Outline of session

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• Awareness of mental health & illness• How to respond to people who are unwell or in

distress/crisis• What local services are available• How to work constructively within 'stuck' situations

with tenants with mental health problems • How to align with protocols that housing have with

local mental health team• Looking after your own mental health

By the end of the session you will have a toolbox of resources to respond

What is mental health?

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What is mental health?

What is mental health?

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Mental health is:• How we feel about ourselves and people

around us

• Our ability to make and keep friends and relationships

• Our ability to learn from others and to develop emotionally.

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A definition from the World Health Organisation:

“... 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.”

What is mental health?

What is mental illness?

What is mental illness?

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• Mental illness can affect the ways we feel, act and think.

• There are many different types of mental illnesses, and some may be more familiar than others

What is mental illness?

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Depression

Anxiety

Suicide Psychosis

Substance misuse

Self-harm

Eating disorders

Good

Poor

Present Absent

Mental health is on a continuum

mental illnessm

enta

lh

ealt

h

Good mental health with

mental illness

Good mental health without mental illness

Poor mental health with

mental illness

Poor mental health without mental illness

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• 1 in 4 people experience mental health problem in their lifetime.

• 1 in 6 working age adults experience a diagnosable problem at any one time.

• Mixed anxiety and depression most common problem – affects about 11% of population.

Mental illness –key facts and figures

Physical Emotional

Psychological Behavioural

Possible signs of mental health problems

Physical• Constant tiredness• Appetite/weight changes• Increased aches and pains• Sleep patterns affected• Lowered immune system

Emotional• Mood swings• Guilt, low self esteem• Fear, worry, anxiety• Sad, tearful• Irritable, angry

Psychological•Changed perceptions•Suspiciousness/paranoia•Grandiose ideas or unusual beliefs•Inability to follow train of thought•Difficulties with memory, concentration and decision making

Behavioural• Withdrawal/isolation• Reduced or unusually increased

energy levels• Poor self-care• Lack of co-operation• Increased use of drugs/alcohol

Possible signs of mental health problems

• What are the features of the difficult conversations you are having with people with a mental health problem?

• What is your reaction? (What do you do and say?)

• What is the impact on the person?• What is the impact on you?

Mental health problems and difficult conversations

What can affectmy mental health?

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Recovery from mental illness – what does it mean?

• Not necessarily clinical recovery.

• Different for every person.

• Ongoing process rather than a finite goal.

• About self-worth, social connections, meaning and purpose, managing your health proactively.

• Culturally defined.

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Time to Change’s 2008 ‘Stigma Shout’ Survey said:

• 87% reported a negative impact of stigma.

• Many people report the effects of stigma and discrimination worse than actual symptoms.

• Self-stigma impacts on persons self esteem, confidence and ability to relate to others.

The impact of stigma

www.rethink.org Source: Towards Mental Health, Health services Research at the Institute of Psychiatry, King’s College London, Issue 1 2006

The impact of stigma

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Withdrawal and rejection

Unemployment

HomelessnessLoss of social networks

DebtWorsening

mental health

The cycle of social exclusion

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Tackling stigma

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A Assess risk (of harm to themselves or others).

L Listen and respect.

I Information and reassurance.

A Appropriate help and support.

S Seek support for yourself.

A 5-step approach to helping someone in distress: ALIAS

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• How are they feeling.

• Thoughts of suicide or self harm?

• Gather information: Do they have a plan? Have they done something similar before? Who could they ask for help?

• Ensure you are safe at all times.

• If you think they are at immediate risk call 999.

A: assess risk

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L: listen and respect

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Hope and recovery

I: information and assurance

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Remember this can be difficult for people: • GP • Community Services – the person may

already be supported by their community mental health team

• Talking therapies (ICOPE – self referral – across Islington)

• Crisis? A&E• National support helplines – Samaritans

A: appropriate help and support

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Sometimes children and young people are thought to be at risk due to their own mental health or the mental health of the person that cares for them.

• If you are worried - Talk to your line manager/Call local social services or child line

People over 18 are sometime also seen to be at risk due to their mental health – the legislation around this is quite specific – if you are worried you can call social service.

• Always ask a line manager first

Getting support for someone – safeguarding

• 999 if urgent and immediate risk of harm• Deal with immediate needs of the client• Report safeguarding concerns to Adult Social Services

Access Team on 02075272299 ASAP• If children at risk contact Children’s Services• Consider reporting to police if a crime has been

committed• Inform line manager• Record what you saw/heard etc and actions taken

Joint protocol says….

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Talk to someone about what has happened:

• Line manager

• Samaritans

S: support for yourself

BREAK15mins

Group discussion:-• What is your experience of people expressing

suicidal ideas?• What is difficult/challenging about these

conversations?• Any fears or worries about these

conversations?• Role play

Suicidality

• In pairs – one is the customer and one the housing officer– De-roll

• Rotate• Discussion

Role play

If risk….

• 999• Crisis team - 020 7561 4278• Assessment and Advice Team - 020 3317 6805

Aggression

• What is your experience of people being aggressive?

• What is difficult/challenging about these conversations?

• Any fears or worries about these conversations?

• What do you do/say?• What is the impact on you/them?

• Ask what’s happening, use open questions• Sort out confusions• Use person’s name• Speak clearly, say who you are, remind of

existing relationship and offer your help• Paraphrase and check what they have said

Clarify

• Show interest and concern• Listen, hear, acknowledge feelings• Don’t yell or shout over• Extend self and thinking to understand viewpoint• Answer all requests for information, however they

are phrased.• Empathise with feelings, not aggressive behaviour

‘I understand you are angry but it is not okay to…’

Respect and empathy

• Act calmly and confidently• Body language• Breath deeply and concentrate on the situation• Slow gentle movements• Don’t corner person, threaten or make false

promises• Don’t judge, criticise, show irritation, anger or be

retaliative (its not personal, its not about you)• Don’t argue and say they are wrong and you are right

Control yourself

• Request rather than command• Give reasons, explain rules, reasoning behind

them, be honest, express fallibility (or even agree that its unfair)

• Give person opportunity to control him/herself• Outline consequences of different courses of

action• Offer choices and options, leaving power with

person

Resolve

• Move to a quiet place, ask to come aside• Invite person to sit down• Establish aid/support/backup• Maintain distance

Environment

• 999• Crisis team - 020 7561 4278• Assessment and Advice Team - 020 3317 6805More general concerns• North recovery team 02033176378• South recovery team 02033174850• Not sure, Assessment and Advice Team as

above

Extreme distress or distressing behaviour

• Telephone to relevant CIFT/IHS Team Leader or next available manager

• Follow up email marked urgent• Contact with Housing Aid Team on 0207

5272000 to see about floating support or other support or to access temporary support to avoid homelessness.

Court eviction possible

BREAK15mins

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Signposting

SOS booklet GP ICOPE Rethink Advice and Information Samaritans

Listening with respectBe prepared – build a toolkit

Encouraging someone to get help

• Spend time with others

• Be active

• Eat and sleep well

• Do something you enjoy

• Relax

• Seek help

Looking after yourself

45

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Build a toolkit Things to put in your tool bag are:

• Information, leaflets, websites, helplines.

• Services – local to the area.

• Key professional contacts.

• A reminder of the ALIAS approach.

• Support for yourself – manager, counselling,

friends, GP etc.

Action from today

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• Please fill out a feedback form before you leave.

• Your opinion is important for us to improve these sessions for future audiences.

• Contact: Cerdic.Hall@candi.nhs.ukNurse Consultant – Primary Care (Mental Health)

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