1 Mental Health in the WorkplacePresenter: David Clarke Durham Mental Health Services

2 Agenda Mental Illness – impact, stigma, signsPromoting mental wellbeing in the workplace Defusing strong emotion – crisis response (active listening, validation) DMHS Crisis Services – a doorway to the wider service sector

3 Mental illness: Impact, stigma, signs

4 Ingredients for Good Mental HealthThe basics: food, shelter, money, security, healthy routines Positive view of self Connection to others Hope for future Sense of purpose, direction, control, accomplishment Let’s start by thinking about good mental health. Recall a time when you felt really healthy, emotionally and mentally; a time when you were saying “Yes” to life in a big way (maybe that’s now, maybe yesterday, maybe last week ... maybe longer ago). What’s happening in your life that contributes to that sense of health and well-being? (Wait for and validate responses). Show bullet-points.

5 Two quotes on good mental healthPat Capponi What people need is “a job, a home, and a friend” “The key to happiness is someone to love, something to do, and something to look forward to.” The King! I want to share two wise quotes on the ingredients for good mental health. Pat Capponi, an advocate for people with mental illnesses and someone who experienced mental illness in her own life, says that “What people need is a job, a home, and a friend.” Can you relate to that? Another wise person said that “The key to happiness ...” Anyone know who said that? Which great philosopher? It was Elvis Presley. We’ve all felt happy and relaxed at times in our lives, but we all know there are real challenges to feeling our best. (you list some)

6 What do you feel when you hear the words “mental illness” or “mental health problems”?Fearful Uncomfortable We can all relate to having challenges to mental health – sometimes we experience these challenges as intractable problems – but if I were to say to you, “Hi, my name is David and I have mental health problems,” what thoughts or feelings might you have? (Have the audience volunteer some responses.) We might think words like ... Cuckoo, unreliable, crazy, dangerous, loser, weak. We might be (click) fearful, or uncertain ... Uncomfortable with a person, or even on guard or hostile towards them. It’s a bit silly to think that someone would introduce themselves by saying, “Hi, I have mental health problems.” But if a person’s struggles with mental illness are visible, that mental illness can become an engulfing identity. The person – with all their unique gifts and potentials – is lost, submerged under the label “MENTALLY ILL.” The illness may be all that people see. We can think of mental health and mental illness as points on a continuum. [Show mental health continuum.] On guard or hostile Uncertain

7 The Mental Health-Mental Illness ContinuumMental health problems Health Illness Well-being Emotional problems or concerns Mental illness Occasional stress to mild distress No impairment Mild to moderate distress Mild or temporary impairment Marked distress Moderate to disabling or chronic impairment Most of the time, most of us will experience good health. We’ll face demands but we feel up to meeting those demands. When the demands start to overwhelm our capacity to respond, we might slide into having emotional problems or concerns – we’ll feel some distress and may not be as productive or as comfortable with our different roles as we do when we’re feeling healthy and on top of things. At the far end of the spectrum is mental illness, associated with marked distress and moderate to chronic impairment of our ability to function effectively. This is where mental illness may be diagnosed. In any given year, 1 in 5 people will find themselves here, experiencing diagnosable mental illness. That’s almost 7 million Canadians. When you came in you saw some of the faces of mental illness – most of the people we saw were politicians or entertainers, people in the media spotlight. But if that spotlight shone on teachers, or policemen, or stay-at-home moms, or on [fill in the blank], we would hear many similar stories. Mental illness is often invisible. You can’t always see it, and rarely do we openly talk about it, like we are doing now. And that silence has real costs. It leads to misinformation about mental illness and, for individuals who experience mental illness and their families, it creates barriers to obtaining accurate information, effective treatment, and adequate community support. Here’s one example of the price of our society’s silence when it comes to mental illness. Adapted from “Understanding U: What is Mental Health?” (http://www.hr.umich.edu/mhealthy/programs/mental_emotional/understandingu/learn/mental_health.html)

8 OHRC Definition of Mental Illness… [clinically significant] patterns of behaviour or emotions associated with some level of distress, suffering (i.e., pain, death), or impairment in one or more areas of functioning (school, work, social and family interactions). At the root of this impairment are symptoms of biological, psychological or behavioural dysfunction, or a combination of these.

9 Focusing on tasks/paying attention Attention-Deficit DisorderResponding emotionally to situations in helpful ways Giving us a tolerably accurate picture of ourselves Depression/Anxiety Eating Disorder

10 Mental Illness in Canada – CMHA20% of Canadians will personally experience a mental illness in their lifetime Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem. Healthcare costs in 1998 were estimated to be at least $7.9 billion (care, disability, early death)

11 Canadian Attitudes towards Mental IllnessAlmost half of Canadians (46%) think people use the term mental illness as an excuse for bad behaviour. One in four Canadians are fearful of being around those who suffer from serious mental illness. In 2008, the Canadian Medical Association surveyed Canadians about their attitudes towards individuals with mental illness. They found that ... In releasing these findings, CMA President Dr. Brian Day commented that “In some ways, mental illness is the final frontier of socially-acceptable discrimination.” Let’s look at another example of the cost of silence and stigma. If we were to have a broken arm ... not one of those things can be assumed when it comes to mental pain. I’ve noticed that children don’t make this distinction between physical and mental or emotional pain. My daughter Emma and I were leaving the Legends Centre one day when she noticed a boy who was upset. “Why is that boy crying?” she asked me. I said “I’m not sure … Why do you think he’s crying?” Emma thought for a moment and said, “Maybe he scraped his knee.” I said, “Could be …” She said, “Or may someone hurt his feelings.” I said, “Well, that could be too.” Emma didn’t think for a moment, “Well, if he has a scraped knee, then that’s OK, let him cry, but if he got his feelings hurt, well, he’d better get over it.” She recognized a person who was hurting and she empathized. But somewhere along the line we learn to make this distinction: physical pain – OK; mental pain – not OK, shameful and weak. This might have something to do with the information we receive about mental illness. Where do we get most of our information about mental illness from?

13 The Business Case for Prevention and InterventionDisability costs Time off due to illness Worker loyalty Job satisfaction Productivity and cohesion

14 Mental Health Benefits of WorkingThe basics: food, shelter, money, security, healthy routines Positive view of self Connection to others Hope for future Sense of purpose, direction, control, accomplishment Let’s start by thinking about good mental health. Recall a time when you felt really healthy, emotionally and mentally; a time when you were saying “Yes” to life in a big way (maybe that’s now, maybe yesterday, maybe last week ... maybe longer ago). What’s happening in your life that contributes to that sense of health and well-being? (Wait for and validate responses). Show bullet-points.

15 Possible Signs of a Mental Health Concern 1Uncharacteristic behavior (a catch-all) Consistent late arrivals/early departures or frequent absences Lack of cooperation, inability to work with colleagues Decreased productivity Increased accidents or safety problems Displays of anger or blaming others How to tell if an employee has a mental illness, in J. B. Payne & N. Werhun, Accommodating Mental Illness in the Workplace: A Practical Guide (Nelligan/O’Brien/Payne, 2012), p. 3 (item 2.2.1)

16 Possible Signs of a Mental Health Concern 2Difficulty concentrating, making decisions or remembering things Making excuses for missed deadlines or poor work Decreased interest or involvement in one’s work Working excessive overtime over a prolonged period of time Expressions of strange or grandiose ideas How to tell if an employee has a mental illness, in J. B. Payne & N. Werhun, Accommodating Mental Illness in the Workplace: A Practical Guide (Nelligan/O’Brien/Payne, 2012), p. 3 (item 2.2.1)

17 PROMOTING HEALTH, preventing illness

18 Resilience Defined “the capacity to bounce back, to withstand hardship, and to repair yourself” When we pay attention to the self-righting tendencies that all of us share, we’re going to learn more about them and find ways to strengthen them and foster healthy development despite adversity. So, resilience is more than a universal human capacity. It’s also a …

19 The Resiliency Attitude“What is right with us is more powerful than anything that is wrong with us.”

20 Individual Protective FactorsPositive View of Personal Future Relationships Flexibility Humour Independence Inner Direction Self-Worth Perceptiveness Love of Learning HAVE THEM DO THE RESILIENCE QUIZ, PART ONE … Competence Self-Motivation Spirituality Creativity Perseverance

21 Environmental Protective FactorsHigh Warmth, Low Criticism Style of Interaction Access to Resources Clear Boundaries Prosocial Values Values and Encourages Education Opportunities for Meaningful Participation PROTECTIVE ENVIRONMENTS OPERATE IN TWO WAYS: provide buffers and encourage development of internal factors Service to Others Supportive Relationships with Caring Others Shared Responsibilities Appreciates Unique Talents of Each Individual High and Realistic Expectations

22 Provide Caring & SupportNan Henderson’s Resiliency Wheel Provide Opportunities for Meaningful Participation Increase Prosocial Bonding Set and Communicate High Expectations Set Clear, Consistent Boundaries Building Resilience Mitigating Risk DEFINE EACH CATEGORY (emphasize fundamental place of caring and support) Increase Prosocial Bonding: involves increasing the connections between individuals and any prosocial person or activity; children with strong positive bonds are far less involved in risk behaviours than children without these bonds; Set Clear and Consistent Boundaries: in a general sense, this refers to having a strong sense of one’s identity and of acceptable limits; in a school context, it refers to consistent implementation of school policies and speaks to the importance of clarifying expectations of behaviour Teach “Life Skills”: cooperation, conflict resolution, assertiveness, communication, problem-solving, decision-making Provide Caring & Support Teach “Life Skills” Henderson, Resiliency in Schools, p. 12

23 Other Factors Good job design:Skill variety Task significance Autonomy Feedback Availability of professional, confidential support (EAP, HR support)

24 DEFUSING STRONG EMOTION – CRISIS RESPONSE

25 Anatomy of a Crisis – The Four P’sPRESS PUSH (to act) PAIN PERTUR-BATION Pain – frustration, distress Press – sense of urgency; constriction Perturbation – temperature is rising; agitation Push can be focused out (aggression) or focused in (suicide)

26 Pre-frontal cortex (wise mind)Amygdala (lizard brain) AMYGDALA: Watching out for emotionally-charged happenings; processing emotionally-charged memories AND STORING THEM FOR INSTANT AUTOMATIC RETRIEVAL! PREFRONTAL CORTEX: The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals.

27 We are part of the person’s environment

28 Provide Caring & SupportNan Henderson’s Resiliency Wheel Provide Opportunities for Meaningful Participation Increase Prosocial Bonding Set and Communicate High Expectations Set Clear, Consistent Boundaries Building Resilience Mitigating Risk DEFINE EACH CATEGORY (emphasize fundamental place of caring and support) Increase Prosocial Bonding: involves increasing the connections between individuals and any prosocial person or activity; children with strong positive bonds are far less involved in risk behaviours than children without these bonds; Set Clear and Consistent Boundaries: in a general sense, this refers to having a strong sense of one’s identity and of acceptable limits; in a school context, it refers to consistent implementation of school policies and speaks to the importance of clarifying expectations of behaviour Teach “Life Skills”: cooperation, conflict resolution, assertiveness, communication, problem-solving, decision-making Provide Caring & Support Teach “Life Skills” Henderson, Resiliency in Schools, p. 12

29 VALIDATION is the key to healthy connections and safe outcomes.

30 VALIDATION SPEAKS TO THE AMYGDALA, CALMS IT DOWNCONVERSATION NOT CONFRONTATION (the BPD dance)

31 Practicing Validation(Communicating that You Understand and Value the Wisdom in the Other Person’s Point-of-View) Daughter (crying): “You just don’t get it! Lizzie is my best friend, and she understands me better than anybody else.” Father (raised voice): “She’s no best friend as far as I’m concerned. I don’t think she’s a friend at all! What kind of friend supports you cutting yourself?” Daughter: “She doesn’t support my cutting. She just talks with me about my problems.”

32 (Coaching Mentality) Empathy vs. Detachment

33 S-E-T: A Communication Strategy Specifically for BPDSupport (“I” statement) “I want to try to help.” “I am very concerned about how you are feeling.” Keep all 3 elements in balance “This is the situation ... These are the consequences ... This is what I can and can’t do ... What can you do to resolve it? “This must be very painful for you.” “You’re in a tough situation.” Write out 3 typical case studies – OK, how would you respond using the S-E-T technique? Truth (calm, assuming competence) Empathy (“You” statement) Jerold Kreisman, Sometimes I Act Crazy

34 Five Steps to Better OutcomesRegulate your own emotion Validate (do this at every step) Ask/assess (don’t jump in the problem pool) Brainstorm/troubleshoot  Get information on your role (if any) and plan follow-up

35 DMHS CRISIS SERVICES – A DOORWAY TO THE WIDER SERVICE SYSTEM

36 DMHS C.A.L.L. Centre – Crisis Access Linkage Line Acute crisis support Multidisciplinary team approach System information, navigation and linkage Mobile support and crisis bed services, in addition to telephone support

37 Encouraging the Person to Seek Help

38 Avoid communication pitfalls such as labelling – your message needs to be that you see her as a responsible, capable person – someone who, when she sees a problem, wants to fix it Frame support as a way of learning new responses to old problems, of skill building – it’s not a judgment on her character or a punishment for some misdeed. Avoid the topic when either of you are stressed. Provide educational materials and contact information for available help.

39 Appeal to his values. Explore the activities and qualities that matter to him. Then ask how any current struggles might be interfering with his ability to pursue any of those activities or to live up to standards he values. Focus on specific problem areas, such as communication skills, memory lapses, parenting, or anger or stress management – try to find common ground in identifying these as “problems” that extra support could helpfully address. Frame “mental health” as being about living the life you want to live – about feeling your best, physically, mentally and emotionally. It doesn’t mean you’re “crazy” or damaged in some way. If he values independence and being in control, explain that extra support can help him become even more self-reliant and have more control over his reactions.

40 Don’t hesitate to contact David Clarke at [email protected]Thank you for listening! Always remember ... What is right about you and your workplace is more powerful than anything that is wrong. Don’t hesitate to contact David Clarke at