Monday, November 9, 2020

5 stress management tools (WHO 2020)

Re: 5 Stress Management Tools (Summary, pp. 124-128)

Fr: WHO 2020 April 29. “Doing what matters in times of stress: An illustrated guide” (132 pp) https://www.who.int/publications/i/item/9789240003927

 

Tools: 1. Grounding 2. Unhooking 3. Acting on your values 4. Being kind 5. Making room

 

Tool 1. GROUNDING (p. 124)

GROUND YOURSELF during emotional storms by NOTICING your thoughts and feelings, SLOWING DOWN and CONNECTING with your body by slowly pushing your feet into the floor, stretching and breathing, and then REFOCUSING and ENGAGING with the world around you.

   What can you see, hear, touch, taste and smell? Pay attention with curiosity to what is in front of you. Notice where you are, who is with you and what you are doing.

Practical tip:

Grounding is especially useful during stressful situations or emotional storms. You can also practice grounding when you simply have one or two minutes available, like when you’re waiting for something, or before or after an activity you do every day, like washing, eating, cooking or sleeping. If you practice during these times, you may find that boring activities become more enjoyable, and it will be easier to use grounding later in more difficult situations.

 

Tool 2. UNHOOKIING (p. 125)

UNHOOK YOURSELF with these three steps:

1)   NOTICE that a difficult thought or feeling has hooked you. Realize that you are distracted by a difficult thought or feeling, and notice it with curiosity.

2)   Then silently NAME the difficult thought or feeling; for example:

“Here is a difficult feeling”

“Here is tightness in my chest”

“Here is a feeling of anger”

“Here is a difficult thought about the past”

“I notice here is a difficult thought”

“I notice here are fears about the future”

3)   Then, REFOCUS on what you are doing. Pay full attention to whoever is with you and whatever you are doing.

 

Tool 3. ACTING ON YOUR VALUES

Choose the values that are most important to you. For example:

>being kind and caring

>being helpful

>being brave

>being hardworking.

   You get to decide which values are MOST IMPORTANT to you!

   Then pick one small way that you can ACT according to these values in the next week. What will you do? What will you say? Even tiny actions matter!

   Remember that there are three approaches to any difficult situation:

1.    LEAVE

2.    CHANGE WHAT CAN BE CHANGED, ACCEPT THE PAIN THAT CANNOT BE CHANGED, AND LIVE BY YOUR VALUES

3.    GIVE UP AND MOVE AWAY FROM YOUR VALUES

 

Tool 4. BEING KIND

BE KIND. Notice pain in yourself and others and respond with kindness. Unhook from unkind thoughts by NOTICING and NAMING them. Then, try speaking to yourself kindly. If you are kind to yourself you will have more energy to help others and more motivation to be kind to others, so everyone benefits.

   You can also take one of your hands and imagine filling it with kindness. Place this hand gently somewhere on our body where you feel pain. Feel the warmth flowing from your hand into your body. See if you can be kind to yourself through this hand.

 

Tool 5. MAKING ROOM

Trying to push away difficult thoughts and feelings often does not work very well. So, instead, MAKE ROOM for them.

1)   NOTICE the difficult thought or feeling with CURIOSITY. Focus your attention on it. Imagine the painful feeling as an OBJECT, and notice its size, shape, color and temperature.

2)   NAME the difficult thought or feeling. For example:

“Here is a difficult feeling”

“Here is a difficult thought about the past”

“I notice here is sadness”

“I notice here is a thought that I am weak”

3)   ALLOW the painful feeling or thought to come and go like the weather. As you BREATHE, imagine your breath flowing into and around your pain to make room for it. Instead of fighting with the thought or feeling, allow it to move through you, just like the weather moves through the sky. If you are not fighting with the weather, then you will have more time and energy to engage with the world around you and do things that are important to you.

Wednesday, November 4, 2020

mental health module outline (rayco 2020)

 A. Mental Health

1. Definition of Mental Health

2. Wholistic Wellness Model

3. Self-Care & Lifestyle Balance

B. Mental Illness

1. Definition of Mental Illness

2. Signs & Symptoms of Mental Illness

3. The Biopsychosocial Model

C. Practical Tips

1. Stress Management Techniques

2. Problem Solving Steps

3. Suicide Prevention & Management


Sunday, October 11, 2020

5 warning signs of mental illness

source: newroadstreatment.org

\/ long-lasting sadness & irritability

/\ \/ extremely high or low moods

< excessive fear, worry, or anxiety

social withdrawal

dramatic changes in eating or eating habits

Friday, October 9, 2020

addressing mental health stigma

source: https://www.camh.ca/en/driving-change/addressing-stigma

Re: “Addressing Stigma”

Fr:  Center for Addiction & Mental Health (Canada) https://www.camh.ca/en/driving-change/addressing-stigma (headings & divisions mine)

 >Abstract: Challenging the stigma associated with mental illness takes (a) UNDERSTANDING, (b) EDUCATION & (c) a closer look at our own ATTITUDES toward health.

 A.   “Diagnosis”

 >Principle: Mental Illness is NOT a Character Defect!

--causes: genetic / biological; childhood trauma or overwhelming stress at school, work or home; environmental injustices or violence; UNKNOWN (“sometimes we just don’t know)

 >Dynamics of Stigma: (a) causes: FEAR & MISUNDERSTANDING (b) effects: on others = PREJUDICE; on self: HOPELESSNESS & SHAME

 >Statistics: stigma prevents 40% of people with Anxiety and Depression from seeking medical help.

 >Principle: “Stigma SERIOUSLY affects the well-being of those who experience it.” It “PROFOUNDLY changes how people feel about themselves and the way others see them.”

 B.     “Treatment”

 Seven Things You Can Do to Reduce Stigma

      1. KNOWLEDGE OF FACTS

Know the facts. Educate yourself about mental illness including substance use disorders.

  1. SELF-AWARENESS

Be aware of your attitudes and behaviour. Examine your own judgmental thinking, reinforced by upbringing and society.

  1. NEUTRAL & RESPECTFUL LANGUAGE

Choose your words carefully. The way we speak can affect the attitudes of others.

  1. INFORMATION & EDUCATION CAMPAIGN

Educate others. Pass on facts and positive attitudes; challenge MYTHS and STEREOTYPES.

  1. POSITIVITY & PERSPECTIVE

Focus on the positive. Mental illness, including addictions, are only part of anyone's larger picture.

  1. EMPATY & COMPASSION

Support people. Treat everyone with dignity and respect; offer support and encouragement.

  1. INCLUSIVITY

Include everyone. It's against the law to deny jobs or services to anyone with these health issues.

 

Thursday, September 24, 2020

the status of mental health services in the PH

Mental health services in the Philippines

John Lally, John Tully, and Rene Samaniego

BJPsy Int. 2019 Aug; 16(3):62-64.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646843/?fbclid=IwAR2-pORUQr5siDiBkBXsQVdB_7t2ayPDnFdmOnhC4kFvLAz7cQAs4o9dDZ8


abstract: 

while the 2018 mental health (MH) law provides for the legal framework for a COMPREHENSIVE & INTEGRATED MH services, the challenge still remains for their ACCESSIBILITY & AFFORDABILITY

highlights:

I. MH services

>poorly resourced
--- 3.5 to 5% of total health budget (70% in hospital care) (WHO & DOH, 2005)
>underdeveloped community MH services
--NCMH = 67% psychiatric beds (Conde, 2004)
--1.08 My beds in gen hosp / 100k pop &
--4.95 beds in psychiatric hosp / 100k pop (WHO, 2014)
--46 out-patient facilities (0.05/100k pop) &
--4 community residential facilities (0.02/100k pop) (WHO, 2014)
--only 2 tertiary care psychiatric hosps:
(1) NCMH 4.2k beds
(2) Mariveles Mh 500 beds
plus 12 satellite NCMH-affiliated hops
--ongoing problems:
(1) overcrowding
(2) poorly functioning units
(3) chronic staff shortages
(4) funding constraints
--no dedicated forensic hosp
 
II. MH Staff

>severe shortage
--1 MD / 80k (WHO & DOH, 2012)
--brain drain issue
--500+ practising psychiatrists
--2-3 MH workers/100k pop (WHO & DOH, 2006)
--lower than other western pacific rim countries with similar economic status, e.g., malaysia (4.9) & indonesia (3.1)
--psychiatrists = 0.52/100k pop (ISaac et al, 2018)
--majority in private practice in urban areas, particularly in Metro Manila
--psychologists = 0.07/100k pop &
--MH nurses = 0.49/100k pop (WHO, 2014)
--vs WHO recommendation of 10 psychiatrists / 100k pop

III. Burden of Mental Disorders (MDOs)

>nb: little epidemiological evidence
>14% with MDOs (PSA, 2010)
>MH is 3rd most prevalent form of morbidity
>only 88 MH cases / 100k pop (DOH, 2008) is an underestimate
>0.4% SCHIZ (33.2% treated or screened in past 2 wks) &
>14.5% with DEPRESSION (14% treated or screened in past 2 wks)
>42% of 2,562 patients in 14 hosp (private & public) were treated for SCHIZ
>suicide:
--1984 to 2005: 0.23 --> 3.59 / 100k pop (males) &
--0.12 to 1.09 / 100k pop (females) (Redaniel et al, 2011)

IV. Access to Treatment

>issues:
--prohibitive ECONOMIC conditions
--INACCESSIBILITY of MH services
--STIGMA (perceived & internalized) is barrier to help-seeking (Tuliao & Velasquez, 2014) similar to west
--cultural drive to "save face" vis-a-vis threat to or loss of social position
--strong sense of FAMILY; thus, seek help from family & peers before medical help (Tuliao, 2014)
>only 1/3 people with SCHIZ treated or screened (WHO, 2005)
>most commonly used 2nd generation psychotropics (c/o DOH Medical Access Program for MH)
1. antipsychotics: clozapine, olanzapine, quetiapine, risperidone
2. antidepressants: fluoxetine, sertraline, escitalopram
3. mood stabilizers: lithium carbonate, valproic acid, carbamazepine, lamotrigine
4. anticholinergics: biperiden, diphenhydramine
5. benzodiazepine: clonazepam
6. cholinesterase inhibitor: donepezil
7. NMDA receptor antagonist: memantine

V. Psychiatry Training

>Psychiatry remains a less popular specialty for MD grads.
>47 accredited med schools
>psychiatry is core curriculum (ave of 2 wks teaching & clinical exposure)
>13 postgrad psycha trgn institutions (8 in MM, incl NCMH)
>2 postgrad trgn progs offering 2-yr fellowship in subspecs, e.g., CHILD & ADOLESCENT, CONSULTATION-LIAISON, COMMUNITY, & ADDICTION
>postgrad residency trgn: 3-4 yrs (3 mos Neuro + 2 mos IM)

VI. Conclusions

>M Heathcare challenges
--underinvestment
--lack of MH professionals
--underdeveloped community NH services
--although MH act gave legal framework, economic restrictions toward equitable access remains
--NEED: invest for recruitment & trgn of psychiatrists, nurses, psychologists, &social workers & other multidisciplinary team members esp vis-a-vis emigration

ps: thanks to Rey Lumawag, RN for giving me the source! :-)