MENTAL HEALTH AWARENESSTRAININGFOR PROBATION WORKERS’

Trainer and Group Introductions

Housekeeping

Ground Rules:Confidentiality

Take time out and seek further support if needed Respect yourself and each otherAllow each other time to talkLook after our own and each others wellbeing

Ice Breaker Exercise

CONTENTS Course Structure

Defining mental health and coping

What is mental illness

The mental health continuum

Mental Illness and Stigma

Mental disorders

The Offender with Anxiety

The Offender with Depression

The Offender with Eating Distress

The Offender with Bi-Polar Disorder

The Offender with Schizophrenia

The Offender with a Personality disorder

Young Offenders and Mental Health

Mental health in Older Offenders

Self injury and Suicidal Behaviour

The Offender with Dual Diagnosis

Communication

Working with risk

Diversity and Equality

MENTAL HEALTHGroup activity

How would you define good mental health?

• How would you define poor mental health?

The stigma surrounding mental illness adds to the distress and isolation felt by offenders who experience mental health problems

25% of us may experience mental distress at some point in our lives.

We can all have positive and negative ‘life experiences’ which have an impact on how we think, feel and engage with the world.

Certain circumstances increase the risk of mental illness.

MENTAL ILLNESS AND STIGMA

What ‘coping mechanisms’ do you use to maintain or improveyour mental health?

• What resources might offenders use to help themselves cope?

COPING MECHANISMSGroup activity

“Mental health is the emotional and spiritual resilience which

enables us to enjoy life and to survive pain, disappointment

and sadness. It is a positive sense of well-being and an

underlying belief in our own, and others “dignity and worth.”

Mental Health Promotion 2006

HOW WOULD YOU DEFINE MENTAL HEALTH?

MENTAL DISORDER

What are the causes of mental disorder?

Many theories, many factors, complex reasons

WHAT FACTORS COULDCAUSE MENTAL DISTRESS

THE MENTAL HEALTHCONTINUUM

Where are you on the continuum at the moment?

THE MAIN CATEGORIES OF MENTAL DISORDERS

Anxiety is physiological sense of unease we experience in response to environmental stressors.

More prevalent amongst offenders.

Often associated with other mental illnesses, such as depression and Post Traumatic Stress Disorder.

Considered a mental health problem when it is prolonged, severe and interferes with everyday activities.

If left unmanaged may develop into other problems such as panic attacks, phobias and obsessive compulsive disorders.

WHAT IS ANXIETY?

ANXIETY

What are the physical and psychological effects of anxiety?

How can we recognise it?

THE EFFECTS OF ANXIETY

Anxiety may take the form of a panic attack..

Panic attacks are a rapid build-up of powerful sensations generally associated with physical feelings

Pounding and sometimes irregular heartbeat

Chest pains, inability to breathe

Feeling faint and/or sick, sweating

Shaky limbs, legs turning to jelly

Feelings of losing control

Offenders fear that they are going mad, blacking out or having a heart attack.

It can be a terrifying experience.

PANIC ATTACKS

Symptoms of depression vary from offender to offender but may include: Low mood & low energy – neglect of personal hygiene.Disturbed sleep or appetite.Withdrawing from social situations.Loss of interest in usual activities.Low self-worth

Depression can be a long-term illness or may last for just one episode.

The severity and effect it has on the offender varies significantly

WHAT IS DEPRESSION?

DEPRESSION

Make a list of some of the symptoms of depression

HOW DO YOU THINK AN OFFENDER WITH DEPRESSION MIGHT BEHAVE?

Eating disorders are treatable medical conditions.

Although eating disorders are experienced predominantly by women men can be also be affected

Offenders with an eating disorder may also have other mental health problems such as generalised anxiety or depression.

In severe cases eating disorders can lead onto physical health problems including heart conditions and kidney failure.

EATING DISTRESS

EATING DISTRESS

How would you define eating normally?

Is it the same for everyone?

Bipolar illness (manic depression) is a mood disorder which can involve extreme swings of mood ranging from severe depression to severe mania (‘lows’ to ‘highs’).

There may be long periods of stability in between.

Each individual will have a unique pattern of severity and duration.

The most common types of Bipolar disorder are known as Bipolar I and Bipolar II…

UNDERSTANDING OFFENDERS WITH BIPOLAR DISORDER

BIPOLAR I AND BIPOLAR II

Incoherent, rapid or disjointed thought

Paranoia

Hallucinations affecting vision, hearing or perception

Grandiose delusions or ideas

Psychosis – losing touch with reality

HOW DOES MANIA AFFECT INDIVIDUALS

Hypomania is a less severe form of mania.

Self confident and euphoric but may also react with sudden anger, impatience, or become irritable.

More ideas than usual, very creative.

More reckless, more talkative or more challenging.

HOW DOES HYPOMANIA AFFECT INDIVIDUALS

Severe depression usually follows an episode of mania.

Feelings of emptiness or worthlessness.

Loss of energy and motivation for many or all day-to-day activities.

Pessimism and negativity about most things (or everything).

Thoughts of death and suicide can be common but may be hard to discuss.

THE DEPRESSIVE PHASE IN BIPOLAR DISORDER IS SIMILAR TO DEPRESSION…

“Schizophrenia is a severe mental disorder, characterized by

profound disruptions in thinking, affecting language, perception,

and the sense of self. It often includes psychotic experiences, such

as hearing voices or delusions. It can impair functioning through

the loss of an acquired capability to earn a livelihood, or the

disruption of studies”. (W.H.O. 2009).

WHAT IS SCHIZOPHRENIA?

It’s important to say that Schizophrenia is not:• Split or Multiple Personalities• Caused by parents or the way someone was brought up• Untreatable• A guarantee that a person will be in hospital for life.• A guarantee that the offender will be dangerous.

People with Schizophrenia are more likely to:• Harm themselves• Be passive• Withdraw

STIGMA AND SCHIZOPHRENIA

Generally 1 in 100 people experience Schizophrenia The highest incidence is in the late teens and early twenties It affects men and women equally Onset of illness is earlier in men than women 25-50% of sufferers make a full recovery 25% may experience long lasting problems

SCHIZOPHRENIA

• Hallucinations

• Delusions

• Agitation

• Disorganised thinking

• Slowness to move, think, speak, react

• Social withdrawal

• Apathy

These experiences may occur separately, together or alternately.

HOW ARE INDIVIDUALS AFFECTED BY SCHIZOPHRENIA?

Hallucinations are when a person hears, sees, smells or feels things that others do not.

The most common type are auditory hallucinations - i.e. hearing voices.

To the person experiencing them the voices are very real.

These experiences can be very frightening.

UNDERSTANDING HALLUCINATIONS

Delusions happen when a person has a belief that seems very real to them but others do not share.

Examples include: Having special powers - e.g. the ability to read other peoples minds.

Believing that people are against them.

Thinking that people may be trying to harm them.

Their thoughts are being broadcast out loud.

Everybody knows what they are thinking.

It is important to bear in mind the cultural context – strange behaviour in our culture may not be considered strange in other cultures.

DELUSIONS

PERSONALITY DISORDERS

An offender with a personality disorder may show some of the following traits: Aggression and sudden outbursts of inappropriate anger. Signs of anxiety or depression. Deliberate acts of self harm. Signs of eating distress. Provocative and antagonistic behaviour. Pre-occupation with routine. Lack of emotion and remorse and/or taking everything personally. Constantly seeking approval. Dependence on others, deceitfulness, bullying and disregard for others.

• Why might older adults in the criminal justice system be more vulnerable than younger adults?

• What particular problems do older adults face within the criminal justice services?

OLDER PROBATION SERVICE USERSGroup activity

• What are the causes of self harm?

SELF HARM AND SUICIDEGroup activity

• The term ‘dual diagnosis’ can be defined in a number of ways but for the purpose of this publication it will be taken to mean the co-existence of severe mental health and substance misuse problems.

• It is generally accepted that individuals with dual diagnosis

suffer poorer health outcomes and present significant challenges to both health and criminal justice services.

DUAL DIAGNOSIS

HOW ARE MENTAL DISORDERS TREATED?

Prescribed medication Self and advocacy groups Talking therapies Advocacy Complementary therapies

Some people find prescription medicine helpful, while others find that talking treatments are better. For some people find that a combination works best.

Everyone is different and what works for one offender may not work for another.

When would you need to refer to Mental Health services?

Where do you refer to?

Is there a single entry to Mental Health services?

Are you aware of local care pathways?

Group to discuss…

REFERRING ON…