Week 1: Acute Mental Health

Sudden onset of serious study! – Acute Mental Health - Week 1 of 10

It's Week One of keeping my promise to take you on a journey that dances along the edges of the vast world of Mental Health and we’re diving straight in!

My first subject – Acute Mental Health

According to the Oxford Dictionary, the definition of 'acute' relates to something that is "present or experienced to a severe or intense degree". For me - returning to study was also an acute experience!

Before we go further, please remember:?Any discussion on Mental Health and Illness can be triggering, so whilst we're not going into traumatic details, you may still be affected. If you find emotions bubbling up as you read this, please take a moment of rest and do something that distracts or calms you and of course, seek help if you are stuggling with any unusual thoughts, feelings or behaviours for an extended time. If you're not in a great place before diving in, perhaps bookmark this for another day.?

Let's get into it. With zero idea of what that entailed, I learned what happens when things get terrible for someone with a mental illness. For the next few minutes, I’ll touch on the four main areas covered in this section

-?????????Acute mental illness – what is it?

-????????It seems impossible - where ethics and safety meet legal and human rights

-?????????Where it all began – the lifelong impacts of childhood trauma

-?????????The chicken and egg – Physical or mental illness, which comes first?

What is Acute Mental Illness?

In my first week of study, those of us without clinical experience were encouraged to start our course by watching the ABC short docu-series – Changing Minds which follows several people, including young people, on their journey through hospitalisation with acute mental illnesses. It was probably one of my studies' most acute' experiences overall, and I encourage you to watch it.?

Although not always, acute mental illness is often experienced by people with existing mental disorders (disorder and illness are interchangeable terms). ??50% of us will experience a mental illness in our lifetime.?Around 3% of people will experience psychosis in their lifetime, and the most common onset of this and the most common mental illnesses are in the teens and early 20s.

?Psychosis and suicidal ideation are two common reasons for people to be admitted to hospital or inpatient environments because, in both cases, the potential for that person to harm themselves, someone else, or their environment is very real and immediate.

The challenge with psychosis is often that people don’t have what we call ‘insight’.?A lack of insight is when a person is not able to see that their thoughts, feelings and behaviours are unusual.?Without that self-awareness, people can engage in a wide range of dangerous behaviours.?This can be the case when someone is having a psychotic or dissociative episode or a number of other acute conditions.

In Australia, people experiencing an acute episode may be admitted to a hospital or other inpatient facility. Around ? of the time spent as an inpatient in acute care facilities in Australia is due to an 'involuntary admission', which is when suitably authorised people ‘commit’ the person to care under the Mental Health Act.

The Mental Health Act isn't really about Mental Health

Each State and Territory in Australia has its own Mental Health Act (The Acts). The Acts are based upon a national Model Act. Because of this, they are reasonably similar. As our lecturer pointed out, The Acts don't say much about Mental Health but instead set out the legalities around dealing with a person experiencing an acute psychotic episode. What's interesting when you stop and think about it is that with any physical illness, we, as consumers, have choices and rights as to what treatment we receive or don't receive, who administers it, and where and when.

So the conundrum for The Acts is that they enable the removal of a person's civil liberties when they cannot control their behaviours to keep them and those around them from harm while simultaneously trying to respect and protect their rights.

When a person has lost the ability to make sound decisions, their behaviour may place themselves, other people or property at risk. This can be lead to admission and continue whilst a person is an inpatient. ?Removing the person from a situation forcibly (seclusion) or inhibiting their ability to act through administering drugs or other physical means (restraint) can seem the only option to prevent injury or harm.?

Seclusion and restraint are a big topic worldwide.?

Seclusion and restraint can add to a person's trauma and thereby make recovery even harder – failing to restrain or seclude a person can result in injury to our incredible healthcare workers. I heard terrible stories of harm from some of the many highly experienced mental health practitioners doing the course with me.

Safety – Administration or Action?

So whilst discussing the ethical dilemma around a patient's rights vs potential harm to them, their carers or the environment, we realise there's a massive safety challenge to address. ??The basis of safety systems in Australia and around the world is built on understanding and reducing risks.

BUT….How do you assess the emergency room risk when you have no idea who or how many people might come in and what behaviours they might engage in?

And the big question in a highly administrative world like a hospital; is where do we find the time? In a hospital setting, patients are involved in completing the risk assessment as often as possible.?This helps build a trusting relationship and respects the patient's right to self-advocacy.

Our lecturers posed the following question to students:

Is it possible to complete a risk assessment in relation to, say, self-harming risks while someone is verbally threatening you?

The physical and mental health risks and impacts on our health workers when working in these acute settings are HUGE.?And the intersection of proving compliance – the paperwork – and truly collaborating with patients and other carers in a face to face setting is what the traffic cops would definitely call a ‘black spot’.

The final word on Safety in Acute Mental health will be well received and understood by many of my forward-thinking colleagues in the safety space. ??Research has shown that there is no actuarial, or numerically predictable – solution for risk assessing in acute mental health settings.?A culture of collaboration between everyone involved, including the patient is the best chance we give the patient and carers for safety, both mentally and physically in this challenging setting.

The Roots of Acute Mental Health - Trauma

So how does Acute Mental Illness happen? Much of the time, it can be traced back, sadly, to childhood Trauma.

Trauma can be defined in many ways.?Our old mate, the DSM-5 describes it as ‘exposure to actual or threatened death, serious injury or sexual violence’.?

An extensive international study formed the basis for much of the early understanding of Trauma. In the Adverse Childhood Experiences (ACEs) study, 17,000 adults were asked ten questions about various childhood experiences that could be considered traumatic such as whether they had experienced death of a parent, violence towards a parent or themselves, sexual assault or neglect. 61% of people who took part experienced at least one Trauma. 14% of participants had four or more.

We will talk a lot more about trauma and its effects over the next nine weeks.?For now, take some time to reflect.?Over half of Australia’s children have experienced at least one trauma.?Many of them can cope and recover, but some can’t.?And for some, like me for example, the impacts last for many years, often well into adulthood, before they are identified as mental health problems.??A wonderful Australian Organisation – Emerging Minds, adapted this diagram from the Centers for Disease Control in the USA, where the ACEs study originated.

Researchers worldwide have been seeking to understand the impact of childhood trauma, or trauma later in life, as they contribute to a person’s mental and physical well-being later in life.?An Australian-led study that pulled together over 100 other studies – yes, that is a thing – a study of studies – found that mental illness can shorten life by up to 20 years! Only 17% of those early deaths are attributable to suicide; the rest result from physical conditions – often more than one at once.

No wonder they called it ‘acute’ mental health; this thing gets more complex every corner we turn!

Chicken or Egg – Mental Illness or Physical Illness

Studies show that mental illness increases the likelihood of physical illness and physical illness increases the incidence of mental illness.?This chicken and egg situation leads to a thing called ‘Co-morbidity’.?Co-morbidity is defined by the Culturise urban interpretation guide as

“a fancy word used to describe when a person has two or more conditions that could ultimately kill them”

Trauma doesn't just lead to mental illness; it was shown through this study and many others to correlate with a vast range of psychological AND physical diseases. In a few weeks, we'll talk more about the chicken and egg challenge of co-morbidity in our ramblings on the interaction of physical and mental health. ?

For now I hope you’ve either learned or reflected on something useful in this summary.?I’ve certainly learned that distilling the key points of around 100 hours of study is no small exercise, but it has been extremely beneficial to my ongoing growth!

Until next time, here’s my 3 suggested actions.

1.???Watch at least one of the ABC Changing Minds stories – to change your mind about acute mental illness and psychosis

2.???Please spare a thought for our incredible health workers

3.???Ask for a full download of this article that includes even more links to tools, articles and a really good TED Talk or two!

And feel free to add questions and comments!

Thanks to

-?????????Southern Cross University – Acute Mental Health for the content direction.

-?????????Commonwealth of Australia for the Acts, the guidelines and lots of the studies carried out

-?????????Thanks to Centres for Disease Control and Prevention for the facts on Adverse Childhoold Experiences and to Felitti and friends for doing the hard yards of the study itself

-?????????Lancet Psychiatry for the study of 100 studies that showed us how much mental illness impacts life expectancy

-?????????T Wand – for your in-depth 2011 analysis of risk assessments in acute care and for what you taught me about actuarial predictions

-?????????Order the full download for full APA 7th References