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Mental Health and Wellbeing

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Young people are at increased risk for poor mental health. What does that mean? Why? and What can we do about it?

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Mental Health and Wellbeing

  1. 1. SFU
  2. 2. Objectives • Define mental health and mental illness. • Explain why young people are at elevated risk for mental illness. • Identify common mental health conditions impacting young people. • Review common treatments and therapies for mental health conditions. • Describe how society can help people living with or susceptible to mental health conditions can.
  3. 3. Why do we tell stories?
  4. 4. What is Mental Health?
  5. 5. Mental Distress Mental Problem No Distress, Problem or Disorder Mental Disorder/ Illness
  6. 6. ENTAL HEALTHM Cerebellum Occipital Lobe Parietal Lobe Frontal Lobe Temporal Lobe Brain Stem Sensory perception Visual Processing Motor Coordination Bodily Function Alertness Speech Auditory Processing Personality Problem Solving Reasoning Emotional Regulation Limbic System Emotions Behaviour Memory
  7. 7. Gray Matter Contrasted with white matter, gray matter contains most of the brains neurons. It includes regions of the brain responsible for muscle control, sensory perception, hearing, speech, decision making, memory, and self control. Density Age 5 Age 20 Development occurs back to front. Gray matter proliferates in early childhood, peaking at about age 11 for girls and 13 for boys. During adolescence the brain becomes “specialized” and excess gray matter is “pruned out.” In late adolescences, myelination further improves neuronal efficiency.
  8. 8. ENTAL HEALTHM Thinking Perception Emotion Signaling Physical Behaviour Personality/Behavioral Disorders Oppositional Defiance, Conduct Disorder, Attention Deficit, Narcissism Anxiety Disorders Generalized Anxiety, Social Anxiety, Post Traumatic Stress, Obsessive-Compulsive Mood Disorders Major Depression, Bipolar (Manic Depression), Dysthemia Eating Disorder Anorexia Nervosa, Bulimia Nervosa, Muscle Dysmorphia, Binge Eating Psychotic Disorders Schizophrenia, Psychosis
  9. 9. ADHD Bulimia Schizophrenia Anxiety Disorder Substance Abuse Depression TypicalOnsetofCommonMentalIllness 70% of mental illness starts during this period 0 5 10 15 20 25 30
  10. 10. Sukhera, Fisman & Davidson. (2015). “Mind the gap: a review of mental health service delivery for transition age youth” “Authors found that current mental health systems in several jurisdictions lack the capacity to effectively transition youth between the ages of 16 and 25 to adult systems of care.” Mandarino. (2014). “Transitional-Age Youths: Barriers to Accessing Adult Mental Health Services and the Changing Definition of Adolescence” “Youth typically age out of the children's mental health system at 18 years, yet adult services often fail to meet the unique needs of “Transitional Aged Youth” (TAY). Given the changing demands of society, traditional milestones and roles associated with becoming an adult have now been pushed into mid-20s. This requires a changing definition of adolescence with expanded services to match this population's needs.” B.C. Representative for Children and Youth. (2017). “Missing Pieces: Joshua’s Story” “Despite an exhaustive review that included 43 interviews with family members, community professionals, hospital staff and government employees, the Representative cannot say conclusively that better services would have prevented [the suicide of 17 year old Joshua]. What this investigation does conclude, however, is that a truly clear and comprehensive youth mental health system would have given Joshua and his family a better chance to deal with his challenging illness.
  11. 11. MOOD & BIPOLAR DISORDERS
  12. 12. Typical Mood - Normal Baseline Mood Normal Range & Intensity of Mood Transient shift toward (-) pole consequent of (-) life events Transient shift toward (+) pole consequent of (+) life events + Mania Depression
  13. 13. • Mania (at least 1 week) • Distinct period of abnormally and persistently elevated, expansive, or irritable mood • Abnormally and persistently increased goal-directed activity or energy • Significant impairment in functioning • Hypomania (4 days) • Distinct period of abnormally and persistently elevated, expansive, or irritable mood • Abnormally and persistently increased goal-directed activity or energy • Does not cause significant functioning impairment
  14. 14. Dysthymia - + Normal Range & Intensity of Mood - + Normal Range & Intensity of Mood Major Depression Typical Depressed
  15. 15. Bipolar Typical Bipolar • Bipolar disorder is linked to insufficient pruning – leading to less efficient neuronal signaling and more “cross-talk” between neurons (i.e., over active signaling). • Gray matter is normal in sensory and visual regions, but thinned in frontal brain regions involved in self control. - + Bipolar I Bipolar II 1 week Cyclothymia
  16. 16. ANXIETY & PANIC DISORDERS • Intense and prolonged feelings of fear and distress that occur out of proportion to the actual threat or danger. • Feelings of fear and distress that interfere with normal daily functioning.
  17. 17. Anxiety • Lifetime prevalence of any anxiety disorder in U.S. children or adolescents (15-20%) • Separation anxiety (2.8-8%) • Selective mutism (0.03-1%) • Specific phobias (10%) • Social phobias (7%) • Agoraphobia and panic disorder (1% in children) and (2-4% in adolescents) • Generalized anxiety disorder (0.09% in adolescents) • Girls are affected with anxiety disorders at twice the rate of boys. Amygdala Anterior Cingulate Cortex Insula “Fear Network”
  18. 18. Parents Alerted Concern Identified by teacher Teacher seeks help from administration Refers child for counseling Refers child for disciplinary action PSYCHOLOGIST PSYCHIATRIST SOCIAL WORKER SOCIAL SERVICES CLINICAL SOCIAL WORKER What “weak points” can you identity in this care cascade?
  19. 19. What daily activities can promote mental health in youth?
  20. 20. McHugh & Lawlor. (2012). “Exercise and social support are associated with psychological distress outcomes in a population of community- dwelling older adults.” “Exercise reduces the likelihood of psychological distress, but this may be due to incidental socializing. We gathered information on exercise, social support and three aspects of psychological distress from 583 community-dwelling older adults. Exercise and social support from friends were both associated with lower scores of depression, anxiety and perceived stress. For infrequent exercisers, having a low level of social support indicated higher levels of depression, whereas for frequent exercisers, having a low level of social support did not affect depression levels. Both exercise and social support have roles in regulating psychological well-being in older populations and exercisers are less susceptible to effects of low social support on depression.” Mammen & Faulkner. (2013). “Physical Activity and the Prevention of Depression: A Systematic Review of Prospective Studies” “After a thorough selection process, 30 studies were included for analyses. Among these, 25 studies demonstrated that baseline PA was negatively associated with a risk of subsequent depression…There is promising evidence that any level of PA, including low levels (e.g., walking <150 minutes/weeks), can prevent future depression.
  21. 21. Cognitive Behavioral Therapy (CBT) is an evidence based, problem focused, and action-oriented form of therapy. CBT aims to helps patients become aware of their thinking process, identity maladaptive thought processes, and practice effective strategies to reshape these processes. Interpersonal Psychotherapy (IPT) is based on attachment theory and focuses on the reciprocal relationship between one’s mood and one’s relationships to others. Therapy generally focuses on how to improve relationships (or deal with the loss of a relationship) and leverage these relationships to address life stressors. Usually lasts 12-16 weeks. Mindfulness focuses on helping redirect patient’s attention to real-life contemporaneous events with the aim of diminishing the importance of abstract pressures. REATMENTT
  22. 22. Motivational Interviewing is a therapeutic method that focuses on (1) helping individuals to identify problematic behaviour and (2) motivating them to practice strategies to avoid these behaviours. In other words, it is a way of talking to people that helps them overcome antipathy towards negative behaviour. Core skills used in MI include (1) asking open ended questions, (2) providing affirmation, (3) reflecting on events, and (4) summarizing the problems at hand. Acceptance and Commitment Theory (ACT) aims to help individuals gain perspective about their lives, reframe negative experiences as commonplace, make values-based goals for proper reactions, and take consistent action. Doing so is believed to help individuals cope with rather than react to unpleasant experiences. REATMENTT
  23. 23. Psychoanalysis assumes that cognition and behaviour are rooted in unconscious (and often repressed) drives. It is believed that mental illness results from adverse experience during childhood development and the resulting dissonance between conscious and unconscious thought processes. Furthermore, this approach posits that mental health conditions can be relieved by therapy (i.e., reexperiencing and reframing past traumas). Pharmacology assumes that mental health problems are due to chemical imbalances and disrupted neuronal signaling. This approach uses psychoactive pharmaceutical drugs to correct these imbalances. Exposure Therapy is based on respondent conditioning and uses exposure stimuli to adjust gradually adjust emotional and psychological reactions to unharmful stimuli. REATMENTT
  24. 24. What can society do to promote better mental health in young people?
  25. 25. • Most with mental illness don't get better • Most go on to be successful with proper treatment • It is just a phase • Early identification and treatments improve long-term outcomes. • People with mental disorders are violent • Young people with mental illness are more likely to be the victims not perpetrators of violence
  26. 26. Individuals and Families • Build strong, positive relationships with family and friends. • Become more involved in the community (e.g., mentor or tutor youth, join a faith or spiritual community). • Encourage children and adolescents to participate in extracurricular and out-of-school activities. • Work to make sure children feel comfortable talking about problems, such as bullying, and seek appropriate assistance as needed.
  27. 27. Community Organizations • Provide space and organized activities (e.g., opportunities for volunteering) that encourage social participation and inclusion for all people, including older people and persons with disabilities. • Support child and youth development programs (e.g., peer mentoring programs, volunteering programs) and promote inclusion of youth with mental, emotional, and behavioral problems. • Train key community members (e.g., adults who work with the older adults, youth, and armed services personnel) to identify the signs of depression and suicide and refer people to resources. • Expand access to mental health services (e.g., patient navigation, support groups) and enhance linkages between mental health, substance abuse, disability, and other social services.
  28. 28. Schools • Implement programs and policies to prevent abuse, bullying, violence, and social exclusion. • Build social connectedness. • Promote positive mental and emotional health. • Implement programs to identify risks and early indicators of mental, emotional, and behavioral problems among youth and ensure that youth with such problems are referred to appropriate services. • Ensure students have access to comprehensive health services, including mental health and counseling services.
  29. 29. Employers • Implement organizational changes to reduce employee stress (e.g., develop clearly defined roles and responsibilities). • Provide reasonable accommodations (e.g., flexible work schedules, assistive technology, adapted work stations). • Ensure that mental health services are included as a benefit on health plans and encourage employees to use these services as needed. • Provide education, outreach, and training to address mental health parity in employment-based health insurance coverage and group health plans
  30. 30. Health Care Systems • Educate parents on normal child development and conduct early childhood interventions to enhance mental and emotional well-being and provide support (e.g., home visits for pregnant women and new parents). • Screen for mental health needs among children and adults, especially those with disabilities and chronic conditions, and refer people to treatment and community resources as needed. • Develop integrated care programs to address mental health, substance abuse, and other needs within primary care settings. • Enhance communication and data sharing (with patient consent) with social services networks to identify and treat those in need of mental health services.
  31. 31. Governments & Municipalities • Enhance data collection systems to better identify and address mental and emotional health needs. • Include safe shared spaces for people to interact (e.g., parks, community centers) in community development plans, which can foster healthy relationships and positive mental health among community residents. • Ensure that those in need, especially potentially vulnerable groups, are identified and referred to mental health services. • Pilot and evaluate models of integrated mental and physical health in primary care, with particular attention to underserved populations and areas, such as rural communities.
  32. 32. Reminders • Next week we will NOT have lecture. • Draft of persuasive essay due in next week’s tutorial for peer review.

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