Module 5: Mental Health

POST-MODULE QUIZ LINK: https://forms.gle/GHPyyy7DU3nSdK337

This is a mandatory quiz to be completed upon reviewing this week’s materials.

It is only graded for completion, so take the quiz for your learning!

What Is Mental Health?

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Many factors contribute to mental health problems, including:

• Biological factors, such as genetic makeup or brain chemistry

• Life experiences, such as trauma or abuse

• Family history of mental health problems 

It’s incredibly common! 1 in 5 Americans and 12% of Bostonians experience a mental illness while prevalence varies slightly among racial/ethnic groups.

Image from: https://bit.ly/2LM523t

This week, we hope you can watch this quick video demonstrating common warning signs for both adults and adolescents that may be suffering from mental illness or a mental health crisis:

Stigma around mental health persists. Simply asking clients about mental health can be very empowering and validating. It sends the message that you care and that their suffering is real.

• If you are interested, here is a video you can watch about stigma: Stigma and Mental Illness

How we screen for mental illness:

In REDCap, you will notice we ask 4 questions to screen for depression and anxiety. These questions are taken from a well-validated measure called the PHQ-4.

Image source: http://www.nationalpartnership.org/our-work/health/listening-to-mothers-ca/report/chapter-6.html

Tips for using the PHQ-4

Some volunteers have told us that reading the PHQ-4 word-for-word can seem robotic and/or awkward. Here are some tips for making mental health screening more natural. Everyone has their own style and every client is different, so try experimenting with a few different approaches.

1.   Use Transition Statements

• Normalize

  • Prior to the PQH-4, make a statement that normalizes the depression and anxiety. For example, “Many people that we work with experience times of feeling down/sad or worrying. We have started asking all our clients about this.”

• Pick-up on something mentioned earlier

  • You mentioned before you were stressed. Have you been “feeling nervous, anxious, or on edge?”

2.   Shorten and break-up questions

• REDCap reads: “Over the past 2 weeks how often have you been bothered by the following symptoms: little interest or pleasure in doing things”

• Try breaking up this question into multiple parts:

  • “Have you noticed that you have little interest or pleasure in doing things?”

  • If yes, then follow up by asking, “How often has this occurred in the past 2 weeks?”

3.   Rely on communication and listening skills

• As you become more familiar with the questions, try to limit time looking at the laptop.

• Make eye contact while patient responds

• Nod

• Practice active listening

• Use PEARLS techniques (see below)

Communication skills

At times, the PHQ-4 questions may bring up strong emotions in both you and the client. If you feel uncomfortable or are unsure of how to respond, you can turn to the PEARLS framework, which is designed to facilitate rapport building by responding to patients’ emotions.

 P: Partnership

• Establishes teamwork and a desire to work with the client to accomplish their goals.

• Example: “It sounds like it has been really hard to remember to take your anti-depressant medications, let’s work together to think about how we can make it easier for you to take your medications.”

E: Empathy

• Sends the message that you are listening and care about their experiences.

• Examples:

  • “It sounds like you have been feeling overwhelmed and frustrated.”

  • “I can only imagine how upsetting it must be to have to wait so long to get an appointment with a psychiatrist when you need help now.”

A: Apology

• Can diffuse anger or frustration and build trust.

• Example:

  • In an irritated tone, a client says, “why wasn’t the van here last week? I came all the way out here for nothing.” You could reply, “I am sorry we weren’t here last week. That must have been frustrating. You have my undivided time and attention now. How can I help you today?”

R: Respect

• Conveyed through verbal and non-verbal communication. Be an engaged, non-judgmental, and accepting listener. Simple behaviors like making eye contact, nodding while listening, and shaking hands can go a long way.

• Example:

  • “I admire how hard you have worked to try to quit smoking.”

 L: Legitimation

• Acceptance, normalization, and validation of the clients experience

• Example:

  • “It sounds like you have been feeling down and hopeless lately. This may be because you have been depressed. Depression is very common and many of our clients on the van have depression. You are not alone are there are many resources and treatments out there that can help.”

b.   S: Support

• Establishes that you would like to help.

• Example:

  • “Let me see if I can find some resources that may be helpful for you.”

  • Then can show intention to follow-up over time: “The van will be here next week. What do you think about coming back next week and we can see how reaching out to referrals went.” NOTE: you can also fill out the referral tab in REDCap.

A number of you expressed interest in learning how to talk to patients about sensitive subjects. Here are some phrases to use when talking to patients during difficult times: Speaking with Patients

Suicide

Identifying patients at risk of suicide and with undertreated or untreated mental illness is important to reducing the risk of suicide.

Key statistics:

-      Suicide is the 10th leading cause of death in the United States and is even higher for certain age groups.

-      In 2017, over 47,000 people died from suicide in the United States with an estimated 1.4 million suicide attempts.

-      It is estimated that 90% of people who die by suicide have a mental disorder.

Screening for suicide

If a patient has a high score on the PHQ-4, consider asking about suicidal thoughts. Some may worry that asking about suicide could increase suicidal behavior, but the National Institute of Mental Health (NIMH) report that asking about suicide does not increase suicides or suicidal thoughts.

NIMH outlines key steps when asking about suicide (below). For additional information: Click Here

Image source: https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml

If a client says they are thinking about suicide, important additional questions include:

1.   Do they have a specific plan and method?

2.   Do they have intention to act on plan? If so, what is their timeline?

3.   Have they already done anything to prepare to end your life (obtained a weapon, collected pills, wrote a suicide note etc.)?

A “yes” to any of the above questions warrants immediate evaluation by a healthcare professional (e.g., emergency room, call BEST team). Even if a patient answers “no” to all the above questions, make sure to connect them to a healthcare professional ASAP. Give out the National Suicide Prevention Lifeline to all patients (988).

For your reference, a well-validated screening questionnaire for suicide is the Columbia-Suicide Severity Rating Scale (C-SSRS): Link to C-SSRS

MORE INFORMATION:

• To read common questions about anxiety and how to answer them: Click Here!

• To read common questions about depression and how to answer them: Click Here!

• National Alliance on Mental Illness Multicultural Fact Sheet: Click Here!

• Boston Public Health Commission Mental Health 2016-2017: Click Here!

• Department of Mental Health Resource Guide: Click Here!