1.1 Identify causes of distress

This guide will help you answer 1.1 Identify causes of distress.

Distress is a strong feeling of sorrow, anxiety, or discomfort that affects people’s minds and bodies. In the context of health and social care, distress can impact individuals receiving support, their families, and even staff. It can be temporary or ongoing. Recognising causes of distress helps workers provide appropriate care and respond compassionately.

Distress might show itself through crying, withdrawal, anger, agitation, or physical signs like shaking. Someone in distress might not clearly explain what is wrong. Picking up on subtle cues often requires observation and knowledge of each person.

Life Events

Major life changes often trigger distress. These can include:

• Bereavement, or loss of a loved one
• Divorce or relationship breakdown
• Diagnosis of a serious illness
• Moving house or moving into care
• Loss of independence or mobility
• Financial difficulties, such as debt or unemployment

Life events disrupt routines and force people to adapt, sometimes abruptly. Loss, in particular, can leave an individual feeling helpless, anxious, or alone. Some people might grieve openly, while others struggle to communicate their emotions.

Physical Health Conditions

Health problems often cause distress, especially if they limit independence or involve pain. Examples are:

• Chronic illnesses, like diabetes or heart disease
• Long-term pain
• Acute illness, such as infections or injury
• Disability affecting movement, vision, or hearing
• Terminal illness

The fear of more loss or worry about the future can build distress. Side effects from medication or treatments might worsen feelings. Some people feel frustrated at relying on others.

Mental Health Conditions

Mental distress is an everyday experience for people living with mental health conditions. Examples include:

• Depression, which can cause low mood and lack of interest
• Anxiety disorders, leading to constant worry or panic
• Schizophrenia or other psychotic disorders, sometimes causing paranoia or confusion
• Eating disorders, such as anorexia or bulimia

Mental health struggles often increase when someone withdraws from support or faces stigma. People may feel misunderstood.

Communication Difficulties

Some individuals cannot communicate their needs or emotions clearly. This can leave them feeling isolated or ignored. Causes of communication difficulty include:

• Learning disabilities, such as autism or Down’s syndrome
• Sensory impairments, like hearing loss
• Stroke, which might lead to aphasia (difficulty speaking or understanding language)
• Dementia

When people try to express distress but are not understood, frustration grows. Going unheard is a major cause of stress, especially for people used to independence.

Environmental Triggers

The physical environment affects well-being and can easily cause distress. Triggers might include:

• Loud noises or crowded spaces
• Bright, flashing lights
• Unfamiliar surroundings
• Sudden changes to routine
• Too hot or too cold temperatures

Some people, particularly those with sensory processing issues, are highly affected by the setting. A busy, unpredictable place can make a person uneasy or scared.

Poor Relationships and Social Isolation

Relationships shape emotional health. Conflict, bullying, or neglect at home, in care, or among peers can create distress. Examples include:

• Family breakdown or abuse
• Cyberbullying or social exclusion
• Arguments with carers, staff, or other residents
• Being left out of activities

Loneliness is a common problem, especially amongst older adults or people living with disabilities. Lack of regular interaction and support increases vulnerability to distress.

Abuse and Neglect

Being treated badly or ignored by others can severely impact a person’s health and sense of safety. Abuse can be:

• Physical: hitting, slapping, rough handling
• Emotional: humiliation, threats, shouted at
• Sexual: unwanted touching or behaviour
• Financial: theft or controlling someone’s money
• Neglect: not meeting basic needs (food, warmth, cleanliness)

Any suspicion or evidence of abuse must be treated seriously and reported, following workplace policies.

Lack of Person-Centred Support

Person-centred support means focusing on the individual’s needs, wishes, likes, and dislikes. Lack of such support leads to:

• Not feeling listened to
• Being treated like a number, not a person
• Inflexible routines or lack of choice
• Ignoring cultural, religious, or personal preferences

If people feel their individuality is ignored, they are much more likely to become distressed.

Change or Uncertainty

Many people find change difficult. This may include:

• Changes in staff or caregivers
• Altered daily routines
• Schedule disruptions, such as trips out cancelled
• Unclear information or lack of communication

Predictability and consistency give a sense of security. Without it, stress and confusion follow. People with autism often rely on routine; even minor changes can lead to meltdowns.

Lack of Control or Autonomy

Having no say in what happens can bring strong negative feelings. Causes include:

• Not being consulted about care
• No choice over meals, clothes, or activities
• Being moved places or having personal items lost
• Forced hospital admission or treatment

This affects self-esteem and leaves people anxious or resistant. Feeling powerless often leads to frustration and distress.

Basic Needs Not Met

Every person has basic needs: food, drink, sleep, hygiene, and safety. If any are missed, distress follows. Examples:

• Skipping meals or poor nutrition
• Dehydration
• Inadequate shelter or warmth
• Lack of privacy or dignity
• Insufficient pain relief

Unmet needs are not always obvious. An individual may seem agitated when, in reality, they are hungry, thirsty, tired, or cold.

Pain and Discomfort

Undiagnosed or uncontrolled pain is a major cause of distress, especially in people unable to verbalise their feelings. Causes include:

• Injuries
• Arthritis or joint issues
• Toothache
• Constipation or digestive problems
• Bedsores

Observation is key, particularly if someone cannot speak. Look for facial grimacing, moaning, or withdrawing from touch.

Stigma and Discrimination

Negative attitudes toward certain conditions, disabilities, or backgrounds create distress. Examples:

• Racial or religious discrimination
• Misunderstanding mental health needs
• Stereotyping older adults or people with learning disabilities
• Lack of respect or patience from staff

Discrimination stops people seeking help. It increases the risk of being left unsupported and misunderstood.

Medication Issues

Medication can affect mood, alertness, and behaviour. Causes of distress include:

• Side effects, such as drowsiness or agitation
• Missed or late medication doses
• Withdrawal symptoms during medication change
• Being forced to take medicine

Confusion over drugs, especially among people with dementia, can make them fearful. Errors and delays often disrupt routines and create anxiety.

Family or Friend Issues

Family problems are common triggers. These include:

• Worry about family health or finances
• Lack of visits or contact
• Arguments between loved ones
• Family unable to provide support due to distance or other reasons

Worrying about those we care for is a source of continuous distress. Uncertainty about their wellbeing or feeling abandoned adds to the emotional toll.

Unfamiliar People or Settings

People might feel threatened or uneasy around new staff, volunteers, or in new places. This often happens:

• In hospital, residential care or day centres
• After discharge home
• When seeing unknown professionals for the first time

Building relationships and trust takes time. At first, fear of the new or unknown makes people anxious or upset.

Lack of Structure or Meaningful Activity

Boredom and having nothing to do often result in distress. Causes include:

• No planned activities or routine
• Lack of hobbies or interests supported
• Isolation in one’s own room for most of the day

Engagement in meaningful tasks can reduce distress and help people focus on positive experiences.

Spiritual, Cultural, and Religious Needs

Ignoring an individual’s spiritual, cultural, or religious practices is distressing. Causes are:

• Not being able to attend religious services
• Lack of opportunity to practise faith
• No respect for dietary rules or dress code
• Lack of interpreter if person speaks a different language

Feeling out of touch with one’s culture or beliefs undermines identity and confidence.

Financial Stress

Money worries are common for people on low incomes, facing unexpected bills, or in debt. Issues may be:

• Worried about paying for care or accommodation
• Losing benefits
• Theft or misuse of funds by others

Financial stress often makes people feel unsafe and frightened, affecting their physical health too.

Main Causes

Distress may arise from one specific trigger or build up over time due to many small factors. People in health and social care often have more than one vulnerability, which raises their risk.

Stress is an expected part of life change, illness, or trauma. Yet, prolonged or overwhelming distress signals a need for professional support and tailored intervention. Recognising the root cause is the first step to providing meaningful care.

Recognising Signs of Distress

Distress can look different in each person. Some common signs are:

• Crying or tearfulness
• Withdrawal from others
• Changes in appetite or sleep
• Angry outbursts or aggression
• Loss of interest in hobbies
• Self-harm or risky behaviour
• Confused speech or actions

Pay attention to sudden changes. Quiet people may become loud; outgoing people might withdraw. Physical symptoms, such as headaches or stomach pains, could represent emotional distress.

Final Thoughts

Identifying causes of distress in health and social care is a key skill. It involves considering life events, health, relationships, basic needs, and the wider environment. Stay alert to the many ways distress can show itself. Use observation, communication, and background knowledge to pick up on underlying issues. Respect, patience, and kindness are needed at all times.

If you think someone is distressed, act promptly and use workplace procedures to report and address your concerns. Providing support is everyone’s responsibility. Each action you take can make a positive difference to the person’s wellbeing.