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Supporting Youth �

The Mental Health Literacy Approach

Presented by

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© This material is under copyright.�This material cannot be altered, modified or sold.�Teens and parents are welcome to use this material for their own purposes. Health providers are welcome to use this material in their provision of health care. Educators are welcome to use this material for teaching or similar purposes. Permission for use in whole or part for any other purpose must be obtained in writing from:

https://mentalhealthliteracy.org/talk-to-us/

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Housekeeping and Expectations

Participation

Confidentiality

Topics

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Plan for Today

Explaining Mental Health Literacy

Role for those working with youth

Understanding stress, anxiety, depression, substance use and ADHD

Understanding treatment and working with parents

Boosting our mental health and resiliency

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What is mental health literacy?

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4 Components of Mental Health Literacy

Understand how to obtain & maintain good mental health

Understand & identify mental disorders & their treatments

Reduce Stigma

Enhance help-seeking efficacy

Consider:

Where have we made gains as a society/in our schools and agencies?

Where do we still need to improve?

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Reduce Stigma

Understand Disorders

Know How to Get Help

Obtain/Maintain Positive MH

Mental Health Literacy

Promotion

Prevention

Treatment/Care

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Developing Shared Literacy

Shared Mental Health Literacy

Family School Liaisons

Support Staff

Psychologists

System Leadership

Teachers

Occupational Therapists

Speech Language Pathologists

Educational Assistants

Youth Workers

Social Workers

Police

Parents

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Semantic Confusion

mental health illness

mental wellness illness

mental health condition

mental wellness

mental and social well-being

mental happiness and well-being

mental health issue

mental wholeness

mental illness

mental health

mental well-being

mental disorder

mental wholeness

mental health problem

All the words on this slide have been pulled out of academic literature and government documents to describe mental disorders. This slide demonstrates how much confusion there is around the topic of mental health and mental disorders, not only in the general public but also amongst professionals in the field.

By calling mental illness or disorder anything else – we perpetuate stigma!

E.g. of ‘mental health ‘issue’’ ….This term is very unclear. It muddies the water when everything can be referred to as a mental health issue. (e.g. a child having a tantrum at a store for not getting a candy may be having a ‘mental health issue’ but so is a person with Schizophrenia having a psychotic break…When we call both of these states a ‘mental health issue’, it obfuscates the meaning.

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The Confusion

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Pandemic Headlines

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Pandemic Headlines

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Inaccuracy of self reports�� Sadness = Depression��

Organized = OCD

Stressed = Anxiety

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Mental States

Mental Distress

Mental Health Problem

No Distress, Problem or Disorder

Mental Disorder/Illness

Mental Health

(In online delivery, it is good to cue your audience to the most important slides in case they are multitasking. Give them a ‘heads up’ for this one ☺).

This pyramid shows the various mental states where we exist. It is bigger at the bottom than the top, to demonstrate that more of us are in the bottom state than the top more of the time.

Let’s review each term.

At the bottom of the pyramid we have a state where we are doing just fine. No particular distress, problem or disorder worth mentioning.

Next is Mental Distress. (You can ask your audience if they ever experience mental distress- via poll question or just throw it out there if you like)

Mental distress is everywhere and unavoidable. Another word for this state is STRESS! It is an inevitable part of life and can spur on developing life skills and build resiliency!! (You may be asked about toxic stress from prolonged abuse and neglect, and you can clarify that here we are talking about the usual kind of everyday stressors experienced).

Example to share:

e.g.. “I lost wifi connection in the middle of delivering a presentation. This led to me experience mental distress.” (Feel free to give your own recent example of experiencing stress to connect to the audience – e.g. choose something relatable, and better yet humorous!)

Point out: Mental distress is a signal from our brain that we need to adapt to our environment, that there is a problem that we have to solve. When we solve the problem the distress goes away, and we are left with a new skill that we can use to help us solve future problems. Mental distress is necessary for growth and development. We ALL have the ability to mitigate stress and this is how we learn to problem solve and develop coping skills to manage in adulthood!

Next term is a Mental health problem – Also may arise in response to an environmental stressor, but one of significantly greater magnitude, such as loss of a loved one, loss of a job, immigration, or ….a world- wide pandemic!! When faced with such a large stressor our capacity to mitigate it may be overwhelmed for a time. This doesn’t mean there is an illness. On the contrary, what we are experiencing is an expected response to a significant stressor. Mental problems are an indicator that we are having difficulties adapting to the environment and may need external help (e.g. counselling, additional family and/or community support).

A good example of a mental health problem is grief: which is a normal response to a significant life stressor. Other examples are adjusting to life in a new country without adequate supports, or the loss of a job, divorce etc.

Note that experiencing the COVID pandemic MAY or MAY not be a mental problem for someone. For one person, it may be a very manageable stressor, perhaps leading to some mental distress, and for someone else, not really an issue at all!

At the top of the pyramid is a Mental Illness or Disorder: This is caused by a perturbation in usual brain function. (aka a disruption or hiccup in brain function.) It can sometimes occur regardless of environmental factors. Most often it is the result of a complex interaction between the environment and genetics/epigenetic factors. Worldwide, 15-20 % of the population will have a mental illness. Youth with mental disorders/illnesses need rapid access to trained professionals for proper diagnosis and proven effective treatments.

Remember that you can exist in all of these states at the same time. (Provide an example here). For example, a grade 12 student who has ADHD may be experiencing a mental problem – break up with his girlfriend that he has had since grade 10, and may be stressed about his upcoming physics final, (mental distress) and at other times he is enjoying a video game with his friends, and feeling no distress. )

It is not a continuum and you don’t have to work your way up in order. We all experience mental distress but not all of us end up developing a mental disorder.

Note that Mental Health is present in all states! Mental health is not about being happy all the time. The WHO defines Mental Health as “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.”

* Note: Someone with a well treated mental disorder may have better mental health than someone who doesn’t have a mental disorder!

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Events & adjectives on the pyramid

Depression

Grief, devastation, demoralization

Agitated, disappointed, nervous

Contemplative

Lost keys, first date, didn’t make the team

Parent dies, romantic breakup, lost job

None required

Mental Distress

Mental Health Problem

No Distress, Problem or Disorder

Mental Disorder/Illness

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Role of those working with youth

Teach & Promote

student mental health literacy

Recognize

potential problems

Refer

appropriately linking within the agency first

Support

in agency & with other professionals

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DO NOT DIAGNOSE!

-instead describe what you see

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Age of Onset of Major Disorders

This is a Cross-national comparisons of the onset of psychiatric disorders

Ask people what they notice when they look at the results from various countries.

These graphs show people who are diagnosed over their lifetime with various disorders. This shows the age of onset. Note when we identify' 50% of those that will be diagnosed (anxiety is around age 5, depression around 12, and substance abuse around 13): this "S" curve or "jump" starts at different ages, typically during adolescent years. The age of onset of mental illness is similar across the world and about 70 % of all mental disorders can be diagnosed prior to age 25 years.

The International Consortium in Psychiatric Epidemiology (ICPE) was established in 1998 by WHO to carry out cross-national comparative studies of the prevalence and correlates of mental disorders. The graphics describe the findings of ICPE surveys in seven countries in North America (Canada and USA), Latin America (Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey), using a version of the WHO Composite International Diagnostic Interview (CIDI) to generate diagnoses. The results are reported using DSM-III-R and DSM-IV criteria without diagnostic hierarchy rules for mental disorders and with hierarchy rules for substance-use disorders.

Retrospective reports suggest that mental disorders typically had early ages of onset, with estimated medians of 15 years for Anxiety Disorders, 26 years for Mood Disorders and 21 years for substance-use disorders. All three classes of disorder were positively related to a number of socioeconomic measures of disadvantage (such as low income and education, unemployed, unmarried). Analysis of retrospective age-of-onset reports suggest that lifetime prevalencies had increased in recent cohorts, but the increase was less for Anxiety Disorders than for Mood or Substance Use Disorders. Delays in seeking professional treatment were widespread, especially among early-onset cases, and only a minority of people with prevailing disorders received any treatment.

Theme Papers

Contributing ICPE authors: Laura Andrade (University of Sao Paulo, Sao Paulo, Brazil); J.J. Caraveo-Anduaga (Mexican Institute of Psychiatry, Mexico City, Mexico); Patricia Berglund (University of Michigan, Ann Arbor, MI, USA); R. Bijl (Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands); R.C. Kessler, Olga Demler, and Ellen Walters (Harvard Medical School, Boston, MA, USA); C. Kylyc¸ (Hacettepe University Medical School, Ankara, Turkey); D. Offord (Chedoke-McMaster Hospital, Hamilton, Canada); T. B.Ustun

(WHO, Geneva, Switzerland); and H-U. Wittchen (Max Planck Institute of Psychiatry, Munich, Germany). Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology. Bulletin of the World Health Organization, 2000, 78 (4):413-426

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Age of Diagnosis of Major Mental Disorders

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Why do some people develop a mental illness while others do not?

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Mental disorders

Symptom Expression

Perturbations in Usual Brain Functions

Cultural Factors

Some Signs & Symptoms but

No Disease

Environmental Influences

Genetics

Prenatal

Perinatal

Birth

Postnatal

Infancy

Childhood

Adolescence

Adult

Interaction, Correlation, Epigenetic Effects

We don't know the specific reason(s) as to why any one person gets a Mental Disorder, but we do know that it is a complex interplay between genes and environment. It is always a combination of factors.

There are sensitive periods during our development (prenatal and early childhood and adolescence etc.) where different environmental influences may have more impact. For example maternal alcohol abuse while in utero may lead to FASD, or consider a young child’s ability to learn multiple languages without an accent. When we are older we can still learn a different language, however it will take more effort as our brain is not as primed for this as when we are a young child.

Researchers are learning about Epigenetics- meaning “above/around genes” to better understand the causes of mental illness/disorder. Epigenetics means that the environment can shape how your genes are expressed. For example: good food or good sleep may influence genes to turn on or turn off, thus affecting how they make proteins which then may impact different aspects of human emotions, cognition and behaviour. In some cases, these impacts may leave markers on your genes which may be passed on to the next generation. These can be positive or negative effects and they can be demonstrated in studies with rats and mice to "echo" or continue into future generations. Not every environmental impact is "echoed” in future generations and much work remains to be done to understand this process fully. Therefore, it is important to understand that this impact MAY occur, but it is not useful to identify any current situation and assume that this impact did occur. For example, because a student becomes depressed, it does not mean that the Depression is a result of some past historical event. Some people may have some signs or symptoms without a full disorder (mental health problems). For example: sadness without clinical Depression while others may develop a full blown illness.

All symptom expression happens in a culture that can influence the impact or outcomes or even the types of commonly expressed symptoms themselves. Examples may be of youth being identified with ADHD in traditional classroom settings but a youth who has the same symptoms in a hunter gathering setting may not be impacted. Another example is Social Anxiety Disorder. For a student from the dominant North American low context culture, they may worry about embarrassing themselves in front of other students. For a student with Social Anxiety Disorder from a high context culture (such as from Asia), that student may worry more about bringing shame upon their family.

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What makes it challenging to identify a youth who may be struggling?

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Identification may be difficult in the school/agency setting...

The “presentation” of the illness may be different at different times

If a youth is using drugs or alcohol the effects of those substances can be confusing

Sometimes the youth is not well known to the staff person

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How can I tell if there is need for further assessment?

Start with a good understanding about mental disorders & range of normal negative states

Critical consideration of the “weight of evidence”

Collaborate with others- teachers, parents, support staff, etc..

Differentiate: crisis; urgent; non-urgent

You may need to engage in watchful waiting

Consider all available sources of information

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Identification Keys

History: Previous significant mental health problems or a mental disorder (including family history if known)

Significant change in mood, cognition or behaviour? Is there a known diagnosis already? (e.g. ADHD)

Are the problems causing distress to them or others? Is there a lack of social convention?

Noticeable decrease in functioning: social, academic, other?

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Identification Keys continued

Substantial and unexplained major changes in peer group participation?

Are parents or others raising concerns?

Does a close friend have a mental disorder or a major mental health problem?

Has there been a recent head injury (concussion)?

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Functions of the brain

Perception / Sensing

Thinking/Cognition

Emotion/Feeling

Signalling (being responsive & reacting to the environment

Physical/ Somatic

Behaviour

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Mental Disorders: Symptoms + Impairment

Time

Intensity

Symptoms

Impairment

Disorder

Prodrome

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Key Takeaways!

70% of mental disorders are identified between the ages of 12 and 25

Generally affect about 20% of youth but MH care is underfunded and underserved

Importance of early identification and treatment

Most experience good outcomes with treatment

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Mental Disorders: Stigma Busters!

Myth	Fact
People with mental illness don’t get better	With early identification and proper treatment, substantial improvement and success is likely
Poverty causes mental illness	Poverty does not cause mental illness but it can have negative impact on outcomes
People with mental illness are violent	People with mental illness are more likely to be victims than perpetrators of violence
Mental illness is a weakness of character or the result of bad parenting	MI is the result of complex factors including genes and environment

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Brain Growth & Development

Significant brain growth and development occurs during adolescence and continues into the twenties.

Some studies show that this growth and development extends to the age of 30!

Our brain is always changing and evolving, even from the beginning of this training to the end!

Highlight: There are key times of development however and adolescence is one of these times. Significant growth and development extends longer than was first thought however! This may take even longer in men than in women.

The brain is never fully developed because it is constantly reshaping to meet the demands of everyday life, as well as being shaped in part by its current environment. There is a complex and continuing bi-directional interaction between brain development and environment that persists across the life span.

During adolescent years, brain circuits become better functioning and efficient

Rapid brain development occurs.

Drugs, alcohol, and head injuries can disrupt development. Nevertheless, the brain is surprisingly resilient.

Cannot predict for any individual how environment or genetics will affect the brain.

We do know that good social relationships help improve growth and development.

You may wish to show this video: https://youtu.be/EGdlpaWi3rc

(teen brain upgrade).

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“Adolescence is a period of rapid changes.

Between the ages of 12 and 17, for example, a parent ages as much as 20 years!”

Author Unknown

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Proliferation of grey matter through development

1. This image shows the brain developing over time (age 5 to age 20). The purple colour represents areas of high connection (meaning high development) and red is low connection (low development).

Ask the audience what they notice in the images.

2. The brain develops from the back to front (generally) and the brain is not completely developed until later in life. The final section of the brain to mature is the prefrontal cortex which is responsible for “higher-order” functions of cognition such as complex problem solving and moral reasoning. Linking of different brain areas (such as the limbic system and prefrontal cortex discussed above) also improves during these years (these linkages are not shown on this slide as they are what is called “white matter”) and this results in better brain function. Researchers suggest that a mismatch of maturation timing between the limbic system (maturation often in early adolescence) and the still developing prefrontal cortex is what makes adolescents more prone to risk-taking behaviours, but also promotes creativity and more flexible adaptation to their environment.

Highlight: The teen brain may be comparable in size but is different from the adult brain!

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Mental Disorders

Perception Sensing

Thinking Cognition

Emotion Feeling

Signaling

Physical Somatic

Mental Disorders are associated with disturbances in 6 primary domains of brain function:

Behaviour

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Emotions and Moods – what am I feeling inside?

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Most mood symptoms are normal

Everyday life gives rise to numerous negative emotional states: sadness; unhappiness; disgruntlement; disappointment; demoralization; etc. This is NOT Depression

Everyday life can also lead to emotional states of elation; joy; irritability; anger, etc. This is NOT Mania

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Normal Mood Graph

+

-

Normal Baseline Mood

Normal Range & Intensity of Mood

Transient shift toward (-) pole consequent of (-) life events

Transient shift toward (+) pole consequent of (+) life events

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A Baseline Shift To The Negative Pole -Depression

+

-

Normal Baseline Mood

Normal Range & Intensity of Mood

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Depression: What to look for

Loss of interest in usual life activities

Loss of pleasure in those things usually found to be pleasurable

Decreased functioning at home at work/school

– poor concentration

Thoughts of death/suicide or preparation for death

Withdrawal from family or peers/friends

A change from baseline behaviour

Difficult to explain frequent & persistent physical complaints (headaches; stomach aches; fatigue; etc.)

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Depression: What to do

Highly treatable (medications and evidence based psychological therapies)

Performance expectations may need to be modified due to effects on motivation and cognition

Mood enhancing activities should be implemented (e.g. ‘Taking charge of your health’ resource)

Be aware of suicide risk – discuss with health providers what the role of youth support staff should be in each individual’s case. Collaboration with consents

Develop a crisis plan

Importance of family engagement

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Depression: Additional Concerns

Always ask about suicidal thoughts and suicide plans and refer to a qualified professional for assessment

Substance abuse is often found

with depression

CAUTION

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Persistent Self-harm (NSSI)

Has complex “causes” Helpful to reframe as an unhelpful method to address ongoing problems in life: get specialty mental health team assistance

Behaviour that can occur by itself or in the context of another mental disorder -numerous complex “causes”

Do not agree to keep it “secret”

Usually requires complex treatment strategies (including: CBT; DBT; medications; etc.)

Aim for consistent messaging and communication amongst care providers

Can be an attempt to seek professional assistance in difficult life situation

Often secretive or “shared” in sub-groups

“Contagion” -vulnerable youth can be influenced to try this maladaptive coping technique by others

Behaviour that can occur by itself or in the context of another mental disorder -numerous complex “causes”

Often secretive or “shared” in sub-groups
Has complex “causes” Helpful to reframe as an unhelpful method to address ongoing problems in life: get specialty mental health team assistance

Can be an attempt to seek professional assistance in difficult life situation

NSSI stands for Non suicidal self injury. When someone self-injures, they do not intend to die. Young people who self-injure may do so as a method to cope with stress– hurting themselves is often seen as a way to control their upsetting feelings. Others do so to dissociate from their problems (e.g. to distract themselves from emotional pain). Research suggests that self-injury can activate different chemicals in the brain which relieve emotional turmoil for a short period of time.

Self-harming teens need assistance to learn more effective ways to deal with their emotions and solve life problems. Aim to connect the student to professional assistance.

Please don’t call these students “cutters”! ”. *DO NOT bring in a guest speaker to talk about self harming as this can be triggering!

Be familiar with your agency’s protocol for responding to NSSI.

Additional info:

http://teenmentalhealth.org/understanding-self-injury-self-harm/

http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/FFF-Guide/Self-Injury-In-Adolescents-073.aspx

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Healthy Signaling

DANGER!!!!

Prepared to FIGHT, FLEE

or FREEZE!

Initiation of physiologic cascade

Increased heart rate, alertness, perception, tension

Sensory Perception + Internal Signals

Brain Registers Danger!

Signaling is part of the brain system.

What we have on this slide is a visual representation of the Sympathetic Nervous System Cascade…it’s instant.

Danger happens!
We sense the danger
Brain registers DANGER
Our body initiates the cascade of signals and circuits to make us respond instantly for survival:
We go into fight flight freeze response

When you’re in danger, your body’s natural reaction is to rapidly initiate the fight-or-flight response. This brain response occurs immediately when someone senses danger and it activates many brain areas that are designed to protect you from that danger by preparing you to “fight” the danger or to escape from it (i.e., “flight”).

As part of this response, the brain triggers the release of adrenaline and other hormones throughout your body, so you can respond to the threat. This protective mechanism is called the fight-or-flight response and it helps us to survive. Your emotional and physical responses during fight-or-flight can be described as high arousal to fight or take flight

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Anxiety

No Danger

Initiation of physiologic cascade

Increased heart rate, alertness, perception, tension

Sensory Perception + Internal Signals

Brain Registers Danger!

ANXIETY

!

We often use signaling, the stress response and anxiety interchangeably which is not very helpful and can cause confusion. Often, we just lump them under the category of “stress”, without noting whether the condition is acute or chronic (the impact is different) or whether the condition is “positive”, “tolerable” or “toxic” We also often use the word “anxiety” to mean a stress-response created by something in the environment that is not likely to be harmful. We can differentiate this concept of arousal or stress as healthy and resilience building or as negative and resilience impeding. This depends on how we think about and act in response to the anxiety (or stress – response) signal.

Anxiety Disorders – are persistent, excessive, inappropriate, cause impairment and lead to dysfunctional coping such as withdrawal and avoidance. The good news about anxiety disorders is that they are treatable! People can make tremendous progress in learning to manage their anxiety in healthy ways.

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Typical stress response

Situation or Trigger

Examples: first date

preparing for exam

performing at a concert

giving a speech

moving from home

climbing a tall ladder

Outcome

Transient; drives adaptation to the stressor and when successful results in learning of new skills – the person becomes more resilient

Stress Response

Apprehension

Tension

Edginess

Nausea

Sweating

Trembling

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Anxiety

Examples: first date

preparing for exam

performing at a concert

giving a speech

moving from home

climbing a tall ladder

Situation or Trigger

Stress Response

Apprehension

Tension

Edginess

Nausea

Sweating

Trembling

Outcome

Persistent, excessive, out of proportion.

Causes impairment

High Intensity

Leads to dysfunctional coping

-withdrawal

-avoidance

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Inverted U-shaped relationships between arousal & performance

Performance

Good

Poor

Emotional Arousal

Low

(Under aroused)

Moderate

(Optimally aroused)

High

(Over aroused)

Maximum Performance

Hebb, D.O. (1955). Psychological Review, 62, 243-254

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Exposure Curve

Time

Arousal

Stimulus

exposure

1st exp. with avoidance

2nd exp. with avoidance

habituation

3rd exp. without avoidance

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Arousal

High

Low

First Exposure

Exposure after avoidance

Exposure after practice

Time

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Types of Stress

Positive Stress

Tolerable Stress

Toxic Stress

Relatively brief, leads to adaptation and learning, does include negative emotional, physical, behavioral and cognitive states. Occurs daily

Prolonged; extreme – physical/sexual abuse; chronic neglect, violence; caretaker mental illness/substance abuse – without adequate adult support (complex outcomes). Occurs acutely or chronically

Serious impact, temporary, buffered by supportive relationships. Occurs across lifetime

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Three things to do: The curve

Stress Response

High

Low

Time

1

2

3

Stress Response Curve

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Helpful	Not Helpful
1. Identify and correct any thought distortions (Cognitive attribution)	“Turn in” & isolate
2. Consider how to solve the problem. (Problem solving) Consult with others & be proactive	Focus only on modulation of the stress response while ignoring the other approaches
3. Modulate the apex of the stress response. Use simple & effective breath-holding & “centering”, progressive muscle relaxation techniques	AVOID
Understand the Stress Response, its purpose and its various levels	Provide only one stress management technique
Interpret the stress response as positive, not negative. i.e. a challenge to be faced; a problem to be solved	Pathologize stress

Managing the stress response & signaling

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Video

https://www.youtube.com/watch?v=jHjkEfwfECo&t=20s

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Mental Disorders of Signaling: The anxiety disorders

Now that we have reviewed signaling and how to understand anxious coping, let’s now focus on Anxiety Disorders.

What is anxiety?

Anxiety is an overused term! It usually describes a normal feeling people experience when faced with threat or danger, or when stressed.

When people become anxious, they typically feel upset, uncomfortable and tense and may experience many physical symptoms such as stomach upset, shaking, headaches, etc.

Feelings of anxiety are caused by experiences of life, such as a new relationship, a new job or school, illness, accident, etc. Feeling anxious is appropriate in these situations and usually we feel anxious for only a limited time. These feelings are not regarded as clinical anxiety, but are a part of everyday life.

What are anxiety disorders?

The anxiety disorders are a group of illnesses characterized by persistent feelings of intense anxiety. There are feelings of continual or extreme discomfort and tension, and may include panic attacks.
People are likely to be diagnosed with an anxiety disorder when their level of anxiety and feelings of panic are so extreme that they significantly interfere with daily life and stop them from doing what they want to do. This is what characterizes an anxiety disorder as more than normal feelings of anxiety.
Anxiety disorders affect the way the person thinks, feels and behaves and, if not treated, cause considerable suffering and distress. They often begin in adolescence or early adulthood and may sometimes be triggered by significant stressful events.
Anxiety disorders are common and may affect one in twenty people at any given time.
All anxiety disorders are characterized by heightened anxiety or panic leading to significant problems in functioning in everyday life.

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Generalized Anxiety Disorder

Approximately 1% of young people

Worrying about many things, much more than other people seem to worry and seeking constant reassurance

Having trouble “letting go” of the worry

Usually seeming tense or “on edge”

Worrying with such intensity that it interferes with enjoying life or doing activities that they would like to participate in

Persistent physical symptoms that cause distress but for which there is no good medical explanation.

(headaches; stomach aches; pain; etc.

Generalized Anxiety Disorder (GAD) is a disruption in how your brain controls the signals it uses to identify danger and initiate action to help you avoid it. In GAD, this signaling mechanism does not work as it should and you experience the danger signal when there is no danger or relatively little danger in proportion to the reaction. Note that the physical symptoms expressed are related to the heightened physiological response.

GAD is excessive anxiety and worry about everyday events that occurs over a prolonged period of time.

Someone with GAD worries excessively about many different things and is not able to control his or her worry. They are Masterful Worriers

The worrying and anxiety causes serious emotional distress, and causes problems at school, at work, and in relationships.

These feelings of anxiety usually also have physical components, including headaches, aches and pains, nausea, shaking and sweating.

Feeling anxious in response to danger or in new situations is a perfectly normal response. It’s called the fight-or-flight response and helps us survive in dangerous situations. But these typical feelings are different from GAD. A person with GAD constantly feels tense and on edge, even when there is no danger present.

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Social Anxiety Disorder

Leads to restricted or poorly tolerated daily activities

Significant fear or anxiety about social situations where they may be judged

Fear is intense, out of proportion to the actual threat, persistent, and pervasive

Approximately 4% of 14 to 25 year olds

Presentations or performances and social interactions trigger this

Social Anxiety Disorder is when certain social or performance situations (e.g., meeting new people or giving a speech) are avoided due to substantial fear of being judged or embarrassed in front of other people.

When exposed to a social situation, someone with Social Anxiety Disorder is so afraid of being negatively evaluated or judged that it significantly interferes with their ability to live a normal life.

This can lead to avoiding everyday social situations, like going shopping, speaking up in class, using a public bathroom, or participating in gym class.

It is perfectly acceptable to be anxious occasionally during social situations. This type of anxiety often helps us prepare for that situation.

For example: practicing a speech before giving it in class; making sure you have enough money before going out on a date; etc.

However, usual, expected, and normal social situations almost always provoke fear or anxiety in individuals with Social Anxiety Disorder. This fear or anxiety is way out of proportion to the situation. Someone with Social Anxiety Disorder often knows that his or her fears are unreasonable and that other people don’t feel the same way. This can make them feel really alone and think that no one else can understand how they feel, which can lead to feelings of loneliness or sadness.

For 75% of people with Social Anxiety Disorder, it began when they were between 8 and 15 years old. Social Anxiety Disorder is thought to be caused by a combination of genetics, the environment, and learning.

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Panic Attacks

Time in Minutes

0

5

10

Feelings of Panic

“Am I going crazy?!”

“Am I going to DIE?!”

Common Symptoms:

Heart pounding, sweating, trembling, ‘air hunger’, smothering chest pain, stomach pain, nausea, dizziness, tingling, numbness of feet & hands, feeling flushed, or feeling chilled

Sometimes panic can occur “out of the blue”, when you’re not in any danger.

These panic episodes are called panic attacks. Because you’re not in any danger, these panic attacks aren’t useful; and in fact, they can cause significant problems.

If someone experiences many panic attacks, they often begin to worry about having another panic attack and the anticipation causes them to feel even more anxiety. Sometimes this worry becomes so strong that they will avoid going to places where a panic attack might happen. For some people, this may severely limit where they feel comfortable going (such as: school, the mall, driving on the highway, etc.), resulting in another mental disorder called Agoraphobia.

Panic attacks are common – they happen. Most people will experience a few over the course of their lifetime. This doesn’t indicate a mental illness. Chronic repeated panic attacks however may lead to Panic Disorder, which may meet the threshold for a mental illness.

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Panic Disorder

Avoidance of difficult-to-escape-from situations (Agoraphobia)

Approximately 2% of 15 to 24 year olds

Fear of future panic attacks (anticipatory anxiety)

Recurrent panic attacks with no obvious cause

Usually starts in late adolescence or early adulthood

Panic Disorder occurs when people suffer from sudden, unexpected and uncontrollable panic attacks.

These panic attacks aren’t caused by any obvious fear (e.g., having a panic attack because you’re afraid of heights and on top of a ladder or if you’re afraid of flying and about to board a plane).
People with Panic Disorder experience anticipatory anxiety (worrying about having another attack or the consequences of having another attack) and avoid going to places where a panic attack might happen.

Not all people who have panic attacks have Panic Disorder. Panic attacks can occur in many different Anxiety Disorders and also in people who don’t have an Anxiety Disorder at all. In Panic Disorder, the panic attacks occur without any obvious reason. In other Anxiety Disorders (e.g., Social Anxiety Disorder), the panic attacks are triggered only by feared situations or thoughts (e.g. being in certain social situations).

In any one-year period, about 2-3 percent of people will have Panic Disorder. Although anyone can develop Panic Disorder, rates are higher among family members of people with Panic Disorder or other anxiety disorders.

Panic attacks may begin in childhood or the early teen years, although Panic Disorder usually begins in late adolescence or early adulthood.

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Anxiety Disorders if left untreated...

Substance use disorders or substance misuse (alcohol, nicotine)

Functional impairment: social; vocational

Depression

N.B. Effective Treatment of Anxiety Disorders is a solid example of secondary prevention!

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Anxiety Disorders: Treatment

Often can be effectively treated in primary care (family doctor)

Psychological treatments such as CBT are effective and considered to be first line treatments

Medications such as some SSRI’s can be helpful – often necessary in some severe cases

Treatment usually takes 8 – 10 weeks before a substantial improvement takes place. Large placebo response

Make sure that accommodations for Anxiety Disorders do not interfere with interventions designed to treat anxiety disorder (i.e. be certain that accommodation does not become avoidance)

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Bulimia

Anorexia

Rare but powerful emotional impact and may have very serious consequences -death

Severe weight loss; associated physical symptoms; severely distorted body image; “phobic” about food

Approximately 0.4% of women

Much more common and more hidden than Anorexia Nervosa

Cycles of excessive, rapid eating (binging) often followed by purging (self-induced vomiting or laxatives)

Often self-harming behaviours accompany this disorder

Often associated with multiple “weight control” activities

Typically starts in adolescence

Differentiate from population variance in eating behaviours, including “teen” dietary chaos, fad diets, etc.
10x as common in women as in men; Typically starts in adolescence

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Anorexia

Rare but powerful emotional impact & may have very serious health consequences –can be fatal

Prevalence of about 0.4% of women

Severe weight loss; associated physical symptoms; severely distorted body image; “phobic” about food

Often associated with multiple “weight control” activities

Typically starts in adolescence

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With eating disorders...

Critical to differentiate from population variance in eating behaviours, including “teen” dietary chaos, fad diets, etc.

10x as common in women as in men

Can be very challenging to treat

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Treatment of Eating Disorders

Usually require specialty mental health services

Psychological treatments considered to be first line treatments. Family therapy important.

Medications can be helpful for some BN

12 weeks +before a substantial improvement. Hospitalization may be needed

Secrecy and avoidance of treatment recommendations are common

Self-harm behaviours should be communicated to treatment team

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Eating Disorders: What to do

Raise concerns about health of the youth

Inform them that help is available

Refer to health care provider

Do not become involved in power struggles over food or “preaching” about healthy eating

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Attention Deficit Hyperactivity Disorder

Onset before age twelve

Three Major Domains:

Attention

Hyperactivity

Impulsivity

Functional impairment in multiple domains

A disorder of executive functioning

Attention Deficit Hyperactivity Disorder is the most commonly diagnosed behavioural disorder of childhood. In any six-month period, ADHD affects an estimated 4 -6 % of young people between the ages of 9 and 17. Boys are two to three times more likely than girls to develop ADHD. Although ADHD is usually associated with children, the disorder can persist into adulthood. Children and adults with ADHD are easily distracted by sights and sounds and other features of their environment, cannot concentrate for long periods of time, are restless and impulsive, or have a tendency to daydream and be slow to complete tasks

Symptoms

The three predominant symptoms of ADHD are 1) inability to regulate activity level (hyperactivity); 2) inability to attend to tasks (inattention); and 3) impulsivity, or inability to inhibit behaviour.

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Attention Deficit Hyperactivity Disorder

ADHD

It is a disorder of executive functioning

Onset before 12 years of age

Impacts three major domains:

Attention, Hyperactivity & Impulsivity

Oppositionality is NOT a feature of the disorder & and it can have significant impacts

Approximately 3-7% of school-aged children and adolescents

Common signs and symptoms include varying degrees of the following:

Poor concentration and brief attention span
Increased activity - always on the go
Impulsive - doesn't stop to think
Social and relationship problems
Fearless and takes undue risks
Poor coordination
Sleep problems
Normal or high intelligence but under perform at school

ADHD is a neurodevelopmental disorder, which means that it’s a disorder caused by problems in the growth or development of the brain. This is why some children may “grow out” of ADHD. Their brain growth and development improves. What causes these problems? From what we understand today, ADHD has an important genetic component. It tends to run in families, which means that the immediate family members of someone with ADHD are much more likely to also have ADHD than the general population. Environmental factors may also play a role. Of particular concern are those that impact brain growth and development in the womb, during birth or in early childhood. A person’s environment can also influence the extent to which ADHD causes problems in his or her life.

ADHD is diagnosed more often in boys than girls. Girls with ADHD are more likely to have difficulty paying attention, but they often don’t demonstrate as much hyperactivity as boys. Girls who have trouble paying attention often daydream, whereas inattentive boys are more likely to move around constantly or fiddle aimlessly.

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ADHD: What to do

Participate in assessment & treatment protocols with health care providers

Provide access to useful information about ADHD and its treatments

Encourage strength-based interventions and approach

Always assess for presence of a learning disability

Family liaison role is important

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ADHD: Treatment

Often can be effectively treated in primary care & school participation in assessment of treatment very helpful

Effective treatments improve outcomes, when they are maintained– some students will improve with age & as their brains mature –decrease risk for substance abuse

Medications are usually necessary: psychostimulants and others

Treatment response usually evident within one week (psychostimulants) versus 2 -4 weeks with other medications

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How to think about treatment: Use of best available evidence

Standard treatments –have been scientifically demonstrated to show significant positive effects in a specific disorder (for example: SSRI medicine in adolescent depression; CBT in social anxiety disorder, etc.).

Complementary treatments – interventions that may help specific treatments work more effectively but are not likely to be effective on their own, OR bring added value, such as: exercise; nutrition; specific social interactions; etc.

Alternative treatments – interventions that take the place of specific treatments but without the evidence needed to consider them to be specific treatments.

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What are treatments expected to do?

Improve the symptoms that the person is suffering from

Improve the person’s ability to function at home; at work; with friends; etc.

Stop the disorder from coming back

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Evidence is Hierarchical

Randomized controlled trials

Prospective cohort

or case-control studies

Retrospective cohort or case-control studies

Case Series or studies with no controls

Expert opinions without explicit critical appraisal

Quality of Evidence

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Positive Treatment Effect

Time

Depression

Positive Treatment Effect

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Substance use and abuse

What may prompt a youth to use substances?

What concerns are you hearing in your community?

How is substance use talked about/addressed in your setting?

What do youth learn about substance use and misuse?

What do you want to learn?

Encourage discussion here

Youth may use substances for many of the following:

•Curiosity/Fun seeking/Excitement - substance use is common in our culture and media. It is often portrayed as really fun and something that enhances many other activities.

•Euphoria – it feels good.

•Peer pressure (Influence)- It is hard for us to say no to our friends or to go against the crowd. That’s why youth benefit from developing refusal skills.

•To look more mature and assert independence – substance use gives adolescents a way to demonstrate that they are not children anymore, they are adults who can engage in what is typically considered adult behavior. To do something they have been told they shouldn’t do… To feel the excitement associated with taking a risk.

•Self-medication- using substances to try to feel better or treat symptoms, like smoking marijuana or drinking to lessen anxious feelings .

•Escape problems/Fill gaps/Cover feelings- substance use is one way that we can dampen unpleasant feelings and avoid dealing with problems.

•Expansion – use allows the young person to look at/understand things from a different perspective.

•Lack of positive coping skills- this is linked to using drugs to escape or cover feelings. If youth don’t have healthy coping skills, like being able to talk about feelings for example, then they may decide to use substances to try to cope with feelings by numbing them or avoiding them. Just think about how common it is in our culture to associate drinking with dealing with a stressful situation.

•Family or community norms - if a young person’s family uses substances or it’s normal in their community, they are more likely to use substances too. This is the behavior that has been modeled for the youth, and in that household substances are more accessible. “So I won’t feel left out”

•Routine – use because a person is bored, or out of habit

•Availability/acceptability: For example, in light of legalization/pending legalization, less concern is being expressed about cannabis use as harmful or problematic.

Conclusion:

It is important to remember that young people use for a reason. From their perspective, there is a positive aspect to substance use. It is important to help them figure out and understand why they are using. It is also important to have conversations for parents and professionals to have conversations with youth about making healthy choices early on (1).

Sources:

(1) Alberta Health Services. (2009). Parent information series: How do I talk to my teenager about drugs? Retrieved from http://www.albertahealthservices.ca/assets/healthinfo/AddictionsSubstanceAbuse/if-par-parent-info-series-3-5.pdf

(2) George, T., & Vaccarino, F. (Eds.). (2015). Substance abuse in Canada: The effects of cannabis use during adolescence. Ottawa, ON: Canadian Centre on Substance Abuse. Retrieved from http://www.ccsa.ca/Resource%20Library/CCSA-Effects-of-Cannabis-Use-during-Adolescence-Report-2015-en.pdf

Other points to bring into the conversation:

Adolescence is a time of impulsivity

Use during teenage years is one of the best predictors of use in later life

The brain doesn’t know what is legal

Health messages don’t usually land with youth

A harm reduction model is recommended

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Terms: Words Matter!

Non-Use

Misuse

Social Use

Addiction/

Dependency

Problem Use/Abuse

Language matters. When we talk about medicine, use the words medicine. Don’t call Tylenol “drugs” or reinforce the conflation of medicine and drugs.

When talking about drugs, use the word drugs.

Substance use can be viewed along a continuum.

•Different models of this same continuum can use different words that generally expand on/mean the same thing as the terms above. “Experimental use” can be placed between non-use and social-use.

•Social use can also be called recreational use.

•Misuse and problem use can be termed “harmfully involved”. Dependency can be called addiction.

•Regardless of the terminology, we all start in a place of non-use, and any type of use puts us on the continuum. Generally speaking, moving to the right suggests increased amounts used at greater frequency, with more negative consequences as a result. People can move back and forth along the continuum, or stay in one spot, at different times in their life (1).

Some people may be aware that their substance use causes problems but continue to use, even when they want to stop. They may use more than they intended, or in situations where they didn’t want to use. Some people may not see that their substance use is out of control and is causing problems. Whether people realize it or not, lack of control is another sign that substance use is a problem (2).

Some teens become dependent on or addicted to alcohol or other drugs.

•At this stage, their body is physically adapted to the presence of the drug, and they might need it to feel normal. When they quit drinking or using, they often experience hangovers/withdrawal that can range from quite mild to very severe. It’s also possible to develop “psychological dependence” on the drug, meaning that the users think they function better when they are high or that they need a drink to face certain situations or people. When teens are dependent, they typically benefit from help to stop using (1).

The harms of substance use can affect every aspect of a person’s life.

They include:

•injuries while under the influence

•feelings of anxiety, irritability or depression

•trouble thinking clearly

•blackouts

•problems with relationships

•spending money on substances rather than on food, rent or other essentials

•legal problems related to substance use

•loss of hope, feelings of emptiness (2).

Conclusion:

•DSM V: Substance Use Disorder Criteria is discussed on the next slide..

** Speaker notes directly taken from resources:

(1)Alberta Health Services. (2009). Parent information series: How bad is my teen’s drinking or drug use? Retrieved from http://www.albertahealthservices.ca/assets/healthinfo/AddictionsSubstanceAbuse/if-par-parent-info-series-4-2.pdf

(2)CAMH (2010). Addiction. Retrieved from: http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/drug-use-addiction/Pages/addiction.aspx

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Substance Use Disorder

•Taking more/for longer than intended

•Wanting to cut down/quit, but can’t

•Time spent (obtaining, using, recovering)

•Craving

•Repeatedly unable to carry out major obligations

•Using despite problems (social, interpersonal, physical, psychological)

•Stopping/reducing important social, occupational, recreational activities

•Using in physically hazardous situations

•Tolerance

•Withdrawal

According to the DSM V, a minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, while 4-5 is moderate, and 6-7 is severe.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Retrieved from: https://www.buppractice.com/node/12351

The Diagnostic Statistical Manual (DSM V) identifies how substance use disorder diagnosis is made. Substance use disorder can be mild, moderate or severe.

According to the DSM V, a minimum of 2-3 criteria is required for a mild substance use disorder diagnosis, while 4-5 is moderate, and 6-7 is severe.

Criteria:

•Taking the substance in larger amounts and for longer than intended

•Wanting to cut down or quit but not being able to do it

•Spending a lot of time obtaining the substance

•Craving or a strong desire to use the substance

•Repeatedly unable to carry out major obligations at work, school, or home due to substance use

•Consistent use of substances despite acknowledgment of persistent or recurrent physical or psychological difficulties from using substances, including social or interpersonal problems caused or made worse by substance use

•Stopping or reducing important social, occupational, or recreational activities due to substance use

•Recurrent use of substances in physically hazardous situations (ex. while driving)

•*Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount. (Does not apply for diminished effect when used appropriately under medical supervision)

•*Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal (Does not apply when used appropriately under medical supervision)(1)

Conclusion:

These criteria are a good list of those symptoms that people might see that suggest problematic use. Seeing these in a student/young person should cause concern.

(1) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Retrieved from: https://www.buppractice.com/node/12351

I

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What is Addiction?

Essential Criteria For Drug Addiction: The ABCs of Addiction

Abuse of Intended Use: Use for non therapeutic purposes

Dysfunctional Behaviour: Presence of typical drug seeking behaviours / neglect of responsibilities / Use despite negative personal, vocational, legal consequences

Craving induced by the substance

A=

B=

C=

People are most likely to begin abusing drugs*—including tobacco, alcohol, and illegal and prescription drugs—during adolescence and young adulthood

By the time they are seniors, almost 70 percent of high school students will have tried alcohol, half will have taken an illegal drug, nearly 40 percent will have smoked a cigarette, and more than 20 percent will have used a prescription drug for a non-medical purpose.¹ There are many reasons adolescents use these substances, including the desire for new experiences, an attempt to deal with problems or perform better in school, and simple peer pressure. Adolescents are “biologically wired” to seek new experiences and take risks, as well as to carve out their own identity.

Trying drugs may fulfill all of these normal developmental drives, but in an unhealthy way that can have very serious long-term consequences. Most teens do not escalate from trying drugs to developing an addiction or other substance use disorders.

https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/introduction

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Adolescent Alcohol & Substance Use Screen (CRAFFT)

C- Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?

R- Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?

A- Do you ever use alcohol/drugs while you are by yourself, ALONE?

F- Do you ever FORGET things you did while using alcohol or drugs?

F- Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?

T- Have you gotten into TROUBLE while you were using alcohol or drugs?

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Consider MLA’s (Major Life Areas)

The key word is: Change

School/Work

Health (mental and physical, spirituality, purpose)

Recreation/ Fun

Legal

Finances/means

Relationships (family, friends, dating)

Consider physical environment and supervision/monitoring as well. (Consider the time between 4 and 7 pm)

Impact on MLAs for youth is different than how substance use impacts MLAs in adults.

For youth, they usually do not have the money/means for alcohol or drugs so may take it from their parents or get involved in other illicit activity.

Cannabis use is much higher in youth than tobacco use, which surprises some adults.

Lectures on negative impacts on their health is not usually meaningful.

The key word is “change” – changes in performance, behaviour and friends. Keep in mind that these changes could be due to other reasons. No one sign alone indicates drug use. Look for patterns or combinations of indicators. Trust yourself to know when there is a problem.

Possible changes to watch for include

· changes in school performance

· changes in attitudes toward sports and other activities

· changes in weight or physical appearance

· changes in eating or sleeping habits

· changes in friends

· changes in behaviour

We encourage parents to consider a young person’s Major Life Area’s (MLA). MLA’s are an area in someone's life that can be positively or negatively impacted by the choices they make. There are 8 MLA’s that we consider when making decisions that will not only impact you, but other’s in your life:

-Family

-School/Work

-Health and Fitness

-Social/Fun

-Friends/Dating

-Life purpose/Spirituality/Religion

-Physical Environment

-Future Plans

•By taking a look at how something is impacting someone’s Major Life Areas (MLAs), we are able to develop a clearer picture of whether or not there is a problem.

•There is no clear “formula” approach to determine whether or not someone is abusing a substance or experiencing problematic use

•A level of use that one person is able to participate in without significant problems may be unmanageable for another person

•

Conclusion

Trust your instincts. Seeing change in a young person’s MLA’s is a sign that something is going on that they are having difficulty managing. Always consider adolescent development before making assumptions. Most importantly, if you are concerned, have a conversation with them!

Speaker notes directly from resource. Some changes made to reflect adolescents.

(1)Alberta Health Services. (2009). Parent information series: How do I know if my teen is using drugs? Retrieved from http://www.albertahealthservices.ca/assets/healthinfo/AddictionsSubstanceAbuse/if-par-parent-info-series-3-4.pdf

(2)Image: https://charlesstone.com/when-ministry-overwhelms-this-tool-can-help/

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Substance Abuse: Treatment

Usually requires concurrent mental health treatment – inpatient or outpatient

Psychosocial interventions most commonly used – with medications if there is a concurrent mental disorder that is known to respond to medication

Treatment centers would include a school component

Substance use treatment needs to be individualized. Wrap around approach is best (parents, school staff, community)

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Key Takeaways

Be willing to look beyond the obvious signs and symptoms with students

View Oppositional behaviour as a sign they need help

‘Kids do well if they can do well’

Be proactive as much as possible.

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The Big 5 to Thrive!

Exercise

Sufficient Sleep

Positive supportive relationships

Healthy nutrition (& no substance abuse)

Helping Others

A good routine helps too!!

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Acting on your Concerns: Identification; Triage; Support; Referral; more Support

Know your agency’s policies and protocols around confidentiality/ how and when to contact caregivers etc.

Have referral places and resources ready for both children and families

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Working with Parents

Don’t wait for a problem to start a relationship

�

Don’t go it alone

Don't assume the worst

Source: Center for the Advancement of Mental Health Practices in Schools. Effective Communication with Parents

Three important “Don’ts”:

#1: Don’t wait for a problem to start a relationship.�If the first time you introduce yourself to a youth’s parents is when you meet to discuss a mental health concern, your challenge, and the resistance you may meet, are that much greater. Instead, make an attempt to call or meet the parents of each participant in your c\program early on if possible and appropriate to do so. Let them know that you are looking forward to partnering with them to help their child succeed. If possible, try to call parents occasionally to share positive feedback about their children as well. If and when a concern arises, you’ll be glad you did!

#2: Don’t go it alone. �As soon as you notice a potential mental health concern with one of your youth, your first call should be to your agency’s designated person for support with this.

#3: Don't assume the worst.�Discussing a concern with a youth’s parents doesn't always set up an adversarial relationship. Most parents will be grateful for the candid fact-based information you can share, and many will be relieved to have their own concerns validated.

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Working with Parents

✔ Do:

Use a strengths-based, respectful approach

Use active listening and empathize!

Be flexible and open-minded

Expect some defensiveness; a parent may need time to absorb your feedback

Remember that parents may struggle with stigma and may be misinformed

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What if a parent appears resistant

or ‘in denial’?

From a parent: “Remember you are not seeing us at our best”.

Group Share: What have you found to be helpful?

It’s not uncommon for family members to deny the existence of a mental health or behavioural problem. If during your conversation a parent/guardian grows defensive or rejects your concern, continue to rely on these conversational tools.* And remember: the way you behave and respond plays a big role in diffusing or aggravating that resistance.

Welcome constructive criticism and ideas.
Remember that you and the parent are allies.
Focus on problems, not personalities.
Share feedback – if you have objective data about the concern (grades, attendance, etc.), share it.
Affirm, reinforce and complement – frequently acknowledge the positives in both the student and the parents.
Discuss a plan – transition from discussing the concern to providing options and negotiating a plan for addressing it.
Provide information and resources

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In sum:

Words matter

Evidence matters

Connection matters

You matter!!

“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”

Margaret Mead

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Additional Mental Health Literacy Resources

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Additional Mental Health Literacy Resources

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Additional Mental Health Literacy Resources

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