Panic Attacks
Someone having a panic attack experiences a sudden and intense sensation of fear. They may feel they have lost control and feel desperate to get out of the situation that has triggered their anxiety (link to anxiety). Symptoms of panic attack include:
- rapid breathing
- feeling breathless
- sweating
- feeling very hot or cold
- feeling sick
- feeling faint or dizzy
- tingling fingers
- shivering or shaking
- racing heart or irregular heartbeat (palpitations).
The problem may get worse if over-breathing sets in because this triggers sensations such as confusion, cramps, pains and feelings of weakness. The symptoms of a severe panic attack can be quite similar to a heart attack and someone experiencing one may be convinced they are going to die.
To someone having a panic attack, an activity that other people consider simple may seem impossible.
Self Management
Many people who regularly experience panic attacks seem to be helped by learning to breathe calmly when an attack feels near.
An acute panic attack often subsides if you breathe in and out into a paper bag. This allows you to re-breathe your own carbon dioxide, allowing the acidity in the blood that is upset by over-breathing to return to normal. This removes many of the strange sensations that panic causes.
For some people, just knowing that their panic is caused by a vicious circle of fear and physical sensations can help calm them down.
The Mental Health Foundation has produced a range of well-being podcasts that can help you relax and improve your sense of well-being: http://www.mentalhealth.org.uk/help-information/podcasts/
Treatments
Talking treatments, such as cognitive behavioural therapy, can help you rethink the meanings you attach to changes in your body. For example, you may need to recognise that a fast pulse could be due to running upstairs or drinking too much coffee, rather than interpreting symptoms in a catastrophic way (eg. I’m going to die, or I’m going to faint).
This kind of rethinking is achieved through demonstrations by the therapist and through activities you practice at home.
Parental Mental Illness
When a parent becomes mentally unwell, it can be difficult for them to explain to their child what is happening and for the child to make sense of their parent’s behaviour.
Parents and children or young people often feel isolated and unsupported when the parent is unwell, which can increase distress and anxiety across the family. It is important that mental health and social services support both the parent and their child.
Parents With Mental Health Problems
Large numbers of children grow up with a parent who has a mental health problem. Many of these parents will have a mild or short-lived problem. Many children live with a parent who has a long-term alcohol problem or drug dependency, sometimes combined with a mental health problem.
Some parents have a severe and enduring mental illness. These long-term illnesses include schizophrenia, personality disorders and bi-polar disorder.
Estimates in the UK suggest that between 50% and 66% of parents with a severe and enduring mental illness live with one or more children under 18. That amounts to about 17,000 children and young people in the UK.
How Does Ill Health Affect Parenting?
Research has shown that some children of parents with a severe and enduring mental illness experience greater levels of emotional, psychological and behavioural problems than children and young people in the rest of the population. This may be because the genes that some of them inherit make them more vulnerable to mental ill health, but it could also be because of their situation and the environment in which they are growing up. For instance, parents with a severe illness are more likely to live in poverty, which in turn can affect their children’s mental health. The children may also feel insecure and anxious that their parent will become unwell. They will also have to be living with the stigma attached to mental ill health and may be bullied at school.
As well as worrying about their parents, children may be reluctant to ask for help for fear that they will be taken away from their parents. Children may become carers for their parents and lose out socially and educationally.
What Can Protect Children's Mental Health?
- Children need to be given clear, factual information about their parents’ mental ill health – children say they feel less anxious if they are told the truth. The internet increasingly provides a source of information for children and young people to find out about topics that they don’t want to discuss with their friends or other people.
- Writing up an information sheet with their parents can prepare children for times when their parent may be absent. It could describe the children’s daily/weekly routine and their likes and dislikes. If other caregivers follow this guidance it can provide children with continuity and a sense of security. It can also enable parents to maintain a sense of control and that they are contributing to their children’s well-being when they are in hospital.
- Parents can write down what they find helpful and unhelpful when they are unwell. Children often carry this information in their heads which means they may assume the role of their parent’s carer without looking for support outside the family. Sharing the parent’s support needs with a trusted adult reduces the likelihood of the child taking on inappropriate caring responsibilities and can reduce the guilt that parents may feel about being a burden on their children.
- If a child is going to visit their parent in an inpatient unit it is important that whoever takes them can explain beforehand what to expect – what the building looks like, how their parent may look and behave, and the effects of medication, how the other service users behave. Mental health units should be able to provide a family room when children can see their parent safely, outside the ward environment.
What Can Help Children And Young People?
- Children need to be given clear, factual information about their parents’ mental ill health – children say they feel less anxious if they are told the truth. The internet increasingly provides a source of information for children and young people to find out about topics that they don’t want to discuss with their friends or other people.
- Writing up an information sheet with their parents can prepare children for times when their parent may be absent. It could describe the children’s daily/weekly routine and their likes and dislikes. If other caregivers follow this guidance it can provide children with continuity and a sense of security. It can also enable parents to maintain a sense of control and that they are contributing to their children’s well-being when they are in hospital.
- Parents can write down what they find helpful and unhelpful when they are unwell. Children often carry this information in their heads which means they may assume the role of their parent’s carer without looking for support outside the family. Sharing the parent’s support needs with a trusted adult reduces the likelihood of the child taking on inappropriate caring responsibilities and can reduce the guilt that parents may feel about being a burden on their children.
- If a child is going to visit their parent in an inpatient unit it is important that whoever takes them can explain beforehand what to expect – what the building looks like, how their parent may look and behave, and the effects of medication, how the other service users behave. Mental health units should be able to provide a family room when children can see their parent safely, outside the ward environment.
Childline Ireland
www.childline.ie
Text TALK to 50101
Tel: 1800 66 66 66
”I get this bubble of rage. I go wild. I feel like crying cos I don’t know how to control myself. It happens too quickly.
”I get this bubble of rage. I go wild. I feel like crying cos I don’t know how to control myself. It happens too quickly..
Peer Support
Peer Support may be defined as the help and support that people with lived experience of a mental illness or a learning disability are able to give to one another.
It may be social, emotional or practical support but importantly this support is mutually offered and reciprocal, allowing peers to benefit from the support whether they are giving or receiving it.
Key elements of Peer Support in mental health include that it is built on shared personal experience and empathy, it focuses on an individual’s strengths not weaknesses, and works towards the individual’s wellbeing and recovery.
Though the language of peer support is relatively new, in practice self-help groups and mutual support has been around for many years. In Canada and the USA, Peer Support in its various forms has been a widely recognised and utilised resource that has been developing since the 1960s. In recent years there has been an increasing emphasis on the value of peer support in Ireland.
A number of our Mental Health Associations offer Peer Support to people in their communities. Two such organisations are Dublin based Gateway Mental Health Association and Tipperary based Áras Folláin Mental Health Association – see Local Associations for details.
Research has shown that peer-run self-help groups yield improvement in psychiatric symptoms resulting in decreased hospitalisation, larger social support networks and enhanced self-esteem and social functioning.
The Benefits
The benefits of Peer Support are wide ranging for those receiving the support, peer-support workers themselves, and for the mental health system as a whole. One of the key benefits of Peer Support is the greater perceived empathy and respect that peer supporters are seen to have for the individuals they support.
Peer Support also has benefits for peer support workers themselves, increasing levels of self-esteem, confidence and positive feelings that they are doing good. Peer-support workers often experience an increase in their own ability to cope mental health problems.
Peer Support also benefits the health system as a whole as it can lead to decrease in hospital admissions for those taking part.
Types Of Peer Support
Peer Listening
A peer supporter who offers a listening service is a person who has been trained in counselling skills that include active listening, verbal and non-verbal communication, confidentiality and problem solving. Peer supporters who have completed certain training may then go on to offer support to their peers on a formal basis.
Peer Education
This involves peers educating peers on specific topics, such as coping with depression, anxiety or addiction. This will generally include a group of peers of similar age, status and background to the people to whom they are delivering material.
Peer Tutoring
Peer tutoring is a model whereby a peer supporter aids a peer, whether of the same age or younger, with his or her academic and social learning. The support offered by the peer tutor can be cross-curricular and take the form of paired reading or paired writing.
Peer Mentoring
One example of a this would be a ‘buddy’ system or befriending in which people who have received certain training are attached to a new group and act as a friend, mentor and guide to ease people into a new environment, eg a school, hospital.
Another aspect of peer mentoring is that of a positive role model, involving a long-term commitment between the mentor and mentee. The peer mentor is linked to a mentee and has the role of befriender, listener and mediator.
Peer Mediation
Conflict resolution is another name for peer mediation. Peer mediators are trained specifically in conflict resolution skills. They help people find solutions to disputes in formal and informal situations. It is unusual to find an organisation adopting just a peer mediation model, though such a model is often part of a fuller peer-support programme.
Our Work With Peer Support
We have been involved in developing Peer Support for a number of years. We continue to be involved in a number of projects providing, promoting and evaluating Peer Support related to mental health.
Self Management
The study ‘Exploring Peer Support as an Approach to Supporting Self Management, Scotland 2010-2011‘ aimed to explore peer support as an approach to support self-management and to assess the potential for formalised peer support to be developed for people with long term conditions. The study found that those who participated demonstrated passionate support for the unique added benefits that peer support can bring to those living with long term conditions and the professionals who support them.
Peer Support and Self Management Your Mental Health
Personality Disorder
Personality disorders are a group of conditions characterised by an inability to get on with other people and learn from experience. People with a personality disorder may find that their beliefs and attitudes are different from those of most other people. Others may find their behaviour unusual, unexpected or perhaps offensive.
Personality disorders usually become apparent in adolescence or early adulthood, although they can start in childhood. People with a personality disorder may find it difficult to start or maintain relationships, or to work effectively with others. As a result, many may feel hurt, distressed, alienated and alone.
Personality disorders affect how a person thinks and behaves, making it hard for them to live a normal life. People diagnosed with personality disorder may be very inflexible – they may have a narrow range of attitudes, behaviours and coping mechanisms which they can’t change easily, if at all. They may not understand why they need to change, as they do not feel they have a problem.
Personality disorder is a controversial diagnosis. They are very deep-rooted, so hard to treat, but people can be helped to manage their difficulties. There are no accurate figures, but an estimated 10% of the general population have some kind of personality disorder. The risk of suicide in someone with a personality disorder is about three times higher than average. People who think they may be suffering from a personality disorder should consult a GP (For useful links see yourmentalhealth.ie’s)
People with personality disorders may find it difficult to:
- make or keep relationships
- get on with people at work
- get on with friends and family
- keep out of trouble
- control their feelings or behaviour.
Personality disorders in children or adolescents are sometimes called conduct disorders. However most conduct disorders in children do not necessarily lead to personality disorders in adulthood.
Types of Personality Disorders
Cluster A
- paranoid personality disorder
- schizoid personality disorder
- schizotypal personality disorder
Cluster B
- anti-social personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissistic personality disorder
Cluster C
- avoidant personality disorder
- dependent personality disorder
- obsessive compulsive personality disorder
Misconceptions
There is a widespread belief that all people with a personality disorder are very dangerous and can harm other people. This is not true. Some people with anti-social or psychopathic personality disorder may be dangerous. But people diagnosed with borderline or paranoid personality disorder are more likely to harm or even kill themselves.
People with personality disorder are likely to have experienced great trauma in their childhood, and often have multiple and complex needs because of their difficulties fitting in with ordinary life and expectations.
People with personality disorder may also have other mental health problems, such as depression, anxiety, panic disorders, eating disorders, self-harm, substance misuse, and bi-polar disorder.
It can be very difficult to diagnose personality disorders if other mental health problems are masking the personality disorder. Sometimes people with similar symptoms – people with PTSD or Asperger’s syndrome – are misdiagnosed as having a personality disorder.
Causes of Personality Disorders
The causes of personality disorders are not fully known. Possible causes include trauma in early childhood such as abuse, violence, inadequate parenting and neglect. Neurological and genetic factors may also play a part.
Treatments and Management Strategies
Very little research has been undertaken into treatments for personality disorder. What we do know is that most forms of personality disorder can be managed, but no single treatment or management strategy will be effective in all cases.
Personality disorders may be difficult to treat because they involve lifelong, pervasive attitudes and behaviours and because people with personality disorders often have other mental health problems. When a treatment is seen to fail it is often the patient who is blamed for not fitting the programme rather than the service admitting that it has not met the individual’s needs.
Medication (Pharmalogical Treatments)
Personality disorder is not strictly a mental health problem. Medication is often used, but mainly to control other, associated symptoms. Short-term treatments may include anxiolytic or neuroleptic drugs, which are given for short periods or at times of severe stress
Long-term treatments may involve the use of neuroleptics, which can be helpful in cases of paranoid and schizotypal personality disorders. However it is possible that the medication is mainly controlling risk and stress, rather than having any long term impact on the personality disorder itself.
Cognitive therapies and self-management approaches are also proving successful in helping people live with personality disorder.
Psychodynamic Treatment
Cognitive and Behavioural Therapies
Cognitive and behavioural therapies such as cognitive therapy, dialectical behaviour therapy, interpersonal psychotherapy and cognitive analytic therapy can also be helpful. Most cognitive behavioural approaches address specific aspects of thoughts, feelings, behaviour or attitude, and do not claim to treat the entire personality disorder of the person. Research suggests that there are some short term benefits to these approaches but more research is required into the long term benefits.
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Pets
The companionship that a pet offers is a great way to reduce anxiety and stress.
A pet can be a great source of comfort, companionship and motivation for their owners. In many ways, pets can help us to live mentally healthier lives.
Pets and Depression
Pets are also a great motivator for people. Dogs especially are great at encouraging owners to get exercise, and this can be beneficial for those suffering from depression. Pets can also have calming effects on their owner. Just by stroking, sitting next to or playing with a pet can gives owning a chance to relax and calm their minds. Caring for a pet also gives your day purpose and reward, and a sense of achievement. It also helps you feel valuable and needed.
Pets and Socialising
Walking a dog often leads to conversations with other dog owners and this helps owners to stay socially connected and less withdrawn. People who have more social relationships and friendships tend to be mentally healthier.
Pets and Lonliness
A pet is great companion. They give owners company, a sense of security and someone to share the routine of the day with. Pets can be especially valuable company for those in later life and living alone.
Pets and People in Later Life
People in later life experiencing typical life stresses can be comforted by a companion pet. It is thought that a dog can be a stress buffer that softens the effects of adverse events on a person. With an animal in the home, people with Alzheimer’s are thought to have fewer anxious outbursts.
Pets and Children with ADHD
Children with ADHD can benefit from working with and keeping a pet. Taking charge of the jobs on a pet care schedule, such as feeding, walking and bathing, helps a child learn to plan and be responsible.
Pets need to play, and playing with a pet is an great way to release excess energy. Your child can burn off energy walking a dog or running around with a kitten, making them more relaxed later in the day and calmer at night. Fresh air and good circulation from aerobic exercise increases oxygen-filled blood flow to a child’s brain, therefore increasing their ability to concentrate.
Children with ADHD are used to their parents trying to calm them down or reprimanding them. A pet is a great listener, and offers unconditional love and will not criticize a child for having too much energy. This can aid a child’s self-confidence.
Pets and Autism
Sensory issues are common among children with autism. Sensory integration activities are designed to help them get used to the way something feels against their skin or how it smells or sounds. Dogs and horses have both been used for this purpose. Children with autism often find it calming to work with animals.
It has been claimed that in the case of people with autism, animals can reduce stereotyped behavior, lessen sensory sensitivity, and increase the desire and ability to connect socially with others. Further research into this area needs to be carried out however.
Research
Mental Health Foundation carried out a study with Cats Protection in 2011 which involved over 600 cat- and non-cat-owning respondents, with half of them describing themselves as currently having a mental health problem. The survey found that 87% of people who owned a cat felt it had a positive impact on their wellbeing, while 76% said they could cope with everyday life much better thanks to the company of their feline friends.
Half of the cat owners felt that their cat’s presence and companionship was most helpful, followed by a third of respondents who described stroking a cat as a calming and helpful activity.
Phobias
Types of Phobias
- social phobia – anxiety about how you are seen and judged by other people or fear of being humiliated in social situations or at times when you are on show, speaking or performing in public
- agoraphobia – fear of leaving home; going into shops, crowds and public places or travelling alone in trains, buses or planes
- fears attached to specific things, such as fear of heights, spiders, mice, enclosed spaces (claustrophobia), needles, thunder, darkness, flying, dentistry, using public toilets, eating certain foods or the sight of blood or injury.
People with a phobia will try to avoid the object or situation they fear. For example, someone with agoraphobia may find it very difficult to leave their house at all.
The symptoms of your anxiety – such as a racing heart or feeling faint – may be frightening in themselves and these are often associated with secondary fears of dying, losing control, or ‘going mad’.
The Mental Health Foundation has produced a range of well-being podcasts that can help you relax and improve your sense of well-being.
Strategies to Help you Cope
You may find it useful to draw up a list of the things or situations that make you anxious. You can then imagine the least frightening while practising relaxation techniques. For example, someone with a phobia for spiders might begin by looking at a picture of a spider and finish by touching a spider, while practising relaxation techniques throughout.
With the support of a mental health professional, this technique is usually very successful.
You may prefer to put yourself directly into a situation where you have to face up to your fear, with help and support from a friend or therapist. This is known as exposure treatment. For example, if you are frightened of flying you may be able to cure your fear by actually getting on to a plane.
For Further Support Contact The Samaritans
Samaritans is a unique charity dedicated to reducing feelings of isolation and disconnection that can lead to suicide. Every six seconds they respond to a call for help. They’re there 24/7, before, during and after a crisis and they make sure there’s always someone there, for anyone who needs someone.
Physical Health
A clear distinction is often made between ‘mind’ and ‘body’. But when considering mental health and physical health, the two should not be thought of as separate.
Poor physical health can lead to an increased risk of developing mental health problems. Similarly, poor mental health can negatively impact on physical health, leading to an increased risk of some conditions.
There are various ways in which poor mental health has been shown to be detrimental to physical health.
Depression has been linked to:
- 67% increased risk of death from heart disease
- 50% increased risk of death from cancer.
While schizophrenia is associated with:
- double the risk of death from heart disease
- three times the risk of death from respiratory disease.
This is because people with mental health conditions are less likely to receive the physical healthcare they’re entitled to. Mental health service users are statistically less likely to receive the routine checks (like blood pressure, weight and cholesterol) that might detect symptoms of these physical health conditions earlier. They are also not as likely to be offered help to give up smoking, reduce alcohol consumption and make positive adjustments to their diet.
These lifestyle factors can influence the state of both your physical and mental health.
Exercise
Physical activity in any form is a great way to keep you physically healthy as well as improving your mental wellbeing. Research shows that doing exercise influences the release and uptake of feel-good chemicals called endorphins in the brain. Even a short burst of 10 minutes brisk walking increases our mental alertness, energy and positive mood. Read the HSE Physical Health section for more on the positive health benefits of physical activity.
Physical activity means any movement of your body that uses your muscles and expends energy. From tending your garden to running a marathon, even gentle forms of exercise can significantly improve your quality of life.
See Exercise for more information.
Diet
Good nutrition is a crucial factor in influencing the way we feel. A healthy balanced diet is one that includes healthy amounts of proteins, essential fats, complex carbohydrates, vitamins, minerals and water. The food we eat can influence the development, management and prevention of numerous mental health conditions including depression and Alzheimer’s. Read SafeFood.eu’s guide about the ways in which you can ensure you are getting a balanced diet.
See Diet for more information.
Long Term Health Conditions and Mental Health
Smoking
Smoking has a negative impact on both mental and physical health. Many people with mental health problems believe that smoking relieves their symptoms, but these effects are only short-term.
- People with depression are twice as likely to smoke as other people.
- People with schizophrenia are three times as likely to smoke as other people.
Nicotine in cigarettes interferes with the chemicals in our brains. Dopamine is a chemical which influences positive feelings, and is often found to be lower in people with depression. Nicotine temporarily increases the levels of dopamine, but also switches off the brain’s natural mechanism for making the chemical. In the long term, this can make a person feel as though they need more and more nicotine in order to repeat this positive sensation.
See Smoking for more information.
Post Natal Depression
The term ‘baby blues’ is often used to describe a short period of mild depression that women may experience after having a baby. But between eight and 15% of new mothers go on to develop postnatal depression (PND), which is much more severe.
Many new mothers experience this severe depression without recognising it or realising that it is a treatable illness. This causes needless distress, which also affects family and friends.
A small minority of women may develop puerperal psychosis. This is a very acute condition that occurs suddenly within the first six weeks after childbirth.
What Are The Symptoms?
PND can develop from a worsening of baby blues, or it may develop more slowly and may not be noticeable until several weeks after the baby’s birth.
There are many symptoms of PND. You may feel you can’t cope with your baby and so feel guilty because of this. Or you may feel very sad and cry frequently. Some mothers with PND feel anxious and worry about their own health and that of the baby. They may suffer from panic attacks and feel tense and irritable all the time. Most depressed mothers feel tired and lack energy. They may feel unable to concentrate or find simple tasks confusing. Some mothers experience pains with no apparent cause (other than tension and anxiety). Many have problems sleeping and a poor appetite. Many depressed mothers lose interest in sex.
The symptoms of puerperal psychosis may include manic behaviour. You may feel excited and elated and may talk very fast. You may be hyperactive – not sleeping and rushing about. You may become angry and aggressive if crossed. Some sufferers become severely depressed or have both manic and depressive phases. Other possible symptoms include hallucinations and delusions.
Medical Treatment
If your depression lasts longer than a few days, you need to see your doctor. PND can be treated successfully.
Drug treatments usually involve anti-depressants, which are not addictive. These drugs work slowly and improvement is gradual, but if you don’t feel better after a few weeks, ask your doctor for a stronger dose or a different drug. If you find your depression is worse just before or during your period, it may be worth asking about progesterone therapy.
Mothers with puerperal psychosis need to be treated by a psychiatrist. It may be possible to be treated at home, but hospital admission is usually necessary. Some hospitals have specialist mother and baby psychiatric units. Treatment is usually with anti-psychotic and anti-depressant drugs.
How Friends and Family Can Help?
Family and friends need to be very understanding. Although the illness is temporary and very treatable, you may need lots of help and support before you recover. Everyone around you needs to accept that you are unwell and they need to treat you as if you had a physical illness.
Your family can help make sure you are getting treatment from your doctor and can give you support if you need to go back and ask for your medication it to be changed.
Rest will also help recovery, so let family and friends take on as many of the everyday jobs that you can give up. But when you are feeling better, do as much as you want to. It’s common to have bad and good days with this illness.
If you hate being left alone, ask family and friends to try and organise for someone to be with you for much of the time. Physical contact from a partner in the form of hugging and cuddling can also be very reassuring – especially if the sexual side of your relationship has been affected.
Counselling
Self Help
Post Traumatic Stress Disorder
Post-traumatic stress disorder is a reaction to exposure to very stressful and traumatising events. People experience flashbacks, panic attacks and other acute symptoms. It can be treated, so it is important to get expert help.
Post-traumatic stress disorder (PTSD) occurs in response to exposure to a very stressful or traumatic event or an exceptionally shocking, threatening or catastrophic situation. Examples include rape, violent attack, traumatic accidents, sudden destruction of your home or community, or threat or harm to you or to your close relatives or friends. Deliberate acts of violence are more likely than natural events or accidents to result in PTSD.
PTSD is a potentially severe and long-term mental health problem that can hampers your ability to live your life to the full. People experiencing it can feel anxious for years after the trauma, whether or not they suffered a physical injury as well.
Common symptoms of PTSD include re-experiencing the event in nightmares or flashbacks, avoiding things or places associated with the event, panic attacks, sleep disturbance and poor concentration. Depression, emotional numbing, drug or alcohol misuse and anger are also common.
Debriefing someone who has experienced trauma immediately afterwards does not prevent PTSD.
People with PTSD usually develop the symptoms immediately after the traumatic event but some people develop symptoms much later. People experiencing PTSD may not seek treatment for months or years after the onset of symptoms because they do not think they can be helped.
Treatment
The most effective therapeutic approach for long-term, severe PTSD appears to be talking treatments with a clinical psychologist, in which the person with PTSD is encouraged to talk through their experiences in detail. This may involve behavioural or cognitive therapeutic approaches.
Antidepressants may also be prescribed to relieve the depression which people who have survived trauma often experience at the same time as PTSD.