Transcript Self harm and Eating Disorders - King Edward VI College

Dudley educational
pschology service
Neuro-psychological and
emotional influences on
achievement
Training session for staff at King Edwards VI College
Wednesday 4th June 2014, 1.00 – 4.00 pm
Objectives
Objectives are to:
1. Provide an overview of key neuro-psychological
changes in adolescence
2. Offer an overview of social and emotional
development in adolescence and early adulthood
3. Consider the interaction between ‘mental capital’
and achievement
4. Consider mental health vulnerabilities in
adolescence – Anxiety/Depression/Eating
Disorders/ Self harm and Psychosis
5. Give specific information on referral routes
6. highlight strategies to promote mental capital,
“And men ought to
know that from nothing
else but thence [from
the brain] come joys,
delights, laughter and
sports, and sorrows,
griefs, despondency,
and lamentations.
Hippocrates (c 460 BC)
Educational psychologist role
Educational psychology involves the
study and application of knowledge about
how people learn
Includes topics such as student
outcomes, the instructional process,
individual differences in learning, gifted
learners and learning disabilities.
Cultural context of teenagers and young adults
Click on picture above to play video
http://www.youtube.com/watch?v=dLuEY6jN6gY&feature=
player_detailpage
Myths about the brain
1. We are born with all the neurons
we ever have
2. Almost all the brain growth and
development happens by age 3
3. We only use about 10% of our
brain
4. Brain damage is permanent
5. People are either ‘right’ or ‘left’
brained
Cell structure of a neuron
•
Neurons and synapses
Brain structure
Brain Architecture – The Cortex
Cerebellum
Brain Architecture; the lobes
Brain Architecture: the limbic system
Brain Architecture: the Brain Stem
The Developing Brain
• The brain grows and shapes
until age 2-3 years.
• Slows down during primary age
• In adolescence hormones
stimulate the brain
• The brain begins to grow and
shape again
• In late 20’s the brain extensive
development is complete and
further changes are minor
Hardwiring the teenage brain for future success
•New understanding of brain
development in teenagers
•Ongoing growth peaking at puberty
•Massive synaptic re-organisation
Adolescent Development: Increasing Brain Maturity
Impact of synaptic pruning on key brain functions:
Executive function
•Pre-frontal cortex which is pruned is responsible for
thinking, reasoning, logic and decision making
• Executive functions – umbrella term for a set of cognitive
abilities which control and regulate other processes and
behaviour
•Executive function is the set of skills necessary to plan
and execute a goal
•Includes: thinking flexibly to solve a problem;
organisation; planning; behaviour and impulse control;
shifting attention; decision making and working memory
Impact of synaptic pruning on key brain functions:
Emotional brain differences
• Synaptic pruning in the prefrontal cortex seems to lead to overreliance on reaction to read
emotions
•Pre-frontal cortex seems to work
harder for teenagers in some
situations
•Outcome is that teenagers are
more likely to misread facial
expression and find it harder to
read social cues
Neuro-psychological patterns:
Attachment
• Children who have overwhelming stress
when young have overdeveloped ‘survival
mechanisms’
• Children with insecure attachments think
of themselves as unlovable, undervalued,
uninteresting and ineffective
• This sets up pattern of thinking into young
adulthood
• As students are vulnerable to rapidly
experiencing ‘toxic shame’
Neuro-psychological patterns:
Autism Spectrum Disorders
1. Notable differences in presentation,
skills and behaviour in ASD
2. Resulted in 3 key theories of ASD:
•
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Central coherence vs systematising
Executive functioning skills
Theory of mind development
3. Maybe some key neurological
differences especially in mirror
neurones – emerging area
CLICK on picture above to start video
https://www.ted.com/talks/sarah_jayne_blakemore_the_mysterio
us_workings_of_the_adolescent_brain
Adolescent Development: Psychological Impact
“as children move through early childhood to adulthood
their sense of self becomes increasingly complex but
reflects changes in their cognitive and social
development” (Hunter, 2003).
•Physical changes of puberty
impact self-concept
•Self concept vs self-esteem
•Social constructs of
adolescence
•Time of turbulence – trying
different identities
Erikson’s Psychosocial Stages
• Development is a life long
process
• Concerned with
emotional/mental health
• Emphasis on the role of
socialisation
• 8 Psychosocial stages crises
Erikson’s Psychosocial Stages
• BASIC TRUST vs MISTRUST (0-1 YEARS)
• AUTONOMY vs SHAME AND DOUBT (1-3 YEARS)
• INITIATIVE vs GUILT (3-5/6 YEARS)
• INDUSTRY vs INFERIORITY (7-12 YEARS)
• IDENTITY vs ROLE CONFUSION (12 - 18 YEARS)
• INTIMACY vs ISOLATION (20 YEARS)
• GENERATIVITY vs STAGNATION (LATE 20s - 50s)
• EGO INTEGRITY vs DESPAIR (50s +)
Impact of adolescent neuropsychology and physiology
on ‘mental capital’
• Foresight report: Mental Capital
and Wellbeing
• Mental capital = person’s cognitive
and emotional resources
• Mental wellbeing = the dynamic
state in which a person is able to
develop their potential
•Mental capital ‘map’ of factors,
threats and protectors
Influences on mental capital: Risk v Resilience
Key Mental health statistics
•1 in 10 children and young people aged 5 - 16 suffer
from a diagnosable mental health disorder
•More than half of all adults with mental health problems
were diagnosed in childhood
•Nearly 80,000 c/yp’s suffer from severe depression
•72% of LAC have behavioural or emotional problems
•95% of young offenders in custody - mental health
disorder.
•The number of young people aged 15-16 with
depression nearly doubled 1980s - 2000s
How does anxiety feel?
Range of moods and emotions: Anxiety
• All experience anxiety from time
to time
•Anxiety is feeling of fear or panic
•‘Fight or flight’ response protects
us from dangers
•Anxiety can prepare us to
perform
•Usually subsides when an
anxiety provoking event is
passed
Problem Anxiety
•Sometimes feelings of anxiety or threat continue
•May experience overwhelming levels of anxiety
•Symptoms are feeling frightened, nervous or
panicky much of the time
•If the anxiety stays at a high level for a long time
or it interferes with a young person's everyday
functioning we should refer for advice
•Variety of causes of anxiety
Anxiety Disorders
1. General anxiety disorder (GAD)
- Have the symptoms of anxiety most of the time
2. Panic attacks
- Get unpredictable, sudden and intense anxiety
3. Phobias
- Being fearful of something that isn’t dangerous
4. Obsessions and compulsions - OCD
1 in 10 people have troublesome anxiety or
phobias at some point in their life.
Aspects of Mood: Depression
Range of moods and emotions: Depression
Signs and symptoms of depression in teens
•Sadness or hopelessness
•Irritability, anger, or hostility
•Tearfulness or frequent crying
•Withdrawal from friends and family
•Loss of interest in activities
•Changes in eating and sleeping habits
•Restlessness and agitation
•Feelings of worthlessness and guilt
•Lack of enthusiasm and motivation
•Fatigue or lack of energy
•Difficulty concentrating
•Thoughts of death or suicide
When to seek further medical
advice …
Young person’s anxiety,
low mood/depression is
persistently interfering
with everyday life, at
home or in college.
Self-Harm
‘Self-harm is when you hurt yourself as a way of dealing
with very difficult feelings, old memories, or
overwhelming situations and experiences. The ways
you hurt yourself can be physical, such as cutting
yourself. They can also be less obvious, such as
putting yourself in risky situations, or not looking after
your own physical or emotional needs.’
(mind.org.uk)
Functions of Self-Harm
•
Releasing/regulating emotions
• Externalising emotional pain
• Control
• Distraction/escape
• Self-punishment and blame
• Prevent dissociative symptoms
• Habitual
• Calming/soothing
• Cleansing
• Suicidal intent
Factors Associated with Self-Harm
•
Sexual, physical or emotional abuse and neglect
•
Socioeconomic deprivation
•
Looked after children
•
Pressurised or challenging circumstances such as homelessness, separation
of parents or financial difficulty
•
A personal history of self harm or friends and family who self harm
•
Eating Disorders
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Depression, paranoia or obsessive-compulsive disorder
•
Low-self esteem, self-worth or resilience
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Experience of being bullied
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Relationship/attachment difficulties
•
Age and gender
Self-harming: Warning Signs
• Poor functioning including:
– Poor eating habits
– Tiredness
– Increased social isolation
– Changes in mood
• Wearing long sleeves or excessive jewellery such as
bracelets
• Unexplained frequent injuries
• Behaviour changes – elusive, evasive or secretive
behaviour, (especially about injuries) and low self-esteem
• Possession of razors, lighters or other sharp objects
Who is Affected by Eating Disorders?
Factors Associated with Eating Disorders
•
Parental attitudes to food or a family history of eating disorders
•
Physical, sexual or emotional abuse
•
Experience of being teased or bullied due to eating habits, body shape or weight
•
Cultural expectations
•
Occupational pressures (for example ballet dancers, models or athletes)
•
Stressful or challenging circumstances at work/school or home
•
Low self-esteem
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Feelings of inadequacy of lack of control in life
•
Depression
•
Anxiety
•
Age and gender
Eating disorders: Warning Signs
• Missing meals
• Complaining of being fat, even though they have a normal weight
or are underweight
• Repeatedly weighing themselves and looking at themselves in
the mirror
• Making repeated claims that they have already eaten, or they will
shortly be going out to eat somewhere else
• Cooking big or complicated meals for other people, but eating
little or none of the food themselves
• Only eating certain low-calorie foods in your presence
• Feeling uncomfortable or refusing to eat in public places
• The use of "pro-anorexia" websites
Self harm and Eating Disorders:
What can you do?
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How you respond to a disclosure is important. The reaction a young person
receives when they reveal their self-harm has a major impact on whether
they will go on to receive help .
If you receive a disclosure stay calm and demonstrate high levels of
empathy, recognising how hard it is for the young person to discuss these
issues.
Remember that the behaviour provides a function for the individual, although
they may not be able to express what this is.
Be aware of the warning signs.
Ensure awareness of the college safe guarding policy and outside-agencies
that can offer support.
Find out more information from websites such as: mind.org.uk and beat.co.uk. These sites also provide a helpline which offers further support
and guidance.
Psychosis: Importance of Early Intervention
•Psychosis is a symptom of serious mental illness.
•Person loses touch with what is usually accepted as reality.
•May feel paranoid, hallucinate, hear voices or have delusions, or
have confused thoughts.
•Psychosis is said to a ‘psychotic episode’.
•First episode often in their teens or early 20s.
•May only have one episode, or can have more
•1/3 have ‘one off’ episode/ 1/3 have a relapse/ 1/3 chronic issue
•Maybe part of symptoms of schizophrenia and/or bipolar
disorder.
• Psychotic episodes can be due to severe stress or depression,
or as a result of drug (cannabis especially) or alcohol use.
•More likely to have family history of mental illness
•Undiagnosed psychosis likely to lead to poorer outcome and
may impair cognitive function in the future
Psychosis: How to intervene early
•Early Intervention Team for Psychosis 01384 362389 can be
approached informally for advice
“The Early Interventions in Psychosis service offers younger
people, aged between 14 and 35 with a recent diagnosis of
psychosis, intensive interventions aimed at preventing relapse
and hospital admission. We aim to promote less traumatic and
stigmatising recovery whilst preventing further episodes of
psychosis.
The team works with a variety of youth, community and health
agencies to assist young people in accessing accommodation,
financial support, education, training, work and specialist
counselling services. “
•http://www.dwmh.nhs.uk/early-intervention-service/
Range of moods and emotions
Click on picture above to play video
http://healthtalkonline.org/young-peoples-experiences/depression-and-low-mood/jackinterview-24
How to refer for medical advice and support
• All medical referrals for students 16 or over need to be made
to via the student’s GP
•The GP will decide whether to offer support via the practice or
refer onto adult mental health services
•The Child and Adolescent Mental Health Services also transfer
patients over to adult services at this transition point
• It is possible to support a student and ideally their family with any
referral through providing information about the concern to take to
the GP consultation
•If the student has seen an EP in college we can provide a referral
pack (with the student’s permission)
•Other services such as the Early Assessment Service, and
the Early Intervention Team for Psychosis can be approached
informally for advice
Dudley Mental Health Services accessed via GP
The Enhanced Primary Care service offers access to primary care
based mental health screening, assessment and interventions.
The team provides a flexible service that meets the various needs of
adults aged 16 years and upwards presenting with mild to moderate
mental health problems associated with low risks. Tel: 01384 361960
The Early Access Service (EAS) delivers a single point of entry into
secondary mental health services for all adults (17 to 65) presenting
with a moderate to severe mental illness and provides comprehensive
mental health assessments. 01384 324578
Mental Health crisis out of hours where GP believes a mental health
assessment is required then initially the Crisis Team should be
contacted by telephone 01384 324578
How to make a difference 1:
Key strategies for students with mental health issues
• Listen and take the student’s view
seriously
• Reassure the student that a range
of feelings are normal
• Use relevant on-line resources to
highlight self-help strategies – with
student
• Work out practical solutions –
problem solve
• Prioritise relaxation and teach or
suggest a routine – apps useful
How to make a difference 2:
Key strategies for students with mental health issues
Encourage the following:
• Being mindful
• Involvement in enjoyable activities
• Involvement in social activities
• Safe expression of feelings – diary,
drawing, blog
• Talking to parent/ other trusted person
• Consider other college based support
e.g. counselling/ EP involvement
• Agree a ‘check in’ time to review
situation with student
Maslow’s hierarchy of need: motivation and achievement
An alternative view of the teenage brain
•
‘Aggregation of marginal
gains’ to promote mental
capital in college
• Promoting emotional wellbeing will impact on brain
functioning and has potential to influence results,
impact and value added in college
Two quick wins:
• Be alert to ‘hidden vulnerabilities’ of students
• Be aware of the opportunities you have to make
everyday interactions count
Future opportunities to promote mental capital in
College?
•Study buddy scheme YR12 > YR13
•Peer mentoring
•Consideration of systemic
promotion of emotional health and
wellbeing
•And your ideas...???
Inspiring young minds is hard work!
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Taking care of ourselves and each other is important