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Tag Archive for: mental health

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13 Reasons Why NOT to Watch

The new Netflix series 13 Reasons Why has become a popular topic of conversation for both adults and youth, both online and in person.  Many kids will watch this before their parents even know that they have.  Yet, parents beware because the content in this is apparently both graphic and at times, disturbing.  In fact, the content is so concerning that school boards and even the Canadian Mental Health Association have issued statements cautioning viewers of this series:  CMHA National Statement Responding to Netflix Series: 13 Reasons Why. 

Personally, I take no pleasure in watching gory or graphic content of rape and suicide and do not see the value in sensationalizing this for the youth of today.  However, others argue that this series aims to deter suicide by showing how disturbing this can be.  At the least, know what your children are watching and heed the warnings.  Mental Health and Suicide are very sensitive topics – not to be taken lightly.   

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How To Improve Mental Health at Work

When it comes to health and safety in the workplace, we are often quick to think of work-related musculoskeletal disorders and other physical injuries, but just as with health in general, we also need to make mental health in the workplace a priority. Nearly half of all Canadians experience some form of mental health concerns at work. Mental health issues are the number one cause of short term and long term disability leave.

The following video from our OT-V series discusses the ways an Occupational Therapist can work with employees, employers and medical teams to help employees overcome mental health stressors at work in order to be more productive and miss less time from work.

 

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Parents Alert! The Signs of Mental Health Challenges in Children and Teens

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I was recently reviewing my daughter’s school handbook and noticed the section on child and youth mental health.  According to this (and the Canadian Mental Association) 1 in 5 children and youth struggle with mental health problems.  While great strides have been made over the last several years to destigmatize and demystify mental health problems in both adults and kids, I feel this remains generally misunderstood.  In my practice, I still see the common misperceptions that people with anxiety don’t leave the house or appear nervous and anxious in public, or that people with depression sleep all day, don’t attend to their appearance, and sit around crying and feeling sorry for themselves.  The truth is that mental health is a spectrum, or a continuum if you will.  It can vary and no one’s experience will be the same.  In children, mental health problems can present differently.  As per the handbook I was reading, the signs might include:

·        Anxiety and fear that does not go away

·        Frequent crying and weepiness

·        Loss of interest in activities that were a source of pleasure in the past

·        Difficulty concentrating

·        Lack of energy or motivation

·        Problems at school with falling marks

·        Withdrawal from family, friends and school activities

·        Increased school absences

·        Loss or increase in appetite

·        Sleeping too much or too little

·        Increased irritability, anger or aggression

·        Neglect of personal appearance

·        Frequent stomach aches or headaches

·        Increased alcohol or drug use

In general, parents should be able to monitor most of these and overt changes might be obvious (suddenly disconnecting from friends, drastic changes in grades, behavior change at home, quitting enjoyed activities, not eating food or participating in meal times, etc).  But like with the continuum of mental health in adults, some of these might present some days and not others, or be so subtle that they deteriorate very slowly over time.   As parents of teens we need to be the barometer for our kids as they may lack the ability to relate some of these signs to mental health or internal struggle.

Luckily, in Southern Ontario anyway, I see the mental health problems of kids being taken seriously and there are publicly funded community supports available.  But getting your child connected with these can be the challenge.  It can be hard to convince a teen to do anything they don’t agree with, let alone getting them to the myriad of appointments with doctors and clinicians that can help.

Occupational therapy plays many roles in helping kids and teens address issues with mental health.  While some occupational therapists are trained to provide psychotherapy, others use meaningful and enjoyable tasks to help with mood elevation, reactivation and reengagement.  We are skilled at looking beyond the obvious to get a better sense of what might help at home, school or in the community to get your child or teen on track.  Sometimes it is as simple as helping them to reorganize their school work, create a process for managing assignments and tests, teaching them how to study in a way that works for them based on their learning style, or even looking at how their week is managed to make changes.  Occupational therapists tackle things like sleep / wake schedules, eating and diet, activity participation, grades and school success, managing friends and relationships, motivation through engagement, and dealing with negative pressures that create more stress and anxiety.

My advice if you are concerned about your child?  Start with your family doctor and discuss your concerns, even if your child won’t attend with you.  Involve the school in your concerns to get their support and guidance, after all your child spends several hours a day in their supervision and care.  Teachers can be a great resource and form of support as well, but you need to open those lines of communication.  Don’t expect the school to come to you – often they don’t.  If your child is in crisis, call your local Crisis Outreach and Support Team (COAST) and ask them for help.  They can (and should) also connect you and your child to other community programs.

If you have coverage for mental health treatment for your teen (extended benefits, other insurance funding, out-of-pocket), including occupational therapy, consider enlisting a private therapist.  Private therapy often provides a larger scope of service, is more specialized, and can be provided over a prolonged period if appropriate.  Any good private therapist will try to work themselves out of a job by getting your child on track as quickly as possible and they will want you to immediately feel the benefit of their involvement.  Also, if you have private dollars or insurance coverage, I would suggest a psycho-educational assessment.  These are extremely thorough “brain tests” that look at all aspects of how your child processes information, manages cognitive tasks, and addresses the complicated relationship between our brain and our emotions.  The outcome of these assessments can be extremely helpful, and will provide both you as a family, and the school, with suggestions for how to best help your child to succeed.

I have always said watching my kids grow up is the best and worst part of parenting.  It is especially heart-wrenching if your child is struggling.  Watch for the signs, talk to your child and get them (and you!) support if they need it.

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The Role of Occupational Therapy in Adolescent Eating Disorders

Guest Blogger: Carolyn Rocca, Student Occupational Therapist, 2017

According to Statistics Canada, in 2012 over 130,000 Canadians over the age of 15 years old reported that they have been diagnosed by a health professional as having an eating disorder. Considering these high rates, and the likely underestimation of reported diagnoses, eating disorders remain a form of mental illness that are not openly talked about.

Eating disorder is an umbrella term for several categories of diagnoses, with anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified being the most common. Although symptoms vary based on the diagnosis, some overall symptoms experienced with eating disorders include a pre-occupation with body weight, body dissatisfaction, behaviours to prevent weight gain, perfectionism, emotional dysregulation, depressed mood (including suicidality), anxiety, and low self-esteem. Naturally, these symptoms can lead to secondary impacts such as physical adverse effects, social isolation, and a compromise of occupation in the areas of self-care, daily living, leisure, and productivity (NCCMH, 2004).

The treatment and recovery of adolescents with eating disorders involves the collective work of many healthcare professionals including physicians, dietitians, nurses, psychiatrists, psychologists, social workers, teachers, child and youth counselors, and, yes, occupational therapists (Norris et al., 2013). Each of these team members works collaboratively to deliver the best practice approaches of pharmacotherapy, nutritional rehabilitation, and psychosocial interventions, including cognitive behavioural, dialectical behavioural, interpersonal, and family based therapies, among others (APA, 2006; NCCMH, 2004). Several of the healthcare professionals working with adolescents with eating disorders can deliver these therapies, including occupational therapists.

This means that occupational therapists work effectively with several disciplines to deliver best practice approaches, while also integrating their unique focus on occupational functioning to the team. Occupational therapists’ unique contribution is their ability to holistically address the physical, cognitive, behavioural, and psychosocial aspects of adolescent eating disorders through occupation-based approaches to improve adolescents’ self-worth and self-esteem (Kloczko & Ikiugu, 2006). As mentioned previously, eating disorders commonly have a substantial impact on adolescents’ function in the areas of leisure, self-care, daily living, and productivity (NCCMH, 2004), meaning many youth have difficulty balancing their family and social lives, education, employment, extra-curricular participation, ability to regulate their own activities, and thus overall health.

Occupational therapists have the expertise to work closely with adolescents and their family to help them with their goals around succeeding in school, work, leisure, and overall re-engagement in meaningful activities. In fact, Occupational Therapists are skilled at using meaningful activities as a vessel to get to the underlying problem of the eating disorder.  Sessions don’t focus on eating, food or binging behavior, but on being productive, enjoying life, and accomplishing things that matter.  The indirect influence is better choices in other areas (including diet) and recognizing the link between mental and physical health, quality of life and wellness.

If you know a teen (or adult for that matter) that may be dealing with an eating disorder, encourage them get help.  There is a team of professionals, including occupational therapy, that are skilled at assisting teens to recover from these, and other mental health issues.

 

References & Resources:

American Psychiatric Association (APA). (2006). Practice guideline for the treatment of patients with eating disorders (3rd ed). Retrieved from https://www.guideline.gov/summaries/summary/9318/practice-guideline-for-the-treatment-of-patients-with-eating-disorders

Kloczko, E., & Ikiugu, M. N. (2006). The role of occupational therapy in the treatment of adolescents with eating disorders as perceived by mental health therapists. Occupational Therapy in Mental Health, 22(1), 63-83. doi:10.1300/J004v22n01_05

National Collaborating Centre for Mental Health (NCCMH). (2004). Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Retrieved from https://www.nice.org.uk/guidance/cg9/evidence

Norris, M., Strike, M., Pinhas, L., Gomez, R., Elliott, A., Ferguson, P., & Gusella, J. (2013). The Canadian eating disorder program survey–exploring intensive treatment programs for youth with eating disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22(4), 310.

Statistics Canada: http://www.statcan.gc.ca/pub/82-619-m/2012004/sections/sectiond-eng.htm

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Monitoring Your Mood

In our previous post, Blue Monday and Beyond – Tips to Beat the Winter Blues we discussed how some research suggests that up to 15% of people in Ontario experience the “winter blues” and 2-3% of the population suffer from Seasonal Affective Disorder (SAD).

If you are suffering from depression, anxiety, SAD or simply the “winter blues” being aware of your feelings, thoughts, emotions and overall mood can help you to understand and cope.  The following printable “Mood Diary” will help you to track when you are feeling a certain emotion, the intensity of it, the situational aspects and the effectiveness of your coping mechanisms.  Doing so will give you and your healthcare professionals a better understanding of the problem.

For more helpful tools visit our Printable Resources Page.

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Recognizing Mental Illness in Children

According to The Canadian Mental Health Association “it is estimated that 10-20% of Canadian youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide.”  Parents can often easily identify and seek help for physical problems in their children, but mental illness can be harder to recognize.  The following from Psychology Today provides changes and signs to watch for, and advice on how to seek help for a child.

Psychology Today:  13 Concerning Signs of Mental Illness in a Child

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Blue Monday and Beyond — Tips to Beat the Winter Blues

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I made a comment after the Holidays that I was slowly recovering from Christmas Affective Disorder.  For me, Christmas is stressful, hectic and challenging.  I struggle with it every year.  After the seasonal rush, it takes me days, or even weeks, to get back to my normal equilibrium.  However, really, winter despair is not a joke and for some, can be debilitating.

In fact, some research suggests that up to 15% of people in Ontario experience the “winter blues”. These leave you feeling tired, groggy, and maybe even sad or irritable.  While this causes discomfort, it is not incapacitating.  However, a more serious form of the winter blues, known as Seasonal Affective Disorder (SAD), can be.  While occurring less frequently at 2-3% of the population, the symptoms can prevent individuals from leading a normal life.  Symptoms of SAD include decreased energy, changes in appetite, especially leading to cravings for starchy or sweet foods, oversleeping and weight gain, among other things.  If you feel this is you, talk to your doctor and have your symptoms investigated.

The problem is not always the blues, but how these create a negative behavior cycle.  When you feel down, you revert, avoid, or change habits.  This leads to feeling worse and the cycle continues.  Occupational therapists (OTs) recognize the importance of being engaged in activities that are meaningful, active and productive, and understand how these contribute to health and well-being. In fact, one of the best treatments for beating the winter blues involves just “keep on keeping on” by doing what you normally do every day.  Some tips include:

 1.       Use behavioral activation to keep your normal routine.  Make the bed, have a shower, prepare a decent breakfast, walk to the mail box.  Don’t change habits that are ingrained just because it is winter.  Never underestimate how damaging it can be if you avoid even small things that ultimately add up to a productive day.  Gradually try to get back to those important tasks if you have found that your daily behaviors have become unproductive.

2.       Stay active.  Those that love the winter do so because they get outdoors.  Walk, ski, skate, toboggan – something to help you appreciate how wonderful a change of seasons can be.  This is best facilitated by proper clothing that will keep you warm.  If exercise is tough for you, build it into your day by default – park farther from the door, use the stairs, make a few trips from the car with the groceries to get the blood flowing.

3.       Consider light therapy.  Sit by the window at lunch, get some fresh air when the sun is out, or consider purchasing an artificial light for your use at home.

4.       Up the nutrients.  When some bad eating habits creep into your winter these can be hard to break come spring, and only contribute to further mood declines.  Shop in the fruit and veggie isles, and avoid the isles that house the bad foods you seem to be eating too much of.

Finding ways to help you do the things you want to, need to, or enjoy, is at the heart of occupational therapy. While the winter months can be long, dark, and cold, ultimately how we adapt to the seasonal change is up to us.  If moving or going south is not an option, consider some of the above tips to make the winter bearable, or dare I say, even enjoyable?

Seasonal Affective Disorder. (Canadian Mental Health Association, 2013) http://www.cmha.ca/mental_health/seasonal-affective-disorder-sad/
Beat The Winter Blues (Readers Digest, no date) http://www.readersdigest.ca/health/healthy-living/beat-winter-blues
Kurlansik, SL & Ibay, AD. (2012).
Seasonal Affective Disorder. Am Fam Physician. 2012 Dec 1;86(11):1037-1041.
10 Winter Depression Busters for Seasonal Affective Disorder (Borchard, no date) http://psychcentral.com/blog/archives/2012/12/30/10-winter-depression-busters-for-seasonal-affective-disorder/

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PTSD and Occupational Therapy

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

From when I was a teen I have been highly sensitive to movies, news stories, songs or videos that involve violence (particularly against women).  In fact, I avoid movies and shows in general (beyond thoughtless sitcoms or socially interesting reality TV), fearing that I will see (or hear) a bothersome scene.  If my screening process fails and I catch something disturbing, I have problems sleeping for days as the images or sounds replay in my mind.   In talking to my friend about this, she asked me a pointed question:  Do you think you have PTSD?

Her question was referring to her knowledge of my experience as a teenager in 1991:  My former elementary classmate Leslie Mahaffy and later Kristen French were both abducted, tortured, sexually assaulted and murdered by the notorious Paul Bernardo and his wife Carla Homolka.  Kristen’s body was found near my community.  Not long after, Nina de Villier was abducted and murdered after leaving for a run from the tennis club where I played and her brother was my double’s partner.  I was part of the search party for Nina in the days of her disappearance and following these tragedies my mother became involved in an organization developed by Nina’s mother Prescilla called “Canadians Against Violence” (CAVEAT).  Over the next few years I assisted with the organization at times, meeting many people whose lives were horribly impacted by the tragic loss of a daughter or sister, or who were victimized, stalked and threatened (some ongoing) by men.  Now, as a mother of four girls, I recognize that these experiences still foundationally impact how I parent and I try to not let my fears about the safety of my girls restrict them from experiencing the important milestones of growing up.

Whether I have friend-diagnosed PTSD or not, according to the Canadian Mental Health Association, PTSD is a mental illness. It involves exposure to trauma involving death or the threat of death, serious injury, or sexual violence.  In general, the traumatic event involves real or threatened physical harm to the self or to others, and causes intense fear, hopelessness, and/or horror. Emotional impairment results due to anxiety, depression, recurrent flashbacks, difficulty sleeping and concentrating, and feelings of guilt of having survived when others may not have (Stats Canada).  In the military, one in six are reported to experience PTSD as a result of their service (Learn more from the Globe and Mail).

Occupational therapy, a profession vested in helping people to function safely and independently in their life-roles, is often one of the many health care providers that can assist people to overcome the symptoms associated with PTSD.  Problems like anxiety, depression, flashbacks, difficultly sleeping and concentrating, and overcoming feelings of guilt can be tackled through: cognitive and / or behavioral strategies aimed at increasing activity participation slowly over time; by identifying, recording and sharing thoughts and feelings; and through engagement in healing-focused activities.  Occupational therapists break down life tasks into smaller and manageable chunks to grade the successful return to meaningful roles.  Over time, previously challenging tasks become easier as we help people master the roadblocks that are preventing their successful engagement in function.

However, with something as significant as PTSD, it will be the collaboration of multiple professionals helping the client to overcome their challenges that will have the most impact.  Medical doctors, social work, psychology, psychotherapy, even massage, art or yoga therapy can help to provide a holistic approach to helping people move beyond these often crippling experiences.  If you have PTSD and this is impacting your ability to do the things you need or want to do, please seek the help of professionals.

As for me, I don’t currently have the goal of wanting to return to watching movies and shows riddled with violence, rape and murder.  I personally don’t find that entertaining and actually wonder why other people do.  I am not sure I will ever understand, PTSD or not, why people derive pleasure watching (even if simulated) images of people’s horrible mistreatment.  So, I will stay in my bubble for now enjoying Modern Family, Survivor and The Amazing Race.  However, if my past does start to impact my ability to parent my girls, participate in activities I would otherwise enjoy, or snags my engagement in any other necessary or important area of my life, I will surely reach out for help.

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Depression and Disability Insurance

Depression is a common and serious health condition that Health Canada estimates about 11 per cent of men and 16 per cent of women in Canada will experience at some point in their lives.  Learn more about potential treatment options and the importance of disability benefits for those suffering from Depression in the following post by Brad Moscato of Howie Sacks and Henry Personal Injury Law.

Long-Term Disability Series: Depression’s Impact On Life & Work – The Importance of Disability Insurance Benefits