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Key Questions - Mental Health

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Tony Leiba, PhD, PGCE, RNT, RMN, is professor of educational development (mental health), Faculty of Health and Social Care, London South Bank University and North East London Mental Health Trust.

What is the Mental Health Act 1983 about?

This act covers the assessment, treatment and rights of people with a mental health condition.

People can only be detained if the strict criteria in the act are met. The person must be suffering from a mental disorder as defined by the act. The relevant disorders are detailed in the Diagnostic and Statistical Manual of Mental Disorders DSM IV (2000).

The application for assessment or treatment, which is made by an approved social worker or the nearest relative, must be supported in writing by two registered medical practitioners. The recommendation must include a statement about why an assessment and/or treatment is necessary, and why other methods of dealing with the person are not appropriate.

What is meant by stigma in mental health?

People with mental disorders are sometimes subjected to critical and derogatory attitudes. The media, although it is not wholly to blame, often portrays stereotypes or fails to clarify misunderstandings, thus helping to perpetuate myths.

People with mental disorders continue to experience prejudice and discrimination in every area of their lives, from finding somewhere to live to getting a job. It is up to all of us to become aware of the harm done by negative attitudes.

Are people with mental illness violent?

In current media reports, there is a tendency to emphasise the supposed link between violence and mental illness. News stories regularly suggest that there is a strong connection between mental illness and crime. However, the majority of people who are violent do not have mental illnesses. In fact, people with a mental illness are more likely to be victims, rather than the perpetrators of violence.

This most often occurs when such factors as poverty, transient lifestyle and substance misuse are present. Any of these factors makes a person with mental illness more vulnerable to assault and the possibility of becoming violent in response.

Mental illness plays no part in the majority of violent crimes. However, symptoms that may cause the person to feel threatened and/or involve the overriding of personal control (such as command hallucinations or feeling that one’s mind is being dominated by outside forces) coupled with harassing or bullying the person, may result in aggression or violence.

Alcohol and substance misuse far outweigh mental illness in contributing to violence.

What is meant by dual diagnosis?

There is no common understanding about what is meat by dual diagnosis. To answer this question it will be defined as the co-existence of mental health and substance misuse problems.

Dual diagnosis can suggest that there are only two problems. In fact many people have multiple needs. These might include one or more medical problems and a range of social issues such as housing, income, employment and social isolation.

The term dual diagnosis does not specify the disorders and so could potentially apply to a person with any two conditions, for example a learning disability and a mental health problem.

The relationship between mental health and substance misuse is complex, controversial and varies from person to person. There are four possible relationships:

A primary mental health disorder precipitates or leads to substance misuse;
Use of substances makes the mental health disorder worse or alters its course;
Intoxication and/or substance dependency leads to psychological symptoms;
Substance misuse and/or withdrawal leads to mental health symptoms or illnesses.

What treatments are available for people with mental health problems?

People with mental illness may receive medical treatment from:

  • A GP, who can provide ongoing treatment to many people. They also play a vital role in ensuring that a patient’s physical health is not neglected;

  • A psychiatrist, who provides specialist treatment for mental illness. Most people affected by mental illness will have contact with a psychiatrist at some stage of their illness.

  • Treatment and help is available in hospitals and community mental health services.

Clinical treatments are:

  • Medication - the main ones are antidepressants, antipsychotics and mood stabilisers;

  • Psychological therapies such as cognitive behaviour therapy, interpersonal psychotherapy and dialectical behaviour therapy.

Other forms of treatments may involve: community support; electroconvulsive therapy; hospital admission; involuntary treatment; and social and occupational therapy.

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