Mental health is highly stigmatised and is rarely spoke about in public, however it has recently becoming a prevalent topic of discussion in terms of the NHS budget as it was revealed last week that mental health spending has fallen by 2%. Frankly this is not on. After attending a mental health first aid course last week, the surprising and shocking statistics really highlight the need for more to be done.
So do you have mental health? Perhaps a difficult question to answer? What actually is mental health?
Mental health is defined as the emotional and spiritual resilience which enables us to enjoy life and to survive pain, disappointment and sadness. It is a positive sense of wellbeing with an underlying belief in ones self worth.
What are the influences on a child’s mental wellbeing?
A child’s upbringing has a significant influence in their wellbeing in the future, whether this be in terms of parenting styles or family relationships. Additionally the education of the child becomes a determining factor, especially in terms of exam pressures, bullying and friendship pressures.
Why is mental health so hard to talk about?
During this talk we did an exercise in groups in which task one was to write down as many derogatory terms for a person with poor mental health; and this was surprisingly easy. Task two was to articulate as many supportive phrases you could offer to one with a mental health problem; this task was much more onerous task. The moral of the task was to highlight the derogatory terms associated with mental health has become second nature and perhaps more ought to be done in learning to display effective support. Its important to remember that often the stigma and discrimination hurts mental health sufferers more than the illness itself. This is the reason why those affected are reluctant to open up about their experiences.
I recently saw an article which displayed a series of comic strip images which are changing the way social media view mental health. The artist said “I wasn’t really drawing anyone but clearly it has deep resonance”. I truly believe this depiction is a strong message which really makes it easier to interpret exactly how those experiencing problems feel, plus being displayed on social media makes it ever more accessible to the everyday person. Perhaps as more people see these images, the social stigmas will begin to change.
The six key points taken from my mental health first aid course were:
- We all have mental health needs
- 1 in 4 people will experience mental health issues
- People do recover, mental health can be managed
- To be supportive all you need to do is listen
- Treat people as though you want to be treated
- Take it easy and learn to look after yourself
Whilst attending my school’s MedSoc a doctor from outside school lead a discussion in which we discussed “what makes a good doctor?”. I thought I would share some of the ideas presented in our discussions:
Our schools thoughts on attributes of a good doctor:
- A good listener
- Good at articulating their words with clear, precise and understandable explanations
- Show strong signs of professionalism in terms of confidentiality
- Able to recognise their own personal limitations of knowledge and be able to accept help from colleagues
- Level headed with a strong focus
- Confidence which does not be perceived as arrogance
- A strong and advanced knowledge
- Someone who would never be discriminatory towards a patient, treating them all with equal respect
Sir Peter Rubin, chair of the GMC (general medical council) said:
“Doctors have the enormous privilege of touching and changing lives. Through all the changes driven by research and public expectations, some of the art and science of medicine has endured down the ages and defines medicine as a profession, whatever a doctor’s area of practice. Doctors:
- synthesise conflicting and incomplete information to reach a diagnosis;
- deal with uncertainty – protocols are great, but doctors often must work off-protocol in the best interests of the patient, for example when the best treatment for one condition may make a co-existing condition worse;
- manage risk – many patients are alive today because doctors took risks and as doctors we bring all our professional experience to bear on knowing when acceptable, informed and carefully considered risk ends and recklessness begins – and we share that information openly and honestly with our patients, always respecting that the final decision is theirs;
- recognise that change both in medicine and society is constant, ensuring that those standards which are immutable are preserved while those that are simply a product of their time are consigned to history
- carry and accept ultimate responsibility for our actions. “
Another nurse said:
“To me and my patients I have always found the following qualities essential ingredients for the making of a good doctor:
- Approachable, confident, decisive, intelligent, interested, compassionate and caring – being able to absorb people’s pain and anxieties without losing focus, treating patients as a human being rather than a symptom or collection of symptoms. Their integrity is without question.
- Takes time to listen and communicate honestly and effectively with patients, relatives, staff teams, managers, peers and dignitaries pitched at the appropriate level whilst putting everyone at ease.
Respect for everyone’s capabilities and their contribution to the team. Knowing everyone’s name in the team regardless of their position. Being fair and non-judgmental.
- Having technical skills, being competent, knowledgeable using evidence based practice. The ability to remain calm and proficient when under pressure and still make clear and timely decisions.
- Inspiring, always learning and teaching without fear of humiliation, lead and train the team as a team.
- Trustworthy, loyal, dedicated, thorough, a mentor, reliable, respected rather than revered and dedicated to up holding their Hippocratic Oath.
- A visionary leader who is confident about their standards and stands firm to up hold their and the team’s values and beliefs.
A great doctor knows and remembers his/her patients and treats them with a kind heart and gentle hands as if they were one of their own family, dedicating their working life of service to creating and preserving health.”
All doctors that have spoken at our weekly MedSoc have stressed the concept that you must treat the patient and not the disease and as stressed by the visiting doctor the communication aspect of being a doctor is becoming increasingly more important. People skills were once overlooked in the past, now they reign the list of the most important qualities of a good doctor.
This has always been a topic of interest for me. After having both my grandmothers suffer from the condition it has incentivised me to find out more about the everyday occurring disease that scientists often turn a blind eye too.
Ultimately, Alzheimers disease is caused by the death of brain cells and being a neurodegenerative disease it worsens over time, often leading to dementia.
Each sufferer has their own individual relationship with the condition but most experience significant cognitive symptoms such as:
- Problems with their day to day memory with difficulties recalling recent events
- Difficulties with concentration and organising with strong indecisiveness and the inability to carry out a sequence of tasks
- Lack of visuospatial skills with issues judging distances and visualising 3D objects
- Losing track of the date and their location
- Difficulties with language and following a conversation or finding the right work to express themselves
Additionally many sufferers battle with severe mood changes causing them to be anxious or unusually sad in particular situations.
So what actually causes Alzheimers?
Clumps of protein, known as “plaques” and “tangles”, gradually form in the brain. The plaques and tangles are thought to be responsible for the increasing loss of brain cells. These brain cells become surrounded by an abnormal protein which leads to an alteration of their internal structure which ultimately interferes with the chemical connections within the brain.
How is the Alzheimers and Dementia diagnosed?
Making a diagnosis of dementia is often difficult, particularly in the early stages. This is because there is no one simple test and early symptoms can be similar to those of lots of other common conditions. The first port of call, as usual, is the GP. They often prefer to assess and observe their behaviour in the patients home as the person is in a familiar environment. The GP will assess the person through the following procedures:
- The GP will spend some time talking to the person and someone who knows them well and will ask about how and when the symptoms started and how they are affecting the person’s life. The GP will look at the person’s medical history and those of other family members. They will also review the medicines the person is taking.
- The GP may also carry out a physical examination, particularly if a stroke or Parkinson’s disease is suspected. They will also take samples (blood and possibly urine) to send off for tests. These may identify other conditions that are causing the symptoms.
- The GP will ask the person a series of questions or give them a short pen-and-paper test. These are designed to test thinking, memory and orientation.
If there is cause for concern the patient is often referred to a specialist and CT scans can be taken for further diagnostics. The image below shows a CT scan of a patient with Alzheimers.
After the consultation the following information will become known:
- details on symptoms and the prognosis for the future
- type of dementia one has
- potential appropriate treatments for the patient
- care and support services
- information on financial and legal advice
What increases your risk of Alzheimers?
Risk factors associated with this disease include age (as the disorder is more prevalent in older patients) and family history (the inheritance of genes which have stimulated the disorder has been proven to increase your risk of Alzheimers)
What are the implications for the carers?
In the UK there are over 700,000 carers of demential patients who are unpaid. These carers release the burden on the NHS by over £12billion but there knock on effects for those taking on the mammoth task.
A recent survey revealed 9 in 10 carers for people with dementia experience feelings of stress or anxiety several times a week and a further 80 per cent find it difficult to talk about the emotional impact of caring. This is a worrying statistic and has certainly made me reflect upon my family’s personal experiences with the disease. However there is no doubt the unconditional love for the family member makes each tough day worthwhile. There is currently an extensive research programme surveying potential cognitive behavioural therapy with the hope of with further information on the disease. With this comes greater guidance for carers on how to cope with the every day struggles.
The unpredictable nature of a dementia patients can lead to caring being an incredible arduous task, incomparable to those with physical disabilities. Often being a carer can have detrimental problems to one’s health including sleep deprivation and can lead to an individual losing the social aspect of their lifestyle.
I can say from family experience that caring for someone with dementia is an emotionally discerning experience, seeing the person you know and love so well become less and less like themselves to such an extent where they no longer recognise who you are is truly heartbreaking. I strongly believe more should be done to ease the pressure on carers and help them cope with this life changing experience.