Instructor Date.

Instructor Date

Course Outline – Session 1
Mental Health First Aid Common mental health problems The five basic steps of mental health first aid What are substance use disorders? Symptoms and risk factors Crisis first aid for overdose Mental health first aid for substance use disorders Treatment and resources

What is depression? Symptoms of depression Risk factors for depression Alcohol, drugs and depression Suicide in Canada Crisis first aid for suicidal behaviour Mental health first aid for depression Treatment and resources

What are anxiety disorders? Symptoms of anxiety disorders Risk factors for anxiety disorders Alcohol, drugs and anxiety disorders Crisis first aid for panic attacks Crisis first aid for acute stress reaction Mental health first aid for anxiety disorders Treatment and resources

What are psychotic disorders? Symptoms of psychotic disorders Risk factors for psychosis Alcohol, drugs and psychotic disorders Crisis first aid for acute psychosis Mental health first aid for psychosis Treatment and resources Other expressions of distress

World Health Organization
Health is “a state of (complete) physical, mental and social well-being and not merely the absence of disease or infirmity.” Mental Health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

The Mental Health Continuum
Maximum Mental Health Minimal Mental Disorder Minimal Mental Health Maximum Mental Disorder Diagnosis of a serious illness and poor mental health Diagnosis of a serious illness but copes well and has positive mental health No illness or disorder and positive mental health No diagnosable illness or disorder but has poor mental health

What are Mental Health Problems?
A mental health problem causes major changes in a person’s thinking, emotional state and behaviour, and disrupts the person’s ability to work and carry on their usual personal relationships.

What is Mental Health First Aid?
Mental Health First Aid is the help provided to a person developing a mental health problem or in a mental health crisis. The first aid is given until appropriate professional help is received or until the crisis is resolved.

Assess risk of suicide or harm Listen non-judgmentally
The Five Basic Steps Assess risk of suicide or harm Listen non-judgmentally Give reassurance and information Encourage the person to get appropriate professional help Encourage self-help strategies

Why Mental Health First Aid?
There is stigma associated with mental health problems Imagine if we treated everyone like we treated the mentally ill.

Why Mental Health First Aid?
There is stigma associated with mental health problems Mental health problems are common Many people are not well informed about mental health/problems Professional help is not always on hand People often do not know how to respond

Prevalence At least 1 in 3 Canadians will experience a mental health problem at some point in their life At least 1 in 5 Canadians will experience a mental health problem in a year In Canada 20 per cent of all sick leaves are related to mental health

Impact The economic costs of mental illnesses in Canada was estimated to be at least $14.3 billion in 1998 Mental illnesses are disabling Six of the 10 leading causes of ‘years lived with disability’ are mental health problems

The ALGEE Rap Assess situation and evaluate the risk
Listen very carefully and don’t tsk tsk Give reassurance and the good info Encourage them to see appropriate pro Encourage them to use self help ideas And that is the ALGEE rap my dears!

What is a Substance Use Disorder?
Using alcohol or drugs does not in itself mean that a person has a substance use disorder (SUD) Dependence on a substance Use leads to problems at work, school, home Use causes damage to health

= One Standard Drink Table Wine 5 oz/142 mL (12% alcohol) Regular Beer
Spirits 1.5 oz/43 mL (40% alcohol) Centre for Addiction and Mental Health

Low-Risk Drinking Guidelines
0 drinks = lowest risk of an alcohol- related problem No more than 2 standard drinks on any one day Women: up to 9 standard drinks a week Men: up to 14 standard drinks a week

Long-Term Effects of Alcohol
Brain Heart Lungs Liver, pancreas, stomach and intestines Genitals and reproductive system Muscles, nervous system, motor skills Skin

Other Abused Substances
Tobacco Nicotine is a powerful stimulant Male smokers are twice as likely to experience impotence Spit tobacco contains more than 3,000 chemicals Withdrawal symptoms include anxiety, insomnia, restlessness Some long term effects - heart disease, stroke, cancer

Cannabis (marijuana, hashish, joints, reefers) Most widely used illegal drug in Canada About 2% of the population have problem with cannabis abuse/dependence. More than twice as likely to suffer from an anxiety disorder or depression More than three times the risk of suffering from psychotic symptoms

Cannabis (marijuana, hashish, joints, reefers) Adolescents using cannabis are more likely to suffer from depression, conduct problems, drinking and other drug use More frequent use of cannabis increases risk of diagnosis of schizophrenia over next 15 years

Amphetamines – a stimulant drug Examples: crystal meth, ice, speed, uppers, bennies, crank, ecstasy Amphetamines have the temporary effect of increasing energy and apparent mental alertness Users develop a tolerance and need to take more to get same effects

Amphetamines – a stimulant drug An overdose can cause delusions, hallucinations, high fever, coma, death A particular mental health risk is amphetamine psychosis or “speed psychosis” which involves symptoms similar to schizophrenia

Opioids Examples: heroin, morphine, codeine, oxycodone Effects can include pain relief, drowsiness, constipation, tiny pupils Users develop a tolerance and need to take more to get same effects Overdose can result in coma and death

Cocaine (crack, coke, C, snow, flake) A cocaine high can last from 5 minutes to 2 hours Overdose can cause seizures, strokes heart attacks, coma, death Users develop a tolerance and need to take more to get same effects

Risk Factors Family history of substance abuse
Childhood abuse or neglect Acceptance of substance use (community, peer) Low parental support/monitoring Poor social skills

First Aid for Substance Use Disorders
Assess risk of suicide or harm Listen non-judgmentally Give reassurance and information Encourage the person to get appropriate professional help Encourage self-help strategies

Step 1 Assess the Risk of Suicide or Harm
If you determine the person has taken an overdose, follow the steps for Crisis First Aid for an Overdose If the person is not at risk, move on to Step 2 – Listen Non-Judgmentally

Crisis First Aid for an Overdose
If they are unconscious: Make sure the person’s airway is clear and roll them into the recovery position Phone 911 for an ambulance Try to find out what substances were used Keep the person warm, especially if alcohol is involved

Crisis First Aid for an Overdose
If the person is conscious Phone or take the person to the nearest emergency department Do not give any food or fluids Reassure the person Try to find out what substances were used Keep the person warm, especially if alcohol is involved

Step 2 Listen Non-Judgmentally
Listen without interrupting Ask appropriate questions to make sure you are both clear on what is being said Listen to the word and tone of voice and watch their body language Restate what the person has said Summarize facts and feelings

Be attentive Keep eye contact comfortable (don’t stare or avoid eye contact) Keep an open body position Sit down, even if they stand Try not to sit directly opposite (facing) the person

Step 3 Give Reassurance and Information
Tell the person you want to help them Substance use disorder is a real medical condition It is a common illness Programs are available to help Often depressive and anxiety disorders underlie SUDs and can be treated

Step 4 Encourage the Person to Get Appropriate Professional Help
Family doctor or physician Drug and alcohol specialists Mental health team

The Change Model Contemplation Pre-contemplation
Determination/ Preparation Relapse Maintenance Action

Step 5 Encourage Self-Help Strategies
Many people with a substance use disorder may also have another underlying mental health problem such as depression or anxiety. The self-help strategies for these conditions may help but should not be the main source of treatment.

Resources Alberta Alcohol and Drug Abuse Commission
Centre for Addiction and Mental Health

If If you can always be cheerful If you can sleep without drugs
If you can relax without alcohol If you can start the day without caffeine If you can take blame without resentment If you can resist without complaining If you can eat the same food every day without complaining and be grateful

If If you can understand when your loved ones are too busy to spend time with you If you can overlook it when those you love take things out on you when, through no fault of yours, something goes wrong Then you are almost as good as your dog

Session 2 What is depression? Symptoms of depression
Risk factors for depression Alcohol, drugs and depression Suicide in Canada Crisis first aid for suicidal behaviour Mental health first aid for depression Treatment and resources

What is Depression? Clinical depression lasts at least two weeks, affects the person’s behaviour and has physical, emotional and cognitive effects. It interferes with the ability to work and have satisfying personal relationships.

Symptoms of Depression
Emotions: sadness, mood swings, hopelessness, anxiety Thoughts: Self-criticism, indecisiveness, thoughts of suicide, pessimism Behaviour: Crying spells, neglect personal appearance, withdrawal, no motivation Physical: Lack of energy, sleeping too much/too little, overeating/loss of appetite

Depression in the Workplace
Decreased productivity Morale problems Lack of co-operation Safety problems Absenteeism Complaints of being tired, having aches/pains Alcohol and/or drug abuse

Bipolar Disorder (Manic Depression)
Bipolar disorder is characterized by extreme mood swings A person has periods of depression and mania with periods of ‘normal’ mood in between A person must have episodes of both depression and mania to be diagnosed

Symptoms of Bipolar Disorder
Depression Mania Increased energy and over activity Elated mood Needing less sleep than usual Irritability Rapid thinking and speech Lack of inhibitions Grandiose delusions Lack of insight

Risk Factors for Depression
Break up of relationship or living in conflict Having a baby Job loss, unsuccessful job hunting Long term illness or disability or caring for someone with illness/disability Being a victim of a crime Alcohol or drug abuse

Risk Factors for Depression
Side effect of medications or drugs Stress from another mental disorder Hormonal changes Lack of exposure to bright light in winter Family history of depression Previous episodes of depression Difficult childhood (abuse, neglect)

Suicide in Canada About 4,000 Canadians die by suicide each year
In 2001, there were 3.5 suicides among men for every suicide among women. People in their 40s accounted for almost one in four suicides. Deaths by suicide surpassed deaths by motor vehicle accidents in that same year.

Suicide Rates by Province Per 100,000 population, 2001
18 6 9 3 12 15 Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Canada British Columbia 11.3 10 13.2 7.7 16.5 11.4 14.1 10.4

First Aid for Depression

If you determine the person is at risk, follow the steps for Crisis First Aid for Suicidal Behaviour If the person is not at risk, move on to Step 2 – Listen Non-Judgmentally

Crisis First Aid for Suicidal Behaviour
Engage the person in serious conversation about how they are feeling Determine if the person has thoughts of suicide Explore and assess the risk further Find out about prior suicidal behaviour Find out about their supports

Crisis First Aid for Suicidal Behaviour
Ensure the person is not left alone Seek additional help If they are consuming alcohol or drugs, try to ensure they do not take more Try to ensure they do not have ready access to some means to take their life Encourage the person to talk Ensure your own personal safety

Self Care Supporting a suicidal person can be unsettling and stressful
Do not underestimate the effect on your own well-being Find ways of reducing the immediate stress (exercise, relaxation techniques, sleep) Find someone to talk to about your experience

Listen to the person without judging. Do not be critical of the person. Do not express frustration with the person for having these symptoms. Do not give glib advice such as ‘pull yourself together’. Avoid confrontation unless necessary to prevent harmful acts.

Depression is a real medical condition Depression is a common illness Depression is not a weakness or character defect Depression is not laziness Effective help and treatments are available

Community-based care Family doctor or physician Counsellors and clinical psychologists Psychiatrists

What Helps for Depression?
 Very severe depression only Electroconvulsive therapy (ECT)  Adults  Adolescents Antidepressants Rating Medical Treatments  Very good evidence  Good evidence  Promising treatment

 Reading depression self-help books based on CBT Psychodynamic psychotherapy Interpersonal psychotherapy  Cognitive behaviour therapy (CBT) Rating Psychological Treatments

Ten Common Thinking Distortions
Black and white thinking Setting unrealistic expectations Selective thinking Converting positives into negatives Over generalizing Exaggerating unpleasantness Catastrophizing Personalizing Mistaking feelings for facts Jumping to negative conclusions

Self-help strategies have proven therapeutic effects They also help people to feel they are regaining control of their lives

 Massage therapy Relaxation therapy Yoga breathing exercises  Winter depression  Non-seasonal depression Light therapy  Exercise Rating Lifestyle & Alternative Treatments

 Alcohol avoidance – for people with drinking problems Folate St John’s wort* Acupuncture Rating Lifestyle & Alternative Treatments * St John’s wort should not be taken with antidepressants. This herb has interactions with a number of prescribed medications.

Resources Refer to MHFA Canada Manual Section 2, page 11

Session 3 What are anxiety disorders? Symptoms of anxiety disorders
Risk factors for anxiety disorders Alcohol, drugs and anxiety disorders Crisis first aid for panic attacks Crisis first aid for acute stress reaction Mental health first aid for anxiety disorders Treatment and resources

What are Anxiety Disorders?
An anxiety disorder differs from normal anxiety Anxiety disorders are more severe, they last longer and they interfere with work or relationships There are several types of anxiety disorders – symptoms will vary.

Dizzy, disoriented, lightheaded? Mind Racing?
Possible sleep disturbance? Vision strange or blurry? Difficulty swallowing? Feeling breathless, breathing fast & Shallow? Heart racing, palpitations? Nausea, lack of appetite? Trembling? Sweating or shivering? Restless? Jelly-like legs? Wanting to run?

General Symptoms of Anxiety
Physical Cardiovascular: palpitations, chest pain, rapid heartbeat, flushing Respiratory: hyperventilation, shortness of breath Neurological: dizziness, headache, sweating, tingling and numbness

Physical Gastrointestinal: choking, dry mouth, nausea, vomiting, diarrhea Musculoskeletal: muscle aches and pains (esp. neck, shoulders), restlessness, tremors and shaking

Psychological Unrealistic and/or excessive fear and worry (about past or future events) Mind racing or going blank Decreased concentration and memory

Psychological Difficulty making decisions, confusion Restlessness, feeling ‘on edge’ or nervousness Tiredness, sleep disturbances, vivid dreams Irritability, impatience, anger

Behavioural Avoidance of situations Obsessive or compulsive behaviour Distress in social situations Phobic behaviour

Types of Anxiety Disorders
Generalized anxiety disorder (GAD) Panic disorder (with or without agoraphobia) Agoraphobia Social anxiety disorder (social phobia) Phobic disorders Obsessive-compulsive disorder (OCD) Post traumatic stress disorder (PTSD) Acute stress disorder

Do You Worry All the Time?
Which problems have you had often over the last 6 months? I never stop worrying about things big and small I have headaches or aches and pains for no reason I am tense a lot and have trouble relaxing I have trouble keeping my mind on things

Do You Worry All the Time?
Which problems have you had often over the last 6 months? I get crabby or grouchy I have trouble falling asleep or staying asleep I sometimes have a lump in my throat or feel like I need to throw up when I am worried I sweat and have hot flushes

Generalized Anxiety Disorder (GAD)
Overwhelming and unfounded anxiety Physical and psychological symptoms of anxiety and tension for more than 6 months General worries over money, health and family etc. even when no problem exists

Do You Have Sudden Bursts of Fear for No Reason?
Which problems have you had during these bursts of fear? I have chest pains or a racing heart I have a hard time breathing or a choking feeling I feel dizzy, or I sweat a lot I have stomach problems or feel like I need to throw up

Do You Have Sudden Bursts of Fear for No Reason?
Which problems have you had during these bursts of fear? I shake, tremble, or tingle I feel out of control I feel unreal I am afraid I am dying or going crazy

Panic Disorder A person with a panic disorder has panic attacks
A panic attack is the sudden onset of intense fear or terror The attacks develop suddenly The fear is inappropriate for the circumstances in which it is occurring

Agoraphobia Fear of panic attacks
Fear of being in a situation with no help or escape Avoidance of places where it is felt that a panic attack could happen

Do You Feel Afraid or Uncomfortable When You are Around Other People?
Is it hard to be at work or school? I have an intense fear that I will do or say something and embarrass myself in front of other people I am always very afraid of making a mistake and being watched and judged by other people My fear of embarrassment makes me avoid doing things that I want to do or speaking to people

Do You Feel Afraid or Uncomfortable When You are Around Other People?
Is it hard to be at work or school? I worry for days or weeks before I meet new people I blush, sweat, tremble, or feel like I have to throw up before or during an event where I am with new people I usually stay away from social situations such as school events and making speeches I often drink to try and make these fears go away

Social Anxiety Disorder
Common anxiety disorder Fear of humiliation, embarrassment or scrutiny by others Fear that others are thinking negatively about them Tends to develop in shy children as they move into adolescence

Phobic Disorders A person with a phobia avoids or restricts activities because of fear The fear appear persistent, excessive and unreasonable The fear will cause the person to avoid specific things, events or places

Have You Lived Through a Very Scary or Dangerous Event?
Which problems have you had after the event? I jump and feel very upset when something happens without warning I have a hard time trusting or feeling close to people I stay away from places that remind me of the event I feel guilty because others died and I lived

Have You Lived Through a Very Scary or Dangerous Event?
Which problems have you had after the event? I have trouble sleeping and my muscles are tense I feel like the terrible event is happening all over again. This feeling often comes without warning I have nightmares and scary memories of the terrifying event I get mad very easily

Post-Traumatic Stress Disorder and Acute Stress Disorder
Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD) occur after experiencing a distressing event ASD – distress is usually resolved within a month PTSD – distress lasts longer than a month

Do You Feel Trapped in a Pattern of Unwanted and Upsetting Thoughts?
Are any of these problems interfering with your life? I have upsetting thoughts or images enter my mind again and again I feel like I can’t stop these thoughts or images, even though I want to I worry a lot about terrible things that could happen if I’m not careful

Do You Feel Trapped in a Pattern of Unwanted and Upsetting Thoughts?
Are any of these problems interfering with your life? I have unwanted urges to hurt someone but know I never would I have a hard time stopping myself from doing things again and again, like counting, checking on things, washing my hands, re-arranging objects, doing things until it feels right, collecting useless objects

Obsessive-Compulsive Disorder
Obsessive thoughts and compulsive behaviours accompany feelings of anxiety. Obsessive thoughts are unwanted and inappropriate recurrent thoughts, impulses or images the person cannot get rid of. Compulsive behaviours are repetitive behaviours or mental acts such as counting, checking or washing.

Risk Factors for Anxiety Disorders
Gender People with an anxious parent Difficult childhood (abuse, neglect) Some medical conditions Side-effects of some prescription drugs Some non-prescription drugs (caffeine, amphetamines, cocaine, etc.)

First Aid for Anxiety Disorders

People with anxiety disorders are at greater risk of dying by suicide, particularly if they also have depression. If you determine the person is at risk, follow the steps for Crisis First Aid for Suicidal Behaviour. If the person is not at risk, move on to Step 2 – Listen Non-Judgmentally.

Crisis First Aid for Panic Attacks
If you are unsure if it is a panic attack or a heart attack call an ambulance. If you are sure it is a panic attack, move the person to a quiet safe place. Help calm the person by helping them control their breathing. Be a good listener, without judging.

Crisis First Aid for Panic Attacks
Explain they are having a panic attack and it is not life threatening. Explain the attack will be over soon and they will recover. Assure them that someone will stay with them until the attack stops.

Crisis First Aid for Acute Stress Reaction
Let the person tell their story but do not push them to do so. Be a patient and sympathetic listener. Reassure the person that stress reactions are normal responses to abnormal events and in time most people have a normal recovery of their emotions.

Crisis First Aid for Acute Stress Reaction
Encourage the person to share feelings with others. Advise the person not to use alcohol or drugs to cope. If the stress reaction persists for more than a month, encourage the person to seek professional help.

YOU ARE NOT LISTENING TO ME WHEN: You say you understand. You say you have an answer to my problem, before I’ve finished telling you my problem. You cut me off before I’ve finished speaking. You finish my sentences for me.

YOU ARE NOT LISTENING TO ME WHEN: You are dying to tell me something. You tell me about your experiences, making mine seem unimportant. You refuse my thanks by saying you really haven’t done anything.

YOU ARE LISTENING TO ME WHEN: You try to understand me, even if I’m not making much sense. You grasp my point of view, even when it’s against your own sincere convictions. You realize the hour I took from you has left you a bit tired and a bit drained.

YOU ARE LISTENING TO ME WHEN: You allow me the dignity of making my own decisions, even though you think they may be wrong. You do not take my problem from me, but allow me to deal with it in my own way. You hold back the desire to give me good advice.

YOU ARE LISTENING TO ME WHEN: You do not offer me religious solace when I am not ready for it. You give me enough room to discover for myself what is really going on. You accept my gratitude by telling me how good it makes you feel to know that you have been helpful.

Anxiety is a real medical condition. An anxiety disorder is a common illness. An anxiety disorder is not a weakness or character defect. Effective help and treatments are available. Anxiety can be unpleasant but is rarely harmful.

Family doctor or physician Counselling or psychotherapy for specific anxiety disorder

Anxiety is best overcome by confronting fear rather than avoiding it Use evidence-based self help books Practice daily relaxation methods to reduce physical symptoms of tension Exercise regularly and get enough sleep Reduce caffeine intake Engage in leisure time

What Helps for Anxiety Disorders?
 Generalized anxiety disorder Physical exercise Specific phobias Anxiety Disorder  Acupuncture Relaxation training CBT self-help books Rating Treatments

What Helps for Anxiety Disorders?
 Generalized anxiety disorder Meditation Range of anxiety disorders Anxiety Disorder Alcohol Avoidance Relaxing Music Rating Treatments

Session 4 What are psychotic disorders?
Symptoms of psychotic disorders Risk factors for psychosis Alcohol, drugs and psychotic disorders Crisis first aid for acute psychosis Mental health first aid for psychosis Treatment and resources Other expressions of distress

What is Psychosis? Psychosis is a mental health problem in which a person has lost some contact with reality Severe disturbances in thinking, emotion and behaviour Psychotic illnesses are not common compared to other mental health problems

What is Psychosis? Psychosis may appear as a symptom in a number of mental health problems including: Schizophrenia Schizoaffective disorder Brief psychotic disorder Psychotic disorder due to a general medical condition Substance induced psychotic disorder

Symptoms of Psychosis Changes in emotion and motivation
Depression or anxiety Suspiciousness Blunted, flat or inappropriate emotion Irritability Change in appetite Reduced energy and motivation

Symptoms of Psychosis Changes in thinking and perception
Difficulties concentrating Sense of alteration of self or others – feeling that self or others have changed or are acting differently Odd ideas Unusual perceptual experiences – reduced or greater intensity of smell, sound, colour

Symptoms of Psychosis Changes in behaviour Sleep disturbance
Social isolation or withdrawal Reduced ability to work or carry out social roles Odd or strange behaviour

Symptoms of Psychosis Changes in speech Disorganized speech
Speech becomes rapid

Schizophrenia Schizophrenia is a chronic and disabling disorder
Mental function changes and thoughts and perceptions become disordered Schizophrenia is not a constant or static condition – severity of symptoms fluctuate or do not appear at all

Symptoms of Schizophrenia
Delusions Hallucinations Thinking difficulties Loss of drive Blunted emotions Social withdrawal

Other Psychotic Disorders
Psychotic depression – a depression so intense it causes psychotic symptoms Schizoaffective disorder – Symptoms of both schizophrenia and mood disorder (depression, bipolar disorder) Substance induced psychosis – psychosis brought on by drug use. Drug use may also trigger another psychotic illness such as schizophrenia

Risk Factors for Psychotic Disorders
It is believed that psychosis is caused by a combination of factors including: Genetics Biochemistry Stress

First Aid for Psychotic Disorders

Psychotic disorders involve high risk of suicide If you determine the person is at risk, follow the steps for Crisis First Aid for Suicidal Behaviour If the person is not at risk, move on to Step 2 – Listen Non-Judgmentally

What if a Psychotic Person is Threatening Violence?
Do not get involved physically Call the police Try to create a calm, non-threatening atmosphere Try to get the person to sit down Do not try to reason with acute psychosis Express empathy for the person’s emotional distress Comply with reasonable requests

Listen to the person without judging Speak calmly, clearly and in short sentences Do not be critical of the person and do not express frustration with the person Do not give glib advice such as ‘pull yourself together’

Avoid confrontation unless necessary to prevent harmful acts Do not argue with the person about their delusions and hallucinations but do not pretend they are real to you

When a person is in a psychotic state it is difficult and inappropriate to give them information about psychosis – wait until they are in touch with reality Do not make promises you cannot keep and do not lie

When the person is thinking more clearly explain: You want to help them They have a real medical condition Their condition is not a common illness but well known and researched Psychosis is not a weakness or character defect Effective medications are available

Early intervention is important. The person needs to be placed on appropriate medication Family doctor or physician Psychiatrist Community mental health teams Family and friends

Have an agreement with family/friends Many people with a psychotic disorder also have depression and/or anxiety The self-help strategies for these conditions may help but should not be the main source of treatment

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