Download What is Mental Health First Aid?

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Instructor
Date
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Course Outline – Session 1
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Mental Health First Aid
Common mental health problems
Five basic actions of mental health first aid
What is a substance-related disorder?
Symptoms
Risk factors
MHFA for substance-related problems
– Crisis first aid for overdose
• Treatment and resources
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Course Outline – Session 2
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What is a mood disorder?
Types of mood disorders
Symptoms
Risk factors
Substance use and mood disorders
Suicide in Canada
MHFA for mood problems
– Crisis first aid for suicidal behaviour
• Treatment and resources
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Course Outline – Session 3
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What is an anxiety disorder?
Symptoms
Types of anxiety disorders
Risk factors
Substance use and anxiety disorders
MHFA for anxiety problems
– Crisis first aid for panic attacks
– Crisis first aid for acute stress reaction
• Treatment and resources
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Course Outline – Session 4
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What is a psychotic disorder?
Types of psychotic disorders
Symptoms
Risk factors
Substance use and psychotic disorders
MHFA for psychosis problems
– Crisis first aid for a psychotic episode
• Treatment and resources
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World Health Organization
• Health is “a state of (complete) physical,
mental and social well-being and not
merely the absence of disease or
infirmity.”
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World Health Organization
• Mental Health is “a state of well-being in
which the individual realizes his or her own
abilities, can cope with the normal stresses
of life, can work productively and fruitfully,
and is able to make a contribution to his or
her community.”
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The Mental Health Continuum
Maximum
Mental Health
Diagnosis of a serious
illness but copes well and
has positive mental health
No illness or disorder
and positive mental
health
Maximum
Mental Disorder
Minimal
Mental Disorder
Diagnosis of a serious
illness and poor
mental health
No diagnosable illness
or disorder but has
poor mental health
Minimal
Mental Health
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What are Mental Health Problems?
A mental health problem causes major
changes in a person’s thinking, emotional
state and behaviour, and disrupts the
person’s ability to work and carry on their
usual personal relationships.
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What is Mental Health First Aid?
Mental health first aid is the help provided
to a person developing a mental health
problem or in a mental health crisis. The
first aid is given until appropriate
professional help is received or until the
crisis is resolved.
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Aims of Mental Health First Aid
• Preserve life where a person may be a
danger to themselves or others
• Provide help to prevent the mental health
problem from becoming more serious
• Promote the recovery of good mental
health
• Provide comfort to a person experiencing
a mental health problem
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The Five Basic Actions
Assess risk of suicide and/or harm
Listen non-judgmentally
Give reassurance and information
Encourage the person to get appropriate
professional help
Encourage other supports
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Why Mental Health First Aid?
• Mental health problems are common
– At least 1 in 3 Canadians will experience a
mental health problem at some point in
their life
– At least 1 in 5 Canadians will experience a
mental health problem in a year
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Why Mental Health First Aid?
• Professional help is not always on hand
• People often do not know how to
respond
• Not everyone seeks treatment or
realizes they need help
• Many people are not well informed
about mental health/problems
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Why Mental Health First Aid?
There is stigma associated with mental
health problems
Imagine if we treated everyone like
we treat people with mental illness.
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Impact of Mental Health Problems
In the workplace
– 23% of workers experienced physical
health problems caused by stress, anxiety
or major depression
– 1 in 5 workers experienced fatigue,
sleeping problems, headaches and anxiety
– 20% of all sick leaves are related to mental
health
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What is a Substance-Related
Disorder?
• Use does not equal disorder
• Physical or psychological dependence
• Problems affect a person’s life
– Social
– Personal
– Work/school
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Types of Substance-Related
Disorders
• Substance use disorder
– Substance Abuse
– Substance Dependence
• Substance-induced disorder
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Types of Substances
• Depressants
• Stimulants
• Hallucinogens
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Depressants – Alcohol
• Most widely used substance in Canada
• Found in numerous substances
• Effects vary from person to person
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One Standard Drink
=
Regular Beer
12 oz/341 mL
(5% alcohol)
=
Table Wine
5 oz/142 mL
(12% alcohol)
Centre for Addiction and Mental Health
Spirits
1.5 oz/43 mL
(40% alcohol)
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Harmful Effects of Excess Alcohol
Physical Effects:
• Nervous system
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Harmful Effects of Excess Alcohol
Physical Effects:
• Nervous system
• Heart
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Harmful Effects of Excess Alcohol
Physical Effects:
• Nervous system
• Heart
• Liver, pancreas, stomach
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Harmful Effects of Excess Alcohol
Physical Effects:
• Nervous system
• Heart
• Liver, pancreas, stomach
• Muscles
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Harmful Effects of Excess Alcohol
Physical Effects:
• Nervous system
• Heart
• Liver, pancreas, stomach
• Muscles
• Reproductive system
• Bones
• Throat
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Harmful Effects of Excess Alcohol
Social Effects:
• Money
• Work
• Legal
• Relationships
Emotional Effects:
• Personality
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Depressants – Barbiturates
• Amytal ® and phenobarbital
• Street names: reds, yellow jackets, blue
heaven
• Produce a feeling of calm, drowsiness
and well-being
• First developed as sleeping pills
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Depressants – Benzodiazepines
• Valium® and Ativan®
• Street names: tranks, downers, roofies
• Produce a feeling of calm, drowsiness
and well-being
• Commonly prescribed for anxiety, sleep
problems
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Depressants – Inhalants
• Cleaning fluids, glues, paint thinners
and removers, hair and deodorant
sprays, gasoline, etc.
• Produce feelings of euphoria, lightheadedness, exhilaration and vivid
fantasies or hallucinations
• Sniffed or inhaled
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Depressants – Opiates
• Heroin, codeine, morphine, fentanyl
oxycodone and others
• Produce a short-term feeling of
euphoria and well-being and relieve
pain
• Have a high risk of creating
dependence
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Stimulants – Amphetamines
• Dexedrine® and Ritalin®
• Street names: speed, crystal meth, ice,
uppers, crank
• Have the temporary effect of increasing
energy and apparent mental alertness
• Risk of amphetamine psychosis –
symptoms similar to schizophrenia
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Stimulants - Caffeine
• Can be found in many substances
including tea, coffee, chocolate, cola
drinks or medication
• Causes mild mood elevation and
reduced drowsiness and fatigue
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Stimulants – Cocaine
• Street names: Coke, C, snow, flake
• Two forms – powder and crack
• Produces intense pleasure, euphoria,
hallucinations, twitching, agitated
behaviour and fever
• Psychological dependence produced by
cocaine is believed to be among the
strongest of all drugs
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Stimulants – Nicotine
• Comes from tobacco leaves
• Can be burned and inhaled or absorbed
• Smoking affects the metabolism of
many medications prescribed for the
treatment of mental disorders and of
other substances
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Hallucinogens - Cannabis
• Street names: marijuana, grass, pot,
weed, hashish, hash oil
• Most widely used illegal drug
• Can cause both hallucinogenic and
depressant effects
• May contribute to development of
psychosis in people who are vulnerable
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Risk Factors
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Genetic predisposition
Age
Psychological stress
Physical illness
Social factors
Alcohol sensitivity
Dependence risk
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First Aid for Substance Problems
• Assess risk of suicide and/or harm
– Crisis first aid for overdose
• Listen non-judgmentally
• Give reassurance and information
• Encourage the person to get
appropriate professional help
• Encourage other supports
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Action 1 Assess the Risk of
Suicide and/or Harm
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• If a person is thinking of suicide, alcohol
will increase the chances that they will
harm themselves or die by suicide
• If you determine the person is at risk for
suicide, follow the steps for Crisis First
Aid for Suicidal Behaviour
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Action 1 Assess the Risk of
Suicide and/or Harm
• If you determine the person has taken
an overdose, follow the steps for Crisis
First Aid for an Overdose
• If the person does not seem to be at
risk, move on to Action 2 – Listen NonJudgmentally
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Crisis First Aid for an Overdose
If they are unconscious:
• Ensure personal safety
• Place person in recovery position
• Call emergency services
• If possible, determine type of substance
taken
• Keep the person warm
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Crisis First Aid for an Overdose
If the person is conscious:
• Call emergency services
• Don’t give food or water
• Reassure that help is coming
• If possible, determine type of substance
taken
• Keep the person warm
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Action 2 Listen Non-Judgmentally
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Attitudes
The effective listener
Verbal skills
Non-verbal skills
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Action 3 Give Reassurance
and Information
• They have a real medical condition
• Substance problems are common
• Some people are more prone to these
problems than others
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Action 3 Give Reassurance
and Information
• Substance use can cause harm
• Programs are available to help people
deal with alcohol or drug problems
• Often mood and/or anxiety problems
underlie a substance problem
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Action 4 Encourage the Person to Get
Appropriate Professional Help
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Family doctor or physician
Drug and alcohol specialists
Mental health team
Treatment centres
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Stages of Change Model
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Action 5 Encourage Other Supports
• Support groups
• Family and friends
• Self-help strategies used for other
mental health problems
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If
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If you can always be cheerful
If you can sleep without drugs
If you can relax without alcohol
If you can start the day without caffeine
If you can take blame without resentment
If you can resist without complaining
If you can eat the same food every
day without complaining and be
grateful
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If
• If you can understand when your loved
ones are too busy to spend time with you
• If you can overlook it when those you love
take things out on you when, through no
fault of yours, something goes wrong
Then you are almost
as good as your dog
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Session 2
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What is a mood disorder?
Types of mood disorders
Symptoms
Risk factors
Substance use and mood disorders
Suicide in Canada
MHFA for mood problems
– Crisis first aid for suicidal behaviour
• Treatment and resources
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What is a Mood Disorder?
Mood disorders are characterized by
disturbances:
• In the way a person feels
• In the way a person experiences
emotion
This makes it difficult for the person to
function day-to-day.
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Types of Mood Disorders
Two main forms
• Depressive disorders
– Clinical depression (major depressive
disorder)
– Postpartum depression
– Seasonal affective disorder
• Bipolar disorder
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What is Depression?
• Clinical depression lasts at least two
weeks
• It affects a person’s behaviour and has
physical, emotional and cognitive
effects
• It interferes with the ability to work and
have satisfying personal relationships
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Signs and Symptoms of Depression
• Emotions: sadness, mood swings,
hopelessness, anxiety
• Thoughts: Self-criticism, thoughts of
suicide, indecisiveness, pessimism
• Behaviour: Crying spells, withdrawal,
neglect personal appearance, no
motivation
• Physical: Lack of energy, sleeping too
much/too little, weight loss/gain
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Depression in the Workplace
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Decreased productivity
Morale problems
Lack of co-operation
Safety problems
Absenteeism, presenteeism
Complaints of being tired, having
aches/pains
• Alcohol and/or drug abuse
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Bipolar Disorder (Manic Depression)
• Characterized by extreme mood swings
• A person has periods of depression and
mania with periods of “normal” mood in
between
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Symptoms of Bipolar Disorder
• Depression
• Mania
– Increased energy and overactivity
– Elevated or elated mood
– Needing less sleep than usual
– Irritability
– Rapid thinking and speech
– Lack of inhibitions
– Grandiose delusions
– Lack of insight
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Risk Factors for Depression
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Distressing life event
Having a baby
Medical conditions
Side effect of medications or drugs
Stress from another mental disorder
Hormonal changes
Lack of exposure to bright light
in winter
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Risk Factors for Depression
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Substance dependence
Family history of depression
Previous episodes of depression
Difficult childhood (abuse, neglect)
Exposure to harassment, bullying,
discrimination
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Risk Factors for Bipolar Disorder
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Family history
Chemical changes in the brain
Stress
Drugs
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Suicide in Canada
• Many Canadians die by suicide each
year
• Out of all causes of death in Canada,
suicide ranks 9th highest
• More women than men attempt suicide
• More men than women die by suicide
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Suicide Rates by Province
Per 100,000 population, 2004
Nunavut
NWT
Yukon
Que
Alta
NB
Canada
Man
Sask
BC
Nfld
NS
Ont
PEI
80.9
25.7
19.4
15.3
14.0
11.8
11.3
11.3
11.2
11.1
10.2
9.6
8.2
5.8
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First Aid for Mood Problems
• Assess risk of suicide and/or harm
– Crisis first aid for suicidal behaviour
• Listen non-judgmentally
• Give reassurance and information
• Encourage the person to get
appropriate professional help
• Encourage other supports
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Action 1 Assess the Risk of
Suicide and/or Harm
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• If you determine the person is at risk for
suicide, follow the steps for Crisis First
Aid for Suicidal Behaviour
• If the person does not seem to be at
risk, move on to Action 2 – Listen NonJudgmentally
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Crisis First Aid for Suicidal Behaviour
• Engage the person in a serious
conversation
• Look and listen for warning signs of
suicide
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Warning Signs of Suicide
• Expressing negative comments about self
• Expressing intent to die by suicide and
having a plan to do so
• Expressing suicidal thoughts
• Putting personal affairs in order
• Repeated expressions of hopelessness,
helplessness or desperation
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Crisis First Aid for Suicidal Behaviour
• Ask about suicide
• Explore risk
– Plan
– Prior suicidal behaviour
– Support
• Engage the person in a plan
for safety
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Self-Care
• Supporting a suicidal person can be
unsettling and stressful
• Do not underestimate the effect on your
own well-being
• Find ways of reducing the immediate
stress (exercise, relaxation techniques,
sleep)
• Find someone to talk to about your
experience
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Action 2 Listen Non-Judgmentally
• Engage the person in a discussion
• Listen to the person without judging
them
• Do not be critical
• Do not express frustration with the
person for having such symptoms
• Do not offer glib advice
• Avoid confrontation
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Action 3 Give Reassurance
and Information
Depression
• It is a real medical condition
• It is a common illness
• It is not a weakness or character defect
• It is not laziness
• Effective help and treatments are
available
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Action 3 Give Reassurance
and Information
Mania
• It is a real medical condition
• Although not common, it is very well
known and researched
• It is not a weakness or character defect
• Effective help and treatments are
available
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Action 4 Encourage the Person to Get
Appropriate Professional Help
• Community-based care
• Family doctor/physician
• Counsellors, mental health therapists
and clinical psychologists
• Psychiatrists
• Voluntary sector
• Telephone helplines
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What Helps for Depression?
Medical Treatments
Electroconvulsive
therapy (ECT)
Rating
 Very severe
depression only
Antidepressants
 Adults
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Adolescents
 Very good evidence
 Good evidence
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Promising treatment
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What helps for Depression?
Psychological Treatments
Rating
Cognitive behaviour therapy (CBT)
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Interpersonal psychotherapy
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Reading depression self-help books
based on CBT
Psychodynamic psychotherapy
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Ten Common Thinking Distortions
1. Black and white
6. Exaggerating
thinking
unpleasantness
2. Setting unrealistic
7. Catastrophizing
expectations
8. Personalizing
3. Selective thinking
4. Converting positives 9. Mistaking feelings
for facts
into negatives
10.Jumping to negative
5. Over generalizing
conclusions
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Action 5 Encourage Other Supports
• Family and friends can provide support
• Self-help strategies have proven
therapeutic effects
• They also help people to feel they are
regaining control of their lives
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What Helps for Depression?
Lifestyle & Alternative Treatments Rating
Exercise
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Light Therapy
 Seasonal
 Non-seasonal
Acupuncture
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Massage Therapy
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Relaxation Therapy
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What Helps for Depression?
Lifestyle & Alternative Treatments
Yoga breathing exercises
St. John’s wort*
Alcohol avoidance – people with
Rating
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drinking problems
Folic acid
*St John’s wort should not be taken with
antidepressants. This herb has interactions
with a number of prescribed medications.
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Session 3
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What is an anxiety disorder?
Symptoms
Types of anxiety disorders
Risk factors
Substance use and anxiety disorders
MHFA for anxiety problems
– Crisis first aid for panic attacks
– Crisis first aid for acute stress reaction
• Treatment and resources
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What is an Anxiety Disorder?
• Anxiety is a state of worry,
apprehension or uneasiness
• Anxiety disorders differ from “normal”
anxiety
• Excessive levels of anxiety that
interfere with day-to-day living
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Mind Racing?
Possible sleep
disturbance?
Feeling breathless,
breathing fast &
Shallow?
Nausea, lack
of appetite?
Restless?
Jelly-like legs?
Dizzy, disoriented,
lightheaded?
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Vision strange or blurry?
Difficulty swallowing?
Heart racing,
palpitations?
Trembling?
Sweating or
shivering?
Wanting to
run?
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General Symptoms of Anxiety
Psychological
• Sense of impending doom or imminent
danger
• Excessive inappropriate worry
• Fear of dying
• Decreased attention and concentration
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General Symptoms of Anxiety
Psychological
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Feeling detached from oneself
Speeding or slowing of thoughts
Easily distracted, insomnia, vivid dreams
Irritability, impatience, anger
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General Symptoms of Anxiety
Physical
• Cardiovascular: palpitations, chest
pain, rapid heartbeat, flushing
• Respiratory: hyperventilation,
shortness of breath
• Neurological: dizziness, headache,
sweating, tingling and numbness
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General Symptoms of Anxiety
Physical
• Gastrointestinal: choking, dry mouth,
nausea, vomiting, diarrhea
• Musculoskeletal: muscle aches and
pains (esp. neck and shoulders),
restlessness, tremors and shaking
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Types of Anxiety Disorders
• Generalized anxiety disorder
• Panic disorder (with or without
agoraphobia)
• Agoraphobia
• Specific phobia disorders
• Social anxiety disorder (social phobia)
• Obsessive-compulsive disorder
• Acute stress disorder
• Post-traumatic stress disorder
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Do You Worry All the Time?
Which problems have you had often over
the last 6 months?
 I never stop worrying about things big
and small
 I have headaches or aches and pains
for no reason
 I am tense a lot and have trouble
relaxing
 I have trouble keeping my mind
on things
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Do You Worry All the Time?
Which problems have you had often over
the last 6 months?
 I get crabby or grouchy
 I have trouble falling asleep or staying
asleep
 I sometimes have a lump in my throat
or feel like I need to throw up when I
am worried
 I sweat and have hot flashes
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Generalized Anxiety Disorder (GAD)
• Overwhelming and unfounded anxiety
• Physical and psychological symptoms
of anxiety and tension for more than
six months
• General worries over money, health,
family, etc., even when no problem
exists
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Do You Have Sudden Bursts of
Fear for No Reason?
Which problems have you had during
these bursts of fear?
 I have chest pains or a racing heart
 I have a hard time breathing or a
choking feeling
 I feel dizzy or I sweat a lot
 I have stomach problems or feel like I
need to throw up
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Do You Have Sudden Bursts of
Fear for No Reason?
Which problems have you had during
these bursts of fear?
 I shake, tremble or tingle
 I feel out of control
 I feel unreal
 I am afraid I am dying or going crazy
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Panic Disorder
• A person with a panic disorder has
panic attacks
• A panic attack is the sudden onset of
intense fear or terror
• The attacks develop suddenly
• The fear is inappropriate for the
circumstances in which it is occurring
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Agoraphobia
• Fear of having a panic attack
• Fear of being in a situation or place with
no help or escape
• Avoidance of places where it is felt that
a panic attack could happen
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Specific Phobia Disorders
• A person with a phobia avoids or
restricts activities because of fear
• The fear appears persistent, excessive
and unreasonable
• The fear will cause the person to avoid
specific things, events or places
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Do You Feel Afraid or Uncomfortable
When You are Around Other People?
Is it hard to be at work or school?
 I have an intense fear that I will do or
say something and embarrass myself
in front of other people
 I am always very afraid of making a
mistake and being watched and
judged by other people
 My fear of embarrassment makes me
avoid doing things that I want to do or
speaking to people
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Do You Feel Afraid or Uncomfortable
When You are Around Other People?
Is it hard to be at work or school?
 I worry for days or weeks before I
meet new people
 I blush, sweat, tremble or feel like I
have to throw up before or during an
event where I am with new people
 I usually stay away from social
situations such as school events and
making speeches
 I often drink to try and make
these fears go away
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Social Anxiety Disorder
• Common anxiety disorder
• Fear of humiliation, embarrassment or
scrutiny by others
• Fear that others are thinking negatively
about them
• Tends to develop in shy children as they
move into adolescence
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Do You Feel Trapped in a Pattern of
Unwanted and Upsetting Thoughts?
Are any of these problems interfering with
your life?
 I have upsetting thoughts or images
enter my mind again and again
 I feel like I can’t stop these thoughts or
images, even though I want to
 I worry a lot about terrible things that
could happen if I’m not careful
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Do You Feel Trapped in a Pattern of
Unwanted and Upsetting Thoughts?
Are any of these problems interfering with
your life?
 I have unwanted urges to hurt
someone but know I never would
 I have a hard time stopping myself
from doing things again and again, like
counting, checking on things, washing
my hands, re-arranging objects, doing
things until it feels right,
collecting useless objects
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Obsessive-Compulsive Disorder
• Obsessions and compulsions
accompany feelings of anxiety
• Obsessions are unwanted and
inappropriate recurrent thoughts,
impulses or images the person cannot
get rid of
• Compulsions are repetitive behaviours
or mental acts such as counting,
checking or washing
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Have You Lived Through a Very
Scary or Dangerous Event?
Which problems have you had after the
event?
 I jump and feel very upset when
something happens without warning
 I have a hard time trusting or feeling
close to people
 I stay away from places that remind
me of the event
 I feel guilty because others died
and I lived
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Have You Lived Through a Very
Scary or Dangerous Event?
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Which problems have you had after the
event?
 I have trouble sleeping and my
muscles are tense
 I feel like the terrible event is
happening all over again. This feeling
often comes without warning
 I have nightmares and scary memories
of the terrifying event
 I get mad very easily
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Acute Stress Disorder and
Post-Traumatic Stress Disorder
• Acute Stress Disorder (ASD) and PostTraumatic Stress Disorder (PTSD)
occur after experiencing a distressing
event
• ASD – distress is usually resolved
within a month
• PTSD – distress lasts longer than a
month
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Risk Factors
• Gender
• Family history or people with an anxious
parent
• Stressful life events (abuse, neglect,
trauma)
• Other mental health problems
• Drugs
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First Aid for Anxiety Problems
• Assess risk of suicide and/or harm
– Crisis first aid for panic attacks
– Crisis first aid for acute stress reaction
• Listen non-judgmentally
• Give reassurance and information
• Encourage the person to get
appropriate professional help
• Encourage other supports
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Action 1 Assess the Risk of
Suicide and/or Harm
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• People with anxiety disorders are at
greater risk of dying by suicide,
particularly if they also have depression
• If you determine the person is at risk for
suicide, follow the steps for Crisis First
Aid for Suicidal Behaviour
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Action 1 Assess the Risk of
Suicide and/or Harm
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• If the person appears to be having a
panic attack, follow the steps for Crisis
First Aid for Panic Attacks
• If the person is having a reaction to a
traumatic event, follow the steps for Crisis
First Aid for Acute Stress Reactions
• If the person does not seem to be at risk,
move on to Action 2 – Listen NonJudgmentally
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Crisis First Aid for Panic Attacks
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Call for help
If possible, move to a quiet location
Encourage slow breathing
Listen without judging
Explain that it could be a panic attack
and not life threatening
• Stay with the person until help
arrives or the panic attack is over
123
Crisis First Aid for Acute
Stress Reaction
123
• Let the person tell their story, if they want
• Be empathetic
• Validate normal responses to abnormal
events
• Encourage personal supports (where
appropriate)
• Suggest they avoid alcohol and drugs
• Encourage professional help
124
124
Action 2 Listen Non-Judgmentally
YOU ARE NOT LISTENING TO ME WHEN:
• You say you understand.
• You say you have an answer to my
problem, before I’ve finished telling you
my problem.
• You cut me off before I’ve finished
speaking.
• You finish my sentences for me.
125
125
Action 2 Listen Non-Judgmentally
YOU ARE NOT LISTENING TO ME WHEN:
• You are dying to tell me something.
• You tell me about your experiences,
making mine seem unimportant.
• You refuse my thanks by saying you
really haven’t done anything.
126
126
Action 2 Listen Non-Judgmentally
YOU ARE LISTENING TO ME WHEN:
• You try to understand me, even if I’m
not making much sense.
• You grasp my point of view, even when
it’s against your own sincere
convictions.
• You realize the hour I took from you has
left you a bit tired and a bit drained.
127
127
Action 2 Listen Non-Judgmentally
YOU ARE LISTENING TO ME WHEN:
• You allow me the dignity of making my
own decisions, even though you think
they may be wrong.
• You do not take my problem from me,
but allow me to deal with it in my own
way.
• You hold back the desire to give me
good advice.
128
128
Action 2 Listen Non-Judgmentally
YOU ARE LISTENING TO ME WHEN:
• You do not offer me religious solace
when I am not ready for it.
• You give me enough room to discover
for myself what is really going on.
• You accept my gratitude by telling me
how good it makes you feel to know that
you have been helpful.
129
129
Action 2 Listen Non-Judgmentally
• Listen to the person without judging
• Do not be critical of the person
• Do not express frustration at the person
for having such symptoms
• Do not give glib advice such as “pull
yourself together”
• Avoid confrontation
130
Action 3 Give Reassurance
and Information
130
• Anxiety disorder is a real medical condition
• An anxiety disorder is a common illness
• An anxiety disorder is not a weakness or
character defect
• Effective help and treatments are available
• Skills can be learned to reduce the effects
of stress and anxiety
131
131
Action 4 Encourage the Person to Get
Appropriate Professional Help
• Family doctor or physician
• Counselling or psychotherapy for
specific anxiety disorder
132
132
Action 5 Encourage Other Supports
• Anxiety is best overcome by confronting
fear rather than avoiding it
• Use evidence-based self-help books
• Practice daily relaxation methods to
reduce physical symptoms of tension
• Exercise regularly and get enough sleep
• Reduce caffeine intake
• Engage in leisure time
133
133
What Helps for Anxiety Disorders?
Treatments
Anxiety Disorder
CBT self-help books Specific phobias
Physical exercise
Generalized anxiety
disorder
Relaxation training Generalized anxiety
disorder
Acupuncture
Generalized anxiety
disorder
Rating
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


134
134
What Helps for Anxiety Disorders?
Treatments
Meditation
Relaxing music
Alcohol avoidance
Anxiety Disorder
Generalized anxiety
disorder
Generalized anxiety
disorder
Range of anxiety
disorders
Rating



135
135
Session 4
•
•
•
•
•
•
What is a psychotic disorder?
Types of psychotic disorders
Symptoms
Risk factors
Substance use and psychotic disorders
MHFA for psychosis
– Crisis first aid for a psychotic episode
• Treatment and resources
136
136
What is a Psychotic Disorder?
• Causes a person to lose some touch
with reality
• Severe disturbances in thinking,
emotion and behaviour
• Not as common compared to other
mental health problems
137
137
What is a Psychotic Disorder?
• Psychosis may appear as a symptom in
a number of mental health problems
including:
– Schizophrenia
– Schizoaffective disorder
– Psychotic depression
– Substance-induced psychotic
disorder
138
138
Four phases of psychosis
• Premorbid: Time before symptoms start
• Prodrome: Symptoms are barely
noticeable
• Acute: Psychotic symptoms
experienced
• Recovery: With treatment, people can
recover
139
139
140
140
Symptoms of Psychosis
Changes in emotion and motivation
• Depression
• Mood swings
• Increased anxiety
• Suspiciousness
141
141
Symptoms of Psychosis
Changes in emotion and motivation
• Blunted, flat or inappropriate emotion
• Irrational, angry or fearful responses
• Change in appetite
• Reduced energy and motivation
142
142
Symptoms of Psychosis
Changes in thinking and perception
• Difficulties concentrating
• Sense of alteration of self or others –
feeling that self or others have changed
or are acting differently
• Inability to turn off imagination, odd
ideas
143
143
Symptoms of Psychosis
Changes in thinking and perception
• Unusual perceptual experiences –
reduced or greater intensity of smell,
sound, colour
• Inappropriate use of language – words
don’t make sense to others
• Difficulty controlling thoughts
144
144
Symptoms of Psychosis
Changes in behaviour
• Sleep disturbances
• Loss of appetite
• Withdrawal from activities and social contacts
• Deterioration in studies or work
• Deterioration in personal hygiene
• Physical symptoms
• Sudden excesses
145
145
Schizophrenia
• Schizophrenia is a chronic and disabling
disorder
• Mental function changes and thoughts
and perceptions become disordered
• It is not a constant or static condition
146
146
Symptoms of Schizophrenia
Positive Symptoms
• Delusions
• Hallucinations
Negative Symptoms
• Thinking difficulties
• Loss of drive
• Blunted emotions
• Social withdrawal
147
147
Other Psychotic Disorders
• Schizoaffective disorder
• Psychotic depression
• Substance-induced psychosis
148
148
Risk Factors
It is believed that psychosis is caused by
a combination of factors including:
• Family history
• Chemical changes
• Stress
• Other factors
149
149
First Aid for Psychosis Problems
• Assess risk of suicide and/or harm
– Crisis first aid for a psychotic episode
• Listen non-judgmentally
• Give reassurance and information
• Encourage the person to get
appropriate professional help
• Encourage other supports
150
Action 1 Assess the Risk of
Suicide and/or Harm
150
• Psychotic disorders involve high risk of
suicide
• If you determine the person is at risk for
suicide, follow the steps for Crisis First
Aid for Suicidal Behaviour
151
Action 1 Assess the Risk of
Suicide and/or Harm
151
• If the person is having a psychotic
episode, follow the steps for Crisis First
Aid for Psychotic Episodes
• If the person does not seem to be at
risk, move on to Action 2 – Listen NonJudgmentally
152
152
Crisis First Aid for a Psychotic Episode
• Ensure personal safety
• Call the police or emergency medical
services, if necessary
• Try to create a calm, non-threatening
atmosphere
• Express empathy
153
153
Action 2 Listen Non-Judgmentally
• Listen to the person without judging
them as weak
• Speak calmly, clearly and in short
sentences – repeat things if necessary
• Do not be critical of the person and do
not express frustration with the person
for having such symptoms
154
154
Action 2 Listen Non-Judgmentally
• Do not offer glib advice such as “pull
yourself together”
• Avoid confrontation
• Do not argue with a person about their
delusions and hallucinations
• Do not pretend the delusions and
hallucinations are real for you
155
Action 3 Give Reassurance
and Information
155
• When a person is in a psychotic state, it
is difficult and inappropriate to give
them information about psychosis – wait
until they are in touch with reality
• Do not make promises you cannot keep
and do not lie
156
Step 3 Give Reassurance and
Information
156
• When the person is thinking more
clearly explain:
– You want to help them
– They have a real medical condition
– Their condition is not common, but it is well
known and researched
– Psychosis is not a weakness or character
defect
– Effective medications are available
157
157
Action 4 Encourage the Person to Get
Appropriate Professional Help
• Early intervention is important
• The person needs to receive
appropriate treatment
– Family doctor or physician
– Psychiatrist
– Community mental health programs
158
158
Action 5 Encourage Other Supports
•
•
•
•
Family and friends
Support groups
Crisis lines
Many people with a psychotic disorder
also have depression and/or anxiety