Mental Health Awareness & Challenging Behaviours by Dawn Collins

Mental Health Awareness & Challenging Behaviours Dawn Collins June – July 2022

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Depression Facts -

Approximately one in four people experience depression at some point in their lives and as well as it being the most common reason for visits to our GP’s in the UK, it has been said to be the leading cause of disability and ill health globally. Individuals can feel helplessness and hopelessness, and this can be very mild to severe – Depression is more than feeling a bit low and fed up and can significantly affect a person’s ability to function. Depression can be caused by various factors. The most widely accepted model is the Bio-Psychosocial model - Genetics and then life events can trigger symptoms, e.g., bereavement, illness, unemployment, relationship problems, financial difficulties. There is not always be a specific incident that has ‘caused’ someone to become depressed although hormonal changes, (menopause), childbirth, weather and gender are examples of factors that may increase risk. As well as varying in terms of severity, depression has different ‘types’ including perinatal depression, psychotic depression and seasonal affective disorder (SAD). For clinical diagnosis, symptoms must be experienced for at least two weeks, but it is more likely that people will experience symptoms for 6-8 months before asking for help and receiving any diagnosis.

Symptoms The ICD-10 (International Classification for Disease), states that to be diagnosed with ‘clinical depression’ you will have some of these symptoms for 2 weeks or more: -

Lack of energy and tiredness. Sadness that does not go away. Loss of interest in activities that used to be enjoyable Loss of self-confidence and poor self-esteem. Difficulty concentrating. Avoiding people Feeling guilty Feelings of helplessness, hopelessness and worthlessness. Sleep disturbances Inability or difficulty functioning at work/school/college Loss of appetite or eating too much. Loss of sex drive and/or sexual problems. Physical aches and pains. Thinking about suicide and death. Self-harming behaviours including self-medication.

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Workplace signs Some people seem to mask their symptoms within a work environment and working remotely can make some signs more difficult to spot. -

Poor performance Lack of motivation Relationship difficulties with colleagues and managers Work can take longer, may be incomplete to the required standard and things may be forgotten Hypersensitivity to comments/constructive criticism Anxiety around performance Needing reassurance from colleagues and managers Secretive Withdrawal from usual work-based activities

You can watch the WHO’s ‘I had a black dog’ animation here: https://www.youtube.com/watch?v=XiCrniLQGYc

Anxiety Disorders Facts -

More than one in eight people are likely to experience troublesome anxiety that meets criterion for diagnosis of an anxiety disorder at some point in their life Mixed anxiety and depression are the most common mental health condition in the UK Common at any age Affects women more than men Is not the same as the anxiety we may all feel under certain circumstances, e.g., at an interview

Symptoms Anxiety is normal and can be advantageous, but people with an anxiety disorder are likely to struggle to control their worries and fears. For an individual with an anxiety disorder, it is likely that they will experience symptoms which affect their ability to function in daily life, in relationships and will stop them engaging in activities they would usually enjoy. Examples of types of anxiety disorders include: -

OCD GAD Panic Disorder Phobias

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Trauma disorders are also currently listed as anxiety disorders and include PTSD and Acute Stress Disorder. Anxiety causes the body to prepare for a real or perceived threat. As with depression, the symptoms can affect us physically, behaviorally and psychologically. Symptoms may include: -

Increased heart rate and breathing rate Headaches and muscle tension Dizziness Nausea, stomach pain and diarrhoea Sleep disturbance Difficulty concentrating, making decisions and communicating effectively Restlessness Irritability and angry outbursts Feeling on edge and a sense of impending doom/dread

Workplace signs -

Performance anxiety Constantly needing reassurance from colleagues and managers Frequently disappearing and requests for unplanned leave (avoidance) Lateness and absenteeism Lack of concentration and being easily distracted Inability to make a simple decision Relationship issues

Bipolar Affective Disorder Facts -

Previously known as manic depression Characterised by high and low moods - a person’s mood can alternate between the ‘poles’, mania, (highs) and depression, (lows). Affects approx. 2 in 100 people in the UK but is often misdiagnosed or goes undiagnosed when symptoms are less severe. Often appears in late adolescence when young people typically present with signs of depression. Equally affects men and women

Symptoms During a ‘manic episode’ individuals may seem excited, overly happy and outgoing. They may not need much sleep and be full of energy and enthusiasm. Being ‘wired’ may describe how people feel during mania. Fast speech, irritability and racing thoughts occur and people become restless. Other symptoms include: Dawn Collins Training Ltd

An increase in goal-directed activities, such as taking on new projects An unrealistic belief in one's abilities Impulsivity and taking part in a lot of pleasurable, high-risk behaviours, such as spending sprees, impulsive sex, and impulsive business investment.

This manic feeling can be very alluring and attractive. During a ‘depressive episode’ – please see Depression. Workplace signs -

Mood stabilising medication can cause tiredness and low attention span/ easily distracted Pronounced mood swings Extreme tiredness and other signs of depression (see above) May display extreme behaviours or be ‘out of character’ Changes in productivity – taking on more projects / working longer hours during manic phases Difficulty with relationships Difficulty sustaining employment due to the fluctuating moods

Psychotic Disorders Facts -

About one in 100 adults in the UK will experience psychosis, and two thirds of these will go on to have future episodes. Early onset of symptoms is typically late adolescence/early adulthood. Although less common, there will be employees who have this condition and manage it in the workplace.

Symptoms During a psychotic episode, an individual may have an altered or distorted sense of reality and experience: -

Hallucinations Delusions Thought disorder

An episode of psychosis can last for several weeks and can be very frightening. Individuals may believe they are hearing other people’s thoughts or having their own thoughts removed, broadcast or interfered with. Prior to a diagnosis, individuals may experience psychosis, which is not a disorder in itself but is characterised by stopping the person from thinking clearly.

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People may be unable to tell the difference between reality and their own thoughts and imagination. Psychotic symptoms can also be experienced by people with other conditions such as Bipolar Disorder, Parkinson’s disease, a brain tumour or drug/alcohol misuse. Workplace signs -

Flattened emotional responses Parkinson’s-like movements due to side effects of medication. Individuals may express little emotion or may show emotion that appears out of context, for example crying at a joke. Withdrawal and avoidance of colleagues, e.g., eating lunch alone. Individuals may say little and rarely initiate a conversation. Speaking in a way that seems muddled and illogical – no meaning to a sentence. Psychosis may mean individuals think or act in a way that cannot easily be understood. May become uncharacteristically hostile to members of the team.

Personality Disorders Facts It is thought that approx. 15% of people in the UK meet criterion for diagnosis of a Personality Disorder. Personality disorders can be described as a set of disorders people may experience as a result of, E.g., childhood trauma and sometimes attachment/separation issues which affect a persons’ ability to function and cope in adulthood. Individuals may struggle with forming and sustaining relationships and self-harming behaviours are common. People with PD’s sometimes inadvertently cause distress to themselves and people around them. There are different types of personality disorders, examples include Narcissistic, Borderline/Emotionally Unstable and Anti-social personality disorder. Symptoms Each personality disorder has its own set of symptoms, but common to all are: -

Behaving in a way that others consider outside of the norm Feeling overwhelmed by emotions Social anxiety Relationship difficulties with family, friends and colleagues. Losing contact with reality

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Self-harming behaviours Struggling to cope with daily functioning

Workplace signs Within a workplace environment we come in to contact with all sorts of ‘personalities’. Personality disorders may become noticeable in the workplace. -

Relationship difficulties with colleagues and managers Lack of cooperation Complaints about people/teams/managers Intense, unstable relationships Anger/irritability Withdrawal Lack of empathy Exaggerating abilities Feeling inadequate and asking for lots of reassurance Depression Anxiety Psychosis Excessive interest in lists and hoarding behaviours – usually OCPD Inability to delegate

Eating Disorders Facts It is estimated that 1.25 million people in the UK have a diagnosable eating disorder. Having an unhealthy relationship with food is relatively common; however, eating disorders can be very dangerous, - anorexia has the highest mortality rate of any mental health condition. Eating disorders can be a negative coping strategy and often those who experience them do not realize that they are developing at first. This group of related conditions can be about control and underlying a lack of self-esteem. Common eating disorders include Anorexia, Bulimia, Binge Eating Disorder and Orthorexia. Symptoms Symptoms of eating disorders include: -

Restricting food intake Eating too much

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Purging after eating Worrying about food Thinking and talking about food An obsession with healthy eating and/or exercise

Workplace signs You may notice some of the following: -

Avoiding mealtimes Preoccupation with food, calorie counting or exercise Irritation and anger if challenged Denial Disappearing after eating Weight loss/gain

Self-harm – BEHAVIOURS not DISORDERS Facts Self-harming is a behavior and not classified as a mental health condition. It can range from scratching at oneself to more dangerous, risky behaviors. Self-harm is inflicting injury upon oneself as a way of coping or communicating distress. Sometimes people self-harm as a release, sometimes to feel something or punish themselves. This varies from person to person. Types of self-harm include: -

Cutting Burning Hair pulling/skin picking Banging limbs/head Drinking or eating harmful things Self-medication

Drug and Alcohol Use Self-harming behavior may be in the form of ‘self-medication’. This could be by taking alcohol, prescribed medications or illicit substances or all of these. Addictions and Substance misuse disorders are classified as mental health conditions and very clearly linked to mental ill health. For more info about these and other mental health conditions, please visit: www.mind.org.uk

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Activity sheets

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The Stress Bucket

Original Source: Brabban & Turkington, 2002 We all have a ‘Stress Bucket’. Our vulnerability is shown by the size of our bucket. The sources of stress in our lives our many and varied. Stress flows into your bucket and fills it. If your bucket overflows, this could be the point at which a mental health condition is triggered and so we need to ensure we use our ‘coping tap’ effectively.

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Draw yourself a bucket in the space below. Write down inside the bucket the various ‘layers’ or sources of stress that you are currently managing. Include physical stressors, environmental stressors, psychological stressors, work-based stressors. Ask yourself the following questions: − − − − − − −

Is anything in my bucket there unnecessarily? Can anyone help me with any of the layers? Can I prioritise layers in my bucket? Which layers do I need to accept and better manage? (These are stressors you cannot control). What am I doing to help myself (Helpful coping strategies)? What else could you do to help yourself? What am I doing to potentially add layers? (Unhelpful coping strategies)

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Challenging Behaviours Your ‘cases’ and/or general scenarios

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3 minutes for person to introduce background to case and highlight what support looking for from the group

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3 minutes for the group to ask clarifying questions, (avoiding dressing up questions as advice).

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3 minutes for the rest of the group to discuss what advice they would give, (case owner must only listen)

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Few minutes for feedback from case owner

NOTES

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Challenging Behaviours Definitions A person's behaviour can be defined as "challenging" if it puts them or those around them (such as their carer) at risk or leads to a poorer quality of life. (NHS, UK). Challenging behaviour describes behaviour that is challenging to parents, carers, teachers, and other professionals. (Mencap) ‘Challenging behaviour’ is how we talk about a range of behaviours which some people with LD’s may display to get needs met. (challengingbehaviour.org.uk) Challenging behaviour is any behaviour that someone displays that is a challenge for others to manage and/or puts the young person or others at risk. (NHS)

Types • • • • •

Behaviours that challenge include but are not limited to: Aggression Self-harm Destructiveness Disruptiveness

Causes All behaviour is a form of communication and there is a reason for all behaviour. Behaviour that challenges is a way to communicate unmet needs when an individual struggles to communicate their needs in other ways often due to factors such as anxiety, neglect, abuse, learning disabilities and conditions like dementia. Understanding the causes of challenging behaviour is the first step towards finding ways to support individuals and manage their behaviour. There are numerous causes of behaviour that challenges, which are usually unique to each individual.

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What exacerbates the situation? ▪ ▪ ▪ ▪ ▪

Becoming agitated or upset Attempting to restrain or corner the individual Not listening, shouting or talking over them Embarrassing, humiliating or laughing at them Forcing them to make eye contact

What was the person trying to communicate? Triggers: What happened before the behaviour? Are they under the influence of drugs or alcohol?

And if preventative measures don’t work: • • • • • •

Stay calm and give the individual space Try to find out what the problem is Speak gently and clearly whilst thinking about your body language, try not to appear threatening in any way Be compassionate and show empathy for the individual Try to negotiate and work out a compromise Distract the individual

General Tips • • • • • •

Figure out what triggers behaviour that challenges Encourage alternative ways of communicating and expressing themselves Be aware of warning signs and potential problems Develop strategies to diffuse the situation Explain things clearly and be patient, allow extra time for the individual to process information Find out the individual’s personal preferences i.e. do they have issues with being touched or do they struggle to make eye contact?

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WRAP

The Wellness Recovery Action Plan ‘WRAP’ “Taking control of your wellness”

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Please see abbreviated version of the WRAP separately here: https://www.getselfhelp.co.uk/docs/WRAP.pdf

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Fa m ily

Wo rk

C o n su m e r

Me d ic a l

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Fin a n c ia l

Le g a l

Self-Care In addition to the ‘TOP FOUR’ basic self-care strategies, the Five Ways to Well-being are now incorporated in to MHFA England/Action For Happiness: Ten Keys to Happier Living:

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Crisis support and helplines If you, or someone you know is in mental health crisis and needs help fast: − − − −

999 A&E 111 GP

You could also call any of these numbers in a crisis for guidance: − Samaritans 116 123 or jo@samaritans.org − HOPELINE UK (under 35’s) 0800 068 4141 or text 07786 209697. e: pat@papyrus-uk.org − CALM 0800 58 58 58 UK wide, or LONDON 0808 802 58 58 − SHOUT Text: 85258. Shout 85258 is a free, confidential, anonymous text support service. You can text from wherever you are in the UK.

− Mind info line 0300 123 3393 or text 869463

Useful weblinks: − MIND the Mental Health Charity provides access to resources, advice, telephone support and training. http://www.mind.org.uk/ − Improving Access to Psychological Therapies (IAPT). Each region across England has an IAPT service providing support e.g., therapy, counselling, and support groups. http://www.iapt.nhs.uk/ − NHS Choices has a wide variety of resources including online Cognitive Behavioural Therapy (CBT) and online forums for support: http://www.nhs.uk/LiveWell/Mentalhealth/Pages/Mentalhealthhome.aspx − Mindfulness is a useful tool for people experiencing depression and anxiety: http://bemindful.co.uk/ − Confidence building. Mindtools has some very useful resources and exercises for helping to increase self-confidence: http://www.mindtools.com/selfconf.html

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− Relaxation Techniques are helpful for anyone experiencing any mental health condition or stress. Helpguide has a number of useful techniques with tips on what will work best for individuals: http://www.helpguide.org/mental/stress_relief_meditation_yoga_relaxation .htm − Support for people with caring responsibilities o http://www.carers.org/?gclid=CPz87NvbsboCFfSWtAodAgIAhw o Carers UK: http://www.carersuk.org/support − Rethink Mental Illness: www.rethink.org − NHS: www.nhs.uk/pathways/depression − Anxiety UK: www.anxietyuk.org.uk − Bipolar UK: http://www.bipolaruk.org.uk/ − Centre for Clinical Interventions (CCI): http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=38 – Bipolar support, takes the individual through modules for self-awareness − Mood Gym: https://moodgym.anu.edu.au/welcome - online CBT − Schizophrenia World: http://www.schizophrenia-world.org.uk/ − B-eat: https://www.b-eat.co.uk − Every Mind Matters: https://www.nhs.uk/oneyou/about-one-you/ Simple, practical advice from how to deal with stress and anxiety, to boosting our mood or sleeping better. It will help you spot the signs of common mental health conditions, get personalised practical self-care tips and information on further support.

Management Resources − Equality and Human Rights Commission provides advice and guidance on reasonable adjustments in the workplace: http://www.equalityhumanrights.com/advice-and-guidance/guidance-foremployers/the-duty-to-make-reasonable-adjustments-for-disabledpeople/reasonable-adjustments-in-practice/ − ACAS Guide to Challenging Conversations: http://www.acas.org.uk/index.aspx?articleid=3799 o (Advisory, Conciliation and Arbitration Service) Phone: 0300 123 1100 www.acas.org.uk o Free, impartial information and advice to employers & employees on all aspects of workplace relations and employment law and also provides conciliation services to resolve workplace problems. − EoH guidance on workplace adjustments for mental health www.nhshealthatwork.co.uk/images/library/files/Government%20policy/Me Dawn Collins Training Ltd

ntal_Health_Adjustments_Guidance_May_2012.pdf (Accessed 12/10/2016) o The Department of Health published this advice on providing reasonable adjustments for mental health conditions, outlining examples of adaptations and good practice on applying any adjustments. − Fit for Work 0800 032 6235 www.fitforwork.org o Voluntary service offering access to occupational health (OH) advice and support. Employers can refer employees who've been off work for 4 weeks or more a free 'fit for work' assessment. An employer's guide and a stress risk assessment tool can also be found here. − Government policy and guidance o A full list of governmental policy and guidance documents, including those relating to disability support schemes for the workplace like Access to Work, is available from: www.gov.uk/government/policies/employment − HSE management standards indicator tool Available from: http://www.hse.gov.uk/stress/standards/pdfs/indicatortool.pdf o This is a comprehensive risk management tool for assessing and monitoring work-related stress, created by the HSE. o − NICE guideline Workplace Health Management Practices This guideline by the National Institute for Health and Care Excellence covers how to improve the health and wellbeing of employees, with a focus on organisational culture and the role of line mangers: Available from: www.nice.org.uk/guidance/ng13 − Time to Change’s guide to workplace mental health o http://www.time-to-change.org.uk/get-involved/get-your-workplaceinvolved/support-managers o Anti-stigma campaign providing guidance, tips and tricks on many aspects of dealing with mental health in the workplace, including legal guidance and onwards signposting to additional resources.

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Mental Health Awareness & Challenging Behaviours

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