Mental Health by Teacher Superstore

RIC-6411 6.3/180

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Foreword

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Mental health is a comprehensive coverage of mental health issues. It aims to break down the myths and stereotypes surrounding mental illness by providing factual information and thoughtful discussion and awareness activities.

As a psychiatrist, I have become accustomed to seeing people in distress. Unfortunately, while a significant number of them will have problems that began in adolescence or even childhood, they will have suffered for many years before seeking help. These are delays which can lead to a reduced effectiveness of treatment and even an increased likelihood of disability.

The reasons behind these long delays between onset of symptoms and the seeking of help are complex. Despite some positive changes in community attitudes, ignorance, shame, fear and a lack of awareness of the availability of safe and effective treatments remain significant factors. Overcoming these is a challenge, but knowledge represents a powerful and effective weapon.

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The provision of education regarding the widespread nature of mental health problems, their various forms, the risk factors, early warning signs and the availability of good treatments and how they are delivered, helps to destigmatise mental illness. This can increase the likelihood that those in need will present early, and that those who see someone they care about affected by mental health problems will support them in seeking appropriate help. This limits the distress of sufferers of mental illness and also reduces the burden that the family and friends of those affected will endure.

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Young people represent a particularly important target group for such an intervention; they are at significant risk of developing mental health problems but are poorly equipped to deal with them and reluctant to seek help, often coping with them in unhealthy ways. Teachers are well-placed to play a vital role in improving the mental health literacy of young people at crucial periods of development. With Mental health, Jenni Harrold has written a well-researched, thorough and comprehensive guide to mental health issues that will support educators in dealing with this extremely important subject in a clear and practical way. Dr R O Date MBBS, FRANZCP Psychiatrist

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Mental health

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Contents

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Teachers notes...............................................................vi – vii

Stigma................................................................................ 6–9 Report................................................................................ 9

Anxiety disorders............................................................ 10–37 Anxiety disorders........................................................ 10–13 Support group............................................................. 13 Generalised anxiety disorder........................................ 14–17 Relaxation report......................................................... 17 Panic disorder.............................................................18–21 Agoraphobia and specific phobias................................ 22–25 Social anxiety disorder................................................. 26–29 Obsessive-compulsive disorder.................................... 30–33 Post-traumatic stress disorder..................................... 34–36 Review – message board.................................................. 37

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Mental illness..................................................................... 2–5 Survey................................................................................ 4 Biography........................................................................... 5

Eating disorders.............................................................. 68–79 Symptoms........................................................................ 69 Causes............................................................................. 69 Effects and treatment........................................................ 70 Food diary........................................................................ 72 Kate’s story.................................................................73-79

Self-harm....................................................................... 80–85 Causes............................................................................. 81 Risk factors...................................................................... 81 Treatment and coping skills............................................... 82 Things to remember.......................................................... 85 Suicide.......................................................................... 86–101 Risk factors and warning signs.......................................... 87 Coping with suicidal thoughts............................................ 88 Coping with someone who feels suicidal............................. 89 Who can I rely on?............................................................ 92 Silver lining....................................................................... 92 Situation/Action plan......................................................... 93 Identifying positive aspects of life....................................... 94 Mark’s story..............................................................95–101

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Depression......................................................................38–55 Causes and symptoms...................................................... 40 Treatment......................................................................... 41 Women and depression..................................................... 42 Men and depression.......................................................... 42 Young people and depression............................................ 43 Older people and depression............................................. 43 Weekly journal.................................................................. 47 Weekly chart..................................................................... 48 Cassie’s story..............................................................49-55

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Drugs and mental illness............................................ 102–105 Drug research report....................................................... 105 Getting help................................................................ 106–109 Healthcare professionals................................................. 107 Hospital admission.......................................................... 107 Contacts......................................................................... 109

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Bipolar disorder.............................................................. 56–63 Symptoms........................................................................ 57 Causes............................................................................. 58 Treatment......................................................................... 59 My mood states................................................................ 61 Mood diary....................................................................... 62 The facts.......................................................................... 63

Treatments..................................................................110–115 Therapy, training and medication...................................... 111 Natural therapies and relaxation....................................... 112 Structured problem-solving.............................................. 114 Cognitive behavioural therapy.......................................... 115 How to help/How others are affected......................... 116–118 Where to find help.............................................................. 119

Schizophrenia.................................................................64–67 Symptoms........................................................................ 65 Causes............................................................................. 66 Treatment......................................................................... 66

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Mental health

Teacher information pages The teacher information page accompanies each of the fact sheets and student activity pages. It provides the following information: • Specific indicators explain what the students are expected to gain from the information and activities. • Discussion points have been suggested to develop awareness and understanding of each topic and support the activities on the student page. • Additional activities are provided to further develop outcomes and extend students’ understanding. These activities provide ideas that are an extension of the issue and can generally be completed independently. Some of these additional activities are provided in a worksheet format.

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• Answers to all worksheet activities are included. Although student responses to many of the activities will differ depending on personal thoughts and opinions, suggested responses are provided as a guide.

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Factual information pages

It is not recommended that the fact pages simply be distributed without opportunity for discussion and understanding.

The fact pages should be used in the most appropriate way for the age and experience of the students involved. Teachers may wish to copy these pages and use them throughout a class discussion. They can be an excellent resource for students to collect and refer to at a later time. Teachers can also promote the opportunity for students to share information with parents and create open communication at home.

It is strongly suggested that teachers first read and understand the fact pages prior to any student discussion.

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Suggestions for teaching mental health

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Talking about mental health issues can be a sensitive matter. With mental illness impacting on so many people’s lives, it is likely that many of the topics will affect students in some way. This may be very personally and directly, or because of a family member or close friend.

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Mental health introduces and develops the knowledge, skills, attitudes and values that will enable students to lead healthy and fulfilling lives. Students will consider what it means to be mentally healthy and will be given the tools to become responsible, caring members of society. Many of the activities in this book provide students with an opportunity to formulate their thoughts on a topic and express their opinions and feelings. Classroom discussions are valuable for encouraging critical and reflective thinking. • • • • • •

Create a safe atmosphere in the classroom so students feel they can share their thoughts and feelings. Identify what it is the students are going to take away from the lesson. (Refer to the ‘Indicators’.) Begin with a discussion or hypothetical situation. (Refer to ‘Discussion points’.) Listen to and be honest with students. (Give something of yourself. Share some of your own experiences, where appropriate.) Show respect for the students’ thoughts and feelings. Be non-judgmental.

In your responses, encourage students to analyse their statements by asking such things as ‘What could happen if you did that?’ or ‘Who else would be affected by that?’, rather than giving your own opinion.

Mental health

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Creating a safe atmosphere For an effective lesson to take place, students need to feel comfortable enough to share their thoughts, feelings, opinions and past experiences. They need to feel there will be a non-judgmental atmosphere with no ridicule and no put-downs. Students should be encouraged to become respectful listeners. Set clear rules, such as one person speaking at a time, no put-downs or pulling faces, and no interruptions. Explain that many people often only ‘half listen’ because they are thinking about what they might say when the speaker is finished.

r o e t s Bo r e p ok u S Tolerance and empathy

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It is important for students to understand that personal issues discussed are not to become topics of conversation outside the classroom. Teachers will also need to show this same respect to the students. Of course, if issues are raised that need further attention, the principal and parents may need to be consulted.

Tolerance and empathy need to be encouraged in students. Activities are provided where students can put themselves in someone else’s place and imagine how that person feels, helping to foster empathy. Tolerance is an ongoing process that teaches students not to hate or judge. Teachers can teach tolerance most effectively by modelling tolerant behaviour in the classroom and playground, ensuring students are exposed to a variety of literature and images, and teaching them about various faiths, ethnicity and lifestyles. Educating students to be tolerant will: • promote the understanding and acceptance of individual differences

• promote the idea that differences can enhance our relationships and enrich our society • minimise generalisations and stereotyping, and

• promote the need to combat prejudice and discrimination.

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This book emphasises the importance of respecting the feelings, emotions, thoughts and opinions of others.

Values

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Values are those qualities which an individual or a society considers to be important as principles for conduct. Mental health helps students to consider their personal strengths and weaknesses and reinforces the advantages of having a strong set of values.

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A person’s set of values affects his or her thinking and behaviour. When people are confident in themselves and have strong values, it is easier to do things that are ‘right’. Those who have weaker values can often be led easily and may do things they don’t really want to do. Teachers can encourage students to have a positive self-image through praise and by recognising their achievements. Teachers can foster the development of personal qualities such as perseverance, kindness and dealing with stress and criticism. They can also discuss other values with students, such as honesty, generosity and tolerance.

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Mental health

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Mental illness Indicators • Understands that mental illness is common and can affect anyone. • Realises that effective treatment is available for the different mental illnesses.

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2. True. Although there is no complete cure, most forms of mental illness can be effectively managed with medication, therapy, support and lifestyle changes.

11. True. Left untreated, a person’s suicidal feelings can escalate. Research shows that people who have a mental illness (especially those diagnosed with depression, schizophrenia and bipolar disorder) are at an increased risk of suicide.

• Discuss and list the types of mental illnesses that students are aware of. • Explain that a mental illness is like having any other physical illness.

3. False. People being treated for a mental illness are no more violent or dangerous than the general population. They are actually more likely to be victims of violence, especially self-harm. A small percentage of those with mental illness may be violent if they abuse drugs or alcohol, have a history of violence, are not receiving treatment or are not taking prescribed medication. 4. True. Many different factors can trigger a mental illness, so anyone is susceptible during their lifetime. 5. True. Research shows that some people can be more predisposed to mental illness and that genetics does play a role, particularly with the risk of schizophrenia, bipolar disorder and clinical depression.

12. False. Medication is usually only one part of effective treatment for a mental illness. Different types of mental illness may not even require medication. Medication is rarely the first line treatment for children and adolescents. Therapy, family support and lifestyle changes are explored first. The more serious illnesses (schizophrenia, bipolar disorder, major depression) require medication to stabilise brain chemistry, moods and psychosis.

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• Have students complete the survey and discuss answers. (page 4)

1. True. About 20% of the population will experience some kind of mental illness in their life. About 1% will experience the more severe forms, such as schizophrenia and bipolar disorder.

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• Identifies the factors that can contribute to a person developing a mental illness.

Discussion points

Mental illness survey – answers

13. True. Research shows that illicit drugs can trigger illness in those who may already be susceptible. Illicit drugs can also induce psychosis.

14. False. Mental illness affects people differently. Some forms of mental illness (bipolar disorder) are characterised by episodes of mania, where the person has an elevated mood. Even with clinical depression, sufferers may feel more empty and show no emotion, rather than act miserable and cry all the time.

• Reinforce the fact that most symptoms of mental illness appear before the age of 30.

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• Explain that there is effective treatment available for all mental illnesses and that most people can recover well. • Discuss high profile people who have acknowledged they have a mental illness.

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6. False. The vast majority of those who suffer with a mental illness can manage to maintain effective treatment outside a hospital environment. For those who are suffering severe psychosis, are at risk of harming themselves or pose a threat to others, hospital treatment is a safe option. Some people can be so unwell that they do not understand the dangers, and so a small percentage of sufferers will be admitted involuntarily to a secure hospital facility.

15. True.

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16. True. Alcohol and drugs can affect medications prescribed to treat an illness. They are depressants that can have more impact on a person who is predisposed to mental illness. Alcohol and illicit drugs can induce psychosis.

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• Highlight how common it is for people to experience mental illness.

17. True. The earlier people are diagnosed, the better their prospect of long-term success.

o c . che e r o t r s super 7. False. Schizophrenia is an illness which affects the way the brain works. This can cause people to see themselves and the world around them in a way that is out of touch with how things really are.

8. True. A psychotic episode occurs when a person is unable to perceive reality. Psychosis can be experienced as a symptom of a mental illness and can also be triggered by alcohol and drugs. 9. False. A mental illness can be the result of chemical changes in the brain but is not usually associated with brain damage. A severely untreated illness may have an affect on the brain, especially if there is prolonged use of alcohol and drugs as a major factor.

18. True. A mental illness can produce wide-ranging physical symptoms, including lethargy, sleep problems, eating and gut problems, headaches, nausea, dizziness, racing heart, sweating, vision problems and unexplained pains. 19. True. A psychiatrist is a registered medical doctor who can prescribe and monitor medications and can elect to use different types of therapy to suit individual patients. Psychiatrists work in the public and private sectors and need a referral from a GP. 20. True.

(no explanation required)

10. False. Having a mental illness is not a weakness or a flaw in a person’s character. Mental health

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Mental illness Mental illness is a general term that refers to a group of illnesses that cause people to think, feel and act differently from how they might usually, and from how others might. A mental illness can affect any person, from any background, during any time of their life. Approximately 20% of the population will experience some kind of mental illness in their lifetime.

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Any of the mental illnesses can be effectively treated and managed. Most people respond positively to the correct treatment. Despite the severity of some types of mental illness, there are very few people who will develop chronic symptoms that are not manageable.

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Unfortunately, many people fail to recognise and acknowledge their symptoms. Even when they feel something may be wrong, they can be hesitant to seek treatment. Young people, especially, need to be aware and responsive since symptoms of most mental illnesses appear before the age of 30. Statistics show that about one-third of people in public hospitals who are being treated for a mental illness are under 30. Ignoring symptoms of mental illness can increase the likelihood of developing further problems. People with an untreated mental illness may use unhelpful ways to try to alleviate their symptoms. They may turn to alcohol, prescription or illicit drugs to help them feel as though they are coping. They are also less likely to maintain a healthy diet, exercise regularly and engage in rewarding social activities. Leaving a mental illness untreated can seriously increase the risk of suicide.

A mental illness is just like any other form of illness. Having a mental illness does not mean a person is inadequate, lazy, stupid or weak. A mental illness does not reflect a person’s intellectual functioning.

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• Family history A mental illness can be genetically linked, so if a family member has an illness, others can be at a higher risk of developing that illness. • Chemical imbalance An imbalance of chemicals in the brain can cause symptoms of mental illness. The medications used to manage some mental illnesses try to correct this imbalance.

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• Stressful life events Any kind of stressful life experience can be a trigger for developing a mental illness.

• Drug use Research shows a definite link between some mental illnesses and illicit drug use, especially cannabis and amphetamines. Alcohol use can also be a trigger for mental illness. Any of these factors can develop separately to contribute to a mental illness. There can also be a combination of factors that can trigger a mental illness. I never really knew there was a name for the way I was feeling. I just thought I was messed up and hopeless at dealing with things. Even though I was scared to talk to a doctor, it was much more of a relief to know I had an illness that could be treated. Ryan R.I.C. Publications® – www.ricpublications.com.au

Mental health

Mental illness survey Indicate whether you believe these statements to be True or False

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Mental illness is common.

r o e t s Bo r e p ok u S Most mental illnesses can be effectively treated.

A person with a mental illness is often violent and dangerous. Anyone can develop a mental illness.

A mental illness can be inherited.

A person with a mental illness should be kept in hospital.

Schizophrenia means ‘split personality’.

A person experiencing psychosis may lose touch with reality.

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A person with a mental illness has an increased risk of suicide.

12.

Medication is the only effective treatment for a mental illness.

Illicit drugs can trigger a mental illness.

13. 14.

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11.

People with a mental illness are always miserable and crying.

Most mental illness symptoms appear before the age of 30.

16.

Alcohol and drugs can make things worse for a person with a mental illness.

17.

A mental illness can be managed better with early treatment.

18.

A person with a mental illness can experience physical symptoms.

19.

A psychiatrist can prescribe medication and offer therapy.

20.

A stressful event can trigger a mental illness.

15.

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Biography Name: Background:

Occupation:

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Interests:

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Achievements:

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Difficulties faced:

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Positive outcomes:

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Interesting facts:

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Mental health

Stigma

Indicators • Understands how stigma is related to mental illness. • Appreciates that education can help to reduce the stigma surrounding mental illness. • Suggests appropriate ways to show greater tolerance of issues regarding mental illness.

• Discuss other examples where stigma may be apparent; for example, religion, physical disability, race, dress, speech.

• Discuss labels we may put on individuals and groups of people. Where do these labels come from? How accurate are they? How do we know? • What is discrimination? How are individuals and/or groups discriminated against? Which members of society are more likely to be discriminated against? • Discuss the prevalence of false misunderstandings and how these can lead to bullying. • Discuss how students might feel if a teacher explained they were dealing with a mental illness. What might be the reactions? What repercussions could there be for the teacher? If you were a teacher, would you admit to a mental illness? Under what circumstances would if be helpful to know if someone was dealing with a mental illness?

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Discussion points

r o e t s Bo r e p ok u S Answers

1. Student responses will differ. Suggest asking for a response before discussion. 2. Student responses will differ. Suggested responses could include myths and stereotypes portrayed in movies and the media, people can’t ‘see’ the illness (unlike a broken leg), fear, secrecy, shame, lack of education, and understanding.

3. Student responses will differ. Suggestions could include talking openly, being supportive, understanding and caring, educating yourself and others, listening and being patient. 4. Student responses will differ.

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• Design a card that you might send to a relative or friend who is dealing with a mental illness. • Why is education about the facts on mental illness so important for everyone? Write an article to include in a school newsletter. Explain the stigma attached to mental illness and what can be done about it. (see page 9)

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5. Discrimination is to make an inaccurate distinction against someone because of a perceived difference.

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Additional activities

6. Student responses will differ. Some advantages in sharing would be allowing friends to help, not having to keep secrets, making it easier to talk with teachers if problems arise, feeling accepted. Some disadvantages could be the risk of bullying, harassment or discrimination.

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• Choose one group in the community (based on gender, race, religion, sexual preference, economics) and research the relevant anti-discrimination laws. Compile a report on your findings.

7. Student responses will differ. Some responses may include religious groups, gay and lesbian, immigrants, young people, old people, intellectually disabled, single mothers, women in positions of power, single fathers, mentally ill, Indigenous people.

Mental health

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Stigma Mental illness does not discriminate. People do. A dictionary definition for the word stigma is a mark of disgrace; a stain on one’s reputation. A thesaurus will show words like shame, disgrace and dishonour. Stigma around mental illness is everywhere. It occurs at many different levels and takes many different forms. Have you ever thought that someone with a mental illness is probably violent, homeless or unemployed? Answering yes may mean that you are like so many other people who believe in the myths and stereotypes about mental illness. Stigma can make you believe that you know the truth, when in reality, your beliefs may be based on misunderstandings.

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Many people mistakenly believe that mental illness won’t affect them or anyone they know but mental illnesses are very common. If the stigma about mental illness hasn’t affected you or your family personally, then it’s sure to have affected someone around you. Just think about all the insulting and offensive terms that have been used about mental illness and those suffering from it. Imagine how difficult it is for those diagnosed with a mental illness, when they have already associated their illness with words like ‘psycho’ and ‘loony’. It would be quite scary. So scary, that people might not even ask for help because they were afraid they may be labelled ‘the crazy one’. When people don’t understand all the facts about mental illness, it is easy for them to believe whatever they’ve been told. Stigma can prevent someone from being supportive and caring. It can make one person feel more superior to another. The stigma surrounding mental illness can have serious consequences within families, among friends, at school and in the workplace. Some people live with a mental illness without telling those close to them, for fear of being labelled the wrong way.

© R. I . C.Publ i cat i ons I’ve been teaching for seven years and there was no way I was going to let on to students or their parents that I had been diagnosed with depression. When my •f ormyillness r e vi r p oIs emost sofo l y •I’d was ate its w worst, Ip tooku unpaid leave. think then school thought gone away for a wonderful holiday somewhere.

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It is so important for everyone in society to gain a better understanding of mental illness and stop the stigma attached to it. A mental illness should be seen in the same way as any other illness. Those who suffer with a mental illness should be treated with the same respect and understanding as anyone else who is living with an illness. Education is the most powerful weapon we have against the discrimination and stigma attached to mental illness. As an individual, and within the community, we should try to:

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• talk openly about mental illness • help family and friends to get the best treatment available • think about mental illness in the same way we think about any other illness • promote healthy attitudes from an early age

• learn effective ways of managing difficult life situations • encourage research into mental health issues • support those who are contributing to the effective treatment of mental illness • stamp out discrimination for people with mental illness.

I agreed to be admitted to a psychiatric clinic for two weeks. It kept me safe from thoughts about harming myself, but it was very isolating and lonely. I didn’t see any flowers or balloons in any of the rooms. They didn’t even have a little gift shop like you find in most hospitals. No one sent me a Get Well card. I felt like I was contagious. Claire

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Mental health

Stigma 1. Write down any preconceived ideas you may have had about mental illness.

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2. Give reasons to explain why you think there is often a stigma attached to mental illness.

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4. Describe a time when your views about someone may have been wrong.

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3. Suggest ways you could show support to someone who is affected by a mental illness.

5. What is discrimination?

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Who would you share that information with?

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What advantages would there be in telling others?

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6. Within a school community, most people show tolerance and understanding when someone is dealing with a physical illness or disability. Imagine you were diagnosed with a mental illness.

What disadvantages would there be?

7. Consider some of the individuals or groups in our society that might face discrimination. List ways they may be discriminated against. 8

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Stigma Write a report outlining why education about mental illness is important. Discuss the stigma that can be associated with mental illness.

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Mental health

Anxiety disorders Indicators • Identifies what an anxiety disorder is. • Recognises the ‘flight or fight’ response that a person can experience. • Understands factors that can contribute to someone developing an anxiety disorder.

Discussion points

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• Allow students to discuss some of the situations that have caused them anxiety. • Discuss ‘flight or fight’ responses that everyone experiences. Suggest personal experiences and allow students to contribute their own experiences. • Discuss contributing factors to developing anxiety disorders and explain that personality is constantly changing in adolescence. • Explain situations when anxiety can be helpful and allow students to explore their personal situations. It is important for students to recognise that anxiety can be a positive and healthy reaction and not necessarily a precursor to developing a disorder.

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• Highlight the fact that high anxiety can cause physical symptoms.

• Detail an experience where the ‘flight or fight’ response was activated and describe the consequences.

• With a partner, list different situations where a flight response or a fight response would be the most appropriate. Discuss responses you may have different views on.

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• Recall an anxious behaviour you have noticed in a family member or friend. Describe how their reaction has influenced your own thoughts on the situation. • A close friend is feeling extremely stressed about submitting a major assignment in a subject she has not been very successful at in the past. What actions and suggestions can you offer to help alleviate her anxiety?

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1. Suggested responses should include situations where adrenaline increases, such as before a big event or when there is a ‘flight’ response required. 2. Student responses will differ. Suggest teacher recount an experience as a guide.

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Additional activities

3. Student responses will differ. 4. Student responses will differ.

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• Locate information about an anxiety disorder’s support group and compile a report to show how they may assist individuals. What are the underlying principles? Discuss the pros and cons of such groups. Develop ideas to promote the service. Examine how appropriate such groups may be to those in your age group. Consider the realities of establishing support groups for school-age participants. Develop a proposal to deliver to someone in authority. (page 13)

5. Character traits could include confidence, self-belief, self-awareness, honesty, tolerance, humour, even temper, pride, courage.

Review

Message Board (page 37)

• Message Board (page 37) As a review of the different anxiety disorders, ask students to identify the correct illness for each of the messages posted.

Social anxiety disorder, post-traumatic stress disorder, generalised anxiety disorder, panic disorder, specific phobia, obsessivecompulsive disorder, agoraphobia

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Anxiety disorders Everyone experiences feelings of anxiety, especially when facing something that is difficult or dangerous, stressful or embarrassing. A person might feel tense, upset or uncomfortable and his/her pulse rate might rise. He/She might also feel sweaty and have those ‘tummy butterflies’. This is all normal and the feelings usually go away after a short time. For those who have an anxiety disorder, these feelings may not have an apparent cause and are frequent and severe enough to interfere with normal life.

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Extreme anxiety can cause panic attacks, nightmares and quite scary physical symptoms. Some people might feel that they can’t even leave the safety of their own home because their fear is so intense. We all have a ‘flight or fight’ response to challenging and difficult situations. It is like a safety valve that protects us from any threat. There is an instant adrenaline charge and we can either run, or stay and fight. For those who have severe anxiety, the stress response is very sensitive and often triggered at the wrong times. If the alarm goes off too early, a person can react much more anxiously than other people might, given the same situation. Anxiety can be a very helpful emotion because it can allow you to be ready for anything. For those who live with an anxiety disorder, their anxiety has the opposite effect and, in fact, achieves nothing. The feelings are so powerful that everyday activities can seem almost impossible to achieve. The flight or fight response is turned on so often that it can be never ending. The more a person has the response, the more anxious he/she feels, and so on.

The main anxiety disorders are:

• Obsessive-compulsive disorder

• Post-traumatic stress disorder.

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Apart from post-traumatic stress disorder (which is a result of a traumatic event), the causes of anxiety disorders vary from person to person. Here are some factors that can contribute to a person developing an anxiety disorder:

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• Family history and learned response Anxiety disorders can ‘run in families’ and may be an inherited tendency. Children can learn anxious behaviour from a family member or friend. A learned response can also be a reaction to people seeing their own behaviour. They could presume that they might react in the same way again and so they might do whatever they can to avoid the situation that made them anxious.

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• Personality Those who are more vulnerable to anxiety disorders can often be sensitive, emotional, easily upset and shy. • Chemical imbalance For those who have an anxiety disorder, there may be an imbalance of chemicals in the brain. Anxiety disorders can be treated successfully, so it is important to find professional help. Not all are treated in the same way. Behavioural therapies help to change anxious behaviour and worrying thoughts and are usually the most effective types of treatment. Medications can prove helpful for some people.

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Mental health

Anxiety disorders 1. Describe a situation when it might be acceptable or helpful to be in an anxious state. 2. Recount an experience you have had in each of the following situations. List the physical and emotional symptoms that affected you.

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My experience in a Difficult situation

Emotional symptoms

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Dangerous situation

Physical symptoms

Stressful situation

Embarrassing situation 3. Describe the measures you might take to avoid situations that cause anxiety.

Activities •

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5. List character traits that a person could try to develop so as to avoid the possibility of developing an anxiety disorder. 12

Mental health

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Anxiety disorders’ support group Name of group: Location:

Meeting times:

Aims: • • • •

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Advantages of joining: • • •

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Disadvantages of joining:

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This group is appropriate for my age

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Why?

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Mental health

Generalised anxiety disorder

Indicators • Recognises symptoms of generalised anxiety disorder. • Considers personal experiences that may have caused excessive worry. • Understands the types of approaches used to treat generalised anxiety disorder.

Discussion points

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• Allow students the opportunity to discuss important issues that worry them.

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• Do people worry more now than they did 5/10/20/50/100 years ago? • Discuss how negative thoughts and feelings can become overwhelming and allow little room for clarity and logic.

Additional activities

• Use a diagrammatic representation to show how one worrying situation can become completely out of proportion. Show alternative and reasonable responses and reactions.

Answers

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• Discuss the issues that different groups of people in our society (adolescents, men, women, the elderly) might worry about.

1. Student responses will differ. Suggested descriptive words could include: Physical—restless, tired, tense, sore, stiff, exhausted, drained, aching Emotional—nervous, scared, anxious, worried, uneasy, upset, troubled, agitated, stressed, edgy

• Undertake research to show how good breathing techniques can decrease physical responses to tension and anxiety in the body.

2. Student responses will differ. Suggested responses could include:

(a) If I work hard and stay focused I can have my dream job.

(b) My friend is probably busy, hasn’t forgotten me and will call when he can.

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• Research a relaxation technique that interests you. Create a report that could be presented to a class group. (page 17) • Create a survey to show the issues a specific group of people might worry about.

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• Recount a time when a friend or family member responded to a situation that you felt was out of proportion to the worry he/she was feeling. How dismissive were you of the person’s feelings? What were your responses? What steps could you have taken to help him/her feel less anxious?

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(d) I’m not going to be intimidated by things I can’t control, or other people’s actions.

(e) I am not the cause of my parents’ arguments.

3. Student responses will differ.

Mental health

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Generalised anxiety disorder Generalised anxiety disorder is quite common. The main symptom of this disorder is persistent and excessive worry. A person with generalised anxiety disorder can worry about all sorts of things, especially everyday issues, and the worry can become overwhelming and hard to manage. Whatever the worry is, it is usually completely out of proportion to the actual situation.

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If a person is intensely worried all the time, he/she may suffer from these symptoms: • feeling restless and on edge

• having difficulty concentrating

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• experiencing muscle tension • becoming tired easily

• suffering sleep problems.

Generalised anxiety disorder can be treated very successfully. The main aims are to gain better control over the worry and learn how to overcome the physical symptoms of anxiety. The most effective treatment method is learning how to process the thoughts that affect feelings and behaviour. Behaviour therapy encourages a person to replace negative thoughts with positive thoughts. It is important to challenge the negative thoughts and find more reasonable alternatives. For example, a friend is late. You might worry that there has been an accident, that something terrible has happened or that your friend doesn’t want to see you. All sorts of bad things might go through your mind and you feel extremely anxious. By turning around those negative thoughts, you can look for more realistic possibilities.

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I worry all the time about my health. Every time I get a stomach ache or a sore throat, I’m sure it’s cancer. Amanda

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Learning relaxation techniques is also an important treatment for controlling anxiety. Once a person learns how to relax, the physical symptoms of anxiety can be interrupted and managed more effectively. Learning how to control breathing can quickly break the cycle of increased tension. When a person can focus on controlling physical symptoms, it is easier to calm down and look for more appropriate responses to the situation.

Whenever we drive somewhere after dark, I always worry that our car will be hit by a drunk or speeding driver. I’m scared we’ll all be killed. My muscles get so tight and I have a headache by the time we get home. Adam

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Mental health

Generalised anxiety disorder 1. Write words to describe how you feel physically and emotionally when you have a major worry. Physical: Emotional:

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2. Suggest an alternative thinking pattern for each of the following: (a) I will never have my dream job.

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(b) My friend hasn’t returned my call, so he’s probably mad at me.

(d) Terrorists could attack so I need to stay away from public places.

(e) My parents are arguing and it’s because I’m not doing well in school.

Friends

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School

Family

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Sporting/hobbies

Other relationships

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3. Use the following headings and list three things that cause you anxiety. Indicate the most serious worry in each category and write a positive statement to counteract it.

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My future

Community issues

Environmental issues

World issues

Mental health

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Relaxation Write a report about relaxation.

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Mental health

Panic disorder

Indicators • Understands the feelings, behaviours and thought patterns associated with panic disorder. • Recognises that panic disorder can be successfully treated. • Considers personal reactions to specific experiences.

Discussion points

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• Discuss the cycle of reinforcement and avoidance that panic attacks can bring about. • Students need to understand that this disorder can be treated with different coping strategies.

• Discuss how fear of a negative situation repeating can stop a person from doing things. • Identify and discuss factors that can aggravate anxiety.

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• Reinforce that panic attacks can create physical symptoms and that these symptoms are not life-threatening (even though it may feel like it).

1. A panic attack can be so frightening because it can strike suddenly and without warning, can occur anywhere and at any time, and because a person may feel he/she is losing control, going crazy, having a heart attack or even dying. 2. Student responses will differ.

3. Even after one panic attack, a person may develop such a fear of it happening again that he/she may continue to avoid the situation. With the increased fear of a recurrence, a person may continue to avoid even the smallest amount of anxiety.

• Research and compile a report to show how alcohol or an illicit drug can aggravate symptoms of panic disorder.

• Find an article (in a newspaper or magazine) relating a situation that might cause you personal feelings of anxiety or panic.

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• Imagine a person experienced a major panic attack at a crowded shopping centre and felt fearful of returning. Make a list to show how the person’s life could be affected if the fear continued.

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4. Ways to alleviate a panic attack include professional therapy to change thinking patterns, behaviour therapy to change negative thoughts, relaxation techniques, controlled breathing, gradual exposure to feared situations. 5. Student responses will differ.

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Additional activities

6. Student responses will differ. Suggested thinking patterns for each situation could include: Long-haul overseas flight—The plane is sure to crash/Plane crashes are not that common. Waiting in line at a crowded supermarket—I’m going to faint with all these people around/Breathe slowly and stay calm. Preparing for a driving test—I’ll definitely fail or crash the car/I’ve practised hard and know exactly what I need to do.

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7. Student responses will differ. Suggest a plan that includes talking with a professional, regular exercise and sleep, healthy diet, avoiding caffeine, illicit drugs and alcohol, joining a support group. 8. Physical symptoms listed should be marked on the appropriate parts of the body.

Mental health

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Panic disorder A panic attack is an intense feeling of fear and anxiety that can strike suddenly and without warning. It can occur anywhere, at any time. Some people may even experience an attack when they are sleeping. Not everyone who has a panic attack will develop the disorder. Some people may only ever have one attack, but for those who do have the disorder, life can become very difficult. Some people will avoid everyday situations and their lives can be so restricted that they become housebound.

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A panic attack can create intense physical symptoms which feel overwhelming and induce fear. The following physical symptoms may be experienced when someone has a panic attack: • pounding heart and chest pain

• sweating, hot and cold flushes

• trembling, tingling or numbness

• nausea and stomach pain

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• feeling dizzy and light headed

• heat or searing pain throughout the body.

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• shortness of breath

The thoughts and feelings that accompany these physical symptoms include beliefs of losing control, going crazy, having a heart attack and even dying. It is understandable then, that panic attacks can be extremely frightening.

Even once the panic has gone, there is still a fear that it may return at any time. This fear can make it feel impossible to return to the place or situation where the attack happened. Someone who has suffered a panic attack can soon become afraid of even a small amount of anxiety because he/she believes that this will create an extreme feeling of panic.

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Like any anxiety disorder, panic attacks can be successfully treated. It is essential to seek effective treatment early. When panic disorder is left untreated it can really stop a person functioning well in everyday life. A professional therapist can help a person to recognise his/her thinking patterns so that reactions to anxiety can be altered. Behaviour therapies focus on changing negative thoughts and worrying behaviours. Therapy can help with techniques such as relaxation, learning how to control breathing and gradual exposure to feared situations. All of these can help to lessen the frequency of panic attacks

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There are many areas where a person can make simple changes which can reduce the severity of panic attacks. It is important to be involved in regular exercise, get enough sleep and maintain a healthy diet. Talking with trusted friends and supportive family members often helps, and some people find self-help groups work well for them. It is widely recognised that caffeine, alcohol, illicit drugs and even some over-the-counter medications can aggravate anxiety symptoms.

I was in a shopping centre when I felt like I was going to die. I had pains in my chest and I was sweating a lot. I was so dizzy that I had to sit down on the ground. I didn’t know what was going on. After it happened a second time, I mentioned it to my GP. He told me I had experienced a panic attack and we talked about treatment. I was so relieved I wasn’t dying! Matilda

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Mental health

Panic disorder 1. List the reasons why a panic attack can be so frightening. 2. Describe an experience when you felt yourself experiencing symptoms of a panic attack.

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3. Explain how the severity of just one panic attack can develop into panic disorder.

4. Suggest three ways of alleviating the symptoms of a panic attack.

5. List any situations or experiences that you would try to avoid so as not to experience feelings of panic or anxiety.

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6. Suggest a negative and positive thought for each of these situations:

Negative thought

Positive thought

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Panic disorder

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8. On the body outline, write the physical symptoms that can be experienced during a panic attack.

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Mental health

Agoraphobia and specific phobias

Indicators • Shows an understanding of the term agoraphobia. • Recognises the importance of goal setting. • Identifies specific phobias and understands possible effects on everyday life.

Answers

r o e t s Bo r e p ok u S 1. Student responses will differ.

Discussion points

• List phobias that students have experienced. • Discuss examples of places and situations that someone with agoraphobia might fear. • Discuss how a person’s life an be seriously affected by a specific fear like crowded places or using public transport. • Discuss goal setting and how it is important to make each goal small enough to be manageable.

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• Reinforce that agoraphobia is not a fear of open spaces but a fear of specific places and situations.

2. Student responses will differ. Suggested positive statements include: (a) If the power goes off, there are emergency back-ups. (b) The ride is only short so I just need to control my breathing. (c) If I miss my floor for any reason, I can always use the stairs, or just go back up/down. (d) If I don’t think about the small space, I can relax and think about something else. 3. Gradual exposure works by setting goals and breaking them into very small steps. The first step is repeated until a comfort level is achieved and then the next step is dealt with. The process continues until the major goal is achieved successfully.

• Consider specific phobias that are likely to interfere with a person’s everyday life and discuss the consequences if it is left untreated.

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• Outline ways you could help a friend who has agoraphobia or a specific phobia. • Use a diagram to show the cycle of fear that can occur when a person develops a specific phobia.

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• Write a journal entry to describe a real or imagined phobia and how it affected you.

4. Student responses will differ. A suggested plan could include: (a) Look at pictures of dogs in a magazine or on the Internet. (b) Visit a friend’s house where there is a dog that is outside (just looking). (c) Be in the same room with a friend and his/her dog. (d) Go for a walk with a friend who has his/her dog on a lead. (e) Get close enough to pat the dog.

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• Discuss specific phobias that students are aware of.

5. Student responses will differ. Suggested advice would be to encourage they talk with a professional to find ways to overcome their fear, set goals, learn ways to relax and slow breathe.

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6. Student responses will differ. Suggested alternate thinking patterns could include: (a) I’m on a crowded train, what if I can’t reach the doors in time for my stop? I’m on a crowded train, I’ll be sure to stand as close to the door as possible. (b) I’m taking a plane trip, what if I need to go to the bathroom and I can’t get out? I’m taking a plane trip, I’ll ask for an aisle seat. (c) There’s a huge dog, what if it runs over and attacks me? There’s a huge dog, I’ll just cross over to the other side of the street. (d) I need an injection at the doctor’s, what if I cry and get scared? I need an injection at the doctor’s, I’ll be sure to tell him/her I’m a bit anxious. 7. Slow breathing can help people to stay calm and focused and make sure their body doesn’t react badly in a physical way.

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Agoraphobia Agoraphobia is a fear of being in places or situations where it might be difficult or embarrassing to get away, or to find help if it is needed. People with agoraphobia will avoid places for fear of having a panic attack. Some of the places that people with agoraphobia might avoid are crowded areas, public transport, elevators and standing in queues. For a person with agoraphobia, continually avoiding a situation will only increase anxiety and fear of panic. Facing a fear and learning how to control thoughts and feelings are the best ways to overcome this disorder. Because anxiety is unpleasant, and escaping anxiety can bring a huge relief, sufferers may do whatever they can to relieve their immediate symptoms. Even if an errand is important, they may still walk out of a crowded bank, for example. This may work in the short term. In the long term though, more and more time is spent trying to avoid certain situations and fear can consume everyday life.

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Treatment for agoraphobia is aimed at identifying the triggers that influence fearful thoughts in the first place. A trigger may be a memory of a past reaction, or an anticipation of a difficult situation. There is a thought of, ‘Oh no, what if…?’ Learning how to challenge these thoughts and remain calm and relaxed is the first step to breaking the cycle of fear and panic. Gradual exposure to any challenging situation is a major focus of preventing this disorder from overtaking a person’s life. It is important to set a goal and break that down into small steps. If each step is repeated until a comfort level is achieved, then the next step can be dealt with, and so on. For a person who finds using public transport a difficult situation, the goal would be to actually use the service alone. The first step might be to simply walk to the station. The second step might be to travel a short distance with a friend. By building up confidence and challenging negative thoughts, the process can continue until the major goal is achieved successfully.

I’m terrified of being in an elevator. I’m always afraid it will break down and there will be no way out. I hate the thought that I could be stuck in a small space with other people around. I take the stairs whenever I can. Phil

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Specific phobias

A phobia is an intense fear about a thing or situation. A phobia is a problem when it interferes with a person’s life. Some examples of a specific phobia are: dogs, spiders, snakes, heights, deep water, the dark, sight of blood and injections. A person with a phobia of dogs might be perfectly fine when not around them, then become distressed and have a panic attack whenever he/she sees one. The fear of having a panic attack might stop that person from enjoying many different activities.

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Some fears may rarely interfere with a person’s life. For example, a person may have a fear of sharks. If that person lives away from the coast, or doesn’t swim, then the phobia won’t necessarily affect him/her going on with the things he/she wants to. There are different ways to help a person who has developed a specific phobia. To control the anxiety felt, a person needs to learn how to face the fear. This needs to be done gradually, so the anxiety is always manageable. By becoming more familiar with the thing or situation, the fear and anxiety can lessen. Setting goals and working towards them with small steps increases confidence. It is helpful to learn ways to relax and relieve tension, such as slow breathing. It is important to talk with a professional if a phobia develops that is likely to interfere with a person’s regular life. The first plane flight I took was awful. There was so much turbulence that I was sure we would crash. That was ten years ago and I haven’t been on a plane since. I missed out on a holiday with friends because I was so afraid of the plane flight. Mia

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Mental health

Agoraphobia and specific phobias 1. Surveys have shown that the number one fear many people have is public speaking. Make a list of six things, places or experiences that you have a fear of, or anxiety about. Rank them in order. Write three strategies you could consider to ensure your first ranked item did not develop into a phobia.

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Strategies

© R. I . C.Publ i cat i ons 2. A person with agoraphobia might have a fear of using an elevator. Match each of the negative statements •f orr evi ew pur posesonl y• with a positive one. (a) The power will go off and I’ll be stuck.

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(b) There will be too many people and I won’t be able to breathe.

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(d) I’ll feel too claustrophobic and panic. 3. Explain how gradual exposure works as a form of treatment. 24

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Agoraphobia and specific phobias 4. A person has a set goal to overcome a phobia of dogs. Write five steps that could form part of a gradual exposure plan.

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5. What advice would you give to a person who has a phobia of heights?

6. Write the negative ‘What if?’ statement a person might say if he/she had a phobia of each of the following. Match each with an alternate thinking pattern. (a) I’m on a crowded train, what if

I’m on a crowded train, I’ll

(b) I’m taking a plane trip, what if

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I’m taking a plane trip, I’ll

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There’s a huge dog, I’ll

(d) I need an injection at the doctor’s, what if

I need an injection at the doctor’s, I’ll

7. Describe how a slow breathing technique can help someone who is experiencing a phobia. R.I.C. Publications® – www.ricpublications.com.au

Mental health

Social anxiety disorder

Indicators • Understands the difference between shyness and social anxiety disorder. • Identifies situations people with social anxiety disorder can fear. • Recognises symptoms of the disorder and effective treatment approaches.

Discussion points

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• Discuss situations in which students may feel shy or lacking in confidence.

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• Discuss how symptoms of social anxiety disorder can be very physical. • Discuss the importance of realising that symptoms can greatly affect an individual and interfere in everyday life. • Discuss the impact that social anxiety disorder can have on individuals in specific occupations. • Students should recognise that public speaking is often named as the number one fear for most people. Unless such a fear seriously impacts on a person’s everyday life, it is not a sole reason for diagnosing social anxiety disorder.

Answers

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• Students should understand that feeling shy or nervous is a normal reaction to different situations and that social anxiety disorder develops when fears become excessive.

1. Student responses will differ.

2. The disorder may be difficult to recognise early because feeling shy is common and sufferers can find ways to avoid social situations that cause anxiety.

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• Suggest ways you could support a friend who has social anxiety disorder. • The creator of a small home-based company suffers with social anxiety disorder. What issues can you imagine he/she is faced with on a daily basis? How would these issues eventually impact on the success of the business? What suggestions can you offer to assist this person?

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6. Student responses will differ. Situations should be selected from the list outlined on the fact sheet. 7. Student responses will differ. Suggested negative and positive thinking patterns could include: ‘I won’t know what to say if someone talks to me’ — ‘It’s okay just to talk with my friends’ ‘People will be looking at me and I’ll feel embarrassed’ — ‘Everyone will be busy doing their own thing’ ‘I won’t have the right clothes to wear’ — ‘I’ll look just as good as anyone else’ ‘I can’t dance’ — ‘Most people probably think the same way and we’re all there to just have fun’

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• Draw a diagram of a person and label the parts of the body that may be physically affected when someone has social anxiety disorder and is facing a difficult situation.

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Mental health

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Social anxiety disorder Feeling shy is common and, with confidence and maturity, most people learn to deal with it positively. Social phobia is a disorder where people have a fear of situations where they have to interact with others. They are afraid that others will judge and criticise them and they can become extremely anxious and so fearful that they will do anything to avoid a stressful situation. This excessive fear can become so intense that it can greatly affect their ability to work, study and make friends. A person can react emotionally and physically in stressful situations and part of the fear can be that other people are noticing his/her behaviour. Social phobia can be a distressing disorder and sufferers can lead lonely and unhappy lives without treatment.

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Situations that people with social anxiety disorder may fear include: • meeting people

• making speeches or presentations

• going to a party

• speaking on the phone

• writing while being watched

• doing exams

• eating or drinking in public

• making small talk

• talking to someone in authority.

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• being the centre of attention

There may be many of these situations that can make anyone feel uncomfortable or nervous, especially public speaking. Social anxiety disorder is diagnosed when the fear of these situations make it too difficult to lead a productive and stimulating life.

© R. I . C.Publ i cat i ons Symptoms that people with social anxiety disorder may experience include: •f orr evi ew pur posesonl y • • blushing, shaking, trembling • racing heart and fast breathing • sweating • shaky voice and ‘butterflies’

• feeling of wanting to vomit, or rush to the toilet

• dry mouth and throat

• blank mind, confusion, lack of concentration.

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• dizziness

It is not always clear what causes social anxiety disorder. For some people it can be a past stressful, embarrassing or upsetting event and for others it is a more gradual problem that develops slowly. Some people may already have a shy personality and worry about being criticised. Whatever the cause, a pattern is established and reinforced over time. Some people try to cope with their social phobia by keeping away from stressful situations, but this doesn’t help the problem—it only avoids having to deal with it.

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Social anxiety disorder can be successfully treated. A person first has to realise that the problem interferes with his/her life and then seek professional help. Without help, a person with social phobia may develop depression, other phobias, or turn to alcohol and drugs to help him/her cope. Therapy techniques aim to change the belief patterns that other people are watching and judging, and so help a person become more comfortable in social situations. Because social phobia can take many years to develop, it can also be slow, hard work to overcome. The benefits of feeling confident and in control will be worth it though. I would rather do anything than make a presentation in class. As soon as I stand up, my mind goes blank and I start shaking. I always feel physically sick the day before. Jamie

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Mental health

Social anxiety disorder 1. Rate your usual anxiety levels on a scale of 1–10 for the following situations.

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answering questions in class

sitting exams

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going to a party with friends

going somewhere alone

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speaking in public

1 . 2Pu 3b 4l 5a 6i 7 s 8 9 10 © R. I . C i c t on •f orr evi e w pur posesonl y• speaking to someone in authority 1 2 3 4 5 6 7 8 9 10

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dealing with conflict among friends

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making an important telephone call

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introducing yourself to a stranger

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eating in public

2. Suggest reasons why social anxiety disorder may be difficult to recognise early.

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Social anxiety disorder 3. Recount a social situation when you felt anxious, shy, fearful and/or lacking in confidence. List the positive and/or negative outcomes.

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4. Make a list of five social situations when you generally react confidently. •

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5. Describe a situation that you may have tried to avoid in order to keep away from feeling anxious.

6. Imagine a person in the following professions has social anxiety disorder. Isolate one situation that he/she might find difficult to deal with. Teacher Doctor

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Company president

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Accountant Politician

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7. Imagine someone has social anxiety disorder but is hoping to attend an end of year school function. Write four negative thoughts that person may have. Suggest a positive alternative for each. • • • • R.I.C. Publications® – www.ricpublications.com.au

Mental health

Obsessive-compulsive disorder

Indicators • Understands that obsessive-compulsive disorder involves obsessions and compulsions that interfere in a person’s everyday life. • Appreciates that although sufferers are aware their actions are illogical, they are unable to control them.

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• Recognises that professional treatment is available.

Discussion points

• Discuss and define the terms obsessions, compulsions, repetitive, ritualistic. • Explain that interacting issues can lead to someone developing obsessivecompulsive disorder and that there may not be one single cause. • Use examples to show how a stressful life event (e.g. violent break-in) can make a person vulnerable to developing obsessive-compulsive disorder. • Reinforce the suggestion that sufferers of obsessive-compulsive disorder usually require professional treatment.

2. The illness can be exhausting to live with because the obsessions are distressing and always present and the compulsions can take up so much time because they become increasingly repetitive.

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1. Student responses will differ.

• Discuss the difference between ‘safe’ repetitive behaviours such as washing hands after the toilet, and ritualistic behaviours that can indicate obsessivecompulsive disorder.

3. The cycle continues to repeat because no matter what the person does, the distressing thoughts always remain, no matter how often rituals are performed.

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• Research the availability of services in your community that support people with obsessive-compulsive disorder. • Use the Internet to compile a list of movies and books that highlight people experiencing obsessive-compulsive disorder.

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• From the information provided, use bullet points to highlight the facts about obsessive-compulsive disorder.

4. Student responses will differ. Suggested compulsions include: (a) washing hands, surfaces, clothes (b) checking doors and windows are locked, rechecking alarms (c) checking appliances are turned off (d) calling help lines, making appointments, only eating certain foods, staying away from others

5. Gradual exposure aims to teach someone how to confront and deal with anxious thoughts by planning activities that don’t incorporate the damaging rituals.

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6. Support groups can help someone feel accepted and understood, share information, problems and successes and make new friends. 7. Students responses will differ. Stressful life events can include situations where a person was burgled or assaulted at home or in a public place, faced an illness or had a difficult medical experience, was involved in a fire or serious accident. Personality traits can include shyness, anxious, fearful, lacking in confidence, isolated, sensitive, emotional, easily upset.

Mental health

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Obsessive-compulsive disorder Obsessive-compulsive disorder is when a person has unwanted and disturbing thoughts, called obsessions, that continually recur. To try to prevent these obsessions from coming true, a person will feel a compulsion to do something that might overcome his/her fear. An example of an obsession might be a fear that touching something might contaminate or make the person ill. The compulsion then would be to wash, as a way to calm anxiety. People with obsessive-compulsive disorder are often aware that their actions are excessive or even irrational, but they are unable to control their obsessions or resist their compulsions.

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Some common obsessions include fear of harm to self or others, fear of germs and dirt, irrational fears of everyday objects and situations, and concerns with illness, religion or symmetry. Common compulsions of repeating routine activities and actions can include washing, cleaning, counting, checking and touching. Doubting oneself can cause constant worry that appliances aren’t switched off and so a fire might start, or doors and windows aren’t locked so a burglar might enter. Such obsessions and compulsions can be distressing and exhausting, taking up so much time that they interfere with a person’s daily life. The causes of obsessive-compulsive disorder are not fully understood and it is likely that there are interacting issues that contribute to the disorder. Research indicates there may be chemical, structural or functional brain abnormalities, genetics and hereditary factors, hormonal imbalances, stressful life events and personality traits that may all play a part in a person developing this disorder.

For people who have obsessive-compulsive disorder, it is rare that they will get better without any treatment. Trying to use repetitive behaviours to ease anxiety can completely take over a person’s life and then cause even more anxiety. Eventually it becomes obvious that no matter what the ritual, or how often it is performed, the bad thoughts will always remain, and the cycle continues to repeat. When obsessions and compulsions become in-built, it is difficult for thought and behaviour patterns to change without some kind of specialised intervention.

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A trained professional can help a person with obsessive-compulsive disorder to manage the obsessions and compulsions and try to eliminate the symptoms. Behaviour therapy involves a gradual exposure to the thoughts that make a person anxious. He/She can learn how to confront and deal with these thoughts without resorting to repetitive compulsions. With carefully planned activities, a person can eventually come to realise and believe that he/she really will be okay without performing the accustomed rituals.

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Medications can be helpful but do not always make the symptoms go away. Some people can benefit by joining groups that provide an environment where support is given and received.

I couldn’t fall asleep at night unless I’d checked that every door and window was locked. Things got so bad that I had to get up a second, then third time, just to make sure that I’d checked everything properly the first time! I was exhausted every single day—from lack of sleep and the constant worry! Cassie

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Mental health

Obsessive-compulsive disorder 1. Make a list of some of your behaviours that are habitual.

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Which one of your daily habits would you feel uneasy about omitting from your routine? Why?

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3. Explain how the cycle for obsessive-compulsive disorder can continue to repeat.

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4. Write one compulsion that someone with the following obsession might experience: (a) fear of germs (b) worry that a burglar may enter

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Obsessive-compulsive disorder (c) fear of a fire burning the house down (d) worry about falling ill

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5. Describe how the ‘gradual exposure’ therapy approach can help someone who has obsessive-compulsive disorder.

6. List the benefits you might expect someone with obsessive-compulsive disorder to receive from a support group.

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7. Identify stressful life events and personality traits that could contribute to a person developing symptoms of obsessive-compulsive disorder.

Stressful life events

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Personality traits

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Mental health

Post-traumatic stress disorder

Indicators • Understands that post-traumatic stress disorder is the result of a significant traumatic event. • Recognises that symptoms of post-traumatic stress disorder are categorised in three interacting groups.

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• Identifies associated issues linked to post-traumatic stress disorder.

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Discussion points

• Discuss events that may be a trigger for post-traumatic stress disorder.

• Explain that symptoms of the disorder are characterised by three groups that are all interacting. • Explain how other health issues can be related to this disorder and how people can try to ‘self-medicate’. • Discuss why professional therapy is an important part of treatment.

Answers

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• Allow opportunity for students to relate personal experiences of a traumatic event.

1. Suggested words could include: shocked, traumatised, anxious, nervous, fearful, afraid, withdrawn, lonely, grieving, guilty, angry, detached, isolated, jumpy, on edge, irritable, tired, exhausted, numb, vulnerable, depressed.

• Use bullet points to highlight the facts about post-traumatic stress disorder. • Explain how a support group might help someone who is suffering from symptoms of post-traumatic stress disorder.

• Use the Internet to research how children can be affected by war in their country.

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• Use the Internet to research the reason why Vietnam Veterans are one group who are strongly linked to post-traumatic stress disorder.

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2. Benefits of therapy include a greater understanding of personal reactions and feelings, reduced anxiety, changed thought patterns, and a gradual exposure to the details of the trauma so the impact lessens.

3. Some might turn to alcohol and/or drugs as a desperate measure to help them forget the trauma or feel numb to the pain they feel. They may not know an alternative way of coping. They may use alcohol or drugs to help them sleep, especially if they experience nightmares. They may be trying to avoid reality or ‘take the edge off’. Alternative strategies include professional therapy, medication, support groups, exercise, social activities.

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Additional activities

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4. Student responses will differ. Suggest teacher discusses an article as an example, using the headings given.

Mental health

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Post-traumatic stress disorder Post-traumatic stress disorder affects some people who have experienced or witnessed a major trauma and who continue to feel fear and anxiety long after the trauma is over. Everyone will experience some degree of stress after a traumatic event and it is common for these feelings to vary in intensity over time. For people who suffer from post-traumatic stress disorder, the symptoms are severe and can last for many years. In some cases, symptoms may not appear for months or even years after the event. The traumas people may experience include major accidents, sexual assault, domestic violence, child abuse, war, torture, fire, or any other situation that threatens life.

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The symptoms of post-traumatic stress disorder are usually characterised by three interacting groups:

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• Intrusive These are the distressing and recurring memories, images, nightmares and flashbacks of the event that can intrude into the life of an individual. These intrusions can happen suddenly and can force a person to live through the trauma over and over again. Intense emotions such as grief, anger, fear and guilt will often be experienced. • Avoidant This involves avoiding triggers such as places, people, thoughts, conversations, things and events that may invoke a memory of the traumatic event. People with post-traumatic stress disorder can feel a detachment from others, have difficulty expressing emotions and generally withdraw from those they are closest to.

• Arousal This is the feeling of increased vulnerability and sensitivity to further trauma. People with post-traumatic stress disorder can feel ‘jumpy’ and ‘on edge’, anxious and affected by anything that takes them by surprise. They may have difficulty concentrating, feel irritable and angry, and suffer from sleep problems.

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Post-traumatic stress disorder can often be associated with other problems such as alcohol and drug dependency, depression, panic attacks and other mental illnesses. It is essential that a person who suffers from this disorder seeks professional treatment before the symptoms become overwhelming. With effective therapy, post-traumatic stress disorder can be treated and a person can learn to face his/her fears and gain relief from his/her trauma.

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Therapy includes understanding personal reactions and feelings, reducing anxiety, changing thought patterns and gradual exposure to the details surrounding the original trauma. It is important to find a professional who is caring and easy to talk to. Prescription medication can be helpful in relieving severe symptoms, though without professional therapy, may not be effective enough to allow a person to resume a satisfying and functioning life.

My friend was seriously injured in a car accident. He had flashbacks and nightmares all the time. He was too afraid to travel in a car again. He eventually recovered from his physical injuries but he is still seeing a psychiatrist regularly. Thomas

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Mental health

Post-traumatic stress disorder 1. Make a list of words to describe how a person might feel after experiencing a traumatic event.

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2. List the benefits of therapy in helping to treat-post traumatic stress disorder.

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3. Explain why someone might turn to alcohol or other drugs after experiencing a traumatic event.

Suggest alternative coping strategies.

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4. Find a newspaper/magazine/Internet article that reports a traumatic event.

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Describe the event

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o c . che e r o Possible avoidant symptoms t r s super Possible intrusive symptoms

Possible arousal symptoms

Recovery advice

Mental health

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Anxiety disorders – review For each message posted, identify the anxiety disorder that may be affecting the sender.

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Click on the MEMBER to reply to a message

From:

Post a new message

Posted: Sun 24 08 08

2:12PM

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I’ve been to two interviews for a part-time job but they were both disasters. I’d start shaking and sweating and when I tried to speak my voice was shaky. I couldn’t concentrate on the questions I was asked—it was like my mind was blank. All I wanted to do was throw up.

From:

Posted: Sun 24 08 08

2:09PM

About a month after the accident I started having nightmares when I tried to sleep and flashbacks during the day. I can’t stand being around anyone. I’m usually irritated easily. I’m always on edge and any loud noise scares me badly.

From:

2:02PM

Seems like I spend every minute worrying about something. I always feel anxious and nervous and I hardly sleep from all the worrying I do.

From:

Posted: Sun 24 08 08

1:53PM

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I really felt like I was having a heart attack. The pain in my chest was awful and my heart was pounding so loudly. I was scared I was going to die.

Posted: Sun 24 08 08

1:44PM

I won’t go near the water anymore and I don’t even own bathers. I know how to swim. I just can’t forget how I felt when I was caught in a rip. The water was so deep. I’m never going through that again so I’ve just stopped doing things I used to.

From:

o c . che e r o t r s super Posted: Sun 24 08 08

1:39PM

I was seriously ill when I was younger and now I’m afraid to get sick at all. I worry about germs and dirt so I am cleaning all the time. I have a strict order of doing things so I can be sure everything is spotless. Not much else gets done because I run out of time.

From:

Posted: Sun 24 08 08

1:31PM

I can’t be around crowds of people anymore. I used to get such a panicked feeling and it was so bad I would end up shaking and desperate to get away. I just avoid places where there are too many people, which means I don’t go out that much.

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Mental health

Depression

Indicators • Understand that depression is a medical condition that can be successfully treated. • Appreciates that depression can affect anyone. • Shows awareness of the impact depression can have on individuals, families, friends and the community.

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Discussion points

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• Read and discuss Cassie’s story. (pages 49–55)

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• It is important for students to understand the difference between normal feelings of sadness and depression as an illness. Depression is diagnosed when symptoms affect how a person functions in everyday life. • There are different causes of depression and people are affected in different ways. • Highlight symptoms of depression and reinforce how severe these symptoms can become.

• Explain that depression can be successfully treated and there are a number of treatment options available. • Reinforce the value of the family GP as the first point of contact. • Explain how different groups in society are affected by depression.

• Complete a weekly chart to gauge regular habits. (page 48)

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• Write contact details for your family GP.

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• List the services in your community that can help someone who is experiencing depression. • Create a poster that highlights one fact or myth about depression. • Plan an effective campaign to increase the awareness of depression in your community.

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• Research a relaxation technique and provide a guide showing general information, community resources, benefits and costs.

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• Consider a creative activity that you may be interested in pursuing. Write a report detailing your interest, materials required, classes and resources, costs and benefits. Set personal goals to engage in success. • Design a survey to discover how young people are affected by depression.

• People with depression often withdraw from friends and activities they once enjoyed. Design a weekly plan of activities that a person who is being treated for depression might engage in. • Research information to compile a report that discusses the impact of depression on society.

• There are many well-known people who suffer from depression and have spoken about their illness. Research one individual and compile a report that illustrates the impact of depression on his/her life. • The World Health Organisation has predicted that depression will become the second biggest health issue in the Western world. Discuss. • Undertake research on the Internet to report on a website dedicated to young people and depression. • Design an activity (with a partner, in small groups) that students could initiate with a local aged persons care facility. A class letter can be written to make an offer to visit the facility. Students can follow up with personal letters or cards.

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Depression in different groups, Answers r o e t s Bo r e p ok u S

Depression—causes and symptoms, Answers

1. Student responses will differ. Suggest asking for a response before discussion.

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3.–5. Student responses will differ.

6. Student responses will differ. Examples of triggers may include fights with friends, family conflict, exams, homework, relationship issues, loneliness, boredom, health issues, worry, finances, alcohol/drug use.

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2. Feeling sad is a normal feeling that has a trigger and passes after a relatively short time. A diagnosis of depression occurs when there is a persistent low mood with negative thoughts and an inability to find pleasure in everyday activities. A diagnosis is made when these symptoms significantly affect how a person functions in his/her regular life.

1. Risk factors for women include expectations of excelling in all areas of life, pressures to stay slim, fit and youthful, lack of personal time, trauma of assault or violence, hormonal changes. Risk factors for men include refusal to seek help, refusal to talk about problems, being a workaholic, using drugs and alcohol, engaging in risk-taking behaviours, being angry and aggressive. Risk factors for young people include females with a history of family depression, high/overachievers, poor body image, low self-esteem, victims of abuse, anxiety sufferers and those who rely on alcohol, drugs, impulsive/reckless behaviours. Risk factors for older people include retirement, retrenchment, death of a partner, physical illness, family problems, isolation and complications from any untreated illness.

2. Student responses will differ.

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3. Student responses will differ. Suggested positive statements include: (a) It’s okay to fail and I just need to remember all the things I am successful at. (b) My life might seem difficult today but things can change so I just need to be patient. (c) Everyone makes mistakes and I’m probably being too hard on myself. (d) Nobody is perfect and being beautiful/handsome doesn’t necessarily make someone happy. (e) I’ll try hard to find just one thing I’d like to do today and have a go.

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3. Women are more likely to seek help because they are more able to recognise there may be a problem and find it easier to talk to someone about it. Untreated depression in women can have serious consequences on those around them, especially children, and this might help them to seek treatment.

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1. Student responses will differ. See fact sheet for suggested positive choices.

4. The suicide rate for males is higher because men can move from dangerous thoughts to action much quicker than women. They are often more impulsive and choose more violent methods.

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5. It can be difficult to recognise symptoms in young people because they are already going through major physical and emotional changes and many of these changes can involve symptoms of depression. 6. Student responses will differ.

4. Student responses will differ. Suggestions could include: listen, try to be understanding, suggest seeking help from a professional. 5. A GP can help with education about the illness, suggesting lifestyle changes, developing problem-solving skills, counselling, behaviour therapies, medication, referral to a specialist, hospital admission. 6. Student responses will differ.

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Mental health

Depression – causes and symptoms Depression is a medical condition. It is much more than the normal feelings of sadness that everyone experiences. Depression causes a persistent low mood, negative thoughts and an inability to find pleasure in different activities. A diagnosis is made when the symptoms of depression significantly affect how a person functions in his/her regular life. Depression is a common illness and once diagnosed, usually responds well to treatment.

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I feel like there’s a black cloud suffocating me and draining all my energy. Lucy

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People are affected by depression in different ways and there is often more than one specific reason why someone might experience the illness. Some possible causes of depression include: • A reaction to a difficult and stressful life event Family breakdown, family conflict, child abuse, death of a family member or friend, ongoing bullying and harassment, relationship break up, work or school pressures, birth of a child, loss of employment and sexual assault. • A chemical imbalance in the brain Neurotransmitters are chemicals in the brain that help to regulate a person’s mood. A person suffering with depression may not produce the right amount of these chemicals. This imbalance may be inherited.

© R. I . C.Publ i cat i ons •f orr evi ew pur posesonl y• There are a variety of symptoms that someone suffering depression might experience. Individuals are affected in varying • A part of another illness People who have bipolar disorder experience extreme moods that are very low (depression) and very high (mania). Depression can also be a part of post-traumatic stress disorder, schizophrenia and anxiety disorders.

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degrees, from mild to severe. Not everyone diagnosed with depression will experience all symptoms. In extreme cases, depression can be associated with symptoms of hallucinations and delusions (psychosis).

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Symptoms of depression include: • feeling miserable and sad

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• crying for no apparent reason

• not sleeping or sleeping too much

• withdrawing from people and activities

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• lacking interest and motivation

• difficulty concentrating and making decisions

• feeling fatigued, with a loss of energy

• feeling worthless, helpless, hopeless, unloved, guilty

• feeling restless, agitated, irritated, frustrated

• changing weight and eating habits

• excessively worrying

• slow movement and speech

• feeling suicidal.

Symptoms of depression can seriously affect a person’s physical health. Untreated depression can alter hormone levels, immune responses, adrenaline production and affect the digestive system. Decreased physical activity and an increase in drug, alcohol and cigarette use also contribute to poor physical health. Every small thing feels like a major drama. I’m exhausted just from taking a shower. Kyle

Mental health

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Treatment of depression Depression is an illness that can be effectively treated. Most people will recover completely and go on to lead happy, productive lives. Because the success rate is so high, it is important to recognise symptoms of depression and then seek out professional treatment as soon as possible. Getting help for depression is not a sign of weakness. Treatment can reduce the risk of depressive episodes recurring throughout a person’s life.

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The first step in treating depression is to find someone to talk to. Trusting a family member or close friend to listen can help sort out confused thoughts and make it easier to decide about seeking professional help. Some people find they are too embarrassed to talk about their feelings and worry what others will think of them. It’s extremely important not to let fear get in the way, especially if symptoms include thoughts about suicide and self-harm.

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Making an appointment to see a family doctor (GP) will provide the best opportunity for effective treatment. A GP can treat most cases of depression and, when necessary, provide referrals to more specialist services. GPs are trained to recognise signs of depression and they understand how difficult it can be for some people to ask for help. When making an appointment, it is a good idea to ask for a little longer than usual, so there is enough time for the GP to make a full assessment of the situation. Complete honesty is vital, so it’s helpful to remember that talking to any medical professional is confidential. Try to make a list of any symptoms, thoughts and feelings that are worrying and think about family, school, work and social situations that are difficult to handle. Be up front about any drug or alcohol use. Depending on the outcome of an assessment, a GP can recommend different solutions. Education about depression, lifestyle changes and problem-solving skills are the most important areas to explore first. Medication is rarely the first option for adolescent patients and those suffering mild to moderate depression. Counselling and behaviour therapies are proven methods in treating depression. More serious types of depression often do require antidepressant medication. Treatment is very individual, so what works for one person, may not work for another.

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When depression is severe, an admission to a hospital or clinic can be very helpful. Suicidal feelings are a very serious symptom of depression and some people require extra help to deal with those thoughts. A hospital is a safe place to receive treatment and support and most people require only a short stay.

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For any treatment to prove successful, a person needs to be committed to working hard to deal with the illness. There are positive choices to be made that will increase the likelihood of managing symptoms effectively. These include:

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• developing a trusting and honest relationship with the treating health professional

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• continuing with treatment for as long as necessary

• learning how to turn negative thoughts into positive thoughts • planning a healthy diet • exercising regularly

• maintaining healthy friendships • setting achievable goals

I started walking every morning, no matter what the weather. It was the best thing I ever did. I felt more peaceful and more able to cope with the day ahead. Sam

• learning different relaxation techniques • learning how to manage stress and anger • engaging in creative activities • writing in a journal • completing a mood chart to monitor daily feelings • identifying triggers that can contribute to depression • avoiding alcohol and illicit drugs. R.I.C. Publications® – www.ricpublications.com.au

Mental health

Women and depression Women are twice as likely to be affected by depression as men. This may be because they are more likely to seek treatment. Women who are vulnerable to developing depression will usually experience the first symptoms during their reproductive years. There are different factors to explain why women are more at risk of suffering depression. • Expectations Many women feel they should excel in all areas of their life. The expectations of finding a balance with a successful career, raising children, caring for family, maintaining a relationship with a partner and living healthily, can be very demanding.

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• Pressure Many women feel a pressure to stay slim, fit and youthful, which can lead to issues regarding body image, selfesteem and obsessions. Caring for children, family and friends can decrease the amount of time and energy a woman might reserve for her own wellbeing. • Trauma Women who have experienced childhood sexual abuse, adult sexual assault or domestic violence have higher rates of depression.

• Biological A woman’s hormones can contribute to depression developing in someone who is already at risk. Hormonal changes are associated with menstruation, pregnancy, childbirth and menopause.

Postnatal depression is a serious illness that requires medical assessment and treatment. It usually appears in the first month after a women has given birth. Symptoms include anxiety, irritability, uncontrollable crying, conflict with family, social withdrawal, fear of harming the baby, obsessional behaviours and an increased physical presence of headaches, chest pain and numbness. Postnatal depression can be successfully treated.

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Men and depression

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The impact of depression on a woman’s life is significant and can have serious consequences on those who are close to her. Depression can lead women to withdraw from family and close relationships and feel much less able to respond to those around them. When this includes partners, children, friends and work colleagues, the effect of untreated depression can be damaging. Women who don’t seek help may try to relieve their symptoms by using alcohol, illicit drugs, painkillers and sleeping tablets. This kind of behaviour only makes the illness worse and often leads to further problems.

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Although research shows that men are less at risk than women of developing depression, the consequences of an untreated illness can be disastrous. Men who have depression are four times more likely to commit suicide than women. They are less likely to seek help, instead choosing to try to manage their own symptoms. This can include becoming a workaholic, using illicit drugs, drinking alcohol and engaging in risk-taking behaviours. Men can be more reluctant to talk about their feelings and what might be bothering them. They may see it as a sign of weakness to feel vulnerable. Men often express their feelings in different ways from women, so while a woman may be more teary and sad, a man may be angry and aggressive when depressed. In Australia, the annual suicide rate is mostly male and half of those are men aged between 25 and 44. These statistics suggest that men are more likely to move from dangerous thoughts to action quicker than women. Men often choose more violent methods than women. When the symptoms of depression are ignored and left untreated, the illness can have a severe impact on the individual and those around him. When men are unable to recognise and deal with their own symptoms, it is important for those around them to be aware of any behavioural changes. Reducing the stigma of mental illness in our society can help men to understand that depression is an illness, rather than a weakness. 42

Mental health

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Young people and depression Recognising symptoms of depression in young people can be challenging because there are so many different changes already happening. Adolescents are affected by hormonal changes and can be moody, withdrawn and show many other symptoms associated with a depressive illness. It is important then, that persistent symptoms are recognised and treated appropriately. Research shows that untreated depression in adolescence can lead to major issues in adulthood. Problems can develop when relationships with peers and significant others worsen, academic/work performance is damaged and the risk of suicide rises.

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Young people who are most at risk of developing depression include:

• females with a family history of depression, especially those whose mothers were diagnosed with depression • those with a distorted or unrealistic body image • those with a damaged self-esteem • those who have suffered sexual abuse and/or neglect • those who suffer from anxiety • those who rely on alcohol, illicit drugs, impulsive and/or reckless behaviours.

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• high/overachievers

Adolescents face many challenges to conform and adapt to peer pressure and family requirements. When a young person shows significant symptoms that may indicate a depressive illness, it is important that professional help is sought and treatment is started as soon as possible. With growing brains, medication is generally not the first line of treatment for depression in adolescents. Much more focus can be put on management and coping skills. Treatment programs can include:

• learning how to set goals and achieve those goals successfully

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• exploring new ways to relax and manage stress • recognising factors that trigger anxiety and feelings of depression

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• creating a more positive self-image and increasing self-esteem

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• finding different ways of solving problems

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Depression in the senior years can be a serious problem. Symptoms can remain unnoticed and may even be dismissed as ‘just getting older’. There are many reasons why older people might develop depression. These include: • retirement or retrenchment from the work force—this can bring about a change in finances, routine, leisure time and a sense of identity • death of a partner or close friend • physical illness—this can contribute to more hospital stays and/or surgery, increase the number of medications used and affect mobility and regular exercise • family problems • social isolation • complications from years of untreated depression or other illness. R.I.C. Publications® – www.ricpublications.com.au

Mental health

Depression – causes and symptoms 1. List three people you would trust to approach if you felt you were experiencing any symptoms of depression. 2. Explain the difference between feeling sad and having a diagnosis of depression.

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3. Write a symptom of depression you have experienced and describe the situation that contributed to it.

4. The last time I felt depressed was

I reacted by

My depressed mood improved when

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5. Use the following categories to identify things that can make you feel depressed.

My friends

My community

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My family

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6. Identify personal triggers that can affect your life in a negative way. 44

Mental health

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Treatment of depression 1. Record the positive ways you cope with depressive feelings. 2. Describe how a friend or family member has helped you deal with feelings of depression or sadness.

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3. When someone suffers from depression, he/she often has very negative thoughts that are difficult to turn around. Write a positive statement for each of these negative thoughts. (a) I’m a failure at everything.

(b) My life is hopeless.

(e) There’s no reason to get out of bed in the morning.

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4. Outline ways you could help a friend who is experiencing symptoms of depression.

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5. Explain how a GP can help in the treatment of depression.

6. Check the things that you do to make yourself less vulnerable to depression.

Set achievable goals

Engage in creative activities

Use different relaxation techniques

Write a journal

Know how to turn negative thoughts into positive thoughts Eat a healthy diet

Exercise regularly

Know how to manage stress

Know the triggers that can make me depressed

Maintain healthy friendships

Know how to manage anger

Avoid alcohol and illicit drugs

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Mental health

Depression in different groups 1. Outline the risk factors for developing depression in each of the four groups.

Women

Men

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Young people

2. What group do you consider most at risk of developing symptoms of depression? Give reasons for your answer.

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4. Suggest reasons why the suicide rate for males is much higher than for females.

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5. Give reasons to explain why it can be difficult to recognise symptoms of depression in young people. 6. Check any of the following areas you could improve to help you stay depression-free.

Learn how to set goals

Manage stress better

Find different ways to solve problems

Work on a better self-image

Increase my self-esteem

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Manage personal relationships better

Deal with anxiety issues R.I.C. Publications® – www.ricpublications.com.au

Weekly journal Monday

Wednesday

Thursday

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Tuesday

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Sunday

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Notes

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Sleep

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Date

Weekly chart

Meals

Mood

Anxiety

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Energy

Activities

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Cassie’s story Some weeks I have felt so low that I’ve thought about suicide. I’m not sure which scares me the most—the feelings or the thought of suicide. These feelings aren’t like the ones I had when I was younger. You know, when you’re just fed up, feeling like crap and just can’t be bothered much. I had plenty of those days at primary school but they wouldn’t usually last too long. Something would come along to cheer me up and I’d get over feeling down easy enough. The other thing about those times was there was usually a reason why I felt sad or down. Once I’d figured out what it was, it was much easier to do something to change the way I was feeling.

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You always hear talk of how teenagers are supposed to be moody. Hormones and all the changes and pressures. Whatever. My friends and I have talked about that and we recognise the things that set us off. The guys and girls in our group mostly feel the same way. I think the only difference is girls might have a few more hormonal issues every month. I know I do! So, apart from that issue, if I made a list of things that contributed to moody behaviour it would definitely include some or all of the following: First for me would be school, the subjects I need to choose and what job I want to pursue when I’m done. Then there’s parents, my older brother and younger sisters, sport, money, friends, fashion and a part-time job I want. I can’t forget boyfriends, how I look and everything about sex and drugs either! I guess that, depending on your own circumstances, there are probably a lot more you can add yourself. Maybe religion or major problems at home. I know that most of the things I’ve listed have at one time or another driven me crazy and made me so depressed and moody I wanted to totally lose it. Like I said before though, you try and figure it out, talk to friends or family and, hopefully, life sorts itself out.

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My real problems started around 15. The sad days and the moody days were replaced by longer and longer periods of feeling totally depressed. Some days I could hardly drag myself out of bed I felt so lethargic. It didn’t matter whether it was a school day or the weekend. It made no difference if an exam was scheduled or if I had something really fun planned with my friends. Actually, when I felt like this, nothing much was fun anyway. I just couldn’t find the energy to even get excited about the things I loved doing. I would find myself not answering my mobile or returning messages. It was too hard to even send a text and I just didn’t want the hassle of telling my friends I wasn’t going out with them. Even making the decision to say no was difficult. I often just felt like crying for no reason and I didn’t want to be around other people, bawling like a baby.

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After spending a couple of weeks feeling so low, I thought it must be the pressures of school and I decided to set up a better schedule to help me get more homework done. Throughout school, I’ve always worked hard and received high marks. To be honest, I’ve always been at the top of my class but it’s nothing I’ve raved on about. I am a perfectionist in everything I do and I guess that shows in the results I get. The longer I stayed in this mood though, the harder everything at school became. I couldn’t concentrate on what we were doing. I’d listen to all the instructions, follow what was being said and then when I had to put something into practice, I felt like crying. I had no clue what I was doing. I’d reread pages of text to try and refresh my memory. I couldn’t seem to grasp anything we were doing, no matter what the subject. Even at sport, I would find myself making a wrong pass, dropping the ball or practically falling over my own feet. I’d start to panic, R.I.C. Publications® – www.ricpublications.com.au

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worry that I wasn’t as good as I thought I was and that maybe I’d fail. I was getting stressed, tired and run down. I couldn’t sleep, hardly bothered eating and I had constant headaches.

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One Sunday afternoon when I’d declined another social event with my best friend, Mum came in to ‘have a chat’. I was still in PJs, my hair was a mess and she knew I had been crying. Unlike one of my friends who has a hard time at home, my Mum is usually pretty cool and we can talk about a lot of things. When she sat down on my bed and gave me a hug, I really lost it. Cried and cried for what seemed like an hour. I told her that for at least a month I had felt so unhappy and miserable and I couldn’t shake it. That I was feeling empty inside and not interested in anything at all. I felt like a failure at school, a bitch to my friends and a horrible person to be around. I complained about all the physical things that were bothering me as well and then the big bombshell that really scared us both. Through my tears, I told her how I felt life wasn’t worth living some days and I’d thought about suicide. Poor Mum, I felt really bad for her. She’s such a positive person and it must have really upset her to hear such negative, horrible words coming from her daughter. We sat together for ages and kept talking until I had calmed enough to go and have a shower. For a few hours that afternoon, I felt like a weight had been lifted from my shoulders. Just to actually say how I was feeling out loud, to someone I trusted, was a relief. It didn’t stop the tears though, or the hopeless feelings I couldn’t let go of. By the end of the day, I began to feel a little guilty about my outburst and then so overwhelmed by everything. After trying to watch a movie I couldn’t concentrate on, I went back to my room and curled up under the covers. The thought of one more night with no sleep and then school and friends the following day, had me miserable again.

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For the first time since I can remember, I skipped school that next day and Mum took me to see our regular doctor. I’d only ever missed school when I was sick and I worried all morning about what more I’d have to catch up on. My hands were actually trembling, sitting in that waiting room and I was feeling panicked. I went outside and sat on a step, just trying to breathe calmly, think about nothing. It was ridiculous and I felt like an idiot. I was sure nothing was really wrong but somehow I felt like my life had been lost. I’m not certain that makes much sense but it was a feeling of being a stranger in my own body.

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Even though everyone in our family had been seeing Dr Taylor for years, I was nervous. Luckily, Mum started in first and then talked to him about some of the things I had already told her. He did all the usual check-ups—took my blood pressure and temperature, then weighed me. I’d definitely lost some weight but everything else was normal. The next thing I knew I was crying again, right there in his office. I was so embarrassed but I couldn’t seem to stop. All I remember saying was that this was happening all the time and I had no reason to feel so miserable. He’s a kindly, older guy who has a nice gentle voice and he was very patient as he waited for me to answer some of his questions. All I kept thinking was, I need to get out of here before I make a bigger fool of myself. I snapped back to reality when Dr Taylor held a brochure out and said, ‘Cassie, I’m fairly certain you are showing symptoms of depression’. He asked me to read the information and do some research on the Internet. That was fine with me but when he said he would like to make an appointment for me to talk with 50

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a psychiatrist, I was sure I would throw up. It’s one thing to feel a bit sad and miserable but to go and see a shrink! No way was I up for that. I was obviously just worrying too much about things and I decided then and there that I would just snap out of it as soon as we got home. Ring my friend Miranda and organise to go out somewhere. I left Mum to say all the right things; I just wanted out of there. The drive home was almost silent. I’d lost interest in talking about the whole thing.

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I spent the next week keeping myself so busy that I rarely had a clear moment to think about anything. I refused to talk with Mum about anything Dr Taylor had said. I put the brochure away, concentrated on my homework and my friends. There were plenty of times when I felt the tears, the frustration and all the negative thoughts I’d been having, right at the surface but I pushed them away every time. I told Miranda one afternoon what the doctor had said and tried to brush it off. I was so surprised when she gave me a hug and said that her aunt had been diagnosed with depression. Then she said how happy she was that I was getting some help. I couldn’t believe what I was hearing. Miranda was a lifesaver to me that day. When I told her I hadn’t really taken it seriously, she hugged me harder and we sat in the park, talking for ages. It was a conversation that really turned my life around and another reason why Miranda and I will always remain the closest of friends. I’m not saying she saved my life that day, but it may have come to that if I had continued to ignore what was happening to me. Miranda and her aunt had always been close and she was also someone I loved visiting. She had her first baby at 26 and even though she was so excited, she became very sad for quite a while after. Everyone thought it was the usual stress of having a new-born, especially not having any sleep. It was actually post-natal depression and Miranda’s aunt felt like she was really losing it. Her husband took her to a doctor who diagnosed her and she began treatment straight away. Miranda seemed to know everything about it, which didn’t surprise me because of the great relationship they have. It did explain a lot of things and why I didn’t get to see her aunt or the baby for ages. Still, as I said to Miranda, I’ve hardly had a baby! She looked at me like a teacher who looks at a naughty child and firmly told me that there were different types of depression.

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The extreme homework schedule I had set for myself was put aside that evening as I spent hours reading everything I could on the Internet. I went to all the Australian sites first, like Beyondblue and Sane. The more I read, the more of those little quick quizzes I did, the more I started to believe in what Dr Taylor had said. I printed out a lot of information and lay on my bed reading everything. This time, my tears seemed real because I was a little bit relieved and then a lot scared. It’s hard to understand that something is a real illness when you can’t actually see it. Deep down though, I knew I had some reason for feeling so miserable and whatever I was doing to snap out of it hadn’t worked so far. I don’t think I’ve seen my Mum look so relieved when I asked her to find the number of that psychiatrist that Dr Taylor had recommended. She almost fell over herself to get to the phone and within minutes I had an appointment for the following week.

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During that week, I stuck close to Miranda. She was the only one I could talk to and I was terrified that word would get out at school that I was going to see a shrink. The last thing I needed was for anyone to think I was psycho. I was already having a hard enough time convincing myself that I wasn’t crazy. One afternoon, R.I.C. Publications® – www.ricpublications.com.au

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Miranda and I went to visit her aunt. It was great being able to talk with her a little but I still couldn’t help feeling that Miranda’s aunt probably had a real reason to be unwell, and that I didn’t. She told me about the psychiatrist she sees and how she takes medication each day, just to keep her from feeling too low. She’s confident that she will be able to reduce the medication over time and even do without it when she feels ready. I really started to get nervous and afraid again and worried about having to take drugs myself. Miranda’s aunt said one thing to me that stuck in my mind. She said, ‘Cassie, if a doctor diagnosed you with diabetes, do you think you would take the insulin every day?’ ‘Of course’, I replied. ‘Well, honey, it’s just the same thing. If you have an illness and taking a drug can help make you well, then that’s just what you do.’

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One of the things that I found quite hard to accept is just how ignorant I was about depression. Actually, any mental illness. The statistics show what a serious problem it is and yet I really knew nothing. I think that maybe we touched on it a little in a health class at school. People like Miranda who have had some contact with depression were probably the only ones that knew much. For me, that’s where the fear comes in a lot because you don’t really want people to know. I think I could even handle having something as bad as diabetes. Maybe it’s different because people know more about it and understand that you have to inject insulin, or you might die. When it’s something in your head, well, you just wait to be called crazy or psycho, I guess.

© R. I . C.Publ i cat i ons I agreed to let Mum drive me in to see the psychiatrist because there was no way I was going on my own. •f oIr ev i ew pu p o se senough on I did decide though that wasr going in alone to talk with himr and she was happy tol sity and• wait for

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me. A one-hour session! I couldn’t imagine what I’d be able to talk about for that long to a complete stranger. I was feeling that sick, much worse than being in Dr Taylor’s waiting room. For all I knew, he’d have a big leather sofa that I would have to lie down on! I was really hoping that he wouldn’t be some old guy, like my grandad, who I love, but eeewh, I couldn’t share my feelings with him! I was ready to make a run for it and Mum must have sensed it because she showed me some stupid article in one of those dumb magazines. There were four other people in that waiting room and I was desperate not to look at any of them. I didn’t want to see what other crazy people looked like and I sure didn’t want them to notice me.

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When I heard my name called, I stood up slowly and my legs nearly buckled beneath me. I was shaking worse than I ever had before and I continued to look at the ground. Just put one foot in front of the other, I told myself. Well, I had to look up, see where I was headed and when I caught sight of the man in front of me, I was absolutely relieved. He may have been a little balding but he definitely wasn’t too old. Thank god, no sofa! I slouched in a chair opposite where he sat and kept my eyes on the carpet. I don’t remember a single thing I was thinking right then. When he spoke, I remember looking up and thinking that he had a gentle voice, just like Dr Taylor’s. He asked if he should call me Cassie, instead of Cassandra, and then said I could call him Martin. Pretty cool to call a fancy doctor by his first name, I thought. Still, I was certainly not relaxed, that’s for sure. I also definitely thought that there was no real need for me to be here, that it was all a big mistake.

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Somehow, during that one hour of my life, I understood more about what was happening to me than I thought would be possible. And boy, did I talk. Nonstop. I think these guys must do a subject at psychiatry school that goes on all year, just teaching them how to get people to relax and talk. I suppose that’s what it’s all about really. They can’t decide what’s wrong if you don’t tell them. I was just so surprised that I was able to talk so easily and so much! I remember he wrote down a lot of what I was saying but to be honest it didn’t bother me too much. When he started to explain the symptoms of depression, I was totally engrossed in his every word. He was treating all of this like it was something real and assuring me that I wasn’t crazy. I’m embarrassed to say that I actually cried a little but he didn’t make a big deal out of it, or get all funny like Dad does when I cry. For the first time since Mum had come in to talk with me that Sunday, I felt calmer and a lot less afraid. My anxiety levels went up a few notches when we talked about treatment and the reasons that could be behind my depression. In that first session, Martin leaned towards my perfectionism as a basis for the pressure I put on myself in whatever I do. Without realising it, I had always put myself under a lot of stress to succeed at absolutely everything I did. When things didn’t always work out how I planned, my thoughts would become negative. If that happened, nothing I could do was right. That’s when I became agitated and easily frustrated. Then the tears would come and I would lose the plot, feeling more and more depressed.

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Martin suggested that the most effective way for us to deal with my depression was with talk therapy and cognitive behaviour therapy (CBT). That meant that I would visit with him and talk about how I was feeling. CBT would help me to change those unhelpful patterns where I thought negative things. He suggested that I keep a diary where I could record any negative thoughts and feelings. Then, we could use that to see how I could change those patterns to make them more helpful. That all seemed easy enough to me and I told him I already kept a journal. When I asked him about taking medication, he told me he preferred not to use any at this stage. He was hopeful that the treatment he had planned would help. I was feeling confident about him and how he wanted to treat my illness. I knew I would come back to see him. I was glad he didn’t say, ‘time’s up’, like they do in the movies, when our session had ended. Instead, he said he was really pleased to have met me and he looked forward to seeing me in two weeks. I was about on cloud nine when I left his room and I could see the look of complete relief on Mum’s face when she saw me.

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On the drive home I told her everything I could remember (well, nearly everything!) and explained to her what CBT and talk therapy meant. I really felt like I’d been treated maturely and I told her how wonderful I thought Martin was. Already I was looking forward to seeing him in two weeks. It felt like someone had validated how I felt, really understood that I wasn’t ‘just being moody’. To be honest, I actually felt quite special. During the next two weeks, I paid plenty of attention to virtually everything I did. I wrote in my journal every night. Instead of just writing what had happened that day, I also wrote about how I felt and thought about everything. My journal became the single most important thing I did! It made me feel like I was doing something to get better. I was still having a lot of trouble getting to sleep and I wasn’t spending much time R.I.C. Publications® – www.ricpublications.com.au

Mental health

with my friends or family. I really didn’t feel like it much. I tried to eat properly though and went for a walk a few times each week. Towards the end of the second week, I was counting off the days until my next appointment. The novelty of writing everything down was starting to wear off and I was still getting frustrated and annoyed too easily!

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Obviously, that second visit to see Martin was much easier than the first. Still, I was a little bit nervous. I had my journal with me and lots of things in my mind to talk about. Actually, I had spent half the night thinking what I should talk about. Pretty stupid but I couldn’t help it. I shouldn’t have worried at all because Martin is so easy to talk to and he knows just the right things to ask and say. I really surprised myself when I asked if he would like to read some of the things I had written in my journal. Absolutely nobody gets near my journal! I started to stress a bit as he was reading and he looked up and said, ‘Don’t worry Cassie, I’m not allowed to tell anyone what you write or what we talk about’. Okay, that made me feel better because there was some stuff in there about the family and boys (of course!). Also, it’s just really personal when someone else can read about exactly what you’re thinking. Funny how you can trust an almost stranger but not your own best friend to read stuff like that! Martin asked a few questions after he had finished reading about the trials of my last two weeks. He told me that it really helped him to understand how I felt and about some of the thought patterns I had. I was actually pretty pleased with myself. It was a bit like the teacher telling you what a great assignment you did. I figured that if it helped him to help know me better, then that was a good thing. He highlighted a few times when I had felt really bad about myself and the more we talked, the more I could see how I was beating myself up over little things. While I was talking to him, I could see it all so easily. He told me I should be kinder to myself, just like I would to my friends. That seemed to make sense but it’s not always so easy to do. When we decided to set some goals for the next two weeks, that was the first one I wrote down.

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Our 45-minute session seemed to fly by and I was almost disappointed that we were done. Martin suggested a few ‘homework’ tasks to work on before I returned. The first was to continue the journal I was writing. The second was to write down two short-term and two long-term goals that I wanted to work towards. The third was to start making a list of any negative thoughts or feelings I had. In my mind, I was already imagining the new notebook I would buy on the way home!

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My journal became like my own secret treatment plan. I wrote about everything! I had always kept a journal and I enjoyed writing. This was like a mission though! Something that I could really put some energy into that was going to help. Every now and then I’d write something and worry about Martin reading it. After a while though, I really didn’t think about it that much. So what if I got a little embarrassed? I was already telling him all my personal stuff anyway! When I first started the list of things I said to myself that were negative, I filled nearly a whole page in a couple of days!! Things like, ‘I can’t do that right’, ‘I’m hopeless’, ‘I look too fat in these jeans’ or ‘I’ll never get in to Uni’. Once I started putting these thoughts on paper, I realised just how negative they were and how much it stressed me out to think that way. It’s so amazing how easy it is sometimes to turn your thoughts around so they are negative. I don’t even know I’m doing it half the time! I expect a lot of myself, so if I think if I’m not 54

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being ‘perfect’, then I must be a failure. Now that’s a sure recipe for disaster and it was obvious to me how negative my thoughts were when I felt like that. My goals were pretty simple. Short-term: I wanted to spend more time with my friends and sleep better. Long-term: I wanted to be kinder to myself and change my thought patterns.

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It’s really funny how clearer some things become in your mind when you write them down. I spent a lot of time, between visits to Martin, reading over the things I had written. Some things made me cringe and I felt so stupid that I had thought that way. Other things made me realise that I was making progress with the ways I was thinking. I was still finding it hard to shake a lot of the early symptoms I had though. Some days, I would cry for absolutely no reason. I always felt anxious before an exam or a class presentation and there were times when I didn’t concentrate as well as I should have. As the months went on, I found that all the talking I did with Martin was making a huge difference. I still wasn’t quite my old self but I did feel so much happier and more able to do the things I really enjoy. I was starting to feel calmer and more in control because I was learning the skills I needed to overcome my depression symptoms. I started to feel like I had more energy and I wasn’t so tired because I was sleeping better. At school, I found I could concentrate more and I wasn’t quite so anxious about everything. I still wasn’t spending a lot of time with my friends, preferring to be alone, but I just wasn’t as stressed out. The key is to learn how to reduce the stress and take the pressure off so you don’t develop those negative thoughts. The more I talked with Martin, the more I could see the areas I needed to work on.

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One other thing I did that helped me move quicker down the recovery road was to start a mood chart. I recorded how I was feeling each day and added things like whether I ate properly, how I slept, if I socialised and what activities I did during the day. I made notes of anything special that came up, like an important exam. It really helped me to think about my moods and how I was feeling.

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Each time I went to visit Martin, I took my journal and the charts and lists and we talked about ways to change my thoughts, so that they were more positive. With all the talking I was doing, I felt like I could really beat this illness. I actually felt better than I ever had and I was looking forward to each day with a lot more enthusiasm. It took me a while to talk openly about being diagnosed with depression. I guess I shouldn’t have been surprised that most people were understanding and supportive. I realised how very lucky I was that my illness was diagnosed early and I was able to get professional treatment. There are so many who don’t get help until things are really, really bad for them. The therapy I had helped me see things in a more positive way and understand myself a lot better. I still see Martin, just not nearly as often as I used to.

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Mental health

Bipolar disorder

Indicators • Understands that a person with bipolar disorder experiences extreme mood swings. • Recognises and understands the different mood states of bipolar disorder.

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• Realises that treatment for bipolar disorder is varied but involves some kind of professional intervention for recovery.

• It is important for students to understand the difference between ‘everyday’ mood swings and symptoms of bipolar disorder.

• Explain the following terms: manic, depressive, mixed state, psychosis and reinforce that different people experience these different mood states in different ways. • Discuss factors that can influence a person’s chance of developing bipolar disorder. • Discuss the reasons why the risk of suicide is high for sufferers of bipolar disorder, and the importance of seeking professional treatment.

2. A person with bipolar disorder may experience high or low moods, often for no apparent reason. The mood swings can be so extreme that they can seriously interfere with a person’s ability to function well on a day-to-day basis.

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Discussion points

1. Bipolar disorder is a medical condition that affects the brain, causing extreme moods.

3. In a manic state a person may be overexcited, energetic, talkative, distracted, irritable and unable to concentrate. He/She will need little sleep, tend to engage in risky or inappropriate behaviour and may feel more confident or important.

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• Complete the open-ended statements to highlight how everyone has moods that affect them. (page 61) Reinforce that mood states are normal but bipolar disorder is characterised by extremes.

4. Bipolar disorder is often misdiagnosed or the symptoms are not recognised. 5. Bipolar disorder sufferers can be a higher suicide risk because their symptoms have often gone undiagnosed for a long time and this can cause an increased risk of developing alcohol and drug problems. Depression, mania and psychosis can all lead to an increased risk of suicide.

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• Explain that bipolar disorder is not as common as other mental illnesses and those who have the illness can manage their symptoms with effective, professional treatment.

• Identify support services that are available in the local community to people who suffer with bipolar disorder. Make recommendations to add to or improve available services.

6. Psychosis occurs when a person loses touch with reality and has problems thinking clearly, so that delusions and hallucinations develop. The main risk of psychosis in a depressed state is suicide. The main risk of psychosis in a manic state is risky behaviour associated with the feeling of being someone important or special.

• Use the Internet to research a private clinic or hospital that specialises in the treatment of a psychiatric illness such as bipolar disorder. Compile a report to show the services available.

7. Risk factors include family history (genetics), a chemical imbalance in the brain and stressful life events.

• Complete a mood diary using a 1–5 scale. (page 62)

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• Create a pamphlet that explains the facts about bipolar disorder. (page 63)

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8. Suggested treatment for bipolar disorder includes medications, professional support and therapy, community services and a commitment to a healthy lifestyle. 9. Hospital treatment might be required if a person is severely depressed and at risk of suicide, if he/she is psychotic, needs medication monitored or is at risk of harming others.

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Bipolar disorder It is very normal to experience changes in mood and most people deal with these ups and downs as part of their everyday lives. Hanging out with good friends can make a person feel happy, but too much homework might make him/her feel irritable and grumpy! A person with bipolar disorder experiences extreme mood swings, often for no apparent reason. The change in mood can last for weeks, months and even longer. These moods can range from very high (mania) to very low (depression), with periods of normal moods in between. Some people will also experience hallucinations and delusions. Extreme mood swings can seriously interfere with a person’s ability to function well on a day-to-day basis.

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First symptoms of bipolar disorder usually appear in adolescence. Unfortunately, the illness is often misdiagnosed or not recognised and a person can suffer for years without proper treatment. Bipolar disorder affects males and females equally. There is no cure for bipolar disorder but symptoms can be managed with effective treatment. With careful management, a person with bipolar disorder can lead a stable, happy, productive and successful life.

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The symptoms of bipolar disorder are varied and individuals are affected in different ways. Some people experience mostly mania, some have more depressive episodes, others experience both extremes, and some experience both high and low moods together. The three types of mood state in bipolar disorder are manic, depressive and mixed. A manic episode occurs when a person experiences an extremely high mood that includes symptoms of: • feeling very excited, energetic and happy • • talking very fast, being very talkative, having racing thoughts, bubbling with new ideas • needing little sleep • being distracted, unable to concentrate, feeling irritable •

engaging in risky behaviour and being unaware of such inappropriate behaviour. This may be an increased desire to spend more money, eat or drink more, have sex more often, drive too fast feeling more confident/important/intelligent/ stronger/richer/popular.

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The first manic episode I had was pretty bizarre. I had so much energy to burn and I didn’t sleep for days. I wrote all these songs that I just knew would be hits. My friends got sick of listening to me rave on about it. I failed every assignment at school during the time I was manic. Everything I wrote was rubbish, even though I thought it was great! Kelly

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Episodes of mania can cause real problems at school, at work and within relationships. Sometimes, the symptoms can be so severe that a person may need treatment in hospital. Depressive

A depressive episode occurs when a person experiences an extremely low mood that includes symptoms of: • feeling miserable and sad • feeling worthless, helpless, hopeless, unloved, guilty • not sleeping or sleeping too much • feeling restless, agitated, irritated, frustrated • crying for no apparent reason • changing weight and eating habits • withdrawing from people and activities • excessively worrying • lacking interest and motivation • slow movement and speech • difficulty concentrating and making decisions • feeling suicidal. • feeling fatigued with a loss of energy Episodes of depression persist and can seriously affect a person’s ability to function in everyday life. Sometimes, the symptoms can be so severe that a person may need treatment in hospital. R.I.C. Publications® – www.ricpublications.com.au

Mental health

I started to worry about exams and fell into a really bad depression. All I wanted to do was sleep and I had no energy for anything except crying. After a while, I felt so hopeless and I couldn’t see any way that I would pass any of my subjects. Things got so bad that I seriously thought of ways to kill myself. Pete

Mixed

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A mixed episode occurs when a person experiences symptoms of mania and depression at the same time, or when the mood changes from mania to depression very quickly (within minutes or hours). Psychotic

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Psychosis is a severe symptom of bipolar disorder. Psychosis occurs when a person loses touch with reality and has problems thinking clearly. During psychosis, a person can develop delusions (false and irrational thoughts and beliefs) and hallucinations (seeing, hearing or sensing things that are not really there). Psychosis can occur in any mood state. If a person is in a depressed state of psychosis, he/she may feel so negative as to be suicidal. The person may believe he/she has a life-threatening illness, or even that he/she has committed a crime and deserves to be punished. If in a manic state of psychosis, the person may feel he/she is someone very important, who needs to do very special things. Psychosis is a serious state and requires immediate treatment from a professional. Psychosis is more likely to happen if a person’s illness is undiagnosed, or he/she does not take prescribed medication correctly. Illicit drug use can also induce psychosis.

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People who have bipolar disorder are often at higher risk of having other illnesses, especially those who were not diagnosed when early symptoms appeared. An increased percentage of those with bipolar disorder develop problems with alcohol and other drugs. This may because they try to ‘self-medicate’ or make themselves feel better this way. Anxiety disorders and personality disorders are also more common among those who suffer with bipolar disorder. The risk of suicide among those who have bipolar disorder is very high. Severe depression and/or risky behaviours associated with mania, contribute to an increased risk of suicide. Suicidal thoughts are real and require immediate treatment from a professional.

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Like many medical conditions, the causes of bipolar disorder are not fully understood. There are different factors that influence a person’s chance of developing the illness. These factors include:

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• Family history Research suggests that a person is at a higher risk of developing bipolar disorder if a parent has the illness. There is no specific gene that has been identified so there is no test that can be done. Just because one family member has the illness, it does not mean that others will also develop it. Individuals all have different factors that influence their likelihood of inheriting any illness.

My father left when I was young, so it wasn’t until I was 23 that my mother recognised I might be suffering the same symptoms he did. We didn’t know bipolar disorder could run in families. David

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• The brain Studies show that chemicals in the brain are affected for someone who has bipolar disorder, and that mood swings are caused by an imbalance of these chemicals.

• Life events Stressful life events can trigger an episode of mania or depression for someone who is vulnerable. Research shows that episodes do occur without any obvious stressful event though.

Mental health

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Treatment Even though there is no cure for bipolar disorder, there is effective treatment available that can do a lot to reduce symptoms. Some symptoms can even be eliminated for many people. A psychiatrist is generally the best professional to make a correct diagnosis, so seeing a family GP for a referral is the first step. I felt so afraid when I was first diagnosed with bipolar disorder. I have a good psychiatrist who I can talk with about everything. He’s helped me understand and manage my symptoms better and I feel much stronger now. Matt

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The most effective treatment for bipolar disorder usually involves a combination of medication, support from professionals and community services, and a commitment to a healthy lifestyle. One of the hardest things for many people with bipolar disorder is accepting that medication is a necessary part of treatment. Because many of the symptoms are caused by changes in brain chemistry, medication can help restore a normal balance. There are different drugs that are used as mood stabilisers, antidepressants and antipsychotics. Finding the right combination of drugs to suit an individual is usually the biggest challenge because everyone is so different. I got so sick of trying different drugs to help my illness. I thought nothing would ever work. It’s a shame that there isn’t one drug that just fixes things in a few weeks. I had to be really patient, which wasn’t something I was good at! Tracey

© R. I . C.Publ i cat i ons As well as medication, therapy plays an important part in the treatment of bipolar disorder. Talking to a mental health •helpf o rr evi e w p u r pmanage ose on l y professional can a person understand and accept the illness, thes symptoms and learn• new ways to cope

with problems. There are different kinds of therapy and decisions about the most suitable are best made with a mental health professional. As with medication, what works for one person does not always work for another.

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Treatment in hospital is usually only necessary if someone is very ill. For most of these people, only short stays are required so that medications can be monitored and symptoms managed more closely. There are psychiatric units in most major hospitals, as well as specialised psychiatric clinics. When a person is suffering severe symptoms of depression, mania or psychosis, he/she may be admitted to a hospital without giving consent. This usually only happens if a person is in danger of harming himself/herself or others.

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Although medication and therapy are important parts of treatment, it is essential to have a healthy lifestyle. This combination is the best way of managing an ongoing illness like bipolar disorder. Some of the most positive actions a person can take are:

• • • • • • •

learning to manage stress avoiding alcohol, illicit drugs and cigarettes enjoying healthy food getting a good night’s sleep exercising regularly keeping watch for the signs that indicate a mood swing learning how to deal with suicidal thoughts—having an action plan in place • making an effort to stay in contact with friends and family members • joining a support group. R.I.C. Publications® – www.ricpublications.com.au

Mental health

Joining a support group really helped me. It’s great to talk to people who know what you’re going through. I didn’t feel so isolated and lonely. I loved seeing that all these people were just regular. We’re all just trying to deal with an illness the best way we can. Sue

Bipolar disorder 1. What is bipolar disorder? 2. Describe how a person with bipolar disorder is affected by his/her moods.

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4. Explain why so many people with bipolar disorder can go untreated for many years.

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3. Describe how a person with bipolar disorder might behave in a manic state.

5. List reasons why a person with bipolar disorder can be at a higher suicide risk than the general population.

6. Explain the term psychosis.

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Write one of the risks of psychosis in a depressed state.

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Write one of the risks of psychosis in a manic state.

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7. What are the risk factors for developing bipolar disorder?

8. List the suggested treatments for managing bipolar disorder.

9. Identify reasons why a person with bipolar disorder may need hospital treatment. 60

Mental health

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My mood states I feel energetic when …

I’m overexcited when …

I feel happy when …

I’m usually talkative when …

I don’t sleep well when … r o e t s Bo r e p ok u S I’m easily distracted when … I feel irritable when …

I have a hard time concentrating when …

I feel confident when …

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I lack motivation when …

I sleep too much when … © R. I . C.Pub l i c a t i o ns •f orr evi ew pur posesonl y•

I can easily lose interest when …

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I cry when …

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I feel guilty when …

I eat too much when …

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I don’t eat enough when …

I lack confidence when …

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I’m miserable when …

I have a hard time making decisions when …

I worry too much when …

I feel frustrated when …

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Mental health

Mood diary Use the scale 1–5 to record your mood for each day of the month. 1 – Very low: miserable, don’t feel like doing anything, easily upset, very negative, exhausted 2 – Low: unhappy, needing time alone, easily frustrated, somewhat negative, bored 3 – Fine: able to cope with most things, mostly happy, positive 4 – Great: coping well with daily activities, happy, positive, relaxed, active 5 – Terrific: confident, enthusiastic about everything, energetic, in high spirits, optimistic

Month: 1

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2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st

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1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st

r o e t s Bo r Month: e p 5 o3 1 2 k 3 u4 S 1st

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Mental health

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page 2

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Bipolar disorder - The facts

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Mental health

Schizophrenia

Indicators • Understands that schizophrenia is a serious illness, though it only affects a small percentage of the population. • Understands the symptoms and possible causes of schizophrenia. • Appreciates there is often a stigma surrounding schizophrenia.

Discussion points

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• Define terms such as logic, thought disorder, delusions, hallucinations, psychosis.

1. (a) Schizophrenia affects only a small percentage of the population.

(b) Most people with schizophrenia are not violent. Since their symptoms can be isolating, many people with this illness keep to themselves, avoiding situations they may feel threatened by.

(d) Schizophrenia is not an intellectual disability. When unwell, thoughts, feelings and actions can become disconnected but this is not a sign of lower intelligence.

(e) Symptoms of schizophrenia rarely disappear on their own; treatment and support are needed for a person to stay well and manage his/her symptoms.

• Discuss reasons why some people with schizophrenia can be a high suicide risk. • Explain how alcohol and illicit drug use can seriously impact on a vulnerable person developing symptoms of schizophrenia. • Highlight the need for professional treatment of schizophrenia.

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• Discuss symptoms with the awareness that most develop in adolescence and the early 20s.

Additional activities

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• Create an advertisement to promote the awareness and understanding of schizophrenia. Find an approach that can help to lessen the stigma about the illness. • Research and compile a report to show the effects of illicit drug use on schizophrenia.

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• A small complex has been proposed for an area in the community, with the intention of providing affordable housing to people with a mental illness. The government has made it clear that the people suitable for this housing will be undergoing professional treatment and are able to manage their symptoms. Outline the concerns some members of the community may have. Develop an awareness campaign to educate about the benefits of such a complex for the individuals concerned.

2. Students should be referred to the symptoms on the fact sheet. Responses to this question should include all the everyday tasks students are involved in, as someone who is unwell with schizophrenia will generally find everything challenging.

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• What services are available to assist those who are caring for someone with schizophrenia? Identify the issues and problems that carers might face. Choose one issue and suggest possible improvements or solutions.

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3. Positive lifestyle choices include abstaining from alcohol and any illicit drugs, dealing with stress, maintaining correct medication, attending therapy, joining a support group, healthy diet, regular sleep and exercise, staying in touch with family and friends. 4. Symptoms affected by drug use include thought disorder, delusions, hallucinations, emotional expression, thinking skills, motivation, withdrawal and lack of awareness. 5. A carer would face challenges such as ensuring the person is taking medication regularly, attending therapy, identifying symptoms that may be getting worse, staying patient, taking care of himself/herself.

Mental health

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Schizophrenia Schizophrenia is an illness that interferes with a person’s mental functioning, affecting thinking, emotions and behaviour. Only a small percentage of the population will suffer from the illness. Males and females are affected equally. First onset of the illness usually occurs in adolescence and the early 20s. The symptoms can develop quickly, over a few weeks, or they can appear slowly, over months and years. Some people may only experience one or more brief episodes and respond well to treatment. For others it can be a chronic condition, lasting throughout a person’s life. Professional treatment is essential for anyone with this illness.

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Having schizophrenia does not mean that a person has a ‘split personality’. People with schizophrenia are not ‘normal’ one minute and ‘crazy’ the next. They are not necessarily more violent than anyone else. Schizophrenia is not an intellectual disability. When a person is unwell, his/her thoughts can become illogical and confused. Thoughts, feelings and actions can become disconnected from each other. What a person actually says may not match up with what he/she actually does or feels. The symptoms of schizophrenia can be frightening and affect every aspect of a person’s life. Individuals will experience and be affected by symptoms in different ways. The major symptoms of schizophrenia include: • Thought disorder The ability to think logically is affected so that thoughts are disorganised. Thoughts can come and go quickly. A person may be unable to concentrate on one thought for long and become easily distracted. Conversation can be difficult because the sufferer may not make a lot of sense to others.

• Delusions A delusion is a false belief that is not logical. People with schizophrenia may believe they have special powers or are being controlled or pursued by others. A person may feel that someone is trying to interfere with his/her thoughts. People may withdraw from friends, family and society because their fear is so great.

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• Hallucinations People with schizophrenia can believe they hear, smell, see or feel something, without that thing actually being there. Hearing voices is the most common type of hallucination in schizophrenia. Voices can sound so real that the person is convinced they are there. These voices that other people do not hear might talk about the person and talk to him/her. It is not uncommon for people to believe they are receiving orders, having a conversation or being warned of danger.

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Other symptoms of schizophrenia include:

• Emotional expression Someone who is unwell can appear very flat and emotionless. He/She may speak in a slow, boring voice, seem not to care and show little emotion on his/her face and in his/her body language. Sometimes an emotion may not be appropriate to the situation; for example, a person might laugh when someone is telling a sad story.

• Motivation There is a marked loss of motivation to participate in routines and activities. It can be difficult for a person to have the energy to wash or tidy up, bother to go out, or even get out of bed. This lack of motivation is part of the illness and not laziness. • Withdrawal Those who are unwell tend to avoid meeting with people. They might withdraw because they are afraid someone might hurt them, or because they think they don’t have appropriate social skills.

• Thinking skills Memory, concentration, planning and organising • Lack of awareness are all affected and can make it difficult to Sufferers may be unaware that they are ill, especially if their communicate, reason and complete regular delusions and hallucinations are very real to them. tasks at home, school, work or socially. R.I.C. Publications® – www.ricpublications.com.au

Mental health

I had no idea that I had an illness that was causing me to behave differently. I just couldn’t see what was wrong with my thinking. I needed my parents to take some action and find me the right treatment. They knew I was angry with them but I’m glad that didn’t stop them. Dean

Like any mental illness, the causes of schizophrenia are not certain. Research shows that a number of factors can contribute to a person developing the illness. These include:

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• Family history Schizophrenia sometimes runs in families and people who have a close relative with the illness may be more likely to develop it themselves.

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• A chemical imbalance Neurotransmitters are substances in the brain that allow communication between nerve cells. Research shows that there is some imbalance with these chemicals.

• Life events Stressful life events can trigger the illness in those who are vulnerable to developing it. A person can become irritable, anxious and unable to concentrate and these symptoms can lead to other more serious problems. It is difficult to know whether the illness has caused the reaction to a crisis, or the crisis has contributed to the illness. So, stressful experiences may be a cause or a result of the illness.

• Drug use The use of illicit drugs can trigger the illness or cause a relapse. People who are vulnerable to or have schizophrenia may experience particularly bad reactions to certain drugs. Illicit drugs, cigarettes and alcohol can also interfere with the medication necessary to treat schizophrenia. Treatment

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Schizophrenia is an illness that can be treated. There is no one cure to make the illness go away but there is a lot that can be done to manage the symptoms. Effective treatment includes medication, professional therapy and help with managing everyday life. The earlier treatment begins, the better the long-term outcome is. Schizophrenia does not just disappear on its own. The goal of treatment is to help the person resume a normal life as easily as possible. Drug treatments focus on reducing the major symptoms of the illness. Medication helps to restore the chemical imbalance that contributes to the illness. A combination of medications is sometimes used. Some of these can have side effects, but most drugs used in the treatment of schizophrenia are not addictive. Accepting that medication plays an important role in treatment can often be confronting, especially for those who are not completely aware just how unwell they are. Professional therapy can help a person to recognise the value of a treatment plan and explore ways of coping with the illness on a long-term basis.

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My psychiatrist started me on medication. I was scared at first. After a while, the voices I had been hearing stopped invading every thought I had. I was able to sleep peacefully for the first time in ages. I wasn’t so afraid of everything. Now I have a little pill box and taking the medication has just become part of my routine. Kristal

Mental health

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Schizophrenia 1. There are many misunderstandings about schizophrenia. Write facts for each of these false statements. (a) Schizophrenia is a very common mental illness. (b) People with schizophrenia are usually violent.

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(e) Symptoms of schizophrenia will disappear after a while.

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(d) People with schizophrenia are not very intelligent.

2. Make a list of some of the everyday tasks that might be challenging for someone your age who has schizophrenia.

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3. Suggest positive lifestyle choices that can help a person who is dealing with schizophrenia.

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4. List the symptoms of schizophrenia that would be affected by drug use.

5. Describe the challenges that someone caring for a person with schizophrenia might face. R.I.C. Publications® – www.ricpublications.com.au

Mental health

Eating disorders

Indicators • Identifies the types of eating disorders and their symptoms. • Understands the risk factors associated with developing an eating disorder. • Realises that serious physical and psychological problems can affect a person with an eating disorder.

Discussion points

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• Discuss the types of eating disorders and emphasise that they can become a serious illness requiring treatment and support.

• Identify and discuss the risk factors associated with developing eating disorders. Highlight the importance of developing a positive self-esteem. • Discuss peer, family and media pressures to conform. • Use magazines to highlight the pressure on celebrities to maintain an ‘ideal’ body weight and discuss the unrealistic expectations of achieving these ideals for the general population.

Answers

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• Read and discuss Kate’s story. (pages 73–79)

1. Similarities: both are classified as disorders, preoccupation with weight and food, fear of no control, unrealistic body image, low self esteem, compulsive exercise.

• Write a journal entry to describe how you feel about your body shape and size.

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• Make a collage of favourite celebrities and write words that describe their appearance. • Make a list of words that could describe how a person with an eating disorder views himself/herself.

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2. Eating disorders may develop if someone has low self-esteem and a poor body image, is a perfectionist needing control and seeking approval from others, change in life circumstances including a crisis or trauma, chemical or hormonal imbalances, pressure to conform, other psychological problems.

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• Complete a food diary to show eating habits. Highlight healthy and unhealthy eating habits. Suggest improvements. (page 72)

Differences: amount of food eaten, difference in weight, binges/not eating enough, physical side effects.

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• An Australian size 10 is approximately the same as a US size 4. Suggest reasons why you think the labels are so much smaller in the United States. • Overeating is much more dangerous than under-eating. Discuss.

3. Student responses will differ.

4. Student responses will differ. Refer to indicators in Question 2 as a guide. 5. Student responses will differ.

Mental health

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Eating disorders An eating disorder is an illness where sufferers have an emotional disturbance that shows up as a preoccupation with food and weight. The two major eating disorders are anorexia nervosa and bulimia nervosa. Compulsive overeating is also recognised as an eating disorder. An eating disorder is a serious illness that can be treated with professional support.

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Sufferers of anorexia are unwilling or unable to maintain a normal body weight for their age and height. The symptoms that define this disorder are: • a loss of at least 15% of normal body weight because of a refusal to eat enough food

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• an intense fear of losing control and becoming ‘fat’

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• an unrealistic perception of body image, so that they see themselves as fat and overestimate their size, regardless of how thin they become • a need to exercise obsessively

• preoccupations with food – the preparation of food, making ‘good’ and ‘bad’ food lists.

Initial compliments on weight loss can encourage symptoms, leading the person to believe that thin is better. Extreme eating behaviour will eventually dominate the person’s life and starvation will have a devastating impact on the body.

Sufferers of bulimia usually have an average, or slightly above average, body weight. The symptoms that define this disorder are:

feels a complete lack of control, self-disgust, depression and guilt

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• self-induced vomiting and/or use of laxatives in an attempt to avoid weight gain and make up for the binges

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• combining compulsive exercise with restrictive eating, so that weight control dominates the person’s life. Eating disorders can affect anyone. Both males and females can develop the disorders, though more females are affected, especially by bulimia. First symptoms usually appear in adolescence, though the illness can be experienced earlier or later in life. Some people who are more likely to be at risk of developing an eating disorder, may experience:

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• low self-esteem • perfectionism

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• a need to seek approval from others

• poor body image

• a need to feel in control of one’s life

• pressure to conform to media-related ideals of the ‘perfect look’

• a life crisis • a change in life circumstances; e.g. relationship breakdown

• other psychological problems.

The exact causes of eating disorders are unclear, and can differ among individuals.

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Mental health

Eating disorders The are many serious physical and psychological effects of eating disorders. If treatment is started early, many of these symptoms can be reversed. Left untreated, sufferers can experience ongoing and life-threatening problems. The physical effects of a severe eating disorder are: • dehydration, diarrhoea and constipation • kidney damage • chronic indigestion

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• bladder infections and gut problems

• irregular periods or loss of menstruation

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• cramps, muscle spasms and seizures

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• strain on most body organs.

In addition, anorexia suffers will likely develop an extreme sensitivity to cold and an inability to think clearly and concentrate. Bulimia sufferers will likely develop a chronic sore throat, swollen salivary glands, the erosion of dental enamel from continued vomiting and the possibility of a ruptured stomach. Serious psychological issues are likely to affect sufferers of eating disorders. These can include: • mood swings

• an inability to develop personal relationships

© R. I . C.P l i ca i o ns u • b difficulties witht any activities that involve food • depression • lying about issues related to food • f o r r e v i e w p ur posesonl y• • emotional outbursts • fear that others will disapprove if the illness is

• changes in personality

discovered.

• loneliness, due to self-imposed isolation

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Treatment Treatment of an eating disorder can involve a range of different options. Once a diagnosis has been made, there are a variety of professionals that can become involved in a treatment program. These may include a GP, nurse, mental health professional, dietician, social worker, occupational therapist and counsellor. Depending on the severity of the illness, some people might be admitted to a hospital or clinic to undergo intensive treatment. This is especially the case if a patient is seriously malnourished and his/her physical health is deteriorating. Participating in a therapy program (as an inpatient or outpatient) can greatly increase the chances of a complete recovery. Such programs may include:

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• educational sessions about the eating disorder

• lifestyle sessions that encourage a person to recognise factors that have influenced the eating disorder • cognitive therapy that shows a person how to identify and change negative thought patterns and behaviours. Therapy sessions also aim to address beliefs about perfection, expectations and control • developing practical and useful coping skills • self-esteem sessions • diet and nutrition information to retrain healthy eating habits • ways to prevent relapse.

Mental health

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Eating disorders 1. List the similarities and difference between anorexia nervosa and bulimia nervosa.

Similarities

Differences

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3. How’s your self-image?

4. Outline modifications you could make to your current lifestyle to ensure you are as healthy, both physically and mentally, as possible.

I’m happy with the way I look

Yes

My weight is in the healthy range

Yes

I’m a confident person

Yes

I often need reassurance from others

Yes

I feel under pressure to always look ‘perfect’

Yes

Fashion and image is very important to me

Yes

I care about how I look and dress

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2. Suggest reasons why a person might develop an eating disorder.

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I have a good exercise routine

I’m happy with my lifestyle

I almost always have a positive attitude

5. What media images affect the way you feel about your selfesteem and body image?

I’m able to deal with most problems

I can ask for help when I need it

Yes

I’m a perfectionist

Yes

I’m a mature decision maker

Yes

I can be easily influenced by others

Yes

I feel in control of my life

Yes

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Mental health

Sunday Saturday Thursday Te ach Friday er

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Dinner

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Lunch

Breakfast

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Kate’s story I was 14 when my mother died. It was two weeks after her birthday that a drunk driver hit her car on a particularly wet and dark evening. The rain had been relentless since around 3 pm and I was soaked through by the time I got home from school. I was grumpy, tired and cold as I let myself in to the house. I knew Mum would not be home until around 5.30. She worked part-time in a doctor’s surgery. I took a hot shower, put on my favourite old trackies and lay on the sofa. School had been a pain and I was not in the mood to start on any homework yet. All I wanted was chocolate and a rest.

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I’m an only child and I’ve always been fairly mature for my age. My folks had a hard time conceiving and ended up on the IVF program. I always joked with them that they didn’t need another child because I was already perfect! The three of us had a great relationship and I always felt like the luckiest kid in the world. I was happy enough with the way I looked, I did well in school and I had loads of friends (including the cutest boyfriend). My life was pretty much ideal. When 5.30 came and went, I assumed Mum had been held up with some emergency at the surgery and didn’t worry too much. If she knows she’s going to be late, she’ll usually call and pick up some takeaway on the way home. So, even though she hadn’t called by 6.00, I didn’t bother to think about finding anything for dinner. Sometimes I like to cook a stir fry but I sure wasn’t in the mood tonight. When the phone rang and I heard Dad’s voice, I realised that dinner would be the last thing on anyone’s mind that night. ‘Mum’s been in an accident honey. I’m on my way to pick you up. I’ll tell you everything in the car. I love you.’ This was bad, I knew it. I raced to my room to change into jeans and grabbed my warm coat. I just had time to turn everything off before I heard the car in the driveway.

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Dad’s hands were shaking and he looked terrible. He didn’t really know a lot, only that someone had hit Mum’s car and she was in a critical condition. We made it to the hospital in record time, though I almost wish we hadn’t. I was feeling really frightened as Dad and I found out where they had Mum. It was about an hour before two doctors came in and told us they were very sorry, but the internal injuries were too severe. Mum had died while they were operating on her. One of the doctors sat with us for a while and answered a lot of Dad’s questions. I couldn’t speak. Nothing seemed real. Even when we went into that little room to say goodbye, I just couldn’t understand what was happening. Honestly, Mum looked just like she was asleep.

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The two weeks after Mum died were awful. Dad and I really hung on to each other. I think we were both more worried about the other. People were coming and going every day, bringing food and hugs and words of comfort. I hardly remember much. The funeral was beautiful and I think Mum would have been happy with the whole service. I didn’t cry but Dad did, especially when he got up to speak about Mum. I felt like crying but I just couldn’t. This is dumb but I kinda thought, maybe if I don’t cry and don’t feel and don’t think about it, then it won’t be true. I know you can’t think or feel someone back to life but it was how I managed to get through it all for those couple of weeks.

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What’s so strange about someone you love dying is that after a while, things just have to keep going on. You know, all the regular stuff that makes up your life. I went back to school, Dad went back to work. There was still homework to do, meals to have, washing to be done, a house to be cleaned. Then there were friends to see and my boyfriend, Drew, who had been so sweet. The house seemed empty without Mum, and Dad and I did our best to cheer each other up. Sometimes we’d talk but it was so hard. We’d both just get really upset. Doing normal stuff was the best way for us to manage and Dad kept saying that Mum would hate for us to go to pieces and lose it.

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The drunk driver who caused the accident that killed Mum was charged. Dad went to the court case but I didn’t want to even see him. All I know is he was sent to jail. I thought I’d be happy about that but it didn’t change anything. We still didn’t have Mum in our lives. I would get really angry some days and that’s when I’d cry a lot. Usually alone in my room. Dad took me to see a counsellor a few times but there really wasn’t much I wanted to talk about. I wasn’t pretending things hadn’t happened, like maybe I did before, it was just harder when I thought about everything. I didn’t want to talk with a stranger anyway. I felt like I was doing okay.

I was actually glad that I had school to go to every day. It kept me busy and I liked being around my friends. It was like our whole group had made this big blanket that we could just throw around us all. I felt like they were protecting me. I felt safer and more comfortable than I did anywhere else. Even at home. My best friend, Nic, was wonderful. We’d been through a lot together and had known each other since we were both nine. Her folks were divorced and she had a hard time dealing with all of that. I guess it was like payback now and she was taking care of me, like I took care of her. When she stayed over at my house, things livened up a little and I think Dad was happier to have a bit more noise around the place.

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On the outside, Dad and I seemed to be moving forward and keeping things together. I’m so glad that we’ve always had such a great relationship. I’m sure it made things much easier for us. About four months after that night, I came home from school and Dad’s car was already in the driveway. He is hardly ever home so early. I stood on the footpath and just kept staring at his car. Then my whole body started shaking and I felt like I was going to vomit. Something was wrong, I just knew it. All these things ran through my mind and I was terrified that something had happened to Dad. I couldn’t move. I just stood there, outside our house, with tears rolling down my face. God, I was so scared. I felt completely out of control and nothing seemed real.

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Dad had been expecting me and he came out to see what I was doing. He took one look, put his arms around me and took me inside. I could not stop crying. The tap had been turned on and nothing was going to stop it. He kept telling me over and over and over that he was fine. He had just felt a little crook after the lunch he’d had and decided to bring his work home to finish. I reckon he hugged me for an hour before I calmed down. We sat on the sofa and just talked for a while. I was that exhausted after all that crying and stressing out! I don’t know why I reacted so badly. Everything seemed to be going okay but I guess I just got a real shock. While I went up for a shower, Dad ordered takeaway. I couldn’t eat a thing though. I just looked at the food on the table and felt like I would be sick if I ate anything. Dad tried his best to make

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me eat something but soon backed off when he realised I was still too upset. He didn’t feel like too much to eat either. We watched a little TV and then I went up to my room. I felt so emotional. I couldn’t stop thinking about Mum and then what would happen to me if Dad had an accident or something. It was horrible having all these emotions mixed up in my head. I really felt like I was losing it.

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After that experience, each day for me felt just a little worse than the previous one. I was getting upset with small things, thinking about Mum a lot and worrying about everything. Honestly, I really thought I had no control over what I was thinking or feeling. All the things that never bothered me before, like schoolwork and my friends and Drew, even how I looked, all became important. I stressed about every single thing. The more I stressed out, the harder it was to sleep and the more worried I became. Some days I didn’t feel like eating anything and when I did eat, I often felt sick. As each day passed and I felt worse, I realised how awful I was starting to look. My face always looked blotchy and with the warmer weather coming, I thought I would look terrible in summery clothes. I decided I needed to lose some weight, just enough to fit into those new shorts I had my eye on. I also set my mind to making sure that Dad stayed well by taking on even more of the role Mum had. I made all the decisions about meals and went through all the recipe books. I weighed and measured everything to make sure it was all healthy. Dad needed to eat properly and I needed to lose a couple of kilos. Shopping and cooking gave me a real focus and I became a little less stressed about other things. At least I knew what I was doing and Dad loved the meals I made for him. Once or twice he’d ask why I wasn’t eating much but I would tell him I had been taste testing all afternoon. I loved how much he appreciated what I was doing. I loved being in control of the kitchen duties and I loved not having to eat anything I didn’t want to. Finally, life was beginning to make a little more sense to me and I stopped crying and worrying every single day.

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Somewhere in the very back of my mind, I knew I was eating less than I used to. Still, I was happy with my new diet and fascinated with adding up the calories and checking which foods contained what. Now that I was running more I felt less stressed. All in all, the diet and increased exercise were keeping my weight controlled and I began to think again about a part-time modelling career. I had talked with the folks about it a while back and they were happy for me to pursue that goal, just as long as I didn’t plan on leaving school. So, I kept up my routine of eating only what I thought I should and exercising every day.

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Quite a while passed before my friend, Nic, cornered me at home one day. She practically screamed at me when I put on my shorts to sit by the pool. ‘How the hell did you get so skinny? Look at your legs, they’re like sticks. God, Kate, what is going on?’ I had never seen Nic look so angry with me. The weird thing was, I had no idea what she was talking about. I certainly didn’t think I looked too skinny! In fact, I was pretty pleased with the new shorts and with a bit more colour on my legs, thought I would look perfect. So, she was mad at me and I was mad at her. I was insulted and upset and wanted her to go home. She was scared, I think and was not moving. ‘I am not too skinny, Nic. I’ve been cooking healthy food for Dad and exercising but that’s all. I just needed to get in shape for summer and it’s making me feel so much better.’ ‘You might be cooking healthy food, Kate, but I bet you’re not eating it!’ She walked over and put her arm

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around me. ‘Kate, I’m sorry but you’re looking really unhealthy and I’m worried about you. After all you’ve been through I just can’t stand to see you get sick. Please don’t be so stubborn.’ I hugged her back and told her I loved her. I did admit that maybe I could be eating a little more and then begged her to drop the subject.

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Later that night the phone rang and Dad spent about half an hour talking to someone. When he finished, he looked all pale and was a bit shaky. That nearly sent me crazy again, seeing him looking like that. What had happened now?! He came and sat down and switched off the TV. ‘Who were you talking to? What’s wrong? Dad, you look terrible!’ ‘Kate, that was Nic’s mother on the phone. I need to talk to you about a few things and I want you to be really honest with me. Please.’ ‘If this is about my skinny legs, then don’t worry! I’m fine, Dad. I’ve just been stressing a little and wanting to look better now it’s summer. Honestly, I’m not sick and there’s no problem.’ I was so mad at Nic. Dad didn’t need to be getting stressed out about me, he had enough to deal with. Dad told me he had noticed that I wasn’t eating as much and asked what I had eaten for lunch. It was so frustrating, he was treating me like a child! ‘I have seriously had enough of all this crap for one day and I’m not listening to one more word. I’m going to my room to do my homework and I don’t need to be disturbed!’ It was the first time I had really lost it with Dad but I was so bloody mad. I only just made it to my room before bursting into tears. The last thing I needed was everyone hassling me out about something so stupid. So what if I had lost a little weight? It made me feel good and it was no-one else’s business. Not even Dad’s and definitely not Nic’s mother. Thinking about Nic and her mum just made me cry harder. It was times like this that I would have done anything at all to have Mum around. She’d understand. The tears just kept coming and it was like I’ve felt before, where things are just out of control. Life would be okay for a while and then I just couldn’t get a grip on things and it was like I was spinning around in big circles. At least I could look the way I wanted to and wear what I wanted to and only eat if I wanted to. Some days it seemed that they were the only things I could control.

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Thankfully it was the weekend so I was able to creep out of the house before Dad was up and go for my run. I liked the cool of the mornings and there weren’t many people around so it was a lot more relaxing. I had been slowly building up the distance I was running and I loved that my body could take me so far. I felt sure I would have to eat a few meals with Dad over the next couple of days, just so he wouldn’t worry, so I was keen to burn off as many calories as I could. When I went on these runs, I thought a lot about Mum and when I missed her too much, it was like I was running from the pain. I reckon everyone must have their own special ways of dealing with bad things that happen to them. There was nothing I could do about the idiot that smashed into Mum and there was nothing I could do about her dying. But I could control how I looked and right now that was making me feel more confident and able to cope. Especially if Dad and I were going to fight! That was something I just couldn’t stand the thought of. I hoped he would be fine over the weekend and maybe we could spend some time together having a bit of fun.

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Unfortunately, fun wasn’t on Dad’s agenda. At breakfast, he told me he had been up until late, searching the Internet for eating disorder sites. Here we go again, I thought! ‘Dad, I DO NOT have an eating disorder! I am NOT too skinny. I AM eating. I DON’T throw up. There is absolutely nothing wrong with me!’ God, I swear

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I may as well have been talking to the wall. He totally ignored my outburst, just slid a whole heap of printouts across the table and left the room. Before I could say a word, he called over his shoulder, ‘Oh and while you were out exercising obsessively, Nic called. She’ll be over around 10.’ Great! Not only was Dad angry at me but now I had my so-called best friend heading over to hassle me as well. No wonder I didn’t feel like eating! I left his stupid papers on the table and went up to my room to shower and change.

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I was surprised when Nic suggested we head to a movie. I really thought I was up for a big drama and lots of one-sided conversations about me and my health. I was relieved but insisted we walk instead of catching the bus in. The great things about going to a movie are you don’t have to talk and if you choose the right one, you can be entertained as well. I went to the loo when Nic lined up to buy a snack. We found a spot right up the back and settled in. It was nice to feel so relaxed, though I thought Nic would start an argument when she offered me chips and I refused. She didn’t and we both enjoyed a good laugh through the movie. Now that was easy enough, I thought to myself. Maybe Nic really does understand that I am doing just fine. When we got back to my place, Dad was sitting outside with Drew. Although they both looked relaxed, I was suspicious. When Dad came inside and Drew stayed, I went out and left Nic in the lounge. Drew and I talked about our day and I knew there was something wrong. After an awkward silence, he told me that he was going to break up with me. I couldn’t believe what I was hearing. ‘Why?’ I asked, as calmly as I could. ‘I can’t cope with all your moods anymore, Kate. Things have changed and half the time, I never know what to expect from you. Are you going to be happy to see me, or ready to knock my head off? It doesn’t seem to matter what I do, it’s always wrong. You’re different. Not the fun and interesting Kate you used to be.’ I knew it would have been hard for him to tell me what he was feeling but I wasn’t going to make it easy for him. He wanted to see a mood, I’d give him one! I ranted and raved at him about how he wasn’t being supportive, didn’t care, shouldn’t listen to what my dad said … absolutely everything I could think of, including that he probably already had a new girlfriend! I was so mad and felt so let down. I left him and marched inside, ignoring Nic and slamming my bedroom door.

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My life was going downhill, big time. I could feel that control slipping away again. I was prepared to acknowledge that I was having some problems. What I really didn’t see though was that my eating habits were turning my life upside down. I blamed my moodiness, which I didn’t think was that bad, on stress at school. Some of my grades were falling but it was nothing that serious. I just didn’t have enough time to get everything done these days. Even though I was exercising a lot, my energy levels were low. Perhaps I had a medical issue I needed to have looked at. Something minor. After all, my periods had stopped a while ago, so maybe it had something to do with that. I resolved to make an appointment with our family doctor and try and sort things out. In the meantime, I was planning on forgetting about Drew right now. He was just a wimp and there were plenty more boys I could date, if I wanted to! The weeks seemed to fly by and I was still to make that appointment. I drew up a better schedule so I could work as hard as possible to catch up on schoolwork. It wasn’t easy and I always felt tired. Too tired to eat or spend time with friends most days. That hit home with a huge blow when Nic told me she was getting fed

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Mental health

up with worrying so much about me. She said it was causing her stress! I couldn’t be bothered listening any more so I told her not to continue stressing about me and to find another friend to hang out with. I was bored with her hassling me and she was becoming boring to me anyway. When I saw the tears in her eyes, I had to turn away. Friendships change all the time, I told myself. Nic and I really had nothing in common anymore.

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After squeezing in a run before Dad returned home from work, I started on making dinner for us. That’s about all I remember. Dad found me passed out on the kitchen floor when he got home from work and drove me straight to the hospital. In the emergency department, I had nurses fussing around and a very worried looking father talking to a doctor. I wished then that I had made that appointment with our doctor, before things had got so bad. There was obviously some condition that had made me sick and I just hoped it wasn’t too serious. I don’t think just passing out is anything really, really bad so I felt confident enough that they would give me something and I could go home. Probably just stress. The nurses had put a needle in the top of my hand which hurt! There was some kind of fluid dripping in to me that was attached to a pole beside the bed. It just looked like water but I asked anyway. The nurse said it was glucose and I thought great, pure sugar dripping through my body.

I was pretty surprised when the doctor disappeared and Dad came over to sit beside me. He looked terrible and I think we were both remembering that last time we were in this hospital. It made me feel guilty as hell. Dad looked so sad and when I leaned over to hold his hand, I saw tears in his eyes. ‘Dad, I’m going to be just fine. It’s only something minor right? Just trying to do too much, you know what I’m like. What did that doctor say to you? Actually, why didn’t he come and speak to me as well?’ That seemed a bit strange to me. After all, I wasn’t a child. At this point, I think my heart rate went a little higher and I could feel some panic. Maybe I was wrong and this was cancer or something and I was going to die and Dad would be alone. I felt like screaming at him to answer my questions.

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I was absolutely not prepared for what my official diagnosis would be and I can barely describe how I felt when I heard the words, anorexia nervosa. Dad stumbled over the conversation with the doctor, murmured the words and sat back looking even worse than he had 10 minutes before. I was furious, disgusted, annoyed and a whole heap more! What a ridiculous thing to tell my father! I wanted to punch that doctor right out. ‘It’s a mistake, Dad. He doesn’t know what he’s talking about. I told you before that I don’t have that problem.’ The desperate look he had almost made me crumble but I was really angry now. ‘Where is that doctor?’ I truly felt like yelling the place down right then. ‘They have an eating disorders ward upstairs, Kate. The doctor is making arrangements for you to be admitted there.’ ‘Dad, I’m not going to any ward upstairs. I just want to go home. Dinner is organised and I promise to eat with you. Please, just take me home now.’ ‘Kate, I love you so much and I just can’t do that. I know you’re sick and you won’t get better without help. I have to do what’s right for you, even if you hate me for it right now.’ Dad’s voice was so quiet, I could barely hear him. ‘I won’t take you home, honey, until you are well and healthy.’ This had turned into a nightmare. I couldn’t believe what was happening. All that carefully planned control had suddenly slipped right away from me and I was scared and panicked.

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So many things were racing through my mind and it seemed that I had no answers to any of my questions. I couldn’t make myself calm down and nothing was making any sense to me. Dad kept holding my hand 78

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tight but I felt like I was losing my mind. I wanted to pull that big ugly needle out of my arm and make a run for it. Hopeless and helpless, was how I felt. Totally. To my horror, I felt tears rolling down my face and I couldn’t stop them. It felt like I was watching someone else and I wanted to hug that person and tell them not to worry. But this was me. And I was more than worried. I was terrified.

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Those stupid printouts that Dad had left lying around invaded my thoughts. I had read them. Then I had thrown them out. All the treatment plans and therapy and talks of recovery and how drastic the illness was were so clear in my memory. I remember having all sorts of feelings as I was reading through the information, always convincing myself that nothing there applied to me. Now I felt like I was in some kind of conspiracy where I was going to be stuck in a boring hospital, just so I could eat more. It was ridiculous. If I thought I needed to put on weight, I knew what I needed to do. I’m not exactly stupid! It felt like hours before that doctor returned and told us both he had made the necessary arrangements to transfer me to ‘The Clinic’. I thought they were going to restrain me at one point as I felt myself going crazy, especially when Dad left the room. It was probably breaking his heart to watch his little girl go through such a hard time but I’m almost ashamed to say that I didn’t much care at that point. As far as I was concerned, I was being admitted against my will, to some place where insecure girls starved so they could look like a famous movie star. Just the thought of being around too-skinny, sick girls all day long made my rage return. The only time I have ever had so many emotions bubbling so close to the surface was when Mum died.

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too-skinny, sick girls. I just couldn’t see it. I hadn’t wanted to release the control I had over my eating. The control that was masking the pain I felt inside. The pain of losing my mum. The emotional issues I had kept inside needed to be resolved for me to get well. I spent hours with a therapist and hours more in group therapy. I talked and cried until I thought I could never do either again.

Trying to recover from this illness is, at best, a nightmare. Having someone watch you eat, weigh you each day and monitor any movement you seem to make is humiliating. The restrictions and rules were relentless. What was the absolute hardest was having to give up all of the control I had so carefully put in place for myself. Apart from what clothes I wore each day, there was virtually nothing else I had control over. Losing that power nearly broke my spirit time and again.

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Now that I am home, I have been able to put in to practice all the strategies that I was taught. Instead of thinking I have dealt with an issue, now I know the steps I need to take to make sure. My mental health issues are so much easier to confront, talk about and work on. I continue to see a therapist on a frequent basis. My physical health issues are definitely improving. I still need to go for very regular checks and I am careful to monitor my exercise and set strict goals. By understanding that I could develop a healthier control over my mind and body, I have been able to enter a safer stage of recovery. If it’s even possible, the relationship I have with Dad is even better than it was before. Nic and I are once again the best of friends— and there is a new guy in our neighbourhood who is very cute.

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Mental health

Self-harm

Indicators • Understands that self-harm is a behaviour, not an illness. • Recognises the risk factors associated with self-harming behaviour. • Identifies alternative coping skills in times of stress.

Discussion points

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• Discuss types of behaviours that may indicate self-harm.

• Discuss why females are more likely to overdose as a form of self-harm.

• Reinforce that self-harming behaviour is unlikely to be a way of seeking attention. Instead it is an indication that someone is having problems coping.

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• Debate why more females than males engage in self-harming behaviour.

• Highlight the risks associated with self-harming behaviour and the need for treatment.

Answers

Additional activities

1. People who self-harm might be having genuine difficulties coping with deep emotional distress and cannot find another way to manage.

• What advice would you give to someone who is self-harming? Write your response as a personal letter.

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• Devise a plan that would help increase the awareness of the important issues about self-harm. Work individually, with a partner or in a small group. Final presentations could include a report, PowerPoint™ presentation, poster, brochure, newspaper/magazine article, short story, poem, artwork.

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2. Physical issues include obvious physical injury and risk of infection or complications, suicide or accidental death.

Emotional issues include social isolation, lying, secrecy, not dealing with problems, frustration, loneliness, anger, resentment fear.

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• People can often forget to be kind to themselves, especially when they are dealing with difficult issues. Ask students to add to the list of ‘How to be kind to me’. (page 85)

3. A mental health professional can help to find the reasons why the behaviour is happening, provide support in a nonjudgmental way and teach new coping strategies.

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4. Student responses will differ. Suggest a discussion on bullying when dealing with this topic. 5. Student responses will differ. 6. Student responses will differ.

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Self-harm Self-harm is a behaviour, not an illness. Self-harm includes overdose, poisoning and injuries such as cutting and burning. A person might harm himself/herself as a way of coping with deep emotional distress. Deliberate self-harm is not necessarily a suicide attempt, though some individuals can feel suicidal at the time. Selfharm is more common among younger people. More females than males engage in self-harming behaviour. An overdose is the most common form of self-harm, especially in females.

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A person who deliberately self-harms should not be seen as ‘just an attention seeker’. Self-harming behaviour indicates that a person is having genuine difficulties coping. Some reasons to explain why people self-harm include: • as a way to express difficult feelings such as anger, sadness, hurt or grief • as a way to feel less invisible and more ‘real’

• temporarily helping to take away emotional pain through physical harm

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• providing a sense of control when other aspects of that person’s life might feel out of their control

• using physical harm to make emotional pain easier to understand because there is something visible to focus on • a perceived need to punish themselves for something; a way to deal with guilt.

There is no specific cause to suggest why one person might self-harm, though research shows that some can be more at risk than others. These include those who:

• are under stress or involved in a crisis

• have a serious illness, either physical or mental • have a problem with alcohol or drugs • have lost a close family member or friend

• experience problems with family, school, work and/or peer groups

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• have problem-solving difficulties, which can lead to frustration and feeling out of control.

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The frustration, anger, hurt and grief I felt when my mother died were overwhelming. Everyone in the family was trying to manage but I was the one who just couldn’t get it together. One night, I just sat in my room and cut my arm with a razor. Seeing the blood and feeling the pain from the cuts helped me feel more in control of my feelings. That feeling never lasted for long enough though. Angie

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Deliberate self-harm can bring about an immediate feeling of relief but it is only ever temporary. Self-harming behaviour can often have serious effects on a person’s physical and mental health. Some problems associated with self-harming behaviour include: • the risk of isolation from other people, especially from those who may be able to help • an inability to deal with the underlying issues that are contributing to the behaviour • lying to others to cover up; such secrecy can become very distressing • physical injuries can become infected or cause other complications • the very real risk that serious damage can be done that may lead to unintentional death. R.I.C. Publications® – www.ricpublications.com.au

Mental health

Self-harm Professional treatment is available to help someone who is deliberately harming himself/herself. Finding someone to talk to is the most important step to recovery. The sense of relief at sharing thoughts, feelings and behaviours can be long lasting, as opposed to the ‘quick fix’ of self-harm. Psychiatrists, psychologists, doctors, nurses and counsellors are all trained to listen and help in a very non-judgmental way. Treatment with a therapist will involve finding the reasons why the selfharm behaviour is happening, and learning new coping strategies to deal with the internal pain and distress.

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There is a wide range of alternative coping skills that can help a person who is trying to change his/her self-harming behaviour. Suggestions include:

• choosing to wait 15 minutes, then another, until the anxious feelings pass • crying! It’s a healthy way to release built-up emotions • writing in a journal

• drawing or writing on the body (instead of harming it) • calling a friend to chat

• singing loudly to favourite music (into a pillow if necessary!)

• finding a distraction to focus on—watching TV or a DVD, playing a video game, cleaning, reading

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• trying something physical—going for a walk or run, playing a game, going to the gym, riding a bike

• having a go at something relaxing, like meditation or yoga. Practising slow breathing

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• always keeping an emergency number close by and making use of it when things get too much. This might be a trusted family member or friend, a health professional or a crisis help line.

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• holding ice cubes—there might be some pain but it’s not harmful

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It is important to recognise situations that can contribute to distressing feelings and learn how to either deal with them, or avoid them. Everyone needs to take care of themselves by eating healthy food, exercising and sleeping well. Feeling better on the outside can help a person to feel better on the inside. Trying to have more fun and not taking life too seriously also helps. One of the most valuable things a person can do is to remember to be kind to himself/herself. I went from a small primary school, where I did really well, to a really big high school. I just felt lost and making new friends wasn’t easy. I felt overwhelmed and invisible most of the time. I felt like I couldn’t talk to Mum because she’s always expected me to cope. I didn’t want to disappoint her. One night I used a match to burn my leg. It hurt, a lot. It gave me something else to focus on though. I knew it was stupid but I just couldn’t help it. It took weeks before anyone noticed, and that only happened because my leg got infected. I talked with the doctor my Mum took me to. I’m learning new ways of coping. It’s not easy but I’m trying. I haven’t caused myself any harm for five months now. Kate 82

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Self-harm 1. A common belief is that someone who self-harms is simply an ‘attention seeker’. Explain why this is a myth.

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2. Record the physical and emotional issues associated with self-harming behaviour. Physical

Emotional

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3. Describe how a mental health professional might help someone who is self-harming.

4. A young person has started to self-harm in response to ongoing harassment.

may be self-harming.

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may be experiencing.

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5. It can be just as important to recognise that situations need to be avoided in order to keep safe and healthy. Make a list of situations that you would avoid in order to take care of yourself.

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6. People manage problems in different ways. Make a list of the strengths you have that help you deal with problems. My Strengths

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Identify one weakness that you could work on developing. 84

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r o e t s Bo r e p ok u S be my own best friend focus on the positives allow myself to be less than perfect enjoy my achievements

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Things to remember

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ask for help when I need it

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Suicide

Indicators • Understands that any suicide has a wide-reaching impact. • Identifies risk factors that might indicate someone is experiencing suicidal thoughts. • Identifies warning signs that could indicate suicidal thoughts.

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• Understands there are strategies to deal with suicidal thoughts.

Discussion points

• Read and discuss ‘Mark’s story’. (pages 95–101) • Discuss the social taboo that often makes speaking openly about suicide so difficult. • Discuss the reasons why young people are often at higher risk of suicide. Why do they often believe there is no other ‘way out’? • Reinforce that any talk of suicide should be taken seriously and discuss ways to help someone in distress.

Answers

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• Appreciates the need for personal coping strategies if a friend is expressing thoughts of suicide.

1. Student responses will differ. People may find suicide difficult to discuss because of religious beliefs or for cultural reasons. There are often many unanswered questions and feelings of guilt, shame and confusion after a suicide, with many people blaming themselves.

• Explain and discuss suggested strategies to deal with suicidal thoughts.

• Emphasise the importance of discussing concerns about a friend’s behaviour with a trusted adult.

2. (a) Men are more likely to take their own life because they usually use more violent methods (guns, hanging, car crashes), can be more aggressive and impulsive.

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Additional activities

• Who can I rely on? Ask students to write names of people they can rely on. (page 92)

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3. Young people may act more impulsively because they can easily forget that problems can be solved, pain can be dealt with and circumstances can improve. They may feel overwhelmed and out of control and engage in risk-taking behaviour.

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• Every cloud has a silver lining. Discuss the saying and ask students to write negative thoughts and add a ‘silver lining’ positive coping strategy. (page 92)

• Use the plan outline to identify different situations or issues of concern. Write down thoughts, actions taken and the result of those actions. (page 93)

• Use the puzzle pieces page and ask students to identify all the positive aspects of their life. Ask them to create their own categories that could include family, friends, school, sport, hobbies/interests, talents. The aim is to recognise that there are many aspects of our lives that can work together to create a safe and healthy environment. (page 94) • Create groups of five. Have students assume one of the following: sister, father, best friend, teacher, sports team member. Explain that a young man has taken his own life and ask each ‘character’ to write a letter outlining the effect the person’s death has had on him/her.

(b) Women have a higher risk of suicidal behaviour because they are generally a lot more emotional and use less lethal methods (overdose of prescription medication, other drugs) of attempting suicide.

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• Highlight that some people may carefully plan their actions, but that there is also a large number of (especially young) people who act impulsively.

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4. (a), (b), (c), (e) and (f) are false

(d), (g), (h), (i) and (j) are true

5. Student responses will differ. 6. Student responses will differ.

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Suicide Suicide is a particularly difficult issue for many people to understand and deal with. Unfortunately, it is a real problem in our society. Although many people are affected by suicide, it is rarely discussed openly. Young people can be very vulnerable to suicidal thoughts, often believing there is no other ‘way out’ from their pain and emotional distress. Men are more likely to take their own life, though women have a higher risk of suicidal behaviour.

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There are risk factors that might indicate someone is having a difficult time and experiencing suicidal thoughts. Those at a higher risk may:

• lack the ability to problem-solve effectively

• feel lonely and as though they don’t ‘fit in’ anywhere

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• be very high achievers who are perfectionists, putting • be young males who lack the ability to communicate themselves under extra pressure to excel effectively in times of personal crisis • be aggressive, impulsive males who may be loners • have suffered bullying, harassment or discrimination • have a mental illness such as depression, bipolar disorder or schizophrenia • be living in an unhappy family environment

• be unemployed or homeless

• have suffered physical, emotional and/or sexual abuse

• have experienced a major loss, such as the death of • have a family history of mental illness and/or suicide a loved one • have financial difficulties • use alcohol and other drugs on a regular basis • have a serious and disabling physical illness • be young males who are isolated in rural areas • have made a previous suicide attempt.

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Research shows that some people who are suicidal take great care in planning their actions and that there can be significant changes in their behaviour. However, a large majority, especially younger people, act impulsively and there may be few clues to their state of mind. There are warning signs that could indicate an individual is experiencing suicidal thoughts. These include: • talking directly or indirectly about suicide and death • changes in school results or work performance

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• withdrawing from family, friends and social activities • changes in sleeping patterns and eating habits

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• increasing the use of alcohol and other drugs

• irrational behaviour

• a sudden change in dealing with life circumstances • feelings of guilt and lowered self-esteem • appearing unusually happy or calm, when it may be • saying goodbye, writing letters or giving away treasured possessions. out of context with what’s really happening • changes in personality and appearance

• lack of motivation and any interest in future activities and making plans Any suicide attempt or threat should be taken seriously and anyone showing ‘at risk’ behaviour should be watched as carefully as possible. The most important thing, but often the most difficult, is to encourage honest and open communication. Young people can find it especially difficult to express their feelings because they may not understand why they feel as they do. Such frustration and confusion can cloud judgment and lead to suicidal thoughts as a way of ‘solving’ problems. R.I.C. Publications® – www.ricpublications.com.au

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Coping with suicidal thoughts Suicide means taking your own life and choosing death, instead of living. Most people do not really want to die; they just want to stop the inside pain. When someone is feeling suicidal, he/she ‘forgets’ that problems can be solved, pain will go away and circumstances will improve. A suicidal person can become overwhelmed by depressive feelings and feel out of control. The most important thing to remember is that thoughts are just that, and they are thoughts that don’t need to be acted on. Thoughts can pass. Thoughts can change.

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There are strategies that can help anyone who needs to stay safe when dealing with suicidal thoughts. Suggestions include:

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• Talking to someone. This can seem like the hardest thing in the world but talking to someone is always the right thing to do. If someone can open up about how he/she feels, all the better. If not, just the act of speaking with someone else can often be a distraction. Since suicide can be a very impulsive act, even a minor distraction can make all the difference.

• Calling a crisis line or help line. These services are staffed by understanding, professional and compassionate people. They are a brilliant alternative if there is no one else available and a person is scared to talk about his/her feelings with a family member or close friend. • Postponing any decision to cause harm in any way. The problem when suicidal feelings escalate is the belief that the person has to act right now. Decisions don’t need to be acted on immediately. Things change. Most people report that, by postponing this major decision, the urge to act passes. The hardest part is to get past that urge. It can be done, and there are many distractions that might prove useful. Watching TV or a movie, going for a walk, reading a book, listening to music, chatting or texting someone or playing a computer game are all good distractions.

can help with finding solutions to problems. Drawing or painting is another way to express feelings in a safe way. • Avoiding alcohol and drugs. They are depressants and always make feelings and thoughts worse.

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• Writing down some small, fun and achievable goals. Trying harder to focus on the future can help, especially by writing some rewards for when each goal is achieved. • Making a commitment to eat, sleep and exercise regularly. Exercise helps to stimulate the ‘feel good’ hormones (endorphins) in the body. Regular sleep can help decrease levels of frustration and allow the mind to relax. Junk food and fast food can increase feelings of depression and lethargy.

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• Deciding to make an appointment with a GP or other professional. It is important to understand that feelings are real and valid, and that asking for help is a smart, mature way of coping. I’ve felt suicidal so many times and it’s such a desperate feeling. Somewhere in the back of my mind, I really do know that I don’t want to die. Sometimes I forget that though and I start to make plans. Those plans can give me a focus, even if that seems warped. By the time I’ve written things down, I can almost feel the desperation leaving my insides. It’s what I count on every time. So far, it’s working. Brooke I’ve always thought I was hopeless at school and most of the time I hate it. I enjoy art though and I’ve learnt to draw, paint, scribble, anything really, just to get the feelings out of me. When I feel suicidal it helps to express myself through art and it doesn’t matter if no-one else understands it. I use it to get rid of the frustrations. Art gives me a reason to focus. While I’m drawing, I forget about needing to die. I forget about making plans. Drew 88

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Coping with someone who feels suicidal Young people especially might try to confide in a close friend about their suicidal feelings, long before they feel able to talk with an adult or professional. It’s a scary experience to hear that someone you care about has suicidal feelings and may want to end his/her life. Being supportive and helpful is not always easy in such a serious situation because the feelings experienced can be overwhelming. There are steps a person can take to protect a friend, and himself/herself. These include:

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• Encouraging the friend to get help by talking to a parent, teacher, doctor, counsellor or other professional. This may not be easy. There are help lines and websites that can be suggested as a starting point.

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• Not keeping secrets. Any talk about suicide and death should be taken seriously. Keeping a friend’s problems secret can cause personal distress and won’t be of any help if the friend reaches a crisis point. No matter how much the friend might ask for promises to say nothing, it is important to talk with another adult who is trustworthy. • Asking for a promise that the person will postpone the decision. Try to help the person come up with a goal to reach. • Avoiding arguments and simply trying to listen. • Being mindful of choosing the right time to talk.

• Gently reminding the friend that suicidal thoughts don’t need to be acted on and that there is no reason to believe he/she will always have those thoughts. Encourage the positives.

• Taking time to speak with someone trustworthy so that a friend’s problems do not become overwhelming. • Taking time away from the friend so that there is time to relax and enjoy personal activities.

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I became the only person my suicidal friend would talk to. I tried everything to convince him to talk to our school counsellor. He refused. I eventually spoke to Mum about him and she called his parents. They made an appointment for him at their family GP and made him go. He is seeing a counsellor outside of school and I don’t feel so scared and stressed anymore. I thought I was going to lose him but I also realised I couldn’t really save him. I’m glad I spoke up. It was too much pressure for me and I was a mess. William

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Listening to my friend talk about how she wanted to kill herself just sucked. I’d never felt like she did and I couldn’t understand why she felt so hopeless. I was angry with her because I thought she was being so selfish. We were best friends but I didn’t know much about her family situation. She was being abused and there was no way I knew how to deal with that. I stayed after school and went with her to see a teacher. I just sat outside but I was glad to do anything to help. I was much more relieved that someone could help her because I just felt helpless. All I wanted was for her to feel better about herself. I’m so proud now of how well she is coping. Tasha

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Suicide 1. Why do you think suicide is such a difficult issue for many people to discuss?

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2. Give reasons to explain each statement.

(a) Men are more likely to take their own life.

(b) Women have a higher risk of suicidal behaviour.

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4. Decide if the following are true of false.

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(a) People who talk about suicide are attention-seeking.

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(b) All suicides are impulsive acts.

(e) Anyone with a mental illness thinks about suicide. (f) All suicides are carefully planned.

(g) Suicidal thoughts don’t need to be acted on because they can change. (h) Any family can be affected by suicide. (i) Alcohol can make suicidal feelings worse. (j) Talking to someone on a help line can help prevent suicide. 90

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5. Everybody experiences distressing feelings sometimes. Write down three strategies you can rely on to help during difficult times.

r o e t s B r e oShort-term Short-term goal 1 p ok goal 2 u S

Step 1:

Step 2:

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6. Goal setting is an extremely positive lifestyle strategy. Write two short-term and two long-term goals that will encourage you in a positive way.

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Long-term goal 1

Step 1:

Step 2:

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Step 1:

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Who can I rely on? Complete the chart by adding the name of those people you can rely on.

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Start in the centre by writing the name of the person you can rely on the most.

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Write down some of the negative feelings you have, or have had. Add a positive coping strategy for each.

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Result

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Situation/Issue

Situation/Action plan

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Thoughts

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Identifying positive aspects of life

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Mark’s story Mark is my younger brother. I’m telling his story because he took his own life six months ago. I can’t imagine that any other day, for the rest of my life, will be as traumatic as that day. I was the one who found him, with a yellow rope around his neck, hanging from a beam in our garage. He was 16 years old. I am still dealing with a lot of issues surrounding his suicide but this story isn’t about me. It’s about Mark’s life, and death. It’s about how our family used to be.

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Our family was fairly regular. Dad had his own computer business, Mum worked part-time and beside Mark and me, there was our younger brother, Jason. Everything always seemed fairly ordinary to me about our family. Mum and Dad got on well most of the time and there was never anything violent or abusive going on in our house. I know they had their fair share of disagreements but nothing really serious. Jason was five years younger than Mark and I’m the eldest by two years, so Mark and I were the closest. I used to always feel a bit sorry for Mum that she was the only female in the house but it never seemed to bother her. Mark and I did everything together when we were really young. We shared a room, played footy in the backyard and got into our fair share of trouble together. Probably because I was the eldest, I was always the bossiest and I know I teased him a lot too. I was pretty much the confident, outgoing one and Mark was a lot quieter than I was. I know he looked up to me a lot. When I got to high school and Mark was still in primary school, things changed a lot. I found a new group of friends and wanted to do things without my little brother hanging around. Mark had a harder time than me too, when Jason was small. I was always at football training, or doing homework (maybe even chasing girls) so he had to spend more time looking after our little brother. I guess being the middle kid wasn’t always that easy. I was becoming more independent and Jason was the ‘cute one’. Maybe Mark felt a bit left out at times, though he never really complained.

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To be honest, Mark never really complained about anything. He didn’t get too emotional about things and he hated an argument or a fight. He’d usually just walk away. Mostly he did what he was supposed to do and I remember thinking that he was the ‘good one’ who didn’t do anything wrong. If we were watching something on TV and I wanted to change the station, he would let me. If he didn’t like the program, he’d just go to his room. Sometimes I’d feel guilty because I knew it was easy to get my own way with Mark. It just seemed like nothing bothered him and he was so easy going.

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When I moved up to a different football grade, Mark decided to stop playing. Dad wasn’t impressed with his decision. It was one argument I do remember the folks having! Dad called Mark a quitter and a wimp for not wanting to play without his big brother. Mum was furious, defending Mark and not speaking to Dad for a few days. I don’t know why Mark decided not to play anymore. I didn’t really ask, I don’t think. He wasn’t the world’s greatest footballer but I still thought he enjoyed the game enough to keep playing. Come to think of it, I probably thought he was quitting for no good reason as well. Easy for me to think that then, I was always winning ‘Fairest & Best’ awards. Anyway, Mark just stopped going to training, though he would still come to most games to watch me play.

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This is probably going to sound like I’m really big-noting myself but I think it’s important to tell. I was pretty much good at everything I did, whether it was football, school, getting the girls or being the ‘life of the party’. Most things I did were effortless, even studying for exams. I was always near the top of my class and I got on well with all my teachers. Mark, on the other hand, really struggled with a lot of schoolwork. I used to help him but I would get bored quickly with that. One subject that Mark loved was art and he was really talented and very creative. I know it was something he wanted to try and pursue after high school. The major problem was that he didn’t believe he was good enough. I now know that he struggled with his self-esteem a lot.

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As I’m telling this story, I can see so clearly how Mark felt about some things. I was the ‘popular one’, Jason was the ‘younger cute one’ and Mark just believed that he sat in the middle, being a nothing. I don’t believe any of us saw it that way in our family, although Mark was always very sensitive, especially to any criticism he received. It was when one of his high school teachers told him to forget about trying to be ‘some famous artist’ and concentrate on ‘real’ things instead, that he lost all interest in school. He also threw out a lot of his artwork.

Two weeks after Mark’s death, I found a journal he had been writing in for some time. It was well hidden but I was in such a rage that I practically tore his room apart. I sat for hours, oblivious to everything, reading page after page. His thoughts and feelings were interspersed with sketches that matched his mood. Most were dark, lonely and depressing line drawings that were colourless. There is a lot from that journal that I won’t share, so I won’t put in dates or names. Some things are just too personal. I’m hoping that someone can read what Mark has written and decide to talk to someone and get some help.

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That stupid exam we had today was so boring that I’m glad I didn’t study for it and I don’t even care if I fail. I still haven’t worked out why we have to learn some of the stuff they give us. I’m useless at exams anyway. Even if I know what the teacher is on about, I just go blank when I have to sit for so long and write. I hate high school. At least at primary school, there was a teacher who got to know you pretty well. There’s too many kids here.

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Maybe I am too quiet sometimes. I’ve got friends but we don’t mess around like my older brother does with his mates. They always seem to have loads of fun. I know I’m a bit more serious and worry about dumb things. The girls in my year always seem to talk nonstop. I don’t share my feelings much. Well, I think I can when I’m drawing but I don’t let many people see my art anymore. Most people like to see colourful stuff and that’s not how I feel. In a health class today we talked about how much families have changed. When I listen to other people, I know I’m pretty lucky. Most kids in that class have major problems at home. My family’s pretty basic compared to some of them. I just wish I fitted in better. I’m the boring one. I’m not good at much either.

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I am so sick of that idiot in my maths class. Every day he sits behind me and makes some smart remark to me. Today I wanted to stand up and throw my chair at him!! Why are bullies always such idiots??? Mostly I couldn’t care less about him but some days, he really upsets me. I’d love to tell the teacher what he says but what’s the point? He’ll probably just hassle me even more. The worst thing is that now he and his stupid mates hang around and give me a hard time after school. I wish I was more like my older brother and could stand up for myself. I don’t even know why they hassle me anymore. It’s been going on for ages. Maybe when I had my art displayed and they started calling me stupid names that they thought were funny. The teacher had a go at them but it didn’t help much.

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I was reading something on the Internet tonight about suicide and how kids think about it, sometimes a lot. There was a list of some of the reasons why kids called in to help lines. I don’t know why I think about it sometimes because I don’t have any of those major problems. Sometimes, I just feel like crap. Some days I get sick of that dumb group of bullies. Most days I think I’m just useless at most stuff. That’s the worst. I know if I was smarter, not so chubby, better at sport and could talk to girls easily, I’d be happier. Like my older brother. He’s so good at everything and I just wish I was more like him. They’re not great reasons probably to think about dying. I’m such a wuss sometimes.

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I’m sure you can understand how much I was crying my eyes out while I was reading this. I knew Mark was quiet but I never knew he felt so bad about himself. Like I said earlier, I’m dealing with issues now and a lot of them are about why I was so good at things and Mark didn’t think he was good at anything. When you’re caught up in all your own stuff, you just don’t see how others feel sometimes. The psychiatrist I see since Mark died keeps reminding me it’s not my fault but it’s so hard to convince myself. He says that when someone close to you suicides, you always have too many questions and you always blame yourself. It’s not very logical but that’s the way it is. I know my folks blame themselves every day as well. It’s like, why didn’t we all see this was how Mark was feeling? One of the biggest lessons I think we’ve all learnt is to make sure we share things more, especially as a family. We’re probably even closer now and we rely on each other a lot more. I know my folks are scared all the time. I guess you never really get over losing your own child. Especially not to suicide.

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School sucked today, big time. I wish I never had to go back there. Why can’t we live in the bush somewhere so I can do School of the Air or something and there would be no other people around to tell me how to do things that they think are right? The one thing I thought I was pretty good at … sometimes, was art. I was dumb enough in class to say I wanted to be an artist when I left school and heaps of kids laughed and the teacher asked if that was a ‘real job’. I was embarrassed and h-u-mi-l-i-a-t-e-d. I came home and ripped up most of the sketches and things I had been working on. I wonder if humiliation is a good reason to think you don’t belong and should be dead? For the past week, I have spent the entire time in my room after school. I don’t even want to hang out with any of my friends. I’m glad Jason has some big karate championship on because no-one is R.I.C. Publications® – www.ricpublications.com.au

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taking too much notice if I’m being quieter than usual. Life is just screwed right now and I’m sick of everything.

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Here’s where I started to wonder about what it was that set me off and what the difference was about how I handled things, and how Mark did. I guess I just didn’t let things bother me too much. Like I said, Mark was sensitive to a lot more things than I was. I know that if something or someone did upset me, I’d just sort it out straight up. Then I’d forget it. Everyone deals with things in different ways though and it seems like Mark let all the negative stuff stay in his head. Although it’s never bothered me much, some guys probably think it’s a bit of a ‘girl’ thing to do … you know ‘share your feelings’. Like you’re being a wuss if you talk about stuff that upsets you. I just hope that while you’re reading this, you can think of at least one person you can talk to when you feel bad about life. I know I wrote down some names. Obviously, life isn’t perfect all the time. Since I threw out most of my artwork, I’ve just lost interest. I don’t know what I want to be or do or have or anything when I’ve finished school … if I ever do! I just feel lonely and worried about what kind of future I’ll have. What if I don’t pass every exam and I don’t have a heap of friends who like me? I think the worst thing is feeling lonely and like I’m just useless at stuff.

Last night I felt worse than I’ve ever felt. I called one of those help lines but I got scared when someone answered and just hung up. It’s probably stupid trying to talk to someone you don’t even know. What are they going to do anyway? I don’t even know what I would say. No wonder I feel like such a nerd sometimes at school. I don’t even know what my problem is. Sometimes it’s nothing and then it’s just every single thing.

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How I wish Mark had made that call. I’m guessing he was trying to talk with someone on the Kids Help Line. They have a whole lot of counsellors who are trained to talk about anything and everything. I went on their website to have a look and some of the problems kids have really upset me. It looked like the staff spent a lot of time talking to each person who called in, no matter what their problem was. They must have access to all the professionals and places you can go to as well. Some of their information includes how they refer callers to different avenues to help even more. Maybe if Mark had called back, he would have realised that there was someone on the other end of the phone who would understand how bad he felt about things. I wish Mark had talked to one of us. A stranger who is qualified to talk about all the problems we have is the next best thing. I guess Mark just felt like he couldn’t open up to anyone. That’s what’s so hard to deal with. It’s so sad that he thought he had no-one to discuss things with. I just want him back so I can give him a big hug.

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I am so glad it’s the weekend. I’m not going to the footy game today and Jason is at his karate lessons for most of the morning. I told the folks I’d just hang out at home and they were okay about that. Mum did ask me if I was feeling alright but I just said, yeah and shrugged my shoulders. Pretty much like I always do. She knows I don’t like to say much and I’m glad that she doesn’t hassle me. Well, most times. Some days I wish I was like a real little kid again and I could just go curl up on her lap and get a hug. She’d probably put a fancy band aid on some imaginary sore and I’d feel so much better. 98

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I don’t reckon they’ve made anything to put on something that hurts inside. Especially when you don’t know what it is. I feel like drawing a big sign that reads, LIFE SUCKS! Wish I knew why. I wonder if other kids feel the same and think about giving up. I thought I’d do some drawings again but the first one I did was really depressing. I messed around with it for a while and then added bright yellow to one part. It scared me and I actually wished that everyone was home, making a heap of noise. It’s just all too quiet. I can’t be bothered writing too much more today. I just don’t care enough.

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I’m thinking it’s about now that Mark is having some seriously bad thoughts about life. Seeing that picture he drew, the one with the yellow rope, just made me lose it totally. I knew I couldn’t show this journal to the folks. Our house had become as silent as Mark felt it was on that day. It is creepy and sad and I cried a lot more. You might think this sounds horrible but I am so mad at Mark right now. It’s like everyone’s life gets wrecked as well. You just have to live with all these questions in your head and the only person who can answer them is gone. Even though I thought that I would be okay, I know I’m not. I reckon it will take forever to deal with Mark’s death. When I see my psychiatrist and we talk, I’m still surprised at how strong all the feelings are. It’s a great place to let out all my anger.

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Some days I catch myself talking about Mark just as though he was still here. Not much has changed in his room and all his stuff is still there. It’s all about the little things though that I want to tell him. Stuff I never thought about but I always talked with him about. He was a great listener. I wish I had been just as good. I know I’m not a kid anymore but every now and then, I can’t help but think that he’ll just be lying on his bed, drawing something. I’ll annoy him by jumping on the bed and we’ll just talk about nothing much. I never missed him every day, like I do now.

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After the week I’ve had, I just can’t see any hope. My so-called best friend asked out the girl he knows I like … and she said YES! I hate him and I hate her. I have a face full of zits and another stupid essay due tomorrow that I haven’t even started. I feel like writing “F*** THIS” just to see what reaction I might get. I don’t think I’ll hand anything in at all. It will probably be a week or two before the teacher gets around to marking them all anyway. By then, maybe I really won’t care.

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If just one single good thing could happen maybe I wouldn’t feel so bad. It’s like a whole heap of stuff is normal and then there’s this other side that isn’t. I hang out with the family, eat, watch TV … all that stuff. Then something changes and I feel like such crap I want to just die. The last few nights I’ve had dreams, I suppose some people would say nightmares, about being killed. Like a car hitting me or a terrorist attack or something dramatic. Probably not going to happen. If I did die, it would probably be something really boring. Some of those dreams are about me being a hero when I die, like saving the family from a fire or rescuing someone. It’ll never happen. I’m not special enough for that. I reckon if I tried to kill myself I’d probably mess that up as well.

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I’m not sure how hard you find this to read but I’ve never thought about wanting to die like Mark has. Things might get bad sometimes but I’ve always thought you can work it out. I just don’t understand how someone who was only as young as 16 can think such morbid thoughts. It’s not as if our life was a bloody disaster area or he was blind and deaf and couldn’t walk or talk. If Mark was here right now, I would want to just shake him that hard. I am so angry he felt that way. I am so sad he felt that way. I am so ashamed that I am angry at him when he was struggling so hard to find some reason to his life.

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I asked my psychiatrist yesterday to give me a reason why someone who is young thinks that he would be better off dead than alive. I just can’t get my head around it. He said, ‘People are complicated and we all react to different things in different ways’. I think it’s a lot to do with all the violence we see around us as well. Again, he said the same thing, ‘We all see things differently’. I wondered if Mark realised that his actions that day would really be forever. The end. Did he expect someone to find him sooner? Was he trying to call out? Did he imagine that he would be resuscitated by whoever found him, like happens on TV? More questions that haunt me all the time. Ones I’ll never get answers to.

I know it’s too late for Mark but what I want to know is, how can you tell if someone is feeling so bad that he or she is thinking about suicide? I think about it a lot and spend time going over tiny details, things that perhaps I should have seen earlier. There are a whole lot of things I know nothing about but there is one thing I have decided. No matter how old or young someone is, I don’t think they ever really mean to die. I think they’ve just given up for a bit and can’t see any other way. I have to believe that Mark just got so overwhelmed by everything he was feeling and thinking. The most important thing I’ve discovered is that when you get to feeling like that, you absolutely HAVE to do something about it. There are always other options. There is always someone to help. The bad stuff will go away. It’s like my nanna says, ‘The sun will shine tomorrow, even if it’s a bit cloudy’.

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The folks have planned a weekend away to celebrate their wedding anniversary. Nanna’s going to stay over, mostly to keep an eye on Jason. She’s a great cook and she always fusses over us all. ‘My three grandsons’ she calls us. She’s pretty old-fashioned but I do love her. Except when she wants to try to read me a story before I got to bed!!

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For the first time in my whole life, I almost cried when the folks left. It felt like I was never going to see them again. Just this bad feeling I had. It stayed with me and then I couldn’t have cared less about Nanna coming to stay, or her cooking. I ate nothing, just went to my room. Jason can be Nanna’s boy, I’m too old for that now. Just like everything. Too old, too young, too ugly, too stupid, too fat, too useless. I drew another picture but it was almost the same as the last one. I ripped it up. When Nanna took Jason to karate, I stayed home. I told her I would be fine by myself and said very sarcastically, ‘I’m sure my big brother will be home with all his friends soon anyway’. She had a sad look on her face but I didn’t care. I don’t care about anyone today, least of all me. I decided I could either go into my room and cry like a baby over everything, or make a plan. I chose the plan. 100

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Except for the folks being away, this Sunday was like most. Jason went to karate and I went to footy. Usually I brought home a few friends after the game and we hung outside. Lately, a few of the girls had come back to the house as well, so sometimes we had a barbie by the pool. I remember I checked in on Mark when I got in but he was doing his usual. Lying on his bed and drawing or something. I told him he should come out but he didn’t look impressed with the invitation, so I left him.

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By the time Nanna got back with Jason, we were still outside and everyone was in good spirits. We’d won the game, so there were a few beers and plenty of sausages to get into. It really was a regular thing. Mum, especially, was much happier to have us at home. She thought she could at least keep an eye on what we were up to if we were here! I wish she had been home that day. I wish nobody had come back to celebrate the win. I wish Mark hadn’t felt left out. I wish Mark hadn’t died. I wish I hadn’t found him. I know they’ve won their game and all the cool guys and gorgeous model-type girls are out there having a great time. When Nick told me to come out and join them, did he really think I would?!! No-one would bother talking to me! All the girls wanted was to show off to the guys and all the guys wanted was to have a few beers and check out the girls. I knew I’d just be ignored. Last time I joined them all, some girl said, ‘Oh, my god, I can’t believe you’re Nick’s little brother!’ Like I was some deformed weirdo or something. I can’t manage to say anything cool around one girl, let alone a whole group of them!

© R. I . C.Publ i cat i ons Listening to everyone having such a good time has just made my mind snap. I just can’t stand it any •f orr evi ew pur posesonl y• longer. I am so sick of being the boring, ugly, useless one. SICK OF IT!! It’s no-one else’s fault. Just

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stupid me for being this way. All this crap I’ve written about my sorry screwed-up life—I can’t take it anymore. That picture I had drawn, the one that had scared me before—right now, I don’t feel scared. I just don’t see a reason to live any more. I feel my mind go blank, like a robot. I’m about to put this journal back where it belongs. Maybe someone will find it in a few months but I won’t be around to worry about that. I think I’ll swipe a can of beer from the fridge before I go to the garage.

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By around eight that night, everyone was on their way home. It had been a long day, a great weekend actually. The folks were due back in a few hours so I figured I’d wait up for them. As I picked up the last of the empties, I was thinking about how happy they were to be going away and spending some time together. I guess that once you get married and have kids, there’s not a lot of time for that. It’s almost impossible to believe, even now, that I had such great thoughts in my head at the very time that Mark was alone in the garage. I tried to imagine what he was thinking at the time, but I just can’t. When I agreed to write about what happened to Mark, I did it for one reason only. I did it in the hope that one person might read it and decide that their life was more important to them than they thought.

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Drugs and mental illness

Indicators • Understands that drugs can have a negative impact on mental health. • Realises that drug use has a direct effect on the brain. • Recognises that drug reactions vary according to different factors.

Discussion points

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• Define and discuss psychosis and how drugs can contribute to this state developing.

• Reinforce that all drugs carry risks and no-one really knows how a particular drug will affect him/her at any given time. • Highlight the different factors that influence drug reactions and discuss in detail. • Discuss any current reports on drug use and their consequences.

Answers

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• Reinforce that different factors can trigger a mental illness and that drug use is one of those factors.

1. (a), (d) and (h) are false

(b), (c), (e), (f), (g), (i) and (j) are true

Additional activities

• Make a list of all the drugs students are aware of. Categorise into legal and illegal drugs.

• Describe the effects that drug taking can have on a person who is vulnerable to developing a mental illness. • Create a poster to highlight the dangers that drugs can have on a person’s mental health.

2. Student responses will differ. Suggest discussing reasons given and alternative strategies in small groups or as a whole class. 3. Student responses will differ. Suggested responses could include:

• Choose one drug to research. Write a report and include information on product and street names, symptoms associated with the drug, potential consequences of using the drug. Discuss how the drug can affect the user’s mental health. (page 105) Useful information sites for students: – Australian Drug Foundation <www.adf.org.au> – Australian Drug Information Network <www.adin.com.au> – Where’s Your Head At? <www.drugs.health.gov.au>

Why are young people more at risk?

Why are there more emergency department admissions?

What types of drugs increase the chances of developing a mental illness?

What can young people do to avoid drugs?

• ‘Alcohol is legal and part of the Australian culture.’ Discuss this statement.

What should someone do if a friend has reacted badly to a drug?

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How do drugs induce psychosis?

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• Imagine you are a nurse, paramedic, doctor or police officer. Write a letter to the newspaper that outlines your concerns about drug use among young people. • Use the Internet to find reasons why drug use has been linked to mental health problems.

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Drugs and mental illness Drugs can have a serious impact on a person’s mental health. Research indicates that there is a link between some mental illnesses and drug use. It is clear that some drugs can trigger a mental illness, especially depression and psychosis. If a person is already vulnerable to mental illness, then drug use can contribute to that illness developing further. A person with a mental illness can be at a higher risk of using drugs to ‘manage’ symptoms. Any drug—alcohol, nicotine, caffeine, prescription and illicit drugs—can affect a person’s mental health in a negative way.

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Drugs have a direct effect on the brain. These effects include:

• loss of inhibitions

• sedation

• increased anxiety, restlessness

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• feelings of relaxation, wellbeing, euphoria • increased talkativeness

• depression

• confusion and panic

• aggression

• inability to concentrate and remember

• paranoia, hallucinations and delusions.

The effects of any drug can last from minutes to hours, and much longer with more serious and sustained use. All drugs carry risks and can be especially dangerous when mixed. It is impossible to be sure what effects any one person might experience from any particular drug. Different people can have different reactions to the same drug, and one person can have a different reaction each time he/she uses the same drug. Drug reactions vary according to factors such as:

• gender

• the amount taken

• a person’s mood

• how the drug is taken

• the setting

• previous use

• other drugs taken.

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• the strength or quality of the drug

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Drug use among young people has increased and the full extent of mental health problems associated with this issue is yet to be realised. It is a fact that hospital emergency departments are becoming overwhelmed with people suffering the effects of drug use. More and more people are being treated for drug-induced psychosis, especially after using amphetamines such as crystal methamphetamine, commonly known as crystal meth or ice.

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It is important for young people to think carefully about the decisions they make concerning drug use. Since most mental illnesses first appear during adolescence, drug use can seriously impact on a person’s ability to cope and recover. It must be remembered that anyone is at risk of triggering a mental illness, one that may be lifelong, when he/she uses or abuses drugs. I’m prone to mild depression when I feel stressed and under pressure. I’ve tried drinking alcohol a few times, hoping that would help me feel better. It doesn’t. My depression gets worse and twice now, after a few beers, I’ve felt suicidal. I’ve finally realised that mixing alcohol and depression is just not worth the risk. Jack

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Drugs and mental illness 1. Write true or false for each statement. (a) Drug use causes mental illness.

(b) Some people with a mental illness may use drugs to try to alleviate symptoms.

(d) Drug use among young people continues to decline.

(e) Drug reactions vary from person to person.

(f)

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(g) Amphetamines can induce psychosis.

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(h) Once a person is used to a drug, his/her reaction will always be the same. (i)

Drug use can make an existing mental illness worse.

(j)

All drugs have a direct effect on the brain.

2. Listed below are some reasons adolescents have given to explain why they have used drugs. Suggest an alternative strategy and/or activity for each. ToC feel. accepted friends A way to relax © R. I . Pubyb l i cat i ons •f orr evi ew pur posesonl y•

A way to cope with boredom

A way to cope with problems

Depression

Dealing with stress

Because they’re easily available

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Dealing with painful feelings

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Rebellion against parents

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Curiosity

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Everyone else is

3. Devise a list of 6–8 questions that you could use to interview a mental health professional about the issues of drug use, in relation to young people and mental health problems. 104

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Drug research report Product

Street names

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Symptoms

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Getting help

Indicators • Recognises the difference between private and public practice. • Identifies the qualifications and expertise of different health professionals. • Understands the nature of an appointment with a health professional.

Answers r o e t s B r e oo p u k S

• Differentiates between voluntary and involuntary hospital admission. • Appreciates reasons why a person may be admitted to a hospital.

1. GP: medically qualified doctor, prescribe medication, make specialist referrals, arrange hospital admission.

• Reinforce that a family GP is the most appropriate person to approach first.

Psychiatrist: medically qualified doctor, additional specialist training in mental illness, prescribe medication, arrange hospital admission. Works in private or public practice.

Psychologist: qualified in psychology, not usually a qualified doctor so cannot prescribe medication. Works in private or public practice.

• Highlight the differences between a psychiatrist (trained doctor with extra specialist training) and a psychologist. Discuss similarities. • Explain that there are many counsellors and therapists who are sufficiently trained but that it is possible for anyone to call themselves a ‘therapist’. • Discuss that most therapies are not ‘like the movies’ where extensive sessions are scheduled for many years. Most mental illnesses can be treated more easily and managed well. Individuals who suffer from the more serious illnesses may require a more detailed treatment plan.

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Discussion points

Additional activities

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• Ask students to locate contact details for professional services. (page 109) Useful information for students - Office of Mental Health (Western Australia) <www.mental.health.wa.gov.au> • Research the role of a healthcare professional and present a written report.

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• Design a card for someone who has been admitted to a hospital for a mental health problem.

3. Student responses will differ. People might feel anxious because they are scared or embarrassed, worried about the stigma of seeing a psychiatrist, fearful of the diagnosis and treatment.

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• Discuss the differences between voluntary and involuntary hospital admission and that there are professional documents that need to be signed for a person to be admitted involuntarily.

2. Symptoms of mental illness rarely disappear on their own and seeing a professional can help with a correct diagnosis and treatment.

4. Student answers will differ. Qualities may include trustworthy, sincere, caring, patient, understanding, kind, professional. 5. Student responses will differ. A patient might ask about diagnosis, cost, number of sessions required, type of treatment, medications, specialist’s qualifications, confidentiality.

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• Use a professional website (such as <www.ranzcp.org> – the Royal Australian and New Zealand College of Psychiatrists) to research types of therapies a psychiatrist might use in the treatment of a mental illness.

6. Student responses will differ. A professional might ask about family history and dynamics, medical history, reason for attending, drug and alcohol use, personalty style, coping strategies, support networks. 7. Voluntary hospital admission is when a person requests to go or his/her treating doctor suggests they go. Involuntary admission is when a qualified doctor (usually a psychiatrist) signs a document to admit someone who is not capable of taking care of himself/herself, is a danger to himself/herself or to others.

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Getting help There are a number of different healthcare professionals who can help a person who is experiencing symptoms of mental illness. Some charge a set fee and work in private practice, while others are funded and work in public hospitals and clinics. Some may divide their time between public and private practice. General practitioner (GP) A GP is a medically qualified doctor. This is the best person to see first with any physical or mental health problem. Most GPs have experience at recognising mental health symptoms. They can prescribe medication, make a referral to a specialist and arrange hospital admission.

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Psychiatrist A psychiatrist is a medically qualified doctor who has completed additional years of specialist training in the treatment of mental illness. Because a psychiatrist already has medical qualifications, he/she can prescribe medication and also arrange admission to hospital. After a diagnosis is made, the psychiatrist will discuss a treatment plan that best suits the needs of each individual. A psychiatrist can work in a private practice, in the public system or sometimes in both. Psychologist A psychologist has a qualification in psychology (the study of the mind). A psychologist is trained to provide psychological treatment. Psychologists are not qualified to prescribe medication unless they are also qualified as medical doctors. Some psychologists work in the public system, though many operate privately.

Other professionals There is a range of other people who do not have medical or psychology qualifications but who are trained to deliver mental health services. These may be counsellors, therapists, social workers and nurses. It is best to check with your GP to ensure you are getting the right professional treatment for your particular illness.

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Visiting a mental health professional might seem a little scary and it is understandable for someone to feel anxious. Some people take a family member or friend with them, though that person does not have to actually go in for the session. The first session will involve questions from the professional to make an assessment of what the issues are. These initial appointments are a little longer than normal. The professional will understand that it might be a difficult experience for the patient. He/She is trained to ask questions carefully and put people at ease. Once there is a general idea of a diagnosis, he/she can offer a treatment plan and discuss what should happen next. A follow-up appointment is usually made for quite soon after so any plans can be monitored carefully.

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Hospital admission There are two ways that someone can be admitted to hospital with a mental health problem: either voluntarily or involuntarily. A voluntary admission is when a person requests to go, or his/her treating doctor suggests it. A person is admitted involuntarily if he/she does not seem capable of taking care of himself/herself, he/she is a danger to himself/ herself, or to others. A qualified doctor must sign a document to admit a person involuntarily. There are psychiatric wards within public and private hospitals. A person can also be admitted to a public or private clinic that specialises in mental health problems. Spending time in a hospital or clinic can be a helpful way to: • find out what the problem is

• stabilise or trial medication

• make use of intensive treatment offered by a variety • take time out from normal routines and pressures in of specialists a safe environment.

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Getting help 1. Record the main points relevant to each professional.

General practitioner

Psychiatrist

Psychologist

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2. Suggest reasons why it is important for someone who has symptoms of a mental illness to visit a professional.

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3. Give reasons to explain why someone might feel anxious about visiting a mental health professional.

4. List the qualities that you would expect a mental health professional to have.

5. Write four questions that a patient might ask a health care professional on the first visit.

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6. Write four questions that a health care professional might ask a patient on the first visit. 7. Explain the difference between voluntary and involuntary hospital admission. 108

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Getting help—Contacts Record the contact details for each of the nearest services.

Emergency

Phone Address

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Hospital emergency department

Mental health emergency team

Phone

Address

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Community mental health centre

Adolescent mental health centre

Phone

Address

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Community support group

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Specialist psychiatric clinic/hospital Public

Private

Phone

Address

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Treatments

Indicators • Appreciates that there are a variety of treatments to suit different people’s needs. • Shows an understanding of the more common treatments available. • Recognises that exercise, relaxation, quality sleep and a healthy diet are important in the treatment of any mental illness.

• Explain that there are many different treatment approaches. Highlight that individuals react differently and so one treatment may work for one person, but not for another. • Define the terms psychotherapy, cognitive, assertiveness. • Emphasise that medication is rarely the first line of treatment for adolescents, mainly because their brains are still growing and personalities are still forming. • Establish that exercise, relaxation, sleep and diet should be areas that are constantly monitored to help alleviate symptoms of mental illness. • Differentiate between relaxing activities and the need to learn how to actively relax to change the way the body feels and reacts under stress.

Answers

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1. Individual therapy aims to develop a trusting relationship so that personal issues can be discussed and solved.

Family therapy aims to support everyone involved and provide a safe situation in which to solve problems and discuss important issues.

Group therapy aims to give people the opportunity to interact with others who have similar problems and to develop stronger, healthier relationships.

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• Discuss the concept of cognitive behavioural therapy and ask students to change negative statements into positive statements. (page 115) • Describe a time when you felt you were unable to assert your rights in a healthy way. Suggest an alternative way you could have dealt with the situation.

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Natural therapies include exercise, relaxation techniques, quality sleep, healthy diet, art therapy, meditation, yoga, massage therapy, light therapy, acupuncture, naturopathy, homeopathy, kinesiology.

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• Write assertive statements that could be used when someone is feeling peer pressure.

• Participating in enjoyable activities can help in the treatment of a mental illness. Ask students to take an artistic approach to create a piece that highlights the activities they find enjoyable and rewarding. • Use an art style to represent a personal image that you might visualise when you are feeling under pressure.

• Research an alternative therapy mentioned and create a brochure to explain the approach.

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2. Professional treatments include psychotherapy, cognitive behavioural therapy, assertiveness training, structured problem-solving, medication, electroconvulsive therapy.

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• Structured problem-solving is an effective tool that can help with finding alternative ways of coping. Discuss the aims and steps of this strategy and allow students to work through a chosen problem. (page 114)

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3. Brains are still growing and personalities are still forming in adolescents. 4. Students response will differ.

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Treatments There are a number of treatments available to manage a mental illness. Different treatments will suit different people and not everyone will respond in the same way. Choosing the treatment that best suits an individual can be challenging at first, but most people are able to find a combination that works best for them. Treatments most used include therapy and training, medication and natural therapies Therapy and training

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Psychotherapy is the treatment used in a working relationship between a trained therapist and a patient who needs support. Different professionals use different approaches to therapy, and these will depend on the nature of the illness. Individual therapy is based on developing a trusting relationship so that personal issues can be discussed and solved. Family therapy aims to support everyone involved and provide a safe situation in which to solve problems and discuss important issues. Group therapy offers the opportunity to interact with people who have similar problems and to develop stronger, healthier relationships with others. Cognitive behavioural therapy is a very effective treatment for depression and anxiety, that aims to work on alternative ways of thinking and better ways of managing symptoms. A mental illness affects the way a person thinks about things and this thinking can become very negative. Cognitive behavioural therapy helps to recognise unhelpful thoughts and how to challenge them with more realistic and positive thoughts. It can help someone to understand how and why he/she thinks, feels and behaves that way and then develop new ways of coping. The therapy encourages people to become more responsible for their own mental and physical health, to manage stress, improve relationships and increase self-esteem. Cognitive behavioural therapy is a structured program that can be completed in an individual or group setting.

who is not assertive can be more likely to feel depressed and anxious, especially during times of stress. Becoming more confident and learning new skills can help to relieve tension and reduce the symptoms of depression.

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Structured problem-solving can help in finding new ways to cope with, and resolve, stress. When someone is depressed, his/her problem-solving skills are less effective than normal and situations can easily become overwhelming. Improved skills can help with identifying the problem and options available, listing advantages and disadvantages, choosing the best option and then listing steps to carry out the preferred option. Learning how to effectively deal with problems is important in the ongoing recovery from mental illness and is a valuable life skill.

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Medication can be useful (and is sometimes necessary) in treating a mental illness. Not everyone requires medication and it is generally not the first line of treatment for adolescents because brains are still growing and personalities forming. The medications most used include antidepressants, mood stabilisers and antipsychotics. Medications can only be prescribed by a general practioner or psychiatrist. Some people can trial a certain medication and experience benefits quite quickly. For others, finding the most suitable medication can be harder. Because any mental illness affects people in different ways, so medications will also affect people differently. What works for one person may not work for another with the same illness. Electroconvulsive therapy is most commonly used to treat severe forms of depression. It is particularly useful for those people who do not respond well to drug or other treatments. Electroconvulsive therapy is safe and usually very effective. It works on stimulating certain parts of the brain to help relieve serious symptoms. A treating psychiatrist can best determine if this therapy would be beneficial. R.I.C. Publications® – www.ricpublications.com.au

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Treatments Natural therapies Exercise, relaxation and quality sleep are easy and practical ways of relieving some symptoms of mental illness. Maintaining a healthy, well-balanced diet is also important. Research indicates that using exercise as a therapy can help to significantly reduce the symptoms of mental illness. Some form of daily exercise can have a positive effect on someone who is suffering a depressive illness. Although lack of motivation and energy are major symptoms of depression, those who can make exercise part of a basic routine can greatly benefit. Exercise contributes to improved sleep patterns, reduces stress and positively affects mood. Regular exercise can be part of a social activity and this helps to promote healthy relationships and improve anxiety symptoms.

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Sleep problems are very common in those who have a mental illness. People can have difficulty getting to sleep and staying asleep. Poor quality sleep causes irritability, poor concentration and a lack of energy. It can make recovery from illness much more difficult. A health professional can advise on the most effective ways to deal with sleep problems. Some basic rules to follow include: • wake up at the same time every day

• avoid alcohol, nicotine and caffeine

• avoid staying too long in bed and taking unnecessary naps

• do something relaxing before set sleep times.

Relaxation Learning how to relax is an important treatment in the management of any mental illness. Relaxation can help with:

• improved sleep patterns

• more effective communication

• work performance.

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Relaxation means different things to different people. Playing, reading, watching TV, taking a bath and walking can all be relaxing activities. Learning how to actively change the way the body feels and reacts under stress is a skill that can be used to improve symptoms of illness. Knowing how to practise relaxation techniques can help a person take better control of the way his/her mind is working. Three of the most common relaxation techniques are:

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• controlled breathing. This is a simple strategy that involves breathing in through the nose, then breathing out through the mouth. The idea is to focus on the actual breathing to relax and imagine tension flowing out of the body. • visual imagery. This involves imagining yourself in a pleasant surrounding or situation that is relaxing. The idea is to focus only on the pleasant thoughts and feelings and release the negativity and stress. By picturing the scene in detail, and using all the senses, the mind can focus in a stronger way. • muscle relaxation. This involves a focus on slow breathing and tensing and relaxing muscle groups, one at a time. Art therapy involves time with a trained therapist to explore feelings and thoughts creatively. Specialist therapists can help a person to use art to deal with stressful and distressing experiences. For some people, being able to express themselves through art can be much more effective than just using words. Art therapy allows the opportunity to express emotions that might be difficult to explore in other settings. Meditation, yoga, massage therapy, light therapy, acupuncture, naturopathy, homeopathy and kinesiology are all treatments that can help some people to manage mental illness symptoms. 112

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Treatments 1. Identify the main aim of each of the following therapies. Individual Family Group

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2. List the treatments available to treat mental illness.

3. Explain why medication is generally not the first line of treatment recommended for adolescents.

Day

Exercise

Relaxation

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Diet

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Sleep

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Structured problem-solving Structured problem-solving aims to help a person work logically through a problem.

Structured problem-solving aims to help a person work through a problem using specific steps:

It is important for:

1. Write down exactly what the problem is.

• recognising why a problem feels overwhelming

2. Decide what options are available.

• realising personal strengths and the support available

3. List the advantages and disadvantages of each option.

• remembering how problems were previously solved

4. Decide which is the best option.

• learning new approaches to deal with difficulties

5. Identify the steps needed for the chosen option.

• helping to feel more in control of problems

6. Go ahead with the chosen option and evaluate how effective it was.

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• understanding ways to deal with future issues more effectively.

Problem:

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Option 1:

Option 2:

Option 3:

Advantages:

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Best option: Steps needed: 1. 2. 3. 4.

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Disadvantages:

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5. 6. Evaluate:

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Cognitive behavioural therapy Cognitive behavioural therapy is based on finding alternative ways of thinking. When people are depressed, anxious or stressed they can often have negative feelings about themselves and the world. Cognitive behavioural therapy helps to challenge negative feelings and turn them around into more positive thoughts. Negative thoughts can have a huge impact on the way we feel and behave.

r o e t s Bo r e p ok u Negative statements Positive statements S

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Challenge the following negative statements with more positive statements.

I’m no good at anything. I always mess things up. It’s all my fault.

No-one cares about me.

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Things will never change. No-one can help me.

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Everyone hates me. I’m hopeless. I feel ugly.

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I’m stupid.

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How to help

Indicators • Recognises effective ways to help someone who has a mental illness. • Understands that family and friends can be affected when someone has a mental illness. • Appreciates that children are vulnerable when someone they love has a mental illness.

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Discussion points

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• Discuss the importance of the support of family and friends.

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• Discuss the list of ways that family and friends can be supportive.

Answers

• Identify the difficulties carers can face when looking after someone who has a mental illness.

1. Student responses will differ. Students should be referred to the fact sheet and choose those ways that most apply to them.

• Discuss the ways family and friends can be affected when someone they care about has a mental illness. • Consider reasons why children are vulnerable when a loved one has a mental illness.

2. Student responses will differ. Suggestions include statements such as ‘get over it’, ‘you’re lazy/boring/annoying’, ‘don’t be such a wuss’, ‘just think happy’, ‘you should be able to cope better’, ‘there’s people much worse off than you’.

• Design a poster or pamphlet that emphasises the effective ways that people can help someone who has a mental illness. • A friend has just been diagnosed with a mental illness. In a letter, outline the ways that you would be prepared to help. • Find information about community services that provide support for carers.

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• Create a children’s book that could be used to introduce the subject of mental illness. Use computer graphics or pictures to illustrate the pages. With careful editing, completed books could be used to introduce the topic to a group of younger students.

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3. Student responses will differ. Suggestions include worrying about suicidal and reckless behaviour, concern if there is social isolation, a decline in school results, feeling obliged to ‘keep watch’ all the time, trying to stay positive and patient, learning about the illness diagnosed, alleviating pressures from the child, ensuring treatment plans are adhered to.

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Additional activities

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4. Carers need support so that they don’t become overwhelmed and isolated, or feel under pressure to fix everything. Carers can look after themselves by eating well, exercising, sleeping regularly, taking time out for themselves, staying in touch with friends, developing a network and joining a support group. 5. Student responses will differ depending on the types of services available in individual communities.

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How to help someone with a mental illness One of the most important ways that someone can recover from a mental illness is to have supportive family and friends. Here are some ways to help: • encouraging the person to get professional treatment • accepting that the illness is a genuine medical problem • understanding that the illness is not someone’s fault • encouraging the person to stay with the treatment • being patient

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• keeping in contact as often as possible

• encouraging the person to focus on the positives • involving the person in activities he/she enjoys • being predictable • learning about the illness to have a better understanding

• letting the person and his/her doctor set the pace of the treatment

• appreciating that the person is trying to do his/her best to get well • trying not to judge or add any extra pressures

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• listening

• trying not to feel put out if the person can’t manage a get-together one day

• understanding that there is no overnight ‘magic cure’ • being alert for any signs that the person may be having a relapse • remembering that saying just ‘get over it’ is pointless—the person would feel better if he/she could!

© R. I . C.Publ i cat i ons I have a friend who calls me every single week, no matter what. Sometimes I don’t want picku up r thep phone, bute I’ms always gladl when• I do. It just •f orr ev i e wto p os on y reminds me that someone is thinking about me.

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How others are affected

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Family and friends are often greatly affected when they are close to someone who has a mental illness. A sufferer can be moody, withdrawn, anxious, lethargic, angry and even aggressive. It is not always easy to be fully supportive and recovery from mental illness can be a long, gradual process. Family and friends might become confused and frustrated by someone else’s illness. They might feel angry that the person is unable to do different things, and then guilty that they feel that way. Close family and friends can often feel isolated and helpless. They might feel it’s their ‘job’ to ‘fix’ the person and end up wearing themselves out with the stress. Carers need to take good care of themselves and make sure they have their own support.

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It is important to remember that the person with a mental illness is not to blame, and neither are the family and friends of that person. A serious illness can affect people in different ways so it is vital to have open and honest communication among everyone affected, and learn about symptoms, treatment and how to be helpful. There are groups available to support family and friends and many of these have training and education courses. Children who are affected by a family member suffering with a mental illness are especially vulnerable. They need guidance and reassurance that they are not at fault. Children need to be shown that their parent or sibling has not changed the way he/she feels about them. It is important for children to know as much as possible about the illness and how it is affecting their family member. R.I.C. Publications® – www.ricpublications.com.au

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How to help 1. Imagine your best friend has been diagnosed with a mental illness. Write down the six most valuable ways you would be able to help. • • • •

•

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2. Write five statements that would be unhelpful for a person diagnosed with a mental illness to hear from a friend or family member. • • •

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4. Explain why it is important for carers to receive support.

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with a mental illness.

Suggest ways that carers can look after themselves. 5. Recommend three ways that your community could be more supportive of people with a mental illness. • • • 118

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Where to find help Telephone services Dial 000 in an emergency General Practitioner (see Yellow Pages for listing) Mental Health Team (see Community Health Centres in the White Pages)

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Kids Help line . ................................................... 1800 551 800

Lifeline 24-hour counselling ...................................... 13 11 14

Samaritan Youth line . ........................................ 1800 198 313 SANE Australia provides a helpline service on 1800 18 SANE (7263)

Websites

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Lifeline Just Ask (information line only) . ............. 1300 13 11 14

www.anxietynetwork.com.au . .................. Information on anxiety disorders www.beyondblue.org.au . .......................... Information on depression

www.eatingdisorders.org.au ..................... Information on eating disorders

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www.depressionet.com.au . ...................... Information on depression

www.headroom.net.au .............................. Mental health information for young people

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www.headspace.org.au ............................. National youth mental health foundation

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www.itsallright.org .................................... Sane site for young people

www.kidshelp.com.au ............................... Information, telephone and email counselling for young people www.kidsinmind.org.au ............................ Child and youth mental health services

www.mmha.org.au .................................... Multicultural mental health and suicide prevention www.orygen.org.au ................................... Youth mental health services www.reachout.com.au .............................. Information about suicide prevention www.sane.org ........................................... Information and referral service www.ybblue.com.au .................................. Information about youth depression www.youthfocus.com.au . ......................... Information and support for the prevention of youth suicide R.I.C. Publications® – www.ricpublications.com.au

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