HEALTH PROFESSIONALS WEBINAR SERIES Mental ......priorities, content and process. Social Science & Medicine, 74 (2): p. 143-149. jcu.edu.au HEALTH PROFESSIONALS WEBINAR SERIES Mental

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HEALTH PROFESSIONALS WEBINAR SERIES Mental Health Skills Update

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GPs provide the bulk of mental health care to the communityGeneral Practitioners

• 2018-19

8.7% Australians received a Medicare Mental Health service

• 2015-16 BEACH

12.4% of all consultations MH related

Other practitioners 2018-2019

• Psychiatrists

1.6% Australians received service

• Psychologists

2.1% Australians

Source: https://www.aihw.gov.au/getmedia/66853416-fffe-480e-a40c-2211139077ed/Medicare-subsidised-mental-health-related-services-2018-19.pdf.aspx

https://www.aihw.gov.au/getmedia/66853416-fffe-480e-a40c-2211139077ed/Medicare-subsidised-mental-health-related-services-2018-19.pdf.aspx

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GPs will see a variety of Covid-related MH presentations

Without pre-morbid MH disorder

• Increased levels of stress

o Burnouto Financial/employmento Isolationo Home schoolingo Isolation from loved ones

• Loss of normal stress modifiers

o Exercise, social activity, hobbieso Holidays

With pre-morbid disorder

• Introverts/agoraphobic/OCD patients probably fine!

• Catastrophisation, fear

• Hypervigilence

• Added stress to current vulnerability

• Access to help limited

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The Heart of Generalist Mental Health

Dr Johanna Lynch

PhD MBBS FRACGP

www.drjohannalynch.com

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“The disparity between physical and psychological stressors is an illusion.

Host defence mechanisms respond in adaptive and meaningful ways to both”

Fleshner, M. and M.L. Laudenslager, Psychoneuroimmunology: then and now.Behavioral and Cognitive Neuroscience Reviews, 2004. 3(2): p. 114-130.(p.114)

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What is happening inside

our bodies when we are

comforted?

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Tolerable Stress Toxic

StressEustress

Presence of the “buffering protection of a supportive adult relationship…..

facilitating adaptive coping and sense of control”

Shonkoff, J.P., et al., The lifelong effects of early childhood adversity and toxic stress.Pediatrics, 2012. 129(1): p. e232-e246. p e236

`

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Art of Empathic Interrupting

(Janina Fisher)

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Window of Tolerance … Dual Awareness

TOO MUCH EMOTION

Reliving

Overwhelmed

Can’t think straight

Dissociate/Numb

Agitated Hypervigilant

TOO MUCH COGNITION

Intellectual discussion

Distant

Disconnected

Theoretical

Analytical

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Top down and bottom UP processing

Johanna Lynch 2019 www.drjohannalynch.com

BOTTOM

Reason DialogueMetaphorHumour

ImaginationPlanning

ProsodyProprioceptionInteroception

SensesRhythm

Movement

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Brains and HEARTS form in relationship

Connection and Integration:

• Awareness

• Senses

• Emotion regulation

• Meaning

• Community Image from bbc

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Resources

• Nadine Burke Harris (2018) The Deepest Well: Healing Long Term Effects of Childhood Adversity. Mariner Books: New York

• Blue Knot Guidelines https://www.blueknot.org.au/resources/Publications/Practice-Guidelines

• Atkinson, J., (2002) Trauma Trails: Recreating Songlines. The transgenerational effects of trauma in Indigenous Australia. Melbourne: Spinifex Press.

• Lynch, J.M. and A.L. Kirkengen (2019), Biology and Experience intertwined: trauma, neglect and physical health., in Humanising Mental Health Care in Australia: A Guide to Trauma-informed Approaches, R. Benjamin, J. Haliburn, and S. King, Editors. 2019, CRC Press Taylor and Francis Group, Routledge: Sydney.

• Nadine Burke Harris TED talk https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

• Eleanor Longden TED https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

• Seth Porges TED https://www.youtube.com/watch?v=br8-qebjIgs

• Dowrick, C., (2004) Beyond depression: a new approach to understanding and management. 2004, London: Oxford University Press.

• Lynch, J.M., et al.,(2012)Beyond symptoms: Defining primary care mental health clinical assessment priorities, content and process. Social Science & Medicine, 74(2): p. 143-149.

https://www.blueknot.org.au/resources/Publications/Practice-Guidelines

https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

https://www.youtube.com/watch?v=br8-qebjIgs

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‘Bite-Sized pieces’ of psychotherapy:Focused Psychological Strategies for GPs

Dr Mary Emeleus

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Basic Empathy Formula

You feel… here name the correct emotion and intensity

…. because (or when) here indicate the correct experiences and behaviours that give rise to feelings

Source: Egan, G. (1998). The Skilled Helper: A Problem-Management Approach to Helping. (6th Ed). Pacific Grove: Brooks/Cole Publishing Co

With thanks to Dr Richard Lakeman, Senior Lecturer Mental Health Nursing, Southern Cross University, for the empathy slides

http://blog.medicalgps.com/the-importance-of-empathy-in-healthcare/

http://blog.medicalgps.com/the-importance-of-empathy-in-healthcare/

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I could kill him! He failed to take the kids again last weekend. This is three

times out of the last six weeks

You feel furious because he

keeps failing to hold up his part of the bargain.

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I keep asking when he is

going to come home… but the doctors keep evading the question.

You feel troubled about what they are not telling you.


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The Triangle of Wellbeing

https://trauma-recovery.ca/resiliency/triangle-of-well-being/

https://trauma-recovery.ca/resiliency/triangle-of-well-being/

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The Autonomic Nervous System• Our “Neuroception” determines whether our bodies respond with more of the accelerator

(stress hormones, sympathetic NS) or the brakes (vagal system, parasympathetic) or when we are overwhelmed, the emergency brakes (unmyelinated vagus)

• https://youtu.be/br8-qebjIgs

• We can help our patients:o Connect everyday with what gives them a “Sense of Safety”

o Notice when they are starting to disconnect

o Learn/remember strategies for re-connecting

o https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/relaxationtechniques.pdf

https://youtu.be/br8-qebjIgs

https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/relaxationtechniques.pdf

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PERMA

PLUS: sleep, physical activity, nutrition and learned optimismhttps://www.wellbeingandresilience.com/sites/swrc5/media/pdf/permaandcentreoverview.pdf

Positive Emotions

Engagement

Positive Relationships

Meaning

Accomplishment

https://www.wellbeingandresilience.com/sites/swrc5/media/pdf/permaandcentreoverview.pdf

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https://www.drdansiegel.com/resources/healthy_mind_platter/

https://www.drdansiegel.com/resources/healthy_mind_platter/

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CBT triangle

https://thiswayup.org.au/for-clinicians/returning-clinicians/

https://thiswayup.org.au/for-clinicians/returning-clinicians/

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Cognitive triangle

Beliefs

ConsequenceActivating event

https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Anxiety/Anxiety---Information-Sheets/Anxiety-Information-Sheet---03---Analysing-your-Thinking.pdf

https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Anxiety/Anxiety---Information-Sheets/Anxiety-Information-Sheet---03---Analysing-your-Thinking.pdf

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Other Resources

• https://www.actmindfully.com.au/wp-content/uploads/2020/03/FACE-COVID-eBook-by-Russ-Harris-March-2020.pdf Dr Russ Harris (Acceptance and Commitment Therapy)

• https://medium.com/@liz.sheean/10-thoughts-for-responding-to-distress-and-fear-in-the-chaos-and-complexity-of-coronavirus-e131292a1dc5

(Liz Sheean )

• https://headtohealth.gov.au/covid-19-support/covid-19 (One-stop shop for online MH resources, Australian Government)

https://www.actmindfully.com.au/wp-content/uploads/2020/03/FACE-COVID-eBook-by-Russ-Harris-March-2020.pdf

https://medium.com/@liz.sheean/10-thoughts-for-responding-to-distress-and-fear-in-the-chaos-and-complexity-of-coronavirus-e131292a1dc5

https://headtohealth.gov.au/covid-19-support/covid-19

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Thank youFor more webinars in the series and to view recordings visit www.jcu.edu.au/webinars

Documents

HEALTH PROFESSIONALS WEBINAR SERIES Mental ......priorities, content and process. Social Science & Medicine, 74 (2): p. 143-149. jcu.edu.au HEALTH PROFESSIONALS WEBINAR SERIES Mental