Patel V. Where There Is No Psychiatrist. A Mental Health Care Manual

Gaskell, 2003. — 290 p.Where There Is No Psychiatrist - A Mental Health Care Manual by Vikram Patel is an invaluable reference guide and go-to handbook for anyone who might need to offer or receive psychological/psychiatric help.Mental illnesses are common and cause great suffering to individuals and communities everywhere in the world, but many health workers are more comfortable dealing with physical illness. This practical manual of mental health care is vital for community health workers, primary care nurses, social workers and primary care doctors, particularly in low-resource settings. This guide gives the reader a basic understanding of mental illness by describing more than thirty clinical problems associated with mental illness and uses a problem-solving approach to guide the reader through their assessment and management. Mental health issues as they arise in specific contexts are described - in refugee camps, in school health programmes, as well as in mental health promotion. The final section helps the reader to personalise for a particular location, for example, by entering local information on voluntary agencies, the names and costs of medicines and words in the local language for symptoms.Health in its broadest sense includes physical and mental health. Even though many health workers agree with this broad conception of health, in reality the focus is mainly on physical health. There are many reasons for this. Probably the most important reason is that health workers do not understand much about mental health and are therefore less comfortable dealing with mental health problems. However, in recent years there has been growing awareness about various types of mental illnesses. Many health workers have become more interested in dealing with these problems. Mental illnesses have been shown to be common, occurring in all societies and in all sections of any society. We now know that mental illnesses cause great suffering and disability. As well as in the general adult population, mental illnesses have been found to occur in children, in the elderly and in mothers. Mental health is no longer a subject for the specialists; in fact, it is a basic aspect of care for any health worker in any community. It is essential that, just as with physical illnesses, the health worker is well informed about mental illnesses. It is with this goal in mind that this manual has been written.This manual was written for two key reasons. The first is that there are no practical, clinically oriented manuals for mental health care designed for general health workers. Those that exist focus entirely on medical practitioners or are in the form of local handouts or leaflets, and so lack depth. The second reason is that in my years of working in developing countries I have realised that the single biggest obstacle to achieving our shared goal of mental health for all is the increasingly complex and technical language of psychiatry. I have sought to break down the wall that psychiatry has built around itself, with the aim of liberating mental health from its hold. In the process, I hope this manual will serve to empower health workers to feel confident to deal with mental illness. This manual has been written with the needs of the general health worker in mind. Who might this be? It would include anyone who works in a health care setting, or who works with people who are ill, but who is not specially trained to work with persons with mental illness. Thus, this manual can be used by the community health worker, the primary care nurse, the social worker and the general practitioner. This fairly diverse group of health workers will have different levels of training and skills. However, they all often have in common a low level of awareness about mental illnesses and their treatments. Furthermore, because the ‘medical’ treatment of most mental illnesses is relatively straightforward, this is one topic that can be communicated to both medical and non-medical health workers in a similar medium. Of course, some readers may find the manual too simple, while others may find it too complex. I only hope that most find it easy to follow and use in their day-to-day clinical work.Table of ContentsList of boxes and tables
Foreword by David Morley
Preface
Acknowledgements
How to use this manualPart I. An overview of mental illnessAn introduction to mental illness
Mental health and mental illness
Why should you be concerned about mental illness?
The types of mental illness
Common mental disorders (depression and anxiety)
‘Bad habits’
Severe mental disorders (psychoses)
Mental retardation
Mental health problems in the elderly
Mental health problems in children
The causes of mental illness
Culture and mental illnessAssessing someone with a mental illness
Can you examine a mentally ill person?
Will you have the time to talk to someone who may have a mental illness?
Who will have a mental illness?
What to ask a person with a probable mental illness
Symptom checklists to diagnose mental disorders
To diagnose a common mental disorder (depression or anxiety)
To diagnose a severe mental disorder
To diagnose alcohol (or drug) dependence
What to look for during the interview
How to conduct interviews
How to reach a diagnosis
Special situations in assessment
Assessing someone who refuses to talk
Assessing physical complaints in a person with a mental illness
Assessing someone on the telephone
Assessing someone with the family presentThe treatment of mental illness
Drug treatments
When to use medicines
Which medicines to use
What if the person does not improve?
What if there are side-effects?
When are injections needed in the treatment of mental illness?
Cost of medicines
How to make sure people take medicines
Talking treatments and counselling
Give reassurance
Provide an explanation
Relaxation and breathing exercises
Advice for specific symptoms
Problem-solving
Counselling in a crisis
Rehabilitation for the mentally ill
The importance of follow-up in the treatment of mental illness
Other treatments
Referring to a mental health specialistPart II. Clinical problems
Behaviours that cause concern
The person who is aggressive or violent
Why do mentally ill people become aggressive?
How to deal with this problem
The person who is confused or agitated
What are the causes of confusion and agitation?
How to deal with this problem
The person who is suspicious, has odd beliefs or is hearing voices
What is ‘hearing voices’?
Why do some people have these experiences?
Can ‘normal’ people have these experiences?
How to deal with this problem
The person who is thinking of suicide or has attempted suicide
Why do some people want to end their life?
Gender and suicide
How to deal with this problem
The medical treatment of suicide attempts
When suicide becomes a crime
What to do when the family is not interested
The person who threatens or attempts suicide again and again … and again
Loneliness and isolation
Someone with seizures or fits
What types of seizures are there?
Is epilepsy a mental illness?
The important medical causes of seizures
How to deal with this problem
When fits don’t stop: status epilepticus
Advice to the person with epilepsy and family
Prescribing drugs for a person with epilepsy
The mother who becomes disturbed after childbirth
Why do some mothers become disturbed after childbirth?
Why is the mother’s mental health important?
How to deal with this problem
The elderly person with disturbed behaviour
What can make an elderly person behave like this?
Deciding what’s wrong
Memory problems in old age: when is this abnormal?
When should you suspect dementia?
How does dementia affect the family?
Why is diagnosis of dementia important?
How to deal with this problemSymptoms that are medically unexplained
The person with multiple physical complaints
Why are physical complaints relevant to mental health?
When to suspect that physical complaints are related to mental illness
How to deal with this problem
The person who worries, gets scared or panics
Fear and panic
Being scared of specific situations
Why do people worry or have panic attacks or phobias?
How to deal with this problem
The person with sleep problems (insomnia)
How does insomnia affect the person?
What causes insomnia?
How to deal with this problem
The person who is tired all the time
Why do some people feel tired?
When to suspect that tiredness is the result of a mental illness
Is tiredness the same as laziness?
How to deal with this problem
The person who complains of sexual problems
Sexual problems in men
Sexual problems in women
Abnormal sexual behaviour
How to deal with this problem
Special interview suggestions
Same-sex relationships and mental health
Sex and the mentally handicapped
Sudden loss of a body function
How can something so ‘physical’ happen because of mental problems?
Can this happen like an epidemic?
When to suspect a psychological cause
How to deal with this problem
The person who repeats the same behaviour again and again
How to deal with this problemHabits that cause problems
The person who drinks too much alcohol
How much drinking is ‘too much’?
Why do some people drink too much?
What does drinking too much do to a person and the family?
When should you suspect that a person has a drinking problem?
Gender and drinking
How to deal with this problem
Living with a person who has a drinking problem
The person who is abusing drugs
Does anyone who takes a drug have a problem?
What drugs are abused?
How are drugs used?
What does drug abuse do to the person?
Why do people use drugs at all?
Why do drug users seek your help?
When to suspect drug abuse
How to deal with this problem
The person with a sleeping pill habit
Why do people become dependent on sleeping pills?
When to suspect sleeping pill dependence
How to deal with this problem
The person with a tobacco dependence
Why tobacco use is dangerous
When to ask about tobacco use
How to deal with this problem
The person with a gambling habit
How does gambling become a habit?
Pathological gambling and health
When to suspect gambling is a problem
How to deal with this problemProblems arising from loss and violence
The person who has experienced a traumatic event
How does trauma affect health?
Why do some victims of violence develop mental illness?
How to deal with this problem
The woman who is being beaten or abused by her partner
Why is violence against women a health issue?
How do women suffering domestic violence present to health workers?
Why do some people beat or abuse their partners?How to identify domestic violence
How to deal with this problem
Working with men who are violent
The woman who has been raped or sexually assaulted
Why is rape a health issue?
How do women react to being raped?
Who rapes a woman?
How to deal with this problem
When men get raped
The person who has been bereaved
How does a person react to bereavement?
When is a bereavement abnormal?
How to deal with this problemProblems in childhood and adolescence
The child who is developing slowly
What is mental retardation?
What causes mental retardation (MR)?
When a child does not speak normally
How does mental retardation affect the child?
When should you suspect mental retardation?
How to deal with this problem
The child who has difficulties with studies
What causes children to have difficulties with studies?
How to deal with this problem
The child who cannot sit still
What is attention deficit hyperactivity disorder (ADHD)?
Why is ADHD an important problem?
How to deal with this problem
The child who has been abused
Why do children get abused?
How are children affected by abuse?
When to suspect child abuse
How to deal with this problem
The child who behaves ‘badly’
When is misbehaviour a health problem?
Why do children behave badly?
How to deal with this problem
The child who wets the bed
Why do children wet the bed?
How to deal with this problem
Soiling clothes
The adolescent who is sad or complains of aches and pains
Why do some adolescents feel sad?
Depression in adolescents
How to deal with this problemPart III. Integrating mental healthMental health in other contexts
Primary and general health care
Mental disorders in primary care
Primary mental health care
Improving the system
Reproductive health
Gynaecological health and mental health
Maternal health and mental health
Health of prisoners
Mental illness and crime
The mental health of prisoners
Caring for the mental health of prisoners
Improving the system
Refugees
Meet basic needs first
The mental health of refugees
Children involved in war
Mental health promotion in a refugee camp
Disasters
Disasters and mental health
Integrating mental health with disaster relief
Adolescent health
Growing up should be fun
Mental health issues
Integrating mental health with education
The provision of school-based counselling
Homeless people and street children
Homelessness and mental health
Street children
HIV/AIDS
Why should mental health be affected?
Integrating mental health with health care for those who are HIV positive
The health of the elderly
The mental health problems faced by the elderly
Caring for the elderly
Caring for carers
The stresses of caring
The mental health of carers
Promoting the mental health of carers
Helping a carer in distress
The mental health of health workers
Looking after yourself
When to seek professional helpMental health promotion and advocacy
Support groups for mental health
How do support groups work?
Setting up a support group
The first meeting
The role of the group leader
Basic rules of groups
Keeping the group going
The prevention of mental retardation
Before the child is born
At the time of childbirth
After childbirth
Early intervention for babies at high risk
Mental health promotion in schools
Promoting school mental health
When a child drops out of school
The early identification of mental illness
Detecting the onset of a new mental illness
Relapse prevention
Preventing alcohol and tobacco abuse
Prevention in the clinic
Prevention in the community
Prevention in schools and colleges
Promoting the rights of people with a mental illness
Human rights and mental illness
Relationships in distress
Why relationships break down
How to help rebuild relationships
Knowing when to separate
Poverty and mental health
Mental health promotion among the poor
Gender and mental health
Gender inequality and mental health
Promoting mental health for womenPart IV. Localising this manual for your areaMedicines for mental illness
Choosing the right medicine: cost and efficacy
A quick reference guide to medicines for mental illnesses
Cautions when using medicines for mental illness
Resources in your area
Resources for children
Resources for the elderly
Resources for drug and alcohol problems
Resources for women and domestic violence
Resources for families of the mentally ill
Mental health professionals
Telephone helplinesAppendix. Flow charts for clinical problem-solving
Behaviours that cause concern
Symptoms that are medically unexplained
Habits that cause health problems
Children with mental health problemsBibliography
Glossary of terms for mental illnesses and their symptoms
Please send us your comments
Index