BORE DA - GOOD MORNING

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BORE DA - GOOD MORNING
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FACTS AND MYTHS ABOUT MENTAL ILLNESS Jayne
Anderson / Bleddyn Lewis
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Facts and Myths about Mental Illness

• 1.Mental health problems only happen to other
  people
• Fact 1 in 4 of the adult population will suffer
  from mental health problems in any one year, and
  one in six experiences this at any given time. -
  The Office for National Statistics Psychiatric
  Morbidity report (2001). It is estimated that
  approximately 450 million people worldwide have a
  mental health problem- World Health Organisation
  (2001)
• 2. People with mental illness are violent and
  dangerous
• The risk of being killed by a stranger with a
  severe mental health problem is roughly
  110,000,000, about the same probability as being
  hit by lightning. The number of homicides by
  people with schizophrenia is around 30 per year.
  This is 5 of all homicides, the prevalence of
  schizophrenia in the population being 1 or less
  Avoidable Deaths, Five year report of the
  national confidential inquiry into suicide and
  homicide by people with mental illness (December
  2006).

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Facts and Myths about Mental Illness

• 3. People with mental illness are poor and/or
  less intelligent
• Mental illness, like physical illness, can affect
  anyone regardless of intelligence, social class
  or income level. Celebrities such as Stephen Fry,
  Nick Drake, Paula Yates, Kurt Cobain, Virginia
  Woolfe, Brooke Shields and Winston Churchill have
  all experienced mental illness.
• 4. People who self-harm are attention-seekers
• This is untrue. Most people who self-harm do it
  in secret and its only when they need to seek
  medical attention, that they come to the
  attention of others

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Facts and Myths about Mental Illness

• 5. People with poor mental health are weird
• Everyone suffers from low mood and 1 in 4 of the
  population will experience mental ill health at
  some point in their lives. Think of 12 people you
  know. Are 3 of them rocking in the corner
  muttering to themselves? Thought not.
• 6. Mental illness is caused by emotional weakness
  
• People do not choose to become mentally ill. As
  with other medical conditions, like heart disease
  or diabetes, it has nothing to do with being weak
  or lacking will-power.

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Facts and Myths about Mental Illness

• 7. Once youve had a mental illness, you never
  recover
• People can and do recover from mental illness.
  Medications, psychological interventions, a
  strong support network and alternative therapy
  treatments from cognitive behavioural therapy to
  improved diet and exercise habits are also very
  effective in leading to a complete recovery
• 8. Since care in the community was started,
  people with mental health problems have been left
  to roam the streets
• Even before the closure of the old large scale
  psychiatric hospitals, around 95 of people
  received care and treatment for mental illnesses
  in the community. What has changed is the type of
  accommodation and treatment available. For
  example, people requiring long term care in a
  hospital are usually no longer in the same
  building as those requiring short term
  admissions.

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Facts and Myths about Mental Illness

• 9. All people who suffer from depression are
  suicidal
• Suicide is not a mental illness. Not everyone who
  is depressed will consider suicide. It is as
  inaccurate as saying that all football fans are
  hooligans. However it is true to say that
  individuals experiencing a mental health problem
  are, generally, associated with a higher risk of
  suicide. If you suspect someone is feeling
  suicidal ask them it could help save their
  lives.
• 10. If I seek help for my mental health problem,
  others will think I am "crazy"
• Early treatment can assist with a faster
  recovery. If you broke your arm would you delay
  getting a cast applied incase people thought you
  were weak? Not likely!

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Risk Factors Certain factors can indicate an
increased risk of physically violent behaviour .
The following lists are not intended to be
exhaustive and these risk factors should be
considered on an individual basis.
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Demographic or personal history indicators

• Evidence of recent severe stress, particularly a
  loss event or the threat of loss
• One or more of the above in combination with any
  of the following
• Cruelty to animals
• reckless driving
• History of bed wetting
• Loss of parent before the age of 8 years D(GPP)

• History of disturbed / violent behaviours
• History of misuse of substances or alcohol
• Carers reporting service users previous anger or
  violent feelings
• Previous expression of intent to harm others
• Evidence of rootlessness or social restlessness
  
• Previous use of weapons
• Previous established dangerous acts
• Severity of previous acts
• Known personal trigger factors

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Clinical variables

• Misuse of substances and / or alcohol
• Drug effects (disinhibition, alcathisia)
• Active symptoms of schizophrenia or mania in
  particular
• Delusions or hallucinations focused on a
  particular person
• Command hallucinations
• Preoccupation with violent fantasy
• Delusions of control (especially with a violent
  theme)
• Agitation, excitement, overt hostility or
  suspiciousness

• Poor collaboration with suggested treatments
• Antisocial, explosive or impulsive personality
  traits or disorder
• Organic dysfunction D(GPP)

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Situational variables

• Extent of social support
• Immediate availability of potential weapon
• Relationship to potential victim (for example,
  difficulties in relationship are known)
• Access to potential victim
• Limit setting (for example, staff members setting
  parameters for activities, choices, etc.)
• Staff attitudes D(GPP)

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ReferenceViolence - The short-term management
ofdisturbed/violent behaviour inpsychiatric
in-patient settingsand emergency
departmentsNICE 2005
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These were just a few of the most common
misconceptions surrounding mental health and
mental illness.
Unfortunately, there are many more!
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WHAT AFFECTS MENTAL HEALTH AND WELLBEING ?
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• There is now a considerable amount of evidence
  about the factors that promote and protect mental
  health and wellbeing and those which are
  associated with risk of poor mental health.
• Improve Your Mental Health No matter how old or
  young you may be, mental health is there in
  everyday life in how we think and how we feel,
  how we react to others and how we are with
  ourselves. We all need to look after it, just as
  we do with our physical health.

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Top Tips for Positive Mental Health

• Staying mentally healthy isn't just about
  treating illness far from it! There are lots of
  things we can do to help prevent ourselves
  getting ill in the first place, and plenty more
  we can try if we (or those around us) do
  encounter problems.
• So, to get you started, we've put together these
  Top Tips for Positive Mental Health. Don't keep
  them under your hat either tell your family,
  friends and colleagues. Everyone should know this
  stuff!

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Top Tips

• Talk about your feelings
• Write it down
• Keep active
• Eat well
• Sleep well
• Drink sensibly
• Keep in touch with friends and loved ones
• Get the knowledge, take control
• Get professional help
• Look beyond drug therapies
• Change the scene
• Time for another cuppa?
• Hold that thought

• Go for green
• Let there be light
• Listen up!
• Improve your coping skills
• Set realistic goals
• Keep an eye on personal stress
• Three good things...
• Get involved
• The long way
• Find a hobby
• Do good
• Ask for help
• http//www.wellscotland.info/top-tips.html

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MEDIA ENTERTAINMENT OR INFORMATION HHOW
BALANCED IS THIS?
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Media Entertainment or Information How
balanced is this?

• Some programmes and media outlets are seen as
  being significantly more helpful than others. In
  a surveys regional newspapers, regional TV news
  and regional radio news programmes were all felt
  to be fairer or more mixed in their coverage than
  national media.
• The Big Issue, The Guardian and EastEnders were
  all highlighted as fair and balanced reporters of
  mental health issues.
• Sue Baker of Mind said "Really, it is tabloid
  coverage which gives us most cause for concern.
  They are looking for snappy headlines which will
  sell papers and they inevitably go for 'psycho'
  angles.

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Bonkers Bruno Locked Up
On Tuesday 23 September 2003, The Sun published
the offensive headline "Bonkers Bruno Locked Up".
For later editions, this was toned down to "Sad
Bruno in mental home". The coverage was roundly
condemned by the main groups in the mental health
field. At SANE, chief executive Marjorie Wallace
said it was "ignorant reporting" and that "it did
both the media and the public a huge
disservice".
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Brit, dont end up like your Gran
THE life of troubled BRITNEY SPEARS appears to be
unravelling before the eyes of the world. On the
surface it seems the pressures of fame have
pushed the former Pop Princess to the brink. But
today The Sun can reveal that the seeds of the
stars dramatic downfall may well have been sown
in her troubled childhood. The demons of
suicide, mental and emotional instability,
addiction, homelessness and violence all lurk
within the multi-millionairesss dark past. Even
her great-uncle, Earnest, has said of Britney
She didnt have a hope of turning out normal.
In a chilling parallel to her situation, The Sun
can today reveal that Britneys own GRANDMOTHER
committed suicide aged just 31, after her baby
son died. And some fear sad Britneys own sad
life could come to a tragic end, just like her
poor grandmothers.
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I'd kick Britney off the bi-polar express
Britney Spears appears to be locked in a downward
spiral which, we're reliably informed, is a
result of bipolar disorder. Strangely enough
Kerry Katona is also a sufferer. This,
apparently, accounts for the way these young
mothers end up in desperate domestic brawls
splashed all over the front pages. The path to
self-destruction is not, as we might have
imagined, due to an excess of mind-bending drugs,
alcohol or general self-indulgence, but in
Britney and Kerry's case, the mental disorder,
bipolar. So much sexier and hip than manic
depression - as it was called until it became
trendy.
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KNIFE THREAT TO COPS
Addict slashes own throat after police zap him
with Taser. A mental patient slit his own throat
after being shot by police with a 50,000-volt
Taser. Disturbed Justin Perry suffered massive
blood loss which led to a heart attack and he
died despite efforts to save him. The drama
happened after officers rushed to the home of
crack addict Perry when he threatened to kill his
mum June.
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'Gascoigne thought aliens were coming to abduct
him'
Paul Gascoigne, pictured here in 2006, has been
arrested and sectioned after his allegedly
menacing behaviour at the Malmaison hotel in
Gateshead. He became wired and unpredictable and
would flip and turn violent over nothing. He was
uncontrollable.
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A more balanced approach?
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• Rethink calls for urgent national attention to
  prevent another Taylor tragedy
• 14 December 2007
• Spokesperson for Taylor family says they are
  vindicated but destroyed
• Mental health charity Rethink today (December 14)
  called for national action to prevent the
  catalogue of failings that led to Garry Taylor
  killing his friend.

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• Rethink call for action on report from the
  Disability Rights Commission
• 27 September 2007
• Leading mental health charity Rethink today
  (September 27) called for immediate government
  action to save the lives of thousands of people
  with schizophrenia after a damning report on
  health inequalities from the Disability Rights
  Commission.

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• NEWS RELEASE
• Monday December 4 2006
• OVER 50 HOMICIDES PER YEAR BY MENTAL HEALTH
  PATIENTS
• National study finds 1 in 20 homicides committed
  by people with schizophrenia many are
  preventable.

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Avoidable Deaths (2006)

• Over 50 homicides are committed each year in
  England and Wales by mental health patients,
  according to a new report by the National
  Confidential Inquiry into Suicide and Homicide by
  People with Mental Illness (NCI).
• Many follow poor recognition of risk by mental
  health services. However, the number of cases is
  not increasing, and the risk of random killings
  by mentally ill people has not risen in the last
  30 years.
• The NCI examined all suicides and homicides by
  mental health patients over a 5-year period. Of
  the 600 homicide convictions per year in England
  and Wales, it found that 30 (5) were committed
  by people with schizophrenia, although only half
  were known patients.

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Avoidable Deaths (2006) Cont.

• Key findings and recommendations from the study
  on homicide (data collected from April 2000 to
  December 2003) include
• The Inquiry investigated 249 cases of homicide by
  people with a history of mental illness 9 of
  all homicides in England and Wales during this
  period.
• In the week prior to homicide 71 (29) patients
  were seen by services only 9 were thought to be
  of short-term moderate or high risk of violent
  behaviour.
• Stranger homicides, i.e. random attacks on
  members of the public by people with mental
  illness, have remained at five per year
  indicating that community care has not increased
  the risk to the general public.
• Services should ensure that high risk patients
  receive enhanced CPA, backed up by peer review in
  the most high risk cases.

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The way forward !

• We all have a duty to
• KEEP AN OPEN MIND
• BE INFORMED
• PROMOTE GOOD MENTAL HEALTH
• TACKLE STIGMA

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STEPPING STONES. ONE STEP AT A TIME Richard
Jones
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Recovery
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A process of recovering from a mental health
problem
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What is Mental Health?

• The concept of madness is one which is accepted
  globally across many different cultures.
• In modern Western culture it is viewed as an
  illness or disease.
• Because people are viewed as ill they are
  generally relieved of their usual
  responsibilities and their support becomes the
  domain of professionals.

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• The mentally ill person is often seen as an
  other.
• A distinct class of person.
• Different and apart from normal people.
• They become the illness that they are deemed to
  have schizophrenic, manic depressive,
  anorexic.

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• Is it possible to restore these people to full
  humanity when we actually fear their difference
  so much and when they themselves secretly feel
  less than human?
• Campbell (1998)

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The difference between the medical view and the
persons experience

• beyond symptoms and deficits

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The person

• Today I wanted to die. Everything was hurting.
  My body was screaming. I saw the doctor. I said
  nothing. Now I feel terrible. Nothing seems good
  and nothing seems possible.
• Written in a patients diary

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The Doctor

• Flat. Lacking in motivation, sleep and appetite
  good. Discussed aetiology. Cont. LiCarb 250mg
  qid. Levels next time.
• Written in medical notes
• from Repper Perkins (2003)

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What do people want frommental health services?
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• Choice
• Accessibility
• Advocacy
• Equal opportunities
• Income and employment
• Self help
• Self organisation
• Read (1996)

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What do they feel are their unmet needs?
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• Adequate income
• Intimacy
• Privacy
• Meaningful work
• A satisfying social life
• Happiness
• Adequate resources
• Warmth
• Estroff (1993)

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So What is recovery?
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It is not a cure
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A personal process of overcoming the negative
impact of a psychiatric disability despite its
continued presence.
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It involves

• personal development and transformation
• acceptance of the illness
• a sense of responsibility or control over ones
  life
• hope
• the support of others
• and working collaboratively with others on
  treatment and rehabilitation.

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What matters?

• Are we living the life we want to be living?
• Are we achieving our personal goals?
• Do we have friends?
• Do we have connections with the community?
• Are we contributing or giving back in some way?

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Recovery is a process, not a place.Looking at
where we want to be and what we want to achieve.
Not where we came from.
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Recovery is about

• recovering what was lost rights, roles,
  responsibilities, decisions, potential and
  support
• involving people in having a personal vision of
  the life they want to live
• discovering symptoms can be managed and doing it
• doing more of what works and less of what doesnt
• reclaiming the roles of a healthy person and
  not a sick person.
• getting there.

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What we know

• People can and do recover.
• Recovery is a process or a journey rather that an
  end point.
• Recovery means much more than an absence of
  symptoms
• Attitudes and values can have a powerful impact.
• Recovery is a common human experience.
• Different things help different people recover.

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Main ingredients

• Belief by the person experiencing mental
  illness/distress that they can and will recover
• Belief by people supporting them
• Commitment by the person experiencing mental
  distress to recover
• A personal strategy for recovery
• Resources to enable the person to recover
• Personal growth is shared with others seeking to
  recover.

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What people say helps them

• Having hope.
• A belief in change.
• Being ready to lead their own recovery.
• Self management and coping skills development.
• Being optimistic yet realistic.
• Having a chance to contribute or give back.
• Finding meaning and purpose.
• Supportive relationships.
• Becoming engaged and involved.
• Supportive and accessible services and
  treatments.
• Patience
• Creativity.

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How have mental health services adapted to assist
the recovery process?
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• Mental Health Policy
• The Care Programme Approach (England Wales)
• National Service Framework (Equity, Empowerment,
  Effectiveness, Efficiency)
• Standard 1 - social inclusion, health promotion,
  tackling stigma
• Standard 2 - service user and carer empowerment
• Standard 3 - promotion of opportunities for a
  normal life

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How does this work?
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• The care plan does not only address health needs.
• It must cover aspects of social care and
  functioning.
• A psychosocial approach is used.
• The care coordinator links in with other
  agencies, both statutory and non-statutory, to
  promote social inclusion and recovery.

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Services should combine and
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• Tackle stigma and discrimination
• Ensure advocacy services are available
• Provide and maintain good quality housing
• Help access educational and training
  opportunities
• Help find supportive networks which include
  opportunities for friendship.

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In Summary
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• The process of recovery is a journey traveled by
  a service user and those closest to them.
• It encompasses all aspects of life to help
  provide a meaningful and happy life without fear
  and prejudice.
• It does not replace the medical model of care but
  works with it.

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• Service users are offered a greater degree of
  input into their care.
• They agree a care plan, and a way forward that
  suits their individual circumstances, with their
  care coordinator.
• The people closest to them are offered a carers
  assessment and input into the service users
  care. They are recognised as key individuals to
  recovery.

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Further information

• Rethink - mental health charity
• www.rethink.org
• Julie Repper / Rachel Perkins

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Refreshments.
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Hassen Joomraty
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A PERSONAL AND PROFESSIONAL VIEW OF THE
GAP Kathy Giles
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WHY ?

• Heads are shaking
• People tutting
• Yes, I am behaving strangely
• But have they asked me WHY?
• No-one will come near me
• They all seem so afraid
• Yes, I know that I am shouting
• But no-one asks me WHY?
• I am really hot and bothered
• My head it hurts like hell
• I feel disorientated
• I want to know the reason WHY?

• I am someones brother, sister, father, mother
• I dont always act like this
• I really dont feel quite myself
• Will someone ask me WHY?
• As children we drive adults to distraction
• With what and where and why and when
• Surely as adults we should not make assumptions
• But ask the question WHY?
• To all those who profess to care
• Look beyond what you can see and
• Try to find the person who is me
• To do that, ask the question WHY?

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A CO-ORDINATED APPROACH TO CARE Bleddyn Lewis
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UNSCHEDULED CARE PROJECT

• Some facts
• About the project
• Work we have done
• What this means to you

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• Unscheduled care is defined as when someone seeks
  treatment or advice for a health problem without
  arranging to do so more than a day in advance.
• OCaithan et al 2007

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Some facts

• It is estimated that up to 5 of those attending
  an Emergency Department have a primary diagnosis
  of mental ill health .
• A further 20-30 of attendees have co-existing
  physical and psychological problems, with much of
  the latter remaining undetected.
• In January 2004, a Department of Health audit
  suggested that up to 10 of emergency
  departments four hour breaches involved patients
  with mental ill health. In addition, a third of
  patients with mental ill health wait longer than
  four hours compared to 10 of all patients.
• Improving the management of patients with mental
  ill health in emergency care settings. Department
  of Health Checklist 2004

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• People with mental health problems are
• more likely to leave the Emergency Department
  before being seen,
• are associated with a higher number of serious
  incidents,
• more likely to report their experience of the
  emergency department as negative.
• Managing urgent mental health needs in the Acute
  Trust. Academy of Medical Royal Colleges 2008.

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• Self-harm is one of the top five reasons for
  admission to hospital for emergency medical
  treatment, accounting for up to 170,000
  admissions in the UK each year.
• NICE 2004
• Over a quarter of the 682 adult service users
  surveyed in the Royal College of Psychiatrists
  Self-Harm Project (2006/07) rated staff poorly in
  terms of their attitude and understanding.
• Mental health is a major issue for acute hospital
  inpatients, for example 60 of patients over 65
  years of age will have a mental health problem
  and such patients have higher levels of physical
  morbidity and longer lengths of stay.
• Who Care Wins, RCPsych, 2005.

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Core values

• The same standard of urgent assessment, diagnosis
  and intervention should be provided for mental
  health care as is expected for physical health
  care.
• Good management of mental health problems can
  make a significant contribution to the
  effectiveness and efficiency of acute hospitals
  and improve the outcome for patients.
• There should not be any discrimination against an
  individual because of mental health problems.

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Main aims

• To develop an Integrated Care Pathway for
  unscheduled mental health assessment and
  treatment
• To produce proposals for service development and
  improvement
• To link in with the wider unscheduled care
  developments across the three counties
• To provide the optimal conditions to deliver
  mental health interventions.

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NEED FOR THE PROJECT
There were concerns about current out of hours
unscheduled care arrangements from the following
stakeholders
PATIENTS Delays in accessing Treatment. Confusi
ng procedures. Conflicting advice.
ON DUTY PSYCHIATRIST Unnecessary
assessments. Lack of skills / support. Patients
not clerked in to AE. Lack of clinical/risk
info.
AE STAFF Having to care for patients waiting
for MH assessment. Feeling under skilled. Delays
in accessing Assessment.
OUT OF HOURS GP Having to manage single
handedly until MH assessor arrives. Delays. Expo
sure to risks related to Above points.
CRHT SERVICE Poor clinical risk Information. Lack
of medical access for Joint decision making /
Prescribing.
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BASELINE REVIEW

• The out of hours service activities of the
  mental health services across the three counties
  of Carmarthenshire, Ceredigion and Pembrokeshire.
• Audits
• Questionnaires
• Engaged widely
• Leg work

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FINDINGS

• The main findings summarised
• Unacceptable delays in accessing assessment (5
  hours).
• Confusing procedures and conflicting advice
• Proportion of unnecessary assessments /
  admissions
• Lack of skills/ lack of support
• Patients not clerked / booked / registered into
  AE
• Concerns about contact with service being
  recorded
• Lack of clinical or risk information

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ISSUES

• History taking
• Assessment
• Record keeping
• Managing individuals with complex needs
• Medical prescribing
• Physical health examination
• Fitness for assessment
• Safety
• Child Protection Legislation
• Knowledge Application of MHA s.12 MHA Approval

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THE AGREED PLAN

• Implement a care pathway, assessment tool and
  comprehensive training programme-
• Introducing a central referral point (Divisional
  screening / discussion )
• Develop role of initial assessor
• Assessments by CRHT , MH Practitioner based on
  acute ward
• Divisional on-call doctor only
• Problems resolved
• Equity
• Resource implications

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MHLD
BASELINE REVIEW
BUSINESS CASE
IMPLEMENTATION PLAN
IMPLEMENTATION
EVALUATION
0CT 07
OCT 08 FEB
09
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MULTI FUNCTIONAL MULTI DISCIPLINARY PROVISION FOR
UNSCHEDULED CARE 24 HOURS OF CARE 00.00HRS


24.00HRS
09.00 CMHT
17.00
16.30 MH PRACTITIONER
MH PRACTITIONER 08.30
08.30 CRHTT
22.00
09.00 LIAISON PRACTITIONER 17.00
INPATIENT UNITS 24HRS
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TRAINING

• Baseline review

• Tender specification
• Closing date
• Filming _at_ WWGH
• Launch date
• All practitioners

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Lunch break
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Closing the Gap Disability Rights Commission
(2006)
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ALL MY HEALTH NEEDS Jayne Anderson
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All my health needs

• Definition of the concept of health
• A state of complete physical, mental and social
  well being and not merely an absence of disease.
  WHO (1991)

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Policy etc.

• Health services should adopt a holistic view of
  the assessment and development of care plans for
  mental health service users (DoH, 1990)
• Recommendations for the physical health care of
  people with SMI (DoH, 2005,2006)
• Guidelines for the treatment of schizophrenia in
  primary and secondary care (NICE, 2002)
• CNOs review of mental health nursing (DoH, 2006)
• Designed for Life, the WAGs 10 year vision for
  Health, states that there is to be a Revised
  Health Inequalities Strategy to be published in
  2009
• Closing the Gap (DRC Report, 2006)

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Six key priorities for health improvement

• Tackling health inequalities
• Reducing the numbers of people who smoke
• Tackling obesity
• Improving sexual health
• Improving mental health well being
• Reducing harm and encouraging sensible drinking
• (DoH, 2005)

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What physical health problems do people with SMI
/ LD experience?

• People with SMI have higher morbidity and
  mortality rates
• It is estimated that the life expectancy of
  people with schizophrenia is reduced by 10 years
  (Newman Bland, 1991) or more recently 25 years
  (Parks et al., 2006)
• People with intellectual disabilities have an
  increased risk of early death compared to the
  general population (Hollins et al., 1998
  McGuigan et al., 1995).
• People with Down's syndrome have a shorter life
  expectancy than people with intellectual
  disabilities generally, although the life
  expectancy of this group is increasing
  particularly quickly (Puri et al., 1995).

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Higher rates of major diseases

• The analysis of data on people with learning
  disabilities in Wales shows that
• There is a much higher rate of obesity amongst
  people with learning disabilities (35, as
  compared with a general population figure of
  22). The figure for women with learning
  disabilities is particularly high at 40.
• 9 of people with learning disabilities have
  diabetes, compared with 4 in the general
  population.

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Higher rates of major diseases

• People with bi-polar disorder, depression or
  schizophrenia have higher rates of
• Diabetes more than 10 higher than the general
  population (Holt Peveler, 2006, Busche Holt,
  2004)
• Cardiovascular disease 2-3 times higher than
  the general population (Brown et al., 2000 Osby
  et al., 2000)
• Respiratory disease more likely to suffer
  asthma, chronic bronchitis and emphysema (Sokal
  et al., 2004)
• Obesity Increasing evidence of higher rates of
  upper body obesity (Ryan Thakore, 2001)
• Stroke
• Cancers higher rates of digestive breast
  cancer (Schoos Cohen, 2003)

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Higher rates of major diseases

• People with schizophrenia
• Twice as likely to have bowel cancer as other
  citizens (new finding internationally)
• (Disability Rights Commission Formal
  Investigation Report 2006)

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Causes ?

• Health behaviours Smoking, diet, physical
  inactivity, alcohol substance misuse, sexual
  behaviour
• Illness Symptoms, poor spontaneous reporting of
  physical health problems
• Services not geared to meet peoples needs -
  Lack of knowledge, lack of training, attitudes,
  confidence, lack of integrated care
• Adverse effects of medication Extrapyramidal
  side effects, weight gain, glucose intolerance
  diabetes, cardiovascular effects, sexual
  dysfunction, neuroleptic malignant syndrome
• Environment Poverty, poor housing, social
  exclusion
• Difficulties recognising symptoms
• Barriers to accessing primary care
• Communication barriers
• Inequalities in screening treatment

96
Recommendations from the DRC Closing the gap
Report 2007

• All professionals and organisations with a role
  in the provision of primary care health services
  to people with learning disabilities and/or
  mental health problems must act now to tackle the
  inequalities in physical health and primary
  health care services they experience
• The planning and commissioning of primary care
  services for people with learning disabilities
  and/or mental health problems need to take
  greater account of their physical health care
  needs
• Urgent and positive action is needed to
  ensurethat people with learning disabilities
  and/or mental health problems and their carers
  (and other support workers) where relevant know
  their rights in relation to physical health and
  the services to support this, and are able to
  take part or receive appropriate help in
  programmes geared to supporting them in managing
  their physical health conditions

97
Recommendations from the DRC Closing the gap
Report 2007

• People with learning disabilities and/or mental
  health problems have a right to be registered
  with a GP and this needs to be made a reality
• Everyone with learning disabilities and/or mental
  health problems under the active care of a
  psychiatrist should also have their physical
  health monitored by regular review from primary
  health care services, including a GP or other
  primary care practitioner
• People with learning disabilities and/or mental
  health problems living in residential or nursing
  homes, in supported living arrangements, in
  prisons or in secure accommodation for young
  people should have equal access to a GP and
  access to options for healthy living
• Services and equality schemes need to be put in
  place to ensure that people with learning
  disabilities and/or mental health problems who do
  not have easy access to a GP or experience
  exclusion on multiple grounds receive full and
  proper primary health care services

98
Recommendations from the DRC Closing the gap
Report 2007

• GP practices and primary care centres need to
  make reasonable adjustments to make it easier
  for people with learning disabilities and/or
  mental health problems to get proper access to
  the services offered by the practice
• People with learning disabilities and/or people
  with enduring mental health problems should be
  offered an annual check on their physical health
  by a primary care specialist and access to health
  interventions that fit the level of their health
  needs regardless of age
• We recommend that people with learning
  disabilities and/or mental health problems should
  be offered accessible and appropriate support to
  encourage healthy living and overcome any
  physical health disadvantages which come with
  their condition or treatments administered for
  the condition including information, advice and
  support, in an accessible, relevant and targeted
  form, on how to quit smoking, on good diet, on
  sexual health, on alcohol, on street drugs and on
  physical exercise
• There should be a comprehensive programme of
  evidence based training and information resources
  (the design and at least some of the delivery of
  which involves users and user groups) for primary
  health care staff

99
Initiatives

• National Developments
• Incentivised GP contract
• Direct enhanced learning disability health check
• WAG Department of Health and Social Services
  Equality Group
• Local Developments (amongst others)
• Embedded into Service philosophy ICM Policy
  Developed Reviewed in 2006
• Physical health protocol development Developed
  in 2006
• Well-being support programme 2 cohorts in 2007
  and a further 2 cohorts 2008 a further 2
  planned for early 2009
• Care Co-ordinator training - ongoing
• Unscheduled Care Project commenced mid 2007
• Nutritional screening audit - 2007
• Physical health protocol audit - 2007

100
Physical health protocol development
101
Well-being Support Programme
102
Supporting Health Promotion for Mental Health
Service Users Jan Batty
103
Jan BattyDevelopment WorkerMind Your
Heartjan.batty_at_nphs.wales.nhs.uktel. 01570
423957
104
True or False?

• People with mental health problems are not
  interested in their physical health
• Health promotion is not a priority in a 10
  minute GP appointment with people with mental
  health problems. Getting by day to day is often a
  major challenge for the people and support
  regarding this is a priority.
• (Quoted in the Disability Rights Commission
  Report Equal Treatment Closing the Gap 2006)

105

• People with severe mental illness want to look
  and feel well, no matter how long they have been
  ill and are not willing to compromise on either
  aspect
• (Neuroleptic Weight Gain, Tweedell, Sutter,
  Dolan 2004)

106

• Efforts directed at increasing activity levels,
  making healthier lifestyle choices and managing
  weight gain are highly valued by clients and they
  identify these efforts as important in their
  recovery.
• (Mum I used to be good looking, look at me now,
  Dean, Todd, Morrow, Sheldon 2001)

107
Potential Obstacles

• Lack of motivation
• Effects of medication
• Lack of money
• Boredom
• Mental health culture
• Attitudes and beliefs of health staff

108
Mind Your Heart Programme

• Our aim is to improve the physical health of
  mental health service users in Ceredigion by
• Engaging people in activities that reduce their
  risks of illness
• Removing obstacles
• Raising awareness

109
What did we do?

• Training for staff and volunteers
• Small grants supported engagement in activities
• Presentations and networking to raise awareness
• Worked with Mental health voluntary
  organisations, Community Mental Health Teams and
  Afallon ward, Bronglais Hospital

110
Mind Your Heart Toolkit
111
What did we find?

• Training led to changes in personal health
  behaviour of staff
• Changes in culture
• We introduced no smoking on our premises even
  before the ban was introduced and would not have
  done it without Mind Your Heart
• (Staff member at drop-in)

112
What did we find?

• Gave authority and legitimacy
• I could back up information I was giving with
  factsI felt sure of what I was saying
• (Staff member after Food and Mood training)

113
Conclusions

• An effective, sustainable and efficient
  intervention
• Promoting mental and physical health together is
  helpful
• Working in partnership is crucial

114
Summary

• People with mental health problems are interested
  in their physical health
• Expectations of staff and lack of opportunities
  can hold them back
• People can use healthier lifestyles to aid
  recovery

115
POSTER PRESENTATIONS Caroline Oakley
116
MAKING A DIFFERENCE !
117
Making a difference !

• 10 minutes
• key points from today that have made you think
  differently
• 3 things that you will do differently

118
QUESTION TIME
119
Closing Remarks