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Mental Health

Mental Health

What is it?

In small groups, discuss what it means to you and write down a definition.

Definitions

Definitions

WHO

Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (WHO, 2004)

MHF

"It can be easy to forget, we all have mental health. Mental health is a spectrum." (MHF)

Mind

Positive Mental Health is...

"You care about yourself and you care for yourself. You love yourself, not hate yourself. You look after your physical health – eat well, sleep well, exercise and enjoy yourself.

You see yourself as being a valuable person in your own right. You don't have to earn the right to exist. You exist, so you have the right to exist.

You judge yourself on reasonable standards. You don't set yourself impossible goals, such as 'I have to be perfect in everything I do', and then punish yourself when you don't reach those goals." (Mind)

Psychopathology through the ages

Model History

Madness & Melancholia

Fear & Sadness

  • Hippocrates (460-379 BC) suggested all health was affected by 'humors' (blood, black bile, yellow bile and phlegm). Mental health problems, often referred to as 'temperaments' were seen to be caused by an imbalance in humors.
  • Melancholic patients were seen to have an excess of black bile and treatment consisted of a strict nutrition plan and a selection of herbal tonics and purgatives, including St John's Wort and mistletoe.

By the First Century AD, the concept of separating emotional upset and 'intellectual delusion' became more commonplace and 'abnormal beliefs', were often accepted as a reason for mental health problems with no obvious emotional or situational cause.

Being 'disturbed' in The Middle Ages

The word 'lunatic' comes from the Latin, 'lunaticus' meaning 'moon-sick'. That the phases of the moon affected mental health was a popular belief throughout most of the middle ages.

Many popular treatments involved cold water - throwing the afflicted in a river or lake to 'snap them out of lunacy'. Bleeding, cupping and leeching were common - to rid the body of 'bad blood'.

Bethlem Royal Hospital in London, founded in 1247, often housed people with learning difficulties and those with epilepsy or paralysis. The hospital also admitted patients for having an 'overtaxed brain', refusing to marry a cousin, desertion of spouse and unplanned pregnancy along with those who had committed crimes.

The monks who founded 'Bedlam' believed in purging the sick part of the mind through harsh treatment, fasting and isolation. Later treatments were more experimental, including rotation therapy and lobotomy. Guards at the hospital charged visitors to view patients in cages as a tourist attraction

What is 'disturbed'? The Middle Ages (476AD - 1492AD)

During these centuries, healthcare throughout most of Europe was provided by the church and the theory of interactionistic dualism (the idea that the body is governed by the soul) meant that mental health problems were often seen as purely spiritual.

This led to many people believing that mental health problems had supernatural causes such as witchcraft and possession.

Treatment could include exorcism, prayer, bleeding, beating and some towns had special towers or cells for those 'deprived of reason' to be isolated from others as many also believed mental health problems were contagious.

Dividing melancholia

"All melancholic patients have a disturbed imagination" (Laurentius, 1599)

Between the 16th and 19th centuries, much interest was given to the different types of 'melancholy'.

"Universal and particular melancholia"

(Willis, 1683)

"Partial insanity" describing depressive and "universal insanity" associated with manic states (Cullen, 1793)

"Melancholia, Mania, Idiocy and Dementia"

(Pinel, 1806)

In 1917, Freud published his essay "Mourning and Melancholia", which compares grief with depression

"Depression with melancholic features" (DSM-V)

By the beginning of the twentieth century, the use of the term depression started appearing in medical manuals to describe feelings of anxiety, sadness or a lowered mood and gradually replaced melancholia in describing affective, situational or reactive depression.

The term is still used when diagnosing individuals with endongenous depression, which is thought to have a mainly neurobiological cause

There are many current diagnostic terms in use to explain mental health problems.

The DSM-V lists several types of depressive disorder, separately from those associated with bipolar affective disorders including 'other specified' and 'unspecified'

  • We now have terms such as mild, moderate and severe depression; dysthymia; cyclothymia; Seasonal Affective Disorder; pre and postnatal depression
  • Anxiety is usually given a separate diagnosis, although depression and anxiety combined is the most common closely followed by Generalised Anxiety Disorder
  • NICE aim to update their guidelines every two years to stay current with research and best practice

Medical Models

"Health A-Z - Conditions and treatments by subject - Mental health disorders" (NHS.UK)

In explaining the causes of common mental health problems, the NHS website suggests a combination of physical, genetic, psychological and environmental factors.

A purely biological approach to mental health looks at the physical causes such as genetic vulnerability, brain differences (including levels of neurotransmitters), hormonal changes and imbalances (such as those experienced during pregnancy and birth) and the impact of medication and substances.

The current UK medical model recognises socioeconomic and environmental factors as risk indicators and triggers for some mental health problems e.g. ACEs

Experience and mental wellbeing

  • Adverse Childhood Experiences (ACEs) are traumatic experiences that occur before the age of 18 but are remembered throughout adulthood.

  • In 2016, a PHW study found that 41% of adults in Wales who suffered four or more adverse experiences in childhood are now living with low mental well-being.

  • This compares to 14% of those individuals who experienced no ACEs during their childhood

(http://www.wales.nhs.uk/sitesplus/888/page/88505)

Higher risk, not a guarantee...

  • There is no universally agreed definition of an adverse childhood experience (ACE), but studies addressing the issue have mostly converged on a similar set of experiences falling under this term
  • A typical list of ACEs was used by Public Health Wales in a 2017 survey investigating the childhood experiences of approximately 2,500 Welsh adults. That survey used the following experiences:
  • verbal abuse;
  • physical abuse;
  • sexual abuse;
  • physical neglect;
  • emotional neglect;
  • parental separation;
  • household mental illness;
  • household domestic violence;
  • household alcohol abuse;
  • household drug abuse; and
  • incarceration of a household member

(https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/506/50605.htm)

Inside and out

Holistic Models

The 'whole person'

Holistic approaches are used by many organisations, such as Hafal, to assess need and provide care (www.mentalhealthwales.net).

How do you assess clients' mental health? Discuss in your groups, including your own ideas and your agency assessment process.

Problems & Levels

CMHPs

Don't forget the stage of change...

Neurosis or psychosis?

7.8% of people in UK with anxiety & depression

Most mental health diagnoses have traditionally been divided into groups based on presentation of either ‘neurotic’ or ‘psychotic’ symptoms. ‘Neurotic’ covers those symptoms which can be regarded as severe forms of ‘normal’ emotional experiences such as depression, anxiety or panic. Conditions formerly referred to as ‘neuroses’ are now more frequently called ‘common mental health problems.’ (mentalhealth.org.uk)

Overall, around one in six adults (17 per cent) surveyed in England met the criteria for a common mental disorder (CMD) in 2014.

Women were more likely than men to have reported CMD symptoms. One in five women (19 per cent) had reported CMD symptoms, compared with one in eight men (12 per cent) (NHS England, 2014)

The "waking dream"

Freud wrote that “in neurosis, the ego suppresses part of the id out of allegiance to reality, whereas in psychosis it lets itself be carried away by the id and detached from a part of reality" (1924)

Laing created a 'rumpus room' experiment in 1955 to allow patients in a state of psychosis to stop medication and have more social interaction, in a safe, comfortable environment. All patients improved enough to be released, although they were all back in hospital within a year.

Laing suggested the outside world was the problem.

The idea of 'metanoia' (Greek for 'change of mind'), where someone undergoes a spiritual experience, leading to "change from the depths of oneself upwards" (Cooper, 1974) is explored within existential philosophy repeatedly. The Metanoia Institute in London, regularly conducts research into the impact of meaning on mental health.

Psychosis is not a disorder in itself; it is an experience, sometimes linked to a mental health problem.

What are CMHPs?

NICE

Management of specific mental health problems is covered by NICE guidelines on

  • depression
  • generalised anxiety disorder
  • panic disorder
  • obsessive-compulsive disorder
  • post‑traumatic stress disorder
  • social anxiety disorder.

Complex problems

Less common mental

health problems: more likely

to experience a'psychotic

episode'

Psychotic disorder 0.7 in 100 people*

Bipolar disorder 2.0 in 100 people

Antisocial personality disorder 3.3 in 100 people

Borderline personality disorder 2.4 in 100 people (NHS England, 2014)

A or B

CPCAB Service Levels and model of helping

We will all face obstacles to our wellbeing and sometimes need help to explore the context of a situation that is affecting our mental health.

Being overwhelmed or stressed

A

  • Clients who are at Service Level A are struggling to cope with 'everyday life problems' that are often external.
  • Our role is to support and help clients explore their problem in the context of their thoughts and feelings, relationships and life stage in order to make changes
  • Some clients are not ready to make change, sometimes due to an underlying CMHP (Service Level B)

Psychological problems

B

Service Level B clients are struggling with themselves, although they will still face life problems

These psychological problems with thinking, feeling, relationships or life stages may be explicit or implicit

There may be a diagnosis of a CMHP

Severe & complex

Or C?

Service Level C clients usually have a diagnosis and wider support from statutory mental health services.

Counsellors working at this level need to be highly trained and experienced.

From an existential perspective, these problems are seen to be caused by ontological insecurity and work involves changing the foundations of self.

"Such a divorce of self from body deprives the unembodied self from direct participation in any aspect of the life of the world...the unembodied self, as onlooker at all the body does, engages in nothing directly” (Laing, 1960)

Wellbeing

Obstacles to wellbeing

We are all likely to experience certain life events such as loss and bereavement, relationship breakdowns, traumas and life stage changes.

In pairs, discuss how these can affect your mental health. Try to link to theory.

How do we make sense of mental health in our core model?

HE Ideas

'Personal theories'

Humanistic

Humanistic theory is all about the subjective experience - how does this individual make sense of themselves?

Authenticity

The organismic

Humanistic theories suggest authentic living is the way to wellbeing. People struggling with their mental health are not able to live as their organismic, or 'real' self. We seek positive regard from others for who we really are.

Who am I?

We are born as our organismic self, striving for self actualisation.

As we grow, we look for positive regard from others and our experience of receiving this shapes our ideas of who we are and who we should be - our self concept is influenced by conditions of worth and introjected values.

Our ability to meet these conditions and live by these values congruently, affects our mental health and wellbeing.

Self concept

Locus of evaluation

Introjected values are those of others which we have absorbed into our self concept

An external locus of evaluation uses others' judgements to assess self worth

What happens when we fail to live up to these opinions of us?

Who judges?

Conditions of worth

What happens when it's my fight?

'Restricted growth'

"Psychologically healthy persons... are men and women who have been lucky enough to live in contexts which have been conducive to the development of self-concepts which allow them to be in touch for at least some of the time with their deepest experiences and feelings without having to censure them or distort them" (Thorne, 1990)

"The best vantage point for understanding behavior is from the internal frame of reference of the individual" (Rogers)

Denial, distortion & incongruence

Mental health problems are deemed to happen due to incongruence - experience not matching our self concept. We distort or deny our experience to try and avoid this anxiety;

"at pains to preserve and defend the self concept which wins approval and esteem and will be thrown into anxiety and confusion when incongruity arises" (Thorne, 1990)

Disorder without labels?

Person-centred theory suggests a way of working with psychopathology, without labelling or losing the person-centred approach, by acknowledging and exploring:

"1- the nature of the predominant conditions of worth the person has experienced

2 - the person's particular way of coping with the conflict between the conditions and the self

3 - the combination of the above with other predisposing hereditary, cultural, social and situational factors"

(Lambers, 1994)

Subjective deviance

In your groups, discuss how configurations of self might affect mental health.

More than one or parts of the same?

Sum of the parts

Humanistic theory suggests we are made up of parts - configurations of self

"the individual may go on to develop a plurality of self-concepts; a different self to maximise positive self-regard in relation to each social grouping" (Cooper, 1999)

A philosophical approach

Existential

Most existential theory focuses more on how the individual relates with their experience of the world; how we find meaning in existence.

"God is dead"

"Life is nothing until it is lived; but it is yours to make sense of and the value of it is nothing else but the sense that you choose" (Sartre, 1946)

"Here the ways of men part: if you wish to strive for peace of soul and pleasure, then believe; if you wish to be a devotee of truth, then inquire" (Nietzsche, 1865)

“Yet it is an indescribable blessing to me that I was mentally depressed as I was" (Kierkegaard, 1849)

Anxiety

"I create myself as I exist and have to reinvent myself daily...this impermanence and uncertainty give rise to a deep sense of anxiety" (van Deurzen, 2006)

"Anxiety has a purpose...to protect us from dangers that threaten our existence or values that we identify with our existence. This normal anxiety of life cannot be avoided except at the price of apathy or the numbing of one's sensibilities and imagination.” (May, 1977)

Meaning in anxiety

Freedom, Isolation, Meaninglessness, Death

Accepting givens

Each of these givens of existence creates a paradox that can be challenging.

“...the more unlived your life, the greater your death anxiety. The more you fail to experience your life fully, the more you will fear death.”

Yalom, (2008)

“He who has a why to live for can bear almost any how.”

Friedrich Nietzsche

Finding meaning

“Thus it can be seen that mental health is based on...the tension between what one has already achieved and what one still ought to accomplish...Such a tension is inherent in the human being and therefore is indispensable to mental well-being...What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal...What he needs is not the discharge of tension at any cost but the call of a potential meaning waiting to be fulfilled by him.” (Frankl, 2006)

Facing life

"It is only in facing both positive and negative poles of existence that we generate the necessary power to move ahead. Thus well-being is not the naive enjoyment of a state of total balance given to one by Mother Nature and perfect parents. It can only be negotiated gradually by coming to terms with life, the world and oneself."

(van Deurzen, 2007)

Realms of existence

Facing or avoiding?

In your groups, discuss how mental health can be affected in each of the four realms by facing or avoiding existential givens

Question &Apply

Practice

Thoughts, comments or questions?

In mixed year groups, use your core theoretical model to explain common life or mental health problems that your clients have faced.

Useful links

Links

Possible criteria???

Criteria

6.1.1

6.1.2

6.2.1

6.2.2

6.2.3

6.2.4

1.3.1

3.2.1

3.2.2

5.1.1

5.1.2

5.1.3

5.3.1

References

Online links

https://www.mind.org.uk/information-support/your-stories/what-is-mental-health-and-mental-wellbeing/#.Ws3AvojwbIU

http://www.who.int/features/factfiles/mental_health/en/

https://www.mentalhealth.org.uk/your-mental-health/about-mental-health/what-are-mental-health-problems

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857376/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314947/#B21

https://www.nhs.uk/livewell/mentalhealth/Pages/Mentalhealthhome.aspx

http://www.cpcab.co.uk/Content/Publicdocs/The%20CPCAB%20model%20of%20helping%20work%20and%20counselling%20practice%20(7.2).pdf

https://www.mentalhealth.org.uk/news/mental-health-foundation-welcomes-new-prevention-resources

http://digital.nhs.uk/catalogue/PUB21748

https://www.rcpsych.ac.uk/pdf/MH_new_models_care_Kings_Fund_May_2017.pdf

http://www.metanoia.ac.uk/research/research-groups/meaningful-living-research-group-mlrg/

https://www.nspc.org.uk/about-the-school/who-are-nspc/

Online

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