To provide a vision for mental health management and treatment, to identify areas of priority, outline aims and principles, roles and responsibilities.

Promotion of mental health,  and prevention of MH issues and illness. Improvement of service responsiveness.

To improve clinical outcomes for people with a mental illness through provision of accessible community services. Early identification, intervention and recovery.

Consumer centered.

Return to wellness

Instills hope, optimism, focus on future

No cure, but management.

Process of changing one's attitude/values/goals- new meaning and purpose- growth beyond psychiatric disability.
Enables client to move beyond neg consequences of their condition.

Heath

Psychological distress

Illness (signs and symptoms now impacting significantly on the individual).

1)Appearance

2) behavior

3)Speech

 4) Mood

5) Affect

6) Thought form

7) Thought content

8) Perception

9) Cognition

10) Insight

Axis 1 disorders

DSM IV-TR

Affective

Anxious

Psychotic

Correct term: Unipolar depression

Sad, irritable mood that doesn't shift

Lack of energy/tiredness

Feelings of worthlessness

Loss of interest in things

Difficulty sleeping

Treatment: CBT

Antidepressants if severe and resistant to talking therapies (assists motivation)

Anxiety symptoms and treatment

Psychological- unrealistic or excessive fear/worry

Impatience, anger, confusion, nervousness

Behavioral-Obsessive compulsive behavior, distress in public situations, avoidance etc

Physical: Palpitations, SOB, sweating, G.I upset

Treatment: Systemic desenitization, graded exposure, CBT

Changes in thinking and perception

Changes in behavior

Depression, anxiety, blunted, flat or inappropriate emotion

Treatment: Anti-psychotics

Mood stabilizers

Psychological counselling

What are the core principles of the Mental health Act 1996

 Core principles:

1) protection of patient rights

2) Treatment in the leas restrictive environment

3) mental illness alone is not sufficient enough to warrant invol. admission

4) Balance of rights and responsibilities

Dialectial behavioral therapy

CBT

Pharma therapies- mood stabilizers, antidepressants, possibly antipsychs.

For: Management of unstable mood states

Examples: Lithium, sodium valproate

How:

Lithium- modifies production and repuptake of serotonin and dopamine...increases serotinin, decreases dopamine, reduces dopamine receptor sensitivity.  Not fully known how, but is thought to bind to enzymes that forms part of a nerve signalling pathway implicated in the regulation of mood.

Sodium valproate- increases GABA production (nerve calming chem), and prevents it's breadown. Decreases glutamate (nerve stimulating chem) in the synaptic fluid, thus working to stablilize electrical activity in the brain.

Very toxic in OD!

Why? Management of depression

What?

Tricyclics (TCA's)

SSRI's (selective serotonin reuptake inhibitors)

SNRI's (selective noreadrenaline reuptake inhibitors)

MAOI (monoamine oxidase inhibitors)

How?

TCA's- blocks reuptake of serotonin & norepinepherine
SSRI's- blocks the reuptake of serotonin @ the synapse. Non sedating.

SNRI's- blocks reuptake of serotonin & noreadrenaline & post-synaptic cleft

MAOI's- inhibit the metabolism of tyramine

*blocking the reuptake function means more neurotransmitter in the synaptic fluid= improvement in transmission of messages= boost in mood.

Why? Anxiety

Examples- benzodiazepines, beta-blockers

sedative actions, addictive

How?
Beta-blockers: binds to and blocks beta adrenergic receptors- receptors found in different parts of the body that are activated by epinephrine and norepinephrine.

Benzo's- block GABA (inhibitory neurotransmitter) receptor sites, thus increasing the quantity in the brain- slows transmission of neurotransmission between synapses- effectively slows brain down.

Why? Psychotic symptoms

What? Typical (1st gen)- more effective at managing positive symptoms

Atypical (2nd gen) more effective at managing both positive and negative symptoms.

Potential for extrapyramidal side effects

How? Dopamine antagonist. Binds to dopamine receptors, blocks dopamine from activating the cell at the synapse- basically, prevents transmission of dopamine across synapses.

Why? Management of side effects of antipsychotics

How? Inhibits the effects of acetylcholine- by inhibiting cholinergic transmission at sympathetic and parasympathetic nerve fibers and receptor sites.

What is co-morbidity?

The presence or co-occurance of one or more disorders.

eg: mental illness + drug misuse

1) stimulants- caffine, tobacco, amphetamines, cocaine, ecstacy.

2) Depressants- alcohol, benzo's, opiates

3) Hallicinogens- LSD, mushies

4) Other- cannibis (contains elements of all of the above).

Mental Health Act 1996:

What is it?

MH Act is an Act passed by parliment that was designed to ensure that people with mental illness receive the best care, in the least restrictive manner, and with the least amount of interference with their rights and dignity. Ensures protection of patients and public.

Minimizes the adverse effects of mental illness on family life.
Dictates treatment protocol etc by health professionals.

Community Treatment Order

Used in accordance with the mental health Act 1996 to provide mandated access to treatment while the client is able to reside within the community.
Valid for up to 3 months- can be revoked, or renewed.

1) The person has a mental illness requiring treatment

2) The treatment can be provided via detention in an authorized hospital or CTO and is required to be provided in order to

i) protect health & safety of the individual or others

ii) Protect the individual from self-harm

iii) Prevent the individual from doing serious  harm to property

3) The person has refused treatment, or is unable to provide consent due to the nature of the illness.

4) Treatment cannot be adequately provided in a way that is less restrictive on personal freedom/choice/movement that what will result from being an invol. patient.

Forms in mental health

1,3,4 and 6

Form 1: Referral to hossy. Signed by authorized MH practitioner. Invol referral for examination is being made. Valid for 24 or 48 hours?

Form 3: Transport order with police: Signed by authorized MH practitioner. Used to convey a person to an authorized hossy for examination. Authorizes police to apprehend and transport pt to place of examination. Lapses once person is received into authorized facility. Valid for 72 hours.

Form 4: Order to be seen by a psychiatrist + detainment for 72 hours. Signed by psychiatrist. Enables detainment and allows for further assessment, which must take place within 72 hours of a person being received into an authorized hossy.

Form 6: Order to be seen my psychiatrist and detainment for 28 days.
Signed by psychiatrist. Allows for invol detainment in an authorized hossy or CTO.

Models of drug use

Roizen's 4 L's.

Liver: Represents all physical and psychological problems caused by drug use.

Lover: Represents problems with relationships- family/friends/self

Livelihood: Represents issues of employment (demotion, sacking etc), financial issues, study issues etc.

Law: Represents legal issues that may arise as a result of drug use.

The drug:

Purity, route of admin, dosage, legality, form, other drugs, availability.

Set (The individual):

Age + metabolism, gender, health, mood, tolerance, past experience.

Setting:

Where, with whom, what time, how, safety of setting, peer influence, cultural factors.

Intoxication:

Accident, violence, drink driving, suicide, OD

Regular use:

Disease, financial issues, relationship issues

Dependance:

Withdrawal, dependance, obsessive, isolation cognitive conflict (awareness of destructive behaviors but not knowing what to do about it).

Precontemplation: No conception of problem, no connection between behavior and consequence.

Contemplation: Realization of possibility of problem. Ambivalent- torn between desire to change & the difficulties involved.

Preparation: Recognition of problem, recognition of need for help.

Action: Ackowledgement of problem and need for treatment; active engagement of treatment program.

Maintenance: Behavior modification, alternative behavior, reduction in use.

Relapse:

Dementia: Gradual deterioration of intellectual function & other cognitive skills. Progressive deterioration (thinking, memory, behavior, personality, motor function).

Delirium: Sudden onset, response to toxicity in the body. Temporary. General reversable once source of toxicity has been removed/rectified.

What is CAMHS?

Predominant approaches in CAMHS assessment, diagnosis and treatment.

CAMHS: Child and adolescent mental health service.

Family therapy

Play therapy- uses play as a medium- mechanism of communication.

Describe the biopsychosocial model

A model of health that takes into account the intersecting biological, psychological and social factors that influnce a person's health and wellbeing.

Aspects of biology: biomedical history, current biomed issues, aging, disability, physical environment, diet etc.

Aspects of psychology: Capacity, isolation, anxiety, depression, loneliness, cognition, grief and loss etc.

Aspects of social: Family, friends, relationships, education, sexuality, finances, occupation, religion, ethnicity, community, values etc.

Suicide risk assessment.

Head represents thoughts, feelings and emotions; ambivalence,suicidal ideation.

Hands represents actions- how open someone is to options other than suicide, and risk factors.

Knees represent availibity of support, and willingness to access support.

Feet represent any coming events that may antagonise the risk of suicide.

Block underneath represents anything else of relevance (illnesses etc).