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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. 83 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 84 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. 85 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 86 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) 87 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. 88 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 89 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. 90 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 91 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.” 92 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. 93 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. 94 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…”. 95 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. 96 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. 97 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?” 98 99