Links between Mental Health and Physical Health
This session will cover:
- How to identify mental distress-A brief overview of common Mental Health issues- The link between diet/physical exercise and Mental Health- Agencies you can refer to for further advice
Myth or Fact
Mental Health problems are rare?
Myth
Mental health problems affect one in four people in any one year. So, even if you don’t have a mental health problem, it’s likely your best friend, a family member or work colleague/fellow student will be affected
People with mental health problems are violent?
Myth
People with mental health problems are much more likely to be the victim of violence. The violence myth makes it harder for people to talk openly about mental health problems. It can also make friends reluctant to stay in touch.
People can recover completely from a mental illness?
Fact
Many people can and do recover completely from mental health problems. Alongside professional help, the support of friends, family and getting back to work are all important in helping people recover.
People with severe mental illnesses die ten years younger?
Fact
But it’s not the mental illness that kills- it’s the discrimination. The physical health needs of people with mental health problems are often dismissed, causing higher rates of death from heart attacks, diabetes and cancer for people with severe mental illness.
You can be open about mental health problems without fearing you’ll be treated differently
Myth
People fear telling friends, family and work colleagues if they have a mental health problem because of stigma. In fact, 87% of people with a mental health problem have experienced discrimination
Attitudes towards Mental Health
In a Survey by The Mental Health Foundation in 2000:
42% of people with mental health problems didn’t tell members of their family.
22% didn’t tell their partners.
74% didn’t mention it on forms.
19% didn’t even tell their GP.
If you use a mental health service, there’s a one in four chance you’ll lose contact with friends
Myth
Sometimes friends feel like they don’t know enough to be able to help or feel uncomfortable. But you don’t need to be an expert on mental health to be a friend. It’s often the everyday things, like a phone call or text, that makes a difference.
There’s not much you can do to help a friend experiencing a mental health problem
Myth
If someone you know is experiencing a mental health problem, just staying in touch can really help. For many people, it is the small things that friends do that can make a difference like visiting or phoning.
How much impact do Mental Health issues have on the UK economy? £££
Mental health problems are estimated to cost the UK economy over £77 billion a year through the costs of care, economic losses and premature death (The Economic and Social Costs of Mental Illness 2003, The Sainsbury Centre for Mental Health).
You’re more likely to be hired if you have a physical disability than a mental health issue
Fact
Only four in ten employers would hire someone with mental health problems
Six in ten would hire someone with a physical disability
Southall Park Asylum Fire
This is part of the report from the British Medical Journal, 15th September, 1883 about the fire at Southall Park Asylum. It seems that most victims died through smoke inhalation and a servant leaped from the roof and died from her injuries.
‘It appears, from the evidence of Mr Frere, one of the Commissioners in Lunacy, that, some time ago the danger of fire was noticed by the Commissioners, and certain means of escape, in the way of external ladders and staircases, were suggested. This suggestion was not persevered for as Mr Frere pointed out, ‘the object of an asylum is not to provide means of exit, but to secure the custody of the patients’. Dr Boyd, able and distinguished in psychological medicine, and experienced in the custody of the insane, thought the proposed alterations would endanger the primary object of the asylum; and the Commissioners in Lunacy seem to have yielded to his opinion.’
Map of the Hanwell Asylum Grounds
Facilities in the grounds included:
- A printers
- Tailors and Shoemakers
- Coach house and stables
- Blacksmiths
- Bakery
- Brewery
Patients were encouraged to work at the facilities in the compound as part of their ongoing therapy
What causes mental health problems?
No single cause, a combination of:
GeneticsIt's possible that some people may be more prone to developing problems than others. For example, some problems seem to run in families, suggesting there is a genetic reason for some diagnoses; for example, schizophrenia.
Life eventsThere are many reasons why you may get depressed or elated in response to what's happened in your life, and certain events may trigger your mental distress. It has been suggested that we all have the potential to have mental health problems, and it is exposure to certain forms of stress that causes the problems to appear.It is difficult to say, sometimes, whether life events are the cause of certain difficulties, or the effect of them. For example, you may have depression, causing you to sleep badly; alternatively, if you are not sleeping well, this may result in you feeling anxious or depressed. The same holds true for changes in appetite or eating habits.
Brain chemicalsThere is evidence that mood problems are linked to changes in brain chemistry, but it isn't possible to say which comes first, the mood change or the chemical change.
Early signs of Mental Distress Losing interest in activities and tasks that
were previously enjoyed. Poor performance at work. Mood swings that are very extreme or fast
and out of character Self-harming behaviour, such as cutting Changes in eating habits and/or appetite:
over-eating, bingeing, not eating. Loss of, or increase in, sexual desire. Sleep problems. Increased anxiety, looking or feeling ‘jumpy’
or agitated, sometimes including panic attacks.
Feeling tired and lacking energy. Isolating yourself, socialising less; spending
too much time in bed. Wanting to go out a lot more, needing very
little sleep, feeling highly energetic, creative and sociable, making new friends rapidly, trusting strangers or spending excessively – this may signal that you are becoming 'high'.
Hearing and seeing things that others don't. Other differences in perception; for example,
mistakenly believing that someone is trying to harm you, is laughing at you, or trying to take over your body.
If you are concerned about a client’s Mental Health
Discuss your concerns with the person: – Choose a quiet, private time when they are not agitated. – Advise them of your concerns about their recent changes in
behaviour or manner. – Try not to argue if they become defensive, instead
approach the subject again in the near future. Encourage them to book an appointment with their
GP to discuss their concerns. If appropriate offer to attend the appointment with them, even if you wait in the waiting room, while they speak to the GP.
Assist them to call the Mental Health & Well-being Service on 020 3313 5660 and self refer
If someone has been diagnosed with a MH condition
Researching their condition: Join a support group for carers/friends of people with the condition, with permission of the person you could attend their GP with them and ask questions about how you can help and the warning signs to look out for.
Just being there, listening when the person is distressed, and helping them to complete everyday tasks. Develop code words for when you are concerned about the persons behaviour e.g. you seem a bit 'yellow' today is a non judgmental way to describe increasing manic or erratic behaviours.
Ensuring that they are eating healthily, exercising – even if it’s just the pair of you walking around the park on a regular basis, and socialising with others.
5 elements of wellbeing
Connect – interact and build relationships with people around
Be Active – go outside, take a walk, do physical activity on a regular basis
Take notice – be curious, look for changes in your surroundings
Keep Learning – take up a new hobby or course, within work or outside of it
Give – share your skills with those around you, volunteer, join a community group
What is…. Bipolar Disorder, also known as manic depressive illness, is a serious medical illness that causes shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe.
Bi-Polar Disorder
Panic Disorder
Panic DisorderPanic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
Signs & Symptoms
People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. During a panic attack, most likely your heart will pound and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have nausea, chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control.
Obsessive compulsive disorder (OCD) is a chronic mental health condition that is usually associated with both obsessive thoughts and compulsive behaviour.
Obsessions An obsession is defined as an unwanted thought, image or urge that repeatedly enters a person’s mind.
Compulsions A compulsion is defined as a repetitive behaviour or mental act that a person feels compelled to perform. Unlike some other types of compulsive behaviour, such as an addiction to drugs or gambling, a person with OCD gets no pleasure from their compulsive behaviour. They feel that they need to carry out their compulsion to prevent their obsession becoming true. For example, a person who is obsessed with the fear they’ll catch a serious disease may feel compelled to have a shower every time they use a public toilet
PhobiasA phobia is an anxiety disorder. It is an extreme or irrational fear of an animal, object, place, or situation. Phobias are more than simple fears. They develop when a person begins to organise their life around avoiding the things they are afraid of. If you have a phobia, you will have an overwhelming need to avoid all contact with the source of your anxiety. Coming into contact, or even the thought of coming into contact, with the cause of your phobia will make you anxious and may cause you to panic. If the cause of your phobia is an object or animal, such as snakes, and you do not come into contact with it regularly, it is unlikely to affect your day-to-day life. However, if you have a more complex phobia, such as agoraphobia (the fear of open spaces and public places), you may find it very difficult to lead a normal life.
What Anxiety feels like
Anxiety can be experienced as a range of feelings from uneasiness to severe panic. It is usually experienced in three ways:
Emotionally: with feelings of fear and nervousness.
Physically: dry mouth, feeling sick or a churning stomach, heart beating faster than usual, sweating, shaking, wanting to go to the lavatory all the time, breathing difficulties.
Cognitively: frightening thoughts, such as "I'm going to fail / make a fool of myself / losing control / I'm going mad" and so on.
At worst, anxiety and the fear of panic attacks can affect our life and behaviour in all kinds of ways: we may be unable to work or sleep, find ourselves avoiding people or places, or trying to cope by drinking or smoking too much.
Clinical Depression Depression is a serious illness. It is very
different from the common experience of feeling miserable or fed up for a short period of time.
When you’re depressed, you may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, and can last for weeks or months.
15% of people will have a bout of severe depression at some point in their lives. Women are twice as likely to suffer from depression as men, although men are far more likely to commit suicide.
Depression can affect people of any age, including children.
People with a family history of depression more likely to experience depression themselves. Depression can cause a wide variety of physical, psychological (mental) and social symptoms.
Depression is a real illness with real effects, and it is certainly not a sign of failure.
Finding it hard to enjoy activities you used to
Loss of appetite
Trouble sleeping
Medications used to treat Depression
Depression is commonly treated with antidepressant medications. Antidepressants work to balance some of the natural chemicals in our brains. These chemicals are called neurotransmitters, and they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin, norepinephrine, and dopamine
The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These include:- Fluoxetine (Prozac) – Increases appetite, also prescribed for certain eating disorders
Increases appetite, also prescribed for people with eating disorders- Citalopram (Celexa)- Most commonly prescribed by GPs- Sertraline (Zoloft)- Paroxetine (Paxil)- Escitalopram (Lexapro)- Venlafaxine- Combats depression and underlying anxiety, prescribed by psychiatrists, NOT GPs
Anti-depressants not addictive in themselves, but should not be stopped abruptly and patients should wean themselves off them gradually.
* Debate over effectiveness?
Side effects of Anti-Depressants
Headache, which usually goes away within a few days. Nausea (feeling sick to your stomach), which usually goes away
within a few days. Sleeplessness or drowsiness, which may happen during the first
few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects.
Agitation (feeling jittery). Sexual problems, which can affect both men and women and
may include reduced sex drive, and problems having and enjoying sex.
What should I ask my doctor if I am prescribed a psychiatric medication?
You and your family can help your doctor find the right medications for you. The doctor needs to know your medical history; family history; information about allergies; other medications, supplements or herbal remedies you take; and other details about your overall health. You or a family member should ask the following questions when a medication is prescribed:
What is the name of the medication? What is the medication supposed to do? How and when should I take it? How much should I take? What should I do if I miss a dose? When and how should I stop taking it? Will it interact with other medications I take? Do I need to avoid any types of food or drink while taking the medication? What should I
avoid? Should it be taken with or without food? Is it safe to drink alcohol while taking this medication? What are the side effects? What should I do if I experience them? Is the Patient Package Insert for the medication available?
What medications are used to treat anxiety disorders?
Benzodiazepines (anti-anxiety medications) The anti-anxiety medications called benzodiazepines can start working
more quickly than antidepressants. The ones used to treat anxiety disorders include:
Clonazepam (Klonopin), which is used for social phobia and GAD Lorazepam (Ativan), which is used for panic disorder, highly addictive.
Side effects include- anger issues/violent episodes. Widely used for violent inpatients to calm them.
Alprazolam (Xanax), which is used for panic disorder and GAD. Not widely used in the UK
Buspirone (Buspar) is an anti-anxiety medication used to treat GAD. Unlike benzodiazepines, however, it takes at least two weeks for buspirone to begin working.
Citalopram- Commo
In the UK, smoking rates among adults with depression are about twice as high as among adults without depression. People with depression have particular difficulty when they try to stop smoking and have more severe withdrawal symptoms during attempts to give up.
Nicotine stimulates the release of the chemical dopamine in the brain. Dopamine is involved in triggering positive feelings. It is often found to be low in people with depression, who may then use cigarettes as a way of temporarily increasing their dopamine supply.
However, smoking encourages the brain to switch off its own mechanism for making dopamine so in the long term the supply decreases, which in turn prompts people to smoke more.between the two.
Smoking and depression
Cannabis and Mental Health
Even hardcore smokers can become anxious, panicky, suspicious or paranoid.
If you’ve a history of mental health problems, then taking cannabis is not a good idea: It can cause paranoia in the short term, but in those with a pre-existing psychotic illness, such as schizophrenia, it can contribute to relapse.
If you use cannabis and have a family background of mental illness, such as schizophrenia, you may be at increased risk of developing a psychotic illness.
Alcohol
Alcohol may relieve stress in the short term, but it is a depressant drug. This means if you're feeling down when you drink, chances are the issues are going to seem worse when you sober up.
Drinking interferes with sleep patterns, which can leave you feeling ragged. Bad sleep also has an effect on mental agility and stress management.
Regular drinking is usually a factor in worsening existing mental problems. It is often linked to depression, especially because people tend to turn to alcohol in a bid to improve their mood.
Alcohol interferes with the way antidepressants work, which makes it bad news for anyone taking medication for a mental health problem. Mixing alcohol with any kind of medication carries risks, and can be fatal in some cases.
Junk Food leads to Depression?
Each participant completed a questionnaire about their eating habits and a self-report assessment for depression five years later.
The researchers found that those with the highest consumption of processed food were 58 per cent more likely to be depressed five years later than those eating the least amount.
Why is this the case?
Symptoms and suggested dietary changes mix and match
Feeling tired all of the time
Feel low in the winter
Feel unmotivated
Stressed/Anxious or Hyperactive
Lack of seeds/nuts and green vegetables
Lack of Omega-3 fats
Chromium minerals
Lack of Vitamin D
Symptoms answers
Feeling tired all of the time
Feel low in the winter
Feel unmotivated
Stressed/Anxious or Hyperactive
Chromium is recommended to balance blood sugarLack of Vitamin D
Lack of Omega-3 fats
Lack of seeds/nuts and vegetables
Omega-3
What do the numbers along the bottom represent?
Omega-3
One of the most potent mood boosting ‘drugs’ in capsule form
Higher chance of pregnant women suffering depression if lower intake of Omega-3
A lack of fish or fish oil is linked to hostility and aggression
Higher levels of Omega-3= higher levels of Seratonin Greater reduction in depression than anti-
depressants (15% compared to 50%)
Chromium
Daily supplements of chromium reduces carb. Cravings and improved mood, energy levels and weight gain perception
Helps maintain insulin function, diabetics are twice as likely to suffer from depression than general population
Practical Support for people with Mental Health Issues
Health Trainers Advocacy Vocational Advisors Support Groups
What is Advocacy?
Advocacy is defined as taking action to help people say what they want, secure their rights, represent their interests and obtain services they need
Advocacy sees things from the service user’s perspective
Advocacy helps to build confidence and skills and supports individuals to make decisions
Secure diverse solutions for diverse needs
Examples of what we have supported clients with
Information & signposting / Care & treatment issues Health education / Making complaints & appeals /
Housing / Obtaining services / Debt / Benefits / Accessing support groups /
/ Education / University / Arranging meetings with others /
And much more….
Primary Care Counsellor
Ealing PCT Mental Health & Wellbeing Service
Referral Pathways in Mental Health GP Diagnosis
Mild/Moderate Common Mental Health Problem:Referral via PCMHW SAQ
Moderate/Severe Common Mental Health Problem:
Referral via CBT Referral form
Severe & Enduring Mental Illness:Referral via letter
Uncertain Mental Health presentation:
Referral via GW SAQ
PCMHW:
Gateway Worker:
CMHRC Secondary/TertiaryServices
Most appropriate referral
Interventionpost assessment
Guided Self-help CBT
Signposting/Referral:•ADVOCACY•Other Primary/Secondary services•Voluntary/Community services•Vocational Advisor
Face to face CBTCBT Therapist
Counselling
Groups the MH & WB Service Run
Mood Improvement (Depression) Low Self-Esteem Anxiety Management Stress at Work Anger Management Mindfulness-based CBT
What do we look for?
Two main sets of psychological measures
Patient Health Questionnaire- (PHQ-9) General Anxiety Disorder (GAD-7)
Could you incorporate any of these questions in your workshop sessions?
Office Hours contacts (9-5)
The Mental Health and Wellbeing Service Local Community Mental Health Teams
(CMHTs)
Details in the ‘Blue Book’
Out of hours support
Samaritans- 08457 90 90 90 NHS Direct- 0845 46 47
Who to Contact
Mental Health and Wellbeing Service-
Community Mental Health Teams- Southall Norwood- Southall Lammas Centre- Acton and Central Ealing Manor Gate- Northolt
Thank you for attending this presentation. Any questions?
