Mental Health and Addictions, Practical Information for Supporting Students with Mental Health Challenges. May 2013

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1 Mental Health and Addictions, Practical Information for Supporting Students with Mental Health Challenges May 2013

2 Parts of this presentation are adapted from the Mental health awareness workshop developed by the Ontario Centre of Excellence for Child and Youth Mental Health

3 Objectives To gain further understanding on mental health language across the sectors and identify and respond to mental health challenges To provide opportunities to network and share information with members of the multi-disciplinary team To gain general insight into common psychotropic medication, uses and possible adverse reactions for medications that may be prescribed to children and youth Adapted by (Centre for Excellence for Child and Youth Mental Health, 2013)

4 Mental Health What does mental health mean to you?

5 Child and Youth Mental Studies suggest that between 15 and 21% of Ontario s children and youth have at least one mental health disorder. Untreated child/youth mental health problems become adult mental health problems, with 70% of adults with mental health issues reported problems started in childhood (Ontario Centre of Excellence for Child and Youth Mental Health, 2010) Suicide is the 2nd leading cause of death in ages (Statistics Canada, 2002)

6 Overview of Mental Health and Addiction School Program Ontario s comprehensive Mental Health and Addictions strategy, Open Minds, Healthy Minds includes the introduction of Mental Health and Addiction Nurses to the Community Care Access Center Funded by the Ministry of Health and Long-Term Care Target child and youth population- students Mild to complex mental health and/or substance abuse issues Transitioning back to school from hospital/institution due to mental health/addiction issues Assisting in critical incident stress debriefing Nurse will assist school boards in recognizing and responding to student mental health and addictions issues

7 School Based Mental Health School Boards know their students best. The CCAC nurse will partner with school boards to recognize and respond to student mental health and addictions issues. support community nurses, support development of school board strategies, participate in health care system planning and collaborate with community health partners in order to enable a consistent support for children and youth across the province.

8 CCAC Goals Success of students to thrive in school, remain in school or successfully transition back to school Collaboration with school board, teachers and community based organizations to support students in their early struggles with mental health and addictions Information to students, families and teaching staff regarding medications and side effects Opening the lines of communication

9 Directives Early intervention System navigation Consultation Collaboration/ partnerships Impatient transitions Crisis debriefing

10 Anyone can make a referral however, the student must agree to the referral and be willing to participate prior to initial meeting. Sources include but are not limited to: Self-referrals Families/caregivers School resource teams Teachers, Principles Hospitals Community agencies

11 Eligibility Student is in need of services related to an identified and /or suspected mental health and/or addiction issue Student is aware and has consented to the referral The student is an insured person under the Health Insurance Act (possesses a valid Health Card Number) *students who do not posses a valid Heath Card Number will still be accepted for service if criteria #1 and #2 are met

12 Awareness What is your role with children and youth experiencing a mental health challenge? Have you witnessed changes in youth behaviours or moods? Physiological changes, such as weight loss, hygiene ect? Criminal activity? Do you feel that children and youth have adequate support at home, school or in the community?

13 MENTAL HEALTH AND ACHIEVEMENT School success includes competency in the following areas: academic, social, physical, spiritual, and emotional. Research consistently shows that success at school is a strong indicator for success later in life. Mental health problems can seriously impair a child s ability to be successful at school and in their relationships with peers. A supportive and positive learning environment (both at home and at school) will allow children to explore and test their abilities, improve their skill level and enhance pro-social behaviour. (Ontario Centre of Excellence for Child and Youth Mental Health, 2013)

14 CHILDREN S MENTAL HEALTH IS Developing the capacity to: Experience, regulate, and express emotions Form close interpersonal relationships Explore the environment and learn Child mental health= healthy social and emotional development (Ontario Centre of Excellence for Child and Youth Mental Health, 2013)

15 Mental Health is a Continuum

16 Determinants of Health Many factors in the lives of individuals can affect whether a person is health or not. Where we live, the environment we live in and our friends and family have large impacts on the health of an individual. (WHO,2013) Income and social status Education Physical environment Social support networks Heath services Gender What determinants contribute most to the health of students in your schools?

17 Risk Factors The individual, family and community characteristics that increase the probability of the onset, severity and duration of major mental health problems. Source: Ottawa SSLI 2009 What are the most common risk factors faced by our chidlren and youth?

18 Protective Factors Understanding and recognizing protective factors are just as important as identifying risk factors. Building and working with protective factors may promote positive outcomes for children and youth. Protective factors can be individual or family and social or peer. (CDC,2011) Positive social orientation religiosity Open communication with guardians Social activity Commitment to school

19 As providers for children and youth As providers for children and youth, we need to work together to reduce stigma support students while ensuring continuity of care collaborate to ensure optimal care for our students open the lines of communication Talk about mental health and educate

20 Mental Health Challenges What are some mental health challenges you are aware of that are affecting our children and youth? Do you feel equipped in assisting and promoting mental health issues with your children and youth?

21 Anxiety Anxiety disorders are the most prevalent mental illness in Canadian children between 4 and 17 years of age. (Austin & Boyd, 2010) There are naturally developed fears in children and youth such as fear of the dark, fear of animals in older children and worries about relationships in teens. Anxiety become a problem when it interferes child s development and functioning. (Austin & Boyd, 2010)

22 Types of Anxiety Separation Anxiety Disorder Extra ordinary reluctance of refusal to separate from primary caregiver Generalized Anxiety disorder Chronic worrying nervousness and tension Obsessive compulsive disorder Repetitive thoughts/behaviours that cause problems Social anxiety disorder Extreme shyness that causes problems (Austin & Boyd, 2010), (Centre for Excellence for Child and Youth Mental Health, 2013)

23 Symptoms of Anxiety Excessive worry Reluctance to attend school Complaints of physical symptoms with no apparent cause Crying Tremors Sweating Increased sweating Social withdrawal Refusal to participate in class *Consider these symptoms in a child in your care that may experience anxiety

24 Mood Disorders Major depression (clinical depression, major depressive episode) Dysthymic disorder (low-grade depression) Adjustment disorder (mood problems following a stress, but not severe enough to be major depression) Bipolar disorder (extreme, disabling mood swings) (Centre for Excellence for Child and Youth Mental Health, 2013)

25 Symptoms of depression self-harm, suicidal ideation Low mood Diminished interest in previously enjoyed activities Difficulty concentrating Distress or impairment of social, academic and other functional areas Substance misuse, self-medicating Feelings of worthlessness Fatigue, loss of energy Anorexia or weight gain (Austin & Boyd, 2013)

26 When should medication be used For some conditions (such as depression, anxiety), medications can be useful if non-pharmaceutical options have been tried but have not been effective There should be evidence that the medication improves the symptoms The benefits of treatment outweigh the risks For severe symptoms of a disorder (Centre for Excellence for Child and Youth Mental Health, 2013)

27 Anti-depressant Medication Used to relieve distress of depression and anxiety. They may be prescribed for unlabeled uses such as chronic pain, obsessive compulsive disorder and bulimia. Cipralex, Prozac, Luvox There are several different classification of anti-depressants. Doctors prescribe appropriate medications based on patient symptoms and least side effects. Selective serotonin reuptake inhibitors (SSRI s) are considered the best medicinal therapy for youth with depression and non-selective Cyclic antidepressant are recommended for children with anxiety. Takes about 4-6 weeks to reach therapeutic levels. Positive changes may be noticed as early as 2 weeks however, is important to assess youths in the beginning of anti-depressant therapy as suicidal ideation may be increased.

28 Adverse effects Headache Agitation, restlessness, irritability. Dizziness and impaired balance Nausea, diarrhea, bloating Anorexia or weight gain. Decreased libido, impotence, ejaculatory disturbances Allergic reactions (rash, redness, itching, swelling)

29 Precautions Risk of self harm and suicidal ideation may be increased. Monitor for risk and inform student on possible changes while using medication. Serotonin Syndrome usually occurs within 24 hours of medication initiation. Watch for chills, sweating, elevated temperature, elevated blood pressure, increased muscle tone with twitching, tremor, unsteady gait or disorientation. May impair mental and physical ability to perform hazardous tasks.

30 Anti-psychotic medication May reduce or relieve symptoms of psychosis, such as delusions and hallucinations. Also prescribed for treatment of psychosis that occurs in bipolar disorder and depression. Other uses include stabilizing moods in bipolar disorder, reducing anxiety in anxiety disorders and reducing tics in Tourette's syndrome. Abilify, Risperidone, Seroquel 2nd generation medications are preferred as research has shown less side effects with the newer class.

31 Adverse Reactions Sedation, fatigue especially during the first 2 weeks of therapy Insomnia, vivid dreams or nightmares Confusion, disturbed concentration Increased agitation and anxiety Lowered seizure threshold. Warning in children with history of seizure Weight gain, anorexia Photosensitivity and photo allergy reactions

32 Precautions Extrapyramidal syndrome can be a serious adverse effect of anti-psychotics. It is manifested by rigidity and stiffness in muscles. Can be reversed using anticholinergic medication or by titrating and reducing the causing medication.

33 Mood Stabilizers Used in treatment of bipolar disorder. Assist in reducing mood swings and prevent manic and depressive episodes. Generally take up to several weeks to reach full effect so it may be possible that an antidepressant or antipsychotic may be prescribed in the early stages of treatment. Combining medication with other therapy such as forms of talk therapy, cognitive behavioral therapy and peer support are effective in the maintenance of a person with bipolar disorder. Lithium, Divalproex

34 Psychostimulants Used in the treatment of Attention Deficit Hyperactivity Disorder. Aims to decrease interrupting and impulsive responses and to increase attention, focus, short-term memory, problem solving and improve interpersonal reactions. General response occurs within the first week. Suggested to decrease physical and verbal aggression and reduce negative antisocial interactions. Ritalin, Concerta, Strattera

35 Adverse Effects Anorexia, gastrointestinal distress and weight loss. Hyperactive rebound can occur in afternoon or evening Sadness, irritability, anxiety, clinging behavior and insomnia. May increase psychosis in children with a genetic predisposition or prior history of psychosis.

36 Precautions Use with caution and with careful monitoring in individuals with a recent history of alcohol and/or drug abuse. Some individuals may divert Psychostimulants for illegal purposes.

37 Methadone Methadone is a opioid pain reliever, similar to morphine. It also reduces withdrawal symptoms in people addicted to heroin or other narcotic drugs without causing the "high" associated with the drug addiction. Methadone is used as a pain reliever and as part of drug addiction detoxification and maintenance programs.

38 Harm Reduction If taken regularly, same time daily, can reduce sickness from opoid withdrawal. Taking an oral dose of medication is safer than injecting, snorting or smoking. Does not give a high feeling but reduces the physical drugs cravings or feeling of need to get high. when prescribed by a physician and dispensed by a pharmacy methadone is legal. Blocks the euphoric effect of other opioid drugs. Eg: if you take heroin while on methadone you may not feel the high.

39 Adverse effects Serious adverse effects needing medical attention immediately shallow breathing hallucinations or confusion chest pain, dizziness, fainting, fast or pounding heartbeat trouble breathing, feeling light-headed, or fainting Less serious methadone side effects may include: feeling anxious, nervous, or restless insomnia feeling weak or drowsy dry mouth, nausea, vomiting, diarrhea, constipation, loss of appetite decreased sex drive, impotence, or difficulty having an orgasm

40 Precautions Taking methadone improperly can increase the risk of serious side effects or death. Even if an individual has used other narcotic medications, they may still experience serious side effects from methadone. Like other narcotic medicines, methadone can slow breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak. Do not use methadone with any other opioid pain medications, sedatives, tranquilizers, sleeping pills, muscle relaxers, or other medicines that can cause sleepiness or slow breathing.

41 Returning to school and community Do you feel confident in supporting children and youth returning to school and community after a hospitalization for a broken arm, surgery or infection?

42 Do you feel confident in supporting children and youth returning to school and community after a hospitalization for a mental health challenge?

43 Educators Guide Making a difference An Educators Guide to Child and Youth Mental Health Problems

44 Supportive websites s/pages/default.aspx

45

46

47 ault.aspx

48 Questions?

49 References Austin & Boyd. (2010) Psychiatric & mental health nursing for Canadian practice. (2 nd ed). Lippincott, Williams & Wilkins:CA. Bezchilibnyk-Butler, K. & Virani, A.S (2007). Clinical Handbook of psychotropic drugs for children and adolescents. Higrefe & Huber:MA Center for Disease Control and Prevention (2011) retrieved from Mosby s Drug Reference. (2010). (23 rd ed). Mosby:MI Ontario Centre of Excellence for Child and Youth Mental Health retrieved from World Health Organization (2013) retrieved from

50 Reminder: This presentation should not replace medical advice or direction. It is intended to act as a resource and guideline for front line staff awareness.

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