Mental illness

Mental illness

 Mental illness is a general term for a group of illnesses. A mental illness can be mild or severe, temporary or prolonged. Most mental illnesses can be treated.
Mental illness can come and go throughout a person’s life. Some people experience their illness only once and fully recover. For others, it is prolonged and recurs over time. Mental illness can make it difficult for someone to cope with work, relationships and other aspects of their life.

The symptoms of mental illness

 A person with a mental illness can experience problems with their thinking, emotions and/or behaviour. These changes may happen quickly, or they may be gradual and subtle. It may take time to understand and identify what is happening.
Psychotic symptoms
These symptoms can include:
    Thoughts and feelings that are out of the ordinary or difficult to understand, such as thought of being persecuted or under surveillance for which there is no proof
    Experiencing sensations (seeing, hearing, smelling, tasting something when there is nothing there that others can identify)
    Odd behaviour.
Schizophrenia is a psychotic illness
Mood symptoms
Some of the symptoms of a changed mood may include:
    Persistent and pervasive feelings of sadness, elation, anxiety, fear or irritability
    Changes in sleep patterns
    Changes in appetite
    Loss of interest in things that were previously enjoyable
    Periods of increased or decreased activity, where things may be started and not finished
    Difficulty thinking and concentrating
    Excessive worries
    Changes in use of alcohol and other drugs
Exact causes are unknown
Many mental illnesses are thought to have a biological cause. What triggers a mental illness is not known.
The relationship between stress and mental illness is complex, but it is known that stress can worsen an episode of mental illness.
Compassion and understanding helps recovery
Many people may not know how to respond to a person who is mentally ill. People may react with embarrassment, rejection and abuse if they do not understand unusual behaviour. Such reactions can be a big hurdle for people with a mental illness who are trying to get well.
A person with a mental illness often faces isolation and discrimination from family, friends, employers and neighbours. These attitudes can make people hide their illness and feel ashamed. Family, friends, colleagues and other people can make a huge difference to a person’s recovery with understanding and compassion.

Mental illness and violence

 Research has shown that people receiving treatment for a mental illness are no more violent or dangerous than the rest of the population. People with a mental illness are more likely to harm themselves – or to be harmed – than they are to hurt other people. A person with schizophrenia is around 2,000 times more likely to commit suicide than they are to harm someone else.
A weak association between mental illness and violence
Violence is not a symptom of psychotic illnesses such as schizophrenia. There is a slightly increased possibility someone with a psychotic illness may be violent if they:
    Are not receiving treatment
    Have a previous history of violence
    Misuse alcohol or drugs.
Symptoms of psychotic illnesses may include frightening hallucinations and delusions as well as paranoia. This means there is a small chance someone who is experiencing these symptoms may become violent when they are scared and misinterpret what is happening around them. This is especially true when someone experiences these symptoms for the first time. However, if a person is being effectively treated for psychotic illness and is not misusing alcohol or drugs, there is no more risk they will be violent than anyone else.
Putting violence and mental illness into perspective
Research by the Australian Institute of Criminology shows that the vast majority of violence is committed by males aged 18–30 years. This is more likely when someone has been violent in the past and misuses alcohol or drugs. People in this group are far more likely to be violent than someone with a mental illness.
Schizophrenia and violence
People with schizophrenia who are receiving treatment are no more dangerous than the rest of the population. Research has shown that people with schizophrenia are about 2,000 times more likely to harm themselves than others.
Violence is generally not a problem, as long as the person is receiving appropriate treatment and support. However, it is true that a minority of people with schizophrenia can become aggressive when unwell. One reason for such a response could be a fear of symptoms, such as hallucinations. Aggression is usually expressed towards themselves, or family and friends – rarely to strangers.
Self-harm or abuse from others is more common
A Federal Government study found that a sizeable group of Australians with a psychotic illness (for example, schizophrenia) reported physical abuse within the previous year. For instance:
    18 per cent had been a victim of violence
    17 per cent attempted suicide or deliberate self-harm
    15 per cent did not feel safe in the area where they were living. This highlights that people with a psychotic illness have the added burden of feeling vulnerable to harm.
Early treatment is the key to preventing violence
Mental health workers, people with a mental illness and their families all agree that the most important step in preventing violence is to make sure people receive effective treatment. Mental health workers need to know who is most at risk of being violent or a victim of violence and make sure they receive the right treatment – as quickly as possible and for as long as they need it. This is especially important in the first episode of illness.
It is important for everyone in the community to understand that mental illness is not a choice and could happen to anybody. It is equally important to understand that violence is always unacceptable.
How families can cope with aggressive or violent behaviour
If a family member with a mental illness becomes aggressive or violent:
    Avoid a confrontation – sometimes it can be best just to leave the person until they calm down and become reasonable again.
    Speak firmly – a very firm ‘please stop’ can sometimes help the person to regain control.
    Have a plan – know who you are going to call if the aggressive behaviour persists. This may be a mental health crisis team, police or a neighbour.

Bipolar disorder

 Bipolar disorder, or bipolar mood disorder, used to be called ‘manic depression’. It is a psychiatric illness characterised by extreme mood swings. A person may feel euphoric and extremely energetic, only to drop into a period of paralysing depression, in a cycle of elation followed by sadness. The exact cause is unknown and a number of factors may be involved, although a genetic predisposition has been clearly established.
It is estimated that around one in 50 Australians develops this illness, which affects men and women equally. Most of those affected are aged in their 20s when first diagnosed.
Bipolar disorder typically involves extreme moods of mania and depression – each lasting days, weeks or even months. Some people experience more highs than lows, others report more lows than highs. The severity of the mood swings and the symptoms will also vary from person to person. The person may be affected so much that they experience the symptoms of psychosis and are unable to distinguish reality from fantasy.
Bipolar disorder and mania
Common symptoms include:
    Feeling extremely euphoric (‘high’) or energetic
    Going without sleep
    Thinking and speaking quickly
    Delusions of importance
    Reckless behaviour, such as overspending
    Unsafe sexual activity
    Aggression
    Irritability
    Grandiose, unrealistic plans.
Bipolar disorder and depression
Common symptoms include:
    Withdrawal from people and activities
    Overpowering feelings of sadness and hopelessness
    Lack of appetite and weight loss
    Feeling anxious or guilty without reason
    Difficulty concentrating
    Suicidal thoughts and behaviour.
Contributing factors to bipolar disorder
The underlying mechanisms of bipolar disorder are not fully understood, although a strong genetic predisposition has been established. One theory is that the illness might be linked to particular brain chemicals (neurotransmitters) called serotonin and norepinephrine that help regulate mood. In a person with bipolar disorder, it is thought that these chemicals are easily thrown out of balance.
Other contributing factors may include stressors in life that can trigger episodes of illness.
Treatment for acute episodes of bipolar disorder
When people experience an acute episode of mania or depression, they often require immediate care and treatment. These episodes can often be prevented by regular medication such as lithium.

Post-traumatic stress disorder (PTSD)

 Post-traumatic stress disorder (PTSD) is a set of mental health reactions that can develop in people who have experienced or witnessed an event that threatens their life or safety (or others around them) and leads to feelings of intense fear, helplessness or horror. This could be a car or other serious accident, physical or sexual assault, war-related events or torture, or a natural disaster such as bushfire or flood.
Other life-changing situations such as being retrenched, getting divorced or the expected death of an ill family member are very distressing, and may cause mental health problems, but are not considered events that can cause PTSD.
Anyone can develop PTSD following a traumatic event but people are at greater risk if:
    The event involved physical or sexual assault
    They have had repeated traumatic experiences such as sexual abuse or living in a war zone
    They have suffered from PTSD in the past.
Signs and symptoms
People with PTSD often experience feelings of panic or extreme fear, which may resemble what was felt during the traumatic event. A person with PTSD has three main types of difficulties:
    Reliving the traumatic event – through unwanted and recurring memories and vivid nightmares. There may be intense emotional or physical reactions when reminded of the event. These can include sweating, heart palpitations or panic.
    Being overly alert or ‘wound up’ – sleeping difficulties, irritability, lack of concentration, becoming easily startled and constantly being on the lookout for signs of danger.
    Avoiding reminders of the event and feeling emotionally numb – deliberately avoiding activities, places, people, thoughts or feelings associated with the event. People may lose interest in day-to-day activities, feel cut off and detached from friends and family, or feel flat and numb.
People with PTSD can also have what are termed ‘dissociative experiences’, which are frequently described as follows:
    ‘It was as though I wasn’t even there.’
    ‘Time was standing still.’
    ‘I felt like I was watching things happen from above.’
    ‘I can’t remember most of what happened.’
A health practitioner may diagnose PTSD if a person has a number of symptoms in each of the three areas for a month or more, which:
    Lead to significant distress, or
    Impact on their ability to work and study, their relationships and day-to-day life.
It is not unusual for people with PTSD to experience other mental health problems at the same time. Up to 80 per cent of people who have long-standing PTSD develop additional problems, most commonly depression, anxiety and alcohol or other substance misuse. These may have developed directly in response to the traumatic event or have developed sometime later after the onset of PTSD.
Impact of PTSD on relationships and day-to-day life
PTSD can affect a person’s ability to work, perform day-to-day activities or relate to their family and friends. A person with PTSD can often seem disinterested or distant as they try not to think or feel in order to block out painful memories. They may stop participating in family life, ignore offers of help or become irritable. This can lead to loved ones feeling shut out.
It is important to remember that these behaviours are part of the problem. People with PTSD need the support of family and friends but may not know that they need help. There are many ways you can help someone with PTSD. See ‘Where to get help’ for further information and resources.
Risky alcohol and drug use
People commonly use alcohol or other drugs to blunt the emotional pain that they are experiencing. Alcohol and drugs may help block out painful memories in the short term, but they can get in the way of a successful recovery.
When to get help
A person who has experienced a traumatic event should seek professional help if they:
    Don’t feel any better after two weeks
    Feel highly anxious or distressed
    Have reactions to the traumatic event that are interfering with home, work and relationships
    Are thinking of harming themselves or someone else.
Some of the signs that a problem may be developing are:
    Being constantly on edge or irritable
    Having difficulty performing tasks at home or at work
    Being unable to respond emotionally to others
    Being unusually busy to avoid issues
    Using alcohol, drugs or gambling to cope
    Having severe sleeping difficulties.
Support is important for recovery
Many people experience some of the symptoms of PTSD in the first couple of weeks after a traumatic event, but most recover on their own or with the help of family and friends. For this reason, formal treatment for PTSD does not usually start for at least two weeks following a traumatic experience.
It is important during those first few days and weeks after a traumatic event to get whatever help is needed. This might include information and access to people and resources that can assist you to recover. Support from family and friends may be all that is needed. Otherwise, a doctor is the best place to start, to get further help.
A range of treatments
If problems persist after two weeks, a doctor or a mental health professional may discuss starting treatment. Effective treatments are available. Most involve psychological treatment but medication can also be prescribed. Generally, it’s best to start with psychological treatment rather than use medication as the first and only solution to the problem.
The cornerstone of treatment for PTSD involves confronting the traumatic memory and working through thoughts and beliefs associated with the experience. Trauma-focussed treatments can:
    Reduce PTSD symptoms
    Lessen anxiety and depression
    Improve a person’s quality of life
    Be effective for people who have experienced prolonged or repeated traumatic events, but treatment may be required for a longer period.

Mental health - care plans

 Mental health care plans are for people with a mental illness who have several healthcare professionals working with them. A care plan explains the support provided by each of those professionals and when treatment should be provided. Your care plan might also include what to do in a crisis or to prevent relapse.
Your doctor will use a care plan to help you work out what services you need, set goals and decide on the best treatment options for you. At other times, your doctor may contribute to a care plan that someone else has organised – for example, when you are returning home from spending time in hospital.
Reasons for a mental health care plan
Providing ongoing care and support for someone who is living with a mental illness can involve many different support organisations. These may include psychologists, GPs, psychiatrists, psychiatric nurses or other community care providers. They are all part of the healthcare team, which works together to provide you with the best level of care possible.
Everyone’s treatment needs are different. A care plan puts down in writing the support you can expect from each of the people in your mental healthcare team and makes sure that everyone knows who is responsible for what and when. You are an important part of this team and should be fully involved in preparing your mental health care plan.
Preparing your mental health care plan
Your doctor will work with you to decide:
    What your mental health needs are
    What help you require – your medical, physical, psychological and social needs are all considered
    What result you would like
    What treatment would be best for you.
Once you and your doctor have agreed on your goals and what support you need to achieve them, your doctor will write out a mental health care plan. They will then discuss this with the other members of your healthcare team. Preparing the plan might take one visit or it might take a number of visits.
Your doctor will offer you a copy of the plan and will also keep a copy on your medical record. If you give permission, a copy can also be given to other people, such as psychologists or your carer. You should tell your doctor if there is any information you don’t want other people in your healthcare team to know.
Benefits of a mental health care plan
Having a care plan will help you become more involved in your healthcare. A care plan can:
    Help you to set and achieve goals
    Make sure everyone involved in your mental healthcare team is working towards the same goals
    Help you and your doctor manage your long-term care in a way that is clear and easy to understand
    Give you a way to monitor your progress and check that you continue to receive the care you need
    Lead to better treatment by focusing on improving and maintaining your health rather than just dealing with problems as they arise
    Provide life-saving information in emergencies.
Issues to consider with care plans
Most care plans are done in your doctor’s office. However, you may also have a care plan prepared for you when you leave hospital. The time it takes to draw up the care plan depends on your healthcare professional and the complexity of your situation.
Some things to think about include:
    You will need to request a long consultation with your doctor to allow enough time to prepare your care plan and discuss your treatment options.
    If you would like a carer, family member or someone else to accompany you to the care plan appointments, you may wish to let your doctor know beforehand.
    Your doctor must get your consent before a care plan is developed, and you should be given a written statement of your rights and responsibilities.
    Discuss with your doctor any aspects of your assessment that you do not want discussed with the other members of your healthcare team.
Regular reviews are important
Once you have a mental health care plan, you should continue to see the same doctor for review and management. Significant changes in your health may mean you need to make a new care plan. Even if there are no big changes to your situation, your care plan should be reviewed regularly to make sure it continues to meet your needs.
How often a new plan is prepared may vary depending on which health professionals are involved. Care plans may be prepared every 12 months and should be reviewed after three or six months, or sooner if needed. A date for review should be written into your care plan.
Costs of a mental health care plan
If you have a Medicare card, Medicare will cover some or all of the cost of care planning by a doctor. It may also rebate some of the costs of certain specialists or other health professionals, which will be charged separately. Your doctor should tell you what costs (if any) are involved when you agree to make a mental health care plan. If you are unsure, ask your doctor what fees will be involved.
Mental illness services - residential care
A wide range of public mental health services is available for people of all ages. Residential care services can provide short-term or long-term beds, and offer treatment and support to people who are experiencing a serious mental illness. These services can be offered in hospitals or other residential care facilities.
Short-term residential care for people experiencing mental illness
Sometimes, people with a mental illness need short-term care in a hospital or residential care facility. These ‘acute inpatient units’ provide a bed with short-term treatment for people who have been referred by a community mental health service.
Secure and extended residential care for people experiencing mental illness
Secure treatment in a residential care facility can be provided for people with serious, enduring mental illness and associated behavioural disturbance. Sometimes people in this situation need an extended period of treatment and rehabilitation in a contained environment.
Community care units for people experiencing mental illnes
Community care units provide clinical treatment for people with a serious mental illness and major psychosocial disabilities. The services help people learn and reinforce everyday skills that are needed to live in the community.
Residential rehabilitation services for people experiencing mental illness
Residential rehabilitation services help people with a serious mental illness and associated disabilities learn and reinforce everyday skills that are needed to live successfully in the community.
Services for older people experiencing mental illness
Aged persons mental health residential services care for older people with a mental illness. The facilities are designed to have a home-like atmosphere and residents can participate in a range of activities.