Looking at the needs assessment process of students with mental health difficulties:

1
Looking at the needs assessment process of
students with mental health difficulties
The impact on learning and the student journey
Challenge of mental health problems on daily
living DO role in assessment process findings
from 1st year experience survey Impact on
learning Medication, treatments and supports.

• Brendan Power
• Disability Officer,
• Trinity College Dublin

2
Presentation Overview

• Challenge of mental health problems on daily
  living.
• Findings from a 1st year experience survey.
• Medication and treatments and the impact on the
  student journey Case studies.
• The Disability Officer role in assessment
  process.

3
What is Mental Health?

• Mental health and well-being are fundamental to
  our collective and individual ability as humans
  to think, emote, interact with each other, earn a
  living and enjoy life (World Health Organisation,
  2013).
• Good mental health is an integral component of
  general health and well-being, allowing a person
  to fully realise his or her abilities. With a
  balanced mental disposition, people are more
  effective in coping with the stresses of life
  (Department of Health and Children, 2006).

4
Recovery in Mental Health

• Doing with instead of for

• A Recovery Approach within the Irish Metal Health
  Services.

The recovery approach in mental health
services emphasises the expectation of recovery
from mental ill health and promotes both enhanced
self-management for mental health service users
and the development of services which facilitate
the individuals personal journey towards
recovery. (Mental Health Commission, 2008)
5
Mental Health problems

• Risk Relevance in the student population

• The Lifetime occurrence of psychiatric disorders
  is frequent among young Irish adults aged between
  19 to 24 years (Harley et al, 2015).
• The risk of mental health difficulties exist at
  every level of adolescence which highlights the
  importance that mental health is every bodys
  business.
• At present, mental health services in Ireland
  are not configured to support a model of
  continuing integrated care through adolescence
  into young adulthood(Power et al, 2015).
• Many patients first experience mania or psychosis
  as adolescents or young adults (Malhi, et al
  2015).

6
Trinity College Dublin

• Disability Service first year experience survey
  Category of disability

7
Mental Health problems

• Medical management Recovery

• Within a mental health context, the role of
  medication supports personal recovery from
  periods of ill-health and is not just a treatment
  but a tool that helps achieve personal recovery
  goals (Baker et al, 2013).
• Medication management in Psychiatry has assisted
  in the care and treatment of clients with
  differing mental health conditions for over sixty
  years (Sheridan, 2008).

8
Mental Health problems

• Disorders, conditions and medication management

9
Mental Health problems

• Learning through experience

• Case studies are an invaluable record of both
  classical and unusual presentations which may
  confront a service provider (Budgell, 2008).
• Two case studies will be presented
• John
• Mary

10
Case Study - John

• Introduction

• John is a thirty-five year old mature student
  studying social studies.
• His primary diagnosis is Chronic Fatigue.
• John also presents with secondary mental health
  problems, exhibiting symptoms of anxiety and
  depression. He is in the care of a community
  mental health team.
• John is registered with the Disability Services
  since entering into college. Interventions
  provided included UNILINK support, exam
  accommodations and the development of a Learning
  Educational Needs Summary (LENS).

11
Case Study - John

• Impact of disability on academic life

• John exhibits significant weakness in verbal
  memory, working memory and speed of processing,
  affecting reading fluency, comprehension,
  spelling and written expression.
• John also experiences visual stress when reading
  print.
• Patients with chronic fatigue syndrome (CFS)
  suffer from medically unexplained and severely
  disabling fatigue that lasts for at least six
  months (Wiborg et al, 2014).
• John also presents with secondary mental health
  problems, exhibiting anxiety and depression.

12
Case Study - John

• Role of the disability officer

• Just prior to commencing end of year exams, John
  had requested to meet his assigned Disability
  Officer as he did not wish to proceed with exams
  with the way he was feeling.
• During interactions with John to explore current
  circumstances his current mental health problems
  were explored including what the management plan
  of his condition. John then had outlined he was
  actually going through a complete re-titration of
  a new medication upon exploration of his care and
  treatment plan. New medication was named as
  Sertraline.
• Pharmacological therapies are an important
  element of treatment received by people with
  mental health problems (Doherty, 2014).

13
Case Study - John

• Medication Sertraline
• Type Anti-depressant - Serotonin reuptake
  inhibitor (SSRI)

Family Generic drug name UK trade name US trade name Irish trade names
Anti-depressant Sertraline Lustral Zoloft Depreger, Lustral
Sertraline is indicated for the treatment of Major depressive episodes. Prevention of recurrence of major depressive episodes. Panic disorder, with or without agoraphobia. Obsessive compulsive disorder (OCD) in adults and paediatric patients aged 6-17 years. Social anxiety disorder. Post traumatic stress disorder (PTSD) (www.medicines.ie) Some side effects Feeling drowsy or fatigued, inability to sleep, dry mouth, urinary difficulties, dyskinesias (involuntary muscle movements), tooth grinding, headache, blurred vision, weight gain, nausea, rashes and infections (Healy, 2005). Sertraline is indicated for the treatment of Major depressive episodes. Prevention of recurrence of major depressive episodes. Panic disorder, with or without agoraphobia. Obsessive compulsive disorder (OCD) in adults and paediatric patients aged 6-17 years. Social anxiety disorder. Post traumatic stress disorder (PTSD) (www.medicines.ie) Some side effects Feeling drowsy or fatigued, inability to sleep, dry mouth, urinary difficulties, dyskinesias (involuntary muscle movements), tooth grinding, headache, blurred vision, weight gain, nausea, rashes and infections (Healy, 2005). Sertraline is indicated for the treatment of Major depressive episodes. Prevention of recurrence of major depressive episodes. Panic disorder, with or without agoraphobia. Obsessive compulsive disorder (OCD) in adults and paediatric patients aged 6-17 years. Social anxiety disorder. Post traumatic stress disorder (PTSD) (www.medicines.ie) Some side effects Feeling drowsy or fatigued, inability to sleep, dry mouth, urinary difficulties, dyskinesias (involuntary muscle movements), tooth grinding, headache, blurred vision, weight gain, nausea, rashes and infections (Healy, 2005). Sertraline is indicated for the treatment of Major depressive episodes. Prevention of recurrence of major depressive episodes. Panic disorder, with or without agoraphobia. Obsessive compulsive disorder (OCD) in adults and paediatric patients aged 6-17 years. Social anxiety disorder. Post traumatic stress disorder (PTSD) (www.medicines.ie) Some side effects Feeling drowsy or fatigued, inability to sleep, dry mouth, urinary difficulties, dyskinesias (involuntary muscle movements), tooth grinding, headache, blurred vision, weight gain, nausea, rashes and infections (Healy, 2005). Sertraline is indicated for the treatment of Major depressive episodes. Prevention of recurrence of major depressive episodes. Panic disorder, with or without agoraphobia. Obsessive compulsive disorder (OCD) in adults and paediatric patients aged 6-17 years. Social anxiety disorder. Post traumatic stress disorder (PTSD) (www.medicines.ie) Some side effects Feeling drowsy or fatigued, inability to sleep, dry mouth, urinary difficulties, dyskinesias (involuntary muscle movements), tooth grinding, headache, blurred vision, weight gain, nausea, rashes and infections (Healy, 2005).
14
Case Study Mary

• Introduction

• Mary is a twenty year old general nursing student
• Her primary diagnosis is Bipolar Affective
  Disorder
• Mary also presents with secondary mental health
  problems, exhibiting symptoms of anxiety.
• Mary is registered with the Disability Services
  since entering into college. Interventions
  provided included UNILINK support, exam
  accommodations, a Learning Educational Needs
  Summary (LENS) and placement planning.

15
Case Study Mary

• Impact of disability on academic life

• Mary exhibits fatigue and tiredness on a daily
  basis. Her anxiety increases in social gatherings
  and this impacts on small group work in the
  course and on placement. Mary also has problems
  with working memory which effects her spelling
  and written expression.
• Mary also must attend regular outpatient clinic
  appointments once a month.
• Bipolar disorder is defined by its poles,
  elevated mood or irritability characterises
  mania, and marked low mood and lack of energy
  typifies depression (Malhi, 2015).
• Mary is currently on a placement and has been in
  contact to say she hasnt been attending over the
  last few days due to tiredness and not waking up
  on time.

16
Case Study Mary

• Role of the disability officer

• Mary requested to meet her disability officer
• Mary was assessed on her current problem of
  non-attendance to placement and symptom of
  tiredness.
• A placement planning meeting was undertaken prior
  to Mary commencing her placement where fatigue
  was identified as impacting on her.
• Mary was also provided with the flexibility of
  shortening her longer shifts.

17
Case Study Mary

• Role of the disability officer

• During interaction with Mary the absence from
  placement was explored and her fatigue.
• The Disability Officer assessment explored
  current problem(s) to look at rationale. There
  was no change in any circumstances but Mary did
  report she had been commenced on a new
  medication, as a short-term management plan.
• Mary reported that she takes Lithuim and has been
  on this for years for her BPAD. She had been
  commenced on Olanzapine as she had been feeling
  a little off and made an appointment with her
  Consultant Psychiatrist.

18
Case Study Mary

• Medication Lithium Carbonate
• Type Mood-stabiliser

19
Case Study Mary

• Medication Olanzapine
• Type Second generation anti-psychotic

Family Generic drug name UK trade name US trade name Irish trade names
Anti-psychotic Olanzapine Zyprexa Zyprexa Zyprexa, Olanzapine Mylan
Olanzapine is indicated for the treatment of Schizophrenia. Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response. Moderate to severe manic episode. Patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder (www.medicines.ie) Some side effects Stiffness/lack of movement (akinesia), abnormal muscle tone (dystonia), restlessness/agitation (akathesia), lack of interest (demotivation), weight gain, diabetes, sedation. (Healy, 2005). Olanzapine is indicated for the treatment of Schizophrenia. Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response. Moderate to severe manic episode. Patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder (www.medicines.ie) Some side effects Stiffness/lack of movement (akinesia), abnormal muscle tone (dystonia), restlessness/agitation (akathesia), lack of interest (demotivation), weight gain, diabetes, sedation. (Healy, 2005). Olanzapine is indicated for the treatment of Schizophrenia. Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response. Moderate to severe manic episode. Patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder (www.medicines.ie) Some side effects Stiffness/lack of movement (akinesia), abnormal muscle tone (dystonia), restlessness/agitation (akathesia), lack of interest (demotivation), weight gain, diabetes, sedation. (Healy, 2005). Olanzapine is indicated for the treatment of Schizophrenia. Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response. Moderate to severe manic episode. Patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder (www.medicines.ie) Some side effects Stiffness/lack of movement (akinesia), abnormal muscle tone (dystonia), restlessness/agitation (akathesia), lack of interest (demotivation), weight gain, diabetes, sedation. (Healy, 2005). Olanzapine is indicated for the treatment of Schizophrenia. Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response. Moderate to severe manic episode. Patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder (www.medicines.ie) Some side effects Stiffness/lack of movement (akinesia), abnormal muscle tone (dystonia), restlessness/agitation (akathesia), lack of interest (demotivation), weight gain, diabetes, sedation. (Healy, 2005).
20
Role of the Disability Officer (DO)

• Generating awareness to academic schools and
  departments during routine training and DS
  activities of impact medications may have on
  students.
• During student assessments DOs should explore
  impact of medication on individual and the
  associated side effects that could result from
  treatments.
• DO role is not about knowing the wide array of
  medications but exploring the medications with
  students and impact it may have on their student
  journey.

21
Role of the Disability Officer (DO)

• Side-effects of medications are very individual
  and important to sign-post student to the
  relevant services they are attending for
  assistance.
• Medications are not specific to mental health
  treatments as there is often a co-morbidity of
  more than one condition that affects individuals.
• i.e. Schizophrenia and diabetes Student could
  be on anti-psychotic medication and insulin
  therapy as part of their management for both
  conditions.

22
Sources for general information on medication(s)

• General Information

• The information on medicines.ie relates to
  medicines available in Ireland. It is the most
  comprehensive source of information on medicinal
  products available in Ireland and is widely
  regarded as an invaluable reference source by
  healthcare professionals, the Department of
  Health and the Health Products Regulatory
  Authority.

23
Sources for general information on medication(s)

• General Information

• Health Service Executive Republic of Ireland
• http//www.hse.ie/eng/services/list/4/olderpeople/
  tipsforhealthyliving/drugsmedicine.html
• National Health Service United Kingdom
• http//www.nhs.uk/medicine-guides/pages/browsebyme
  dicine.aspx

24
Sources for general information on medication(s)

• Mental Health Specific

• Mind.co.uk United Kingdom
• http//www.mind.org.uk/information-support/drugs-a
  nd-treatments/
• Choice Medication United Kingdom
• http//www.choiceandmedication.org/cms/?langen
• Healy, D (2005) Psychiatric Drugs Explained,
  Elsevier Churchill Livingston London.

25
Next Steps

• Trinity Disability Services

• Developing a general guide to some medications
  that students may be prescribed for awareness
  within Trinity.
• With multi-morbidity of more than one condition
  prominent medication guide will be inclusive of
  primary medications, not just mental health
• Involvement of Disability service staff,
  experts-by-experience, and clinicians in its
  development.

26
Thank You
27
Source Material

• Baker, E., Fee, J., Bovingdon, L., Campbell, T.,
  Hewis, E., Lewis, D., Mahoney, L. Roberts, G.
  (2013) From taking to using medication
  Recovery-focused prescribing and medicines
  management, Advances in Psychiatric Treatment,
  19(2), pp. 2-10.
•  Budgell, B. (2008) Guidelines to the writing of
  case studies, The Journal of the Canadian
  Chiropractic Association, 52(4), pp.199-204
• Department of Health and Children (2006) A Vision
  for Change Report on the expert group on mental
  health policy, The Stationary Office Dublin.
•  Doherty, A.M. Gaughan, F. (2014) The
  interface of physical and mental health, Social
  Psychiatry Psychiatric Epidemiology, 49, pp.
  673-682.
•  E. Power, M. Clarke, I. Kelleher, H. Coughlan,
  F. Lynch, D. Connor, C. Fitzpatrick, M. Harley
  and M. Cannon (2015) The association between
  economic inactivity and mental health among young
  people a longitudinal study of young adults who
  are not in employment, education or training,
  Irish Journal of Psychological Medicine , 32(1),
  pp. 155-160.
• Healy, D (2005) Psychiatric Drugs Explained,
  Elsevier Churchill Livingston London.
•  Jan F. Wiborg, J.F., Wensing, M., Tummers, M.,
  Knoop, H. Bleijenberg, G. (2014) Implementing
  Evidence-Based Practice for Patients with Chronic
  Fatigue Syndrome, Clinical Psychology and
  Psychotherapy, 21, PP.108114.

28
Source Material

• M. E. Harley, D. Connor, M. C. Clarke, I.
  Kelleher, H. Coughlan, F. Lynch, C. Fitzpatrick
  M. Cannon (2015) Prevalence of Mental Disorder
  among young adults in Ireland a population based
  study, Irish Journal of Psychological Medicine ,
  32 (1), pp 79 91.
•  Malhi, G.S., McAulay, C., Das, P. Fritz, K.
  (2015) Maintaining mood stability in bipolar
  disorder a clinical perspective, Evidence Based
  Mental Health, 18(1), pp.1-6.
•  Mental Health Commission (2008) A recovery
  approach within the Irish mental health services
  A framework for development, Mental Health
  Commission online. Available at
  http//www.mhcirl.ie/File/framedevarecov.pdf
•  Sheridan, A. (2008) Psychiatric nursing
  practice A historical overview, in Morrisey, J.,
  Keogh, B. Doyle, L. (eds.) Psychiatric/Mental
  Health Nursing An irish Perspective, Gill
  Macmillian Dublin.
•  World Health Organisation (2013) Investing in
  Mental Health Evidence for Action, World Health
  Organisaiton, Geneva. Online Available at
  http//apps.who.int/iris/bitstream/10665/87232/1/9
  789241564618_eng.pdf?ua1