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Health and Society (Year 3) > Mental Health > Flashcards

Mental Health Flashcards

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1
Q

what are the strengths of ICD-10/DSM categories? (3)

A
  1. Standardisation of diagnostic criteria
  2. Allows epidemiological studies, geographical comparisons of prevalence + incidence
  3. Alphanumerical format, allows quick referral and easy addition of categories.
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2
Q

what are the limitations of the ICD-10/DSM categories? (3)

A
  1. TWO different criteria sets…who uses what?
  2. Schizophrenia diagnosis relies on many psychotic symptoms, which are a common final pathway in other disease
  3. Just groups commonly co-existing symptom patterns, without understanding of underlying cause/nature.
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3
Q

what are the roles of an advocate? (5)

A
  1. listen to views and concerns
  2. help explore your options/rights without advising
  3. give info to help informed decision making
  4. help you contact people, or contact on your behalf
  5. accompany and support you in meetings/appointments
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4
Q

what is everyone detained under the mental health act legally entitled to?

A

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.
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5
Q

describe the epidemiology of deliberate self harm?

A
  • 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.
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6
Q

what are the sociodemographic risk factors for self harm?

A
  • 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
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7
Q

what are the clinical risk factors for self harm?

A
  • 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
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8
Q

what is the role of GP in the mental health team?

A

diagnosis + community management

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9
Q

what is the role of CPN in the mental health team?

A

Talk through problems, offer advice + support, give meds + monitor Fx

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10
Q

what is the role of psychiatrists in the mental health team?

A

Diagnosis + primary assessment ->prescribe medication

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11
Q

what is the role of OT in the mental health team?

A

teach skills, help ↑ confidence + independence

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12
Q

what is the role of social workers in the mental health team?

A

money, housing, childcare

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13
Q

what are the roles of key workers in the mental health team?

A

manage cases

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14
Q

what is the role of pharmacists in the mental health team?

A

dispensing meds, expert advice to docs/nurses

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15
Q

describe the relative impact of mental health problems in primary care?

A
  • 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.
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16
Q

what are the most common illness in primary care?

A

Mood/affective disorders – dysthymia, depression.
Anxiety – GAD, OCD, panic.
DEPRESSION most common
Conditions that present more acutely ->2° care

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17
Q

what is the impact of race/ethnicity, culture and age on schizophrenia?

A
  • ↑ young men > women
  • BME groups ↑
  • ↑ in socially disadvantaged groups
  • Incidence stable over time (any ↑ could be explained by ethnic make-up of study population)
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18
Q

what is the impact of race/ethnicity, culture and age on affective psychoses?

A
  • M = F
  • No evidence for geographical/neighbourhood effects on incidence
  • Rest as for schizophrenia
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19
Q

describe the principles underpinning the organisation of UK mental health services?

A

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
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20
Q

how does current UK mental health services differ from the past?

A

Mainly COMMUNITY-based – formerly psychiatrist @ centre, with long inpatient stay

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21
Q

what is the role of CAMHs?

A

look after children + adolescents - often eating disorder team

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22
Q

what is the role of the addiction clinic?

A

Substance misuse specialists, community clinics

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23
Q

what is the role of learning disability sevices?

A

look after adults and young people

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24
Q

what is the role of liaison psychiatry teams?

A

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)

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25
Q

what is the role of the assertive outreach team?

A

community team caring for severe + personality disorders

26
Q

what is the role of early intervention for psychosis teams?

A

Deal with 18-35yrs with 1st episode psychosis. Follow-up for years.

27
Q

what is the role of forensic teams?

A

work with those who’ve committed serious crimes

28
Q

what is the role of memory assessment?

A

old age pyschiatrists, treating + advising upon dementia care.

29
Q

describe primary health promotion strategies for mental health wellbeing?

A
  1. Parenting programmes – for those with children with conduct disorder – prevent ->PD
  2. Healthy visitor interventions – for women at ↑ risk of postnatal depression
  3. School-based programmes – preventing violence, bullying, offending + reoffending
  4. Screening + brief intervention – Alcohol CAGE questions, brief advice
  5. Debt advice
  6. Physical activity campaigns
  7. Anti-stigma campaigns
  8. Promote well-being + early depression detection at WORK
30
Q

describe community support for patients suffering from psychiatric disorders in old age?

A
  • 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
31
Q

describe sheltered housing for patients suffering from psychiatric disorders in old age?

A

Semi-independent living, in apartment complexes with a warden
Often offer group activities + HC worker visits

32
Q

describe role of nursing homes for patients suffering from psychiatric disorders in old age?

A
  • Highly dependent residents who are unable to care for themselves
  • Regular doctor visits + ↑nursing staff compared to other styles
33
Q

who are carers?

A
  • 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.
34
Q

what are the effects of caring on health?

A
  • 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?
35
Q

what policy and legislation is in place to support carers?

A
  • 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
36
Q

what is the carer’s allowance?

A

£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.

37
Q

what is the bedroom tax?

A

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%

38
Q

what employment support is available for carers?

A

Work + Families Act (2006) – carers of adults can request flexible hours.

39
Q

what practical support is available for carers?

A
  • 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.
40
Q

what emotional support is available for carers?

A

counselling, support groups

41
Q

what is the importance of prevention in child mental health?

A

•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

42
Q

what is the role of school in managing child mental health?

A
  • 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
43
Q

what is the role of health visitors in managing child mental health?

A
  • Monitor + ID problem at early age, via visiting home + observing interactions with parent
  • Help parents cope with child’s mental illness – educate, advise
44
Q

what is the role of educational psychologists in managing child mental health?

A
  • Assess educational level + suggest interventions to help ↑ learning ability
  • Observe behaviour in class -> REPORT
45
Q

what is the impact of addiction on society, the family and individuals?

A
  • Addiction closely follows levels of criminal activity

* Clinics + provision of medical therapy costs billions each year

46
Q

what are the harms associated with alcohol?

A
  • deaths and hospital admissions
  • crime and disorder
  • workplace
  • family
47
Q

describe how alcohol leads to death and hospital admissions?

A

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

48
Q

describe how alcohol can lead to crime and disorder?

A

alcohol particularly implicated in violent crimes (assault, domestic violence, robbery, criminal dmg). 50% domestic violence perpetrators alcohol-dependent.

49
Q

describe how alcohol can impact the workplace?

A

impact of drunkenness and hangovers on productivity, absence/leave for alcohol-related reasons (10.5m-26m days lost).

50
Q

describe how alcohol can impact family life?

A

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.

51
Q

what are the origins of addiction?

A
  • 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
52
Q

describe the maintenance of addiction?

A
  • 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.
53
Q

how does addiction influence healthcare response?

A

•Informs treatment modalities pharma – to counteract the physiological FX, psycho – CBT, counselling etc. and social – employment, housing, support groups

54
Q

describe the role of education in health promotion for alcohol and drug use?

A

-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

55
Q

describe the role of policy in health promotion for alcohol and drug use?

A

-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

56
Q

describe the role of mass media campaigns in health promotion for alcohol and drug use?

A

•DRINK AWARE – largest campaign in UK, focusses on ‘responsible drinking’, though still encourages drinking
oRun + funded by breweries…

57
Q

what support and information is available regarding alcohol and drug misuse?

A

•FRANK – Government education programme
o confidential advice phone line/web chat
oAvailable 24 hours a day
oWebsite good source of information

58
Q

what is the role of healthcare workers in alcohol and drug misuse?

A

•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.

59
Q

what is the cycle of change?

A

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

60
Q

what other agencies are involved with mental health care

A
  • Social services
  • GP
  • Police
  • Charity
  • MH trust
  • Crisis resolution team
  • Comm MH
  • Prison service workers
  • Social services
  • Pt support groups
  • Psychologists

Health and Society (Year 3) (6 decks)

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