hi everybody my name is mckenna bigelow and i am with the holland youth advisory council so a little bit of information about the how news advisory council there are four different groups me and all the people here wearing name tags are part of the special events committee which is sort of we planned events for the city of holland to benefit the community we've done events in the past for homeless youth and energy awareness  decided this year plan and event surrounding mental health awareness we also on saturday have a five k run slash walk for mental health awareness at starting at nine in the morning so all of you who would like to come and support that as well would be great so today we have speakers from our own hospital pathways being nice and the community mental health and the first speaker we have today is dr duma medical director at hospital behavioral health services you thank you mccann and thank you to the youth advisory council for their work in bringing this together i also want to think esther givens from the city of holland and what better place to have an event like this then at the heart of our community because this is an issue that is at the heart of our community is there are advance the slide button so when when i speak at an event like this whatever specific topic i'm addressing i really have two major goals one is to underscore that when we talk about mental health we're talking about health this is a part of the health of of every person and in all of our lives our mental health will be challenged at some point to a greater  lesser degree and some of us to a much greater degree with a diagnosable illness but this is an issue for all of us in our lives and most of us have either experienced something ourselves in the way of significant mental illness or love someone and care about someone who has the second very important issue which has gotten better over over the last i think twenty years but we have a way to go is to broaden the understanding of everyone in the community a bad out the need for readily available treatment and to get rid of any remaining really clicking so what i'm going to be talking about today yes or i may just ask you to see if you can advance it manually is the medical model that's what i've been asked to to discuss and i'll speak to why that's important it's a fairly broad theme one of the things again i want to emphasize is that advocates for mental health feel that we went to underscore that this is a universal issue for all of us and that prevention and early intervention are extremely important so we can think of this in the same way we think of other aspects of physical health as being along a line or a continuum and we all move along that line or that continuum as our life goes along there are going to be times where we're more challenged in terms of our mental health of somebody tells me well gee i have gone the entire seventy years of my life with no emotional struggles or times where i've dealt with mal health that's a whole other discussion about denial but the reality is again all of us will struggle at some point and again i very seldom meet somebody who doesn't have someone they care deeply about who has been affected by one of these issues so one in four people will in the course of a year meet the criteria for something that would qualify as a mental illness now some of these are much less impactful or disabling some of them are extremely disabling or life threatening in terms of very serious and potentially life threatening illness we're talking about one in seventeen so  significant number of people are impacted by these conditions so what is illness i think we all have a general feeling for what illness or disease it is we all experience these at different points in our lives one sort of dictionary definition is an illness is something that a condition of being unhealthy in body and mind disease a pathological process with a characteristic set of signs or symptoms  in the mental health field are largely no different so the medical model deal represents issues that involve significant changes in a person's psychology though the way they experience the world emotion at a emotionally and and and intellectually and that get in the way of their ability to function cause significant distress and we understand that diagnoses such as bipolar illness and depression and anxiety and schizophrenia are more similar than not to other illnesses in terms of having characteristic changes in in the body in the brain as well as signs and symptoms why does this matter several reasons first of all i think most of us in our society think facts are important and the evidence overwhelmingly supports this model it provides a universal language in talking about the conditions that we treat and therefore being able to research understand develop effective approaches to helping people with these issues very importantly understanding the medical basis for conditions like depression like anxiety disorders like addiction it's reduces hopefully some of the shame or stigma that goes historically with  with having these conditions and her barrier to care importantly also preventing discrimination in the workplace or in other areas for people who have these particular health conditions which are covered under things like the family medical leave act the americans with disabilities act and recognizing that this is part of one's overall health profile prevents people who are getting help who are suffering from these conditions from discrimination the other important thing in the way our health system is structured is mandating that people who are covered under whatever it might be medicare medicaid blue cross that the treatment for these conditions also needs to be covered and available for people and finally promoting prevention early intervention because we know that the sooner people are able to access treatment and support the better outcome they are going to have the other model i kind of under the the medical model that i think is important to talk about is something that we refer to as the bio psycho social model of of illness and particularly the illnesses that we're talking about well that's a you know that's a mouthful let's break it down so bio refers to the biology of these illnesses they specifically live in the brain which is our most complicated organ by far it's it's where our thoughts our memories our perceptions our feelings our creativity lives and brain structure and function is affected in these in these illnesses the psychology the  one approaches understands addresses any illness again whether it's heart disease cancer or clinical depression how how do i think about this how do i address getting help for it and moving forward is an important component and then the social environment in which this happens an environment that either embraces the person and supports them getting the help they need or in any way causes the person to feel different less than or shunned makes a tremendous difference in people getting appropriate health care and the best possible outcome so that's what we talk about with all of those elements being important so with these illnesses are they primarily biological psychological and social component the answer is yes stuff to all of that people are both biological beings and live in a social environment and so in some ways it doesn't really matter how you know is it fifty percent genetic and fifty percent stress factors the fact is it tends to be all of those things for people the causes for these conditions are very complex just as the causes for for heart diseases is very complex and the importance of us understanding as much as we can means that we can provide the best treatment for people and so i'm going to talk briefly about about how we diagnose conditions in twenty seventeen in the united states there are so there's some generally agreed upon language in in the medical mental health community in terms of understanding the symptoms that people can suffer from with with various illnesses so i'm going to give one example in a moment and the example is one of the most common things we treat which is major depression or clinical depression  diagnosing and understanding these conditions the strength of it is it provides a standard way of communicating and understanding diagnosis and therefore it leading to what's the best evidence based treatment the limitation is it's purely descriptive it doesn't necessarily say what caused something it doesn't necessarily say what's the most effective treatment for something but it's important that we have a somewhat systematic way of understanding these conditions so that we can educate people about what they're dealing with and develop the most effective treatment plan so example of this is how we understand what a major depressive episode is again an extremely common condition a leading cause of disability and death and and a treatable condition so india sam we understand that if if somebody has a number of symptoms over a period of time two weeks or more in in our current in our current understanding this including low mood loss of interest or pleasure kind of a raying out of things changes in sleep patterns changes in appetite or weight feeling very hyper or on having a a set of those symptoms constitutes what we would call a major depressive episode and again the important thing is understanding what it is that the person is experiencing and dealing with so that appropriate help can be offered to them there are a number of reasons why a person can develop clinical depression again an extremely common condition there are genetic factors that are involved there's changes in the chemistry the chemical functioning of the brain there's changes in stress hormones that happen there's changes in sleep patterns that that are both a a symptom and contribute to this condition strains in the environment poverty or abuse negative life events loss of job loss of relationship all of those are risk factors and in terms of the psychological factors that can play into this for people learned helplessness no matter what i do i can't make myself feel better or no matter what i do i can't make this set of relationships better so the way a person comes to look at the world over time can change with us and that ends up being an importan target of counseling and therapy so what does this look like these are what are called functional studies functional m r i z and i've got a few of these but the reason i'm showing these is a picture paints a thousand words and one of the difficulties with these illnesses is in one way they're invisible the person can look just fine  and so you know that this is been some of the challenge that there are people out there suffering from depression pushing themself along you know very much the walking wounded but unlike some other medical conditions on like a broken leg you might not know what they're for is it real well yes it is real it's very real so these are pet scans showing brain activity in a person who is in their baseline state of mental health versus in a state of depression and you don't have to be a functional radiologist to say there's there's a real difference in brain activity and brain function  that goes on here this is a person before and after on the left this individual had a functional scan done when they were suffering from all of the symptoms of serious clinical depression and with treatment over time thankfully they recovered and recover is on the right you can literally see where their brain has has has lit up so this has to do with with brain activity i've been doing this for a very long time and i mentioned that one of the symptoms is concentration and i've treated some brilliant people some very very intelligent people with clinical depression i have yet to have somebody tell me you know doc i'm i'm really we're going with depression but i feel sharper than ever people when they're in the state of clinical depression feel like my brain just can't work i can't think i can't concentrate and it's extremely distressing we rely on this every day and it's very very discouraging for people this is just to to go to a different illness that we see this is an individual with bipolar disorder in the three scans in the middle or an individual in a manic state sort of a heightened brain can't slow down can't sleep judgment becomes affected  you can see sort of the glowing red areas where the brain is in overdrive so these conditions again live in brain functioning and really i hear it less now thankfully but the language of well you can just sort of buck up pull yourself up by your bootstraps and will yourself out of this that really doesn't fit what we understand about the the biology of these illnesses go on to the next one i wanted to mention too because these are complex and i thought would be worth giving an example  of an important aspect of most of these illnesses and i'm going to use one of the the more dramatic examples and this has to do with individuals with  schizophrenia schizophrenia affects about one percent of the population it's treatable people can do very well and and have you know good recovery function quality of life but they they need to get treatment and this is a disorder of thought rather than mode it can affect the person's perceptions judgments interpretations and it can be very disabling so the example of what are called manas i gotta call more commonly identical twins if you can do the next slide so if you have two people and they share all of their genetics i mean those two guys were even wearing the same shirt right they share all of their genetics there's a fifty percent concordance rate what does that mean it means that in identical or monozygotic twins if one of them has schizophrenia there's a fifty percent chance that their twin will if you think about that for a moment that says a couple of things well there's a pretty big genetic component to this but it's not one hundred percent and this leads us to understand something important for most of these conditions there may be a tendency or a genetic tendency toward having the illness but often there is more that goes into that illness really developing for the person we don't always know what that is but again these are twins the one on the left does not have the onus the one on the right develop schizophrenia and you can actually see changes in the structure of the brain for the twin who had schizophrenia which which in this case went untreated for a period of time so that speaks to the fact that some of it is is the  genetics the tendency toward something and some of it may well be environmental factors that trigger the us and we're still a long way from fully understanding all of this but again speaking to the fact that this has to do with pretty complex changes in in the brain and the need for us to to learn more and more so we can help people have the best outcomes in their life  i won't spend too much time with this other than to make a point this is a slide of having to do with access to care for individuals who have diagnosable clinical depression  you can if you can see the slide ok it points out that that is not quite a majority of people get to treatment of any kind and even fewer get what we would consider to be fully adequate treatment which the evidence for for treatment of clinical depression shows that people with a diagnosable episode of major depression are clinical depression do best with a combination of approach that includes professional therapy with a trained mental health clinician and adequate evidence based medication but unfortunately it's almost the exception rather than the rule for somebody to to get both and we want to raise the bar so people are getting adequate appropriate treatment for their condition next one  and again there you know we we want to to get the door widened for the entire community there are some differences in the community that are maybe cultural may have to do with access to care in terms of coverage for treatment and this is an ongoing effort to to ensure that everyone regardless of their background has access to adequate mental health treatment that's when this this is one of the reasons many of us are here we recognize that there is these are high risk illnesses and leading cause of death in this country for the entire time i've been in the field suicide has been one of the top ten causes of death and one of the top three among adolescents and young adults and so we are literally talking life or death when we talk about access to care reducing shame and stigma and encouraging people to to seek out support from from those that they care about and that care about them and to get into treatment and briefly this three leading cause of death in adolescents and young adults so the importance of prevention education knocking down any barriers to people seeking help as one of the reasons why we have someone vailable in the emergency department at how in hospital twenty four seven if somebody is in a crisis and is is having thoughts of it in their life we always want them to know we look at that the way we would look at any other health emergency that's why we're there twenty four seven this is also a top cause of disability i'm  speaking primarily of depression but it has consistently been the top five or six leading causes of disability and so to adequate treatment as early as possible is extremely important both to the individual but also to society so what are briefly some components of treatment for somebody with a serious illness and again we're using the example of depression but we can talk about other conditions as well medication typically plays a part in a person's recovery and there are a number of evidence based f d a approved treatments to help individuals with these conditions therapy and counseling has been shown to significantly improve people's recovery and people's outcome social support i can't emphasize this enough these are lonely conditions and having the care and the support of others whether it be family friends howland has a wonderful drop in center that community which is comprised of people who are in treatment for for these conditions is literally life saving for for people lifestyle choices self medicating with alcohol and drugs is is unfortunately common with some of these illnesses and and can in a large way get in the way of recovery from from some of these conditions spiritual support for people who have that as a part of their to segue to briefly give a commercial for the five k walk and run and two which i encourage you to sign up for if you haven't already i have  saturday exercise and physical activity i have yet and i've treated a lot of people i've yet to have somebody who i have been treating for depression come in and say you know what i've started walking twenty minutes a day and it's making me feel worse that has never happened i think that will never happen when people are moving they tend to feel better now that's a big ask for somebody who is is struggling and so i try to encourage without nagging improve sense of wellbeing improve sleep which we know is extremely important so there's huge benefits of exercise and it does not have to be the next slide and you don't have to be doing this activity which i can assure you i will never do you can do the next activity which is more i think realistic for most of us you know if you don't if you're not an ice hockey player and i'm certainly not you know a good walk build it into your day it does make a difference if you can do it with somebody else even better ok but but be moving this is just a brief slide and it's a little hard to see this is a swedish study looking at individuals treated with depression and can quote control group that that wasn't really doing much in the way of physical activity a treatment group that was adding physical activity to their treatment and the improvement over the course of twelve weeks for people that were getting up and moving and i believe it was three to four times a week for twenty to thirty minutes so if you know it wasn't hitting the gym for two hours a day the building walking and moving into your lifestyle along with the other things that we're talking about are certainly helpful and important in summary we need to work toward a more universal recognition that mental health is just part of health and and to drop the barriers that keep people from from getting care get rid of shame stigma that that are lessening thankfully but still exist to some degree and i suspect most or all of us would agree that a good and just society works toward making access to good care universal and i thank you for your attention right thank you yes my name is lee more to come the community is development program director for pathways a program of arbor circle i am not really used to presenting in front of a podium so i will try to stay by the microphone you know  out of our county and we have about almost five thousand youth who take the survey every other year and so really what i just wanted to show you really quickly is that this is happening in our community actually depression is getting worse and and making a plan about attempting suicide is also statistically getting worse in our community you know next and then this shows the breakdown between males and females and so you can see that in two thousand and fifteen at least our girls were struggling a lot more than our boys were this depression and suicide ideation does actually happen to be worse for our young ladies and younger than excited so i was asked to talk about signs and symptoms and kind of what to look for so we first we want to talk about what is typical development because the other thing that i talk about a lot is substance abuse and i talk about all of these signs and symptoms and they describe them and then i have parents look at me and go you just described every teenager ever right because  we're talking about extreme change is an attitude changes and sorry for the teenagers in the room it does sometimes describe you but some of that is normal so in adolescence we are having hormone changes we are increasing our height you might be increasing our weight that could be muscular we're becoming more focused on what we look like we have that we are developing some of our mental capacities in terms of our abstract thinking or using logic more or also developing our own beliefs parents in the room know your kids probably started saying well i don't agree with you and so we want to we want to say that that's normal and that should  happen and they should be questioning authority that they should ask us why we make the decisions that we make and we should tell we should say why we do and then we do have emotional changes that happen in adolescence  so in our emotions can be quick to change we might feel our emotions more intensely and adolescence really is that impulsive time that risk taking time and it should be and that is how that how we learn what's an appropriate risk and what's not an appropriate risk and then we have a lot more influence from our peers and from our social social circles and then also we start to explore what our sexual identity is and for most most us most of our adolescence we get through this with relatively little difficulty it feels like huge difficulty at the time but really in the as we've kind of look across the lifespan and how long our lives are most of the time we get through adolescence with really small challenges and so when we encounter difficulty is and we're able to look at them and address them and kind of move through them in healthy ways then that's when we get to our resiliency that's when we can thrive that's when we learn we grow we mature and that's when we really build our our country tents in different areas but then what happens if resiliency isn't there and that's where we really get to the mental health challenges so the depression anxiety and attention deficit hyperactivity disorder and post traumatic stress syndrome and so really what we say is to take all clues and warning signs seriously you know when parents look at me and say ok everything you just described described my teenager when i start talking about with the withdraw from families when they start talking about you know mood changes or i don't want to hang out with mom and dad as much anymore and parents are saying yeah ok that's my teen i say you know what look for clusters of these things and look for look for several of them together and look for play times when they change quite a bit because the it might not it might be a clue of one thing but it might be a clue of something else and it's our cue that we need to ask questions that we need to find out what's going on i don't have kids yet but every time i do one of these presentations and i talk i just fess up that i'm going to be the nosiest parent ever and i am going to probably search my kids rooms more times than they ever want so then we have some general signs and symptoms that there might be a had mental health concern so sudden withdraw from both family and friends or from activities you know we were just talking about depression and so that that almost that tired feeling that not wanting to do anything sometimes it's just the not wanting to get out of bed for multiple days and it might be a rapid decline in school performance maybe a lack of enthusiasm a lack of energy  talking about lethargy over reaction to criticism feelings of being unable to satisfy whatever their ideal might be indecision lack of concentration agitation changes in eating and sleeping man asleep important and most of us have these little devices that's actually sitting here in my backpack it right have these devices mine sits on my nightstand and it wakes me up sometimes and i youth i know that you have them near your bed and so when you're not getting enough sleep it really does impact our mental health and that you know in certain mental health concerns there might be an obsession with death giving away belongings overwhelming senses of guilt or shame substance use that is one of the things that i talk about quite a bit is i also work for the substance abuse prevention coalition and substance use really is a sign that something is going on with our kids and that we really need to a figure out what it is and address that and then the biggest thing is these extreme changes the all the sudden i was involved and now i'm totally not involved or i did love to do these family vacations and now i don't even want to go and it might just be our opportunity to ask some questions to build that relationship to really focus and or for use with your friends it's the time to ask the question it's the time to get the adults involved so that we can figure out what is going on so then that kind of looking at several different mental health disorders anxiety is the first one so i just did kind of a smattering of signs and symptoms so maybe a pounding heart rapid or shallow breathing dizziness racing and the thing that i notice with them is they have this internal story that they keep telling themselves over and over that isn't that isn't actually true they over and over tell themselves i'm not where the why would this person like me why would the situation work out at work and and it just repeats on the salute in their head and when they're really struggling with it they can't get that loop to turn off they know that the loop should turn off they can logically tell me that sad mood and again i am just like smatter in some of these in there's a lot more i'm sure that you can find them on the be nice website community mental health our website i haue and hospital the agencies here tonight have really good resources available if you need more information but so just the smattering for signs and symptoms for those with the pression an unusually sa mood that loss of enjoyment there you talked about lack of energy feeling worthless thinking about death lethargy difficulty concentrating and again we go back to sleeping sleeping habits and what the sleeping habits look like and changes in those sleeping habits and a youth main step spending time with friends or family there may be a decline in grades maybe through a failure to engage in a discussion they'd normally engage in  failure to engage when you ask the question what's going on they makes these snap at you and then again the alcohol or other drugs and you know sometimes things happen in our lives that cause situational depression there is a there is situational depression and then there's long term clinical depression but even situational depression is something that really really probably should be treated even share  and trauma really can create both personal trauma and community level trauma can really create some of these things so i'll just share something from my own life several years ago i had moved in with my grandmother to help take care of her and our eight weeks after i moved in the house caught on fire while we were in the house and burned down and quite honestly we lost most things and luckily for me i was already seeing a counsellor lucky for me i had a ton of support around me but even with that my counselor like really suggested that i start coming more often because she just wanted to make sure that everything was ok and i think that we should celebrate the we have counselors that do that and i think we as the support system for our community members should really celebrate that and say you know if you've had if you've had that car accident or you've had that trauma maybe you should talk to someone and there's a lot of people available and they know that every one of the organizations has people available to help as well and one of the things we really want to make sure we know is that depression is one of the warning signs depression is often the illness that leads to suicide ideation and that can lead to a suicide attempt and so honestly most of my presentation is about suicide  because that's that's one of the things that we really we really need to address in our community even one suicide happening in our community is too many and so  and suicide is really we see it most of us that are experiencing mental health a mental health challenge we really see suicide as a problem but for some an experience in this these is suicide is the as the solution they see a pain that they can't solve they are experiencing a hopelessness that they don't know how to pull themselves out of and so we need to restore their hope and so some of the strongest predictors for suicide  previous suicide attempts current talk especially talk of making a plan a strong preoccupation with death so one of the things that we have to bookmarks over there that are geared towards  teens and a couple of the things that we talk about on those bookmarks are what are the music your friends are listening to is it music that really glorifies death that might it may not be but it might be a sign and also what's going on on their social media accounts what are they posting about what pages are they following and depending on what that is it really could be a sign that we need to ask some questions and really dig deeper into what's going on but also again we talked about depression hopelessness withdrawal substance abuse also a recent attempt by a friend or family member remember that if suicide is seen as the potential solution we're seeing somebody else use that solution might make that seem like a better solution and so what we need to do is really say hey there are other solutions out there there is  there is a solution to this problem there is hope we can bring hope back so then there's also some verbal cues to look for especially around suicide so some direct to verbal cues are i've decided to kill myself i wish i were dead i'm going to commit suicide and going to end it all or saying if such and such as that happen i'm going to attempt suicide but then there's also the indirect verbal cues of the next one which might be just i'm tired of life i just can't go on or my family would be better off without me or i'd just walk out one of the things that being trained on this and talking about this is how many of us have ever joked about her mean ourselves like i was so frustrated or something and i just want to and then and with a joke about how mean ourselves and so that's something for me i've had to check in say that's not a joke that's not something we could about anymore that that has been taken out of my vocabulary but it might even be something as something like pretty soon you won't have to worry about me anymore and then a suicide there's some behavioral cues to look for so any previous suicide attempt acquiring the means to do it some co occurring depression moodiness or hopelessness putting personal affairs in order like seeming to tie up different cues and statistically most of us in here have probably had have probably dealt with this in some way from a friend or family member and so the thing to remember is we don't know what we don't know and so these are things we now know moving forward but we can't we can't go back and go if only i had known or if only i had done because if you haven't been trained in this before if you didn't know this stuff before you didn't know it before it's for it's starting now going forward because now you know what to look for it's why every one of the organizations here spends so much time training our community and trying to educate our community on this but then we are the one thing we haven't talked about yet are some situational accuse so maybe being fired or maybe being expelled from school maybe moving when they didn't want when someone didn't want to a lot of a major relationship the death of someone close to them a diagnosis especially in our elderly population a diagnosis of a terminal illness actually have a friend whose mother was diagnosed with pretty terminal cancer current life because of it a sudden unexpected loss of freedom anticipated loss of financial security and of fear of being a burden to others and so then we have some specific youth related ques which is a change in interaction with family and friends recent disappointment or rejection the sudden change in academic performance eating disturbances we keep coming back to those changes in sleep patterns chronic headaches stomach problems an increased apathy just the sense of i don't care anymore so then we kind of move into trauma and so these are and i'm not going to read this entire list it's a pretty long list so if you're interested in more there's recognise trama doubt or will help you find some more of these in but first symptoms of trauma and children ages six to twelve some of this excessive anger may very verbal abuse towards others school problems difficulty concentrating confusion irritability sleeplessness and definitely in children ages six to twelve of twelve if there's any substance use at all and then symptoms of trauma in children thirteen to eighteen so again unusually high level of anger aggression verbal abuse overly controlling panic attacks shame flashbacks hostility hoarding of food maybe starting fights maybe being very mistrustful maybe having stomach problems lots of headaches eating problems nightmares sleeplessness irritability and then because i just was covering all of all of the different mental health disorders we do have eating disorders and so eating disorders might be dieting behaviors evidence of deliberate binge eating or vomiting rigid patterns around food sensitivity to cold extreme body dissatisfaction so really having extreme dissatisfaction even though they shouldn't have you know they they are healthy whatever healthy  people who some very general basic dietary changes have changed their e t d or age before them oh i'm sorry this is actually the wrong the wrong side i apologize  it really is some of that inability to concentrate inability to focus inability to make a logical decisions very impulsive and then i really want to reiterate that it's ok to talk about our mental health we need to talk about this i don't think that we talk about it very often and we need to talk about it more i feel like i have a pretty skewed  because i spend my day in the nonprofit world especially the health and human service industry in an agency that does do clinical treatment and so i talk about it a lot but it amazes me when and so sometimes it amuses me when my friends or family don't talk about it as much and my openness to talk about it has increased their openness to talk about it and so we need to talk about it more because the more we talk about it the more our friends and family will feel like they can talk about it and that they feel like they'll feel like they can they feel like they can really share with the challenges that they're having and so we always have to ask the questions asking the questions are you ok are you feeling a sense of hopelessness are you think of thinking of hurting yourselves and really that bringing hope back into the equation and hopefully i believe christy i believe your next and hopefully have set you up really well to talk about now what do we do now that we've noticed some signs and symptoms well a pleasure to be here this evening and i want to thank a good friend of mine who is here he's been back and forth out of town but jeff our heart he is one of my best friends and we only got to know each other a year and a half ago and i feel that john has really helped after the loss of his brother's suicide he became quite involved in numerous ways and i think has definitely pushed all of west michigan to create a conversation and to change improve and save lives and so jeff became extremely passionate about the being nice initiative and he understands that it's bigger than what some people think that it's just a behavior change to be nice it actually is an action plan so what i'm going to do is introduce you to the action plan and i believe that the previous two speakers and then the fourth speaker you're going to get it when you leave you're going to say wow that makes a lot of sense to be nice by implementing the action plan of notice invite challenge and empower someone to try not to reiterate too much information but a lot of times a reiteration lasts and sticks in our memories  we've got a tremendously awesome website that we that we launched about two weeks ago and it is the tool so following tonight's presentation i hope you'll all go on and see if you want to take the pledge  so be nice was created by the mental health foundation in two thousand and ten and that was following the death by suicide of a young man from rutgers university and so it isn't that brand new but the action plan was created following the brand so jeff introduced me to this and he likes to think of being nice as the stop drop and roll of mental illness when i say the word stop drop and roll we relate that with a afire when i say the word depression what's a stop drop and roll well what we know it is is be nice it's an action plan there's a screen there too i don't know how the doctor was doing this i'm like god he has a really good memory anyway to be nice is a lifesaving tool that helps individuals understand that they can have an effect on how someone thinks acts and feels and if we go back to presenters that's what a mental health mental health is is how you think act and feel and want to becomes an illness that's changed so this is how we need to think about and room  even instructing in classrooms and teaching kids from five to eighteen years old talking about mental health should be just as easy as talking about physical health so when you put it into easy terms especially to a five six seven eight year old then they can understand that it's really super important for us to talk about feelings and actions and our thoughts so we know that mental illnesses are common and you are much more likely to come in contact with somebody who might have a mental health disorder than someone who needs c p r so that's why super important that we understand that we have the tools and with the right tools i can actually help someone mental health disorders very common and like our doctor said earlier is a one in four serious emotional disturbances affect one in ten so what we know is that mental health disorders like physical health disorders can come in different forms so there could be mild moderate and severe and the goal is we never want anyone to get to that most severe point where they're actually possibly thinking about taking their life or taking the life of someone else approximately eighty percent of kids never receive the help that they need a lot has to do is stigma a lot has to do with not recognizing and just like our speakers have been saying specially about the fact that sometimes you just blow things off of it as it being just normal teenage dorm all behavior typical behavior when in actuality if i'm going to be a detective can i see the difference suicide is the third leading cause of death amongst adolescence and it is the second leading cause of death among college students and why that is is the biggest stat to me is that understanding that half of all mental health disorders come on by the age of fourteen years old seventy five percent by the age of twenty four so we have a solid awesome part of someone's life to make a difference to get some help before they actually are thinking about taking the life and this is why mental health education and awareness is really really important to youth and this is why my passion is all about this action plan being introduced to kids as young as five years old up in a college and then let's let's hit all the silos so adults understand the importance of talking about mental health at an early age and understanding maybe what i'm struggling with now is a fifty year old maybe it was things that were there when i was a child depression nine or ten times someone who dies by suicide and i'm going to see if you're catching anything here i have not said the word committed suicide at all and that is because the language has even changed and the water the reason why is if you take the word committed and put it into a sentence it is somebody is they actually committing themselves to do something so committing a crime when someone dies by suicide it is because they are ending their life because they have something in their life that they think is not repairable there is no solution so remember that as we leave here today try to change your vocabulary to again why be nice why this tool professional help is not always in hand so maybe i can help someone go get help i love the last one and that's early diagnosis and treatment and this is exactly what the doctor this is so cool results in accelerated recovery to the organ that is being affected and that is your brain so what is the action plan so the first step is to notice the second is to invite the third is to challenge and the fourth is to empower so what is that i like the end because just like we've been talking about for the past hour this is one of the most important stops this is where i'm going to be the detective and when a detective goes out they have to keep repeating the step of looking for clues looking for clues with notice i'm going to keep repeating this i'm going to be paying attention to all of these circumstances just like that we've been going over for the last hour for me to recognize as somebody at risk is there a change in someone's behavior so the next flight is the first step is what is right and what is good and that's where that's just to be nice that is begin to notice what is good about a person what is right about a person because if i know those things then i actually can move to that third step and that is what is different so if i know what is good about my coworkers what is great what is right about them but all of them that come to work and all of a sudden i'm seeing something different in the way they're acting in their words with the way they're treating others same with kids what is right what is good and believe it or not this goes all in line with a huge movement in schools and that is to really concentrate on positives ok it's called positive behavior interventions and that is looking at the positive for kids can we help kids to be resilient by focusing on what is right what is good the mental health piece comes in when i'm looking at what is different so what is different what are the risk factors that somebody's going to be experience in their life and that's the whole host of things that lead got up and talked about what are the traumas that a child might be experiencing what are the stressors in an adult's life one of the stressors in a college child's life and then i'm not going to reiterate anything because we've got documentation on the tables to tell you more but i think lee's presentation and the doctor's presentation  over water the signs in the symptoms and that's what i'm going to be looking for and i'm to keep in mind what is right what is good what is different for the past two weeks or longer ok and those are the big clues so marked change in someone's behavior five remember we repeat that ok and then i'm going to move on to my state next slide which is to the next step which is to notice some of the warning signs of suicide all right because now i really want to be wanted to pay attention this with kids impulsivity plays a big part because we know for kids sometimes i'm embarrassed i'm humiliated what i did this stress or i'm getting suspended from school my girlfriend broke up with me i got this nasty taxed facebook those things seem like on repairable that there is no solution to that problem so we need to be looking for when someone is experiencing the inability to change a frustrating circumstance to find a solution to their problem and our next speaker in a moment in about twenty minutes think he's going to get up and talk about coping skills and this is where that important step is helping kids to find solutions not solving the problem and that's a lot of what we're doing right now in general as we're solving the problems for our kids and helping them to find solutions through coping skills what are some of the warning signs the suicide and i'm just going to highlight a few and that is definitely  seeking access to a means so that would be over fifty percent of deaths by suicide are done are completed with gone so we need to understand that somebody who has access to that then has access to a means to die by suicide other things if you look at these feelings of worthlessness hopelessness feeling trapped feeling guilty some of those are also signs of depression and that's why it's super important not to dismiss what we've been talking about because at one moment someone could be at the in the middle of the night trying to solve problems trying to figure it out and at that moment thinking the best solution would be to end my life so at all times we need to understand that depression ninety percent of the time none of the ten times the person who dies by suicide has that illness called depression so i want to remind everybody that notices noticing changes in behavior warning signs for suicide and understand the risk factors next step is to invite some with invite it is invite yourself to start the conversation invite yourself to reach out invite yourself to talk to the person so now i've noticed i want to keep repeating the plan i've noticed changes in a person's behavior i've noticed the risk factors i've noticed that the person might even be talking about feeling hopeless they may be in verbal verbalizing things like there's no point in me living anymore i'm not worth it i'm a pain to my family i bring everybody down i mean these also are warning signs so how do you start the conversation and i just love it you use the word i in front you never want to use the word we because that can put somebody on the defensive immediately to think everybody's talking about me so you want to claim it it's real social work in my husband eyes tells me this when i use the word i he says you're going all social working on me cut it out but it works so i have noticed i am concerned i have noticed i am concerned and you follow it up exactly what you have noticed not bad so i have noticed that you haven't been coming to our family gatherings i have noticed that you've been angry more often you can even started off with you know what you were always like have a smile on your face when you come to work but what i have noticed lately is you haven't you're always coming to work on time but what i've noticed lately is you're running late but that's the thing is you're putting it into terms that also give a person idea that you care when somebody notices something about me when they notice what is good what is right it's awesome but if somebody notices a change in my behavior it actually yells out to me that somebody is concerned about me they care about me invite yourself to listen nine judge mentally and not to want to jump into the conversation to again solve the problem for the person so again putting into practice starting the conversation is i am concerned i have noticed listening now i judge actually would be to be  patient silence is ok because a lot of times when ever we're talking to someone about something that i'm noticing even with my own kids they might not want to talk about it right then but it's important to start the conversation be consistent be aware of your body language this big this big one as a lay person when you are actually going to ask somebody this it makes a lot of sense to sit down it makes a lot of sense to even have that person sit down ok that even can be intimidating be understanding empathy is the key so no sympathy or i'm so sorry you're feeling this way wow that must be tough how you're feeling so empathy versus sympathy empathy versus sympathy be an active listener how do you know when somebody is listening how do you know when some is listening they're looking at you they're not on the phone ok that's huge they're not looking at their computer screen ok when people catch me to talk to me sometimes in my office about something really serious that i dast one ok i really want to turn and i want to get on the computer and catch up but that means maybe even moving to a different place how else their body language how they're looking at you their i contact they may even if you can tell when someone is listening they may even repeat back what i just heard so what you said was this ok that shows that you're listening be honest and the biggest thing is that it's ok to say i don't know but let's figure it out which will take you into the next two steps ok again we don't have the answers for everything and that's why today we're presenting to you this material and then on top of it all we've got great people here where there's tons of resources so it's ok so the see so we've got notice right what is right what it is good notice changes in a person's behavior i've got i invite myself to reach out invite myself to let that person know what i'm noticing and then what seat challenge so challenge yourself this is absolutely huge when it comes to implementing the c and this is challenging yourself to ask questions and that would be how long have you been feeling this way how just the simple ones of trying to find out what is going on and what's changed in your life you might even be able to say i've noticed since your husband passed away or i've noticed since your son moved to dallas this isn't your life that you seem sad every now and then so identifying again asking questions and then ultimately it's even challenging yourself to ask the question and that's exactly what we was talking about earlier is the biggest question is if you are very concerned and the person x is expressing feelings of worthlessness hopelessness even depression for two weeks or longer you are allowed to ask the question if they thinking about killing themselves in this challenge area when you bring these up you might even encounter stigma and that would be a person's reaction to even talking about thinking acting and feeling and that it might be the time where somebody might even be saying what do you think i am a nut job what do you think i am psycho what do you think i'm going to do go kill myself those are all stigma because that's a lot of the times what we believe what a mental health disorder because what we see in the media and what we see on t v ok you never see it hardly ever rarely ninety nine percent of the time t v shows in the media brings about stigmatizing results to put any type of mental  there the biggest stories of the night are usually senator around somebody who has a mental health disorder that either went on to kill themselves or killed somebody else committed a crime so we got to challenge the stigma asking the question again we've gone through the steps of i've noticed i'm concerned i need to ask you this question are you thinking about killing yourself that's a big question to ask somebody but believe it or not the myth is that if you ask a person that question you're putting the idea in the had actually you're not you're only bringing up the subject in order for that person to say yes or no if they say no it doesn't mean that you're not going to believe them but you know what you've done you've brought the question up and sometimes that is the most terrifying thing to ask a person the first time i asked someone it was on in a high school and this was ten years ago and we were watching a movie on mental health and it was a suicide prevention it's called signs of suicide acknowledge here tell and she got up and walked out of the room and many times will see this and then she remained she came back in to get her books and i asked her to stay this is the first time i met her i'd seen her couple weeks before that when she you know wore the black hood and you know typical somebody that would have been labeled somebody who has emotional problems and i asked her to stay after and i said are you ok and she said yeah i'm fine well why i said because while we were showing this movie surrounding signs of suicide you walked out so i need to ask you are you thinking about suicide and then she said no i would never do that to anybody my dad died by suicide all right so then that brought about a whole new conversation so when her dad died by suicide and that would have been in the ninety's she went to school the same day that her dad died by suicide they sent her to school and when she got home it was never brought up again and to the family and so for her she'd never even been in counseling so it was a pretty amazing fact that i asked her this question because it brought up a whole nother topic of conversation and we were able to access help for her she was a sophomore in high school and it was pretty amazing within those two years when she graduated we kept in touch you came and spoke at an event and it was more about the importance of why we need to do mental health education and high schools so it's it's scary but it's a really important question if the person says yes then you want to know do you have a plan it might be that they have they have a plan i'm going to take an overdose do you have the pills and then that goes a little bit further because you're asking them if they have that means ok so if someone side yeah i'm going to go jump off a bridge and you live in a city where there are no bridges ok there's still the risk factor that there's still that intention they're thinking they've got a plan but they're at that moment i got a little time i can get them to get some help because they don't have the means right there do not try to talk anyone out of it what we're trying to do is get that person help challenge the stigma again the fear of getting help this is going to be a point where possibly i'm in the position that i want to get the help at that point and they don't want to go get help super important that again you can go back to the first presentation which is really a comparison of this is a health issue going back to the basics ok this doesn't have to do just with your mental health this is a health problem what would you do if you had a broken leg i mean you can kind of explain things that way next stop i love it's one of my favorites because that ultimately is empowerment and i'm going to tell you if you go through the plan to notice to invite to challenge it's all leading up to showing that person that you care and you want to help them because empowerment is giving myself the power empowerment to help ultimately go getting that person giving them empowerment to go get help so what are we talking about giving someone help making someone stronger more confident ok by knowing my confidence and boy i recognise the signs for that person boy this friend of mine  my coworker or my mom my sister my aunt my uncle my grandma recognize this than me wow this is pretty powerful so what is it empower yourself to help empower the person to get professional help so at this point when you're at the point where you want him there they're in agreement yeah you know what i do need some help then you want to i want to concentrate on where do you start to go get help ok so navigation of getting help can be extremely complicated one first step is always health and that is for people who are uninsured medicaid and medicare you got it right so we've got sources we've got hospitals that specialize in behavioral health we have amazing agencies that provide counseling to families kids everyone and then in addition you've got your primary care physician so sometimes that's the way we have to route the system is to start with our primary care physician today i heard that you know even colling your insurance if you have private insurance kollin them first to find out what my coverage is but you never read you never stop to get someone help because we have resources like holland hospital community mental health and pathways the best thing that's available is a suicide prevention hotline and so before you leave today i hope you'll put in your phone the phone number which is one eight hundred two seven three eight two five five be bold and be brave enough to put it in as a suicide prevention hotline in your contacts because i'll tell you when you are doing notice invite challenge when you get to that challenge part and you're asking maybe the question you have maybe you've asked it maybe you haven't maybe it's the beginning the safest time is to say i want you to have this phone number i'm here for you but if i can't talk to you you have this phone number it's twenty four seven you've got to reiterate this one eight hundred two seven three two five five an amazing text hotline was created now because we know how people like to text and i don't want to tell somebody how i'm feeling and that seven four one seven four one in addition when we go out and do presentations a lot of times in companies will go in introduce them to their employee assistance program and that's a starting point to get help too and then in addition local therapists one of my favorite in holland also be besides pathways is t c m counseling so you've got a host of resources and i know that our table over here saying he's got a resource list yeah because i'm loud and i'm greek ok empower yourself to empower the person to identify protective factors so when you're in that challenge mode and you're going to do that wow i'm making a breakthrough here these are the great things this is the what is good what is right ok they might be accessing services or now decide you know what they're struggling again so my daughter is struggling and i want my i want to say to her you know what catarina you were feeling better when you were taking your mads were you feeling better and all of a sudden putting it back into their head you know what i do remember that time that i was taking my medicine and i was feeling better or maybe it's either maybe they were accessing services those are what is good what is right concentrate on letting them know what is good what is right and if they need to go back to that point to feed try to figure it out then you go back so gosh when you were hanging around with those friends that really make you feel good it seems like you were feeling good who are those friends again i'm empowering that person to identify crash those are the people that i should be hanging around with geez when you drink all the time you don't feel good physically or mentally she's you're right maybe i can start to exercise which i love the real point of making about exercise again trying for those folks to understand empowering them to realize what is good and what is right around them that is building resiliency again good things having self awareness keeping strong morals having positive role models in your life having faith a positive attitude when someone is struggling with a mental health disorder they tend to mean more negative for our family we like to call we like to point it at your  yours in the house you know we need to go here so anyway really focusing on trying to help them to understand to be positive maintaining good boundaries again that goes along with relationships who makes me feel good who doesn't help me geez whenever i'm not feeling well i tend to go back to that person in a relationship with that person that abuses me that doesn't make me feel good so again good boundaries conflict resolution skills and what i'm excited about is when  he's going to talk more about coping skills prevention strategies are awesome and that means for this weekend if you don't have anything going on we would love to see you all come out to the walk and we've got more details in the back you can still register today tomorrow i would like to see hundred fifty two hundred people three hundred people out walking around an illness walking surrounding a topic that is not talked about enough so  bring a friend bring two friends and then say you know what we need more presentations like this around our community so that is this weekend saturday jeff is going to be a speaker there i love it and i love this quote because tonight we went over only want one finds what one looks for one or looks for what one knows so i am leaving you this evening with a plan of notice invite challenge and empower thank  you now if you're following speakers don't mind we're going to take a few minutes to have a break in so you guys can get up and stretch and there are cookies muffins bagels and drinks all in the back if you are a city employee there is a sign up in the back for you guys to get your wellness points you have to sign that there's information about our race if you guys would like to donate there's a jar there and we will draw a name at the end and someone will win a phone  all right our next speaker sandy stass co will be speaking about coping skills is told i need to stay by the microphone and that's going to be challenging i'm a wanderer so if i start wandering someone needs to shoo me back to where i need to be and i also have to cheat because i can't really read my slides up there i'm getting way too old  so i have to use my laptop in order to see them so yeah we're going to go through some coping skills and again my name is sam just ask i'm with out of a kind of community mental health i work with a lot of kiddos and i work with a lot of agencies that work with a lot of kiddos and their families of course because kids come with other people that's kind of how it works so we work a lot within the families so what i'm going to go through today is coping skills and what it's really going to break down is to not only cope with the things that you're dealing with but also how to help others cope essentially it's self care how do you take care of yourself because we're really no good to anyone else if we can't keep ourselves standing up on two legs a lot of us know what it means to work yourself to the bone or to poor everything you have into raising your kids and forgetting that you have a life as well and how losing yourself that little bit can be  tough and then also you know all of these are not age discriminatory we can all do different coping skills and i'll take care of ourselves and whatever it means to take care of yourself so in going into coping skills one thing that all of us have really spoken about already is asking for help we have to not be ashamed we have to not be afraid and those are really big hurdles to get over and so many of us are talking about reducing or erasing the stigma and that's so true because to ask for help is really hard whether it's i need help at work i don't ask for help i'm too proud right i got this when i'm buried and i got a foot and a half of paperwork on my desk true story i have i asked for help no because i'll get there i'll figure it out someday so we're too proud we've got we've got i got this and it shows a sign of weakness if we ask for help when we're in reality it shows strength when you can ask for help and you can realize that maybe i don't got this completely i could use a little bit of help and you'll realize that there a lot of people that are willing if you're willing to ask for it so professional societal family whatever you need to do to get the help and ask for that help learn about what's happening what are you struggling with are you struggling with stuff at work while learn about what who would be able to help you if you're struggling with a mental illness it's empowering to know that what you're struggling with you aren't doing it alone there are at that i know of there is nothing in the d s m the diagnostic manual that has one person that's ever been diagnosed with this illness you're not alone if you're depressed there are other people that are depressed if you're anxious there are other people that are anxious and when you define it and identify it it really helps to just really reiterate that you're not alone there are others that are struggling too and it always feels a little bit better if you're not in this dark silo by yourself sleep sleeps really importantly mentioned that it's so important for all of us to get sleep and it's usually the thing that goes to the wayside either because we're anxious and stressed and we can't sleep because we can't shut our minds up or because we've got our phones next to our bed with things that light up when we get messages from people who are still awake at two o'clock in the morning or we take our jobs really seriously we want to make sure we're available for our  consumers and people who need us so that's always something that's necessary we want to simplify our lives sometimes and just break it down take it back to something when times are a little bit easier maybe we need to not to do with thousand things maybe we need to say no when someone asks us sometimes that's a great form of self care is when you can't handle it and you can't do it all is to say i really would love to help you but i can't i have to take care of myself right now and it was something that was really hard for me to learn because i'm a helper i will always try and help people and do things for people but to say no i really i can't do this right now i've got a friend who's dealing with her son who has a bunch of who has some really serious mental illnesses and when she calls me at seven o'clock at night and wants to unload on me i want to be that friend and i usually try to be but there are times when i know i'm not going to be a good person to talk to and i say that i'm not a good person for you to talk to right now i've heard it all day and i know yours different and i'm so sorry i can't be a friend that i need to be for you right now but we have to sometimes understand that we have our own things and sometimes we and sometimes helping helps helping others helps us feel better but sometimes we just can't and we have to be ok with that to exercise we're talking about that a little bit so we want to go and get out and get exercise and move because that helps our brain work things out more than we can ever really realize healthy eating and enjoying the food that we're eating eating healthy can help stimulate the right parts of our brain and body to work with itself and enjoying that food enjoying and not just eating for eating sake is always a re just kind of looking at kind of little tidbits of information self care is unselfish you can't help someone if you aren't able to help yourself and then going on to another idea would be just knowing that we have to love ourselves and everyone says that no one else can love you unless you love yourself and that's pretty true there are people that definitely can care for you and love you but it really helps if you can take care of yourself and then you can give yourself a warm hug every once in a while so exactly what is self care self care is kind of the obvious taking care of yourself because how you care for your for other how can you care for others if you can't care for yourself but what isn't obvious is ok i got how to take care of my kid make sure his home works on his lunch is ready know he goes to the doctor when he needs to i know how to do all this stuff when you can do that for myself so we forget how we actually can go there and help ourselves a little bit so self care there is mental there's body and then there spiritual so mental physical and emotional ways to take care of yourself  so this kind of just breaks it down and going into it so when we think about a mental how we take care of or don't wander anybody got any of those cement under my feet all right so mental there's a bunch of different ways to think about how to take care of your mind and how to take care of yourself mentally one of the things i've found some suggestions and there's a complement bar and every time someone gives you a complement jot it down and put it in a jar so when you're feeling empty and like you haven't heard anything good about yourself and don't feel good about yourself you can pull these out and hear things or read things that people have said about you that were nice about you have someone say hey thanks for your help that i could have done it without you wow that's a big compliment and one that we always just kind of push off yeah whatever no if someone says that there's a really good chance they meant it so take that and jot those little things down first of all by writing it down it commits to our brain and gives us some of format to reinforce that and then secondly we said we save it for later for that rainy day when we really need it work toward in the loose of goal that dratted junk drawer that just catches everything or that pile of all those things that you mean to read that you haven't read that just gets more things that you mean to read piled on top of it go through that get rid of the stuff that you don't think you're actually ever going to get to read a couple of things do something that's been something that you've meant to do that you can say i didn't think i'd finish that and give yourself a little bit of credit for doing just that be a little bit carefree lay down in the grass look up at the sky find a cat you know cloud watching these are things that as adults we don't do this anymore why not because we don't think we can use our imaginations anymore we don't think we get to be whimsical anymore but these are the things that connect us with the feel goods pay attention to something mundane this is getting so i'll get to that but mindfulness when you're brushing your teeth pay attention to how it feels before during after what is it like pay attention to the little things things you do every day automatically when you sipped the coffee what do you taste i drink cups and cups of coffee every day and i can tell you taste good or bad maybe on a given day but it's like air to me for the most part i can't really tell you which creamer i put in my coffee on most days because i don't take the time to taste it so figure out some just little things and pay attention to it it brings you back to the here and now and it makes you pay attention to how you're doing and how you're feeling when you get to that and we're talking about enjoying your food eat intentionally we all eat too fast i blame my high school we had seventeen minutes for lunch so that that's where i'm just blaming him there are other issues at stake i'm well aware but i'm blaming them i inhale my food  and favorite food pizza i can get through it after pizza and i can go like a taste any that's probably right if we eat intentionally we can enjoy these little things again and it becomes more enjoyable because wow if you actually take a bite and shoo it what do they say the hundred times you're supposed to you actually get to enjoy the different flavors that are in it instead of and it takes the fun out of eating and it makes us overeat because we eat too fast and then our bodies don't catch up and say hey you were full forty minutes ago oh so those are things to do so that brings us to the being mindful and doing things that we keep our keep us kind of focused on in mind we want to mute those negative people and by muting i mean if you need to mute them on facebook because that's what we're all realizing now is that i think the election kind of brought that to light pretty seriously for a lot of people but i found myself not unfriending because i don't ever really  in personal or on facebook but just meeting them if they're too negative and i can't see it i can't it doesn't make me either think about something it just makes me upset i can you can meet them mute them in life again if you know you can't handle that phone call right now give yourself the grace to say i'm going to give myself thirty minutes and then i'll call them back because i can't do it right now it's ok we're in a very immediate and immediate gratification society and we think that everything should be right there right now and everyone should be available to us right there right now reality is we can't be gracious to yourself and meet those negative people if you need to change something up it creates our brains and by nature we're usually very patterned people and patterns are usually really really good makes us comfortable but sometimes just taking that different route to work in the morning take the left earlier and go block off from where you usually do and then come back around at the same place if you do that you notice different things or just notice the drive into work jeff or get to work and realize you didn't really realize how you got there so i notice the cars around you what color other is the car that you're following could tell you what color the cars that i was following on the way in here no idea so notice things and again bringing yourself back around you're taking time and you're focusing your body and mind on what's going on now and that's really good for us to  kind of just bring it back to now because the for ever of future that we think of all the time is really tough and they face forever of a past that were always harboring over and wish we could change it's really hard to live there too so bringing it to the now is really  helpful create a deliberate habit i created a deliberate habit spent over a year now i set my alarm painfully twenty five minutes earlier in the morning and i get up and i take my vitamins and i feed my dogs after a lot of outside and then i go downstairs into my basement and i just pedal on my bike while i play like a mindless game on my phone just to wake my body and mind up a little bit and to give it a little bit of grace and time to get there so by getting a little bit of movement and waking myself up physically and i'm setting myself up for what my day's looking like and i let myself not think if i don't want to and just do something mindless on my phone instead of going through everything that's going to happen for the rest of that day because i can get in the shower and do that for a while that's kind of the other part that i do but do something make a deliberate habit that helps set up your day good or well we have seen a presenter who said get out of bed when you put your feet on the floor say it's going to be a great day and see what that does to your day so it doesn't take getting up twenty five minutes earlier you can do it in twenty five seconds it's going to be a great day and see how that changes your outlook and sort of it's monday again the feet on the ground it's monday again and it's going to be a great monday ok so the next one is body our physical body how do we take care of that mindfulness that's where again we bring our body and mind in the place do a body scan what is your body feeling we run through a day and we never technically stop and listen to our body to see what it's trying to tell us we hardly listen when it's when it's hungry we run through the day and eat when we have time or when it's scheduled but we don't listen to our bodies so take that time breathing it's amazing we have to do it it's pretty necessary one of the first things our bodies figure out how to do is breathe how often do you pay attention to everything if you're a runner sometimes you do that because it burns or you have to or my running is paced with my breathing if i have to run because i'm chased but but just paying attention to your breathing is always really good we'll go through a couple breathing exercises i think it will have a minute at the end south suit them we there's the let your baby cry it out type of a thing and there's moments where that's appropriate for sure  because we need to teach them how to see themselves at some point in time because mom's not always going to be there because their boo boo and make it better we want to be but we're not always there so self soothing whether it's rubbing your arms and just kind of gettin contact with your body doing the little hand massages they say that you can get rid of headaches if you massage right here there's your pressure points and really it's worked for me on many occasions where if you work that pressure point you can relieve headaches and strain in your head and neck different things like that the other thing is there's one just take your hand of one hand on your heart and one hand on your stomach you really can this is supposedly a very comforting feeling for us the other thing i want you to do so now you're doing this ok flip it which one is more comfortable first one ok who has the right hand on top who had their left hand on top right dan siegel is one of my favorite brilliant  minds but he did a he does the site almost all of his presentations and it's really good self soothing and if you put just light pressure there and just breathe a little bit it can be a really good quick self soothing thing for thirty seconds but one thing that he said is that most people are right hand on top and about twenty five percent are left on top and has nothing to do with what your dominant hand is so it's always something i kind of test for him and there you go laughing if i didn't laugh i had be really awful because that just helps me relieve a lot of stress what the old if i'm not if i can't laugh about it i'm going to cry more true more often than not a lot of different things a lot of us have pretty stressful lives so we got to find stuff to laugh at find what works for you i put my suggestions in there are things that help me just kind of go and just get happy calvin and hobbes and you'll see him in a second big bang theory is my idiot t v show watching just because it's just ridiculous and they're funny i think and those of us who remember  seinfeld were just talking about a little bit the other day and in a couple different places so i had to put it in there because if you've ever seen it you know there's some some stupid scene from it where they're you know being ridiculous had someone remind me of the elaine the other day i'm like oh my here's all right she has but no it's just that stuff so the next one is our spiritual emotional selves one of the things that we are talking about kind of helping yourself spiritually is imagine that you're your own best friend what would you say to yourself if you had to step back and you had to be your own best friend what would you say and you're working a little bit too much one of my friends just called me when i was here and i'm like presenting this thing you're busy up there is my friend talking to me yeah that's what we do and i have seen each other many days and it's not going to stop today and tomorrow again too so i mean and these are good these are good things but just be able to step back and ask yourself ok if i was my best friend looking at my life what would i say or in this challenge that i'm facing what would my best friend tell me and i need to be my own best friend which i listen to myself or find the beauty in things go on a beauty beauty or pretty things scavenger hunt or on your way to work challenge yourself to find four beautiful things it can be the glinting off of a car parked out that's for sale but it looks really pretty in the morning sun it can be the flowers it can be the tulips as you're driving through holland something find something beautiful they can be the mother walking with her kid on the side of the road and you just see that they're holding hands and that they're really you know it's that comfortable place that's cool so find some beautiful things on your way to work a car wash if you go to a car wash and you wash your car there are lots of writing bills on jeeps so they don't always get very clean if you drive them through a car  wash so if i got out of the car wash and i stepped back and i wanted to find the dirt on my jeep i could find a lot of it and i could be really angry because that dang car wash didn't get my jeep very clean or if i want to step back and look and go as a free car i like it it's johnny and i want to see with the shiny there's plenty of shiny out there too so it depends on what i'm looking for and what i'm going to find you see what you know you that what you're what you wrapped up with christie you'll find what you're looking for so sometimes we just need to change what we're looking for don't look for the dirt look for the shiny and so much better when the hand i was telling you to learn how to say no but also if you need to have a little give back feel free to give back volunteer donate some stuff that they don't really take much time say a prayer send off a well wish some some good karma to somebody whatever works for you that's some feel good stuff and the same the per thing doesn't take a lot of time it's good for us going to mediate take yourself somewhere nice get a pedicure get a manicure go to the driving range go do something that makes you feel good catch a movie by yourself allow yourself to eat the popcorn without having to share it mindfully enjoy the flavor free to good book i was walking through aman park last weekend and there were two girls one girl brought a hammock and strong it between two trees and was laying in her hammock in the park in the beautiful weather that we had sunday and reading the book another girl was sitting on a couple of stumps that are propped up together and reading her book and i'm like you guys are poor really yet why didn't i think of that  music but there's a lot of good happy uplifting music happy by for all am i wrong and i didn't i've always i've sang along with that song a million times by nico invincible top forty one out right now had no idea but it's really really uplifting and kind of cool wake me up by vici is another one for kids we've got lots of good songs that are really uplifting and you can look on pandora or spotify and say uplifting music and you kid a whole bunch of it go on youtube and find uplifting and it brings up a whole bunch from you can find it anywhere so listen to some good music that helps you feel good and my favorite is fuzzy therapy and this is where  calvin and hobbes come in this i have remembered the some most of my life i saw this for the first time maybe i was eight or ten and it's calvin had a bad days all grumbly and he's going  mean goes and he rubs his head in hobbes's belly and then walks away saying fuzzy therapy oh better i love my fuzzy therapy find your fuzzy therapy if you have pets use them because those are the one beings that regardless of what your day was like they are happy to see you test well ted or what you didn't do a lot of you kids can sometimes do that where a little more conditional now but do you find your fuzzy therapy find what it is for you and sometimes it's just something that feels good so how do you do all of the above there's several practices but the big ones are meditating yoga and mindfulness so how do you meditate i took a class in college i took a class that taught me how to meditate still can't do it very well  the point is you have to give yourself some grace on that too because you don't use your mind well if you need to meditate your mind is going to wander and if you're really good at it and have a good zen place already your mind isn't going to wander nearly as much but if you need to meditate your mind's going to wander so what you do is you notice your mind wandered what it was and then go back to concentrating on your breathing and that's what it's about is just kind of getting in touch with your body and concentrating on breathing feel your body feeling what your body is doing feel and what it's telling you and there's lots of youtube stuff that shows you how to do this more walk you through and do stuff it's incredible so the next one talking about yoga where do yoga where can you do yoga and where lead comes to my office once a week and helps if i don't overbook myself helps us yoga it's a really  also community centers gyms there's yoga studios on right across the street from every starbucks and it's easy you can have it really really easy or can be sweat inducing it can be hot yoga it can be restorative there's a little bit of everything out there i was not a yoga person for a really long time and i'm like i like muscle stuff i like cardio i need to breathe heavy and feel like i worked out and after a few different different yoga classes and trying to get out of bed the next morning a couple of times i went i think it worked out that works so it's different it's not cardio but it's still working out it's still exercise and you're still moving your body  mindfulness what's mindfulness i keep talking about it it's anything that you do and being aware of it it's moving through life mindful of what's happening around you and paying attention to what's happening around you so you can do anything walking so cool to walk mindfully to ever pay attention to how it feels in your feet when you take a step nope we don't do that we rarely pay attention to that stuff but if you walk and you feel how your body and what how your foot rocks in each step what toes touch the ground what toes don't what does it feel like in your calves what does it feel like in your knees to your knees hurt do they crack like mine do your ankles pop  and as you walk do you favor a foot a leg is your gait even paying attention to all of these things as you walk walk out of here tonight paying attention to a couple of steps just a couple even and you realize that i have really never paid attention to that unless you've had a pretty decent accident you might remember how that feels to really learn that stuff but that's a really good thing just all of the muscles that you're using what your arms do are you hunched are you standing up what are you doing you mindful of that stuff it's a really good way to pay attention to your surroundings and get a little exercise so be aware of emotions and how they impact your body when you're angry our bodies tense up when we're stressed our bodies stress and tense up i carry it right up here so any any of my close friends know that if they want me to do something all they have to do is massage my shoulders and i'm pretty yeah i'll do your laundry whatever and then again you to do mindfulness and you'll get a thousand different things it's everywhere so i've mentioned you to the honest guys are some my favorite meditations videos on you tube they have some great ones there's some guided relaxation some meditation jason stephens and i had some really good ones when i was looking the other day and then yoga with adrian was really good she had a lot of beginners and focused yoga for different things so if you're stuck at home and you want to do yoga and you don't have anywhere to go to do it there's a lot of ways you can do it on the internet beats buddhist meditation trainer there's a stop or even think that's my favorite what it does it has you log your emotions and have to log how you feel and then based on what you just logged it gives you some suggestions of five ten and thirty minute things that you can do to help feel better and it's really cool because a little track it for you and what you've got going on and daily basis so it kind of helps us be mindful on an ongoing basis and then there's another proper helps kind of go through and just regulate some breathing so what else are right this is where i turn it to you what do you guys do to feel good what helps you feel better yes honestly walking yeah super easy what else playing with kids gosh and if you actually play with that one how young does that make you feel how many of us say i don't want to be an adult anymore adult ing socks y'all so play allow yourself some time to play and they are great kids can help us refresh they can also drive us crazy but they can help us refresh to what else reading go off into a different land how much fun is that movies kind of can take you there too running reading a friend of mine said i almost sent you a picture there's this would thing the card out there is for a bottle of wine over here in your glass over here and for your phone right there so you can watch tough time like i never get out of the t so yeah i know it's really really get boxing i have a bag in my basement if i'm particularly stressed or nxne i think takes a beating and let me tell you i know exactly where the hard part is there's a big sand  go walk go run saturday pick yourself up and play do some goofy running while you're out there skip some of it do something fun you can help a cause and raise awareness and help yourself when we when awesome all right the final thing actually we're probably not going to have time to do too much so i'm just going to go through and do the my favorite  ming exercise because you can do it anywhere no one can even tell you're doing it it's called square breathing and i'll tell you the little thing you can even mess this up trust me because it's breathing in fo on a square and if you're in a stressful situation i was in an accident a while back totally fine but lost track of my vehicle shortly after the accident on some ice and went into a complete panic state and i went ok i know how to do this i can do square breathing and i call my heart and breathing down i got it so i was doing breathing and it was a triangle they were trying to was all over the place i was missing steps all over i wasn't holding and i was just i was failing horribly my step but then realizing that i was not doing it right helped me bring it back home down even more and bring it you know and just kind of focus on what i needed to to get back into so i could stop my heart from jumping out of my chest so what i need to do is just come to your breath out and we're going to breathe in for for one two three four and hold it there for two three four out slowly for four two three four out for four that's the one i missed three four in for four two three four hold it two three four out two three four and hold it and when you do that your body naturally combs because you're regulating something that you usually take for granted breathing and calming our breathing and taking deep breaths and filling our lungs and giving ourselves that life blood can really help us kind of reset where we're at and with that we're going to go into some community resources so how once you've taken care of yourself and provided these to other people we can get you hooked up with some professional services and anything else of the community can provide well we've been sitting through a little bit of a of an evening and this is the last part i'm going to go a little rogue on you i don't have any anything prepared there because what i'm talking about as far as community resources i want to you to have that information should you wish to be and so i do have handouts that have some of the different agencies and things that i'm going to mention if you feel free to take one if you wish or not if you if you don't need one there is also one in spanish so if you are you know somebody who might want to know community resources and have that available in the spanish language there's a list here too some of th so several of the speakers talked about prevention right what can you do to help yourself if you're stressed preventing you from from maybe things progressing into your stress progressing into a more serious kind of state where you might need professional help but if you are a loved one is at a point where you need professional help we want to just highlight some of the places that you can go do that but before i get to that and do something a little bit different i mean that calling this challenge by choice and that means i'm going to give you a little challenge but you don't have to do it it's your choice whether you do it or not all right you ready ok so who wants to do this with me we're going to do a super back on the shoulders carefully don't injure yourself and then go ahead and have a seat all right so a couple things i want to illustrate with that one is the idea of bail an presenters a touched on that all of these coping skills we talk about the mindfulness taking time for yourself why because we need balance don't we we get out of balance in life and we're so busy with this with it's family or this group or that group we're so busy with one thing we get out of whack or maybe it's the other you're not doing much of anything you're sitting home you need balance you need to get out and see people so balance have that be a key word another thing for those of you who didn't choose to do my challenge but who are willing to share what you think stopped you say i'm putting you on the spot anybody want to be brave and share where they didn't participate shyness ok thank you you overcame some of your shyness just yet but you're getting to what i was getting it was trying to get at and that is what other people think you know this i'm doing this weird thing who's kept their arms out here right some people felt comfortable some people didn't fe others might have felt shy and maybe some of that is you don't like being the center of attention you don't like people looking at you or that social stigma what would people think if i did that so what would people think if i actually went and got professional help you and then we tell ourselves that that's bad somehow that that sweet part of this is a cultural thing and part of it's generational there's there's a lots a layers to this but the main point of tonight hopefully is the more that we talk about it the easier it gets and the less stigma that there is and even if you feel shy about g yourself how you're worth it why wouldn't you but the thing is if you're depressed that depression feeds into thoughts of the self you know the  word the or you're a big drain on somebody else and that's where you can for yourself or your loved one you can challenge some of that and that's where by doing the be nice action all of those things the underlying communication message that you're telling that person is i care enough to say something's different maybe we need to get you help in even if you don't say those words your actions say that because you are worth it and your loved one is worth that as well so where can you go if even if it's tough and you feel shy or feel nervous where can you go to get help if you're not sure where to start one really good place to start is your p c p per a primary care provider so your family doc your internist for your child their pediatrician and often they will have people that they've worked with they are besser physicians psychiatrists that they will recommend that you  go and seek help there or here's another thing you can do if you have a loved one who's you're pretty sure is struggling emotionally and it's not just one to one or two days because something happened in there you know that's very common in typical something happens we're stressed out a few days we get back to balance right but if something happens we're stressed out and we don't get back to balance and those two weeks go by or more and it's like ok we need to and they are working with their loved one who's reluctant  quell you know your looks like things are out of whack you're really out of balance maybe we ought to go talk to you know dr sted about that or dr folds or so on so and often you can get your family member to agree to go see the p c p yeah i haven't really been feelin myself ok i guess i'll go or the other thing maybe you notice we are talking and dr doomer off and others presenters were talking about some of the mental illnesses there is often a physiological or physical component because of the changes going on in the body so for example anxiety it's very common to have stomach aches or headaches in fact that's a very that's a highlight that we see in children that often and children first get identified because they go the parent is seeing the physical headaches and stomach aches takes them to the pediatrician and the pediatrician maybe treats it even we see that they'll treat the stomach ache and they'll treat things for the physical basis and then it doesn't go away and then the p c p says oh maybe you need to go see you know the child psychiatrist or a therapist if they're sort of clued in that maybe there's it's mainly driven by an emotional component so use your p c p your family doctor your child's pediatrician the other thing if you have commercial insurance you can call the one eight hundred number on the back of that and they will tell you who the participating providers are meaning they will your benefits will cover treatment with that provider excuse me the hospital and hospital emergency room we have to still show workers they are staffed twenty four seven and so if you are loved one is in an urgent place or even in a place where they are expressing their time out suicide or their done self interests behavior s i be not all self interest behavior is an attempt at suicide that's things like when you hear about people cutting there's burning some different things that people can do but that's a very serious thing and to take that seriously or suicidal or homicidal you know i'm so mad i'm going to go off there hospital's emergency rooms are twenty four seven we have social workers will do a mental health evaluation and then depending on the outcome of that we'll wreck to make a treatment recommendation ok you need a high level of care which is perhaps an inpatient stay or no you don't quite need an inpatient stay but we need to get you in to see somebody a s a p and if you already have a provider or therapist in the community or psychiatrist that you already have a relationship with the work with you to get an appointment with them as soon as possible so they'll come up with some kind of treatment plan and go from there so that's for an urgent emergent situation there's also the national suicide hotline that christy talked about there's a local one throughout all county community mental health so and those are available as well so dry boring topic the basics are there i'm going to open it up now to questions we've been doing a lot of presenting you guys are real quiet i want to know what you want to hear about and i'll try to answer for you yes h a lot of people may go through one episode and either on their own it remits or they come out of it or with the help of medication therapy or both and that may be the only one they have their whole life although we do know that once you've had an episode of clinical depressive episode you're at risk to have it again another group is the group where they they have it we assist them with medication and therapy and things get much better or completely well they're completely fine sort of back to themselves and maybe a year goes by or two years but then something triggers and then they can have another one and then you're into management mode then you're probably going to need medical medication long term and support are a lot of what therapy is not all of it but a chunk of it is educating the person what is the disorder that you're struggling with just like you hear about diabetes education right and you may not cured diabetes but you manage it healthy lifestyle diet and in the cases of severe insulin well it's very similar with depression for example a healthy lifestyle helps medication can help if it's really to that degree that level of severity and and then you manage it and then you go sort of go in the sense back to where things were but you have to be conscientious about it because there may or may not it may or may not come back it's hard to predict and then there are those people that just sort of struggle with it on and off you know maybe long term and have to have a lot more involvement with medication management or perhaps even that they go on disability and have long term care that kind of thing  so it's difficult i mean again i like i like to make the physical illness comparisons because i help think that that helps to stigmatize as well but it's the same with cancer right you can be diagnosed with cancer you can be treated for it and that can be the only boat of cancer you have or it may come back in a month or seven years and you might get it in the same place or a different place or you might have cancer we do the best we can and it just has a course of its own so very similar for the mental health side of things yes well i don't think there's a universal answer to that someone going to vary depending on the clinic that you go to or the place that you're presenting and if you're most p c p s offices in the area that i'm aware of there's there's some screening tools out there that they do use and so they may there's one that's only two questions i can't remember what those questions are but something about the happiness for you know have you been feeling down in that can't remember with the second one as another one is about a nine question very short and depending on how you answer that your p c p will then talk with you further to explore do they think that you are depressed or anxious or whatever it is that comes out if you go into the emergency room for i'm sorry forgot what your example was a cut finger they're probably not going to do a screening or an assessment for depression no but most well visits like when you go to your doctor once a year there is some kind of screening tool that they sure sure i'm not sure i understand your question about adding and on though ok right ok you talk about in this in this suicide piece of things what i what i can share with you is i'm not currently doing therapy i did for a number of years now i'm more in management but i hear there are therapists at our facility that do work with teens who are experiencing you know gender identity issues are struggling with that and they typically come into us not because of that but because they're depressed and a lot of that is because they're struggling is society going to accept me what's going on with me this is only happening to me sometimes they've accepted it that you know that they're transgender or whatever but sometimes mother or a father has but the other parent has not and that causes a lot of family conflict and so then that itself is stressful and that weighs on the teen as well because then you get into those thoughts of look at me i'm i'm drowning the family because of this but yes certainly that that can contribute that's a great question right now we do we do a little bit of education of families for some of the people that we see with substance use and addictive disorders we don't have any for for general family members but i want to ask the other day agencies in the room if they want to speak to that as far as having family support  groups and that brings up a really good point because if you have a loved one who is suffering from mental illness just as if you had a loved one who's suffering from cancer that's that's a strain on you as well and knowing how to support your loved one while taking care of yourself there's a lot of things pulling at you different ways different needs are pulling at you you're not sure how to balance all of that out especially the question of how do i ca re for my loved one to the extent they need it but not not encourage dependence on you right we want people to be as independent as they are able to be but yet if figuring out what that is can be very tricky so how much am i doing too much for my loved one who's suffering with some condition and how much am i supporting them and helping them do as much as they can do that's a very tricky thing so that's just an example of some of the topics that probably are discussed at the family support groups i think there was a question back here yes  wow that's a very thoughtful question what are your ideas on that  well i guess one thing and not to sound like a broken record but first of all having talks like this an awareness events so that everybody here in our area gets the idea that it's ok to ask for help so partly partly we don't know why those statistics and statistics are the way they are we may say it's well there's something cultural well i don't know there may or may not be because there are people who identify for example as asian but they're generations have been here in america so they're really part of the western american culture so that's a tricky one and i really don't have a great answer for you  it does it may access is a tricky thing because sometimes we look at the whole insurance piece and can you pay and can you not pay but that's why it's great to have the variety of agencies that we do have in the area and not you know county communal health or any county community mental health are there to help people with seriously persistent mental illness as well as people who have difficulty affording care and then it's same with a lot of the nonprofits who are doing treatment they'll have sliding fee scale and things like that as far as them financial barrier to treatment right so stigma can be a barrier to treatment finances can be a barrier to treatment what else might be a barrier to treatment language i'm sorry transportation yup and for depending on your insurance some for some people who are on medicaid and can't afford transportation medicaid does make arrangements to  transport people to their visit so we're all trying to work together to break down some of these barriers right and i do appreciate you being here tonight i'm very open to taking any other questions at this point yes well it depends on the realistically not a whole lot farther ok hopefully by you paying attention and talking with them that's going to leverage them to hear your words and also the unspoken communication which is you are important i notice this about you and i really hope you go get help and we hopefully that invites them to do that at the same time we have to understand the limits of our control right we can't take that person by hand and say you're going to go to emergency room right now and talk to a social worker because they may look at you like you know what are you crazy kind of thing but if you're to if you're with somebody in there they're i mean they're talking suicide they have the means sort of like what christie said you know that's ok then you call nine one one you if you're at school and you're with a colleague and there's trusted adults around you go to that trusted adult the school counselor teacher that kind of thing so safety physical safety is one of the key things that if there's physical safety issues involved then you need to get an adult in maybe even the police involved right then in a very extreme situation i don't think that this happens a lot in the community but once in a while we have to do this you can call the police and ask them to do what's called a wellness or safety check on somebody so if you have very high reason to suspect to be concerned that somebody may be suicidal or homicidal then you can ask the police to check on them but i that's like i said that's very rare even for us and so it would be highly unlikely probably for people in the community right me just like you would expect yourself to know how to set somebody who's broken leg you know we don't expect you to know what to say to somebody in the in the height of despair and despondency other than we need to get you help in what can we do to help make things better and maybe that's going to the emergency room maybe that's going to their trusted adult whatever the situation yet great point one of the things when somebody is struggling emotionally you want to be heard you want to be validated you want to know that what you're feeling what is going on inside your body as far as your thoughts and feelings are true and valid and so when you say when you say to a person i know just how you feel even though your intent is to help them you think that's a good thing to say to them the underlying message to them as you don't you have anything special lady i felt the saying and that actually diminishes and makes them feel worse so you're absolutely right don't try to suppose that you've had their experience maybe you've had something similar say that you know be really hard to feel that way i think christie said something similar to that earlier you know that sounds sounds like you're in a really bad place you know what when you've been in a bad place before what's helped you something like that and don't necessarily bring yourself into it because they they can't hear it number one and even if you have a well intended they'll probably take it wrong ok yes ma'am yes and then actually just triggered that just triggered a memory there there was i don't know if it's still going but it through saint francis church there was a woman and her adult son had a support group for families  ladies remember that ringing any bells with anybody i wish i could remember the name of that apologize for for not having that but yes the family support is crucial for support for you to be able to help support him sure sure thank you for sharing well i want to be respectful of our time i think we're probably over time and i do want to thank everybody for coming out mckenna did you want to say any parting words are ok there you go and i'll hang around if anybody wants to talk with me individually thanks time i hope you all learned something and took something away from these different presentations again our race is saturday morning and mr al her will be speaking sign up and registration starts at eight thirty our race begins at nine thirty and i hope to see you all there thank you for coming