In this article
After reading this Care Certificate Standard 9 – Awareness of Mental Health, Dementia and Learning Disabilities, you should be able to:
- Understand the key legislation around mental health, dementia and learning disabilities.
- Understand the different types of mental health problems.
- Understand dementia awareness.
- Understand the medical and social model.
The Care Certificate Standards detail what you must achieve and be assessed against to meet these learning outcomes.
If you have any concerns or queries, you should discuss these with your employer and/or assessor.
Key definitions and legislation
It is important for all health and social care workers to have awareness on mental health, dementia and learning disabilities. Having awareness can help you notice any signs and symptoms, which will enable you to support people and work in a compassionate and understanding way.
Statistics on mental health
- 1 in 4 people will experience a mental health problem each year.
- Male suicide rates hit a two-decade high in 2019.
- 75% of mental illness starts before the age of 18.
Statistics on dementia
- 1 in 4 hospital beds are occupied by people living with dementia who are over 65.
- The prevalence of dementia in care homes has risen from 56% in 2002 to 70% in 2013.
- Dementia affects 1 in 6 people over the age of 80.
Statistics on learning disabilities
- Around 2.16% of adults in the UK are believed to have a learning disability.
- There are 1.4 million people in the UK living with a learning disability.
- 54% of people with a learning disability have a mental health problem.
- Anxiety – A feeling of unease, that can be mild or sever and result in panic attacks.
- Autism – A developmental disorder, often causing difficulties with communication and social interaction.
- Bipolar Disorder – A mental health condition that causes extreme mood swings.
- Cognitive Behavioural Therapy – A talking therapy that can help you manage your problems, by helping change negative thinking patterns.
- Consent – Where a person voluntarily agrees.
- Dementia – On going decline of brain function.
- Depression – A low mood that affects your daily life and can last for weeks or months.
- Discrimination – Treating an individual or group of individuals less favourably because of a specific characteristic.
- Hallucinations – Where someone hears, sees, smells or feels things that don’t exist out of their mind.
- Human Rights – Moral principles or norms that describe certain standards of human behaviour.
- Learning Disabilities – Affect a person’s ability to understand or use spoken or written language.
- Makaton – Use of symbols and signs to communicate.
- Mental Capacity – The ability to make personal decisions.
- Mental Health – A state of well-being in which a person can cope with the normal stresses of life.
- Paranoia – Intense feelings of anxiousness.
- Psychosis – Where you hear or see things that are not there or believe things that are not true.
- Schizophrenia – Mental health condition where you hear or see things that are not real.
- Stereotyping – Mistaken idea or belief, based upon how someone looks from the outside.
- Wellbeing – Being comfortable, healthy and happy within yourself.
The Care Act 2014
In accordance with this Act, a local authority in England must provide an individual with an advocate if it is determined that an individual would have ‘substantial difficulties’ in one or more of the following:
- Understanding relevant information.
- Retaining the information.
- Using the information to make a decision.
- Being able to communicate their decision by any relevant means.
Without assistance with one of more of these factors, individuals may fail a test of mental capacity, which means that their liberty may deprived when it should not be.
Human Rights Act 1998
The Human Rights Act gives everyone legal protection of their human rights. It contains 16 ‘Articles’ such as ‘right to life’ (Article 2) or ‘right to a fair trial’ (Article 6).
Other Articles from the Act, include:
- Freedom from torture and inhuman or degrading treatment – Article 3.
- Right to liberty and security – Article 5.
- Respect for your private and family life home and correspondence – Article 8.
- Freedom of thought, belief and religion – Article 9.
- Freedom of expression – Article 10.
- Right to marry and start a family – Article 12.
- Prohibition of discrimination in respect of these rights and freedoms – Article 14.
Everyone who lives within the UK is protected by this Act and this includes those people who are in prison or in hospital or residential care or those who are foreign nationals.
The Act applies to all public authorities, for example the police, the NHS and all prison staff, however it does not apply to individual and private companies.
Mental Capacity Act 2005
The Social Care Institute for Excellence (SCIE) maintains that the following are key messages that apply to this Act and all must be adhered to when there is an instance where the Act should be applied:
- The Act applies to individuals who are aged 16 and over and who are unable to make all or some decisions for themselves.
- The Act is designed to protect and restore power to individuals who lack capacity.
- The Act enables individuals over the age of 18 to plan for their future – this applies to everyone in the general population.
- All professionals must abide by the Act and must know how it applies to their role.
- The Act provides guidance and support for informal carers.
- The Act’s five principles are a benchmark and must underpin all acts that are carried out in relation to the Mental Capacity Act.
- Any person who is involved in caring for an individual who may lack capacity must be involved in assessing their capacity.
- If it is found that capacity is lacking, the checklist concerning the individual’s best interests in the Code must be followed.
The MCA has been in force since 2007 and applies to England and Wales. The primary purpose of the MCA is to promote and safeguard decision-making within a legal framework.
All health and social care practitioners are bound by the Act when working with individuals who have been appropriately assessed and been found to be lacking capacity.
This ensures that any decisions taken on behalf of an individual have been made lawfully, in their best interests and with the least restriction to their liberty as possible.
Mental Capacity Act – 5 key principles
The Mental Capacity Act contains five key principles, which must be applied at any time when the Act is being used for individuals who lack capacity.
It is useful for practitioners if they consider the principles in chronological order; principles 1 to 3 support the process before or at the point in identifying if someone lacks capacity.
Once this has been ascertained, principles 4 and 5 support the subsequent decision-making process.
The five key principles are:
- Principle 1 – A presumption of capacity.
- Principle 2 – The right to be supported when making decisions.
- Principle 3 – An unwise decision cannot be seen as the wrong decision.
- Principle 4 – Best interests must be at the heart of all decision making.
- Principle 5 – Any intervention must be with the least restriction possible.
Mental Health Act 1983 (amended 2007)
The Mental Health Act is a law which sets out when an individual can be admitted, detained and treated in hospital against their wishes. Many people who are being treated in a hospital’s psychiatric wards are there because they have agreed to treatment; these individuals are known as ‘informal’ or ‘voluntary’ patients.
The act also contains further information regarding:
- An individual’s full rights whilst they are detained against their will.
- The rights of an individual’s family whilst they are detained against their will.
- An individual’s rights regarding consenting to treatment whilst they are detained.
- An individual’s rights regarding treatment in the community – also known as a Community Treatment Order.
- The free treatment that an individual will be entitled to once they have left hospital – this is known as ‘section 117 aftercare’.
Data Protection Act 2018
The Data Protection Act 2018 sets out the newest framework for data protection law in the UK. It updates and replaces the Data Protection Act 1998 and it came into effect on 25th May 2018.
It aims to empower individuals to be able to take control of their personal data and support organisations to process such data in a lawful way.
It works alongside the GDPR (General Data Protection Regulation) and sets out how the GDPR applies in the UK. It also outlines separate data protection rules for law enforcement authorities and extends data protection to some other areas where it is most relevant, such as national security and defence, and, importantly, it also details the Information Commissioner’s functions and powers.
The Safeguarding Vulnerable Groups Act 2006
The aim of this Act is to help avoid harm or risk of harm by preventing people who are deemed unsuitable to work with vulnerable groups from gaining access to them by their role at work.
The overall principles of the Act are:
- Those who are not suitable should be barred from working with both children and vulnerable adults.
- Employers should be able to have an easy way of assessing whether or not someone is barred from working with children and vulnerable adults.
- Checks of someone’s eligibility to work with children and vulnerable adults should not be one-offs but should be ongoing in order to identify those people who may have committed a crime since initially being assessed.
Awareness of Mental Health Conditions
According to health professionals, the key components of mental well-being can be broken down into several parts:
- Coping with stress.
- Managing emotions.
- Forming and maintaining friendships and relationships.
- Having an appropriate level of fitness and a good balanced diet.
- Dealing with experiences and life events.
- Feeling secure and supported.
Stress and mental health
Stress and mental ill health are commonly linked because when someone feels overwhelmed with stress, their ability to carry out day-to-day functions is compromised.
These can include functions such as:
- Cognition (thinking) – The ability to think about information and make decisions in a sound manner.
- Perception – The ability to accurately understand events that are going on around you.
- Emotions and mood – The ability to express how you are feeling in an appropriate fashion, including the way in which you respond to the feelings of others.
Common mental health problems
A risk factor is defined as something which increases the likelihood of an individual developing a disease.
Risk factors can be one or more of the following:
Examples of mental health problems include:
Depression can cause overwhelming feelings for individuals who have the condition.
Symptoms of depression, as stated by the NHS, include:
- Constant feelings of sadness or low mood.
- Low self-esteem.
- Constantly tearful.
- Being guilt-ridden.
- Being irritable and intolerant of other people.
- Having no interest in activities that were once pleasurable.
- Being unable to make decisions.
- Finding no enjoyment in anything.
- Being fearful or anxious.
- Self-harming or having suicidal thoughts.
Bipolar disorder, formerly known as ‘manic depression’, is a serious mental illness that is characterised by extreme changes in mood and behaviour that cause individuals to go from feeling severely depressed to extremely elated, often in a very short space of time.
Symptoms of bipolar include:
- Talking quickly and not making sense
- Spending money recklessly
- Risky sexual behaviour
- Being rude or aggressive
- Eating more or less than usual
- Abusing drugs and alcohol
Schizophrenia is a very serious mental illness where individuals are unable to differentiate between reality and imagination. It is the most common type of psychotic illness and is thought to affect up to 1 in 100 people in the UK during their lifetime.
Schizophrenia results in a disturbance of thoughts and feelings and can lead to odd and troubling behaviours. It is often mistaken for, and incorrectly labelled as, ‘split personality’, which makes the perception of it inaccurate and therefore more difficult to understand.
Symptoms of depression include:
- Disordered thinking
- Disordered movement
- Flat emotions
- Loss of pleasure in previously enjoyable activities
- Personal neglect
- Lifeless speech and body language.
Symptoms of anxiety include:
- Panic attacks
- Excessive worrying
- Feeling agitated
- Feeling on edge
- Difficulty concentrating.
Symptoms of panic attacks include:
- Racing heart
- A feeling of being detached from reality
- A ringing in the ears
- Chest pain.
Contrary to popular belief, dementia is not actually a condition itself. It is an umbrella term used to describe a group of symptoms, which people would recognize as dementia. Some of these symptoms include loss of memory, the decline in ability to think and reason and issues with communication. Symptoms of dementia are caused by a variety of different disorders and conditions and can vary enormously between individuals.
Dementia is thought to currently affect up to 850,000 people in the UK, with this figure set to rise to 1,000,000 by 2025.
The types of dementia
There are several types of dementia, which are most commonly diagnosed and whilst each has some symptoms that are unique to the type, many will share symptoms, which can make diagnosing what type of dementia someone has, quite difficult.
The types of dementia are:
- Alzheimer’s disease.
- Vascular dementia.
- Mixed dementia.
- Dementia with Lewy bodies.
- Frontotemporal dementia (Pick’s disease).
- Parkinson’s dementia.
Alzheimer’s disease is the most common form of dementia and is caused by destruction of brain cells and nerves which interrupt transmitters that carry messages to and from the brain.
With this cause of dementia, the area of the brain most associated with memory will likely be most significantly impacted, which means that the storing of new information and the retrieving of old information may become more difficult.
This does not just affect the individual’s ability to remember events but also their ability to make decisions, communicate and follow the correct sequence in a set of instructions.
Vascular dementia is the second most common cause of dementia and refers to blood vessels which are responsible for carrying blood around the body and how these are affected.
Vascular dementia occurs when these blood vessels are damaged and the supply of oxygen to the brain is subsequently reduced, which then leads to a series of ‘mini strokes’.
Some of the mini strokes that are the cause of vascular dementia may be so small that an individual does not notice them. However, each one will cause damage to an area of the brain and eventually symptoms that are associated with this cause of dementia will be noticeable.
Vascular dementia usually affects the areas of the brain that are responsible for speech, language, memory and coordination and it can be experienced alongside Alzheimer’s disease.
This kind of dementia is caused by damage to the frontal lobe and/or the temporal parts of the brain. It covers several conditions, which include dementia that is caused by motor neurone disease.
Frontotemporal dementia is most likely to cause problems with behaviour, problem solving, planning, emotional responses and use of language.
Dementia with Lewy bodies
Dementia with Lewy bodies is caused by the ongoing degeneration and death of nerve cells in the brain where the ‘Lewy’ bodies are abnormal collections of proteins, which obstruct messages going to and from the brain.
It is thought that about half of individuals who develop dementia with Lewy bodies also have signs and symptoms of Parkinson’s disease.
Dementia with Lewy bodies is most likely to affect an individual’s concentration and attention, memory, language and reasoning and decision making.
Dementia as a disability
Dementia is classed as a disability in line with the definition of disability that is cited in the Equality Act 2010, which states that a person has a disability if they have a physical or mental impairment, which has a substantial and long-term adverse effect on their ability to perform day-to-day activities.
Having dementia defined as a disability ensures that individuals are able to uphold their rights to equal treatment in society, such as the ability to find and maintain employment and the right to access appropriate health and social care to support their needs.
Living with dementia
Dementia worsens because of gradual but consistent damage to brain cells, but there are some types of medication that can slow the damage down in Alzheimer’s disease and DLB, which are:
- Memantine (Alzheimer’s disease only).
This medication is not a cure for any type of dementia but it may give individuals more opportunity to remain independent for longer, lessening the possibility of them having to live in residential care for a much longer time.
For vascular dementia, it may be possible to manage the symptoms of dementia by offering the individual types of medication that promote other aspects of their health that are thought to be linked to this type of dementia. So, medication to control blood pressure and cholesterol may be a useful alternative to the medications that are meant specifically for dementia.
What are the behaviours an individual may experience?
The types of behaviours that an individual may experience will vary greatly from person to person but some examples may include:
- Repetitive behaviours.
- Shouting and screaming.
- Using inappropriate language.
- Hiding and hoarding items.
- Losing inhibitions.
- Harming or attempting to harm someone else.
It is important for carers to remember that the individual is not behaving in a way that challenges on purpose. They are likely to be expressing a need and their reality may be very different to that of other people.
However, should the individual’s behaviour become overwhelming for their carer(s) then support should be sought for the carer at the first opportunity. They may be able to take a break by organising care by someone else such as another family member or they may be able to organise formal respite care by getting in contact with Social Services.
Some of the possible ways of preventing dementia include:
- Being physically active: It is thought that regular physical exercise is one of the best ways to reduce the risk of dementia. It is recommended that individuals take part in 150 minutes of moderate aerobic activity per week, such as walking or riding a bike.
- Eating healthily: A healthy balanced diet can not only potentially reduce the risk of dementia but also other conditions as well such as type 2 diabetes, obesity and heart disease. Eating five portions of fruit and vegetables per day, reducing fat and sugar intake and drinking two litres of water per day are all thought to contribute to overall good health.
- Don’t smoke: The risk of developing dementia for individuals who smoke is thought to be much higher than for those individuals who do not. Smoking causes damage to the circulation of blood around the body including blood vessels.
- Drink less alcohol: Moderating the amount of alcohol that an individual drinks in a week is also thought to be important in reducing the risk of dementia. it is recommended that no more than 14 units per week should be consumed and this should be over a period of three days or more.
- Being mentally active: Regular challenges to the brain are thought to be important in helping to prevent the onset of dementia. For example, doing a qualification, crosswords, quizzes and board games. Additionally, the social aspect of remaining mentally active is also thought to be a useful preventative measure as well.
Generally, a learning disability affects the way that an individual learns and how they communicate. This does not mean that they just experience issues when learning in an academic sense but in other areas as well, such as socially, financially and emotionally.
Individuals with learning disabilities might be able to communicate fairly well and look after themselves if their disability is mild. However, moderate and severe learning disabilities can mean that the individual has more complex needs and therefore more care and support.
Individuals who have profound or multiple learning difficulties are likely to need full time care and some may have physical disabilities as well. Learning disabilities are lifelong and cannot be cured.
A learning disability and a learning difficulty are not the same thing. A learning difficulty, such as dyslexia does not impact on an individual’s overall intellect, whereas a learning disability does. The two are often used interchangeably but this should not be the case.
The causes of learning disabilities
For some learning disabilities, there are no known causes, however for others, the cause is identifiable and is stated as occurring during one of the following times:
- Before birth.
- During birth..
- After birth.
The medical model
The medical model of disability defines a person by their disability or their condition. The model does not empower the person as their medical diagnosis controls many aspects of their life, such as the types of benefits that they may be entitled to or the type of housing that is available to them.
The medical model sees people as dependent upon others in order to live their life. They are seen as needing to be cured and health professionals are seen as experts in deciding what is best for the individual and they, therefore, have a lot of control and input into the individual’s life.
The medical model sees the individual as the problem in their circumstances rather than society and, it is sometimes referred to as the ‘individual model’. Although the model is less well favoured now than in previous times and is strongly rejected by disabled people, many others still view disabled individuals in this way and often, so do health professionals who do not enable the individual to make their own choices.
The social model
The social model of disability, on the other hand, has been developed by disabled people in response to the negative consequences of the medical model. The social model sees society as the cause of disability rather than being the ‘fault’ of the person who is disabled. The model also sees disability as a product of the negative way in which disability and disabled people are viewed by society and the barriers caused by this, which ultimately lead to discrimination. The model states that in order for discrimination to be eliminated, changes in attitudes will be needed so that disability is not seen as a stigma but as part of everyday society.
The social model sees disabled people as valuable contributors to society but who have been negatively stereotyped by others and by the media as somehow being ‘second class citizens’ and the model aims to have these attitudes, and the barriers that cause them in the first place completely removed.
The difference between the medical and social model
An example of the difference between the medical and the social model might be seen in the example of Gaynor, who is a wheelchair user and has been since she was involved in a car accident at the age of nine.
When Gaynor is at home, she is not disabled because she has full access to everything that she needs in order to live her life in a meaningful way. Her house has been adapted so that everything is available to her and she does not need to rely on anyone else in order to go about her daily activities.
However, when Gaynor needs to visit her local town to go shopping, she is seen as disabled. This is because the bus that she travels on does not always have space for her wheelchair, meaning that she either has to wait until one arrives, which does have space, or she has to take an expensive taxi ride instead. When she is in town, there are some shops that she cannot get into because they do not have adequate ramp access and when she is in other shops, their floor merchandise is organised in a way that makes maneuvering her wheelchair almost impossible.
The social model has changed the way in which disabled people are viewed, it has certainly had an effect on some equality and anti-discriminatory legislation. However, many people still revert to the medical model when they think of disabled people, and it is these attitudes that the social model is being developed in order to change.
Promoting communication with individuals with learning disabilities
There are many ways in which verbal communication can be adapted to suit an individual’s needs, some of which are as follows:
- Using clear, concise and simple language: learning disabilities can mean that individuals take longer to process information, so keeping sentences short and to the point can avoid confusion and misunderstanding. Telling an individual that they have got a very sore throat rather than tonsillitis might not give a completely accurate picture of a situation but it will help them to better understand what is happening.
- Avoiding jargon or dialect words: jargon can be any word that is specific to a subject, whilst dialect words are those that are specific to a particular region of the country. When faced with jargon and dialect words, any individual whether or not they have learning disabilities can struggle to follow a conversation, so it is important to leave these completely out and find other ways of explaining things.
- Keeping information simple: asking one question at a time rather than several in succession can help information to be better understood. This also applies to not using words that are overly complex or which may be subject to misinterpretation.
- Repeating information as often as required: although it can be frustrating to repeat things more than once or twice, if this is what the individual needs in order to understand then information should be repeated until the individual knows what is being said.
- Ensuring that voice tone matches the content of the information: giving positive information with a somber tone of voice or stating something very serious in a way that sounds happy and joking, will cause much confusion so ensuring that tone and information content match is vital.
- Keeping distractions to a minimum: having a conversation where there is a very loud television or where others are speaking can be very distracting. Minimising distractions helps concentration, which may help individuals to take in information and understand it more quickly.
- Ensuring the lighting and other environmental factors are appropriate: a room that is too bright, dark, loud, hot or cold does not make an ideal environment for any conversation so it is important to fix any of these factors prior to having a conversation, whenever this is possible.
- Face the individual and use appropriate eye contact: not looking someone in the eye suggests that someone is not listening to them or is listening but distracted by someone else. It is respectful to use appropriate eye contact, whenever this is culturally appropriate.
- Allow plenty of time for the individual to respond and do not interrupt: learning disabilities can often mean that individuals take longer to understand information. When communicating with someone therefore, enabling them to have enough time is not only respectful but encourages them to continue the conversation. Interrupting when someone is speaking is not only rude but suggests that someone wants the conversation to be over and is not really interested in hearing what the other person has to say.
- Speak directly to the individual and not to an advocate or care worker: again, respecting the individual by speaking directly to them and not to the person they are with is very important. This applies to any form of advocate, care worker or possibly interpreter as well.
- Using Makaton: can be used to develop communication skills, the visual way of communicating helps language development
Why individuals with disabilities may be at risk of abuse
Some individual’s disabilities can make them more vulnerable. This can make them more susceptible to abuse. The question of precisely why individuals are at more risk of abuse is under constant scrutiny with findings so complex that they are beyond the scope of this course.
However, here it is useful to consider the types of abuse that people with disabilities may be at risk of and some basic information as to why this might be the case.
Types of abuse
Abuse can take many different forms:
- Physical: violence, misuse of medication, inappropriate restraint
- Sexual: any form of sexual act or contact
- Emotional or psychological: threats of harm or abandonment, humiliation, blaming, controlling, intimidation, harassment, verbal abuse
- Financial: theft, fraud, exploitation, pressure related to wills, misuse of property, possessions or benefits
- Institutional: neglect and poor practice within an organisation such as a hospital or care home
- Self-neglect: many different forms of behaviour relating to personal hygiene, health and surroundings – this can also include hoarding
- Neglect by others: ignoring medical or physical care needs, failure to provide access to services, withholding medication, nutrition or heating
It is argued that there are several risk factors, which make some individuals more susceptible to abuse and these include:
- Low mental capacity.
- Increasing age.
- Being physically dependent on others.
- Having low self-esteem.
- Social isolation.