Navigating Mental Health

Navigating Mental Health
Rebecca Turpin
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Edge Employment Solutions
(BA Psychology Honours)
Conditionally registered psychologist
Aims of this seminar
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To provide information and education about
psychiatric disabilities
To enable individuals to understand what is
needed to provide effective services to people
with a psychiatric disability
To enhance individuals ability to work together
between organisations, and to develop effective
networks in working with people with a
psychiatric disability.
Mental Illness – The basics
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Mental health issues constitute one of the most
serious and perplexing problems we face in
today’s society.
Mental illnesses touches all of us at some time
during our lives. If we are not the ones afflicted,
then it will be a family member, a loved one, a
friend and in our case, a client we are
supporting within the agency.
Some famous and historically
important people who claimed they
heard voices
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Socrates (philosopher)
Moses (prophet)
Jesus (prophet)
Mohammed (prophet)
Joan of Arc (martyr)
Luther (religious leader)
Swedenbourg (philosopher/politician)
John Welsely (founder of Methodism)
Carl Jung (psychologist)
Evelyn Waugh(writer)
Malcolm Lowry (writer)
Zoe Wannamaker (actress)
Philip K. Dick (writer)
Beethoven (composer)
Charlemagne (Emperor)
Caeser (Emperor)
Alexander the Great (Emperor)
Teresa of Avila (religious mystic)
Columbus (discoverer)
Calvin (religious leader)
William Blake (artist)
Jonathan Swift (writer)
Ghandi (politician/ pacifist)
Anthony Hopkins (actor)
Charles Dickens (writer)
Sylvia Plath (poet)
John Paul Sartre (writer)
Virginia Woolf (writer)
Abnormal Behaviour
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Society has explained and treated abnormal behaviour in different
ways in different times.
How a particular society reacts to abnormality depends on the
society’s values and assumptions about human life and behaviour.
For example during the Middle Ages, when a religious point of view
was predominant, abnormality was usually explained in terms of
supernatural causes such as demons, and treatment involved
prayers and various forms of exorcism.
Contrast this with current trends in Western society to which science
is important and in which people have a great deal of faith in the
miracles of modern medicine, abnormal behaviour is considered
evidence of mental illness and is often treated with drugs.
Classification of abnormal
behaviour
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So what is the line between normality and mental
illness?
There is no single definitive widely accepted truth about
what constitutes psychological abnormality.
However there are guidelines for defining abnormality
and practical standards for the formal diagnosis of
disorders.
As you saw earlier, today’s definitions have evolved over
the centuries and have changed even more so within the
last few years with the recovery movement gaining
momentum.
To examine the question of what defines abnormal
behaviour let us pose a number of questions
Does infrequency define
Abnormality?
Does Suffering Define
Abnormality
Does Strangeness Define
Abnormality?
Does the Behaviour Define
Abnormality?
Is normality a guideline?
So what is defined as abnormal
behaviour
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Professionals generally use two practical guidelines to
define abnormal behaviour.
Firstly they take into account the persons behaviour, the
context in which it occurs, and the appropriateness for
that context. In other words they consider whether the
persons behaviour causes impaired functioning.
Secondly they consider whether the person displays a
consistent set of maladaptive feelings or behaviours that
have been defined by mental health professionals as
constituting mental dysfunction.
Diagnostic Systems
There are two major classification systems of mental illness/disorders
in use in Australia:
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The current edition (DSM IV) is the most widely accepted system in
the world for classifying psychological problems and disorders.
WHO (World Health Organisation) publishes another manual
worldwide, The International Classification of Diseases (ICD) which
in many respects is similar to the DSM.
To be diagnosed with a disorder the person must exhibit multiple
behaviours that fit a defined pattern, their behaviour must cause
dysfunction, it must be present for a specific amount of time, and it
must not be due to some other explanation or physical disorder.
So what are we to conclude?
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Although most serious behaviour disorders are
universally recognized many others are culture
specific.
This is why there is no single, universally
accepted definition of abnormal behaviour.
Instead we have some guidelines (DSM) which
vary in their applicability depending on the case.
According to these guidelines abnormal
behaviour is unusual, maladaptive, and causes
distress.
It also typically violated social norms.
The Disease Analogy and
Medical Model of Mental
Illness
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This analogy can help scientists apply the
scientific methods that have worked so
well in medicine.
Yet the Illness analogy can obscure the
social nature of much abnormal behaviour.
Criticisms of the DSM
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Sometimes the personal and cultural
points of view concerning what is
abnormal come into conflict.
Some psychologists allege that if we take
environmental circumstances into account
then mental disorders are not medical
illnesses.
David Rosenham’s study
(1973)
Other criticisms have been made regarding
the validity of diagnostic categories.
Diagnostic Labels also become
a self-fulfilling prophecy
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Once a person begins to behave abnormally a second
force comes into play, society’s reaction.
People diagnosed as mentally ill are stigmatized and
socially disadvantaged.
To adapt they withdraw from social contacts and may
behave violently or act out towards a society that has
shunned them.
Eventually diagnostic labels even begin to affect how
people think about themselves.
They may lose faith in their ability to control their own
life and become dependent on mental health
professionals. They may view themselves as nothing
more than “a schizophrenic”.
Should mental health
professionals be using the DSM
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This does not mean that everything contained in
the DSMIV is uncritically accepted.
Mental health, psychology and psychiatry is a
rapidly moving field in which there are still more
questions than answers.
Neither the current DSM nor any DSMs in the
foreseeable future can or will claim to be
definitive.
New information on mental health is constantly
being accumulated and no single research study
is likely to be the last word on any issue.
What causes mental illness?
Most mental illnesses are caused by the interaction of a
number of factors including:
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Biological predisposition (genetic or acquired)
Adverse early life experiences (eg abuse, neglect, death
of parents or other losses and traumas)
Individual psychological factors (self-esteem, thinking
style)
Current social circumstances (financial, work,
relationship or family stress, or adverse life events)
A “single” cause is highly unlikely. Rather an episode of
illness appears to occur in a biologically and
psychologically predisposed individual, under the trigger
of social/environmental stress.
Depression
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The word depression is used in many different ways.
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Everyone can feel sad or blue when bad things happen.
However everyday blues or sadness is not depression.
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People with the blues may have a short-term depressed
mood but they can manage to cope and soon recover
without treatment.
The depression we are talking about is clinical
depression which lasts for at least two weeks and affects
a persons ability to carry out their work or to have
satisfying personal relationships.
Clinical depression is a common but serious illness and is
often recurrent (that is people recover but develop
another episode later on).
Mental Status Indicators
Emotions
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Sadness, anxiety, guilt anger, mood swings, lack of emotional
responsiveness, Anhedonia (e.g. lack of pleasure) helplessness, of
unrelentless hopelessness (e.g., I can’t take one more day of this. I just
cant do it. Things are never going to change, no matter what I do).
Thoughts
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Frequent self-criticism, self-blame, worry, pessimism, impaired memory and
concentration, indecisiveness and confusion, tendency to believe others see
you in a negative light, suicidal ideation, idyllic thoughts of death as a
release (e.g. I’ll be up in heaven, no-one will be able to hurt me anymore)
Behaviour
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Crying spells, withdrawal; from others, neglect of responsibilities, loss of
interest in personal appearance, loss of motivation
Physical
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Chronic fatigue, lack of energy, sleeping too much or too little, overeating
or loss of appetite, constipation, weight loss or gain, irregular menstrual
cycle, loss of sexual desire, unexplained aches and pains.
What causes Depression
Depression has no single cause and often
involves the interaction of many diverse
biological, psychological and social factors
ANXIETY DISORDERS
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Everybody experiences anxiety at some point in their
lives
Anxiety can be quite useful in helping a person to avoid
dangerous situations and motivate them to motivate
them to solve everyday problems.
Anxiety can vary in severity form mild uneasiness
through to a terrifying panic attack.
Anxiety can also vary in how long it lasts, from a few
moments to many years.
An Anxiety Disorder differs from normal anxiety in the
following ways:
 It is more severe
 It is long lasting
 It interferes with the persons work or relationships
General symptoms of Anxiety
Anxiety can show in a variety of ways: physical, psychological and behavioural
Physical
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Cardiovascular: palpitations, chest pain, rapid heartbeat, flushing
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Respiratory: hyperventilation, shortness of breath
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Neurological: dizziness, headache, sweating, tingling and numbness
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Gastrointestinal: choking, dry mouth, nausea, vomiting, diarrhoea
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Musculoskeletal: muscle aches and pains (especially neck, shoulders, and
lower back), restlessness, tremor, and shaking
Psychological
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Unrealistic and/or excessive fear and worry (about past or future events),
mind racing or going blank, decreased concentration and memory,
indecisiveness, irritability, impatience, anger, confusion, restlessness or
feeling on edge or nervousness, tiredness, sleep disturbances, vivid dreams
Behavioural
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Avoidance of situations, obsessive or compulsive behaviour, distress in
social situations, phobic behaviour
Anxiety Disorders
Generalized Anxiety Disorder (GAD)
Panic Disorder
Phobic Disorders
 Agoraphobia
 Social Phobia
 Specific Phobia
Acute stress disorder and post-traumatic stress
disorder (PTSD)
Obsessive Compulsive Disorder
Compulsive behaviours are repetitive behaviours or mental
acts that the person feels driven to perform in response to
an obsession in order to reduce anxiety e.g. washing,
counting, checking
PSYCHOSIS
What is psychosis?
 Psychosis is a general term to describe a mental
health problem in which a person has lost some
contact with reality.
 There are severe disturbances in thinking,
emotion and behaviour. Psychosis severally
disrupts a persons life. Relationships, work and
self-care are difficult to initiate and/or maintain.
 The main psychotic illnesses are schizophrenia,
bipolar disorder, psychotic depression,
schizoaffective disorder, and drug-induced
psychosis.
Schizophrenia
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Schizophrenia is nothing to do with split personality. This is a
common misconception, which is often confused with dissociative
identity disorder (formerly known as multiple personality disorder)
The term schizophrenia means fractured mind, and refers to
changes in mental function where thoughts and perceptions become
disordered. when first affected.
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The major symptoms of schizophrenia are
defined as either positive or negative.
Symptoms such as hearing voices no-one else
can are positive as they are added to normal
experience by the illness.
When the illness causes things to be missing
from a persons normal experience and
behaviour, this is called negative symptoms e.g.
lack of motivation, withdrawing from people.
The symptoms of schizophrenia include:
Delusions
 These are false beliefs held by the person,
which is not held by others of the same
cultural background. The person is so
convinced of their delusion, that the most
logical argument against it is useless.
Delusions take various forms:
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Paranoid delusion - a belief that you are
being watched and singled out for some
harmful purpose
Grandiose delusion - a belief that you
have special powers – that you are an
important religious leader, politician,
scientist
Depressive delusion – a belief that you
are guilty of some terrible crime or
responsible for horrific world events
Hallucinations
 These are false perceptions. Hallucinations
most commonly involve hearing voices,
but can also involve seeing, feeling,
tasting or smelling things. These are
perceived as very real by the person with
schizophrenia but are not actually there.
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While the voices are unpleasant for some
people for others they provide
companionship or reassurance.
Visual hallucinations are less common
however they most commonly occur when
the psychosis is drug induced.
Hallucinations of taste and smell can also
occur so that what seems to be the
peculiar taste of food can cause someone
who feels paranoid to believe they are
being poisoned.
Confused thinking
 The everyday thoughts that let us lead our daily
lives become confused and don’t join up
properly. Some even believe their thoughts are
being interfered with or that they can influence
the thoughts of others, or that everybody else
can read their thoughts.
 These disturbances in thinking mean that the
person often has difficulty concentrating,
following conversation or remembering things.
Thoughts are all jumbles up
Thinking Difficulties
 There may be difficulties in concentration,
memory and ability to plan. These make it more
difficult for the person to reason, communicate
and complete daily tasks.
Loss of drive/motivation
 A secondary symptom often associated
with psychosis is low motivation.
Sometimes we under-estimate or forget
about this.
 It can be genuinely difficult for the brain
to translate a thought or wish into actual
action.
Diagnosing Schizophrenia
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Schizophrenia is only diagnosed if the symptoms
last over 6 months.
A diagnosis of schizophreniform disorder is made
if the psychotic symptoms last more than one
month but less than 6 months.
Brief Reactive Psychosis is the diagnosis if
symptoms last for less than one month and may
be a temporary reaction by the brain to a very
stressful event.
Bipolar Disorder
People suffering from Bipolar Disorder have extreme mood swings, fluctuating between
periods of depression, mania and normal mood. Common symptoms in mania
include:
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Increased energy and overactivity
Elated mood
The person will feel high, happy, full of energy, on top of the world, invincible
Need less sleep than usual
The person can go for days with little sleep
Irritability
This may occur if others disagree with a manic persons unrealistic plans or ideas
Rapid thinking and speech
The person may talk too much, too fast, and keep changing topics
Lack of inhibitions
The person may disregard risks, spend money extravagantly or be very sexually
active
Grandiose delusions
These involve very inflated self esteem such as a belief that the person is
superhuman, especially talented, or an important religious figure
Lack of insight
The person is so convinced that their manic delusions are real that they do not realise
they are ill
Psychotic Depression
 Sometimes depression can be so intense it causes
psychotic symptoms. E.g. the person may have delusions
involving guilt, severe physical illness or hopelessness.
Schizoaffective Disorder
 Sometimes its not possible to tell the difference between
schizophrenia and bipolar disorder as the person has
symptoms of both illnesses. Schizoaffective disorder just
means a form of psychosis which falls midway between
diagnosis of schizophrenia and bipolar disorder.
Drug-induced Psychosis
 This is a psychosis brought on by the use of drugs. The
symptoms usually appear quickly and last a short time
(from a few hours to a few days) until the effects of the
drug wear off. The most common symptoms are visual
hallucinations, disorientation, and memory problems.
Drugs that can cause psychosis are marijuana, cocaine,
ecstasy, amphetamines.
The jigsaw – you, your client and
the system
Crisis Intervention
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A crisis is a situation when a person feels
completely overwhelmed or defeated by the
problems they are facing.
Crisis intervention is immediate person to person
assistance. It helps restore self-determination in
people who have exhausted their usual coping
resources.
The intervener aids in the search for solutions by
encouraging the individual to consider and to
clarify thoughts, feelings and options.
Relating to a person who is
experiencing a crisis
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Be warm, respectful and matter of fact.
The situation varies from one individual to
another.
Recognise that the experience is real for
this person at this time and that they may
have difficulty paying attention to you.
Keep sentences short: stick to one thing at
a time.
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Be honest but not argumentative.
It can be useful to ask the person what
they want right now
Ask about friends, relatives, therapists or
psychiatrists
If the person is doing things which annoy
or anger you ask them firmly to stop.
Don’t make generalised criticisms.
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If the person is violent or if you feel
unsafe, make it clear that you are not
going to harm the person, but you will not
tolerate violence.
If the person does not calm down, ring
the police for your own protection.
Remember that not everyone who
experiences active symptoms of mental
illness will be in a state of crisis,
What to do for someone experiencing
depression and suicidal thoughts
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People often disclose information to employment
consultants that they would not disclose to even a
spouse or family member due to the rapport built and
the trust that has been instilled in the relationship. These
disclosures may include feelings of hopelessness or
despair or frank suicidal thoughts.
A suicidal patient may evoke significant strong emotions
for an individual, such as anger toward the person or
fear of losing the person, of personal failure in
preventing suicide. However, despite these emotions,
employment consultants have tremendous potential to
respond to this call to action by arming themselves with
the knowledge of risk factors for potential suicide
Risk Assessment
A number of suicide risk assessment tools
have been devised.
Depression is a major risk factor for suicide, but
there are others as listed below
(http://www.capefearpsych.org/documents/SADPERSONSsuiciderisk.pdf)
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The SAD person’s risk assessment TOOL
Sex: males kill themselves more than 4 times more often
than females
Age: certain age groups are more at risk
Depression: Depressed persons are more at risk
Previous attempt: more likely to attempt in the future
Ethanol: alcohol abuse very often implicated in suicide
Rational thought: more prone to suicide if psychotic
Social network: the less social support, the greater the
risk
Organised Plan: greater risk if suicide plans are
organised
No spouse: greater risk of suicide if there is no partner
Sickness: a chronic physical illness makes suicide more
likely
The two most important risk
factors to look for are:
1 Current Plan
 Does the person have a plan about how they will
kill themselves? Have they go the means to do
it?
2 Previous attempt
 Has the person attempted to kill themselves in
the past? Another factor that may increase the
risk that someone will choose suicide as a way
to end their suffering is if a significant person in
their life has chosen suicide
The presence of Warning Signs
Myth: People who commit suicide always
give off some kind of clear warning sign or
call for help
Warning signs
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Expressions of wanting to die, not wanting to go
on living, to put an end to their relentless
suffering
An overwhelming sense of guilt
Organizing their affairs
Giving away possessions
Sudden change (better or worse) of appearance
or behaviour
No longer including themselves in plans for the
future
Withdrawing into themselves
What to do immediately
Ask the following questions
 Have you often thought of death or dying?
 Do you have a specific suicide plan?
 Have you made serious suicide attempts before?
 Can I be sure you will not act on suicidal ideas?
 What help could make it easier for you to cope with your problems
at the moment?
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If the person is talking of committing suicide, listen to the persons
expression of their feelings and take them seriously.
Contact the doctor or local mental health service (Ensure the person
is not left alone – stay with the person if you consider the risk of
suicide is high or try to arrange that someone be with them while
they get through the immediate crisis
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Seek immediate help:
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Phone the mental health crisis number in our area
Phone Emergency 000 or
Take the person to a hospital emergency department
or
Take the person to a GP
Preferably contact such services with the clients
permission, but be aware of your duty of care.
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It the person is consuming alcohol or drugs, try
to stop them from consuming any more
Try to ensure the person does not have ready
access to some means to take their life
What doesn’t help?
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• There’s no point in just telling someone with
depression to get better as they cannot “snap
out of it” or “get over it.”
• You should not be hostile or sarcastic when
the person attempts to be responsive but rather
accept these responses as the
best the person has to offer at that time.
• Avoid speaking to the person with a
patronising tone of voice and do not use overlycompassionate looks of concern.
• Resist the urge to try to cure the person’s
depression or to come up with answers to their
problems.
The person who threatens or
attempts suicide again and
again…. And again
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This is the type of person who is brought
into emergency unit repeatedly. It is often
easy to become frustrated with such a
person because the suicide attempts are
not dangerous.
However these people are not acting, their
lives are unhappy and they need help.
Establishing Liaison with other
Parties
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Staff need to be familiar with community resources
specifically deigned to meet the needs of people who
have a psychiatric disability. This may include issues
associated with housing and local treatment services.
Frequently it is factors such as loss of housing or change
in medication that impact on an individuals ability to
maintain employment.
If the clients primary case worker is part of the mental
health system, it is important for employment program
staff to have a working knowledge of the language,
philosophy and principles upon which the mental
treatment is based.
The Mental Health Sector
There are many services available to clients which broadly fall under
the heading of mental health provision. They include:
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Psychiatric institutions, for residential and outpatient care
Crisis Emergency Teams - which will assist in emergencies and
assess whether someone is unwell enough to warrant hospitalization
Psycho-social rehabilitation programs, which often provide
assistance with daily living skills and leisure activities
Housing programs, which assist people to find suitable
accommodation in the community
Mental health clinics, which may provide both counselling and
medication services, along with various education programs
Support groups, which provide an opportunity for people to meet
with other consumers, share experiences, and lobby for additional
services
Private practitioners, including psychiatrists and psychologists
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It is essential that you develop good
working relationships with the staff of
these other agencies.
It is simply not possible to assist someone
with a serious illness in isolation from
other resources – your client will need
assistance beyond the boundaries of
employment agency, and it is important
that you are able to refer them to more
appropriate services when necessary.
Mental Health Professionals
GP’s
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A GP can provide the following types of help:
Explaining a mental illness and how the person
can best be helped
Prescribing medication if needed
Referring the person to a counsellor, clinical
psychologist or psychiatrist
Counsellors and Clinical Psychologists
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Counsellors and clinical psychologists specialise in the
psychological treatment of mental health problems.
They are not medically qualified, so they cannot
prescribe antidepressants or other drugs. A counsellor of
clinical psychologist can provide a person with the
following types of help:
An opportunity to talk about problems and to be listened
to in an emotionally supportive and non-judgementally
way
Specific methods for overcoming mental illness and
preventing its recurrence. A counsellor will provide active
listening techniques and an opportunity to discuss life
problems, however a clinical psychologist is able to
provide therapeutic intervention such as CBT
If a person wants help from a counsellor or clinical
psychologist they can contact one themselves or get a
recommendation form their GP.
Psychiatrists
 Psychiatrists are medical specialities who
treat mental health problems.
 Psychiatrists generally only treat people
who have severe or long lasting problems.
They are experts on medication and can
help people who are having side-effects
from their medication or interactions with
their other medications.
 It is possible to see a psychiatrist only by
getting a referral from a GP.
What if the person doesn’t
want professional help?
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The person may not want to seek professional help. You
should find out if there are specific reasons why this is
the case.
If the person still doesn’t want help after you have
explored their reasons with them, let them know that if
they change their mind in the future about seeking help
they can contact you. You must respect the person’s
right not to seek help at all times unless you believe that
they are at risk of harming themselves or others.
Psychiatric Treatment
Admission for Psychiatric Treatment
 Voluntary Admission
 This is normally on the grounds that the person is
exhibiting signs of mental disorder. It is recognised that
it would be most appropriate place for them to be, and
that they would not benefit from treatment at any other
place.
Involuntary Admission
 This covers the following two separate criteria:
 That the person is suffering from mental illness to a
degree that warrants hospitalisation
 That they ought to be detained either in the interests of
the persons own welfare or with a view to the protection
of other persons.
Stopping Medication
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Clients sometimes make decisions without consulting
their doctor, about stopping their own medication. They
may do this because their job-seeking has been
successful and they see it as a part of returning to the
normal world, but it can be a disastrous step to make
without close discussion with the doctor.
Some rules of thumb if your client wishes to cease taking
medication:
 Try not to be judgemental
 Advise your client of the possible repercussions
 Encourage your client to discuss their decision with
people they trust – their psychiatrist, doctor and
rehabilitation consultant
Cyclical nature of
psychiatric disability
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A characteristic of many psychiatric
conditions is their repetitive pattern of
occurrence and the unpredictability of the
course they take.
To deal with this support staff can help
the client establish an illness pattern, by
looking at when they became ill during
their past work history.
Relapse and Crisis
 What needs to be considered closely are
the triggers for episodes or some
particular idiosyncratic early warning signs
which are components displayed by the
client early in the episode.
 Early negotiation with the client and
relevant others e.g. close friends, family,
psychiatrists and counsellors about an
appropriate way to deal with a crisis.
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Close collaboration with the treating
psychiatrist, especially if they have known
the client for some time is invaluable as
long as the client is happy for this transfer
of information to occur.
Dependency
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Very often, a client who is highly
dependent is suffering from the effects of
institutionalisation, where they may have
had a little power or control over their
environment, and where every facet of
their life was organised by others.
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Discuss the issue with your client. They
may be unaware that you have less time
to spare than they either need or want.
Set boundaries on the amount of time you
can spend with them and define your role
more clearly
Assist the person to gain assistance or
support from somewhere other than the
employment agency. Discuss
rehabilitation, recreational and
psychosocial rehabilitation programs run in
the region if appropriate.
Self –Care
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The social services sector is renown for being a tough
place to work, and a place where burnout of workers is
more common than we would like to believe.
Burnout is a very real risk in any human service field, but
perhaps particularly when staff are working with people
with psychiatric disabilities. The results of burnout can
be serious for both staff members involved and the
agency as a whole.
There is no question that working with people who at
times are in need of substantial emotional support can
be draining. Developing effective ways of dealing with
this is essential
Discussion
Contact Details
rebecca.turpin@edge.org.au