Mental health continuum

P bar Y Safety Consultants

Mental Health Continuum

Do you understand the safety risks!Workplace Mental Health, Stress, and

Productivity


How many times in our career do we come across this


Just like the use of force modelThis model can help you recognize that mental and physical health occur on a continuum and that movement can happen between the di fferent categories. The model categorizes symptoms for good to poor mental and physical health on a four colour continuum: green (healthy), yellow (reacting), orange (injured) and red (ill). It lists some of the behaviours associated with each part of the continuum, from healthy adaptive coping (green), through mild and limited distress or disruption in normal function (yellow), to more severe, persistent injury or impairment (orange) and clinical illnesses and disorders that require more concentrated medical care (red). When you or someone you care about is moving towards orange, it is important to seek help early.


How may times in our career do we talk about it!


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 ContinuumMaximum

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.


Mental Health

• Defined as “The successful adaptation to stressors from the internal or external environment, evidenced by

thoughts, feelings, and behaviors that are age- appropriate and congruent with local and cultural norms.”


Holism: Five Dimensions of the Person

• The person at a development stage• 1. Physical - basic needs, healing capacity• 2. Intellectual – memory, learning• 3. Emotional – feelings, self image• 4. Spiritual – relatedness, beliefs• 5. Sociocultural – culture, relationships• Another way to define Health is the ability to

integrate all dimensions.


Mental Health

• Freud – “To work and to love”• - Occupational functioning• role as mother, wife• work outside home roles• meet requirements and expectations• - relationships• intimate• satisfying and have reciprocity


Continued:

• Can meet basic needs• Able to cope with daily stress• Can resolve conflict successfully• Positive self concept/positive way of dealing

with self: talk, cry, sports. • Capacity for empathy and social sensitivity


Mental Illness

• Defined as “Maladaptive responses to stressors from the internal or external environment,

evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual’s social, occupational, or physical functioning.”


Illness

• Symptoms get in the way of effective occupational, role and relationship functioning

• - paranoia – “People I work with are out to make me look like a fool or for me to fail.”

• - hallucinations – The voices tell the person to jump out of the window

• - low self-esteem – “I am unlovable”.


Continued:

• Suicidal thinking• Extreme anger or hostility• Delusions, hallucinations• Abuse of alcohol and drugs• Denial of problems• Inability to cope with daily activities


Continued:

• Marked personality change• Confused thinking• Prolonged mood disturbance• Excessive anxiety, fear, suspiciousness• Withdrawal from society• Abnormal self-centeredness


Myths about Mental Illness

• To be mentally ill is to be different and odd• To be healthy, a person must be logical and rational• - All of us dream “irrational” dreams every night• - “irrational” emotions are not only a universal

experience but necessary for a fulfilling life• There are people who show extremely abnormal

behavior and are mentally ill who are far more like the rest of us than different from us


Remember

• Mental health and illness • - Exist on a continuum• All people move back and forth• Not all mental illnesses are equal• It can happen to anyone


Reasons for impaired function

1. Stressors such as• -Developmental phases/Life events• - Job security• - Poverty/Economic pressures• - Crime2. Inability to cope with stressors, life changes –

Adaptation3. Genetics


Psychological Adaptation to Stress

Anxiety • Behavioral adaptation responses to anxiety

• At the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include eating,

drinking, sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they feel comfortable.


Psychological Adaptation to Stress Anxiety – caused by stress. We all have it.• A diffuse apprehension that is vague in nature

and is associated with feelings of uncertainty and helplessness.

• Extremely common in our society. • Mild anxiety is adaptive and can provide motivation for survival.



Anxiety • Peplau’s four levels of anxiety

– Mild – seldom a problem– Moderate – perceptual field diminishes– Severe – perceptual field is so diminished that

concentration centers on one detail only or on many extraneous details

– Panic – the most intense state


Psychological Adaptation to Stress Anxiety • Anxiety at the moderate to severe level that remains unresolved over an extended period of time can contribute to a number of physiological disorders – for example, migraine headaches, IBS, and cardiac arrhythmias.

• Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving – for example, anxiety disorders and somatoform disorders.



Anxiety • Extended periods of functioning at the panic

level of anxiety may result in psychotic behavior; for example, schizophrenic, schizoaffective, and delusional disorders.


Psychological Adaptation to Stress Anxiety • At the mild to moderate level, the ego

calls on defense mechanisms for protection, such as

– Denial– Displacement– Identification– Intellectualization– Projection

– Regression– Repression– Sublimation– Suppression– Undoing


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


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

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


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

Centre for Addiction and Mental Health

= =Table Wine

5 oz/142 mL (12% alcohol)

Regular Beer12 oz/341 mL (5% alcohol)

Spirits1.5 oz/43 mL (40% alcohol)


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


The Change Model

Contemplation

Pre-contemplation

Determination/Preparation

Relapse

Maintenance

Action


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)


First Aid for Depression







Ten Common Thinking Distortions

1. Black and white thinking

2. Setting unrealistic expectations

3. Selective thinking4. Converting

positives into negatives

5. Over generalizing

6. Exaggerating unpleasantness

7. Catastrophizing8. Personalizing9. Mistaking feelings

for facts10.Jumping to

negative conclusions







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.


Mind Racing?

Vision strange or blurry?

Possible sleep disturbance?

Heart racing, palpitations?

Difficulty swallowing?

Dizzy, disoriented, lightheaded?

Trembling?

Sweating or shivering?

Wanting to run?

Feeling breathless,

breathing fast & Shallow?

Nausea, lack of appetite?

Restless?

Jelly-like legs?


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







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



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



Changes in behaviour• Sleep disturbance• Social isolation or withdrawal• Reduced ability to work or carry out social

roles• Odd or strange behaviour



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 DisordersIt is believed that psychosis is caused by a

combination of factors including:• Genetics• Biochemistry• Stress


First Aid for Psychotic Disorders







Hopes• Recognize good mental health is fundamental to

the health and well-being of every individual, our organization, and our community as a whole

• Understand how to protect and intentionally improve our mental health, and know when to seek help for ourselves or someone close to us


Hopes• Access to affordable, personalized, preventive,

early identification and treatment services when and if the need arises

• Knowledge and resources to help you respond to the mental health of your employees


Hopes• Recognize where you and your staff sit on the

mental health continuum

• Believe you have the time to pause and understand the concerns that come to you

• Create conditions in the workplace that invite employee engagement and flourishing


Hopes• Partner with one another to create a culture

where we can talk about mental health and substance misuse issues in a way that results in growth of the individual, our team, and our organization


Mental health matters – without it, happiness declines, relationships suffer, productivity slips, and personal and organizational resiliency declines. Our minds dictate our level of happiness, success, productivity, and quality of our relationships. Mental health is the capacity for each of us to feel, think, and act in ways that enhance our ability to enjoy life and face challenges.


What if I told you…• I am sad• I am anxious• I can’t breathe• My husband lost his job• I’m going through a divorce• I’m worried about my daughter• My mother is dying• I was just diagnosed with diabetes / cancer /

hypertension

• I’m not sleeping well• I can’t keep up with my assignment• My daughter is addicted to drugs• I feel stressed at work• I can’t work mandatory overtime• I don’t have time to stop and eat• I don’t make a difference


What if I told you…• I can’t focus / concentrate• I feel frustrated with my co-worker• I am burned out• I am working more hours• I feel disengaged from my friends• I have depression• I don’t have resources to do my job

• I am in an abusive relationship• I made an error• I was disrespected by a co-worker• My co-worker isn’t communicating with me• I can’t work with my co-workers• I am angry• I feel under pressure


Would you help me?


Key Points

• 1 in 5 people will experience depression in the course of their lifetime, but only half seek treatment

• 25 million people suffer from some form of anxiety

• 8-12% of people misuse alcohol and drugs

• The vast majority of drug and alcohol abusers are employed


Mental Health Continuum


Occasional to Mild Stress

• All of us face stress and situational / psychological stress at times in our life

• Where do you find yourself when you look at this continuum?

• What do you call upon?


Work-related Stress• Six key areas / risk factors that can be causes of

work-related stress1. Demand of job2. Control over work3. Support receive4. Relationships at work5. Role in organization6. Change and how it’s managed


Emotional Awareness

• Education to increase awareness of both negative and positive emotions to increase– Empathy– Compassion– Self-compassion


Emotional Intelligence

• Coping skills• Resilience• Effective use of social supports• Openness• Access to mental health and wellness counseling /

coaching


Most Frequently Encountered Mental Health Illnesses

Depression– Clinical Depression– Bipolar or Manic Depressive Disorder– Postpartum Depression

Anxiety– Generalized Anxiety– Panic-Disorder– Post-Traumatic Stress Disorder (PTSD)– Obsessive Compulsive Disorder (OCD)– Phobias

Attention Deficit Disorder (ADD or ADHD)


Mental Health IllnessesDiagnostic Issues• Diagnosis can take time

Treatment Issues• Can take time to find the “right” medication• Have to be taken as prescribed• Takes 4 to 5 weeks for most antidepressants to work• Medications may need to be changed over time• Medications have side-effects• Side-effects may require accommodations


Mental Health Illnesses

Disclosure• Complex personal decision• Frequently delayed or not done due to stigma and

fear• Often delayed until problems arise• Required if accommodations are requested• Confidentiality required• Appropriate sharing with work group


Life• Gratitude• Ability to love & be

loved• Joy• Meaning• Curiosity• Zest• Perseverance

• Awe• Stress• Depression• Substance Misuse• Conflict• Change• Loss


What Gives Us Energy?

• Celebrating Gratitude• Joy• Meaning• Curiosity

• Zest• Perseverance• Awe


The Contract - A word from the ledAnd in the end we follow them –not because we are paid,not because we might see some advantage,not because of the things they have accomplished,not even because of the dreams they dreambut simply because of who they are:the man, the woman, the leader, the bossstanding up there when the wave hits the rock,passing out faith and confidence like life jackets,knowing the currents, holding the doubts,imagining the delights and terrors of every landfall:captain, pirate, and parent by turns,the bearer of our countless hopes and expectations.We give them our trust. We give them our effort.What we ask in return is that they stay true.

~ William Ayot

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Mental health continuum

Healthcare