Mental Health and Wellbeing Conversation Skills

1. Session 2 Royal Society for Public Health Manchester Health and Wellbeing Service Stockport Together

2. Welcome! • Introductions • Housekeeping • Ground rules

3. Brief wellbeing intervention: to promote mental health and wellbeing • after taking part in the course you will be able to: • Apply the five areas model in conversations about mental health and wellbeing • Recognise the nature and extent of mental health and wellbeing issues being presented and how best to deal with it. • Practice skills needed to start, follow and end a conversation about mental health and wellbeing • Identify steps that can be taken to improve mental health • Identify local services and resources that help break the vicious cycle to improve Mental Health and Wellbeing

4. Recap • In Pairs: what do you remember from Session 1?

7. Active ingredients of activity • Achievement • Enjoyment • Pleasure • Connection

8. Five Areas Model and the ‘vicious cycle’

9. Balloon Game

10. Life situations card game In small groups: • Select one of the life situations cards you have been given • Use imagination and experience to apply 5 areas model to this situation • Make notes on the A4 template of what might be happening in the 5 areas as a result of the selected life situation

11. What stops you? In pairs discuss: • What blocks or stops or makes it difficult for you to initiate or have a conversation about mental wellbeing with someone? • Consider things about you or the situation / environment – NOT about the other person.

12. Barriers to Talking about Mental Wellbeing Fears • Unleashing strong emotions • Making things worse • Facing difficult questions • Taking up too much time • Not knowing what to do Lack of skills and confidence in • Starting conversations about feelings • Exploring issues • Handling difficult questions – saying the right thing • Closing the conversation Beliefs • Emotional problems are inevitable and nothing can be done about them • It’s not my role to discuss such things • There’s no point talking about problems that cannot be solved Place • Lack of privacy • Time constraints • Noise/distractions

13. Common Pitfalls in Mental Wellbeing Conversations • Getting into solutions too soon • Giving advice too soon • Dismissing a person’s experience • Blocking cues • Making the conversation more like an interview • Filling the silences Beginning Info gathering Middle Exploring End Next Steps

14. The Monkey Business Illusion - YouTube

15. Key communication skills formental wellbeing conversations • Using questions: open, open directive • How are you • How have you been since I last saw you? • What’s going on for you at the moment? • Negotiation • Could we spend some time talking about that today? • Responding to cues: empathic acknowledgement • That sounds really difficult • I can hear how upset you are • I can see how that would be overwhelming • Reflection • You said it’d been hard since you left work and you’d been spending time just sitting at home watching telly. • Summaries • You’ve mentioned three things that are getting you down: the way that your partner treats you, your back pain and the pressure about not having enough money coming in.

16. Responses to the suffering and misfortunes of others

17. Practising conversational skills in pairs • Person ‘A’ –Think of a difficult work/home situation you have recently faced that you are comfortable talking about now • Person ‘B’ –Use the skills to open the conversation and let the person know you are really hearing what they are saying

18. Questions for 5 Areas • What questions might you ask that will start to get information for each of the 5 areas?

19. Structure for practice • Opening question (how are you? how are things?) • Quick exploration of the situation • Introduce the 5 areas map • Negotiate with the character about having a go • Ask questions so that each area is covered, and fill in the map, so that the character can see it; if the worker is not sure which area to put something, ask the character where they want to put it • Help the character to make the links between the 5 areas and see how they form a vicious cycle

20. BATHE Technique BACKGROUND What’s been happening since I last saw you? What is going on in your life? AFFECT How do you feel about it? TROUBLE What troubles you most about the situation? HANDLE How are you handling it? What helps you to handle it? EMPATHY That must be very difficult for you / I can see how upset you are/ I can hear how angry you are about that / Your reaction makes sense to me From: Stuart, M.R. & Lieberman, J.R. ‘The Fifteen Minute Hour: applied Psychotherapy for the Primary Care Physician. New York: Praeger, 1993

21. Exploring intensity questions It would be useful for us to get a better understanding of the difficult feelings that you mentioned: • How long have you been feeling like this? • What seems to set off these feelings? (where, with whom, when) • What effect is this having on your life? Is it impacting on your personal life, work life, levels of activity (coping)

22. Exploring Intensity - practice • Person ‘A’ – Steve, using update • Person ‘B’ – ask questions to explore Steve’s situation

23. Suicide prevention • In the UK there is one death by suicide every two hours - and at least ten times that number attempt • Suicide is the leading cause of death among young people aged 20-34 years • Nearly four times as many men dying as a result of suicide compared to women. • Those at highest risk are men aged between 45 and 59 years • One reason that men are more likely to complete suicide is because they are less likely than women to ask for help or talk about depressive or suicidal feelings. 72% of people who died by suicide between 2002 and 2012 had not been in contact with their GP or a health professional about these feelings in the year before their suicide. • The statistics highlight that talking about suicide is still highly stigmatised. Talking about suicide and understanding it better is necessary to help prevent further suicides

24. Asking the person about suicide:finding the words If the worker thinks that the intensity of feelings seems particularly troublesome, ask the question about thoughts of suicide, then use the flowchart to explore urgency and protective factors. Sometimes when people are having the feelings and experiences you are describing , it’s not uncommon for them to have thoughts about ending their own life. Is this something that you have thought about?”

25. STEPPING UP FLOWCHART The Question: When people are feeling low or anxious it is not uncommon to have thoughts about ending their lives. Is this something you have thought about? YesNo Explore Intensity How intense are these thoughts for you How long have you been feeling this way? Identify resilience factors What keeps you safe? What if things were to change? Method Have you gone so far as to think about how you might do this? Give key contacts for mental health support. Agree plan for staying safe Planning I just need to check. Is it something you’ve got a plan in mind for? I’m really worried about you and don’t want you to leave here today without a plan for how to get you through where you are now. Emergency Action Arrange help Inform Manager Follow protocol

26. Asking the question - practice “Sometimes when people are having the feelings and experiences you are describing , it’s not uncommon for them to have thoughts about ending their own life. Is this something that you have thought about?” • person ‘A’ – Steve, update • Person ‘B’ – use flow chart • What needs to be done ?

27. Services and resources