Language

Mental Health

Mental Illness

‘Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully,

and is able to make a contribution to her or his community.’

‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’

– World Health organisation

“Professionals should have mental health training.”“Professionals should be trained in counselling.”“Professionals should understand the signs of mental illness.”

What about…

Professionals should be given the tools and language to have a conversation about a young person’s levels of distress, pain or overwhelm.

We can have these human conversations.

Some useful adaptations in language;

Disorder – Condition

Them – Their behaviour

You/personality – Your brain / your thoughts

Emotion – Emotional state / emotions

Supporting Inquiry and Articulation

We need to reclaim the narrative and clarify the definitions

Committing suicide – Taking their life, died by suicide.

Resilience – Healthy models of resilience involve co dependence.

Chemical imbalance – Neurotransmitters of course.

But also situational. Life is not linear.

Society’s myths – Follow your gut, believe your brain.

Helping young people build language in which to articulate their pain is vital. Much of the time people must hear someone else talk of their experience before the language resonates and they can put words to their own pain or experiences. Building that language through the way we discuss emotions and thoughts is an important process for all professionals.

Emotion Theories

Many care experienced children are given the label of anger.

For many young people who have experienced trauma the physiology of emotions is particularly complicated due to the adverse affect on their nervous system.

Poly Vagal Theory – Dr Stephen Porgess

Often their bodies’ reaction to circumstance means the correct cognitive label/interpretation or reasoning is not always attached to the emotion.

A note on interoception (linked to sensory attachment) - Interoception is the sense of knowing what is going on INSIDE our bodies.

Things such as feeling:

● Hunger

● Thirst

● Tired

● Feeling pain

● Temperature (Feeling hot or cold etc)

● Using the bathroom

● Any other internal sensations

Hyper-responsive, also known as over-responsive or hypersensitive means a child is extremely sensitive to this input.

Hypo-responsive, also known as under-responsive or hyposensitive means a child often needs a large amount of input to recognize the type of sensory information their brain is receiving.

Sometimes its sensory not behaviour.

Temporality of emotions

Primary emotions can shift and vary according to several parameters. Let’s look at the impact of time on primary emotions.

The way we discuss emotions with young people needs to adapt to the circumstance and their experiences. Effective and careful questioning can enhance conversations;

- Talking of emotions not singular emotion- Emotional states- How did your body/brain react?- What other emotions do you think your brain or body felt?- Is there a chance you might have been feeling more than one? Something as well as?- Now that we know that, what’s possible now?- What thoughts have you been experiencing recently?- What’s your brain been telling you?

Supporting Mental health

It is true that clinical treatment is often needed to support mental health needs. However, social factors are a key part of recovery and staying well. Within a young person’s daily life, there exists multiple opportunity to engage with them in aspects of routine, connection and healthy living etc that can all be targeted to support recovery.

Routines – we all need them

Connection & socialising

Food

Exercise

Interests / hobbies

Nature

Distancing / reflection

Example wellbeing plan:

Aspects of wellbeing to incorporate weekly:

● Food – Healthy choices, Trying new food.

● Exercise – ? Times a week – Evening – With company?

● Socialising – Fridays are the usual times, once or twice a month.

● Interests – Guitar, rugby.

● Thoughts – Affirmations, bedtime management, self-compassion

● Learning – Timetable manageable currently.

● Senses – Incense, Jumpers.

● Distancing/Reflection – Music, New music, Podcasts – Try a few, Meditation &

Breathing – Vagal breathing.

● Comfort – Phone calls once or twice a week to sister, Friend from school Contact,

Mood lighting and decoration, de clutter – Room tidy once a month, positive memories – places i’ve been, comfort clothing – dressing gown, tv series – documentary’s, Analogue phone usage.

● Healthy chat – Aunty, mentor, walking therapy.

● Bedtime routines – Need to try a few things, Sleeping positions.

● Goals – Holidays, half marathon September, Surfing, Rugby.

What thoughts am I likely to think?

Catastrophise – worst case scenario, worry – and get frustrated because I’m worrying

Worst thought – why don’t I jump out of window or put myself in harm’s way? Rational thoughts kick in. At this point I may go for a walk or move. Need for Cigarettes. It’s the walk and space that helps.

Planning around therapeutic input is essential.

What is resilience?

‘Resilient children are made, not born.’ – Dr Bruce Perry

Having an adequate supply of emotional, social, practical, financial, physical & social resources to cope with a non-toxic amount of stress without being adversely affected.

Care experienced children need to build safety and dependency first.

Acute needs

If you listen and allow someone to feel understood, then that is a therapeutic intervention in itself.

Anxiety

Anxiety is a feeling of fear or panic. Feeling generally anxious sometimes is normal. Most people worry about something - money or exams - but once the difficult situation is over, you feel better and calm down.

If the problem has gone but the feeling of fear or panic stays or even gets stronger, that’s when anxiety becomes a problem.

Signs/indicators of Anxiety ‘disorders’

● Not eating properly

● Quickly getting angry or irritable, and being out of control during outbursts

● Constantly worrying or having negative thoughts

● Feeling tense and fidgety, or using the toilet often

● Always crying

● Being clingy all the time (when other children are ok)

● Complaining of tummy aches and feeling unwell

● Withdrawing socially

● Fear of failure

● Physical tension

● Fear of change

● Constantly feeling the need to be reassured

What types of anxiety can young people experience?

Common types include;

A fear or phobia about something specific

Children are typically afraid of things like monsters, water or the dark. This is a perfectly normal part of growing up but has the potential to become a phobia (a type of anxiety disorder) when the fear becomes overwhelming and affects a child's day-to-day life.

Feeling anxious for most of the time for no apparent reasonWhile it's normal for children to frequently have fears and worries, some anxious children may grow up to develop a long-term condition called generalised anxiety disorder when they become a teenager or young adult.Generalised anxiety disorder causes you to feel anxious about a wide range of situations and issues, rather than one specific event.Young people suffering from this anxiety will feel anxious most days and often struggle to remember the last time they felt relaxed.

Separation anxiety Separation anxiety means a child worrying about not being with their parent or regular care giver. It is common in young children, and normally develops at about six months of age. It can make settling into an early years environment very difficult.Separation anxiety in older children may be a sign that they’re feeling insecure about something – they could be reacting to changes at home, for example.

Social anxietySocial anxiety is not wanting to go out in public, see friends or take part in activities.Shyness is perfectly normal for some young people and is often seen as a personality trait, but it becomes a problem ( 'social anxiety disorder' ) when everyday activities like shopping or speaking on the phone cause intense, overwhelming fear. Young people affected by it tend to fear doing or saying something they think will be humiliating.Social anxiety disorder tends to affect older children who have gone through puberty.

School-based anxietySome children become anxious about going to school, schoolwork, friendships or bullying, especially if they're changing school or moving classes/year groups.They may not always share these worries with you, and instead complain of tummy aches or feeling sick. One of the signs is crying or seeming tired in the morning. This may be a problem that needs tackling if it is significantly affecting their daily life

Long-term anxiety can severely affect a child's personal development, family life and education. Anxiety disorders that start in childhood often persist into the teenage years and early adulthood.

Anxiety disorders are a serious issue and need attention when:

● You feel it is not getting better or is getting worse, and strategies to tackle it have not worked

● You think it's slowing down their development or having a significant effect on their life

● It happens very frequently

How to support anxiety

- Present facts- Be prepared to reiterate calmly - Grounding- Distraction- Planning- Be explicit- Provide certainty where possible- Be flexible- Don’t put everything down to someone’s anxiety- Build safety- Talk about thoughts and brains- Reiterate safe and caring messages to counter act destructive self-talk

DepressionWe need to once again re iterate that mental illness is a physical condition. Depression is often described as a mindset, this is not the case. Depression can take many forms and affects people differently.

Depression in children can be caused by a biochemical imbalance in the brain. Chemicals in the brain play a role in the transmission of nerve impulses. When these brain chemicals are imbalanced, messages are not transmitted effectively, so the brain functions differently. For example, imbalances of the brain chemical serotonin may cause sleep problems, irritability, and anxiety characteristic of depression. It is just as important to remember that depression can also be caused by situation or circumstances. Lack of opportunity etc.

Young people are already going through significant changes often at quite a drastic pace and this can often be a contributing factor to low mood or depression.

Below are some of the many indicators of depression:

● Irritability or anger

● Continued feelings of sadness and hopelessness

● Social withdrawal

● Increased sensitivity to rejection

● Changes in appetite -- either increased or decreased

● Changes in sleep -- sleeplessness or excessive sleep

● Vocal outbursts or crying

● Shorter concentration span

● Fatigue and low energy

● Physical complaints (such as stomach aches, headaches) that don't respond to treatment

● Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests

● Feelings of worthlessness or guilt

● Flawed thinking (irrational, void of care)

● Thoughts of death or suicide

● Direct or indirect disclosure or allegation

● Unusual anxiety or fearfulness

● Avoidance of certain people or situations

● Tearfulness

● Lack of motivation

● Injuries sustained from self-harm or self-destructive behaviour

● Excessive compliance

● Extreme low self esteem

● Lack of insight into persons needs or behaviour

● Self-harm or self-destructive behaviour

● Emotional withdrawal

● Extreme attention seeking behaviour

● Suicide attempts

● Anxiety attacks

For children that are suffering from childhood depression it is essential that they have a strong and positive relationship with their care giver, having someone there to counteract these destructive thoughts is a vital part in the treatment of depression.

How to support a young person with depression

o Help them find hope

o Understand the fluidity of need (just because they have a good hour doesn’t mean they are no longer depressed)

o Unconditional acceptanceo Adapt social situations (encourage to engage but don’t force)o Plan for a transition in a conversation or circumstance o Validate feelings and refrain from ‘look on the bright side chat’o Talk about the futureo Try to not get frustrated with them as this can load guilto Encourage healthy distancing and lighto Be open about depression and find role modelso Actively support but still ensure they do things for themselves where they are

ableo Monitor Alcohol, smoking, substance use

Monitor changes in medication. Order regular medication reviews if necessary.

Self-harm

Defining self-harm and suicide Self-harm is a broad term that can be used to describe the various things that young people do to hurt themselves physically. It can include cutting or scratching the skin, burning/branding with cigarettes/lighters, scalding, overdose of tablets or other toxins, tying ligatures around the neck, punching oneself or other surfaces, banging limbs/head and hair pulling (Mental Health Foundation, 2006).

The term self-harm is sometimes used to describe behaviours that may be culturally acceptable yet lead to self-inflicted physical or psychological damage, such as smoking, recreational drug use, excessive alcohol or body enhancement. For this guidance self-harm is understood as physical injury inflicted as a means to manage an extreme emotional state - it can be lifesaving or self-destructive.

Phrases we don’t use – Deliberate self-harm.

Distress and pain are the drivers behind self-harm, blaming a person is a barrier not a solution. People do not ask for their pain.

Why do young people self-harm?

Each individual’s relationship with self-harm is complex and will differ, therefore avoid making judgements or assumptions about motivation for self-harm. However self-harm is often primarily a coping strategy which can serve various functions including:

Dealing with distressing experiences and difficult emotions - Most coping mechanisms are ‘adaptive’ in that they help us cope/adapt in the short term. Others might be considered ‘maladaptive’ in that they help us cope in the short term, but may be considered harmful to us emotionally or physically. Although self-harm is maladaptive it can be considered a valid way of coping with distressing thoughts or emotions if a young person has no alternatives available. Young people may resort to self-harm at times when they feel overwhelmed, exposed, anxious, stressed, angry or unable to cope. Self-harm can lead to feelings of relief, calmness and of being in control.

To feel real - Some young people also self-harm to deal with feeling unreal, numb, isolated, disconnected. Self-harm in these circumstances can awaken the young person and lead to feeling more real, more alive, functioning and able to cope in the short term.

Enlist help or concern - For some young people self-harm is a way of expressing their distress nonverbally, often in the absence of the ability (for whatever reason) to articulate this verbally.

Self-harm should not be dismissed as ‘attention-seeking’ behaviour, however superficial it appears. It is almost always a sign that something is wrong and needs to be taken seriously.

Keeping people away - Some young people self-harm with the intention of making themselves unattractive to others or to keep people at bay.

Physical pain - Some young people self-harm because physical pain seems more real and therefore easier to deal with than emotional pain. Young people may feel that their injuries are evidence that their emotional pain is valid. For some the sight of blood and bleeding represents a release of emotions. There is some evidence that when the body experiences injury, a group of neurochemicals may lead to a feeling of calm and wellbeing.

Myths around self-harm

Attention seeking - Sometimes people think that they should not respond to self-harm as it is 'attention seeking' or 'manipulative' behaviour. If a child or young person is seeking attention through self-harming behaviour they are communicating their very real need for attention or help.

A way of fitting in - Children and young people do not self-harm as a way of fitting in, or as a response to media such as film or music, or to ‘emo’ or ‘goth’ culture. Young people who have similar needs may gravitate towards one another, but reasons for self-harm will not be to fit in.

A rite of passage - Self-harm is never just a usual part of adolescent development. It is employed where a young person may feel they have no alternative coping strategy.

Those who talk about suicide are least likely to attempt it - Those who talk about suicidal feelings do attempt suicide. The experience of the Samaritans shows that many people who take their lives will have given warning of their intentions in the weeks prior to their death.

Talking about suicide encourages it - On the contrary, giving someone the opportunity to explore their worst fears and feelings may provide them with a lifeline which makes all the difference between choosing life and choosing to death.

Self-harm is a suicide attempt - Self-harm is often considered only in the context of suicide - more often in fact self-harm is a survival strategy rather than an attempt to end life.

How to support someone self-harming

● Acknowledge their distress and show concern. For example: “That sounds very

frightening. Let’s see what we can work out together to help.”

● Use active listening. For example:” Can I just check that I have understood what you

mean?”

● Do not focus solely on the self-harm but try to understand the reasons why they

have self-harmed.

● Be non-judgemental and do not react with shock or distaste Present yourself as

confident and in control (however you may feel inside). For example: “Let’s work through this together to find a way forward.” Talk at their pace and give them time to talk

● Don’t make promises. Be realistic about what you can and can’t do. However, don’t

avoid talking about self-harm with the young person. Talking about it won’t make matters worse but ignoring it may make the young person feel alone and unheard

● Be interested in them as a person and not just as someone who self-harms

● Do not tell them to stop or make ultimatums. This will not work

● Ask the young person what they want to do and plan the next steps together

Questions to ask –

● How are these issues related to the self-harm – are there specific triggers?

● What measures have been taken to address these underlying issues? Have they

helped?

● Are there times when they can use other coping strategies? What other strategies

do they have?

● Regarding self-harm – when does it happen? How often? Who knows about it?

● Has it changed over time i.e. Increased in frequency, severity or mode?

● What do they feel would help right now?

● Have they ever felt that life is not worth living?

Suicide mitigation

Suicide is a symptom of distress, not illness. Anyone at any given moment can experience a suicidal thought. It’s the severity and intention of the thought we must be concerned with.

People can find it hard to see a way out. It is not that they necessarily want their life to end: it is just that they cannot cope with their emotional or physical pain any more.

Language is important

The phrase ‘committing suicide’ is always something we have always used right? But it’s only when we stop and consider why this is that it prompts the need to change our language. ‘Committing suicide’ is a phrase derived from the fact that up until 1961, suicide was a criminal offence. Previously if you attempted suicide and survived, you would be prosecuted. Now a days that seems incomprehensible. Yet our language surrounding the issue is yet to evolve. It was something I had never questioned until a mother who lost her 13-year-old son to suicide told me; “Suicide is often seen as quite a clinical act. I think the phrase ‘someone taking their own life’ has the potential to encourage more empathy. It refers to the tragedy of a life and future not lived, not just the act itself.”

Taken their life

Died by suicide

Ended their life

Attempted suicide

Attempted to end their life

Not…

Unsuccessful/failed/Completed/Successful – I don’t know about you but I find linking success or achievement to suicide, a rather odd thing to do.

A word on stigma…

There is still a huge amount of stigma surrounding suicide. This stigma isn’t just reserved for when someone dies by suicide, it’s also prominent when a person experiences suicidal thoughts.

It is important to note that not everyone who has experienced a suicidal thought is at risk of suicide. Not everyone experiences harmful thoughts for long periods of time before contemplating suicide. At any given time throughout our lives, we may be presented with a circumstance that causes us distress.

Many report that the thought of putting them self in harm’s way, is enough to bring them back to rational thought and so the thought of suicide is no longer active and prominent. Contemplating our existence or death is something many of us do so I would

Those experiencing ideation and planning for suicide are those at immediate risk.

Links:

Www.maytree.org.uk

Www.mind.org.uk

Www.mentalhealth.org.uk

Www.samaritans.org.uk

Www.papyrus-uk.org

Many don’t ask through fear of opening a can of worms and making things worse, however harmful thoughts thrive on silence.

Safety Planning

- Establish reasons for living- Activities and things to lift mood- Identify distress triggers- Safe environment- Contacts- Key people/confidants- Specific Suicide prevention support – Crisis team- Professional support

1) Safe environment – Removal or mitigation of access to means, ask young person to avoid and identify triggers

2) Activities to distract or calm – if suicidal thoughts are getting stronger3) Support – Names of loved ones, family, friends4) Specific suicide prevention safety plan – names of supportive confidents,

voluntary or professional support agenciesA Safety Plan designed to be co-produced with a young person & carer if appropriate and includes agreed actions that they are happy to take when their suicidal thoughts become stronger or more persistent. If a safety plan is drawn up it is always recommended that the young person is provided with a copy to keep on their phone, printed out etc.

Key message - Distance yourself from the distress until it passes, because it will pass eventually.

Enquiry –

Some useful questions;

How are things for you at the moment?

How do you feel about your life at the moment?

How are you managing that?

Do you think about your future? If so what does it look like?

Do you feel that life is worth living? Have you ever felt that it’s not?

What thoughts are you likely to think when things feel out of control?

Sometimes when you feel….your brain can think about….

Sometimes our thoughts can…

Have you thought about harming yourself?

Have you thought about ending your life/suicide?

Have you made a plan to end your life?

How do you think we could keep you safe?

What calms or helps you in those moments?

Responding

That must be so difficult…

WE …

That’s understandable…

I’m so glad we’ve had this conversation…

Know that you’re never alone…

There are so many who can feel like this…