Mental Health Flashcards
what are the strengths of ICD-10/DSM categories? (3)
- Standardisation of diagnostic criteria
- Allows epidemiological studies, geographical comparisons of prevalence + incidence
- Alphanumerical format, allows quick referral and easy addition of categories.
what are the limitations of the ICD-10/DSM categories? (3)
- TWO different criteria sets…who uses what?
- Schizophrenia diagnosis relies on many psychotic symptoms, which are a common final pathway in other disease
- Just groups commonly co-existing symptom patterns, without understanding of underlying cause/nature.
what are the roles of an advocate? (5)
- listen to views and concerns
- help explore your options/rights without advising
- give info to help informed decision making
- help you contact people, or contact on your behalf
- accompany and support you in meetings/appointments
what is everyone detained under the mental health act legally entitled to?
professional mental health advocate = Statutory Advocacy
- Independent MH Advocate (IMHA) or an…
- IM Capacity A (IMCA)
- Otherwise can be professional, family, friends, carers or you can be your own (self-advocacy)
- Helps ensure the patient’s opinions + ideas are articulated clearly and taken seriously.
describe the epidemiology of deliberate self harm?
- DSH F>M
- Suicide M>F
- Previous attempts ↑ risk of success x40
- M aged 30-44 yrs are the group in which suicide is most common.
- ↑ common on evenings, weekends, spring + autumn.
- Rates ↑ fastest in western countries
- Eastern Europe – former USSR has ↑est rates
- Presence of these factors influence RISK to others + self ->may manage differently.
what are the sociodemographic risk factors for self harm?
- Male
- Elderly
- ↓Social status
- ↓ Educational status
- Unmarried, separated, divorced, widowed.
- Unemployed/insecure employment
- Students, prisoners, immigrants, refugees
- Farmers, sailors + female doctors
- Lack of social support
what are the clinical risk factors for self harm?
- FHx of MH disorder
- Specific illnesses have ↑er rate: anorexia, severe depression, psychosis, BAD, PD, substance misuse
- Recent post-discharge period
- Previous attempts
- Access to lethal methods
what is the role of GP in the mental health team?
diagnosis + community management
what is the role of CPN in the mental health team?
Talk through problems, offer advice + support, give meds + monitor Fx
what is the role of psychiatrists in the mental health team?
Diagnosis + primary assessment ->prescribe medication
what is the role of OT in the mental health team?
teach skills, help ↑ confidence + independence
what is the role of social workers in the mental health team?
money, housing, childcare
what are the roles of key workers in the mental health team?
manage cases
what is the role of pharmacists in the mental health team?
dispensing meds, expert advice to docs/nurses
describe the relative impact of mental health problems in primary care?
- 1° care – chronic, milder, well-controlled cases - depression, grief reactions, dementia, anxiety, and substance abuse.
- 25% of GP consultations = MH
- 2° care – ACUTE 1° disorder, self-harm/attempted suicide + other crises (i.e. mania), ↑↑risk of suicide + self-harm, forensic cases.
what are the most common illness in primary care?
Mood/affective disorders – dysthymia, depression.
Anxiety – GAD, OCD, panic.
DEPRESSION most common
Conditions that present more acutely ->2° care
what is the impact of race/ethnicity, culture and age on schizophrenia?
- ↑ young men > women
- BME groups ↑
- ↑ in socially disadvantaged groups
- Incidence stable over time (any ↑ could be explained by ethnic make-up of study population)
what is the impact of race/ethnicity, culture and age on affective psychoses?
- M = F
- No evidence for geographical/neighbourhood effects on incidence
- Rest as for schizophrenia
describe the principles underpinning the organisation of UK mental health services?
Cornerstone of care is well structured + coordinated system @ local level:
- Built around individual’s needs + views of users/carers •Rapidly accessible
- Range of services functioning as a system -Sensitive to local needs, resources + culture
how does current UK mental health services differ from the past?
Mainly COMMUNITY-based – formerly psychiatrist @ centre, with long inpatient stay
what is the role of CAMHs?
look after children + adolescents - often eating disorder team
what is the role of the addiction clinic?
Substance misuse specialists, community clinics
what is the role of learning disability sevices?
look after adults and young people
what is the role of liaison psychiatry teams?
mainly work in general hospitals + 1° care – aims to bridge gap between physical + psychological symptoms (i.e. someone with diabetes who’s depressed may benefit from psychological intervention – evidence shows ↑glycaemic control)
what is the role of the assertive outreach team?
community team caring for severe + personality disorders
what is the role of early intervention for psychosis teams?
Deal with 18-35yrs with 1st episode psychosis. Follow-up for years.
what is the role of forensic teams?
work with those who’ve committed serious crimes
what is the role of memory assessment?
old age pyschiatrists, treating + advising upon dementia care.
describe primary health promotion strategies for mental health wellbeing?
- Parenting programmes – for those with children with conduct disorder – prevent ->PD
- Healthy visitor interventions – for women at ↑ risk of postnatal depression
- School-based programmes – preventing violence, bullying, offending + reoffending
- Screening + brief intervention – Alcohol CAGE questions, brief advice
- Debt advice
- Physical activity campaigns
- Anti-stigma campaigns
- Promote well-being + early depression detection at WORK
describe community support for patients suffering from psychiatric disorders in old age?
- CPN + care assistant visits allow people to stay in own home – private or social services funding. Helps relatives, though may be expensive!
- Day centres – available for socialising, provide food + place of contact with MH practitioners
- Respite care – giving carers a break
describe sheltered housing for patients suffering from psychiatric disorders in old age?
Semi-independent living, in apartment complexes with a warden
Often offer group activities + HC worker visits
describe role of nursing homes for patients suffering from psychiatric disorders in old age?
- Highly dependent residents who are unable to care for themselves
- Regular doctor visits + ↑nursing staff compared to other styles
who are carers?
- Women>Men
- 50-64 year old age bracket has highest proportion of carers
- Exist in younger generations
- > impact on early opportunities?
- Highest proportion in more economically deprived areas – poorer health.
- pakistani/Bangladeshi most likely to be carers.
what are the effects of caring on health?
- Carers 2x ↑ likely to report physical/mental health problems
- Relationship breakdown. Co-resident > extra-resident.
- Difficult to establish causal relationship between caring + ill health
- The greatest impact is on emotional + psychiatric health
- Carers don’t have time to look after their own health – put others before them. Neglect physical symptoms -> present late?
what policy and legislation is in place to support carers?
- Carers have right to assessment of OWN needs, despite refusal by recipient of care. Carers must be made aware of this – may be valuable role of doc/nurse/citizens advice
- Carers’ Special Grant: Funding for respite/short breaks
- Assessments must consider carers’ wishes re: employment, education leisure etc. – wellbeing NOT just health
what is the carer’s allowance?
£61.35 pw, taxable – criteria to meet in order to get it:
oCare recipient in middle/higher rate of disability living allowance (DLA) AND
oCaring for at least 35hrs/w
oOver 16
oStudying <21hrs/w etc. ->difficult for students and employed people.
what is the bedroom tax?
oHousing benefit -14% per ‘spare’ room in house.
oBased on couple, 2 same-sex under 16s or 2 mixed-sex under 10s per room. One room allowed one for carer. BUT…
oWhat if couple want to sleep separately due to condition? 3rd room= -14%! State insisting couple must stay together OR classed as ‘under-occupying’.
oDisabled children? May not be feasible for sibling to share?
Gorry case 2012 overturned this for children who are unable to ‘reasonably’ share to severe disabilities.
BUT what if need extra room for storage of large equipment ->‘under-occupying’ -14%
what employment support is available for carers?
Work + Families Act (2006) – carers of adults can request flexible hours.
what practical support is available for carers?
- Moving + handling training • Education – signs, symptoms, natural Hx -> prognosis
- Respite – recipient of care in home/hospice to allow carer a break.
- Social services/Community nursing – cleaning, personal care etc.
what emotional support is available for carers?
counselling, support groups
what is the importance of prevention in child mental health?
•Promote self-esteem and self-efficacy through secure + supportive personal relationships
•Need to ID risk factors in child’s life (unstable home, lack of secure attachment relationships, stressful early life events, ABUSE, FPsycH, Low self-esteem, Learning difficulty)
•Protective factors help individuals to COPE and avoid development MH illness
oSecure attachment relationships
oHigher intelligence
oGood communication skills
oReligious faith
oClear firm + consistent discipline from parent
oWide supportive network of friends + families
what is the role of school in managing child mental health?
- Must train school staff to recognise onset of psychiatric difficulty - ↓ performance, withdrawn, quiet etc. ->talk + advise, teach interpersonal skills + intervene where necessary ->SAFEGUARDING
- Provide report/assessment of behaviour to medical/social services
what is the role of health visitors in managing child mental health?
- Monitor + ID problem at early age, via visiting home + observing interactions with parent
- Help parents cope with child’s mental illness – educate, advise
what is the role of educational psychologists in managing child mental health?
- Assess educational level + suggest interventions to help ↑ learning ability
- Observe behaviour in class -> REPORT
what is the impact of addiction on society, the family and individuals?
- Addiction closely follows levels of criminal activity
* Clinics + provision of medical therapy costs billions each year
what are the harms associated with alcohol?
- deaths and hospital admissions
- crime and disorder
- workplace
- family
describe how alcohol leads to death and hospital admissions?
some conditions wholly attributable to alcohol (Alc. Liver diease), some partially (colon cancer). Impossible to tell if alcohol has caused a partially-attributable illness -> Causal impact of alcohol estimated from epidemiological studies and expressed as Alcohol Attributable Fractions (AAFs) + applied to deaths + hosp admissions.
•slow ↑ in wholly attributed deaths, mirrored by similar pattern in ↑ in alc. Liver disease
•Large ↑ in admissions since 2000 – cost £3.5bn to NHS
describe how alcohol can lead to crime and disorder?
alcohol particularly implicated in violent crimes (assault, domestic violence, robbery, criminal dmg). 50% domestic violence perpetrators alcohol-dependent.
describe how alcohol can impact the workplace?
impact of drunkenness and hangovers on productivity, absence/leave for alcohol-related reasons (10.5m-26m days lost).
describe how alcohol can impact family life?
2.5m adults drinking at ‘harmful level’ (50+ units/week), FX on wider family -> 1.3m children affected by parental alcohol problems (abuse/neglect). Associated argument, violence, debt + relationship problems -> psychological morbidity + ↑ 1° care attendance.
what are the origins of addiction?
- Genetics – way you metabolise + how the drug affects you (we differ in our inherent susceptibility)
- Social – peer pressures, family influence (learned acceptable behaviour)
- Occupation - ↑ in unskilled labourers
- Social stressors – debt, stressful life events
describe the maintenance of addiction?
- Conditioning – taking drug removes negative SEs of withdrawal (-ve reinforcement)
- Physiological – tolerance develops ->need ↑ for same effect
- Psychological crutch – becomes a habitual method of dealing with stress (-ve coping mechanism)
- Social – Peers + socialising become drug-oriented.
how does addiction influence healthcare response?
•Informs treatment modalities pharma – to counteract the physiological FX, psycho – CBT, counselling etc. and social – employment, housing, support groups
describe the role of education in health promotion for alcohol and drug use?
-less effective
•PHSE in schools ->dangers + consequences of alcohol + drug abuse
•TV/radio advertisements – highlighting dangers + RDAs
•Provison of information in GP surgeries, online in 2° + 3° care centres
describe the role of policy in health promotion for alcohol and drug use?
-effective
•Minimum unit pricing + TAXATION
• Restrict availability (i.e. Non for sale after 10pm)
•Restrictions on promotions + placement on the shop floor.
•Stricter licensing laws -> ↓ hours which alcohol is for sale.
• Restrict ADVERTISING
•Get big money OUT OF POLITICS – so that breweries can’t buy politicians + lobby them on how to vote
describe the role of mass media campaigns in health promotion for alcohol and drug use?
•DRINK AWARE – largest campaign in UK, focusses on ‘responsible drinking’, though still encourages drinking
oRun + funded by breweries…
what support and information is available regarding alcohol and drug misuse?
•FRANK – Government education programme
o confidential advice phone line/web chat
oAvailable 24 hours a day
oWebsite good source of information
what is the role of healthcare workers in alcohol and drug misuse?
•ID + brief advice – delivered in a range of environments – CAGE questions
•Hospital alcohol health workers – Hosptial admission/ED = a teachable moment
o Nuse/specialist worker can ‘…implement screening, detox, brief intervention, referral + support other staff.’ (RCP 2001)
•Specialist treatment – CBT etc. etc. etc.
what is the cycle of change?
Rekates to MH as often use drugs/alcohol as a coping mechanism ->this needs to be addressed, HOWEVER underlying MH illness MUST be treated – or relapse ↑↑↑likley
what other agencies are involved with mental health care
- Social services
- GP
- Police
- Charity
- MH trust
- Crisis resolution team
- Comm MH
- Prison service workers
- Social services
- Pt support groups
- Psychologists
