Presentation at Missions Interlink ConNEXTions 2013 by:

Dr Katherine ThompsonMental Health Social WorkerBA, BAppSci(Hons), PhD(PsychMed), BTheol, BSW

164a Warrandyte RdNorth Ringwood Vic 31340402 343 029katherinethompson@guitech.com.au

Mental Health First Aid for Missionaries and the Need to Focus on Prevention

Dr Katherine Thompson

That was then and this is now…

• Globalisation• Internet, email, mobile phones, etc.• Transport changes• Normalisation of cross cultural work• Health focus on prevention and intervention

Social Readjustment Rating Scale

• The Stress Scale – a scientific scale used to assess the stress load we carry over the past 12-month period

» "The Social Readjustment Rating Scale", Thomas H. Holmes and Richard H. Rahe, Journal of Psychosomatic Research, Volume 11, Issue 2, August 1967, Pages 213-218.

Life Event ValueCheck if

this applies

1 Death of spouse 1002 Divorce 733 Marital separation 654 Jail term 635 Death of close family member 636 Personal injury or illness 537 Marriage 508 Fired at work 479 Marital reconciliation 45

10 Retirement 4511 Change in health of family member 4412 Pregnancy 4013 Sex difficulties 3914 Gain of new family member 3915 Business readjustment 3916 Change in financial state 3817 Death of close friend 3718 Change to a different line of work 3619 Change in number of arguments with spouse 3520 A large mortgage or loan 31

Life Event ValueCheck if

this applies

1 Death of spouse 1002 Divorce 733 Marital separation 654 Jail term 635 Death of close family member 636 Personal injury or illness 537 Marriage 508 Fired at work 479 Marital reconciliation 45

10 Retirement 4511 Change in health of family member 4412 Pregnancy 4013 Sex difficulties 3914 Gain of new family member 3915 Business readjustment 39 16 Change in financial state 38 17 Death of close friend 3718 Change to a different line of work 36 19 Change in number of arguments with spouse 35 20 A large mortgage or loan 31

21 Foreclosure of mortgage or loan 3022 Change in responsibilities at work 2923 Son or daughter leaving home 2924 Trouble with in-laws 2925 Outstanding personal achievement 2826 Spouse begins or stops work 2627 Begin or end school/college 2628 Change in living conditions 2529 Revision of personal habits 2430 Trouble with boss 2331 Change in work hours or conditions 2032 Change in residence 2033 Change in school/college 2034 Change in recreation 1935 Change in church activities 1936 Change in social activities 1837 A moderate loan or mortgage 1738 Change in sleeping habits 1639 Change in number of family get-togethers 1540 Change in eating habits 1541 Vacation 1342 Christmas 1243 Minor violations of the law 11

Your Total

21 Foreclosure of mortgage or loan 3022 Change in responsibilities at work 29 23 Son or daughter leaving home 2924 Trouble with in-laws 2925 Outstanding personal achievement 2826 Spouse begins or stops work 26 27 Begin or end school/college 2628 Change in living conditions 25 29 Revision of personal habits 24 30 Trouble with boss 2331 Change in work hours or conditions 20 32 Change in residence 20 33 Change in school/college 2034 Change in recreation 19 35 Change in church activities 19 36 Change in social activities 18 37 A moderate loan or mortgage 1738 Change in sleeping habits 16 39 Change in number of family get-togethers 15 40 Change in eating habits 15 41 Vacation 1342 Christmas 1243 Minor violations of the law 11

Your Total 394

0

• If you fill out the Stress Scale according to common experiences faced by people going to work cross-culturally it generally adds to + 300 score

• This indicates the person has a high or very high risk of becoming ill in the near future.

What happens when we change cultures?

• Eco-maps are a method of plotting how well someone is functioning socially,

how much support they have,and how many resources they have.

• A healthy life that supports good mental health will have a broad range of activities and people within this map.

Eco-map

Katherine

CloseFriends

Church

Pets

Mentors

Other FamilyJack

Ian

Mother

Neigh-bours

Peoplein my

neighbour-hood

Jack’s School

Other Friends

Ian’s work

Work 2

Work 1Pilates

Draw-ing

Other Hobbies

Garden-ing

• Cross-cultural Work Exposes Staff to a higher risk of mental illness because it takes away their normal protective factors,

and exposes them to high stress.

Total Peopleaged 16-85 years

16 015 300 100%

Any lifetime mental disorder

7 286 60045%

Any 12-month mental disorder

3 197 80020%

No 12-month mental disorder

4 088 80025%

No lifetime mental disorder

8 728 70055%

Mental Illness in Australia

http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4326.0Main%20Features32007?opendocument&tabname=Summary&prodno=4326.0&issue=2007&num=&view=

National Survey of Mental Health and Wellbeing 2007

Any 12-month mental disorder

20%

Anxiety disorders

14.4%

Affective disorders

6.2%

Substance Use disorders

5.1%

High Prevalence Disorders

1. Anxiety Disorders2. Affective Disorders3. Substance Use Disorders

K10For all questions, please fill in the appropriate response.

In the past 4 weeks: None of the time

A little of the time

Some of the time

Most of the time

All of the time

1 About how often did you feel tired out for no good reason?

2 About how often did you feel nervous?

3 About how often did you feel so nervous that nothing could calm you down?

4 About how often did you feel hopeless?

5 About how often did you feel restless or fidgety?

6 About how often did you feel so restless you could not sit still?

7 About how often did you feel depressed?

8 About how often did you feel that everything was an effort?

9 About how often did you feel so sad that nothing could cheer you up?

10 About how often did you feel worthless?

• K10 Scores:• score under 20 are likely to be well • score 20-24 are likely to have a mild mental disorder • score 25-29 are likely to have moderate mental disorder • score 30 and over are likely to have a severe mental disorder

• 13% of the adult population will score 20 and over» For further information on the K10 please refer to

www.crufad.org or » Andrews, G Slade, T. Interpreting scores on the Kessler

Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health: 2001; 25:6: 494-497.

Anxiety Disorders

• Types:– Panic disorder– Agoraphobia– Social phobia– Generalised anxiety disorder– Obsessive compulsive disorder– Post-traumatic stress disorder

• Anxiety is based on the body’s normal stress response

• When we are under threat we either “fight” or “flight”

• Anxiety is a problem when it causes us to avoid things and starts to impact how we live our life

Affective Disorders

• Types:– Major Depression– Dysthymia– Bipolar Affective Disorder

• Symptoms of Depression (+ 2 weeks duration):– Unusually sad mood– Loss of enjoyment– Lack of energy– Feeling worthless and guilty– Thinking about death– Difficulty making decisions– Moving slowly or becoming agitated– Sleep difficulties– Loss appetite or eating too much

Depression Compression

The Life That’s Waiting for You

Healthy Relationships

Spiritual Satisfaction

What happens when people have existing mental illness?

• Insight/Acceptance of illness• Medication• History of the illness and personal

management

Prevention is better than cure

Self-Care

• Sleep:– Routine– Constant amount– Constant time– No naps– Strategies for dealing

with insomnia

• Exercise:– Burns off stress– Improves mood– Assists with sleep

• Foster Creativity:– Reading– Craft– Gardening– Cooking

• Social connection:– Thoughts and feelings– Hospitality– Connectedness– Meaning– Belonging

• Relaxation:– Prayer– Meditation– Silence– Stretching– Relaxation exercises

• Luke 4.42– At daybreak he departed and went into a deserted

place. And the crowds were looking for him…• Luke 5.15-16– But now more than ever the word about Jesus

spread abroad; many crowds would gather to hear him and to be cured of their diseases. But he would withdraw to deserted places and pray.

Are there any people who should not be allowed to work cross culturally?

• Families with children who have:– Autism Spectrum Disorders or other disabilities?

• Families with adolescents who have:– Eating disorders, anxiety, depression, self-harm?

• Adults with Personality Disorders:– Borderline Personality Disorder– Dependent Personality