Module O4 – Senior HCSW (Mental Health Support) 4.1.1 A Can you explain current legal policy and service frameworks for mental health? Mental Capacity Act The Mental Capacity Act (MCA) 2005 was aimed at safeguarding those people who were unable to make decisions for themselves due to a 'lack of capacity' through mental health problems. The Office of the Public Guardian and The Court of Protection were introduced to ensure these individuals were fairly treated. 5 key principles underpin the MCA. presumption of capacity - everyone has the right to make their own decisions and is presumed to have capacity unless proved otherwise. support to make own decisions - all practicable help should be given to allow a person to make their own decision. unwise decisions - everyone has the right to make a decision others may view as unwise or eccentric. People’s values, beliefs and preferences may not be the same as other people. best interests - anything done for, or on behalf of a person who lacks capacity must be done in their best interests. less restrictive option - anyone making a decision or acting on behalf of a person who lacks capacity must consider if there is another way which would interfere less with that person’s rights and freedoms of action. Deprivation of Liberty The Mental Health Act (MHA) 2007 made changes to the MCA 2005 by introducing the Deprivation of Liberty Safeguards (DOLS). This was in response to the lack of a procedure to challenge the deprivation of liberty of a person lacking capacity to give consent while residing in a hospital or care home. DOLS were introduced to protect people who do not have capacity to consent to arrangements for their care that would deprive them of their liberty. Deprivation of Liberty is only authorised if identified by an independent assessment as a necessary and proportionate action to prevent a person from harm. Safeguards Safeguards protect an individual’s right to live in safety, free from abuse and neglect. Local authorities have a legal duty towards people who are experiencing or are at risk of abuse and neglect. If the local authority thinks a person is at risk, and they are in its area, then it must make enquiries to decide what action should be taken. There are 6 principles of safeguarding as set out in The Care Act 2014. These are: Empowerment – supporting and encouraging people to make their own decisions with informed consent. Prevention – It is better to take action before harm occurs – ensuring people know how to recognise the signs of abuse and what they can do to get help. Proportionality – Taking the least intrusive response appropriate to the risk presented – professionals should work in the interest of the individual and only get involved as much is as necessary. Protection – supporting and representing those in greatest need – getting people the help and support to allow them to report abuse and neglect so they are involved in the safeguarding process to the level or extent that they want to be. Partnership – Offering local solutions through working closely with communities to enable services to play their part in preventing, detecting and reporting neglect and abuse to achieve the best result possible for the individual. Accountability – remaining accountable and transparent throughout the delivery of safeguarding so that the individual will understand the role of everyone involved in their life. Mental Health Act The Mental Health Act (MHA) 1983 deals with the assessment, treatment and detention of people with a mental disorder. It also gives the legal rights of a person following their compulsory admission into hospital. It relates to people who have a mental disorder; allows people to be detained who are a threat to themselves or others; different sections of the act allow for people to be 'sectioned' under different conditions; it allows for people to be treated without their consent (some treatments must be consented to) and allows for detained patients to apply for their own discharge. The Mental Health Act (MHA) 2007 amended the MHA 1983 in order to bring it into line with The Human Rights Act 1998. It amended the MHA 1983 by changing the definition of mental disorder; introducing a new criteria for detention; allowing someone detained to be discharged into the community to access treatment (subject to recall to hospital if required); providing age appropriate services; placing a duty on national authority to provide mental health advocates; and introducing new safeguards for patients undergoing Electro-convulsive Therapy. 4.1.1 B Can you explain the impact they have on interventions including: rights of people using services or giving formal or informal support and the role of advocacy? The Mental Capacity Act 2005, DOLS, Safeguarding and Mental Health Act 1983 all have an enormous impact on the rights of people using services. They provide support around every aspect of accessing services and how service providers treat individuals accessing their services; they provide information and rules around accessing advocacy services, assessment of mental state, treatment options and protect the legal rights of individuals being detained because of their mental health. These legal frameworks (in addition to other pieces of legislation) are the very fundamental foundations of relationships between mental health services and service users and their impact cannot be underestimated as every contact with service users and carers is governed by these legislations. (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf) (https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs62_deprivation_of_liberty_safeguards_fcs.pdf) (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/315993/Care-Act-Guidance.pdf) (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/435512/MHA_Code_of_Practice.PDF) Module C1 1.1, 1.2 &1.3 4.1.2 –Can you explain the range of physiological states that can be measured including body temperature, height, weight, blood pressure, pulse, urinary output, breathing rate, oxygen saturation, and blood sugar levels and the types of equipment used for measuring physiological states in adults, how to check they are in working order? People with a severe mental illness are more likely than other citizens to have significant health risks and develop major physical health problems. They are 3 times more at risk from death caused by coronary heart disease; 2 - 3 times more at risk of death from hypertension; have double the risk of death from diabetes and are 70 to 80% more likely to smoke (consuming 42% of all tobacco in England, according to adult psychiatric morbidity survey, 2007). They are at a higher risk of obesity due to lifestyle factors and medication effects. Women with schizophrenia are 42% more likely to develop breast cancer and people with schizophrenia are 90% more likely to develop cancer of the bowel than others. People with severe mental illness who develop cancer are more likely to die. (Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust Physical Health Training) Because of these issues facing people with severe mental illness it is imperative a close eye is kept on individual’s physical health while treating their mental health. Body temperature is the body's ability to generate and get rid of heat. The body is very good at keeping its temperature within a narrow, safe range in spite of large variations in temperatures outside the body. It is measured in any of the following ways: Axillary - Temperatures can be taken under the arm using a glass or digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4 degrees F lower than those temperatures taken by mouth. By ear using a tympanic thermometer which quickly measures the temperature of the ear drum, reflecting the body's core temperature. By skin - a special thermometer can quickly measure the temperature of the skin on the forehead. Oral and rectal temperatures not now used due to risks involved. Tympanic thermometers are the most accurate way to check temperature. Before use, the thermometer is checked as according to the operating manual, the temperature is taking and recorded and the ear bud is disposed of in an appropriate waste receptacle. When not in use the handset is stored on the attached base. (https://www.cardinalhealth.co.uk/content/dam/corp/web/documents/Manual/cardinal-health-genius-2-operating-manual.pdf) Height and weight is needed to calculate Body Mass Index (BMI) which is, in itself, one of the best methods of assessing if people are overweight or obese. Height is measured using a high level ruler fitted to a wall and is most accurate if any footwear, headgear, hairclips or braids are removed. The individual should stand erect looking straight ahead, with their feet and heels parallel, buttocks, shoulders and back of head touching the wall if possible. The high level ruler is placed on top of the individual’s head and the measurement recorded. Weight is measured using a variety of scales, the most common being scales which are stood on, or a chair scale or bed scale for those less mobile. Using a floor scale, scales should be situated on a level or flat surface and the setting should be at zero before the procedure begins; extra clothing, jewellery or items in pockets should be removed, as should shoes. Individuals should stand at the centre of the scale, not touching anything, arms hanging & relaxed on sides and ensure body weight is evenly distributed between both feet. The measurement can then be recorded Blood Pressure Two numbers are recorded when measuring blood pressure. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body (systole). The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as "mm Hg" (millimetres of mercury) and blood pressure is recorded as systolic over diastolic e.g. 120/60. When taking blood pressure, it is generally recorded using a digital pressure monitor. It is best practice for the individual to be seated for at least 10 minutes prior to taking the reading, relaxed and not moving or speaking, with legs and arms uncrossed. The arm to be used must be supported at the level of the heart (an unsupported arm may elevate diastolic by 10%). Clothing should be loose as tight clothing will constrict the arm and it is important to use a cuff that covers the circumference of the upper arm (as per cuff markers) sufficiently and seek advice on correct cuff/bladder size for age/body size. The cuff is placed and secured around the bicep, there are markers on the cuff to ensure correct placement. The machine is activated and will record the blood pressure after a short while. It is then best practice to take the blood pressure reading again, only this time in a standing position at least 1 minute following the previous reading. (file:///C:/Users/smakinson/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/IB%20BP%20A100Plus&T&W%20V13-1%205015%20(1).pdf) These blood pressure monitors also record the pulse rate. Pulse is the pressure wave transmitted through the arterial system with each heartbeat. It is caused by the expansion and recoil of the arteries during each cardiac cycle. Pulse can be measured manually by placing the pads of the first two fingers at any place that allows an artery to be compressed against a bone – but more usually on the wrist or inner elbow. The patient should be relaxed and in a supported posture; the pulse should be counted for a full minute to allow for irregular or missed beats to be measured and as pulse pattern can be clinically significant it is important to note the rate in beats per minute, the rhythm of pulse (fast, slow, irregular), and the strength of the pulse (absent, barely palpable, easily palpable, full or bounding). The average pulse for an adult is between 55 - 100 beats per minute. Anything below or over these numbers may be sign of an underlying health condition. The pulse rate may also be recorded when using a digital blood pressure monitor. Urinary output is monitored to prevent dehydration or fluid retention. All fluids provided to the patient are measured and documented and the amount of fluid passed is also measured. Respiration is measured to acquire a baseline, to monitor a patient with breathing problems, to aid in the diagnosis of disease and to evaluate the response to medication. When monitoring respirations it is important to monitor the rate per minute, the sound, depth and physical effort involved and whether there is any discomfort whilst breathing. Normal respiration rates for an adult person at rest range from 12 to 20 breaths per minute. Usually breathing is relaxed, regular, automatic and silent – discrete observation of respirations is more accurate (do not tell the patient you are counting their respirations!) are people are not usually aware they are breathing and will then think about it and alter the pattern. Oxygen saturation is measured using a pulse oximeter which sends a light wave through blood vessels which measures blood colour against a spectrum. It indicates the level of usable oxygen in blood and pulse rate and can provide continual monitoring of an individual’s oxygen level. (https://images-na.ssl-images-amazon.com/images/I/81HYiFgn88L.pdf) There are some things that will interfere with the accurate recording of the oximeter and it is important to be aware of these. Light sources (Infra-red warming devices, excessive sunlight) Incorrect attachment Poor fit (loosely applied sensor, old worn adhesive, inappropriate sensor size) Personal Movement, restlessness, agitation, seizures (anaesthetic induction / recovery ECT) Poor circulation (hypothermia, anaemia, severe peripheral vascular disease) Nail varnish / false nails / size of fingers / length of nails Blood sugar levels are measured to monitor diabetes control. Blood glucose level is the concentration of glucose in your blood at a single point in time, i.e. the very moment of the test. This is measured using a plasma glucose test, which can be carried out using blood taken from a finger or can be taken from a blood sample from the arm. The test for monitoring blood glucose levels involves pricking a finger and producing a bead of blood, absorbing this onto a test strip inserted into blood glucose meter. The meter provides a reading of the glucose level and the picture below shows the safe levels of glucose. Hypoglycaemia - low blood sugar (less than 4 mmol/l) is classed as an emergency and can be fatal! This would need immediate treatment with a quick acting sugar (glucagon injection if unconscious or oral dextrose gel if conscious) and would need following up with regular monitoring and long acting starches. It can have symptoms of mood changes, trembling, paleness, sweating, dizziness, headaches, blurred vision and tiredness. Hyperglycaemia – high blood sugar (above 7mmol/l pre-meal, although symptoms may not be visible until 15-20 mmol/l) can cause long term damage if chronic in nature and will require regular monitoring. It can have symptoms of tiredness, drowsiness, dry mouth, extreme thirst and the urge to frequently urinate. The knowledge of how all of the relevant equipment works and is maintained would be achieved through professional training on all of the equipment used within a person’s role and is also available within the equipment user manuals. Module C1 1.5 4.1.3 Can you explain the range of communication techniques relevant to mental health situations, including dealing with barriers to communication and conflicting opinions, powerful emotions, past experiences, delusions, hallucinations, confusion, stereotypes and assumptions, medication or substance misuse, environment, personality clashes, unrealistic expectations, issues of power or control, cultural differences, overload, organisational dynamics? Barriers to communication come in several forms, such as hearing loss; sensory impairment; culture; difficulty understanding dialect or accent and having English as a secondary language. Should an individual have hearing loss and require use of a hearing aid it is important to ensure it is in, turned on and the volume is at an appropriate level. Individuals with cochlea implants may need to use a microphone attachment in conjunction with the implant - ensure batteries are inserted and it is switched on. Position yourself correctly to ensure effective communication and use the correct tone/volume. Use of an appropriate sign language interpreter can be facilitated if necessary and the use of text to communicate is becoming increasingly popular with individuals with hearing issues. Individuals suffering with sensory impairment should make sure they are wearing glasses or aids as required and ensure they can see you or are aware of where you are. Sufferers of dysphonia may require the use of mechanical aids to aid communication. Difficulties understanding dialect or accent can be overcome by avoiding the use of jargon and slang. Speaking slowly and clearly and checking the individual is understanding as you go along can also help. For individuals with English as a secondary language the use of an appropriate translating service, either facilitating translation via a 3 way phone call or having a translator present during a face to face contact with an individual. Effective communication during challenging situations with conflicting opinions and powerful emotions relies on realising that body language and non-verbal communication play an important part in our daily communication with others as well as verbal communication. With regards to body language and non-verbal skills, maintaining an ‘open posture’ (sitting or standing up straight with your head raised, and keeping your chest and abdomen exposed; feet spread wide and the palms of your hands facing outward) portrays friendliness and positivity, and people with open postures are perceived as being more persuasive than those with other postures. Maintaining a relaxed facial expression and good eye contact enables a person to be perceived as approachable and composed and during conversation – this helps to establish trust and build rapport with the individual. Verbal communication is equally important, maintaining a voice which remains calm in tone and pitch is vital as raising your voice will lead to a loss of control as emotion takes over and the situation will deteriorate; speaking slowly and actively listening to the other person’s issues and points of view; avoiding jargon (using clear vocabulary can avoid misunderstandings) and not interrupting or speaking over the other person will all aid the communication process. It is important to be empathetic and non-judgmental - the other person’s points of view and argument is as valid as yours, and once you have listened to them you will be better able to negotiate the situation to an acceptable outcome or compromise. Sometimes it is not always possible to come to an understanding if the other person is too emotional and an effective strategy is to offer to leave the conversation and resume it within a time frame in order for emotions and feelings to calm to facilitate further communication and an agreeable solution. It is important when communicating with a person who is delusional not to ignore the delusion or write it off as just a fleeting belief or inconsequential. Should someone be experiencing a clinical delusion, it’s vital you recognize it for what it is. Remaining non-judgmental and asking imperative and objective questions to better understand why they believe what they do is valuable for many reasons - it can force the individual to articulate how they came to reach their conclusions, which opens the door to the possibility that they’ll recognize the failings of their own logic (how did they arrive at their belief? How long have they held their belief? What do they plan to do in response to it?). Do not play along with their delusion, and no matter how bizarre their answers, don’t react one way or the other; just listen – should medical attention be required by the individual then it should be sought (as a general rule of thumb, the more resolute they are and the more bizarre their delusion, the more grim their prognosis and the more pressing their need for medical attention.) People who are experiencing hallucinations may very well be distracted as they respond to the hallucinations. Someone experiencing auditory hallucinations should not be expected to be able to “switch them off” and “lucid answers” to questions cannot necessarily be expected. By remaining patient and pragmatic whilst openly acknowledging the hallucination may impact on communication, a professional may achieve a reasonably successful conversation with a sufferer. Hallucinating patients cannot cope with excessive amounts of information, or over stimulation through a noisy environment so it would be important to accommodate these issues when attempting conversation. Referring to the patient by name throughout the conversation can help to retain an individual’s attention. Patients who are confused or suffering with dementia can be difficult to communicate with, it can help to start conversations with them; speaking clearly and slowly and using short sentences; making eye contact with the individual when they are speaking; and giving them time to process what you have said and allowing them to formulate a response. Encouraging conversation with others wherever possible can aid a confused individuals communication skills. Communication is not just talking. Gestures, movement and facial expressions can all convey meaning or help you get a message across. Body language and physical contact become significant when speech is difficult for a person with dementia or confusion. It is also important to remain calm and patient; use a positive and friendly tone of voice and avoid intimidating them (being at the same level or lower than they are (for example, if they are sitting) can also help); and patting or holding the person's hand while talking to them to help reassure them and make you feel closer. Active listening is especially beneficial when communication with a person who is confused or has dementia; maintaining eye contact and encouraging them to look at you when speaking; not interrupting; giving that person your full attention and minimising distraction within the environment are all important skills to utilise. Stereotyping is making assumptions about someone because of factors like their race, status, beliefs, etc. It is a barrier to communication because it can mean that you don’t take some of their arguments seriously, you believe that they can’t be right because of their past or you generally shun them because you never believe they will be respectable. People often leap to conclusions based on their own experiences and interpretation, it may not always be deliberate and people often do not realise that they are doing this. We should continually question our own attitudes and assumptions about any groups of people and always ensure that our communications are open, genuine and non-judgmental, are far as is possible. The more we discover real facts and are open to actual experience about an individual, the more likely it is that the group stereotype we may have been applying breaks down or can be disregarded. Communication with patients with substance misuse issues faces many barriers. Patients may be embarrassed, ashamed, frightened, defiant, or even unaware they have a problem. Some patients may be cautious, secretive, aggressive, angry, and suspicious, denying that there is a problem. Patients might be aware that their substance use is illegal and might need reassurance around confidentiality. Patients may consider that their substance use is a personal lifestyle choice and nothing to do with a professional (and they have that right to make that lifestyle decision). If they feel they are being judged or stereotyped they may be apprehensive about divulging information about their drug or alcohol use and the impact this has on their lifestyle; should a patient sense that you don’t have time, that you are rushed or you seem distracted, it is likely that they will not openly discuss their issues. To overcome these barriers it is important to; Introduce and ask difficult questions in a sensitive manner (“I am going to ask you some questions now that I routinely ask all patients.”) Avoid leading questions, e.g. you don’t drink do you? This suggests that the staff member is looking for no as an answer. The use of open ended questions is likely to elicit more information. Be empathetic, respectful and non-judgemental in attitude when speaking to patients. Do not making assumptions because of race, religion, sexuality etc. – keep an open mind. Environmental barriers to communication tend to be noise and physical barriers. Noise barriers which occur during the communication process can include physical interruptions by people; interruption by technology, e.g. ringing telephone, new email, instant message, etc.; external noise e.g. distracting activities going on nearby such as traffic noise outside the building or conversations taking place in or near the room; distortions of sound leading to delivery of incomplete messages, e.g. not hearing full words or phrases; and internal noise – physiological (e.g. blocked up ears), or psychological (e.g. distracting thoughts) Noise creates distortions of the message and prevents it from being understood the way it was intended, resulting in a deterioration in comprehension which interferes with the communication assimilation process. The level of noise is very important - generally, quiet background noise can easily be filtered out, whereas loud or intrusive noise cannot. Physical environmental barriers to communication almost always occur at the beginning of the communication process. They are generally very obvious and, because they are neutral, pose no risk of offending either the message sender or receiver. These barriers include ventilation and temperature; seating and layout of furniture; lighting; and time and space Noise and physical barriers are probably some of the easiest barriers to address. Make sure the environment is well ventilated, at an ambient temperature, there are no technological distractions such as telephones and noisy equipment. Ensure the room is laid out well and furniture is comfortable and lighting is not so harsh it will cause fatigue or headaches. There are four different types of personality. These are: The Playfuls – Energetic, funny, loud, enthusiastic, extroverts who love speaking to people. They are best at networking and socializing. They are also unorganized, forgiving, and easily distracted. They are innovative, full of ideas, creative, and tend to work fast. Playfuls typically need fondness, attention, and approval. The Peacefuls – Just as the title says it, they crave peace and order. They are easy going, patient and diplomatic – always avoiding confrontation with others. They are well grounded and emotionally stable. They balance out companies who are on the move or fast-paced, and are best at building a working team. Peacefuls typically want respect, value, and harmony between people. The Powerfuls – These have an authoritative presence, are productive and decisive, take control, do not give up easily and are internally strong. They get to the point, work hard and accomplish their many goals. Powerfuls typically want credit, loyalty, and appreciation. The Precises – They value structure, order, and compliance. They are organized, procedurally strong perfectionists. They put work before play and generally stop working only after they have done everything right. Precises typically want quiet, space to work alone, and sensitivity. Personality becomes a barrier to communication when types of personality clash. For example, Playfuls vs. Precises. Playfuls like attention, and precises like to work alone in quiet. Playfuls are extroverts, and precises are introverts. These two are completely opposite of each other. The best way to overcome this kind of barrier is to be aware of your own personality type, realise you may clash with other personalities and develop communication strategies to aid in an effective management of situations. A person having unrealistic expectations during communication can be difficult. They may feel everyone should agree with them. Whilst that person may indeed know what they’re talking about, and for that reason should be taken seriously, if they expect people to agree with them out of courtesy or because their ideas are so incredibly sound then that is more difficult. Something that’s obvious to one person might not be so obvious to someone with different experiences and a different agenda. There is no one right answer! It can be hard not being offended when people disagree with you, and not assuming that there is only one right answer (yours); and instead, focussing on how you can find solutions that give everyone what they need. Some people have an expectation that everyone knows what they are trying to say. People can’t read minds, and it is unfair to expect people to understand you just because you’re talking—you have to be clear and precise - avoiding jargon will help with this. Communication isn’t anything if it isn’t clear, and your communication won’t be clear until you take the time to understand the other person’s perspective. Issues of power and control can often be a barrier to communication, especially within the workplace, where the attitude of the superiors and the subordinates play a vital role in determining the success of communication. A hostile attitude or sense of superiority may filter the information being provided or manipulate the message, sometimes intentionally, in order to achieve certain selfish motives. Should superiors not be open to suggestions and feedback, presuming subordinates are not capable of advising them it can cause a breakdown in communication, resulting in the downward flow of information within the organization being badly affected and leading to poor communication and performance. Upward communication from subordinates to superiors can be adversely affected through a lack of confidence and fear causing subordinates to fail to communicate openly and comfortably with the superiors. Different cultures and backgrounds can interpret communication methods differently. It is important to ensure if you are communicating with someone from a different culture that you familiarise yourself with their culture and beliefs in order to facilitate effective communication with the individual. It is tempting to rely heavily on the use of non-verbal communication with those from a different background or culture to ourselves but it is important to be aware that some forms of non-verbal communication can mean different things to others – for example, when communicating with nationals from West Africa or parts of the Middle East including Iran or Iraq a ‘thumbs up’ is a gesture of contempt or disapproval and is equivalent to giving the middle finger! Information overload becomes a barrier to communication as when the amount of information we have to work with exceeds an individual’s processing capacity, it is human nature to either select, ignore or forget some of that information until the amount processed becomes manageable. (https://www.physio-pedia.com/Communication_in_Healthcare) (https://www.mentalhealthtoday.co.uk/blog/therapy/communication-is-a-key-ingredient-in-mental-health-recovery) (http://challengethestorm.org/talk-someone-experiencing-clinical-delusion-just-radically-different-point-view/) (https://www.kcl.ac.uk/ioppn/depts/hspr/archive/mhn/projects/Talking.pdf) (https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/tips-for-communicating-dementia) (https://www.nhs.uk/conditions/dementia/communication-and-dementia/) (https://lauriebrown.com/communication-barriers/overcoming-communication-barriers) (http://blog.readytomanage.com/overcoming-social-stereotypes-when-communicating/) (https://www.addiction-ssa.org/images/uploads/Clin_111_Communication_treat.pdf) (https://www.potentialunearthed.co.uk/wp-content/uploads/2017/09/overcoming-communication-barriers-noise-and-physical-barriers.pdf) (https://www.forbes.com/sites/travisbradberry/2016/08/02/8-unrealistic-expectations-that-will-ruin-you/#271da2019f00) (https://www.ukessays.com/essays/management/the-barriers-to-communication-management-essay.php?vref=1) 4.1.5 – What are the main interventions in mental health, including their strengths and limitations, adhering to national guidelines; the key principles and factors for choosing them; the benefits of early intervention? There are many different treatment interventions within mental health. The main treatment pathways in England and Wales are a combination of psychological therapy and psychiatric medication. Psychological therapy, also known as counselling, psychotherapy, or talking therapies provide time and opportunity for individuals to talk about their thoughts and experiences and explore difficult feelings with a trained professional. Therapy can help individuals manage and cope with difficult life events such as bereavement, or losing your job. It can also be beneficial when experiencing relationship problems or dealing with difficult emotions, such as grief, guilt, sadness, confusion, anger and low self-esteem. Talking to someone about upsetting or traumatic experiences (whether something recent or something that happened a long time ago) can help a person to face memories and emotions which are affecting their current life. Talking therapies can help with a range of diagnoses, and specific talking treatments have been developed for some mental health problems such as depression and anxiety. NICE (National Institute for Health and Care Excellence) recommends psychological therapies as part of a stepped-care model for treating common mental health disorders - providing the least intrusive, most effective intervention first, and monitoring individual progress to ensure the patient moves to a higher step if needed. CBT (cognitive behaviour therapy) is a relatively short-term treatment which aims to identify connections between your thoughts, feelings and behaviours, and to help you develop practical skills to manage any negative patterns that may be causing you difficulties. It is one of the most common treatments for a range of mental health problems, from anxiety, depression, bipolar, OCD or schizophrenia and is based on the idea that the way we think about situations can affect the way we feel and behave. By working with a therapist to identify and challenge any negative thinking patterns and behaviour which may be causing difficulties, individuals can change the way they feel about situations, and enable them to change their behaviour in future. Dialectical behaviour therapy (DBT) is also a type of talking treatment and is based on CBT, but has been adapted to help people who experience emotions very intensely. It is mainly used to treat problems associated with borderline personality disorder (BPD). Where CBT focuses on helping you to change unhelpful ways of thinking and behaving, DBT also helps you to change unhelpful behaviours, focussing on accepting who you are at the same time. The goal of DBT is to help an individual learn to manage their difficult emotions by letting themselves experience, recognise and accept those emotions. DBT therapists use a balance of acceptance (accepting who you are) and change techniques (making positive changes in your life). Acceptance techniques focus on understanding yourself as a person, and making sense of why you might do things such as self-harm or misuse drugs. Change techniques encourage you to change your behaviour and learn more effective ways of dealing with your distress. They encourage you to replace behaviours that are harmful to you with behaviours that can help you move forward with your life. Arts and creative therapies are treatments which involve using arts-based activities in a therapeutic environment, with the support of a trained professional, using the arts (music, painting, dance or drama) to express and understand yourself. They aim to give individuals a safe time and place in a non-judgmental environment; help individuals make sense of things and understand themselves better; help people resolve complicated feelings, or find ways to live with them; and help people communicate and express themselves. This can especially be helpful for individuals who struggle to talk to people and put things into words. Guidelines from the NICE recommend that arts therapies are considered for everyone who has psychosis or schizophrenia, which includes related conditions such as schizoaffective disorder. Some people find complementary and alternative therapies helpful to manage stress and other common symptoms of mental health problems. These can include things like yoga, meditation, aromatherapy, hypnotherapy, herbal remedies and acupuncture, and whilst clinical evidence for these options is not as robust as it is for other treatments, some individuals may find they work well for them. Complementary and alternative therapies typically take a holistic approach to a person’s physical and mental health wellbeing as a whole, rather than treating particular symptoms separately. For example, some complementary therapies focus on the mind, body and spirit or on the flow of energy through your body. 'Complementary' describes therapies which may be used alongside treatments offered by your doctor (such as yoga, massage and meditation). 'Alternative' describes approaches which are generally meant to replace the treatments offered by your doctor (such as Traditional Chinese medicine or Ayurvedic medicine, or some herbal remedies such as St John's wort). Complementary and alternative therapies can be used as a treatment for both physical and mental health problems. The particular problems that they can help will depend on the specific therapy that the individual is interested in, but many can help to reduce feelings of depression and anxiety. Some people also find they can help with sleep problems, relaxation and feelings of stress. Psychiatric medication does not cure mental health problems, but can ease many symptoms. The type of drug offered will depend on a person’s diagnosis. Antidepressants are available on prescription and are licensed to treat depression. Some are also licensed to treat other conditions, such as anxiety, phobias, bulimia (an eating disorder) and some physical conditions. They work as they regulate chemical activity levels within the brain, boosting levels of noradrenaline and serotonin, which are thought to be involved with mood regulation. By altering the chemistry within the brain, antidepressants may lift your mood, however they may not work for everyone. The most commonly prescribed type of antidepressant in the UK is SSRIs (selective serotonin reuptake inhibitors) which work by blocking the reuptake of serotonin into the nerve cell that released it, prolonging its action in the brain. SNRIs (serotonin and noradrenaline reuptake inhibitors) are one of the newer types of antidepressant. Very similar in action to SSRIs, they act on noradrenaline as well as serotonin and are better at targeting the brain chemicals which affect your mood, without causing unwanted side effects. Antipsychotics are psychiatric drugs which are available on prescription, and are licensed to treat mental health problems whose symptoms include psychotic experiences, such as schizophrenia; schizoaffective disorder; some forms of bipolar disorder and severe depression. They are generally prescribed in tablet or liquid form but can also be administered by depot injection. There are two main categories of antipsychotics, first generation (older) antipsychotics and second generation (newer) antipsychotics. Both types can potentially work well, but they differ in the kind of side effects they can cause and how severe these may be. First generation antipsychotics are sometimes referred to as ‘typicals’; they divide into various chemical groups which all act in a similar way and can cause similar side effects - including severe neuromuscular side effects; some may cause more severe movement disorders than others, or be more likely to make you more drowsy. Second generation antipsychotics are sometimes referred to as 'atypicals'; they generally cause less severe neuromuscular side effects than first generation antipsychotics; can also cause fewer sexual side effects compared to first generation antipsychotics; but second generation antipsychotics are more likely to cause serious metabolic side effects, including rapid weight gain. Mood stabilisers are psychiatric drugs that are licensed as part of the long-term treatment for bipolar disorder (manic depression), mania and hypomania and sometimes recurrent severe depression. They can help to stabilise mood if a person experiences problems with extreme highs, extreme lows, or mood swings between extreme highs and lows. The 5 individual drugs that can be used as mood stabilisers are lithium – which is an element naturally occurring in the environment and not a manufactured drug; carbamazepine, lamotrigine and valproate – which are all anticonvulsant medication (antiepileptic); and asenapine – which is actually an antipsychotic drug but is usually used as a mood stabiliser. Many people find these drugs helpful, as they can lessen symptoms and allow people to cope at work and at home. However, they sometimes have unpleasant side effects making individuals feel worse rather than better, and they can also be difficult to withdraw from, or cause physical harm if taken in too high a dose. Early intervention and treatment can dramatically impact the course of mental illness and many people can go on to live normal and productive lives with appropriate treatment, and the earlier that individuals access treatment then the more quickly problems are prevented from becoming worse. Early intervention can help to reduce or lower the risk of relapse; reduce vocational or developmental disruption; reduce the need for hospitalisation; lower family disruption and distress; improve recovery and encourage better attitudes to treatment; and reduce the risk of suicide. (https://www.mind.org.uk/information-support/types-of-mental-health-problems/mental-health-problems-introduction/treatment-options/) (https://www.nice.org.uk/Media/Default/About/what-we-do/Into-practice/measuring-uptake/NICEimpact-mental-health.pdf) 4.2.1 – Can you identify the needs of people with mental ill health and those supporting them at key stages and through times of change or transition e.g. when they first develop mental health problems, if they go into psychiatric care, over the long term; how and when to refer; the impact of the individual’s mental ill-health on their life, family, friendships, ability to work and actively participate in society? When a person first develops mental health problems they need to be listened to, assessed and screened for a general diagnosis and their first point of contact for support is usually their GP. GP’s can signpost and refer individuals towards the most appropriate service for their problems, be that local Talking Therapies; alcohol or drug recovery programs; support groups or self-help programmes and local Community Treatment Teams; and they can prescribe psychiatric medication should it be felt necessary. GP’s are in a unique position because they often already have a longstanding relationship with patients and this can help to optimise the quality of an assessment and in establishing the characterisation of the patient’s problems. When going into psychiatric care individuals need to have the process explained to them clearly, whether they are admitted voluntarily or being detained under the Mental Health Act. They need to feel safe, have access to appropriate qualified staff and be fully aware of their rights as an inpatient. They should be able to have their medication optimised quickly through monitoring and review of mental state, prompt adjustments to regular medication, and administering further medication to relieve distressing symptoms as required. They need frequent evaluations of risk and appropriate responses to changing circumstances e.g. adjusting levels of support, providing reassurance, de-escalation, and relaxation, or giving additional medication. They need access to other treatments that can help patients treat symptoms e.g. cognitive and behavioural remodelling, exercise, nutrition; and they need to be allowed time to respond to treatment. Over the long term mental health patients need access to the least restrictive but most supportive treatment pathways. The majority of acutely ill patients who retain their capacity to make decisions and are willing to engage in long term treatment, while still requiring support from a psychiatrist or therapist, home or community treatment would be suitable. This is generally provided by nurse-led Community Treatment Teams (CTT). CTT provide flexible, long term care; structure and containment on an individual basis; regular reviews by a psychiatrist and a broad range of therapy and treatment options. Patients accessing CTT have control and choice over their care; they are involved in the development of an individualised treatment plan, team composition & frequency of sessions. This long term individualised approach encourages stronger therapeutic relationships with 1:1 named nurse which benefits the patient’s chances of recovery and management of their condition. Mental health services within the UK are free on the NHS, some of them can be accessed by self-referral (drug and alcohol services, psychological therapies and some Crisis Teams; while others need a referral from a GP to access them (CTT, specialist teams such as perinatal teams and older persons mental health teams. Throughout each stage of an individual’s mental health treatment journey, the involvement of carers and family can be of huge importance. They know the individual best, are aware of their needs and wishes and can provide a useful bridge or liaison between patient and service providers. An individual’s mental health has a huge impact on their life, family, friendships, ability to work and active participation in society. Anxiety and depression manifests with symptoms such as irritability, mood swings, being negative, poor concentration and poor sleep. These can make interpersonal relationship difficult and strained. Sufferers may feel like they are disconnected from the world around them or feel like someone on the outside looking in and worry they are losing touch with reality making others feel as if they are being shut out and ignored. They often struggle with inability to carry out day-to-day tasks and this can have a serious impact on relationships. If the sufferer uses coping strategies such as alcohol or drugs then the strain in relationships can feel massively increased. Depression affects everyone around an individual suffering with it - it can be emotionally exhausting and difficult to deal with. Those closest to the person suffering depression will be the most affected - lack of energy, irritability, bursts of anger and sadness will all upset the family unit. Low self-esteem and negative thinking may result in arguments and a breakdown in communications. It puts extra pressure on a spouse as they shoulder more responsibility and become the caregiver. This extra burden can lead to feelings of resentment or generate a "what about me" attitude as they begin to feel ignored and put upon. Any children within the family either won't understand or may even think they share some fault. Similar to divorce, children tend to think the problem revolves around them, even though they really have nothing to do with it. Often family members and friends do not have a clear understanding of the depth of anxiety or the severity of the depression. They may see the problems without fully understanding or knowing how to help - they care about the depressed person and want to fix the problem, even though the problem isn't "fixable" in any direct way. This may lead to them feeling frustrated, angry, helpless and rejected and (without support for themselves) they may feel impotent to help and support the individual. Co-workers may not be aware or understand that an individual is depressed and the fatigue and inability to enjoy interactions can be misinterpreted as disappointment in them or the job itself leading to avoidance by other workers amplifying the feelings of isolation. (https://www.nice.org.uk/guidance/cg123/chapter/1-guidance) (https://www.nice.org.uk/guidance/cg123/resources/clinical-case-scenarios-pdf-version-pdf-181726381) (https://www.rethink.org/advice-and-information/living-with-mental-illness/treatment-and-support/going-into-hospital/) (https://www.brevin.co.uk/mental-health-briefings/home-care-as-an-alternative-to-psychiatric-hospital) 4.2.2 –Can you describe the range of coping strategies and skills; sources of specialist support including: other services, interpreters, translators, speech therapy, psychologists, advocacy, equipment and communication aids? There are 2 main types of coping skills – problem based and emotion based; and there isn’t always one best way to proceed. The decision of which skill to use lies with the individual and their answer to the question do I need to change my situation or do I need to find a way to better cope with the situation? Problem-based coping can be helpful when someone needs to change their situation, perhaps by removing a stressful thing from their life. For example, if you’re in an unhealthy relationship, your anxiety and sadness might be best resolved by ending the relationship (as opposed to soothing your emotions). Emotion-based coping can be helpful when needing to take care of feelings, when an individual either doesn’t want to change their situation or when circumstances are out of their control. For example, when grieving the loss of a loved one, it would be important to take care of your feelings in a healthy way (since you can’t change the circumstance). Coping strategies and skills don't necessarily remove stress or eradicate challenges like mental illness, but they go a long way toward helping people function well despite challenges. Some of the simplest coping skills such as distraction from thoughts and feeling can be the most effective. Engaging in techniques to encourage mindfulness such as colouring; reading; playing games on a phone/tablet; watching TV etc. distract the mind and can destress an individual quite quickly. Exercising regularly helps by increasing the blood flow in the body, relaxing tense muscles and releasing of endorphins in the brain which lift a person’s mood. It does not have to be long periods of strenuous exercise, simply walking in the fresh air for half an hour will help. Having a healthy sleep pattern and routine will help. Between six and eight hours is the recommended amount of sleep. If getting to sleep is an issue then eating a banana before bed can increase levels of potassium which helps sleep and having a warm bath or listening to music can be beneficial too. Practising controlling breathing can help. Breathing in to a count of four, holding for a count of four and breathing out to a count of 5 will help to regulate breathing and bring about a feeling of calmness and being more in control. Connecting with friends and family, talking the situation through, laughing and relaxing are all strategies that can help. Looking for the positives in life can also help - people with a more pessimistic view on life are more likely to suffer with stress. (https://www.verywellmind.com/forty-healthy-coping-skills-4586742) (https://www.healthyplace.com/other-info/mental-health-newsletter/coping-skills-for-mental-health-and-wellbeing) Interpreters provide a service for patients, carers and clinicians to help them understand each other when they do not speak the same language. Not being able to communicate well with health professionals can impact on health outcomes, increase the frequency of missed appointments, the effectiveness of consultations and patient experience. Translators provide a very similar service to interpreters but specialise in the translation of written documents from one language to another. (https://www.england.nhs.uk/wp-content/uploads/2018/09/guidance-for-commissioners-interpreting-and-translation-services-in-primary-care.pdf) Speech and language therapy plays a unique role in identifying the communication characteristics and swallowing difficulties. As an integral part of the multidisciplinary team supporting clients with mental health problems they Identify speech, language, communication and eating, drinking and swallowing difficulties; they support patient safety by reducing the risk of swallowing problems which can lead to malnutrition, dehydration, choking or aspiration pneumonia requiring hospital admission and in some cases causing death; they support access to verbally-mediated interventions and individual or group-based talking therapies which require significant understanding and expressive language skills; and they support other professionals and staff to recognise and understand how to respond to communication needs and dysphagia and how to tailor information to support decision-making and discuss treatment options. (https://www.rcslt.org/speech-and-language-therapy/clinical-information/mental-health-adults) Psychology is the study of the way people think, behave and interact. Looking at the way the mind works, psychology covers everyday functioning such as learning and remembering as well as more complex mental health conditions. Psychologists are normally described as being 'applied' (using their knowledge in a practical capacity to help patients) or 'research-oriented' (aiming to further society’s knowledge of the human mind). Psychologists can choose to specialise in a certain area of psychology. Many specialise in a particular type of assessment or therapy (for example CBT or neuropsychology). Counselling psychologists tend to deal with the same types of issues as counsellors, including bereavement, trauma and relationship issues, and they also take on more serious, long-term issues such as domestic violence and sexual abuse. (https://www.counselling-directory.org.uk/psychiatrists-psychologists-psychotherapists-counsellors.html#psychologist) Having a mental health problem can sometimes mean it's even harder to have your opinions and ideas taken seriously by others. This can be often be very difficult to deal with, especially when you need to communicate often with health and social care professionals, and individuals might find they aren’t always offered all the opportunities and choices they would like, or feel fully involved in decisions about their care. Advocacy means an individual can access support from another person to help them express their views and wishes, and help them stand up for their rights. (https://www.mind.org.uk/information-support/guides-to-support-and-services/advocacy/what-is-advocacy/) Regional Communication Aid Services are specialists in improving the independence of people who experience severe communication difficulties through the provision of specialised services for Alternative and Augmentative Communication (AAC) Aids. They support local mental health teams in working with individuals to understand their AAC needs; and in providing specialised communication aids. The Regional Communication Aid Service offer a visiting assessment service; an equipment loan service (post assessment); advice and training on specialist Communication Aid Equipment. (https://www.nhs.uk/conditions/social-care-and-support-guide/practical-tips-if-you-care-for-someone/how-to-care-for-someone-with-communication-difficulties/) (https://www.cntw.nhs.uk/services/regional-communication-aid-service-neurological-service-walkergate/) 4.3.1 –Can you identify the risk factors e.g. risk of harm to self or others, being harmed by others (including mental health services), a range of triggers which may occur and the impact of the environment? The risk factors associated with developing mental health problems are anything which can increase a person's likelihood to develop a mental health problem. Genetic inheritance - having a close blood relative with a mental health disorder can increase a person's risk of developing mental health problems themselves. However, this link would only increase the likelihood of developing the same mental health problem as that close relative. For example if a parent has bi-polar disorder then it is possible their child would be at risk of the same condition. Gender and age - Women are more at risk than men of experiencing depression, anxiety and phobias - a study by Cambridge University in 2016 found women were twice as likely to suffer anxiety than men, and men and women under the age of 35 were more at risk than older people. Lack of access to food, water or shelter - The constant stress of coping without basic environmental resources will wear a person's resilience and ability to cope away. If you are hungry or thirsty you are more likely to experience a change in your behaviour (the term 'hangry' indicates hunger can make a person more prone to anger and less likely to cope with the emotion). Thirst can cause a slowdown in thought process making decision making more risky and problematic. Lack of shelter (homelessness) can cause a deterioration in a person's self-esteem, manifesting a feeling of worthlessness and puts them at an increase in possible risk taking. Negative experiences at school or in the workplace - bullying in any form can have a major impact on a person's ability to cope with stress and can impact on a person's ability to change their pattern of thinking/behaving. Research in the past has shown that if you're bullied as a child or teenager, you might be twice as likely to use mental health services as an adult. Substance abuse - the abuse of substances can often hide an underlying mental health problem. Using alcohol to 'self-medicate' anxiety when in a social situation to feel more at ease can lead to an increase in risky behaviour and development of a lower mood. A recent study looked at patterns of cannabis use, such as how often people used it and what type they used, in 16 areas of Europe and 1 in Brazil. Using the results, along with rates of psychosis, researchers’ estimated what effect cannabis use might have on the numbers of new diagnoses of psychosis in these areas. They found daily use of high-strength cannabis was common in London and Amsterdam, and that this might account for 30% of new cases of psychosis in London and 50% in Amsterdam each year. Compared with not using cannabis, daily use of high-strength cannabis is linked to having a 5 times greater risk of a psychotic episode. (https://www.nhs.uk/oneyou/every-mind-matters/possible-causes/) (http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=14&cad=rja&uact=8&ved=2ahUKEwjFlfLE7YHpAhVSQMAKHSUYD14QFjANegQIAxAB&url=http%3A%2F%2Fwww.dchs.nhs.uk%2Fyour_health_useful_info%2Fcyph%2Fdownload%3Fnid%3D823%26did%3D36547&usg=AOvVaw0ayTYYZ047H2hEbjWnnPnS) (https://www.nhs.uk/news/mental-health/daily-use-high-strength-cannabis-increases-risk-psychosis/) 4.3.2 –Can you describe the prevention and risk reduction strategies, including suicide, behaviours which challenge, substance misuse, self-neglect? Suicide is a major issue for society, in 2018 a total of 6,507 suicides were registered in the UK (an increase of 11.8% on the previous year). Suicides are not inevitable, but in order to prevent and reduce the risk of them we need to be aware of the areas requiring action. 6 areas identified by the 2012 publication ‘Preventing suicide in England’ are: Reduce the risk of suicide in key high-risk groups Tailor approaches to improve mental health in specific groups Reduce access to the means of suicide Provide better information and support to those bereaved or affected by suicide Support the media in delivering sensitive approaches to suicide and suicidal behaviour Support research, data collection and monitoring. By identifying high risk groups - young and middle-aged men; people in the care of mental health services, including inpatients; people with a history of self-harm; people in contact with the criminal justice system; specific occupational groups (such as doctors, nurses, veterinary workers, farmers and agricultural workers) we can raise awareness of their risks and improve the support networks around these groups. Improving the training of staff within services to be particularly alert in identifying signs of suicidal behaviour; treating mental and physical health as equally important in the context of suicide prevention; providing 24 hour responses to mental health crises and ensuring access to high quality mental health services are all fundamental to reducing the risk of suicide in individuals. Ensuring individuals who self-harm and attend emergency departments have access to mental health assessment if deemed necessary and improving the provision of mental health services within the criminal justice system and the delivery of safer custody will also contribute to the prevention of suicide. (https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2018registrations#suicides-in-the-uk) (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/430720/Preventing-Suicide-.pdf) (https://en.wikipedia.org/wiki/Suicide_prevention) Prevention and risk reduction strategies around challenging behaviour (including non-verbal, verbal or physical behaviour) is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. Factors increasing the risk of challenging behaviour include personal factors, such as a severe learning disability; autism; dementia; communication difficulties (expressive and receptive); visual impairment (which may lead to increased self-injury) and physical health problems. Environmental factors, such as abusive or restrictive social environments; environments with little or too much sensory stimulation and those with low engagement levels; developmentally inappropriate environments; environments where disrespectful social relationships and poor communication are typical, or where staff do not have the capacity or resources to respond to people's needs; and enforced changes to a person's environment also have a huge impact on the risk of challenging behaviour. The development and implementation of a written behaviour support plan (BSP) for individuals with a learning disability will help to identify proactive strategies designed to improve the person's quality of life and remove the conditions likely to promote behaviour that challenges. These may include changing the individual’s environment (reducing noise and increasing predictability); promoting active engagement through structured and personalised daily activities; and identifying individualised adaptations required to a person's environment and routine, in order to develop strategies to help them react with an alternative behaviour. A BSP will also identify strategies to calm the person when they begin to show early signs of distress; identify strategies to manage behaviours that are not preventable and will include how family members, carers or staff should respond if a person's agitation escalates and there is a significant risk of harm to themselves or others. It will be reviewed regularly, identify training needs of family and carers; identify those responsible for delivery of the plan and incorporate risk management and take into account the effect of the behaviour support plan on the level of risk. De-escalation of the behaviour and situation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques – maintaining safety, self-regulation, effective communication, and assessment and actions – to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes. (https://www.nice.org.uk/guidance/ng11/chapter/1-recommendations) (https://journals.rcni.com/nursing-standard/preventing-and-managing-challenging-behaviour-aop-ns.2018.e10969) Substance misuse causes a wide range of social and health harms and costs. It is both a cause and consequence of wider factors including physical and mental ill-health, problems relating to employment, housing, family life and crime issues. It is a global problem, not just within the UK and affects people of all ages and socio-economic diversity. The most effective way to reduce the risks around substance misuse and facilitate prevention of increasing use of illicit substances is to reduce demand; restrict supply; build on recovery and take action globally. By improving education and openness around substance misuse and placing an increased emphasis on building resilience and confidence among young people we can reduce the range of risks they face (e.g. drug and alcohol misuse, crime, exploitation, unhealthy relationships) and therefore hope to reduce their demand for substances as a coping mechanism. Attempting to restrict the supply of drugs by adapting our approach to reflect changes in criminal activity; using innovative data and technology; and taking coordinated partnership action to tackle drugs alongside other criminal activity can aim to reduce the availability of illicit substances. Building recovery can be achieved by improving both treatment quality and outcomes for different user groups; ensuring the right interventions are given to people according to their individual needs; and facilitating the delivery of an enhanced co-ordinated approach to commissioning the wide range of services that are essential to supporting individuals to live a life free from drugs. (https://www.nice.org.uk/guidance/ng64/documents/evidence-review-3) (https://publichealthmatters.blog.gov.uk/2017/07/20/the-government-drug-strategy-tackling-the-complex-issue-of-drug-misuse/) (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/628148/Drug_strategy_2017.PDF) Self-neglect is an extreme lack of self-care to such an extent that it threatens personal health and safety. It develops when an individual neglects to care for one’s personal hygiene, health or surroundings and that individual fails to seek help or access services to meet health and social care needs. People who neglect themselves often decline help from others, feeling that they do not need it. There are limitations to what others can do if the individual has the mental capacity to make their own decisions about how they live. Sometimes, despite everything in an agency’s power being attempted to support an individual, they may die or suffer significant harm as a result of their own action or inaction. The most effective approach to prevent and reduce the risk around self-neglect involves working with multiple agencies to ensure the correct approach for the individual; adopting a person-centred approach, taking the individual’s views and wishes into account and respecting those views and wishes to work towards an acceptable outcome for all involved; adopting an appropriate level of risk management as it may not be possible to change the person’s lifestyle or behaviour. Remaining non-judgmental, empathetic and demonstrating patience will all facilitate an easier pathway for engagement for the individual and regular, encouraging engagement and gentle persistence may help with progress and risk management. (https://www.scie.org.uk/self-neglect/at-a-glance) Module C1 1.4 4.3.3 –Can you explain ways to review/protect own mental health and wellbeing? Our mental wellbeing is dynamic. It can change from moment to moment, day to day, month to month or year to year. There are many ways to review and protect your own mental health and wellbeing. Talking to others about how you are feeling can help you to feel listened to and supported. Just acknowledging your feelings by saying them out loud can help. Exercise releases chemicals in your brain that make you feel good. Regular exercise can boost your self-esteem and help you concentrate, sleep and feel better. It does not have to be a gym class or session, walks in the park, gardening or housework can also keep you active. Food can also have a long-lasting effect on your mental health. The brain needs a mix of nutrients to stay healthy and function well, just like the other organs in the body. By eating a healthy balanced diet consisting of lots of different types of fruit and vegetables; wholegrain cereals or bread; nuts and seeds; dairy products; oily fish and plenty of water you are benefitting your mental health as well as your physical health. Alcohol is a natural depressant and while the alcohol may initially make your mood feel better, in the long term you feel worse because of the way alcohol withdrawal symptoms affect your brain and the rest of your body. Drinking is not a good way to manage difficult feelings. Connecting with others can help us to feel a greater sense of belonging and can help to challenge feelings of loneliness. Making time for the people you love and keeping in regular contact with friends and family (whether it's face-to-face, on the phone or by text) can strengthen your relationships. Taking up a hobby or joining a group can help with mental well-being. Meeting others with a shared interest can increase your confidence and build your support network. Asking for help when we become overwhelmed is important, it is not a sign of weakness to seek help – it is a sign of self-awareness. Have some ‘me time’ – be it 5 minutes peace, and hour of doing something you want to or even taking a break somewhere, taking that time to focus on yourself can be of massive benefit to your mental well-being. (https://www.mentalhealth.org.uk/publications/how-to-mental-health) (https://www.mind.org.uk/information-support/tips-for-everyday-living/wellbeing/wellbeing/) Module C1 1.6 1.6 – Can you reflect on how to perform basic life support and use adjuncts to support resuscitation? Whilst I have never had to administer CPR, it is an essential part of mandatory training for people working within the care sector and it is important should anyone require basic life support to follow certain protocols. Firstly, ensure that the area is safe and that both the casualty and your self are not in danger. Once it is ascertained it is safe, assess the casualty and, if necessary, dial 999 or 112 for an ambulance. The 3 priorities when dealing with and assessing a casualty are commonly referred to as ABC, which stands for Airway, Breathing and Circulation. Airway Should the casualty appear unresponsive, ask them loudly if they're OK and if they can open their eyes. If they respond, leave them in the position they're in until help arrives, whilst regularly checking their breathing, pulse and level of response. If there's no response, leave the casualty in the position they're in or gently lay them on their back and open their airway by placing 1 hand on the casualty's forehead and gently tilting their head back, lifting the tip of the chin using 2 fingers. This moves the tongue away from the back of the throat. If you think the person may have a spinal injury, place your hands on either side of their head and use your fingertips to gently lift the angle of the jaw forward and upwards, without moving the head, to open the airway. Take care not to move the casualty's neck, but opening the airway takes priority over a neck injury. This is known as the jaw thrust technique. Breathing To check if a person is still breathing you can look to see if their chest is rising and falling, listen over their mouth and nose for breathing sounds and feel their breath against your cheek for 10 seconds. If they're breathing normally, place them in the recovery position so their airway remains clear of obstructions, and continue to monitor normal breathing. Gasping or irregular breathing is not normal breathing – this may be a sign of agonal breathing which is common in the first few minutes after a sudden cardiac arrest and CPR should be given straight away. If the casualty isn't breathing, call 999 or 112 for an ambulance and then begin CPR. Circulation If the casualty isn't breathing normally, you must start chest compressions immediately. Hands-only CPR – this is carried out by placing the heel of your hand on the breastbone at the centre of the person's chest. Place your other hand on top of your first hand and interlock your fingers. Position yourself with your shoulders above your hands and using your body weight (not just your arms), press straight down by 5 to 6cm (2 to 2.5 inches) on their chest. Keeping your hands on their chest, release the compression and allow the chest to return to its original position. These compressions should be repeated at a rate of 100 to 120 times a minute until an ambulance arrives or you become exhausted. CPR with rescue breaths – This should be carried out only if you have been trained in CPR including rescue breaths, and you feel confident using your skills. Otherwise attempt hands-only CPR instead. Place the heel of your hand on the centre of the person's chest, then place the other hand on top and press down by 5 to 6cm (2 to 2.5 inches) at a steady rate of 100 to 120 compressions a minute. After every 30 chest compressions, give 2 rescue breaths (ideally breaths should be given with the use of a CPR rescue mask which is placed over the casualty’s mouth and allows you to breath without coming into skin or fluid contact with the casualty). Tilt the casualty's head gently and lift the chin up with 2 fingers. Pinch the person's nose. Place the rescue mask so it seals over the casualty’s mouth and blow steadily and firmly into their mouth for about 1 second. Check that their chest rises. Give 2 rescue breaths. Continue with cycles of 30 chest compressions and 2 rescue breaths until they begin to recover or emergency help arrives. Should a defibrillator be available, this should be used according to the instructions, placing the pads onto the chest of the casualty – most modern defibrillators provide spoken instructions and a safety check so it will indicate if shocking or CPR is required. The above instructions apply to adults, some adaptations to the method would be put into practice for children and infants – the main difference being the number of hands used to administer the compressions and the number of initial breaths provided. During the current COVID-19 situation, CNTW (Cumbria, Northumberland, Tyne and Wear) NHS Trust resuscitation protocols have changed slightly, in that full personal protection equipment (PPE) – FFP3 face mask, disposable gloves, disposable apron, and eye protection (visor or goggles) should be worn. The face mask must be checked for fitting and a non-rebreathe face mask and 15 litres of oxygen can be used to assist breathing. DO NOT place your face next to the patient to listen for breath sounds, and DO NOT attempt to use mouth to mouth ventilation (with or without use of barrier device; face shield or rescue mask). Patient interventions   can be undertaken  must not be undertaken The patient does NOT have possible or confirmed COVID-19 The patient HAS possible or confirmed COVID-19 Staff member has NOT been fit tested and trained in use of FFP3 mask OR FFP3 mask is not available The patient HAS possible or confirmed COVID-19 Staff member has been fit tested and trained in use of FFP3 mask AND FFP3 mask is available Chest compression    Apply defibrillation if indicated    Airway management including insertion of airway    Bag-valve-mask ventilation    Oral cavity suction    Deep airway suction    (https://www.nhs.uk/conditions/first-aid/after-an-accident/) (https://ee494c7bcaebc61df9a5-e19ab9a66520ad61c29310eafb66e6e6.ssl.cf3.rackcdn.com/content/uploads/2018/04/CNTWC01-ResusPolicy-V05.3-Oct-19.pdf)