Mental Health First Aid - If we talked about physical health the way we talk about mental health - PSNC
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08/02/2019
Mental Health First Aid
Improving services for patients
If we talked about physical health the
way we talk about mental health…
https://www.youtube.com/watch?v=yWA0es85hMs
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08/02/2019
Agenda
• The impact of mental health problems
nationally and locally
• Understanding key mental health conditions
• Screening for depression
• Making Every Contact Count
• Every Mind Matters
• Signposting to resources
• Managing our own mental health
Public Mental Health for
pharmacists
Tammy Coles MPH, BSc, RSCN, RGN
Health and Wellbeing Manager
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08/02/2019
The ‘strategy story’ so far….
National investment, Integrating physical and mental health care, Increasing access
to psychological therapies, Improving access to services, reducing out of area
placements, children and young people, suicide prevention, perinatal mental health
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A life course approach …………….
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How much do you know ?
How many children and young
people in England have a clinically
diagnosed mental health condition?
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Children and Young People in England
1:10 with a clinically diagnosed
mental health condition
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Locally
• 1:10 children aged 5-16 years has a clinically
diagnosable mental health problem in Nottingham and
Nottinghamshire
• Self harm 626.6/100,000 young people in Nottingham
and 585.5/100,000 in Nottinghamshire
• There are around 9055 young people in Nottingham with
and eating disorder and 10834 in Nottinghamshire
Pharmacy presentation 15th Nov 2018
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Pharmacy presentation 15th Nov 2018
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What help is out there?
http://www.bemhnottingham.co.uk/professionals/
https://www.nottshelpyourself.org.uk/kb5/nottinghamshire/directory/service.page?id=9dJWtrOvRUk
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What do we know about mental health
in adults?
1:5 Common MH
problems
1:8
40% with anxiety and depression
accessing MH treatment
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08/02/2019
Adults in Nottingham and Nottinghamshire
• 22,000 experienced high levels of anxiety
• 62,885 experience both anxiety and depression
• 7000 are known to GPs with a Serious Mental Illness. (SMI)
Adults with SMI Over 3.7 times more likely to die before the age of 75 than
the general population
http://www.nottinghamshireinsight.org.uk/research-areas/jsna/adults-and-vulnerable-adults/mental-health-adults-and-older-people/
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LTC’s and mental health
• 30% of population has
a LTC
• 66% of those have a
co-morbid MH
condition
• 70% MUS have
anxiety and
depression
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08/02/2019
Opportunities
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Activity
How much do you know about different
mental health problems?
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Anxiety
Definition
Feeling of unease, worry or fear that are hard to control. The feelings in
anxiety are more constant and can often affect daily lives.
Types
Panic disorders, phobias, PTSD, social anxiety disorder, GAD
Symptoms
Physical Psychological
• Increased hear rate and muscle • Feelings may loose control, die,
tension faint
• Tingling in hands and feet • Feeling on edge
• Dizziness • Hyper-alert
• Chest pain and palpitations • Detached
• Dry mouth
Anxiety
Treatment options
Psychological therapy (CBT, mindfulness, EMDR)
Medication (SSRI, SNRI, Pregabalin, Benzodiazepines)
Patient profile
♀>♂
Family history
History of traumatic events
Painful, long term condition
History of alcohol/drug abuse
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08/02/2019
Depression
Definition
Persistent sadness and loss of interest that impacts on normal day to day
activities
Types
Major, Psychotic, antenatal & postnatal, bipolar, SAD
Symptoms
Physical Psychological
• Disturbed sleep • Sad / low mood
• Diminished appetite • Loss of interest / enjoyment
• Lack of energy • Reduced concentration / attention
• Constipation / self esteem / self confidence
• Low sex drive • Irritable / intolerant
• Changes to menstrual cycle • Feeling tearful
Depression
Treatment options
Psychological therapy (CBT, mindfulness)
Exercise
Medication (SSRI, SNRIs, TCAs)
Patient profile
Age
Family history
Difficult life events
Personality
Loneliness
Long term condition
History of alcohol/drug abuse
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Depression
1108/02/2019
Cognitive Behavioural Therapy
PTSD
Definition
Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by
very stressful, frightening or distressing events.
Symptoms
Physical Psychological
• Sleeping problems • Reliving experience
• Stress symptoms • Intrusive thoughts
• Neurological • Alertness/feeling on edge
• Respiratory • Irritability / agression
• Musculoskeletal • Easily startled
• Cardiovascular • Avoiding feelings / memories
• Overwhelming feelings
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Bipolar disorder
Definition
a condition that affects your moods which can swing from one extreme
to another (formerly known as manic depression)
Symptoms
Physical Psychological
• Agitation • Depression
• Hyperactivity • Mania
• Low activity
• Lack of energy
• Diminished appetite
Mania
Definition
A state of physical and mental over-activity
Symptoms
Physical Psychological
• Misuse of drugs/alcohol • uncontrollably excited
• Decreased need for sleep • racing and jumbled thoughts
• Agitation • very easily distracted and unable to
• Repetitive movements concentrate on anything
• loss of insight
• delusions and paranoia
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OCD
Definition
a common mental health condition in which a person has obsessive thoughts
and compulsive behaviours.
Symptoms
Physical Psychological
• Excessive double-checking of things, • Fear of being contaminated or
• Repeatedly checking in on loved ones contaminating others
to make sure they’re safe • Fear of losing control and harming
• Counting, tapping or repeating certain yourself or others
words to reduce anxiety • Intrusive sexually explicit or violent
• Spending a lot of time washing or thoughts and images
cleaning • Order and symmetry: the idea that
• Ordering or arranging things “just so” everything must line up “just right”
• Accumulating “junk” such as old • Superstitions; excessive attention to
newspapers or empty food containers something considered lucky or unlucky
Psychosis
Definition
a mental health problem that causes people to perceive or interpret
things differently from those around them (including hallucinations
delusions, confused/disturbed thoughts and/or lack of insight/self-
awareness).
Symptoms
Physical Psychological
• Rapid / constant speech • Hallucinations
• Disturbed speech • Delusions
• Abrupt pauses in conversation • Confused/disturbed thoughts
or activity • Lack of insight/self-awareness.
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Schizophrenia
Definition
a breakdown in the relation between thought, emotion, and behaviour; a
type of psychosis
Symptoms
Physical Psychological
• Disorganised speech • Hallucinations
• Disorganised behaviour • Delusions
• Catatonic behaviour • Emotional flatness
• Lack of speech • Apathy
• Lack of personal care / looking • Difficulty concentrating
after one’s self • Feeling disconnected from feelings
• Avoiding social contact
Multidimensional health
Sexual Mental
Social Physical
Spiritual Emotional
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Screening for
depression and anxiety
PHQ-9
Depression Severity:
0-4 none,
5-9 mild,
10-14 moderate,
15-19 moderately severe
20-27 severe.
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PHQ-2
% predicative value of
depressive disorder
Score Major Any
1 15.4 36.9
2 21.1 48.3
3 38.4 75.0
4 45.5 81.2
5 56.4 84.6
6 78.6 92.9
GAD-7
0-5 Mild
6-10 Moderate
Moderately
11-15
severe
16-21 Severe
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Making Every Contact Count(MECC)
• Delivering very brief lifestyle advice
(30 seconds to 3 minutes) when
appropriate
• Recognising when advice is appropriate
and when it will be effective
• 1 in 8 people respond to brief advice about
alcohol intake by reducing their drinking
behaviour by one level e.g. from increasing
risk to lower risk
• 1 in 20 people go on to quit smoking
following brief advice
• Prevention of illness will, in the long run,
save the NHS time and money
The Wisdom of Pooh
“ Here he is Edward Bear, coming
downstairs now, bump, bump, bump,
on the back of his head, behind
Christopher Robin. It is, as far as he
knows, the only way of coming
downstairs, but sometimes he feels that
there really is another way, if only he
could stop bumping for a moment and
think of it…”
A. A. Milne
1808/02/2019
Activity
How can you use the screening tools in the
pharmacy?
How can we use mental health as the focus for
an HLP campaigns?
Every Mind Matters
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1908/02/2019
Resources and support
https://fingertips.phe.org.uk/ More information
You could also check out some of the links below, which take you to various websites with lots of useful information about things you can do to
improve the way you feel, about where you can get help and support, and about mental health. Some of them also have details and contact
numbers for telephone helplines, and several of these are open 24/7.
YOUNG MINDS: (a leading charity focussed on improving mental health)
KOOTH: (a free online support service for young people)
YOUNG SANE: (a virtual mental health community for young people
LIVING LIFE TO THE FULL (a free online course showing you easy ways to feel better)
NGYmyplace (a support centre for all Nottingham’s young people)
MIND: (a major mental health charity and information hub)
RETHINK: (a leading charity and source of further information)
FRANK: (friendly and confidential advice about drugs)
SAMARITANS: (confidential advice for people with suicidal thoughts)
you & co: – (support for victims of crime)
THE MIX: (essential support for under 25s)
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Who wants a life without stress?
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2008/02/2019
Stress and stressors
3 Stressors
Predisposition
2 Appraisal
Mental Physical Behavioural
Prof Graham Jones
1 Coping
2108/02/2019
Mindfulness
Mental Health First Aid
Improving services for patients
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