Mental Health First Aid in Workplace

Mental Health & MH First Aid

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Therapy - principle: connect emotions to trauma - mind and body in one. Explore the trauma in a structured way (still mindfulness or walking “to traumatic experience”

Mental Health Helpline

Source: Find mental health support | ontario.ca

Free Health Services Information: 1-866-531-2600

About Us

The Mental Health Helpline provides information about mental health services in Ontario. We are funded by the Government of Ontario.

Information is the first step.

A helpful Information and Referral Specialist will answer your call, email or web chat 24/7. Our service is free and confidential.

We can:

provide information about counselling services and supports in your community
listen, offer support and provide strategies to help you meet your goals
provide basic education about mental illness

Mental Health First Aid course

Mental Health First Aid is a new classroom course using curriculum from the Mental Health Commission of Canada, to help people continue to build awareness about mental health in our workplaces including all people and youth programs.

Mental Health in the Workplace for Employees

Source: My personal notes from work course on March 18, 2016

Mental Health in the Workplace for Employees

Introduction Module

A word of caution

The information in this e-Learning is intended to provide an introduction to mental health in the workplace.

Please do not attempt to diagnose yourself or others. If you suspect a problem, please consult with a qualified doctor.

Module 1 – Stigma

Learning Objectives

At the end of this module, you will be able to:

understand the impact of mental health issues in the workplace,
discover how many Canadians experience mental health issues,
recognize mental health issues as one of the leading causes of disability worldwide, and
evaluate the stigma surrounding mental health.

Why should I be concerned?

Ask yourself, “Why should I be concerned about mental health in my workplace?”

Mental health issues are growing in importance. Regardless of sex, age, race, and ethnicity, mental health is a problem that touches everyone. It impacts:

you,
your co-workers,
your organization,
your country, and
the world

Canadian Perspective

Can you guess what percentage of Canadians experience mental health issues each year? Is it:

If you guessed 20% you are correct!

The answers may startle you. But 1 in 5 Canadians will experience some type of mental health issue each year. An equally startling statistic, of that 20% of Canadians, only 6% seek or receive treatment. (source – CMHA (Ont.) 2012)

The global perspective

The World Health Organization predicts that by 2020, depression alone will be the second-leading cause of disability worldwide, second only to heart disease.

You might also be surprised to know that:

7.5 million Canadians suffer from depression, anxiety, substance abuse, or other disorders each year.
Mental disorders cost the Canadian economy $51 billion dollars annually.
78% of those diagnosed with depression keep it to themselves for fear of losing their jobs.
Physical illness absences increase 2-3 times when accompanied by depression.

Impacts to organizations

Every day, 500,000 Canadians are absent from work because of a mental health issue.

In many cases, psychological claims are the number one cause of salaried short-term and long-term disability claims.

Antidepressants are the number two most claimed drug category by employees and their families, with the top 5 stress-related conditions. Stress is the number one reason for Employee Assistance Program (EAP) counseling.

Why not seek treatment?

You may be asking yourself, “why don’t people seek or receive treatment?” In many cases, the problem is related to stigma.

Let’s look at the different types of stigma. Roll your mouse over each type below or press the corresponding letter (A, B, and C) on your keyboard to learn more.

Societal Stigma is the type of stigma that speaks to how people view a person with a mental disorder. Society feels uncomfortable about mental disorders as it is not often seen like other illnesses such as heart disease or cancer.

Through stereotypes, people believe that an individual with a mental disorder has a weak character or is inevitably dangerous.

Self Stigma is a type of stigma that a person with a mental disorder experiences internally.

People with mental disorders report that there is a real barrier in their progress to getting mentally healthy since they worry how people perceive them or how others will judge them.

Associative stigma is a type of stigma that is discriminatory or harassing behaviour resulting in inequitable and unfair treatment of people with a mental disorder and their family members.

This often manifests in forms of rejection encountered by someone with a mental disorder and their family.

Stigma in the workplace

Let’s look at some examples of how stigma manifests itself in the workplace. Examples can include:

failing to grant an interview to a qualified job applicant who has disclosed a mental disorder because it may be assumed that they may be unpredictable and emotionally volatile,
making assumptions that a colleague recovering from depression is incapable of doing their job or is unreliable,
spreading rumours that a colleague’s mental disorder is “all in their head,”
assuming they are lazy and using mental disorder as an excuse to get out of doing their job, and
telling inappropriate jokes about someone’s mental disorder.

Gustav’s case study – part 1

Gustav has been a highly respected member of your work team for many years. You work on many projects with him and often eat lunch with him in the cafeteria. You like Gustav and think of him as a friend.

Lately, you have noticed that Gustav has changed. At work, he has begun to come in late and looking disheveled. Instead of speaking up in team meetings as he used to, Gustav just sits there, staring at the wall until the meeting is dismissed. You know that he has missed key deadlines on important projects, because all of the rest of your team have had to scramble to get the work out on time. When a team member made a half-humorous remark about this, Gustav seemed to over-react by responding in a loud and rude way.

Continued

You haven’t seen much of Gustav in the cafeteria lately. From what you have heard, he just stays at his desk through the lunch hour, however, he is the topic of much discussion. Today at lunch time one person said, “I heard that old Gustav is seeing a psychiatrist. I’m not surprised because nowadays his behaviour scares me. They should get him out of here before he hurts someone. It’s not like he’s of any use to the team anymore.” You noticed that nobody protested or stood up for Gustav. In fact, they all seemed to agree that the best thing to do was to keep their distance.

Members of the team began to stigmatize Gustav as soon as word got out that he was seeing a psychiatrist. Why?

Pause for a few minutes here and reflect on why the team reacted this way.

Answers may vary, but your answer could include any or all of these points:

People do not know what to say or how to act towards someone with a mental health issue.
It is hard to understand mental health issues and often we are afraid of what we do not know.
They may be worried that Gustav might behave in an unpredictable manner.
The team does not realize that mental health issues can be temporary, managed, and sometimes treated, or
They have heard stories about people with mental health issues becoming violent in the workplace.

Continued

Now imagine that everything else in the case study was the same, except that Gustav was suffering from cancer rather than a mental health issue. Would the team react by stigmatizing Gustav?

Pause for a few minutes here and reflect on how you may respond in this situation.

Answers may vary, but your answer should include these points:

In general, people understand physical illness better than mental health issues.
As long as the physical illness is not contagious, people do not fear those who are ill and therefore have less need to stigmatize them.
People know that physical illnesses are treatable and that many people can recover from them. While this is true for mental health issues as well, many people do not realize this, and
People are more comfortable with physical illnesses primarily because they are often not stigmatized the same way.

Continued

You are Gustav’s friend. You seek him out at lunchtime and in a private place you tell him that you are happy to hear that he is now getting help.

Gustav becomes upset and shouts, “You are just like the rest of them. You think I’m crazy. You probably think I can’t do my job anymore, too!” And storms off.

Why do you think Gustav reacted this way? Reflect on the situation to determine what may have caused Gustav to react the way that he did.

Answers may vary, but your answer should include these points:

Likely, Gustav believes that his friend is judging him - he feels hurt and isolated.
Gustav may not have shared his health concerns with others on his team. People with a mental health issue are sometimes afraid to tell others or to seek out treatment for fear of being judged or labelled.

Gustav’s case study, conclusion

In this case study, we learned that each member of the team has a different view or understanding of mental health issues. To be supportive team members, we have to take part in removing the stigma surrounding mental health. Each of us is responsible for taking part in the safety and well-being of our team.

In addition, we must also maintain privacy and confidentiality at the highest level to avoid awkward situations between team members.

Summary

Well done. As you can see, mental health is a large and growing problem not only in Canada but around the world.

It can impact everyone in our society in some way including those we work with so we have to be sensitive and respond in a caring way when dealing with mental disorders.

We also learned that stigma associated with a mental disorder is a great barrier to the recovery of those with mental disorders.

Review

In this module, you learned how to:

understand the impact of mental health issues in the workplace,
discover how many Canadians experience mental health issues,
recognize mental health issues as one of the leading causes of disability worldwide, and
evaluate the stigma surrounding mental health.

You have come to the end of this module. You may now close the browser to end this module.

Module 2 – Mental Health Facts

Objectives

By the end of this module, you will learn how to:

Describe what mental health is and how it can affect an individual’s quality of life.
Understand the Mental Health Continuum. We’ll learn that our mental health is fluid and can change over time.
Appreciate medical science’s view of mental health disorders, and understand how these are diseases of the brain.
Understand the most common mental health issues that a significant number of people face.
Better manage your stress.

Mental health continuum

Let’s look at the full continuum of mental health. It starts with good mental health, being balanced, and handling the ups and downs of everyday life.

The Mental Health Commission of Canada maintains that good mental health acts as a “buffer from the stresses and hardships that are part of everyday life for most of us.” Unfortunately, many of us take our mental health for granted and it is not until our mental health is negatively impacted that we are able to fully appreciate how important it is.

In the middle of the continuum is a Temporary Mental Health Problem most often triggered by a significant upset in life or a major stressor, that throws us upside down for a period of time. Any one of us might experience such a stressor during our lives.

On the far right is the category of Mental Disorders, seen by medical science as diseases of the brain. This is when a person usually requires some professional help to get back on track. It is extremely difficult to will oneself back to good mental health. It is helpful to think of mental health as a continuum. In summary, a person’s mental health status is not static, but can fluctuate across the continuum, moving in either direction.

Mental health defined

Good mental health is comprised of many factors that can affect an individual’s quality of life including the ability to:

think independently and make decisions,
experience enjoyment and socialize,
feel in charge and able to make choices, and
Communicate our wants and needs straightforwardly.

According to Health Canada, mental health is defined by “the capacity to feel, think and act in ways that enhance one’s ability to enjoy life and deal with challenges.”

This definition is useful – it is simple, down-to-earth and easy to understand. But let’s dive down a little bit to better understand what it means for us practically.
It begins with the capacity to ‘feel’. Why is the word ‘feel’ so prominent? We can understand why the word ‘think’ is a part of the definition, but why is being in touch with our own feelings so important?

Good mental health means…

We feel well
We can cope with difficulty, and
We can achieve our personal goals

Mental health defined - Feelings

Good mental health is having …

“the capacity to feel, think and act in ways that enhance one’s ability to enjoy life and deal with challenges.”

This includes being:

in touch with your feelings,
able to know when to express them when and how you choose,
sensitive to the emotions of others, and
able to express empathy

So, why is it useful for us to be aware of our feelings? First, they are your guideposts in life, letting you know when you are doing the right thing and keeping you on track. If you are self-aware, you can make choices about when and how you express your feelings.

If you are unaware, just operating on auto pilot, your feelings may leak out in everyday interactions; in ways that you don’t really intend. If the frustration you feel when the traffic is heavier than expected, and you are late for work, your frustration may become your mood when you arrive at work and impact the way you deal with colleagues or customers. This attitude can be perceived as unprofessional.

If you never express your feelings*,* they don’t go away. They build up, like a pressure cooker, and eventually tend to bubble up and affect your mood, relationships, and even health.

Being sensitive to the feelings of others helps you at home and at work. Putting yourself in another person’s shoes, especially understanding how they feel, is a key ingredient in expressing empathy, building trust, and keeping relationships positive.

Mental health defined – thinking

Good mental health is having …

“the capacity to feel, think and act in ways that enhance one’s ability to enjoy life and deal with challenges.”

This includes being:

aware of your internal dialogue,
able to insert a “take two” script,
aware of the visualizations, and
able to change the picture to a healthier one.

What do you do when you “think?”

What processes do you engage in that you call thinking?

The most common way you think is by talking to yourself.

You compare pros and cons; articulate possible options, and wonder what is meant by a question. If you are aware of this internal dialogue, you will become aware of when it is an unhelpful perspective.

For example, if there is a problem on a project you are completing, you might say to yourself, “Oh my gosh, this is the worst thing that could have happened! This is going to throw my whole project plan off kilter. This is terrible!”

Now, this way of representing the situation is bound to make you feel stressed and upset.

Well, being stressed and upset is not the best attitude to solve the problem or fix the situation. That is best accomplished by having a calm, cool, and collected frame of mind. You need to say internally, “I’m making myself pretty stressed by how I’m framing this problem. It IS a significant problem and I need to solve it, but I’ll do a better job if I’m focused and rational.

Let me reframe this and do a “take two”. You can also say, “Yes, this is a problem, but I’m a good problem solver, I’ve got a smart team around me, and we’ll get through this. How should I begin?” Then, you can approach the problem in a constructive way because you are more aware.

Another common way you think is by visualizing, running a movie or picture in your mind’s eye. You remember a past event to assess it, you imagine a future event to anticipate it.

For good mental health, the key is awareness. If you are aware that you are producing these images in your mind’s eye, you can then have control and choice. This equals good mental health.

For example, if you are on your way to your in-laws for dinner on Sunday night, and you catch yourself having an image of the evening ahead, and it is of yourself “crawling out of your skin” with boredom, you are heading to a long, unpleasant evening. You can catch yourself and realize that you are producing this image and it’s predicting an unpleasant time. You are then capable of deciding to change that image to one that predicts a better time for you, which probably involves getting engaged in conversations, etc…

Mental health continuum

Now that we understand good mental health, let’s turn our attention to the middle of the continuum – temporary mental health problems. In other words, coping when there has been significant stress or trauma in our lives:

Mental health problems are:

…/temporary problems that can interfere with our ability to function, and affect our quality of life. You can react to such things as:/

stressful changes at work,
illness of a loved one,
relationship struggles,
financial uncertainty.

Often resolved through personal coping strategies, taking some down time, connecting with family & friends, or counselling

Almost everyone will experience mental health problems during their lifetime. These are temporary problems that might include periods of worry, trouble sleeping or eating, feeling fatigued, anxious, having difficulty concentrating, and focusing on work-life responsibilities or simply being in a bad mood.

Generally, mental health problems will be resolved when we are able to draw on resources and personal coping strategies, such as taking some downtime to connect with close friends or family, getting a good night’s sleep, connecting with communities of faith, or speaking with a counsellor*.* We’ll look at some resources to help support our mental health later in this training.

Obviously stress is a significant part of the equation here … Let’s now take a closer look at stress – how it works and how we can stay healthy in the midst of it.

Demystifying Stress

Stress does have value in your life, but left unchecked, stress can lead to distress and be counterproductive to good mental and physical health.

Biologically, the stress response is designed to be a brief and temporary reaction to an event that needs your sudden and complete attention to save you from harm. On the positive side, you need a certain amount of stress to keep you motivated and safe. In other words, stress is part of the human condition. A certain mount of stress is unavoidable. However, when it takes over your life, it can be problematic. And while stress is unavoidable, the way you perceive or react to it is not. Let’s take a look.

Stress vs. distress

Most personal, social and work related events by themselves are not stressful.
It is how you react to them or how you perceive them that determines whether they will cause you distress.

Some personalities are more prone to distress:

high performers
perfectionists

Perhaps the most important thing to remember, is that many daily situations aren’t inherently stressful. You have the choice whether stress will be the keynote speaker in your day.

Given that we can, to a great extent, control our reactions to situations and not the situations themselves, it makes common sense that we should take control of our “reaction equipment”. In other words, when an event happens, whether in our personal, social, or professional lives, we filter it through our own perceptions or filters to determine what the event means to us. The level of stress we feel and how well we manage that stress, is greatly influenced by our interpretation of the event.

In truth, being “stressed” gets a bad reputation just for doing what it was designed to do, it is what we call the “fight of flight” reaction. This is another name for stress.

And remember stress, in and of itself, is not a mental health disorder.

The fight or flight stress response

Without an immediate response to stress, human beings would have likely failed to thrive and adapt the way we have. Today, whether in your personal, social, or professional life, mild stress helps prepare us for challenges, dealing with difficulty, or avoiding getting hurt.

The diagram depicts that stress itself is unavoidable but our perception and reaction to it is not.

There are indeed many factors that will contribute to, and result in stress. For example, the knowledge that your child has been hurt surely incites stress! The key to managing stress is being aware of and choosing healthy reactions to it. Essentially, you must work to avoid reacting habitually to life’s uncertainties, and remind yourself not to ‘sweat the small stuff.’

Any perceived threat (real or imagined)

Stress reaction is triggered
Hormones flow into bloodstream (adrenaline, cortisol, noradrenaline)
- Increases to:
  - Muscle tension
  - Blood pressure
  - Breathing rate
  - Heart rate
  - Mental alertness
  - Emotional anxiety
  - Blood sugars and fats
  - Metabolism
- Decreases to:
  - Digestion
  - Immune system
  - Mental creativity
  - Emotional stability
  - Sex hormones
Body prepares itself for the fight or flight

When you do perceive a threat or danger, your body reacts and if you don’t choose fight or flight, you can end up frozen in your emotional state. This can have a negative effect on all aspects of your health.

Note: In the lower box, the decreases in functioning that occur with our digestion, immune system, mental creativity, emotional stability, and sex hormones.

Signs of distress

PHYSICAL
- Muscular tension/headaches
- Upset stomach
- Shortness of breath
- Difficulty sleeping/fatigue
- Grinding/clenching teeth
- Cold hands & feet
- Trembling/shaking
- Frequent colds, flu, infections
EMOTIONAL
- Worry/Anxiety
- Anger
- Irritability
- Apathy
- Hopeless/trapped
- Out of control
- Guilty/self-conscious
- Low self-confidence
SPIRITUAL
- Loss of purpose and meaning
- Questioning values
- Isolating yourself from friends, family, and your community
- Loneliness
- Excessive ‘busyness’
INTELLECTUAL
- Impaired judgment
- Inability to concentrate
- Easily distracted
- Memory loss
- Excessive worry
- Difficulty in making decisions/procrastination

So, what can you do to stay healthy in the face of inevitable stress of life? As usual, self-awareness is the key, recognizing the consequences of distress over time, and choosing healthy responses.

Coping with stress – staying resilient

PHYSICAL
- Exercise
- Fitness
- Diet
- Yoga
- Relaxation activities
- See family doctor regularly
EMOTIONAL
- Express emotions
- Vent with someone who cares
- Counselling (EFAP)
- Don’t let it build up
SPIRITUAL
- Meditation
- Inspirational reading, movies
- Prayer
- Talk to spiritual advisors and religious leaders
- Quality family time
INTELLECTUAL
- Monitor self-talk and adjust
- Cognitive Behavioural Therapy
- One thing at a time approach
- Don’t sweat the small stuff

It is important to take care of your physical well-being especially during stressful times. The most direct way to manage stress is by simulating the fight or flight that your body and mind has been preparing for. This literally burns up the adrenalin and cortisol that you produce and leaves you able to relax and recharge afterward. Many studies have historically shown the long term benefits of staying fit. This benefit also accrues to the healthy functioning of your mind. Excess cortisol in particular can damage brain nerves and compromise our ability to think properly.

Human beings have feelings and emotions that are born to be expressed. If you keep your feelings bottled up inside, you risk even more stress and consequences. It is helpful to vent with someone who cares to deal with the emotions in order to move on. We’ll reinforce the value of the Employee Family Assistance Program in a moment.

Spiritually: It is important to have a sense of purpose in life, a reason to get up in the morning. If that wanes over time, our life can turn negative quite quickly.

*Intellectually: W*e’ve discussed the expression “don’t sweat the small stuff”. If you are functioning optimally, you are able to perceive an event appropriately as “just small stuff” and we manage it. But, if you are not in a good mindset, you might perceive that same event as a big deal and become somewhat distressed because you feel unable to handle the level of stress you feel.

Rita’s story

Imagine that Rita works near you, although you don’t really know her well. Lately it seems that Rita has changed. She used to be very participative at team meetings and now she doesn’t seem to care.

Also, Rita used to be impeccably dressed, but these days her hair isn’t quite combed and her overall grooming isn’t what it used to be. She seems tired and her eyes often look red.

At lunchtime, instead of joining others in the cafeteria, she sits at her desk and either stares into space or puts her head into her hands.

Continued

So what do you think of Rita’s mental health?

You might be tempted to think about her behavior in light of the Mental Health Continuum, and begin to wonder whether she is dealing with a serious mental disorder.

But you’d be off course in that interpretation - there are important facts that you don’t know. Rita’s mother is extremely ill and has recently entered hospice care. Rita spends most of her off-work hours at the hospice centre with her mother, which accounts for the deterioration in Rita’s grooming and for her tired, less engaged demeanor.

Continued

The point of this example is that diagnosing from a few observed symptoms can be very inaccurate.

That is why it is so important to leave diagnosis to the health care professionals. As a friend, you can potentially help build a bridge to professional help for them, but let’s not try and be diagnosticians ourselves.

That said, let’s explore the last part of the Metal Health Continuum.

Mental health continuum

Let’s consider the right hand side of our continuum. This is the category of Mental Disorders, seen by medical science as diseases of the brain. This is when a person usually requires some professional help to get back on track.

As we’ve just discussed, our objective here is not to become diagnosticians, but rather to better understand these diseases and thereby reduce our ignorance and prejudices.

Startling statistics

Take a minute to read these and reflect. Which statistics stand out for you? What might be the impact of these statistics in your workplace?

7.5 million Canadians suffer from Depression, Anxiety, Substance Abuse or other mental health disorders each year but only one-third of those who need mental health services in Canada actually receive them (Sources: Canadian Mental Health Association, 2011; Statistics Canada, 2011)
78% of those diagnosed with depression would keep it to themselves for fear over their jobs (Global and Economic Roundtable on Mental Health, 2007)

-These statistics mean that we are all likely working with someone with a mental health issue who won’t tell us or anyone else about it. -The big question is why in today’s world, only one-third of those who need mental health services in Canada are not receiving them.

The stigma surrounding mental disorders

What is stigma?

Stigma is defined as negative, stereotypical thinking, and prejudicial attitudes about people who have experienced a mental disorder. Stigma can result in discriminatory or harassing behaviours that lead to inequitable and unfair treatment of people who have experienced a mental disorder, especially in the workplace.

What is self-stigma?

Someone with a mental disorder typically feels shame and fears rejection. Ultimately, self-stigma is the most significant barrier to getting help. People with a mental disorder, report that how others judge them is one of their greatest barriers to coming forward and seeking the help they need. This results in 2/3 of affected people not getting the help they need. People can’t usually get over mental disorders by relying on inner strength or willpower, but these myths contribute to self-stigma, preventing affected individuals from getting help.

Example of self-stigma

“I don’t know why I’m feeling this sad and hopeless, I wish I could talk to someone but no one will understand. Everyone will tell me what I already know; I just need to pick myself up and get it together!”

What is societal stigma?

People living with mental disorders face increased rejection and discrimination from society.

Example of societal stigma

“I don’t understand what is going on with Pat. We all have to deal with a lot in our lives and we just manage to do it. The moods and crying seem over-the-top. I mean, really!”

What is associative stigma?

Up to 83% of close friends and family members of someone living with a mental disorder encounter shame and discrimination.

Example of associative stigma

“It’s been an uphill battle since Bob’s diagnosis. I understand why each day seems like a struggle but my family just doesn’t get that he tires easily and is not up to big family gatherings. They’re upset because we missed the holiday dinner. Now we’re not invited to my niece’s wedding.”

Diagnosing mental disorders

Diagnosing mental disorders properly is difficult and complex, and it is best done by a health care professional.

We will review in some detail, how doctors make diagnoses so that we can better understand mental disorders and ultimately help reduce stigma.

Mental disorders are defined as a range of disorders affecting the emotional or mental health of an individual. It is marked by a disturbance in thoughts, feelings, and perceptions that is severe enough to affect day to day functioning.

Thorough descriptions of each mental disorder are contained in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM for short). Health care professionals use this manual to diagnose specific mental disorders including, depression, anxiety, alcoholism, and bi-polar disorder.

Let’s explore some of the most common mental health disorders to understand them better.

Mental Disorders

The DSM 5 lists many mental disorders. Based on recent statistics, the three most commonly seen in the workplace are:

Major Depressive Disorder,
Generalized Anxiety Disorder, and
Adjustment Disorder

Unlike mental health problems, mental disorders are not temporary problems that can be resolved through personal coping strategies. They are far more persistent and severe, and if left untreated, will likely get worse. Just like physical illnesses, they often require medical intervention, which includes medication, and psychological counselling. The good news is that most people affected by these disorders will recover and get back on their feet.

1 in 5 Canadians will experience a mental health disorder in their lifetime. Let’s learn more about each one.

Major depressive disorder

Since it is the most frequently diagnosed and the disorder most likely to trigger a disability leave, let’s provide an overview of the causes and symptoms of Major Depressive Disorder.

Research suggests that mental disorders are the result of a complex interaction of genetic, biological, and environmental factors. However, the brain is the final common pathway for the control of behaviour, cognition, mood, and anxiety.

However, a great deal remains unknown about the respective roles and interactions of heredity, environment, and brain dysfunction. Therefore, it is prudent to give them somewhat equal consideration.

Every one of us occasionally feels sad or down. It is a normal, healthy response to adversity. Clinical depression is much more than this; more than just the “blues”. It’s a complex mood disorder that affects Canadians of all ages and stages. This gives us a general notion about the disease but let’s peel back the layers a bit more.

While it can suddenly go into remission, depression is not something that people can “get over” just by their own will.

How does the family doctor actually diagnose major depressive disorder? Let’s see what it says in the DMS V.

A diagnosis requires a specific cluster of symptoms, at least 5 present every day and all day. This cluster must last two weeks or more.

Look at the list in the chart on the next slide. One of the first adjectives that comes to mind is that these are actually quite ‘common’ symptoms for all of us. Other than perhaps suicidal thoughts, we can relate to most of these every once in a while. They are not weird and wacky symptoms.

At the present time, there is no one scientific test that can conclusively diagnose a mental disorder. Researchers using MRI technology have found differences in the brain in individuals who have experienced severe mental disorders over the long-term but medical imaging cannot be used yet to conclusively diagnose mental disorders at this time.

However, just because we can’t yet detect mental disorders using simple medical tests, doesn’t mean physiological changes aren’t occurring. Some of us have heard the term, “chemical imbalance” used to describe depression and other mental disorders. What’s really imbalanced? Let’s look at one model to how it really works according to medical science.

Major depressive disorder – how does it work?

To help us better understand how mental disorders work, let’s explore a little further. Broadly speaking, our brain is made of 3 major areas; the Primitive Brain, the Limbic System and Prefrontal Cortex.

When a brain is functioning well, information is transmitted electrically from neuron to neuron across gaps from the Primitive Brain, through the limbic system, to the prefrontal cortex. This is done with the help of bio-chemicals called neurotransmitters. This process allows us to think clearly and to process our emotions.

Neurotransmitters are hormones that transmit information through our brains and bodies, helping to regulate such things as pleasure, pain, thought, and mood. Serotonin, dopamine, epinephrine and norepinephrine are the names of these neurotransmitters that affect our mood and emotion. Mental disorders such as major depressive disorder are believed to be a function of an imbalance - too many or too few neurotransmitters.

Medication is designed to influence the brain to restore the chemical balance, enabling the neurotransmitters to work properly.

If there is a problem with these neurotransmitters, the thought process can be compromised. Thoughts get stuck in the Primitive Brain and the Limbic system, leaving the person in a stress response, locked in emotion. They are unable to access the executive centre to deal with the situation constructively. This chemical imbalance is believed to contribute significantly to the development of mental disorders. The situation can also be thought of as a ‘wiring’ problem. It is NOT about a weak character as our stigmatized view suggests.

Here is a brief overview of the 3 parts of the brain discussed above:

Primitive Brain - This is where the stress response occurs.

Limbic System - This is where we process our feelings and emotions.

Prefrontal cortex - This is where our logic and decision making occurs.

Major depressive disorder

An example in action – the brain’s response

Imagine the following scenario:

You slept through your alarm and are late leaving the house for work. You get into your car, turn the key in the ignition and find that your car won’t start. Most of us would experience distress at this moment - frustration, anger or worry, as our stress hormones (adrenalin and cortisol) flood our nervous system. Here is what the person’s inner dialogue might sound like.

“Oh no! The car won’t start. This is bad!” - This is the STRESS RESPONSE from the Primitive, hot part of the brain. “I can’t believe it happened today, on a day I was already behind!” - This is the mid-brain reacting with frustration and emotion - still a hot part of the brain.

“Well, I’ve got to get to work – what can I do?. Maybe Chris hasn’t left for work yet and he could pick me up.” This is the executive centre doing the PROBLEM SOLVING – the pre-frontal cortex – the calm, cool, collected part of the brain.

This is how the brain is supposed to work. Alerted to the need for action by stress and fueled by emotion, we take action based on a cool analysis of options.

Let’s see what it is like when a person is experiencing an imbalance of neurotransmitters (Major Depressive Disorder or Anxiety).

When a person is experiencing an imbalance of neurotransmitters (Major Depressive Disorder or Anxiety) , they might have a different experience. They might feel the impact of the stress hormones and the consequent emotions, but the bio-chemical messages that alleviate the stress response might not kick in as expected in the prefrontal cortex, making it difficult for the person to calm down enough to think clearly. The person might feel so overwhelmed, they simply give up and call in sick.

From an outside point of view it might seem like this person lacks problem-solving smarts, willpower or is just lazy. The person him/herself might even experience self-depreciating thoughts and shame over the inability to act. However, what’s really happening is that the brain is not fully functioning and are preventing him/her from being able to think and act as a healthy person would.

Generalized anxiety disorder

The second most frequently diagnosed mental disorder is Generalized Anxiety Disorder. This disorder is about worry gone overboard.

A “Disorder” it is a type of uneasiness or panic that is severe, long lasting, and interferes with work and with relationships.

Examples include: Generalized Anxiety Disorder, Panic Disorder, and Social Phobias.

Worry helps us to stay healthy – as it reminds us to be cautious in the face of dangers.

worry prepares for challenges and it motivates us to solve everyday problems.

Sometimes, however, worry can dominate every day and situation. This is what happens when one’s biochemistry or wiring is out of balance.

The most common symptoms include:

Heart rate changes, respiratory difficulties, digestive aches and pains, headaches, vision changes, tingling or numbness in the extremities, and the person finds it very difficult to control the worry.

The DSM 5 lists the following symptoms for Generalized Anxiety Disorder:

The anxiety, worry, or physical symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
The disturbance is not better explained by another mental disorder.

Adjustment disorder

Adjustment Disorder is the third most frequently diagnosed mental disorder and it can often be seen in the workplace. This type of disorder is different than Depression or Anxiety as it is always related to a stressful triggering event and not necessarily a wiring problem.

The symptoms must clearly follow significant stress. The symptoms should be more severe than would be expected.
There should not appear to be other underlying disorders. The symptoms that are present are not part of a normal grieving for the death of a family member or other loved one.
Symptoms do not resolve themselves within 6 months of termination of stressor.
The cause of the stress is understandable and known.

All of the disorders in this category relate to a significantly more difficult adjustment to a life situation than would normally be expected considering the circumstances. For example, it is common to need months and perhaps even years to feel normal again after the loss of a long-time spouse. However, when this loss causes significant problems for an abnormal length of time it may be considered an adjustment disorder; that is, the person is having difficulty adjusting back to life after the stress or trauma.

Most of the common symptoms of Adjustment Disorder are very similar to the symptoms of depression. As with Depression, most people can get back on their feet after treatment.
Often, the recommended treatment for adjustment disorder is talking therapy, such as Cognitive Behavioural Therapy. The goal of psychotherapy is symptom relief and behavior change.

For any of us who might suffer from a mental disorder or excess stress, there are many resources to help us recover and cope.

Easy to access resources

On the job:

Your leaders
Human resource management
Employee and Family Assistance Program – EFAP (workhealthlife.com)

At home:

Family
Friends
Spiritual advisor
General Practitioner
Therapist
Mentor

In your community:

The Canadian Mental Health Association
Mood Disorder Society
Center for Addition and Mental Health (CAMH)

Recap

Mental health disorders have earned the status of the fastest growing cause of disability on a global scale. Mental disorders are treatable and stress is manageable. Early treatment is critical for a successful recovery. Mental health conditions can be treated in a variety of ways including medication, talking therapy, and community support aimed at achieving positive mental health. It is important to remember that diagnosis must be left to mental health professionals.

New medications have positively impacted the lives of people living with mental disorders. Specific medications are used to treat specific illnesses. For example, depression is treated with antidepressant medications, which support the neurotransmitters in the brain.

Talking therapy, commonly used in conjunction with medication, allows individuals to dialogue with a mental health professional with the goal of assisting with healthy change in behavior. This can help train our brains as well.

As we have seen, mental health plays a big part in how we live our lives. Remember, you can be mentally healthy even if you have had a mental health disorder; that is, you can be completely functional with the appropriate treatment and recovery. No one is immune to mental health issues, including some of the best performing employees. Even when suffering, a person can still contribute at home and at work. And although stress is not a mental health disorder, it can put a heavier strain on a person struggling with a mental disorder.

Remember, stigma is a barrier to progress. Education and responding to stigma in the workplace will help to remove this barrier.

Let’s conclude by considering the case of a colleague, named Gustav.

Gustav’s story – part 2

Gustav has worked for the company for 10 years, and he has consistently held up his end as a member of the team.

Lately you have noticed some changes in his behaviour. He’s been more argumentative and stubborn in meetings for example, but you tell yourself, it’s not really your business to say anything to him, you are just his peer.

You consider talking to your Manager about it but you’re not sure if that’s the right thing to do either.

Question 1

The team notices that Gustav’s behaviour is continuing. As a result, the team responds by talking amongst themselves and speculating as to what might be going on with Gustav. Since you seem to be the only person at work that he still seems to trust, the team has asked you to talk to him and find out what is going on. You find a private moment to discuss this with Gustav.

How do you begin this conversation?

Let me cut right to the chase Gustav. You have been difficult to deal with lately. What’s going on?
I have some personal feedback for you and I’m wondering if you are open to hearing it? (and wait for an OK to proceed)
Everybody on the team is concerned for you and we feel like you are shutting us out. You’ve been in such a negative mood lately that it’s really getting to us. I’ve been chosen to say something to you. So …?

When you are ready, continue reading to get the correct answer.

The correct answer is B). The best option is to respectfully ask for permission to offer negative feedback before delivering it. If we accuse, blame or negatively judge Gustav initially, we are likely to provoke a natural defensiveness, which will undermine our attempts to learn more or to support him.

If you chose a different answer:

The best option is to respectfully ask for permission to offer negative feedback before delivering it. If we accuse, blame or negatively judge Gustav initially, we are likely to provoke a natural defensiveness, which will undermine our attempts to learn more or to support him. Asking aggressive questions will also predictably trigger a defensive or even offensive reply from Gustav.

Question 2

Gustav says he is willing to talk to you about what is going on with him after you ask for permission. He tells you that he hasn’t been able to get a good night’s sleep for months and it’s taking a toll on his energy, patience, and enjoyment of life.

How do you respond?

Be a good listener and try to put yourself in his shoes. Try to understand what he is going through and then let him know that you understand how tough it must be.
Immediately telling him that he should get some professional help. This isn’t normal and he needs to take action.
Say to him “Well that’s not really an excuse for your attitude around here lately. No matter what you’re going through, the team wants you to be easier to get along with. OK?

When you are ready, continue reading to get the correct answer.

The correct answer is A). The best option is to be a good listener, and try to put yourself in his shoes for a minute, to understand what he is going through and then letting him know that you understand how tough it must be. By pushing Gustav to take action we may be inviting him to push right back, and tell us to mind our own business.

If you chose a different answer:

The best option is to be a good listener, and try to put yourself in his shoes for a minute, to understand what he is going through and then letting him know that you understand how tough it must be. By pushing Gustav to take action we may be inviting him to push right back, and tell us to mind our own business. By putting demands on Gustav to change, we make the conversation about our needs versus truly supporting Gustav.

Question 3

Gustav acknowledges that it has been very tough on him to go so long without proper sleep. He confirms that you do seem to understand what he’s going through.

How do you support Gustav?

You can say, “It’s hard to know what to do sometimes. What options have you considered?”
You can ask, “Have you talked to your family doctor about this? I imagine he or she might be helpful.”
You can say, “I can only imagine what you’ve been going through. Have you considered reaching out to the Employee Family Assistance Program? They have professionals there to help us when we have concerns and can help us get back on track. It’s confidential and free of charge.”
Any of the above

When you are ready, continue reading to get the correct answer.

The correct answer is D) There are many ways to be supportive. We can offer a choice of options to Gustav, which is respectful of him. We don’t want to use a “hard sell”, but rather offer options, invite Gustav to consider the possible ways he might get professional help to resolve his condition. Our job as a caring colleague can be to build a bridge for our teammates to get the help they need – it is not to be their doctor or counsellor or manager.

If you chose a different answer:

You are right, that would be helpful. But, so are the other responses. There are actually many ways to be supportive. When we offer a choice of options to Gustav, it is respectful of him. We don’t want to use a “hard sell”, but rather offer options, invite Gustav to consider the possible ways he might get professional help to resolve his condition. Our job as a caring colleague, can be to build a bridge for our teammates to get the help they need – it is not to be their doctor or counsellor

Summary

In this module we have learned how to:

Describe what mental health is and how it can affect an individual’s quality of life,
Understand the Mental Health Continuum,
Discover the basic physiology of mental disorders,
Recognize the most common mental disorders, and
Consider how to support a co-worker if they share their situation with you.

Thank you for your attention

Take a moment to pause and think how you can apply what you have learned here on the job or at home. Spread the word – become an advocate for tearing down the stigma and shame surrounding mental health issues.

Module 3 – Strategies for Mental Health Resiliency

Learning objectives

At the end of this module, you will be able to:

- discover basic techniques to strengthen resilience to mental health issues, and - learn strategies for building personal resiliency

Why resiliency?

Building your personal resiliency is an important piece of the puzzle when it comes to staying healthy and safe on the job. Resiliency refers to someone’s ability to cope.

The healthier a person is psychologically, emotionally, and physically, the more successful they will be when faced with life’s demands, stress, and adversity.

A resilient person is someone who:

remains calm and copes well under pressure,
has confidence in themselves,
is capable of setting limits and boundaries, and
takes time for themselves

Building your resiliency

Below are the 4 strategies for building your personal resiliency

Connect

Here are some important strategies for building resiliency by connecting with others:

Develop strong connections with persons who care. These could include family, friends, spiritual connections, and support groups
Spend time with people who make you happy
Seek help or support when needed, and
Communicate about what you need

Cope

Here are healthy self-care strategies:

Exercise regularly
Get regular sleep
Eat a good nutritious diet
Take time for yourself and have fun
Don’t overdo it. Set boundaries for yourself

Adapt

Reduce daily stressors and build your adaptive capabilities
Find your natural coping mechanisms and use them more
Practise relaxation and deep-breathing techniques
Don’t sweat the small stuff. Maintain perspective
Humour can help you adapt in stressful situations
Find the parts of the problem you can manage. “Let go” of the parts that are out of your control
Maintain a positive outlook
Practice self-talk to maintain confidence, and
Say “no” when you need to

Know

Know when you can care for yourself and when you need care from others
Recognize your personal stress signs and stress triggers
Accept yourself and the fact that you are vulnerable
Know when to delegate
Keep things in perspective
Get help if you experience negative changes in behaviour

Strengthening your resiliency

Below are some basic approaches to strengthening your resilience to mental health issues and lapses into mental health distress:

Develop healthy habits like getting enough rest, good nutrition, hydration
Get regular exercise and stress management
Regular exercise and stress management
Strengthen family relationships and social ties
Take scheduled breaks in your day including a break from work
Nurture a hopeful, optimistic and confident outlook about the future and yourself, and
Keep things in perspective

Summary

That’s it. As you can see, building and strengthening mental resilience through a balanced lifestyle plays a key role in helping us cope with adversities and stress, which could lead to a mental health issue.

Key points to remember for building resiliency include:

coping,
connection,
knowing yourself and your limits, and
adapting to reduce stress

Review

In this module, you discovered:

basic techniques to strengthening resilience to mental health issues, and
strategies for building personal resiliency

You have come to the end of this module.

Module 4 - Resources

Learning objectives

At the end of this module, you will be able to:

- discover resources and support to find assistance when dealing with mental health issues

Ways your organization can help

Organizations are becoming increasingly aware of the need to take the issue of mental health seriously and lend help and support where appropriate while respecting people’s privacy.

As a preventative measure, organizations are keeping a close watch on the health and well-being of their employees by trying to maintain a healthy work environment.

Organizations are equipping leaders with the training and tools to recognize unusual and unexplained changes in their employees’ behaviours.

Early intervention is important.

Having a conversation with your manager, leader, or HR representative about a condition you may be experiencing may help in a faster recovery to a healthier mental state. Accommodation and empathy are factors workplaces are putting in place to help avoid a “slip” into an impaired mental health state.

Support and referral to resources that provide additional services may also be helpful before the need for a mental health related disability occurs.

Please do not attempt to diagnose yourself or others. If you suspect a problem, please consult with a qualified doctor.

Ways to help others

Should you wish to provide support and be there for someone, here are some general guidelines:

Be respectful and maintain confidentiality. Consider how you would like to be approached if you were in the same situation.
Find a time and place to talk that is mutually convenient and private.
Keep questions open-ended and supportive. Listen with empathy. Allow the person space to talk. Let them know that “your door is always open” if they need to talk.
Offer support. Remind the person about availability of resources.
Most importantly, do not assume or judge. Do ask the person how they are feeling, but do not say “what happened to you?” Instead, say “I have noticed that you…” and describe what you have observed.

Where to find help?

While recovering from a mental health disorder, it is important to get support and to maintain some social contact – this aids in recovery. There are many resources that can help provide support.

Your organization has invested in resources to support you on the job. Your family, friends, physician, including psychiatrist and therapists, can support you in your personal life. There are also resources in your community that are available to you.

On the job

Manager/leader
Colleagues
Human resource
EFAP
My EAP mobile app
www.shepellfgi.com

At home

Family
Friends
Medical doctor
Psychiatrist/therapist

In your community

Canadian Mental Health Association:

http://www.cmha.ca

Mood Disorders Society:

http://www.mooddisorderscanada.ca

Center for Addiction and Mental Health (CAMH):

http://www.camh.net

Suicide Prevention Resource Center:

[http://www.sprc.org](http://www.sprc.md/)

Employee and family assistance program

The Employee and Family Assistance Program (EFAP) provides employees 24/7 toll-free confidential telephone access via the Care Access Centre. It is also available in a secure and confidential access online via workhealthlife.com. Assistance is provided by trained counselors in English and in French.

Summary

Organizations have an important role to play in promoting good mental health and helping those with mental disorders. Your organization is committed to providing resources for dealing with mental health issues. Your leaders, managers, and HR team are equipped to accommodate and support you on your road to recovery.

In addition, personal support and community resources also play a big role when dealing with a mental health issue. And should you choose to provide support and be there for someone, it is important to be respectful and supportive.

Please do not attempt to diagnose yourself or others. If you suspect a problem, please consult with a qualified doctor.

Review

In this module, you discovered:

how to support others including your colleagues experiencing mental health disorders, and
resources and support to find assistance when dealing with mental health issues.

You have come to the end of this module.

Module 5 – Assessment (Exam)

There are 10 randomly drawn questions for you to assess your own knowledge of the material covered in the course.

Note: The ten questions in the interactive course vary and are chosen from the 22 questions listed here:

Question 1

What percentage of Canadians experience mental health issues each year?

When you are ready, continue reading to get the correct answer.

The correct answer is C).

Question 2

The World Health Organization predicts by the year 2020, depression will be the _______ leading cause of disability worldwide.

First
Second
Third
Fourth

When you are ready, continue reading to get the correct answer.

The correct answer is B).

Question 3

People with a mental health disorder report that how others judge them, or how they perceive that others are judging them, is one of their greatest barriers to a complete and satisfying life.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 4

Breaking the stigma surrounding mental disorders is an important step in understanding and fighting the illness.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 5

An individual with a mental health disorder has a weak character or is inevitably dangerous.

True

When you are ready, continue reading to get the correct answer.

The correct answer is B).

Question 6

Mental health is comprised of which of the following factors that can affect an individual’s quality of life, including:

The ability to think independently, make decisions
The ability to experience enjoyment, socialize
The ability to feel in charge, to be able to make choices
The ability to communicate wants and needs straightforwardly
All of the above

When you are ready, continue reading to get the correct answer.

The correct answer is E).

Question 7

Being mentally healthy means:

We deal with life’s difficulties
We feel well
We can achieve our personal goals
All of the above

When you are ready, continue reading to get the correct answer.

The correct answer is D).

Question 8

A person’s mental health status is static.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is B).

Question 9

Diagnosing mental health disorders should be left to health care professionals.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 10

A physician bases mental health disorders on which of the following?

How much distress is the person experiencing?
How closely do the symptoms correlate to the clinical definition of the impairment
Both A and B
None of the above

When you are ready, continue reading to get the correct answer.

The correct answer is C).

Question 11

Adjustment disorder is another type of mental health disorder that is often seen in the workplace.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 12

They symptoms of Anxiety disorder are characterized by extreme, chronic anxiety that disturbs mood, thought, behavior and ability to function.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 13

Anxiety helps a person avoid danger, and motivates them to solve everyday problems.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 14

Anxiety disorders are characterized by which of the following symptoms:

Extreme, chronic, anxiety that disturbs mood
Extreme, chronic, anxiety that disturbs thought
Extreme, chronic, anxiety that disturbs behavior
Extreme, chronic, anxiety that disturbs ability to function
Any or all of the above

When you are ready, continue reading to get the correct answer.

The correct answer is E).

Question 15

Generalized anxiety disorder is characterized by:

Too much fun in the sun
Exaggerated worry and tension, even when there is little to provoke it
Characteristics are unknown
A little bit of worry or uneasiness

When you are ready, continue reading to get the correct answer.

The correct answer is B).

Question 16

Anxiety only has negative effects.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is F).

Question 17

Stress is not a mental health disorder

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 18

Our personal perception determines our response to stress.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 19

Stress is a very physical thing affecting almost every system in our body.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).

Question 20

Which of the following persistent physical symptoms can be signs of distress?

Muscular tension

Headaches
Grinding/clenching of teeth
Trembling/shakiness
All of the above

When you are ready, continue reading to get the correct answer.

The correct answer is E).

Question 21

Which of the following are ways that you can support someone with a mental health issue?

Be respectful, sincere and maintain confidentiality
Listen with empathy and allow the individual space to talk
Let them know that “your door is always open” if they need to talk
Keep questions open-ended and supportive
Any or all of the above

When you are ready, continue reading to get the correct answer.

The correct answer is E).

Question 22

The healthier a person is psychologically, emotionally and physically, the more successful they will be when faced with life’s demands, stress and adversity.

True
False

When you are ready, continue reading to get the correct answer.

The correct answer is A).