Emotional HEALTH Support
A STAFF GUIDE TO UNDERSTANDING MENTAL ILL-HEALTH ANXIETY AND HOMELESSNESS
2016/2017
About Emotional HEALTH Support In the UK, there are direct links between homelessness and depression/anxiety disorders. Around 80% of homeless adults suffer from mental ill-health. Only 45% of those will have their condition diagnosed. A homeless adult is twice as likely to suffer from a common mental health problem and 4-15 times more likely to suffer from psychosis compared to the general adult population in the UK. For some, they will have a genetic, chemical predisposition to suffer from mental ill health. For others, their depression may be triggered by their circumstances. When working with homeless adults and vulnerable people, it can be hard to recognise some of the more subtle symptoms. It can also be especially hard to know what to do when you do notice these symptoms. This booklet will provide you will some basic information around mental ill-health in the UK: the types, their symptoms, the language used around them. Understanding this information will help the YMCA ensure that all clients have their mental health support needs recognised and met, no matter how advanced. It will also inform you of who you can contact in the local area for external, specialised support.
CONTENT
Recognising mental health conditions and their symptoms........... 6 Activities that keyworkers can run with clients of concern............ 24 How can we help as key workers?................................................. 38 Contact Info: Haringey Mental Wellbeing Services......................... 42 Contact Info: YMCA Mental Health concern action flowchart....... 44 Contact Info: Haringey substance misuse support services.......... 46 Contact Info: National Emotional Support Services...................... 48 Contact Info: Domestic Violence Support.................................... 50
Clinical Depression Although we all feel depressed from time to time, Major Depression is the medical sense of the term. In its mildest form, depression can mean just being in low spirits. It doesn’t stop you from leading a normal life, but makes everything harder to do. At its most severe, clinic depression can be life-threatening. Season Affective Disorder (SAD) - A depression that comes on during the autumn and winter which is thought to be caused by a lack of light. Symptoms include irritability, persistent low mood, loss of pleasure and feeling lethargic. This will be diagnosed by a GP. Postnatal Depression - A depression that women may develop after giving birth. It is usually unapparent until around six months after birth and can be developed as late as two years after birth. Symptoms include irritability, episodes of tearfulness, mood changes and difficulty sleeping. Again, a GP will diagnose this and recommend a course of treatment. Bipolar Disorder - A sufferer will have major mood swings where periods of depression alternate with periods of mania. When manic, they are in a state of high excitement and may plan to carry out overambitious schemes and ideas. They often have periods of extreme depression.
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Anxiety People who are depressed often suffer from anxiety as well. The two problems make each other worse. Those suffering from anxiety may suffer from repetitive thoughts which make it hard to concentrate, relax or sleep. There may also be physical symptoms such as headaches, aching muscles, sweating and dizziness. Anxiety may cause physical exhaustion and general ill health. Psychotic Experiences Those suffering from major depression may have experiences that those around them do not share. For example, they may be hearing voices, seeing visions, extreme paranoia about other’s behaviour or a self belief that they are influencing events in way that is harmful to others. They may believe that they are a bad person and so deserve to feel the way that they are feeling. Suicidal Thoughts Those suffering from major depression may feel that life is no longer worth living and start thinking about ways to kill themselves. Thoughts like these are difficult to control and can be very frightening. If you believe that your client is having suicidal thoughts, encourage your client to call the Samaritans on 08457909090 immediately. It is worth calling them yourself for advice if your clients does not want to.
What causes depression? Life Events
Loss
Triggered by an unwelcome or traumatic event such as divorce, physical assault or sexual assault.
Triggered by a death of someone close, a major life change (moving house / changing jobs), or simply moving from one phase of life into another. It is not the experience of the change, it is how we deal with it that contributes to depression.
Anger Some people refer to depression as “frozen anger”. When a person’s experience leaves them feeling angry / helpless, and if they were unable to express their feelings at the time (perhaps because they were a child or their feelings were unacceptable to others) the anger becomes internalised and is expressed in depression.
Childhood Experiences A traumatic event in childhood including physical or emotional abuse (or if a person was not able to learn good coping skills as a child) may leave an adult less able to cope with difficulties.
Physical Conditions The following conditions may cause depression but are sometimes overlooked because of the focus on their physical symptoms: • • • •
conditions affecting the brain and nervous system hormonal problems, especially thyroid and parathyroid problems; symptoms relating to the menstrual cycle or the menopause low blood sugar sleep problems
All these conditions can be diagnosed by a simple bloodtest and so it is important to make sure that your client informs their GP of any of these symptoms.
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Side Effects of Medication
Diet
If your client has been recently prescribed a new medication and you have noticed a change in their behaviour it is worth looking at the patient information leaflet for that drug to see if depression is listed among the side effects. If you believe that the drug is causing depression, encourage your client to speak about this with their GP so that they can explored alternative medications.
Poor diet and general lack of fitness can both contribute to depression. Anecdotal evidence suggests that occasionally people become very depressed in response to some specific foods. If a person becomes suddenly depressed, it is worth considering if they recently introduced a new food or drink into their diet (for example, protein shakes).
Street Drugs or Alcohol
Genetics
Alcohol is a depressant and drug use can alter the chemistry within a person’s brain. Any use of drugs, especially frequent, may effect your client’s mental state negatively.
Although there are no identified specific genes for depression, some people are more prone to depression that others. It is worth exploring a client’s family history to understand if there may be an increased risk of anxiety disorders or depression.
causes
MIND & BODY Physical Symptoms of Mental Ill-Health
Blurred vision / “spots in front of eyes” / disorientation flushed complexion
Increased worry levels / feeling lightheaded or faint / recurring headaches Complains of “dry mouth” / Increased speed of speech / “hard to swallow” Muscular pain in neck and shoulders
Breathing speeds up dramatically / “harder to breathe”
Tingling sensations / “pins and needles”
Chest becomes tight and painful / heart pounds or skips a beat
Slow digestion / “feels sick” Stomach churns / needs to rush to the toilet
Shaking hands / sweats / numb 10
feel wobbly “like jelly�
tingling sensations / feel numb
physical
Anxiety and Panic Attacks Anxiety helps us get out of harm’s way and prepare for important events, and it warns us when we need to take action but for some people it can develop into an excessive, irrational dread of everyday situations. It can be disabling. When anxiety interferes with daily activities, a client may have an anxiety disorder. A panic attack is a sudden episode of fear which can trigger a person to believe that they are going to die. This person may feel that they need to rush to the hospital or seek emergency medical assistance. Recurring panic attacks can cause a panic disorder; agoraphobia can develop which will cause the person to have an irrational fear of everyday situations, including a fear of crowded places. Due to excessive worrying about issues in a person’s life (relationships, work, school,money, housing etc.), a person may suffer an anxiety attack. Unlike the immediate nature of a panic attack, an anxiety attack lasts over a long period of time (ranging from days to months). Both panic attacks and anxiety attacks can be treated through professional consultation. The term “anxiety disorder” includes generalized anxiety disorder (GAD), panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective mutism, separation anxiety, and specific phobias. Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time, along with depression. xxxxxxxxxxxxxxxxxxxxxxxxx If you want to know more about anxiety, organisations such as No More Panic, Anxiety UK and Triumph Over Phobia (TOP UK) all provide information and support for carers, friends and family members which can be found online.
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Symptoms • • • • • • • • • • •
racing heartbeat difficulty breathing almost paralyzing terror dizziness lightheadedness nausea trembling sweating chest pains hot flashes // sudden chills pins and needles tingling in fingers and toes
When someone is having a panic attack... Get them to breathe out a little longer than when they breathe in, especially if they feel like they’re going to faint. Breathe in and out for 7 seconds at a time. Count breaths if needed. Get them to close their eyes. Reassure them that you are there to help them.
Breathe
Everyday Anxiety
Anxiety Disorder
Worry about paying bills, landing a job, a romantic breakup, or other important life events
Constant, unsubstantiated worry that causes significant distress and interferes with daily life
Embarrassment in an uncomfortable or awkward social situation
Avoiding social situations for fear of being judged, embarrassed, or humiliated
A case of nerves or sweating before a big test, presentation, interview etc.
Seemingly out-of-the-blue panic attacks and preoccupying fear of having another one
Realistic fear of a dangerous object, place or situation
Irrational fear or avoidance of an object, place, or situation that poses little or no threat/danger
Anxiety, sadness, or difficulty sleeping immediately after a traumatic event
Recurring nightmares, flashbacks, or emotional numbing related to a traumatic
Researchers are learning that anxiety disorders run in families, and that they have a biological basis, much like allergies or diabetes and other disorders. Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.
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What medication is there for anxiety? As part of a client’s treatment, their doctor might offer to prescribe them some medication. There are 4 types of medication which can be helpful in managing anxiety: • antidepressants • beta blockers • tranquillisers (benzodiazepines) • pregabalin (an anticonvuslant)
ANTIDEPRESSANTS
Might calm a person/help them feel better but can sometimes cause unwanted side effects, such as problems with sleeping.
BETA-BLOCKERS
Can treat physical symptoms of anxiety, (eg. a rapid heartbeat or shaking) but are not psychiatric medication.
TRANQUILISERS
Temporary treatment for extreme cases. Can’t tackle the cause of problems, can bring some short-term relief.
PREGABALIN
This drug is an anticonvulsant medication which is normally used to treat epilepsy, but is also licensed to treat anxiety.
xxxxxxxxxxxxxxxxxxxxxxxxx According to the National Institute for Health and Care Excellence (NICE) – the organisation that produces health care guidelines – ideally their doctor should offer them other kinds of treatment for anxiety first, before prescribing these drugs.
Agoraphobia Agoraphobia is a fear of being in situations where escape might be difficult, or help won’t be available if things go wrong. Agoraphobia usually develops as a complication of a panic disorder (an anxiety disorder involving panic attacks and moments of intense fear). It may arise as a result of associating panic attacks with the places or situations where they occurred and then avoiding them. Traumatic events, such as bereavement, may contribute towards agoraphobia, as well as certain genes that are inherited from your parents. A person with agoraphobia may be scared of: • • •
travelling on public transport visiting a shopping centre leaving home
If someone with agoraphobia finds themselves in a stressful situation they’ll usually experience symptoms of a panic attack such as: • • • •
rapid heartbeat rapid breathing (hyperventilating) feeling hot and sweaty feeling sick
They will avoid situations that cause anxiety and may only leave the hostel with a friend or partner. They will order toiletries online rather than go to the shop. This change in behaviour is known as “avoidance”.
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Diagnosing Agoraphobia Contact your client’s GP if you think they may be affected by agoraphobia. It should be possible to arrange a telephone consultation if they don’t feel ready to visit their GP in person. The GP will ask them to describe their symptoms, how often they occur and in what situations. The GP may ask the following questions: • • •
Do you find leaving the house stressful? Are there certain places or situations you have to avoid? Do you have any avoidance strategies to help you cope with your symptoms, such as relying on others to shop for you?
Treating Agoraphobia A stepwise approach is usually recommended for treating agoraphobia. These are usually: •
Step 1: Educate yourself about your condition, possible lifestyle changes you can make, and selfhelp techniques to help relieve symptoms.
•
Step 2: Enroll yourself on a guided self-help program.
•
Step 3: More intensive treatments, such as cognitive behavioural therapy (CBT) or medication.
Social Anxiety Disorder Social anxiety disorder (social phobia) is a persistent and overwhelming fear of social situations. It’s one of the most common anxiety disorders. It can be intense fear and anxiety over simple everyday activities, such as shopping or speaking on the phone. Many people sometimes worry about certain social situations, but someone with social anxiety disorder will worry excessively about them before, during and afterwards. Social anxiety disorder is a type of complex phobia. This type of phobia has a disruptive or disabling impact on a person’s life. It can severely affect a person’s confidence and self-esteem, interfere with relationships and impair performance at work or school. Social anxiety disorder often starts during childhood or adolescence and tends to be more common in women. Teens and adults with social anxiety disorder may dread everyday activities, such as: • • • • • • •
meeting strangers talking in groups or starting conversations speaking on the telephone talking to authority figures working eating or drinking with company shopping
They may also: • • • •
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have low self-esteem and feel insecure about their relationships fear being criticized avoid eye-to-eye contact misuse drugs or alcohol to try to reduce their anxiety
Diagnosing Social Anxiety Disorder Again, contact your client’s GP if you believe that are showing symptoms of Social Anxiety Disorder. Their GP may ask them some questions from a diagnostic questionnaire, such as the Social Phobia Inventory, Social Phobia Scale or Social Interaction Anxiety Scale. These give a score that indicates their level of anxiety in social situations. The type of questions their GP might ask are: • • •
do you tend to avoid social places or activities? do you get scared about doing things with other people, like talking, eating and going to parties? do you find it difficult to do things when others are watching?
Treatments •
CBT. Your client will work with a therapist to change behaviour and replace unhelpful beliefs with more realistic and balanced ones.
•
Supported self-help. This could be in the form of a CBT-based book or computer program to try over 3-4 months. One of the most widely-used self-help therapies for people with anxiety or phobias is FearFighter, which is available on the NHS in some areas.
•
Antidepressants. This will usually be a selective serotonin re-uptake inhibitor (SSRI), either instead of or in combination with individual CBT.SSRIs increase the level of serotonin in your brain. They can be taken on a longterm basis.
Obsessive-Compulsive Disorder (OCD) / Post-traumatic Stress Disorder (PTSD) OCD is characterized by the experience of recurring excessive obsessive activities and mental rituals, as well as repetitive behaviors or thoughts (also called compulsions), such as hand washing, counting, or checking. Obsessions are defined as recurring and persistent thoughts, impulses, and/or images that are viewed as intrusive and inappropriate. Compulsions are defined as repetitive behaviors (for example, excessive hand washing, checking, hoarding, or constantly trying to put things around you in order) or mental rituals (for example, frequently praying, counting in your head, or repeating phrases constantly in your mind) that someone feels like they have to do in response to the experience of obsessive thoughts. PTSD and OCD or obsessive-compulsive disorder, as well as other anxiety disorders, often co-occur. In regards to obsessive-compulsive disorder (or OCD) specifically, studies have found that anywhere between 4% and 22% of people with PTSD also have a diagnosis of OCD. In addition, people with OCD also show a high likelihood of having experienced traumatic events. For example, one study found that 54% of people with a diagnosis of OCD report having experienced at least one traumatic event in their lifetime. The experience of traumatic events has also been connected to compulsive behaviors often seen in OCD, such as hoarding (for example, constantly acquiring and not getting rid of a large amount of possessions).
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How are PTSD and OCD connected? In addition to PTSD, people who have experienced a traumatic life event may also be more likely to develop symptoms of OCD. In fact, it has been shown that the severity of a person’s OCD symptoms is connected to the number of traumatic events they have experienced in their lifetime. After experiencing a traumatic event, a person may constantly feel anxious and have concerns about their safety. Compulsive behaviors (like checking, ordering, or hoarding) may make a person feel more in control, safe and reduce anxiety in the short-run. However, in the long-run, compulsive behaviors do not adequately address the source of the anxiety and can even increase the amount of anxiety someone experiences.
Drug-Induced Psychosis Drugs like cocaine, cannabis, and hallucinogens can cause mental health problems and, when paired with a pre-existing mental illness, can exacerbate the symptoms of such illnesses. Some drugs, when taken frequently for long periods of time, can actually manifest as psychotic symptoms indicative of schizophrenia and bipolar disorder. Psychosis in general is considered to be an illness accompanied by delusions and/or hallucinations. Usually these hallucinations occur outside of the user’s understanding and scope of cognition. Hallucinations are primarily visual, and their effects can be elevated with the use of certain psychedelic drugs. Delusions, on the other hand, are shifts in the user’s reality in such that he or she believes something outside of what is really going on. When a drug user has a mental illness prior to drug use, it may be hard to identify symptoms that are exclusively due to the drug use itself. Most symptoms, if the condition is unrelated to drugs, will continue after abstinence from the drug. The opposite is true for drug-induced psychosis; the schizophrenic-like effects will more or less subside after the drug wears off. However, this is not true for all drug users as frequent and prolonged use can cause side effects that last up to years after use discontinues.
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Early symptoms of psychosis are gradual and progress as the individual ages and/or drug use continues. Aside from delusions and hallucinations, here are some things to look for: • • • • •
Changes in emotion: no emotional response, difficulty expressing feelings, flat affect (appearance or no emotional expression) Lethargy; lack of motivation Socially withdrawn Incoherence in thought and actions; disorganized speech Violent behavior; erratic, sometimes dangerous, actions
With heavy, long-term use, nearly any drug can cause symptoms of psychosis in the user. A few, however, tend to be more closely correlated with drug-induced psychosis than others. • Cocaine and Amphetamines: These stimulants can contribute to psychotic symptoms that can last days, months, and years after the drug use stops. Long-term use is attributed to loss of memory and problems with concentration. • Alcohol: Delusions attributed to alcohol can cause disorientation, disorganized speech and mental confusion. In most cases, these effects go into remission when sobriety occurs. In co-morbid patients with schizophrenia, alcohol is also one of the most widely abused substances, along with marijuana and cocaine. • Hallucinogens: Psychedelic drugs affect the user in a way that mimics actual psychosis. These drugs, however, are not shown to induce psychosis with the first use. The symptoms are more prevalent after repeated use of the drug over a period of time.
The K10 Checklist K10 (or The Kessler Psychological Distress Scale) is a simple checklist intended to offer a measure of distress based on questions about anxiety and depressive symptoms that a person has experienced in the most recent 4 week period. It was created at Harvard Medical School in Boston and is used by clinicians throughout the world as a genuine attempt to collect information on the client’s current condition and to establish a productive dialogue. When completing the K10, a client should be provided with complete privacy. It is advised that those delivering the checklist step out of the room whilst the client completes it. The higher the score the more likely a person may be experiencing depression and/or anxiety. The K10 is screening instrument and it is up to those delivering the questionnaire to make a judgment as to whether a person needs treatment. Statistically, 1 in 4 adults in supported accommodation will show symptoms of mental ill-health. These results range from mild to extreme issues. Scores usually decline with effective treatment As a general rule, clients who rate most commonly “Some of the time” or “All of the time” are in immediate need of a more detailed professional assessment and must be linked in with their GP, or IAPTS, right away. Clients who rate most commonly “A little of the time” or “None of the time” are unlikely to be experiencing extreme depression or anxiety but may also benefit from early intervention for mild disorders and help with strategies to prevent/cope with future mental ill-health.
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In the past 4 weeks... About how often did you feel tired for no good reason?
About how often did you feel nervous? About how often did you feel so nervous that nothing could calm you down? About how often did you feel hopeless? About how often did you feel restless or fidgety? About how often did you feel so restless you could not sit still? About how often did you feel depressed? About how often did you feel that everything was an effort? About how often did you feel so sad that nothing could cheer you up? About how often did you feel worthless?
1 None of the time
2 A little of the time
3 Some of the time
4 Most of the time
5 All of the time
Warwick Scale of Wellbeing The Warwick-Edinburgh Mental Wellbeing scale was developed to enable the monitoring of mental wellbeing in the general population and the evaluation of projects, programs and policies which aim to improve mental wellbeing. It is a scale of 14 positively worded items, with five response categories, for assessing a client’s mental wellbeing. It is very similar to the K10 checklist. It is a points-based scale. Total POINTS up to reveal score: • • • • •
None of the time ( 1 POINT ) A little of the time ( 2 POINT ) Some of the time ( 3 POINT ) Most of the time ( 4 POINT ) All of the time ( 5 POINT )
The average person will score between 41 and 59. The LOWER the score, the more likely it is that your client is at risk of suffering from a mental wellbeing issue. xxxxxxxxxxxxxxxxxxxxxxxxxxx
There are five evidence-based steps we can all take to improve our mental wellbeing. They are: • • • • •
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Get active Connect with others Keep learning Be aware of yourself and the world Give to others
In the past 2 weeks...
1 None of the time
I’ve been feeling optimistic about the future. I’ve been feeling useful. I’ve been feeling relaxed. I’ve been feeling interested in other people. I’ve had energy to spare. I’ve been dealing with problems well. I’ve been thinking clearly. I’ve been feeling good about myself. I’ve been feeling close to other people . I’ve been feeling confident. I’ve been able to make up my own mind about things. I’ve been feeling loved. I’ve been interested in new things. I’ve been feeling cheerful .
2 A little of the time
3 Some of the time
4 Most of the time
5 All of the time
Genograms A genogram is a graphic representation of a family tree and personal history that displays detailed data on relationships among individuals. It extends beyond a traditional family tree by allowing the user to analyze hereditary patterns and psychological factors that may punctuate relationships. Genograms allow support staff and clients to work together in quickly identifying and understand various patterns in the client’s family history which may have had an influence on the client’s current state of mind. Genograms hold a great deal of information on the families represented. First, they contain basic data found in family trees such as the name, gender, date of birth, and date of death of each individual. Additional data may include education, occupation, major life events, chronic illnesses, social behaviors, nature of family relationships, emotional relationships, and social relationships. Some genograms also include information on disorders running in the family such as alcoholism, depression, diseases, alliances, and living situations. Genograms can vary significantly because there is no limitation as to what type of data can be included.
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How to start a genogram for your client: 1. Put a client box in the centre of the page – either a square for a male or a circle for a female, and put the client’s age in the centre. 2. Map the client’s key relationships – family, friends, staff members and add a link (close, distant, broken, abuse – see emotional relationships page) between the client box and these key relationships. 3. Very close relationships should be mapped nearer the client, and more distant relationships should be mapped further away. 4. Think about the key events and moments in your client’s life. There are different colour coded boxes which correspond with different areas of their life. Start with current events and work backwards to include information about their medical history and background. 5. All of these boxes and symbols should be linked to one another or to the resident as appropriate. Remember • • • •
Males are represented by squares, females by circles Put the age of any individual inside the symbol The closer the relationship the closer the symbol should be to the resident The use of the correct linking symbol is very important
Male ( Put age inside the square) Female ( Put age inside the circle)
Death Marriage (male/female) Marital Separation Divorce Getting back together after a divorce Living together, affair or intimate relationship Gay Couple
Lesbian Couple 30
Relationships between people and events – Used to describe the bond between any two individuals or two events .
Standard Link Important Link Key relationship Close relationship Abuse (physical/ emotional/sexual) Distant/poor Separation Break in relationship
Children – list in birth order with oldest on left
Child
Foster or Adopted
Stillbirth
M
A
P
Miscarriage
Abortion
Pregnancy
Notes •
Male
•
Female
•
Put ages of the child inside of the symbol
Key Life Events – draw around areas that you want to highlight using different colours
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Important Life Events
Questionable Areas
Background
Medical Events
Twins
Symbols denoting drug, alcohol and/or mental health problems (example uses male clients – females would be circle) Drug or Alcohol Abuse
Suspected Abuse
In recovery from drug or alcohol abuse
Serious mental / physical problem
Drug / alcohol misuse AND serious mental / physical problems
visualising history
Resilience Plan The following are some questions you could explore with your client to help them understand any triggers that effect their wellbeing.
Things that have a positive effect on my wellbeing
Things that have a negative effect on my wellbeing
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Things that I could do to try to improve my situation
Who might I ask for help
Mental Health Treatment Checklist “A Checklist for people with mental health problems” was designed by the Royal College of Psychiatrists. If your client has been diagnosed with a mental health condition or is receiving professional psychiatric help, this checklist can help you establish a conversation around the steps of their treatment with your client. When you don’t know an answer, it can flag up some questions around the illness, treatment and care that either you or your client may want to ask their psychiatrist or external care practitioner.
If a diagnosis has been made: What illness (diagnosis) do I have? ....................................................... What symptoms suggest this diagnosis? .............................................. What tests have already been done? ................................................... Are there any other tests that might needed? ..................................... Have any physical problems been found and what will need to be done about them? .............................................................................. Why has this happened to me and will I get better? ............................ Where can I find written information about my problem? ...................
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If a diagnosis has NOT YET been made: What are the possible diagnoses that I may have? ............................... What tests have already been done? ................................................... What type of help am I currently receiving? ........................................ Are there any other tests that might needed? .....................................
About care and treatment: What are the aims of my care and treatment? .................................... Where can I get written information about the treatment I will have / am currently having? ........................................................................... Who will be responsible for my care (nurse / doctor / therapist / keyworker etc.)? Name all that you know of. What exactly will they do? How often will they see me? ............................................................... Who else will be involved in my treatment? ........................................ How often will the psychiatrist see me? .............................................. What are the plans for my treatment? ................................................. Do I have any choice? ......................................................................... Have I been prescribed any medication? ............................................ If so, how and how often do I need to take it? .................................... Who do I contact in an emotional emergency? ...................................
How can we help as key workers? The following pages provide guidance to help you to identify people who may be at risk of abuse and to know how to respond. You will need to know how to identify which tenants may have care and support needs. If a client discloses to you that they are suffering from a lack of emotional stability, assure the person that the matter will be taken seriously. Listen and be non-judgmental. Explain the services that are on offer for their needs. Don’t promise confidentiality – explain how and why the information might need to be shared. Even if a client has not disclosed anything, it is important to consistently provide a safe and accepting atmosphere for clients. 1. Be there. The best thing you can do for someone with emotional instability is to be there. ‘Tell me what I can do to help you.’ ‘We’re going to find a way to help you to feel better.’” 2. Try a small gesture. You could consider writing a letter to your client that praises work that they have done. You could also consider offering a cup of tea in your keywork session. Although these small gestures won’t make a powerful impact on their condition, they will provide a safe space and help the client to feel relaxed. 3. Don’t judge or criticize. What you say can have a powerful impact on your client. Avoid saying statements such as: “You just need to see things as half full, not half empty” or “I think this is really all just in your head. If you got up out of bed and moved around, you’d see things better.” Clients do not have a choice in how they feel.
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Ways to start the conversation • “I have been feeling concerned about you lately.” • “Recently, I have noticed some differences in you and wondered how you are doing.” • “I wanted to check in with you because you have seemed pretty down lately.”
Questions you can ask: • “When did you begin feeling like this? • “Did something happen that made you start feeling this way? • “Is there anyone outside of the hostel that you would l Ike me to contact?” • “Will you allow me to find you some professional help?”
Which service do we contact for help? The following pages will give you information of the different services you can contact when you are concerned about a client. These are presented thematically: national mental health support services; YMCA flowchart of action; local mental health support services; who to contact in a mental health crisis; a map that shows you the main sites of Haringey’s drug and alcohol recovery services; and domestic violence services. It is advised that you contact the relevant service at the first sign of symptoms especially in regards to substance misuse. This includes casual marijuana use. Even if it isn’t effecting their emotional state, it will be financially draining their resources. Getting your client linked in as early as possible can help intervene before their substance misuse jeopordises their place at the YMCA.
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Haringey Mental Wellbeing Services Big White Wall W: www.bigwhitewall.com A free online, anonymous support network for adults aged 16 and over who are struggling with depression, anxiety and other common mental health issues. 95% of members report feeling better as a result of joining Big White Wall.
Open Door Service T : 020 8348 5947 W: www.opendooronline.org A free confidential, counseling and psychotherapy service for young people under 24 in Haringey to learn to cope with anger, aggression, depression, anxiety and eating difficulties.
Nafsiyat T : 020 7263 6947 W: www.nafsiyat.org.uk Nafiysat provides group psychologist therapy for Turkish men aged 18-40 years old with mental health problems.
Tottenham Thinking Space T : 0779 238 6773 W: www.travistockandportman.nhs.uk/tottenhamthinkingspace Regular meetings for those who wish to meet others wanting to reduce isolation and improve well-being in Tottenham.
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Maytree T : 020 7263 7070 E : maytree@maytree.org.uk Provides help and support in non-medical, confidential setting to people feeling suicidal. Have a safe space that those at risk of suicide can stay for free for three nights in Finsbury Park.
Mental Health Champions T : 020 8885 9330 E : hun@mhacs.co.uk A network of Haringey residents with first hand, personal experience of mental health.
Samaritans T : 08457 909090 W: www.samiritans.org Speak anonymously and in confidence, 24/7.
MIND in Haringey T : 020 8340 2474 W: www.mindinharingey.org.uk E : admin@mih.org.uk Can provide telephone support aswell offer a range of free courses which uses the Warwick Scale of Wellbeing to support those in Haringey who are in need of mental health care.
The YMCA action flowchart for mental health concerns:
Immediate danger to themselves or someone else
Ambulance / Police 999
Find out which hospital or station they will be taken to.
Urgent Mental Health Assessment Needed
CMHT/Early Intervention Team
Mental Health Counseling & Advice
Samaritans
0208 702 6700 24/7 service Accept self referrals
08457 909090
Emergency Mental Health Team 0208 702 3000
Open Door 0208 348 5947 Counseling/ therapy up to age 24. Accept self referrals.
Lets Talk : IAPT Therapy for Anxiety/ Depression 0203 074 2280
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Which services will help with a mental health crisis? A mental health crisis is when you feel your mental health is at breaking point. For example, you might be experiencing: suicidal feelings or self-harming behaviour; extreme anxiety or panic attacks; psychotic episodes (such as delusions, hallucinations, paranoia or hearing voices). Please use the contact the following numbers if you believe that your client is suffering a mental health crisis:
Their GP or other allocated health professional (e.g. Community Psychiatric Nurse)
Haringey Crisis Resolution & Home Treatment Centre, St Ann’s Hospital - 0208 702 6700 Samaritans - 0845 790 9090 (24hr) Maytree, Finsbury Park - 0207 263 7070
(Offer three days of respite care in a safe place.)
Mind Info Line - 0300 123 3393
(For mental health emergency information)
Call 999
If someone is at serious risk of injury call 999 and ask for police, fire or ambulance service.
Go to North Middlesex Emergency Reception Centre Self refer via casualty (walk in) for psychiatric assessment Sterling Way Edmonton, N18 1QX - 0208 227 2000
HAGA - Haringey Alcohol Services 171 Park Lane, Rothbury Walk, London, N17 0HJ 020 8800 6999 / hello@haga.co.uk Call HAGA to make an appointment for your client. You will then be able to accompany them to an appointment in the following few days. Clients will receive one to one support to help them move away from alcohol. This support may include detoxification, counseling, therapy, groupwork etc.
The Grove (DASH) - Drug Treatment 9 Bruce Grove, London, N17 6RA 020 8885 6195 / haringeydrugservice@blenheimcdp.org.uk You can take your client there without an appointment and they will be seen very quickly. Clients will be drug tested at the end of their initial appointment and treatment will begin within a week. This service is free and will support your clients in several ways including groupwork, therapy and detoxification treatments. It is advised to drop in Monday - Thursday 9-4pm as this is their least busy time.
Haringey Recovery Service 590 Seven Sisters Road, London, N15 6HR 020 8801 3999 / haringeyrecovery@mungos.org Haringey Recovery Service assist with clients who are in recovery from other substance misuse. Help will include recovery planning, mutual aid, peer support, counseling and other talking therapies. They do carer inclusion so you can be become part of your client’s treatment. They provide a Drug Rehabilitation Requirement (DRR) program and A Recovery Academy with courses designed and delivered by people in recovery with a range of courses covering creativity, health and well-being. 46
White Heart Lane
Park Lane
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Northumberland Park
Bruce Grove
Tottenham Hale
West Gr e en
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Seven Sisters
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a Ro rs te s i nS eve
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substance misuse
National Emotional Support Services Mind T : 0300 123 3393 W: www.mind.org.uk E : info@mind.org.uk Mental health charity who operate in Haringey. Provide mental health support and a legal advice line. Language Line is available for talking in a language other than English. Opening hours are 9am to 6pm, Monday to Friday
Anxiety UK T : 0844 477 5774 W: www.anxietyuk.org.uk Information and counseling. Offers a helpline and online support for those suffering from anxiety disorders.
Be Mindful W: www.bemindful.co.uk Information on mindfulness and details of local mindfulness courses and therapists.
Complementary and Natural Healthcare Council (CHNC) T : 020 3178 2199 W: www.cnhc.org.uk Regulator body with a register of complementary therapy practioners.
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Depression Alliance T : 0845 123 2320 W: www.depressionalliance.org Information and support for people with depression. To receive an information pack, call the number and leave your name and address.
Disability Rights UK W: www.disabilityrightuk.org Information and support for people living with a disability, including contact details of local disability groups.
Hearing Voices Network T : 0114 271 8210 W: www.hearing-voices.org Local support for people who hear voices.
NICE (National Institute for Health and Care Excellence) W: www.nice.org.uk Evidence based guidelines on treatments.
Rethink Mental Illness T : 0300 500 0927 W: www.rethink.org Information and support for people with mental health problems.
Domestic Violence Support Hearthstone T : 020 8888 5362 Haringey specific service that work with male and female survivors and all levels of risk. They operate both emergency and scheduled appointments and accept self referrals. Opening hours are 9am to 4pm, Monday to Friday
Freephone 24 Hour National DV Helpline T : 0808 2000 247 W: www.womensaid.org.uk
Rape Crisis T : 0808 8029 999 W: www.rapecrisislondon.org A national feminist organisation that offer a range of support, advocacy, counseling and information in a women-only safe space. They exists to promote the needs and rights of women and girls who have experienced sexual violence, to improve services to them and to work towards the elimination of sexual violence.
Forced Marriage Unit T : 020 7008 0151 A government run organisation who you should contact if you are worried that a client is at risk of being forced into marriage by family.
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NOTES
Designed by Lottie Hanson-Lowe