Mental Illness and Working with Clients Lecture PDF

M ental Illness and Working with Clients Presented by Shannon Walsh, Ps. Ed Local Wellness Advisor  Territory Acknowledgment McGill University is on the traditional territory of the Haudenosaunee and Anishinabeg nations, a place which has long served as a site of meetin...

M ental Illness and Working with Clients Presented by Shannon Walsh, Ps. Ed Local Wellness Advisor  Territory Acknowledgment McGill University is on the traditional territory of the Haudenosaunee and Anishinabeg nations, a place which has long served as a site of meeting and exchange amongst nations.  What is a Local Wellness Advisor? Mental health Resource-provider in Bridge to care - Specialist professional in your your faculty for your in referring to resources faculty, promoting faculty on campus and in the Awareness, Prevention & community Early Intervention  Workshop Purpose: To understand mental health and mental illness as it affects working with clients. Topics covered will include:  The mental health and mental illness continuum  M ental illnesses  Intervention  Boundaries in professional practice  Self-care as a helper  Definition of Well-Being “The capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual wellbeing that respects the importance of culture, equity, social justice, interconnections and personal dignity.” -Public Health Agency of Canada (2006) Identifying Clients Having Difficulty What are some red flags that someone is in distress? In crisis? Range of Red Flags Overwhelmed Trouble coping Disorganized/confused Inconsistent Disheveled, tired Socially withdrawn Looks stressed/fearful/ worried/sad Angry outbursts Mental Health & Mental Illness Continuum Diagnosis In Canada mental illnesses are diagnosed by medical doctors or psychologists. These diagnoses are guided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. The manual is revised periodically with input from professionals in Canada and the United States. Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes. Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder. Cyclothymic Disorder (also called Cyclothymia)— defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode. People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors—often without recognizing their likely harmful or undesirable effects. Depression —also known as major depressive disorder or clinical depression —is a common but serious mood disorder that can interfere with how people feel, think, and handle daily activities, such as sleeping, eating, or working. Although sadness can be a symptom of depression, it does not characterize the disorder. People with depression experience symptoms nearly every day for at least two weeks Symptoms: Persistent sad, anxious, or “empty” mood Feelings of hopelessness Irritability Feelings of guilt, worthlessness, or helplessness Loss of interest or pleasure in hobbies and activities Decreased energy or fatigue Moving or talking more slowly Difficulty concentrating, remembering, or making decisions Difficulty sleeping Appetite and/or weight changes Thoughts of death or suicide, or suicide attempts Aches or pains Suicide is defined as death caused by self-directed injurious behavior with intent to die as a result of the behavior. A suicide attempt is a non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior. A suicide attempt might not result in injury. Suicidal ideation refers to thinking about, considering, or planning suicide Personality disorders represent “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture” per the Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5). These patterns tend to be fixed and consistent across situations and leads to distress or impairment. Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days. People with borderline personality disorder tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. These shifting feelings can lead to intense and unstable relationships. Symptoms: A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation) Distorted and unstable self-image or sense of self Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating. *Please note: If these behaviors occur primarily during a period of elevated mood or energy, they may be signs of a mood disorder—not borderline personality disorder Symptoms continued: Self-harming behavior, such as cutting Recurring thoughts of suicidal behaviors or threats Intense and highly changeable moods, with each episode lasting from a few hours to a few days Chronic feelings of emptiness Inappropriate, intense anger or problems controlling anger Difficulty trusting, which is sometimes accompanied by irrational fear of other people’s intentions Feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia- related disorders. People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work. Symptoms: Feeling restless, wound-up, or on-edge Being easily fatigued Having difficulty concentrating; mind going blank Being irritable Having muscle tension Difficulty controlling feelings of worry Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation. During a panic attack, people may experience: Heart palpitations, a pounding heartbeat, or an accelerated heartrate Sweating Trembling or shaking Sensations of shortness of breath, smothering, or choking Feelings of impending doom Feelings of being out of control A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object. There are several types of phobias and phobia-related disorders: Specific Phobias (sometimes called simple phobias). Social anxiety disorder (previously called social phobia). Agoraphobia Separation anxiety disorder Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior. Although autism can be diagnosed at any age, it is said to be a “developmental disorder” because symptoms generally appear in the first two years of life. Symptoms: Making little or inconsistent eye contact Having difficulties with the back and forth of conversation Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond Having facial expressions, movements, and gestures that do not match what is being said Having an unusual tone of voice that may sound sing-song or flat and robot-like Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions Difficulty with multi-commands Schizophrenia Spectrum and Other Psychotic Disorders They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms. Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes (e.g., persecutory, referential, somatic, religious, grandiose). Persecutory delusions (i.e., belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group) are most common. Referential delusions (i.e., belief that certain gestures, comments, environmental cues, and so forth are directed at oneself) are also common. Grandiose delusions (i.e., when an individual believes that he or she has exceptional abilities, wealth, or fame). Hallucinations are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but auditory hallucinations are the most common in schizophrenia and related disorders. Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual's own thoughts. Disorganized thinking (formal thought disorder) is typically inferred from the individual's speech. The individual may switch from one topic to another {derailment or loose associations). Answers to questions may be obliquely related or completely unrelated.  Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Orthorexia Other Specified Feeding and Eating Disorders (OSFED) Avoidant Restrictive Intake Disorder (ARFID) Unspecified Feeding or Eating Disorder (UFED) Rumination Disorder Trauma and nutrition Trauma distinct from PTSD, representing a lived experience rather than a clinical disorder. A third of people with trauma will develop PTSD. Symptoms: 1) Intrusive thoughts such as flashbacks, 2) Avoidance, 3) Altered cognition and mood, and 4) Altered arousal and reactivity; which can include anxiety symptoms and increased threat vigilance, as well as sleep difficulties. *Food can become a form of self-medication. *Food addiction, or Binge Eating Disorder can be associated with trauma. Trauma and PTSD can lead to an unhealthy relationship with food, compromised nutritional status, and various forms of disordered eating  Nutrition and Mental Health Nutrition interventions can lead to: Reduced nutrition-related side effects of psychiatric medications Better self-management of health conditions Improved mental and physical health Enhanced social inclusion Self-reliance Food security A healthier body image https://www.dietitians.ca/mentalhealth Barriers to Intervention What are some reasons why you might hesitate to intervene when you see a student having difficulty? “If I ask it may make it worse” “I will wait for them to bring it up” “I will say the wrong thing” Intervention Provide safe space Initiate contact Actively listen Roles and collaboration The value of the safe space Hold space for person in distress Validate their need for support Show warmth while respecting boundaries Not there to save but to support The most powerful interventions: – Little to do with the person’s story/advice given – A lot to do with their leaving the interaction feeling seen, heard, connected Initiate Contact Identify Behavior Objectively: – “I am concerned about changes I’ve seen in you… – “This behavior seems really different for you…” – “Can we talk about what it going on…” Actively Listen Verbal & non-verbal behaviors Open questions Normalize, validate Understanding Roles & Maximizing Collaboration How can we collaborate to enhance the wellbeing of our clients? Boundaries Your joy first: We do not rise by lifting others Not what we do but how we be Your order and liability Organizational expectation A systems perspective Your own compass  How to take care of your mental health as a helper?  Self-care  Mindfulness  Compassion  Support Self-care is… M indfulness is… Being aware in a way that is:  Purposeful  In the present moment Helpful Tool:  Non-judgmental  Calm  Headspace  Down Dog  RespiRelax Compassion is…  Friends & Family Support Benefits of Social Support: Professional  Increased Health  Decreased Depression  What type of support do you  Longer Lifespan need from your social (more important network? than smoking, drinking, exercise  How can you ask people in and eating well) your life for support when you  Increased immune need it? functioning Resources: The Montreal Suicide Prevention Center (CPSM) https://cpsmontreal.ca 1-866-277-3553 or SMS 535353 West-Island Crisis Center 514-684-6160 Ami-Quebec 514-636-6885 811– info santé  Off-campus Virtual Services Mental Health Support: For 24/7 immediate support all McGill students can call Keep Me Safe a free, confidential counselling service available 24/7 by calling 1-844-451-9700, or by downloading the Telus Health Student Support app. The Student Wellness Hub has the following supports available: Booking Online *Access Advisors schedules open up every 72hrs for the next 72hrs. If you check first thing in the morning you can usually access an appointment within 3 days Book with an Access Advisor Students can also book with a counselor by calling 514-398-6017. A student can ask to be booked with the next available counsellor (be seen within a week) or to meet with the Macdonald Campus counsellor. Phone lines: Monday-Friday (8:30-3:30) *a student can also walk over to Centennial Center Student Services and see the front desk person there to book an appointment with the Mac counselor. Services: Monday-Friday 8-4 https://www.mcgill.ca/wellness-hub/  References: Diagnostic and Statistic Manual (DSM 5) Friends for Mental Health http://www.asmfmh.org/ National Institute for Mental Health https://www.nimh.nih.gov/index.shtm Mental Health Commission of Canada https://www.mentalhealthcommissi Dieticians of Canada https://www.dietitians.ca/mentalhealth Dieticians of Canada https://www.dietitians.ca/mentalhealth https://wisemindnutrition.com/blog/trauma-informed-nutrition-therapy THANK YOU