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Archive for category: Mental Health

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With PTSD Every Day is Remembrance Day

Tomorrow, November 11, is Remembrance Day, a day where Canadians pay respect to the men and women who have fought and continue to fight for our country’s freedom.

On this day we remember those who lost their lives and have suffered injury and/or illness fighting for our country.  One of the largest illnesses afflicting our veterans is Post Traumatic Stress Disorder (PTSD).  It is estimated that, in the military, one in six are reported to experience PTSD as a result of their service.  The following article care of Global News discusses how for those who suffer from PTSD, Remembrance Day can be one of the most difficult.

Global News:  Remembrance Day a time of anxiety, stress for some veterans

Learn more about PTSD:  its causes, symptoms and treatment strategies in our post PTSD and Occupational Therapy.

 

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Mental Health at Work: How to Seek Help

While minor accidents are common in the workplace and quickly addressed, higher instances of stress, mental illness, and workplace bullying are being seen across all industries.  If you are suffering where do you go to get help?  If you see signs of mental distress in a fellow employee, how can you help?  The following from The Globe and Mail discusses how and where to seek help if you are concerned.

The Globe and Mail:  Where to get help when you’re concerned with your mental health

Learn more about strategies to improve mental health in the workplace in the following episode from our OT-V series:

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Tragedy and Terror are Everywhere – What Do You Say to Your Kids?

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

Co-authored by Angie Kingma, OT at 

Every generation is said to be shaped, influenced and molded by the major world events that they experience.  These events hit us so deeply that most of us can remember where we were when we “heard the news”, how we felt in the moment, and the way the world changed following the event.  Today is the anniversary of 9/11 and marks a day of mourning for those of us that still feel deeply connected to the senseless tragedy that remains the world’s worst terrorist attack.  But the threats aren’t over and the connected world we live in exposes all of us, including our children, to these events in gory detail complete with photos, video and even the live streaming of things as they unfold.  If parents are not careful, these events can have a negative, harmful and life-lasting impact on children especially if we don’t help them process what they are seeing or hearing. 

So, in the spirit of both mourning and hope, today I wanted to try and provide some suggestions on ways we can talk to our children about events like 9/11, the bombing at the Ariana Grande concert, North Korea testing missiles, the terrorism in Paris and London, attacks on Parliament Hill, or even the recent suffering caused by hurricane Harvey and the wildfires in Western Canada.  Despite the fact that I am a mom of four, I still struggle to have these conversations with my kids, and as such reached out to an Occupational Therapist friend and colleague skilled in mindfulness (Angie Kingma www.mindfulnessforhealth.ca) to get her take on how all parents can try and manage these conversations better.  Here is what Angie had to say:

Some parents take the stance that they’d rather shield their kids from the disturbing events that continue to happen daily around the world.  These parents are well-meaning, assuming that talking about these grim facts will not only upset their kids but perhaps also cause harm.  However, literature shows quite the opposite. What happens is that these kids are denied the opportunity to develop the resilience that is necessary to become a healthy, fully functioning adult. There are other parents who would like to discuss these issues but just don’t know what to say or where to start.

Mindful parenting can greatly enhance our ability to be skillful when talking to our kids about the world’s hard truths.  So, what exactly is mindful parenting? It involves the intention to bring a particular quality of attention to the interactions with our children, as they unfold moment-by-moment. To do this, we choose to consciously pay attention to what is arising in the present moment, becoming aware of what’s happening internally for both the parent and the child, as well as what’s happening externally. Mindful attention is enveloped by attitudes of non-judgment, gentle curiosity, open-heartedness (kindness and compassion), as well as acceptance.  We are especially interested in the child’s thoughts, feelings and bodily sensations, as well as our own. We practice mindful listening, which just means listening with full attention, staying present, conveying to your child that you are truly listening and care about their experience.   This quality of focused attention and awareness goes beyond just listening to the words, and includes awareness of facial expressions and body language.

Here are some mindful communication tips when talking to kids about life’s difficulties:

Don’t avoid the conversation. Depending on your own comfort level, let kids know that darkness, misfortune, evil, natural catastrophes and other unpleasant life pressures do exist.

Explain issues to kids in an honest and age-appropriate manner.

Keep it simple. Kids don’t need the gruesome details, just the gist of the event.  Find out what they know about it first and then fill in the gaps with the basics of what happened.

Remind your child that you might not have all the answers but that you know it’s important to have these types of discussions. Sometimes they aren’t looking for answers, our kids just need to feel “seen” and “heard”, and to feel a sense of safety.

Stay level-headed when you’re discussing difficult news. Practice ‘radical acceptance’ of these realities, which simply means acknowledging the truth of things (radical acceptance doesn’t mean we that we have to like it or approve).

Pay attention to your own feelings.  Since events like terrorist attacks evoke strong emotions in us and our kids, be aware of what feelings are coming up in you before the conversation and during. Pay attention to your feeling(s) and observe them, breathing with them, without having to act on or get overwhelmed by them. When we can regulate our own feelings, it can help your child to regulate their own feelings (a term called “co-regulation”).

Share with your child what strategies you use to deal with distressing situations.

Seek professional assistance if you’re having feelings that are too difficult to manage on your own or your coping strategies are unhealthy or ineffective.

Pay attention to your child’s feelings.  Help them name what they are feeling, which tips us in the direction of emotional regulation. Ask them if they can describe where in their body they feel their emotion, ex. tightening in chest, butterflies in the tummy, tension around their head.

Listen open-heartedly to your child’s feelings about the situation. Ask open-ended questions such as “How does hearing about this make you feel?” or “Is there anything else that you’d like to talk about?”

Validate your child’s feelings, even if you don’t understand them yourself. Say “Of course you’d feel that way. That makes total sense to me”.

If you notice a significant increase in fear and anxiety in your child that begins to affect their daily functioning, report this to your family doctor as soon as possible and consider getting a referral to a children’s mental health specialist.

Respect it if your child will simply not talk about certain topics. Some children, particularly kids who already have anxiety, won’t be able to tolerate the conversation so don’t force it. Other kids will have a lot to say and want to discuss it at length. Neither response is better than the other.

Difficulty helps to build our resilience. Let your child know that the things that we go through in life make us stronger and teach us important lessons.  Point out specific stories of heroism, survivors, first responders or people coming together to help one another during times of need.

Teach the concept of impermanence, meaning that while difficulties in the world do exist in the present moment, things are always changing. There is hope that things will change for the better. Practice modelling attitudes of hope and optimism and discuss the importance of these with your child.

Not only does mindful parenting and communication strengthen the parent-child bond and facilitate a strong attachment, it also cultivates emotional awareness and self-regulation, which our world so desperately needs.

“Your mindful presence is the most valuable and precious gift you can give to yourself and to your children.”

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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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Solutions for Disability-Related Financial Stress

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

I can say with certainty that 100% of my clients suffer from financial difficulty when faced with disability, trauma or injury.  It is just not common for people to plan for the “rainy day” that could be ill health.  Yet, the impact of financial strain is significant.  Stress, anxiety, panic, excessive worry, loss of sleep, relationship issues, poor decision making, and maladaptive coping are all common reactions to feeling that you are unable to survive a change in income or increased expenses from medication, devices or therapy.

In the following video from our OT-V series, we discuss how an Occupational Therapist uses strategies to help you through financial difficulties and to help manage the negative effects to your health.

 

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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