1. Promoting positive mental health in schools
Unseen Hurts:
Promoting positive mental health in schools
With Canada’s youth suicide rate the third highest in the industrialized world, mental illness is increasingly threatening the lives of children. With 70% of mental illnesses having their onset during childhood or adolescence, schools are becoming the first responders to these issues. Mental illness refers to conditions that can be diagnosed, such as depression, bipolar condition, schizophrenia, anxiety or eating disorders. These are examples of conditions that usually require medical treatment.
Teachers are in a position to identify the symptoms of mental illnesses including unusual changes in thoughts, moods and behaviours and to refer students to appropriate mental health professional.
Schools can be pro-active and teach about positive mental health to help prevent mental health problems and mental health illnesses. By integrating positive mental health activities throughout the curriculum and grade levels, schools can become safe and positive spaces for students, teachers and families.
This workshop will help participants understand a vision of mental health, raise their awareness of mental health issues, identify the signs of specific mental health issues and explore practical strategies and interventions to promote positive mental health. Participants will also learn strategies to protect their own mental health
With all your choices this morning – I respect and appreciate your dedication to your students and yourself to investigate more deeply some of the challenges and perhaps some of the strategies to help promote positive mental health in your school (and you).
Geoff MacDonald
ATA Instructor

2. Goals -Learn how to protect your own mental health
Raise awareness and decrease stigmatization of mental health issues
Explore response and intervention methods
Introduce yourself
Explain your role as an ATA Association Instructor and tell participants that these workshops are facilitated activities that allow time and space for professional conversations.
Present the goals for the workshop
* Understand a vision of positive mental health (strengths based perspective)
* Raise awareness and decrease stigmatization of mental health issues
* Understand the signs of specific mental health issues
* Explore response and intervention strategies
* Learn how to protect your own mental health (teachers!!!!)
I am in no way a mental health specialist – merely a facilitator – we are here to share our collective knowledge to move ourself through this workshop .

3. Who Am I?
Geoff MacDonald
ATA Instructor

4. Inclusive Classrooms and School Series
Who are you?
Who are you? . Audio introductions
ON the sheet using the grafitti simply write what grade and subject you teach. Audio introductions
Div I
Div II
DLTs?

5. Why are we here?

6. what does mental health look like?

7. Terrible, horrible, no-good, very bad daY?
At what point does a bad day become a mental illness?
Day
Month
Year
Mental illness can affect anyone and can creep up gradually, unless addressed effectively
Ask participants to think about when they have had a bad day, bad month, bad year and to reflect on what that looked like. When someone consistently experiences more bad than good days over a significant period of time, there may be concern of a mental health problem or mental illness.

8. Mental Illness vs. Mental Health:
What’s the difference?
Define the differences between mental illness and mental health problems.
Mental illness refers to conditions that can be diagnosed, such as schizophrenia, depression, bipolar condition, obsessive compulsive disorder (OCD) and eating disorders. These are examples of conditions that usually require medical treatment.
Mental health problems describes the more common struggles and difficulties that people experience. When people are stressed, confused or upset, they often feel overwhelmed and incapable of coping. People with mental health problems could benefit from help, support and understanding even in the short term. If mental health problems are not addressed, they can lead to a mental illness.

9. What are the foundations of Positive Mental Health?
Other elements may include: proper nutrition, sleep, exercise, socialization, spiritual development, fun! The priority that one places on each foundation may vary from person to person but they are all essential.
Discuss the difference between introverts vs. extroverts in regards to coping
Ask participants to discuss in small groups if they feel they have a balance in their foundations to positive mental health and if not, what they might need to do to change their lifestyles to protect their positive mental health.
What works for YOU?

10. What is positive mental health?
“…a state of (complete) physical, mental and social well-being and not merely the absence of disease or infirmity”
World Health Organization
When we think of mental health, sometimes, we only think of mental health problems or illnesses.
It is important to understand that we ALL have mental health and we need to engage in behaviours that will promote POSITIVE mental health.
The definitions shared will help participants understand the role of schools in promoting positive mental health. The following slides build a rationale for teaching positive mental health in schools.

11. A dozen things I love to do.
Scheduling Playtime
A dozen things I love to do.
Have participants state the things they do for fun.

12. The Appropriate Role of Teachers
Observe
Ask and Listen
Support
Refer
Advocate
Stress that the appropriate role of teachers is not to solve the problems of the person who is experiencing a mental illness or mental health problem,
but instead to observe for symptoms of a mental health issue,
listen nonjudgmentally,
provide support in the form of reassurance that you will help them get the assistance they need,
refer to mental health professionals and to advocate for appropriate services.

13. Cautions Confidentiality cannot be guaranteed.
You have a duty to report if the student is at risk for harming themselves or others.
It is important to remember that even when dealing with sensitive issues, teachers are always working under the Code of Professional Conduct. Section 5 of the Code may become very relevant when assisting a student with a mental health problem.
“The teacher may not divulge information about a pupil received in confidence or in the course of professional duties except as required by law or where, in the judgment of the teacher, to do so is in the best interest of the pupil.”

14. Cautions Teachers are not practitioners.
Like First Aid, the goal is to provide support until professional assistance can be provided.

15. ALL teachers are front-line responders!
Video
Share the Healthy Minds Canada video that demonstrates the need for front line responders in mental health issues. Due to the ratio of time children spend at school, it may be common for teachers to be front line responders; the first ones “on the scene”.
Debrief
After showing the video, ask participants:
What message does this video highlight regarding stigmatism of mental health issues?
How would the response have been different if there were some obvious physical injury to the victim (blood, broken bones, etc)?
What is the role of the bystander in mental health issues?
ALL teachers are front-line responders!

16. Stats
70 per cent of mental illnesses have their onset during childhood or adolescence (Government of Canada 2006 , the Human Face of Mental Health and Mental Illness in Canada)
Mental illness is the second leading cause of disability and premature death in Canada (Waddell et all, 2005, a Public Health Strategy to Improve the Mental Health of Canadian Children)
10-20 per cent of Canadian youth are affected by a mental illness—the single most disabling group of disorders worldwide.

17. Mental Health Problem or Mental Illness?
Stress, overwhelmed by life, dealing with a difficult life situation
Such As: ___________________________________________________
Mental Illness:
Can be diagnosed
Such As: _____________________________________________________
Both groups benefit from help
MHP: Lack of sleep, tough workload, moving, death of a loved one, divorce
MI : e.g. schizophrenia, depression, obsessive compulsive distorder)
If left untreated MHP can lead to MI.

18. In Canada, only one out of five children who need mental health services receives them.
More than 50 per cent of people with mental health problems don’t go for help.
Almost a third of Canadians who seek mental health care report that their needs are unmet or only partially met— this rate is even higher for children and youth.

19. Suicide accounts for 23 per cent of deaths in 15-19 year old Canadians, second only to accidents.
Suicide rates for Inuit youth are among the highest in the world at 11 times the national average.

20. WRITE A WORD THAT DESCRIBES HOW THESE STATISTICS MAKE YOU FEEL.

21. Reducing the stigma
How can teachers help to reduce the stigma of Mental Health?
(Audio Response)
Attitude can make a big difference in the ability of someone to discuss their own mental health issues and seek help.
Mental health problems are common
Mental health problems are real medical conditions
Mental health problems are not character flaws
Effective help and treatments are available

22. What causes mental illness?
A chemical imbalance in the brain
Psychological and social factors
Genetics and heredity
There is no single cause of mental illness, a complex interplay of factors affect a person’s mental health. However, mental illnesses are thought to be triggered by the following:
A chemical imbalance in the brain
A chemical imbalance in the brain is caused by an imbalance of neurotransmitters, which can lead to symptoms such as depression, anxiety or stress reactions. We are all at risk for changes in our brain’s chemistry. Recognizing these changes is an important part of treatment and the return to health.
Biological Factors
The following biological factors can also affect the brain and the onset of a mental illness: prenatal damage, birth trauma, viral infection and faulty brain chemistry.
Psychological and social factors
It is commonly thought that mental illness can be triggered by a traumatic life event or situation, and/or prolonged stress. Some examples of traumatic events are child abuse and neglect, family violence, severe or prolonged stress and unemployment.
Genetics and Heredity
Most mental illnesses are more common among close family members, which suggests that genetics play a role. However, people don’t inherit the illness itself; they inherit only the tendency to get it.

23. A closer look at specific mental health problems

24. Major types of mental health problems
Mood disorders—depression, bipolar
Anxiety—generalized anxiety disorder, panic attack, phobias, OCD, PTSD, others
Eating disorders
Substance abuse
Deliberate self injury
The following slides will review the prevalence and symptoms of some of the more common mental health illnesses.

25. Prevalence
Depression—mood disorders (5 per cent aged 13-17), bipolar (2 per cent)
Anxiety (11-21 per cent)
Eating disorders (11-19 per cent)
Substance abuse (8 per cent)
Deliberate self injury (12 per cent)
Symptoms can vary with each type of mental illness and each person. Changes in mood or behaviour that are troubling or last longer than two weeks should always prompt an evaluation by a doctor as he or she can rule out any physical causes for changes in mood or behaviour and refer patients to a mental health professional.
The prevalence of mental health illnesses is increasing in society in general, and in children specifically.

26. Most common of all mood disorders.
Depression
Most common of all mood disorders.
Symptoms Include:
Unusually sad mood most of the day and nearly every day
Loss of interest in activities that used to be enjoyable
Weight gain/loss
Sleeping too much/too little
Recurring thoughts of death
A mood disorder is an illness that involves the body, mood and thoughts. It affects the way a person feels about himself or herself, and even the way he or she eats, sleeps and thinks. Common mood disorders include clinical depression, seasonal affective disorder and bipolar disorder.
It’s important to remember that people with mood disorders, as with other mental illnesses, cannot “pull themselves together” and get better using willpower alone.
Clinical depression
By 2020, the World Health Organization anticipates that depression will be the leading cause of disability for all ages and sexes in developed countries.

27. Adolescent Depression
Research suggests that the number of adolescents with depressive disorders is twice as high as adults with depressive disorders.
Why do we think this is?
Have participants audio in on this question.
Depression can affect the following areas of development in children and adolescents:
Emotional
Behavioural
Physical
Mental

28. Bipolar/ Manic depression
1 in 100 people are diagnosed with Bipolar
Classified by severe mood swings alternating between mania and depression
Cycles can be rapid or longer term
Symptoms of the depression state are similar to those previously listed
Bipolar disorder, also called manic depression, is an illness marked by periods of serious depression followed by episodes of markedly elevated or irritable moods or highs (in the absence of drugs or alcohol).
These mood swings are not necessarily related to events in a person’s life.
Bipolar disorder affects approximately 1 per cent of the population, and affects men and women equally.

29. Anxiety
Generalized anxiety disorder, panic attack, phobias, OCD, PTSD, others
One in nine people will be diagnosed with an anxiety disorder.
Anxiety is a normal feeling that everyone experiences at some time. It is a natural response that is useful in helping us avoid dangerous situations and motivating us to solve regular problems. Anxiety can vary in severity. It can range from mild uneasiness to panic attacks and can last from a few minutes to months or even a lifetime. Those with anxiety disorder have levels
of anxiety that interfere with day–to–day living.

30. Symptoms of all Anxiety Disorders include:
Physical—fast heart rate, shortness of breath, dizziness, nausea, chest pain
Psychological—irrational fear/worry, feeling unreal, fear of losing control or dying, reliving images of traumatic event
Behavioural—obsessive compulsive behaviour, avoiding situations, distress in social situations, phobic behaviour, increased use of alcohol or drugs

31. Eating Disorders Most Common Bulimia and Anorexia
Seven percent of people will be diagnosed with an eating disorder.
Eating disorders have the highest mortality rate of all mental illnesses, with per cent eventually dying from physical complications.
Despite their collective label, these disorders are not about food, they are a way of coping with deeper problems that are too painful or difficult to deal with.

32. Substance Related Disorders
Types of Substances:
Depressants—alcohol, barbiturates, benzodiazepines, inhalants, opiates
Stimulants—amphetamines, caffeine, cocaine, nicotine, hallucinogens, cannabis
May Include:
Physical dependence
Psychological (emotional) dependence
Have partipants chime in on the types of substances for each.

33. How are we doing?
Ask participants for comments questions and how things are going.

34. Deliberate self injury
Done without the intent to take one's life
Onset typically occurs between 14 and 24 years of age
Reasons include: self-punishment, escape, sensation seeking, to show distress to others, to relieve tension, to get back at people and make them feel guilty
Young people learn to cope with emotions in different ways. Some teens who are unable to cope with a build up of feelings or painful emotions try to release the bottleneck by striking out physically or verbally at others, while others may seek relief through self-harm or self-injury, including cutting or burning themselves.
Nonsuicidal self-harm includes behaviours such as self-cutting, scratching and burning, done without the conscious intent to take one's life. Onset typically occurs between 14 and 24 years of age.
The most common reasons for this type of harm are regulation of affect (e.g., to reduce tension or relieve dysphoric feelings), but reasons may also include self-punishment, interpersonal reasons, and sensation seeking
Factors associated with nonsuicidal self-harm include being female, awareness of self harm in peers, family members who self harm, drug misuse, depression, anxiety, impulsivity, disruptive disorders and low self-esteem.4,5 Suicide ideation and attempts are more likely to be reported among those with repeated nonsuicidal self-harm.6
The definition of self harm focuses on the intent to the self harm or self injury behaviour.
Definition of self harm : Repetitive impulsive actions that damage their own body such as cutting or burning.
The purpose or intent of these actions is to relive emotional pain, extreme anxiety or tension. The youth do not want to die; they just want to get relief.
It is very important that the caregiver find out the intention for the self harming behaviour by asking the student directly about suicide. The vast majority of youth who engage in self harming behaviour do not attempt suicide HOWEVER suicide attempts are more common in youth who self harm than in youth who do not self harm
Self-injury includes: 1) cutting, 2) scratching, 3) picking scabs or interfering with wound healing, 4) burning, 5) punching self or objects, 6) infecting oneself, 7) inserting objects in body openings, 8) bruising or breaking bones, 9) some forms of hair-pulling, as well as other various forms of bodily harm. These behaviors, which pose serious risks, may by symptoms of a mental health problem that can be treated.
Behavior patterns. Many who self-harm use multiple methods. Cutting arms or legs is the most common practice. Self-injurers may attempt to conceal the resultant scarring with clothing, and if discovered, often make excuses as to how an injury happened.
Diagnoses. The diagnosis for someone who self-injures can only be determined by a licensed psychiatric professional. Self-harm behavior can be a symptom of several psychiatric illnesses: personality disorders (esp. borderline personality disorder); bipolar disorder (manic depression); major depression; anxiety disorders (esp. obsessive-compulsive disorder); as well as psychoses such as schizophrenia.
Evaluation. If someone displays the signs and symptoms of self-injury, a mental health professional with self-injury expertise should be consulted. An evaluation or assessment is the first step, followed by a recommended course of treatment to prevent the self-destructive cycle from continuing.
Treatment. Self-injury treatment options include outpatient therapy, partial (6-12 hours a day) and inpatient hospitalization. When the behaviors interfere with daily living, such as employment and relationships, and are health or life-threatening, a specialized self-injury hospital program with an experienced staff is recommended.

35. Deliberate self injury
Warning Signs
Unexplained injuries and scars
Long pants and sleeves
Low self esteem
Elusive or secretive
Carrying razor, lighters or sharp objects
Warning Signs. Warning signs that someone is injuring themselves include:
unexplained frequent injury including cuts and burns,
wearing long pants and sleeves in warm weather,
low self-esteem, difficulty handling feelings, relationship problems, and
poor functioning at school
Elusive, evasive or secretive, especially if asked about injuries
Carrying razors, lighters or sharp objects that are not normally needed
Dangers. Self-injurers often become desperate about their lack of self-control and the addictive-like nature of their acts, which may lead them to true suicide attempts. The self-injury behaviors may also cause more harm than intended, which could result in medical complications or death. Eating disorders and alcohol or substance abuse intensify the threats to the individual’s overall health and quality of life.

36. New Information for YOU?
In the Box: Add points that you found interesting from the information we’ve discussed.
You may want to ask the following:
What was the most interesting piece you heard?
What did you find most challenging?
What resonated most within the context of your teaching?

37. Responses and Interventions

38. What can teachers do? “Can we talk?”
Teachers have a critical role to play in supporting students who may be experiencing mental health problems. Listening is one of the most important ways that teachers can help.

39. Communicating and listening non-judgmentally
Listen without interrupting
Keep an open mind
Make listening a priority
Avoid giving advice
Learn the art of asking openended questions
Listen with empathy
Watch non-verbal cues
Check for understanding
Provide feedback
Audibly: What can we do when listening?

40. Compassionate classrooms
Youth mental health quiz
Stress Test
Other screening and self assessment tools:
Anxiety disorder checklist
Child and adolescent depression checklist
Hand out pamphlets – more available from the ATA
Much of the information previously shared regarding specific mental health illnesses is included in the Compassionate Classrooms handbook. The Compassionate Classrooms project was a joint effort between Canadian Mental Health Association, ATA and Global Television. These handbooks are available to ATA members free of charge and are included in your packages today.
Teachers may be the first and only people to notice the possibility of a mental health problem in a student. A general awareness of some assessment tools may be helpful for teachers to identify students who may be experiencing a mental health issue.
Compassionate Classrooms includes 2 helpful self assessment tools, the Youth Mental Health Quiz and a Stress Test that can be shared with students and staff, when deemed appropriate to do so.
Included in the PG is the Anxiety Disorder checklist and the Child and Adolescent checklist.
These checklists are for information only and can be referred to by teachers when deciding to refer students to mental health professionals. It is important to note that teachers are not in a position to diagnose mental health illnesses of students, only to be aware of symptoms and to refer to mental health professionals, such as school guidance counselors or school psychologists.

41. Refer to professionals
School counselor
District psychologist
Community services agencies
Family doctor
Also…Kids Help Phone
Audio Responses: Who do we refer students to?

42. Embedding Positive Education
Education for happinessskills for happiness can be taught!
Skills that increase: resilience, positive emotion, positive relationships, gratitude, engagement and meaning can be taught
There is substantial evidence from well controlled studies that demonstrate that resilience, gratitude, positive emotion, engagement and meaning can be taught in schools.
It has been demonstrated that when positive education is integrated throughout the grade levels and subject areas, frequency of depression, anxiety and behavioural problems are reduced. Following are some strategies to promote positive education throughout the grade levels and subject areas.

43. Strategies & resources available

44. Bipolar disorder connect The Panic Attack Eliminator PTSD Coach
Phone Apps
Depression monitor
Bipolar disorder connect
The Panic Attack Eliminator
PTSD Coach
Stress Tips
Mood and Anxiety Diary
Other Suggestions?
----- Meeting Notes ( :34) -----
Ask for suggestions of others that participants know.

45. Search: Iris the Dragon, Mental Health Storybooks for the Classroom
Ebooks
Free mental health ebooks for your class!
Search: Iris the Dragon, Mental Health Storybooks
for the Classroom

46. Child & youth mental health toolkits
The child and youth mental health online toolkits are a wealth of resources of interactive games, videos, apps, and websites on a broad range of topics including: trauma, divorce/separation, eating disorders, mood disorders, etc.

47. The benefits of gratitude three good things activity
Write down three good things that happened each day for a week.
To each positive event listed, reflect on one of the following:
What does this mean to you?
Why did this good thing happen?
How can you increase the chances of having more of this good thing in the future?
-Gratitude/blessings journal, WWW (What Went Well) to share every morning (in class or personal)
-Three Colorful/Position Adjectives: Bring your classroom esteem up!
Studies show that gratitude can have a significant increase on your long term well being. Gratitude can be nurtured in class in a variety of ways including: daily gratitude journals or opportunities to share out loud ‘What Went Well’ (WWW).
Gratitude increases sleep quality, reduces the time required to fall asleep and increases sleep duration. It can’t cure cancer but it can strengthen your physiological functioning, positive emotion improves health. Some recent studies show that those who engage in gratitude practices have been shown to feel less pain, go to the doctor less often, have lower blood pressure and are less likely to develop a mental disorder

48. Positive self talk
A man is but the product of his thoughts. What he thinks, he becomes.
Mahatma Gandhi
We can create and/or change our experiences through our thoughts!
Identify that voice in your head. What is it saying to you? Reframe it into the positive – You have the power to talk back to your inner voice

49. Positive self talk … application
Positive self-talk takes practice! Teach it to yourself and teach it to your students.
“Fake it ‘til you make it!”
“Start small”
For more information on positive self-talk check out these authors:
Louise L. Hay -Gretchen Rubin
Wayne Dyer
Martin Seligman
(Fake It Til You Make It) Sometimes we just have a bad day. Taking just one negative thought and making it positive can help us feel just a bit better. Catch those negatives and reframe it for yourself even if it feels “fake!”
(Start Small) if catching yourself in a negative thought pattern is hard, pick one positive phrase and repeat it over and over to yourself hundreds of time throughout the day. Start with something simple like: “I am awesome.” “I am smart.” “I love my life,” or “I am willing to change.”

50. Relaxation techniques
Get from OMG to OM!
How do you relax?
Go for a walk, Meditate/pray, Breathe deeply, Sing, Dance, Take a time-out
How can we help students relax?

51. Focus on strengths
Do a strengths inventory (
Interview family members to develop a “family tree” of strengths
Create a plan to develop a strength that is not among one’s Top Five

52. CONSIDER IntegratING POSITIVE MENTAL HEALTH DISCUSSIONS throughout THE curriculum
English—‘give a speech on a time when you were of value to others’, instead of ‘give a speech on a time when you were embarrassed or made a fool of yourself’
Religion—students and parents receive a deck of 60 cards with different quotations about life purpose to stimulate conversations about meaning
Math—explore how to measure the gross national happiness of a nation
Physical education—introduce guided imagery to prepare for games

53. Urgent to self
Write a note to remind yourself what you plan to do to keep yourself well. Share this with your students.

54. Support After the Workshop
ATA Library
Books, resources, multimedia, journal articles
Support for web searching
ATA Workshops
More than 30 different workshops available for only $100
Teacher Welfare and Member Services
Workshops and services available
Become an ATA Instructor
Evaluation