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

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.

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

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

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

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

Depression
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

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

Stress
Thoughts
I cant cope! Its unfair! I dont have enough time! Ill 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

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

STRESS INVENTORY

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. Heres 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!

Stress Management
Identify Stressors
Where am I when Im 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

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

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.

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 wouldnt ask for unreasonable things!

They wont accept it

Even if you said no, they wouldnt believe it

They wont accept me

They will be upset with me and wont like me

I dont have the right

Im selfish if I say no. I should help.

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 Dont apologize when it isnt necessary Dont defend yourself or make excuses unless necessary Dont ask permission to say no Strengthen your position Broken record Dont wait for acceptance Accept the consequences

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

Common Boundary Myths

If I set boundaries, Im 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 Im angry When others set boundaries, it hurts me Boundaries cause feelings of guilt Boundaries are permanent

Boundary Issues
Compliant
Feels guilty and/or controlled by others; cant set boundaries. Cant say no.

Avoidant
Sets boundaries against receiving care of others. Cant hear yes.

Controllers
Aggressively or manipulatively violates boundaries of other. Cant hear no.

Non-Responsive
Critical towards others and narcissistic of self. Cant say yes.

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

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

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?

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

References
http://www.stressaffect.com/Stressful-LifeEvents-List.html http://www.surgeongeneral.gov/library/m entalhealth/chapter1/sec1.html#approac h DSM-IV TR www.getselfhelp.co.uk