YSRP0001 Lecture 1 – Introduction: Why taking this course?

1. YSRP0001 Lecture 1 –Introduction: Why taking this course? Dr. Paul Wong D.Psyc.(Clinical) E-mail: paulw@hku.hk Centre for Suicide Research and Prevention (CSRP) Course website: http://csrp.hku.hk/bc

2. This Lecture’s Overview • Objectives, framework, and assessment of this course • An overview of the content of this course • The epidemiology of suicidal behaviour and mental health among the general public and university students in Hong Kong; • Where to seek help if you are distressed? Introduction of the Centre of Development and Resources for Students (CEDARS)

3. Course Objectives: • To increase students’ knowledge about stress, depression and suicide. • To enhance students’ awareness and self-understanding relating to stress and well-being. • To equip students with stress-reduction techniques and other life-enhancing coping strategies to deal with possible stressors. • To cultivate a positive attitude towards life based on a holistic wellness model.

4. Intended Learning Outcomes - Knowledge level • Declarative Outcomes: • discuss issues related to the definitions and causes of stress, depression, and suicide • describe the cognitive-behavioural model of stress and depression • describe the physiological, psychological, and social changes associated with stress, depression, and suicide • describe and critically evaluate the concept of coping • evaluate the different effects of daily hassles, life stress and extreme stress of peoples’ mental well being

5. Intended Learning Outcomes - Practical level • Functioning Outcomes: • evaluate the role of cognitions, behaviours, and social behaviours in the individual experience of stress, depression, and suicide • relate and explain the aetiology from the understanding and knowledge about stress, depression, and suicide onto his/her own personal experience • teach others about the management of stress, depression, and suicidal tendencies • apply the learned knowledge and skills onto one’s future experience • generate individualized life skills to manage future physical and psychological demands

6. Intended Learning Outcomes - Value level • Value outcomes: • becomes a more understanding person about him/herself as well as other peoples’ mental well-being; • becomes more aware of the significance of mental wellness towards a healthy life.

7. Teaching method • Based on a “"Tell me, I'll forget. Show me, I'll remember. Involve me, I'll understand" principle. • Thus, I will do some lecturing, show you some skills and videos, and most importantly, you will practice the skills in five of the lectures/tutorials. • Also, I am open for comments and suggestions along the way, please do send me e-mails anytime during the course. The last thing I want to see in lectures: http://www.youtube.com/watch?v=k__2_Am3a9w • paulw@hku.hk

8. Assessment • All of these assignments will be submitted to me at the last lecture on or before 20 April, 2011. • Please e-mail and hand in your assignments to your tutor. Also, you can also hand in other materials to me if you would like to, e.g., newspaper clippings. • There are three modes of assessments in this broadening course: • One problem-based case study (25%) – students will be given a case who is stressful at school and to formulate a “helping plan”, which consists of the taught skills from this course, to help another person who are in-need from an educated person about mental health. • A self-refectory report – (25%) - (i) a collection of the in-class exercises, and after-class application activities, reflection exercises, observation tasks, etc. that students do throughout this course and (ii) a brief Self-reflection Report (no less than 700 words). The exercises and activities will gradually build up students’ learning and form the backbone of the Student Learning Portfolio. The Student Learning Portfolio should be submitted on or before the last session.

9. Assignment (cont.) • Group project and presentation (50%) – This assignment is to motivate students to enhance their knowledge on mental health and mental ill-health based on the self-learning principle. A group of 4-5 students will write a proposal (about 1500-2000 words) and present their proposal during a tutorial. One topic that students can choose from is “Enhancing the mental health of high-school students using a e-learning approach (such as in form of games, interactive activities, animations, videos, music, etc.)”. Since you are all not expected to implement the design, any creative idea is much welcomed. Besides, students can also choose any topic relating to the course but may not have thoroughly covered during lectures and tutorials.

10. To get an A • Case report/Presentation - The student deeply reflects on the concepts and issues discussed in class, and not only shows understanding of the main ideas introduced but also generate deep meaning out of such knowledge/skill. The student concretely identifies the relevance and importance of the knowledge, and describes specific ways in which the knowledge can be used for their life in general. • Self-reflection report - The student records the self-observation in a clear and organized way, and reflects deeply on the observations. The observations are explained not only with proper terms/knowledge introduced in lectures, but also in sufficient depth and/or breath.

11. Some feedback from ex-students • General comments about the course “I can find comfort whenever attending the lectures as if someone understanding me is teaching me how to walk on.” “My parents and I appreciate this course much as we have never thought of certain daily life related course would appear in the university which cares much about students’ mental health. We have used the problem-solving and anger management exercises together.” “The most important thing I enjoy this course because it emphasizes expression of real feeling without critiquing by Paul”. “Dr. Wong not only taught us to use the skills ourselves but also told us how to teach them to others. I think this is the most important element of the course”.

12. Some feedback from ex-students • Skills that like and use most Communication and anger management skills and practice on conflicts with boyfriend. The brain-storming step of problem-solving skill – “To kill Paul, or to ask all the classmates not to hand in assignments”. Some creative ideas generated to solve the deadline problem.

13. Some feedback from ex-students • Examples of helping others by what’s been learned from the course Teach mother to use computer using the problem-solving method because mom was anxious about learning computer Teach a depressed and hopeless friend to use the ABC model, he found the exercise calming and help to raise self-esteem Helping a patient from a nursing student. “One of my patients had suicidal ideation so that his movement had to be reduced as he was very agitated. The next day I brought along with the problem-solving exercise to see whether I can help him with this tool. He had such suicidal ideation because his face got burned due to an industrial accident that he was afraid others may discriminate him due to his altered appearance. We brainstormed some solutions and we found some of them like “perform plastic surgery after his condition stabilized” and “skin grafting” are more feasible. I reflected the problem to the nurse and doctors and they thought the solutions could be feasible but they said time is still needed to observe the condition of the patient. Few days later, good news happened. The doctor decided to do the skin grafting for the patient. He was delighted and thanked for my help. The next day his restrainers were off and he was preparing his skin grafting surgery”.

14. Comments on education method This type of lectures seems to be the combination of normal lectures and PBL. They allow us to have enough information before thinking it through and practicing the knowledge on ourselves and people around us. I think the “intentional learning outcomes” approach used in this course does help students to understand better the techniques which are being taught in class through practicing them in classes. “I would like to praise the good organization of this course – the in-class activities gave us opportunity to practice individually; the after class activities provided us with chances to use and practice what was learnt in class and develop an automatic-processing system in our mind; the report-writing tasks enabled us to reflect what we learned and real-life applications.”.

15. The content of this course

16. The organization of this course is based on a therapeutic model called “Cognitive-Behavioural Therapy” • Its approach to tackling mental disorders/disturbances is based on the assumption that emotional responses are mediated through the interpretations, or meanings, that we give to experience. • Thus, in order to improve one's mental health, the behaviour and the cognition of an individual need to be educated or trained.

17. External Stressors • Working on Assignments • Exam • etc Behavioural Reactions: Got into an argument with your course coordinator because you are one mark less to get an A • Cognitive Processes • “I am going to fail” or • “ I will surely get an A for it” Emotional Reactions – Happy, upset, depressed Physiological Reactions – Sleep problems, reduced immune response or increased risk of blood clots etc. The content

18. External Stressors • Lecture 2 & 3 Behavioural Reactions Lecture 9 & 10 Cognitive Processes Lecture 4-7 Emotional Reactions Lecture 8 & 11 Physiological Reactions Lecture 11

19. The Dimensions of Suicidal Behaviour in Hong Kong

22. Risk and Protective Factors for Suicide in Hong Kong

25. Characteristics of Youth Suicidein Hong Kong

26. T. P. Ho, S. F. Hung, C. C. Lee, K. F. Chung and S. Y. Chung (2000). Characteristics of youth suicide in Hong Kong . Social Psychiatry and Psychiatric EpidemiologyVolume 30, Number 3, 107-112,

27. Adolescent Suicidal behaviour 28-42% secondary school students had ever thought about suicide (Chan, 1995; Fong, 1993; Stewart et al., 1999) 2.2% adolescents aged 15-19 had attempted suicide in the past year (Prevalence study, CSRP) Adolescent suicide, though constituted to only 6-11% of all suicides, has caused a significant proportion of socio-economic burden to the community (Yip et al., 2005).

28. Adolescent Suicidal Ideation From our household survey study, we found statistically significant (p<0.05) factors for adolescent (aged 15-19 years) suicidal ideation:

29. Young People Bereaved by Suicide in Hong Kong

34. What can we learn from these two studies? Although exposure to completed suicide can be a traumatic event (especially for those who are close with the deceased), exposure to attempted suicide(s) may have a stronger impact on young people.

35. An Overview of Suicide

36. Facing the facts… One million people die by suicide across the globe each year. Approximately 1,000 people in Hong Kong die by suicide each year. Although the suicide rate fell from 2003 (18.6 per 100,000) to 2008 (13.5 per 100,000), it is still higher than the world average.

37. Source: World Health Organization: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

38. Suicide rates by Asia Pacific Countries

39. Facing the facts… Prevention may be a matter of a caring person with the rightknowledge being available in the rightplace at the right time.

40. American Journal of Psychiatry, 164:5, May 2007

41. Preventing Suicide

42. You Can Help!

43. You can help. . . (1) Know warning signs (2) Intervention

44. Warning signs • Observable signs of serious depression • Unrelenting low mood, Pessimism, Hopelessness, Desperation, Anxiety, Withdrawal, Sleep problems • Increased alcohol and/or other drug use • Recent impulsiveness and taking unnecessary risks • Threatening suicide or expressing strong wish to die • Making a plan • Giving away prized possessions • Purchasing a firearm • Obtaining other means of killing oneself • Unexpected rage or anger

45. Intervention • Three Basic Steps • Show you care • Ask about suicide • Get help

46. 1. Show you care Take ALL talk of suicide seriously If you are concerned that someone may take their life, trust your judgment! Listen Carefully Reflect what you hear Use language appropriate for age of person involved Do not worry about doing or saying exactly the “right” thing. Your genuine interest is what is most important.

47. Be Genuine • Let the person know you really care. Talk about your feelings and ask about his or hers. “I’m concerned about you…about how you feel.” “Tell me about your pain.” “You mean a lot to me and I want to help.” “I care about you, about how you’re holding up.” “I don’t want you to kill yourself.” “I’m on your side…we’ll get through this.”

48. 2. Ask About Suicide Be direct but non-confrontational • Are you thinking about suicide? • What thoughts or plans do you have? • Are you thinking about harming yourself, ending your life? • How long have you been thinking about suicide? • Have you thought about how you would do it? • Do you have __? (Insert the lethal means they have mentioned.) • Do you really want to die? Or do you want the pain to go away?

49. 3. Get help but do NOT leave the person alone • Know referral resources (ask 1083 if you don’t know) • Reassure the person • Encourage the person to participate in helping process • Outline safety plan

50. Where to seek help if you are distressed?