This document discusses links between mental health and physical health. It begins by outlining what will be covered, including identifying mental distress, common mental health issues, and the link between diet/exercise and mental health. It then addresses several myths about mental health, including that problems are rare, that those with problems are violent, and that people cannot recover. It also discusses stigma and discrimination faced by those with mental health issues.

1. Links between Mental Health and
Physical Health
This session will cover:
- How to identify mental distress
-A brief overview of common Mental Health
issues
- The link between diet/physical exercise and
Mental Health
- Agencies you can refer to for further advice

2. Myth or Fact

3. Mental Health problems are rare?
Myth
Mental health problems affect one in four
people in any one year. So, even if you don’t
have a mental health problem, it’s likely your
best friend, a family member or work
colleague/fellow student will be affected

4. People with mental health problems
are violent?
Myth
People with mental health problems are
much more likely to be the victim of violence.
The violence myth makes it harder for people
to talk openly about mental health problems.
It can also make friends reluctant to stay in
touch.

5. People can recover completely
from a mental illness?
Fact
Many people can and do recover completely
from mental health problems. Alongside
professional help, the support of friends,
family and getting back to work are all
important in helping people recover.

6. People with severe mental illnesses
die ten years younger?
Fact
But it’s not the mental illness that kills- it’s the
discrimination. The physical health needs of
people with mental health problems are often
dismissed, causing higher rates of death
from heart attacks, diabetes and cancer for
people with severe mental illness.

7. You can be open about mental health
problems without fearing you’ll be
treated differently
Myth
People fear telling friends, family and work
colleagues if they have a mental health
problem because of stigma. In fact, 87% of
people with a mental health problem have
experienced discrimination

8. Attitudes towards Mental Health
 In a Survey by The Mental Health Foundation in 2000:
 42% of people with mental health problems didn’t tell
members of their family.
 22% didn’t tell their partners.
 74% didn’t mention it on forms.
 19% didn’t even tell their GP.

9. If you use a mental health service, there’s a one in four
chance you’ll lose contact with friends
Myth
Sometimes friends feel like they don’t know
enough to be able to help or feel
uncomfortable. But you don’t need to be an
expert on mental health to be a friend. It’s
often the everyday things, like a phone call or
text, that makes a difference.

10. There’s not much you can do to help a friend
experiencing a mental health problem
Myth
If someone you know is experiencing a
mental health problem, just staying in touch
can really help. For many people, it is the
small things that friends do that can make a
difference like visiting or phoning.

11. How much impact do Mental Health
issues have on the UK economy? £££
Mental health problems are estimated to cost
the UK economy over £77 billion a year
through the costs of care, economic losses
and premature death (The Economic and
Social Costs of Mental Illness 2003, The
Sainsbury Centre for Mental Health).

12. You’re more likely to be hired if you have a
physical disability than a mental health
issue
Fact
Only four in ten employers would hire
someone with mental health problems
Six in ten would hire someone with a physical
disability

13. Hanwell Asylum - 1848

14. Southall Park Asylum Fire
 This is part of the report from the British Medical Journal, 15th
September, 1883 about the fire at Southall Park Asylum. It seems that
most victims died through smoke inhalation and a servant leaped from
the roof and died from her injuries.
 ‘It appears, from the evidence of Mr Frere, one of the Commissioners
in Lunacy, that, some time ago the danger of fire was noticed by the
Commissioners, and certain means of escape, in the way of external
ladders and staircases, were suggested. This suggestion was not
persevered for as Mr Frere pointed out, ‘the object of an asylum is not
to provide means of exit, but to secure the custody of the patients’. Dr
Boyd, able and distinguished in psychological medicine, and
experienced in the custody of the insane, thought the proposed
alterations would endanger the primary object of the asylum; and the
Commissioners in Lunacy seem to have yielded to his opinion.’

15. Map of the Hanwell
Asylum Grounds
Facilities in the grounds included:
- A printers
- Tailors and Shoemakers
- Coach house and stables
- Blacksmiths
- Bakery
- Brewery
Patients were encouraged to work at the
facilities in the compound as part of their
ongoing therapy

16. What causes mental health problems?
 No single cause, a combination of:
 Genetics
It's possible that some people may be more prone to developing problems than others. For
example, some problems seem to run in families, suggesting there is a genetic reason for
some diagnoses; for example, schizophrenia.
 Life events
There are many reasons why you may get depressed or elated in response to what's
happened in your life, and certain events may trigger your mental distress. It has been
suggested that we all have the potential to have mental health problems, and it is
exposure to certain forms of stress that causes the problems to appear.
It is difficult to say, sometimes, whether life events are the cause of certain difficulties, or
the effect of them. For example, you may have depression, causing you to sleep badly;
alternatively, if you are not sleeping well, this may result in you feeling anxious or
depressed. The same holds true for changes in appetite or eating habits.
 Brain chemicals
There is evidence that mood problems are linked to changes in brain chemistry, but it isn't
possible to say which comes first, the mood change or the chemical change.

17. Early signs of Mental Distress
 Losing interest in activities and tasks that
were previously enjoyed.
 Poor performance at work.
 Mood swings that are very extreme or fast
and out of character
 Self-harming behaviour, such as cutting
 Changes in eating habits and/or appetite:
over-eating, bingeing, not eating.
 Loss of, or increase in, sexual desire.
 Sleep problems.
 Increased anxiety, looking or feeling ‘jumpy’
or agitated, sometimes including panic
attacks.
 Feeling tired and lacking energy.
 Isolating yourself, socialising less; spending
too much time in bed.
 Wanting to go out a lot more, needing very
little sleep, feeling highly energetic, creative
and sociable, making new friends rapidly,
trusting strangers or spending excessively –
this may signal that you are becoming 'high'.
 Hearing and seeing things that others don't.
 Other differences in perception; for example,
mistakenly believing that someone is trying
to harm you, is laughing at you, or trying to
take over your body.

18. If you are concerned about a client’s
Mental Health
 Discuss your concerns with the person:
– Choose a quiet, private time when they are not agitated.
– Advise them of your concerns about their recent changes in
behaviour or manner.
– Try not to argue if they become defensive, instead
approach the subject again in the near future.
 Encourage them to book an appointment with their
GP to discuss their concerns. If appropriate offer to
attend the appointment with them, even if you wait in
the waiting room, while they speak to the GP.
 Assist them to call the Mental Health & Well-being
Service on 020 3313 5660 and self refer

19. If someone has been diagnosed with a
MH condition
 Researching their condition: Join a support group for carers/friends
of people with the condition, with permission of the person you could
attend their GP with them and ask questions about how you can help
and the warning signs to look out for.
 Just being there, listening when the person is distressed, and
helping them to complete everyday tasks. Develop code words for
when you are concerned about the persons behaviour e.g. you seem
a bit 'yellow' today is a non judgmental way to describe increasing
manic or erratic behaviours.
 Ensuring that they are eating healthily, exercising – even if it’s just
the pair of you walking around the park on a regular basis, and
socialising with others.

20. 5 elements of wellbeing
 Connect – interact and build relationships with
people around
 Be Active – go outside, take a walk, do physical
activity on a regular basis
 Take notice – be curious, look for changes in your
surroundings
 Keep Learning – take up a new hobby or course,
within work or outside of it
 Give – share your skills with those around you,
volunteer, join a community group

21. What is…. Bipolar Disorder, also
known as manic
depressive illness, is a
serious medical illness
that causes shifts in a
person's mood, energy,
and ability to function.
Different from the normal
ups and downs that
everyone goes through,
the symptoms of bipolar
disorder are severe.
Bi-Polar Disorder

22. Panic Disorder
Panic Disorder
Panic disorder is an anxiety disorder and is characterized by unexpected and repeated
episodes of intense fear accompanied by physical symptoms that may include chest
pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
Signs & Symptoms
People with panic disorder
have feelings of terror that
strike suddenly and
repeatedly with no warning.
During a panic attack, most
likely your heart will pound
and you may feel sweaty,
weak, faint, or dizzy. Your
hands may tingle or feel
numb, and you might feel
flushed or chilled. You may
have nausea, chest pain or
smothering sensations, a
sense of unreality, or fear of
impending doom or loss of
control.

23. Obsessive compulsive
disorder (OCD)
is a chronic mental health condition that is
usually associated with both obsessive
thoughts and compulsive behaviour.
Obsessions
An obsession is defined as an unwanted
thought, image or urge that repeatedly
enters a person’s mind.
Compulsions
A compulsion is defined as a repetitive
behaviour or mental act that a person feels
compelled to perform. Unlike some other
types of compulsive behaviour, such as an
addiction to drugs or gambling, a person
with OCD gets no pleasure from their
compulsive behaviour. They feel that they
need to carry out their compulsion to
prevent their obsession becoming true. For
example, a person who is obsessed with
the fear they’ll catch a serious disease may
feel compelled to have a shower every time
they use a public toilet

24. Phobias
A phobia is an anxiety disorder. It is an extreme or irrational fear of an animal, object,
place, or situation. Phobias are more than simple fears. They develop when a person
begins to organise their life around avoiding the things they are afraid of. If you have a
phobia, you will have an overwhelming need to avoid all contact with the source of your
anxiety. Coming into contact, or even the thought of coming into contact, with the cause
of your phobia will make you anxious and may cause you to panic. If the cause of your
phobia is an object or animal, such as snakes, and you do not come into contact with it
regularly, it is unlikely to affect your day-to-day life. However, if you have a more
complex phobia, such as agoraphobia (the fear of open spaces and public places), you
may find it very difficult to lead a normal life.

25. What Anxiety feels like
 Anxiety can be experienced as a range of feelings from uneasiness to severe
panic. It is usually experienced in three ways:
 Emotionally: with feelings of fear and nervousness.
 Physically: dry mouth, feeling sick or a churning stomach, heart beating faster
than usual, sweating, shaking, wanting to go to the lavatory all the time,
breathing difficulties.
 Cognitively: frightening thoughts, such as "I'm going to fail / make a fool of
myself / losing control / I'm going mad" and so on.
 At worst, anxiety and the fear of panic attacks can affect our life and behaviour
in all kinds of ways: we may be unable to work or sleep, find ourselves avoiding
people or places, or trying to cope by drinking or smoking too much.

26. Clinical Depression
 Depression is a serious illness. It is very
different from the common experience of
feeling miserable or fed up for a short
period of time.
 When you’re depressed, you may have
feelings of extreme sadness that can last
for a long time. These feelings are
severe enough to interfere with your daily
life, and can last for weeks or months.
 15% of people will have a bout of severe
depression at some point in their lives.
Women are twice as likely to suffer from
depression as men, although men are far
more likely to commit suicide.
 Depression can affect people of any age,
including children.
 People with a family history of
depression more likely to experience
depression themselves. Depression can
cause a wide variety of physical,
psychological (mental) and social
symptoms.
 Depression is a real illness with real
effects, and it is certainly not a sign of
failure.

27. Finding it hard to enjoy activities you used to

28. Loss of appetite

29. Trouble sleeping

30. Medications used to treat Depression
 Depression is commonly treated with antidepressant medications. Antidepressants work to balance some
of the natural chemicals in our brains. These chemicals are called neurotransmitters, and they affect our
mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin,
norepinephrine, and dopamine
 The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs).
These include:
- Fluoxetine (Prozac) – Increases appetite, also prescribed for certain eating disorders
Increases appetite, also prescribed for people with eating disorders
- Citalopram (Celexa)- Most commonly prescribed by GPs
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Escitalopram (Lexapro)
- Venlafaxine- Combats depression and underlying anxiety, prescribed by psychiatrists, NOT GPs
Anti-depressants not addictive in themselves, but should not be stopped abruptly and patients should
wean themselves off them gradually.
* Debate over effectiveness?

31. Side effects of Anti-Depressants
 Headache, which usually goes away within a few days.
 Nausea (feeling sick to your stomach), which usually goes
away within a few days.
 Sleeplessness or drowsiness, which may happen during the
first few weeks but then goes away. Sometimes the medication
dose needs to be reduced or the time of day it is taken needs to
be adjusted to help lessen these side effects.
 Agitation (feeling jittery).
 Sexual problems, which can affect both men and women and
may include reduced sex drive, and problems having and
enjoying sex.

32. What should I ask my doctor if I am
prescribed a psychiatric medication?
 You and your family can help your doctor find the right medications for you. The
doctor needs to know your medical history; family history; information about
allergies; other medications, supplements or herbal remedies you take; and
other details about your overall health. You or a family member should ask the
following questions when a medication is prescribed:
 What is the name of the medication?
 What is the medication supposed to do?
 How and when should I take it?
 How much should I take?
 What should I do if I miss a dose?
 When and how should I stop taking it?
 Will it interact with other medications I take?
 Do I need to avoid any types of food or drink while taking the medication? What
should I avoid?
 Should it be taken with or without food?
 Is it safe to drink alcohol while taking this medication?
 What are the side effects? What should I do if I experience them?
 Is the Patient Package Insert for the medication available?

33. What medications are used to treat
anxiety disorders?
 Benzodiazepines (anti-anxiety medications)
 The anti-anxiety medications called benzodiazepines can start working
more quickly than antidepressants. The ones used to treat anxiety
disorders include:
 Clonazepam (Klonopin), which is used for social phobia and GAD
 Lorazepam (Ativan), which is used for panic disorder, highly addictive.
Side effects include- anger issues/violent episodes. Widely used for
violent inpatients to calm them.
 Alprazolam (Xanax), which is used for panic disorder and GAD. Not
widely used in the UK
 Buspirone (Buspar) is an anti-anxiety medication used to treat GAD.
Unlike benzodiazepines, however, it takes at least two weeks for
buspirone to begin working.
 Citalopram- Commo

34.  In the UK, smoking
rates among adults
with depression are
about twice as high as
among adults without
depression. People
with depression have
particular difficulty
when they try to stop
smoking and have
more severe
withdrawal symptoms
during attempts to
give up.
 Nicotine stimulates the
release of the
chemical dopamine in
the brain. Dopamine is
involved in triggering
positive feelings. It is
often found to be low
in people with
depression, who may
then use cigarettes as
a way of temporarily
increasing their
dopamine supply.
 However, smoking
encourages the brain
to switch off its own
mechanism for making
dopamine so in the
long term the supply
decreases, which in
turn prompts people to
smoke more.
between the two.
Smoking and depression

35. Cannabis and
Mental Health
Even hardcore smokers can
become anxious, panicky,
suspicious or paranoid.
If you’ve a history of mental
health problems, then taking
cannabis is not a good idea: It
can cause paranoia in the short
term, but in those with a pre-
existing psychotic illness, such
as schizophrenia, it can
contribute to relapse.
If you use cannabis and have a
family background of mental
illness, such as schizophrenia,
you may be at increased risk of
developing a psychotic illness.

36. Alcohol
Alcohol may relieve stress in the short term, but
it is a depressant drug. This means if you're
feeling down when you drink, chances are the
issues are going to seem worse when you
sober up.
Drinking interferes with sleep patterns, which
can leave you feeling ragged. Bad sleep also
has an effect on mental agility and stress
management.
Regular drinking is usually a factor in worsening
existing mental problems. It is often linked to
depression, especially because people tend to
turn to alcohol in a bid to improve their mood.
Alcohol interferes with the way antidepressants
work, which makes it bad news for anyone
taking medication for a mental health problem.
Mixing alcohol with any kind of medication
carries risks, and can be fatal in some cases.

37. Junk Food leads to Depression?
Each participant completed a
questionnaire about their eating
habits and a self-report assessment
for depression five years later.
The researchers found that those
with the highest consumption of
processed food were 58 per cent
more likely to be depressed five
years later than those eating the
least amount.
Why is this the case?

38. Symptoms and suggested dietary
changes mix and match
Feeling tired all of the time
Feel low in the winter
Feel unmotivated
Stressed/Anxious or
Hyperactive
Lack of seeds/nuts and
green vegetables
Lack of Omega-3 fats
Chromium minerals
Lack of Vitamin D

39. Symptoms answers
Feeling tired all of the time
Feel low in the winter
Feel unmotivated
Stressed/Anxious or
Hyperactive
Chromium is
recommended to balance
blood sugar
Lack of Vitamin D
Lack of Omega-3 fats
Lack of seeds/nuts and
vegetables

40. Omega-3
What do the numbers along the bottom represent?

42. Omega-3
 One of the most potent mood boosting ‘drugs’ in
capsule form
 Higher chance of pregnant women suffering
depression if lower intake of Omega-3
 A lack of fish or fish oil is linked to hostility and
aggression
 Higher levels of Omega-3= higher levels of Seratonin
 Greater reduction in depression than anti-
depressants (15% compared to 50%)

43. Chromium
 Daily supplements of chromium reduces
carb. Cravings and improved mood, energy
levels and weight gain perception
 Helps maintain insulin function, diabetics are
twice as likely to suffer from depression than
general population

44. Practical Support for people with
Mental Health Issues
 Health Trainers
 Advocacy
 Vocational Advisors
 Support Groups

45. What is Advocacy?
Advocacy is defined as taking action to help people say what
they want, secure their rights, represent their interests and
obtain services they need
Advocacy sees things from the service user’s perspective
Advocacy helps to build confidence and skills and supports
individuals to make decisions
Secure diverse solutions for diverse needs

46. Examples of what we have supported clients with
Information & signposting / Care & treatment issues
Health education / Making complaints & appeals /
Housing / Obtaining services / Debt /
Benefits / Accessing support groups /
/ Education / University /
Arranging meetings with others /
And much more….

47. Primary Care
Counsellor
Ealing PCT
Mental Health & Wellbeing Service
Referral Pathways in Mental Health
GP Diagnosis
Mild/Moderate Common
Mental Health Problem:
Referral via PCMHW SAQ
Moderate/Severe Common
Mental Health Problem:
Referral via CBT Referral form
Severe & Enduring Mental Illness:
Referral via letter
Uncertain
Mental Health presentation:
Referral via GW SAQ
PCMHW:
Gateway Worker:
CMHRC
Secondary/Tertiary
Services
Most appropriate
referral
Intervention
post assessment
Guided Self-help CBT
Signposting/Referral:
•ADVOCACY
•Other Primary/Secondary
services
•Voluntary/Community
services
•Vocational Advisor
Face to face CBTCBT Therapist
Counselling

48. Groups the MH & WB Service Run
 Mood Improvement (Depression)
 Low Self-Esteem
 Anxiety Management
 Stress at Work
 Anger Management
 Mindfulness-based CBT

49. What do we look for?
 Two main sets of psychological measures
 Patient Health Questionnaire- (PHQ-9)
 General Anxiety Disorder (GAD-7)
 Could you incorporate any of these questions
in your workshop sessions?

50. Office Hours contacts (9-5)
 The Mental Health and Wellbeing Service
 Local Community Mental Health Teams
(CMHTs)
 Details in the ‘Blue Book’

51. Out of hours support
 Samaritans- 08457 90 90 90
 NHS Direct- 0845 46 47

52. Who to Contact
Mental Health and Wellbeing Service-
 Community Mental Health Teams-
 Southall Norwood- Southall
 Lammas Centre- Acton and Central Ealing
 Manor Gate- Northolt

53. Thank you for attending this
presentation. Any questions?