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Understand mental well-being and
mental health promotion CMH 302
Jacqui Ramus
Today we shall cover
• The main forms of mental ill health
• The impact of mental ill health on individuals and others in
their social network
Understand mental well-being and mental
health promotion
Medical Model – classification systems – individual impairment
Social Model – social barriers which affect mental well-being and mental
health
Psycho-social Model – Freud and Erikson – developmental influences on
mental well-being and mental health
DIFFERENT VIEWS ON MENTAL WELLBEING AND MENTAL HEALTH
Understand mental well-being and mental health
promotion
Four Models have been proposed over the past
100 years
• Psycho-social / psycho-analytic model (Erikson and Freud) –
Freud believed that childhood experiences and unconscious desires
influenced behaviour, and conflicts during these stages caused mental ill
health. Erikson eight-stage theory of psychosocial development describes
growth and change throughout the lifespan, focusing on social interaction
and conflicts that arise during different stages of development.
• Biological model - The basic idea is that mental disorders are rooted in
physical problems and that they require physical treatments to alleviate
them (drug therapy/ECT/lobotomy).
• Social model - the social model is interested in the way that society at
large reacts to people. It places responsibility for people’s problems as
much in the lap of society as it does in the lap of the person themselves.
Understand mental well-being and mental health
promotion
Medical Model - Classification of Mental Health
• There are two main
• International Statistical Classification of Diseases, Injuries and
Causes of Death (ICD). First published in 1900 and adopted by
the World Health Organisation in 1949 since 1994 ICD-10 is
currently in use and any updates due 2015
• DSM Classification of mental health first occurred in 1952
when the Diagnostic and Statistical Manual of Mental Disorders
was first published DSM produced by the American Psychiatric
association - DSM-IV-TR - (2000) is the current version.
Understand mental well-being and mental health
promotion
Main types of Mental ill-health
DSM Group / ICD-10
Examples
Cognitive Disorders
Alzheimer's disease, Vascular Dementia,
Picks Disease
Substance-related disorders
Alcohol abuse
psychotic disorders
Schizophrenia, delusional disorder,
dysmorphia
Mood disorders
Major depressive disorder, Bipolar
disorder
Anxiety disorders
General anxiety disorder
Understand mental well-being and mental
health promotion
Main types of Mental ill-health
DSM Group / ICD-10
Examples
Eating disorders
Anorexia nervosa, Bulimia nervosa
Sleep disorders
Insomnia
Impulse control disorders not elsewhere
classified
Kleptomania
Personality / behaviour disorders
Obsessive compulsive disorder
Understand mental well-being and mental health
promotion
What do you feel are the key strengths and
limitations of a classification system in relation to:
• Diagnosis
• Treatment
• Research
• Social implications (what do friends and family think?)
• Economic implications ( impact on work / benefits etc)
Understand mental well-being and mental health
promotion
Concerns have also been raised over
• Accuracy of descriptions used for classifications
• Cultural differences and how these may affect interpretation
Understand mental well-being and mental
health promotion
Can social influences influence mental health and
well being?
• Think of older people you know, for example, relatives,
neighbours and friends. Now consider ways in which the
following can contribute to the person’s good / poor mental
health:
• A sense of well-being
• The person’s living circumstances
• Being able to make, and keep, relationships with other people
• Coping with the challenges which life brings
Understand mental well-being and mental
health promotion
Erikson’s Psycho-social model
Approx
Age
0–2 years
2–4 years
4–5 years
5–12
years
Virtues
Hopes
Will
Purpose
Competenc
e
Psycho Social
Crisis
Basic Trust vs. Mistrust
Autonomy vs. Shame and
Doubt
Initiative vs. Guilt
Industry vs. Inferiority
Significant Existential
Relationship Question
Examples
Can I Trust
the World?
Feeding,
Abandonmen
t
Parents
Is It Okay To
Be Me?
Toilet
Training,
Clothing
Themselves
Family
Is It Okay For
Me To Do,
Move and
Act?
Exploring,
Using Tools
or Making
Art
Neighbors,
School
Can I Make It
In The World
Of People
And Things?
School,
Sports
Mother
Understand mental well-being and mental
health promotion
Erikson’s Psycho-social model
Approx Age
Virtues
Psycho
Social
Crisis
Significant
Relationshi
p
Existential
Question
Examples
13–19 years
Fidelity
Identity vs.
Role
Confusion
20–24 years
Love
Intimacy vs.
Isolation
Friends,
Partners
Can I Love?
Romantic
Relationships
Care
Generativity
vs. Stagnation
Household,
Workmates
Can I Make
My Life
Count?
Work,
Parenthood
Wisdom
Ego Integrity
vs. Despair
Mankind, My
Kind
Is It Okay To
Have Been
Me?
Reflection on
Life
25–64 years
65-death
Peers, Role
Model
Who Am I?
What Can I
Be?
Social
Relationships
Understand mental well-being and mental
health promotion
Evaluating the models
• Compare and contrast the strengths and limitations of each
model?
• Does each model apply equally to all forms of mental ill
health?
• Is there a place for a mix of models?
Understand mental well-being and mental health
promotion
THE IMPACT OF MENTAL ILL HEALTH ON
INDIVIDUALS AND OTHERS
IN THEIR SOCIAL NETWORK
Understand mental well-being and mental health
promotion
What undermines mental health in later life?
• Depression
• Dementia (covered in a separate session)
• Alcohol abuse
• Problems caused by medication
• Other mental health problems (such as anxiety, delirium, late
onset schizophrenia, Bi-polar disorder)
Understand mental well-being and mental health
promotion
Mental Health
DEPRESSION
Understand mental well-being and mental health
promotion
Signs symptoms and treatment of depression
• Video outlining key issues for people living with depression
• Note down the key points that you wish to clarify / discuss
or learn from this video
• Discuss in pairs
Understand mental well-being and mental health
promotion
Depression in older people – the facts
• One in four older people have symptoms of
depression that require treatment
• Fewer than one in six older people with depression
discuss their symptoms with their GP and only half of
these receive adequate treatment
• Physical illness increases the risk of depression
• Untreated depression is the leading cause of suicide
among older people, with men living alone at
particularly high risk
Understand mental well-being and mental health
promotion
Incidence of depression among different ethnic groups
Understand mental well-being and mental health
promotion
Case studies
• Depression can affect people in different ways depending on
the type and severity of the condition.
Understand mental well-being and mental health
promotion
Risk factors for depression in older people
• Receiving high levels of care
• Recent bereavement
• Social isolation and loneliness
• Excessive alcohol use
• Poverty
• Regular sleep problems
• Dementia
Understand mental well-being and mental health
promotion
Certain medical conditions can directly or indirectly
cause depression in the elderly
•Parkinson’s disease
•stroke
•heart disease
•cancer
•diabetes
•thyroid disorders
•Vitamin B12 deficiency
•dementia and Alzheimer’s
disease
•lupus
•multiple sclerosis
Understand mental well-being and mental health
promotion
Depression in older people – the facts
• There is good evidence for the effectiveness both of
counselling and antidepressants for the treatment of
depression in older people
• Referral to an Old Age Mental Health Team should
be considered if the person is considered to be at risk
or not responding to treatment
• Increased exercise, opportunities to socialise,
continued learning and volunteering, and financial
help and advice can prevent or minimise depression,
particularly in older people
Understand mental well-being and mental health
promotion
Mental Health
and Older People
ANXIETY
Understand mental well-being and mental health
promotion
How does anxiety affect us ?
• How do we feel when we become anxious?
• How can it change our behaviour?
Understand mental well-being and mental health
promotion
Physical and emotional symptoms of anxiety
www.campacademia.com/blog/wp-content/uploads/2010/11/Physical-Effects-of-disorders.gif
Understand mental well-being and mental health
promotion
WHAT LEADS TO ANXIETY DISORDER?
A number of things can contribute to an anxiety disorder:
• Extreme stress or trauma
• Bereavement and complicated or chronic grief
• Alcohol, caffeine, drugs (prescription, over-the-counter, and
illegal)
• A family history of anxiety disorders
• Other medical or mental illnesses or
• Alzheimer’s or other dementias
Geriatric Mental Health Foundation
Understand mental well-being and mental health
promotion
SIGNS OF ANXIETY DISORDER
•
•
•
•
•
•
•
•
•
•
Excessive worry or fear
Refusing to do routine activities or being overly preoccupied with routine
Avoiding social situations
Overly concerned about safety
Racing heart, shallow breathing, trembling, nausea, sweating
Poor sleep
Muscle tension, feeling weak and shaky
Hoarding/collecting
Depression
Significant use of alcohol
Geriatric Mental Health Foundation
Understand mental well-being and mental health
promotion
Some people describe the following as the most
common symptoms
• Dizziness
• Unsteadiness
• Feeling terrified
•
•
•
•
Feeling like you are choking
Flushed face or feeling “heat in the head”
Stomach pains
Feeling faint
• http://www.mysahana.org/2010/12/anxiety
Understand mental well-being and mental health
promotion
Managing and treating anxiety
• Medication
• Talking therapies, such as counselling, Cognitive Behavioural
Therapies (CBT)
• Exercise
• Avoiding stimulants such as caffeine, nicotine, alcohol
Geriatric Mental Health Foundation
Understand mental well-being and mental health
promotion
If you suspect an older adult you know might have
a problem with anxiety,
Notice and ask about any changes in:
• Daily routines and activities. Is the person avoiding situations
and activities he or she once enjoyed?
• Worries. Does he or she seem to worry excessively?
• Medication. Is he or she taking a new medication, either
prescription or over-the-counter? Or has the dosage changed
for one of the medications?
• Is he or she drinking more alcoholic drinks than previously?
• Mood. Is the older adult tearful, lacking emotion, or “just
doesn’t feel right.”
Understand mental well-being and mental health
promotion
When talking with an older adult who has an
anxiety problem
• Be calm and reassuring
• Acknowledge their fears but do not play along with them
• Be supportive without supporting their anxiety
• Encourage them to engage in social activities
• Offer assistance in getting them help from a physician or
mental health professional
Understand mental well-being and mental health
promotion
BI-POLAR DISORDER
Stephen Fry talking about his experience of Bipolar disorder
Understand mental well-being and mental health
promotion
EXCESSIVE ALCOHOL USE
Understand mental well-being and mental health
promotion
Research has shown that there are different
drinking rates among various ethnic groups
• High abstinence, low drinking rates among many non-white minority
ethnic groups
• Irish people report frequent & heavy alcohol use
• South Asians have lowest rates of alcohol use, but high rates among some
drinkers
• Black Caribbean, Black British, Black African people consume less than
general population
• People of Mixed ethnicity drink more than non-white minority ethnic
groups
• Low rates of consumption among Chinese people
• Less variation in heavy drinking by age among Black Caribbean and Indian
and Sikh men
–
Ethnicity and alcohol: a review of the UK literature, MIDDLESEX UNIVERSITY
Understand mental well-being and mental health
promotion
Mental Health and Older People
DELIRIUM
Understand mental well-being and mental health
promotion
Delirium or dementia?
Delirium
Dementia
• Suddenly starts with a clear,
identifiable time of onset
• Cause is usually treatable such as
infection, constipation,
• Slow, gradual changes. Typically notice
changes over months
• Due to chronic disorder such as
Alzheimer’s
• Usually reversible Attention impaired
• Consciousness ranges from lethargic
to very alert
• Effect on memory varies
• Progressive process
• Attention not affection until late stages
• No effect on consciousness until late
stages
• Loss of memory especially for recent
events
• Medical attention required, less
urgently
• Medical attention usually required
immediately (usually ceases once
source of infection is treated)
Understand mental well-being and mental health
promotion
Video: the importance of housing on mental wellbeing
• There is an important link between housing and mental
wellbeing.
• Cultural or language barriers may prevent people accessing
services providing repairs or adaptation.
• Poverty can mean that some older home owners and private
tenants are unable to repair or maintain their property.
Sources of charitable funding or grants may be available to
help.
• Disrepair and maintenance can affect not only physical health
but can lead to anxiety and stress. It can also cause social
isolation as older people may feel embarrassed to invite
friends and family.
Understand mental well-being and mental health
promotion
Services in the community
• Make links with the specialist services in your area for older
people with mental health needs. Find out their criteria for
referrals. Ask for their help or advice if you feel you need it.
• Try to put yourself in the position of the older person – how
would these symptoms make you feel? Would you be
frightened, worried? How would you want to be treated?
Understand mental well-being and mental health
promotion
Accepting help– case study
Mrs W had been persuaded to accept a regular home care visit as it
was clear she was neglecting herself, but she found the visits tiresome
and could not see why she needed help. On a number of occasions
she wrote to the Director of Social Services politely asking for the care
to be withdrawn. On each occasion the social worker from the
community mental health team for older people came to see her and
persuaded her to continue. He understood and sympathised with her
irritation, but he also knew from previous discussions with her that it
was important to her not to feel a burden on her family. He was able to
convince her that the home care visits stopped her family worrying
about her, and she was prepared to accept them on this basis.
Gradually the home carers became trusted by Mrs W, and as her
needs increased the social worker was able to increase the visits.
Assessing the mental health needs of older adults: SCIE publication 1996
Understand mental well-being and mental health
promotion
What you can do to help
• Recognise that family carers may have difficulty recognising or
pinpointing what is wrong with their relative, particularly if
the onset of the problem has been gradual.
• Being able to suggest support organisations / information can
be helpful, for instance the Alzheimer’s Society, which may be
able help them with support, information and advice.
• Recognise that some carers are reluctant to accept help
because they fear that they will be excluded and that services
will ‘take over’, although it is important that they receive
appropriate support, otherwise it may affect their own
mental health and well-being.
Understand mental well-being and mental health
promotion
Other sources of reference for CMH 302
• BBC Website Health ( Emotional health)
http://www.bbc.co.uk/health/emotional_health/mental_health/
stigma.shtml#research_on_mental_health_stigma
• SCIE Introduction to adult mental Health Services
http://www.scie.org.uk/publications/introductionto/adultment
alhealthservices/mentaldisorders.asp and
http://www.scie.org.uk/topic/careneeds/mentalhealth
• MIND - http://www.mind.org.uk
Understand mental well-being and mental health
promotion
Today we covered
The main forms of mental ill health affecting older people
The impact of mental ill health on individuals and others in
their social network
Understand mental well-being and mental health
promotion
Evaluation flipcharts
• How can you put this learning into your work?
• Can you think of any service users in particular who might
have poor mental health and for whom your increased
awareness may be useful? (Don’t record names of people –
just the person’s situation)
Understand mental well-being and mental health
promotion