school mental health teacher training

Mental Health & High School Curriculum Guide

Understanding Mental Health and Mental Illness

August 2009 version

Kutcher, Chehil, LeBlanc, Kelly, and Wei©

The Sun Life Financial Chair in Adolescent Mental Health and

Canadian Mental Health Association

Table: World: DALYs in 2000 attributable to selected causes by age

Adapted from: World Health Organization (2003). Caring for children and adolescents with

mental disorders. Setting WHO directions. Page 3, Figure 1. World: DALYs in 2000 attributable

to selected causes, by age and sex.

Ages 0-9 Ages 10-19

Neuro-psychiatric conditions (including self-inflicted injuries)

12 29

Malignant Neoplasms 3 5

Cardiovascular Diseases 2 4

Child and Adolescent Health Comparative Burden of Illness for Mental Illness

Disorder 6 Month Prevalence (%) Age = 9-17

Anxiety Disorder 13.0

Mood Disorder 6.2

Disruptive Behavioral Disorders 10.3

Substance Use Disorders 2.0

Any Disorder 20.9

Child and Adolescent Mental Disorders

WHO Health Report, 2001

PDD/ Autism

ADHD

Anxiety Disorder

Obsessive Compulsive Disorder

Substance Abuse

Anorexia Nervosa

Major Depressive Disorder

Bipolar Disorder

Schizophrenia

Bulimia Nervosa

0 10 20 30Age

Source: DSM-IV, 2000

Age of Onset of Major Mental Disorders

Cross-national Comparisons of the Onset of Psychiatric Disorders

Age of onset distributions of any anxiety disorders* Age of onset distributions of any mood disorders*

Age of onset distributions of any substance use disorders*

*Data for Germany were omitted because of the narrow age range of the sample

Prevalence of Mental Disorders in Young People

Population Prevalence

Depression (6%)

Psychosis (1%)

Anxiety Disorders (10%)

ADHD (4%)

Anorexia Nervosa (0.2%)

Total (15 – 20%)

Translation to the

“average” Classroom

Depression (2)

Psychosis (rare)

Anxiety Disorders (3)

ADHD (1)

Anorexia Nervosa (rare)

Total (4 – 5)

What is Stigma?

In the context of mental health, stigma is the use of negative labels to identify a person living with mental illness. It is about disrespect and keeps mental illness in the closet. Stigma is a barrier and discourages individuals and their families from getting the help they need. It closes minds and fuels discrimination. Many say that living with the stigma is worse than living with the illness itself. (CMHA)

Source: http://www.cmha.ca/bins/content_page.asp?cid=284-683-1549-2352-2354&lang=1

Stigma is a major cause of discrimination and exclusion-WHO

It hampers the prevention of mental health disorders, the promotion of mental well-being and the provision of effective treatment and care.

It also contributes to the abuse of human rights.

Source: http://www.euro.who.int/mentalhealth/topics/20061129_3

Ten Things You Can Do to Fight Stigma and Discrimination

1. Learn more about mental illnesses, to become more informed.

2. Listen to people who have experienced mental illness-how they have been stigmatized, how it affected their lives.

3. Watch your language-avoid terms and expressions that can perpetuate stereotypes, such as 'lunatics', 'nuts' or 'schizophrenic'.

4. Monitor media and report stigmatizing material.

Source: Adapted from Telling is Risky Business: Mental Health Consumers Confront Stigma, by Otto Wahl, Rutgers University Press, 1999 http://www.cmha.ca/bins/content_page.asp?cid=284-683-1549-2352-2354-2402&lang=1


5. Respond to stigmatizing material in the media. Protest such material to those responsible-journalists, editors, advertisers, movie producers - and provide more appropriate information.

6. Speak up about stigma. When someone misuses a psychiatric term (such as 'schizophrenic'), tells a joke that ridicules mental illness or makes disrespectful terms, let them know you find it hurtful and unacceptable.

7. Talk openly about mental illness. The more mental illness remains hidden, the more people will continue to believe it is shameful



8. Demand change from your elected representatives. Speak up on issues such as insurance parity, limited funding for research and inadequate budgets for mental health services.

9. Support organizations that fight stigma and discrimination. Join them, donate money to them and volunteer for them.

10. Contribute to research related to mental illness and stigma.


Most young people with mental disorders will go on to be successful at school and live productive and positive lives when receiving proper treatments for their mental illness.

Some young people have severe and persistent mental disorders which respond poorly to current treatments (as in all other illnesses) and may require greater supports

Mental illness does not respect any boundaries of race, class or geography.

Young people with mental illness are more likely to be victims not perpetrators of violence

Young people with mental illnesses have difficulty accessing best possible care and face substantial stigma

Early identification and provision of best evidence treatments have the opportunity to substantially improve outcomes

What do we know about young people with mental illnesses?

Thinking About Causes and Effects

How do we know what causes what?

Is there anything about mental disorders that makes thinking about causation difficult?

How do we know what works in the treatment of mental disorders?

Is there anything about mental disorders that makes thinking about treatment difficult?

Correlation VS Causality?

Correlation Causality

Risk factors are Correlations and not

Causes

What is a Risk Factor?

Types of Risk FactorsCausal – these factors always or usually always cause the disease (eg: exposure to HIV)

Associated – these factors may contribute to the cause of the disease but do not actually cause the disease (eg: pneumonia in a person who is bed-ridden)

Co-related – these factors may or may not contribute to the cause of the disease (eg: bullying and depression) but do not cause it

How do we know what works?

How is scientific evidence created?

Is all scientific evidence created equal?

How do we evaluate scientific evidence?

How do we apply scientific evidence to evaluation of treatment?

How do we apply scientific evidence to choosing and evaluating programs?

What is the difference between “evidence of absence” and “absence of evidence”?

Knowing What Works

Scientific evidence is created through experiments, not through other kinds of research

Not all scientific evidence is equal: it is hierarchically evaluated using internationally accepted criteria

Any treatment or program can be scientifically evaluated to see if it works

Many treatments/programs have not yet been properly evaluated so we really do not know if they work or not

What is a Mental Disorder?

Term that is frequently used interchangeably with the term mental illness

Identifies that the brain is not functioning properly in one or more of its six domains – this leads to signs and symptoms (so what are signs and symptoms?)

Leads to significant functional impairment in one or more domains of usual living (intimacy; social relationships; school; work; etc.)

Is consistent with best validated international classifications of disease – ICD or the DSM

Causes are complex – due to complicated gene, environment and neurodevelopment interactions

GeneticsFamily history of

depression, anxiety,

alcohol abuse

Environmental Stress Birth trauma

Nutritional deprivation Infections

Toxins

Clinical Depression

Symptom Expression

Abnormal Brain Development = Vulnerability/Predisposition

Birth

Abnormal Brain Function

Cultural Factors

Environmental Insults +/-Prolonged Severe

Stressors

InfancyChildhood

AdolescenceAdult

Some Signs & Symptoms but

No Disease

No Disease

Are all brain disturbances mental disorders?

Not all disturbances of brain functioning are mental disorders

Some can be a normal or expected response to the environment – for example: grief when somebody dies or acute worry, sleep problems and emotional tension when faced with a natural disaster such as a hurricane

Normal “life” or mental disorder - What’s the difference between

mental distress and mental disorders?

The 2 D’s

Distress DisordersLess common

Frequently onsets without environmental challenges

Frequently long term (may be chronic and episodic) – significant functional impairment

Must meet recognized diagnostic criteria

Frequently requires professional intervention

Usually responds well to evidence based treatments

Usually helped by appropriate supports and positive lifestyle activities

Common

A response to environmental challenges

May be adaptive

Usually short term and not severe – does not significantly impair functioning

Should not be “diagnosed”

Usually does not require professional intervention

Usually responds well to “usual” supports and positive lifestyle activities

Identification of young people who may have a mental disorder – science

or art?Screening tools that have been validated in specific youth populations may be used (pros and cons)

Increasing the level of understanding and providing knowledge about potential “clues” to responsible adults who have knowledge of individual young people (teachers, coaches, religious leaders, etc.)

Identification may be Difficult in the School Setting

It can be more difficult to differentiate “Distress” from “Disorder” in young people than in adults

The “presentation” of the illness may be different at different times

If a student is using drugs or alcohol the effects of those substances can be confusing

Sometimes the student does not share the symptoms (such as low mood or hallucinations)

Sometimes the student is not known to the teacher

Identification Keys

Is the student previously known to have significant mental health problems or a mental disorder? (family member)

Has there been a recent significant change in mood, cognition, behavior?

Are the person’s problems causing distress to them or to others or is there a lack of social convention?

Has there been a noticeable decrease in functioning: social, academic, other?

Are there substantial and unexplained major changes in peer group participation – especially peer group “slide”?

Are parents or others raising concerns?

Does a close friend have a mental disorder or a major mental health problem?

MENTAL DISORDERS ARE

BRAIN DISORDERS

FUNCTIONS OF THE BRAIN

Perception or Sensing

Emotion or Feeling

Behavior

Physical or Somatic

Signaling (being responsive and

reacting to the environment)

Thinking or Cognition

What are the Symptoms of

Mental Disorders?

Thinking

Mental Disorders are Associated with Disturbances in 6

Primary Domains of Brain Function:

Perception

Emotion Signaling

Behavior

Physical

WHAT IS THINKING or COGNITION?

Communicating

AttendingFocusing

Reading

Comprehension

Arithmetic

Memory

PlanningContemplating

Processing

Judgment

Insight

DISTURBANCE IN THOUGHT CONTENT

REAL UNREAL

APPROPRIATE EXCESSIVE

DELUSIONS

What are Delusional Beliefs?

False

Persistent

Not shared by others of same socio-cultural group

Regarded as real and held with conviction despite being given ample evidence to the contrary

Must be evaluated from within socio-cultural context

WHAT IS PERCEPTION?

Our ability to use our five senses to see, hear, taste,

smell, and touch.

See

Hear

Smell

Taste

Touch

Disturbances of Perception

Normal

Hallucination

Illusion

Mental Disorders of COGNITION and PERCEPTION: Psychosis

What is Psychosis?

“Psychosis” is a disturbance in thinking and perception that is

characterized by a loss of contact with reality and that is caused by

abnormal brain functioning.

What is Schizophrenia?

Schizophrenia is the most common of the psychotic disorders. It is a chronic, severe, and

disabling brain disorder characterized by the presence of delusions, hallucinations,

disorganized thinking, disorganized behavior, disturbances in affect, disturbances in initiation

and motivation (avolition), and functional impairment.

Affects 1% - 1.5% of individuals Men and Women are equally affected

Usually begins between ages 14 and 25 years

PSYCHOSIS:WHAT TO LOOK FOR?

Is the person acting differently and in an unusual manner?

Does the person show signs of or admit to hallucinations?

Does the person show a thought form disorder – does his or her speech make sense?

Is the person isolating from others?

Is the person espousing bizarre and unusual ideas?

PSYCHOSIS:WHAT TO DO?

Discuss concerns with other teachers and student support staff.

Investigate the family situation and discuss concerns with appropriate family members.

Support suggestions to seek mental health assessment.

Provide mental health assessors with appropriate information following appropriate consent provision.

Participate in discussions with young person, health providers and family about school related issues.

PSYCHOSIS:WHAT NOT TO MISS?

Voices telling the person to harm him/her self or others.

Delusions that can lead to unpredictable behavior (for example: suspicions of others leading to violence).

CAUTION

Emotions and Moods – What am I feeling inside?

Transient shift towards (-) pole consequent to (-) life events

Transient shift towards (+) pole consequent to (+) life events

Normal range

and intensity

of mood

Normal Baseline

‘Normal’ Mood Graph

+3

-3

Mental Disorders of Emotion and Feeling: Depression and Bipolar

Disorder

What are the Mood Disorders?

Unipolar Mood Disorders

Bipolar Mood Disorders

Example:

Major Depressive Disorder

Example:

Bipolar Disorder

What Happens if the Baseline Shifts Toward the Negative Pole - Depression

0

+3

-3

Normal range

and intensity

of mood

Normal range

and intensity

of mood

Normal Baseline

What Happens if the Baseline Shifts Toward the

Positive Pole - Mania

0

+3

-3

How is a ‘Depressive Episode’ different from feeling sad?

This can happen without can

obvious cause

Low or depressed

mood most of the time for a

long time

Many problems with work, at home or in relationships

with others because of the low

mood

Many physical complaints can accompany the

low mood

The low mood often does not respond to

changes in the environment

DEPRESSION:WHAT TO LOOK FOR?

Difficult to explain frequent and persistent physical complaints (headaches; stomach aches; fatigue; etc)

Loss of interest in usual life activities

Loss of pleasure in those things usually found to be pleasurable – hopelessness

Decreased functioning at home at work/school with family or with peers/friends

Thoughts of death/suicide or preparation for death

DEPRESSION:WHAT TO ASK?

How are you feeling inside of yourself? – How long have you been feeling that way?

Have you been feeling hopeless?

What does the way that you are feeling now prevent you from doing? – What would you be doing if you were not feeling the way you are feeling now?

Are you thinking or feeling that life is not worth living or that you would be better off dead? What have you thought about doing?

Do not agree to keep self-harm or suicide confidential.

Depression: What to Do?

Depression is highly treatable with the proper medications and the proper psychological therapies, so the young person with depression should be referred to the most appropriate health care provider.Academic expectations may need to be modified due to depression effects on motivation and cognition.Be aware of the risk of suicide – discuss with health providers what the role of educators should be in each individuals case.Develop a youth supporting educational/health collaboration with appropriate consents.

DEPRESSION:WHAT NOT TO MISS?

Always ask about suicidal thoughts and suicide plans

If you are not sure for even a tiny bit – ask someone with expertise to immediately evaluate

CAUTION

How is ‘Mania’ different from feeling extremely happy?

Mood is mostly elevated or

irritable

Significant problems in daily life because of the

moodIs not caused by a life problem or

life event

Many behavioral, physical and

thinking problems

Mood may often not reflect the reality of

the environment

BIPOLAR DISORDER:WHAT TO LOOK FOR

History of at least one depressive episode and at least one manic episode.

Rapid mood changes including irritability and anger outbursts.

Self-destructive or self-harmful behaviors – including: spending sprees; violence towards others; sexual indiscretions; etc.

Drug or alcohol overuse, misuse or abuse.

Psychotic symptoms including: hallucinations and delusions

Youth Suicide

Youth suicide is a rare but tragic event for any communityMost youth suicide is associated with the presence of a mental disorder (often depression) that has either not been diagnosed or is not being appropriately treated.Youth suicide is not the result of the usual stresses of being a teenager.Suicide attempts need to be differentiated from self-harm events – they require different approaches to deal with them.The use of youth specific suicide assessment tools (such as the TASR-A) can assist professionals in the evaluation of youth suicide risk.

Youth Suicide: Well Established Risk Factors

Presence of a mental disorder

Previous suicide attempt (especially in boys)

Family history of suicide

Family history of mental disorder

Substance abuse

Juvenile justice involvement

General Specific

Empathy Gentle Inquiry

I can see how difficult things have been for you lately…

You seem to be having a hard time…

Would you help me understand how this has been for you?

How have things been for you lately?

Have you ever felt life was not worth living?

Have you ever tried to do anything to yourself that could have seriously harmed you or killed you?

Direct Inquiry

Assessing for Suicide

What Is Signaling?

Brain RegistersDANGER!

Initiation of

Physiologic Cascade

Heart Rate

Tension

Alertness

Perception

Prepared to Fight or Flee for Safety

& Protection

Sensory Perception

Taste

Touch

Nose

Ears Eyes

Internal Signals

DANGER!

What Is Anxiety?

Brain RegistersDANGER!

Initiation of

Physiologic Cascade Heart Rate

Tension

Alertness

Perception

ANXIETY

Sensory Perception

Taste

Touch

Nose

Ears Eyes

Internal Signals

Thoughts Physical

Emotions

No Danger

!?!

!!

What is Normal Anxiety?

Situation or Trigger:

First date Preparing for an exam Performing at a concert

Giving a speech Moving from

home Climbing a tall

ladder

Anxiety:

Apprehension Nervousness Tension Edginess

Nausea Sweating

Trembling

Transient

Does not significantly interfere with a person’s well-being

Does not prevent a person from achieving their goals

What is Pathologic Anxiety?

Situation or Trigger:

First date Preparing for an exam Performing at a concert

Giving a speech Moving from

home Climbing a tall

ladder

ANXIETY

Symptom Domains:

Signaling Cognition Thinking Behavior Physical

Persistent

Excessive & Inappropriate

Intensity

Causes Impairment

Leads to dysfunctional coping:

-Avoidance

-Withdrawal

MENTAL DISORDERS OF SIGNALING: THE ANXIETY DISORDERS

GENERALIZED ANXIETY DISORDER (GAD):WHAT TO LOOK FOR?

Does the youth have many persistent physical symptoms that cause distress but for which there is no good medical explanation – such as: headaches; stomachaches; pain; etc.

Does the youth worry about many things, much more than other people seem to worry?

Does the person have trouble “letting go” of the worry?

Does she or he usually seem tense or “on edge”?

Is the worrying of such intensity that it interferes with the young person enjoying life or doing things that he or she would like to do?

GENERALIZED ANXIETY DISORDER (GAD):WHAT TO ASK?

Would you or others consider you to be a worrier?

Do you tend to worry a lot about most things?

What are the most common worries that you have?

Does your body “worry” by getting headaches; stomach aches; pains; etc.?

How do your worries get in the way of you doing things you like to do or in enjoying life?

Do you sometimes just feel overwhelmed by your worries?

GENERALIZED ANXIETY DISORDER(GAD):WHAT TO DO?

GAD is highly treatable with specific psychological interventions (such as CBT) so referral to a person expert in that type of therapy is suggested.

Reassurance is not usually helpful – at best it provides only minor temporary decrease in symptoms and consistent reassurance can encourage “clingy” behaviours.

Providing simple and practical suggestions about specific anxiety items (such as: since you are worrying about your test why not make sure you have a chance to study for at least one hour tonight) is useful.

GENERALIZED ANXIETY DISORDER (GAD):WHAT NOT TO MISS?

Depressive symptoms or clinical depression

Suicidal ideas or plans

Alcohol over-use; misuse; abuse

CAUTION

Social Anxiety Disorder (SAD)

Unrealistic and irrational fear of social situations in which the person feels that he or she is under scrutiny by othersFeeling of embarrassment and may have occasional panic attacks in the feared situation onlyAvoidance of social situationsSevere distress / Wanting social contactSix months or longerFunctional Impairment

SOCIAL ANXIETY DISORDER (SAD):WHAT TO LOOK FOR?

Does the person get very anxious in one or more social situations that involve strangers or groups – such as classrooms or lunch rooms?Does the youth avoid speaking up in class or are there specific situations that are avoided – the locker room in gym class for example.Does the person get easily embarrassed in a social situation or think that other people are judging him/her or paying particular attention to him/her.Does the person ever have a panic attack in social situations or places where many people congregate?

SOCIAL ANXIETY DISORDER (SAD):WHAT TO ASK?

What kinds of situations cause you to feel anxious, embarrassed or panicky?

What do you do when you feel this way?

How do these feelings/thoughts affect your life?

What do these feelings/thoughts stop you from doing that you would otherwise do?

SOCIAL ANXIETY DISORDER (SAD):WHAT TO DO?

Provide information about what you think the problem is to the young person and inform them that there may be help for their concerns.

SAD is highly treatable with cognitive behaviour therapy so a referral to someone with that skill set is indicated.

Exposure treatment is also useful – sometimes a teacher along with a student support worker (psychologist, social worker) can create a classroom exposure plan.

Public speaking organizations such as “toast masters” are helpful.

SOCIAL ANXIETY DISORDER:WHAT NOT TO MISS?

Depressive symptoms or clinical depression

Alcohol over-use; misuse; abuse

CAUTION

What is a Panic Attack?

0

10 Panic Attack:

Heart pounding Sweating

Trembling Air hunger

Smothering Chest pain Stomach pain Nausea

Dizziness Tingling/numbness

of feet & hands Feeling flushed Feeling chilled

10 minutes TIME

Am I going

Crazy?!Am I going to DIE?!

Am I having

a heart

attack?!

PANIC DISORDER:WHAT TO LOOK FOR?

Does the person have panic attacks – rapid onset of panic feelings and physical symptoms such as rapid or irregular heartbeat; breathing problems; tingling; light-headedness; etc.?

Does the person worry about getting an attack?

Does the person avoid going to places where an attack has happened or where they worry they might get an attack?

Do the panic attacks negatively affect the person’s life or prevent them from doing what they would like to do?

Obsessive Compulsive Disorder (OCD)

Obsessions - recurrent, intrusive, unwanted thoughts or images or impulses that cause significant distress and functional impairmentCompulsions – recurrent, repetitive behaviours that are time consuming and cause significant distress or functional impairmentPerson realizes that the obsessions and compulsions are excessive and unrealistic but can not control them

OBSESSIVE COMPULSIVE DISORDER (OCD): WHAT TO LOOK FOR?

Does the person have repetitive behaviors or rituals such as checking; ordering; counting; etc.that they can not easily stop?

Does the person have repetitive thoughts that are upsetting to them and that they can not easily stop?

Do these behaviors or thoughts cause them difficulties in their everyday life?

Post Traumatic Stress Disorder (PTSD)

Severe and persistent emotional response to a situation in which the safety or body integrity of the person is threatened (rape, war, earthquake, train wreck)

Symptoms noted 6 weeks or longer after the trauma and include: re-experiencing; autonomic hyper-arousal; avoidance

Functional Impairment

1. The Acute Stress Response

EmotionalCognitivePhysical

Behavioral Disturbances

&Functional Impairment

Intensityof

Impairing Symptoms

DAYS WEEKS MONTHS Trauma

Affects 100% of the Population

What to do?Resume usual activities

Mobilize emotional supports

Resolves without medical treatment

Lasts days - weeks

May impair functioning

Affects all domains of brain functioning

2. Post Traumatic Stress Disorder

Intensityof

Impairing Symptoms

DAYS WEEKS MONTHS

CAUTION

Trauma

Re-experiencing Avoidance/Numbing Hyper-arousal Functional Impairment Failure of

stress response to

resolve

CAUTION

POST TRAUMATIC STRESS DISORDER (PTSD):

WHAT TO LOOK FOR?Was there a traumatic event – and if so, what was the event?What symptoms is the person having now? Does the person have symptoms in all three categories: re-experiencing; avoidance/numbness; hyper-arousal?What symptoms did the person have immediately ( 1 – 3 days) after the event?What symptoms did the person have later (4 weeks after the event)?Do the symptoms that the person is having cause significant problems in their every day life?

PTSD and the School Setting

Stress symptoms immediately following a traumatic event are NORMAL and do not require interventions. Information about this should be provided to students, parents and staff.Some interventions (such as CISD) may not be helpful and may even be harmful.Following a traumatic event schools could provide quiet spaces with staff support after school hours and “identification” of symptomatic youth 4 – 6 weeks after the event.Symptomatic students can be offered CBIT or other evidence based psychological interventions.Avoid the pressure to “do something” and focus on doing “the right thing”. With a suicide – consider identification of high-risk youth (friends of the deceased).

WHAT ARE BEHAVIOR FUNCTIONS?

Often the most conspicuous expression of the Mental Disorders to others

What are Disturbances in BEHAVIOUR?

Avoidance

Loss of motivation

(Avolition)

Social Withdrawal

Loss of Social Graces

Odd Behaviours

Violence

Suicide

MENTAL DISORDERS OF BEHAVIOR: ADHD

Conduct Disorder Substance Abuse

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Onsets before age seven

Three Major Domains:

Attention

Hyperactivity

Impulsivity


ADHD:WHAT TO LOOK FOR?

Compared to others his/her age is the person persistently and much more:

Hyperactive (on the go; can not stay still; etc.)

Impulsive (does things without thinking; gets into trouble often because of not considering possible outcomes of his/her actions, etc.)

Problems with sustained attention (often does not finish tasks; forgets easily; etc/)

Girls may have substantial problems with sustained attention and not exhibit symptoms of hyperactivity and impulsivity

Many of these symptoms may diminish in intensity with age but may not completely disappear.

Always assess for learning disorder(s) and be aware of substance misuse.

Self-esteem and demoralization (this is not an ego-dystonic problem)!

ADHD: What to do?

Discuss with young person how they perceive their problems, the diagnosis and the treatment.

Utilize intervention strategies that have been demonstrated to be successful for the young person – do not waste your time on interventions that have not worked or are not likely to work.

Encourage a strength based framework – find the things that he/she does well or suggest activities that do not depend on sustained attention.

Understand the pros and cons of medication treatment.

CONDUCT DISORDER (“DELINQUENCY”)

Onsets before adolescence

Persistent violations of social rules, norms and values

Legal difficulties

May include violent confrontations with others

May include cruelty to animals or people


Dealing with Conduct Disorder

Identification of mental disorders that may contribute to conduct disturbance is important – such as: ADHD; learning disorders; depression; substance abuse.

Support and guidance for young people – finding alternative for expression (such as sports; arts; etc.); developing more responsible peer group relationships

Working with other professionals to assist with behavioral responsive interventions in the classroom and schoolyard

Helping – Get Well, Stay Well, Keep WellAll helping interventions act on the brain – and assist in one or more of the functions of the brain

Psychological (counseling; specific psychotherapies) – common effectsSomatic (medications; others)Social (groups; communities; etc.)Physical (sleep, exercise, etc.)

What are Treatments Expected to Do?

Improve the symptoms that the person is suffering from

Improve the person’s ability to function at home; at work; with friends; etc.

Stop the disorder from coming back

How to think about treatments (remember evidence)

Specific treatments – treatments that have been demonstrated to show significant positive effects in a specific disorder (for example: SSRI medicine in adolescent depression; CBT in social anxiety disorder, etc.)

General or non-specific “treatments”– interventions that have been shown to help ameliorate some symptoms in many different disorders (for example: biblotherapy; psycho-education; social supports, etc.)

Supportive interventions – interventions that are likely to have overall positive results: they are good for you (for example: getting enough sleep, exercise, good nutrition, etc.)

Tips to Fight Mental DisordersDepression

Go outside

Exercise

Be social

Stop thinking so much

Talk to people you trust

Relax

Stay away from booze and drugs

Laugh

Problem solve (use your head!)

Structure your day

Depression is very treatable with a combination of medication, psychotherapy and counseling. Some things you can do to help

include:

Treatment Bipolar Disorders

Bipolar disorder is a medical condition that requires medication

Mood stabilizers

Antidepressants

Counseling is also helpful, along with support from family and friends

The same things you do to help yourself with depression will also help in bipolar disorder BUT it is ESSENTIAL that you maintain a consistent biological rhythm. That means, going to bed about the same time every night and getting about 8 hours of sleep every night. Drugs or alcohol can precipitate a manic or depressive episode – so avoid or highly limit their use.

TreatmentPsychosis

Early intervention is important-Getting help early minimizes the risk of disruption in daily life and is critical to a successful recovery

Treatment for psychosis includes antipsychotic medication, individual and family counseling, and support to help individual get back to their normal daily routines.

Treatment also includes educating the individual about the disorder and encouraging healthy living

Additional educational and vocational programs are also often needed.

TreatmentPsychosis-continued

Focus will also be on decreasing the risk factors to prevent relapse and aid in a successful recovery.

Treatment will depend on the severity of the symptoms and how long they have been present along with the possible causes.

Tips to Fight Mental DisordersAnxiety Disorders

Exercise DailyRelax – deep breathing exercises, yoga, tai chi, meditationSleep well – 8 hours a nightLearn to laughLimit alcohol and drug consumption

Eat a well-balanced dietAdd variety to your lifeCreate a support networkLearn to manage your lifeChallenge your perfectionismChallenge the thoughts that make you feel anxious: are they really true?

Professional treatment is helpful and includes, psychotherapy, counseling or medication

TreatmentEating Disorders

Eating disorders are a mental illness

Eating disorders demonstrate complex emotional and physical problems and require a range of professional treatments for successful recovery.

Medical treatment for weight related health problems

Nutritional counseling

Psychological therapy

Medications for Bulimia may be helpful

Getting HelpUseful links

Sun Life Financial Chair in Adolescent Mental Health: http://www.teenmentalhealth.org/Canadian Health Network: http://www.canadian-health-network.ca/1mental_health.htmlhttp://www.phac-aspc.gc.ca/chn-rcs/index-fra.php (French)Canadian Mental Health Association, National Office: http://www.cmha.ca/Canadian Mental Health Association, Ontario Division: http://www.ontario.cmha.ca/Centre for Addiction and Mental Health: http://www.camh.nethttp://www.camh.net/fr/index.html (French)Health Canada, Mental Health Web site: http://www.hc-sc.gc.ca/hppb/mentalhealth/index.htmlhttp://www.phac-aspc.gc.ca/index-fra.php (French)National Alliance for the Mentally Ill: http://www.nami.org/SAMHSA’s National Mental Health Information Centre:

http://nmhicstore.samhsa.gov/publications/Publications_browse.asp?ID=176&Topic=Mental+Illnesses%2FDisordersMindMatters: A Mental Health Promotion Resource for Secondary Schools: http://www.mindmatters.edu.au/default.aspContinuing Medical Education (CME) mental health information: http://www.cmellc.com/topics/

Other Helpful Resources

Transitions: Student Reality Check (Book)

Metal Health Training for Teachers (Resource book)

Understanding Depression and Suicide in Adolescents (Training program)

Evidence-Based Medicine for Patients (Book)

When Something’s Wrong: Strategies for Teachers (Book)

All these programs and books can be found at the Sun Life Financial Chair in Adolescent Mental Health website

THE END

For further information and resources:

www.teenmentalhealth.org

school mental health teacher training

Health & Medicine