Looking at the needs assessment process of students with mental health difficulties:

Brendan Power Disability Officer,Trinity College Dublin

The impact on learning and the student journey; Challenge of mental health problems on daily living; DO role in assessment process; findings from 1st year experience survey; Impact on learning – Medication, treatments and supports.

Trinity College Dublin, The University of Dublin

Presentation Overview

• Challenge of mental health problems on daily living.

• Findings from a 1st year experience survey.

• Medication and treatments and the impact on the student journey – Case studies.

• The Disability Officer role in assessment process.

Trinity College Dublin, The University of Dublin

What is Mental Health?

Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life (World Health Organisation, 2013).

Good mental health is an integral component of general health and well-being, allowing a person to fully realise his or her abilities. With a balanced mental disposition, people are more effective in coping with the stresses of life (Department of Health and Children, 2006).

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Recovery in Mental Health

– A Recovery Approach within the Irish Metal Health Services.

Doing with instead of for…

“The recovery approach in mental health services emphasises the expectation of recovery from mental ill health and promotes both enhanced self-management for mental health service users and the development of services which facilitate the individual’s personal journey towards recovery”.

(Mental Health Commission, 2008)

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Mental Health problems

• The Lifetime occurrence of psychiatric disorders is frequent among young Irish adults aged between 19 to 24 years (Harley et al, 2015).

• The risk of mental health difficulties exist at every level of adolescence which highlights the importance that mental health is every body’s business.

• At present, mental health services in Ireland are not configured to support a model of continuing integrated care through adolescence into young adulthood(Power et al, 2015).

• Many patients first experience mania or psychosis as adolescents or young adults (Malhi, et al 2015).

Risk & Relevance in the student population

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Trinity College DublinDisability Service first year experience survey : Category of disability

Asperger’s Syndrome5%

ADD / ADHD1%

Blind/Vision Impaired

1%

Deaf/Hearing Impaired

3%

Dyspraxia9%

Mental Health Condition30%

Neurological Conditions5%

Speech & Language Disabilities1%

Physical Disabil-ity9%

Significant Ongoing Illness14%

Specific Learning Difficulty (incl. Dyslexia and Dyscalculia)

21%

)

Mental Health Conditions presented as highest disability type in survey of first year students registered with the Disab-ility Service

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Mental Health problems

• Within a mental health context, the role of medication supports personal recovery from periods of ill-health and is not just a treatment but a tool that helps achieve personal recovery goals (Baker et al, 2013).

• Medication management in Psychiatry has assisted in the care and treatment of clients with differing mental health conditions for over sixty years (Sheridan, 2008).

Medical management & Recovery

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Mental Health problemsDisorders, conditions and medication management

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Mental Health problems

• Case studies are an invaluable record of both classical and unusual presentations which may confront a service provider (Budgell, 2008).

• Two case studies will be presented:

1. John

2. Mary

Learning through experience

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Case Study - John

• John is a thirty-five year old mature student studying social studies.

• His primary diagnosis is Chronic Fatigue.

• John also presents with secondary mental health problems, exhibiting symptoms of anxiety and depression. He is in the care of a community mental health team.

• John is registered with the Disability Services since entering into college. Interventions provided included UNILINK support, exam accommodations and the development of a Learning Educational Needs Summary (LENS).

Introduction

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Case Study - John

• John exhibits significant weakness in verbal memory, working memory and speed of processing, affecting reading fluency, comprehension, spelling and written expression.

• John also experiences visual stress when reading print.

• Patients with chronic fatigue syndrome (CFS) suffer from medically unexplained and severely disabling fatigue that lasts for at least six months (Wiborg et al, 2014).

• John also presents with secondary mental health problems, exhibiting anxiety and depression.

Impact of disability on academic life

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• Just prior to commencing end of year exams, John had requested to meet his assigned Disability Officer as he did not wish to proceed with exams with the way he was feeling.

• During interactions with John to explore current circumstances his current mental health problems were explored including what the management plan of his condition. John then had outlined he was actually going through a complete re-titration of a new medication upon exploration of his care and treatment plan. New medication was named as Sertraline.

• Pharmacological therapies are an important element of treatment received by people with mental health problems (Doherty, 2014).

Role of the disability officer Case Study - John

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• Medication: Sertraline

• Type: Anti-depressant - Serotonin reuptake inhibitor (SSRI)

Case Study - John

Family Generic drug name

UK trade name US trade name Irish trade names

Anti-depressant Sertraline Lustral Zoloft Depreger, Lustral

Sertraline is indicated for the treatment of:• Major depressive episodes. Prevention of recurrence of major depressive episodes.• Panic disorder, with or without agoraphobia.• Obsessive compulsive disorder (OCD) in adults and paediatric patients aged 6-17 years.• Social anxiety disorder.• Post traumatic stress disorder (PTSD) (www.medicines.ie)

Some side effects: Feeling drowsy or fatigued, inability to sleep, dry mouth, urinary difficulties, dyskinesia’s (involuntary muscle movements), tooth grinding, headache, blurred vision, weight gain, nausea, rashes and infections (Healy, 2005).

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Case Study – Mary

• Mary is a twenty year old general nursing student

• Her primary diagnosis is Bipolar Affective Disorder

• Mary also presents with secondary mental health problems, exhibiting symptoms of anxiety.

• Mary is registered with the Disability Services since entering into college. Interventions provided included UNILINK support, exam accommodations, a Learning Educational Needs Summary (LENS) and placement planning.

Introduction

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Case Study – Mary

• Mary exhibits fatigue and tiredness on a daily basis. Her anxiety increases in social gatherings and this impacts on small group work in the course and on placement. Mary also has problems with working memory which effects her spelling and written expression.

• Mary also must attend regular outpatient clinic appointments once a month.

• Bipolar disorder is defined by its poles, elevated mood or irritability characterises mania, and marked low mood and lack of energy typifies depression (Malhi, 2015).

• Mary is currently on a placement and has been in contact to say she hasn’t been attending over the last few days due to tiredness and not waking up on time.

Impact of disability on academic life

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Case Study – Mary

• Mary requested to meet her disability officer

• Mary was assessed on her current problem of non-attendance to placement and symptom of tiredness.

• A placement planning meeting was undertaken prior to Mary commencing her placement where fatigue was identified as impacting on her.

• Mary was also provided with the flexibility of shortening her longer shifts.

Role of the disability officer

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Case Study – Mary

• During interaction with Mary the absence from placement was explored and her fatigue.

• The Disability Officer assessment explored current problem(s) to look at rationale. There was no change in any circumstances but Mary did report she had been commenced on a new medication, as a short-term management plan.

• Mary reported that she takes Lithuim and has been on this for years for her BPAD. She had been commenced on Olanzapine as she had been feeling “a little off” and made an appointment with her Consultant Psychiatrist.

Role of the disability officer

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Case Study – Mary

• Medication: Lithium Carbonate

• Type: Mood-stabiliser

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Case Study – Mary

• Medication: Olanzapine

• Type: Second generation anti-psychotic

Family Generic drug name

UK trade name US trade name Irish trade names

Anti-psychotic Olanzapine Zyprexa Zyprexa Zyprexa, Olanzapine Mylan

Olanzapine is indicated for the treatment of:• Schizophrenia.• Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment

response.• Moderate to severe manic episode.• Patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of

recurrence in patients with bipolar disorder (www.medicines.ie)

Some side effects: Stiffness/lack of movement (akinesia), abnormal muscle tone (dystonia), restlessness/agitation (akathesia), lack of interest (demotivation), weight gain, diabetes, sedation. (Healy, 2005).

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Role of the Disability Officer (DO)

• Generating awareness to academic schools and departments during routine training and DS activities of impact medications may have on students.

• During student assessments DO’s should explore impact of medication on individual and the associated side effects that could result from treatments.

• DO role is not about knowing the wide array of medications but exploring the medications with students and impact it may have on their student journey.

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Role of the Disability Officer (DO)

• Side-effects of medications are very individual and important to sign-post student to the relevant services they are attending for assistance.

• Medications are not specific to mental health treatments as there is often a co-morbidity of more than one condition that affects individuals.

i.e. Schizophrenia and diabetes – Student could be on anti-psychotic medication and insulin therapy as part of their management for both conditions.

Mind Body Holistic Approach

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Sources for general information on medication(s)

The information on medicines.ie relates to medicines available in Ireland. It is the most comprehensive source of information on medicinal products available in Ireland and is widely regarded as an invaluable reference source by healthcare professionals, the Department of Health and the Health Products Regulatory Authority.

General Information

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Sources for general information on medication(s)

Health Service Executive – Republic of Ireland

http://www.hse.ie/eng/services/list/4/olderpeople/tipsforhealthyliving/drugsmedicine.html

National Health Service – United Kingdom

http://www.nhs.uk/medicine-guides/pages/browsebymedicine.aspx

General Information

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Sources for general information on medication(s)

Mind.co.uk – United Kingdom

http://www.mind.org.uk/information-support/drugs-and-treatments/

Choice & Medication – United Kingdom

http://www.choiceandmedication.org/cms/?lang=en

Healy, D (2005) Psychiatric Drugs Explained, Elsevier Churchill Livingston: London.

Mental Health Specific

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Next Steps…

• Developing a general guide to some medications that students may be prescribed for awareness within Trinity.

• With multi-morbidity of more than one condition prominent medication guide will be inclusive of primary medications, not just mental health

• Involvement of Disability service staff, experts-by-experience, and clinicians in its development.

Trinity Disability Services

Thank You

Trinity College Dublin, The University of Dublin

Source Material

Baker, E., Fee, J., Bovingdon, L., Campbell, T., Hewis, E., Lewis, D., Mahoney, L. & Roberts, G. (2013) ‘From taking to using medication: Recovery-focused prescribing and medicines management, Advances in Psychiatric Treatment, 19(2), pp. 2-10.

Budgell, B. (2008) ‘Guidelines to the writing of case studies’, The Journal of the Canadian Chiropractic Association, 52(4), pp.199-204

Department of Health and Children (2006) A Vision for Change: Report on the expert group on mental health policy, The Stationary Office: Dublin.

Doherty, A.M. & Gaughan, F. (2014) ‘The interface of physical and mental health’, Social Psychiatry & Psychiatric Epidemiology, 49, pp. 673-682.

E. Power, M. Clarke, I. Kelleher, H. Coughlan, F. Lynch, D. Connor, C. Fitzpatrick, M. Harley and M. Cannon (2015) The association between economic inactivity and mental health among young people: a longitudinal study of young adults who are not in employment, education or training’, Irish Journal of Psychological Medicine , 32(1), pp. 155-160.

Healy, D (2005) Psychiatric Drugs Explained, Elsevier Churchill Livingston: London.

Jan F. Wiborg, J.F., Wensing, M., Tummers, M., Knoop, H. & Bleijenberg, G. (2014) ‘Implementing Evidence-Based Practice for Patients with Chronic Fatigue Syndrome’, Clinical Psychology and Psychotherapy, 21, PP.108–114.

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Source Material

M. E. Harley, D. Connor, M. C. Clarke, I. Kelleher, H. Coughlan, F. Lynch, C. Fitzpatrick & M. Cannon (2015) ‘Prevalence of Mental Disorder among young adults in Ireland: a population based study’, Irish Journal of Psychological Medicine , 32 (1), pp 79 – 91.

Malhi, G.S., McAulay, C., Das, P. & Fritz, K. (2015) ‘Maintaining mood stability in bipolar disorder: a clinical perspective’, Evidence Based Mental Health, 18(1), pp.1-6.

Mental Health Commission (2008) A recovery approach within the Irish mental health services: A framework for development, Mental Health Commission [online]. Available at: http://www.mhcirl.ie/File/framedevarecov.pdf

Sheridan, A. (2008) Psychiatric nursing practice: A historical overview, in Morrisey, J., Keogh, B. & Doyle, L. (eds.) Psychiatric/Mental Health Nursing: An irish Perspective, Gill & Macmillian: Dublin.

World Health Organisation (2013) Investing in Mental Health: Evidence for Action, World Health Organisaiton, Geneva. [Online] Available at: http://apps.who.int/iris/bitstream/10665/87232/1/9789241564618_eng.pdf?ua=1