Mental Health, Assets & Self Care

1. Mental Health, Assets & Self Care School Health Assistant Training Linda Hummingbird, RN, B. Sc., NCSN School Nurse/School Health Services Coordinator Santa Fe Indian School Santa Fe, NM Rutgers University/Johnson & Johnson School Nurse Fellow

2. Developmental Assets Building Blocks of Healthy Development that Assist Children of all ages to grow up healthy, caring, and responsible

3. Support Empowerment Boundaries and Expectations Constructive Use of Time Commitment to Learning Social Competencies Positive Values Positive Identity External Internal

4. Mental Health • “Successful performance of mental functions • Productive activities • Fulfilling relationships with others • Ability to change and cope with adversity • “Mental Health of Adolescents National Profile” • National Adolescent Health Information Center ‘08

5. Mental Illness • Diagnosable mental disorders characterized by alterations in thinking, mood, or behavior, (or a combination thereof) associated with distress or impaired functioning. • Mental Health of Adolescents National Profile • National Adolescent Health Information Center

6. Developmental Stages • 0-1 year • Develop basic trust • Cry in rage until needs are met • Cuddle, smile, make eye contact • Cry for help: excessive crying, sleep disturbance, feeding disorder, stranger anxiety, muscle rigidity

7. Developmental Stages • 1-3 years • Autonomy • Exploration (climbing, running) • “Klingon” Develop comfort, pleasure, safety seeking behaviors • Hitting/biting for attention • Language development • Exploration of own body (Potty Training) • Occasional regression • Play along with others w/o interaction

8. Developmental Stages • 4-5 years • Independence • Explore limits • Imaginary companions • Express aggression w/sibs or peers • Body curiosity/sexual differences/masturbation • Bathroom talk • Works w/others to plan, carry out activities; shares toys

9. Developmental Stages • 6-7 years • Extremes of emotional response • School phobia • Quarrel w/parents, esp. mother (separation anxiety or test parent/child relationship) • Form multiple, relatively short term relationships • Sex play to satisfy curiosity about genitals • Frequently initiate sib rivalry • May resort to lying or stealing as coping mechanism or sign of rebellion • Able to play together w/ mutually agreed upon rules

10. Developmental Stages • 7-9 years • More emotional balance • Experience fear and rational concern about possible world dangers: crime, violence, catastrophe • Develops interest in sex talk/sex jokes/ curious about mechanics of reproduction • Develops “crushes” • Assume responsibility for actions • Worry about academic performance • Handles competitive play fairly well • Assume more responsibility • Fears being humiliated

11. Developmental stages • 9 – 11 years • Generally happy and content • Rely more and more on peers for approval, direction • Develop more mature relationships w/sibs • “Puppy love” • “Best Friend” • Show concern over issues of justice/fairness • Worry about parents fighting, divorcing, losing jobs, becoming ill or dying

12. Developmental Stages • 11-13 years • Moody/irritable • Self-conscious about body image, development, physical health, sexuality • Fear losing status w/peers • Develop romantic relationships • Close circle of friends for support • Lose patience w/sibs, parents if perceived as interfering w/personal, peer-related interactions

13. Developmental Stages • 13 -19 years • Crave personal freedom from parents but still want and need their love • Intense concern about understanding why things are the way they are • Experiment, test limits of pleasure & pain; may be involved in thrill seeking, risky behaviors • May spend must time at home, sullen, withdrawn, isolated from family group, skip school, run away, treat all adults w/mistrust, disrespect, ignore household rules, “sex, drugs, and rock & roll”

14. School Mental Health Concerns “one in ten children/adolescents suffer from mental illness severe enough to cause some level of impairment”, but only one in five receives mental health services. Mental Health of Adolescents National Profile ‘08 A 2002 study revealed most youth receive mental health services through schools rather than through a PCP. For nearly half of all students with serious emotional disturbances, the school system was the sole provider of mental health services.

15. Common Psychological Problems • Depression • Suicidal Tendencies • Grief • Substance Abuse • Attention Deficit Disorders • Eating Disorders

16. Depressed/Irritable mood for most of day Aggression toward self/others Decreased interest/pleasure in almost all activities Significant weight/appetite increase or decrease Sleep disorders Slowed or hyperactive body movements Fatigue/loss of energy Worthlessness or unnecessary guilt Inability to concentrate Recurrent thoughts of death, suicide Symptoms to Report to School Nurse

17. The School Health Assistant’s Role • Be Warm, ,Open, Compassionate and Supportive of Student/Family • Be Honest, but not Judgmental • Provide Factual Information • Treat Students/Parents with Respect • Be Alert to Mood/Behavior Changes/Grades • Know s/sxs of these most common disorders • Be Aware There Often may be More Than One Mental Illness • Monitor the Student Frequently • Avoid Being Confrontational • Provide Positive Feedback • Be Aware of Confidentiality Laws

18. Health Assistant’s Role • Be a Positive Role Model at all Times • Practice What You Preach • If You Know the Student’s Family, Work These Topics into General Conversation Without Violating Student’s Right to Privacy • Advocate in your school/community for educational programs on these disorders and how they can interfere with the student’s ability to be successful in school • Find allies in your school/community willing to work to erase the stigma of mental/emotional/behavioral health disorders • Ask student how things are going in class and at home • Realize that often in troubled homes, parents are parenting the best they know how

19. Resiliency and Strengths • Youth can be extremely resilient • Help them focus on talents • Art • Music • Sense of humor • Positive personality traits • Treat them with fairness, consistency, and caring. • “You can’t educate a child who isn’t healthy, and you can’t keep a child healthy who isn’t educated.” Joycelyn Elders, M.D. , Former U.S. Surgeon General

20. Self Care

21. Top Ten Stress Relievers • 1. Get Active • 2. Meditate • 3. Laugh • 4. Connect • 5. Assert Yourself • 6. Breathing Exercises/Yoga • 7. Sleep • 8. Journal • 9. Get Musical • 10. Seek Counsel • Mayo Clinic 9/2010

22. Breathing Exercises • Sit straight in chair with hands in relaxed position in lap • Inhale slowly/deeply through nose, filling lungs completely; then exhale • Be aware of your posture • Focus on any tense/painful areas and try to relax them • Continue breathing for at least 2 – 3 minutes

23. Stretches • Eye Circles: open or closed, allow the eyes to slowly move a full circle. Repeat in opposite direction. • Shoulder Rolls: With arms hanging straight at sides, roll your shoulders in a complete circle front to back. Repeat in opposite direction. • Head Rolls: Allow head to gently roll in a complete circle. Repeat in opposite direction.

24. Self-Massage • Temples/Forehead: Using three fingers massage in small circles around temples/across forehead. • Neck: With neck relaxed toward chest, use both hands and massage in small, firm circles from the base of the neck to head. • Shoulders: Sitting upright in a relaxed position, massage one shoulder at a time, using firm strokes to push muscles. Spend extra time on any tense or painful areas.

25. Self Care/Stress Management • Physical Activity • Nutrition • Hobbies • Relaxation • Therapy • Deep Breathing • Enjoy Life • Spirituality • Our work can be stressful at times, yet it is very rewarding to be able to help a child, family, and/or community. We must remember to be good to ourselves, so that we can continue to be good to them.

26. Children are 10% of our population; • THEY ARE 100% OF OUR FUTURE

27. QUESTIONS?