Interventions to Improve MH

Public Sector Equality Duty - equality of opportunity, good relations between those who share protected characteristics and those who do not

- NHS ethos - universal, comprehensive, free
- Policies aimed at reducing persistent inequalities in health and social care

- Prediction of illness and patterns
- Support service design and delivery
- Facilitates intersectional approach

- 1.5x risk of depression
- 2-4x risk of suicide in gay men
- 2x self-harm rates

- 6-9x greater risk of schizophrenia in black people
- 4x more likely to be sectioned
- Worse care reported

- 2:1 depression ratio in women to men
- 60% OCD and phobia
- PTSD 20% for women, 8% for men

- Children with parents who have severe mental illness - greater levels of emotional, psychological and behavioural problems

- 40% deaf children experience MH difficulties
- 33% depression and anxiety
- 90-95% born to hearing households

Endler et al.
- Cognitive (worry)
- Autonomic (emotional/physiological)

Spielberger
- Individual difference in anxiety proneness

- 25% variance in neuroticism due to genetics

- Trait anxiety positively correlated with selective attention to threat stimuli
- Trait anxiety stronger predictor than state anxiety

- Emotional Stroop task - phobics pay more attention to fear related word
- Dot Probe task - word pairs (threat and non-threat) followed by dot probe in same position, more focus on threat word
- Homophone spelling - trait-anxious write threatening word

Processing stage theory
- Anxiety impacts automatic processing
- Stimulus input --> state effect --> trait effect

Hypervigilance theory
- Trait anxious scan environment for threat excessively and lock onto it

S-REF theory
- Anxiety associated with activation of Cognitive Attentional Syndrome (CAS)
- Involves self-focus, worry, monitoring for threat

- Acute stress - within 4 weeks of exposure, decreases within 4 weeks. Persistence results in
- PTSD - occurs after trauma

- Social skills deficit - little support, patients lack social skills
- Cognitive behaviours model (Clark and Wells) - draws on Beck's theory, coping responses are no deficits but are central to anxiety maintenance

- Overgeneralisation
- Magnification or minimisation
- Mind reading
- Arbitrary inference

1. Trigger stimulus
2. Perceived threat
3. Body sensations
- Panic results from catastrophic misinterpretation of interal sensation

- 50% effectiveness in GAD and MDD
- Higher recovery in panic and social phobia

1. ID, assessment, active monitoring
2. low-intensity treatment e.g., self-guided help
3. high intensity treatment e.g., CBT
3+. multi-disciplinary treatment

- Relapse rates
- No more effective than exposure

Wells
- Thoughts don't matter, response does
- Psych distress maintained by style of thinking (cognitive attentional syndrome)

- Negative MCB - uncontrollability/dangerousness of worry
- Positive MCB - benefitssefulness of worry

- Type 1 worry - social, self, world
- Type 2 worry - meta-worry, worrying abnormal, crazy
- Challenging beliefs, evidence of thought, free association etc.

- Formulating - identifying thoughts, explaining how they maintain symptoms
- Normalisation - challenging stigma, correcting misconceptions
- Improving coping - understanding psychosis, responding differently
- Challenging beliefs

1. Substance use causes psychosis - 6x likelihood if THC used before 18
2. Substance use is a result of psychosis - psych patients use THC when paranoid
3. Common origin
4. Bidirectional

- Combines other interventions
- Precontemplation, contemplation, preparation, action, maintenance and relapse
- Motivational interviewing

- Based on Skinner's ideas of reinforcement
- Rewards and incentives to maintain abstinence

- Kroenke and Price - 31% of 26 common symptoms medically unexplained
- Koch et al - 43% with fatigue still unexplained a year on

- Positively correlated (Pawlikowska)
- Emotion results in increased vigilance, can have physical sensations

- Rejecting - denying symptoms outright
- Colluding - GP sanctions patients own explanation
- Empowering - prove tangible mechanisms and offer solutions for self-management

- CBT - can promote behavioural changes that would offset the symptoms
- Reattribution therapy - making link and collaborating on treatment

- Moors
- Appraisal, motivational, somatic, motor and feeling

- Damasio
- 'Body loop' - emotion evoked by changes in body
- 'As-if body loop' - cog. representations of emotion activated without physical sensation

- Predisposing - what factors make P vulnerable?
- Precipitating - what event led to this?
- Presenting - what is the problem? How does P know it is a problem?
- Perpetuating - what keeps the problem going?
- Protective - what does P have in life that is positive?

- IPT framework - aims to solve life situations causing depression
- Behavioural action framework - behaviours maintain negative symptoms, must schedule activities to overcome

- Unipolar depression
- Unipolar mania
- Bipolar I - typical jumps between mania and depression
- Bipolar II - mania last minimum 4 days (hypomania) rather than a week (mania)

Mania and depression do not meet regular threshold

- Medication - high relapse rates
- Psych treatments - reduced rates of relapse
- Family - reduced relapse, symptoms and hospitilisation
- CBT - reduced symptoms, increased functioning

- Mansell
- Beliefs about internal states drive the behavioural strategies that maintain and escalate symptoms

- Goals less dependent on internal state
- Goal identification, plotting continuum

- All psychoses higher in Black populations
- Misdisagnoses, biological hypotheses, psychsocial factors

- 92% completed all 10 session
- 80% agreed they had learnt something and had a better relationship with their families

- Dewey
- Control
- Hierarchies - long term goals implemented by lots of small short term goals
- Conflict - person tries to control same experience in opposing directions
- Reorganisation - control systems change through trial and error to recude conflicts

- Powers, Corey
- Identify problem and present moment disruptions