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Concept Mapping - Learning Skills Programme
Psychosocial Assessment - Deliberate Self Harm, this should identify motives for the act,
and those associated problems which are potentially amenable to intervention such as
psychological or social problems, mental disorder, alcohol or substance misuse.
REFERENCE:- Document 122448 NHS CRD
Psychosocial interventions following suicide attempt
Prevention / Treatment - specific interventions
Psychiatric management of poor compliance with after-care
Guaranteed in-patient shelter
Psychosocial crisis intervention
Cognitive - behavioural treatment
Conclusions - only cognitive - behavioural therapy appeared to significantly reduce incidence
of repeated suicide attempts.
REFERENCE:- Document 122817 NHS CRD
Elements in the Report
- Management of Severe Mental Illness in Hospital
and in the Community.
- Research Training and Practice; & Research relating Nursing Education Online Resources
to issues in the care of the severely mentally ill.
- Psychological Management Techniques.
- Ethics of Cognitive Behavioural Psychotherapy.
- Family Interventions
- Case Management Nursing Resources Northern Ireland
Psychosocial Interventions Specialist Practice World Wide Network
Mental Health Resources
Schizophrenia may effect the most basic functions that give people a feeling
of individuality, uniqueness and self-direction.
Our reality boundary may be effected.
We may hallucinate.
We may develop feelings of bewilderment.
We may become fearful.
We may believe that our deepest thoughts, feelings and acts may be known to,
or controlled by others.
Signs to watch out for:- Severe Sleeplessness
Extreme Withdrawal
Restlessness
Thoughts of Life not worth living.
Irrational Talk
Disruption of Normal Routine
Treatment for Person:- Physical; Biological; Psychological; Social; Vocational;
Spiritual; Cultural; Medical; Occupational; Relaxation; Educational; Family;
Care of Person by:- Self; Family; Friends; Society; Social Work; Medical;
Nurses Midwives Health Visitors;
How is recovery to be protected? How are relapse factors to be noted?
How may families help?
(Life Style) (Community Services) (CAUSE)
During an episode of Schizophrenia, your experience and interpretation
of the world may be disrupted.
You may lose touch with reality:-
see things that are not there
hear things that are not there
taste things that are not there
smell things that are not there
feel things that are not there
act in an unusual way in response to hallucinations
act in an unusual way in response to delusions
People experiencing Psychosis and Schizophrenia episodes
respond to treatment and care.
Symptoms of Schizophrenia:-
Positive Symptoms
- 3 main positive symptoms
- Feelings of being controlled by outside forces, your thoughts & actions are taken over.
- Hearing, Seeing, Smelling, Feeling, Tasting things that are not there. ( Hallucinations)
- False Beliefs fixed and out of keeping with others in your culture. ( Delusions)
Negative Symptoms ( These may be complicated by side-effects of medication )
- Tiredness all the time
- You Cannot Concentrate
- You may loose energy
- You may loose motivation
- Simple things may become impossible for you
- Talking to your friends may become a chore
- Your eating may get neglected
- You may neglect to keep warm
Maintaining relationships may become difficult for you
Maintaining interest may become difficult for you
Maintaining affection in friends and loved ones may become difficult for you
The effect of this experience of Psychosis or Schizophrenia is that recovery from
the social damage caused by the Negative Symptoms is a barrier to your rehabilitation.
Elements of Caring for the Person include:-
Medication Management; Stress Vulnerability; Family Work; Information Processing;
Coping with symptoms.
Mathias, P, & Thompson, T. (2000) Lyttle's Mental Health and Disorder 3rd edition
London, Balliere Tindall.
Psychosocial Interventions for Schizophrenia - Effective Health Care Bulletin - PDF File Download
Trip Clinical Search Engine ~ data base
Handbook for Leading Inpatient and Residential Psychoeducational Group PSYCHOEDUCATIONAL GROUP THERAPY FOR THE DUALLY DIAGNOSED A Handbook for Leading Inpatient and Residential Psychoeducational Groups for Mentally Ill Chemical Abusers
Bipolar Disorder Center: http://www.healthline.com/health/bipolar-disorder
Defining Severe / Serious Mental Illness -
The House of Commons Committee Report (1994)
Diagnosis: schizophrenia
schizo-affective disorder
paranoid psychosis
manic-depression
major depression
Duration: at least one year since the onset of the disorder
Disability: sufficiently severe disability to seriously impair functioning or role
performance in at least one of the following areas.
- occupation
- family responsibilities
- accommodation
House of Commons Select Committee (1994)
Better off in the Community? Care of people who are seriously mentally ill.
Vol 1 HMSO London.
Care for the Person with Schizophrenia - Effective Health Care. August 2000.
Volume 6. Number 3. ISSN: 0965-0288
Supportive Educational Interventions
(Individual Psycho educational Programme)
Family - Social - Biological - Pharmacological: Support, Information, Management.
Pekkala, E., Merinder, L. (2000) Psycho educational intervention for schizophrenia
and other severe mental illness. The Cochrane Review. Issue 3. Oxford. Update Software.
(Family Work)
Provision of support - Education - Interaction - Lower burden of care.
Decrease stress within the family. Education about schizophrenia. Training in problem solving.
Collaboration with relatives who care for the person with schizophrenia.
Reduce emotional stress. Reduce burden on relatives.
Enhance family ability to anticipate problems. Reduce feelings of anger.
Reduce experience of guilt.
Goal setting for person suffering with schizophrenia.
Agreement on limit setting. Agreement on appropriate solitude balanced within family interaction.
Opportunity for adaptation in family interaction.
Exploration of family expectations for care and support.
Forum for healing hostility. Sharing disagreeable ideas.
Department of Health (1999) The National Service Framework for Mental Health. -
Modern standards and service models. :London. DoH.
Skills Training
(Life Skills)
Promote independent daily living. Money management. Home management. Domestic skills.
Personal care.
Nicol, M., Robertson, I., Connaughton, J. (2000) Life skills for chronic mental illness
Cochrane Review. Issue 3. Oxford. Update Software.
(Social Skills)
Enhance social performance. Reduce distress. Assessment of interpersonal skills.
Communication. Perception. Social cue processing. Give and receive social reinforcement.
Build and develop individual elements of social skill into competent social performance.
Pilling, S., Orbach, G., Connaughton, J. (2000) Social skills programmes for schizophrenia.
The Cochrane Review. Issue 3. Oxford. Update Software.
(Vocational Skills)
Pre vocational training. Sheltered work. Supported employment.
Crowther, R., Bond, G., Huxley, P., Marshall, M. (2000) Vocational rehabilitation
for people with severe mental disorders. (Protocol)
The Cochrane Review. Issue 3. Oxford. Update Software.
Symptom focused interventions.
(Cognitive behavioural therapy)
Distress reduction. Examination of distressing belief.
Challenge thinking patterns that cause distress.
Promotion of reasoning. Look for alternative choices. Improve mental state.
Spend time with patient.
Jones, C., Cormac, I., Mota. J., Campbell, C. (2000) Cognitive behaviour therapy
for schizophrenia. The Cochrane Review. Issue 3. Oxford. Update Software.
(Cognitive rehabilitation)
Retraining - memory, attention, speed of mental processing and mental abstraction,
to improve overall mental functioning
Spring, B., Ravdin, I., (1992) Cognitive remediation in schizophrenia:
Should we attempt it? Schizophrenia Bulletin. 18: 15 - 20.
Hayes, R., McGrath, J. (2000) Cognitive Rehabilitation for people with schizophrenia
and related conditions. The Cochrane Review Oxford. Update Software.
(Token economy)
Improvement in negative symptoms of schizophrenia.
McMonagle, T., Sultana, A. (2000) Token economy for schizophrenia.
The Cochrane Review. Issue 3. Oxford. Update Software.
Service Provision
(Assertive community treatment)
Community based multidisciplinary team. - psychiatrist - sister/charge nurse -
staff nurse - social worker - occupational therapist - nursing assistant -
community psychiatric nurse - senior house officer - senior registrar -
liaison psychiatric nurse - specialist nurse practitioner - general medical practitioner -
research nurse - administrator - administrative assistant - transport officer.
Small case load. 24 hour cover. Frequent home contact.
Multidisciplinary team-work in the community. Low client:staff ratio. Assertive outreach.
Medication adherence. Emergency cover. Intensive case management.
Bouras, N., Turnell, G., Brough, D., Watson, J. (1986) Model for integration of
community psychiatric and primary care.
Journal of the Royal College of General Practitioners 36: 62-6.
McGraw, J., Bond, G. (1995) Critical ingredients of Assertive Community Treatment:
judgements of the experts. Journal of Mental Health Administration 22: 113-25.
Marshall, M. Lockwood, A. (2000) Assertive community treatment for
people with severe mental disorders. The Cochrane Review. Issue 3. Oxford. Update Software.
(Community mental health teams)
Nurse - Occupational Therapist - Psychiatrist - Psychologist
Bennett, D., Freeman, H. (1991) Principles and Prospects. Pages 1-39.
in Community Psychiatry Edinburgh: Churchill Livingstone.
Merson, S. Tyrer, P. Onyett, S. (1992) Early intervention in psychiatric emergencies:
a controlled clinical trial. The Lancet 339: 1311-4.
Tyrer, P., Coid, J. Simmons, S. (2000) Community mental health teams for
people with severe mental illness and disordered personality.
The Cochrane Review Issue 3. Oxford. Update Software.
(Home based care & Initial crisis intervention)
24 hour Mental Health 1st Aid.
Querido, A., (1968) The shaping of community mental health care.
British Journal of Psychiatry 114: 293-302.
Weisman, G. (1989) Crisis Intervention. in Bellack, A, (ed).
A clinical guide for the treatment of schizophrenia. New York. Plenum Press.
(Acute Day Hospital)
Creed, F., Black, D., Anthony, P. (1990) Randomised controlled trial of day patient
versus inpatient psychiatric treatment. British Medical Journal 300: 1033-1037.
Sledge, W., Tebes, J., Rakfeldt, J. (1996) Day Hospital crisis respite care versus
inpatient care. part 1. clinical outcomes. American Journal of Psychiatry 153: 1065-1073.
Creed, F., Mbaya, P. Lancashire, S, (1997) Cost effectiveness of day and
inpatient psychiatric treatment: results of a randomised controlled trial.
British Medical Journal 314: 1381-1385.
Almaraz-Serrano, A., Marshall, M. Creed, F. (2000) Day hospitals for
people with psychiatric disorders (protocol) The Cochrane Review Issue 3.
Oxford. Update Software.
(Day Care)
Crisis House.
Catty, J., Burns, T., Comas, A. (2000) Day centres for severe mental illness. (protocol)
The Cochrane Review Issue 3. Oxford. Update Software.
(Case Management)
Co-ordinating services. Case Manager. Assess needs. Develop care plan. Provide care.
Audit quality. Maintain contact. Improve social functioning. Improve quality of life.
Holloway, F. (1991) Case management for the mentally ill: looking at the evidence.
International Journal of Social Psychiatry 37: 2-13.
Thornicroft, G. (1991) The concept of case management for long term mental illness.
International Review of Psychiatry 3: 125-32.
Rossler, W., Loffler, B. Fatkenheuer, A., Riecher-Rossler, A. (2000) Case management
for schizophrenic patients at risk of rehospitalisation - a case control study.
European Archives of Psychiatry & Clinical Neuroscience
Kanter, J. (1991) Integrating case management and psychiatric hospitalisation.
Health & Social Work 16: 34-42.
Rossler, W., Loffler, W. Fatkenheuer, B. Reicher-Rossler, A. (1992) Does case
management reduce the rehospitalisation rate? Acta Psychiatricia Scandinavia. 86:445-9.
Marshall, M. Grey, A., Lockwood, A., Green, R., (2000) Case management for
people with severe mental disorders. The Cochrane Review Issue 3. Oxford. Update Software.
Ericae Test Locator - Search Resource for Scales
The Department of Health : Policy, guidance and publications for NHS and social care professionals
The School of Nursing and Midwifery,
.Thorn-Initiative Queen's University Belfast.
Library Services .
association collaboration encouragement friendship
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The Cochrane Database of Systematic Reviews
The Database of Abstracts of Reviews of Effectiveness DARE
The Cochrane Controlled Trials Register
The Cochrane Methodology Register
The NHS Economic Evaluation Database
Health Technology Assessment Database
Cochrane Database of Methodology Reviews (CDMR).
World Health Organisation Guide to Mental Health in Primary Care
online books
Web edition - BNF
* To search for full-text clinical guidelines use
the SEEK (Sheffield Evidence for Effectiveness and Knowledge)
database <http://www.shef.ac.uk/seek/guidelines.htm>.
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