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Transcript - Helping Students in Distress



What we're going to talk about is mental health. We've labeled it "identifying and responding to students who are in distress", but it's really an introduction to mental health. When it comes to mental illness, what types of assumptions do people tend to make? Good question. Lots of people feel apprehensive or fearful about mental illness.

They often assume, for example that people with mental illness are unpredictable. Uh they sometimes think that people with mental illness are dangerous to other people. They sometimes assume that people with mental health problems, particularly with a problem of something like depression, which isn't always very evident to other people, they think that when people complain of depression, are emotional, that they're being self-centered or weak or lazy. We know that the prime age for the onset of a mental health problem is around the age when students are in post-secondary education, college or university, so between 17 and 25.

And we know that lots of people who develop mental health problems suffer in silence because they are ashamed or embarrassed to seek help. Mental health problems are likely to occur in about 1 person in 5 over the course of their lifetime, which means that if we count all of our friends, our associates, people we work with, people in our class, we're going to encounter a significant number of people or ourselves who have a mental health problem. People used to think that when a person would become depressed, they just needed to pull their socks up, kind of motivate themselves, get back to action and they would be better.

But in fact, we know mental health problems create more lost time from work and more lost pleasure in life than any physical health conditions. They are hugely disabling. And when there are incidents that happen where a person with a mental health problem has been violent, there's often a great deal of attention paid to it in the media, we hear lots of reports about it and then, unfortunately, all that news goes away.

Most people with a mental health problem pose no risk to other people. There have been significant achievements in the area of medication for mental health problems, you could treat people with psychosis, with depression, with anxiety. There are also significant improvements in what we would call "talking therapy" -- psychological therapy and this would include cognitive behavior therapy, relationship therapy.

Now we know that approximately 90% of people who develop a mental health problem will be able to go back to their ordinary day-to-day level of functioning before they became ill. The continuum of mental health is intended to convey the fact that we, all of us, have a mental health life, we, all of us, may have ups and downs in our mood, changes in our level of anxiety, that result from life stresses or from uh crises that may happen in our lives.

So the continuum begins with days when our health is good, we are capable of doing all the kinds of things that we would ordinarily do. So we would describe that as "normal" or "healthy" functioning.

The next level is uh what we call "reacting". There are moments in our lives of what we call "predictable stress". We would expect students to have a certain level of stress perhaps in first year, around moving in and again around midterms and again around finals. That's predictable, expectable and it's reversible. A student who is distressed, stressed about exams and about the workload in late November knows -- 4 weeks from now, I'll feel a lot better.

If you look further up, you move into what they call the "injured" stage and in the injured stage now what's happening is the disruption is becoming more serious and it's not just that a student may feel stressed a little bit and is able to go home and sleep; now the disruption is beginning to eat into and erode other parts of their life. So you see what we call "functional impairment" -- the person may have more difficulty attending or concentrating. They may be able to work fairly effectively during the day and then they go home at night and when they lie down to go to sleep, they start to worry about all the things that are on their plate. And they start to worry about other stuff, not just academics or work; they worry about lots of stuff. So sleep becomes disrupted. And of course, without sleep the next day they don't feel 100%.

And then the final stage is well what is called an ill stage. And this is where the person is a full-fledged diagnoseable psychiatric problem such as depression or anxiety, post-traumatic stress disorder whatever. The amount of disruption in their day to day lives is so great that they often can't function effectively. As a student they may need to drop courses or take time off.  As an employee they may need to take a break from work they may in some cases need to be in a hospital. So it's now a full-fledged mental health disorder.

Emotional control means that for most of us most of the time we can manage and regulate our emotions so that even if we encounter something that distresses us or we have a preoccupation that's in the back of our mind, we can kind of put it to one side and continue on with the rest of what we need to do during the day. A person with a mental health problem often finds it difficult to control aspects of their behavior; for example, they find it difficult to control their emotions. They were in a movie and they suddenly burst into tears. And so you ask, "well, was the movie sad?" -- which might explain the crying. And they say, "no, actually the movie was happy; I just burst into tears."

Difficulty with concentrating has to do with how we absorb and take in information. Because in order for us to be uh responsive to things in our environment, whether we're reading a book or driving a car or giving instructions to somebody else - we have to be able to keep our focus. They have difficulty concentrating, difficulty carrying on a conversation. They may forget things that you've told them or forget things they've read.

What are some of the signs that we're looking for if we're concerned that someone has a mental health problem? First thing we notice is that there's often a significant change in their behavior. A person who may be upbeat and happy and energetic becomes more despondent, more sad.

The second thing is we may notice some changes in the way that they work -- either academically or in their day-to-day work. So for example, they may miss -- a student, they may miss more classes. Uh a person who's in employment may be absent more. Or there may be a deterioration in the quality of their work.

If we're concerned about a friend or a family member or someone we know that may have a mental health problem or a mental health issue -- what can we do to help?

I think there are lots of things that people can do in their day-to-day lives to make the lives of people with a mental health problems much better. When people with mental health problems are asked, "what is it that would help you most?" -- they say, "a job, a safe place to live and a friend."

So the first thing I recommend that people do is -- it's OK to approach or to talk to someone you think may have a mental health problem. So if your friend, for example, seems to be more sad or more withdrawn, it's OK to say, "I noticed you're more withdrawn" and then put in a statement like, "can I help?" or "Is everything OK?"

The second thing we tell people that they can do is to listen. Give people your undivided attention; sit down with them in a place where they can comfortably talk to you. Listening is the most powerful thing we can do for each other. I've had students to whom I've listened over a half an hour, I've said very little and they come back the next week and they tell me how great the session was because they followed all my suggestions. But in fact, if you recorded my suggestions, I only gave them support and said "uh-huh" and "maybe you'd like to try doing something" and then we end the session. They come back the next time and they feel wonderfully powerful, so that's "listen".

The third we tell people that it's OK, in fact it's a great thing to support someone with a mental health problem. Sometimes when people feel out of control and they feel like it's hard to see a positive future -- it's really helpful to give them hope. It, it's fundamental to their well-being to be supporting them -- it gives them hope. You can put it in words -- "I will help you find the help you need"; you can say, "I want to support you, I want to be a good resource for you."

And the fourth thing we tell them is refer. There are agencies, which will help people with mental health problems: community agencies, private practitioners, therapists, counsellors, physicians, psychiatrists -- all can help. We don't want to go in with an assumption, a prepackaged assumption that because they're quiet and because they're more taciturn than usual that it must be depression; we don't know.

What's the difference between diagnosing and observing a mental illness? OK. We're observing changes in behavior and I keep the focus a lot on observing behavior; things that you can observe. I use the phrase, "say what you see". So, for example, we can say to somebody, "I've noticed that you're not eating a lot -- is everything OK?" When people make a diagnosis of a mental health problem that involves sitting down and doing a full-fledged clinical interview.

Behaviour could be caused by lots of different things and changes in behaviour don't necessarily have to suggest it's an, it's a mental health problem; the change in behaviour is just the change in behaviour. It would probably take a professional interview to figure out if the change in behaviour is, in fact, indicative of the presence of a mental health problem.

We need to be patient in our support, we need to know that overcoming depression or anorexia, another mental health problem is not something that necessarily is going to happen quickly. Our support is important, but we need to remain patient and we need to continue with the support even if it seems to take a while for the person to get the help they need.

Remember that people who experience a mental health difficulty often feel that things are out of control. It's very difficult for them to find hope; it's very difficult for them to feel reassured. You can reassure them. You can help them find hope and you can guide them in the direction of getting assistance -- all of this is supportive.

I think it's important to trust yourself; if you know somebody and see a change in their behaviour, even if they're not acknowledging a mental health problem, it's important, you're keeping the door open, you're trusting yourself. When the door is open, it means that they can come back and talk to you at some point in the future, knowing you're a safe person to talk to.

Is it ever appropriate to speak to a counseling service to seek advice on how to help a friend who may have a mental health illness? I think there are times when it's really important -- if you're not sure what to do, to call either a counsellor or a local agency and sometimes there are community resources, such as the Canadian Mental Health Association, that would provide you with information on what you can do.

Early intervention is really important in mental health problems; there is plenty of research evidence to show that when people receive an appropriate assessment and treatment in the beginning, that it results in much better outcomes. They're ill for shorter periods of time of time, uh they can make recovery much more quickly, uh they can lead much more productive and healthy lives; there is absolutely no doubt.

It's important to provide people with support, so that they know they're not alone; support so that they know that in this time of crisis or distress, when things feel like they're out of control, you can be, in effect, a touchstone, something that gives them a sense of stability.

Help-seeking behaviour and reaching out and asking for help is sometimes an act of courage and we need to treat that with respect to people in distress and in pain need support if they're reaching out. I think we need to shift our thinking about mental health to be more positive and to be more compassionate and more understanding. And above all, to make us less fearful about mental health.