‘Welcome to my world’Delivering Mental Health Awareness Training

to Colleagues

David Keegan Melanie WithersMental Health and Wellbeing Coordinator Head of Counselling University of Huddersfield University of Sussex.d.a.keeegan@hud.ac.uk m.h.withers@sussex.ac.uk

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What do we mean by mental health and mental illness?• ‘Mental health encompasses the emotional resilience, which enables us to enjoy life and to survive pain,

disappointment and sadness, and an underlying belief in our own, and others’, dignity and worth and allows us to engage productively and contribute to society or our community.’

• 1 in 4 adults experience at least one diagnosable mental health problem in any one year with mixed anxiety and depression being the most common.

• ‘Mental illness arising from organic, genetic, psychological or behavioural factors (or combinations of these) that occur in an individual and that are not understood or expected as part of normal development or culture.’

• Mental illness exists on a spectrum: at the severe end are illnesses such as schizophrenia and bipolar disorder; at the less severe end of the spectrum are conditions that are milder with regard to distress and disability.

• Over the last five years, the proportion of disabled students who declared a mental health condition increased from 5.9% in 2007/08 to 9.6% in 2011/12 (from 0.4% to 0.8% of the entire student population).

http://www.ecu.ac.uk/publications/equality-in-higher-education-statistical-report-2013

The primary purpose of the Equality Act 2010 is to provide a single legal framework to address disadvantage and discrimination.

It requires equal treatment in access to education regardless of the protected characteristics of age, disability, gender reassignment, marriage and civil partnership, race, religion or belief, sex and sexual orientation.

The Act states: 'You must not discriminate against a student:• in the way you provide, or fail to provide, education for the

student• in the way you afford the student access to a benefit, facility

or service• by excluding the student• by subjecting them to any other detriment• by failing to make a reasonable adjustment when a disabled

person would be placed at a substantial disadvantage.’

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Equality Act 2010

In this regard, the Act of 2010 did not change the law.

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Mental Health Awareness Training might include:

• How to identify that there may be a mental health problem

• Identification of whether a situation is urgent or non urgent and what to do in both cases

• How to respond both inside and outside office hours

• How to react if the student or staff member refuses help

• A list of all the support services offered in the institution

• Handling critical incidents regarding mental ill health

• A list of emergency numbers including police and local hospitals

• A brief on confidentiality and data protection procedures (who information can be shared with, when,

and what implications of disclosure might be for studies i.e. fitness to practise).

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Emotional distress or mental health problems?

The majority of students experiencing difficulties do not fall into the category of having

a mental illness. For a few however age 20+ can mark the onset of more severe

psychiatric problems including schizophrenia and bipolar disorder.

Students with mental health problems fall into two groups.

1. Those who declare a mental health difficulty and for whom a ‘category label’ (such as a medical diagnosis) is helpful in routing them towards practical help to enable them to study effectively. Some of this help may fall within the disability advisor remit, but these students may also need other forms of support.

2. Those who do not need or choose not to declare a mental health problem and may also have longstanding difficulties but are functioning well academically. Nevertheless they may need support in relation to their general well being while at University.

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Students’ Common Presenting Issues

Presenting Issues % of clientsAbuse 5%Academic 19%Anxiety 41%Addictive behaviour 5%Depression/Mood change disorder 44%Loss 20%Other mental health condition 5%Physical health 8%Eating Disorders 10%Relationships 35%Self and identity 29%Sexual issues 2%Transitions 5%Welfare and Employment 2%

Self harm 7%

Note: coding represents three categories per case from sample of 1, 500 students University of Sussex 2013 - 2014

3. A third group however are:

Students who experience temporary but severe disturbance placing them at risk of breakdown may need urgent intervention.

The student’s behaviour may mimic those with more complex and enduring mental health problems.

Factors in vulnerability to short-term mental health crises may include:

Students in crisis

•Unfamiliarity of situation – new learning needed •Severity or traumatic nature of situation

• Overload – too many difficulties at once• Insufficient support/resources

Staff response – panic is catching

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Unconscious or Experience of Thoughts Action barely conscious feelingfeelings

From Hughes & Pengelly (1997) Staff Supervision in a Turbulent Environment: Managing Process and Task in Front-line Services. London and Bristol: Jessica Kingsley

Stop! Think! Feel!

Aim: Stop! Feel! Think!

•In a situation where one person experiences strong unmanageable feelings it becomes harder for others to adopt a reflective position in which the difficulty can be acknowledged and thinking occur. •Student and staff member may jump from a knee jerk, emotional response over to some form of action.

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A mental health difficulty…..

……is one in which a person may have disturbing and upsetting emotions which will affect their ordinary daily life. It may disorientate their view of the world, producing various symptoms and behaviours that may display or cause distress.

Anxiety can precipitate or escalate any mental health issue

Mental Health

Take a balloon …

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Recognising anxiety

What happened for you?

Anxiety – what can happen?

• Heart beats fast• Breathing faster• Muscles weak/tense• Increased sweating• Hot and cold sweats• Stomach churning• Poor concentration• Feel dizzy• Frozen on the spot

• Can’t eat/keep eating• Feeling low/tearful• Sleep difficulties• Irritability• Headaches• Poor concentration• Loss of confidence• Poor coping strategies• Ruminating thoughts

Anxiety – what can help?Seek support:Talk with others:

Friends and familyCounsellingFaith/spiritualityComplimentary therapiesMedicationSupport groups

Care for self:Recognise anxiety (some stress can be helpful)

Eat healthily

Avoid alcohol (or moderate intake)

Exercise

Relaxation

Mindfuness

SignpostingStudent Services Health & Wellbeing teams

Healthcare

DisabilitySupport

Chaplaincy

Counselling

MH & WellbeingSupport

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Identifying Difficulties

Would it be helpful to seek advice from someone else?

Do you need more information from

others?

Do you need more information from the

student?

Is there other information to cause

concern?

How does the student seem?

Is the student’s behaviour causing

concern?

Is this different from your previous experiences of this student?

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Risk factors which may give cause for concern.•Are there significant changes to the student’s level of social engagement?

•Are there significant changes to the student’s level of academic engagement?

•Are there signs of continuing emotional unhappiness?

•Are there signs of violence of aggression?

•Are there signs of mental ill health?

•Is there evidence of sustained changes to weight or appearance?

•Is there evidence of sustained increase in alcohol use?

•Is there evidence of sustained use of drugs (illegal and prescribed)?

•Why now?

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Responding Effectively: working hours

Is the problem URGENT?

Will the student accept help?Yes No

Arrange urgent referral to

Counselling, MHA and/or Health Centre

Seek Advice

Could you help the student?

Yes No

Yes No

Offer appropriate support

Does the student want help?

Refer to Counselling/MHA

YesNo

Record your concernsIs there a risk of

Violence to self or others?

Contact Security and/or police

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Responding Effectively: out of hours

Is the problem URGENT?

Will the student accept help?Yes No

Arrange urgent referral to A&E

Seek Advice

Could you help the student?

Yes NoYes No

Offer appropriate support. Signpost to

other services available in working hours

Does the student want help?

Violent risk to others?

No

Record your concerns

Violent risk to Self?

Contact Security and/or police

Contact A&E, Security and/or

Police

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Debrief (following an incident)

Seek support for yourself.

• Be prepared for a considerable impact on your own feelings.

• Sometimes the student’s story reminds you of something which was personally difficult.

• Sometimes the nature of the difficulty can be very challenging especially if there is violence

• Adequate debriefing with a colleague or line manager, the support of friends and/or partner is vital.

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You notice that an international student has been spending a lot of time in the refectory over the last few weeks.

As the refectory is about to close on Friday evening she is sat in tears in a quiet corner where she thinks nobody can see her.

When you ask if she is okay she says that she can’t go home and is worried she may harm herself.

There aren’t many other people around.

How could you deal with this situation?

Cases for discussion – case study 1

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Cases for discussion – case study 2

You are the departmental co-ordinator and are telling a group of students about exam arrangements.

You notice that one of them seems particularly uneasy.

He is sweating and looking around nervously, and doesn’t appear able to concentrate on what you are saying

How could you deal with this situation?

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A third year student is leaving the library when the alarm goes off and he is found to be trying to take three books from the library without having them issued correctly.

When you further investigate it seems that he has incurred substantial library fines.

He seems embarrassed and starts to get defensive and becomes increasingly aggressive, shouting at you and drawing attention to himself.

How could you deal with this situation?

Cases for discussion – case study 3

David Keegan Melanie WithersMental Health and Wellbeing Coordinator Head of Counselling University of Huddersfield University of Sussex.d.a.keeegan@hud.ac.uk m.h.withers@sussex.ac.uk

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Appendix of further Mental Health Difficulties

Depression – signs and symptoms

• Concentration difficulties

• Difficulties making decisions

• Moving slowly or becoming agitated and unable to settle

• Difficulties sleeping or sleeping too much

• Loss of interest in food or eating too much, weight loss or gain

• Persistent sad mood

• Loss of interest in previously enjoyable activities

• Low energy and tiredness

• Loss of confidence and low self esteem

• Feeling guilty when not at fault

• Thoughts of wishing for death

Bi-polar (manic depression)

An experience of depression at times and mania at other times

• Irritable- lack of insight

• Less need for sleep causing fatigue

• Taking risks they normally would not - lack of inhabitations

• Loosing touch with reality- grandiose delusions

• May become psychotic- auditory and visual hallucinations

• Over confident and full of energy – elated or over active

• Very talkative - rapid speech

• Difficulties in sticking to one subject in conversation

• Rapid thoughts

• Full of ideas

PsychosisIs a general term to describe a mental health problem in which a person experiences changes in thinking, mood, perception and behaviour which can severely disrupt their life. There is an increase in rates of onset in adolescence and it is rare in children. Men 6 per 1,000 of the population – occurs in late teens or early 20’s. Women 5 per 1,000 of the population – occurs from latter part of 20’s

• Depression

• Anxiety

• Irritability

• Blunt or flat emotions

• Inappropriate behaviour

• Changes in thoughts/perceptions

• Suspicious

• Reduced energy

• Concentration/ attention difficulties

• Altered perception of self or others

• Odd ideas

• Perceptual changes to e.g. taste, sound, smell etc.

May loose touch with reality- grandiose delusions

May experience auditory and visual hallucinations

SchizophreniaIs not a split personality, it is a description of a persons mental function whereby thoughts and perceptions become distorted.

• Delusions

• Hallucinations

• Thinking difficulties

• Loss of drive

• Blunted emotions

• Social withdrawal

Suicide

• 5,981 people over the age of 15 committed suicide in the UK in 2012 (3), that is 1% of all adult deaths, Suicide remains the most common cause of death in men under the age of 35.(4)

• A person can feel so overwhelmed and helpless that the future appears hopeless and they may think that suicide is their only solution

• Depression is a major risk in suicide but not everyone who attempts suicide is depressed