Download Slide presentations- 5 modules

Modules:
Mental Health and Addictions through Cultural Lenses
The Meaning of “Culture”
Health, Mental Health, Addiction and Well-Being
Risks and Protective Factors
Tools and Strategies to Help
1
Mental Health and Addictions through Cultural Lenses
The Meaning of “Culture”
2
The Meaning of “Culture”
Activity
What are the core elements and characteristics
of the Canadian culture?
3
The Meaning of “Culture”
Basic elements:
A certain amount of knowledge, beliefs, values, behaviours, laws, morals, artifacts…
…developed and shaped during the time…
…in specific geographic zones and social environments…
…transmitted from generation to generation…
…recognized as meaningful…
…and used to cope with daily life situations and with others.
4
The Meaning of “Culture”
There are 4 elements that
aren’t fully considered
in the definition of “culture”
5
Former, maybe multiple, societies
in which the individual lived
before arriving here
1
Individuals
Organizations
Newcomer
Communities
Society
6
Former, maybe multiple, societies
in which the individual lived
before arriving here
1
Newcomer
7
1
Newcomers
Newcomer
8
1
Migration involves 3 major sets of
transitions:
1. changes in personal ties and the
reconstruction of social networks
2. the move from one socioeconomic system to another
3. the shift from one cultural system
to another
9
The Meaning of “Culture”
2
A certain amount of knowledge, beliefs, values, behaviours, laws, morals, artifacts…
We (mistakenly) assume all members
of a specific culture have the same and complete
knowledge of that culture
and interpret it in the same way.
10
The Meaning of “Culture”
3
…in specific geographic zones and social environments…
Even if someone moves away from home
they still keep some of their own culture.
11
The Meaning of “Culture”
4
…recognized as meaningful…
…and used to cope with the daily life situations and with others.
Migrants can question themselves because of the
migration process: Who am I? How can I adjust?
Sometimes host communities don’t question
themselves. This makes it difficult to develop
a “two-way understanding”.
12
The Meaning of “Culture”
Source: Summerfield, 2005.
We need to remember, it’s not a question of
translation between languages but a
translation between worlds.
Western mental health approaches are based on Western culture.
The concepts of time, space, and distance are often culturally-based.
What does it mean to be “in a rush”? How do you describe ‘close’ and ‘far’?
13
Activity:
The new family in Canada
14
Mental Health and Addictions through Cultural Lenses
Health, Mental Health, Addiction and Well-Being
15
Health, Mental Health, Addiction and Well-Being
Source: Manwell, 2015.
There’s little agreement on a
definition of mental health.
Instead, people are using the term ‘mental health’ to mean ‘mental illness’.
In some countries around the world, it’s very difficult
to talk about mental health because of the stigma.
16
Health, Mental Health, Addiction and Well-Being
Source: Vaillant, 2012.
In defining health and mental health we need to remember:
Cross-cultural differences. The label ‘depression’ doesn’t exist in some
cultures, and in others it’s faced in completely different ways.
The importance of personal perception of health and mental health, as
well as the person’s community and social environment.
17
Health, Mental Health, Addiction and Well-Being
Source: Vaillant, 2012.
In defining health and mental health several precautions are necessary:
The definition of “normal” doesn’t mean anything. It’s “normal” only in a
specific place, among specific people, for that situation or culture.
A specific behaviour can be very unhealthy even if it’s very popular.
Not all unhealthy behaviours become an illness (e.g. youth drinking too much
alcohol - as they get older the amount they drink decreases).
18
Health, Mental Health, Addiction and Well-Being
Which is the current most accepted definition
of mental health among practitioners?
Sources: Manwell, 2015.
“Mental health is the capacity of each and all of us to feel, think,
and act in ways that enhance our ability to enjoy life and deal
with the challenges we face. It is a positive sense of emotional
and spiritual well-being that respects the importance of culture,
equity, social justice, interconnections, and personal dignity”.
- Public Health Agency of Canada
19
Health, Mental Health, Addiction and Well-Being
What is mental illness?
Source: How do you feel today?
When people’s minds are experiencing mental health difficulties,
we say they have a mental illness.
Mental illnesses change severely:
how people think,
people’s moods,
and what people do.
20
Health, Mental Health, Addiction and Well-Being
What causes mental illness?
Source: How do you feel today?
Like physical illness, mental illness can be caused by
a combination of our environment and our biology.
The environment includes everything around us in our daily lives.
Our biology is everything in our body. With some kinds of mental illness,
the structure of our brain can change.
21
Health, Mental Health, Addiction and Well-Being
Source: American Psychiatric Association.
Substance use:
In the broadest sense, a substance can be defined as prescription
medication, alcohol, illegal drugs (for example, cannabis*, cocaine, opiates,
ecstasy, amphetamines, and hallucinogens), steroids, or inhalants.
Not all substances are harmful and moderate use can, in fact, be healthy or
even necessary, in the case of prescribed medication.
* The legislation is changing about this substance
22
Health, Mental Health, Addiction and Well-Being
Source: DSM-5.
Substance use disorders:
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
no longer uses the terms substance abuse and substance dependence.
It refers to substance use disorders, which are defined as
mild, moderate, or severe to indicate the level of severity, which is
determined by the number of diagnostic criteria met by an individual.
23
Health, Mental Health, Addiction and Well-Being
Source: DSM-5.
Substance use disorders:
Substance use disorders occur when the recurrent use of alcohol and/or drugs
causes clinically and functionally significant impairment, such as health problems,
disability, and failure to meet major responsibilities at work, school, or home.
According to the DSM-5, a diagnosis of substance use disorder is based on
evidence of impaired control, social impairment, risky use, and pharmacological
criteria.
24
Health, Mental Health, Addiction and Well-Being
Source: American Psychiatric Association.
Addiction is defined in 2 ways:
psychological dependence (the individual believes the substance
is necessary for social functioning)
physiological dependence (increased consumption over longer
periods of time, increased tolerance, withdrawal symptoms, and
health problems related to substance intake)
25
Health, Mental Health, Addiction and Well-Being
Source: How do you feel today?
What causes addiction?
We don’t know why some people become addicted and others don’t.
It seems people develop addictions for many reasons:
• biology
• cultural influences
• family history of addiction • not fitting in socially
• difficult childhood
• mental health problems
• stress
• trauma including emotional, physical, or
sexual abuse
• discrimination or oppression
• health problems related to substance intake
26
Health, Mental Health, Addiction and Well-Being
Source: Ontario Problem Gambling Research
Centre: http://greo.ca/publisher/ontario-problemgambling-research-centre
Problem gambling
(sometimes called pathological gambling in its severest forms)
Problem gambling is characterized by a preoccupation with
gambling and impaired control i.e. the person is unable to
cut back or quit despite serious negative consequences
27
Health, Mental Health, Addiction and Well-Being
Source: Ontario Problem Gambling Research
Centre: http://greo.ca/publisher/ontario-problemgambling-research-centre
Problem gambling
(sometimes called pathological gambling in its severest forms)
It’s thought there are 3 types of problem gambler:
- in relation to a neurological disorder (e.g. Attention Deficit Hyperactivity Disorder)
- in relation to a mood disorder (the use of gambling to modulate emotions)
- as a dependence disorder (the perceived benefits are such that the person feels
high levels of distress when not gambling)
28
Health, Mental Health, Addiction and Well-Being
Immigrants’ and refugees’ mental health:
Not all refugees and immigrants develop mental health or addiction problems,
and among those who do,
many individuals manage to function effectively despite their internal distress.
Sources: Miller & Rasco 2004; WHO 2010
(http://www.who.int/whosis/whostat/2010
/en/).
29
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
1 in 5 Canadians will experience a mental illness in
their lifetime. The remaining 4 will have a friend,
family member, or colleague who will. (camh 2013)
7 out of 10 mental health
problems and illnesses start
during childhood and teenage
years. (camh 2013)
70%
30%
Childhood
Teenage
Adulthood
Old Age
30
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
Negative
Outcome
20%
Once depression is recognized, help can
make a difference for 8 out of 10 people
who are affected, allowing them to get
back to their regular activities.
(CMHA 2013)
Mental illness affects people of all
ages, educational and income levels,
and cultures. (CMHA 2013)
Positive
Outcome
80%
31
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
Almost 1/2 of people who feel
they have suffered from
depression or anxiety have never
gone to see a doctor about this
problem. (CMHA 2013)
Didn’t
see a
doctor
Saw a
doctor
32
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
Approximately 8 in 100 adults will experience major
depression at some time in their lives. (CMHA 2013)
Anxiety disorders affect 5 in 100 Canadians,
causing mild to severe impairment. (CMHA 2013)
33
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
About 1 in 100 Canadians will experience
bipolar disorder. (CMHA 2013)
Schizophrenia affects 1 in 100 Canadians.
(CMHA 2013)
34
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
1 in 10 Canadian 15 years of age and over report
symptoms consistent with alcohol or illicit drug
dependence. (camh 2013)
35
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
About 1 in 5 people with a mental illness have a
concurrent substance use problem. (camh 2013)
3.8% of adults in Ontario are classified as having
moderate or severe gambling problems. (camh 2013)
Suicide is one of the leading causes of
death in both men and women from
adolescence to middle age. (CMHA 2013)
36
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
Sources: STATS Canada 2002; Mood Disorders
Society of Canada 2009.
Most common symptoms of depression experienced by Canadians
(and those which have the most impact on their daily functioning):
I.
lack of motivation - 90%
II. loss of ability to enjoy favourite activities - 80%
III. difficulty concentrating - 77%
IV. feeling of isolation - 74%
37
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
Sources: STATS Canada 2002; Mood Disorders
Society of Canada 2009.
Likelihood that people with mental illness will commit violent acts:
No greater than the general population
Likelihood that people with mental illness will be victims of crime:
2.5 times that of the general population
38
Health, Mental Health, Addiction and Well-Being
Some stats on Canada’s situation
Sources: STATS Canada 2002; Mood Disorders
Society of Canada 2009.
Depending on which study cited, between 23% and 74% of
people who are homeless in Canada report having a mental
health problem or illness.
Percentage of homeless women with a mental illness: 75%
Stigma case: 35% of Torontonians with mental illness face discrimination
from landlords when trying to rent an apartment, the highest of the
5 groups studied. The other 4 groups were lone parents, black lone parents,
South Asians, and those on social assistance.
39
Health, Mental Health, Addiction and Well-Being
Some stats on immigrants and refugees
mental health conditions
Source: Canadian Guidelines
for Immigrant Health, 2011.
The health of immigrants tends to be better than that of the
general population in both the sending and receiving countries.
The “healthy immigrant effect” tends to vanish over time.
40
Health, Mental Health, Addiction and Well-Being
Some stats on immigrants and refugees
mental health conditions
Source: Canadian Guidelines
for Immigrant Health, 2011.
In contrast to immigrants, refugees are at substantially
higher risk than the general population for a variety of
specific psychiatric disorders, with up to 10 times the rate
of Post-Traumatic Stress Disorder and elevated rates of
depression, chronic pain, and other somatic complaints.
41
Health, Mental Health, Addiction and Well-Being
Some stats on immigrants and refugees
mental health conditions
Source: Canadian Guidelines
for Immigrant Health, 2011.
In many source countries,
mental health services are associated only with
custodial or hospital treatment of the
most severely ill and psychotic patients.
The stigma of a psychiatric diagnosis affects not only patients
but also their siblings and other family members.
42
Health, Mental Health, Addiction and Well-Being
Some stats on immigrants and refugees
mental health conditions
Source: Canadian Guidelines
for Immigrant Health, 2011.
The many roles and responsibilities of immigrant women in
the home and workplace can
impede their access to mental health services.
Immigrant women are at 2 to 3 times the risk of their
Canadian-born counterparts for postpartum depression.
43
Health, Mental Health, Addiction and Well-Being
Some stats on immigrants and refugees
mental health conditions
Source: Canadian Guidelines
for Immigrant Health, 2011.
Refugee women seen in specialized clinics have high rates of
exposure to violence and post-traumatic stress disorder that often
haven’t been addressed clinically. Experts emphasize, however,
that exploring the history of rape or other forms of sexual violence
requires great clinical sensitivity and should always be guided
by patients’ needs and comfort levels.
44
Mental Health and Addictions through Cultural Lenses
45
Mental Health and Addictions through Cultural Lenses
How does culture influence an
individual’s reaction to stressors,
traumas, and difficulties?
46
Mental Health and Addictions through Cultural Lenses
Source: Smith, Lin, and Mendoza, 1993.
Humans have the need to find the reason for, and to
explain, their experiences. This is especially true when
they’re suffering and experiencing illness.
Culturally-shaped beliefs play a vital role in
determining whether a particular explanation of
what’s going on makes sense to the person.
These beliefs affect the person’s
attitudes and behaviours.
47
Mental Health and Addictions through Cultural Lenses
Source: Wilson, 2007.
Where culture intervenes:
Traumatic and stressful experiences demand a response
from culture in terms of:
treatment
healing
counselling
interventions
In the meaning of getting better,
improve, find stability again.
medical care
48
Mental Health and Addictions through Cultural Lenses
Source: Moodley & West, 2005.
Different cultures may have alternative
pathways to healing. For example:
Shamans
Community-based practices
Religious beliefs
……………...
Traditional healers
……………...
Culture-specific rituals
Conventional medical practices
Medicine men and women
……………...
……………...
49
Mental Health and Addictions through Cultural Lenses
What else is affected by culture?
The ways we provide treatments and diagnose.
What we observe and the conclusions we make.
50
Mental Health and Addictions through Cultural Lenses
The 5 areas every healing sub-culture makes
assumptions about:
Source: Marsella, 2008.
1) the nature and causes of problems
2) the best situation and setting to heal
3) the allowed expectations, emotions, and behaviours during the healing process
4) the participation levels and roles of patient, family, and therapist
5) the best therapists' training, skills, and expertise
Use The Western assumptions
51
Mental Health and Addictions through Cultural Lenses
Activity: Our assumptions
Working with immigrants and refugees struggling with
mental health and addiction issues
My organization thinks the best way to welcome our client is …………………………
My organization has a specific role in the healing process, that is ……………………………
My organization believes a crucial skill for its employees is ……………………………
When I meet a new client I …………………………
For the people I work with, it’s impossible to heal without ……………………………
The best client is the client that …………………………………………..
Use the Six Questions for Understanding Culture, Trauma, and Posttraumatic Syndromes
52
Mental Health and Addictions through Cultural Lenses
Cultural Barriers to Mental Health and Addiction Care:
stigmatization from within the
community / culture
alternative ideas about what
is illness and health
Minority Populations
language barriers and
poor communication
Access to Mental Health and
Addiction Services
access barriers, such as inadequate
insurance coverage
mistrust and fear
of treatment
53
Factors affecting relationship
Client looks for support.
Formal conclusion of services.
Relationship could continue.
Adjusting moments:
First contact with
an agency/org. Reception.
Service providers and clients have to find
out how to work / continue together
Service providers’ personal
adjusting moments
Clients’ personal
adjusting moments
Provision
of services.
Meeting with provider.
Greetings.
Case Management; Engagement;
Teaching; Supporting;
Referral; Counselling.
54
Factors affecting relationship
Common cultural background
Previous use of the service
or some knowledge about
the service and/or system
Possibility to use them in
order to explain the service
and the expectations
Elements that affect the adjusting moments:
Absence of knowledge about
the service and the system
Absence of a common
cultural background Biases
Labels
Assumptions
Norms
Necessity to explain situations, concepts,
and things that usually we don’t explain
because we take things for granted
And necessity to verify in some
way that the client understands
55
Risks and Protective Factors
56
Risks and Protective Factors
Micro, Meso, Macro levels
INTERNATIONAL
COMMUNITY
MESO
MICRO
Individual factors
Priorities & expectations
Absence of language
Intergenerational conflicts
Physical, socio-cultural &
community environments
Community conditions
Power relationships
Presence of services
MACRO
Policies & government
Recognition of educational
& professional qualifications
Length of time for immigration
Applications & approval processes
Complex
interaction
57
Risks and Protective Factors
Determinants of Mental Well-being in the Post-Migration phase:
MICRO
PERSONAL
MESO
RELATIONAL
MACRO
ENVIRONMENTAL
Similarity between the culture of origin & the culture of the hosting country
Psycho-SocioPhysicalSpiritual
Well-being
Stability
(housing, employment,
family, health)
Language
Resilience
Social inclusion
Supportive network
Presence of services
Education opportunities
& recognition
Policies &
regulations
The continuum of real experiences
Wrong beliefs
or expectations
Long stay in
precarious conditions
Linguistic &
cultural barriers
Pressures from
home country
Separation from kin
& loss of contacts
Lack of network
Lack of services
System’s rigidities
Adjusting
& coping
difficulties
Illness
Lack of cultural awareness,
sensitivity, training
Mass media
representations
Racism, stigma, discrimination, cultural assumptions
Green arrows = Protective Factors
Purple arrows = Risky Factors
58
Risks and Protective Factors
Pre-Migration period
Risk
Factors
Protective
Imprisonment
Religious/ethnic
Death of family members,
related conflicts
relatives, friends
Vulnerabilities
Economic
Famine, environmental disasters
insecurity
Difficulties in meeting the basic needs
Loss of belongings
Violence (sexual, physical, psychological) & torture
MICRO
Stability (income, family)
Resilience
MACRO
Presence of services
MESO
Supportive network
Peace
Housing
Education opportunities
MICRO / PERSONAL
MESO / RELATIONAL
MACRO / ENVIRONMENTAL
59
Risks and Protective Factors
During the Migration
Separation from kin
& loss of contacts
Risk
Factors
Protective
Imprisonment
Religious/ethnic
Death of family members,
& lack of protection
related conflicts
relatives, friends
Vulnerabilities
Economic
Long stay in
insecurity
Difficulties in meeting the basic needs
precarious conditions
Loss of belongings
Violence (sexual, physical, psychological) & torture
Uncertainty about the future
MICRO
Resilience
Stability (income, family)
MACRO
Presence of services
MESO
Money
Supportive network
Peace
Housing
Education opportunities
MICRO / PERSONAL
MESO / RELATIONAL
MACRO / ENVIRONMENTAL
60
Risks and Protective Factors
Post-Migration period
Lack of cultural awareness, sensitivity, training
Separation from kin
&loss of contacts
Risk
Factors
Protective
Racism, stigma, discrimination, cultural assumptions
Cultural diversity
Imprisonment
Religious/Ethnic
Death of family members,
Lack of network
& lack of protection
related conflicts
relatives, friends
Lack of services
Vulnerabilities
Economic
Long stay in
insecurity
Housing, educational, employment issues
Difficulties in meeting the basic needs
precarious conditions
Housing,
educational,
employment
issues
Isolation
Loss
of belongings
Violence (sexual, physical, psychological)
System rigidities
Language
Uncertainty about the future
Social inclusion
Housing, employment
MICRO
Resilience
Stability (income, family)
Language
MACRO
Peace
Education opportunities
and recognition
MESO
Money
Presence of (part of) the family
MICRO / PERSONAL
Presence of services
Supportive network
Supportive communities
Similarity between the culture of origin & the culture of the hosting country
MESO / RELATIONAL
MACRO / ENVIRONMENTAL
61
Risks and Protective Factors
7 resources for resilience
“Resilience is both the capacity
of individuals to navigate their
way to the psychological,
Relationships
social, cultural, and physical
resources that sustain their
well-being, and their capacity
individually and collectively Power and control
(self-efficacy)
to negotiate for these
resources to be provided in
culturally meaningful ways.”
Source: Resilience Research Centre,
Halifax NS.
Cultural
adherence
Cohesion
(belonging)
RESILIENCE
Access to
material resources
Social
justice
Identity
62
Risks and Protective Factors
repression
The Human Security Values
The human security
framework offers a
comprehensive framework
for clarifying the values
fundamental to human
well-being and civil
society, as well as what
constitute ecological
threats that involve
cultural collapse and the
violation of human rights.
human rights violation
and discrimination
crime
cultural
collapse
Food
natural
disasters
Economic
Political
lack of health
facilities
Source: Bajpai K., 2000, Human security: Concept and measurement.
Kroc Institute Occasional Paper, no. 19: OP: 1
civil conflicts
Security
poverty
precarious
employment
Health
Environmental
genocide
health risks
violence
and abuse
Community Personal
militarization
international
terrorism
environmental
degradation
war
63
Activity:
On what elements do you feel
you could intervene in order
to be supportive?
64
Mental Health
Functioning and adaptation
CONTINUUM
Mentally
Healthy.
Well-being
Degree of
AUTONOMY.
Capacity for control
over one’s self
Physical Health
Healthy
Functioning and adaptation
CONTINUUM
Adjusting/c
oping
difficulties.
Illness
Sense of coherence, unity.
Subjective experience of
understanding and
managing stressors
The “SENSE OF AGENCY” (or sense of
control) refers to the subjective
awareness that one is initiating,
executing, and controlling
autonomously one's own actions in
the world. It is also related to the
capabilities one thinks can use in order
to achieve one’s goals. i.e. Integration.
Illness
Stability. Maintenance
of equilibrium in
response to stress
Mobile
Degree of
MOBILITY.
Capacity for
navigating social
spaces
Subject’s
CONTINUUM
Source: adapted
from Manwell,
2015.
Degree of
CONNECTEDNESS.
Capacity for relating
to and with others
Social Health
Recognition Functioning and adaptation Absence of
CONTINUUM
recognition
and acknowledgement
Interdependence. Mutual and acknowledgement
reliance on and
responsibility to others
within society.
Immobile
65
Agency is:
- Local.
The “SENSE OF AGENCY” (or sense of
control) refers to the subjective
awareness that one is initiating,
executing, and controlling
autonomously one's own actions in
the world. It is also related to the
capabilities one thinks can use in order
to achieve one’s goals. i.e. Integration.
- Contextual.
- Temporary.
66
Tools and Strategies to Help
67
Tools and Strategies to Help
Introduction: How Can You Help?
You may be in a position where immigrants and refugees talk to you
when they have personal mental health or addiction issues.
This could be difficult for you because you may not know what to say.
The How Can You Help? guide can give you tools, strategies, and
suggestions on how to help you: face these situations, have a conversation,
and refer people to services.
68
Tools and Strategies to Help
Introduction: How Can You Help?
It’s important to note and remember that
these tips, suggestions, and strategies
are NOT, and CANNOT be used
like diagnostic tools.
69
Tools and Strategies to Help
Activity:
Let’s go back to the family moving into
Canada that we saw in the previous
activity. Think about the mental health
status of its members, and discuss how
we could be supportive.
70
Tools and Strategies to Help
Some tips for talking about these issues:
Start the conversation by letting the person know you want to
help them and that everything is confidential – except
if they express they might harm themselves or others.
71
Tools and Strategies to Help
Some tips for talking about these issues:
Look at the bigger picture.
e.g. the settlement process may take several years to fully adjust to.
Try to share with your clients a holistic approach.
Don’t make assumptions.
72
Tools and Strategies to Help
Some tips for talking about these issues:
Use a level of language they’ll understand.
Communicate positively, directly, and clearly.
Ask how you can be supportive. Support the person’s efforts
to avoid things that may trigger stress or substance abuse.
73
Tools and Strategies to Help
Some tips for talking about these issues:
Learn as much as you can about the causes, signs, and
symptoms of problem substance use and mental illness.
It’s not your job to know the answers.
Refer them to an appropriate person or agency, with their permission.
74
Tools and Strategies to Help
Some tips for talking about these issues:
Focus on the person’s strengths and his/her support structure.
As the person begins to improve, encourage him or her to begin
to increase his/her social connections and responsibilities.
Collect information whenever possible.
Follow up regularly with this person.
Let’s talk about
your own
experiences…
75
Tools and Strategies to Help
When should you be concerned about mental health issues?
Mental health is a continuum from healthy to unhealthy.
“Problem” behaviours are not ‘proof’
someone has a mental health problem.
76
Tools and Strategies to Help
When should you be concerned about mental health issues?
Consider 3 things if you’re concerned someone may be
struggling with a mental health problem:
FREQUENCY: How often does the person show the
concerning behaviours?
DURATION: How long do the
concerning behaviours last?
INTENSITY: to what extent do the
behaviours interfere with life activities?
77
Tools and Strategies to Help
Observing behaviours of concern
You may be in a position to observe
how a person is coping with the challenges of being a newcomer.
In the next slides you can find partial lists of indicators for
good mental health, reacting to stress, and
experiencing mental health or addiction problems.
These lists are intended to be a guide for your observations and not to diagnose.
78
Tools and Strategies to Help
Activity:
We ask you to check within
the following lists which are
the signs that usually you see
in your clients.
79
Tools and Strategies to Help
Observing behaviours of concern
Signs of good mental health:
Normal mood fluctuations
Calm and takes things in stride
Few sleep difficulties
Physically well
Good sense of humour
Performing well
In control mentally
Normal sleep patterns
Good energy level
Physically and socially active
No or limited use of
alcohol, drugs, gambling
80
Tools and Strategies to Help
Observing behaviours of concern
Stress is our response to a situation we feel is out of control and
in which there are too many things that happen at once.
It’s natural to feel stressed as a reaction to major events in your life.
81
Tools and Strategies to Help
Observing behaviours of concern
Signs a person may be reacting to stress:
Irritable / impatient
Intrusive thoughts
Nervous
Nightmares
Sad / overwhelmed
Muscle tension / headaches
Sarcasm
Procrastination
Forgetfulness
Trouble sleeping
Low energy
Regular but controlled use
of alcohol, drugs, gambling
82
Tools and Strategies to Help
Observing behaviours of concern
Signs a person may be experiencing mental health problems:
Remember, some of the symptoms of mental illness may be
normal ways of dealing with the stresses of life.
Or, they could be caused by a physical illness.
If the person has had the symptoms for a long time and they don’t seem to go
away, the person may have a problem that needs to be treated in some way.
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Tools and Strategies to Help
Observing behaviours of concern
Signs a person may be experiencing mental health problems:
Restless / disturbed sleep
Anger
Recurrent images / nightmares
Anxiety
Constantly sad / hopeless
Increased aches and pains
Negative attitude
Increased fatigue
Avoidance
Poor performance / workaholic
Poor concentration / decisions
Withdrawal
Increased alcohol use or
gambling are hard to
control
Other addictions
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Tools and Strategies to Help
What are the signs that can help me understand
if there’s an addiction?
The presence of harmful consequences over time is an
important sign that there could be some problems.
The consequences of substance abuse or other addictions
(gaming, gambling, etc.) can range from mild to severe.
If a person continues to use substances despite the harmful
consequences, he or she may have a substance use problem.
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Tools and Strategies to Help
What are the signs that can help me understand
if there’s an addiction?
Substance abuse can affect every aspect of a
person’s life. They include:
Injuries and physical problems
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
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Tools and Strategies to Help
What are the signs that can help me understand
if there’s an addiction or substance use problems?
Change in personality or baseline mood
Missing work or school
Loss of interest or motivation
Missing school or work
Deterioration of personal grooming habits
Sudden aggressive behaviour,
irritability, nervousness, or giddiness
Increased secretiveness or
heightened sensitivity to inquiry
Running out of money with no
explanation of how the money was spent
Stealing money or items to sell
Sudden change in friendships or activities
Getting into trouble more than usual
(fights, accidents, illegal activities)
Unexplained change in personality
or attitude (fear or anger)
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Tools and Strategies to Help
When to seek professional help
If the person has made consistent efforts to improve
his or her mental and emotional health but still doesn’t
feel good, then it’s time to seek professional help.
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Tools and Strategies to Help
When to seek professional help
Feelings and behaviours that may require immediate attention:
Inability to sleep
Feeling unable to control your anger and outbursts
or having thoughts of hurting someone else
Feeling down, hopeless, or
helpless most of the time
Concentration problems that are
interfering with your work or home life
Negative or self-destructive thoughts
or fears that you can’t control
Thoughts of death or suicide
Increased use of nicotine, food, drugs, or
alcohol to cope with difficult emotions
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Tools and Strategies to Help
When to seek professional help
Mental health crisis or emergency
In an emergency, a person can be assessed in a hospital without being referred
by a doctor. If someone is having a mental health crisis or emergency and
cannot see their doctor or psychiatrist, they can go to the Emergency
Department at a local hospital. The Emergency Department staff will assess
what treatment they may need and they may decide if the person should be
admitted to the hospital.
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Tools and Strategies to Help
When to seek professional help
Things to remember when dealing with a crisis:
Try to remain calm
Give space by not hovering over
the person or getting too close
Ask others to leave the room and shut off
the TV and radio to reduce distractions
Speak slowly and clearly,
using short, simple sentences
Invite the person to sit down and talk
about what is bothering him or her
Things NOT to do in a crisis:
Shout, patronize, criticize or
insult the person
Block the doorway (you should
allow an escape route)
Make too much eye contact
Be too emotional
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Tools and Strategies to Help
Ways to improve your communication
when English is not their first language:
If possible, greet the person in his or her own language.
Speak slowly, not loudly.
Avoid difficult and uncommon words and idioms, such as
“right on target” or “kill two birds with one stone.”
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Tools and Strategies to Help
Ways to improve your communication
when English is not their first language:
Face the person and use non-verbal communication such as gestures,
pictures, and facial expressions.
But…
…don’t assume the non-verbal communication used in your culture
is the same as that in the person’s culture.
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Tools and Strategies to Help
Ways to improve your communication
when English is not their first language:
Be aware of commonly misunderstood words, such as “anxiety,”
“depression,” “dizziness” and idioms or culturally-specific
phrases that describe sensations
(e.g. “pins and needles”).
Don’t complicate communication with
unnecessary words or information. Keep it simple.
Organize what you say for easy understanding. Use short, simple sentences.
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Tools and Strategies to Help
Ways to improve your communication
when English is not their first language:
Repeat yourself when you haven’t been understood.
Rephrase and summarize often.
Don’t ask questions that can be answered with a “yes” or “no.” If you phrase
questions in a way that the person needs to respond with information (what,
where, when, why and how) you can tell if they understood the question.
Use such phrases as, “Tell me about…”.
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Tools and Strategies to Help
Suggestions for your organization
Understand the cultural biases of staff and
provide training to address educational needs.
Re-evaluate intake and assessment
documentation and policies and
procedures to be more inclusive.
Understand the cultural biases in program design.
Be aware of the power dynamics between
service providers and culturally diverse clients.
Redouble efforts to practice client-centered
evaluations and treatments (Castillo, 1997).
Identify resources and services within the
community that can help
a person recover.
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Tools and Strategies to Help
Helping yourself and your workplace become culturally sensitive
Be aware of your own biases, stereotypes, prejudices, etc.
Awareness helps us be more thoughtful and respectful in our approach.
Ask about the person’s beliefs and definitions of health and healing.
What does “to heal” mean to him/her?
Create a space and service where people feel safe, respected, and welcomed.
Avoid idioms and culturally-specific sayings and phrases.
Learn and ask about cultural greetings and body language.
Eye contact and hand shakes are not universal signs of respect or welcome.
Use open-ended questions to learn about the person’s values, goals, and most urgent
needs. These conversations help you understand, accept, and relate to each other.
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Tools and Strategies to Help
Examples of open ended questions:
“Where are you from?”
Ask this with care. It can be a sensitive
and complicated question.
“Is there any part of your story you think
is useful to share with me right now?”
“Let me understand which are
your priorities and we can see what we can do.”
“Tell me about your future goals,
for you and your family.”
“What do you think could help you right now?”
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