TOPICS IN MENTAL HEALTH: WHAT CAN I DO?

Transcription

1 TOPICS IN MENTAL HEALTH: WHAT CAN I DO? Albert Villa, M.Ed. Project Manager for Behavior, Discipline & Mental Health ESC Region 19 COMMUNITY VOICES IN ACTION CONFERENCE AUGUST 14-15

2 A mental disorder or mental illness is a diagnosable illness that: Affects a person s thinking, emotional state and behavior. Disrupts the person s ability to: Work or attend school. Carry out daily activities. Engage in satisfying relationships.

3 What Are Some of the Disorders We Might Hear About? ADD/ADHD/ODD Anxiety Disorders Bipolar Disorder Depression Eating Disorders Psychosis Substance Use Disorders 3

4 Additional Prevalence Highlights for U.S. Youth 3% of year-olds have an eating disorder. 11% of school-aged youth have ADD/ADHD. 4

5 Prevalence of Depression in Adolescence 5

6 Median Age of Onset ACTIVITY 6

7 Median Age of Onset ½ of all lifetime cases of mental illness begin by age 14; ¾ by age 24. Anxiety Disorders Age 11 Eating Disorders Age 15 Substance Use Disorders Age 20 Schizophrenia Age 23 Bipolar Age 25 Depression Age 32 7

8 Adolescent Development ACTIVITY 8

9 Adolescent Development Physical Changes: Changes in hormones. Increases in height and weight. Mental Changes: Developing more abstract thinking skills. Using more logic and reason in decision making. Forming own beliefs. Questioning authority. Heightened focus on physical concerns. 9

10 Adolescent Development Emotional Changes: Shifts mood quickly. Feels more intensely. Increases in risk-taking and impulsive behavior. Social Changes: Experimentation with different levels of social and cultural identity. Increase in peer influence. Awareness of sexual identity. Learns to manage relationships. 10

11 Resiliency Most youth pass through adolescence with relatively little difficulty despite all of these challenges. When difficulties are encountered, youth tend to be quite resilient. They often: Thrive. Mature. Increase their competence. 11

12 What Do I Do When I Suspect A Student Is Having A Mental Health Crisis? 12

13 The Action Plan Assess for risk of suicide or harm Listen nonjudgmentally Give reassurance and information Encourage appropriate professional help Encourage self-help and other support strategies

14 Signs & Symptoms: Physical Cardiovascular: pounding heart, chest pain, rapid heartbeat, blushing. Respiratory: fast breathing, shortness of breath. Neurological: dizziness, headache, sweating, tingling, numbness. Gastrointestinal: choking, dry mouth, stomach pains, nausea, vomiting, diarrhea. Musculoskeletal: muscle aches and pains, restlessness, tremors and shaking, inability to relax. 14

15 Signs & Symptoms: Physical Pattern adjustments: overeating or not eating at all, sleeping much more or much less. Appearance: Change in hygiene, unkempt, eyes bloodshot or glassy, weight gain or loss. Hormonal: irregular menstrual cycle, loss of nocturnal emissions, loss of sexual desire. 15

16 Signs & Symptoms: Emotions & Behaviors Emotions Depressed mood and/or mood swings Unrealistic or excessive anxiety or guilt Excessive irritability or anger Lack of inhibition Lack of emotion or emotional response Helplessness or hopelessness Oversensitivity to comments/criticism Low self-esteem Behaviors Crying spells Withdrawal from others Inability to manage responsibilities Seemingly disinterested in personal appearance Loss of motivation Slow movement Use of drugs and alcohol Changes in energy level Obsessive or compulsive behavior Avoidance or phobic behavior Showing distress Talking rapidly 16

17 Signs & Symptoms: Thoughts Frequent self-criticism or self-blame. Pessimism. Difficulty making decisions, concentrating or remembering. Rigid thinking. Racing thoughts. Altered sense of self: tendency to believe others see one in a negative light. Delusions or hallucinations. Odd ideas. Lack of insight. Suspiciousness. Thoughts of death and suicide. 17

18 Signs & Symptoms: Video 18

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20 Signs & Symptoms ACTIVITY ah 20

21 Typical Stages vs. Warning Signs Examine the impact of change Is the youth struggling: In school In social settings In daily activities Symptoms of a mental illness can often appear similar to typical development during this period 21

22 Typical Behaviors vs. Symptoms Examine the impact of change to see if the youth is struggling Typical Adolescence Withdrawing from family to spend more time with friends Potential Warning Sign Withdrawing from friends, family and social activity Wanting more privacy Moving from childhood likes to teen pursuits Becoming secretive; need for privacy seems to be hiding something Losing interest in favorite activities and not replacing with other pursuits 22

23 Risk Factors for Developing a Mental Health Disorder Stressful events, abuse or trauma. Learned behavior. Chemical imbalance. Substance misuse and sensitivity. Seasonal changes. Previous episode of mental illness or presence of another mental illness. Ongoing stress and anxiety. Medical conditions and hormonal changes. Side effects of medication. Illness that is life threatening, chronic, or associated with pain. Brain injury. 23

24 Healthy practices. High self-esteem. Good problem solving skills. Feeling of control in their own life. Spirituality. Avoiding alcohol, tobacco and other drugs. Consistent home/family routine. Parental/familial support. Monitoring of youth s activities. Regular school attendance and academic performance. Having a good social support system. Economic security. Availability of constructive recreation. Community bonding. Feeling close to at least one adult. 24

25 THE ACTION PLAN The Action Plan Assess for risk of suicide or harm Listen nonjudgmentally Give reassurance and information Encourage appropriate professional help Encourage self-help and other support strategies 25

26 Considerations When Reaching Out Role/relationship you have to youth Ethical Guidelines Legal Requirements Professional Restrictions Role of family Young person s right to privacy Your ability to help 26

27 Assess for Risk of Suicide or Harm Youth may be at risk for a variety of crisis situations: Suicide or suicidal thoughts Non-suicidal self-injury/other personal safety issues Medical emergencies Extreme distress Aggression 27

28 Assess for Risk of Suicide or Harm Factors that can increase risk for youth: Impulsivity Lack of awareness of risk involved Lack of awareness of time Use of alcohol or other drugs Influence of peer groups 28

29 Listen Nonjudgmentally Using I statements, state nonjudgmentally what you have noticed. Ask questions, but don t push. Realize it may be a relief for the young person to talk about how s/he feels. Remember it s about the young person not you. His/her experiences are not the same as yours. His/her perspective is not the same as yours or necessarily of other youth in the family or peer group. His/her culture may not be the same as yours. S/he needs our empathy. S/he may use language that makes you uncomfortable. 29

30 Listen Nonjudgmentally How to Effectively Communicate with Youth: Be genuine and respectful Be careful about using slang Be comfortable with silence Be in the present with them without comparing to your own youth Be aware that the young person s feelings are very real Be accepting even though you may not agree Be aware of your body language and facial expressions Be positive with your feedback Be helpful with language without telling them how they feel or should feel 30

31 Give Reassurance and Information Do Have realistic expectations Offer consistent emotional support Give the young person hope Provide practical help Provide information Acknowledge the limits of what you can do Do Not Make promises you cannot keep Give Advice Dismiss the problem or emotions Focus on right vs. wrong Focus solely on weight, food, drugs, alcohol, injury or specific external factors unless there is an emergency Try to fix the problem yourself Engage in communication that is: belittling, sarcastic, hostile or patronizing 31

32 Information vs. Advice Reassuring Information Breakups can be tough. It s natural for you to be hurt and upset. I m here for you if you want to talk. There are also people who are trained to help you work through these feelings. You are not alone. Advice I remember my first breakup, here s what you need to do... You really need to talk to a counselor about that. You ll get over it. Just don t worry about it so much. 32

33 Encourage Appropriate Professional Help Individuals with mental disorders are treatable with a variety of therapies and/or supports Evidence-based practices are interventions for which there is consistent scientific evidence showing that they improve individual outcomes 33

34 Encourage Appropriate Professional Help Types of professionals: Doctors (pediatricians/primary care physicians/psychiatrists) Nurse practitioners/physician assistants Mental health professionals (e.g. social workers, licensed counselors) Drug and alcohol specialists School counselors Nutrition experts Certified peer specialists Other professionals 34

35 Encourage Appropriate Professional Help Types of professional help: Individual, family and/or group therapy. Alcohol/drug treatment, withdrawal management. Problem-solving, decision making, or social skills training. Academic counseling. Dietary management. Medication. 35

36 Medication for Youth Medication is rarely the sole treatment for youth with mental health problems. Medication combined with therapy or other treatment may be more effective than either treatment alone. Discussions regarding the use of medication with the youth should include the family and the healthcare provider. Trials often needed to identify the best medication and dose. Monitoring medication use is critical in youth. Knowledge on the use of medication in youth is limited. 36

37 What if the Person or Family Doesn t Want Help? Find out why Address fear of embarrassment or shame Help find solutions to concerns about paying for care or finding a provider Engage professional intervention if an emergency Call 911 School Personnel Social Services Identify resources Hotlines Behavioral Health Providers School Services Faith Leaders Peer/Parent Support Groups Organizations and Websites

38 Encourage Self-Help and Other Support Strategies Identify others who may be helpful. Explore activities that might help manage symptoms. Find strategies that interest the young person. Discuss self-help strategies with a health professional. Engage the family as well as the young person. 38

39 Encourage Self-Help and Other Support Strategies Promising self-help strategies: Are interesting to the young person. Promote a sense of satisfaction. Enhance social connectedness. Should be safe. Note: many natural therapies have not been studied thoroughly in youth and may not be suitable for children or young adults. 39

40 THE ACTION PLAN Video 40

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42 Let s Have the Conversation Ask how the youth is feeling. Describe what you ve seen. Express any concerns. Don t initially focus on changing the person s behavior, perspective or symptom. Use I statements that are not accusatory. 42

43 Assess for Risk of Suicide or Harm In A Crisis Situation Emergency medical services should be sought if the person has any of the following symptoms: Disordered thinking or not making any reasonable sense (may experience delusions or hallucinations). Disorientation not knowing what day it is, where they are or who they are. Unintentionally throwing up several times a day. Fainting. Collapses or is too weak to walk. Painful muscle spasms. 43

44 Assess for Risk of Suicide or Harm Seek emergency help if (cont.): Chest pain or difficulty breathing. Blood in their bowel movements, urine or vomit. A body mass index (BMI) of less than 16. An irregular or very low heartbeat (less than 50 beats per minute). Cold or clammy skin indicating a low body temperature (less than 95 degrees Fahrenheit). 44

45 Assess for Risk of Suicide or Harm Important signs that a young person may be suicidal: Threatening to hurt or kill himself/herself. Seeking access to pills, weapons or other means. Talking or writing about death, dying or suicide. Expressing hopelessness, no reason for living or having no sense of purpose in life. Having rage, anger or seeking revenge. Acting recklessly or engaging in risky activities, seemingly without thinking. Feeling trapped. 45

46 Assess for Risk of Suicide or Harm Important signs that a young person may be suicidal (cont.): Increasing alcohol or drug use. Withdrawing from friends, family or society. Having a dramatic change in mood. Sleeping all the time or being unable to sleep. Being anxious or agitated. Giving away prized possessions. 46

47 How to Talk With Someone who is Suicidal Discuss your observations with the young person. Appear confident, as this can be reassuring. Tell the person that thoughts of suicide are common and do not have to be acted on. Realize the youth may be reluctant to involve family or professional help. Try to involve the person in the decision making about what should be done, who should be told and how to seek professional help. If the person has a weapon or is behaving aggressively, call 911 immediately. 47

48 Assess for Risk of Suicide or Harm Ask the Question: Are you thinking about killing yourself? If the answer is, Yes, then Ask if the person has a plan: Have you decided how you would kill yourself? Have you decided when you would do it? Have you taken any steps to secure the things you would need? Higher level of planning means higher risk. Lower level of planning does not mean there is no risk. 48

49 Assess for Risk of Suicide or Harm Additional Questions to Ask: Have you been using alcohol or other drugs? Have you made a suicide attempt in the past? Have you had family, friends or heroes die by suicide? 49

50 Assess for Risk of Suicide or Harm If there is a risk of suicide, take immediate action to keep the young person safe: Do not leave him/her alone. Ensure he/she has a safety contact at all times. Discuss past supporters and see if they re still available. Do not use guilt or threats to prevent suicide. Seek additional support if needed, including 911.

51 Assess for Risk of Suicide or Harm Inform the crisis team if the young person has: Access to a gun, medications, or other means of suicide. Stopped taking prescribed medicines. Stopped seeing a mental or behavioral health provider or physician. Written a suicide note. Given possessions away. Been in or is currently in an abusive relationship. Recently suffered a loss or other traumatic event. An upcoming anniversary of a loss. Started using alcohol or drugs. Recovered well from a previous suicidal crisis following a certain type of intervention. 51

52 Try to De-escalate the Situation Speak slowly and confidently with a gentle, caring tone of voice. Do not argue or challenge the person. Do not threaten. Do not raise your voice or talk too fast. Use positive words instead of negative words. Stay calm and avoid nervous behavior. Do not restrict the person s movement. Try to be aware of what may increase the person s fear and aggression. Take a break from the conversation. 52

53 Key Considerations for Reaching Out Do: Understand the symptoms for what they are. Empathize with how the person is feeling about his or her beliefs and/or experiences. Do not: Confront the person. Criticize or blame. Take delusional comments personally. Use sarcasm. Use patronizing statements. State any judgments about the content of the beliefs and/or experiences. 53

54 Risk of Suicide Video

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56 Taking Care of Yourself Have I decided what I will do for self-care? Who can I debrief with now? If I feel upset or distressed later, who can I call? If I share with others, how do I ensure the confidentiality of the young person? Do I or my family need a break?

57 ALBERT VILLA, M.Ed. Project Manager Behavior, Discipline, and Mental Health FOR ADULTS ASSISTING YOUNG PEOPLE ESC REGION Boeing Drive El Paso, TX (915) Follow My Project on THANK YOU FOR YOUR PARTICIPATION