MENTAL HEALTH AND DOMESTC ABUSE CONFERENCE- 15TH

OCTOBER 2015

RACHEL BELLENGER CARE COORDINATOR

OXFORD HEALTH FOUNDATION TRUST

DEFINITIONS OF MENTAL HEALTH

“A clinically recognisable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions”

ICD-10 (2011)

"A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or

behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental

disorders are usually associated with significant distress in social, occupational, or other important activities”

DSM-5 (2013)

MENTAL HEALTH DISORDERS

DEPRESSION

BI-POLAR AFFECTIVE

ANXIETY

PERSONALITY DISORDER

PSYCHOSIS

MENTAL HEALTH MYTHS

MENTAL HEALTH MYTHS

MENTAL HEALTH STATISTICS Approximately a quarter of the population will experience some kind of mental health problem in the course of a year, with mixed anxiety and depression the most common mental disorder in Britain

Women are more likely to have been treated for a mental health problem than men and about ten percent of children have a mental health problem at any one time

Male prisoners are 14 times more likely to have two or more disorders than men in general, and female prisoners are 35 times more likely than women in general.

Only 1 in 10 prisoners has no form of mental disorder.

Social Exclusion Unit (2004)

PERSONALITY DISORDERS

In a study in 2011, The Ministry of Justice estimated that between 60-70% male offenders have a personality disorder.

ICD 10 Personality Types-

- Paranoid

- Schizotypal

- Narcissistic

- Anti-Social

AETIOLOGY OF PERSONALITY DISORDERS

-Genetics -Neurotransmitters -Neurobiology -Environmental factors including- being a victim of emotional, physical or sexual abusebeing exposed to chronic fear or distress as a childbeing neglected by one or both parentsgrowing up with another family member who had a serious mental health condition or a drink or drug misuse problem

TREATMENT OF PERSONALITY DISORDER

There is no medication currently licensed for the treatment of any personality disorder. However, medications may be prescribed to treat associated problems, such as depression, anxiety or psychotic symptoms.

Long Term Psychological Therapies-

Psychotherapy

CBT

DBT

Interpersonal Therapy

Therapeutic Community

RISK ASSESSMENT IN MENTAL HEALTH

EXPLORATION OF HISTORICAL FACTORS AND CURRENT PRESENTATION-

-HARM TO SELF – including self neglect and vulnerability

-HARM TO OTHERS

-HARM FROM OTHERS- including history of abuse

-CRIMINAL OFFENDING and SUBSTANCE MISUSE

-PHYSICAL HEALTH

-FAMILY HISTORY and CHILDHOOD AND DEVELOPMENT

-ENVIRONMENTAL AND SOCIAL FACTORS

-EVIDENCE OF RECENT STRESSORS/CHANGES IN RISK FACTORS

-PROTECTIVE FACTORS

RISK MANAGEMENT PRINCIPLES Risk assessment is linked to the practice of risk management, whereby a mutually agreed plan, aimed at reducing identified risks, is negotiated with the individual concerned. The plan incorporates specific therapeutic strategies and is a collaborative, interactive and dynamic process

Risk cannot be eliminated, as there is no such thing as a completely risk-free situation. Outcomes are not easily predicted. The goal is the minimisation of risk and the prevention of harm or further harm.

Risk is a dynamic process, influenced by any number of variables within a given situation. Risk fluctuates and is influenced by the experiences, perceptions and interactions that the individual is subject to at any point in time.

Harrison A (2003)

RISK MANAGEMENT PRINCIPLES

“Positive risk-taking is weighing up the potential benefits and harms of exercising one choice of action over another. This means identifying the potential risks involved, and developing plans and actions that reflect the

positive potentials and stated priorities of the service user. It involves using available resources and support to achieve desired outcomes, and

to minimise potential harmful outcomes” (Morgan, 2004)

ASSESSING CAPACITY

Mental State Screening-

-What were the persons beliefs at the time?

-Any suggestion of perceptual disturbance?

-History of mental disorder and treatment?

-Current diagnosis?

-Contact with specialist services?

MENTAL HEALTH ACT

The person is suffering from a recognised mental disorder of a nature or degree that makes it appropriate to receive treatment in hospital and that the appropriate treatment is available.

Detainment under the MHA does not assume a lack of capacity or preclude being charged and tried for criminal behaviour.

MENTAL HEALTH AND DOMESTIC ABUSE

-Abused women are at least three times more likely to experience depression or anxiety disorders than other women.

-One-third of all female suicide attempts and half of those by Black and ethnic minority women can be attributed to past or current experiences of domestic violence.

-Women who use mental health services are much more likely to have experienced domestic violence than women in the general population.

-70% of women psychiatric in-patients and 80% of those in secure settings have histories of physical or sexual abuse.

MENTAL HEALTH AND DOMESTIC ABUSE

-Children who live with domestic violence are at increased risk of behavioural problems and emotional trauma, and mental health difficulties in adult life. (See also Children and domestic violence.)

 

-An audit in Greenwich found that 60% of mental health service users had experienced domestic violence. Another survey of women using mental health services in Leeds found that half of them had experienced domestic violence and a further quarter had suffered sexual abuse.

Womens Aid (2015) 

-Individuals diagnosed with Borderline/Emotionally Unstable Personality Disorder are more likely than the general population to be verbally, emotionally/psychologically and physically abusive.

Mental Health Matters (2011)

TO ACCESS FURTHER INFORMATION-

* Royal College of Psychiatry

* Rethink Mental Illness

* MIND

* Mental Health Foundation

* Sainsbury’s Centre for Mental Health

* Time to Change Campaign