Jewish Mental Wellness Toolkit by The Blue Dove Foundation

Jewish Mental Wellness

TOOLKIT

Cover and compilation 2020 the Blue Dove Foundation Inc. Published for noncommercial, charitable use by the Blue Dove Foundation. For reprint or redistribution requests, please contact the Blue Dove Foundation. Disclaimer: This Toolkit is intended to be a general summary of publicly available information. It does not take the place of applicable federal or state laws or regulations relating to the subject matter in the Toolkit. This Toolkit is a reference aid only. It is not intended to offer medical or mental health advice or diagnoses. Anyone using the Toolkit should confirm all information through the appropriate medical or mental health care providers. For any and all medical or mental health care questions, please contact a qualified medical or mental health care provider. A note about gender: We made the decision to use the neutral pronouns “them, they and their” as much as possible throughout the book. Where we used other sources’ material, however, we kept whatever terms they used, e.g., him/her/he/she. The Blue Dove Foundation developed this Toolkit based on interviews and information-gathering exercises. We hope you find it meaningful and helpful. To order a Toolkit, visit thebluedovefoundation.org. Distributed by: The Blue Dove Foundation Inc. 1200 Ashwood Parkway, Suite 400 Atlanta, GA 30338 TheBlueDoveFoundation.org Info@TheBlueDoveFoundation.org

We dedicate this Toolkit to those living with mental health struggles and substance use disorders and, most tragically, those who have lost their lives.

TABLE OF CONTENTS Welcome

About the Blue Dove Foundation

Acknowledgments

Facts & Statistics

Kavanah - Intention

Part One: Making Mental Wellness Our Jewish Community Culture

Preface

Introduction

Section A: Our Mental Wellness Philosophy

Our Jewish Mental Health Values

Our Mental Health Definitions

Section B: Creating a Mental Wellness and Stigma-Free Environment

Section C: Jewish Prayers, Rituals, and Resources

Jewish Mental Health Resources

Part Two: Recognition, Response, and the Road to Healing

Introduction

What to do in an Emergency

Additional Emergency Resources

Mental Disorders and Conditions

Anxiety

Depression

Bipolar Disorder

Personality Disorders

Suicide

Substance-Related and Addictive Disorders

106

Trauma

114

Low Self-Esteem

122

Kavanah - Intention

127

Part Three: Resources

128

Grounding Exercises to Help Someone Who is Struggling

129

Self-care with a Jewish Connection

131

Gratitude & Joy with a Jewish Connection

135

Jewish Mental Wellness Workshops

138

Tools and Resources from the Partnership Center

139

Mental Health Glossary

142

Suggested Readings

148

WELCOME Hope is one of the greatest resources we have to change the culture of silence and stigma around mental health in the Jewish community. The Blue Dove Foundation wants to inspire you to be courageous and confident in offering hope to people who struggle with their mental well-being and addiction. This work is personal to me. Having lost a sister to an opioid overdose as a result of a mental health condition, I know firsthand how mental health struggles and addiction affect the individual, the family, and the community. I envision a Jewish society where we lead by example, educating one another and offering support so fewer people have to suffer the heartbreak my family experienced. The Jewish Mental Wellness Toolkit is a response to continuous requests for help in the area of mental health. As a practical guide for everyday use, it is designed to supplement some terrific tools that already exist. We believe it will help us take a tangible step toward creating a stigma-free, supportive Jewish community. In the pages that follow, we offer guidance and support for transforming our culture along with practical and concrete information about mental health and wellness. Created through a Jewish lens, this Toolkit is full of resources, facts, and suggested readings. We hope it will empower you to turn hope into action. The Talmud teaches us â&#x20AC;&#x153;Whoever saves a single life, it is considered as if he saved an entire world.â&#x20AC;? I believe, together, we can do just that. Warmly, Gabrielle Spatt Executive Director The Blue Dove Foundation

ABOUT THE BLUE DOVE FOUNDATION

WWW

@ TheBlueDoveFoundation

@BlueDoveFoundation

TheBlueDoveFoundation.org

Who We Are The Blue Dove Foundation was created to help address the issues of mental illness and addiction in the Jewish community and beyond. Based in Atlanta, we work with people and organizations across the United States and around the world. The Jewish community is not immune to the problems the rest of society wrestles with when it comes to mental health and substance abuse. Yet we as a group too often have refused to acknowledge and discuss the issues. As a result, many individuals and their families suffer privately and lack the information necessary to address their struggles. Recognizing the importance of collaboration when it comes to solving this community problem, we accomplish our work through program, promotional, and support partnerships. The Foundation values both our existing relationships and future partners whose missions align with ours.

Our Mission To educate, equip, and ignite our Jewish community with tools to understand, support, and overcome the challenges presented by mental illness and substance abuse. As a community with a focus on tikkun olam, we work to eradicate the shame and stigma surrounding these issues. Once we achieve this goal, we can begin to improve and save lives.

Our Work 1. Education, awareness, and outreach: We encourage conversations and provide information and tools for individuals and families seeking assistance. 2. Financial assistance for treatment: We provide hardship scholarships and/or interest-free loans. 3. Scalable programs: We develop, design, and launch easily replicated programs for schools, synagogues, community centers, camps, institutions, and affinity groups. Programs include speaker series, mental health Shabbat dinners, community trainings utilizing the Blue Dove Foundation Mental Wellness Toolkit, and more.

Why the Dove In the book of Genesis, Noah released a dove after the great flood in order to see if the water had subsided. It came back carrying a freshly plucked olive leaf (Hebrew: ‫ עלה זית‬alay zayit), a sign of life and of God’s bringing Noah, his family, and the animals to a renewed land. The dove represents peace of the deepest kind. It soothes and quiets our worried or troubled thoughts, enabling us to find renewal in the silence of the mind. Its roles as a spiritual messenger, maternal symbol, and liaison impart an inner peace that helps us go about our lives calmly and with purpose. Some believe the dove also represents hope, while others believe it denotes freedom. Bringing peace, life, hope, and freedom for those facing addiction or other mental health challenges is the goal of the Blue Dove Foundation.

ACKNOWLEDGMENTS The Blue Dove Foundation expresses our utmost gratitude to the individuals and organizations that played a role in bringing this Jewish Mental Wellness Toolkit and the accompanying workshops to life. They truly exemplify the meaning of #QuietingTheSilence and the importance of working to eliminate the shame and stigma associated with mental illness and addiction. Special thanks to the following community partners for providing insight, expertise, heart, and, above all, support.

The Breman Foundation, Inc.

DAVID RAPHAEL CONSULTING

We're proud to be supported by a Propel Innovation grant from the Jewish Federation of Greater Atlanta

Dr. Ariela M. Freedman, Rabbi Joshua Lesser, Emily Wilkinson, and Cynthia S. Freedman

KAVANAH - INTENTION Adapted from the OneTable and Blue Dove Foundation mi sheberach Shabbat guide.

Medical professionals often say setting intentions is the first step in mental health recovery. This is also a deeply held Jewish value known as kavanah, or personal intention. There is a dance in Judaism between kevah, or standard practice, and kavanah. A practice enacted only from a place of kevah can feel stagnant. The Jewish sages agree that to have a practice that is deeply personal, lively, and inspiring, one needs kavanah. As you begin to review this Jewish Mental Wellness Toolkit, what is your kavanah in doing so? Take a few minutes to think about it and write it down (below or on a separate piece of paper). When you commit it to paper, the intention becomes a bit more real and sacred.

PART ONE

Making Mental Wellness Our Jewish Community Culture

PREFACE TALMUD BERACHOT 5B Translated and adapted by Rabbi Joshua Lesser of Congregation Bet Haverim in Atlanta. Once, when Rabbi Yoḥanan’s student Rabbi Ḥiyya bar Abba became ill, Rabbi Yoḥanan came to visit. He asked: “Are your sufferings dear to you?” Rabbi Ḥiyya responded: “I welcome neither this suffering nor its reward." Rabbi Yoḥanan told him, “Give me your hand.” He gave him his hand. Rabbi Yoḥanan raised him up. Then Rabbi Yoḥanan fell ill. Rabbi Ḥanina entered to visit him. He asked: “Are your sufferings dear to you?” Rabbi Yoḥanan replied: “I welcome neither this suffering nor its reward.” Rabbi Ḥanina said to him: “Give me your hand.” He gave him his hand, and Rabbi Ḥanina raised him up. The Gemara asks: Why did Rabbi Yoḥanan have to wait for Rabbi Ḥanina to restore him to health? If he was able to heal his student, couldn’t Rabbi Yoḥanan “right” himself and get up from his condition? The Gemara answers, no, because a prisoner cannot free oneself from prison.

This Talmudic text on healing has been one of my favorites to teach. Like the best of Jewish teachings, there are many ways to understand it. In its fuller context (there is discussion of traumatic loss and self-worth), it can be considered to address mental and spiritual wellness. It is quite likely our ancestors did not compartmentalize wellness in the ways we do; the spiritual, mental, and physical were likely more integrated. In preparing a Jewish communal approach to mental wellness, health, and illness, this text has been my guide. It begins by teaching us that even our greatest leaders are affected by mental wellness. How powerful to note that the rabbi who is the healer in the first part of the story needs healing in the second. In other words, this is a conversation for everyone; we all can benefit.

Making Mental Wellness Our Jewish Community Culture

Second, the healing in this text emerges from being present with another. The rabbi asks an important question and listens to the answer: “Are your sufferings dear to you?” This reflects the idea that some feel their struggles are part of their identities. Part of inclusion is recognizing that when supporting someone, it’s important to center the help you give on the needs they are expressing. When the rabbi who seeks healing responds with a “no” and is met with “Give me your hand,” it opens up the space for him to receive support that is meaningful and consensual. Isn’t this what we want for our Jewish organizations? We can create communities that support one another’s wholeness and healing. And when people are suffering, we can extend sanctuary and comfort. Ultimately, like the text says, when done well, everyone is raised and our community is elevated. After all, our ancient wisdom tells us this is not an endeavor that can be successful alone. Just as a prisoner cannot free themselves; we must join together and generate the conditions for wholeness and health as a community.

As your community works toward healing, we hope this Toolkit will provide support and guidance to help you get there.

Making Mental Wellness Our Jewish Community Culture

INTRODUCTION A compassionate and knowledgeable approach to mental wellness can strengthen any community. Imagine one where people openly discuss their mental health needs without the fear of being judged and where they receive the caring and informed support they need. The Blue Dove Foundation believes for our Jewish communities to thrive, we must equip our communal professionals and lay leaders sufficiently to support the mental wellness of our members. We have spoken to rabbis, executive directors, programming staff, educators, and other professionals. All have expressed how mental health has affected their jobs and have indicated a need for additional resources and educational materials to help them support their communities. We hope this Toolkit provides the assistance they need to do their work. We chose to use a holistic approach that conceptualizes the individual as a whole, interconnected being with physical, mental, emotional, social, and spiritual needs. In addition to addressing specific issues like depression and addiction, we have to look at the environments in our communities. Too often, shame and stigma create barriers that prevent us from responding to mental health needs. Not only do they stop people from discussing their hardships and hopes, but they also discourage organizations from creating safe environments that can guide people on the path to mental wellness in a caring way. We created a Toolkit that focuses on mental wellness and well-being and includes everyone in the conversation. Mental wellness is an all-encompassing topic. Our goal with this guide is to help you find the support you need to become better educated, so you can increase awareness, offer assistance, and make referrals. You should think of it as a starting place.

You do not need to be an expert to make a substantial impact. You just need to be caring and informed. But you also need to be aware of your limits.

Making Mental Wellness Our Jewish Community Culture

The Toolkit comprises two sections. The first focuses on holistic philosophical approaches to mental health and wellness. This includes Jewish values that undergird creating communities of care. We explore the most common barriers, such as stigma and shame, that prevent our communities from achieving our best. We also offer general tools and suggestions to help you provide a safe and dignified environment where people feel comfortable talking about mental wellness. We break things down so they are understandable, actionable, and manageable. In the second section, we take a more specific approach in identifying some of the most common mental health challenges people face. We aim to help you identify when people are struggling, the kind of help you might offer, and how you can support them on their journey. We also include specific examples for how to push back against stigma in the community and demystify the experience. When possible, we want to empower you to extend hope and aid healing. If you need more advanced support, we hope you will call on the Blue Dove Foundation and other local Jewish organizations. Together, we can bring greater health and vitality to our global Jewish community.

Note: The Toolkit includes a number of hyperlinks, with each having a corresponding shortened URL that opens it. For easy access to all websites included in it, participants can visit thebluedovefoundation.org/toolkitlinks and enter the password â&#x20AC;&#x153;wellness.â&#x20AC;?

Making Mental Wellness Our Jewish Community Culture

SECTION A: OUR MENTAL WELLNESS PHILOSOPHY

“Be a lamp, or a lifeboat, or a ladder. Help someone's soul heal…” - Rumi1 When communities seek to become beacons of mental wellness, they promote an atmosphere of honesty, authenticity, and dignity. But shame and stigma frequently prevent us from living up to our fullest potential. The Jewish community has the power to move toward becoming a more inclusive, stigma-free space that uplifts us all. Doing so will encourage people to seek the aid they need and promote the overall well-being of everyone. We envision a greater Jewish community where authenticity is valued, where support is accessible without fear or shame, and where we can offer effective and affirming responses to the needs of organizations, individuals, and families.

Our Jewish Mental Health Values Jewish values, or middot, help build the foundation on which the Jewish community stands. We believe middot empower us to connect Jewish thought to mental wellness. Jewish literature and discussion have focused on healing, wellness, and community for years, yet we often shroud mental health in a cone of silence. To emphasize the role the Jewish community plays in promoting mental wellness, the Blue Dove Foundation focuses on the following eight middot:

We have selected a variety of quotes from universal and popular sources. We will offer a brief description of each one. 1 Rumi was a thirteenth-century Persian Sufi mystical poet who has been appreciated as a

universal spiritual teacher.

Making Mental Wellness Our Jewish Community Culture

‫ בצלם אלוהים‬- B’tzelem Elohim - Created “in God’s Image” Any conversation about mental wellness in its full spectrum must begin with a foundation of dignity and respect. Being created b’tzelem Elohim (Genesis1:26)—in God's image—means all of humanity should be afforded dignity and respect, and showing these values to those experiencing mental illness and/or addiction can counter the shame and stigma that exist. When they ate off the tree of knowledge, Adam and Eve gave birth to the concept of awareness. An important tool, awareness can prevent and heal, or it can harm. A mental health approach that combines dignity with awareness will move us closer to a stigma-free environment. The leaders of the Jewish community can boldly change attitudes around mental wellness to become sources of health and healing.

‫ כל ישראל ערבים זה לזה‬- Kol Yisrael Arevim Zeh La Zeh - All Jews are Responsible for One Another The Talmud (Shavuot 39a) teaches that members of the Jewish community are responsible for each other. In simple terms, we are interconnected and must be invested in the mental wellness and overall well-being of everyone. We must be willing, informed, and prepared to help one another, because we all benefit.

‫ רפואה שלימה‬- Refuah Shleimah - Healing and Wholeness Judaism has a long tradition of recognizing that healing is not just physical; it is holistic, which is to say it has physical, mental, emotional, social, and spiritual components that are all interconnected. When we recite the mi sheberach for healing, we pray for refuat hanefesh v'refuat haguf, a healing of spirit and of body. Many wise people in our tradition have long understood our spirit to encompass both our emotional and spiritual well-being. Such a time-honored tradition has prepared us well

Making Mental Wellness Our Jewish Community Culture

to inherit this value and put it into practice. With our resources and greater understanding today, our twenty-first-century Jewish communities can interpret and expand how we pray for refuat hanefesh v'refuat haguf. The Jewish tradition also emphasizes healing rather than curing. Even when mental illness is under control, healing and a return to wholeness is in order. We see healing as a process that has many components and may be a lifelong journey.

‫ חסד וגבורה‬- Chesed u'Gevurah - Balancing Loving Kindness and Discernment In the mystical tradition, chesed (loving kindness) and gevurah (judgment and limitation) balance one another. Rabbi Moshe Chaim Luzzato taught that the world was formed so we might extend kindness and love to all that was created. It has also been noted that chesed is an embodied practice where nothing material is required except an open and caring presence. Rabbi Shlomo Wolbe (a teacher of Mussar, an ethical Jewish movement) instructs that, executed well, chesed requires us to put aside our projections and assumptions about what someone needs and really listen, so we can see what the person in front of us is saying. Too often we diagnose someone or think we know what might “fix” a situation, but when it comes to mental wellness, we must come from a place of listening and openness. We don’t want to make anyone feel like they are defined by their illness or struggle. At the same time, we want people to know they are being heard. Rabbi Wolbe, an early twentieth century Haredi rabbi, reminds us one of the greatest acts of chesed is to bear a burden with another. While chesed can be used to break down boundaries so we feel connected to one another, the mystics taught there are times when judgment, discernment, limitations, and boundaries are essential. Unbounded chesed can lead to unrealistic promises, overextending, unhealthy dependence, and depletion. We must understand our limitations. Very few of us using this Toolkit are mental health experts; our skills and

Making Mental Wellness Our Jewish Community Culture

support come with very clear limitations. We also need to be aware of the realistic nature of our time, resources, and ability. Too many boundaries and limitations lead to an unwelcoming rigidity; without gevurah, we are able to practice chesed more freely.

‫ פיקוח נפש‬- Pikuach Nefesh - Saving a Life In Jewish law, there is no greater priority than saving a life. This comes from two texts: 1) “You shall keep My laws and My rules, by the pursuit of which man shall live” (Leviticus 18:5) and 2) The Talmudic sage Rabbi Akiva, who said “You shall keep my statutes and my commandments; you shall live by them, but you shall not die because of them.” (Yoma 85b). This leads to the idea that Jewish mitzvot, or commandments, are not about restricting life but rather about enabling us to live our most meaningful lives and helping others do the same. This reading of Pikuach Nefesh pushes us to reflect on our own actions: Are we life affirming to ourselves and others? Are we acting in ways that celebrate the divine spark (B’tzelem Elohim) in others?

‫ נושא בעול עם חברו‬- Nosei B’ol Im Chaveiro - Sharing a Burden with One’s Friend Beyond the idea that all Jews are responsible for one another (kol Yisrael arevim zeh la zeh), the rabbis teach the value of supporting another person (Pirkei Avot 6:6). The Bible includes a story of a special friendship between Ruth and her mother-in-law, Naomi. When faced with struggles, Ruth urges her daughters-in-law to turn back to their own land, their own people, and their own gods. But Ruth refuses, saying to Naomi, "Do not urge me to leave you, to turn back and not follow you. For wherever you go, I will go; wherever you lodge, I will lodge; your people shall be my people, and your God my God." (Ruth 1:16). Together, Ruth and Naomi confront many difficulties but are able to overcome them, because they support each other, exemplifying the middah nosei b'ol im chaveiro.

Making Mental Wellness Our Jewish Community Culture

‫ לפני עיוור‬- Lifnei Iver - Before the Blind (Inclusivity) The Torah says, “You shall not curse the deaf nor place a stumbling block before the blind.” (Leviticus 19:14). There are many pieces of Jewish teaching that consider the figurative implications of not harming those in vulnerable positions, whether they be do to disabilities (deafness and blindness) or disempowered positions (the widow, the orphan, the stranger). It is our responsibility to do our best to create a community that meets the needs and celebrates the value of everyone. Rather than looking at a disability or mental illness through the lens of handicaps, we can uphold this value by seeking to ensure all individuals are fully able to participate in the community.

‫ תיקון עולם‬- Tikkun Olam - Repairing the World Tikkun olam refers to the Jewish value of repairing the world or making the world whole again through acts of social change. It focuses on social justice and communal responsibility—what can we, as human beings, do to make this world a better place? The Torah says, “Justice, justice shall you pursue, that you may live and inherit the land that the Lord your God is giving you.” (Deuteronomy 16:20) From this we pull the idea that all human beings have ownership and accountability to others. Jewish thought also includes the idea that “Any person who works for [the] needs of community, it is as if that person is studying Torah.” (P. Tal., Berachot 5:1) Building our community is therefore a mitzvah when done to help meet the needs of all those who belong to it. Jewish thought has taken this idea a step further with tikkun hanefesh, repairing the soul. The work of repairing the world begins with repairing the soul. Before we are responsible to others, we are responsible for ourselves. In healing ourselves, we heal the world, and in healing the world, we bring healing into our own lives.

Making Mental Wellness Our Jewish Community Culture

OUR MENTAL HEALTH DEFINITIONS In order to create a shared language and help readers understand complex topics, we have included a short explanation of the terms we will be using in this Toolkit.

Mental Wellness: “Wellness is the complete integration of body, mind, and spirit—the realization that everything we do, think, feel, and believe has an effect on our state of well-being.” - Greg Anderson2, Wellness Author

According to the World Health Organization, the definition of mental wellness is “a state of well-being in which...individuals realize...[their] own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and are able to make a contribution to [their] community.” The Blue Dove Foundation embraces the idea that all individuals are unique, worthy, and able to contribute meaningfully to their communities when they are supported and able to cope. Mental wellness emphasizes wholeness and inclusivity. It sends the message that while we all face stress in our lives, we have the ability to nurture and enhance our resiliency, and everyone is capable of living meaningful and productive lives. We view mental wellness as a cornerstone for our philosophy. An inclusive term that can engage the entire community, it invites us to think about our whole selves. It breaks down our tendency to fall into us/them thinking and replaces it with a unifying approach.

2 Greg Anderson was diagnosed with lung cancer in 1984 and given only thirty days to live.

He is the founder of the Cancer Recovery Foundation International group of charities and is recognized as a leading wellness authority.

Making Mental Wellness Our Jewish Community Culture

Mental Health: “What mental health needs is more sunlight, more candor, and more unashamed conversation.” - Glenn Close3, Actor

For many people, the terms “mental health” and “mental wellness” are synonyms, and we use them as such throughout this Toolkit. Following are some nuances to deepen our conversation. The U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control (CDC) and Prevention expand mental health to include our “emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.” This underlies a holistic understanding of how mental health affects us as individuals throughout our whole lives and of its impact on society. This framing makes evident how mental wellness can affect the Jewish community and explains why the Blue Dove Foundation is committed to both empowering you and becoming your partner. The more we engage in this work of promoting open and supportive communication, the more effective and self-sustaining we are as a people. To embrace this approach, we must also look at the most common obstacles we can overcome to bring mental wellness to the forefront.

3 Inspired by her sister’s struggles, the award-winning actor and activist Glenn Close works to

end the stigma surrounding mental health conditions.

Making Mental Wellness Our Jewish Community Culture

Shame: “Shame corrodes the very part of us that believes we are capable of change.” - Dr. Brené Brown4, professor, author, and podcast host

The American Psychological Association (APA) defines shame as a highly unpleasant, painful self-conscious emotion arising from the sense of there being something dishonorable or troublesome in one’s own being or circumstances. Shame is often felt as a mix of regret and self-hate. While guilt and remorse are feelings about something external to our worth—specifically conduct or choices—shame affects the sense of who we are; we often feel diminished by it.

Shame is typically characterized by withdrawal and hiding, and can prolongs the experience of suffering. It is a common obstacle in making connections with others and participating in communal life. Dr. Brené Brown, PhD, MSW, defines shame as “the intensely painful feeling or experience of believing we are flawed and therefore unworthy of love and belonging—something we’ve experienced, done, or failed to do makes us unworthy of connection.”

4 Brené Brown is a research professor at the University of Houston Graduate College of Social

Work. She has spent more than a decade studying vulnerability, courage, authenticity, and shame.

Making Mental Wellness Our Jewish Community Culture

Stigma: “Some of the most comforting words in the universe are ‘me too.’ That moment when you find out your struggle is also someone else’s struggle, you’re not alone, and others have been down the same road.” - Unknown

The origin of the word stigma is telling: In the late sixteenth century, the Greeks used it to refer to a mark that was either cut or burned into the skin in order to identify people as outcasts, criminals, or slaves. Today it refers to a set of attitudes that leads people to shun, reject, or mistreat others they perceive as being different or “other.” Those who live with mental illness or addiction often are stigmatized by the larger society. People fear that those living with mental illness are awkward, unpredictable, damaged, dangerous, or even violent. These attitudes can turn into prejudice and create unsafe or restricted spaces. Thus people often are challenged not only by their mental health struggle, but also by how they are treated by their communities. When Jewish communities do not work to reduce stigma, it creates a culture of suppression, and it isolates our members who have the greatest need for support from their spiritual, religious, and cultural organizations. The Blue Dove Foundation has found that when individuals share their personal stories with members of the community, the stigma associated with mental illness begins to disappear, and personal connections begin to form.

Making Mental Wellness Our Jewish Community Culture

Mental Illness: “At the root of this dilemma is the way we view mental health in this country. Whether an illness affects your heart, your leg, or your brain, it’s still an illness, and there should be no distraction.” Michelle Obama5, Former First Lady of the United States

The National Alliance on Mental Illness (NAMI) describes mental illness as “a condition that affects a person's thinking, feeling, or mood. Such conditions may affect someone's ability to relate to others and function. A mental health condition isn’t the result of one event. Research suggests multiple, linking causes. Genetics, environment, and lifestyle influence whether someone develops a mental health condition. A stressful job or home life makes some people more susceptible, as do traumatic life events like being the victim of a crime. Biochemical processes and circuits, and basic brain structure may play a role, too.” It is important to understand mental illness is another kind of illness and therefore should not be diminished, dismissed, or ignored. Like other illnesses, recovery is often possible. But it is a life-long journey that requires ongoing support. Jewish communities, especially ones with a spiritual, social, or well-being component, are suited to be places of healing. When people are faced with traumatic events and stressors and are trying to make meaning of life, they tend to seek out such places.

5 Michelle Obama helped launch an APA-supported campaign that aimed to revolutionize the

way Americans perceive—and seek care for—mental health problems.

Making Mental Wellness Our Jewish Community Culture

It’s also important to note that mental health struggles affect us all. Anxiety is not reserved solely for those with an anxiety disorder; it is something we all contend with. A mental health disorder is characterized by how much something like anxiety interferes with an individual's life. While most of the communities and organizations using this Toolkit are not designed to address mental health and illness professionally, we want to highlight that much of what you offer either already is or can be therapeutic and healing.

Addiction: “Addiction is a hugely complex and destructive disease, and its impact can be simply devastating. All too often, lives and families can be shattered by it.” - Kate Middleton6, Duchess of Cambridge

The American Psychiatric Association (APA) defines addiction as “a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences. People with an addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their lives. They keep using alcohol or a drug even when they know it will cause problems. Yet a number of effective treatments are available, and people can recover from addiction and lead normal, productive lives.”7 This clinical definition is important in helping us understand addiction is a disease that can have profoundly harmful consequences. Exacerbating the disease are twenty-first century drugs that are more potent and often 6 Kate Middleton is a passionate advocate for ending the stigma of mental illness and

promoting mental wellness for children. 7 psychiatry.org/patients-families/addiction/what-is-addiction

Making Mental Wellness Our Jewish Community Culture

combined with other hazardous and addictive ingredients. In addition to substance abuse, many people recognize that behaviors like gambling, spending money, playing video games, online activity, and sex can become addictive too. In addition to a clinical definition, sobriety programs like those based on the Twelve Steps invite a spiritual and social component. The philosophy of Beit T’Shuvah, a residential treatment facility, congregation, and educational institute in Los Angeles, views addiction as “a symptom of a divided self; an unhealthy dependence on substances or compulsive activities to provide a temporary sense of wholeness and well-being.”8 Its inpatient program is based on the perspective that “addiction is a disease of the soul,” and Jewish practices can affect and support healing and sustain sobriety.

Recovery: “Rock bottom became the solid foundation on which I rebuilt my life.” - J.K. Rowling9, Author

The Substance Abuse and Mental Health Services Administration (SAMHSA), a part of the U.S. Department of Human and Health Services, offers a working definition of recovery: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” It outlines four major elements that support a life in recovery: ● Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;

8 beittshuvah.org/about-us 9 J.K. Rowling, renowned author of Harry Potter fame, has spoken openly about her struggles

with depression and hitting rock bottom.

Making Mental Wellness Our Jewish Community Culture

● Home: a stable and safe place to live; ● Purpose: meaningful daily activities, such as a job, school, volunteerism, and family caretaking; creative endeavors; and the independence, income, and resources to participate in society; ● Community: relationships and social networks that provide support, friendship, love, and hope.”10 This understanding of recovery allows many pathways for Jewish communities to contribute to helping people heal from addiction. Much of what makes addiction so challenging is its pathway to self-destructive behavior; therefore, the road to recovery includes an element of self-discovery. Self-discovery is an intimate and deeply human journey that can lead to healing and even redemption. While the work must be done by individuals, a supportive community can make all the difference. In the field of recovery, we say, “the opposite of addiction is connection!” As such, we are well suited to support people in their sobriety and recovery as centers of self-reflection and communal strength.

Stigma-free: “Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary.” Fred Rogers11, Television Personality and Presbyterian Minister

10 samhsa.gov 11 Fred Rogers, known to many as Mr. Rogers from the popular television show, was an

outspoken advocate for mental wellness and for people of all ages expressing honestly the complexities of their emotions.

Making Mental Wellness Our Jewish Community Culture

NAMI encourages responsible caring communities to fight stigma. The Blue Dove Foundation wants to support our entire Jewish community in normalizing mental health, breaking down prejudices, and fighting stigma. Brené Brown expresses it perfectly in a blog post on her website: “Everyone has a story or a struggle that will break your heart. And, if we’re really paying attention, most people have a story that will bring us to our knees. You would think the universal nature of struggle would make it easier for all of us to ask for help, but in a culture of scarcity and perfectionism, there can still be so much shame around reaching out, especially if we’re not raised to understand the irreducible nature of human need.” We believe the Jewish community can be a powerful voice for inclusion and destigmatization. When we talk about mental health openly and non-judgmentally, and not only accept but celebrate all members of our community, we change our culture. Becoming stigma-free is possible by normalizing mental health and inviting people to be open and honest. We encourage the entire community to lead by taking these achievable steps toward accomplishing this goal: ● Talk openly about mental health, mental wellness, and mental illness. ● Treat people with dignity, create a culture of compassion and listening. ● Make it easier for people to ask for help. ● Assist people in connecting with others. ● Offer support and referrals. ● Start listening sessions and conversations to keep your pulse on the community.

Making Mental Wellness Our Jewish Community Culture

Everyone benefits when we commit to these practices. Not only will we become a more compassionate and sincere Jewish community; we will become more effective and inclusive.

In the next section, we take the list from above and expand it with ideas, suggestions, and tools.

Making Mental Wellness Our Jewish Community Culture

SECTION B: CREATING A MENTAL WELLNESS AND STIGMA-FREE ENVIRONMENT Creating stigma-free environments that focus on mental wellness reminds us our role in the Jewish community is to accompany and assist people as they grow and realize their full potential. It also brings a refreshing honesty to what most of us know: Life can be stressful, and we all could use support to help us cope better. None of us is a stranger to adversity. Ultimately, we believe when we are thoughtful in our approach to creating welcoming environments, we all benefit. Our communities grow stronger, and our members become more engaged when we teach skills that help individuals support themselves while creating an environment where we can support each other. We will revisit the list of actions the Jewish community can take and expand each one with some concrete recommendations and tools. If you would like to get more involved at a deeper level, we hope you will call on the Blue Dove Foundation to work with you. In the meantime, here are some suggestions for where to begin:

How to Start Talking Openly About Mental Health, Mental Wellness, and Mental Illness: ● Jump in and begin. As a leader, assess your own personal comfort in addressing mental wellness. Your level of comfort sets the tone. Also, assess your own mental well-being. Are you in a good spot to have these conversations? If you don’t feel ready, it’s okay to seek support. ● Let it be natural. There likely are areas in your organization’s life and program that already incorporate or would allow for organic conversations about mental wellness. Assess where you can enhance the impact; for example:

Making Mental Wellness Our Jewish Community Culture

‣ Brochures ‣ Speakers and program offerings ‣ Newsletters and e-blasts ‣ The website ‣ Your organizational mission, vision, and policies ‣ Staff and community meetings ‣ Spiritual, religious, and lifecycle offerings ‣ Religious services

Understand Why it is Important to Create Greater Comfort Around Mental Wellness Preventive care is essential. So much can be achieved by helping people learn coping skills around everyday stressors, providing them with support and making sure they know where to go for help. When we interviewed much of the organized Jewish community, we discovered many organizations have members who experience a great deal of stress around common life issues like divorce, raising children, work, aging parents, and isolation. Being able to talk about life challenges, openly and constructively, can reduce the stress, depression, and some subsequent mental illnesses. People who live with mental illness often feel forced to hide, which creates greater isolation and sometimes worsens symptoms. Our organizations can be safe places for people addressing mental illness to forge connections and integrate back into a community, so they can receive nourishment and contribute meaningfully. We believe it is a Jewish vision for people to be welcomed authentically. Not only is it our ethical and spiritual duty; it ultimately benefits everyone.

Making Mental Wellness Our Jewish Community Culture

Treat People with Dignity We often treat people with mental illness as if they are problems to solve rather than the human beings they are. Even when we mean well, we can miss an opportunity to truly connect with someone by trying to solve a problem we have not been asked to solve. People should feel valued, served, and like their Jewish communal organizations are trustworthy, reliable, and respectful. ● Be mindful of language. Use language that is inclusive. Framing conversation around mental wellness should include everyone. ‣ Use “we” and “us” rather than “you” and “ them.” ‣ Eliminate common sayings that are demeaning to people with mental illness and addiction. For example, avoid using words like crazy, insane, or nuts casually; making false analogies to things like institutions or asylums; or using “being addicted to something” as a metaphor. ‣ Try to mirror the language a person is using, and meet them where they are emotionally. ‣ Respect anonymity, as not everyone is open about their issues with their communities, and use the names and pronouns people prefer for themselves. ● Maintain confidentiality. Upholding people's privacy is a way to honor their dignity. Assuring and keeping confidentiality is essential to building a trusting relationship. Breaking confidentiality can have dire consequences for all parties. ● Resist gossiping or speculating about someone’s mental health. We must not let our fears and judgments lead us to stray from our best intentions and ethics.

Making Mental Wellness Our Jewish Community Culture

Listen Actively, Openly, and with Compassion “The most basic and powerful way to connect to another person is to listen.Just listen… A loving silence often has far more power to heal and to connect than the most well-intentioned words.” – Dr. Rachel Naomi Remen12

Listen with presence and an open mind. We often worry about the right things to say when it comes to mental illness. That anxiety contributes to stigma and turns people away from participating in our communities or asking for help when they need it. Consider the following tips for attentive and active listening: ● Survey your surroundings. Is this the best place and time to have a conversation? If yes, settle in. If not, set a clear time and place to have the conversation or a time to follow up—and then follow through with the person. ● Make sure the person's physiological needs are accounted for. Our basic needs affect our mental health. This can include having enough food and water, feeling like the space is safe, not being too cold or too hot, getting adequate sleep, etc. ● Slow down. Clear your mind of assumptions, and set aside what you think you know. ● Offer a warm and open presence. Face the person and maintain eye contact while staying relaxed. Assure them of confidentiality and acceptance; that allows for warmth and openness to be communicated. Follow up with social cues of nodding and expressing understanding, concern, comfort, and/or encouragement.

12 Dr. Rachel Naomi Remen is the founder of the Remen Institute for the Study of Health and

Illness (RISHI), a clinical professor of family medicine at the University of California, San Francisco School of Medicine, and a professor of family medicine at the Boonshoft School of Medicine at Wright State University. Her books Kitchen Table Wisdom and My Grandfather's Blessings focus on healing.

Making Mental Wellness Our Jewish Community Culture

● Ask if the person needs something, so they can be as present and comfortable as possible. This sets an expectation that you want to create a safe environment. This is particularly helpful for people with certain kinds of mental illnesses to express, because what is typically offered as comfort may not work for everyone. For example, sustained eye contact might make some people more anxious. Other people might want no verbal feedback while they speak. ● Ask what the person is hoping for out of this interaction. We can do our best to support someone when we know if they are looking for advice, a safe space to speak their mind, a referral to professional help, etc. ● Do what is necessary to be as present and comfortable as possible. You may ask someone to slow down or restate something, so you are able to understand. It’s okay to set a clear time boundary, so you are not thinking about other things you need to do. ● Provide regular feedback. While most of it should be nonverbal, you may offer a brief phrase like “I understand” or “I’m with you” or even a response like “That sounds challenging” or “Good for you.” It is important to maintain a connection. ● Pay attention to what the person is feeling, not just what they are saying. Make sure you pick up on their tone, nonverbal cues, and expressions. Empathy is a powerful healing connection. ● Do your best not to interrupt. It can be challenging, but keep the focus on the person you are speaking with, and let them guide the conversation. While sharing your own experience might be a tempting way to connect, it can make the person feel unheard. ● Speak with the intention of listening. Ask questions that focus on understanding what the other person is trying to communicate. If they are struggling, try using open-ended questions to move the conversation in the direction of learning more about needs rather than satisfying your own curiosity. 36

Making Mental Wellness Our Jewish Community Culture

● Restate the most relevant points from time to time. Then ask if you understand correctly. ● Ask before giving information or making referrals. Many people want to be given the space to find their own solutions but are seeking a sense of empathy from whoever is listening. People usually will ask for specific information when they want it. ● Listen to hear and to show you’re present rather than to fix. Fixing often indicates brokenness, when you want to focus on wholeness.

Set Clear Boundaries and Keep to Them Setting clear boundaries, and holding to them, is an expression of compassion and dignity. “Boundaries can be defined as the limits we set with other people, which indicate what we find acceptable and unacceptable in their behavior toward us.” The process of setting boundaries can often be done as a consent-focused conversation, which gives space for everyone to communicate their needs and limits. ● Set boundaries around your time, your resources, and your expertise. We all have limits. Expressing them is healthy and allows for freedom within those limits. ● Consider boundary setting to be an example of self-care. In a culture of mental wellness, when we are setting reasonable boundaries kindly and clearly, we are demonstrating important mental health skills and modeling them for others. Boundary setting enhances our own vitality and our ability to continue to offer support without resentment or burnout. ● Consider boundary setting through open dialogue and respectful conversation. Boundaries are often misunderstood, in part because setting them can feel harsh or impolite. But the lack of boundaries can create confusion, (mutual) resentment, and unrealistic expectations.

Making Mental Wellness Our Jewish Community Culture

● Examine the boundaries that already are the norms of your organization. ‣ Are they well communicated and clear? ‣ Are they reasonable? ‣ Do they align with your personal boundaries? ‣ Is there room to ask questions? ● Focus the boundaries on yourself/your organization, rather than on the individual. For example, “As an organization, we make referrals when we do not have the expertise or ability to provide the care that is needed,” rather than “In situations where people behave as you do, we have to refer out.” ● Be prepared to reinforce a boundary when it is broken. You must be able to impose the appropriate consequence, even when it is challenging. Allowing for boundaries to be broken can reinforce harmful behavior—or even encourage it.

Making Mental Wellness Our Jewish Community Culture

Make it Easier to Ask for Help Many of us find it difficult to ask for help, especially if we fear we will be rejected or perceived as a burden. ● An attitude of service and warmth makes it easier for people to ask. ● Set a tone that encourages question asking and is nonjudgmental of failure. When we destigmatize failure, we make space for vulnerability. ● Many of the steps listed here will lead organically to an environment where people feel they can ask for help. ● Create outlets for all levels of comfort—phone calls, walk-ins, texting, emails, etc.

Offer to Help Only When you Feel Comfortable, Qualified, and Able to Follow Through ● Be clear on the kinds of help you can offer and where you are limited. We each have our own expertise. If we don’t have the training or skills to help, it’s better to refer to someone who does. ● Once someone asks, and you have agreed to help create a stable foundation, it is important to follow through and communicate clear expectations. ● If you make a referral, stay connected, and follow up. This can be through phone calls, email, cards, bringing a meal over, etc. If the resources you offer are unable to help, make sure the person knows they can come back to you with additional questions and for support.

Making Mental Wellness Our Jewish Community Culture

Educate Your Organization’s Staff and, if Applicable, Members and/or Volunteers About Mental Wellness ● Examine together how your mission and values support mental wellness. ● Discuss with your staff members the ways mental health issues can affect their work and how reducing the stigma of mental illness can benefit your organization. ‣ Do not underestimate how having greater knowledge can help them interact with your membership and/or the larger community. Just like anyone, staff members can have mental health struggles themselves—or have a loved one they are supporting. Providing them knowledge and tools can have a positive impact on their personal and professional lives. It also sends the clear message that your organization supports both its community members and its staff holistically and is invested in their mental wellness. ‣ Critically consider how the work culture supports the mental well-being of staff and where more space can be made to incorporate mental wellness. ● When training staff, be sure to include basic information on mental wellness. ● Bring in speakers and experts in the field to work with your staff, board, volunteers, lay leaders, and community to provide education about mental health and wellness. ‣ When possible, invite speakers with real-life experience related to mental wellness to help create an inclusive and affirming environment. ● Identify and share the Jewish and universal values that support mental wellness. ● Use this Toolkit to start conversations, create a common language, and develop your own mental wellness philosophy and culture.

Making Mental Wellness Our Jewish Community Culture

Help Foster Connections Our organizations can have an impact on the mental wellness of the people we serve. Being welcomed into, and supported by, a community can alleviate social isolation and other significant challenges to mental wellness. This need for social connection can be met by offering groups that directly address mental health. At the same time, just being included in the everyday life of an organization can build resilience and improve mental well-being. Simply being a part of a community, developing relationships, and finding a sense of purpose can foster a crucial sense of belonging. ● Consider hosting groups. They can be professional-led sessions, peer support/mutual aid groups, discussion-based meetings, or spiritual direction gatherings, depending on the community needs and available resources. The groups can focus on a variety of topics that can increase mental wellness. Examples include:

‣ Coping: Learning self-care skills or ways to live with anxiety or depression. ‣ Preventive care: Managing stress and/or learning how to balance parenting. ‣ Healing/spiritual-based: Using traditions, values, rituals, and contemplative approaches. ‣ If you have the space, consider hosting a Twelve Step program or recovery group.

Making Mental Wellness Our Jewish Community Culture

● Create social occasions inclusive of everyone. ‣ Offer group meditation, yoga, or contemplative opportunities. These kinds of activities build mental wellness capacity and resilience. Doing them with others creates a sense of community as well. ‣ Provide opportunities for dinners, outings, and activities where people can develop connections, friendships, and a feeling of belonging. (example: Sober Shabbat or a Sober Seder) If you have the resources, consider inviting a trained staff member who feels comfortable talking openly about mental wellness and who knows how to respond to an emergency to lead the program. ‣ Create cohorts such as book clubs, youth groups, etc. ‣ Assess the programs you already offer, and determine if there are ways to make them more inclusive. It might take only a small adjustment or a clearer invitation.

Offer Support and Referrals We encourage each community to offer support in both direct and indirect ways, according to its mission. Direct support includes: ● Speakers and programs ● Support and discussion groups ● Pastoral counseling ● Specific mental health rituals and services ● Referrals and information ● Mobile crisis intervention

Making Mental Wellness Our Jewish Community Culture

Indirect support includes: ● Creating an inclusive environment ● Connecting people and helping to build relationships ● Offering programs and services that strengthen people’s …resilience and wellness capacity ● Practicing kindness, appreciation, and gratitude on a daily …basis, both personally and with others When individuals need more support than you or your organization is equipped to offer, developing a resource bank of therapists, organizations, websites, and books can help. In addition to this Toolkit, which we hope you’ll find useful, we encourage you to call on the Blue Dove Foundation to support your ongoing education and creation of a stigma-free, and inclusive environment.

Making Mental Wellness Our Jewish Community Culture

SECTION C: JEWISH PRAYERS, RITUALS, AND RESOURCES We believe Jewish prayers, rituals, and resources can help to strengthen our mental well-being, resilience, and recovery, in the same way middot, or Jewish values, can promote them. Faith is an important part of healing for many, and Jewish thinkers and leaders historically have brought the two together. When someone is ill or recovering from illness or an accident, we often recite a mi sheberach in synagogue. We can adapt this prayer for those who are struggling with mental health. In creating our own versions of a traditional Jewish prayer for healing, we can engage with Jewish text in a way that is personal, meaningful, and impactful in our lives. We encourage you to explore what a mi sheberach might look like for you, your loved ones, and your community. If you offer your own version of a mi sheberach or another prayer for healing and are open to sharing it as a communal resource, please email a copy to info@thebluedovefoundation.org.

Making Mental Wellness Our Jewish Community Culture

A Mi Sheberach for Mental Health Who named us Israel (Yisrael), those who â&#x20AC;&#x153;struggle,â&#x20AC;? Bless and heal those among us who struggle with mental well-being. May they acknowledge their own strength and resilience in persevering, May they treat themselves with forgiveness and patience, May they find others who share their experiences, so they know they are not alone, May they find help, compassion, and resources when they are able to reach out for them, May they find others willing to reach out first when they cannot, And may they find inclusive and welcoming communities that will uplift and celebrate them. May the Holy One grant us the strength and resilience to support our loved ones, May we find the patience and forgiveness we need for ourselves and others, May we find solidarity and support from other caregivers, May we find the capacity to listen without judgement and with the intention to help when asked, May we find the ability to notice when others are struggling and reach out to them first, And may we create communities that accept, uplift, and celebrate those among us who are struggling.

Making Mental Wellness Our Jewish Community Culture

A Mi Sheberach for Recovery God, there are those among us who struggle with addiction. We offer this special prayer for those in recovery: â&#x2014;? Mi sheberach, to the one who blesses: May God bless you with the courage to conquer your cravings, the strength to stay far from temptations and from people who can lead you astray. â&#x2014;? Mi sheberach, to the one who blesses: May God hear the cry of your soul and bless you with the knowledge that you have the power to remake your life, to repair what has been destroyed, to recover what has been lost, to receive all the blessings that have been ignored. â&#x2014;? Mi sheberach, to the one who blesses: When you fall into despair, may God bless you with hope. If you stray from the path of recovery, may God show you how to begin again. May God renew your faith in yourself. May God open your eyes to all the miracles that surround you. Bless all those who are living in recovery. God, lead them on the path back to life, back to love, and back to You. Amen.

A Prayer of Healing for Mental Illness By Rabbi Elliot Kukla, Bay Area Jewish Healing Center May the One who blessed our ancestors bless all those who live with mental illness, their caregivers, families, and friends; may they walk in the footsteps of Jacob, King Saul, Miriam, Hannah, and Naomi, who struggled with dark moods, hopelessness, isolation, and terrors but survived and led our people. Just as our father, Jacob, spent the night wrestling with an angel and prevailed, may all those who live with mental illness be granted the endurance to wrestle with their pain and prevail night upon night. Grace them with the faith to know that though, like Jacob, they may be wounded, shaped, and renamed by this struggle, still they will live on to continue an ever-unfolding, unpredictable path toward healing. May they not be alone on this path but accompanied by their families, friends,

Making Mental Wellness Our Jewish Community Culture

caregivers, ancestors, and the Divine presence. Surround them with loving kindness, grace, and companionship, and spread over them a sukkat shalom, a shelter of peace and wholeness. And let us say: Amen A full version is available. © Bay Area Jewish Healing Center Rabbi Elliot Kukla, 2008. Rabbi Kukla is the first openly transgender person to be ordained by the Reform Jewish Seminary Hebrew Union CollegeJewish Institute of Religion in Los Angeles.

A Mi Sheberach for Chronic Illness Rabbi Julie Pelc Adler of Aitz Hayim Center for Jewish Learning in Glencoe, Illinois

May the One who blessed our fathers and our mothers, bless _______ son/daughter of _______: Strengthen his/her heart and raise up his/her hand, with the blessings you gave to Yaakov; to Yonatan and David; to Daniel the Prophet; to Tamar, mother of Peretz; to Miriam the Prophetess; and to Naomi. May God give to him/her grace, compassion and loving kindness, love, harmony, peace, and companionship. Speedily, Adonai our God, hear our voices, take up our prayers, and watch over his/her life-force, spirit, and soul. With respect to your power, your loving kindness, and your great compassion, behold we say to him/her: Be strong and of good courage. Spread over us all Your shelter of peace. And let us say: Amen. (This prayer can be adjusted according to the type of illness or the particular wishes of the specific person for whom the prayer is being offered. For example: May the One who blessed our foremother Miriam, who was forced to leave the camp in her illness and then was welcomed in time back to the community, also be with our friend, Esther, daughter of Reuven v’Elisheva, with the blessing of being able to return, soon, to our community…) A full version is available. Rabbi Adler received master's degrees from the University of Judaism and from Harvard Graduate School of Education and was ordained as a rabbi by Hebrew Union College–Jewish Institute of Religion. She currently serves on the JHN Advisory Committee.

Making Mental Wellness Our Jewish Community Culture

Prayer for a Loved One Who Died by Suicide By Rabbi Joseph Meszler, Temple Sinai of Sharon, Massachusetts

Let there be no whispering, no secrets here: Our hearts are broken. _____ took his/her own life. And even though it might appear that s/he died by his/her own hand, no one does this without great, coercing pain, inner suffering that seems to have no end, even though we wish s/he knew that no agony is forever. Source of compassion, help us to cry out loud, to hold each other gently, to live with unanswerable questions, normal feelings of anger and guilt, and this gaping hole of loss. Help us to reach out to others who are suffering, to show them our love, to say the kind word, and that this is not a choice we condone or is worth imitation. It is hard to see the divine image in the lives of those who suffer. The sun sets and rises. We put one foot in front of the other. We hold our hearts in our hands. We lift them up to You, God of eternal peace, and to each other. Help us live each day. Amen. Rabbi Meszler wrote this prayer for those who have lost a loved one to suicide. It first appeared in the Huffington Post Religion Blog on July 22, 2013.

Making Mental Wellness Our Jewish Community Culture

Litany for Healing Rabbi Sonya Starr of Columbia Jewish Congregation in Columbia, Maryland, has shared prayers for those who are struggling and those supporting them.

When Miriam was sick, her brother, Moses, prayed: “Oh G-d, pray, heal her please!” We join in this responsive prayer based on Moses’ words: We pray for those who are now ill. Source of Life, we pray: Heal them. We pray for those whose bodies, holy proof of Your creative goodness, are violated by illness and the pain of illness. Encourage them. Grant strength and compassion to families and friends who give their loving care and support, and help them to overcome despair. Strengthen them. Grant wisdom to those who probe the deepest complexities of Your world as they labor in the search for treatment and cures. Inspire them. Grant clarity of vision and strength of purpose to the leaders of our institutions and our government. May they be moved to act with justice and compassion, and find the courage to overcome fear and hatred. Guide them. Grant insight to us, that we may understand that whenever death comes, we must accept it—but that before it comes, we must resist it, by prolonging life and by making our life worthy as long as it is lived. Bless and heal us all. Read more prayers by Rabbi Starr.

Blessing of the Mourners Finding the appropriate words to express condolences and gain comfort during a time of loss can be difficult. Whether you are preparing for a funeral or unveiling and searching for inspiration or seeking personal comfort and knowledge, we find the poems, parables, and proverbs below to be meaningful and helpful. Those who are worn out and crushed by this mourning, let your hearts consider this: This is the path that has existed from the time of creation and will exist forever. Many have drunk from it and many will yet drink.

Making Mental Wellness Our Jewish Community Culture

As was the first meal, so shall be the last. May the master of comfort comfort you. Blessed are those who comfort the mourners. Additional poems are available.

Candle Lighting Ritual

By Nancy Lee Head, a spiritual leader and contributor to NAMI FaithNet.

(The congregation is invited to call out first names of appropriate persons when each candle is lit. Instructions should be placed in the bulletin, but it is also helpful to invite people prior to the event to be prepared to give names at the appropriate time during this service.) The following statements should be made as the candles are being lit. 1. Let us remember those struggling with their mental health. 2. Let us remember family members and other caregivers. 3. Let us remember those persons who have died as a result of mental illness. 4. Let us remember people who are recovering from mental illness. 5. Let us remember people with mental illness who are living on the â&#x20AC;Śâ&#x20AC;Śstreets and who find themselves in jails or in prisons. 6. Let us remember professional providers who offer treatment and services to people with mental illnesses.

Give Me Your Hand, a Responsive Reading By Rabbi Eric Weiss, Bay Area Healing Center

When all seems dark and the darkness is harsh, When I cannot see light even in the brightest day, When you are tired and every breath is heavy, When my words do not grasp the depth of yearning in my soul, When your feelings are overwhelming or dulled,

GIVE ME YOUR HAND GIVE ME YOUR HAND GIVE ME YOUR HAND GIVE ME YOUR HAND GIVE ME YOUR HAND

Making Mental Wellness Our Jewish Community Culture

When I am confused and don’t know what to do, So that we may be together,

GIVE ME YOUR HAND GIVE ME YOUR HAND

© Rabbi Eric Weiss, based on text from Talmud Bavli, Berachot 5b. Rabbi Weiss, president & CEO of the Bay Area Healing Center, is formally trained in Jewish education, clinical pastoral care, and spiritual direction and holds a master’s degree in Hebrew Letters.

Mikveh Immersion

A mikveh (or mikvah) is a special bath used for the purpose of ritual immersion in Judaism to achieve purity. Mayyim Hayyim, a global network that bills itself as a twenty-first century mikveh, expands that definition to embrace the changes and challenges inflicted by illness and loss. Immersion is also a way to embrace the future with gratitude. The emotional and spiritual toll that follows many kinds of loss and struggles is not always acknowledged. Many people find that a mikveh provides a way to face up to the changes wrought by pain, illness, and loss. While there is no “cure” in its waters, many people do find a sense of healing, wholeness, and enhanced spiritual growth. An immersion ceremony for recovery is available on the Blue Dove Foundation website. Additional mikveh immersion ceremonies for individuals living with mental illness and their caregivers are available at Mayyim Hayyim network mikvehs. Learn more about modern day mikveh and available ceremonies at mayyimhayyim.org.

Mental Health Shabbat Dinners Jewish organizations and individuals can use Shabbat as a time and a ritual way to address the stigma of mental illnesses in our communities. Blue Dove has partnered with OneTable to turn the Shabbat dinner table into a place to engage in powerful conversations about mental health, to connect with others, and to create a community of caring and inclusivity. We challenge individuals and organizations to consider hosting these dinners in May (Mental Health Awareness Month), September (National Recovery Month), or any other Friday night. Learn more and view resources at MentalHealthShabbat.org.

Making Mental Wellness Our Jewish Community Culture

JEWISH MENTAL HEALTH RESOURCES JEWISH ORGANIZATIONS AND WEBSITES ● The Blue Dove Foundation - Addresses the issues of mental illness and substance abuse in the Jewish community and beyond through education, awareness, and outreach. ● AMUDIM - Functions as a confidential resource center that provides assistance, support, and direct referrals for individuals and families affected by sexual abuse, neglect, addiction, and other crisis-related matters. There are several offices in the United States as well as one in Israel. ● Mental Health in the Jewish Community Facebook Group - Offers a safe and confidential space to discuss issues, extend support, ask questions, and share resources related to mental health in the Jewish community. ● OKclarity - Jewish therapist directory + online community. ● Our Jewish Recovery Facebook Group - Welcomes Jews in recovery and their loved ones looking to share experience, strength, and hope. Its main goal is to end the stigma about recovery in the Jewish world. ● Refuat HaNefesh - Focuses on cultivating a Jewish community that is more aware, respectful, and empathetic to people living with mental illness. ● RELIEF - Provides emotional health referrals, education, and support for several Jewish communities in the United States as well as Canada, Israel, and the United Kingdom. ● RUACH - Connects Jewish care providers to individuals in need, looking to make emotional and spiritual support more accessible. A longer list is included on the Blue Dove Foundation website at thebluedovefoundation.org/jewishresources.

Making Mental Wellness Our Jewish Community Culture

JEWISH INITIATIVES ● Synagogue Initiative - Congregation Rodef Sholom ‣ Our Mental Health Initiative: From Synagogue to Sanctuary By Rabbi Stacy Friedman ‣ REAL - Mental Health Initiative ● Jewish Child and Family Services Initiative - JCFS Chicago ‣ Twelve Step Meetings in Jewish Locations ‣ Suicide Prevention and Support ● Jewish Federation Initiative - Detroit Jewish Community ‣ We Need to Talk - a youth mental health initiative

D’VREI TORAH ● Shmirat Hanefesh and Tikkun HaGuf: Cultivating Mental Health by Rabbi Dusty Klass and Rabbi Leah Citrin ● Hannah’s Prayer: Seeking Wholeness in the Face of Mental Illness by Rabbi P.J. Schwartz ● Lifting the Veil of Silence About Mental Illness by Rabbi Paul Kipnes ● Hidden in Love: A Sermon on Mental Health by Rabbi Noah Farkas

ARTICLES ● Telling the Truth About Mental Illness by Ruth Roth ● What About the Jewish Prayer for Those with Mental Illness? by Risa Sugarman ● Modeh Ani - 12 Steps of Spiritual Awakening by Chabad Intown ● Mental Illness and the Jews by Diane Weber Bederman ● How the Jewish Community Can Lead on the Issue of Mental Health by Lenore Greene ● Get Well Soon: Synagogues Finally Tackle Mental Health by Paula Jacobs ● Assorted Articles on the Blue Dove Foundation Blog ● Assorted Articles on the Berman Center Blog

Making Mental Wellness Our Jewish Community Culture

SERMON IDEAS ● The Blue Dove Foundation’s High Holiday Toolkit includes speaking points for rabbis and synagogue leaders, suggested texts to reference, a collection of articles relating mental health to the High Holidays, sample texts to use, a flyer with national assistance hotlines to distribute to congregants, a mi sheberach for those in recovery, and a special tekiah gedolah shofar blast to #QuietTheSilence. ● The Bay Area Jewish Healing Center offers a thoughtful packet that includes High Holiday sermon ideas put together by Rabbi Elliot Kukla. ● The National Alliance on Mental Illness (NAMI) has a multifaith section on its website with service and sermon ideas.

PART TWO

Recognition, Response, and the Road to Healing

Recognition, Response and the Road to Healing

INTRODUCTION An Overall Approach to Healing and Envisioning Wellness The second part of the Mental Wellness Toolkit focuses on building skills and knowledge around common mental health challenges. The goal of this section is not to give you a crash course in being a mental health professional; rather, we focus on giving you the tools you need in order to notice red flags and determine whether it is appropriate to intervene. We also offer strategies for starting conversations about mental health. All aspects of mental wellness are interconnected, just as many areas of mental health are interrelated. As such, you may find redundancy between chapters (for example, suicide and depression are closely related). We have written these sections so they can stand alone and be copied to share with others. This section begins by examining what to do in an emergency. We hope it will give you a better sense of what is needed to respond quickly and effectively in a variety of situations. We provide a list of topic-based resources on the national level. The subsequent sections discuss the following topics: ●

What to do in an emergency

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Anxiety

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Personality disorders

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Depression

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Suicide

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Addiction

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Trauma

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Low self-esteem

Recognition, Response and the Road to Healing

Each chapter is generally laid out as follows: ● What is it? A straightforward explanation of each topic or condition. ● What might you notice? Signs and symptoms, things people may say, do, or describe experiencing. ● What are the potential underlying issues? Explanation of a topic or condition’s origins. ● What should you do if you think someone might be struggling? Concrete strategies for knowing when and how to intervene, including conversation dos and don’ts. ● What are the treatment options? A list of the most common treatments for each condition. ● Information drawn from: References for each section. ● Where to learn more: An annotated list of references for further exploration. ● What other things should you know? Additional relevant information. ● A Jewish connection: Stories from Jewish people who have

…

experienced challenges with each topic or condition. The purpose of this section is to say, “This is real. This happens in our communities.” We know the vast majority of the Toolkit’s readers do not have the skills to identify or treat mental health conditions, and we don’t intend for this section to be used for diagnosis or recommendations for treatment. Racther, we hope this section provides language and direction to help you frame your observations when someone’s behavior feels off to you and make informed decisions about how best to proceed.

Recognition, Response and the Road to Healing

Again, the Blue Dove Foundation is here to assist you. Please reach out to us with questions. We hope you see us as a partner and a knowledgeable mental health resource as you work with the members of your community to create safe and welcoming spaces. Disclaimer: This is not the end-all, be-all list of mental health disorders. This Toolkit is intended to be a starting point and not a full diagnostic manual. Please note this section is based on the Diagnostic and Statistical Manual of Mental Disorders (DSMâ&#x20AC;&#x201C;5). Hundreds of international experts in all aspects of mental health spent more than 10 years developing the DSMâ&#x20AC;&#x201C;5. Their dedication and hard work have yielded an authoritative volume that defines and classifies mental disorders in order to improve diagnoses, treatment, and research.

Recognition, Response and the Road to Healing

WHAT TO DO IN AN EMERGENCY If someone is facing a medical, mental health, or substance abuse emergency or is in immediate danger to themself or others, call 911 immediately. You should also call 911 when you are not sure what to do. Calling 911 about a loved one is an extremely stressful decision, but knowing what to expect can help lower your stress. Here are some tips for helping a 911 call go smoothly: ● Take a deep breath before you call. ● Speak clearly, without shouting. When you shout over the phone, it is difficult for the operator to understand what you are saying. The operator will ask you for the following information: (You may not have answers to all of the questions. It is okay to say you don’t know.) ● Your name ● The address from which you are calling ● The address of the person you are calling about (if different from above) ● The person’s specific location in the house or building ● Your relationship to the person ● The behavior of the person you are calling about, such as: ‣ A drug or alcohol overdose ‣ Violent or harmful behavior to themself or others ‣ Suicidal/homicidal threats or actions ‣ Signs of serious mental illness (hearing voices, paranoia, etc.) ● ● ● ● ● ●

Any prescriptions or over-the-counter medication that has been taken Illegal drugs taken—type of drug(s) and amount Alcoholic beverages consumed—type and amount consumed If the person has a history of mental illness or substance abuse If the person has a history of suicide attempts or talking about suicide If the person has a weapon or access to one

Recognition, Response and the Road to Healing

Mental Health Emergencies If you are concerned someone is about to harm themself or someone else, call 911. Err on the side of caution. In many police precincts, you may request a Crisis Intervention Team (CIT) officer. CIT officers have received special training in how to deal with people exhibiting signs of mental illness. Note: If your county does not have CIT officers, reach out to the local … NAMI office to recommend your local precinct for training. If there is no CIT officer available: ● Let the operator know, "This is a call requesting assistance for someone in a mental health crisis. I need to get them to a hospital.” ● Be clear that you DO NOT want the person to go to jail. ● Give specifics about the behavior of the person with mental illness, e.g., no one is hurt, they are pounding their fists against the wall, etc. ● Be prepared to answer honestly about whether or not the person has weapons. ● Get the operator's name and operator number. What police can do: ● Transport a person who wants to go to the hospital. ● Take a person to a hospital for an involuntary evaluation (laws vary by state). Also, a well-trained officer can often calm an upset person and try to convince them to go to the hospital voluntarily. ● Check on the welfare of someone you can’t reach or are worried about. Call the nonemergency number for the police department in your community, and explain why you are concerned. Ask the operator to send an officer to conduct a welfare check.

Recognition, Response and the Road to Healing

Plan Ahead for Emergencies If you have a loved one at risk for needing a 911 call, you should have certain information written down in a location you can access quickly: ● The phone numbers of your loved one’s medical providers, family members, friends, or neighbors who may be nearby to help. ● Documentation about the person's diagnosis and medications. ● Records of previous hospitalizations, mental health/drug/alcohol crisis, and the specific behaviors that precipitated the crises.

When Must you Notify Someone? Many persons, including volunteers, who work with or treat children and have reasonable cause to suspect a child is the victim of physical or mental abuse, has been exposed to certain criminal acts, exposed to the manufacture of certain drugs, endangered through impaired driving, or otherwise endangered, are mandated to report those reasonable suspicions to the appropriate persons by law. If you are a mandated reporter, and you reasonably suspect a child has been endangered or abused, please review the appropriate legal reporting requirements and report any such suspicions. In situations where adults are engaging in dangerous drug use or sharing suicidal thoughts or desires, these persons should be encouraged to contact appropriate medical or mental health assistance providers. Some states may not have clear mandatory reporting guidelines for adults. Note for licensed individuals: Be sure you are aware of any requirements or mandates based on your license and state.

Recognition, Response and the Road to Healing

Emergency Circumstances Involving Drugs Reporting Amnesty Many states have passed amnesty laws in response to the growing epidemic of drug overdose deaths. These laws allow persons to seek lifesaving treatment for themselves or others who have overdosed on drugs without the fear of being arrested for that activity. According to medical medicalamnesty.org, Medical Amnesty—also known as the 911 Lifeline or 911 Good Samaritan Law in some states—is a state-wide law which grants intoxicated minors a limited legal immunity when they seek help for themselves or another individual who is in need of immediate medical attention. Medical amnesty laws in various states can be found at medicalamnesty.org and Drug Overdose Immunity and Good Samaritan Laws.

Recognizing an Overdose Signs of an overdose: ● Slow or shallow breathing OR no breathing ● Unresponsive, unable to move or can’t be woken up ● Choking, gasping, gurgling, or other similar noises ● Discoloration of lips and nails ● Dizziness and disorientation ● Cold or clammy skin ● Extremely small pupils

Recognition, Response and the Road to Healing

What to do in Case of Overdose ● If an emergency arises, and someone has an overdose, call 911 as soon as possible. Make sure to stay with the person until help arrives. ● Different states have different laws about using an automated external defibrillator [AED] for the purpose of saving the life of another in cardiac arrest. It is recommended that persons using an AED receive appropriate training to do so. Some states require that any person who uses an AED contact emergency medical service as soon as possible by calling 911 or the appropriate emergency telephone number upon use of the AED. Check your state laws for details. ‣ If the person is not breathing and does not have a pulse, and you are trained in CPR or have the use of an AED, then CPR or an AED (per the instructions on the AED) can be used to render emergency care. Please note many organizations have an AED that is often stored in their first aid kit, in their main office or otherwise prominently displayed. ‣ If a person is known or suspected to have an opioid overdose emergency with signs of breathing problems and severe sleepiness or not being able to respond, NARCAN (naloxone HCL) nasal spray may be administered. ‣ If you can, discuss keeping NARCAN on location with your organization’s leaders. NARCAN is the first and only FDA-approved nasal form of naloxone for the emergency treatment of a known or suspected opioid overdose. While it temporarily reverses the effects of opioids and can prevent death, it does not harm an individual who has not ingested opioids. ‣ If you are concerned about someone, residents of every state can purchase NARCAN Nasal Spray directly from a pharmacist under a Statewide Naloxone Standing Order or Collaborative Practice Agreement. To learn more about how to use NARCAN, visit narcan.com/patients/how-to-use-narcan.

Recognition, Response and the Road to Healing

Emergency Circumstances Involving Suicidal Thoughts If you are concerned someone is seriously considering suicide, you may want to call 911. Here are some steps you can take to determine the best course of action: ● Ask if the individual is thinking about killing themself. There is a common myth that asking someone about suicide can put the thought in their head. In reality, however, asking the question directly can be the best way to identify if they are at risk for suicide. ● Listen in a nonjudgmental and supportive way. Take answers seriously, and pay attention to their feelings. Never promise to keep their thoughts of suicide a secret. ● Keep them safe. It is important to find out a few more things to establish immediate safety. Knowing the answers to these questions can help determine the severity of the danger of the situation: ‣ Has the individual attempted death by suicide previously? ‣ Does the person experiencing suicidal thoughts know how they would kill themself? ‣ Do they have a specific, detailed plan? What’s the timing for it? ‣ What sort of access do they have to their planned method? (gin, pills, rope, etc.) ‣ Do they really want to die, or would they rather just not feel the way they do? (Many people in this kind of situation do not want to be dead; they just want relief from the emotional pain.) The more steps and pieces of a plan someone experiencing suicidal thoughts has in place, the higher the severity of risk and capability to enact their plan might be. If this person has immediate access to a firearm and is serious about attempting suicide, it will be necessary to call the authorities or drive the individual to the emergency department. If you do not feel safe doing so, call 911. Do not leave them alone.

Recognition, Response and the Road to Healing

ADDITIONAL EMERGENCY RESOURCES Mental Health Crisis Text Line In the US and Canada, text HOME to 741741 to connect with a Crisis Counselor crisistextline.org

National Alliance on Mental Illness (NAMI) 1-800-950-NAMI (6264) info@nami.org nami.org/help

National Suicide Prevention Lifeline 1-800-273-TALK (8255) (1-800-SUICIDE) suicidepreventionlifeline.org

Substance Abuse and Mental Health Services Administration (SAMHSA) 1-800-662-HELP (4357) samhsa.gov/find-help/nationalhelpline

Free 24/7 support at your fingertips. Text HOME to 741741 from anywhere in the United States, anytime. Crisis Text Line is here for any crisis. A live, trained Crisis Counselor receives the text and responds, all from our secure online platform. The volunteer Crisis Counselor will help you move from a hot moment to a cool moment. The NAMI HelpLine is a free, nationwide peer-support service providing information, resource referrals and support to people living with mental health conditions, their family members and caregivers, mental health providers, and the public. HelpLine staff and volunteers are experienced, well trained and able to provide guidance. The NAMI HelpLine can be reached Monday through Friday from 10 a.m. – 6 p.m. EST. The National Suicide Prevention Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. SAMHSA’s national helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

Recognition, Response and the Road to Healing

Abuse Childhelp National Child Abuse Hotline 1-800-422-4453 childhelp.org/hotline

National Center on Elder Abuse 1-855-500-ELDR (3537) ncea.acl.gov

National Domestic Violence Hotline

Round-the-clock hotline is staffed 24 hours a day, 7 days a week with professional crisis counselors. The hotline offers crisis intervention, information, and referrals to thousands of emergency, social service, and support resources. All calls are confidential. The NCEA provides the latest information regarding research, training, best practices, news and resources on elder abuse, neglect and exploitation to professionals and the public. Round-the-clock hotline that helps victims and survivors of domestic violence.

1-800-799-SAFE (7233) Online chat available thehotline.org

National Human Trafficking Hotline

Round-the-clock hotline that connects victims and survivors of sex and labor trafficking with services and support to get help and stay safe.

1-800-373-7888 Text: 233733 humantraffickinghotline.org

National Teen Dating Abuse Helpline by Love is Respect 1-866-331-9474 (Text or Talk) loveisrespect.org

Rape, Abuse and Incest National Network (RAINN) 1-800-656-HOPE (4673) rainn.org

Round-the-clock helpline staffed by an advocate trained to offer education, support, and advocacy to teens involved in dating abuse relationships as well as concerned friends, siblings, parents, teachers, law enforcement members, and service providers. RAINN’s round-the-clock hotline serves people affected by sexual violence. It automatically routes the caller to their nearest sexual assault service provider.

Recognition, Response and the Road to Healing

Alcohol and Substance Abuse

aa.org

An international fellowship of men and women who have had a drinking problem. Membership is open to anyone who wants to do something about his or her drinking problem.

Al-Anon for Families of Alcoholics

Information hotline answered from 8 a.m. – 6 p.m. EST, M-F to learn about Al-Anon family group meetings in your area.

Alcoholics Anonymous (AA)

1-800-344-2666 al-anon.org

Alcohol and Drug Helpline 1-800-821-4357

National Drug Helpline 1-844-289-0879 drughelpline.org

Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline

Round-the-clock national hotline that provides resources about local alcohol and drug abuse treatment options. Calls are free and confidential. Round-the-clock hotline to help those struggling with addiction. Provides information regarding treatment and recovery.

Free, confidential treatment referral and information service for individuals and families facing mental and/or substance use disorders. Offered round the clock, 365 days a year in English and Spanish.

1-800-662-HELP (4357) or text 1-800-487-4889 samhsa.gov/find-help/nationalhelpline

Recognition, Response and the Road to Healing

Other National Eating Disorders Association (NEDA) 1-800-931-2237 nationaleatingdisorders.org

Poison Control Center 1-800-222-1222 poison.org

Veterans Crisis Line 1-800-273-8255 or text 838255 veteranscrisisline.net

Supports individuals and families affected by eating disorders and serves as a catalyst for prevention, cures, and access to quality care. The NEDA Helpline (800-931-2237) is available Monday-Thursday from 9 a.m. – 9 p.m. and Friday from 9 a.m. – 5 p.m. EST. Free, confidential service that provides support from a poison control professional (including cases involving drugs and/or alcohol). Connects service members and veterans in crisis as well as their family members and friends with qualified, caring VA responders.

Recognition, Response and the Road to Healing

MENTAL DISORDERS & CONDITIONS

The following information comes from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the reference manual mental health professionals and physicians use to diagnose mental disorders in the United States.

Recognition, Response and the Road to Healing

ANXIETY

We all experience anxiety—worry, nervousness, and fear are normal parts of the human experience. Typically, the anxiety we experience in stressful situations is not incapacitating and passes once the situation is resolved. But if it becomes unmanageable, disproportionate to the situation, or persistent after the source of the anxiety is removed, it could indicate a mental health condition. An anxiety disorder is measured by the impact it has on an individual’s life. When anxiety starts to interfere with daily activities like work, school, and relationships, it is considered a disorder.

Major anxiety disorders you may encounter include: ● Generalized anxiety disorder (GAD), defined by chronic anxiety and excessive worry and tension, even when there is little or no reason to provoke these feelings. Think of it like this: People with GAD are consistently anxious to varying degrees, regardless of stimulus, although specific triggers can increase that anxiety. ● Panic disorder, characterized by unexpected and repeated panic attacks—sudden periods of intense fear accompanied by physical symptoms like chest pain, a rapid and irregular heartbeat, shortness of breath, dizziness, or abdominal pain. People with panic disorder worry about panic attacks, and their efforts to try to avoid them can cause significant problems.

Recognition, Response and the Road to Healing

● Social anxiety disorder (also called social phobia), typified by overwhelming anxiety and excessive self-consciousness in everyday social situations. People may fear being judged, criticized, or laughed at, or feeling humiliated in front of others even in ordinary, everyday situations. This fear may cause people with social phobia to avoid social situations. Social phobia can be specific to one type of situation, like a fear of having to give a speech. In its most severe form, a person can experience symptoms nearly every time they are around other people. Like all anxiety disorders, it’s about the impact it has on your life: If you are afraid of public speaking, you are among many Americans (it’s the number one fear in this country); however, if that anxiety is debilitating or excessive, it may be a disorder. ● Post-traumatic stress disorder (PTSD), which can develop in people who have experienced a terrifying, shocking, or dangerous event. While many people will experience a range of reactions after trauma, most will recover from these initial symptoms naturally. Those who continue to experience problems may have PTSD. People with PTSD often have feelings of panic or extreme fear and may relive the traumatic event, be overly alert or wound up, avoid reminders of the event, or feel emotionally numb. ● Agoraphobia, or anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help will not be given in the case of a panic attack. Common anxiety triggers for people with agoraphobia include being home alone; being in a crowd or standing in a line; being on a bridge; and traveling in a bus, train, or automobile. It can be severe enough that people struggle to leave their house. ● Specific phobia, an irrational or excessive fear of a specific stimulus, which can include thoughts of said stimulus, images, anticipation of it, or even being triggered by the name of the stimulus.

Recognition, Response and the Road to Healing

● Obsessive-compulsive disorder (OCD)* People with OCD experience intrusive, recurring, and unwanted thoughts, ideas or sensations (obsessions) that cause anxiety and result in an inability to control their thoughts or behaviors, even when they recognize them as excessive or when they understand the negative impact on their lives. Engaging in behaviors to alleviate the anxiety, e.g., checking to see if you left the stove on every 10 minutes, provides temporary relief, while not completing them may significantly increase anxiety. However, these compulsive behaviors usually fuel the pervasive obsessive thoughts. People with OCD may feel ashamed of their compulsive behaviors and try to keep them a secret, which can delay diagnosis and treatment. * Obsessive-compulsive disorder was previously categorized as an anxiety disorder, but as the field of mental health has evolved, it has been reconceptualized as its own unique set of disorders. However, the challenges OCD creates are similar to the challenges those with an anxiety disorder face.

Each person has unique challenges with anxiety, but there are multiple common responses, including: ● Excessive fear or worry ● Obsessive thinking ● Catastrophizing (predicting a negative outcome to a situation or jumping to extreme negative outcomes) ● Fatigue or insomnia (trouble sleeping and/or staying asleep) ● Restlessness or a feeling of being on edge ● Trouble focusing ● Feeling short of breath or otherwise physically uncomfortable. ● Other physical symptoms including a racing heart, tightening of the chest, quick breathing, sweating, trembling, gastrointestinal (GI) problems, loss of peripheral vision, dissociation

Recognition, Response and the Road to Healing

Someone experiencing anxiety will start to rely on coping mechanisms—the tools we use to navigate difficult situations. This may or may not be a conscious effort and, depending on the coping mechanism, can be either helpful or harmful. In general, coping mechanisms are harmful if they impede a person's daily life.

Unhealthy coping mechanisms common for those experiencing an anxiety disorder include: ● Avoiding situations that make them feel anxious (in a way that impedes their daily life) ● Escapism or distraction for relief from unpleasant realities ● Unhealthy, risky, or self-destructive behaviors (such as excessive drinking or drug use) ● Limiting daily activities to reduce their overall level of anxiety (such as by staying at home) ● Becoming overly attached to a safety object or person

Why do some people struggle with anxiety more than others? An anxiety condition can be caused by a combination of factors: ● Genetic predisposition ● Learned behavior (human beings model behavior they see in others at a young age) ● A traumatic experience ● Hormonal and chemical imbalances ● Stressful life events such as pregnancy, abuse, or problems related to the workplace, family, and relationships ● Certain physical health problems such as diabetes, asthma, or heart disease ● Substance use and misuse ● Other mental health conditions

Recognition, Response and the Road to Healing

What to do if you think someone might have anxiety: ● Start a conversation about how you can support them. ● Do some research and learn about anxiety. It can be exhausting for those with a disorder or disability to have to explain it to everyone. ● Help connect them to resources or help (many of which you can find in this Wellness Toolkit).

Suggestions for starting the discussion: ● I feel like I’ve seen you struggling lately, and I’d like to help. Do you want to talk about it? ● You haven’t seemed like yourself lately. Is everything okay? ● You are really important to me, and I know you’ve said you struggle with anxiety. Is there anything I can do to help?

What you can say that helps: ● I’m always here for you. ● What can I do to help you? ● Are you looking for advice, or would you rather I just listen? ● I care about you, no matter what. ● Your fears/worries are not silly. ● Let’s sort through this together. ● This feeling will pass.

Avoid saying things like: ● There’s no reason to panic. ● It’s all in your head. ● You’re being silly/overreacting. ● Everyone gets stressed sometimes. This is so normal. ● Why aren’t you seeing a therapist/on medication?

Recognition, Response and the Road to Healing

Advice to keep in mind when having conversations: ● Be open, welcoming, and nonjudgmental. ● Validate their experience. Acknowledge that their anxiety may be difficult to handle. ● Encourage them to speak with a mental health professional. ● Challenge their thoughts by asking if there are other ways to view a situation while still validating their anxiety. For example, if they say they are going to fail their exam, you could respond by assuring them it is normal to worry about exams and reminding them they have studied for it and have done well in the past. ● Stop catastrophization by verbalizing. For example, “If I fail my exam, I will fail my class, so I won’t get into college, so I’ll never get a job, so no one will love me” can be challenged by engaging with each step. What really will happen if they fail?

Panic Attacks People with an anxiety disorder may experience panic attacks—periods of intense fear or discomfort. A person having one is in a “triggered” state—they have entered fight, flight, or freeze. What are the signs of a panic attack? ● Sweating, chills, or hot flashes ● Shaking or numbness ● Dizziness ● Irregular or rapid heart beat ● Abdominal distress, nausea, shortness of breath, or chest pain ● Fear of “going crazy” or dying ● Distorted perception of time and space, and/or limited field of vision

Recognition, Response and the Road to Healing

What to do if you think someone is having a panic attack: ● Remain calm and stay with the individual. ● Ask the person if they have had a panic attack before, and what they think might help them (for example, moving away from a crowded area or sitting down). ● Encourage them to breathe as deeply and slowly as possible. ● Ask them to count backward slowly from one hundred. ● Help the person get as comfortable as possible by sitting or lying down. ● Reassure them the panic they are experiencing will go away. ● Call 911 if their symptoms continue or become worse. After the panic attack, follow up with the individual and encourage them to speak with … a mental health professional. Urge them to also lean on other sources … of support like family, friends, or other communities they are a part of. Note: Signs of a panic attack are similar to symptoms of a heart attack. If there is any question about whether someone is having a panic attack or heart attack, call 911 immediately.

What treatment options are available for anxiety? ● Therapy ● Support groups ● Stress management techniques ● Medication

Other things to know about people who struggle with anxiety: Stigma about anxiety, like many other mental illnesses, prevents people from seeking help. Anxiety is not a personal weakness, but rather a medical illness to be taken seriously. For people experiencing it, the perception that “most people” will have a negative attitude toward their condition reduces the chance they will seek support, both formally (from mental health professionals) and informally (from family and friends).

Recognition, Response and the Road to Healing

Where to learn more? Beyond Blue is a nonprofit organization that provides information and support to help people achieve their best possible mental health. Its website offers information and resources such as facts about anxiety, management strategies, support strategies, videos, and stories. The Child Mind Institute is an independent, national nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders. Its website offers resources, articles, and information for parents, educators, and caring adults to support children with anxiety (as well as many other mental health concerns and disorders).

Information drawn from: Beyond Blue

OCD PTSD Signs and symptoms Social phobia Stigma relating to anxiety Talking to someone you are worried about

The Body is Not an Apology

10 things to say to someone who has anxiety

Department of

What are the five major types of

Health and Human

anxiety disorders?

Services (HHS) Gracepoint

The symptoms of anxiety

Mayo Clinic

Anxiety symptoms and causes

Mental Health First

How to help someone who is having a

Aid

panic attack

Recognition, Response and the Road to Healing

National Alliance on

Anxiety disorders

Mental Illness (NAMI) National Institute of Mental Health (NIMH)

Anxiety disorders Obsessive compulsive disorder-OCD Post-traumatic stress disorder-PTSD

ReachOut

How to help a friend who has panic attacks

Right as Rain

What to say and not to say to someone

Self

What to say to a friend with anxiety

with anxiety

A Jewish connection How Judaism Saved Me From Anxiety Rabbi Akiva the Psychologist: Using Traditional Jewish Teachings to Conquer Anxiety The story of the Blue Dove Foundationâ&#x20AC;&#x2122;s executive director and why she does this work

Recognition, Response and the Road to Healing

DEPRESSION

The leading mental health disability globally, depression is a serious medical illness that can negatively affect feelings, thoughts, and actions. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression is different for everyone, but a depressed person is likely to struggle with at least one of the following: ● Sadness, irritability, restlessness, or lethargy ● Guilt, worthlessness, or helplessness ● Difficulty thinking, concentrating, or making decisions ● Unexplained physical manifestations, including pains, headaches, paralysis, or exhaustion ● Feeling tired or run down all the time ● Regular bouts of tearfulness or moodiness without explanation ● Having difficulty coping with daily activities or feeling overwhelmed ● Thoughts of suicide or death

Common and unhealthy responses and coping mechanisms for those experiencing depression include: ● Changes in appetite—weight loss or weight gain ● Trouble sleeping or sleeping too much ● Not going out anymore ● Not getting things done at work/school ● Withdrawing from close family and friends

Recognition, Response and the Road to Healing

● Not doing usually enjoyable activities ● Relying on alcohol and sedatives ● Unable to concentrate

Dysthymia: It’s important to note that while most depression is episodic (a person may go through better periods and worse ones), dysthymia is a form of depression characterized by less severe depressive symptoms over a continuous period lasting multiple years.

What are some potential underlying issues behind depression? The exact cause of depression is unknown; however, a number of factors are linked to its development: ● Biology. Although it is not fully understood, research shows when a person is depressed, certain parts of their brain are not working in ways that help them function. The level of certain chemicals in the brain, and their fluctuations, contribute to depression. ● Life events. Life events that cause continued difficulty (unemployment, living in an abusive relationship, prolonged work stress) or recent events (like losing a job or childbirth) can “trigger” depression especially if someone is already at risk due to previous bad experiences or personal factors. ● Family history. A family history of depression increases the risk of the disease. ● Serious or chronic medical illness. The worry and stress of coping with a serious or chronic illness can lead to depression, especially in instances of long-term management of chronic pain. Some illnesses also have side effects of depression, even if the illness is unrelated. ● Medications and substances. Many prescription drugs can cause symptoms of depression, and drug and alcohol use can lead to or result from depression.

Recognition, Response and the Road to Healing

What to do if you think someone might be experiencing depression: It can be difficult to speak to someone about depression. But being a compassionate listener is much more important than giving advice. People with depression may not acknowledge or even be aware they are depressed and may think their feelings are normal. Or they may feel ashamed about their depression and mistakenly believe they should be able to get better with their willpower alone, especially if they are experiencing symptoms like feelings of worthlessness or failure. Talking with someone, especially someone who is nonjudgmental and supportive, can help them cope with symptoms, overcome negative thoughts, and find appropriate treatment.

Suggestions for starting the discussion: ● I have noticed you don’t seem as interested in X lately, and I’m wondering how you’re doing. ● I wanted to check in with you, because you have seemed pretty down lately. ● You haven’t seemed like yourself lately. Is everything okay?

Questions to ask: ● How are you feeling right now? ● When did you begin feeling like this? ● Did something happen that made you start feeling this way? ● What can I do to help? What do you need? ● Have you thought about calling your doctor or finding someone to talk to? There is support available.

Recognition, Response and the Road to Healing

What you can say that helps: ● I may not be able to understand exactly how you feel, but I care about you and want to help. ● Tell me what I can do to help you. ● You are so important to me. Can you help me understand how you’re feeling? ● I’m not sure what to do, but I’m sure we can figure it out together. ● I’m sorry if I said the wrong thing. Can we start again? ● You may not believe it right now, but it’s going to get better. ● Okay, but you know you can talk to me if you ever need to.

Avoid saying things like: ● It’s all in your head. ● We all go through times like this. ● Look on the bright side. ● Just snap out of it. ● What’s wrong with you? ● Shouldn’t you be better by now?

Advice to keep in mind when having conversations: ● If they seem open to talking about it, remind them depression is a medical condition, not a personal flaw or weakness, that usually gets better with treatment. ● Assure them depression is very common and nothing to be ashamed of. They are not alone; depression is the number one cause of disability worldwide. ● Let them know you are here to support them no matter what. ● Validate their feelings. ● Remind them these feelings usually are episodic and will pass, but until then, you are there to help.

Recognition, Response and the Road to Healing

● Suggest getting help from a mental health professional, and offer to support them in finding one. Given that depression often is characterized by exhaustion, lethargy and feeling overwhelmed, they may need help finding a professional. Assisting the person with setting up a timeline for such work is also useful. ● Offer to help prepare a list of questions to discuss at an initial appointment with a mental health provider.

What treatment options are available for depression? ● Therapy/counseling ● Coping techniques and management skills ● Medication or supplements ● Residential treatment ● Intensive outpatient treatment If the individual’s illness seems severe or potentially life-threatening, contact a doctor, a hospital, or emergency medical services like 911.

Other things to know about people who struggle with depression: ● People with depression are not lazy or unmotivated. When someone has depression, even thinking about doing the things that may help them get better can feel exhausting or impossible to do. Be patient and encourage the individual to take small steps toward recovery. It may help to take concrete tasks off their plate. ● The symptoms of depression are not personal. Depression makes it difficult for a person to connect on a deep emotional level and cannot be “fixed” by their loved ones. While family and friends can offer love and support, recovery is ultimately in the hands of the person with depression. ● Depression is a serious condition and can’t be “fixed” by cheering someone up. Most people with depression require professional support in addition to familial or communal support. Instead of trying to cheer them up, focus on connecting them to resources.

Recognition, Response and the Road to Healing

Where to learn more? Beyond Blue is a nonprofit organization that provides information and support to help people achieve their best possible mental health. Its website offers information and resources such as facts about anxiety, management strategies, support strategies, videos, and stories. Find Your Words is an informational website created by Kaiser Permanente that offers resources for people struggling with depression and their loved ones. The website includes information about depression, treatment, seeking help, helping others with depression, and additional resources.

Information drawn from: Beyond Blue

Signs and symptoms Talking to someone you are worried about What causes depression What to say and why

Help Guide

Helping someone with depression

Mayo Clinic

Depression diagnosis treatment

National Institute of Mental Health (NIMH)

Depression

WebMD

Common causes depression

A Jewish connection Dimensions: A Young Manâ&#x20AC;&#x2122;s Story of Torment: Surviving Depression

Recognition, Response and the Road to Healing

BIPOLAR DISORDER

Bipolar disorder is hard to navigate and generally requires professional support and prescribed medication. You cannot “diagnose,” “fix,” or “cure” someone, but you can be a part of their wellness journey. Likewise, you can be a compassionate, nonjudgemental listener who connects them to the resources they need. It is important to understand that people in the middle of a depressive or manic episode may experience lack of insight, which means they may not not be aware something is wrong. There are three types of bipolar disorder, all characterized by episodic shifts in mood, energy, and effect. These shifts often can be sudden and surprising to the individual and others, and there may or may not be an obvious, identifiable trigger. • Bipolar I disorder — defined by manic episodes, although depressive and mixed episodes may occur. • Bipolar II disorder — defined by a pattern of depressive episodes and hypomanic episodes. • Cyclothymic disorder (Cyclothymia) — defined by episodes that are more mild but persist for at least two years in adults or at least one year in children and adolescents. The intensity does not need to meet the diagnostic requirements for types I and II, as cyclothymia is a more persistent but less intense experience.

Recognition, Response and the Road to Healing

Bipolar disorder is different for everyone, but a person living with this mood disorder will experience one or more of the following mood episodes and their signs and symptoms. While the list below is not exhaustive, these signs and symptoms are the most common. Someone undergoing a manic episode might experience: • Intense feelings of elatedness, irritability, or energized behavior • Racing thoughts • A loss of appetite • Urgency in conversation with inappropriate, unwarranted energy or without clarity (this is known as pressured speech) • Grandiose delusions or a belief that they are unusually important, talented or powerful • Intense, sudden or unprovoked irritability When undergoing a depressive episode one might experience: • A low or empty mood • A feeling of helplessness, indifference, or hopelessness • Loss of motivation • Fatigue, or lethargy • Sleeping too little or too much • Trouble concentrating or making decisions • Difficulty carrying out daily tasks • A loss of interest in activities that once gave them pleasure • Thoughts of death or suicide Note: One might also experience hypomanic episodes, which are less intense than mania and may be harder to identify.

Recognition, Response and the Road to Healing

You might notice some signs in someone experiencing a manic episode: • Impulsive behaviors • Risky and dangerous activities like increased spending leading to debt, sexual activity outside their norm, gambling, and substance misuse • Starting new projects beyond their capacity Those experiencing a depressive episode may exhibit different signs: • Reduced ability to care for themselves • Eating too little or too much • Sleeping too little or too much • Inability to keep up with work or school • Struggling to be/remain involved in hobbies or social activities • Poor hygiene or self-neglect • Self-injurious behavior • Talking about death or suicide

If you think someone you know is experiencing a bipolar episode and you would like to express your concern, try having a conversation. What are some potential underlying issues behind depression? • I have noticed (insert the sign you are concerned about), I am worried about (insert the impact it may have). Do you want to talk about it? • Example: I have noticed you have had difficulty keeping up with work, and I’m worried this is a challenge for you. Do you want to talk about it? • I wanted to check in with you and see how you’re doing.

Recognition, Response and the Road to Healing

Questions to ask: • How are you feeling right now? • When did you begin feeling like this? • What has been helpful in the past? • How can I help? What do you need? • Should we call your doctor together?

What you can say that helps: ● I care about you and want to help. ● Tell me what I can do to help you. ● I’m not sure what to do, but let's find someone who can help.

Avoid saying things like: ● You run hot and cold. ● It’s like there are two of you. ● Snap out of it. ● Go back to being X (depressed, manic, up, down, energized, etc). ● It’s just a mood swing. ● Shouldn’t you be better by now?

Advice to keep in mind when having conversations: ● Assure them there is nothing to be ashamed of, and you are there to support them. ● Validate their feelings. ● Suggest getting help from a mental health professional, and offer to support them in finding one. Given that depression often is characterized by exhaustion, lethargy, and feeling overwhelmed, they may need help finding a professional. Assisting the person with setting up a timeline for such work is also useful.

Recognition, Response and the Road to Healing

What treatment options are available for depression? ● Therapy/counseling ● Coping techniques and management skills ● Medication or supplements ● Residential/inpatient treatment ● Intensive outpatient treatment

Where to learn more? National Alliance on Mental Illness (NAMI) is the nation's largest grassroots mental health organization. BetterHelp offers access to licensed, trained, experienced, and accredited psychologists (PhD / PsyD), marriage and family therapists (LMFT), clinical social workers (LCSW / LMSW), and board licensed professional counselors (LPC). The Child Mind Institute is an independent, national nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders. Its website offers resources, articles, and information for parents, educators, and caring adults to support children with anxiety (as well as many other mental health concerns and disorders).

Information drawn from: National Institute on Mental Illness (NAMI)

Bipolar disorder

National Center for Biotechnology Information (NCBI)

DSM-5 changes: implications for

Very Well Mind

Changes in the DSM-5 for bipolar

Treatment Advocacy Center

Bipolar disorder - fact sheet

child serious emotional disturbance

disorder

Recognition, Response and the Road to Healing

A Jewish connection My Struggle With Bipolar Disorder Bipolar Disorder: What You Need to Know Raising a Child with Bipolar Disorder

Recognition, Response and the Road to Healing

PERSONALITY DISORDERS

A personality disorder is a type of mental health struggle in which someone has rigid and unhealthy patterns of thinking, functioning, and behaving. Someone with a personality disorder may have trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work, and school. Some people with personality disorders may not realize it, because their way of thinking and behaving seems natural to them. They may also blame others for their challenges or insist the person approaching them is the one with the issues. Because of this, when offering support, it is important to set your own boundaries and recognize professional help is always recommended. When having a conversation about getting help, remain firm but nonjudgmental, as shifting rhetoric away from blame and toward a place of caring is more effective. Please note all of these disorders can be conceptualized as spectrums along which an individual falls and moves, and no group is defined by its symptoms. Just because antisocial personality disorder (ASPD) is characterized by lying, it does not mean all people with ASPD are liars.

What are the most common personality disorders? General Personality Disorder: When we talk about a general personality disorder (GPD), weâ&#x20AC;&#x2122;re referring to an umbrella category that includes the other primary personality disorder clusters discussed in the following pages. Someone who exhibits behaviors considered to be markedly different from the cultural expectations but that donâ&#x20AC;&#x2122;t fall neatly into one of the clusters may be diagnosed with GPD.

Recognition, Response and the Road to Healing

Personality disorders fall into three groups, based on similar characteristics and symptoms. Many people with one personality disorder also have signs and symptoms of at least one additional disorder. It's not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed. Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. While each of these disorders is different, and each person has a unique experience, there are some common behaviors. People with PARANOID personality disorder may struggle with: ● A pervasive distrust and suspicion of others and their motives ● An unjustified belief that others are trying to harm or deceive them ● An irrational suspicion of the loyalty or trustworthiness of others ● A hesitancy to confide in others due to unreasonable fear the others will use the information against them ● The perception of innocent remarks or nonthreatening situations as personal insults or attacks ● Angry or hostile reactions to perceived slights or insults ● The tendency to hold grudges ● Unwarranted, recurrent suspicions that their spouse or sexual partner is unfaithful People with SCHIZOID personality disorder may struggle with: ● A lack of interest in social or personal relationships, preferring to be alone ● A limited range of emotional expression ● The inability to take pleasure in most activities ● The failure to pick up normal social cues ● The appearance of being cold or indifferent to others ● Little or no interest in having sex with another person

Recognition, Response and the Road to Healing

People with SCHIZOTYPAL personality disorder may struggle with: ● Peculiar dress, thinking, beliefs, speech, or behavior ● Odd perceptual experiences, such as hearing a voice whisper their name ● Flat emotions or inappropriate emotional responses ● Social anxiety and a lack of or discomfort with close relationships ● Indifferent, inappropriate, or suspicious response to others ● "Magical thinking"—believing they can influence people and events with their thoughts ● The belief that certain casual incidents or events have hidden messages meant only for them Cluster B personality disorders: These are characterized by dramatic, overly emotional, or unpredictable thinking or behavior. As with cluster A, there are some common behaviors of people with these personality disorders. People with ANTISOCIAL personality disorder may struggle with: ● An indifference toward others' needs or feelings, or a lack of empathy ● Persistent lying, stealing, using aliases, conning others ● Recurring problems with the law ● Repeated violations of the rights of others ● Aggressive, often violent behavior ● A disregard for the safety of self or others ● Impulsive behavior ● Consistent irresponsibility ● A lack of remorse for behavior

Recognition, Response and the Road to Healing

People with BORDERLINE personality disorder may struggle with: ● Impulsive and risky behavior, such as having unsafe sex gambling, or binge eating ● An unstable or fragile self-image ● Erratic and intense relationships ● Up and down moods, often as a reaction to interpersonal stress ● Suicidal behavior or threats of self-injury ● An intense fear of being alone or abandoned ● Ongoing feelings of emptiness ● Frequent, intense displays of anger ● Stress-related paranoia that comes and goes People with HISTRIONIC personality disorder may struggle with: ● The constant need for attention ● Excessive emotional, dramatic, or sexually provocative acts to gain attention ● A tendency to argue with strong opinions but offering few facts or details to back them up ● A tendency to be easily influenced by others ● Shallow, rapidly changing emotions ● Excessive concern with physical appearance ● Imagining relationships with others to be closer than they are People with NARCISSISTIC personality disorder may struggle with: ● A belief that they're special and more important than others ● Fantasies about power, success, and attractiveness ● The failure to recognize others' needs and feelings ● A need to exaggerate their own achievements or talents ● The expectation of constant praise and admiration ● Arrogance ● Unreasonable expectations of favors and advantages, often taking advantage of others ● Envy of others or the belief that others envy them

Recognition, Response and the Road to Healing

Cluster C personality disorders: These are characterized by anxious, fearful thinking or behavior. People with these personality disorders share some commonality as well. People with NARCISSISTIC AVOIDANT personality disorder may struggle with: ● Extreme sensitivity to criticism or rejection ● The feeling of being inadequate, inferior, or unattractive ● The desire to avoid work activities that require interpersonal contact ● Being socially inhibited, timid, and isolated, avoiding new activities or meeting strangers ● An extreme shyness in social situations and personal relationships ● The fear of disapproval, embarrassment, or ridicule People with DEPENDENT personality disorder may struggle with: ● An excessive dependence on others and the need to be taken care of ● Submissive or clingy behavior toward others ● The fear of having to provide self-care or fend for themselves …if left alone ● A lack of self-confidence, requiring excessive advice and …reassurance from others to make even small decisions ● Difficulty starting or doing projects on their own due to lack …of self-confidence ● Problems disagreeing with others, fearing disapproval ● The tolerance of poor or abusive treatment, even when other options are available ● The urgent need to start a new relationship when a close one …has ended

Recognition, Response and the Road to Healing

People with OBSESSIVE-COMPULSIVE personality disorder* may struggle with: ● A preoccupation with details, orderliness, and rules ● Extreme perfectionism, resulting in dysfunction and distress when perfection is not achieved and often feeling unable to finish a … project, because they don't meet their own strict standards ● The desire to be in control of people, tasks, and situations, and an inability to delegate tasks ● The neglect of friends and enjoyable activities because of an excessive commitment to work or a project ● The inability to discard broken or worthless objects ● Rigidity and stubbornness ● Being inflexible about morality, ethics, or values ● The need to have tight, miserly control over budgeting and spending money * Note: Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder

What are some potential underlying issues behind personality disorders? A combination of genetic and environmental influences can lead to a personality disorder. One’s genes may make them vulnerable to developing one, and a life situation can then trigger the condition. Although the precise cause of personality disorders is not known, there are certain factors that may increase the risk: ● Family history of personality disorders or other mental illness ● Abusive, unstable, or chaotic family life during childhood ● Being diagnosed with childhood conduct disorder ● Variations in brain chemistry and structure

Recognition, Response and the Road to Healing

What to do if you think someone might have a personality disorder: It can be difficult to talk with someone about getting mental health treatment; however, a person suffering from any type of personality disorder is unlikely to improve without it. Getting a diagnosis is a critical starting point. If untreated, some personality disorders may lead to suicide, self-harm, or other risky behaviors. Most people living with a personality disorder don’t realize they have one. Share your concern by giving someone specific examples of problem behaviors, offer resources to find a doctor, and help make or attend the appointment with them. If an emotional crisis occurs, do not escalate the situation. Remain calm and avoid arguing. If the individual becomes verbally aggressive, do not take offense or respond defensively. Suggest talking again at another time.

What treatment options are available for personality disorders? ● Psychotherapy (talk therapy) ● Medications ● Hospital and residential treatment programs ● Lifestyle strategies (like avoiding drugs and alcohol)

Other things to know about people who struggle with a personality disorder: Some people may feel upset, insulted, or excluded with the diagnosis or label of “personality disorder,” because it feels like they are being told there is something wrong with the way they are. In fact, some psychiatrists disagree with the different types of personality disorders, because they believe the focus should be on what a person needs in order to deal with their problems, not what category they are in. However, some people with a personality disorder find it helpful to have a name for what they are experiencing. Remember, a diagnosis is not a label.

Recognition, Response and the Road to Healing

It is a tool to help professionals decide which types of treatment and support can help someone. You can play a role in reducing stigma by encouraging people to learn about personality disorders and other mental health conditions.

Where to learn more? Mind provides supportive and reliable information about mental health. Its website offers information about the different types of personality disorders, causes, treatments and self-care; guidance for friends and family; facts about self-esteem; tips to improve it; and personal stories. Time to Change is a social movement to change the way people think and act about mental health. Its website offers information about mental health problems; myths and facts; resources for family and friends; personal stories; and ways to get involved in the movement to end mental health discrimination.

Information drawn from: American Addiction Centers

How to help someone with personality

Mayo Clinic

Personality disorders

Mind

Why is it controversial

Time to Change

Personality disorders

The Recovery Village

How to help a friend with borderline

disorders

personality disorder

A Jewish connection My Mom is Not Crazy: A Story About Being Connected to Someone with Borderline Personality Disorder Reach Out Our Hands Torah Reflections for Shabbat Shuva

Recognition, Response and the Road to Healing

SUICIDE

Suicide is death caused by injuring oneself with the intent to die. People considering suicide typically feel an overwhelming, never-ending (or continuous) sense of hopelessness, helplessness, and despair. They believe suicide is the only way to stop the suffering. Suicide is a complex issue and should not be attributed to a single cause. Not everyone who dies by suicide has been diagnosed with a mental illness, and not all people with a mental illness seek to end their lives by suicide. Many factors can contribute to someone’s decision to end their life, such as loss, trauma, addiction, serious illness, and other life events that feel overwhelming. Remember, it is the experience of the events (not necessarily the events themselves) that contribute to a person feeling overwhelmed and unable to cope.

Each person has unique experiences with thoughts of suicide, but people may talk about: ● Killing themselves ● Feeling hopeless ● Having no reason to live ● Being a burden to others ● Feeling trapped ● Being in unbearable emotional or physical pain

Recognition, Response and the Road to Healing

Unhealthy coping mechanisms common for those experiencing compulsive or intrusive thoughts about suicide include: ● Increasing the use of alcohol or drugs ● Researching ways to end their lives, such as searching online for methods ● Withdrawing from activities and/or isolating from family and friends ● Giving away possessions or settling one’s affairs/business tasks ● Sleeping too much or too little ● Visiting or calling people to say goodbye ● Behaving more aggressively or impulsively

You may notice that people struggling with suicidal thoughts demonstrate or express feelings of: ● Depression ● Anxiety ● Irritability ● Boredom ● Humiliation/shame ● Agitation/anger ● Relief/sudden improvement from deep depression

What are some potential underlying issues behind suicide? People may have suicidal thoughts for many reasons. Most often, they are the result of feeling unable to cope when faced with what seems to be an overwhelming life situation. If someone doesn’t have hope for the future, they may think suicide is the only solution. They may experience a sort of tunnel vision, and in the midst of such a crisis, suicide seems the only way out.

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Risk factors are characteristics that make it more likely someone will consider, try, or die from suicide. They include: ● A previous suicide attempt ● Depression and other mental health disorders ● Misusing drugs or alcohol ● A family history that includes a mental health or substance abuse disorder, suicide attempts or successes, or family violence and abuse ● Having guns or other firearms in the home ● Being in prison or jail ● Exposure to suicidal behaviors of others, such as a family …member, peer, or media figure ● A major medical illness and/or persistent and poorly managed …chronic pain issues (this is often connected to issues related to …quality of life)

What to do if you think someone might be considering suicide: ● Ask if the individual is thinking about killing themself. There is a common myth that asking someone about suicide can put the thought in their head. But asking the question directly can be the best way to identify if they are at risk for suicide. ● Listen in a nonjudgmental and supportive way. Take answers seriously, and do not ignore their feelings. Never promise to keep their thoughts of suicide a secret.

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● Keep them safe. It is important to find out a few more things to establish immediate safety. Knowing the answers to these questions can help determine the severity of the danger of the situation: ‣ Has the individual attempted death by suicide previously? ‣ Does the person experiencing suicidal thoughts know how they would kill themself? ‣ Do they have a specific, detailed plan? What’s the timing for it? ‣ What sort of access do they have to their planned method? (gin, pills, rope, etc.) ‣ Do they really want to die, or would they rather just not feel the way they do? (Many people in this kind of situation do not want to be dead; they just want relief from the emotional pain.) The more steps and pieces of a plan someone experiencing suicidal thoughts has in place, the higher their severity of risk and the greater their capability to enact their plan might be. If this person has immediate access to a firearm and is very serious about attempting suicide, it will be necessary to call the authorities or drive them to the emergency department. Do not leave them alone. ● Be there. This could mean being physically present for someone, speaking with them on the phone, or showing support in other ways. Follow through with ways in which you say you’ll be able to support the person. Do not commit to supporting the individual if you are unable or unwilling to follow through. ● Help them connect. Help the individual at risk connect with ongoing support and mental health resources. ● Follow up. Reach out to the individual at risk in the following days and weeks to help improve their feelings of connectedness and share ongoing support.

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What you should and should not say to someone who is suicidal: People who are suicidal need to feel loved and accepted by friends, family, and colleagues. To that end, consider the following: ● When a suicidal person wants to discuss their thoughts, listen. Don’t …change the subject when they want to talk. ● Validate their feelings. ‣ Don’t tell them they are wrong or silly. ‣ Don’t try to analyze or criticize their thoughts and emotions. ‣ Don’t tell them to “cheer up” or “snap out of it.” ‣ Don’t tell them they should be grateful for having such a good life. Validating feelings sounds like “I hear you are feeling [xxxxx]. Can you tell me more about that?” ● Don’t try and brush past it. ‣ Don’t tell them it’s all in their head. ‣ Don’t tell them it’s not a big deal.

What are the treatment options for someone considering suicide? Treatment for suicidal thoughts and behavior depends on the specific situation. It generally takes into account a person’s level of risk and the underlying issues that may be causing their thoughts or behavior. Treatments include: ● Emergency care for injuries ● Talk therapy/counseling ● Medications ● Family support and education ● Hospitalization for stabilization

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Other things to know about suicide: The language you use makes a difference. When talking about suicide or suicide-related behaviors, stay away from “committed suicide.” Instead, use terms such as “died by suicide” or “completed suicide attempt.” It is a common, and harmful, idea that those who died by suicide “commit” something wrong, e.g., a crime, a sin, etc., against themselves. And this blame only furthers stigma. We need to recognize that suicide is a disease that drives people toward self-harm and treat them without blame or shame. By changing the way we speak about it, we can begin to eliminate the stigma and criminalization of suicidal behaviors. Suicide and suicide attempts are not the same as what we often call selfharm. Self-harm or nonsuicidal self-injury disorder (NSSID) refers to hurting oneself on purpose as a way to release painful emotions, distract from emotional pain with physical pain, express self-hatred or low self-esteem, punish oneself for perceived wrongs, or regain a sense of control. Self-harm is not a suicide attempt but rather a sign that the individual is trying to cope with intense emotions. This behavior often becomes addictive, and many people who have overcome self-harm consider themselves in recovery. For more information about NSSID, see the next section. Akathisia is a disorder, induced as a side effect of medications (including selective serotonin reuptake inhibitors (SSRIs) and antipsychotics), which can cause a person such intense inner restlessness that the sufferer is driven to violence, self-harm and/or suicide. If you or a loved one is being treated with medication, be aware of any increase in symptoms described, especially when starting, stopping, or changing the medication in dose or type. Symptoms to watch for include anxiety/panic attacks, agitation, impulsivity, aggressiveness, insomnia, irritability, and hostility. For example, someone struggling with akathisia may experience restlessness, excessive movements such as rocking and extreme tension and discomfort related to staying still.

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Where to learn more? The National Suicide Prevention Lifeline provides resources for people in crisis and their loved ones. In addition to providing a round-the-clock support hotline, it offers resources and information on suicide warning signs, treatment, ways to get help, stories of hope and recovery, and other topics. American Foundation for Suicide Prevention raises awareness, funds scientific research, and provides resources and aid to those affected by suicide.

Information drawn from: American Foundation for Suicide Prevention

Risk factors and warning signs

#BeThe1To

How and why the 5 steps can help

Centers for Disease Control (CDC)

Suicide fast facts

Mayo Clinic

Suicide and suicidal thoughts

MISSD National Institute of Mental Health (NIMH)

Suicide FAQ

National Suicide Prevention Lifeline

How we can all prevent suicide

A Jewish Connection: Breaking the Jewish Community’s Silence Around Suicide One woman’s story about her mother’s suicide Visiting a Shiva After a Suicide

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SUBSTANCE-RELATED AND OTHER ADDICTIVE DISORDERS

Substance use disorders, colloquially called addiction, is a complex disease that affects the functioning of the brain and body. It involves craving something intensely, losing control over its use, and continuing involvement with it despite adverse consequences. Recovery from addiction is very challenging, but it is possible.

What are some common addictions? Substance Abuse Substance abuse is the inappropriate and harmful use of any substance, including prescription drugs, over-the-counter medications, supplements, and alcohol. Substance abuse and addiction are less about the type, amount, or frequency of the substance used and more about the consequences of use. If someoneâ&#x20AC;&#x2122;s substance use is causing problems at work, at home, or in relationships, the individual likely has a substance abuse problem. Although different substances have distinct physical effects, the symptoms of addiction are similar. Common signs of substance abuse include neglecting responsibilities, using drugs under dangerous conditions, taking risks while high, experiencing legal troubles, and having problems in relationships. People with a substance abuse problem may feel like they have lost control. Their life revolves around substance use; they continue to use despite knowing it hurts them. They may have abandoned activities they used to enjoy.

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Feeding and Eating Disorders These disorders are serious but treatable mental and physical illnesses that affect all kinds of people, regardless of age, gender, race, religion, ethnicity, body shape, weight, or sexual orientation. There are multiple types of eating disorders, and these illnesses have different symptoms, signs, and treatments. Some people with eating disorders may exhibit behaviors and attitudes that show weight loss, dieting, and control of food are their primary concerns. They may have an extreme preoccupation with their body or complain of digestive problems. Others may refuse to eat certain foods, appear to be uncomfortable eating around others, skip meals, or withdraw from usual friends and activities. You may also notice extreme mood changes or obvious weight fluctuations, up or down, in a person with an eating disorder. Process Addictions: It isn’t only substances that can be addictive; behaviors can become addictive, especially if we have used them to cope. Technology The inability to control the use of various types of technology has become a serious problem; in particular the internet, smartphones, tablets, video games, and social networking sites. People may experience a “high” during technology use and feel a withdrawal when cut off. As with substance abuse, technology addiction occurs when excessive use negatively affects someone’s mental and physical health, daily life, relationships, and academic or job performance (as opposed to being determined by the amount of time someone uses a device). People with a technology addiction may be preoccupied with online experiences and may tend to think about past and future online experiences even when they are offline. They may feel restless when they are unable to go online and euphoric while using technology.

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Signs and symptoms of a technology addiction include: ● Decreasing interest in offline activities ● Irritability or frustration when forced to disconnect ● Persistent use in spite of negative consequences at school, work, …….or in relationships ● Poor hygiene Sex Sexual addiction refers to a range of behaviors done in excess and that significantly affect one’s life in a negative way, including pornography, prostitution, masturbation, fantasy, sadistic or masochistic behavior, and other sexual pursuits. Someone with a sex addiction may not have healthy boundaries and might become easily involved with people sexually or emotionally, regardless of how well they know someone. They may stay in unhealthy relationships or jump from relationship to relationship. Someone with a sex addiction may endure feelings of emptiness, shame, inadequacy, emotional distress, loneliness, guilt, or fear of being abandoned. People with a sex addiction may also experience declines in relationships and social/family engagement and decreased concentration and productivity at work. Physical consequences of a sexual addiction include sexual dysfunction or sexually transmitted infections (STIs). Gambling When someone cannot control the impulse to gamble, regardless of the negative consequences for themself or loved ones, they have an addiction. Trouble caused by gambling are not just financial; they can include relationship problems, legal issues, job loss, and other mental health challenges. A type of impulse control disorder, gambling addiction is referred to as a “hidden illness,” because there are no obvious physical signs like there are in other types of addiction. Someone with a problem might feel the need to be secretive about gambling, be preoccupied with it, or feel restless or irritable when they try to cut back. They may gamble to escape problems or to relieve feelings of helplessness, guilt, anxiety, or depression.

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Other signs someone may have a gambling problem include the jeopardizing or loss of important relationships or professional opportunities, lying about gambling, resorting to theft or fraud to get gambling money, or asking others to bail them out of financial trouble. Nonsuicidal self-injury disorder (NSSID) AKA Self-harm At their core, process addictions are unhealthy coping mechanisms that become addictive or compulsive. WhileNSSID is its own disorder, it often is characterized by an addictive component. NSSID refers to hurting oneself on purpose as a way to release painful emotions, distract from emotional pain with physical pain, express self-hatred or low self-esteem, punish oneself for perceived wrongs, or regain a sense of control. Self-harm is not a suicide attempt but rather a sign that the individual is trying to cope with intense emotions. This behavior often becomes addictive, and many people who have overcome self-harm consider themselves in recovery.

What are some potential underlying concerns behind all of these disorders? ● Mental health challenges, including depression and/or anxiety ● Trauma, including a history of trauma ● Fear, doubt, insecurity, and self-esteem issues ● Family history of substance abuse disorders or mental health disorders

Talking about substance use disorders can be hard, especially given the stigma that exists around addiction. Here are some ways to approach someone if you think they might be struggling with a substance use or other addictive disorder: Suggestions for starting the conversation: ● I really care about you. I’ve noticed that [insert concerning behavior]. I’m worried about you. Let’s talk about it.

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● You don’t seem like yourself lately, and I’ve noticed [insert concerning behavior]. What you can say that helps: ● You are not alone. ● I am here for you. ● It’s not your fault. ● Everyone needs help. ● Things will get better. ● What can I do to help? Just tell me how. Avoid saying things like: ● You need to pull yourself together. ● You needed to hit rock bottom to change. ● Going cold turkey is the only way to quit. ● There is only one way to quit. ● This is your fault. ● If you were stronger, you wouldn’t be [insert concerning behavior]. Advice to keep in mind when having conversations: ● Don’t worry about saying things perfectly. Expressing concern for the individual in a caring and honest way is the most important message to convey. ● Be precise about the behavior that concerns you. Mention specific incidents, such as “when you cancelled our plans the other day” rather than sweeping statements like “you never keep your promises.” ● Use “I” phrases, such as “I noticed” or “I’m worried.” The person cannot discredit your feelings and perceptions.

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● Talk about the impact of their addiction on whatever they care about most, like their career, children, or sports. They may not care about their situation, but they might care deeply about how their actions affect other people or things that are important to them. ● Be prepared and write down what you want to say before the conversation. Remember to listen, show a caring attitude, and offer your assistance and support. ● Offer to help the individual connect with a mental health professional.

What are the treatment options for addiction? ● Detoxification center ● Counseling and behavioral therapies ● Rehabilitation programs (short-term residential treatments, long-term therapeutic communities, and recovery housing) ● Self-help groups ● Medications

Other things to know about people who struggle with addiction: Addiction is a complex disease that changes the brain, not a moral failing nor a weakness. People who struggle with it do not lack principles or willpower. Recovery requires more than good intentions or strong will.

Where to learn more? Addiction Resource was founded to provide a community for those recovering from addiction and to help patients find the highest quality care for a successful recovery. Its website contains comprehensive resources on many types of addiction, including gambling, sex, technology, and substance abuse, for people struggling and their families.

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The Hazelden Betty Ford Foundation is the nation's largest nonprofit addiction treatment provider. Its website contains information about addiction, treatment, and recovery. The National Eating Disorders Association (NEDA) is the largest nonprofit organization dedicated to supporting individuals and their families affected by eating disorders. NEDAâ&#x20AC;&#x2122;s website offers a treatment locator, screening tests, and comprehensive learning resources for all types of eating disorders. Project Know is an American Addiction Centers Resource that contains information for people who are struggling with addiction and their loved ones.

Where to learn more? Addiction.com American Academy of Family Physicians

Substance abuse disorders

Anaheim Lighthouse

7 things to say to your addicted loved one

Hazelden Betty Ford Foundation

How to talk about addiction

HelpGuide

How addiction hijacks the brain gambling

Maryland Addiction Recovery Center

Addiction underlying conditions

Mayo Clinic

Compulsive gambling

Medical News Today

What are the treatments for addiction?

National Eating Disorders Association (NEDA)

Warning signs and symptoms

National Institute on Drug Use

Understanding drug use addiction

addiction and problem gambling

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PsychGuides

Sex addiction symptoms

Sandstone Care

Technology addiction

Self

3 things not to say when a loved one with

Vertava Health

7 things you should know about

Verywell Mind

What not to say to someone with a drug addiction

Windward Way

6 things not to say to someone struggling with

addiction Relapses—and 6 to try instead people who struggle with addiction

addiction

A Jewish Connection: Spirituality, Prayer, the Twelve Steps, and Judaism My boyfriend died of a heroin overdose - what I know now about addiction A young Jewish woman’s struggle with anorexia One rabbi’s struggle with gambling Loving and Losing an Addict Treating Addiction With Jewish Values How to Help Addicted Jewish Youth Leaving Shame Behind: Sharing My Story as a Recovering Alcoholic Jewish Prayers & Practices for Your 12-Step Journey

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TRAUMA

A traumatic event is a shocking, scary, or dangerous experience that affects someone emotionally. It does not have to involve physical harm, but it often does. The circumstances of the event do not determine whether it is traumatic; rather, how a person emotionally experiences the event does. A traumatic event may be natural, like a hurricane, or caused by other people, like a crime or terror attack.It can be divorce, loss of a job, a medical diagnosis, a death in the family, or another situation in which a person feels powerless. The more frightened and helpless someone feels, the more likely they are to be traumatized by the event. One can sustain trauma by being present at the site of the event or witnessing it from a distance. Itâ&#x20AC;&#x2122;s worth noting that children are especially vulnerable to trauma, and childhood trauma can have long-term effectsâ&#x20AC;&#x201D;especially if a person doesnâ&#x20AC;&#x2122;t receive treatment or support.

What you might notice in someone who has experienced trauma: Everyone responds differently to potentially traumatic events. Most people have intense responses immediately following the event and often for several weeks or even months afterward. But in some cases, stressful thoughts and feelings may continue for a long time and interfere with daily life. It is important for people who continue to feel the effects of the trauma to seek professional help.

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Each person has unique challenges associated with trauma, but there are multiple common responses, including: ● Worrying excessively ● Having frightening thoughts ● Reliving the traumatic experience ● Feeling disconnected or numb ● Returning frequently to describing that event in present-day conversations

As a result of trying to cope with trauma, a person may: ● Avoid people or places that bring back disturbing memories/responses ● Be very jumpy or easily startled ● Withdraw from others ● Cry frequently ● Have specific stimuli that set them off ● Struggle with trusting and relying on others

Physical symptoms may include: ● Digestive issues ● Chronic aches and pains ● A racing heartbeat ● Difficulty concentrating ● Insomnia or nightmares ● Eating disorders ● An inability to relax/increased alertness to surroundings

You may notice people struggling with trauma demonstrate or express feelings of: ● Anxiety, sadness, or anger ● Guilt, shame, or self-blame ● Shock, denial, or disbelief

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● Confusion ● Tiredness ● Irritability ● Mistrust

Signs of trauma in children: ● “Babyish” behavior they had outgrown ● Sudden or new stuttering ● Clinginess or increased independence ● Tantrums and other attention-seeking behaviors ● Struggles with incontinence ● A decline in school performance ● Aches and pains ● Withdrawal or shutting down

What is the relationship between trauma and post-traumatic stress disorder? It is natural to encounter a range of symptoms and reactions after trauma; however, if symptoms do not ease up, an individual may be experiencing post-traumatic stress disorder (PTSD). People with PTSD may feel stressed or frightened, even when they are not in danger. They may have intense thoughts and feelings about the traumatic experience long after the event has ended. Shame, an especially difficult emotion to cope with following a trauma, may play a role in the development of PTSD. It may lead people to cope in unhealthy ways, including substance use disorders or other self-destructive behaviors. These unhealthy coping strategies interfere with the ability to process emotions from a trauma and may contribute to the development or intensification of PTSD symptoms. To learn more about PTSD, see the section on “Anxiety.”

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What to do if you think someone might have experienced trauma: Be open to talking about the traumatic event, if the individual finds this helpful; however, do not pressure someone into speaking about their experience. Some trauma survivors find it difficult to speak about the event. What you can say that helps: ● Reassure the individual their reactions are normal, and offer information about available support. ● Remind them recovery takes time. ● Encourage them to take good care of themselves (eating well, avoiding alcohol/drugs, and getting enough sleep). ● Discuss how you can support them (listening, spending time together, or providing practical support). ● Encourage the individual to get professional help. Advice to keep in mind when having conversations: ● Understand the person may get upset. Reassure them distress is expected after what they have gone through. It is possible the person won’t show any emotions but might speak in a monotone voice or have a “blank” face. This is one of the many normal reactions to trauma. ● Don't interrupt, provide examples from your own life, or talk about yourself. ● Acknowledge their experience with phrases like “It’s really tough to go through something like this,” or “Sometimes it’s hard to see a light at the end of the tunnel.” ● Ask leading questions like, “Would it be helpful to talk about [the event],” or “You’ve had a rough time; how are you doing?”

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● Show understanding by summarizing what they tell you, using phrases such as “You seem really…,” “It sounds like…,” “Did I understand correctly that you…,”, or “No wonder you feel…” ● It’s important to note that discussing trauma in an unsafe emotional setting can cause more harm than good. If you do not feel equipped to have these conversations, please connect the person with a mental health professional. Sharing a trauma and having it received negatively can cause a person harm through a “retraumatization” effect. ● Understand vicarious trauma is a real issue. It is possible for someone to feel traumatized simply by hearing a painful or difficult story. If you feel you are experiencing this, please disengage from the situation as best you can and seek support for yourself.

What can help people who have experienced trauma? When trauma is handled well, and the person is able to regain their sense of safety and receive treatment and/or support, the most acute symptoms usually subside after a few days. Sometimes they can last a few months, however, gradually fading as a person processes the event. Even after a person feels better, they may experience painful memories or emotions, especially in response to triggers like the anniversary or other reminders of the traumatic event. A good self-care practice is a way to manage trauma. Consider offering the following suggestions to help someone recover from trauma: ● Exercise. A traumatic event disrupts the body’s natural state and freezes it in one of hyperarousal and fear. Exercise can help repair the body’s nervous system, burn off stress hormones (adrenaline), and release “feel-good” chemicals that fight off stress (endorphins).

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● Connection. Someone who experiences a trauma may want to isolate themselves from others, but this can make things worse. Encourage trauma survivors to participate in social activities, connect with friends, volunteer, or join a support group. ● Regulating the nervous system. It is important for people who have experienced trauma to change their arousal system and the way they calm themselves. This can help relieve anxiety and give them a greater sense of control. Ways you regulate the nervous system include mindful breathing, mindfulness meditation, sensory input stress relief practices (like listening to music or petting an animal), and acknowledging and accepting the feelings of trauma as they arise. ● Focus on health. Having a healthy body can improve someone’s ability to cope with the stress of trauma. Encourage them to get enough sleep, avoid alcohol and drugs, and eat a well-balanced diet.

What are the treatment options for trauma? People heal at their own pace. If someone is exhibiting the following signs after several months, it might be time to seek professional help from a trauma expert: Signs to watch for include: ● Trouble functioning at work or home ● Severe fear, anxiety, or depression ● An inability to form close, satisfying relationships ● Terrifying memories, nightmares, or flashbacks ● Avoiding situations that remind them of the trauma ● Feeling emotionally numb and disconnected from others ● Using alcohol or drugs to feel better

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Treatment for trauma: ● Therapy ‣ Somatic experiencing (therapy that focuses on bodily sensations rather than thoughts and memories) ‣ Cognitive-behavioral therapy (CBT) (a type of talk therapy that helps process and evaluate thoughts and feelings) ‣ Eye movement desensitization and reprocessing (EMDR) (combines talk therapy with eye movements that can help “unfreeze” traumatic memories) ‣ Rapid resolution therapy (RRT) (a relatively new approach that helps individuals permanently overcome the negative effects of trauma with a fast and relatively painless approach) ● Psychiatric counseling ● In-patient treatment

Other things to know about people who struggle with trauma-related issues: Children are especially vulnerable to trauma because of their rapidly developing brains. When exposed to chronic trauma, the child’s brain stays in a heightened state of stress. This can affect the child’s emotional, behavioral, and cognitive functioning. Traumatic experiences can have a significant impact on a child’s future behavior, emotional development, and mental and physical health.

Where to learn more? The National Child Traumatic Stress Network seeks to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. Its website contains resources on child trauma, trauma-informed care, and treatments and practices. The Sidran Institute is a nonprofit organization devoted to helping people who have experienced traumatic life events. It offers resources on understanding the long-term effects of trauma, self-help recovery strategies for survivors, clinical treatments, and related policy issues.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) offers resources about coping after traumatic events and disasters.

Information drawn from: Beyond Blue

Trauma facts

Cognitive Behavioral Therapy Los Angeles

Build self-esteem

HelpGuide

Emotional and psychological trauma

National Institute of Mental Health (NIMH)

Coping with traumatic events

Phoenix Australia Center for Post-traumatic Mental Health

Helping others

Post traumatic stress disorder - ptsd

A Jewish Connection: Healing Amidst Trauma: Caring for the Soul Through a Jewish Lens JF&CS Toronto: Stories from Jewish families that have experienced trauma

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LOW SELF-ESTEEM

Self-esteem is how someone values and perceives themself. It can affect a person’s ability to make decisions, assert needs, move past mistakes without unfair self-blame, practice self-kindness, and try new or difficult things. When one has low self-esteem, they may place little value on their own opinions and ideas. Instead of feeling secure, they focus on their perceived weaknesses and fear of failure, and they believe others are more capable or successful than they are. Low self-esteem can manifest itself in traits such as indecision, hypersensitivity to criticism, negative outlook, and guilt. People with low self-esteem tend to exaggerate events as being negative. They may interpret neutral comments as criticism. Over time, this could lead to some degree of depression and/or anxiety. In talking with someone who exhibits these kinds of tendencies, it would be useful to understand how they are negatively affecting the person’s life.

What you might notice in someone with low self-esteem: Each person has unique experiences with low self-esteem, but there are multiple common responses, including: ● Hating themselves ● Feeling undeserving of happiness ● Believing they are a burden to others or are unworthy of love ● Deeming themselves a failure at accomplishing something or in general

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● Blaming themselves unfairly for things that go wrong ● Criticizing themselves excessively ● Failing to be resilient in the face of challenges Some common and unhealthy responses and coping mechanisms in those experiencing low self-esteem include: ● Isolating themselves socially ● Engaging in self-destructive behaviors, like abusing substances or neglecting hygiene ● Avoiding previously pleasurable activities due to fear of being judged ● Accepting negative treatment from others ● Bullying and criticizing others

What are some potential underlying issues behind low self-esteem? Everyone responds differently to life’s experiences, which in turn affects self-esteem. Our self-esteem continually fluctuates. Difficult or stressful experiences can play a role in low self-esteem; for example: ● Being bullied or abused ● Experiencing prejudice, discrimination, or stigma ● Losing a job or having difficulty finding employment ● Encountering problems at work or while studying ● Suffering prolonged stress ● Sustaining physical health problems ● Enduring mental health problems ● Facing relationship problems ● Worrying excessively about appearance or body image ● Having problems with money or housing

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What to do if you think someone might have low self-esteem: When someone is struggling with low self-esteem, keep in mind their perception of themselves will differ from how you perceive them. For example, someone with low self-esteem who thinks they aren’t intelligent genuinely believes it, even if they are successful. Pointing out their achievements may not have the desired effect, because in this moment they are unable to internalize them. It’s important to validate their feelings and steer them away from viewing self-perception as fact. Try starting a conversation. ● Encourage the individual to build positive relationships that make them feel uplifted and appreciated. ● Help them to recognize their strengths. ● Talk with them about the importance of self-kindness and compassion. ● Encourage them to say ‘no’ to situations that make them feel overburdened, resentful, angry, or depressed. ● Help them to set a new goal or challenge. ● Encourage them to seek the support of a mental health professional.

What are the treatment options for low self-esteem? ● Psychotherapy (talk therapy) ● Cognitive behavioral therapy (CBT): a type of psychological treatment ● Self-acceptance and improvement strategies

Other things you should know about people who struggle with low self-esteem: Low self-esteem is not always easy to recognize. People may hide it behind various personas, such as: The Imposter: ● Acts happy and successful but is really terrified of failure. ● Lives in constant fear they will be found out.

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● Needs continuous successes to maintain the mask of positive self-esteem. Imposters often tend toward perfectionism, procrastination, competition, and burn-out. The Rebel: ● Acts like the opinions of others, especially of those who are important or powerful, don’t matter. ● Lives with constant anger from never feeling good enough. ● Needs to prove continuously that others' judgments and criticisms don't hurt. Rebels often end up blaming others excessively, breaking rules or laws, and/or opposing authority. The Victim: ● Acts helpless. ● Cannot cope with the world and waits for someone to come to the rescue. ● Uses self-pity or indifference as a shield against the fear of taking responsibility for changing their life. ● Looks repeatedly to others for guidance. Victims often fall into patterns of unassertiveness, underachievement, and excessive reliance on others in relationships.

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Where to learn more: Mind provides supportive and reliable information about mental health. Its website offers information about self-esteem, tips for improvement, videos, and stories.

Information drawn from: Cognitive Behavioral Therapy Los Angeles

Build self-esteem

GoodTherapy

Self-esteem

Mayo Clinic

Self-esteem check: too low or just right?

Mind

What is self-esteem

NHS

Raising low self-esteem

The University of Texas at Austin Counseling and Mental Health Center

Self-esteem

A Jewish Connection: A personal story about the loss of self-esteem

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KAVANAH - INTENTION “Prayer without kavanah is no prayer at all.” - Maimonides, Jewish Philosopher

“The first time an event occurs in nature it is called a miracle; later, it is taken for granted. Let your worship and your service be your miracles each day. Only such worship, performed from the heart, with the enthusiasm of fresh wonder, is acceptable.” - The Baal Shem Tov

Kavanah means intention. It sometimes refers to sincere feelings and direction of the heart. In the work we do, intention counts. We all picked up the Toolkit for various reasons. Whether we as professionals or lay leaders wanted to learn more skills to help us support individuals, families, and communities, or we were seeking to learn for our own mental wellness, it’s important to reflect on what brought us here and where we are going next. Find a comfortable seat. Close your eyes and take three long, deep breaths. Ask yourself the following: ● What in this was meaningful to me and resonated emotionally? ● What do I want to take away with me? ● What kind of impact would I like this new knowledge to have on my work and my community? Now write one intention on a piece of paper—one thing you would like to do moving forward. Then figure out how you’re going to do it.

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Resources

Grounding Exercises to Help Someone Who is Struggling Self-care with a Jewish Connection Gratitude & Joy with a Jewish Connection Jewish Mental Wellness Workshops by the Blue Dove Foundation Tools and resources from the Center for Faith and Opportunity Initiatives (the Partnership Center) at the U.S. Department of Health and human Services (HHS) â&#x2014;? The Partnership Center leads HHSâ&#x20AC;&#x2122;s efforts to build and support collaborations with faith-based and community organizations in order to better serve individuals, families, and communities in need. Learn more at hhs.gov/partnerships.

Mental Health Glossary Suggested Readings

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GROUNDING EXERCISES TO HELP SOMEONE WHO IS STRUGGLING In doing this work, strong emotions are likely to rise to the surface for those you are supporting (or for you). Grounding exercises can help center and calm a person. You can lead someone in these exercises to help them regain a sense of safety and security during a turbulent emotional time. Categories: ● Ask the person to find a comfortable seat. ● Have them sit up and place their feet on the floor. Then take a deep breath. ● Now ask them to name as many X as they can (colors, movies, shapes, .type of shoe, etc). Descriptions: ● Ask the person to find a comfortable seat. ● Have them sit up and place their feet on the floor. Then take a deep breath. ● Ask them to describe an everyday activity in excruciating detail. - Or - Describe the room where they are sitting in excruciating detail. - Or - Describe an item in excruciating detail. ● Ask follow up questions to encourage more details. 5-4-3-2-1: ● Ask the person to find a comfortable seat. ● Have them sit up and place their feet on the floor. Then take a deep breath. ● Ask them to look around, find, and name: 5 things they can see 4 things they can touch 3 things they can hear 2 things they can smell 1 emotion they feel

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Physical grounding tricks for individuals: ● Run your hands under warm or cool water and focus on the feeling. ● Jump up and down, and try to really feel the ground. ● Stretch slowly and focus on how it feels. ● Focus on the feeling of your feet on the floor or your body in a chair. ● Count backward by threes from one hundred (you can swap out any numbers). ● Drink. Break. Snack

Avoid: ● Continuous discussion if it becomes circular (you want to break the cycles negative emotions can cause). ● Judgmental phrases about what one should/should not feel or do. ● Intervening in public or putting the person in the spotlight.

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SELF-CARE WITH A JEWISH CONNECTION What is self-care? It’s different for everyone, and it can be categorized into several buckets, including emotional, physical, mental, social, and spiritual. Only an individual can decide on the type of self-care needed and the frequency in which he or she needs it. And even if you think you don’t need it, trust us; you do. Nothing is more important than taking care of yourself. The first step to creating a self-care practice is to get more in touch with your personal needs and interests. Taking care of yourself doesn’t have to mean massages and manicures, or a round of golf. In fact, it doesn't have to require a lot of money or time. In most cases, the best self-care practices cost nothing. Self-care doesn’t have to be something you’re good at. It can be something you’re interested in learning or accomplishing. Setting a new goal and accomplishing it are great examples of self-care. Self-care is preventative and interventional. If you regularly take time to practice it, you’re acting to prevent stress. If you have a high stress level, it’s important to begin self-care practices as intervention. Self-care comprises two ideas: intention + time. Intention If you don’t know where to begin, ask yourself this: “If I had free time with zero obligations for a day, what would I do? How would I spend my time?” Everyone is going to have a different answer. The key is to be intentional about how you spend your time. You choose to do something because of how it makes you feel. Recognizing the effect of the experience, and knowing the feeling came from your self-care practice, solidifies the intention and sets you up for success.

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Time A little self-care is better than none at all. Starting small will create momentum that results in progress. It may mean taking just ten minutes a day to begin creating your self-care practice. It can be hard to find the time. Life is busy, and individuals are pulled in a hundred ways. The key here is to make the time and change your mindset to include self-care in your daily (or weekly) routine. When you use time and intention in your self-care practice, you’ll find your mind will be clearer, and you'll feel more relaxed and re-energized. As your self-care practice deepens and becomes more routine, the next step is to encourage others in your community to create their own self-care practices. By helping them make positive changes in their lives, you can make a real impact on the world. That’s what tikkun olam is all about, and there is no better feeling.

Judaism's Connection to Self-Care The Jewish people were given the gift of Shabbat. That’s twenty-five hours when you can press the pause button and think about you. A time to share with the people in your community and to nourish your body and mind. Shabbat may look traditional with the authentic meals and prayers, or it can be something unique you create. It brings intention to your life, allows you to set aside time in your busy day, and pushes you to put yourself first. Take this idea of time and intention, and disperse it to other parts of your week. It doesn't matter what you do to care for yourself, as long as it is a boundary you create for yourself and is surrounded by intention. Self-care practiced routinely will become part of your personal ritual. It will grow from something you attempt to do regularly into something you don’t think about doing. And it will change your life before you know it.

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Getting Started with Self-Care The following is not a fully encompassing list of self-care practices but rather some suggestions for starting off. Always begin with time and intention. Challenge yourself to create a self-care practice that doesn’t cost money; the reward is even greater. • Be social ‣ Make plans with friends or family. ‣ Join a new social club or group. ‣ Attend a community event. • Get organized ‣ Create an achievable to-do list each day that will help you feel accomplished and not overwhelmed or lost. Keep it simple and realistic. ‣ Plan your meals for the week to reduce stress around what you’re going to eat and to ensure you’re eating a healthy diet. ‣ Say no. If you're swamped or don’t want to go to something, then don’t. You have limited time each day and week. It’s OK to say no. • Move Your Body ‣ Open your mind, and increase your health through physical activity. ‣ Try a new exercise, sport, or other pastime. ‣ Take a dance class. ‣ Walk your dog as often as you can for at least fifteen minutes. It will be good for both of you! ‣ Visit a local park for a picnic.

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• Reflect ‣ Write in a journal. This will help you reflect on how you are spending your time and what is happening in your day. ‣ Compose a list of the most important things and people in your life. Reference this list weekly to remind yourself to spend time on these things or with these people. ‣ Watch YouTube videos, read books, or research the topic of mindfulness. ‣ Challenge your mind with Sudoku or other brain puzzles. • Relax ‣ Meditate. ‣ Get adequate sleep. ‣ Try cooking or baking. ‣ Find a creative outlet. Try coloring, listening to music, writing, reading a book. • Treat Yourself ‣ Take yourself out to a nice meal. ‣ Spend money doing something you wouldn’t normally do.

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GRATITUDE & JOY WITH A JEWISH CONNECTION It’s easy to see the connection between gratitude and joy. Let’s start with the definition of gratitude: a feeling of thankfulness or appreciation. The feeling becomes magnified when there is intention and awareness. Going further, when you experience appreciation and gratitude, you feel joy. Joy comes from adding something pleasurable or removing something uncomfortable. The feeling of Joy is the release of dopamine, the chemical that allows you to experience pleasure. It helps regulate movement, attention, learning, and emotional responses. It also enables us not only to see rewards but to take action to move toward them.

Judaism’s Connection to Gratitude Prayers are found in all aspects of Jewish life, from birth to death. Take a second to look deeper into their meaning. They scream gratitude and joy. On Shabbat and other holidays, for example, we offer our appreciation by blessing God for giving us the Sabbath, wine, bread, and so forth. Rabbi Geoffrey A. Mitelman, founding director, Sinai and Synapses, shared his thoughts in the article To Be a Jew Is To Give Thanks—By Definition, which ran in the Huffington Post on November 26, 2013. You can read the full version at https://www.huffpost.com/entry/jewishthanksgiving_b_4333641. The Torah tells us of how Leah gave birth to several sons, and when the fourth one was born, she said, “This time, I will give thanks to Adonai,” (odeh et Adonai). The root letters of odeh, “I will give thanks,” form the basis of the name that Leah chose for her son: Yehudah. From Yehudah, we get the name “Judah.” And from “Judah” we get the word “Judaism.” So in the end, our greatest Jewish responsibility is to give thanks, because when we do, we recognize the holy potential of our world and bring more of it into people’s lives. And with that potential, when we look—when we really look—for one hundred blessings every day, we can then create even more of those blessings, for ourselves and for our world.

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Getting Started with Gratitude Gratitude is incredibly personal. To practice feeling and expressing gratitude daily, you’ll want to try different things and pay close attention to how they make you feel afterward. The end goal is the feeling of joy. This list is not a fully encompassing list of ways to show gratitude, but rather a starting point. Send a Card to Someone Sending a hand-written card makes a huge impact. Individuals often assume people in our lives know we’re grateful for them. But many of them don’t. If you’re grateful for someone, let them know by sending a handwritten card. Individuals will acknowledge and appreciate the time you took to think about them, write a note, and mail it. Create a Gratitude List Aim for one hundred things. This can be a very daunting task. The trick is to start with broad categories, and then engage your senses to identify the specific items you’re grateful for relating to the larger category. Examples: Category - My Pet Dog • I love that my dog is always waiting at the door for me when I get home. • The soft touch of his head on my lap. • His excitement when he puts his head out the window. Category - Saying Hello to a Stranger • I see the smile and reaction on a stranger’s face when I say “hello.” • It makes me smile when the stranger returns the “hello.” • I hope I make people feel special when I acknowledge them.

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Start Journaling Journaling gives you the biggest bang for your buck. If you're feeling stressed out or confused, write down what you're going through and what youâ&#x20AC;&#x2122;re thinking. The more details about a specific topic, the better. Try to stay solution-focused, and consider writing about people rather than things. Start thinking about what life would be like without the people who bring you gratitude and joy, and stop thinking about the things you wish you had. Journaling challenges you to move your mind from where it is. The act of writing helps you to clear your mind and offers a sense of calmness. With a commitment to journaling, youâ&#x20AC;&#x2122;ll learn more about yourself and how you react to different situations. This will be a chance for you to develop a new perspective and outlook on life.

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JEWISH MENTAL WELLNESS WORKSHOPS The Blue Dove Foundation has created two educational workshops to accompany this Toolkit. These programs, designed for individuals eighteen and older, are easy to host for your communities and networks. If you’re interested in learning more about the workshops, visit thebluedovefoundation.org/toolkit or email us.

Making Mental Wellness Part of Your Community’s Culture During this workshop, participants will engage in a variety of activities that focus on bringing mental wellness front and center into their Jewish communities. They will use middot (Jewish values) and the mi sheberach prayer to connect Judaism to mental health as well as to critically consider how to bring new-found skills and knowledge back to their communities to begin creating welcoming and inclusive programs.

Recognizing When Someone Needs Help During this workshop, participants will engage in a variety of activities that strengthen their mental health knowledge, which will help them understand their role in supporting others. They will learn about basic mental health concepts, the scope of those affected by mental illness, and red flags for spotting issues. They will develop four core skills needed to respond to mental health concerns in meaningful ways and be given the opportunity to practice and build those skills.

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TOOLS AND RESOURCES FROM THE PARTNERSHIP CENTER Compassion in Action: A Guide for Faith Communities Serving People Experiencing Mental Illness and Their Caregivers The full version is available to download.

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MENTAL HEALTH GLOSSARY U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2019). RAISE Glossary ANTIDEPRESSANT: Medication used to treat depression and other mood and anxiety disorders. ANTIPSYCHOTIC: Medication used to treat psychosis. AUDITORY HALLUCINATIONS: Hearing something that is not real. Hearing voices is an example of auditory hallucinations. BIPOLAR DISORDER: A disorder that causes severe and unusually high and low shifts in mood, energy, and activity levels as well as unusual shifts in the ability to carry out day-to-day tasks. (Also known as manic depression) CHRONIC: Persisting for a long time or constantly recurring. CLINICAL TRIAL: A scientific study using human volunteers to look at new ways to prevent, detect, or treat disease. Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. COGNITION: Conscious mental activities (such as thinking, communicating, understanding, problem solving, information processing, and remembering) that are associated with gaining knowledge and understanding. COGNITIVE IMPAIRMENT: Experiencing difficulty with cognition; For example, include having trouble paying attention, thinking clearly, or remembering new information. (Also see cognition) COGNITIVE REMEDIATION: Training that uses a variety of techniques, including computer exercises and adaptive strategies, to improve cognition. This therapy is designed to strengthen the underlying brain functions that help support cognitive skills such as memory, attention, and problem solving. 142

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COGNITIVE BEHAVIORAL THERAPY (CBT): Helps people focus on how to solve their current problems. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly. COGNITIVE BEHAVIORAL THERAPY FOR PSYCHOSIS (CBT-P): Cognitive behavioral therapy that specifically addresses the positive symptoms of psychosis, e.g., hearing voices. COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT (CMHBG): Administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), the CMHBG program makes funds available to all fifty states, Washington, D.C., Puerto Rico, the U.S. Virgin Islands, and six Pacific jurisdictions to provide community mental health services. COMORBIDITY: The existence of two or more illnesses in the same person. These illnesses can be physical or mental. COORDINATED SPECIALTY CARE (CSC) for first episode psychosis: CSC is a type of treatment that uses a team of specialists who work with the client to create a personal treatment plan. The specialists offer psychotherapy, medication management, CSC case management, family education/support, and supported employment/education, depending on the individual’s needs and preferences. The client and the team work together to make treatment decisions, involving family members as much as possible. CSC CASE MANAGER: This member of the CSC treatment team helps clients with problem solving and coordinates social services. The case manager has frequent in-person meetings with the clinician, the client, and the client’s family. CSC TEAM LEADER: This member of the CSC treatment team coordinates the client’s treatment, leads weekly team meetings, oversees treatment plans and case review conferences, and develops transitions to and from the CSC program. 143

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DELUSIONS: Beliefs that have no basis in reality. DEPRESSION: Sadness, lack of interest or pleasure in daily activities, and feelings of worthlessness or excessive guilt that are severe enough to interfere with working, sleeping, studying, eating, and enjoying life. DURATION OF UNTREATED PSYCHOSIS: The length of time between the beginning of psychotic symptoms and the beginning of antipsychotic treatment. EARLY INTERVENTION: Diagnosing and treating a mental illness when it first develops. EVIDENCE-BASED PRACTICE: Treatments that are supported by clinical research. FAMILY EDUCATION/SUPPORT: This part of coordinated specialty care teaches family and friends about first episode psychosis and helps them support the client’s recovery. Family and friends are involved in the client’s treatment as much as possible and as long as it is consistent with the client’s wishes. FIRST EPISODE PSYCHOSIS: The first time an individual experiences an episode of psychosis. Also see Psychosis. HALLUCINATIONS: Hearing, seeing, touching, smelling, or tasting things that are not real. INPATIENT: Health care treatment for someone who is admitted to a hospital (also see Outpatient). INTERVENTION: Any action taken by one or more people to provide a new treatment, resource, and/or support to someone experiencing an addiction or mental health crisis.

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INDIVIDUAL RESILIENCY TRAINING (IRT): One part of the NAVIGATE treatment program (see NAVIGATE). IRT promotes recovery by identifying client strength and resiliency factors, enhancing illness management, and teaching skills to help functional recovery in order to achieve and maintain personal wellness. LONG-ACTING INJECTABLE (LAI) (drugs): A shot of medication administered once or twice a month. The shot is an alternative to taking a daily dose of medication. MANIA: An abnormally elevated or irritable mood. Associated with bipolar disorder. MANIC DEPRESSION: See Bipolar Disorder. MOOD DISORDERS: Mental disorders primarily affecting a person’s mood. NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI): The nation’s largest grassroots mental health organization. NAMI is one of more than eighty national nonprofit organizations that participate in the NIMH Outreach Partnership Program. NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH): The lead federal agency for research on mental disorders. NIMH is one of the twenty-seven institutes and centers that make up the National Institutes of Health (NIH), the nation’s medical research agency. NIH is part of the US Department of Health and Human Services. NEGATIVE SYMPTOMS: Symptoms of schizophrenia are often classified as positive or negative. Examples of negative symptoms that “take away” from life include social withdrawal, lost interest in life, low energy, emotional flatness, and reduced ability to concentrate and remember. OUTPATIENT: Health care treatment given to individuals who are not admitted to a hospital. (Also see Inpatient.)

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PHARMACOTHERAPY: Medication selection, dosing, and management. Pharmacotherapy for first episode psychosis typically involves a low dose of a single antipsychotic medication and careful monitoring for side effects. POSITIVE SYMPTOMS: Psychotic symptoms are often classified as positive or negative. Examples of positive symptoms that “add to” a person’s experiences include delusions (believing something to be true when it is not) and hallucinations (seeing, hearing, feeling, smelling, or tasting something that is not real). PSYCHOSIS: Used to describe conditions that affect the mind when there has been some loss of contact with reality. When someone becomes ill in this way, it is called a psychotic episode. During a period of psychosis, a person’s thoughts and perceptions are disturbed, and the individual may have difficulty understanding what is real and what is not. Symptoms of psychosis include delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). Other symptoms include incoherent or nonsense speech and behavior that is inappropriate for the situation. A person in a psychotic episode may also experience depression, anxiety, sleep problems, social withdrawal, lack of motivation, and difficulty functioning overall. PSYCHOEDUCATION: Learning about mental illness and ways to communicate, solve problems, and cope. PSYCHOSOCIAL INTERVENTIONS: Nonmedication therapies for people with mental illness and their families. Therapies include psychotherapy, coping skills, training, supported employment, and education services. PSYCHOTHERAPY: Treatment of mental illness by talking about problems rather than by using medication. Treatment for first episode psychosis is based on cognitive behavioral therapy principles and emphasizes resilience training, illness and wellness management, and coping skills. Treatment is tailored to each client’s needs.

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RECOVERY: The process by which people with mental illness return or begin to work, learn, and participate in their communities. For some individuals and their families, recovery means the ability to live a fulfilling and productive life. SAMHSA: The Substance Abuse and Mental Health Services Administration is the agency within the HHS that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. SCHIZOAFFECTIVE DISORDER: A mental condition that causes both a loss of contact with reality (psychosis) and mood problems (depression or mania). SCHIZOPHRENIA: A severe mental disorder that appears in late adolescence or early adulthood. People with schizophrenia may have hallucinations, delusions, loss of personality, confusion, agitation, social withdrawal, psychosis, and/or extremely odd behavior. SCHIZOPHRENIFORM DISORDER: Symptoms consistent with Schizophrenia but that last less than six months. SUPPORTED EMPLOYMENT/EDUCATION (SEE): Part of coordinated specialty care, SEE services help clients return to work or school and achieve personal goals. Emphasis is on rapid placement in a work or school setting, combined with coaching and support to ensure success. Learn more at www.hhs.gov.

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SUGGESTED READINGS For easy access to all website links included in this Toolkit for additional reading, visit thebluedovefoundation.org/atltoolkitlinks, and enter the password â&#x20AC;&#x153;wellness.â&#x20AC;? #QuietingTheSilence: Personal Stories By the Blue Dove Foundation Available on Amazon and quietingthesilence.org.

For the longest time, the Jewish community avoided talking about issues related to mental health. Even today, a stigma remains that prevents individuals from opening up and seeking help. #QuietingTheSilence offers a chance for people to share accounts and perspectives related to their own life-changing experiences involving mental illness and addiction. Through these personal narratives of struggles and loss, we hope to show individuals they are not alone and to work toward eliminating the shame and stigma many feel around these topics. The book also includes Jewish prayers for healing, mental health resources, essays about joy, gratitude, and self-care, and a mental health glossary. And God Created Recovery: Jewish Wisdom to Help You Break Free From Your Addiction, Heal Your Wounds, and Unleash Your Inner Freedom By Rabbi Ilan Glazer Available on Amazon

Rabbi Ilan Glazer has felt the pain of addiction personally. In And God Created Recovery, he shares insights and highlights of his recovery path and aims to help others find experience, strength,

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hope, faith, joy, and a better life, one day at a time. He knows the struggles and is here to guide readers toward a healthier future, wherever they are on your recovery journey. Recovery - the sacred art: The Twelve Steps as Spiritual Practice (The Art of Spiritual Living) By Rabbi Rami Shapiro Available on Amazon

Rami Shapiro describes his personal experience working the Twelve Steps as adapted by Overeaters Anonymous and shares anecdotes from others working the steps in a variety of settings. Drawing on the insights and practices of Christianity, Judaism, Buddhism, Taoism, Hinduism, and Islam, he offers supplementary practices from different religious traditions to help readers move more deeply into the universal spirituality of the Twelve Step system. Finding Recovery and Yourself in Torah: A Daily Spiritual Path to Wholeness By Rabbi Mark Borovitz Available on Amazon

In this soul-restoring resource, Rabbi Mark Borovitz combines his knowledge of Judaism and his experience as a leader in the field of recovery to help you find in the Torah the deeper meaning, wisdom, and guidance for living well in the moment.

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Recovery, the 12 Steps and Jewish Spirituality Paperback By Rabbi Paul Steinberg Available on Amazon

With clarity and passion, Rabbi Paul Steinberg masterfully weaves traditional Jewish wisdom with the experience, strength and hope of AA. He draws on Jewish resources—theological, psychological, and ethical—that speak to the spiritual dimension of the disease and shows how the principles of Jewish spiritual recovery directly align with those of the AA Twelve Steps. Along the way, he courageously shares his own personal struggles with alcoholism and addiction in a way that will help others find guidance and a new life path—and stay on it. Jewish Sisters in Sobriety: Jewish Women’s Untold Stories of Alcoholism, Drug Addiction, and Co-Dependence and Recovery

By the Jewish Board of Family and Children's Services Available on Amazon

A compilation of twenty women’s memoirs merges into a unified story of pain, addiction, and recovery that touches every soul within the Jewish community. Set against the Judaic ethnocultural denial of chemical dependency, this book is an outcry against the shame and isolation of the Jewish mother, daughter, sister, wife, and self against these forces.

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Overcoming Overthinking: 36 Ways to Tame Anxiety for Work, School, and Life

By Sophie Riegel and Debroah Grayson Riegel Available at sophieriegel.com

Written by a mother and daughter who have struggled with anxiety their whole lives, Overcoming Overthinking is a compassionate, practical, and entertaining book for anyone who wrestles with worrying. Braided: A Journey of a Thousand Challahs By Beth Ricanati, MD Available on Amazon

What if you could bake bread once a week, every week? What if the smell of fresh baked bread could turn your house into a home? And what if the act of making the bread—of mixing and kneading, watching, and waiting—could heal your heartache and your emptiness along with your sense of being overwhelmed? This is the surprising lesson physician-mother Beth Ricanati learned when she started baking challah: Simply stopping and baking bread was the best medicine she could prescribe for women in a fast-paced and often troubling world.

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Hope is one of the greatest resources we have to change the culture of silence and stigma around mental health issues in the Jewish community. The Blue Dove Foundation wants to inspire people to be educated, courageous, and confident in offering hope and support to those who struggle with their mental well-being and addiction. The Mental Wellness Toolkit is a response to continuous requests for help in the area of mental health. As a practical guide for everyday use, it offers guidance and support for transforming our culture along with practical and concrete information about mental health and wellness. Created through a Jewish lens, this Toolkit is full of resources, facts, and suggested readings. We hope it will empower all of us to turn hope into action. The Talmud teaches us â&#x20AC;&#x153;Whoever saves a single life, it is considered as if he saved an entire world.â&#x20AC;? Together, we can do just that.

The Blue Dove Foundation was created to help address the issues of mental illness and substance abuse in the Jewish community and beyond. Based in Atlanta, we work with people and organizations across the United States and around the world. Learn more at www.thebluedovefoundation.org.