Anxiety is a feeling of fear, panic, worry, or unease about future events, and can be linked to a fear reaction around current events. When felt unusually intensely or for prolonged periods it can develop into a debilitating anxiety disorder that impacts on a person’s quality of life and their ability to respond appropriately to life events. Anxiety and Depression is almost three times as likely to occur in older people with sight loss than people with good vision.

Anxiety is a broad term that encompasses many underlying disorders and phobias, including:

• Generalised anxiety disorder (GAD): This is characterised by constant worrying, feeling on edge and being unable to relax, which prevents pleasure in day-to-day life.
• Panic disorder: This is characterised by repeated, unexpected bouts of severe anxiety, often accompanied by physical symptoms such as a fast heart rate and shakiness. With time, anxiety becomes more continuous, and the fear of having a panic attack can become embedded.
• Social anxiety disorder: This form of anxiety is typified by a debilitating fear that other people will think badly of the individual. It often has roots in being very shy as a child and can make it hard to develop friendships or a fulfilling social life. It can also affect how people perform in public.

Bipolar disorder, formerly known as manic depression, is a mental illness that has prolonged periods of depression and periods of abnormally elevated moods. These are seen to swing from one extreme to another, giving periods of depression and periods of elevated moods; If the elevated mood is significant it is known as mania or hypomania depending on its severity or whether symptoms of psychosis are present

There are several different types of personality disorder. However, BPD is characterised by a person thinking, feeling and relating to others differently from the average person. This is shown through their patterns of behaviour, varying moods, and unusual self-image.

Depression is a common and serious medical illness that negatively affects how the person feels, the way they think and how they act. There are several types, which are classified based on the impact that they have on individuals and the symptoms that are experienced. It causes feelings of sadness and/ or a loss of interest in activities once enjoyed and can lead to a variety of emotional and physical problems, decreasing a person’s ability to function effectively. Women are more likely to seek depression help and treatment than men. However, it is treatable.

Most common Treatments for depression include:

• Cognitive Behavioural Therapy (CBT). This is a type of psychotherapy that aims to tackle the negative thoughts that are associated with depression. CBT helps people to think in a more balanced way and challenges their negative assumptions about their lives. It aims to identify and change aspects of behaviour that may cause or prolong symptoms of depression.
• Antidepressant Medication. This is typically used alongside CBT to complement the psychotherapy and act as an additional buffer against depression. Antidepressant medication will be the first line of treatment for depression if:
  • It is severe or comes and goes
  • The person has responded well to medication in the past
  • The person has not responded well to psychotherapy in the past

There is a history of familial depression

Eating disorders are mental health conditions where the control of food is used to cope with feelings and other situations. They appear as (severe) disturbances in a person’s eating behaviours. Although many people may be concerned about their health, weight, or appearance on occasion, some become fixated or obsessed with weight loss, body weight or shape, and controlling their food intake. The most common disorders are Anorexia Nervosa: trying to control your weight by not eating enough food, exercising too much, or doing both; Bulimia: losing control over how much you eat and then taking drastic action to not put on weight and Binge Eating Disorder (BED): eating large portions of food until you feel uncomfortably full.

Emotionally Unstable Personality Disorder (also ADHD) is a brain disorder causing a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness that interfere with functioning or development. These are usually noticed at an early age often becoming more apparent at the start of schooling but can continue into adulthood.

OCD is associated with repetitive unwanted thoughts or behaviours which are often related to issues concerning safety, contamination or harm. The behaviours associated with OCD can seem impossible to stop or control and can become extremely time consuming, affecting the individual’s ability to conduct normal life.

PTSD is a specific form of anxiety disorder characterised as a persisting anxiety state related to having had a traumatising experience that was highly stressful, frightening or distressing events; the resultant stress can continue long after the initial triggering events have ended.

Schizophrenia is a psychotic disorder; it is a severe long-term mental health condition that causes a range of different psychological symptoms. These can include:

• Hallucinations – characterised by hearing or seeing things that others do not.
• Delusions – holding unusual or false beliefs that are not based on reality.
• Muddled thoughts – unclear and confused thinking resulting from hallucinations or delusions
• Changes in behaviour patterns/ Abnormal social behaviour or reluctant social interaction and lack of motivation

If a person experiences a combination of schizophrenia symptoms such as hallucinations or delusions and mood disorder symptoms such as depression or mania and deregulated emotions, they are described as having Schizoaffective Disorder.

The phrase ‘self-harm’ is used to describe a wide range of behaviours. Self-harm is often understood to be a physical response to an emotional pain of some kind, and results when a person intends to hurt themselves physically; it can be an addictive behaviour. Some forms of self-harm are quite well known, such as cutting, burning or pinching, but it also includes abusing drugs and alcohol or having an eating disorder.

DES is characterised by of a group of symptoms, usually resulting from brain damage, that fall into cognitive, behavioural and emotional categories and tend to occur together.

The term describes a common pattern of poor function in regard to e.g. planning, abstract thinking, flexibility and behavioural control. It was once known as Frontal Lobe Syndrome, which characterised a location rather than the actual pattern of deficits that are exhibited.

This is the second most common type of progressive dementia after Alzheimer’s disease dementia. Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).

Lewy body dementia causes a progressive decline in mental abilities, and people with Lewy body dementia may experience visual hallucinations, and changes in alertness and attention.

Other effects include Parkinson’s disease-like symptoms such as rigid muscles, slow movement and tremors

Asperger’s syndrome is regarded as part of the Autistic Spectrum as people with the condition also experience difficulties in the three key areas of developing and maintaining Social relationships; Social communication; and Social understanding and imagination.

They do not have any cognitive impairment and are often of above average intelligence. This means that they do not technically have a learning disability, traditionally defined as someone with an IQ of below 70 (Weschler Adult Intelligence Scale). However, because of the difficulties people with Asperger’s Syndrome experience in the areas of social communication, social skills and flexibility, they often find learning, particularly in group settings, challenging and stressful, and may find coping independently difficult in later life. A person with Asperger’s may have restricted patterns or very repetitive patterns of behaviour or interests

Although autism is not a learning disability, people with autism also often have some degree of learning disability which can range from mild to severe.

The condition is described as a “spectrum” because people can be anywhere on a scale from mildly autistic through to extremely affected by the condition, which will impact on their day-to-day life and may result in a requirement for lifelong, specialist support

Autism itself is a life-long development condition that affects the way a person communicates and relates to people and the world around them in these three key areas:

• Social relationships – Difficulty forming relationships with other people and developing and maintaining appropriate social skills
• Social communication – problems with understanding gestures, body language and facial expressions that may be further exacerbated by difficulties with speech and understanding of the spoken word.
• Social understanding and imagination – some people have difficulty understanding abstract ideas, or other people’s points of view. People with autism often have very specific interests and like fixed routine development of appropriate social skills

It is important to recognise that with the right support all people with autism can, and do, learn and develop

This is defined as behaviours that can cause significant distress or danger towards others and if it stops the person achieving things in their daily life, such as making friends or concentrating. It can be displayed by a person:

• Becoming verbally aggressive towards others;
• Throwing a tantrum;
• Hitting and kicking another person;
• Throwing of objects and
• Damaging of property.

It may also present itself by the person self-harming.

Behaviours of Concern and Learning Disability

Behaviours of Concern are not a learning disability, but people with a disability are more likely to display these behaviours. This can be due to people having difficulty communicating and expressing frustrations. Behaviours of Concern can also be a sign that something is physically wrong, i.e. a general health issue causing pain or discomfort and that the person cannot express in any other way. They may also be indicative of wider problems, including with someone’s mental health.

Positive Behaviour Support (PBS)

Positive behaviour support (PBS) is a person-centred approach to support people who display or are at risk of displaying behaviours which challenge. Its primary aim is to improve the quality of a person’s life and that of the people around them, by recognising that behaviour patterns are an outcome and do not define the person who is exhibiting them.

It is about looking for reasons for the presentation of a behaviour rather than attempting to force change without addressing and changing or managing the cause.

Very simply – People behave the way they do for a reason.

Embracing the BILD philosophy of PBS and ensuring all staff are trained in its use, at levels appropriate to their grade and position in the Company, including a cohort of fully trained PBS Coaches, has been a fundamental part of our ethos in managing behaviours of Concern. This has also been linked to recognised PBS based physical intervention training that complements our overall PBS approach and minimises our requirements for its use.

Self – injurious behaviours can be a specific type of behaviours of Concern and therefore may have the same route causes such as pain, discomfort, mental health issues or frustration from an inability to communicate, as others.

Individuals may also use it as a mechanism for being in control of their own surroundings; or if they are uncomfortable with attention that others may be receiving and wish to draw it to themselves.

A person may cause harm to themselves in a number of ways including by cutting; head banging; hand biting and excessive self-rubbing and or scratching

Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). Hyperglycaemia, (elevated blood sugar), that is persistent and/ or occurring often, can lead to serious health problems. Hypoglycaemia (low blood sugar), usually resulting from incorrect use of medication in relation to food intake, can also lead to coma.

Chronic diabetes conditions can be Type 1 or Type 2.

Type 1 results from loss of effective Insulin production by the Pancreas. It usually starts in childhood or adolescence. It is also referred to as Insulin dependent diabetes as treatment requires regular injections of Insulin at correct dose and time to correspond with food intake.

Type 2 occurs as a result of the failure of the body’s cells to process the sugar in the blood correctly, and at least in the early stages can usually be managed through diet, exercise and tablets. It generally occurs in those who are obese and the over 40’s.

Symptoms: The following symptoms of diabetes are typical. However, some people with type 2 diabetes have symptoms so mild that they can go unnoticed.

• Urinating frequently and urgently
• Feeling very thirsty – regardless of fluid intake
• Feeling very hungry – even though you are eating
• Extreme fatigue
• Blurry vision
• Cuts/bruises that are slow to heal
• Weight loss – even though you are eating more
• Tingling, pain, or numbness in the hands/feet (type 2)

There is a risk of developing complications that arise from long-term and/or poorly managed Diabetes, so early detection and effectively managed treatment are essential to reduce these risks.

• Diabetic retinopathy: This is a common complication of diabetes. It occurs when high blood sugar levels damage the cells at the back of the eye, known as the retina. If it is not treated, it can lead to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.Evidence shows that people from the African, African-Caribbean and Asian populations are at a higher risk of developing diabetic eye disease, and that smoking can make diabetes-related sight problems worse. Smoking has also been linked to the development of cataracts.

• Cardiovascular disease: Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). People with diabetes, are more likely to have heart disease or stroke.

• Nerve damage (neuropathy): Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, all sense of feeling in the affected limbs can be lost. Damage to the nerves related to digestion can also cause problems with nausea, vomiting, diarrhoea or constipation.Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
• Kidney damage (nephropathy): The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Alzheimer’s disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer’s disease. The poorer your blood sugar control, the greater the risk appears to be.
• Depression. Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

Epilepsy is one of the most common conditions affecting the brain. It is not a learning disability but, according to Mencap statistics, 30% of people with a learning disability also have epilepsy.

Seizures are bursts of electrical activity in the brain that temporarily affect how it works. These can be triggered by e.g. flashing light, but for others the seizure occurs out of the blue.

People with epilepsy have seizures when the way their brain works becomes disrupted. Most seizures are sudden and short-lived, lasting a matter of seconds or minutes, and aren’t dangerous to the person having them, providing they are in a safe location when they occur.

Seizure signs and symptoms may include:

• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychic symptoms such as fear, anxiety or deja vu

Symptoms vary depending on the type of seizure, however, in most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Medication and Treatment

Most people with epilepsy can become seizure-free by taking anti-seizure (anti-epileptic) medication.

Ensuring that the wishes of the individual are recorded so that in the event of sudden, unexpected or known end of life, these wishes and those of any significant others in their lives can be sensitively and appropriately acted upon.

Palliative care is also commissioned from appropriate external agencies should it become necessary to ensure that an individual can continue to be cared for and live in their Home for as long as is practically possible.

Hypertension means High Blood pressure. In addition to increasing the risk of stroke, uncontrolled high blood pressure increases the risk of both retinal vein and retinal artery occlusion. Both conditions can cause sudden loss of vision in one eye and can lead to further complications.

Thyroid disease is a medical condition that affects the production of Thyroid hormone by the thyroid gland, found at the front of the neck. The symptoms of thyroid disease vary depending on the type.

There are four general types:

• Hypothyroidism (low function) caused by not having enough thyroid hormones
• Hyperthyroidism (high function) caused by having too much thyroid hormones;
• Structural abnormalities, most commonly an enlargement of the thyroid gland; and
• Tumours which can be benign or cancerous.

Common hypothyroid symptoms include fatigue, low energy, weight gain, inability to tolerate the cold, slow heart rate, dry skin and constipation.

Common hyperthyroid symptoms include irritability, weight loss, fast heartbeat, heat intolerance, diarrhoea, and enlargement of the thyroid.

In both hypothyroidism and hyperthyroidism, there may be swelling of a part of the neck, which is also known as goitre.