe.
Common characteristics of adolescents who die by suicide
- Broken home (separation/ divorce/ death).
- Family psychiatric disorder or suicidal behaviour.
- Psychiatric disorder or behavioural disturbance.
- Substance misuse.
- Previous self-harm (~¼ to ½ of suicides have previously self-harmed)..
- Older male teenagers.
- Violent methods of self-harm.
red flags in self harm?
- Current suicidal thoughts
- Previous suicide attempts
- Detailed plans of how to carry out self harm
- Suicide note
- Depression, anxiety, psychosis and other mental illness
- Feeling of hopelessness
- Poor social support
- Family history of self-harm or suicide
- Child in care
CAHMS?
- service for young people up to 18yrs
- works w families and young people
CAHMS liases w other agencies like?
social services, education, voluntary sector, health
referral process to CAHMS?
- SPA - single point of access - call from GP or self referral
- triage system
- then referred to main CAHMS
Tier 1 in CAHMS?
primary care, early intervention: GP, HV
Tier 2 at CAHMS?
individual CAMHS therapists at LTs
Tier 3 at CAHMS?
specialist teams, community teams
Tier 4 at CAHMS?
tertiary services, inpatient service, dead service
What are some tier 3 teams?
- eating disorder teams
- family therapy
- ASD and ADHD
- CAHMS crisis team
- psychosis pathway w the EIT
CAHMS crisis team?
- works at hospital 24/7
- assesses young people who self harm who are admitted to hospital
- complete risk assessment and follow up intevention
- team meet to discuss cases, interventions but also offers home based treatment
MDT at CAHMS?
- MDT assessment, diagnpsis, risk assessment, formulatiom, treatment planning
benefits of MDT working?
- skill mix - EBD treatment
- shared responsibility and knowledge
- sharing of skills
- range of interpersonal approaches
- supervision and support
6 weeks - gross motor milestones?
- good head control - raises head when on tummy
- stabilises head when raised to sitting position
6 weeks - fine motor/ vision?
- tracks objects/ face
6 weeks - speech/ language?
- stills, startles at loud noise
6 weeks - social?
- social smile
6 months - gross motor?
- sit without support, rounded back
- rolls tummy (prone) to back (surprise)
6 months - fine motor?
- palmar grasp
- transfer hand to hand
6 months - language/ speech?
- turns head to loud sounds
- understands bye
- babbles (monosyllabic)
6 months - social?
- puts objects to mouth (stops at 1 yr)
- reaches for bottle/ breast
3 months - gross motor?
head control
3 months - fine motor?
reaches for objects, fixes and follows
3 months - hearing and lanuage?
cries, laughs, vocalises (4 months)
social at 3 months?
laughing
gross motor @ 9 months?
- sits alone
- crawls
9 months - fine motor and vision?
pincer grip - 9 to 12 months
9 months - language?
inappropriate sounds
9 months - social?
stranger anxiety
12 months - gross motor?
stands alone
12 months - fine motor?
pincer grip
12 months - speech?
- babbles, understands simple commands
- says Mamma/ Dadda
12 months - social?
- social: socially responsive
- wave bye
18 months - gross motor?
walks alone
18 months - fine motor?
uses spoon
18 months - language?
uses words
18 months - social?
stranger shyness, tantrums
2 years - GM?
- runs
- stairs (2 feet per step)
2 years - fine motor?
circ scribbles and lines
2 years - social?
knows identity, parallel play
3-4 yrs: gross motor?
- stand on one foot
- stairs (1 foot per step at 3)
3-4 yrs - fine motor?
builds bridge w bricks
3-4 yrs - hearing and language?
short sentences, knows colours
3-4 yrs: social?
interactive play
5 yrs: GM?
skips/ hops
5 yrs: fine motor?
full drawings
5 yrs: hearing and language?
fluent speech
5 yrs: social?
dresses self
how do children learn?
- children learn by observing, family members and caregivers are also the main influencers that determine how a child will socialize and learn—contributing to their overall physical, social and intellectual development.
what do CAHMS offer - therapy?
- Talking therapies - 1 on 1
- group therapy
- family therapy
what do CAHMS offer - other?
- creative therapy - using arts to explore feelings with a creative therapist
- medication - advising on drugs and prescribing them
- inpatient hospital care
- physical checks and medical reviews
- crisis support
CBT in cahms?
- helps them overcome negative thoughts, unhelpful behaviours, difficult emotions
- low self esteem, depression, anxiety, OCD, PTSD
Family therapy in CAHMS?
- helps families work together to improve relationships and support each other in finding solutions to problems resulting from mental health difficulties
support and services available to carers of children with autism spectrum disorders?
- physical help - such as assistance in the home, help with gardening, help with laundry
- other forms of support - such as trips/holidays, travel assistance, training, or short breaks (see below for more information about short breaks).
- a direct payment so you can purchase agreed services or items yourself
Short breaks for carers?
- respite
- break from caring responsibilities
- home-based respite care – eg a sitting service for a few hours a week or a personal assistant to stay overnight
family based short term respite care?
this is where a disabled person is linked with a family who they then go to stay with on a regular basis
other types of short breaks?
- after school clubs
- centre-based short term residential care
early bird for autism?
- for parents whose child has received a diagnosis of autism and is aged under 5
- The programme aims to support parents in the period between diagnosis and school placement, empowering and helping them facilitate their child’s social communication and behaviour in their natural environment.
- It also helps parents to establish good practice in supporting their child at an early age.
early bird helps parents…
understand autism and develop ways of interaction and communication
early bird - parents will have weekly?
commitment of a two-and-a-half hour training session or home visit, and to ongoing work with their child at home.
early bird plus?
- 4-9
- The programme aims to promote a consistent approach across setting e.g. home and school, by encouraging parents/carers to attend the sessions with a professional who is working regularly with their child.
- aims to build parents confidence to problem solve
teen life?
- 6 session programme
- aged 10-16
the teen life programme?
- The Teen Life programme aims to empower parents and supporting professionals to understand more about how autism is experienced by autistic teenagers.
- Topics covered include understanding autism in teenagers, women and girls, self-esteem, spending time with other people, stress and anxiety, behaviour, puberty, independence skills, education strategies and planning for the future.
what does teen life aim to do?
- aims to bring parents together to share info, experiences and ideas in a structured way
- emphasises importance of autistic perspectives
national charities?
- national autistic society
- ambitious about autism
Search
local support groups for autism?
- search using the national autistic society services directory
social media and forums for autism?
- online groups - e.g. national autistic society facebook group
- groups ran by autism charities
- forums - national autistic society community
local offer?
- people under 25 can ask their local council about their local offer - support they provide for young people with special educational needs.
- every council has one
role of schools in MH?
- mental health support teams
- teaching about MH in school
- identifying mental ill health and providing targeted interventions
- prevention - positive school culture
- addressing social deprivation will address one of the root causes of mental illness
role of health visitors in MH?
- offer preventative health promotion
- referral to specialist MH services
- trained to support family relationships
- recognition of early cues and reduction in post natal depression
- specialist health visitors in perinatal and infant mental health
role of social services in MH?
- many social workers have therapeutic training and offer individuals or group therapy to children, young people and their families.
- risk management, community in-reach, safeguarding knowledge
- can refer a child to CAHMS
Role of educational psychologists?
- concerned w children’s learning and development , support schools and the LA to improve the child’s exp of learning
- They use their specialist skills in psychological and educational assessment techniques to help those having difficulties in learning, behaviour or social adjustment
what do EPs help to do?
- they help to understand the child’s strengths and weaknesses and the quality of their learning envir
- encouraging equal access and opportunities to the curriculum for all children
- offering intervention strategies for individuals and organisational situations, for example in schools, classrooms
signs of physical abuse?
- bruises - particularly indicative of abuse if observed in infants and immobile children
- broken/ fractured bones
- burns/ scalds
- bite marks
- The effects of poisoning (e.g. vomiting, drowsiness, seizures)
- Breathing problems from drowning, suffocation, or poisoning
- head injuries
- Seeming frightened of parents, reluctant to return home after school
- Displays frozen watchfulness
- Constantly asking in words/actions what will happen next
- Shrinks away at the approach of adults
signs of online sexual abuse?
- seem distant, upset or angry after using the internet or texting
- spending a lot more/ lot les time online than usual
- be secretive over who they’re talking to
signs of physical sexual abuse?
- bruises
- bleeding, discharge, pains or soreness in their genital or anal area.
- STIs
- pain/ sore throat
- Pregnancy.
- Difficulty in walking/sitting that are not usual for the child.
