Mental Health in Clinical Placements

Jennifer DodsExecutive Director, Student Wellness Services

October 26th, 2017

Outline

•What is Mental Health / Mental Illness•Mental health of university students•How You Can Help•Depression and Anxiety–Depression in clinical–Anxiety in clinical•Resources

Mental Health

Mental Health Disorders / Illness

Absent 

Present ‐ severe

Very poorExcellent Very good Good Fair Poor

Mental Health and Mental Illness

NCHA: Overall Health and Well‐being

4 out of 5 students who completed the survey:

–Describe their general health as good, very good or excellent (81.1%)• Graduate students 86%

–Feel they are part of the Queen’s community (81.5%)

–Feel Queen’s has a sincere interest in the well‐being of its students (84.6%)

–Feel their Faculty/School has a sincere interest in their well‐being (79.6%)

–Would seek help from a mental health professional if they had a personal problem that was bothering them (83.3%)

Health Condition Percentage of Students

Anxiety 20.1%Depression 15%Strep throat 14.1% (GS 10%)Allergies  13.9%Back pain 13.8% (GS 16.4%)

Urinary tract infection 13.7%Sinus infection 11.6%Panic attacks 10%

“Within the last 12 months, I was diagnosed or treated by a professional for the following”:

In the last 12 months• 51.6% (GS 58%) 

were diagnosed or treated for a physical health condition     

• 29.8% (GS 31%) were diagnosed or treated for a mental health condition

NCHA: Common Health Conditions

Have You Found this Very Difficult to Handle? (last 12 months)

YES!1st Yr ALL GRAD

• Academics  58% 61%  51%• Sleep Difficulties  38% 36% 28%• Personal Appearance            39% 35% 23%• Social Relationships              35% 32% 26%• Intimate Relationships         30% 31% 28%• Career Related Issues           21% 31% 36%• Finances                                  28% 31% 31%• Family Problems  30% 31% 27%• Personal Health Issues          29% 27% 20%• Family Health Issue               28% 24% 24%

NCHA: Impacts on Student Mental Health

17.6% (24% GS) reported finding no areas very difficult to handle

58.7% (51% GS)reported 3 or more areas that were very difficult to handle

0

10

20

30

40

50

60

70

80

0 10 20 30 40 50 60 70 80

Depression

AnxietyStress

Sleep Difficulties

Cold/Flu/Sore 

Internet use/computer games

Relationship Difficulties

Concern for troubled family member/ friendWork

Roommate Homesicknes

Extracurricular 

Alcohol use

ADHDLearning 

Death of friend/family

Infection

Chronic Health 

Pregnancy

Eating Disorder

FinancesPhysical Assault

Drug UseInjury

Discrimination

Gambling

Allergies

Sexual Assault

STI

NCHA: Impact on Student Academic Performance

Incidence: Percent in Population Experiencing Condition

Percen

t Experiencing Co

ndition

 Impa

cting Ac

adem

ic Perform

ance

High(er) IncidenceHigh(er) Impact on Academics

Have you ever received psychological or mental health services from any of the following:

Professional help Queen’s 2016 Canada 2016

Counselor / Therapist /Psychologist

44.5% 36.9%

Psychiatrist 12.6% 11.9%

Physician, Nurse practitioner 22% 20.4%

Minister/Priest/Rabbi/Other clergy

3.1% 4.6%

NCHA: Mental Health Service Use 

Contributors to Stress in Academic Environment

•Worth and identity tied up in success or failure• Defined by achievements • Expectations of brilliance and significant contribution• Comparisons and competitiveness• Lack of work‐life balance (ever looming expectations)• Scrutiny • Gaps between positive rewards, effort isn’t always recognized• Perfectionism and personality• Imposter syndrome• Placement expectations• Preceptor – student relationship

Life Stressors

• Transition and Adjustment– Physical relocation– Social transition–Change in supports–Change in routines–Change in typical ways of coping– Independent living

• Financial stress • Relationship stress• Living arrangement• Transportation• Stressful life events

The Mental Health Continuum 

Healthy

Normal functioning

Reacting

Common and reversible distress

Distress

Significant functional

impairment

Crisis

Severe and persistent functional

impairment

Red Flags

• Reduced activity, interaction or social contact – isolating• Mentions that others are worried about them – family / friends• Emotional distress or poor emotional regulation – feeling out of control

• Risk taking behavior – putting self in unsafe situations• Increased substance use• Mood shift – numb, empty, irritable, angry, sad• Overly self‐critical – expecting perfection• Always intending to get work done but not completing it• Changes – changes in eating sleeping, grooming, spending, involvement in extra curricular, social routines, 

• Talk of self‐harm or suicide or death

Healthy Reacting Distress Crisis

Professional CareProfessional Care

Self-care and social supportSelf-care and social support

The Mental Health Continuum 

Strategies and SkillsStrategies and Skills

How YOU Can Help

•Help find resources

• Encourage use of resources 

•Give reassurance and comfort

•Give advice only when asked

•Attentively•Non‐judgementally

•Reach out, make contact

• Talk when you have time

Approach Listen

ReferSupport

“But I might say the wrong thing”

Approach

Anne, you aren’t very good with people; do you think you have a social disorder?

AvoidDiagnosingJudgingMaking assumptionsDisapproval Ignoring 

ALSR: Approach

I’ve noticed that you’ve been coming in late recently and I’m 

concerned.

You don’t seem to be yourself lately. How are 

you doing? 

You haven’t seemed to have been 

yourself this week. Are you feeling OK?

You seem to be under a lot of stress. How is everything going?

Say what you see!

ALSR: Listen

Is there anything I can do to help?

What I hear you saying is ________.

It sounds that you have been feeling very overwhelmed/

stressed/anxious/alone.

That sounds like it is hard to deal with.

It sounds like you’re feeling out of place.

ALSR: Support

I am glad that you’ve told me this.

I want to support you in any way that I can.

It is not uncommon for people to feel this way. 

You are not alone.

I’m here for you.

Because you are feeling this way now doesn’t mean that you will feel this way forever. 

Things can get better.

ALSR: Refer

Have you thought about talking to someone about this?

There are some great resources on campus to help 

you.

I know of some people  who can help.

This sounds like a lot to deal with on 

your own.

Help is available. Be prepared that they may ignore your suggestion to seek out other resources

Importance of Being Aware

• Poor mental health can be a sign of mental illness• Poor mental health for a significant period of time can lead to the development of mental illness

• Poor mental health can lead to loss– fail class or leave school, lose relationship, lose job

• Poor mental health can impact broadly into many areas of life• Poor mental health can lead to self harm or risk of suicide in some cases

• Poor mental health is not a good way to feel.

Anxiety and Depression

Cognitive Distortions

JDODS 2015 N325

What is Anxiety?

Feeling

• Normal human emotion

• Tension, worry,  unease, apprehension

• Protective• Motivating• Temporary or transient

Illness

• Persistent state• Worsens over time ‐ intensity

• Interferes with daily functioning

• Distressing or disabling

• Disorders

What is Anxiety?

Anticipation

Trigger

Physical response

Emotional Response

Cognitive response

Behaviour

Confirm

What is Anxiety?

• Loss of feelings of control or power•Mischaracterized as weakness•Value placed on self‐control–Fight to regain control or find power

• Future oriented – impending doom• Shortcomings, errors, or judgement• Lack of promotion of positive accomplishments• Includes past (cycle), present (reaction and preoccupation), and future (anticipation)

•Anxiety fills the void of the unknown

Anxiety

Academic Environment

Anxiety

Academic Environment

Academic Anxiety

Academic Anxiety

Impact of Anxiety

Can’t fail what you don’t do• Paralysis• Procrastination•Mind games •Avoidance• Isolation• Loss of belief in self•Diminished productivity

• Loss of confidence• Loss of sleep• Indecisiveness• Self‐critical •Hypersensitivity to perceptions of others• Effort doesn’t lead to accomplishment• Expecting the worst

Anxiety in Clinical

•Asking questions they should (or do) know the answers to•Asking the same questions or for clarification repeatedly•Asking for information ahead of time• Seeking reassurance • Seeking approval•Agreeing with what they are being told (even if don’t fully understand) • Trying to give the right answer that they think you want to hear

Anxiety in Clinical

•Avoidance of tasks or people•Over preparing•Not sleeping / eating • Loss of confidence – fearful of hurting someone or doing the wrong thing•Difficulty responding on the spot or under high pressure (despite preparation and knowledge)• Self critical – focuses on negatives or feedback given• Physical or mental restlessness – difficulty calming self or focusing

Panic Disorder

Social Anxiety

GeneralizedAnxiety

Post TraumaticStress

ObsessiveCompulsivePhobia

SeparationAnxiety

Supporting Students who are Anxious in Clinical

• Prepare students for what they will experience / encounter

• Provide clear and realistic expectations–Timelines for skill development

–Scaffolding of skills• Normalize mistakes / failures / lack of knowledge (in a responsible way). We don’t always get it right the first time

• Good to know what you don’t know. 

• Avoid giving repeated reassurance or approval or repeating answers to questions–Ask students to tell you what they know 

• Specific positive / constructive feedback

• Identify avoidant or ‘right’ answers

• Give student time to process

Help Seeking

Supporting Others

What Helps• Encourage self‐kindness and use of strategies

• Respond without judgment so the person knows they can talk to you.

• Keep normal relationship –clinical instructor / student not about the anxiety (not their counsellor)

• Encourage help‐seeking

What Doesn’t Help– “Just relax”– “Calm down”– “It is going to be okay”– “Stop worrying”– “Snap out of it”– “I know how you feel”

• Criticism• Comparing anxiety disorders to feelings of anxiety

• View of anxiety as weakness or need to toughen up

Depression

• Acute episode or chronic• One time or re‐occurring• Mild, moderate, severe

• Differs from feeling depressed or down or sad. –Sad/down ‐ Transient and Situational. Normal and healthy adaptation to a stressful or negative event

• Clinical Depression – Major Depressive Episode–Slippery slope  ‐ hard to recognize–Dark cloud, heavy feeling oppression, black hole–Apathy, indifference, loss of interests and motivation–May have some variation still in mood but any positive is short lived. 

Depressed Mood

Main Mood Profiles1. Tearful and overwhelmed2. Empty and numb3. Irritable and angry

Depression

Sleep (insomnia or hypersomnia)Interest (pleasure, motivation) Guilt (worthlessness, self‐depreciating, failure, negativity, distorted thinking) Energy (apathy, inertia)Concentration (memory, decision making, depth of thought)Appetite (weight gain or weight loss)Psychomotor (slowed down, restless, agitated)Suicidal Ideation (passive or active)

Depression in Clinical

• Poorer hygiene / self‐care• Difficulty with attendance / being on time / preparation / 

assignment deadlines (excuses)• Poorer quality work being done• Disconnection• Emotional reactivity (or lack there of)• Negative self‐talk or view of self and actions. May reject 

positives or assume negative perceptions• Requires significant prompting or direction (little self 

initiative)• Lethargy, fatigue, lack of energy or enthusiasm• Frequent physical symptoms (unwell)• Reduced concentration / focus / memory

Tips to Support Student Mental Health

• Talk about mental health, self care and balance as being important to professional practice.– Organizational, individual– Build into curriculum

• Timing of deadlines for assignments– Avoid early mornings– Flexibility (where possible)• One extension (they set deadline)

• Supportive and understanding while Maintain expectations –academic requirements– Illness / extenuating circumstances can deplete resources. 

May need to consider leave if significant• Taking care of yourself / your health isn’t failure

Tips to Support Student Mental Health

• Talk about positives and negatives often – normalize constructive feedback as part of learning process –rather than as evaluative– What went well today, what didn’t go so well?– What is one thing you would do differently?– What is one thing you realize you need to learn more about?– I thought you did an excellent job with… (specific skill / 

response). I had some concerns when I saw you…• Explicit Instruction

– What is critical thinking in this environment?– Learning plans

• Refer to resources and check in to see if they connected

Supporting Students

• Academic Accommodations for Students with Disabilities– Student can register with QSAS 

• Academic Considerations for Students with Extenuating Circumstances– Faculty / School Office

• Student Wellness Services (on campus)–Doctors, nurses, counsellors, OT, access to psychiatry, mental health nurse, lifestyle appointments. 

• Off campus – SGPS coverage ($500 – mental health annually)

• Good2Talk (24/7 Post secondary help line) – 1‐866‐925‐5454

• Local crisis lines / mental health centers

• Green Folder Peer to PeerSGPS Advisors

Self Care!

Thank You

Jennifer Dodsjennifer.dods@queensu.ca613‐533‐6000 ext 78667

Other help!

Rina Gupta – Director of Counselling

Fatima Couto – Clinic Manager

Jeanette Parsons – Senior Accessibility Advisor