Active IQ Level 2 Award in Mental Health Awareness (sample manual)

Workbook
Level 2 Award in
Mental Health
Awareness
Version AIQ005487

Section 1
Understanding mental health
The mental health continuum
If somebody has a mental illness, people will often expect them to be unhappy and unable to function in everyday
life, while an individual without a mental illness is seen as more likely to have positive mental health; however,
this is not always the case. The mental health continuum explains that having a mental health disorder does not
automatically mean that mental health will be poor.
A person with a mental illness may be managing their symptoms well and enjoying life. Conversely, an individual
without a diagnosis may be unhappy, struggling to cope with life and have poor emotional well-being.
According to the mental health continuum, mental health and mental illness are not at opposite ends of a spectrum.
Individuals living with a mental illness can still have high levels of general mental well-being, while those without a
diagnosed mental illness can show low levels of mental well-being.
People can move along the continuum of mental well-being regardless of mental illness. How we feel depends on
many factors, such as functioning, well-being and mental health. Mental health is not simply the absence of mental
illness; therefore, it is perfectly possible to have mental health while having a mental illness.
Maximum mental
well-being
Example: a person who experiences a
high level of mental well-being despite
being diagnosed with a mental illness
Example: a person who has a high
level of mental well-being and who
has no mental illness
Maximum
mental illness
Minimum
mental illness
Example: a person who exeriences
mental illness and who has a low level
of mental well-being
Example: a person who has no
diagnosable mental illness and who
has a low level of mental well-being
Minimal mental
well-being
ACTIVITY
Read the scenarios and place each of the people on the mental health continuum. Discuss and
justify your reasons.
Scenario 1: Liz has a happy life; her job is fulfilling, she has a large circle of friends, many hobbies, an
active social life and a loving family. She has a large house and a sports car and is loved by everyone.
Liz also has schizophrenia.
Scenario 2: Chris has just graduated from university with a first-class degree in maths. He has just
secured a new job and has moved in with his ‘fiancée’. He is in perfect health and is feeling positive
about his future career and getting married.
Scenario 3: Peter hears a knock at the door; his friends have come to see him. Peter ignores the door
and goes back to bed. He feels worried about what his friends might think of him, but he’d rather not
see them or go outside at all. Peter cannot sleep, he has lost his appetite, he hates how he looks and
contemplates over-dosing on his anti-anxiety drugs in order to end his life.
Scenario 4: Kate has just celebrated her 40 th birthday with a big party with all her family and friends;
she had a wonderful time. She has had a great life and has lots to be thankful for. Recently, though,
Kate has not been feeling herself; her mood has been a little up and down, she has felt unmotivated
and hasn’t been enjoying the things that she normally enjoys.
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Understanding mental health
Section 1
The consequences of mental health stigma can be serious. Individuals experiencing stigma often report some of
the following:
Isolation
Why?
Work
difficulties
Why?
Relationship
problems
Why?
Being
Shunned
Why?
Prevents
help being
sought
Why?
Discrimination
Why?
Self-stigma
Why?
Lack of knowledge and prejudice are often reasons for these, but there can be other causes.
Discrimination is a result of people acting on stigma (due to lack of knowledge or prejudice). There are two types
of mental health discrimination:
Direct mental health discrimination is when somebody is treated less favourably, simply because they have a
mental illness. This most commonly occurs in the workplace; for example, somebody is not offered a job, not given
a promotion, or is sacked from their job, solely because of their mental health.
Indirect mental health discrimination occurs when somebody is
disadvantaged because of their mental health, or there is a failure
to consider the person’s mental health and consequently things are
made more difficult. For example, an organisation may have a policy
that appointments can only be made over the telephone, but an
individual’s social anxiety makes this difficult.
Direct discrimination is deliberate, while in cases of indirect
discrimination there may not be an intention to treat those with a
mental illness differently.
Consequences of mental health discrimination
DISCUSSION
Discuss the consequences of mental health discrimination.
Mental health awareness
Note down further examples of direct and indirect discrimination.
Time to Change state that discrimination can lead to people with a diagnosed mental illness being excluded from
society. This can include not being accepted for insurance policies or for finance. One in three people with mental
health problems reports leaving a job for reasons related to their mental health, and 70% disclose being put off
applying for a job for the same reason. Research has also found that, out of any ‘disability group’, those with a
mental illness have the highest ‘want to work’, but the lowest ‘in work’ rate.
Key fact
The Equality Act 2010 states that it is illegal to be discriminated against due to a mental illness, if it has a longterm
effect (12 months or more) on your normal day-to-day activity. However, if a person’s mental health problem
does not fit this criteria and is therefore not classed as a disability, then discrimination is unfortunately not illegal.
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Section 4
Common treatments and interventions used to manage mental health and mental ill health
Problems with drug treatments
Many patients stop taking antipsychotics due to them
being ineffective, or due to intolerable side effects.
Drugs can reinforce labels and
stigma surrounding mental illness.
The placebo effect (an improvement in symptoms
after taking a ‘fake drug’ due to the belief that it
will make you better) could question the validity
of drugs being an effective treatment and suggest
that a chemical imbalance is not the cause.
The patient is taking on a passive role and they are
not in control of their own recovery.
The use of drugs may be inappropriate for some
people with a mental illness, as it assumes that
the cause is a chemical imbalance, when in fact
this may not be the case.
Medication only treats the symptoms rather than
the cause. When drug treatment stops, symptoms
often return.
People may become reliant on their medication
and could suffer from withdrawal if they stop
taking them.
Electroconvulsive therapy (ECT)
It is unknown exactly how ECT works,
but it is thought that the electric
ECT is an extreme and controversial treatment that should only
shock stimulates the brain, changing
be used as a last resort and if no other treatments have been
neurotransmitter levels. There are
successful. It can be used in severe cases of depression when
two types of ECT: unilateral ECT,
suicide is highly likely and for schizophrenia when catatonic
where an electrode is placed on
symptoms are particularly debilitating.
the non-dominant side of the brain
with a second electrode in the middle, and bilateral ECT, in which
electrodes are placed on the temples of each side of the brain.
The procedure involves drugs being given to the patient to make them
unconscious, and muscle relaxants to prevent injuries. The brain is
then given an electric shock of 0.6 amps; this lasts for 0.5 seconds
and causes a seizure for about a minute. Usually around three
treatments are given a week, for up to five weeks in total.
Although ECT can be effective (Comer, 2002 found up to 70% of
patients improve after treatment), it has been criticised as being an
outdated and inhumane treatment, and the fact that it is now rarely
used reflects this. ECT can cause memory loss and brain damage,
and in rare cases can even result in death.
Psychological treatments
Psychological treatments are also used to treat mental
illness. These involve talking about thoughts and
feelings with a mental health professional; this is also
known as psychotherapy or talking therapy. There are
several different types of psychological treatments,
which most commonly take place within an individual
session, but they can also be alongside family
members or partners (relationship/family therapy),
as part of a group, or even online. The purpose of
psychotherapy is to help the person understand their
own thinking, behaviour and problems, change the
behaviour, reduce symptoms and ultimately improve
the quality of their life through applying the tools learnt
within the sessions.
ACTIVITY
Watch the video at https://www.nhs.uk/
conditions/stress-anxiety-depression/freetherapy-or-counselling/
or conduct your own
research.
Answer the questions below:
What is a talking therapy?
How effective are talking therapies?
How/why do they work?
What are the different types of talking therapy?
Why may talking therapies be more beneficial
than drug treatments?
How can you access talking therapies?
Write your answers in the notes section.
36
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Common treatments and interventions used to manage mental health and mental ill health
Section 4
ACTIVITY
People with mental health problems who have faulty thinking often have difficulty distinguishing
between fact and opinion – many of the beliefs they have about themselves which they think are fact
are actually opinion. Challenging such thoughts can have a positive impact on their mental health.
Try it yourself – In relation to the image, discuss which of these words are facts or opinions.
dog
happy
sad
Mindfulness
Although mindfulness-based therapies
are relatively new treatments, they are
now becoming widely recommended as a
way of treating depression, stress, anxiety
and addiction. Mindfulness can also be an
effective way for anyone to manage their
own mental health.
collie
singing
barking
healthy
clever
hairy
Mental health awareness
Mindfulness is basically being aware of what
is going on inside and outside of ourselves,
moment by moment. It is important to notice
the world around us and to be aware of how
our thoughts are influencing our emotions
and behaviours. Improving our awareness of
the present moment can help us understand
ourselves better, enjoy the world around us,
notice signs and symptoms of poor mental health and deal with them successfully.
Mindfulness was developed from Buddhism and meditation; however, it is not necessary for you to be ‘spiritual’ for
it to work. According to Mind, the main aims are to help people to:
• Be more self-aware.
• Be less stressed.
• Be calmer.
• Deal with difficult or unhelpful thoughts.
• Be able to choose how to respond to your thoughts and feelings.
• Be kinder to yourself.
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SCHIZOPHRENIA
Symptoms of schizophrenia can be broadly
categorised into positive and negative. This does
not mean good and bad – ‘positive’ symptoms
are feelings or behaviours that are not usually
present and are therefore in addition to ‘normal’
experiences, while ‘negative’ relates to the loss
of functioning.
The most common positive symptoms of schizophrenia are
hallucinations and delusions. Hallucinations are perceptions that
are not real; these are often auditory, i.e. hearing voices.
Delusions can be defined as false beliefs. Examples include
persecutory delusions, where the person believes they are to
blame and should be punished for certain events.
Other positive symptoms include disordered thinking and
disorganised speech. Schizophrenia is also characterised by a
lack of insight, which impairs a person’s ability to understand and
perceive their illness.
Negative symptoms of schizophrenia include avolition – an
inability to initiate any behavior, alogia – a lack of speech and
apathy – a lack of interest in previously enjoyed activities.
ANOREXIA NERVOSA
Anorexia nervosa is an illness where the person
actively keeps their weight as low as they possibly
can. This is done by severely limiting their food intake
and/or exercising excessively. Other characteristics
of anorexia include an intense fear of gaining
weight, disturbances in the way body weight/shape
is experienced, and a lack of recognition of the
seriousness of the low weight. The person is often
pre-occupied with food and may display food rituals.
A physical side effect of anorexia is amenorrhea: the
prolonged weight loss causes women’s menstruation
to stop, hair to become brittle, and their skin to
become unhealthy and, in some cases, yellow.
BULIMIA NERVOSA
Bulimia nervosa is characterised by a recurrent ‘bingepurge
cycle’, for example eating a very large amount
of food in a very short amount of time, followed by
compensatory behaviours which prevent weight
being put on through methods such as being sick,
using laxatives, fasting or over-exercising. The person
with bulimia will usually have a lack of control of their
eating. Furthermore, their self-evaluation is overly
influenced by their body shape and weight. Unlike
people with anorexia, people with bulimia will often
have a ‘normal’ weight.
ADDICTION
/ SUBSTANCE MISUSE
Depending on the severity of symptoms, individuals
who misuse substances and/or have an addiction may be
diagnosed with a substance-related disorder or a
(non-substance-related) dependence disorder. Many of
the common signs and symptoms are a consequence of the
substance misuse or addiction, and will usually include:
• Reckless, risk-taking and/or dangerous behaviour, due
to frequent use of substances.
• Financial problems and a change in spending habits.
• Relationships problems.
• Ceasing important social, employment-related or
recreational activities.
• Suspicious movements and keeping secrets.
• Extreme mood changes, which often include
violence, anger, frustration and paranoia.
• Difficulties in keeping time and keeping to a routine.
• Poor sleep hygiene and diet.
• Wanting but failing to stop the use of the
substance/addiction.
• Spending a lot of time obtaining, using or
recovering from the use of the substance/addiction.
BEREAVEMENT
People respond in many different ways to a
bereavement and there are a number of different
symptoms that people may experience, which include
shock and a feeling of numbness, overwhelming
sadness and despair, guilt and anger.
Elisabeth Kubler Ross and David Kessler conducted
research into bereavement and identified five stages
of grief:
DENIAL, ANGER, BARGAINING,
DEPRESSION, ACCEPTANCE.
SELF-HARM
Self-harm is when an individual injures, damages or
hurts themselves intentionally as a way of dealing with
difficult feelings and experiences, and blocking out or
distracting themselves from these emotions. People
may also self-harm to punish, to feel normal, to be in
control of their body after a trauma, or to feel better
due to the adrenaline rush it provides.
The most common method of self-harm is the use of an
object to cut the skin. Other methods include burning,
hitting, starving, poisoning and hair pulling, as well as
misuse of drugs and alcohol and exercising excessively.

Section 2
Providing initial help to a person experiencing mental ill health
MENTAL HEALTH
FIRST AID
Kitchener, B.A., Jorm, A.F., & Kelly, C.M.
(2013). Mental Health First Aid Manual.
Melbourne: Mental Health First Aid International
ALGEE is a term developed by Mental Health First Aid International and the guidance within the workbook has been
developed based on these principles.
A L G E E
Approach, assess
and assist with the
mental health crisis
Listen and
communicate in a
non-judgmental way
Give support and
information
Encourage them to
seek appropriate
professional help
Encourage self-help
and other support
strategies
A – Approach, assess and assist with the mental health crisis: This must
be done at an appropriate time and place. You should start a conversation
with the person that you are concerned about and ask them how they are
feeling and how long they have felt this way.
L – Listen and communicate in a non-judgmental way: Being able to
listen effectively is essential for a mental health fi rst aider. You must
leave behind any pre-conceived views about the person and their
situation. Before taking on board any advice, the person will want to feel
as if they are being genuinely listened to with empathy.
G – Give support and information: If non-judgmental communication has
been established, the person is more likely to accept advice and support.
If they are comfortable to receive information, the following support can be
provided:
• Emotional support. • Practical help.
• Hope for recovery. • Information about mental health issues.
E – Encourage them to seek appropriate professional help: In order to
aid with their recovery, accessing professional help and support should be
considered. Options such as going to the doctor, attending counselling or
taking medication should be explored.
E – Encourage self-help and other support strategies: Suggesting other
sources of support to help manage their well-being can also be discussed at
this stage and may include:
• Family and/or friends.
• Community support.
• Mental health charities.
• Self-help strategies.
Remember that it is important to
respect the person’s privacy and
confi dentiality.
It is important that you adopt
non-verbal communication skills
that allow the person to talk to you
without feeling judged. This will
allow you to hear and understand
what is being said to you.
Ask the person if they are
comfortable to receive advice
or information. Check with them
afterwards what they thought
about the advice or information
given.
These discussions are really
important as they may help
the person to identify and start
to overcome any barriers they
might have in terms of accessing
treatment. This is imperative for
their long-term mental health.
These suggestions can help the
person to make positive choices,
feel like they are in control, and
take ownership of their mental
health.
When carrying out mental health fi rst aid, it is important to follow the principles of ALGEE for any mental health
problems. However, within these steps, there are important points to consider when supporting people with different
mental health problems, particularly during the approaching, assessing and assisting stage.
KEY
POINTS
Once you have completed the fi rst step and you have determined whether the person is having a
mental health crisis, you should then consider escalating the situation. If this is not required, you
can then move onto the other stages of ALGEE.
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MENTAL
HEALTH
Mental health first aid has four key aims:
PRESERVE LIFE
PREVENT FURTHER HARM
PROVIDE COMFORT
PROMOTE RECOVERY
MENTAL HEALTH FIRST AID – DO’S AND DON’TS
FIRST AID
HOW TO HELP
SOMEONE WHO IS EXPERIENCING A
MENTAL HEALTH CRISIS
What is a mental health crisis?
A mental health crisis is when a person’s
health reaches a point where they
cannot cope or are at risk of harming
themselves. This could be as a result of
a steady decline or be triggered by a
major event.
A mental health crisis can occur in
people with a diagnosed illness, or in
someone without a diagnosis who is
experiencing a crisis for the first time.
The experience can be different from
one person to another, but there are
several common signs:
• Suicidal thoughts and actions.
• Self-harm.
• Risky, or out-of-control behaviours.
• A psychotic episode.
• Extreme mania, anxiety or panic
a tt a c k .
DO
Listen
Remain patient and calm
Reassure them that help is available and there are
alternatives
Engage them in conversation about how they are feeling
Find out how and why they are feeling the way they are
Remember that the person is ill and unable to cope with
their problems
Show empathy
Ask open questions
Clarify what they are saying to show that you understand
them
Use the word ‘suicide’ and discuss it directly
Demonstrate positive body language
DON’T
Give advice
Judge
Disagree with their feelings
Tell them that suicide is wrong
Use threats or guilt to prevent suicide
Give empty reassurances such as ‘Everything will be OK’
Try to diagnose them with a mental illness
Minimise their problems
Interrupt and talk about yourself
Use phrases such as ‘committing suicide’ or ‘a failed suicide
a tt e m p t ’
Dare the person to just do it