E ducating the Next G eneration: A University Partnership to Address S tigma in High S chool students

1. Educating the Next Generation: A UniversityPartnership to Address Stigma in High Schoolstudents Christine Lindquist, MPH Director, NAMI Greater Seattle director@nami-greaterseattle.org Kathy Stetz, MN, PhD Professor, Seattle Pacific University kstetz@spu.edu

2. Learning Objectives for Session • Todescribe how stigma, ignorance and bias related to mental illness can be addressed in a 50 minute interactivepresentation to high school and junior high school students • Describe how undergraduate nursing students with a defined interest in mental health make excellent outreach workers, expanding capacity for NAMI affiliates

3. 3. Describe the impact of the program on reducing stigma in middle and high school students.

4. ENG: History • Developed in 2003 by Trez Buckland and other dedicated NAMI volunteers from work done by NAMI Spokane volunteers. The name ENG was adopted from a Spokane program. The script was revised and interactive activities were added. • Development was funded, in part, by the Comprehensive Health Education Foundation (CHEF).

5. NAMI Greater Seattle and Seattle Pacific University (SPU) Partnership • Began 8 years ago • Initial focus was support of a college NAMI chapter at SPU • Living Well Program At SPU • Psychology and Nursing Fellows (undergraduate and graduate) study severe and persistent mental illness for one year via a seminar format. • Student Fellows receive a stipend towards tuition and fees • Must engage in service learning in the community

6. Training by Trez Buckland with Living Well fellows • Creation of a Community Partnership Project as part of an existing academic service learning course. • Began 4 years ago • Implemented each spring quarter (10 weeks) • Academic goals focus on Core Public Health Functions in the practice in nursing in the community. This project focuses on Assessment and Assurance.

7. ENG: Description • 50 minute power point and activity based program • Stigma and stigma reduction • Information on mental illnesses • Recovery approach • Strategies for self care • Community resources • Target audience: middle school, high school youth

8. Example of ENG Program Delivered at High Schools • Content • Learning Activities • Evaluation

9. Educating the Next Generation The National Alliance on Mental Illness NAMI of Greater Seattle

10. What is NAMI? (National Alliance on Mental Illness) NAMI strives to meet the unmet needs of individuals with mental illness and their families through advocacy, public education, information and referral, and self-help groups

11. Things you’re going to learn today • Understanding Stigma • Risk Factors • Common Symptoms • Common Mental Illnesses • Empathy Activity • Diagnosis and Recovery • Resources

12. Understanding… • What is mental illness?

13. What is Mental Illness? Mental Illness’ are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning.

14. Understanding… • What is stigma?

15. What is Stigma? • The term stigma refers to any attribute, trait or disorder that causes a person to be labeled as unacceptably different from “normal” people.

16. Mental health stigma can include: • Use of careless words such as: wacko, schizo, bipolar, crazy, insane • Use of jokes and stereotypes • Discrimination in healthcare, housing and jobs Stigma may lead to alcohol, drug abuse and suicide

17. Myth Busting • Mental Illnesses: • Are REAL • Are neurobiological brain disorders • Are physical illnesses, like diabetes or heart disease and can be treated by a physician • Can happen in any family • Can cause a person to process the world differently • Can be devastating if untreated

18. Myth Busting • Mental Illnesses: • Are NOT contagious • Are NOT due to laziness or choice • Are NOT the fault of the person who is ill • Are NOT due to race, class, gender or sexual orientation • Do NOT make people more violent • Do NOT make people out of touch with reality • Are NOT always due to drug or alcohol abuse

19. How many people • 1 in every 5 adolescents (20%) will develop a mental illness • 1 in every 4 individuals (25%) will develop a mental illness at some point in their life • Fewer than one-third of adults and one-half of children with a diagnosable mental disorder receive mental health services in a given year

20. Risk Factors for Mental Illness • Risk Factor: a variable that increases likelihood or risk • Environment: home, neighborhood, stress, traumatic or abusive situation • Genetic Inheritance: mental illness may run in families • Chronic Medical Conditions: ex. Cancer, HIV

21. Common Symptoms • Withdrawal from normal or previously pleasurable activities • Constant anxiety and worry • Extreme high or low feelings or moods • Physical problems caused by tension (backache, headache, jaw clenching, stomach ache) • Excessively strong feelings of anger, guilt or remorse • Persistent negative self image • Changes in eating or sleeping habits • Inability to cope with daily problems and activities • Self harm – cutting, burning, punching walls • Alcohol and/or drug abuse

22. Symptoms vs. Diagnosis • Symptom: a characteristic sign or indication of the existence of something else • Having symptoms does not mean you have a mental illness diagnosis • Noticing symptoms can allow you to take better care of your mental health • You don’t need a mental health diagnosis to get treatment • Early treatment can lead to better outcomes • A Diagnosis must be confirmed by a mental health professional

23. Common Mental Illnesses Obsessive Compulsive Disorder Bipolar Disorder Panic Disorder Major Depression Phobia Schizophrenia

24. Phobia “I am very afraid of things that aren’t really a danger to me. For example: I might be afraid of certain objects like animals or certain situations like being in high places, small spaces or being around too many people. My fears make me avoid these objects or situations”

25. Johnny Depp • Clourophobia (fear of clowns) • Famous actor, nominated for academy awards in the films Sweeney Todd, Pirates of the Carribean:The Curse of the Black Pearl, and Finding Neverland

26. Panic Disorder “Sometimes I suddenly get really scared without any warning. This can happen a lot. I may have chest pain, my heart may beat really fast, I may be short of breath and feel like I am going to die. This is called a panic attack. When I’m not having a panic attack, I often worry about when and where I will have the next one. I often feel anxious, tense and self conscious.”

27. Michael Jackson • Known as the “King of Pop” • Has received 18 Grammy awards, 26 American music awards • Inducted into the Rock and Roll Hall of Fame

28. Obsessive-Compulsive Disorder “I think of things and do things that don’t make a lot of sense to me but I just can’t seem to stop. Everyone does this at times, but I do it so much that it interferes with my ability to do normal things and it causes me a lot of grief. For example things just keep coming into my mind even when I don’t want to think about them. This is called an obsession. I also do things, like counting all the lines in the sidewalk when I walk somewhere or washing my hands over and over when they are already clean. This is called a compulsion”

29. Cameron Diaz • Starred in “Shrek”, “Knight and Day”, “Charlie’s Angels” and “The Holiday” • Lives with OCD • Opens doors with her elbows and cleans the door knobs in her home so much that the paint has worn off

30. Schizophrenia “I have a thought disorder. The way I think doesn’t make sense to you, but it makes sense to me. This is called a delusion. An example of this is that I often think that people are out to get me, that they are talking about me, or are doing bad things to me such as poisoning my food or stealing my air. I also might think that people are sending me messages or putting thoughts in my head. This is called being paranoid. I can also have auditory or visual hallucinations. That means that I experience things through my senses that people around me do not experience. I might see, smell, hear or feel things that others don’t.”

31. Lionel Aldridge • Super Bowl winning defensive-end with the Green Bay Packers • Winner of the first two Super Bowls • Star Rookie

32. Bipolar Disorder “Sometimes I am extremely energetic and I don’t need much sleep. I can get a lot done. I also have racing thoughts and can behave recklessly. I might party too much, buy things I don’t need or take the car without permission. Everyone does these things to an extent, but I do it to the extreme. This is called mania. Other times I will become very sad, or depressed. I can feel so worthless that all I can think about is dying. I don’t enjoy anything at all.”

33. Robert Downey Jr. • Starred in Iron Man, Sherlock Holmes, Due Date and The Soloist • “Yes, I do have bipolar disorder. There are periods of time that I just …I am so hyper and I spend a lot of money, I’m irritable, and there are periods of time that I go down.”

34. Major Depressive disorder “I either want to sleep a lot or I can’t seem to sleep at all. Things I used to enjoy, like hanging out with my friends, listening to music and going out, just don’t interest me anymore. It is hard for me to concentrate and finish things I start. I feel worthless and wish I could die. I think about trying to kill myself and have even tried it.”

35. J.K. Rowling • J.K. Rowling is the author and creator of Harry Potter • In her darkest hour, she strongly contemplated suicide while suffering from a massive bout of depression

36. Empathy Activity • Experience what it might feel like to process the world differently • How did it feel?

37. Recovery • What are the goals of recovery? • Improve the quality of life by eliminating or reducing symptoms • Resume school, social, and work activities • Stabilize mood • Minimize side-effects • Learn healthy coping strategies • Getting help early is very important.

38. Coping Strategies • Coping Strategy: a positive process of managing stressful circumstances • Problem-focused strategies • Emotion-focused strategies

39. Take care of yourself • Stress Management • Learn and use healthy coping strategies (such as exercise, getting enough rest, eating healthy, hobbies) • Communication Skills • Practice assertive communication – clearly and respectfully expressing your needs, including the need for help • Healthy Relationships • Choose to put your energy into people that make you feel good about yourself and practice healthy behaviors

40. Getting Help If you had a broken bone or cancer you would seek medical help. Mental illness is just as real and there are people and treatments that can help.

41. Who can diagnose and/or treat mental illness? Mental health professionals, such as psychiatrists, psychologists, nurse practitioners and counselors all play a role in the diagnosis of a mental illness

42. Resources • Parents or Guardians • Trusted Teacher or faculty member • School Nurse: • School Counselors: • Teen Link [www.866teenlink.org] • Crisis Clinic: (866) 4CRISIS [866.427.4747] or 206.461.3222 • National Hopeline: 1.800.SUICIDE [1.800.784.2433] • National Alliance on Mental Illness [nami.org] • NAMI information helpline [1-800-950-NAMI]

43. De-Stigmatization • How can we reduce stigma of mental illness?

44. Roosevelt High School Presentation spring 2012

45. Empathy Activity

46. Additional Materials Developed in 2012 Free Association Activity Letter Activity

47. Free Association Activity • Categories: • Myth • Common Misconception • Hurtful Language • Fact • Other

48. Letter Activity Scenario:A friend of yours leaves you this note in your locker, asking for help. What do you do? Dear friend, I am sorry that I have been acting so different lately. I don’t know what is wrong with me. It just seems that everything in my life is going wrong. My dad just lost his job and so my parents are really stressed about money. They fight a lot and start yelling. I don’t know what to do when this happens. I feel like I should help fix the problem but don’t know how. Sometimes I just feel like I am worthless. Lately I don’t even like hanging out with friends anymore. I just want to be alone and sleep all day. I don’t know why I feel this way. I am just so overwhelmed with school and stress at home, it is easier to just not deal with it. I don’t know who to talk to about all of this, that’s why I'm writing you. What should I do? -A friend in need

49. Letter Activity – Student Responses • How would you respond to your friend? • Questions: • List four “stressors” or signs of depression you see in your friend’s letter. • List four different ways they could manage their stress, or resources they could use to get help.

50. Evaluation • Pre-Post tests using a Likert scale • Qualitative data from: • Students • Teachers