Session 4: Recognising mental health problems

Introduction

As indicated in session 1, the way in which we talk about mental health varies from person to person. In general, particularly when it has a major impact on their ability to function, a person who is feeling ‘extremely sad’ or ‘very worried’ may be diagnosed with a mental health condition, for example, ‘depression’ or ‘anxiety’. However, in other cases, such feelings may be viewed as understandable reactions to events that will pass with time. A person who seeks to make sense of their mental health problems may come to understand it in the context of their life experience, while a health professional may be looking for evidence of specific ‘symptoms’ to see if a psychiatric diagnosis is appropriate.

Figure 1: Early symptoms of mental health illness

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The graphic is of a brain, and at the top of the brain the text: early symptoms of mental illness

In the brain there are the following labels: feeling sad, concentration problems, anger management issues, paranoia, suicidal thinking, excessive fears or worries, extreme mood changes, sleeping problems, inability to cope with stress, excessive use of alcohol or drugs.

Figure 1: Early symptoms of mental health illness

Behind the scenes, some mental health practitioners are continually seeking the right balance between making mental health a medical problem, or seeing it as a continuum along a line of ‘healthy’ to ‘unhealthy’ adaptations to life’s stresses. In this session, you will explore the different ways in which mental health is viewed.

To get started, listen to Tanya Byron again, this time talking about different professional approaches to recognising mental health problems. She uses a number of technical terms, but don’t worry too much about this now, as you’ll explore these in Activity 1.

Download this audio clip.Audio player: Audio 1: Interview with Professor Tanya Byron

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Transcript: Audio 1: Interview with Professor Tanya Byron

TANYA BYRON

Well in a sense when I’m working with my colleagues, when I’m working with my teams, and we are assessing a young person, we tend to think in sort of blocks of theory, and in a sense through careful assessment, both

TANYA BYRON

qualitative assessment with the young person, with their family, often with schools and teachers. And sometimes with their friends. I mean if the young person, for example, is very depressed, or unable to communicate, friends are often a very useful resource of information. We are literally sort of kicking down different hypotheses that we may have about why this young person is presenting in crisis. So, to begin with we might wonder whether there are some neuro-developmental issues, is there something actually at

TANYA BYRON

a brain level that is making life increasingly challenging through this complex time? We obviously want to know what is going on at home, is there a specific amount of stress, risk factors, erm, whether it is abuse or domestic violence, or just discord, marital breakdown and discord in the home that is contributing to this young person’s difficulties. Some young people may show very context-specific difficulties.

TANYA BYRON

So if I’m meeting young people where they are generally doing okay, but struggle really specifically at school, and are getting a lot of negative feedback, beginning to feel like they have failed, maybe becoming the person that they are being told they are, so it becomes a self-fulfilling prophecy, they stop thinking, they stop learning, they misbehave. We might then want to explore specific learning difficulties, you know, finding young people with very good IQs, but actually with learning difficulties, whether they are to do with

TANYA BYRON

sensory integration, or to do with dyslexia, or dyspraxia. Whatever we are looking at, it would help us explain why this young person, understandably struggles in that particular learning context.

JOHN OATES

So that sounds pretty wide in the sorts of theoretical orientations you are drawing on, but are there specific therapeutic approaches that you take, or would you say you really have to match that to the case?

TANYA BYRON

We do have to match therapeutic approaches to the case, which is why the most effective way of working with a young person, because of the system that they bring with them, is within a multi-disciplinary team. So, even though I would lead the team, I would rely on the expertise of my colleagues, who come from different skillsets, to be able to contribute to the assessment. And then sometimes themselves do further specific assessment, for example educational assessment, or neuro-developmental assessment. Sometimes you know much more sort of specific -

TANYA BYRON

we might have to scan some young people’s brains, erm, or even more psychotherapeutic colleagues, who might want to work with families and understand the family narrative. So it is quite complex, and in a sense as a consultant my role is to sort of navigate that, and to … what we do as clinical psychologists is we create what we call a formulation. In a sense we are creating an evidence based narrative to the presenting difficulties. And actually just explaining to a young person, and their family

TANYA BYRON

what we think might be behind what is going on for them can be a very empowering experience, because once you understand a problem, to some degree you are almost in a much better position to try and solve it. So, yes, it is about navigating the complexities, sticking with an evidence based model, and evidence based therapeutic approaches. And erm, always working collaboratively with the young person, because obviously they need to be very much central to the treatment

TANYA BYRON

erm, they need to take ownership of it. It is their life, and so they also need to inform us and help us understand where we might not be quite hitting it in the right place for them. Communication is vital really.

End transcript: Audio 1: Interview with Professor Tanya Byron

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Audio 1: Interview with Professor Tanya Byron