Professional Documents
Culture Documents
MENTAL HEALTH
AWARENESS
TRAINING COURSE
WELCOME TO YOUR MENTAL
HEALTH AWARENESS COURSE
SO WHY IS MENTAL
HEALTH AWARENESS
IMPORTANT?
FOR YOU THIS COURSE CAN HELP TO:
Enhance your existing management and observational skills
Increase your understanding of mental health issues
Enable appropriate earlier intervention
Make you more effective in your vital role
90% OF OFFENDERS HAVE Cope better with the issues that can result from being within
the prison environment
AT LEAST ONE MENTAL
HEALTH DISORDER (ONS 1997)
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INTRODUCTION
THERE IS NO HEALTH
WITHOUT MENTAL HEALTH
Life can be described as a continuum that we all move along
- Our mental health is better at some times than others. People
with mental illnesses tend to move along the continuum more.
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Mental Health is the emotional and spiritual resilience which allows
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,
SO WHAT IS MENTAL HEALTH? and others dignity and worth. www.scotland.gov.uk
Age
Class
Gender
Personal experiences and expectations
Ethnicity
Cultural and religious beliefs
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EXERCISE SO WHAT IS POSITIVE MENTAL HEALTH?
Mental health in the prison environment brings its own difculties One commentator, D.W.Winnicott, wrote that: Health is more
- both for staff and offenders. difcult to deal with than illness. Why might this be the case?
0.1 What do you do to maintain or improve your mental health? POSITIVE MENTAL HEALTH IS ABOUT: POSITIVE MENTAL HEALTH CAN BE
ACHIEVED IF INDIVIDUALS:
0.2 Contrast what you do with what opportunities are open to offenders to do the same
McDonald and OHara (1998) identied Ten elements of mental health promotion and
demotion - i.e. factors that can help or hinder positive mental health:
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SO WHAT IS MENTAL ILLNESS? SO WHAT AFFECTS OUR MENTAL HEALTH?
It may impact on the way a person thinks, Not too long ago mentally ill people were Mental health is determined by many complex and related
behaves and interacts with other people. warehoused in public institutions because
they were disruptive or feared to be harmful
reasons all of which can interact to determine the state of our
Mental illness (or mental distress) is to themselves or others. Today most people mental health. There are many theories and different factors that
an umbrella term that refers to various who suffer from a mental illness-including enable us to positively maintain our mental health:
psychiatric disorders. Just like physical those that can be extremely debilitating
illnesses they can vary signicantly in such as Schizophrenia - can be treated
severity and in the symptoms you may see. effectively and lead full lives.
Family, friends, colleagues
Many people suffering from mental Employment
THERE IS NO HEALTH Education
distress may not look as though they are ill
WITHOUT MENTAL HEALTH Stable housing
while others may appear to be confused,
agitated, or withdrawn. Sound nances
Faith and religion
Social activities - hobbies and interests
It is a myth that mental distress is a weakness in SOCIAL Exercise and nutrition
character and that offenders can get better simply Cultural diversity
Mental illnesses are real illnesses, as This is what occurs naturally, within our
real as heart disease and cancer. They brains, over which we have no control
need and can respond well to treatment. Mental Illness often occurs when various
As prison staff you can employ your brain chemicals do not work effectively,
observational skills to play a vital role in working too much - or not at all.
recognising mental distress.
BIOLOGICAL
In the past 20 years especially, psychiatric
research has made great strides forward
in the precise diagnosis and successful
treatment of many mental illnesses. Which of the above are not available to
offenders to maintain their mental health?
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THE MENTAL HEALTH CONTINUUM: Everyones mental health
constantly uctuates and moves up and down the continuum to
varying degrees.
Where are you on the continuum at the moment? SO WHAT IS MENTAL ILLNESS NOT?
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A key part of your role is to promote mental wellbeing, to recognise
the worried well and to enable early intervention to avoid mental
THE 3 MAJOR GROUPS distress. However with 90% of offenders thought to have a mental
OF MENTAL DISORDERS illness, there will be a signicant number who develop an illness
such as those described.
NEUROSES
Neurosis, also previously called a Neurotic Disorder, is a catch all term that Neuroses
refers to any mental imbalance that causes distress but does not impact upon
someones sense of reality, e.g. Depression, Anxiety, Eating Disorders and
Phobias.
Mental Health
Prison Population 90% Psychoses
PSYCHOSIS General Population 25%
Psychosis, or being psychotic, is a generic psychiatric term for a mental state
often described as involving a loss of contact with reality. This loss of reality is
the key difference with neurosis. It may last for short periods. Personality Disorders
People experiencing psychosis may report hallucinations or delusional beliefs,
and may exhibit personality changes and disorganised thinking. This may be
accompanied by unusual or seemingly bizarre behaviours, as well as difculty
with social interaction and impairment in carrying out the activities of daily
living. A wide variety of stress factors can cause a psychotic reaction.
PERSONALITY DISORDERS
Personality Disorders are long lasting and persistent styles of behaviours and
thought. Personality Disorders encompass a group of behavioural disorders
that are different from the psychotic and neurotic disorders. People with
Personality Disorders will behave in a certain manner because of their often
distorted view of the world and how they see themselves. Because of these
distortions they often nd it difcult to conform to social norms.
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Usually, depressed people lie about their depression, so if someone says,
Are you okay? they will say Yes.
Dont try to talk a depressed person out of his or her feelings. Instead, you
might try saying, Im sorry that youre feeling bad. What would help you?
DEPRESSION Ask if they have felt that way before and what has helped in the past.
An example of a Neurotic Illness that is prevalent in prisons: Depression is a disease so progress will take time.
Step back every so often. You may become frustrated when your well-
meaning advice and reassurance are met with sullenness and resistance.
Get help from other professional agencies, talk to health care.
Try to cheer them up, but dont overdo it.
DEFINITION: The World Health Organisation says - Depression is a Listen dont dominate conversations.
Try to hold as much positive conversation as possible.
common mental disorder involving depressed mood, loss of interest, loss Do not snap at the person. They cannot help the way they are feeling.
of pleasure, feelings of guilt, low self-worth, disturbed sleep, appetite, Do not joke about the matter - this is serious!
concentration and low energy Be careful what you say and do to a depressed person.
Dont try to take on their problem all by yourself.
Dont be nosy. If they dont want to discuss something with you,
SOME SIGNS YOU MAY NOTICE dont try to force them to talk about it.
Persistent sad, pessimistic, anxious or empty feelings Knowledge can help both you and the offender!
Feelings of guilt, worthlessness, helplessness
Loss of interest in hobbies or activities POSSIBLE TREATMENTS
Tiredness and loss of energy Medication e.g. Anti-Depressants
Difculty concentrating, remembering, making decisions Talking Treatments e.g. Therapy and Counselling
Insomnia, early-morning awakening or oversleeping Self Help e.g. Relaxation and breathing exercises
Change in appetite and/or weight loss or weight gain
Thoughts of death or suicide LIKELY CAUSES
Physical symptoms such as headaches, digestive disorders, chronic pain Medication e.g. Anti-Depressants
Talking Treatments e.g. Therapy and Counselling
WHAT IT IS NOT Self Help e.g. Relaxation and breathing exercises
Frequently it is not easy to recover from without professional help
AGE OF ONSET:
POSSIBLE RISKS Most commonly starts between 25 and 44 years old
Suicide
Self Harm HOW COMMON IS IT?
Reduction in self care In prisons: (Mixed Depression and Anxiety)
Males: 19% and Females: 31% - Singleton, ONS 1997
WHAT YOU CAN DO TO HELP General population: 1 in every 6
Assess each offender as an individual
Refer the offender on to specialist help at any early stage GENDER ISSUES
Help the person to recognise that there is a problem. Explain that asking for Females are generally more likely to have all types of neurotic disorder
help does not mean they lack character. On the contrary, it takes courage to
know when you need help. Help the offender to understand that they have ASSOCIATED CONDITIONS
taken a big step and encourage them. Post Traumatic Stress Disorder
Monitor possible suicidal gestures or threats. Statements such as I wish I Anxiety
were dead, or I dont want to be here anymore, must be taken seriously.
Depressed people who talk about suicide are NOT doing it for the attention. Physical illnesses
If the person you are dealing with seems to be suicidal, make sure that you Phobias
open an ACCT document and refer to your designated manager. Psychosis
Remember that offenders may not be able to work or comply with rules due to Substance misuse
their illness. Increased chance of having other Neuroses
Provide emotional support. You need to create an environment in which an e.g. Obsessive Compulsive Disorder and Eating Disorders
offender is able to open up. Signpost to Listeners.
What a person suffering from depression needs most is compassion and INTERESTING FACT:
understanding. Telling an offender to snap out of it or lighten up will Occurs disproportionately in the female prison population
just make the matter worse. The best things to say are, How can I help?
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Did you know that there are different
types of Depression?
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POSSIBLE TREATMENTS
Medication e.g. Anti-Depressants
Talking Treatments e.g. Therapy and Counselling
ANXIETY DISORDER Self Help e.g. Relaxation exercises
An example of a Neurotic Illness that is prevalent in prisons:
LIKELY CAUSES
Anxiety Disorders may result from a single event, or a complex combination of factors:
A natural reaction to stress A ght or ight response
Social factors such as the offenders nancial and family situation
Genetics Past traumatic events
DEFINITION: A long term condition involving an excessive and Physical causes Drug misuse
persistent sense of apprehension
AGE OF ONSET:
SOME SIGNS YOU MAY NOTICE Any age
The differing ailments and their intensity will vary from individual to individual
but some common signs are: HOW COMMON IS IT?
Feeling worried a lot of the time and feelings of dread In prisons: (Generalised Anxiety Disorder) Males: 8% and Females: 11%
Feeling tired and having problems sleeping General population: 3-4%
Difculty concentrating
Being irritable GENDER ISSUES
Tension and pains - stomach aches, indigestion and diarrhea Of people with Phobias or OCD, about 60% are female.
Heavy, rapid breathing and heart palpitations i.e. irregular heart beat
Dizziness and fainting ASSOCIATED CONDITIONS
Depressed Mood
WHAT IT IS NOT Somatic or Sexual Dysfunction
A mild illness that can be ignored Anxious or Fearful or Dependent Personality
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Create an environment in which an offender is able to open up
Remember that progress will take time
Dont try to talk the offender out of his or her feelings. The feelings may be
irrational, but you might try saying, Im sorry that you are feeling bad.
EATING DISORDER What can I do to help?
An example of a Neurotic Illness that is prevalent in prisons: Listen - dont dominate conversations
POSSIBLE TREATMENTS
Psychotherapy and counselling
Specialist hospital treatment
DEFINITION: Eating disorders are often described as an outward Medication e.g. antidepressants
With treatment about 60% of people can recover
expression of internal emotional pain and confusion. There are different
types: Anorexia, Bulimia and Compulsive and binge eating LIKELY CAUSES
Social pressure to be thin
SOME SIGNS YOU MAY NOTICE Emotional distress a reaction to an illness, upsetting events etc
Anorexia (1%) Low self-esteem and social pressures to be thin
Distorted perceptions of their weight, size and shape Depression so eat to eating with unhappiness
Behaviour which results in a marked weight loss A need to have control over their weight when they feel they
have no control over rest of life
A morbid fear of gaining weight or becoming fat
Excessive exercising while starving themselves
AGE OF ONSET:
Stopping of periods for women
Mid-teens onwards
Bulimia (4%)
Bouts of eating followed by purging
HOW COMMON IS IT?
Distorted perceptions of their own weight, size and shape
In prisons: 1 in 10 women, 1 in 100 men
A powerful urge to over-eat, leading to binge eating and a resultant feeling of
being out of control General population:1 in 20 women, 1 in 200 men
Compensatory behaviour such as; self-induced vomiting, misuse of
laxatives, diuretics or other medication, fasting or excessive exercise GENDER ISSUES
A morbid fear of gaining weight or becoming fat Women are 10 times more likely to suffer from an eating disorder.
Compulsive or Binge Eating
Recurrent episodes of binge eating then a feeling of being out of control ASSOCIATED CONDITIONS
During a binge the person may; eat more quickly than normal, eat until Anxiety Obsessive Compulsive Disorder (OCD)
uncomfortably over-full, eat large amounts when not hungry, tend to Depression Self-harming
graze rather than eat meals, eat alone in secret, feeling disgusted and
guilty with themselves. INTERESTING FACT:
It is very common for an offender to suffer with more than one eating disorder.
WHAT IT IS NOT
A eeting problem that will just pass without help it can have major, long
term consequences for the persons physical health.
POSSIBLE RISKS
Heart failure / or other internal organs Tooth decay
Infertility Osteoporosis A questionnaire used by doctors asks:
WHAT YOU CAN DO TO HELP
Assess each offender as an individual If you answer yes to two or more of these Do you worry that youve lost control
Refer the offender on to specialist help at any early stage questions, you may have a problem with over how much you eat?
Give the offender an opportunity to talk about their feelings your eating. Please note this is not a guide Have you recently lost more than 6 Kg
Help the person to recognise that there is a problem. Explain that asking for to diagnose someone thats a job for the (about a stone) in three months?
help does not mean they lack character. Help the offender to understand health professionals! Do you believe youre fat when others
that they have taken a big step and encourage them. Do you make yourself sick because say youre thin?
Remember that offenders may not be able to work or comply with rules due youre uncomfortably full? Would you say that food dominates
to their illness your life?
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LIKELY CAUSES
Genetics
Stressful life events
BIPOLAR DISORDER Emotional trauma
An example of a Psychotic Illness that is prevalent in prisons:
AGE OF ONSET:
Symptoms often appear in late adolescence and early adulthood
WHAT IT IS NOT
It is not a state of constant mania (highs) or depression (lows)
POSSIBLE RISKS
Suicide
Extreme elation leading to ignoring basic bodily needs e.g. sleep/food
Did you know that there are different
WHAT YOU CAN DO TO HELP types of Bipolar?
Assess each offender as an individual
Refer the offender on to specialist help at any early stage
Being aware that the times just after someone has been ill are the most BIPOLAR I RAPID CYCLING
dangerous in terms of suicide and self-harm Where there has been at least one high, or The manic and depressive episodes
Remember that offenders may not be able to work or comply with rules due manic episode, which has lasted longer than alternate at least four times a year and, in
to their illness. a week. Some people will only have manic severe cases, can even progress to several
Encourage self-help such as the offender: episodes, although most will also have cycles a day.
Keeping a record of their illness, i.e. a Mood Diary - marking from 0 to 10: depressive ones. Some will have more
0 is endless suicidal thoughts, no way out, no movement, everything is Rapid cycling tends to occur more often
depressive episodes than manic ones.
bleak and it will always be like this and in women and in Bi Polar II patients.
10 is a total loss of judgement, exorbitant spending, religious delusions and BIPOLAR II
hallucinations Typically, rapid cycling starts in the
There has been more than one episode
Recognising early warning signs i.e. emotions, behaviours and events that depressive phase. Frequent and
of major depression, but only minor
may lead to an episode of Bipolar severe episodes of depression may be
manic episodes these are referred to as
Identifying triggers for their own unique pattern the hallmark of this event in many patients.
hypomania:
Concentrate on emotions and feelings
This phase is difcult to treat, particularly
Do not collude in grandiose ideas
since antidepressants can trigger the
switch to mania and set up a cyclical
POSSIBLE TREATMENTS
Medication such as Mood Stabilisers e.g. Lithium pattern.
Talking
Self help e.g. keeping mood diaries
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POSSIBLE TREATMENTS
Medication is the main treatment for Schizophrenia:
Antidepressants - to relieve symptoms of depression
SCHIZOPHRENIA Mood stabilisers - to moderate extreme mood changes
An example of a Psychotic Illness that is prevalent in prisons: Antipsychotics - to relieve symptoms of psychosis
Benzodiazepines - for the relief of anxiety and as a sedative
Talking therapies
Self help and self help organisations
LIKELY CAUSES
DEFINITION: A mental disorder that affects the way the offenders brain Genetics but no individual gene is responsible
processes information. Someone experiencing Schizophrenia will not Stressful life events & social issues play an important role
see or understand things in the same way as other people. Drug and alcohol use can trigger a rst episode
- this is called drug induced psychosis
They may have difculty experiencing appropriate emotions, acting in
an appropriate manner or perceiving reality. AGE OF ONSET:
The peak ages of onset are 2028 years for males and 2632 years for females
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LIKELY CAUSES
Some studies say that Personality Disorders may be inherited
Environmental factors. Many people with Borderline Personality Disorder
BORDERLINE PERSONALITY DISORDER have a history of childhood abuse, neglect and separation.
Between 40% and 70% of BPD patients report having been sexually abused
An example of a Personality Disorder that is prevalent in prisons:
Brain abnormalities. Some research shows changes in certain areas of the
brain are a factor. In addition, certain brain chemicals that help regulate
mood may not function properly
AGE OF ONSET:
DEFINITION: It affects your view of the world and especially how you view BPD is very common amongst adolescent and young adults with the highest
yourself. The World Health Organisation says Personality Disorders are: rates at the ages between 18 and 35
Deeply ingrained and enduring behaviour patterns manifesting themselves
HOW COMMON IS IT?
as inexible responses to a broad range of personal and social situations. In prisons: Males: 14% Females: 20% - Singleton, ONS 1997
General population: 2%
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POSSIBLE TREATMENTS
One of the most difcult Personality Disorders to treat. The effectiveness of
treatment is largely unknown.
ANTI-SOCIAL PERSONALITY DISORDER Medications have not proved helpful. Often they are not taken regularly or are
abused so they are not effective.
An example of a Personality Disorder that is prevalent in prisons:
Group therapy has been shown to be helpful if the patient feels comfortable in
the group setting. Individual therapy may be helpful if the patient develops a
sense of trust with the therapist.
LIKELY CAUSES
DEFINITION: Anti-Social Personality Disorder (ASPD) involves behaviour that Genetic factors
manipulates, exploits and violates the rights of others.This behaviour is often Child abuse
criminal. To receive a diagnosis of ASPD a person must have exhibited certain An antisocial or alcoholic parent
behaviour during childhood. AGE OF ONSET:
Cant be diagnosed before 18 though often there is a history of similar
behaviours before age 15 such as repetitive lying, truancy, delinquency, and
substance abuse.
SOME SIGNS YOU MAY NOTICE
A lack of conscience HOW COMMON IS IT?
Lack of remorse In prisons: 49% of men and 31% of females - Singleton, ONS 1997
Feeling victimized General population: 13% of men and approx 1% of women
Violating others e.g. property, physical, sexual, legal, emotional
Physical aggression GENDER ISSUES
Lack of stability in work and home life Women are rarely diagnosed with ASPD
Supercial charm and wit with a background of repetitive lying
Impulsiveness ASSOCIATED CONDITIONS
Inability to tolerate boredom Alcohol and substance misuse
Disregard for societys expectations and laws Anxiety
A problem with forming relationships Depression
Self-harm
Eating disorders
WHAT IT IS NOT
A treatment that Health Care professionals nd easy to treat INTERESTING FACT:
Anti-Social Personality Disorder is also known as Psychopathic Personality or
POSSIBLE RISKS Sociopathic Personality Disorder. It is estimated that 35-55% of people with
Homicide substance misuse problems also have symptoms of a personality disorder with
Suicide the most prevalent being antisocial personality disorder.
Frequent imprisonment for unlawful behaviour
Alcoholism and drug abuse
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CAMHS, the Child and Adolesent Health Service promotes
the mental health and psychological well being of children and
young people. CAMHS teams provide support to young people
YOUNG OFFENDERS & MENTAL HEALTH and their families.
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ATTENTION DEFICIT
HYPERACTIVITY DISORDER (ADHD)
Its important that the likely causes of the illness are investigated these may be:
Diet
Environmental factors
Chemical imbalances that may respond to drug treatments e.g. Ritalin
Behavioural traits
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POSSIBLE TREATMENTS
For most people, stopping self harming is a long, slow process.
Opportunity to gradually build upon coping skills is paramount.
Generally the recovery process begins with tackling the underlying
SUICIDE AND SELF-HARM problems that were causing the self harm or suicide attempt
Learning new coping strategies or using distraction techniques
when the feeling to hurt themselves arises.
Emergency help-lines, self help groups e.g. Listeners and sourcing other
support networks.
DEFINITION: Self Harm is a coping mechanism. An individual harms their LIKELY CAUSES
physical self to deal with emotional pain, or to break feelings of numbness by Emotional trauma
arousing sensation. Ways of harming include cutting, burning, bruising, scratching, Isolation
hair pulling, breaking bones and ingesting poisonous substances. Close relative has done the same
Family breakdown
Suicide is a response to intolerable pain that appears to have no end. When Low self-esteem
chosen, it feels like the only possible way out of pain. Suicidal people feel hopeless Alcohol and drug misuse
and helpless. They are wounded emotionally and mentally and cannot envision Financial problems
healing or surviving for as long as healing is anticipated to take. History of previous self-harming or attempted suicide
AGE OF ONSET:
SOME SIGNS YOU MAY NOTICE
The average age of onset for Self-harming is 12
Self-harm:
Covering up body even when warm
HOW COMMON IS IT?
Wanting to be alone
Self-harm:
Secretive behaviour 2% men and 8% women
Avoiding sporting activities that involve changing clothes More common in gay, lesbian, transgender communities;
Suicide: People with learning disabilities;
Tidying up affairs e.g. making will, giving away prized possessions. People with Borderline Personality Disorder
Change in behaviour e.g. withdrawn, low spirited, severely agitated. Suicide:
Physical appearance, taking less care of themselves. 0.75% men and 0.25% women
Verbal threats such as Youd be better off without me or
Maybe I wont be around anymore... GENDER ISSUES
Young Asian women are particularly more likely to self-harm and
WHAT IT IS NOT commit suicide.
There is no such thing as a typical self harmer and there is no quick x. Because men are more likely to hit themselves or break bones, it is easier
Acts of deliberate self harm and suicide attempts do not necessarily involve to pass off as an accident or that they have been in a ght.
an intention to die.
ASSOCIATED CONDITIONS
POSSIBLE RISKS Anxiety
Habit forming, therefore risk of repetition Depression
Poisoning Other mental health problems
Broken bones and internal bleeding
Mental disorders INTERESTING FACT:
Young people and adults will often feel very ashamed and guilty about
WHAT YOU CAN DO TO HELP self-harming and do not want to talk about it.
Assess each offender as an individual.
Refer the offender on to specialist help at any early stage. Before 1961 Suicide Act people in UK were sent to prison for attempting suicide.
Show understanding, care and concern for their injuries, be respectful
Give time, support & encouragement to talk about underlying feelings/situations.
Be non judgemental, dont accuse or react with revulsion
Focus on the individual, not just the self-harm or attempted suicide.
Encourage the person to talk about their despair.
Dont try to jolly them out of it.
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I was pushed around like a tennis ball! The alcohol treatment centre
staff said I had a mental illness and the mental health worker said
I had a drink problem. An offender
DUAL DIAGNOSIS
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TREATMENT FOR DUAL DIAGNOSIS: WITHDRAWAL:
The usual treatments for dual diagnosis The effects of withdrawal from illicit drugs
clients are not always effective for a variety can produce or mimic symptoms of mental
of reasons. ill health: CONSIDERATIONS FOR
There is currently no standardised Alcohol withdrawal can cause anxiety, EFFECTIVE COMMUNICATION
treatment. insomnia, hallucinations
(commonly visual) and clouded thinking.
Largely because it ranges across such
a large number of problems and Coming off stimulants (amphetamine
involves both substance use and mental and cocaine) often result in confusion, Effective communication in a prison setting may pose particular difculties to
health services. irritability and low mood. Can make
people feel suicidal, provoking an
staff e.g. language barriers, suspicion, fear, anger and lack of engagement by
Medically orientated services cant the offender. Poor communication may result in confusion, misunderstanding,
attempt.
always help people with multi-problems.
This often reects the stigma that people Withdrawal from opiates can cause missed opportunities and increased risk.
with dual diagnosis face. unpleasant physical side effects.
Also, low mood, irritability. Better communication can be achieved ATTITUDE:
People with the combination of dual through the efforts of all parties to anticipate
diagnoses often have a lot of additional Your attitude is the rst thing people pick up
and eliminate potential sources of confusion. on in face-to-face communication. Just as
difculties, which are not solely medical,
laughing, yawning, and crying are infectious,
psychological or psychiatric.
IT HELPS TO CONSIDER: attitude is infectious. Before you say a word,
More likely to come into contact with your attitudes can infect the people who see
Why? - you need to know why they need
services when they have reached a you with the same behaviour. Just by looking
your message
crisis point, with problems relating to or feeling, you can be infected by another
social, legal, housing, welfare and What information do you wish to convey? persons attitude, and vice versa.
lifestyle issues. Who is your audience? - think about Attitudes drive behaviour. Your body
situational or cultural inuences language is a result of your mental attitude.
They are not only drug users, but also
mentally ill, which are two of the most What do you wish to communicate? By choosing your attitude you get in that
mood and send out a message that everyone
stigmatised groups in society. How can you best communicate this and understands, consciously or unconsciously.
how might this be perceived?
People thought I would be in and out of prison all my life. So did I. When? - is your communication relevant
to that moment? BODY LANGUAGE:
I couldnt see any other option. But when I was in HMP Stafford they had a
Where? - will this affect the The way your message is conveyed
drugs treatment programme and I got on to it. I have been clean and sober communication?
for 8 years now and have even trained as a counsellor, so I can help other
prisoners to get out of the system and lead rewarding lives. Before, I never
dreamed it would be possible to change. An Offender
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EYE CONTACT AND CULTURAL SOME EXAMPLES OF CULTURAL ACTIVE LISTENING: It takes concentration and determination to be
DIFFERENCES: DIFFERENCES:
an active listener and hear what people are really saying. There are 5
Eye contact is one of the most important In some cultures, looking people in the
non-verbal channels you have for eye is assumed to indicate honesty and
key elements to active listening.
communication and connecting with other straightforwardness; in others it is seen as
people. The cheapest, most effective way challenging and rude. Most people in Arab
to connect with people is to look them into cultures share a great deal of eye contact 1. PAYING ATTENTION 4. DEFERRING JUDGMENT
the eye. This helps to answer a critical and may regard too little as disrespectful. Give the speaker your undivided attention Interrupting is a waste of time. It frustrates
question when you are trying to connect In English culture, a certain amount of eye and acknowledge the message. Recognize the speaker and limits full understanding of
Is he/she paying attention to what Im saying? contact is required, but too much makes that what is not said also speaks loudly. the message.
many people uncomfortable. Most English
Look at the speaker directly. Allow the speaker to nish.
people make eye contact at the beginning
and then let their gaze drift to the side Put aside distracting thoughts. Dont Dont interrupt with counterarguments.
periodically to avoid staring the other person mentally prepare a rebuttal!
out. In South Asian and many other cultures Avoid being distracted by environmental
direct eye contact is generally regarded as factors. 5. RESPONDING APPROPRIATELY
aggressive and rude. Active listening is a model for respect and
Listen to the speakers body language.
understanding. You are gaining information
Refrain from side conversations when and perspective. You add nothing by
listening in a group setting. attacking the speaker or otherwise putting
EFFECTIVE QUESTIONING: How you ask questions is very important him or her down.
in establishing a basis for effective communication. Effective questions 2. SHOWING THAT YOU ARE LISTENING Be candid, open, and honest in your
opens the door to knowledge and understanding. The art of questioning Use your own body language and gestures response.
to convey your attention.
lies in knowing which questions to ask when. Assert your opinions respectfully.
Nod occasionally. Treat the other person as he or she would
CHOOSING QUESTIONS: Smile and use other facial expressions. want to be treated.
Ask a specic question if you want to hear A fact-nding question: Note your posture and make sure it is
a specic answer. Open - as opposed to is aimed at getting information on a open and inviting.
leading - questions are those that cannot be particular subject. Encourage the speaker to continue with
answered with a straight yes or no. Use A follow-up question: small verbal comments like yes and
open questions to gain insight into the other is intended to get more information or to uh huh.
persons character, and to invite a response elicit an opinion.
that truly reects what they feel rather than
what they think you want to hear. 3. PROVIDING FEEDBACK
ASKING SEARCHING QUESTIONS: Our personal lters, assumptions,
Asking searching questions starts with judgments, and beliefs can distort what we
GETTING RESPONSE YOU NEED:
challenging assumptions. If you do not hear. As a listener, your role is to understand
An open question: check assumptions you cannot be good what is being said. This may require you to
does not invite any particular answer, but at asking searching questions. Dont ask reect what is being said and ask questions.
opens up discussion or elicits a wide one or two questions and then rush straight Reect what has been said by
range of answers. Typically, open towards a solution. With an incomplete paraphrasing. What Im hearing is
questions start with Why, How, What, understanding of the problem it is very easy and Sounds like you are saying
Tell me about ... to jump to wrong conclusions. are great ways to reect back.
A closed question:
Summarize the speakers comments
is specic and must be answered with a
periodically
yes or no, or with details as appropriate.
Ask questions to clarify certain points.
What do you mean when you say?
Is this what you mean?
42 DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET 43
WATCH YOUR LANGUAGE: DEVELOPING UNDERSTANDING:
De-stigmatise mental health issues, Preparation is the key.
explain things carefully. Watch how you phrase your questions.
Remember language is powerful and just Be exible with your responses.
WORKING WITH RISK by asking about risk you can create
barriers. Learn to listen rst.
Pace the conversation.
44 DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET 45
EQUALITY AND DIVERSITY INTERNAL SOURCES OF INFORMATION
In common with other public authorities, The benets of promoting equality and Please add details to the table below that are relevant to you
staff working with offenders should strive to embracing diversity are to:
extend the concept of equality to all of the To remove any unfairness and TITLE: NAME:
following areas: disadvantage in service provision
Culture - particular days and times of (institutional discrimination) Health Care Contact
days that may be of particular importance To harness the knowledge and
ACCT Assessors
Interpersonal communication experience of stakeholders to make
Discrimination processes transparent and inform
In Reach Team
decision making
Faith
It is quicker, simpler & cheaper to build Chaplain
Equality and diversity
disability equality into a projects design
The presumption of mental health from the start C.A.R.A.Ts team
Language and general communication Improves the chances of success and the
achievement of strategic aims. Suicide Prevention Co-ordinator
Mental Health can be a fascinating and rewarding subject to learn more about. It can make
your job safer and easier as well as improving the lives of offenders.
46 DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET 47
OBSESSIVE-COMPULSIVE Manic Depression:
PERSONALITY DISORDER Also called bipolar affective disorder until
Obsessive-compulsive personality disorder recently, the current name is of fairly recent
is a decreased ability to show warm and origin and refers to the cycling between high
GLOSSARY OF TERMS tender emotions. Also a criterion for the and low episodes; it has replaced the older
Other forms of Personality Disorder: illness is a perfectionism that decreases term manic-depressive illness coined by Emil
the ability to see the larger picture, difculty Kraepelin (1856-1926) in the late nineteenth
doing things any way but their own and century. The new term is designed to be
an excessive devotion to work, as well neutral, to avoid the stigma in the non-mental
as indecisiveness. Essentially, everything health community that comes from conating
PARANOID PERSONALITY DISORDER NARCISSISTIC PERSONALITY DISORDER
must be just right, and nothing can be left to manic and depression.
The person with a paranoid personality Narcissistic Personality Disorder is a
chance. Obsessive-compulsive personality
disorder essentially has an ongoing, disorder in which a person has a grandiose
disorder is different from obsessive- Socio-economic:
unjustied suspiciousness and distrust (inated) self-importance. They have
compulsive disorder and the latter must be When we say this, within the context of this
of people. Along with this they are also preoccupation with fantasies or unlimited
ruled out. workbook, we mean the social background
emotionally detached. success, coupled by a desire for attention
of the individual: be it, class, the area they
& admiration. They have an intolerance
DANGEROUS AND SEVERE come from, employability and generally the
SCHIZOID PERSONALITY DISORDER of criticism, and disturbed self-centred
PERSONALITY DISORDER (DSPD) environment around them.
A person with schizoid personality disorder interpersonal relation. They are often
The government rst introduced the term
has minimal social relationships, expresses described as being conceited, and generally
dangerous and severe personality disorder Interpersonal:
few emotions (especially those of warmth have a low self-esteem as well. They act
in a consultation paper in 1999, which A term meaning the relationship between
and tenderness), and appears to not care selshly interpersonally, with a sense of
suggested how to detain and treat a small people.
about the praise or criticism of others While entitlement over others.
minority of offenders with mental disorders
they do not do well with contact in groups,
who pose a signicant risk of harm to others Impulse control and addiction disorders:
they may excel when placed in positions DEPENDENT PERSONALITY
and themselves. The term DSPD has no People with impulse control disorders
where they have minimal contact with others. Dependent personality is evident by
legal or medical basis. DSPD is thought to are unable to resist urges, or impulses,
passively allowing others to assume
be an extreme form of antisocial personality to perform acts that could be harmful to
SCHIZOTYPAL PERSONALITY DISORDER responsibility for major areas of ones life due
disorder - the diagnosis most commonly themselves or others. Pyromania (starting
Schizotypal personality disorder is to lack of self-condence or lack of ability
associated with psychopathy. res), kleptomania (stealing) and compulsive
characterised by a lack of social and to function independently While everyone
gambling are examples of impulse control
interpersonal relationships. This disorder is dependent on others in some parts of
Co-morbid: disorders. Alcohol and drugs are common
also affects the way a person thinks and their lives, those with dependent personality
This pertains to two or more illnesses that objects of addictions. Often, people with
may come across quite eccentric in their disorder are dependent on almost all major
occur together - for example Depression these disorders become so involved with the
behaviour. They often have magical thinking areas of their lives, and view themselves
and Anxiety. objects of their addiction that they begin to
(if I think this, I can make that happen), poorly and good only through an extension
ignore responsibilities and relationships.
paranoia, and other seemingly strange of others.
Para-suicidal:
thoughts. They may talk to themselves,
Para-suicide, sometimes called Deliberate Dissociative disorders:
dress inappropriately, and are very sensitive AVOIDANT PERSONALITY DISORDER
Self-Harm, is when someone mimics the People with these disorders suffer severe
to criticism. Avoidant personality disorder is where
act of suicide, but does not end up killing disturbances or changes in memory,
a person has an extreme fear of being
themselves. consciousness, identity, and general
HISTRIONIC PERSONALITY DISORDER judged negatively by other people, and
awareness of themselves and their
Histrionic personality disorder is suffers from a high level of social discomfort
Self-Inicted: surroundings. These disorders usually
characterised by a person who is always as a result. They tend to only enter into
This is an American term which means the are associated with overwhelming stress,
calling attention to themselves, who are relationships where uncritical acceptance
same as Self Harm. which may be the result of traumatic
lively and overly dramatic. They easily is almost guaranteed, undergo social
events, accidents or disasters that may be
become bored with normal routines, and withdrawal, suffer low self-esteem, but have
experienced or witnessed by the individual.
crave new, novel situations and excitement. a great desire for affection and acceptance.
Dissociative identity disorder, formerly
In relationships, they form bonds quickly, However, they do not want the affection as
called multiple personality disorder, or split
but the relationships are often shallow, with much as they fear the rejection.
personality, and depersonalization disorder
the person demanding increasing amounts
are examples of dissociative disorders.
of attention.
48 DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET 49
Sexual and gender disorders: Anhedonia:
These include disorders that affect sexual This is an inability to experience pleasure
desire, performance and behaviour. Sexual from normally pleasurable life events such
dysfunction, gender identity disorder are as eating, exercise, and social or sexual
examples of sexual and gender disorders. interaction.
APPENDIX
Somatoform disorders: Benzodiazepines:
Somatoform disorder was formerly known Are a class of psychoactive drugs
as a psychosomatic disorder. This is where considered minor tranquilizers with varying
an offender may experience physical hypnotic, sedative, anticonvulsant, muscle WHOS WHO IN MENTAL HEALTH? There may be many people involved in
symptoms even though a doctor can nd no relaxant and amnesic properties, which the care of clients experiencing mental illness - including medical professionals
medical cause for the symptoms. are mediated by slowing down the central who prescribe medication and therapy. There are also support workers who can
nervous system. These medications are help offenders with everyday tasks to help them stay in the community.
Grandiose: useful in treating anxiety, insomnia and
This is where an offender may have an agitation. These are short term meds, which IN REACH OR OUT REACH TEAMS could discuss thoughts and feelings that an
exaggerated belief in ones importance, can become addictive, so prescriptions are These teams may include: offender may be experiencing and work out
sometimes reaching delusional proportions, often in small supplies. A Social Worker coping strategies.
and occurring as a common symptom of A Community Psychiatric Nurse
mental illnesses. An Occupational Therapist or O.T SOCIAL WORKER (SW)
A Psychiatrist Social workers can offer advice on practical
Dual Diagnosis: A Psychotherapist matters; some social workers are specially
Dual diagnosis is a term that refers to A Clinical Psychologist trained in mental health and can offer
patients who have both a mental health A Counselor counselling.
disorder and substance use disorder. The
COMMUNITY PSYCHIATRIC NURSE (CPN) APPROVED SOCIAL WORKER (ASW)
term substance abuse refers to substance
Community Psychiatric Nurses are registered Approved social workers have been specially
use disorders that range along a continuum trained and can carry out some tasks under
nurses, trained in mental health and can:
from abuse to dependence or addiction. Talk about ways to cope - beneting the the Mental Health Act (1983) such as
offender recommending a compulsory hospital stay.
Neuroses: Give long-term support Approved social workers also have a
Neurosis, also known as psychoneurosis or Prescribe some medication particular duty to look at alternatives to
neurotic disorder, is a catch all term that Community mental health nurses can hospitalisation, for example by looking at the
refers to any mental imbalance that causes specialise in working with older people, range of community care available that may
distress, but, unlike a psychosis or some young people or people with drug or alcohol allow the person with a mental illness to stay
personality disorders, does not prevent or problems. in their community.
affect rational thought.
COUNSELOR CARE COORDINATORS
Counselors provide a talking therapy where If an offender has different elements to his/
Psychosis:
the client will be invited to talk about their her care, for example; seeing a psychiatrist,
Psychosis, in psychiatry; a broad category thoughts and feelings; the counselor will then counsellor, doctor and social worker; they
of mental disorder encompassing the most discuss ways of coping. Counselling can also may have access to a care coordinator
serious emotional disturbances, often be provided by: (sometimes known as key workers or case
rendering the individual incapable of staying Community mental health nurses managers). This person will talk to all the
in contact with reality Psychotherapists different professionals and be a single person
Psychologists to talk, liaise and support the client concerned.
Social workers Care coordinators will be a member of the
Occupational therapists community mental health team and will draw
up a care plan with the client.
PSYCHIATRISTS AND PSYCHOLOGISTS
A psychiatrist mainly deals with the physical CARE PROGRAMME APPROACH (CPA)
aspect of mental health, for example drug Under this approach, all people with
therapy. Psychiatrists often work closely signicant mental health needs should have
with psychologists and counsellors, who a care plan, and a care coordinator to assess
and arrange services for them.
50 DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET DEPARTMENT OF HEALTH DELEGATES INFORMATION BOOKLET 51
This Prison Specic Mental Health Awareness Course was:
Commissioned by the Department of Healths Offender Health Department
Project Managed by Care Services in Partnership (CSIP) West Midlands
Devised by Raise Mental Health Limited www. raise.org.uk