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Mental Health Workshop
Transcript of Mental Health Workshop
Restless / agitated
Numb, empty, despair
Isolated, unable to relate to others
Feel no pleasure in things
Self-confidence & esteem
1% to 2% lifetime prevalence of bipolar disorder.
Recent research - as many as 5% of the population are on the bipolar spectrum.
Hypomania - very self-confident; euphoric; sudden anger; impatient; irritable; easily distracted; talkative; challenging; more reckless leading to errors of judgement e.g. spending too much money or taking on too much
Rapid or disjointed thinking
Racing thoughts - cannot slow mind down
Cannot sleep; over activity
Self-important; grandiose delusions; distorted sense of self
Depression - usually follows period of mania or hypomania.
Emptiness; worthlessness; lack of energy and motivation; excessively anxious; guilt; panic & fear; sleeplessness; loss of appetite; pessimism; negativity; tiredness; self-harm; thoughts of death & suicide
Stressful life event?
Rapid cycling BD - 4 or more episodes of mania and/or major depression per year
Can be monthly, weekly, daily (ultra rapid)
10-20% of those with BPD will have RCBD
More common in those with Type II - less severe highs
More common in women
Link between low thyroxin levels and RCBD
Difficulties: acceptance - stigma
Antidepressants can provoke RCBD
Co-morbidity: ADHD; Aspergers; Autism; Dyslexia; Anxiety Disorder
Drug & alcohol misuse - self-medicate?
Intensity - (experiences and internal states)
Increased perceptual sensitivity, creativity, focus and clarity of thought.
Individually centered solution
Avoid stress e.g. last minute changes to timetable
May need to pace themselves
Medication - hard to get started in the morning - student may ask to record early morning lectures or avoid tutorials before a certain time of day
Use of recording equipment
Reading lists & lecture notes in advance
Extra time / rest breaks in exams
On average: 8 year delay before getting diagnosed
Average age 19
No definitive test
Catherine Zeta Jones
EDNOS (Eating Disorders Not Otherwise Specified: e.g. compulsive eating, types of anorexia or bulimia which are not severe).
Profound fear of weight gain
Phobia helps keep the illness going
Psychological benefits: feeling special; competent; being different; gaining attention
Not having to participate in normal life
Not having to “grow up”
Not even feeling authentic feelings
Help keep the anorexic trapped in his / her illness & overrides wish to recover.
About 1 in 3 anorexics recover
1 in 3 start overeating and may have long term problems with food control
Between 1 in 5 die early as a result mostly of starvation effects or suicide.
Fear of weight gain
Typically normal in weight or even overweight
Regularly use laxatives or vomit (result of overeating or binge eating)
Not usually afraid of being at a normal body weight
Chaotic eating patterns, binge eating and purging frequently
Addictive feel - a way of regulating emotions and helping people cope with life.
Eating disorders = coping behaviours
Outlet for displacement of feelings, which really relate to other areas of life being out of control.
Personal, family, physical or genetic factors
Emotionally vulnerable AND sensitive about weight and shape
Powerlessness / worthlessness
Sensitive to rejection / abandonment
Poor assertion skills
Difficulty managing healthy relationships
Perfectionist attitudes / high expectation of self
Not good at emotional problem solving - avoid difficult situations
Hard to say 'no' - may be people pleasers
Starving, purging and binge eating can lead to depression and anxiety
Physical symptoms of Anorexia Nervosa
Severe weight loss
Difficulty sleeping and tiredness
Lanugo - growth of downy hair
Periods stop or don’t start (girls)
Hair falls out
Feeling fat when underweight
Irritable and moody
Setting high standards / perfectionist
Shutting off from the world
Thinking things are either right or wrong, no in between
Anorexia - behavioural symptoms
Ritual or obsessive behaviours
Lying about eating
Trying to please everyone
Cooking or preparing food for everyone else
Wearing baggy clothes
Physical symptoms of Bulimia Nervosa
Bad breath and mouth infections
Irregular periods (girls)
Dry or poor skin
Kidney and bowel problems.
Psychological symptoms of Bulimia Nervosa
Feeling emotional and depressed
Feeling out of control
Obsessed with dieting
Behavioural symptoms of Bulimia Nervosa
Eating large quantities of food
Being sick after meals or binges
Taking laxatives or diet pills
Being secretive and lying.
Some but not all of the diagnostic signs for anorexia or bulimia.
A ‘partial syndrome’ eating disorder
Family & friends
Suicidal feelings / attempts
1 in 20 in England (NHS); some research says up to 13% of the general population
Most on mild end of spectrum
25% of GP consultations in deprived urban areas Most people in prisons
At least half of homeless people
Between a third and two thirds of inpatients in psychiatric hospitals
"We generally work on a figure of about 4% who would benefit from help."
"I have BPD and for me it feels like [I'm] a child being forced to live in an adult world. I feel too fragile and vulnerable for the world I live in."
Childhood / adolescent experiences
Difficult life events e.g. early loss of a parent, childhood neglect
Sexual or physical abuse
Biological & genetic factors
Stressful experiences e.g. break-up of a relationship or loss of a job, can exacerbate already present symptoms of BPD
Prone to criminal behavior
Reality distortion, tendency to see things in ‘black and white’ terms
Excessive behavior e.g. gambling or sexual promiscuity
Proneness to depression.
Types of PD
Cluster A – odd or eccentric
Paranoid (pervasive mistrust)
Schizoid (socially detached)
Schizotypal (socially isolated, distorted perception)
Cluster B – dramatic, emotional, erratic
Antisocial (discounts others, no empathy)
Borderline (unstable, impulsive)
Histrionic (dramatic attention seeking)
Narcissistic (needs admiration)
Cluster C – anxious or fearful
Avoidant (socially inhibited, inadequate)
Dependent (submissive, separation fear)
Frequent intrusive & unwelcome obsessional thoughts, images, impulses, worries, fears, doubts & repetitive compulsions, impulses, urges
Often unwanted, disturbing - but don't act out
Very difficult to ignore
Significantly interfere with day to day functioning
1.2% of population (50% severe; <25% mild)
WHO - top 10 most disabling illnesses in terms of lost earnings and diminished quality of life
Obsessional thoughts = irrational
Compulsive behaviors to relieve anxiety (perceived danger)
Over inflated sense of responsibility
Relief = temporary & short-lived
Often reinforces original obsessions
Worsening of cycle
Contamination / Mental contamination
Ruminations / intrusive thoughts
Diagnosed when obsessions & compulsions:
1. Consume excessive amounts of time (approx hour or more)
2. Cause significant distress and anguish
3. Interfere with daily functioning - home, work, school, social life, family life, relationships
Affects males & females equally
Males - late adolescence
Females - early 20s
Undiagnosed for many years (10-15 years) - lack of understanding
'Secret illness' - embarrassment, guilt, shame
Symptoms can remain unchanged
Symptoms can wax and wane if untreated - roller coaster
Severity increases during times of stress
Inability to live with doubt and uncertainty drives OCD
Prefer black and white answers
Difficulty accepting shades of grey
Worrying you / something/ someone / somewhere is contaminated
Worrying about catching media publicised illnesses
Worrying that everything needs to be arranged 'just right'
Worrying about causing physical or sexual harm to self or others
Unwanted or unpleasant sexual thoughts and feelings
Intrusive violent thoughts
Worrying something terrible will happen unless you check repeatedly
Worrying you have caused an accident whilst driving
Worrying you are going to shout out obscenities in public
Extreme lengths to block and resist
Return within short time
Can last hours or days
Physical and mental exhaustion
Anguish and despair
Repetitive physical behaviors and actions or mental thought rituals
Very rigid and structured routine
To neutralise the perceived threat
Checking items arranged 'just right'
Saying a particular phrase
Repeatedly opening / sealing letters
Constant checking - light switches, handles, taps, locks
Need to seek constant reassurance
Can be overt or covert
Events can be brought about, or prevented, by thinking about them or by performing certain acts.
Concern over aggressive thoughts
Causes not fully understood
Neurobiological - linked to increased activity in certain parts of the brain; low levels of serotonin
Triggers e.g. traumatic life event
Impact on study
Time - preoccupied
Health impact - physical and mental
Rituals = set pattern of behaviors with a clear defined starting point and end point.
If interrupted must start ritual from beginning.
Flexibility (fatigue, stress, symptoms of OCD, affects of medication)
Suitable accommodation / planning to avoid problematic environments
A 'safe' place
Study skills if appropriate
Handling of equipment (for example in a laboratory)
Extra time in examinations and/or the use of a word processor
Sitting examinations in a controlled environment.
Peer support and awareness training
A support worker - manage resources, plan study routines, take notes
A word processor or computer to produce work, help organise study
Strategies for teaching and learning
Schizophrenia - major psychiatric disorder, or cluster of disorders
Characterised by psychotic symptoms that alter a person’s perception, thoughts and behaviour.
Unique combination of symptoms and experiences.
Often co-morbid with depression, anxiety, post-traumatic stress disorder, personality disorder and substance misuse.
Tired, no energy
Lost appetite & lose weight or reverse
Physical aches & pains
Anxiety (often co-morbid)
Mind full of busy repetitive thoughts
Physical symptoms e.g. headaches, aching muscles, sweating, dizziness
Psychosis - (severe depression)
Hallucinations - hear voices, visions, delusions (false beliefs)
Traumatic life event
Physical conditions - hormones, blood sugar
Side effects of medication
Brain chemistry - neurotransmitters - (activity levels, eating habits, sleeping patterns, alcohol and drug consumption, and medication all have a direct effect on brain chemistry)
Stress responses - thinking patterns and coping habits
Many characteristics = habits that can be changed
Habits = self-reinforcing interaction between:
Fight or flight?
Stress response - physiological, psychological, behavioural - works for short lived and practical
SR repeatedly mobilised & threat not effectively dealt with system goes into overdrive and overloaded.
Chronic spirals of anxiety and anger or low mood and depression.
All or nothing (including suicidal thoughts, perfectionism, control freakery, over generalisation, jumping to conclusions
Rule-bound thinking (oughts and shoulds)
Control freakery - catastrophising, jumping to conclusions, hyper vigilance
Self-bullying - over personalisation, self blame, perfectionism, self-criticism / self-attack (I am / feel bad therefore I am bad)
ADHD occur in adults if not apparent in childhood?
By 25 approx 15% of people diagnosed with childhood ADHD still experience full range of symptoms
Approx 65% have symptoms that affect daily lives
Childhood symptoms differ to those in adults - hyperactivity tends to decrease, inattentiveness to increase
Adult symptoms tend to be more subtle.
Carelessness; lack of attention to detail
Starting new tasks before finishing old ones
Poor organisational skills
Poor time management
Inability to focus or prioritise
Continually losing, misplacing, things
Restlessness; edginess - physical & mental overactivity
Difficulty relaxing - on the go all the time
Depressed when inactive
Similar symptoms to BD but ADHD = persisting trait of irritability & volatility compared to grandiose and euphoric symptoms of mania and depression of BD
Often show decreased symptoms in a novel situation.
Ceaseless, unfocussed mental activity
Leading to impairments
Anxiety & depression
Drug / alcohol abuse disorders
Anti social behaviour
Diagnosing ADHD - specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD.
Methylphenidate e.g. Ritalin, Concerta
Impact on studies
Difficulty staying on task
Difficulty completing work
Poor time management
Unfocussed, muddled, inefficient
Lack of self awareness / difficulty self-monitoring
System of reminders (electronic, whiteboards, phone, on-line calendar)
Break down work into manageable chunks
Reading lists, assignments etc. in advance
Text to speech - concentration / reinforce understanding
Active reading techniques
Auditory learner - read out loud / record into DVR
Visual learners - mind maps, colour, highlighters, visualisation
Difficulty starting an essay - speech recognition
Exams - extra time, separate room, timer / alarm
Often need some sort of sensory stimulation to help concentrate
Teaching staff need to be aware that:
Failure to give close attention to details and thereby making mistakes;
poor listening skills;
poor organisation and misjudging how long it will take to complete tasks, such as essays;
becoming ‘locked into’ / obsessional about a task or activity;
having very fixed ideas and sometimes showing little flexibility;
hyperactivity – appearing over-stimulated and often fidgeting;
inattention in a range of different situations and easily distracted and,
may talk excessively or have difficulties waiting for their turn and interrupt others;
Start by reviewing previous session
Provide overviews of main topics
Provide notes at the start of each teaching session
Allow recording of lectures (personal use only)
Present material in a variety of ways; e.g. diagrams, flow charts, practical demonstrations and tapes
Students with ADHD may need to double check the information they have written down or recorded from lectures. Try using different terminology or in a more straightforward language
Pause and sum up frequently when giving instructions and explanations
Provide short break for longer lectures.
Diagnosed MH conditions / mental illnesses
Does not include ASD, ADHD, neurological disorders, e.g. Tourette's, acquired brain injuries
May be exaggerated forms of common human experiences
DSM V (American Psychiatric Association) most commonly used in UK
Based on medical model
MH conditions defined as illnesses
Not fixed parts of defining who someone is
Not usually conditions a person is born with
Medical model - illness, symptoms & diagnosis
Social model - environment, interaction of disability with someone's day to day life and limited access due to environment
Psychological - impact of adjustments on psychological condition
DSA - main framework = social model
Consider medical & psychological but purpose of DSA assessment is to identify issues arising from the impact of the students difficulties on course activities and their engagement with it.
Focus: inclusion and effective engagement.
Psychological model - concerned with perception of self and perception of others
Significant emphasis on early life events / experiences within the family
Be aware certain situations can trigger difficulties
Awareness of strategies used by MH professionals e.g. CBT approach works to overcome avoidance
i.e. don't facilitate avoidance or make recommendations that conflict
When is a MH condition a disability?
Substantial effect on day to day activities
May well last for a year or more
Difficulty diagnosing a MH condition correctly
Frequent changes of diagnosis
Recommendations should not be rigidly tied to a diagnostic label
Behavioural difficulties not exclusive
Objective, reasonable, proportionate & realistic
Needs relative strategies
Don't go beyond area of expertise
People with MH conditions are frequently disempowered by people making assumptions about abilities and needs - can lead to unnecessary and potentially damaging recommendations.
Refer to Mental Capacity Act (MoJ website) - 'significant personal responsibility'
DSA assessment - independence and effectiveness in learning
Don't encourage dependency
Don't try and 'save' students / take on a rescuing role - student becomes a victim
Attempting to remove difficult and challenging things = unrealistic and detrimental
HE meant to be challenging - develop academic skills and self-confidence
Requires self-confidence and self-awareness
Assessing whether a difficulty is significant
Scale of challenge
Differs from most students' experience
Tendency to overestimate other students' abilities e.g. concentration for duration of lecture; capturing everything that is said
A good assessment is not about repeating what a student describes as the difficulties but working with the student to try and develop a more sophisticated understanding of what is happening.
Consider best use of funding and value for money
Ensure student is able to engage as successfully as possible and facilitate independent learning
What are difficulties related to MH condition and which are challenges large numbers of students face?
Note taker - freeing or aid concentration?
Recording device - involves extra task. Low motivation - is this a useful strategy?
Poor concentration due to low esteem / anxiety? NT or recording device could be counter-productive - reinforces false perception student has of extent and nature of difficulties.
Unhelpful / disabling strategy?
Further negative impact on student's health?
Recommendations must be proportionate
Ask the right questions
Avoid over recommending.
Are students' perceptions of their own needs realistic?
Distorted sense of reality?
Difficulty recognising strengths?
Little self-reliance - may ask for unnecessary interventions
Psychosis - altered sense of reality e.g. auditory, visual, tactile hallucinations; grandiose, paranoid ideas
Real to them. May not realise they are unwell.
Stigma - low sense of entitlement.
Lack good insight.
Dominant model is medical i.e. need for change within individual rather than within society.
Encourages people to access treatment rather than emphasising rights under EA & issues of inclusion and access.
Minimise and / or over emphasise impact
Fluctuate between denial and avoidance
Tendency to catastrophise
Engage in 'all or nothing' thinking
Students may not have thought about access or fairness
May not want 'special treatment'
Often need low level cost effective interventions - might be helpful to compare potential adjustments with those for students with physical or sensory impairments to give perspective
Need to be aware of competency standards when making recs for exams and assessments
Need to be aware of what institutions can provide:
Setting student up in opposition
Extra time = frequent recommended adjustment for concentration / anxiety difficulty
Probably helpful to limited number
May do more harm than good
Discuss how it will work
MH conditions = leading cause of disability in young people
BUT some HEIs don't offer any specialised support
Lack confidence in ability, motivation, poor oragnsiational skills - independent self directed learning difficult
May need generic support or mentoring to validate skills and reassurance to help them develop or regain confidence in their ability to learn.
Different from study skills recommended for SpLDs
Providing support that is not appropriate to needs may:
Be welcome by the student - gives reassurance
BUT can reinforce distorted negative thinking pattern (lacking ability; fewer skills etc.)
May create a dependency
Hinder transition to being independent learner
Remove possibility of raising self-esteem
May attribute success to support rather than own abilities and efforts
Struggle to identify qualities that appeal to future employers
Face to face, e-mail, skype, phone
Generally one hour a week - more may build dependency and be counter productive
Enable student to develop own strategies; build on skills
Directly target specific needs of students with MH conditions
Help students manage effects of MH condition on educational progression
Balance relative harms and merits
Avoidance perpetuates MH conditions - situations that provoke anxiety
Difficulty often becomes more pronounced
Out of practice dealing with challenging situations so triggers become more mundane
e.g. difficulty working around others, distractibility - does using shared facilities disadvantage them to an extent where it will significantly impact on progression?
Facilitating isolation and avoidance?
Time spent transcribing - increase stress?
Should not be recommended as a generic strategy.
Mind mapping - break down tasks into smaller elements; student feels better able to manage; reduce risk of procrastination; keeping track of resources (memory difficulties); useful revision strategy.
Text to speech - difficulty processing information presented visually; extracting meaning for research purposes or for checking own work.
Strategies should only be considered when student presents specific difficulties to which software might be a practical and appropriate response.
Bipolar ( manic depression) = severe
mental health illness characterised by significant mood swings including manic highs and depressive lows.
Majority experience alternating episodes of mania and depression.
Cyclothymia - mild
Over-communicative & incapable of listening to or empathising with others
Sleeplessness; over activity
Paranoia; hallucinations affecting vision or perception
May turn against the people they care about and love - effect on relationships
Exhilaration turns to despair
Psychosis - losing touch with reality
Action plan e.g. identify emotions, behaviours, events that could be warning signals
Feeling of control
App to track mood - Bipol
Emotions up and down (for example, feeling confident one day and feeling despair another)
Difficulty making and maintaining relationships
Unstable sense of identity (e.g. thinking differently about yourself depending on who you are with)
Taking risks; not thinking about the consequences
Fear of abandonment / rejection / being alone
Delusions and hallucinations
"Feeling bereft and lifeless – with a void I can't fill no matter how much food I put down or activity, exercise, self harm and constant thinking I've gone through. I try to keep busy to combat the emptiness but it only masks it. The best antidote is to try to experience life and relationships more fully, then store the better memories."
Increased guilt & anxiety about fatness
Purging / starving
Guilt & self-dislike
Increased resolve to diet
PTSD - traumatic experiences set off a reaction that can last for many months or years.
Usually within 6 months of traumatic event -
seeing other people dying or being injured
violent personal assault
being taken hostage
natural or man-made disasters
diagnosed with a life-threatening illness.
Flashbacks and nightmares
Drug & alcohol abuse
Long term e.g. child abuse, torture, rather than one incident
Up to 3% of population at some time
PTSD Coach - app for android
CBT (Trauma focused CBT)
EMDR (Eye movement desensitisation and reprocessing) - involves making side-to-side eye movements while recalling the traumatic incident. It works by helping the malfunctioning part of the brain (the hippocampus) to process distressing memories and flashbacks so that their influence over your mind is reduced
Physical symptoms include:
Increased heart rate
Increased muscle tension
Tingling in the hands and feet
Hyperventilation (over breathing)
Difficulty in breathing
Wanting to use the toilet more often
Tight band across the chest area
Psychological symptoms :
Thinking that you may lose control and/or go “mad”
Thinking that you might die
Thinking that you may have a heart attack/be sick/faint/have a brain tumour
Feeling that people are looking at you and observing your anxiety
Feeling as though things are speeding up/slowing down
Feeling detached from your environment and the people in it
Feeling like wanting to run away/escape from the situation
Feeling on edge and alert to everything around you
Avoidance brings short-term relief
Short term anxiety can be useful e.g. exam, performance
Fight or flight
If no physical threat, takes longer for affects of adrenaline to subside
Agitated for longer
Goes on for a long time
Difficult to deal with daily life
Out of control
Feel like going mad
Panic attack - exaggeration of the body’s normal response to fear, stress or excitement. It is the rapid build-up of overwhelming sensations.
Between 5 and 20 minutes, peaking after 10
Often random and no warning.
Past or childhood experiences
Strange thinking (‘thought disorder’)
Hallucinations - visual, auditory, smell, touch
Voices usually critical or unfriendly
Discuss thoughts and behaviour
Strongly held beliefs or experiences
Can be unusual or extreme
Ideas of reference - special meanings / connections
‘Negative’ symptoms =
lack of some emotional responses or thought processes e.g. lack of interest, emotional flatness, inability to concentrate, wanting to avoid people or to be protected.
Differences of opinion about the definition of schizophrenia and its symptoms so not easy to identify
Genetic make up = more vulnerable
Life events = triggers
Anti psychotics target dopamine - chemical that carries message between brain cells
Very stressful or life-changing events Social isolation
Losing someone close
Physical or verbal abuse
Sexual or physical abuse
About 1 in 200 people diagnosed with schizophrenia during their lifetime
Roughly same number of men and women
Age of onset tends to be lower in men
Increased incidence in black and ethnic minorities
Most diagnosed between 18 and 35
Everyone diagnosed with schizophrenia will have a different experience of the symptoms.
TMS - transcranial magnetic stimulation
Dysmorphic Disorder (Imagined ugliness syndrome)
OC Spectrum Disorders
Panic Attacks / Panic Disorders
Social Phobia / Social Anxiety Disorder
Personality disorder = a “way of being” developed while growing up.
Some aspects of that personality cause repeated problems in life - particularly with relationships.
10 diagnosable personality disorders
Often a combination
Exact diagnosis unhelpful when deciding treatment
Use scales from mild to severe: “everybody has a personality and nobody is perfect”.
Hard to complete work
Loss of insight
Feelings of being controlled
Schizoaffective disorder -
'schizo' refers to psychotic symptoms
‘affective’ refers to mood symptoms.
MH problems = more common among students than the general population.
The Association for University and College Counselling (AUCC) - 3-10% of student population will have contact with its counselling service in a single year.
Key signs include weight loss or gain, decline in personal hygiene, poor attendance at lectures, working too hard, withdrawn, start speaking in an unusual way, showing more agitation than usual.
Royal College of Psychiatrists
Depression: - http://www.healthline.com/health-slideshow/top-depression-iphone-android-apps#1
OCD - e,g, live OCD free
ADHD - Due, Evernote, Clear , 30/30, MindNode, Sorted
PTSD - Mood tracker, coach
Difficulty keeping quiet; speaking out of turn
Blurting responses; poor social timing when talking to others
Often interrupting others
Mood swings - depressed / excitable
Irritability; quick temper
Inability to deal with stress
Difficulty sustaining relationships
Making rapid and facile decisions without thinking things through
Taking risks in activities, often with little, or no, regard for personal safety, or the safety of others.