Mental Health

1. Mental Health Presented by Mrs. Sigurdson “If the human brain were so simple that we could understand it, we would be so simple that we couldn’t.” Emerson H. Pugh

2. Mental Health Mental Health is something we all need to be concerned with. Lots of people feel overwhelmed, stressed out, and depressed or even suicidal and don’t know where to go for help.

3. Depression Definition: depression is a mental illness where the symptoms last for several weeks or more OR come and go over an entire lifetime. Clinical depression is more than just feeling sort of down and will interfere with school, work, and social life. Symptoms: feeling worthless, loss of interest in life, overwhelming and paralyzing feelings of sadness, or grief, loss of energy, irritability. Ex.: not being able to get out of bed, eat, sleep or enjoy life because you are so sad for a few months in a row. Severely depressed people might, loose all of their friends, have their school grades drop, or stop eating, sleeping and doing fun things all together.

4. Bipolar Disorder Definition: uncontrollable cycles of extreme moods (depression, normal, and mania). It used to be called manic depression because the person is sometimes manic (high) and sometimes depressed (low). Symptoms will be the same as those for depression plus the following: rapid changes of mood (from rage to sadness or sadness to happiness), extremely short attention span, unreasonable optimism and poor judgement. Examples: Making impulsive, grandiose plans, like going on a huge trip with delusions of becoming a movie star over night. Once a high period has passed, a crash will be experienced, leaving the person feeling exhausted, severely depressed and this could result in suicidal thoughts or behaviour.

5. Anxiety/Panic Disorder Definition: Anxiety disorders all affect thoughts, emotions, behaviours and physical health. They include Phobias (including social phobia – fear of people and social situations, and specific phobias, like fear of spiders, heights, etc.); Obsessive Compulsive Disorder or OCD (persistent obsessions or compulsions to do or think certain things); Panic Disorder (attacks of extreme panic for no apparent reason); or General Anxiety (exaggerated worry around everyday things). They may include panic attacks that feel more physical than emotional or mental.

6. Anxiety/Panic Disorder Symptoms: extreme fear of being looked at or listened to, irrational obsessions and doubts (going home 5 times a day to make sure the door is locked), or always anticipating the worst that could happen from every situation. Symptoms of a panic or anxiety attack can be things like a racing heart beat, sweating, tunnel vision, headache, or nausea (sometimes the person feels like they’re having a heart attack).

7. Anxiety/Panic Disorder Examples: Someone who is really outgoing and loves hanging out with large groups of people suddenly withdraws and doesn’t want to go out anymore, might be having panic attacks or feelings of extreme anxiety. If you’re at a party, and you find someone hiding out in the bedroom, that person may be having a panic attack

8. Schizophrenia Definition: a loss of contact with reality, with changes in a person’s way of thinking, believing, and/or behaving. The condition is disorienting and distressing. The disease affects all of the five senses. A person can have a psychotic episode without having full blown schizophrenia. It’s important to detect symptoms early because the sooner one finds out what’s going on for them, the sooner treatment and support can be given.

9. Schizophrenia Symptoms: confused thoughts, feeling like you’ve been slowed down, or sped up in some way, and believing irrational ideas. For example believing others can manipulate or control your thoughts. Hearing voices or seeing things that other people don’t can also be a sign. Example: A person might experience paranoia thinking that their teachers or friends are always out to get them, they may develop elaborate and unusual conspiracy theories, or possibly hear, see and respond to voices/images that they alone experience.

10. Stress Prolonged stress can lead to depression. Stress is considered to be the anxious feeling or threatening feeling resulting from our appraisal of a situation and our perception of demands placed on us. Stress is a basic force of life which can allow us to reach higher levels of performance. Too much stress over a prolonged period of time can deteriorate our physical and mental well being and reduce our performance. Stress then becomes distress.

11. Stress • The most common response to a sudden or powerful stressor is anxiety, which is a feeling of imminent but unclear threat. • In the alarm stage of stress, the body can react in 3 ways: • 1. fight • 2. flight • 3. freeze Automatically, the heart will beat faster, blood will go to the large muscles, breathing will quicken, muscles tense, pupils dilate, the digestive system shuts down or speeds up (diarrhea or constipation), hair stands up on end and hormones that sustain these reactions are secreted. The person becomes exceptionally alert and sensitive to stimuli in the environment (on edge feeling).

12. Stress If exposure to the stressor continues, the individual reaches the stage of exhaustion. There are emotional, cognitive, behavioural and physical responses to the stress. Emotional responses include anxiety, anger, frustration and over long periods depression. Cognitive responses include difficulty concentrating and thinking clearly, recurring thoughts and poor decision making.

13. Stress Behavioural Responses to stress include nervous habits, shaky voice, tremors, change in posture, loss of appetite, loss of interest in personal grooming and aggression to family and friends. Some medical authorities believe that up to 90% of all illness is stress related. Stress also lowers immunity to infection and disease. Even if you are not listening your body is!

14. Top 13 Signals From Your Body when you are under stress: Fatigue that doesn’t go away Recurrent colds/flu/infections Insomnia Muscle aches/stiffness Dizziness/light-headedness Headaches Nausea Allergies/breathing difficulties Skin problems Digestive-tract problems Back Pain Menstrual changes/pain Swollen glands/sore throat.

15. Understanding Stress

16. Negative Coping Strategies • Coping strategies can be positive or negative. Negative or defensive coping strategies often relieve stress in the short term but create more problems in the long term. • Denial – a coping mechanism in which a person ignores the stressful event, doesn’t recognize the emotional, cognitive, behavioural and physical signs or decides that the event is not a stressor. • Intellectualization – a person watches the stressful situation from an emotionally detached standpoint. • Negative Self-Talk – the negative things we say to ourselves in response to any particular situation that affects our mood and feelings. • Drugs, cigarettes and alcohol – can become self medicating substances that are used to help calm down or reduce anxiety but are harmful. • Unhelpful thoughts, mistaken or irrational beliefs or assumptions – the thoughts we have that are not true or that place negative or unrealistic expectations on ourselves.

17. Positive Coping Strategies Body Awareness – learning to focus on how your body feels when you are under stress and then take steps to relax; pay attention to your thoughts, feelings and behaviour Progressive Relaxation techniques Deep Breathing Meditation Yoga Visualization Challenging irrational beliefs, thought stopping, self talk and affirmations Autogenics

18. Tips to Handling Stress Talk it out – talking over your worries with someone you trust can relieve the strain and help bring problems into perspective. Take a break – don’t spend all of your time worrying. Escape with a book, a movie, a game. Breaks can help you see things more clearly when you go back to address the problem. Work off your anger – give your emotions a rest by switching to physical activities. Give in occasionally – if you get into frequent quarrels, stand your ground only when you are sure you are right. The other person may be right and it may be easier for you emotionally and physically to be open or accepting. Give something of yourself – doing things for others can take your mind off your own problems and you’ll have a feeling of accomplishment.

19. Tackle one thing at a time – if your work load seems unbearable, do the most urgent jobs one at a time and put the others aside until you complete one. Don’t try to be perfect – give yourself encouragement and rewards for your efforts. Stop criticism – avoid self criticism. Learn from your mistakes instead. Recognize strengths and weaknesses in yourself and others. Don’t be too competitive – cooperation can make things work smoothly. Have some fun – make time for fun everyday!

20. More tips to reduce stress Prepare for stressful situations by giving yourself time. Rushing only increases stress and anxiety. Get where you are going early and be ready. Keep in mind that the only people who don’t make mistakes are those who are doing nothing! Active, productive people make mistakes and try to learn from them. Doing nothing is the biggest mistake of all. Act responsibly when you do make a mistake. Learn from the mistake and value honesty and reliability. Learn how to say ‘no’. If you feel stressed by certain people keep in mind that nobody can stress you out unless you allow them to. Some people are very good at finding and using other’s buttons. Be aware of this and use it to your advantage. If you are prepared to relax and not let them ‘get your goat’ then you can calmly respond to the situation.

21. How to Help a Friend • Where can you go to get information if you think a friend might be dealing with a mental illness? • A doctor or health care provider • A guidance counsellor or teacher • The internet and library (just be careful that info comes from a reliable source) • A community health centre • A parent, family member, spiritual leader • The important thing is to tell someone you trust and to find the correct information. • Crisis and information phone lines: • Klinic Crisis Line 786-8686 • Kids Help Phone 1-800-668-6868 • Suicide Line 1-877-435-7170 • Youth Emergency Crisis 949-4777

22. How to Help a Friend • Things you can do for a friend who is depressed: • Take them seriously • Sincerely listen • Voice your concern and offer support • Tell them about people that can help and/or go with them to places that can help • Ask them what you can do that would be helpful for them • If helping family and friends becomes too much, it is okay to take a break and get help too.

23. How to Help a Friend • Things you shouldn’t do for a friend who is depressed: • Don’t ignore them • Do not say ‘everything will be okay’ • Do not tell them they are just looking for attention • Do not argue or debate with them (take their concerns seriously) • Don’t act shocked, angry or annoyed • Do not judge them (it takes courage to ask for help) • Do not promise not to tell because you may need to talk to an adult or help line.

24. Pay Attention to Your Feelings Knowing what emotions are going on for us can help us express ourselves and connect with others. Naming those emotions helps us to share them with others in a healthy and respectful way. We can feel many emotions at one time, which can be confusing but is never wrong. Accept that emotions can be mixed and learn to work with them, just like how we can love and hate our siblings or friends at the same time. Emotions are often giving us valuable information that we need to pay attention to.

25. Self-Harm Self-harming is when people cause themselves physical pain that alters their mood (how they feel inside). Some people harm themselves because they feel disconnected and isolated from everybody, and hurting themselves is the only way they feel real or connected. Many people , when they think about what self-harming involves, think about people cutting the skin on their arms or legs. But there are many behaviours that can be classed as self-harm, some are harder to spot than others.

26. Self Harm • Some self-harm behaviours can include: • Cutting the skin with knives or any sharp object • Burning the skin • Choking oneself • Hitting the body with an object or fists (like punching the wall) • Deliberately falling when doing something like extreme sports • Picking at skin • Swallowing pills or sharp objects • Pulling at hair (hair pulling can also be a habit or related to anxiety disorder). • Eating disorders and addictions are also ways that people harm themselves.

27. Why do people start harming themselves? • Self-harming can be a way that people deal with feelings of: • Helplessness, despair and low self-esteem • Anger, loneliness, shame and guilt • Not having control over their own life – cutting or hurting themselves is one way they can gain some control • Some self-harm is related to severe emotional pain. When people have experienced abuse or violence, it often appears as emotional pain in later life

28. Self-Harm • Some people have said that: • When they hurt themselves physically, it helps take away the emotional pain, and this is the only way they can relieve this pain • Self-harm makes internal pain visible on the surface, and easier to understand • Self-harm may be a form of addictive behaviour

29. Self-Harm • People who harm themselves… • May have difficulty expressing their feelings verbally • May dislike themselves and their body • May do it because of difficulties with relationships • May do it because of mental health issues such as depression, anxiety or stress • Self-harm is a way that people punish themselves for something • May have addictive behaviour

30. Self-Harm • It is important to remember that self-harming is just one way of dealing with emotional pain – there are other less hurtful ways for people to express how they feel. • The risks of self-harm: • You may not be dealing with the underlying issues such as depression or emotional pain • You may be isolating yourself and not get the support you need to work out the emotions • There is a risk that you may go to far and one day seriously hurt or kill yourself

31. Self-Harm • Risks of self-harm: • You may have to lie to hide your self-harm which is difficult to maintain and stressful to deal with • Cuts can become infected if not looked after and can cause permanent scars • There is always a risk of infection with hepatitis C or HIV when tools for self-harming are shared with others • Self-harming is not well understood in society and is not seen as an acceptable way of dealing with problems –this can cause more stigma and misunderstanding making it harder to talk about • Can be very confronting and painful for your friends and family to deal with

32. Self-Harm • How can I help if I know someone who harms themselves? • Don’t talk it personally – the person is not doing it to make you feel bad or guilty. Even if that person is trying to manipulate you into feeling a certain way, it may not be the reason they hurt themselves. • Educate yourself – find out as much information as you can, and talk to a professional about what you can do to support the person. • Be supportive without reinforcing the behaviour – let the person know that you are there if he or she wants to talk. Make the initial approach, but don’t push that person to tell you anything they don’t want to.

33. Self-Harm • How can I help? • Don’t try to force the person to stop their self-harm but do encourage them to see a counsellor or therapist • Take care of yourself – recognise that this is a difficult situation, and you need time to adjust and make sure you are taking care of your own needs as well as the person you care about • Be clear about what your limits are – if you feel uncomfortable with the self-harming behaviour, be clear with the person and come to an agreement about what you can and can’t handle • Use empathy and support the person in finding more positive ways of coping with their pain

34. Talking about Mental Health Helps • Be supportive – listen and don’t judge • If helping family and friends becomes too much, it is okay to take a break and get your own support • Ask yourself… • What am I feeling right now? • What do I need in this moment? • Do I need someone to talk to? • Resources: • Child and Adolescent Mental Health Program 958-9660 • Youth Mobile Crisis 949-4777 • Klinic Crisis Line 786-8686 • Kids Help Phone 1-800-668-6868 • Manitoba Suicide Line 1-877-435-7170

35. You are not alone; in fact one in four people will experience a mental illness. Bottling things up isn’t the solution. • Help can include: • Talking to a social worker • Talking to a therapist • Talking to a counsellor or psychologist • Talking to mental health workers • Talking to your doctor • Prescription medications and different types of therapies • Self-Help groups • Everyone is different so what helps one person may not help someone else- do what feels right for you!

36. Passport to Health • 3 people you can talk to: • _____________ • _____________ • _____________ • 3 activities you like to do: • _____________ • _____________ • _____________ • 3 things you like about yourself: • _____________ • _____________ • _____________

37. Suicide Awareness “Life begins on the other side of despair” - Jean-Paul Sartre One of the most intense issues you may have to deal with as a friend or family member is suicide. Dying can be seen as a way to end the incredible feelings of pain, hopelessness and helplessness that people can feel when they are in crisis or going through difficult things, but with professional help people can get through the pain without ending their life.

38. Suicide Awareness Thinking of suicide can make people believe they should isolate themselves and that it’s a personal failure or weakness if they do think of killing themselves. There is a difference between wanting to die and wanting emotional pain to end. It is important to talk to and listen to someone who is thinking about suicide and to always tell an adult so they can intervene. It is not your responsibility to try to stop someone from killing themselves – tell an adult or call 911!

39. Suicide Facts and Stats Suicide is the second leading cause of death among Canadian youth aged 10-24 after motor vehicle accidents Between 70% - 80% of Canadian youth consider suicide before graduation In Canada over 25,000 youth attempt suicide annually and over 250 completed Suicide is a complex process. The cause is typically not attributed to a single factor. It may be a routine event or an overwhelming one that overloads a vulnerable youth’s ability to cope

40. Suicide Facts and Stats About 80% of people give some signals that they are suicidal before ending their life Most people who are considering suicide don’t really want to die. They simply want to stop the pain Talking about suicide does not make suicide happen more. Talking about it openly will more likely give a person the chance to talk about emotions and feelings and will reduce the risk of suicide People who die by suicide have usually attempted it more than once before Up to 30% of gay and lesbian youth attempt suicide

41. Suicide Warning Signs • Anytime the following signs are noticed it is always okay to ask if someone is thinking of suicide • Talking calmly about suicide without showing fear or making judgments, can help relieve a person who feels terribly isolated • A willingness to listen shows that you truly care. • Warning Signs: • Talking about dying – any mention of dying whether direct (‘I want to kill myself’) or indirect (‘I wish I wasn’t here’ or ‘You will miss me’) • Lost interest – loss of interest in friends, hobbies, sports, activities previously enjoyed

42. Suicide Warning Signs Change in personality – sad, withdrawn, irritable, anxious, tired, apathetic Low self-esteem – feeling worthless, shame, overwhelming guilt, self-hatred, ‘everyone would be better off without me’ No hope of the future – believing things will never get better; that nothing will ever change Change in behaviour – can’t concentrate, increase use of drugs or alcohol, risk taking activities, self-harm

43. Suicide Warning Signs Change in sleep patterns – insomnia, often early waking or oversleeping Change in eating habits – loss of appetite, overeating, weight change Making final arrangements – giving away prized possessions, writing a will, putting relationships in order, arranging for the care of pets, saying goodbye Previous attempts – has tried to kill themselves before Plans – has created a plan that involves acquiring the means (ex. – getting a gun or a lethal does of pills), picking a specific time/date and place to complete the plan

44. Suicide Risk Assessment • Talking about suicidal feelings can reduce the risk of an attempt. When assessing someone for suicide remain calm, listen carefully and get help. • Lethality of suicide increases with the following: • Thoughts: Are you thinking about suicide or killing yourself? • Plan: Have your planned how you will do it? • Means: Do you have a weapon or a way to hurt your self • Timing: Do you have a time or date in mind that you want to carry this through? • Previous history: Have you ever tried this before? • Drug and alcohol use: Have you been using or using more drugs or alcohol than usual?

45. A Suicide Lethality Continuum • From low lethality (the intention to cause death) to high • Poor diet, not brushing teeth, poor hygiene • Smoking • Driving fast • Flippancy, cliches, dramatics – ‘Oh, it’s so awful I could kill myself • Thoughts of relief, release, escape; wanting to get away from the pain; some people may go to sleep as a means of escaping pressures • Fantasies – What would happen if…?; What’s it like?; Would I be missed?

46. A Suicide Lethality Continuum cont’d • From low lethality to high (cont’d) • Revenge – “I’ll get even”, “You’ll be sorry when I’m dead”, “You’ll miss me” • Threats – verbal or written • Drug/Alcohol – use or abuse • Self-mutilation – turning anger back at self • Gestures – superficial wrist slashing, non-lethal overdose, actions that are not lethal but communicate something is wrong • Lethal attempts • Completed suicide

47. How to help? When someone you know is going through a hard time or thinking of suicide this list can help: Listen, be calm and empathic Determine the risk Take the situation seriously Ask about the suicidal plan Show you care by giving time Offer realistic hope Focus on handling one day at a time

48. How to help? Identify other supports – friends and family Inform of resources in the community Get help for the suicidal person by talking to an adult Call 911 if the risk is high View suicide as a form of communication Remember it is not your responsibility to keep someone alive Know your boundaries and limits and know when to ask for help for yourself Know you are not alone

49. What not to do • Don’t • Ignore the situation • Act shocked • Leave him or her alone – call an adult to be with them. • Say: “Everything will be alright” – because it doesn’t feel like that for the person • Challenge the person to go ahead • Give advice • Panic or use guilt • Moralize or say it’s wrong • Agree with his/her helpless situation • Minimize the situation • Swear to secrecy

50. Coping with Stress and Mental Health Issues It takes guts but you can ask for help. Some people may deal with harder times better than others as a result of what is called resiliency – the ability to spring back from and overcome or deal with hard times. Resiliency is fostered by protective factors that help to reduce the odds of mental health issues, suicide and self-harm. They improve coping and can balance out some risk factors.