Understanding Social Work Practice in Mental Health

UNDERSTANDING SOCIAL WORK PRACTICE IN MENTAL HEALTH

PRE-TEST

1. What is considered to be “the deadliest mental disorder”.a. Anorexia nervosab. Suicidec. Schizophreniad. Post traumatic stress syndrome

PRE-TEST

2. What is the name of the “stand alone book” that is use as the diagnostic tool in mental disorders. It is considered to be “the bible” of psychiatric disorder.a. NANDAb. DSMc. Merriam’s Dictionaryd. Guinness Book of World Record

PRE-TEST

3. Who is considered to be the leader of the “mental health team:a.Psychiatric Nurseb.Social Workerc.Psychologistd.Psychiatrist

PRE-TEST

4.This mental disorder is characterized by series of binge eating and purging.

a.Anorexia nervosab.Bulimia nervosac.Obsessive-compulsive disorderd.schizophrenia

PRE-TEST

5. Who attempts suicide the most?a.Maleb.Female

PRE-TEST

6. Who commits suicide the most?a.Male b.Female

PRE-TEST

7. The most common reason for mental disorder in adult is?a.Biological elementsb.Stressc.Familyd.Relationship

PRE-TEST

8. A type of disorder which characterized of eating “inedible” materials such as hair, stones and metals.a. Anorexia nervosab. Bulimia nervosac. Picad. Rett’s syndrome

PRE-TEST

9. Are mental disorder generally curable? Yes or No.

PRE-TEST

10. The best approach to a mentally ill person is:a.Give them anti psychotic drugsb.Isolate themc.Listen to their storiesd.Restrain them

UNDERSTANDING MENTAL HEALTH AND MENTAL DISTRESS

Mental Health

• Is the state of relative psychological and emotional well-being in which an individual can make acceptably rational decisions, cope adequately with personal and external stresses.


Mental Illness

• Is any of a wide range of psychological, emotional, or cognitive disorders that impair a person’s ability to function effectively.• Causes may be biological, chemical, physiological,

genetic, psychological or social.


Mental Illness

• Mental illness is “extremely variable in duration, severity and prognosis.• Primary symptoms of mental illness include extreme

anxiety, disturbed thinking process, perceptual distortions, extreme mood variations, and other difficulties in thinking.

EXAMINING OUR ATTITUDES TO MENTAL DISTRESS

•From the onset it is important to acknowledge and reflect on our own individual feelings, attitudes and understanding of mental health and mental distress.

EXAMINING OUR ATTITUDES TO MENTAL DISTRESS

• Acknowledge your own weaknesses.• Empty your self with worries, anxiety and any negative

thoughts.• Equipped ourselves with the right knowledge, attitude

and skills we need.• Conduct self-awareness and self-counselling activities to “free yourselves” before engaging

NEIL THOMPSON’S PCS ANALYSIS

•STRUCTURE• society

•CULTURE• Shared values and

commonalities

•PERSON• individual view and action

SC

P


Personal (P) Level

• This is normally concerned with an individual’s views, particularly in the case of a prejudice against a certain group of people. For example, this could relate to a young person who makes racist comments. It is purely related to individual actions and you are likely to come into contact with this in practice. The ‘P’ is located in the middle of the diagram, because that individual has his beliefs and ideas supported through two other levels...


Cultural (C) Level

• This analysis relates to the ‘shared values’ or ‘commonalties’. For example, shared beliefs about what is right and wrong, good or bad, can form a consensus.

Structural (S) Level

• This analysis demonstrates how oppression is ‘sewn into the fabric’ of society through institutions that support both cultural norms and personal beliefs. Some institutions such as sections of the media, religion and the government can cement the beliefs.


P• I want to be beautiful

• Inferiority complex

C• Your ugly, your out

S• Beauty = skinny and slim

MENTAL DISORDER

=ANOREXIA NERVOSA


How this analysis can help youth workers?

This analysis may help you to build an idea of why young people behave in certain ways – or why they carry out such actions. It can also give you ground for challenging inequality. By first fully identifying what drives people to hold ‘prejudices’. It reminds us that society enforces a lot of our beliefs – helps us to understand how something can become a ‘norm’ and how best we can go about explaining, and challenging, oppression.

DSM-VDiagnostic and Statistical Manual of Mental Disorders (DSM-V)

DSM-V• The Diagnostic and Statistical Manual of Mental Disorders stands alone as the most authoritative reference available for clinical practice in the mental health field, and the structural and diagnostic changes in the fifth edition are "must-know" material for every clinician

ADULT DISORDERSCOMMON DISORDERS

•Alcohol/Substance Abuse•Alcohol/Substance Dependence•Anxiety Disorders•Adult Attention Deficit/Hyperactivity Disorder (ADHD/ADD)


•Bipolar Disorder•Major Depressive Episode•Hypomanic Episode•Manic Episode•Mixed Episode


• Depression

• Eating Disorders

• Generalized Anxiety Disorder

• Obsessive-Compulsive Disorder

• Panic Disorder

• Posttraumatic Stress Disorder (PTSD)

• Schizophrenia

• Seasonal Affective Disorder (SAD)

• Social Phobia (also known as Social Anxiety Disorder)

DISSOCIATIVE DISORDERS

•Depersonalization Disorder•Dissociative Amnesia•Dissociative Fugue•Dissociative Identity Disorder (MPD)•Dissociative Disorder Not Otherwise Specified (NOS)

EATING DISORDERS

•Anorexia Nervosa•Binge Eating Disorder•Bulimia Nervosa

SEXUAL & PARAPHILIC DISORDERS

• Dyspareunia• Erectile Dysfunction (ED)• Exhibitionism• Female and Male Orgasmic Disorders• Female Sexual Arousal Disorder• Fetishism• Frotteurism

SEXUAL & PARAPHILIC DISORDERS

• Hypoactive Sexual Desire Disorder• Premature Ejaculation• Sex Addiction• Sexual Masochism and Sadism• Transvestic Fetishism• Vaginismus• Voyeurism

SLEEP AND WAKING DISORDER

• Circadian Rhythm Sleep Disorder

• Hypersomnia, Primary

• Insomnia

• Nightmare Disorder

• Narcolepsy

• Rapid Eye Movement Sleep Behavior Disorder

• Restless Legs Syndrome

• Sleep Terror Disorder

• Sleepwalking Disorder

CHILDHOOD DISORDERS

• Asperger's Syndrome

• Attachment Disorder

• Attention Deficit/Hyperactivity Disorder (ADHD/ADD)

• Autism

• Conduct Disorder

• Disorder of Written Expression

• Disruptive Mood Dysregulation Disorder

• Encopresis

• Enuresis

• Expressive Language Disorder

CHILDHOOD DISORDERS

• Mathematics Disorder

• Mental Retardation

• Oppositional Defiant Disorder

• Pica

• Reading Disorder

• Rett's Disorder

• Rumination Disorder

• Selective Mutism

CHILDHOOD DISORDERS

• Separation Anxiety Disorder• Social (Pragmatic) Communication Disorder• Stereotypic Movement Disorder• Stuttering• Tourette's Disorder• Transient Tic Disorder

PERSONALITY DISORDERS• Antisocial Personality Disorder

• Avoidant Personality Disorder

• Borderline Personality Disorder

• Dependent Personality Disorder

• Histrionic Personality Disorder

• Multiple Personality Disorder

• Narcissistic Personality Disorder

• Obsessive-Compulsive Personality Disorder

• Paranoid Personality Disorder

• Schizoid Personality Disorder

• Schizotypal Personality Disorder

OTHER MENTAL DISORDERS

• Acute Stress Disorder

• Adjustment Disorders

• Agoraphobia

• Alzheimer's Disease

• Bereavement

• Body Dysmorphic Disorder

• Brief Psychotic Disorder

• Conversion Disorder

• Cyclothymic Disorder


•Delusional Disorder•Disinhibited Social Engagement Disorder•Dysthymic Disorder•Gender Identity Disorder•Hoarding Disorder•Hypochondriasis


• Intermittent Explosive Disorder

• Kleptomania

• Pain Disorder

• Panic Attack

• Pathological Gambling

• Pedophilia

• Premenstrual Dysphoric Disorder

• Psychotic Disorder


• Pyromania• Schizoaffective Disorder• Schizophreniform Disorder• Shared Psychotic Disorder• Somatization Disorder• Specific Phobia• Trichotillomania

SUICIDE

FACTS ABOUT MENTAL ILLNESS AND SUICIDE

• The great majority of people who experience a mental illness do not die by suicide. However, of those who die from suicide, more than 90 percent have a diagnosable mental disorder• People who die by suicide are frequently experiencing

undiagnosed, undertreated, or untreated depression.

• Worldwide, suicide is among the three leading causes of death among people aged 15 to 44.rder.


•An estimated 2-15 % of persons who have been diagnosed with major depression die by suicide. Suicide risk is highest in depressed individuals who feel hopeless about the future, those who have just been discharged from the hospital, those who have a family history of suicide and those who have made a suicide attempt in the past.


•An estimated 3-20% of persons who have been diagnosed with bipolar disorder die by suicide. Hopelessness, recent hospital discharge, family history, and prior suicide attempts all raise the risk of suicide in these individuals.


•An estimated 6-15% of persons diagnosed with schizophrenia die by suicide. Suicide is the leading cause of premature death in those diagnosed with schizophrenia. Between 75 and 95% of these individuals are male.


•Also at high risk are individuals who suffer from depression at the same time as another mental illness. Specifically, the presence of substance abuse, anxiety disorders, schizophrenia and bipolar disorder put those with depression at greater risk for suicide.


•People with personality disorders are approximately three times as likely to die by suicide than those without. Between 25 and 50% of these individuals also have a substance abuse disorder or major depressive disorder.

SAD PERSONS SCALE

• The SAD PERSONS scale is an acronym utilized as a mnemonic device. It was first developed as a clinical assessment tool for medical students to determine suicide risk, by Patterson et al.[1]The Adapted-SAD PERSONS Scale was developed by Gerald A. Juhnke for use with children in 1996.

SAD PERSONS SCALE

• S: Sex

• A: Older age

• D: Depression

• P: Previous attempt

• E: Ethanol abuse

• R: Rational thinking loss

• S: Social supports lacking

• O: Organized plan

• N: No spouse

• S: Sickness

• S: Male sex → 1

• A: Age <19 or >45 years → 1

• D: Depression or hopelessness → 2

• P: Previous suicidal attempts or psychiatric care → 1

• E: Excessive ethanol or drug use → 1

• R: Rational thinking loss (psychotic or organic illness) → 2

• S: Single, widowed or divorced → 1

• O: Organized or serious attempt → 2

• N: No social support → 1

• S: Stated future intent (determined to repeat or ambivalent) → 2

This score is then mapped onto a risk assessment scale as follows:

• 0–5: May be safe to discharge (depending upon circumstances)

• 6-8: Probably requires psychiatric consultation

• >8: Probably requires hospital admission

ANOREXIA NERVOSA

ANOREXIC FOOD BEHAVIOR SIGNS AND SYMPTOMS

• Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.

• Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.

• Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of meals (“I had a huge lunch” or “My stomach isn’t feeling good.”).

ANOREXIC FOOD BEHAVIOR SIGNS AND SYMPTOMS

• Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.• Strange or secretive food rituals – Refusing to eat around

others or in public places. Eating in rigid, ritualistic ways (e.g. cutting food “just so”, chewing food and spitting it out, using a specific plate).

ANOREXIC APPEARANCE AND BODY IMAGE SIGNS AND SYMPTOMS

• Dramatic weight loss – Rapid, drastic weight loss with no medical cause.

• Feeling fat, despite being underweight – You may feel overweight in general or just “too fat” in certain places such as the stomach, hips, or thighs.

• Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.

• Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws.

ANOREXIC APPEARANCE AND BODY IMAGE SIGNS AND SYMPTOMS

• There’s always something to criticize. You’re never thin enough.• Denial that you’re too thin – You may deny that your low

body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

STEPS TO ANOREXIA RECOVERY

• admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight. The first step in anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowledging the physical and emotional damage that you’ve suffered because of it.

• Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your anorexia a secret for a long time. You may be ashamed, ambivalent, or afraid. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.

STEPS TO ANOREXIA RECOVERY

• Stay away from people, places, and activities that trigger your obsession with being thin. You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-ana” sites that promote anorexia.

• Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

BULIMIA NERVOSA

• Bulimia nervosa is an eating disorder characterized by binge eating and purging, or consuming a large amount of food in a short amount of time followed by an attempt to rid oneself of the food consumed (purging), typically by vomiting, taking a laxative, diuretic, or stimulant, and/or excessive exercise, because of an extensive concern for body weight

BULIMIA NERVOSA

BULIMIA NERVOSA

• You can recover from bulimia, but it may be a long and difficult process.

• The first step towards getting better is to recognize the problem and to have a genuine desire to get well. This may involve a big change in lifestyle and circumstances.

• Treatment usually begins with psychological treatments, aimed to help you re-establish healthy attitudes towards eating. People with bulimia need to explore and understand the underlying issues and feelings that are contributing to their eating disorder, and change their attitudes to food and weight.

WHAT CAN I DO NOW?

1.Listen2.Observe3.Assess4.Offer your self

THE DISTINCT CONTRIBUTION OF SOCIAL WORK TO

INTERDISCIPLINARY WORKING IN

MENTAL HEALTH

SOCIAL WORK PERSPECTIVE AND KNOWLEDGE BASE

• Social work is all about change

• The social work knowledge base brings together a range of social science perspectives, linked to an understanding of law and social policy as it affects users of social care services and their families of informal carers.

• Social work has particular expertise in relation to the social and environmental factors that contribute to mental distress through the life course.

• The profession is characterized by a strong tradition of critical questioning, reflection and challenge within a multi-disciplinary context.

DISTINCTIVE PRACTICE CAPABILITIES OF SOCIAL

WORKERS • Assessing complex situations

• Working alongside service users to promote their social inclusion

• Balancing human and legal rights

• Working with the family and informal carers to support an individual’s journey to recovery

• Identifying and working with the personal and social consequences of discrimination, stigma, and abuse

• Seeking changes in the social environmental context which will promote recovery

THE VALUE OF SOCIAL

WORKERS FOR PEOPLE

WITH MENTAL HEALTH

PROBLEMS-A SERVICE USER PERSPECTIVE

•Mental health isn’t simply a medical issue; its about how we can function in the world and how we can relate to others.• Those people with mental health problems have the same basic needs as other members of the society• Social workers have the specialist skills to help and advice us in our efforts to meet these needs.

SO WHAT DO SOCIAL WORKERS OFFER NOW?

•Housing•Benefits system•Education and employment•Legal rights•Advocacy•community

THE VALUE OF SOCIAL WORKERS FOR CARERS OF PEOPLE WITH MENTAL HEALTH

PROBLEMS-A CARER PERSPECTIVE

Caring for loved ones who have enduring mental health problems often has major negative repercussions on the life of the carer:•Mental and physical health•Relationships with family and friends•Ability to work and finances

WHAT CAN YOU OFFER.

• Consequently, carers can have a great need for information, services and support.• Social workers are uniquely qualified and best placed to

help.• Encouraging the carer to get support• Assessing the needs of the carer and seeing through

the implementation of the carer’s care plan• Assisting access to services and carer’s grants

WHAT CAN YOU OFFER.

•Social workers enhance best outcomes by listening to carers who have an important story to tell.•Balancing the sensitive issue of confidentiality.

LECTURE SUMMARY

In the space of a decade, the organization and practice of social work has been transformed. The modern mental health system is driven by the development of new approaches, new specialisms and draws on the integrated skills of a variety of professionals. Social workers are now employed in a diverse range of contexts in the statutory, private, voluntary and independent sectors, many within integrated terms. At the very least they are expected to know how to work collaboratively and effectively with other professionals to provide services to users and carers.

End of lecture

Understanding Social Work Practice in Mental Health

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