Are our kids OK?

Normal worries

Entering school

Friendships

Teachers

School work and home work

Peer group

Moving home and school

Sibling rivalries

Parental conflict

Illness in Family

Resilience

Develops over time, experience, tough times, with support,

Helped by talking it through, perseverance, using resources, holding hands, hugs and pats on the back

Building on strengths, earlier lessons learned, secure foundations

Healthy lifestyle; sleep, good meals, exercise, creativity, learning, good company

Reminders of internal strengths and external supports

Good breathing and mindfulness.

Signs of DepressionFEELING SAD/ MISERABLE/ TEARFUL

Persistent low mood that doesn’t lift

   IRRITABILITY Persistent over-sensitivity. Can appear as aggressive outbursts.

   SOCIAL WITHDRAWAL Isolation from friends and family, hiding away.   POOR CONCENTRATION Difficulty with attention, decision-making and memory.   ALTERED SLEEP PATTERN Difficulty getting off to sleep; disturbed sleep.   ALTERED APPETITE/WEIGHT

Loss or gain in appetite and weight.

   LOW SELF ESTEEM Low opinion of their self/attributes/capabilities.   ANHEDONIA Loss of pleasure in hobbies, work and relationships.   HOPELESSNESS/HELPLESSNESS

Pervasive negative thinking style.

   SUICIDAL THOUGHTS Thoughts that life isn’t worth living. Intent/suicidal plan.   SELF BLAME/GUILT Excessive guilt or preoccupation with past deeds.    It could be depression if:

Some of these symptoms occur for most of the day, for more days than not,And they cause a significant impairment in functioning.

Depression in Educational settingACADEMIC PERFORMANCE INDICATORS

Unexplainable decline in academic performance Loss of interest in course content Decline in effort expended Gives up easily Complains of not having enough energy to complete assignments

    SOCIAL/BEHAVIOURAL INDICATORS

Irritability Looks and acts tired Alienates peers Withdraws from social contact/interactions 

   COGNITIVE/AFFECTIVE INDICATORS

Indecisiveness Concentration difficulties Expression of suicidal wishes Expects to do poorly/fail Poor self-esteem Complains excessively Low mood Feels guilty 

   PHYSICAL INDICATORS Sleep disturbance

Change in appetite Feels weighed down Complains about feeling tired Frequent complaints of aches and pains

 

Strategies to help young people with depressionA LISTENING EAR Talking to someone whom one can trust is a universal strategy for obtaining

support, even when no solution is found. Sometimes a teacher/counsellor may be the adult in a young person’s life in whom they feel they can confide about certain issues. Talking through worries can help a the young person discover new solutions and new ways of coping. It can be sufficient simply to listen, be receptive, and reflect the concerns you are hearing about.

Parents sometimes feel excluded but the same message applies, giving your child space and time to talk without passing judgement. Suggesting a visit to the GP may be the next step if you need further advice and to check out risk.

 

Asking about Feelings

Here are a few suggestions to facilitate the process of asking about feelings: 

1. Find a good time to ask how they are doing, away from distractions. Tell them what you have noticed and try to keep things general and open. Often young people are trying to protect parents from their worst thoughts and feelings but tell their friends or someone at school instead. They may worry you might talk to others. Explain that you want to help and are aware that things often feel worse when they are not communicated.

2. Try to be open and non-judgemental. Ask questions to try to understand their perspective and to clarify the problems.

 3. Be aware of the timeframe so they have the chance to get themselves together before doing something else like meeting friends and arrange another time you can get together to catch up.

 4. Before finishing let them know what you understand about what they have said or have decided to do that would be helpful. Reassure them that they have not overwhelmed you. If they have spoken about self harm or suicidal thoughts, arrange a time to visit the GP to check this out further.

   

MAKING DEPRESSION UNDERSTANDABLE

It may become evident through talking that your young person may be depressed. They often become so absorbed in feelings they haven’t put everything together eg, their sleep difficulties, loss of appetite, irritability, withdrawal from friends, and difficulties with concentration. Hence clarification of the bigger picture, understanding what this may look like and supporting them to see their GP often helps to put this in perspective. It can also allow the emergence of particular problems that they may need help with such as academic work worries, friendship difficulties, sleep problems, and support to get through the day. These individual concerns can then be tackled using the problem solving techniques used regularly by teachers with students who have difficulties and concerns. Web site resources are often very helpful here.

Concerns about riskDeliberate self harm and Suicide risk

Chronic low mood is associated with a ‘negative’ cognitive style with self-deprecatory thoughts and often feelings that life is not worth living like this. These feelings are not in themselves dangerous, and often people feel relieved at being able to voice their concerns and feel unjudged.This alone may be enough, but for some you may need to ask- “have you ever thought about harming yourself or actually harmed yourself ?” Most will say that they have thought about a way of harming themselves but have dismissed the idea. Some may have planned a way to harm themselves but stopped at the last moment eg, after swallowing a small number of pills or making superficial cuts to their arms. Such actions should be taken seriously as they reflect a level of distress and certain degree of intent. Calling the GP to discuss or CAFMHS 0800 218219 will provide advice and recommendations.

Suicide is a difficult area and many may feel completely overwhelmed that this thought has occurred to their young person. However these thoughts occur more than we realise. Reassuringly, there is no evidence that asking about suicidal feelings will initiate them in someone who has not thought about it. Suicidal intent should be assessed urgently by mental health professionals. Similarly a failed attempt, no matter how medically insignificant the method, requires urgent assessment. Some simple measures to be put in place whilst awaiting assessment are: supervising or staying with the young person in a safe place; ensuring that high windows and doors are secure; ensuring sharp objects are out of the way; and checking belongings for potential source of self-harm such as pills.

   

Young person’s concerns about confidentiality  There is good evidence that students’ personal reluctance to

admit to depressive feelings is a major obstacle to better recognition of adolescent depression. Stigma and stoicism probably influence this, but doubts about confiding in an adult also seem crucial. Young people go to doctors reluctantly, and when they do consult most are cautious consulters. There seems to be two main concerns: 

Complete loss of confidentiality; whoever they tell will tell everybody else. 

Fear of peers or parents finding out. The first fear reflects the “black and white” thinking so common among teenagers. The second often seems a fear of disturbing parents – either to protect them from distress or to protect themselves from their parents’ anticipated reaction. It seems likely that depressed students need support to confide in others about how they have been feeling. Three possible ways to help them:

  

SUPPORT OF PEERS 1. The support of friends who’ve observed a change in them. Peer support may prove a crucial element in improving recognition of depression eg helping them to talk to a counsellor or parent, perhaps even accompanying them to the doctor to seek help.

   

ContinuedSUPPORT AND ADVICE FOR PARENTS

1. The school counsellor is available to support and advice Parents in order to help them respond to their young person’s mood concerns. Sharing risk plans and strategies that improve their negative mood states. A clear referral pathway is important as a young person’s depression remaining untreated can only add to the parental worries. 

2. Shared information between counsellor and parent is generally on a ‘need –to-know’ basis. However maintaining the young person’s safety is the main priority at this stage.  

   

DEFINE CRITERIA FOR INFORMATION SHARING

This may include making their teachers aware of their impaired concentration and its cause, so that appropriate support strategies can be developed. In particular, specific information of the student’s particular fears and personal circumstances would not be passed on without very good reason eg, their family’s particular circumstance whether it be financial or psycho-social or illness rarely needs to be shared. Even then, only with the student’s specific consent (ie, on what to share, to whom, and how this will be done).

Supporting the depressed person  A depressed young person can be supported by

offering;  Information on the importance of keeping up

routines for sleep, eating and exercise. 

Contact with peers when they feel ready  Adult support

  Planning of finite and achievable tasks to help get

them through the day What depressed young persons need is time to heal, chances for success, and positive feedback. Offering support can be time intensive for parents and teachers and they may feel that in relative terms the achievements are small. However, these small achievements really do make a positive difference. Reliance on specialist centres is often exaggerated and the normalising activity of the daily routine, even if a young person is only in a student support base, can be an extremely valuable contribution to therapy.

      

Activity Scheduling

A commonly expressed thought by depressed young persons is how difficult it is to get started in the morning and how getting through the day seems like a Herculean task, leaving them feeling hopeless and even more depressed at their own incompetence. A real plus point about school life is its inherent structure that organises the day and keeps a routine. The young person may need help in organising their after school time, scheduling physical activity or planning the weekend. A simple timetable of the external physical world can often help the despair of the internal emotional world.

Mood and eating disordersMOOD AND EATING DISORDERS

Mood and appetite are closely related: low mood invariably impairs both appetite and pleasure in food. In depression normal eating becomes diminished. In some youngsters this can be replaced by comfort-eating, so weight gain rather than weight loss can occur. This may amplify existing feelings of self-disgust and loss of control (reinforced by the cultural emphasis on slimness/fitness). Strenuous efforts to curtail food intake may follow, either sustained restriction – producing consistent weight loss and an anorexic picture – or intermittently maintained because of ‘break-through’ binge eating (bulimia).

   

Difficulties putting feelings into words The teenager who has sought to deal with their depressive feelings by distortions in

eating has usually not found the words they need to express their distress. So they may not welcome any focus upon their feelings; indeed, they may appear subdued or unhappy but strenuously deny the presence of any depressed mood. Preoccupied by feelings of weakness or loss of control, admitting to depression would be the last straw.

 

The best approach may simply involve acknowledging that something is wrong and that they are obviously not very happy at the moment. Diminished calorific intake is now recognised to lower mood, even in normal subjects, so even a very small increase in their diet on a regular basis usually helps these young people. Failure to increase their intake will diminish their wellbeing, but converse to most media coverage, it does not usually threaten their life. There is rarely the same urgency as for those whose depression-induced self-harming can place life at risk, and many would argue the best approach is to respond quietly, taking the long view.

 

Nonetheless, recognising the presence of an eating disorder should usually lead to referral to your school’s immediate support services (health or psychologist). The combined presence of both depression and an eating disorder is strong indication for referral beyond these, to specialist child and adolescent mental health services.

General AdviceGeneral advice Mind and body interact, each affects the other in a circular way. The sensitivity of this interaction varies between individuals. Where there is a close relationship, altering one might produce significant change in the other. The benefits of interrupting or stopping drug or alcohol misuse, increasing dietary intake, regular healthy exercise and accepting advise on measures to re-establish a normal sleep pattern, can become apparent within a few weeks, although none in themselves will ‘cure’ the teenager’s depression. Key Points  Where a depressed young person has any of these problems, they have usually developed

as coping strategies 

The links between mood and these behaviours are not always recognised by them  A shared and agreed understanding of the relationship between mood and behaviour can

be a useful first step in helping the young person help themselves 

Habitual behaviour isn’t readily given up, so follow-up enquiry and support is always important

  Schools can do a lot to help these teenagers, how far a school can succeed on its own will

vary from case to case 

There should be no delay in referring a depressed teenager with self-harming behaviour to a specialist mental health service, but reduction to the risk of further self-harm is likely to take time.

 

About anxiety in Young people

What does anxiety look like in children?

How to treat anxiety

Psycho Education- supportive family and other supportive relationships

Treatment –

o Individual Cognitive Behaviour Therapy

o Group work

o Family Therapy

o Medication

o Self help

Advice for Parents

Parenting is not easy, especially parenting a child who has anxiety

o Be aware of your own expectations. What are you expecting from your child? Expectations can be difficult to identify as they are often ingrained and automatic

o Keep your expectations realistic and balanced

o You may need to challenge your expectations. Are you being realistic?

o Develop a collaborative and supportive relationship with your child to beat anxiety together

o Decide together what roles you will take to be helpful, and remember these might change over time. Are you a clarifier, monitor, cheerleader, motivator, reviewer and advocate

o Reward progress, however small, with praise and encouragement

Cognitive Behavioural Therapy

CBT can help children and young people overcome anxiety by helping them to learn new ways of thinking and doing things in response to it.

CBT teaches children and young people about how thoughts, feelings and behaviours all affect each other.

Before focusing on thoughts, it’s important first to understand what situations cause your child anxiety.

Help them measure their feelings Emotions and feelings are an important part of our daily experiences.

From time to time everyone has negative emotions. These can be important signals that something is not right or needs to change

Find out what situations cause them negative emotions. Write them down and ask them to rate the feelings.

Use an emotional thermometer to rate the feelings on a scale 0-10 (10 being the worst imaginable ever)

Emotions vary in their intensity, from mild to very intense. Negative feelings like anxiety are only a problem when experienced at these intense levels or if they occur frequently.

3 main ways to manage anxiety

After helping them to identify what situations lead to intense anxiety

Help them with:

Detecting unhelpful thoughts and beliefs – help them to begin challenging them to make them more realistic and balanced (will discuss in more detail further on)

Changing actions through setting small achievable goals

Developing and using active coping strategies that aim to help them do something in a situation rather than just live with it

Understanding thoughts and feelings

Thoughts and images create feelings which leads to behaving in certain ways.

Helpful thoughts are flexible and realistic which often lead to more positive feelings

Unhelpful thoughts (negative thoughts) often leads us to feel stressed, down and angry.

Unhelpful and Negative Thought Styles

Discount the positives

Snowballing

Catastrophising

Dustbin Labels

Predicting the Future

My feelings decide how I think

Looking at the World Through Negative Glasses

All or Nothing/ Black and White Thinking

Realistic Thinking Identify the event that is causing concern

Identify the thought behind the feeling

Look for realistic evidence

Examine the realistic consequences

Identify a realistic thought

Rate how much you believe the original thought now.

Fighting and facing fears

Fears often cause us to avoid doing things we would otherwise do and causes us to miss out on fun things, leaving us feeling bad. Fear is pervasive and doesn’t go away unless we actually face the situation we are avoiding. By not letting the fear stop us from doing things we are conquering the fear, therefore by facing the fear it disappears.

Goal setting – get child to identify a goal to work on

Graded exposure – plan each step, how will the goal will be achieved

Step ladders – use eg of one in saved documents hierarchy ladder

Surfing worry – each step will cause anxiety but they must learn to ride

the anxiety wave.

Revising the step-ladder – how are they progressing?

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Developing Coping Strategies- Problem Solving

STEP 1: UNDERSTANDING THE PROBLEM

STEP 2: WORK OUT WHAT THEY CAN CHANGE

STEP 3: ASK THEM TO LIST ALL POSSIBLE SOLUTIONS

STEP 4: LIST POSITIVE AND NEGATIVES OF EACH SOLUTION

STEP 5: DECIDE ON ONE SOLUTION TO TRY

STEP 6: REFLECT ON HOW IT WENT

Developing Coping Strategies- Decision Making

In this step you help them look more in-depth at the solutions generated during the brainstorm, and by weighing up the advantages and disadvantages of potential solutions, you make a decision about which one to implement. The aim is to find a solution that will be effective. Use a decision-making guideline. This is achieved by first considering whether there are any solutions they can immediately discard (initial selection). Then similar solutions are grouped together to gain a sense of the range of options available (grouping solutions). Finally, get them to choose two or three solutions they would like to try out and evaluate them in more depth (weighing the advantages and disadvantages).

Problem:

Potential Solutions:

Weighing up decision making process:

Advantages Disadvantages Neutral

Developing Coping Strategies- Assertive Communication Skills

Assertive communication is the ability to communicate opinion, thought, needs & feelings in a direct, honest & open manner. It requires accepting & respecting your own rights as well as those of others.

3 Styles of communication:o Passive style - the “martyr” or “doormat”o Aggressive style – the “intimidator”o Assertive style – the “respecter”

Steps to take to become assertive:o Acknowledge your feelingso Catch your thoughtso Acknowledge others feelingso Communicate Confidentlyo Use “I” messages

Problem: I feel: Because: I would like:

Relapse Prevention

If a relapse does occur it is important you try to reduce its length and intensity. This not only helps to improve your chances of a good recovery but it also helps to minimise the amount of disruption to your life. Try to identify the factors that have triggered your relapse. Once you have identified these, you will be able to refine your relapse prevention plan and start working towards avoiding any future relapses. Try not to become too disheartened if a relapse has occurred. Learn what you can from it and try to move on.

Anxiety Relapse Prevention Plan Checklist How did you feel when your anxiety was not under control? What things

were you not able to enjoy or do? How does it feel when you are controlling your anxiety? What things are

you able to enjoy? What techniques have you learned? What have you found useful? How can you put what you have found useful into action? What might be the barriers to this? How can you overcome these? How do you know when you are feeling worse? What are the symptoms?

What are your red flags? What are your difficult situations? If you had a setback, how would you cope? Who could help you cope? How would they help? What thoughts or behaviours will keep you motivated to maintain your new

positive ways of managing anxiety?

When should you be concerned

Ideas from parents……..

How is this problem affecting my child’s functioning in normal daily life?

What are they saying, demonstrating that causes concern?

What have we done to provide help/support? Has that been useful?

Who else could help?

What else could help eg Internet support for depression, anxiety

Are there more concerns and risks?

Where do we go for specialised help?

Support services including SMHS Supportive counselling- School, Presbyterian support-366 5472,

Relationship services-7419201, Catholic Social Services-3790012, Petersgate-3433391

Right Services Right Time- 375 1468

BIC co-ordinators- CYMHS-2817616, Waipuna trust-3862159, RPHO-3574970 (mild- mod MH)

298 Youth Health Centre (mild- mod MH)- 943 9298

Puru Puru Whetu- 3798001, Kaupapa Maori service 14-18 & Whanau support

Pacific Trust- 3663900, MHS & Whanau support

ChCh resettlement for refugees and migrants- 3550311 MH assmnt

Specific counselling- START- 3554414, STOP- 3745010, Monarch Centre- 3775401, Waipuna young mothers, young fathers support, ACC funded counsellors

SMHS- CFSS, YSS, CAF-Rural (mod – severe MH) via referral to CAFLInk 0800 218219

CAF emergency service 0800 218219 dial 1 or Crisis Resolution (after hrs) 0800 920092

Internet resources

www.brave.org.nz online program for Anxiety (7-19 yrs)

www.sparx.org.nz online program for mood concerns, www.skylight online and resources, Mood Diary App for Iphones, CALM (online MP3), anxietybc.com, mood scope App, Smiling Mind App, www.lowdown online Info, www.commonground

www.addressthestress.co.nz, youthline 0800 376633 or talk@youthline.co.nz, Social anxiety support group CBD, www.phobic.org.nz, www.headspace.org.nz, www.beyondblue.org.au,

www.thinkfirst.org.nz (cyberspace info for parents and youth), www.netsafe.org.nz, Whatsup (counselling phone line 5-18 yrs),Kidsline (info and phone counselling 9-13 yrs), Attitude.org.nz, www.headmeds.org.uk/conditions/depression kai Xin Xing Dong (MH prog and support for Chinese Community),

www.rootsofaction.com/positive-parenting/

Download onto MP3 players www.biteback, www.blackdog,www.smilingmind, www.getskills, www.psychologytools, www.moodlytics, www.via

Book “Living in the moment” by Anna Black

Any questions?

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