Responding to mental illness in a tertiary setting · 2018. 10. 5. · Stress is caused by an...
Transcript of Responding to mental illness in a tertiary setting · 2018. 10. 5. · Stress is caused by an...
Campus Wellbeing and Support Services
Responding to mental
illness in a tertiary setting
Dr Carmen Germain
Clinical Psychologist MAPS
Student Care and Trauma Lead
Dr Benjamin L Wilkes
Clinical Psychologist MAPS FCCLP
Manager, Allied Health
How many people are affected?
Recent surveys found 1 in 5 Australian adults will suffer from some form of common mental
disorder in any year.
> So for every 5 people in this room, 1 may experience a mental health problem in 2017
18 – 24 yr olds have the highest prevalence of any age group – 1 in every 4 people.
> For every 4 students in this age group on campus, 1 may experience a mental health
problem this year
First onset of psychosis often occurs in late teens and early twenties.
> Psychosis affects around 5 people in every 1000 people, every year
Common issues
The following issues are the most common ones that affect students who seek
counselling and psychological support from Campus Wellbeing:
• Anxiety / stress
• Depression / low mood
• Family / relationships
• Adjustment struggles
• Grief and/or loss
We also see students experiencing psychosis and autism spectrum diagnoses regularly,
but not frequently.
Study related difficulties: progression, procrastination, presentations / participation,
student : student conflict (e.g. group work), supervisor: supervisee conflict.
How can I identify mental health problems?
A mental disorder causes significant change(s) in a person’s thinking,
emotional state and behavior across many different situations.
It significantly disrupts the person’s ability to work/study and their
personal relationships.
Causes and triggers?
Some of the common causes and triggers that we see on campus include:
• Genetic predisposition / vulnerability (family members also experience mental
health problems)
• Stress from the environment e.g. work load, adjustment to living/studying in
Australia, problems with study progression, relationship breakdown, financial
hardship, organizational change, difficulties finding stable accommodation
• Drug and alcohol use
Signs to look for - Anxiety
Panic attacks: Rapid, shallow breathing
Looks fearful/afraid
Reports feeling dizzy
Rapid and/or jumbled speech
Appears agitated (difficulty sitting still, jiggling around or very stiff)
Trembling/shaking
Appears distressed (tearful)
Sweating (although it is not hot and they have not been exercising)
Difficulty concentrating or focusing
Appears to listen but difficulty taking in what you are saying
Feels sick (nausea)
Signs to look out for - Depression
Appears “flat” in facial expression, tone of voice and mood
> This means that there is little emotion as they interact with you;
facial expressions and voice don’t change much
Negative thinking about themselves and the future
Reporting thoughts of suicide/self-harm
Reporting actual attempts to suicide/self-harm
Tearfulness
Slowed speech
Slowed/sluggish walking/movement
Poor grooming (body odour, unwashed hair or clothes)
Signs to look for - Psychosis
Most frequently reported to CWB is odd ideas or odd behaviour
> e.g. telling others that they believe they are being watched,
or that people are talking about them behind their back
Other signs can be:
Confused or irrational language
Incoherent or jumbled speech
Seeing things or hearing things that aren't there
Difficulties concentrating, paying attention
May be responding to voices (e.g. appear to be talking to themselves)
May appear distressed, agitated or disheveled
Inappropriate clothing or grooming
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The Difference between mental disorder
(anxiety) and stress
Both are negative emotional experiences that can make you feel exhausted and edgy, steal your focus, cause you to lose time and not complete tasks.
Stress is caused by an existing stress-causing factor or stressor (temporary).
Anxiety is stress that continues after that stressor is gone (sustained). People are less aware of what they’re anxious and worried about in the moment.
Stress can come from any situation or thought that makes you feel frustrated, angry, nervous, or even anxious.
Why do WE experience difficulty?
When threatened, brain activates threat response
(This is generated before our conscious mind can work)
Reduces capacity for logical thought
Generates fight/flight/freeze
reactions
Characteristics of Distress
Only see their own point of view
Cannot reason logically
Personalise rather than focus on the issues
See the problem not the solution
Find it hard to remember the details
Do not hear other perspectives
May make quick decisions without thinking
What Distressed People May
Want or Need
Acknowledgment
Respect
To be listened to and heard
To be taken seriously
To get immediate action
To gain certainty/control/clarity
Options/choices
Specific Strategies: Anger
Remind yourself it is not personal
Lower the volume of your voice as they raise theirs
Listen for themes/needs
Ask if they would like to speak to your manager
Avoid defending a decision – broken record
Provide a range of options if possible
If extreme, remove yourself from
harm’s way and call for support
Report as appropriate
Specific Strategies: Anxiety
Be aware that anxiety primes us to filter out
the positive
Emphasise what they can do
Write options down together, or give them
written brochure-type information
Let this person know that they can talk to
you about it openly, without any fear of
judgment.
Don’t pressure them to "just relax" or "calm
down"
Specific Strategies: Sadness or
Numbing
Ask to re-state what is happening and what it means
Empathise and acknowledge: “this must be tough for you”
Count to 10 in your mind after you ask a question
May reduce eye contact if tearful:
“I can see that you are getting upset. That’s not my
intention”
If they are not talking - “what is going on for you right now?”
Help them identify what they can manage at this point in
time
What tells me that someone is distressed?
Academic signs
Excessive absences or loss of motivation
Consistent failure to turn in work or complete tasks to deadlines
Marked changes in concentration
Neglect of personal responsibilities
Noticeable decline in quality of work or writing and class participation
Poor performance and preparation
Repeated requests for special consideration/subject withdrawal
Avoiding participation / failed absents
Excessively anxious when called upon
What tells me that someone is distressed?
Behavioural
Increased procrastination and avoidance of tasks
Withdrawing from friends and family
Poor self-care and neglected personal hygiene
Being excessively demanding of others
Increase in impulsive behaviour
Self harm
Increase in alcohol or drug misuse
Talk of suicide (e.g., "I won’t be around to take that exam anyway." or "I’m not worried about getting a job,
I won’t need one.")
Violent acts towards self and/or others
Extreme dependency on faculty or staff, including spending much time visiting during office hours or other
times
Keys to responding
26OFFICE I FACULTY I DEPARTMENT
MHFA MODEL
Assess risk of suicide or harm
Listen non-judgementally
Give reassurance and information
Encourage the person to get appropriate professional help
Encourage self-help strategies
R U OK MODEL
1. Are you okay?
2. Listen without judgement
3. Encourage action
4. Check-in
Do
• If possible, choose a time and place that affords privacy and limited interruptions for your
conversation
• Try to listen attentively and patiently – it may be difficult for the student to find the right
words to explain their situation; sit with the silence and try to focus on what has been said
versus how it has been said
• Try to speak respectfully and take the student’s feelings seriously (“I can see that it is very
upsetting for you”)
• Ask what help they would prefer and support the student’s agency (“Would you like me to
call someone for you?” rather than “I’ll call the Counselling Service now and book you in”)
• Suggest options, encourage them to seek appropriate support – gently (“It sounds like it
might be helpful for you to talk with someone about this; what do you think?”, rather than
“You need to see a psychiatrist or counsellor”)
Don’t
• Promise in advance to keep the information secret as you will need to breach
confidentiality if you believe the student or someone else is at risk of harm
• Analyse the student’s motives (“you only feel that way because…”; ‘Why are you coming
to me with this just as the assignment is due?’)
• Argue, lecture, ridicule or minimise their experiences (“you wouldn’t be in this position if
you had…”; “I think you’re over-reacting”)
• Ask questions that might imply judgement or blame – (“Have you done anything about
this yet?”, “Why didn’t you tell someone before now?”)
• Share your own experiences of being highly anxious or overwhelmed, or your own
experiences of assault/abuse/trauma/grief/loss
• Attempt to physically console or comfort a student by hugging them or holding their hand
When to seek advice
In order to assist a student who may be experiencing mental health difficulties it is wise to
consult with colleagues or Campus Wellbeing (mental health professionals) / Security, IF:
• The situation is unclear or you don’t know the student well enough to assess their
behaviour
• You do not know what to do or what options are available to the student
• You want to talk through how you are managing a situation
• You believe the student is at immediate risk
• You believe there is an imminent risk of harm to others
• You feel overwhelmed or out of your depth
• You feel sad or cannot stop thinking about the personal circumstances of the student
• You think you would find it helpful to do so.
Why someone may communicate self
harm or suicidality
• Being very emotionally upset by their situation/circumstances
• Feeling at their “wits end”
• An attempt to end unmanageable pain
• An attempt to gain a particular outcome
• Related to a mental illness
• Catastrophising a common experience/shame and guilt
Risk Factors Vs Warning Signs
Heart Attack SuicideRisk Factors – indicate that someone is at higher risk
•Tobacco use•Obesity•High LDL cholesterol•Physical inactivity
•Prior suicide attempt•Mood disorder•Substance Misuse•Access to lethal means
Protective Factors – indicate that someone is at lower risk
•Exercise•Healthy diet•High HDL cholesterol•Stress Management
•Strong social connections•Available physical and mental health care•Coping skills
Warning Signs – indicate that someone is having a heart attack or is seriously considering suicide
•Chest pain•Shortness of breath•Cold sweats•Nausea•light-headedness
•Threatening to hurt self•Seeking means to end life•Hopelessness•Increased substance use•Dramatic mood changes
What to do if you are concerned about a
student or staff?
Concerning behaviour (aggression, threats of harm to self or others)
Let your supervisor know
Report the incident to the Risk and Hazard team at Human Resources via concerning or
threatening behaviours online if you don’t require immediate support. Once reported, your health
and safety advisor and other key resources will be drawn upon to address the matter raised.
The report about a student will be shared with Campus Wellbeing for follow-up.
Remember, you do not have to keep this information confidential as you are not a health
practitioner. You have a WH&S obligation to report concerns.
Supports for students
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During business hours:
Immediate risk evident: use standard processes for dealing with emergencies
No immediate risk evident:
Campus Wellbeing: You can phone Reception and discuss the situation and
how to respond.
Phone Ext 7497
Email [email protected]
Macquarie University CareMQ
1800 2273 67 (24 hour service focussed on providing advice regarding the
immediate management of health and wellbeing issues).
Supports for staff
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Immediate risk evident: use standard processes for emergency situations.
No immediate risk evident, you can refer staff to:
Employee Assistance program 24 hours, 7 days/week
Phone: 1300 360 364
E-counselling (available online: https://www.eapdirect.com/)
Your GP or the University Medical Service – Phone: 9812 3944
Mental Health Line 1800 011 511 for referral to out-of-hours mental health
services
Look after yourself
Debrief – with colleagues, family/friends, supervisor.
Take time out – go for a walk, sit in tea room or spare office for a while.
Stress-relieving activities (e.g. physical exercise, listening to music)
Avoid use of alcohol or stimulants (e.g. caffeine).
Try to keep normal routines going at work and home.
CareWISE Wellbeing Information and Support for Employees (iLearn)