Understanding and Recognizing Mental Health Issues

1. Understanding and Recognizing Mental Health Issues AmeriCorps Program Director Retreat 2012 Kayla Morris-Doyle LLMSW Community HealthCorps at Cherry Street Health Services Grand Rapids MI

2. What is Mental Health? • How we think, feel, and act as we cope with life • Determines how we handle stress and make decisions • Determined by cultural norms • Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society.

3. What is Mental Illness? • Mental illness - refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. • Mental health problems - signs and symptoms of insufficient intensity or duration to meet the criteria for any mental disorder. • 25% of people have mental illness

4. Causes of Mental Illness • Genetic/Biological • Family History • Environmental • Learned behaviors • Family and peers • Relational problems • Work, friends, family • Life events • Positive or negative • Society & Culture • Racism, discrimination, socioeconomic status, norms

5. Effects of Mental Illness • Financial • Job loss, treatment cost, substance use • Compounded emotional effects • Relationships • Family: guilt, shame • Friends: decrease in social activities • Isolation leads to less social support, which exacerbates symptoms • Somatic disorders or complaints • Stomachaches, body pains, headaches, ‘flu’

6. Stigmatization • Bias, distrust, stereotyping, fear, embarrassment, anger, and/or avoidance. • Leads others to avoid living, socializing or working with, renting to, or employing people with mental disorders • Reduces access to resources and opportunities (e.g., housing, jobs) and leads to low self-esteem, isolation, and hopelessness • Deprives people of their dignity and interferes with their full participation in society • Why your member might not disclose • 2/3 do not seek treatment

7. Depressed feeling most of day on most days Diminished interest or pleasure in activities Weight loss or gain Insomnia or hypersomnia on daily basis Psychomotor agitation or retardation Fatigue or loss of energy on daily basis Worthlessness or guilt Indecisiveness or inability to concentrate Recurrent thoughts of death or suicidal ideation Symptoms create significant impairment in daily functioning and are not due to substance use Depression

8. Anxiety • 6 months + of excessive anxiety and worry • Significant difficulty controlling anxiety or worry • 3 or more of the following over 6 months: • Feeling wound-up, tense, restless • Easily fatigued or worn-out • Concentration problems • Irritability • Muscle tension • Sleep difficulty • Cause clinically significant distress and interferes with daily functioning

9. Stress • Thoughts • I can’t cope! It’s unfair! I don’t have enough time! I’ll never finish! I have to get this done! • Emotions • Irritable, anxious, impatient, angry, hopeless • Physical Sensations • Heart racing, fast breathing, tense muscles, hot & sweaty, difficulty concentrating, forgetful, agitated, bathroom issues

10. Stress • Behaviors • Constantly busy, rushing about • Lots of things to do, but trouble finishing them • Sleep disturbances • Argumentative • Eating more or less • Substance use increase • Crying • Leads to cycle of stress

11. STRESS INVENTORY

12. Stress Inventory • Add all your numbers together to get the total. The higher the number, the higher your stress level. Your level of susceptibility to illness, disease and mental health problems increases with stressful events happening in your life. • Every time you have a change in your life, you need to adapt, regain stability and therefore maintain health. • The higher your score, the more effort and diligence you will need to relieve stress and tension. • Here’s how you determine your score for the stressful life events list: • Low - if your score is Below 149 • Mild - if your score is Between 150-200 • Moderate - if your score is Between 200-299 • High - if your score is Above 300 • How did you do with the Stressful Life Events List? If your score put you in the moderate to high range, then you need to address your stress level--right away. • You are in danger of having stress affect your overall health--and it may be already interfering with your abilities to function normally and handle everyday issues. • It is very important that you develop a personal stress management plan, and get to work right away to reduce stress and tension in your life!

13. Stress Management • Identify Stressors • Where am I when I’m feeling stressed? What am I doing? Who am I with? • What helpful changes could I make? • What is within my control? • Make small changes • in routine • in behaviors • doing things differently • taking time out • thinking in a different way • getting help • seeking advice

14. Stress Management • Relaxation techniques • Meditation • Help others • Physical activity • Limit responsibilities • Journal thoughts and feelings • Positive self talk • Grounding technique – notice what you see, hear, smell, sense. • Communicate assertively rather than aggressively or passively

15. Unhelpful Thinking Styles • Overgeneralization • This is so typical. Things never work out. • Catastrophising • Predicting the worst – What If • Personalization • Negative events are because of you. Positive events are because of others. • Mountains and Molehills • Exaggerating negatives, minimizing positives • Shoulding and musting • He should know better. I must always get it right. • Labeling • Global statements – I am such an idiot. He is always grouchy.

16. The Assertive NO • Saying no is important. It lets you be in charge of your life. • Barriers to saying no” • Wanting them not to ask • If people were more considerate they wouldn’t ask for unreasonable things! • They won’t accept it • Even if you said no, they wouldn’t believe it • They won’t accept me • They will be upset with me and won’t like me • I don’t have the right • I’m selfish if I say no. I should help.

17. The Assertive NO • Strategies for saying NO • Use assertive body posture • Decide on your position before you speak • Wait for the question • Decide on your wording • Don’t apologize when it isn’t necessary • Don’t defend yourself or make excuses unless necessary • Don’t ask permission to say no • Strengthen your position • Broken record • Don’t wait for acceptance • Accept the consequences

18. Boundaries • Saying no helps us set boundaries. • Boundaries determine what is ‘me’ and what is someone else • Boundaries determine responsibilities • Boundaries define relationships • When boundaries are unclear or too flexible, we become stressed and unsafe

19. Common Boundary Myths • If I set boundaries, I’m being selfish • Boundaries area sign of disobedience • If I begin setting boundaries, I will be hurt by others • If I set boundaries, I will hurt others • Boundaries mean I’m angry • When others set boundaries, it hurts me • Boundaries cause feelings of guilt • Boundaries are permanent

20. Boundary Issues • Compliant • Feels guilty and/or controlled by others; can’t set boundaries. Can’t say no. • Avoidant • Sets boundaries against receiving care of others. Can’t hear yes. • Controllers • Aggressively or manipulatively violates boundaries of other. Can’t hear no. • Non-Responsive • Critical towards others and narcissistic of self. Can’t say yes.

21. Unhealthy Boundaries • Going against personal values or rights to please others • Giving as much as you can for sake of giving • Taking as much as you can for sake of taking • Letting others define you • Expecting others to fill your needs automatically • Feeling bad or guilty about saying no • Not speaking up when treated poorly • Falling apart so someone can take care of you • Falling ‘in love’ with someone you barely know or who reaches out to you • Accepting advances, touches that you do not want • Touching a person without asking

22. Healthy Boundaries • Self-secure. Not threatened by others who are different. Can admit new ideas and perspectives while preserving individuality. • Does not allow self to be intruded upon • Clear sense of own values, view, priorities • Distinguish between safe and unsafe people • Confidence. Unaffected by mean words or actions • Able to protect self without imprisoning self • Able to assert self to avoid being the victim • Can enter into relationship without losing self

23. How to avoid? Start at the interview! • What behaviors do you exhibit when you are stressed? • What do you need from others when you are stressed? • How do you handle conflict? • Decisions: Do you follow your instincts, feelings, or your analytical process? • What 1st impressions do others have of you? • How do you respond to constructive feedback?

24. Resources • http://www.getselfhelp.co.uk/ • http://www.nfmh.us/ • Community mental health agency • Disclosure

25. References • http://www.stressaffect.com/Stressful-Life-Events-List.html • http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html#approach • DSM-IV TR • www.getselfhelp.co.uk