PREVIEW Online Youth Mental Health Champion workbook

This is an Instructor Member preview of the Online Youth Mental Health Champion delegate workbook.

Online Youth Mental Health

Champion Workbook

Contents

Introduction to the Online Youth Mental Champion course Course overview Live session topics Safety procedure The MHFA England Online Learning Hub Using this workbook Attending live sessions

3 3 4 5 5 5 6

Live session 1 Activity 1: The Mental Health Continuum Activity 2: Stigma and language Activity 3: Case study 1

7 8

10 12

Live session 2 Activity 4: Case study 2 Activity 5: Action plan Activity 6: Happiness Hour

13 14 15 16

Lesson plans: Workshop for pupils

On behalf of Mental Health First Aid England Community Interest Company (‘ MHFA England ’) (Company No. 7021392). With regards to this document (in its entirety, the ‘ Workbook ’), MHFA England grants a non-exclusive, revocable, non- transferable licence to MHFA England delegates to reproduce and utilise pages 17–38 inclusive of this workbook (the ‘ Lesson Plans ’) for the sole purpose of delivering mental health and wellbeing lessons to young people in the United Kingdom only. The Workbook and Lesson Plans may not otherwise be translated, reprinted, or reproduced, or utilised in any material form either in whole or in part or by any electronic, mechanical, or other means, now known or invented in the future, including photocopying and recording, or in any information storage and retrieval system, without prior permission in writing from MHFA England. This Workbook and all intellectual property rights to the same owned by MHFA England are protected under UK Copyright law and associated legislation.

Introduction to the Online Youth Mental Health Champion course

Course overview Welcome to the Online Youth Mental Health Champion course, which has been adapted from our Youth MHFA One Day classroom course. By taking this course, you are joining a community of over half a million people in England and over three million people worldwide who are trained in Mental Health First Aid skills and can help others find the support they need. It is this community who will achieve our vision of a society where mental health is accepted as a normal part of life and where everyone has the skills to look after their own and other people’s wellbeing. The Online Youth Mental Health Champion course is interactive and is delivered through slides, video clips, activities, discussions, and case studies, which you will explore through individual learning activities and live sessions. Individual learning will be based on a combination of films, reading, and activities. These can be done at your own pace in advance of and following each live session on the MHFA England Online Learning Hub.

The live sessions are led by one of our approved MHFA England Instructor Members. You will be joined by up to 15 other participants who will be completing the course with you. Check the timings of each live session in your booking confirmation and make a note, as these sessions will not be recorded or repeated. Everyone who completes the course gets a certificate from MHFA England to say they are an MHFA Champion. If you require any clarification or support at any point, get in touch with your MHFA Instructor via the Online Learning Hub or using the contact details you were provided on registration.

Live session topics

Live session 1 Why the Online Youth Mental Health Champion course? What is mental health? Stigma and discrimination Depression recap Suicide recap The Mental Health First Aid action plan

Live session 2 Anxiety recap Self-harm recap Eating disorders recap Psychosis recap

Recovery Resilience

Safety procedure Looking after yourself on the course It is important to recognise that this course covers material which you may find emotionally upsetting. Your self-care is important and your safety throughout is our priority. Don’t do or say anything that makes you feel uncomfortable. In the live session, if you feel that you need to step away at any point, please use the Q&A function to privately message the instructor so that they can provide you with support. The instructor will be in touch with you during a break or after the session. You can step out of the session in this way at any time. If you need to take more than a 10–15 minute break from the session, or you will not be rejoining the session, please let the instructor know. We would also like you to identify someone who could potentially support you during or after the course if you need it. If you are attending with people that you know, then you may want to buddy up with them. Please take some time to identify this The MHFA England Online Learning Hub The Online Learning Hub is where you will be able to: – Complete the individual learning activities – Chat with the other course participants – Join live events – Contact your course instructor You should have received an email from ‘MHFA England Online Learning Hub’ person before the course starts. My identified support person is:

inviting you to register for the Online Learning Hub. Once you have signed up and logged in, you will see that you have been assigned to the Online Youth Mental Health Champion course. The course will direct you through all the individual learning activities. Make sure to complete all the activities you need to in advance of each live session. Once the first live session has taken place, the next set of activities you need to complete will be made available. The activities include reading through pages of your Youth MHFA course manual, watching short films, and answering some reflective questions. Ensure you allow enough time to complete these activities between live sessions. We estimate that the individual learning activities for each session are as follows:

– Session 1: 1hr 30min – Session 2: 1hr 20min

If you require any clarification or support at any point, get in touch with your MHFA instructor. Using this workbook This workbook is for you to use during the live sessions, so make sure you have it with you. You will find activities and instructions and will be able to make notes that will help you to remember and reflect on your learning after the live session is over.

Attending live sessions The live sessions are focused on advancing your knowledge with the support of an MHFA England Instructor Member and are an opportunity to practise your Mental Health First Aid skills with other learners. The first session will introduce you to your instructor, other learners on the course, and some of the fundamental concepts that underpin Mental Health First Aid. It is also an opportunity to make sure that all your equipment is working and ask any questions about the course. Accessing the live sessions – You will need a computer with a webcam, a microphone, and a stable internet connection. – Log into the Online Learning Hub using your email address and your chosen password and log into the Online Youth Mental Health Champion course that you have been assigned to. The live session will open 15 minutes before the advertised course start time. When the live session is open, you will see a camera icon flashing on the menu in the top right-hand corner of your screen. – When you join the live session, you will be prompted to join with your camera and microphone. These are necessary for you to fully be able to participate in the live sessions. – If possible, you should exit other applications and windows on your computer before you enter the live session. Preparing for the live session – Ensure you have completed all the individual learning activities in advance of the live session, as the instructor will be using this time to build on this knowledge. Prepare any questions you have about the content in advance. If you haven’t completed some activities, it may be difficult to participate in the skills practice during the session.

– Bring this workbook with you, as there are some activities that will require you to read from or write in it during the session. – Find a quiet space – minimise background noise by turning off the television and radio, and consider using headphones for the course audio. – Try not to sit directly in front of or beside a bright light source so that you can be seen clearly. It will be important for the instructor to be able to see you during the course. – Try to place yourself away from any distractions and turn mobile phones off or put them on silent once you have successfully joined the online session. Live session group agreement – Mobiles off or on silent please – We keep to time – We respect each others’ views – Confidentiality ‒ personal details shared in this room remain in this room – Opt out/personal safety ‒ don’t do or say anything that makes you feel uncomfortable – No such thing as a silly question ‒ ask if you don’t understand – We all get involved, ‘share the air’ – Enjoy the course ‒ it’s serious subject matter but we can enjoy learning

Live session 1

Activity 1: The Mental Health Continuum Reflect on and clarify how mental health changes over time and in relation to different situations and life stages.

No diagnosis

Diagnosis

1. Read the case studies on the following page.

2. Decide where Sanjit, Emily, Jack, and Marisha fit on the continuum above and write each name in one of the four quadrants.

3. Each one has shifted from another quadrant in the last year or two. Draw an arrow to show which quadrant each person has moved from.

Activity 1: The Mental Health Continuum

Sanjit is in year 7 at school. He has settled well into senior school and, after feeling overwhelmed for the first two weeks, is now enjoying the independence of catching the bus to school. He works hard in his lessons but plays hard too. He enjoys sports, social evenings with his friends, and playing computer games. When he first started senior school, he neglected his homework, tended to eat too much junk food, drink too many energy drinks, and sleep too little. However, experience showed him that this made him less motivated and more anxious than usual, so he was helped to make some small changes to his diet and lifestyle so that it did not interfere too much with his schoolwork. Emily lives with her mum and has two younger siblings. When her first sibling arrived, Emily was very happy and enjoyed helping to care for her baby brother. When her second baby brother arrived less than a year later, Emily’s mum was diagnosed with postnatal depression. Recently Emily’s dad left, telling Emily that he didn’t want to live with them anymore and that Emily’s mum was impossible to live with. Emily was distraught and started self- harming. Her GP referred her to CAMHS, and she was diagnosed with depression. Emily is having trouble concentrating at school and often isolates herself from her friends and family. She feels helpless and is struggling to manage looking after her mum and all the responsibility of the home. Emily’s grandparents have tried to help, but she becomes tearful and moody because she thinks they are criticising her. Her self- esteem is very low, and she is afraid to go back to the doctors to tell them that the therapy she is having doesn’t seem to be working. Emily’s worst fear is that the social workers will take her and her siblings into care. Recently she has started to believe that everyone might be better off without her and imagining what it would be like to simply stop living.

Jack was diagnosed with an anxiety disorder two years ago. At first, he struggled with the diagnosis and felt angry with everyone. He would often stop taking his medication and going to his therapist because he felt weak and hated the thought that he might be like this for life. As he has come to terms with his diagnosis, experience has shown Jack that he can work effectively with his psychiatrist and therapist to manage his mental health and make the best use of support when he needs it. At the moment he is very well and enjoys the challenge of his schoolwork and being part of a local football team. He has created a Wellness Recovery Action Plan (WRAP®) so he can help himself and so that those close to him know what to do if he is unwell again. Jack’s family and friends love his quirky humour and his creativity. He has come to realise that his experience of an anxiety disorder makes him unique and gives him a view of the world that other people may not have. It has also given him a great deal of empathy with others who are struggling with difficult life events. Marisha has always thought of herself as an easy-going person who is easy to get along with. She has lots of friends at school and a good relationship with her teachers. She used to straighten her hair, but, a few months ago, began wearing her hair naturally to school. Since wearing her natural hair to school, several of her friends have asked her why her hair is so big and always frizzy. She feels self- conscious and wishes her friends wouldn’t talk about her. When Marisha told one of her teachers that her friends’ comments were making her feel bad, the teacher told her that they were just curious because Marisha ‘was so pretty before’. She says that if her hair is bothering her then perhaps Marisha should try and tie it back for school. Marisha is becoming increasingly unhappy at school. She feels like the way she looks is stopping her from fitting in and is anxious that there will be further comments. On Sunday evenings, she feels depressed at the thought of the week ahead.

Activity 2: Stigma and language The language we use when talking about mental health can contribute to a young person’s experience of stigma. The purpose of this activity is to discover acceptable language that can be used to discuss and describe mental ill health, and the negative phrases to avoid. Read the phrases below and put a tick next to the ones your group think are acceptable (neutral or positive) and a cross next to the ones your group think are unacceptable (judgemental or negative). Put a question mark next to any phrases you are unsure of to discuss as a whole group.

“A mental health problem” “Suffering from depression” “She is bipolar, so she is going to need time off school” “A person who self-harms” “They are a victim of trauma” “They are disturbed” “A current diagnosis of obsessive-compulsive disorder” “They are accessing support”

“Completed suicide” “Taking happy pills” “Their relative committed suicide” “Experiencing depression”

Use the space below to make some notes to feed back to the whole group.

Activity 3: Case study 1 Demonstrate methods used to talk to someone who may have suicidal thoughts. In your group, read the case study and consider the questions. You arrange to meet your year 11 pupil called Ella, whose mother has recently died after a short illness. You ask her how she is doing since her mother’s death. She tells you she is not doing so well; she keeps waking up early in the morning after a disturbed night and feels tired all the time. She has lost her appetite and doesn’t see the point in eating. She’s also started missing a lot of school and tells you that there’s no point carrying on with her GCSEs. She says that she would be better off dead as she has nothing to live for anymore. She had thought she might go to her GP, but she doesn’t think there is anything the GP will be able to do for her. As she is telling you this, she breaks down in tears and says she feels like she can’t go on living without her mum.

(A) Approach, assess, assist How do you approach Ella, and what do you need to assess for, and assist with? (L) Listen How can you show you are listening to and communicating with Ella non-judgementally?

(G) Give What support and information can you give?

(E) Encourage What professional help is available for Ella and how can you encourage her to access it? (E) Encourage What other supports could you encourage Ella to try so she can help herself?

Live session 2

Activity 4: Case study 2 In your group, read the case study and consider the questions. Lyron is a new 9-year-old child at your school. He displays a range of concerning behaviours where he is often panicky, breathless, tense, and fidgety. He lives with his parents and several siblings. Lyron’s parents told you that he has difficulty paying attention and concentrating. He is also reluctant to do his schoolwork and finds spelling and reading hard. His parents say that Lyron often seems detached and off in ‘his own little world’. He has an active imagination, which includes imaginary friends. Lyron’s parents expressed concerns about his self-esteem and feel he is very introverted. Lyron experienced difficulty adjusting to his class because he feels shy and nervous around other children. According to his parents, Lyron has always been shy and reluctant to participate with others. Lyron is so shy that he does not always answer when someone says ‘hi’ or he speaks so softly that he can’t be heard. He generally appears shy with everyone. In addition, he is reluctant to leave home to go to school or on outings and errands. He needs to be coaxed and cajoled to leave the house. Lyron’s parents also described Lyron as anxious and say he has difficulty sleeping. They reported that when Lyron is nervous he will get up and walk away or detach from the situation and withdraw into his own world.

(A) Approach, assess, assist How do you approach Lyron, and what do you need to assess for, and assist with? (L) Listen How can you show you are listening to and communicating with Lyron non-judgementally? (G) Give What support and information can you give? (E) Encourage What professional help is available for Lyron and how can you encourage him to access it? (E) Encourage What other supports could you encourage Lyron to try so he can help himself?

Activity 5: Action plan

Action steps/tasks What will be done?

Responsibility Who will do it?

Timeline When will it begin and when will it be completed?

Resources What additional resources do you need?

Partners (internal/external) Who will need to be involved to carry out this task/step?

Challenges What challenges or barriers do you anticipate?

Communication How will you communicate this task/step to your partners? Accomplishment What will this step/task accomplish?

Activity 6: Happiness Hour Aim – To encourage you to think about the practicalities of finding time and creating opportunities to enjoy yourself

Imagine you have one hour totally to yourself. What activity would you choose to do?

How often do you have a Happiness Hour?

What practical strategies can you think of to ensure you have regular time to yourself?

Lesson plans: Workshop for pupils

Contents

Lesson 1: What is mental health? Lesson 2: What is in your Stress Container? Lesson 3: Mental health myths Lesson 4: Listening and helpful talking Lesson 5: Finding mental health information and help Lesson 6: Steps to wellbeing

19 27 28 31 34 36

Ground rules example sheet – Be responsible for your own learning. – Respect others’ opinions, accept that views and experiences will differ. – Only one person speaking at a time. – You have the right to pass. Share only what you feel comfortable sharing with the group. This is not a competition – it’s OK to keep things to yourself. – Listen to who is speaking. – Talk about yourself and let other people talk for themselves. Observe confidentiality and don’t share anything you know about another person. – Be thoughtful, considerate and non-judgemental at all times. Additional rules may be added, or existing ones adapted to ensure the groups achieve ownership of the ground rules. It is advisable to revisit the ground rules at the start of every lesson to enable pupils to feel safe and therefore able to contribute to discussions and activities and gain more from the sessions.

Lesson 1: What is mental health?

Introduction The aim of the session is to establish understanding and build upon existing knowledge. It provides the pupils with an opportunity to ask questions, challenge stigma, and develop better coping strategies for their own mental and emotional wellbeing. “Children who are troubled cannot flourish” (Place2b, 2011) Pupils are encouraged to explore the subject of mental ill health. Resources – Flip chart and pens – Photocopied continuum pages and gingerbread case studies – Access to the internet Aims – To establish understanding of mental health – To discuss the impact of language on stigma and discrimination – To explore the Mental Health Continuum – To develop case studies to enable safe discussion around issues Method Starting the session: What is mental health? There are some suggested ground rules at the start of the section, however, teachers and support staff are advised to establish their own so that the class has ownership of them. The teacher then starts the session by asking the group to consider what mental health means to them and then facilitates some feedback. Pupils are encouraged to be open and honest about their views, although it might prove necessary for the teacher to refer back to the ground rules to

ensure everyone feels safe. It is highly likely that, within the classroom, either pupils themselves have experienced some difficulties or they may have family members with mental health issues. Care and consideration are key here. Option to show a film clip: Time to Change – The Stand Up Kid You can find this by searching Time to Change – The Stand Up Kid on YouTube. Make sure you turn on closed captions when showing the film. Pupils can then be asked for their views on the film. How did it make them feel? Were they surprised by any of the content and the reaction by other class members? Activity: Stigma and language The purpose of this activity is to discover acceptable language that can be used to discuss and describe mental ill health, and the negative phrases to avoid. Split pupils into groups and give them each a sheet of paper with the phrases from the next page on it. Ask pupils to read the phrases and put a tick next to the ones their group thinks are acceptable (neutral or positive) and a cross next to the ones their group thinks are unacceptable (judgemental or negative). Ask pupils to put a question mark next to any phrases they are unsure of to discuss as a whole group.

Lesson 1: What is mental health? cont.

“A mental health problem”

“Suffering from depression”

“She is bipolar, so she is going to need time off school”

“A person who self-harms”

“They are a victim of trauma”

“They are disturbed”

“A current diagnosis of obsessive-compulsive disorder”

“They are accessing support”

“Completed suicide”

“Taking happy pills”

“Their relative committed suicide”

“Experiencing depression”

Lesson 1: What is mental health? cont.

Discussion Ask pupils which phrases they were sure were acceptable/unacceptable, and discuss the issues related to language and impact. Ask which phrases they were unsure of and ask how the other groups dealt with those phrases. Ask how it felt to do the task – easy/hard? Do they think this language is always good or bad or can it change over time or in different situations? If necessary, comment on inappropriate/misleading/inaccurate contributions (e.g. ‘taking happy pills’ on the acceptable list).

Activity: Introducing the Mental Health Continuum Show the Mental Health Continuum and explain the four quadrants. The important issue to convey is that we all have mental health and it is not static, as we are affected by life events. There are no absolutes and a key message is that, while a person may have a diagnosis of a serious mental health condition, they can be coping very well with the right support from family and friends. Some individuals may need medication and interventions from health professionals, but others may not. The area is very complex, and every situation is slightly different. For many physical health conditions, diagnosis and treatment is very standardised and straightforward and this is simply not the case with mental health. The subsequent sessions will explore a little further what helps and what does not. Pupils may be asked to quietly reflect on where they fit on the continuum. Discussion may follow if the group safety has been established and people are comfortable to share information which might aid others’ understanding. It is worth highlighting here that for some this might be the first opportunity to talk about mental health and the teacher needs to be aware that issues may arise and that they may require some support. The timing of the session is to be considered prior to starting. It’s important to remind pupils that they should only share what they feel comfortable sharing with the group. The class is divided up into four groups and asked to develop some case studies. The young people created by them will fit into the four quadrants of the continuum. Pupils are provided with a sheet listing some factors to consider (for example, gender, age, ethnicity, hobbies, general health, self-image, relationships, and so on). They are then encouraged to give their young person a name and a real identity, including a drawing with a face.

Examples of acceptable phrases A person who self-harms

Examples of unacceptable phrases

They are disturbed

A current diagnosis of obsessive- compulsive disorder They are accessing support

Their relative committed suicide Taking happy pills

Experiencing depression

They are a victim of trauma

Try to bring the following points out of the discussion if possible: – Many people find it difficult to talk about mental health issues. – The context language is used in is important. – Language can make people feel accepted and supported, or judged and isolated. – People may choose to say nothing rather than risk saying something they are not sure about.

Lesson 1: What is mental health? cont.

When the groups have created their character, they then introduce them to the rest of the class. The teacher promotes discussion around what moves people from one quadrant to another, highlighting that for everyone mental and emotional wellbeing is not static but subject to move through various circumstances. The following definition is one of many: “Mental health influences how we think and feel about ourselves and others and how we interpret events.” “It affects our capacity to learn, to communicate and to form, sustain and end relationships. It also influences our ability to cope with change, transition and life events, having a baby, moving house, experiencing bereavement.” (Dr Lynn Friedli, 2004) Discussion There are some key messages that need highlighting for the group, including the following: – There are no absolutes when it comes to mental health.

– Everyone has mental and emotional health. – Recovery is not only possible; it is likely. – Just because a person has a mental health condition, this does not mean that they are unable to enjoy positive mental wellbeing. – People without a diagnosis may in fact have very poor mental health – they have perhaps not yet admitted to themselves or others that they have a problem. – Stigma, discrimination, and being judged prevent people from seeking the help they need with mental health issues. – Early intervention promotes quicker recovery. This session provides the group with a safe opportunity to discuss issues around mental health and mental illness, carefully guided by the teacher. Pupils are encouraged to explore what impacts upon individuals and explore how we are all different with levels of resilience and vulnerability.

No diagnosis

Diagnosis

Lesson 1: What is mental health? cont.

Create a young person. This might be somebody you know within your environment. Remember confidentiality – change them a little so they can’t be recognised!

S T I G M A 1

S T I G M A

A person with a diagnosis of a mental illness and who has poor mental health

When creating your character, consider the following: – Name, age, and ethnicity – Life situation, school/work/, family/home – Interests and hobbies – General health, disabilities – Identity, self-esteem, self-image, and social presentation

– Housing, employment, and financial situation – (Mental health) services working with the young person – are they getting any support? – Mental and emotional needs – Their friends and carers

– Family and social relationships – Self-help skills and independence

Lesson 1: What is mental health? cont.

Create a young person. This might be somebody you know within your environment. Remember confidentiality – change them a little so they can’t be recognised!

S T I G M A 1

S T I G M A

A person with no diagnosed mental illness or disorder but who has poor mental health

– Family and social relationships – Self-help skills and independence

Lesson 1: What is mental health? cont.

Create a young person. This might be somebody you know within your environment. Remember confidentiality – change them a little so they can’t be recognised!

S T I G M A 1

S T I G M A

A person with a diagnosis of a mental illness but who copes well and has positive mental health

– Family and social relationships – Self-help skills and independence

Lesson 1: What is mental health? cont.

Create a young person. This might be somebody you know within your environment. Remember confidentiality – change them a little so they can’t be recognised!

S T I G M A 1

S T I G M A

A person with no diagnosed mental illness or disorder and who has positive mental health

– Family and social relationships – Self-help skills and independence

Lesson 2: What is in your Stress Container?

Introduction The class are asked to discuss and consider what stress means to them. They are encouraged to think about whether all stress is bad for you. When the term ‘anxiety’ is used, it can have a negative effect upon people, although it is important to realise that some anxiety may be helpful and that it is completely normal, so talking about stress can be more accessible. The teacher introduces the idea of the Stress Container to the class. Essentially, stress flows into our containers and, unless we find ways of coping, the container overflows and we become unwell. Resources – Small plastic, glass, or metal containers – glasses, mugs, bowls – be creative! – Scrap paper – Post-its and flip chart paper – Pens Aims – To consider what stress is and how it affects individuals – To explore and list the protective factors that influence wellbeing – To understand more about resilience and what might promote it to reduce problems Method The idea is that pupils explore what increases their levels of stress. They are encouraged to write them down and place them in their containers. Pupils are reminded of the ground rules to ensure safety and advised that whatever they write on the paper that goes into the buckets will not be read by school staff.

Activity When the containers are full, pupils are asked how they felt completing the activity. They reflect on how cathartic it is to offload your worries and dispose of them. They are then provided with Post-its and asked to write down suggestions of coping strategies. This might mirror their own chosen preferences or ideas they would like to try or have heard about. Flip charts are pinned up around the class and pupils are encouraged to stick their positive coping strategies to the sheets to enable everyone to look at them and make other suggestions. The teacher might like to collate all the ideas and reproduce them for pupils to remind them of ways of coping. Discussion The teacher facilitates discussion around what are the stressful factors that influence young people to determine if there are common themes. (For example, exam stress is likely to come up – what else?) This also provides an opportunity to emphasise the importance of talking to someone if you are worried or feeling stressed and will be continued in the next session. It is also useful to point out that if pupils are concerned about a friend, then perhaps they could talk to someone about that too, as this may prove very helpful. Some people find it easy to talk about their problems, while others find it very difficult and can find having an advocate incredibly helpful. It also provides the opportunity for the teacher to highlight how early intervention helps and that people do not access support for a number of reasons. The class could be encouraged to explore these. The teacher notes some reasons for not getting help: – “I don’t think anything will help and I don’t know where to go.” – “I prefer to manage it myself.” – “I am worried what people will think.” (Child and Adolescent component of Mental Health and Wellbeing survey, 1998)

Lesson 3: Mental health myths

Introduction In this lesson, pupils are encouraged to explore stigma further and clarify understanding and extend knowledge by using a quiz. It helps to highlight that we all believe in some myths around mental health, and that this can get in the way of helping others when they are going through difficult times, or in asking for help ourselves. It also highlights that we will all inevitably talk to someone who will be going through difficulties with their mental health at some point, and so sets the base point for learning about listening and asking for help in the next lesson. Aims – To dispel myths associated with mental health using a quiz – To explore and understand the need for developing some tools to support mental health Resources – Quiz sheets, photocopied

Method The teacher gives pupils the quiz sheets and asks them to guess which of the questions are true, and which are false. They then give the correct answers and use this as the basis for discussion, questions, and reflections. The key message is not to get too hung up on specific numbers, but to highlight the broad messages that mental health issues are common, that stigma is not necessarily justified, and that recovery can and does happen. This can also be a great opportunity for pupils to reflect on what other myths around mental health they may believe and examine myths that stand in the way of treating someone experiencing poor mental health with compassion or looking for help themselves.

Lesson 3: Mental Health myths cont..

Quiz: True or False? 1. About 13% of young people aged 5–19 meet the clinical criteria for a mental health disorder. True or false?

True False

2. About 5% of young people with mental ill health wait more than 6 months to receive care from a specialist. True or false?

True False

3. People with mental health issues never recover. True or false?

True False

4. Exercise helps anxiety and depression. True or false?

True False

5. Black people are up to 3 times more likely than White British people to access mental health treatment for a first episode of psychosis through the police or criminal justice system.

True False

6. Mental health issues are less likely to affect young people who identify as LGBT+ than those who do not.

True False

Lesson 3: Mental Health myths cont..

Quiz answers 1. It’s true. The exact figure is 12.8%.

6. It’s false. LGBT+ people are more likely to experience mental health issues. Marcheselli F, Brodie E, Yeoh SN, Pearce N, McManus S, Sadler K, et al. Mental Health of Children and Young People in England, 2017: Behaviours, lifestyles and identities [Internet]. 2018 [cited 2019 Jan 7]. Available from: https:// digital.nhs.uk/data-and-information/publications/ statistical/mental-health-of-children-and-young- people-in-england/2017/2017 Butler C, Joiner R, Bradley R, Bowles M, Bowes A, Russell C, et al. Self-harm prevalence and ideation in a community sample of cis, trans and other youth. International Journal of Transgenderism [Internet]. 2019 [cited 2019 Jun 10]; Available from: https://www.tandfonline.com/doi/abs/10.108 0/15532739.2019.1614130 Calzo JP, Austin SB, Micali N. Sexual orientation disparities in eating disorder symptoms among adolescent boys and girls in the UK. European Child & Adolescent Psychiatry [Internet]. 2018 Nov 17 [cited 2019 Jun 11];27(11):1483–90. Available from: http://link.springer.com/10.1007/s00787- 018-1145-9 Connolly MD, Zervos MJ, Barone CJ, Johnson CC, Joseph CLM. The mental health of transgender youth: Advances in understanding. Journal of Adolescent Health [Internet]. 2016 Nov 1 [cited 2019 Jun 11];59(5):489–95. Available from: https://www.sciencedirect.com/science/article/pii/ S1054139X1630146X Lucassen MF, Stasiak K, Samra R, Frampton CM, Merry SN. Sexual minority youth and depressive symptoms or depressive disorder: A systematic review and meta-analysis of population-based studies. Australian & New Zealand Journal of Psychiatry [Internet]. 2017 Aug [cited 2020 Jan 15];51(8):774–87. Available from: http://journals. sagepub.com/doi/10.1177/0004867417713664

Sadler K, Vizard T, Ford T, Goodman A, Goodman R, Mcmanus S. Mental Health of Children and Young People in England, 2017: Trends and characteristics [Internet]. 2018 [cited 2019 Jan 7]. Available from: https://digital.nhs.uk/data-and-information/ publications/statistical/mental-health-of-children- and-young-people-in-england/2017/2017 2. It’s false. 20% of young people wait more than 6 months. Mandalia D, Ford T, Hill S, Sadler K, Vizard T, Goodman A, et al. Mental Health of Children and Young People in England, 2017: Professional services, informal support, and education [Internet]. 2018 [cited 2019 Jan 7]. Available from: https:// digital.nhs.uk/data-and-information/publications/ statistical/mental-health-of-children-and-young- people-in-england/2017/2017 3. It’s false. There is consistent and compelling evidence that people can and do recover from even the most serious mental health issues. 4. It’s true. Especially where anxiety or depression is mild or moderate, (structured) exercises is even recommended as part of NICE guidelines in England. It may not be as appropriate in severe anxiety or depression, and additional treatments are required alongside it. 5. It’s true. In the report ‘Breaking the Circles of Fear’, Dr Frank Keating found that Black service users, families, and carers reported that they are not treated with dignity and respect, that their basic needs are not met, and that they fear the consequences of engagement with mental health services. This fear makes Black people less likely to seek support early on. Bhui K, Ullrich S, Kallis C, Coid JW. Criminal justice pathways to psychiatric care for psychosis. British Journal of Psychiatry [Internet]. 2015 Dec 1 [cited 2020 Aug 6];207(6):523–9. Available from: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC4664857/

Lesson 4: Listening and helpful talking

Introduction This session highlights the importance of listening to a person who needs support and introduces some skills on how to listen more effectively. It also emphasises the importance of asking for help and gets pupils to reflect on the social support networks they can turn to. The helpful listening and talking principles are especially useful when having conversations about mental health, but they are really useful life skills we can all apply most days. Aims – To practise listening and reflect on its effectiveness – To encourage pupils to talk about difficult issues and ask for support Resources – Room for pupils to move around – Listening activity page (statements are photocopied, cut into strips and laminated) – Listening and helpful talking activity sheet, with pens

Method The session will be run in two parts. Firstly pupils will be asked to consider how they might identify that someone is having difficulties from an emotional and mental health perspective. Pupils are asked to list signs and symptoms. They are then asked to further consider that there might not be any visible signs or symptoms, as people with mental health difficulties become very good at hiding them. This might be because they feel they may be judged and/ or criticised. The teacher then explains that, however we become aware of someone experiencing poor mental health, having a good conversation with them can be an important step in them looking for help. Learning to listen well can really help with this. On the other hand, if we noticed some signs in ourselves, it is really important we also learn to ask for help and support from others, so we will look at this, too. The teacher then runs through the good listening activity and the listening and helpful talking exercises. Explain to pupils that while listening to someone, sometimes they might tell you about really difficult thoughts they are having, including thoughts of suicide. Explain that if this happens it is important to seek help from an adult immediately. Pupils should not feel that they have to support another pupil if they don’t feel able to do so. Highlight that it is OK to say, “I want to help you, but I don’t know how, so I’m going to ask someone who can.” The helpful talking skills can also make it easier to ask for help.

Lesson 4: Listening and helpful talking cont.

Activity: Good listening Pupils are divided into groups of three and given a role of ‘talker’, ‘listener’, or ‘observer’. They are then asked to practise each of the roles. In order to prevent people becoming upset, they are asked to keep conversations fairly light and not talk specifically about mental health issues or anything upsetting. Pupils are then asked to arrange the listening statements in order of which they think are the most important and reflect on how it feels to be really listened to or not. – You stop what you are doing and look at me – You repeat what I have said to check your understanding – You don’t interrupt me while I am speaking – You don’t try to solve my problems or tell me not to worry – You sit quietly with me – You ask me how you can help – You nod and make ‘mmm’ sounds to show

you are listening – You encourage me to continue talking by smiling at me – You ask questions to help me continue speaking Pupils are given tips on good listening in terms of asking ‘open’ questions (those which require an answer other than yes or no). For example, ‘what’, ‘where’, ‘when’, ‘who’, ‘how’ and ‘why’ questions. Activity: Listening and helpful talking This is a reflective activity providing pupils with an opportunity to consider when they have felt validated and really listened to and also when they have not. They are further encouraged to identify who they talk to when they have concerns or worries. This will enable them to realise that there is no one fixed answer to problems and also that talking to a person you feel you can trust and feel safe with is as important as formal counselling.

A time I felt I was really listened to was:

A time when I felt I was not listened to was:

Lesson 4: Listening and helpful talking cont.

Activity: Helpful talking This is a reflective activity giving pupils an opportunity to reflect on their social networks and who they can turn to for support. When thinking about who they would talk to, they may want to consider who made them feel really listened to in the past and who didn’t in order to identify helpful people. Explain that asking for help is an important skill for all of us to learn

and that it is OK if we don’t quite know what help we are asking for. The important thing is to make the step, and to ask again if necessary and keep trying, even if we have to ask more than one person. Thinking through all the people we could approach in advance really helps with that.

Who would you talk to first?

Next?

After that?

Last?

Lesson 5: Finding mental health information and help

Introduction The teacher reminds pupils about the barriers to people seeking help in a timely fashion and the importance of early intervention. Pupils are encouraged to discuss this further before commencing the activity. Starting the session Ground rules are to be revisited and pupils reminded to adopt a sensitive approach to the session. If possible, the teacher provides some health leaflets for the pupils to explore. If this is not possible, the pupils can access them via the internet.

Suggested websites www.youngminds.org.uk www.time-to-change.org.uk www.mentalhealth.org.uk www.mhfaengland.org www.theplace2be.org.uk www.nice.org.uk www.nhs.uk www.samaritans.org www.rethink.org www.papyrus-uk.org www.actionforhappiness.org Discussion

When the pupils have completed the activity page, they are asked to provide feedback to the rest of the class regarding their findings and opinions. The teacher uses this opportunity to facilitate a lively and interactive discussion which will aim to explore the way in which people find out information about mental health. It is also important to highlight the stigma and discrimination which may be apparent on some of the websites the pupils may have found. If time allows, the pupils are asked how a more positive angle could be achieved with the sites they have found. They could go on to explore how young people might be helped to determine which sites are helpful and which are very misleading. Also, they could consider how positive messages about organisations that promote positive mental health as well as providing help and support could be publicised.

Resources – Access to the internet – Worksheets with questions Aims

– To find out what help and support is available for people with mental health issues – To determine what services are available for young people who might be struggling Method Pupils will be logged on to the internet and provided with the worksheet which contains a series of questions, along with some helpful websites to explore. They are further asked to find out about local services. Activity: Mental health and what help is available Pupils are asked to share: – What they know about in terms of accessing support (a list may be drawn up in groups and shared at the end) – What they need to find out more about

Lesson 5: Finding mental health information and help cont.

Where did you start your search?

How accessible was the information?

Is the information accurate?

How do you know what is reliable and what is not?

How can you determine this?

Is there evidence of stigma and discrimination?

Lesson 6: Steps to wellbeing

Starting the session Ground rules should be emphasised as with all previous sessions. This session highlights the importance of self-care and all the steps we can take ourselves to improve our own wellbeing. Explain that sometimes this can be preventive – if we are well and we practise these activities we can protect our mental health – but it can also be an important part of recovery, even if we are getting other interventions or support for our mental health. Introduction The aim of this session is to highlight what pupils need in order to be content and to have positive mental health. There is evidence to suggest that our society has become very materialistic and that many people think that in order to thrive, we need all sorts of goods. However, research by the New Economics Foundation (2008) revealed quite the opposite and challenges this viewpoint in its 5 Ways to Wellbeing. This idea has been further developed by Action for Happiness in the 10 Keys to Happier Living, which propose practical ways in which we can all promote our own wellbeing. Pupils will be encouraged to consider them, their importance, and how they achieve them each day. The aim of this final session is also to enable pupils to feel they can cope, after reflecting on the subject of mental health and the difficult emotions this can sometimes evoke. Resources – Access to the internet: www. actionforhappiness.org/10-keys-to- happier-living – 5 Ways to Wellbeing activity page – Blank pages to research the 10 Keys to Happier Living

Aims – To encourage pupils to consider what we need to stay mentally and emotionally well – To challenge some of the stereotypical views from the media that we need materialistic goods – To think about applying wellbeing strategies Method The teacher encourages the class to think about and discuss what they need to stay well mentally and emotionally. Pupils are asked to write down some ideas and share with the rest of the class. The teacher facilitates feedback and then introduces the 5 Ways to Wellbeing and the 10 Keys to Happier Living. Pupils are provided with the 5 Ways to Wellbeing activity page and given the link to the Action for Happiness website. Pupils are asked to research the 10 Keys to Happier Living, and then reflect on how they would achieve them and the 5 Ways to Wellbeing as individuals. This will in turn highlight that each step can mean different things to different people. For example, we all have preferences for how to be active and exercise. There is no right or wrong way to care for our mental wellbeing.

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