L3 Mental Health v2 December 2020 PDF

Mental Health (England and Wales) © Department of Clinical Education & Standards 1  Welfare Subjects covered during this training may evoke memories of incidents that you have witnessed or been involved in. If you have any concerns please discuss with...

Mental Health (England and Wales) © Department of Clinical Education & Standards 1  Welfare Subjects covered during this training may evoke memories of incidents that you have witnessed or been involved in. If you have any concerns please discuss with your Course Director/staff at the education centre. Support is available to all staff, more information is available on The Pulse LINC emergency on Call – 0207 922 7539 Staff Counselling Referral Line – 0800 882 4102 MIND Blue Light Infoline – 0300 303 5999 Wellbeing hub – 0203 162 7554 Trim assessment © Department of Clinical Education & Standards 2  Mental Health "Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.“ :https://www.mind.org.uk/information-support/your-stories/what-is-mental-health-and-mental-wellbeing/ © Department of Clinical Education & Standards 3  Mental Health Legislation Mental Health Act (1983) amended in 2007 The Mental Capacity Act © Department of Clinical Education & Standards 4  Mental Health Mental Health Act (1983) Amended 2007 © Department of Clinical Education & Standards 5  Mental Health Applies to England and Wales. The act covers legislation for treatment, care and the management of property for Mentally ill patients. The act covers legislation about the patients rights. Relevant sections: 2, 3, 4, 5, 135 and 136. Emergency Amendments made March 2020 to account for Coronavirus pandemic. © Department of Clinical Education & Standards 6  Mental Health Coronavirus Amendments Summarised Changes to the length of time a patient can be detained for section 2, 3, 135 and 136. Changes in length of time for detainment holding powers. Detainment does not always need a second Doctor’s approval. © Department of Clinical Education & Standards 7  Mental Health Basic Legal Rules for HCPs Mental Health patients can be detained against their wishes if they are deemed as being: At risk to themselves At risk to others And/ Or are vulnerable © Department of Clinical Education & Standards 8  Mental Health Basic Legal Rules for HCPs To detain a patient against their wishes they must be placed under a section order from the mental health act (1983). They can be detained under the mental health act (1983) in order to treat their mental disorder ONLY. © Department of Clinical Education & Standards 9  Mental Health Basic Legal Rules for HCPs A mental health patient, suffering with a physical illness or injury, will need to be assessed under the Mental Capacity Act (2005). © Department of Clinical Education & Standards 10  Mental Health Approved Mental Health Practitioners Psychiatrist Community psychiatric nurse Psychologist Support workers Care coordinator/key worker Police Adult mental health services (AMH) Child and Adolescence mental health services (CAMHS) Mental health services for older people (MHSOP) © Department of Clinical Education & Standards 11  Mental Health The Mental Health Act (1983) as amended 2007 Compulsory detention: Section 2 - Assessment Order Section 3 - Treatment Order Section 4 - Emergency Order Section 5 – Application for a patient already in hospital Section 131- Informal admission, with the patient’s agreement. Section 135 - Warrant to search for and remove patients from private premises for assessment Section 136 - Police power to detain someone in a public place ©Department of Clinical Education & Standards  Mental Health Mental Disorders The Mental Health Act (1983) defines mental disorder as: ‘any disorder or disability of the mind.’ Exceptions: Learning needs, Alcohol or Drug dependency. © Department of Clinical Education & Standards 13  Mental Health The International Classification of Diseases v10 (ICD- 10) organised mental health disorders into common themes such as: Organic Schizophrenia and delusional disorders Mood (affective) disorders Neurotic, stress related and somatoform disorders Disorders of adult personality and behaviour It’s important to note that mental health conditions exist alongside each other. © Department of Clinical Education & Standards 14  Mental Health Living with Mental Health Mental health conditions can have an impact of all aspect of people’s lives including: Psychologically Emotionally Practically Financially People may also face Social exclusion and discrimination There is also a Positive impact on patients ©Department of Clinical Education & Standards  Mental Health Living with Mental Health Mental illness does not only affect those who have it. It can also affect their family and friends. Families may experience different emotions, including anxiety, anger, shame and sadness. They may also feel helpless in regards to the situation. Everyone reacts differently. For instance: Some parents may feel a sense of guilt for their child’s illness Family members may wonder whether the illness is hereditary People in the family may worry and wonder about their new responsibilities towards the person suffering. There may also be economic and practical concerns about how the family with copy. ©Department of Clinical Education & Standards  Mental Health Organic Physical brain disease such as dementia. Disturbed central nervous system such as fever induced delirium. Brain damage/disfunction or physical illness. Personality or behavioural disorders due to brain damage/disfunction/disease. ©Department of Clinical Education & Standards  Mental Health Schizophrenia and delusional disorders A severe mental disorder (or group of disorders) characterized by a disintegration of thought and perception processes, contact with reality and emotional responsiveness. May be acute or chronic and fluctuate in severity. Affects approximately 1% of the population. Onset: mid to late teens (men); slightly later in women Causes are unclear. ©Department of Clinical Education & Standards  Mental Health Mood (affective) disorders Mood can be thought as a temporary state of mind or feeling. Sitting somewhere from severe depression to severe mania, with ‘normal’ mood in the middle. Mania: a condition characterised by episodes of boundless energy, a feeling of euphoria and of the person being very successful. They can be uni-polar or bi-polar. Kumar, 2012 ©Department of Clinical Education & Standards  Mental Health Neurosis A disorder in which anxiety or emotional symptoms are prominent. The sufferer often has insight into their illness or has potential to have insight. Main types: Pathological anxiety Clinical depression Phobias Obsessions / compulsions ©Department of Clinical Education & Standards  Mental Health Acute Behavioural Disturbance Definition: A rare form of severe mania, sometimes considered part of the spectrum of manic depressive psychosis and chronic schizophrenia. Causes: Psychiatric illness, drugs (particularly cocaine) or alcohol, or a combination of these. ©Department of Clinical Education & Standards  Mental Health Acute Behavioural Disturbance can occur in the context of : Psychiatric illness - Typically psychosis Physical illness - Typically in confusion/delirium Substance Misuse - Typically alcohol withdrawal ©Department of Clinical Education & Standards  Mental Health Acute Behavioural Disturbance Risks: Rapid deterioration and death due to cardiac arrest from drug-induced arrhythmias. Greater risk of positional asphyxia, especially in obese patients. May be exacerbated by exhaustion e.g. following a struggle. ©Department of Clinical Education & Standards  Mental Health Acute Behavioural Disturbance Has been linked to the following conditions Head injury Brain tumours Delirium /high temperature Epileptic post-ictal states Heat exhaustion Hypo/hyperglycaemia Thyroid disease Drugs.. Anti psychotic/ Cocaine. ©Department of Clinical Education & Standards  Mental Health Acute Behavioural Disturbance Signs and Symptoms: Bizarre and/or aggressive behaviour Impaired thinking Disorientation Hallucinations Onset of paranoia ©Department of Clinical Education & Standards  Mental Health Acute Behavioural Disturbance Signs and Symptoms: High level of physical strength Sweating, fever, heat intolerance, hot to touch Removal of clothing Decreased/absent response to pain Sudden tranquillity after frenzied activity which may mask reduced Level of Consciousness. ©Department of Clinical Education & Standards  Mental Health Acute Behavioural Disturbance Management: If police on scene, they should already be trained in safe management Summon police assistance if not present Do not place yourself at risk Monitor patient for deterioration Consider position of patient when restrained – sitting or kneeling, lying on side, not face down. ©Department of Clinical Education & Standards  Mental Health Acute Behavioural Disturbance Management Personal safety is paramount. Ideally the patient should be contained rather than restrained. When safe, conduct a primary survey. Treat as required. Document observations. Secondary survey if possible/required. Ideally transport in ambulance. (Police van, subject to local agreement) Transport to A&E ©Department of Clinical Education & Standards  Mental Health Eating disorders “An eating disorder is when patients have an unhealthy attitude to food, which can take over their life and make them ill.” (NHS) It can involve eating too much or too little, or becoming obsessed with their weight and body shape. Men and women of any age can get an eating disorder, but they most commonly affect young women aged 13 to 17 years old. ©Department of Clinical Education & Standards  Mental Health Eating disorders There is no one cause of eating disorders, but they are often associated with: A history of eating disorders, depression, or alcohol or drug addiction Being criticised over eating habits, body shape or weight Being concerned with being slim, particularly if patients also feel pressure from society or their job – for example, ballet dancers. Having anxiety, low self-esteem or an obsessive personality Being sexually abused ©Department of Clinical Education & Standards  Mental Health Substance abuse and addiction “Addiction is defined as not having control over doing, taking or using something, to the point where it could be harmful to you. “ (NHS) According to the charity Action on Addiction, 1 in 3 people are addicted to something. Addiction is most commonly associated with gambling, drugs, alcohol and nicotine, but it's possible to be addicted to just about anything. ©Department of Clinical Education & Standards  Mental Health Substance abuse and addiction Addiction has a range of causes including: The physical and mental “high” when taking the substance, making you want to take it again and unpleasant withdrawal symptoms if you don’t have it. Some studies suggest addiction is genetic, but environmental factors, such as being around other people with addictions, are also thought to increase the risk. Addiction will affect all aspects of a persons life including, their job, family and physical health. ©Department of Clinical Education & Standards  Mental Health Positional/Restraint asphyxia January 2006 inquest Death of a patient in police custody due to positional/restraint asphyxia highlighted need for staff to be aware of condition. ©Department of Clinical Education & Standards  Mental Health Positional/Restraint asphyxia Occurs when the position of the body interferes with respiration, resulting in asphyxia. Patient not able to alter their position due to restraint. ©Department of Clinical Education & Standards  Mental Health Positional/Restraint asphyxia Risk factors include: Patients position resulting in partial or complete airway obstruction. Patient left face down, in the prone position. Pressure applied restricting the shoulder girdle or accessory muscles whilst laid down. ©Department of Clinical Education & Standards  Mental Health Positional/Restraint asphyxia Factors increasing risk include: Drug/alcohol intoxication Physical exhaustion Mental illness Obesity ©Department of Clinical Education & Standards  Mental Health Implications for the Detained person: Forcibly taken to hospital Kept on a ward with movements restricted, no leave without written agreement Forced to take medication if they refuse Subject to constant observation (at least initially) If AWOL there are powers to return the patient to hospital Will be recorded in health records Future implications e.g. work, travel abroad Driving restrictions © Department of Clinical Education & Standards 37  Mental Health JRCALC PLUS Information on the app is under: Mental health presentation Crisis, distress and disordered behaviour, and: self-harm & suicide risk assessment and Acute Behavioural Disturbance ©Department of Clinical Education & Standards  Mental Health Self-Harm and Suicide Risk Assessment Tool - Low risk - Mild – Moderate risk - Severe – Extreme risk © Department of Clinical Education & Standards 39  Mental Health Self Harm Release Makes an emotional pain a ‘real’ physical pain Control Punishment An out of body experience © Department of Clinical Education & Standards 40  Mental Health Management Be prepared for a challenge Effective communication is fundamental and will help alleviate and de-escalate the patients distress. You must combine your assessment of their physical care needs with their mental health care needs. © Department of Clinical Education & Standards 41  Mental Health Local Referral Pathways Different areas have different pathways available for mental health treatment and support, to view what is available in your area, check MiDoS. © Department of Clinical Education & Standards 42  Mental Health Suicide – LA383 Risk Awareness Tool Self harm and Suicide Risk assessment tool Available on the app ©Department of Clinical Education & Standards  Mental Health Clinical Performance Indicators (CPI’s) At least one set of observations recorded and time logged: AVPU, RR & depth, SP02, HR & character, BP, colour, GCS and PEARL? BM recorded for all patients with altered mental state or use of antipsychotic medication. Name of current AMHP/CPN or ASW. © Department of Clinical Education & Standards 44  Mental Health CPI’s Medical history: Including allergies and relevant medications. History of current event: Including onset of symptoms. Psychiatric history: Documenting ‘MH issue’ is not acceptable. Description of the patients appearance: Include non-verbal indicators of state of mind e.g. dehydrated, poor hygiene, malnourished etc. Assessment of the patients behaviour: Agitated, anxious, ability to concentrate, mood swings, aggressive, calm, obsessive etc. © Department of Clinical Education & Standards 45  Mental Health CPI’s Assessment of the patients communication: Description of speech, rapid slow, erratic, rambling or repetitive. Can patient maintain eye contact? Assessment of the patients expressed thoughts: Beliefs, hallucinations, suicidal thoughts, voices etc. © Department of Clinical Education & Standards 46  Mental Health CPI’s Capacity tool used? Safeguarding concerns for patient considered? Safeguarding concerns for all children in house considered? © Department of Clinical Education & Standards 47  Mental Health CPI’s The new EPCR system prompts you to ask these questions as part of your assessment. © Department of Clinical Education & Standards 48  Mental Health 2 full time and 2 part time Mental Health Nurses. There is also a full time Mental Health Nurse Lead. We are a team of senior clinicians who have a background in Mental Health Crisis services. Part of the Clinical Hub (CHUB) within EOC. Available from 1100 – 2300 hrs Mental Health nurses currently provide enhanced telephone assessments of patients as part of the service’s ‘Hear and Treat’ function. The aim is to ensure the patient accesses the most appropriate care for their needs. The nurses also provide support to call takers. The team also provide support to crews via Clinical Support Desk (CSD). If crews on scene have a query relating to Mental Health/Mental Capacity they should call CSD. If there is a MH Nurse on shift the query will be passed to them. If there is a mental health joint response car available they may attend the scene. If not the query will be dealt with by a Clinical Team Manager (CTM) Email us at [email protected] if you would like more information. ©Department of Clinical Education & Standards  Mental Health Remember use LA 383 and JRCALC PLUS app to assist your assessment ©Department of Clinical Education & Standards  Mental Health Any Questions? © Department of Clinical Education & Standards 52