Instructor
Date
2
Course Outline – Session 1
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Mental Health First Aid
Common mental health problems
The five basic steps of mental health first aid
What are substance use disorders?
Symptoms and risk factors
Crisis first aid for overdose
Mental health first aid for substance use
disorders
• Treatment and resources
3
Course Outline – Session 2
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What is depression?
Symptoms of depression
Risk factors for depression
Alcohol, drugs and depression
Suicide in Canada
Crisis first aid for suicidal behaviour
Mental health first aid for depression
Treatment and resources
4
Course Outline – Session 3
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What are anxiety disorders?
Symptoms of anxiety disorders
Risk factors for anxiety disorders
Alcohol, drugs and anxiety disorders
Crisis first aid for panic attacks
Crisis first aid for acute stress reaction
Mental health first aid for anxiety disorders
Treatment and resources
5
Course Outline – Session 4
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What are psychotic disorders?
Symptoms of psychotic disorders
Risk factors for psychosis
Alcohol, drugs and psychotic disorders
Crisis first aid for acute psychosis
Mental health first aid for psychosis
Treatment and resources
Other expressions of distress
6
World Health Organization
• Health is “a state of (complete) physical,
mental and social well-being and not
merely the absence of disease or infirmity.”
• Mental Health is “a state of well-being in
which the individual realizes his or her own
abilities, can cope with the normal stresses
of life, can work productively and fruitfully,
and is able to make a contribution to his or
her community.”
7
The Mental Health Continuum
Maximum
Mental Health
Diagnosis of a serious
illness but copes well and
has positive mental health
No illness or disorder
and positive mental
health
Maximum
Mental Disorder
Minimal
Mental Disorder
Diagnosis of a serious
illness and poor
mental health
No diagnosable illness
or disorder but has
poor mental health
Minimal
Mental Health
8
What are Mental Health Problems?
A mental health problem causes major
changes in a person’s thinking, emotional
state and behaviour, and disrupts the
person’s ability to work and carry on their
usual personal relationships.
9
What is Mental Health First Aid?
Mental Health First Aid is the help
provided to a person developing a mental
health problem or in a mental health
crisis. The first aid is given until
appropriate professional help is received
or until the crisis is resolved.
10
The Five Basic Steps
Assess risk of suicide or harm
Listen non-judgmentally
Give reassurance and information
Encourage the person to get appropriate
professional help
Encourage self-help strategies
11
Why Mental Health First Aid?
There is stigma associated with mental
health problems
Imagine if we treated everyone like
we treated the mentally ill.
12
13
14
Why Mental Health First Aid?
• There is stigma associated with mental
health problems
• Mental health problems are common
• Many people are not well informed
about mental health/problems
• Professional help is not always on hand
• People often do not know how to
respond
15
Prevalence
• At least 1 in 3 Canadians will
experience a mental health problem at
some point in their life
• At least 1 in 5 Canadians will
experience a mental health problem in
a year
• In Canada 20 per cent of all sick leaves
are related to mental health
16
Impact
• The economic costs of mental illnesses
in Canada was estimated to be at least
$14.3 billion in 1998
• Mental illnesses are disabling
• Six of the 10 leading causes of ‘years
lived with disability’ are mental health
problems
17
The ALGEE Rap
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•
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•
Assess situation and evaluate the risk
Listen very carefully and don’t tsk tsk
Give reassurance and the good info
Encourage them to see appropriate pro
Encourage them to use self help ideas
And that is the ALGEE
rap my dears!
18
What is a Substance Use Disorder?
• Using alcohol or drugs does not in itself
mean that a person has a substance
use disorder (SUD)
• Dependence on a substance
• Use leads to problems at work, school,
home
• Use causes damage to health
19
One Standard Drink
=
Regular Beer
12 oz/341 mL
(5% alcohol)
=
Table Wine
5 oz/142 mL
(12% alcohol)
Centre for Addiction and Mental Health
Spirits
1.5 oz/43 mL
(40% alcohol)
20
Low-Risk Drinking Guidelines
• 0 drinks = lowest risk of an alcoholrelated problem
• No more than 2 standard drinks on
any one day
• Women: up to 9 standard drinks a
week
• Men: up to 14 standard drinks
a week
21
Long-Term Effects of Alcohol
•
•
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•
•
•
•
Brain
Heart
Lungs
Liver, pancreas, stomach and intestines
Genitals and reproductive system
Muscles, nervous system, motor skills
Skin
22
Other Abused Substances
Tobacco
• Nicotine is a powerful stimulant
• Male smokers are twice as likely to
experience impotence
• Spit tobacco contains more than 3,000
chemicals
• Withdrawal symptoms include anxiety,
insomnia, restlessness
• Some long term effects - heart disease,
stroke, cancer
23
Other Abused Substances
Cannabis (marijuana, hashish, joints, reefers)
• Most widely used illegal drug in Canada
• About 2% of the population have problem
with cannabis abuse/dependence.
– More than twice as likely to suffer from an
anxiety disorder or depression
– More than three times the risk of suffering
from psychotic symptoms
24
Other Abused Substances
Cannabis (marijuana, hashish, joints, reefers)
• Adolescents using cannabis are more
likely to suffer from depression, conduct
problems, drinking and other drug use
• More frequent use of cannabis increases
risk of diagnosis of schizophrenia over
next 15 years
25
Other Abused Substances
Amphetamines – a stimulant drug
• Examples: crystal meth, ice, speed,
uppers, bennies, crank, ecstasy
• Amphetamines have the temporary
effect of increasing energy and
apparent mental alertness
• Users develop a tolerance and need to
take more to get same effects
26
Other Abused Substances
Amphetamines – a stimulant drug
• An overdose can cause delusions,
hallucinations, high fever, coma, death
• A particular mental health risk is
amphetamine psychosis or “speed
psychosis” which involves symptoms
similar to schizophrenia
27
Other Abused Substances
Opioids
• Examples: heroin, morphine, codeine,
oxycodone
• Effects can include pain relief,
drowsiness, constipation, tiny pupils
• Users develop a tolerance and need to
take more to get same effects
• Overdose can result in coma and
death
28
Other Abused Substances
Cocaine (crack, coke, C, snow, flake)
• A cocaine high can last from 5 minutes
to 2 hours
• Overdose can cause seizures, strokes
heart attacks, coma, death
• Users develop a tolerance and need to
take more to get same effects
29
Risk Factors
• Family history of substance abuse
• Childhood abuse or neglect
• Acceptance of substance use
(community, peer)
• Low parental support/monitoring
• Poor social skills
30
First Aid for Substance Use Disorders
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•
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Assess risk of suicide or harm
Listen non-judgmentally
Give reassurance and information
Encourage the person to get
appropriate professional help
• Encourage self-help strategies
31
Step 1 Assess the Risk of Suicide
or Harm
• If you determine the person has taken
an overdose, follow the steps for Crisis
First Aid for an Overdose
• If the person is not at risk, move on to
Step 2 – Listen Non-Judgmentally
32
Crisis First Aid for an Overdose
If they are unconscious:
• Make sure the person’s airway is clear and roll
them into the recovery position
• Phone 911 for an ambulance
• Try to find out what substances were used
• Keep the person warm, especially if
alcohol is involved
33
Crisis First Aid for an Overdose
If the person is conscious
• Phone or take the person to the nearest
emergency department
• Do not give any food or fluids
• Reassure the person
• Try to find out what substances were
used
• Keep the person warm, especially if
alcohol is involved
34
Step 2 Listen Non-Judgmentally
• Listen without interrupting
• Ask appropriate questions to make sure
you are both clear on what is being said
• Listen to the word and tone of voice and
watch their body language
• Restate what the person has said
• Summarize facts and feelings
35
Step 2 Listen Non-Judgmentally
• Be attentive
• Keep eye contact comfortable (don’t
stare or avoid eye contact)
• Keep an open body position
• Sit down, even if they stand
• Try not to sit directly opposite
(facing) the person
36
Step 3 Give Reassurance and
Information
• Tell the person you want to help them
• Substance use disorder is a real medical
condition
• It is a common illness
• Programs are available to help
• Often depressive and anxiety disorders
underlie SUDs and can be treated
37
Step 4
Encourage the Person to Get
Appropriate Professional Help
• Family doctor or physician
• Drug and alcohol specialists
• Mental health team
38
The Change Model
Relapse
Maintenance
Action
Pre-contemplation
Contemplation
Determination/
Preparation
39
Step 5 Encourage Self-Help
Strategies
• Many people with a substance use
disorder may also have another
underlying mental health problem such
as depression or anxiety.
• The self-help strategies for these
conditions may help but should not be
the main source of treatment.
40
Resources
• Alberta Alcohol and Drug Abuse
Commission
http://www.aadac.com
• Centre for Addiction and Mental Health
http://www.camh.net/
41
If
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If you can always be cheerful
If you can sleep without drugs
If you can relax without alcohol
If you can start the day without caffeine
If you can take blame without resentment
If you can resist without complaining
If you can eat the same food every
day without complaining and be
grateful
42
If
• If you can understand when your loved
ones are too busy to spend time with you
• If you can overlook it when those you love
take things out on you when, through no
fault of yours, something goes wrong
Then you are almost
as good as your dog
43
Session 2
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What is depression?
Symptoms of depression
Risk factors for depression
Alcohol, drugs and depression
Suicide in Canada
Crisis first aid for suicidal behaviour
Mental health first aid for depression
Treatment and resources
44
What is Depression?
Clinical depression lasts at least two
weeks, affects the person’s behaviour and
has physical, emotional and cognitive
effects.
It interferes with the ability to work and
have satisfying personal relationships.
45
Symptoms of Depression
• Emotions: sadness, mood swings,
hopelessness, anxiety
• Thoughts: Self-criticism, indecisiveness,
thoughts of suicide, pessimism
• Behaviour: Crying spells, neglect personal
appearance, withdrawal, no motivation
• Physical: Lack of energy, sleeping too
much/too little, overeating/loss
of appetite
46
Depression in the Workplace
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•
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Decreased productivity
Morale problems
Lack of co-operation
Safety problems
Absenteeism
Complaints of being tired, having
aches/pains
• Alcohol and/or drug abuse
47
Bipolar Disorder (Manic Depression)
• Bipolar disorder is characterized by
extreme mood swings
• A person has periods of depression and
mania with periods of ‘normal’ mood in
between
• A person must have episodes of both
depression and mania to be diagnosed
48
Symptoms of Bipolar Disorder
• Depression
• Mania
– Increased energy and over activity
– Elated mood
– Needing less sleep than usual
– Irritability
– Rapid thinking and speech
– Lack of inhibitions
– Grandiose delusions
– Lack of insight
49
Risk Factors for Depression
• Break up of relationship or living in
conflict
• Having a baby
• Job loss, unsuccessful job hunting
• Long term illness or disability or caring
for someone with illness/disability
• Being a victim of a crime
• Alcohol or drug abuse
50
Risk Factors for Depression
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Side effect of medications or drugs
Stress from another mental disorder
Hormonal changes
Lack of exposure to bright light in winter
Family history of depression
Previous episodes of depression
Difficult childhood (abuse, neglect)
51
Suicide in Canada
• About 4,000 Canadians die by suicide
each year
• In 2001, there were 3.5 suicides among
men for every suicide among women.
• People in their 40s accounted for almost
one in four suicides.
• Deaths by suicide surpassed deaths
by motor vehicle accidents in
that same year.
52
Suicide Rates by Province
Per 100,000 population, 2001
11.3
Canada
Prince Edward Island
Nova Scotia
New Brunswick
Quebec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia
0
3
10
9
13.2
16.5
7.7
11.4
11.3
14.1
10.4
6
9
12
15
18
53
First Aid for Depression
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Assess risk of suicide or harm
Listen non-judgmentally
Give reassurance and information
Encourage the person to get
appropriate professional help
• Encourage self-help strategies
54
Step 1 Assess the Risk of Suicide
or Harm
• If you determine the person is at risk,
follow the steps for Crisis First Aid for
Suicidal Behaviour
• If the person is not at risk, move on to
Step 2 – Listen Non-Judgmentally
55
Crisis First Aid for Suicidal Behaviour
1. Engage the person in serious
conversation about how they are
feeling
2. Determine if the person has thoughts
of suicide
3. Explore and assess the risk further
4. Find out about prior suicidal behaviour
5. Find out about their supports
56
Crisis First Aid for Suicidal Behaviour
6. Ensure the person is not left alone
7. Seek additional help
8. If they are consuming alcohol or drugs,
try to ensure they do not take more
9. Try to ensure they do not have ready
access to some means to take their life
10. Encourage the person to talk
11. Ensure your own personal safety
57
Self Care
• Supporting a suicidal person can be
unsettling and stressful
• Do not underestimate the effect on your
own well-being
• Find ways of reducing the immediate
stress (exercise, relaxation techniques,
sleep)
• Find someone to talk to about your
experience
58
Step 2 Listen Non-Judgmentally
• Listen to the person without judging.
• Do not be critical of the person.
• Do not express frustration with the
person for having these symptoms.
• Do not give glib advice such as ‘pull
yourself together’.
• Avoid confrontation unless necessary to
prevent harmful acts.
59
Step 3 Give Reassurance and
Information
• Depression is a real medical condition
• Depression is a common illness
• Depression is not a weakness or
character defect
• Depression is not laziness
• Effective help and treatments are
available
60
Step 4
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•
•
•
Encourage the Person to Get
Appropriate Professional Help
Community-based care
Family doctor or physician
Counsellors and clinical psychologists
Psychiatrists
61
What Helps for Depression?
Medical Treatments
Rating
Antidepressants


Electroconvulsive therapy (ECT)
 Very severe
depression only
 Very good evidence
 Good evidence

Promising treatment
Adults
Adolescents
62
63
64
What Helps for Depression?
Psychological Treatments
Rating
Cognitive behaviour therapy (CBT)

Interpersonal psychotherapy

Reading depression self-help books based on CBT

Psychodynamic psychotherapy

65
Ten Common Thinking Distortions
1. Black and white
thinking
2. Setting unrealistic
expectations
3. Selective thinking
4. Converting
positives into
negatives
5. Over generalizing
6. Exaggerating
unpleasantness
7. Catastrophizing
8. Personalizing
9. Mistaking feelings
for facts
10. Jumping to negative
conclusions
66
Step 5 Encourage Self-Help
Strategies
• Self-help strategies have proven
therapeutic effects
• They also help people to feel they are
regaining control of their lives
67
What Helps for Depression?
Lifestyle & Alternative Treatments Rating
Exercise

Light therapy


Yoga breathing exercises

Massage therapy

Relaxation therapy

Winter depression
Non-seasonal
depression
68
What Helps for Depression?
Lifestyle & Alternative Treatments
Rating
Acupuncture

St John’s wort*

Alcohol avoidance – for people with drinking problems

Folate

* St John’s wort should not be taken with antidepressants.
This herb has interactions with a number of prescribed
medications.
69
70
71
72
73
74
Resources
• Refer to MHFA Canada Manual
Section 2, page 11
75
Session 3
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What are anxiety disorders?
Symptoms of anxiety disorders
Risk factors for anxiety disorders
Alcohol, drugs and anxiety disorders
Crisis first aid for panic attacks
Crisis first aid for acute stress reaction
Mental health first aid for anxiety disorders
Treatment and resources
76
What are Anxiety Disorders?
• An anxiety disorder differs from normal
anxiety
• Anxiety disorders are more severe, they
last longer and they interfere with work
or relationships
• There are several types of anxiety
disorders – symptoms will vary.
Mind Racing?
Possible sleep
disturbance?
Feeling breathless,
breathing fast &
Shallow?
Nausea, lack
of appetite?
Restless?
Jelly-like legs?
Dizzy, disoriented,
lightheaded?
Vision strange or blurry?
Difficulty swallowing?
Heart racing,
palpitations?
Trembling?
Sweating or
shivering?
Wanting to
run?
77
78
General Symptoms of Anxiety
Physical
• Cardiovascular: palpitations, chest
pain, rapid heartbeat, flushing
• Respiratory: hyperventilation,
shortness of breath
• Neurological: dizziness, headache,
sweating, tingling and numbness
79
General Symptoms of Anxiety
Physical
• Gastrointestinal: choking, dry mouth,
nausea, vomiting, diarrhea
• Musculoskeletal: muscle aches and
pains (esp. neck, shoulders),
restlessness, tremors and shaking
80
General Symptoms of Anxiety
Psychological
• Unrealistic and/or excessive fear and
worry (about past or future events)
• Mind racing or going blank
• Decreased concentration and memory
81
General Symptoms of Anxiety
Psychological
• Difficulty making decisions, confusion
• Restlessness, feeling ‘on edge’ or
nervousness
• Tiredness, sleep disturbances, vivid
dreams
• Irritability, impatience, anger
82
General Symptoms of Anxiety
Behavioural
•
•
•
•
Avoidance of situations
Obsessive or compulsive behaviour
Distress in social situations
Phobic behaviour
83
Types of Anxiety Disorders
• Generalized anxiety disorder (GAD)
• Panic disorder (with or without
agoraphobia)
• Agoraphobia
• Social anxiety disorder (social phobia)
• Phobic disorders
• Obsessive-compulsive disorder (OCD)
• Post traumatic stress disorder (PTSD)
• Acute stress disorder
84
Do You Worry All the Time?
Which problems have you had often over
the last 6 months?
 I never stop worrying about things big
and small
 I have headaches or aches and pains
for no reason
 I am tense a lot and have trouble
relaxing
 I have trouble keeping my mind
on things
85
Do You Worry All the Time?
Which problems have you had often over
the last 6 months?
 I get crabby or grouchy
 I have trouble falling asleep or staying
asleep
 I sometimes have a lump in my throat or
feel like I need to throw up when I am
worried
 I sweat and have hot flushes
86
Generalized Anxiety Disorder (GAD)
• Overwhelming and unfounded anxiety
• Physical and psychological symptoms
of anxiety and tension for more than
6 months
• General worries over money, health and
family etc. even when no problem exists
87
Do You Have Sudden Bursts of
Fear for No Reason?
Which problems have you had during these
bursts of fear?
 I have chest pains or a racing heart
 I have a hard time breathing or a choking
feeling
 I feel dizzy, or I sweat a lot
 I have stomach problems or feel like I
need to throw up
88
Do You Have Sudden Bursts of
Fear for No Reason?
Which problems have you had during these
bursts of fear?
 I shake, tremble, or tingle
 I feel out of control
 I feel unreal
 I am afraid I am dying or going crazy
89
Panic Disorder
• A person with a panic disorder has
panic attacks
• A panic attack is the sudden onset of
intense fear or terror
• The attacks develop suddenly
• The fear is inappropriate for the
circumstances in which it is occurring
90
Agoraphobia
• Fear of panic attacks
• Fear of being in a situation with no help
or escape
• Avoidance of places where it is felt that
a panic attack could happen
91
Do You Feel Afraid or Uncomfortable
When You are Around Other People?
Is it hard to be at work or school?
 I have an intense fear that I will do or say
something and embarrass myself in front
of other people
 I am always very afraid of making a
mistake and being watched and judged
by other people
 My fear of embarrassment makes me
avoid doing things that I want to do or
speaking to people
92
Do You Feel Afraid or Uncomfortable
When You are Around Other People?
Is it hard to be at work or school?
 I worry for days or weeks before I meet
new people
 I blush, sweat, tremble, or feel like I have
to throw up before or during an event
where I am with new people
 I usually stay away from social situations
such as school events and making
speeches
 I often drink to try and make
these fears go away
93
Social Anxiety Disorder
• Common anxiety disorder
• Fear of humiliation, embarrassment or
scrutiny by others
• Fear that others are thinking negatively
about them
• Tends to develop in shy children as they
move into adolescence
94
Phobic Disorders
• A person with a phobia avoids or
restricts activities because of fear
• The fear appear persistent, excessive
and unreasonable
• The fear will cause the person to avoid
specific things, events or places
95
Have You Lived Through a Very
Scary or Dangerous Event?
Which problems have you had after the
event?
 I jump and feel very upset when
something happens without warning
 I have a hard time trusting or feeling
close to people
 I stay away from places that remind me
of the event
 I feel guilty because others died
and I lived
96
Have You Lived Through a Very
Scary or Dangerous Event?
Which problems have you had after the
event?
 I have trouble sleeping and my muscles
are tense
 I feel like the terrible event is happening
all over again. This feeling often comes
without warning
 I have nightmares and scary memories of
the terrifying event
 I get mad very easily
97
Post-Traumatic Stress Disorder
and Acute Stress Disorder
• Post-Traumatic Stress Disorder (PTSD)
and Acute Stress Disorder (ASD) occur
after experiencing a distressing event
• ASD – distress is usually resolved
within a month
• PTSD – distress lasts longer than a
month
98
Do You Feel Trapped in a Pattern of
Unwanted and Upsetting Thoughts?
Are any of these problems interfering with
your life?
 I have upsetting thoughts or images
enter my mind again and again
 I feel like I can’t stop these thoughts or
images, even though I want to
 I worry a lot about terrible things that
could happen if I’m not careful
99
Do You Feel Trapped in a Pattern of
Unwanted and Upsetting Thoughts?
Are any of these problems interfering with
your life?
 I have unwanted urges to hurt someone
but know I never would
 I have a hard time stopping myself from
doing things again and again, like
counting, checking on things, washing
my hands, re-arranging objects, doing
things until it feels right,
collecting useless objects
100
Obsessive-Compulsive Disorder
• Obsessive thoughts and compulsive
behaviours accompany feelings of anxiety.
• Obsessive thoughts are unwanted and
inappropriate recurrent thoughts, impulses
or images the person cannot get rid of.
• Compulsive behaviours are repetitive
behaviours or mental acts such as
counting, checking or washing.
101
Risk Factors for Anxiety Disorders
•
•
•
•
•
•
Gender
People with an anxious parent
Difficult childhood (abuse, neglect)
Some medical conditions
Side-effects of some prescription drugs
Some non-prescription drugs (caffeine,
amphetamines, cocaine, etc.)
102
First Aid for Anxiety Disorders
•
•
•
•
Assess risk of suicide or harm
Listen non-judgmentally
Give reassurance and information
Encourage the person to get
appropriate professional help
• Encourage self-help strategies
103
Step 1 Assess the Risk of Suicide
or Harm
• People with anxiety disorders are at
greater risk of dying by suicide,
particularly if they also have depression.
• If you determine the person is at risk,
follow the steps for Crisis First Aid for
Suicidal Behaviour.
• If the person is not at risk, move on to
Step 2 – Listen Non-Judgmentally.
104
Crisis First Aid for Panic Attacks
1. If you are unsure if it is a panic attack
or a heart attack call an ambulance.
2. If you are sure it is a panic attack,
move the person to a quiet safe place.
3. Help calm the person by helping them
control their breathing.
4. Be a good listener, without judging.
105
Crisis First Aid for Panic Attacks
5. Explain they are having a panic attack
and it is not life threatening.
6. Explain the attack will be over soon
and they will recover.
7. Assure them that someone will stay
with them until the attack stops.
106
Crisis First Aid for Acute
Stress Reaction
1. Let the person tell their story but do not
push them to do so.
2. Be a patient and sympathetic listener.
3. Reassure the person that stress
reactions are normal responses to
abnormal events and in time most
people have a normal recovery of
their emotions.
107
Crisis First Aid for Acute
Stress Reaction
4. Encourage the person to share
feelings with others.
5. Advise the person not to use alcohol
or drugs to cope.
6. If the stress reaction persists for more
than a month, encourage the person
to seek professional help.
108
Step 2 Listen Non-Judgmentally
YOU ARE NOT LISTENING TO ME WHEN:
• You say you understand.
• You say you have an answer to my
problem, before I’ve finished telling you
my problem.
• You cut me off before I’ve finished
speaking.
• You finish my sentences for me.
109
Step 2 Listen Non-Judgmentally
YOU ARE NOT LISTENING TO ME WHEN:
• You are dying to tell me something.
• You tell me about your experiences,
making mine seem unimportant.
• You refuse my thanks by saying you really
haven’t done anything.
110
Step 2 Listen Non-Judgmentally
YOU ARE LISTENING TO ME WHEN:
• You try to understand me, even if I’m not
making much sense.
• You grasp my point of view, even when
it’s against your own sincere convictions.
• You realize the hour I took from you has
left you a bit tired and a bit drained.
111
Step 2 Listen Non-Judgmentally
YOU ARE LISTENING TO ME WHEN:
• You allow me the dignity of making my
own decisions, even though you think
they may be wrong.
• You do not take my problem from me, but
allow me to deal with it in my own way.
• You hold back the desire to give me good
advice.
112
Step 2 Listen Non-Judgmentally
YOU ARE LISTENING TO ME WHEN:
• You do not offer me religious solace
when I am not ready for it.
• You give me enough room to discover for
myself what is really going on.
• You accept my gratitude by telling me
how good it makes you feel to know that
you have been helpful.
113
Step 3 Give Reassurance and
Information
• Anxiety is a real medical condition.
• An anxiety disorder is a common illness.
• An anxiety disorder is not a weakness
or character defect.
• Effective help and treatments are
available.
• Anxiety can be unpleasant but is rarely
harmful.
114
Step 4
Encourage the Person to Get
Appropriate Professional Help
• Family doctor or physician
• Counselling or psychotherapy for
specific anxiety disorder
115
Step 5 Encourage Self-Help
Strategies
• Anxiety is best overcome by confronting
fear rather than avoiding it
• Use evidence-based self help books
• Practice daily relaxation methods to
reduce physical symptoms of tension
• Exercise regularly and get enough sleep
• Reduce caffeine intake
• Engage in leisure time
116
What Helps for Anxiety Disorders?
Treatments
Anxiety Disorder
Rating
CBT self-help books
Specific phobias

Physical exercise
Generalized anxiety disorder

Relaxation training
Generalized anxiety disorder

Acupuncture
Generalized anxiety disorder

117
What Helps for Anxiety Disorders?
Treatments
Anxiety Disorder
Rating
Meditation
Generalized anxiety disorder

Relaxing Music
Generalized anxiety disorder

Alcohol Avoidance
Range of anxiety disorders

118
Resources
• Refer to MHFA Canada Manual
Section 3, page 10
119
Session 4
•
•
•
•
•
•
•
•
What are psychotic disorders?
Symptoms of psychotic disorders
Risk factors for psychosis
Alcohol, drugs and psychotic disorders
Crisis first aid for acute psychosis
Mental health first aid for psychosis
Treatment and resources
Other expressions of distress
120
What is Psychosis?
• Psychosis is a mental health problem in
which a person has lost some contact
with reality
• Severe disturbances in thinking,
emotion and behaviour
• Psychotic illnesses are not common
compared to other mental health
problems
121
What is Psychosis?
• Psychosis may appear as a symptom in
a number of mental health problems
including:
– Schizophrenia
– Schizoaffective disorder
– Brief psychotic disorder
– Psychotic disorder due to a general
medical condition
– Substance induced psychotic
disorder
122
Symptoms of Psychosis
Changes in emotion and motivation
• Depression or anxiety
• Suspiciousness
• Blunted, flat or inappropriate emotion
• Irritability
• Change in appetite
• Reduced energy and motivation
123
Symptoms of Psychosis
Changes in thinking and perception
• Difficulties concentrating
• Sense of alteration of self or others –
feeling that self or others have changed
or are acting differently
• Odd ideas
• Unusual perceptual experiences –
reduced or greater intensity of smell,
sound, colour
124
Symptoms of Psychosis
Changes in behaviour
• Sleep disturbance
• Social isolation or withdrawal
• Reduced ability to work or carry out
social roles
• Odd or strange behaviour
125
Symptoms of Psychosis
Changes in speech
• Disorganized speech
• Speech becomes rapid
126
Schizophrenia
• Schizophrenia is a chronic and disabling
disorder
• Mental function changes and thoughts
and perceptions become disordered
• Schizophrenia is not a constant or static
condition – severity of symptoms
fluctuate or do not appear at all
127
Symptoms of Schizophrenia
•
•
•
•
•
•
Delusions
Hallucinations
Thinking difficulties
Loss of drive
Blunted emotions
Social withdrawal
128
Other Psychotic Disorders
• Psychotic depression – a depression so
intense it causes psychotic symptoms
• Schizoaffective disorder – Symptoms of
both schizophrenia and mood disorder
(depression, bipolar disorder)
• Substance induced psychosis – psychosis
brought on by drug use. Drug use may
also trigger another psychotic
illness such as schizophrenia
129
Risk Factors for Psychotic Disorders
It is believed that psychosis is caused by
a combination of factors including:
• Genetics
• Biochemistry
• Stress
130
First Aid for Psychotic Disorders
•
•
•
•
Assess risk of suicide or harm
Listen non-judgmentally
Give reassurance and information
Encourage the person to get
appropriate professional help
• Encourage self-help strategies
131
Step 1 Assess the Risk of Suicide
or Harm
• Psychotic disorders involve high risk of
suicide
• If you determine the person is at risk,
follow the steps for Crisis First Aid for
Suicidal Behaviour
• If the person is not at risk, move on to
Step 2 – Listen Non-Judgmentally
132
What if a Psychotic Person is
Threatening Violence?
1. Do not get involved physically
2. Call the police
3. Try to create a calm, non-threatening
atmosphere
4. Try to get the person to sit down
5. Do not try to reason with acute psychosis
6. Express empathy for the person’s emotional
distress
7. Comply with reasonable requests
133
Step 2 Listen Non-Judgmentally
• Listen to the person without judging
• Speak calmly, clearly and in short
sentences
• Do not be critical of the person and do
not express frustration with the person
• Do not give glib advice such as ‘pull
yourself together’
134
Step 2 Listen Non-Judgmentally
• Avoid confrontation unless necessary to
prevent harmful acts
• Do not argue with the person about their
delusions and hallucinations but do not
pretend they are real to you
135
Step 3 Give Reassurance and
Information
• When a person is in a psychotic state it
is difficult and inappropriate to give
them information about psychosis – wait
until they are in touch with reality
• Do not make promises you cannot keep
and do not lie
136
Step 3 Give Reassurance and
Information
• When the person is thinking more
clearly explain:
– You want to help them
– They have a real medical condition
– Their condition is not a common illness but
well known and researched
– Psychosis is not a weakness or character
defect
– Effective medications are available
137
Step 4
Encourage the Person to Get
Appropriate Professional Help
• Early intervention is important. The
person needs to be placed on
appropriate medication
– Family doctor or physician
– Psychiatrist
– Community mental health teams
– Family and friends
138
Step 5 Encourage Self-Help
Strategies
• Have an agreement with family/friends
• Many people with a psychotic disorder
also have depression and/or anxiety
• The self-help strategies for these
conditions may help but should not be
the main source of treatment
139
Resources
• Refer to MHFA Canada Manual
Section 4, page 8