200211_Lifeline_A5_AccidentalCBooklet-2020_V4-LR

Accidental Counsellor

LIFELINE NORTHERN BEACHES

Skills learnt in the Workshop

This workshop has provided the foundational skills to enable you to be alert to common signs or behaviour changes that may occur when someone is struggling due to a personal crisis, to have the confidence to respond appropriately, and to be aware of sources of professional support that you can help them to access using the three Rs framework.

recognise 1 2 respond

Know and recognise the SIGNS of a crisis. Watch for CHANGES in behaviour.

Approach without judgement. Create a SAFE SPACE to talk. Engage through ACTIVE LISTENING CHECK SAFETY

3 refer

Refer to SUPPORTS - personal, professional help or websites, helplines and more information

FIGURE 1: THE THREE RS FRAMEWORK

AS AN ACCIDENTAL COUNSELLOR YOU CAN:

• Recognise a crisis - not diagnose it • Respond to a crisis - not solve it • Refer to other professionals who are qualified to diagnose and help

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Mental Illness in Australia

When a person has a condition that affects their mental health, they may have a mental illness or mental health disorder. This includes conditions such as depression, anxiety, schizophrenia and bipolar disorder. In Australia, the framework for mental health services is a highly complex mixture of public and private systems, with funding shared between the Australian, state and territory governments, individuals and private health insurers. The most recent Australian Bureau of Statistics (ABS) National Health Survey estimated there were 4.8 million Australians (20.1%) with a mental or behavioural condition in 2017–18. This was an increase of 2.6% from 2014–15, mainly due to an increase in the number of people reporting anxiety-related conditions, depression, or feelings of depression 1 .

The Australian Child and Adolescent Survey of Mental Health and Wellbeing 2 , conducted between June 2013 and April 2014 by the Department of Health, estimated that almost 14 per cent of young people aged 4 to 17 years (or 560,000 people) experienced a mental disorder in the 12 months before the survey. much mental ill-health in the workplace costs Australian employers. The report found that, mental ill-health in the workplace costs an average of $3,200 per employee with mental illness, and up to $5,600 for employees with severe mental illness. Overall, it was estimated that the cost of workplace mental ill-health in Australia was $12.8 billion in 2015–16 3 . The 2018 KPMG and Mental Health Australia report, Investing to Save, looked at how

1 Australian Parliament. Mental Health in Australia: a quick guide 2. Australian Child and Adolescent Survey of Mental Health and Wellbeing. 3 Mental Health Australia & KPMG (2018) Investing to Save.

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According to the World Health Organization (WHO), mental health is:

‘a state of well-being in which every individual

realizes his or her own potential, can

cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.’

EMOTIONAL CRISIS What is important to remember is that people can experience an emotional crisis at any point in their lives and do not need to have a mental illness that is either diagnosed or undiagnosed. Life events can cause stress and anxiety that can lead to a crisis event for anyone. It is important to know the signs and be able to recognise behavioural changes so that help and support can be offered.

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Recognise

signs and behaviour

WHAT IS A CRISIS?

CRISIS AND EMOTIONAL DISTRESS A crisis can be triggered by any: - - Form of abuse (emotional, physical or sexual; past or present) - - Significant loss (the death of a loved one) - - Relationship breakdown - - Living in remote areas or in social isolation - - Mental illness with negative self-talk - - Previous suicide attempts or deliberate self-harm - - Exposure to suicidal behaviour in others (particularly another completed suicide) - - Parental separation or divorce - - Drug or alcohol abuse - - Homelessness - - Failing subjects at school or dropping out of courses - - Bullying - - Legal or court action - - Financial crises (job loss, drought, bankruptcy). 4

A crisis is a subjective event and can be different things for different people. A crisis usually leads to a unique reaction - one person may be extremely affected by an event - someone else experiencing the same event may experience little or no negative effects.

The problem with mental illness is that the symptoms are not always visible like a broken arm or other physical ailment. You can’t see someone’s internal struggles.

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COMMON SIGNS

Often, it’s not a single factor but a combination. One of the most common signs of emotional crisis is a clear and abrupt change in behaviour. Some examples include:

C R I S I S

Neglect of personal hygiene

Pronounced changes in mood, such as irritability, anger, anxiety or sadness

Sleep problems, tiredness

Weight gain or loss

Quiet or withdrawn

Substance abuse (e.g. alcohol)

Decline in performance at work or school

Withdrawal from routine activities and relationships

Sometimes, these changes happen suddenly and obviously. Events such as a natural disaster or the loss of a job can bring on a crisis in a short period of time. Often, though, behaviour changes come about gradually. If something doesn’t seem right, think back over the past few weeks or months to consider signs of change.

Don’t wait to bring up your concerns. It’s always better to intervene early, before the emotional distress becomes an emergency situation. If you have a feeling that something is wrong, you’re probably right. 5

4 https://www.suicidecallbackservice.org.au/resource/why-people-become-suicidal/ 5 https://www.apa.org/helpcenter/emotional-crisis

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Respond

appropriately and with confidence

Start with a casual invitation if possible, such as:

If you suspect someone is experiencing a mental health crisis, reaching out is the first step to providing the help he or she needs to get better. However, one of the most challenging aspects of helping someone is knowing how to approach them and start the conversation to be able to ‘check in’. It is important to choose a suitable time and place to talk where you both feel comfortable, are unlikely to be disturbed and you are feeling calm. Sit close enough to be supportive but do not invade their personal space. Let them know you are concerned about them and want to check in that they are ok.

“

Let’s talk. You don’t seem like yourself lately. Is there something going on?”

“

I have noticed you seem a little distracted and quiet lately and I am wondering if everything is ok.”

“

I’ve noticed you don’t seem yourself at the moment. I’m concerned about how you are doing.”

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ACTIVE LISTENING If your approach is welcomed and the person is willing to talk, give them time to talk through their concerns and show empathy by actively listening. Empathy is, at its simplest, awareness of the feelings and emotions of other people. It is a key element of emotional intelligence, the link between self and others, because it is how we as individuals understand what others are experiencing as if we were feeling it ourselves. You can encourage someone to continue to talk, open- up more freely and explore issues by using encouragers, paraphrasing and summarising 6 . Encouragers are a variety of verbal and non-verbal ways of prompting someone to continue talking. These include non-verbal minimal responses such as a nod of the head or positive facial expressions, verbal minimal responses such as “Uh-huh” and “I hear what you’re saying” or brief invitations to continue such as “Tell me more”.

Any conversation with a distressed person must involve non-judgemental listening with respect, showing empathy and care

If the person doesn’t feel comfortable talking to you, encourage them to discuss how they are feeling with someone else and restate that you are concerned about them and you are there for them if they need your help or support.

6 https://www.counsellingconnection.com/index.php/2009/07/21/encouragers-paraphrasing-and-summarising/

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Paraphrases capture the essence (or most important details) of what has been said and reflect it back. For example: Original statement I have just broken up with Steve. The way he was treating me just got too much. I tried loads of times to bring it up, but he would just get mad and walk out. It’s a relief now that it’s over. Paraphrased You feel much better after breaking up with Steve. Other examples: - - It sounds like you’re feeling…right now - - You’re feeling……at the moment - - You might be feeling….…at the moment - - Perhaps you could be feeling…….. - - You look as if you may be feeling……. - - From what you’re saying…… Like paraphrases, summaries restate the key details or points from the conversation. Accurate summaries reinforce that the person has been heard accurately and what they have said is valued by the listener.

WHAT IF THEY GET ANGRY WHEN I ASK? An angry person usually wants some kind of connection or action. They want to be heard and taken seriously. An angry person is in an ‘active’ state, so the person may be more willing to take action, make changes or do something. By connecting with an angry person, acknowledging their feelings and allowing them to calm down naturally, you are showing respect and empathy. It is important to recognize that by acknowledging the person’s anger it does not mean you agree with their anger.

ANGER • Keep yourself outwardly calm • Actively listen • Acknowledge their anger • Be aware of your safety • Boundaries – personal, physical and workplace

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SKILL CHECKPOINT

Responding Appropriately

>> Set the scene for good listening >> Open the conversation

>> Listen and support >> De-escalate anger >> Check safety

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Refer

to professional help

WHAT IF THEY DON’T WANT HELP? 7 - - Try to find out if there are any specific reasons why they do not want to seek help. They may be based on mistaken beliefs. You may be able help the person overcome their worry about seeking help. - - If the person still doesn’t want help after you’ve explored their reasons, let them know that if they change their mind in the future they can contact you. - - You must respect the person’s right not to seek help unless you believe their life is at risk or there may be a risk they could harm someone else- if this is the case, ring 000 and stay with them until help arrives.

As an ‘accidental counsellor’ you are not expected to solve someone’s problems, give advice or diagnose a condition. What is expected though, is that now you have undertaken this training, you will have awareness of support services available locally and online. It is important to ask the person if they need help to manage their feelings and if they do, be able to discuss and encourage the use of support available. As a start, encouraging them to see a GP is a good option (or speaking to HR if this is a work situation).

7 mhfa.com.au 8 https://www.suicidecallbackservice.org.au/resource/why-people-become-suicidal/ 9 Turning Points: Imagine a world without suicide 10 Preventing Suicide in England (2016) 11 Thompson, Samara & Lamont-Mills, Andrea. (2017). Poster: Eliciting and Responding to Suicide Ideation: A Collective Case Study.

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Suicide in Australia The idea that someone is feeling suicidal and want to end their life can be a very confronting and difficult concept for many people. It can be very hard to understand why someone has reached the point where they are considering ending their life.

men; people in the care of mental health services; people in contact with the criminal justice system; specific occupational groups, such as doctors, nurses, veterinary workers, farmers and agricultural workers; and people with a history of self-harm. The risk of suicide is significant for many, and our challenge as a society is to work toward an Australia free of suicide. But what do we know about suicide statistics in Australia? We know that between 8-10 Australians die by suicide each day with more than 100 suicide attempts made daily. 11 The latest data available

People who contemplate suicide are experiencing intense emotional pain and may view suicide as a way to end this pain. The pain they are feeling may be due to any number of experiences or circumstances. Negative life events can sometimes act as triggers for suicidal thoughts or behaviour. 8 The statistics for suicide in Australia are comparable with the rest of the world. In 2019, Suicide Prevention Australia survey highlighted that Australians believe economic security and changes to family and relationships will be some of the biggest risks to suicide rates over the next 10 years. We know that there are priority populations that are at greater risk of suicide. In Australia, these include Aboriginal and Torres Strait Islander people, the LGBTI community, those bereaved by suicide and those who struggle with alcohol and drug problems 9 . However, in 2016, the UK National Suicide Strategy 10 highlighted additional vulnerable groups including young and middle-aged conducted an online survey of 1064 Australians aged 18 and older. The

from the Australian Bureau of Statistics (ABS) show that Australia’s suicide rate is at 12.7 deaths per 100,000 people – an average of six men and two women a day (Australian Bureau of Statistics, 2017).

Suicide is the tenth leading cause of death for males and the 23rd leading cause for females 12 with more females making a suicide attempt but more males completing suicide. 13 The highest proportion of suicide deaths occur among young and middle aged people, while the proportion decreases in progressively older age cohorts. More than half of all suicide deaths in 2018 (54.8%) occurred between the ages 30 and 59. 14

12 https://www.lifeinmindaustralia.com.au/about-suicide/suicide-data/suicide-facts-and-stats 13 https://apps.who.int/iris/bitstream/ handle/10665/67603/WHO_MNH_MBD_00.4.pdf 14 https://www.lifeinmindaustralia.com.au/about-suicide/suicide-data/suicide-facts-and-stats

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Recognise signs and

behaviour changes

No emotional crisis is more urgent than suicidal thoughts and behaviour. Like with a mental health crisis, signs may not be obvious, but there are certain signs and behaviours that may indicate that someone is thinking of suicide (aka suicide ideation). A majority of suicidal people communicate their suicidal thoughts by giving some sort of verbal or nonverbal clue about their intention to end their life. That means you could be in a position to guide someone to get help before they commit the one action that can never be taken back. They often send out signals and make statements about wanting to die, feeling useless and so on. 15

WHAT OTHER SIGNS COULD INDICATE SOMEONE MAY BE FEELING SUICIDAL? - - Threatening to hurt or kill themselves - - Seeking access to things they can use to kill themselves - - Talking or writing about death, dying or suicide - - Hopelessness, loss of purpose, despair - - Rage, anger, seeking revenge - - Acting recklessly or engaging in risky activities - - Feeling trapped, like there’s no way out - - Withdrawing from friends, family or society - - Using words that suggest they are overwhelmed with life

15 https://apps.who.int/iris/bitstream/handle/10665/67603/WHO_MNH_MBD_00.4.pdf

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FEELINGS SAD DEPRESSED LONELY HELPLESS WORTHLESS

THOUGHTS “I WISH I WERE DEAD” “I CAN’T DO ANYTHING” “I CAN’T TAKE IT ANYMORE” “I AM A LOSER AND A BURDEN” “OTHERS WILL BE HAPPIER WITHOUT ME”

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Respond

appropriately and with confidence

SO, HOW DO YOU ASK? 1. Listen to their story and build a connection 2. Reflect feeling- you are feeling overwhelmed 3. Normalise the feeling- sometimes when people feel overwhelmed they think about suicide 4. Ask them about suicide CLEARLY & DIRECTLY

It’s a difficult topic to bring up but discussing suicide will not put the idea in someone’s head. In fact, it’s not abnormal for a person to have briefly thought about suicide. It becomes abnormal when someone starts to see suicide as the only solution to his or her problems. For the suicidal person, being asked may bring relief from the anxiety and guilt they have or a new perspective. Remember that to reach out and listen is itself a major step in reducing the level of suicidal despair”. 16 17

16 https://apps.who.int/iris/bitstream/handle/10665/67603/WHO_MNH_MBD_00.4.pdf 17 https://www.aafp.org/afp/2003/1101/p1814.html 18 www.mhfa.com.au

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WHAT WOULD YOU SAY/ DO IF THEY SAY NO? This may feel awkward, but they will probably feel grateful that you cared enough to ask. Thank them for their honesty and restate that you are worried about them. If they continue to share how they are feeling, actively listen, reflect their feelings and ask open questions. Do not rush them to find a solution and offer to help to find support (if they indicate this is what they would like). Empower them and remind them of their strengths. Listen for any more signs that suicide might be an issue and if so, re-check safety by asking the suicide question again. WHAT WOULD YOU SAY/ DO IF THEY SAY YES? Helping a person who is suicidal is complex, however there are three key actions you can use to help them 18 1. If you think someone may be suicidal, ask them directly. 2. If they say yes, DO NOT leave them alone - ask them if they might work with you on a plan to keep them safe for now… When we are feeling this low it is really hard to see situations clearly and to make decisions. What could we do to keep you safe right now? 3. Link to existing supports, their GP, friends, family or colleagues, or if their life is at risk, ring 000. REMEMBER you cannot fix them or solve their problem.

Always ask CLEARLY and DIRECTLY about suicide » » Have you thought about suicide? » » Are you thinking about suicide? » » Are you thinking of taking your life? » » Are you having thoughts of suicide?

What If They Are Reluctant To Get Help? - - Be clear that you are unable to provide sufficient support on your own and you need to bring in extra support from a professional. - - Remind them that their safety is the ultimate priority, and professional support will help keep them safe. - - Normalise the idea of seeking help as much as possible. - - If they’re reluctant to see someone face to face, online counselling can be a non- threatening way to get support. - - If you are comfortable, offer to accompany them to their first appointment to support them.

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In some situations, a personmay refuse help and you cannot force them to get help. You do need to ensure the appropriate people are aware of the situation (for example, family, police, GP).

Don’t shoulder this responsibility yourself.

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SKILL CHECKPOINT

Supporting a suicidal person

ASK GET HELP 1 2 3 STAY & LISTEN

Make sure you ask clearly and directly about suicide. “Are you thinking about suicide?”

Get appropriate help. Call Lifeline 13 11 14 or 000 if life is in danger.

If they say ‘yes’, listen and allow them to express how they are feeling. Don’t leave them alone.

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Self Care

looking after yourself

After helping someone or being involved in an emotive event, we can experience secondary trauma . Possible signs could be irritability, difficulty concentrating, outbursts of anger, feeling numb or emotionally attached, sleep problems, low mood. If you have been helping someone or are affected by an issue or incident and don’t return to normal functioning within 4 weeks, seek professional help for yourself.

After challenging or emotive interactions we often ruminate on what has happened and replay the conversation in our heads critiquing ourselves about what we could have done better or should have said differently- this is all normal, but if it gets out of hand by starting to make us feel guilty, anxious or any other negative emotion, then we need to seek help.

DIMENSIONS OF WELLBEING

Physical

Mental

WELL- BEING

Professional

Emotional

Spiritual

Environmental

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Questions for reflection How do you currently take care of yourself? Do these strategies include all dimensions of wellbeing?

Even if you don’t experience secondary trauma, it is still important to do some form of self-care. WHAT IS SELF-CARE? Self-care is the mindset, activities, practices and habits we bring to bear against stress, unhappiness, illness, depression and many more negative emotions. However, self-care when practiced with purpose, can help build resilience to stress. Self-care is about giving ourselves relief when we feel overwhelmed. It is about addressing our problems holistically. Self- care activities are usually carried out, or at least initiated by, the person themselves.

- - Self-care is any activity that we do deliberately and actively plan in order to take care of our mental, emotional, and physical health - - Could be debriefing or talking through something after an interaction - - It’s an active choice - - “Something that refuels us, rather than takes from us.” - - It is not only about considering our needs; it is rather about knowing what we need to do in order to take care of ourselves, to enable us to be able to take care of others as well 19

19 https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt-2/

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SOME IDEAS FOR SELF-CARE - - Take a walk in the fresh air - - Sit outdoors by a fire pit, watching the flames - - Take a hot shower or a warm bath - - Get a massage - - Cuddle or walk your pet - - Listen to music - - Journal - - Clean out a junk drawer or cupboard - - Read poetry or inspiring quotes - - Meditate - - Spend time in nature - - Write your feelings down

What self-care practices can you incorporate in your life today?

Self-care is a personal journey and each day life is changing, so it is important to continually look after yourself (i.e. make a habit) and reflect on your health and wellbeing.

- - Cry when you need to - - Laugh when you can - - Go for a walk or a run - - Dance - - Stretch - - Go for a bike ride - - Take a nap - - Go on a lunch date - - Call a friend on the phone - - Participate in a book club - - Join a support group

Listen to this podcast: https://psychcentral.com/blog/podcast- self-care-for-your-mental-health/

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The Suicide Call Back Service 1300 659 467 provides immediate support to anyone feeling suicidal. In addition, they can provide ongoing support with up to six telephone counselling sessions. The Suicide Call Back Service also offers online counselling. Referral Resources

NATIONAL 24HR CRISIS SERVICES

Emergency – Police, Ambulance, Fire Emergency Mobile - no network coverage

000

If a life is in danger.

112

Lifeline Many Lifeline centres also offer affordable face to face counselling, support groups, online chat and text services.

13 11 14

www.lifeline.org.au/Get-Help

Suicide Call Back Service

1300 65 94 67 www.suicidecallbackservice.org.au

Kids Helpline (5-25y) Poisons Information

1800 55 1800 www.kidshelp.com.au

131 126 NSW Mental Health Line 24/7 1800 011 511 www.health.nsw.gov.au/mhdao/ pages/default.aspx BeyondBlue 1300 224 636 www.beyondblue.org.au Mens-Line Australia 1300 78 99 78 www.mensline.org.au 1800RESPECT 1800 737 732 www.1800respect.org.au Excellent resources online

National Sexual Assault and Domestic Violence Service

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SUPPORT AND INFORMATION SERVICES

Alcohol and Drug Information Service

1800 422 599 www.yourroom.health.nsw.gov.au

Alcoholics Anonymous Narcotics Anonymous

1300 222 222 www.aa.org.au 1300 652 820 www.na.org.au 1300 657 380 www.blueknot.org.au

Blue Knot Foundation Specialist phone counselling and support, to help adults traumatised as children to recover. Butterfly Foundation Eating Disorders Child Protection Helpline Parents beyond Breakup

1800 33 46 73 www.thebutterflyfoundation.org.au

132 111

1300 853 437 www.parentsbeyondbreakup.com

Gambling Help

1800 858 858 www.gamblinghelponline.org.au

National Relay Service (Hearing Impaired)

1300 555 727 www.relayservice.gov.au

Parent Line 1300 1300 52 www.parentline.org.au QLife (3pm-midnight) LGBTI+ 1800 18 45 27 www.qlife.org.au Relationships Australia 1300 364 277 www.relationshipsnsw.org.au Seahorse Society for Transgender 0490 138 804 www.seahorsesoc.org Telephone Interpreter Service 13 14 50 www.tisnational.gov.au Twenty10 LGBTIQA+, under 26 years 02 8594 9555 www.twenty10.org.au Open Arms: Veterans & Families Counselling 1800 011 046 www.openarms.gov.au

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WEBSITES

BlackDog Institute

www.blackdoginstitute.org.au

Headspace (Mental Health Support Services for youth) Mental Health in Multicultural Australia Mindframe The media and suicide reporting ReachOut! (youth) - webchat Good information for young people and parents Settlement and Multicultural Affairs

www.headspace.org.au

www.mhima.org.au

mindframe.org.au

au.reachout.com

www.homeaffairs.gov.au/about-us/our- portfolios/multicultural-affairs

Multicultural NSW

www.multicultural.nsw.gov.au

APPS

BeyondNow

Suicide crisis support app and safety planning tool Emergency Services & Location finder

Emergency+

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Training We have a range of courses to help the community increase capacity and capability to deal with Crisis and Suicide.

TELEPHONE CRISIS SUPPORTER Become a professional volunteer for Lifeline by undertaking our Certificate IV in Crisis Supporter Workplace Training (CSWT)

CRISIS SUPPORT Accidental Counsellor - Duration 4 hours

SUICIDE PREVENTION safeTALK - Duration 4 hours Applied Suicide Intervention Skills - Duration 2 days

MENTAL HEALTH Mental Health Awareness - Duration 4 hours Mental Health First Aid - Duration 2 days A full range of nationally recognised mental health courses available. Please ask for details.

DOMESTIC VIOLENCE Domestic Violence Awareness - Duration 2 hours Domestic Violence Alert - Duration 2 days

These training programs can also be tailored to meet your organisation’s needs.

Please visit our Lifeline Northern Beaches website: www.lifelinenb.org.au or contact the training team on 02 9949 5522 or training@lifelinenb.org.au for further information.

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Notes

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recognise respond refer

Lifeline Northern Beaches PO Box 681 Balgowlah NSW 2093 t 02 9949 5522 e training@lifelinenb.org.au w lifelinenb.org.au

V4- 11 Feb 2020