mental health in clinical placements otpt › source › mental health in clinical placeme… ·...
TRANSCRIPT
Mental Health in Clinical Placements
Jennifer DodsExecutive Director, Student Wellness Services
October 26th, 2017
Outline
•What is Mental Health / Mental Illness•Mental health of university students•How You Can Help•Depression and Anxiety–Depression in clinical–Anxiety in clinical•Resources
Mental Health
Mental Health Disorders / Illness
Absent
Present ‐ severe
Very poorExcellent Very good Good Fair Poor
Mental Health and Mental Illness
NCHA: Overall Health and Well‐being
4 out of 5 students who completed the survey:
–Describe their general health as good, very good or excellent (81.1%)• Graduate students 86%
–Feel they are part of the Queen’s community (81.5%)
–Feel Queen’s has a sincere interest in the well‐being of its students (84.6%)
–Feel their Faculty/School has a sincere interest in their well‐being (79.6%)
–Would seek help from a mental health professional if they had a personal problem that was bothering them (83.3%)
Health Condition Percentage of Students
Anxiety 20.1%Depression 15%Strep throat 14.1% (GS 10%)Allergies 13.9%Back pain 13.8% (GS 16.4%)
Urinary tract infection 13.7%Sinus infection 11.6%Panic attacks 10%
“Within the last 12 months, I was diagnosed or treated by a professional for the following”:
In the last 12 months• 51.6% (GS 58%)
were diagnosed or treated for a physical health condition
• 29.8% (GS 31%) were diagnosed or treated for a mental health condition
NCHA: Common Health Conditions
Have You Found this Very Difficult to Handle? (last 12 months)
YES!1st Yr ALL GRAD
• Academics 58% 61% 51%• Sleep Difficulties 38% 36% 28%• Personal Appearance 39% 35% 23%• Social Relationships 35% 32% 26%• Intimate Relationships 30% 31% 28%• Career Related Issues 21% 31% 36%• Finances 28% 31% 31%• Family Problems 30% 31% 27%• Personal Health Issues 29% 27% 20%• Family Health Issue 28% 24% 24%
NCHA: Impacts on Student Mental Health
17.6% (24% GS) reported finding no areas very difficult to handle
58.7% (51% GS)reported 3 or more areas that were very difficult to handle
0
10
20
30
40
50
60
70
80
0 10 20 30 40 50 60 70 80
Depression
AnxietyStress
Sleep Difficulties
Cold/Flu/Sore
Internet use/computer games
Relationship Difficulties
Concern for troubled family member/ friendWork
Roommate Homesicknes
Extracurricular
Alcohol use
ADHDLearning
Death of friend/family
Infection
Chronic Health
Pregnancy
Eating Disorder
FinancesPhysical Assault
Drug UseInjury
Discrimination
Gambling
Allergies
Sexual Assault
STI
NCHA: Impact on Student Academic Performance
Incidence: Percent in Population Experiencing Condition
Percen
t Experiencing Co
ndition
Impa
cting Ac
adem
ic Perform
ance
High(er) IncidenceHigh(er) Impact on Academics
Have you ever received psychological or mental health services from any of the following:
Professional help Queen’s 2016 Canada 2016
Counselor / Therapist /Psychologist
44.5% 36.9%
Psychiatrist 12.6% 11.9%
Physician, Nurse practitioner 22% 20.4%
Minister/Priest/Rabbi/Other clergy
3.1% 4.6%
NCHA: Mental Health Service Use
Contributors to Stress in Academic Environment
•Worth and identity tied up in success or failure• Defined by achievements • Expectations of brilliance and significant contribution• Comparisons and competitiveness• Lack of work‐life balance (ever looming expectations)• Scrutiny • Gaps between positive rewards, effort isn’t always recognized• Perfectionism and personality• Imposter syndrome• Placement expectations• Preceptor – student relationship
Life Stressors
• Transition and Adjustment– Physical relocation– Social transition–Change in supports–Change in routines–Change in typical ways of coping– Independent living
• Financial stress • Relationship stress• Living arrangement• Transportation• Stressful life events
The Mental Health Continuum
Healthy
Normal functioning
Reacting
Common and reversible distress
Distress
Significant functional
impairment
Crisis
Severe and persistent functional
impairment
Red Flags
• Reduced activity, interaction or social contact – isolating• Mentions that others are worried about them – family / friends• Emotional distress or poor emotional regulation – feeling out of control
• Risk taking behavior – putting self in unsafe situations• Increased substance use• Mood shift – numb, empty, irritable, angry, sad• Overly self‐critical – expecting perfection• Always intending to get work done but not completing it• Changes – changes in eating sleeping, grooming, spending, involvement in extra curricular, social routines,
• Talk of self‐harm or suicide or death
Healthy Reacting Distress Crisis
Professional CareProfessional Care
Self-care and social supportSelf-care and social support
The Mental Health Continuum
Strategies and SkillsStrategies and Skills
How YOU Can Help
•Help find resources
• Encourage use of resources
•Give reassurance and comfort
•Give advice only when asked
•Attentively•Non‐judgementally
•Reach out, make contact
• Talk when you have time
Approach Listen
ReferSupport
“But I might say the wrong thing”
Approach
Anne, you aren’t very good with people; do you think you have a social disorder?
AvoidDiagnosingJudgingMaking assumptionsDisapproval Ignoring
ALSR: Approach
I’ve noticed that you’ve been coming in late recently and I’m
concerned.
You don’t seem to be yourself lately. How are
you doing?
You haven’t seemed to have been
yourself this week. Are you feeling OK?
You seem to be under a lot of stress. How is everything going?
Say what you see!
ALSR: Listen
Is there anything I can do to help?
What I hear you saying is ________.
It sounds that you have been feeling very overwhelmed/
stressed/anxious/alone.
That sounds like it is hard to deal with.
It sounds like you’re feeling out of place.
ALSR: Support
I am glad that you’ve told me this.
I want to support you in any way that I can.
It is not uncommon for people to feel this way.
You are not alone.
I’m here for you.
Because you are feeling this way now doesn’t mean that you will feel this way forever.
Things can get better.
ALSR: Refer
Have you thought about talking to someone about this?
There are some great resources on campus to help
you.
I know of some people who can help.
This sounds like a lot to deal with on
your own.
Help is available. Be prepared that they may ignore your suggestion to seek out other resources
Importance of Being Aware
• Poor mental health can be a sign of mental illness• Poor mental health for a significant period of time can lead to the development of mental illness
• Poor mental health can lead to loss– fail class or leave school, lose relationship, lose job
• Poor mental health can impact broadly into many areas of life• Poor mental health can lead to self harm or risk of suicide in some cases
• Poor mental health is not a good way to feel.
Anxiety and Depression
Cognitive Distortions
JDODS 2015 N325
What is Anxiety?
Feeling
• Normal human emotion
• Tension, worry, unease, apprehension
• Protective• Motivating• Temporary or transient
Illness
• Persistent state• Worsens over time ‐ intensity
• Interferes with daily functioning
• Distressing or disabling
• Disorders
What is Anxiety?
Anticipation
Trigger
Physical response
Emotional Response
Cognitive response
Behaviour
Confirm
What is Anxiety?
• Loss of feelings of control or power•Mischaracterized as weakness•Value placed on self‐control–Fight to regain control or find power
• Future oriented – impending doom• Shortcomings, errors, or judgement• Lack of promotion of positive accomplishments• Includes past (cycle), present (reaction and preoccupation), and future (anticipation)
•Anxiety fills the void of the unknown
Anxiety
Academic Environment
Anxiety
Academic Environment
Academic Anxiety
Academic Anxiety
Impact of Anxiety
Can’t fail what you don’t do• Paralysis• Procrastination•Mind games •Avoidance• Isolation• Loss of belief in self•Diminished productivity
• Loss of confidence• Loss of sleep• Indecisiveness• Self‐critical •Hypersensitivity to perceptions of others• Effort doesn’t lead to accomplishment• Expecting the worst
Anxiety in Clinical
•Asking questions they should (or do) know the answers to•Asking the same questions or for clarification repeatedly•Asking for information ahead of time• Seeking reassurance • Seeking approval•Agreeing with what they are being told (even if don’t fully understand) • Trying to give the right answer that they think you want to hear
Anxiety in Clinical
•Avoidance of tasks or people•Over preparing•Not sleeping / eating • Loss of confidence – fearful of hurting someone or doing the wrong thing•Difficulty responding on the spot or under high pressure (despite preparation and knowledge)• Self critical – focuses on negatives or feedback given• Physical or mental restlessness – difficulty calming self or focusing
Panic Disorder
Social Anxiety
GeneralizedAnxiety
Post TraumaticStress
ObsessiveCompulsivePhobia
SeparationAnxiety
Supporting Students who are Anxious in Clinical
• Prepare students for what they will experience / encounter
• Provide clear and realistic expectations–Timelines for skill development
–Scaffolding of skills• Normalize mistakes / failures / lack of knowledge (in a responsible way). We don’t always get it right the first time
• Good to know what you don’t know.
• Avoid giving repeated reassurance or approval or repeating answers to questions–Ask students to tell you what they know
• Specific positive / constructive feedback
• Identify avoidant or ‘right’ answers
• Give student time to process
Help Seeking
Supporting Others
What Helps• Encourage self‐kindness and use of strategies
• Respond without judgment so the person knows they can talk to you.
• Keep normal relationship –clinical instructor / student not about the anxiety (not their counsellor)
• Encourage help‐seeking
What Doesn’t Help– “Just relax”– “Calm down”– “It is going to be okay”– “Stop worrying”– “Snap out of it”– “I know how you feel”
• Criticism• Comparing anxiety disorders to feelings of anxiety
• View of anxiety as weakness or need to toughen up
Depression
• Acute episode or chronic• One time or re‐occurring• Mild, moderate, severe
• Differs from feeling depressed or down or sad. –Sad/down ‐ Transient and Situational. Normal and healthy adaptation to a stressful or negative event
• Clinical Depression – Major Depressive Episode–Slippery slope ‐ hard to recognize–Dark cloud, heavy feeling oppression, black hole–Apathy, indifference, loss of interests and motivation–May have some variation still in mood but any positive is short lived.
Depressed Mood
Main Mood Profiles1. Tearful and overwhelmed2. Empty and numb3. Irritable and angry
Depression
Sleep (insomnia or hypersomnia)Interest (pleasure, motivation) Guilt (worthlessness, self‐depreciating, failure, negativity, distorted thinking) Energy (apathy, inertia)Concentration (memory, decision making, depth of thought)Appetite (weight gain or weight loss)Psychomotor (slowed down, restless, agitated)Suicidal Ideation (passive or active)
Depression in Clinical
• Poorer hygiene / self‐care• Difficulty with attendance / being on time / preparation /
assignment deadlines (excuses)• Poorer quality work being done• Disconnection• Emotional reactivity (or lack there of)• Negative self‐talk or view of self and actions. May reject
positives or assume negative perceptions• Requires significant prompting or direction (little self
initiative)• Lethargy, fatigue, lack of energy or enthusiasm• Frequent physical symptoms (unwell)• Reduced concentration / focus / memory
Tips to Support Student Mental Health
• Talk about mental health, self care and balance as being important to professional practice.– Organizational, individual– Build into curriculum
• Timing of deadlines for assignments– Avoid early mornings– Flexibility (where possible)• One extension (they set deadline)
• Supportive and understanding while Maintain expectations –academic requirements– Illness / extenuating circumstances can deplete resources.
May need to consider leave if significant• Taking care of yourself / your health isn’t failure
Tips to Support Student Mental Health
• Talk about positives and negatives often – normalize constructive feedback as part of learning process –rather than as evaluative– What went well today, what didn’t go so well?– What is one thing you would do differently?– What is one thing you realize you need to learn more about?– I thought you did an excellent job with… (specific skill /
response). I had some concerns when I saw you…• Explicit Instruction
– What is critical thinking in this environment?– Learning plans
• Refer to resources and check in to see if they connected
Supporting Students
• Academic Accommodations for Students with Disabilities– Student can register with QSAS
• Academic Considerations for Students with Extenuating Circumstances– Faculty / School Office
• Student Wellness Services (on campus)–Doctors, nurses, counsellors, OT, access to psychiatry, mental health nurse, lifestyle appointments.
• Off campus – SGPS coverage ($500 – mental health annually)
• Good2Talk (24/7 Post secondary help line) – 1‐866‐925‐5454
• Local crisis lines / mental health centers
• Green Folder Peer to PeerSGPS Advisors
Self Care!
Thank You
Jennifer [email protected]‐533‐6000 ext 78667
Other help!
Rina Gupta – Director of Counselling
Fatima Couto – Clinic Manager
Jeanette Parsons – Senior Accessibility Advisor