Maze Advocacy Project Staff Training Day 1 An Intro to Mental Health and Advocacy.

Maze Advocacy Project Staff

Training Day 1

An Intro to Mental Health and Advocacy

Being Healthy

Mental Health and Emotional Wellbeing

Exercise: Create a definition of Mental Health and Emotional Wellbeing

Health Definition 1“Children's mental health is the strength and capacity of children's minds to grow and develop with confidence and enjoyment. It consists of the capacity to learn from experience and to overcome difficulty and adversity.

It's about physical and emotional well-being, the ability to live a full and creative life and the flexibility to give and take in friendships and relationships. Children who are mentally healthy are not saints or models of perfection but ordinary children making the most of their abilities and opportunities.”

Health Definition 2• A capacity to enter into, and sustain, mutually

satisfying and sustaining personal relationships

• Continuing progression of psychological development

• An ability to play and to learn so that attainments are appropriate for age and intellectual level

• A developing moral sense of right and wrong

• A degree of psychological distress and maladaptive behaviour within normal limits for the child’s age and context

Health vs Illness

• These are important definitions, because they emphasise the nature of health, rather than that of illness. Problems may arise from a number or combination of factors – congenital, constitutional, environmental, family or illness. The task of maintaining good mental health is significantly affected by where and how people live, and each individual’s own life events and experiences.

• Children and young people who experience mental health problems usually find the experience very distressing. Most learn to overcome their problems if they receive the right kind of help from family, friends or specialist support services.

History, Models and Concepts

The History of Mental Illness

• The English-speaking world has not always used medical language to describe the behavior we now label as symptomatic of mental illness or mental disorder. Descriptions were sometimes framed in quite different terms, such as possession. What we now call mental illness was not always treated as a medical problem. The medical model is a product of the 18th century, when people with mental health ‘conditions’ first became seen as being sick, and therefore treatable by medical professionals.

• Anthropological work in non-Western cultures suggests that there are many cases of behaviour that psychiatry would classify as symptomatic of mental disorder, which are not seen within their own cultures as signs of mental illness. Indeed, other cultures may not even have a concept of mental illness that corresponds even approximately to the Western concept.

Models of ‘Mental Illness’

Medical Model• Medical Model – People with mental health

problems are seen as sick and therefore not responsible for their conditions. So they are put in the care of doctors and nurses.

• Typified by the classification and identification of different types of disorder, each of which has a characteristic pattern of symptoms. Goals of this are: a common set of terms with agreed-on meanings

• Creates an understanding of the origins of disorders and thereby a common treatment plan (e.g. medication)

Relativist/Cultural Model

• Some have argued for a relativist view, that the reality of mental illness is not an absolute transcultural fact. The relativist view would have to be that statements about the existence of mental illness can be true in some cultures and false in other cultures.

Deviancy Model

• Deviancy from the norm of behaviour and/or mental and emotional experience

Extreme Model

• A more extreme view is that there is no such thing as mental illness in any culture, and that there could not be, because the very notion of mental illness is based on a fundamental mistake or set of mistakes. This sort of view is most closely associated with the psychiatrist Thomas Szasz.

Recovery Model• "Recovery is about seeing people and people

seeing themselves as capable of recovery rather than as passive recipients of professional treatments.

• It is about working out strategies and taking control of their own lives.”

• It’s key elements are: An individual belief and commitment that they can and will recover.

• A shared belief and commitment from people helping them.

• A strategy for recovery; a recovery plan. Adequate and appropriate resources which facilitate recovery.

• A willingness to share the journey of recovery with others.

Or…

• It could be simply seen as the experience of disordered and distressing thoughts.

Reality Bites…

The medical model is the dominant paradigm of thought in approaching mental ill-health and psychiatrists are the one’s who make the diagnoses and who traditionally hold most power.

What does this all mean for an advocate?

• An advocate is not anti-psychiatry, however nor should he or she be limited by the medical model of mental illness, or any others.

• When working with children with mental health issues an advocate needs to understand both the medical model and models of social welfare in order to work within this area and advocate effectively for their client

History

Illness, Disorder and

Problems

Terminology

Young people with mental or psychiatric illness

Young people with mental disorder

Young people with risk factors but no obvious problems

Young people with mental health problems

Definitions

• There is a great complexity around the terminology used to describe ‘mental health problems’ in relation to children and young people. One reasonable definition could be:

“Abnormalities of emotions, behaviour or social relationships sufficiently marked or prolonged to cause suffering or risk to optimal development in the child or distress or disturbance in the community”

Exercise: Create a definition of Mental and Emotional Ill-health

Definitions

• Mental Health Problems are relatively common and consist of…a broad range of emotional and behavioural difficulties which may cause concern or distress

Mental Disorders are less common…but are more severe and/or persistent

How is mental illness diagnosed…1?

At the moment, there are no tests for mental illnesses. A diagnosis will usually be made by an experienced psychiatrist working with other health professionals.

• Child psychiatry takes into consideration the influence on children of a wide variety of modes of living, biological, psychological, social, and developmental aspects and interaction processes within the family and the community

• At first the person will be observed for symptoms, and the doctor will use pre-determined criteria to explore the person's behaviour, then the person will be observed over a period of time.

How is mental illness diagnosed…2

• The psychiatrist's ongoing assessment will follow one of the internationally agreed diagnostic schedules. It will be important for the psychiatrist to check that the symptoms are not part of some other medical syndrome, for example: – high fever, epilepsy, problems with thyroid

gland or diabetes, – use of illicit drugs or alcohol, – brain tumours, brain damage, following head

injury or surgery,

• This is because some symptoms found in mental illnesses, such as hallucinations, can also appear in other medical conditions.

How is mental illness diagnosed…3

• Many different mental illnesses have overlapping symptoms and it can be difficult to tell the conditions apart. Reaching a diagnosis can be difficult and it takes time to be sure that the individual's symptoms truly indicate a particular mental illness.

• Family and friends can and should be involved, as they will be aware of details of family intimacies, cultural differences and religious beliefs. They may well be able to confirm to the professional that a desire for contact with a church, for example, is not a sudden change brought on by illness, but a part of the person's previous upbringing and normal practice.

Types of problems

Brainstorm: Different kinds of problems

Types of problems

Emotional disorders Anxiety, phobias and depression

Conduct disorders Stealing, defiance, fire-setting, and aggression

Hyperkinetic disorders

Attention deficit (hyperactivity) disorder (ADHD).

Developmental disorders

Delay in acquiring speech or bladder control

The most common forms of mental health problems in children and young people are:

Types of problems

Eating disorders Anorexia nervosa or bulimia nervosa

Habit disorders Tics, sleeping problems, soiling

Post-traumatic syndromes, following traumatic events

Psycho-somatic disorders

Chronic fatigue symptoms

Psychotic disorders Schizophrenia and manic depression

Causes & Treatment

Causes & Predisposing Factors

Some children and young people are more likely to develop mental health problems. Important causes include factors in:

• The child,• The family • The environment

Brainstorm: Causes/Predisposing Factors

Predisposing Factors…

• Genetic influences, such as a family history of mental health problems

• Low IQ and learning disability • Other health or development problems, such as

physical illness • Communication difficulties • Academic failure or low self esteem • Overt parental conflict including divorce • Death and loss, including loss of friendship • Abuse, neglect or bullying • Inconsistent or unclear discipline • Poverty, unemployment or crime • Children in contact with CAMHS correlate to children

whose experiences cover all of the main social deprivation indexes.

Treatment • In the treatment of mental health problems and disorders

there is an emphasis on building resilience in children, as well as treating problems and disorders. Of particular importance is the encouragement and teaching of emotional literacy and intelligence - increasing the capacity of children and young people to understand and manage feelings and thoughts about themselves and others.

• Earlier a problem is diagnosed, the greater the chance of some kind of recovery. Psychiatrists generally more cautious about developing diagnoses and prescribing medication to children and adolescents when it comes to severe mental illness. The most common approach that a psychiatrist will recommend will be a whole family approach, usually involving some kind of therapy. The young person and their family are supported in learning to deal with their problem or illness. Already a time of great physiological (e.g hormones) and psychological change and any diagnoses needs to take developmental factors in to account.

Pyramid of CAMHS Provision

What Works?

Exercise: “A service should…”

Describe the way in which you feel a mental health service should work to better help young people…

What Works?Themes from the evidence (YoungMinds 2005), a service should:

• Be readily accessible• Be accepting of young people• Offer an assessment of young people’s needs• Work with the context in which the young person

lives• Seek to engage children, young people and their

parents/carers• Change attitudes• Offer interventions tailored to suit individual needs• Offer advice, consultation and training• Work in close collaboration with relevant

disciplines and agencies• Have the capacity to keep in touch with young

people over the long term

The end