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© Middlesex University
Inter-professional Learning Symposia | 1
Assessing And Caring For People
With Mental Health Problems
Inter-professional Learning Symposia
Herbert Mwebe
Herbert Mwebe –Lecturer
Department of Mental Health, Social work and
Integrative medicine
[email protected]
What are we covering today
1.Experience and beliefs
2. Definitions
3. Prevalence
4. Assessment, care & treatment
1. Experience and
Beliefs
What words did you use as a child to
describe someone who has a mental health
problem?
What words do other people use?
When you think of ‘mental illness’,
what images or ideas come to
mind?
Where do these ideas come from –
cinema, television, personal
experience?
2. Definitions
What IS Mental Health??
Mental and physical health cannot be separated
Mental and physical health are interrelated in a whole host
of ways (WHO, 2004d; WHO, 2004e):
They may have common determinants. Risk factors such as
poor housing can lead to both poor mental and poor physical
health.
Additionally, protective factors can prevent the onset, and
influence the course and outcomes of both physical and
mental disorders.
Psychological beliefs, such as optimism, personal control and
a sense of meaning, protect one’s mental health as well as
physical health.
Defining ‘mental health’ and ‘mental
illness’ is notoriously difficult: you’ll find
that many professionals disagree over
definitions and the area can be a hugely
controversial one. Nevertheless, there are
certain key concepts that are generally (if
not universally) agreed
In your own words, describe
‘mental health’. Describe the
characteristics, behaviour and
abilities of someone you would
perceive as mentally healthy.
What personal characteristics do you
have that indicate good mental
health?
How do you maintain these
characteristics?
What do you do to build on them?
Mental health has many components, and an
array of interlinking factors influence it.
A person’s mental health is never set in stone: it is
always in a dynamic, ever-changing, state of flux.
Elements influencing someone’s mental health
positively can be categorized as individual,
interpersonal and social/cultural
Mental health can be agreed as a state of
emotional, psychological and social ‘wellness’,
evidenced by satisfying interpersonal
relationships, effective social behaviour and
coping, positive self-concepts and emotional
stability.
(Acott and Videbeck, 2009)
A ‘mental disorder’ is a “clinically significant
behavioural or psychological syndrome or pattern
that occurs in an individual; and is associated with
present distress (eg a painful symptom) or
disability (ie impairment in one or more important
areas of functioning) or with a significantly
increased risk of suffering death, pain, disability or
an important loss of freedom.”
Influencing Factors
The factors that influence positive mental health may be
clustered into three key categories:
Factors at a structural level, such as good living
environments, housing, employment, transport, education
and a supportive political structure.
Those at a community level, such as a sense of belonging,
social support, a sense of citizenship and participation in
society.
Factors at the level of the individual, such as the ability to
deal with thoughts, feelings, to manage life, emotional
resilience and the ability to cope with stressful or adverse
circumstances.
Personality traits
Early
experiences
Important life
events
What issues
might cause
mental health
problems?
Genetic disposition
Social
isolation
Physical
disease
Stress / Vulnerability
Impacts
Coping
•Meaningful activity
•Healthy life style
•Supportive relationships
•Coping strategies
•Problem solving
Alcohol and
drug use
worsens
helps
Medication
Biological
vulnerability
to symptoms
helps
worsens
helps
Stress
3. Prevalence
On average, those with a Serious
Mental Illness die between ten and
fifteen years earlier than those without
Summary
 About 5% of population have serious mental illness but about18% of all
deaths are in people with serious mental illness
 About 1 in 6 people has a mental illness but 1 in 3 deaths is among
people with mental illness
 About 50% of the excess deaths in people with mental illness is due to
the big killer diseases- CVD, Cancer, respiratory disease and liver
disease
https://www.mentalhealth.org.uk
The World Health Organisation
forecast that by 2020 depression will
be the second leading contributor to
the global burden of disease
Each year 1/4 adults in Britain
experience at least one diagnosable
mental health problem (Singleton
2001). 1/6 adults has a mental health
problem at any one time. (DOH 2011)
At least 30% of GP consultations are for
a mental health problem, but this is the
tip of the iceberg as many people never
seek help & only 25% of common
mental illnesses are treated at all.
In 2011, as many as
13.3
Mill. working days
were
lost to stress,
depression
and anxiety.
Around 750,000
people in the UK
over 65 have
some form of
dementia, which
accounts for 25%
of all NHS beds.
4. Assessment, Care
and Treatment
Things to remember …
Videbeck, S & Acott, K (2009) Mental
Health Nursing
1. Assessment is part of the process of care and treatment.
2. Assessment can be therapeutic – or counter-therapeutic – in
itself.
3. Assessment is ‘done with’, not ‘done to’, someone.
4. Assessment is NEVER merely the completion of documentation.
5. Assessment is about the exchange of information; it is not a
one-way process.
6. Assessment is a transparent, open, interactive process, a key
part of which involves two or more people having purposeful
conversations.
7. Assessment is both a ‘formal’ and an informal process.
8. Assessment should not be purely deficit- or symptom- driven; it
should be a process whereby a rich, complex narrative is
developed.
9. Assessment is collaborative, tentative, ongoing and everchanging; it is neither ‘scientific’ nor fixed.
10. Assessment must interact primarily with the views and
assessments of the client themselves, with other professionals
and with those of carers, friends and family as appropriate.
Gentleness - Precision - Openness - Trust
There are:
Possibilities in people’s
experiences: we need to
acknowledge and validate
them
Possibilities in action: we
need to help people sort
the OK from the not OK
(‘change the doing’)
Possibilities in stories: we
need to help people sort
the OK from the not OK
(‘change the viewing’)
Working Towards Compassion And Effectiveness:
A 3-Phase Conversational Model
1. CONNECT
(Building Rapport,
Enhancing Safety and
Enabling Change)
Staying mindful of
culture
and the here and now
2. SHARE
INFORMATION
(Using, if necessary,
documentation as a
tool for increasing
understanding)
Staying mindful of
resources, strengths,
exceptions, barriers,
choices/options, fears
and failures
COMPASSION, VALIDATION
AND CHANGE:
Person-centred listening and
solution-focused listening
3. FIND
AGREEMENT
:
(Towards the
Adult:
constructing a
concrete, 2way,
experimental
Plan)
- Staying
mindful of
both dreams
and the
immediate
future
©KS ACOTT (2009/2013) GRAPHICS ADAPTED BY P LINDSAY (2013)
You
The Process
• Be reassuring, empathetic, nonjudgemental.
• Try and relax, this helps to put the
person at ease.
• Be clear, avoid using medical
terms.
• Establish reason for attendance/
assessment – ‘how can I help?’
‘what’s brought you here today?’.
• Work with the client’s priorities /
agree duration of the assessment.
• Show respect and humanity.
• Vary your style of questioning
(open/closed)
• Frequently clarify and check
understanding (Watch out for
clues in what’s being said or how
it’s said).
• Think about your own capability!
• What information do you already
have?
• What are the aims of this
assessment?
• What is the best strategy to
gather the information and meet
these aims? (Use a variety
methods and tools).
• Working with the person to build
a rapport and a clear
understanding of what’s
important.
• Use the information for a
purpose (care planning /
managing risk etc.)
• Record and handover as needed.
• It’s an ongoing process – it can
take time
We assess someone's mental health to establish what
needs they have in order to live safely and well …
Assessments should explore
all clinical symptoms a
person may have.
As well as considering their
social situation - financial,
housing, employment,
health & wellbeing activities.
Try and identify stressors a person
may be experiencing (triggers).
• Debt.
Precipitating factors
• Relationship issues.
Any difficult life event • Loss &
could potentially be a
bereavement.
cause and/or effect of • Traumatic event.
a mental health
• Physical health
difficulty.
issues.
• Substance use alcohol or other
psychoactive agents.
• Relapse of known
diagnosed MH
condition
MENTAL STATE EXAMINATION
Appearance: clothes (clean, old, appropriate for weather, sexually
revealing) gait, level of consciousness, co-ordination over limbs,
mannerisms, stereotypes, agitation, tremor and parkinsonian symptoms,
dystonia, facial expression (frowning, sad, blunted, smiling, incongruent to
emotions) physical disabilities, scars, visible cuts on body, needle marks.
Behaviour: over activity, underactivity, able to hold conversation,
fearful? Shy? Preoccupied by internal experiences, perplexed, long pauses
in responding to questions, distractible, wringing hands, invading personal
space, sexually inappropriate, threatening
Mood; Expansive, elated, grandiose, overfamiliar, laughing, irritable,
angry, unable to hold conversation, restricted range of emotional
expression? Ability to feel remorse, presence of guilt - evidence of
depression (worthlessness, helplessness, morbid fears about body
function, suicidality)
Speech and Thoughts; fluent/non fluent, form, flow, content, thought
disorder, flight of ideas, pressure of speech, hesitant, interrupted distraction,
word finding difficulties, thought insertion, thought blocking, thought
withdrawal, broadcast, over inclusive thinking, concrete thinking
Perceptions; Hallucinations (visual, auditory, somatic, olfactory, tactile)
functional, somatic, depersonalization, derealisation, imagery etc.
Beliefs; Delusions, over-valued ideas. Culturally sanctioned and religious
beliefs can sometimes be misunderstood as indications of illness. If unusual
beliefs are found, offer testing/evidence, how does client respond to this?
What prompted patient to develop such belief system?
Anxiety symptoms; obsessional thinking, compulsive behaviour, panic
attacks, phobias avoidance of places, people, over aware of bodily functions,
sweating, fear, hyper vigilance, tremor
Cognitive assessment: Orientation to time, place, personal age, date of
birth, floor, building - people around who are they?
Attention and concentration- Registration of info, give client numeric test to
repeat a number(s),
Memory & Language - ask patient address, or give info to memorise, visual
memory, short/long term memory exercise, naming objects, fingers etc.
Insight: What is their understanding of problem/needs/situations.
‘Do you think you are having any unusual experiences?’, ‘Could these be a
sign of an illness?’, ‘Have people around you noticed changes in your
thoughts or behaviour?’, ‘Would you accept treatment?’, What do you think
may help?
Risk and self harm history: Current risk to self or othersthoughts/intention/active planning? Aggression, suicide, neglect
Past risk- Incidents, natures/degree? Impulsivity? Drugs used?, did they
require hospitalisation, self harming- scars, lacerations, methods of self
harming, triggers- what helps/makes worse etc.
Physical health, Medical, Psych & Personal histories, Personality / Strengths,
drugs & alcohol hx, social circumstances- forensic hx
“But in my personal life, I have a lot of fears and
negative thoughts. My goal is to change my thinking
from ‘I don’t want to be hurt, I don’t want to be
cheated on’ to ‘I want someone honest.’
What now?
On a personal level you can help keep
yourself in good mental health by:
•talking about your feelings
•keeping active
•eating well and drinking sensibly
•keeping in touch with friends and loved ones
•asking for help when you need it
•taking a break
•doing something you are good at and enjoy
•accepting who you are
•caring for others
Mental Health Foundation www.mentalhealth.org.uk/information