Mental Health Helper Training

Note: These consolidated notes are nearly identical to the slides presented during the
training. Some interactive content were removed since it is not necessary in processing
notes.

What is Mental Health?

- A state of well-being in which an individual realizes his/her own abilities, can
cope with the normal stressors of life, can work productively and fruitfully and
is able to make a contribution to his or her own community.
- Not everybody who have poor mental health are mentally ill.
- Mental health is not the absence of mental illness, it is the presence of
flourishing.

What is Mental Illness?

- Mental illness is diagnoseable which affects a person’s thinking, emotional
and behavior while disrupting the person’s ability to perform day-to-day
activates.

What are their differences?

Mental Health Mental Illness
Everybody has mental health Not everybody has a mental illness
Part of everyday human functioning Diagnosable Condition
Can fluctuate at any time of the day Causes a person significant distress in
his/her daily functioning
Can be handled without help of a Ideal to see a professional to provide
professional support and understanding of the
condition.

What is a mental health problem?

- A more general term which includes signs and symptoms of certain mental
illnesses, but not severe enough to make a diagnosis
- This may include a mental-related related crisis or problems.
- Example: Extreme sadness due to a loss of job
o The sadness is extreme, but this does not automatically mean
depression. Although symptom of sadness is evident, it is not enough
for a diagnosis of depression as per the DSM-V
For this training, we will look at mental health and mental health problems as part of a
continuum.

Mental Health Skills Approach

There are many ways to help a person with a mental health condition which include the
ff:
- Medication
- Psychotherapy (Long-term counseling)
- Counseling
- Spirituality
- Rehabilitation

But, for this training, we will focus on EARLY INTERVENTION.

Prevention - Targeted at everyone in the community for programs to keep them where
they are. These include talks on mental health, parenting talks, drug education,
resilience training program, promotion of physical exercise, awareness of mental health
inside the workplace, stress management. This is most likely YOU right now.

Treatment – Already diagnosed and starting to recover.

• Medical treatment
• Psychological treatment
• Lifestyle changes
• Support groups
• Rehabilitation Programs
• Family and friends
• Intervention programs

Early Intervention - Target people who have mental health problems, starting to
develop mental health problems or re-occurring mental health problems. The goal is to
stop this mental health problem from becoming more serious and reduce its adverse
effects such as loss of job, school dropout, relationship break-ups or drug related
problems.

It is important that people in this stage are supported by family, friends, colleagues and
employers.
When do we use it?
- Help offered to a person developing a mental health problem, experiencing a
worsening or an existing mental health problem or is currently in a mental
health crisis
- This help is given until appropriate help is received or until crisis is over.

Who is this for?

• Anyone who is in close contact with the person’s environment
• Someone who is in human services
• Someone who can observe the behavior of others
• Does not have to be a professional to give this kind of help (medical profession,
psychologists, nurses, social workers or counselors).

What this is?

• Allows you to recognize signs and symptoms exhibited by individuals.
• Allows you to provide initial help and help them navigate the crisis
• Helps you create an environment in deescalating the situation
• Allows you to help this individual until it can be referred to a professional.

What this is NOT!

• This training does not give you the license to diagnose.
• Does not give you permission to do therapy.
• Does not give you permission to take the role of the professional.

Why do we need it?

• Mental health problems are common
• Most mental health concerns can be prevented
• Most people who have mental health concerns do not seek support or delay it
• There is a stigma and discrimination surrounding it
• Individuals going through a mental health concern may not always be “thinking
straight”
• Professional help is not always available immediately.
• First aid is effective

When do we consider a behavior abnormal? 4Ds

- Deviant
- Dysfunctional
- Danger
- Distress

The General Mental Skill Action Plan

A- Approach the person, assess, and assist with any crisis

L- Listen and communicate nonjudgmentally
G- Giving support and information
E- Encourage the person to seek professional help
 E- Encourage other Supports

Step 1: Approach the person, assess, and assist with any crisis
• Approach the person with your concern about them.
• Approach them with a compassionate and coming from a concerned point of
view
• Find a suitable time and space where both people feel comfortable talking
• If the person does not initiate the conversation, ask how they are feeling
• Respect the person’s privacy and confidentiality
• Establish rapport with the person
• Some possible lines to say:
• “Hi, I noticed you’re not usual smiling self today. Is everything alright?”
• “Friend, you did not eat lunch. Okay ka lang?”
• “Sis, medyo tahimik ka ata ngayon at nakita ko kanina medyo may
tumulong luha. Alam ko di tayo close, pero kailangan mo ng kausap”?

Step 2: Listen and communicate nonjudgmentally

• Set aside personal judgment, values or beliefs when talking with to the person
• “lend an ear”
• Do not interrupt
• Do not make it all about you
• Limit your talking time as much as possible.
• Practice active listening skills
• Summarizing
• I hope you don’t mind. I just want to check if I got things right. What
I am hearing is that you are saying that you are feeling sad
because you feel that everything you do is not making you feel you
are a valuable employee in our company. Did I get that right?

• Paraphrasing
• Workmate: I know it doesn’t help my depression, but I just want to
keep looking at his pictures to know how he is doing with his life.
• You: It sounds like you know that looking at his pictures makes you
sad.

• Encouragers
• Nodding of the head
• Saying prompts such as “go on”
• Smiling
• Some possible lines to say:
• “I hear that you are having difficult time at home because of your situation with
your in-laws”.
• “Uh-huh, go on”
• “nod head”
• So, let met this correct, you are saying that you feel anxious whenever a deadline
approaches?
Step 3: Give Support and Information
• Provide various kinds of support (emotional, social, interpersonal etc.)
• Information about what they are feeling
• Example: Anxiety is a normal feeling (everyone feels it)
• Psychoeducation
• Statistics on their mental health condition
• Some possible lines to say:
• Did you know that depression is the 3rd most common form of disability in
the Philippines?
• Are you open to some suggestions from me?
• Would it be okay if I said something?
• What you are feeling is normal after a loss

Step 4: Encourage the person to seek appropriate help

• Tell this person his/her available options for professional help within the area
• Try to encourage them to go to therapy or any assistance in any form.
• If they are already taking medicine and stop, ask why they stopped and
encourage them to continue or go back to their doctor.
• Some possible lines to say:
• “I know this great clinic in our city who specializes with these problems.
Are you open to going there”?
• I am seeing a therapist right now because I too am feeling a bit down. She
helps me a lot. Would you want me to set up an appointment if you’re
willing? I can go with you if you want”
• “Did you know that the medicine you’re taking has that side effect. Maybe
you can go back to your therapist to ask again of other alternatives.”

Step 5: Encourage Other Supports

• Offer other self-help strategies
• Applications of journaling, self-help, breathing, mindfulness
• Provide numbers for mental health services
• Options for support groups
• Offer alternatives such as leisure activities or personal growth activities
• Be aware of their culture and sexuality
• Some possible lines to say:
• Did you know that taking a 15-minute walk everyday helps increase
mood?
• I know of this cool app on my phone about mindfulness. I use it before I
sleep. Would you like to try it too?
• I read that having a gratitude journal and writing 3 things you are thankful
for each and everyday helps. I do that right now.

Understanding Depression: Common Signs and Symptops

Thinking Feeling Behavior Physical

Self-blame Sadness Withdrawn Fatigued

Self-criticism Guilt Crying Decreased Energy

Worry Anxiety Loss on interest Loss of Appetite

Pessimism Mood Swings Loss of motivation Headaches

Suicidal Helpless Self-harm Weight Loss

Ideation

Indecisivenes Hopeless Substance Use Loss of Sexual Desire

s

  Irritability Sleeping Change  

What you might hear from them?

• “Life is too hard”
• “Life has no point”
• “I’m no good”
• “Everything I do is wrong”
• “I can’t seem to do anything right”
• “My problems are too difficult to solve”

Causes of depression:

• Genetics
• Environmental Factors
• Biochemical Factors
• Illness
• Personality Style
• Lifestyle
• Ageing
 • Long-term pressure (bullying, poor workplace environment)
• Stressful or traumatic events
• Pregnancy (postnatal)

Action Plan for Depression

Note: Please follow earlier general guidelines. Added some important parts for
depression specifically in this section

Step 1: Approach the person, assess and assist with any crisis.
- Ask how are you or mention what you noticed
- Do not mention all the signs and to not to nosy
- Come from a place of concern, care, and compassion
- ASESS the ff:
o Is there suicidal ideation?
o Is there NSSI present?
o Is this person in need of immediate medical concern?
Step 2: Listen and communicate non-judgmentally
- Limit your own talking time
- Do not impose your values of beliefs
- Do not minimize their feelings

Step 3: Give support and information

- Normalize their feelings
- Respect confidentiality
- Say realistic expectations
- Provide hope for recovery
- Practice verbal skills:
o Ask Questions – This shows interest
o Check for understanding – re-stating what was said
o Listen to what is not being said – voice, tone, pauses
o Use prompts - “uh-huh”, “go on”, “go ahead”, nod head
o Be patient – Not everyone will open up right away
o Avoid showing frustration – judgmental (REMEMBER!)
o Avoid being too positive – “cheer up”, “kaya mo yan”
o Do not interrupt – THEM not YOU
o Avoid confrontation – unless when threat is present
- Practice SOLER
o Sit Squarely
o Open Posture
o Lean Forward
o Eye Contact
o Relax

Step 4: Encourage the person to seek professional help

 - Discuss options for seeking professional help
- Clarify misconceptions
- Know who they can referred to in your company or community
- Do not make the decision for them. You should only be supporting

Step 5: Encourage Other Supports

- Others who can help (family, friends, peers, workmates, boss, management).
- Encourage to join support group if available
- Spiritual support will help too especially for Filipinos
- Other means (card, letters, gifts)
- Offer self-help strategies (what worked for them before)
- Helpful resources for mental health hotline

Non-suicidal Self Injury (NSSI)

Nssi is a process of harming the self without intention of killing oneself or suicide.

How to Asses if NSSI is present?

• Visibly cuts
• Scratches in the body which is not natural
• Hitting the body or a hard surface
• Punching of slapping the self
• Bite marks
• Burn marks

How to assist?
• Look for signs – sometimes they are not obvious or hidden
• Do not ignore the signs when you seem them
• Do not talk to this person if you are not confident or are going through a difficult
time
• Do not force them to discuss or ask for details
• Avoid expressing anger, frustration

The Magic Question: Sometimes when people are struggling with emotional pain,
they tend to hurt themselves on purpose. Is that how your injury happened?

Action Plan for NSSI

Note: Please follow earlier general guidelines. Added some important parts for
depression specifically in this section

Step 1: Approach the person, assess and assist with any crisis.
• Approach the person expressing your concern about their injury
• ASSESS if the injury is lethal.
• ASSESS if there are many indicators of NSSI
• Use the magic question to normalize the situation
Step 2: Listen and communicate non-judgmentally
• Do not judge or blame them for their action
 • Show compassion and concern
• Ask about their problem and listen
• Ask if any medical condition is needed
• Use “I” statements rather than “YOU”
• I am concerned about your safety vs You are not taking care of yourself.
• Do not focus on the injury – focus on what can be done
Step 3: Give support and information

• Set realistic expectations – NSSI does not disappear tomorrow

• Ask them if they are open to listening to what you have just heard
• Validate their emotions and thoughts (NOT THE ACTION)
• Give them a sense that they are not alone
• Don’t promise anything (Some instances you might need to break this)
Step 4: Encourage the person to seek professional help

• Ask if they need medical attention

• Ask if they are open to seeing a mental health professional.

Step 5: Encourage Other Supports

• Applications
• Support groups
• Family, Friends
• Emergency Contacts

Things to Know:

• Talk to them in a calm voice and avoid personal biases

• Avoid minimize their feelings
• Avoid dismissive statements
• Avoid touching without permission
• Accuse them of seeking attention
• Guild trip/emotional blackmail
• Contract or goals (if you promise not to hurt yourself…)
• Be supportive

Managing Anxiety

- Anxiety is felt by the body when it feels a threat (perceived, imagined, or real)
as a way of protecting itself.
- It can be felt physically (physical symptoms), emotionally (sadness, guilt),
cognitively (worry, ruminating) or psychologically (somatization)
- Everyone feels anxiety – thus making it normal
- Running away from it, makes it worse.
Signs and Symptoms of Anxiety:

Thinking Feeling Behavior Physical

Mind racing Unrealistic Avoidance Pounding of Heart/Rapid H

Fear/Worry

Blank thoughts Excessive Fear/Worry “Needing” to do things Chest Pain

Poor Irritable Distress in Social Situations Difficulty Breathing

concentration

Poor memory Impatient Sleep disturbance Dizziness, Headache, Swe

Indecisiveness Anger Use of substance Stomach pains, butterfly in

Confusion Nervousness   Muscle tension, pains

      Shaking,
restlenessness.

Risk Factors for Anxiety:

• More sensitive and emotional individual who feel the worlds as threatening
• History of anxiety
• Female
• Experience of a traumatic event

Action Plan for Anxiety

Note: Please follow earlier general guidelines. Added some important parts for
depression specifically in this section

Please follow the Action plan for Depression earlier.

Additional Info on Anxiety:
 Anxiety does not usually have suicidal ideation
 Anxiety is most often paired with substance use
 Anxiety is normal
 Trying to make them calm down may not be a good idea, they have been trying
to already.

Action Plan for Substance Use

Note: Please follow earlier general guidelines. Added some important parts for
depression specifically in this section

General Information: Using a substance, drug does not automatically mean you are
abusing. An over the counter drug and a glass of wine are also substances.

Examples of Substances:
• Alcohol
• Tobacco
• Marijuana
• Opioid (Heroin)
• Amphetamines
• Hallucinogen
• Tobacco

When do we know that there might be a possible substance abuse?

• Substance is often taken in larger amounts for a longer period than intended.
• Person who wants to cut down but is having difficulty
• Craving of substance is present
• Repeated use has affected their ability to fulfil duties (school, work, home,
parenting, chores etc.)
• Repeated use even if problem exists
• Use may lead to a dangerous situation (driving, babysitting etc.)
• Increased tolerance

Step 1: Approach the person, assess and assist with any crisis.
• Organize your thoughts before speaking to this person
• Know more about their opinion about their problem
• Know more about their readiness to talk about their problem
• Use “I” statements, not “you”
• The problem is the use NOT the PERSON
Step 2: Listen and communicate non-judgmentally
• Avoid labelling them as druggies or alcoholics
• Do not express or show frustration
 • Support do not lecture
Step 3: Give support and information
 Stages of change is a good guide for this step:
o Stage 1: Pre-contemplation: Provide information about the effects
o Stage 2: Contemplation: Encourage and share realistic goals
o Stage 3: Preparation: Showing support on their decision to stop
o Stage 4: Making the Change: Help to develop strategies to say NO
o Stage 5: New Habits: Praise their achievements
 Explain the relapse is normal

Step 4: Encourage the person to seek professional help

• Discuss options for seeking help

• Normalize the situation
• Ask the reason/s for not wanting to seek help
• Clarify misconceptions
• Do not force them, but keep the line open

Step 5: Encourage Other Supports

• For substance use individuals, social support is very important and crucial.
• Stable family relationships
• Supportive friends
• Co-workers and bosses
• Avoid environment that may trigger relapse
• Avoid being critical and hostile towards them

Mental Health Action Plan for Suicidal Ideation and Behavior

 Someone who is hurting themselves may be at risk of suicide.

 Self-injury can be a pattern over weeks, months or years
 3 I’s of suicide
o Intolerable
o Inescapable
o Interminable

What should I look out for?

• Threatening to hurt or kill themselves
• Looking for ways to kill themselves: seeking access to pills, weapons, or other
means
• Talking or writing about death, dying or suicide
• Hopelessness
• Range, anger, seeking revenge
 • Acting recklessly or engaging in risky activities without understanding
consequences
• Feeling trapped with no way out
• Increased use of alcohol or drugs
• Social Withdrawal
• Dramatic changes in mood
• No sense for living, no sense of purpose in life

How to approach this person?

 Approach when you are psychologically and emotionally ready – make sure you
are okay.
 Understand the context (religion, sexuality, beliefs, trauma etc.)
 Approach with compassion, care, and concern.
 Do not show you are nervous, they will know
 Approach immediately when you see signs
 Tell this person what you observed and why you are concerned
 Do not force them to talk
 Let them vent out. They might cry, shout, be angry – allow them to do this.
o If they are threatening to hurt the self, intervene right away
 Ask them about their suicide
o ASK the question directly – you will be surprised
 “Are you having thoughts of suicide?”
 “Are you thinking of ending your life?“
o DON’T SAY:
 “Are you thinking of doing something stupid?”
 “Are you going to commit suicide and hurt people around you?”
 “Think about your family/parents/children”

 THE MAGIC QUESTION: Sometimes when people feel stressed,

overwhelmed, sad, they think about suicide. Have you thought about
suicide?

 ASK about the plan (How, when, why, where, what time)
 Assess if the threat is high, medium or low
o If it is high, keep them safe. Remove object they will use to end their life.

How can I assist?

 Do not treat suicide as a joke (no matter how many times they say they will do it)
 Suicidal signs are invitations for us to help them
 Look for a lifeline
 Keep them safe for now
 Create a safety plan
o Do not leave them alone
o Provide support and information
 o Look for lifelines

What not to do?

• Argue or debate with them
• Discuss if suicide is right or wrong
• Guilt trip or emotional blackmail
• Minimize their feelings
• Too positive (cheer up, it will be alright, can’t you see XY)
• Add interpretation to their story
• Show boredom
• PROVOKE THEM ( SIGE, GAWIN MO!)