- If you are concerned about someone’s mental health
- Specialist mental health services
- Care plan
- Care Programme Approach
- Care pathways
- What sort of treatment and care are available?
- Family involvement
- Being cared for by a GP
- Physical health care
- Moving house
- Personal health budgets
Oftentimes, there are signs that something is not quite right when it comes to a person’s mental health. Of course, in many stressful events and situations (such as bereavement, job loss, the end of a relationship and moving house) there will be natural responses of sadness, feeling stressed and anger. These feelings are normal and even if they are intense for a period of time, many are often temporary. Supporting a loved one with understanding and patience will help them recover.
Sometimes, however, a person might display behaviour changes that indicate the development of a serious mental health condition or psychotic illness. Psychosis will rarely happen suddenly. It is usually preceded by gradual changes over time. You might see someone:
- Becoming more irritable or anxious
- Becoming depressed
- Have difficulty concentrating
- Being preoccupied with odd beliefs or new ideas that are unusual
- Experience changes to their sleep patterns – they might sleep too much or not enough
- Demonstrate changes in their social behaviour – they might become withdrawn or overly friendly
- Experience mood changes
- Not being able to cope with their studies or work
- Not being able to complete basic tasks like food preparation or personal hygiene
- Becoming suspicious or paranoid
Alone, a lot of these signs won’t necessarily point to the development of mental illness however, a few of them together is an indication that something is happening. If these feelings and behaviours are allowed to continue with no intervention it could develop into suicidal feelings, a distinct lack of communication, severe sleep problems or a belief that everyone is after them.
There is evidence to suggest that early treatments lead to better outcomes.
Unless there is an imminent mental health crisis, it is best to contact your loved one’s GP who will decide on the appropriate treatment.
Mental health care is broken down into many different services:
This is the care that you receive from your GP. Primary care is responsible for the diagnosis and treatment of mental disorders. Primary Care is all about the patient rather than any specific conditions so primary care workers are not specialists in any particular field. They will treat common illnesses, manage some long term conditions and prevent ill health.
Secondary care refers to specialists that are usually accessed via a GP referral or other primary care physician. A person will be referred to secondary care when primary care is unable to resolve the problem. When you see a secondary care professional, it will not be your first contact you have had about your medical problem. Secondary care is usually based in clinics or hospitals and, for mental health patients, might be referrals to psychiatrists.
This is care that is provided in a specialist clinic. Either GPs or secondary care professionals can refer people to tertiary care centres. These are usually so specialised that you might have to travel a good distance to get there.
This specialist service is the Child and Adolescent Mental Health Service and specialises in helping young people overcome mental health problems.
Perinatal Mental Health Services
This is a specialist service for pregnant women and postnatal women. Referrals can be arranged via a GP, midwife or obstetrician.
Whoever sees you for a mental-health related appointment will assess you. The purpose of this is to get a picture of you and your needs.
Assessments may involve more than one professional or expert. You could see a social worker, a nurse, a specialist pharmacist, a psychologist or a psychiatrist.
Assessments will consider your mental health symptoms, your thoughts and feelings, your physical health, your circumstances (home life/employment/relationships/culture), your gender and your sexuality, substance use (alcohol or drugs), previous medical history, whether or not you have dependents and what you aspire and hope for your future.
It helps to be as open as you can be, but if there is something you do not wish to discuss, your feelings will be respected.
A care plan is something that is created for someone that has a mental health disorder. This may be a straight forward care plan written by your GP or it could be quite detailed if it is written by a psychiatrist or other specialist.
The purpose of a care plan is to identify health care needs.
This is an approach to caring for people who have mental health conditions. People who get this approach will probably have a more severe condition that could include a risk of self-harm, suicide or self-neglect. Other people could also be offered CPA support if they have previously misused alcohol or drugs, have learning difficulties, are a carer or rely on a carer, have been sectioned recently, are a parent or have a history of self-harm or violence.
People who have CPA support have a care-coordinator assigned to them. This is either a nurse, occupational therapist or social worker.
Depending on the mental health condition, individuals will be involved under different mental health care pathways. Here is a selection of pathways that might be used:
- Early intervention in psychosis
- Eating disorder services for young people and children
- Emergency mental health
- IAPT pathway for long-term conditions
- Perinatal pathway
There are many different ways of treating mental health conditions and the treatment will vary on a case-by-case basis. Two common treatments are talking therapies (counselling) and medication. You might also come across alternative and complementary therapies or art and creative therapies.
Talking treatments help provide people with a dedicated space to open up about experiences and thoughts, allowing people to explore feelings with someone who is a trained professional. Talking therapy can help individuals cope with upsetting experiences or memories, deal with specific problems and improve their relationships.
CBT – Cognitive behavioural therapy
One type of talking therapy is CBT. This helps individuals to develop skills to manage negative thought processes. CBT can be effective for many conditions but it doesn’t work for everyone.
Medication for mental health conditions isn’t a cure, it is simply a treatment for symptoms. There are lots of different medications available that are used for different mental health conditions.
These are given to people with depression but people with obsessive-compulsive disorder (OCD), anxiety and eating problems might also be offered them.
Low-level tranquillisers and sleeping pills
For those with problems sleeping or with anxiety, this medication can help ease the symptoms.
Antipsychotics are issued to relieve distressing symptoms of conditions such as schizoaffective disorder, schizophrenia, psychosis and even severe anxiety.
Mood stabilisers can help people who suffer from extreme mood swings – in bipolar disorder for example. This can be difficult to stop taking and are really dangerous if too many are taken.
There is well-documented research on how family involvement can help patients manage their conditions and get better.
Nine out of ten people with a mental health problem will have all of their care within primary care. Primary care is usually the first port of call for mental health conditions and is very person-centred. Often a GP is the best person to deal with less severe mental health conditions as they have known patients throughout their lives in many cases.
When it comes to health care, there is often a separation between physical health and mental health. However, it is vital that the two are considered together and not thought of as two separate parts of a human being.
When an individual has poor physical health, they have an increased risk of having problems with their mental health too. In a similar way, individuals with mental health problems have an increased risk of worsening physical health.
How physical health is affected by mental health
There are many ways in which poorer mental health is detrimental to one’s physical health.
In terms of schizophrenia, for example, someone with this condition has a risk of dying from a respiratory disease that is three times greater than someone without schizophrenia. Equally, there is double the risk of dying from heart disease. These statistics are down to the fact that if an individual has a mental health condition, they will be less likely to care for their physical health and are less likely to get physical health care that they are entitled to receive. For example, individuals who use mental health services don’t end up receiving routine checks like weight, cholesterol and blood pressure. This means that other conditions and physical problems won’t be picked up as quickly. Also, individuals with mental health conditions are less likely to receive help with their poor lifestyle, i.e. smoking, alcohol and diet.
There are many lifestyle factors that influence mental and physical health.
Exercise is a great way to maintain physical fitness, but it also improves mental wellbeing. Research has shown that exercise releases endorphins. Even ten minutes of walking at a brisk pace will increase an individual’s positive mood, energy and alertness. Even tending your garden can improve a person’s quality of life.
Being well-nourished is vital in maintaining mental wellness. Having a healthy diet means eating adequate amounts of essential fats, proteins, vitamins, minerals, complex carbohydrates and drinking enough water. What a person eats will drastically influence the prevention, management and development of many mental health conditions – including depression.
This has a serious negative impact on a person’s physical health and mental health. People often say that smoking helps them relieve their symptoms of a mental health problem but the effects of this are really short-term.
It is true that people who have depression will indeed be twice as likely to smoke as others. In addition, individuals with schizophrenia will be three times as likely to smoke as others.
When people smoke cigarettes, the nicotine influences the balance of chemicals in our brain. When smoking, nicotine increases the level of dopamine temporarily and it turns off the production of it too. The Brain chemical dopamine is what influences a person’s positive feelings. People with depression have lower levels of dopamine. Given what nicotine does to dopamine, it can make people want more and more nicotine so that they can have this brief positive sensation again.
Mental health conditions and long-term health
When people are treating a physical condition, it is easy to overlook the promotion of good mental health. The condition psoriasis affects both physical life and psychological wellbeing. It is a condition whereby the skin develops sores on the surface. It is an auto-immune condition that often has stress as a trigger. There are 1.8 million diagnoses of psoriasis in the United Kingdom and its sufferers often comment on their worse mental health.
For example one in three will experience depression or anxiety, one-tenth might feel suicidal and one-third feel humiliated because of their condition. This is why it is vital to make the links between mental and physical health and treat both.
It is well known that moving house is one of the most stressful events in a person’s life. It is a huge life change and will affect everyone’s anxiety levels and mood. What’s more, with all of the box packing and moving, going up (and down) stairs, etc., it is physically exhausting too. Mentally, there are lots of new things to think about. Getting used to a new space, learning different routes to work or school, sleeping in a room that feels ‘different’ etc. and it can take time for people to get used to their new home.
It can take a while until a new home actually feels like our home. It can help to unpack things that make a house feel cosy, homely and familiar. A rug, throw, cushion, etc. can help with this.
Personal health budgets for mental health are a way of giving disabled people and those with long-term medical conditions greater control and choice in how they are supported by the NHS to improve and manage their health and their care.
These budgets have recovery in mind. This means that they don’t just focus on symptoms but also focus on establishing a life that is meaningful for the person with a mental health condition.