121. CCA Study Notes: Mental Health Disorders and Supporting Clients and Families

The Big Picture

Mental health affects how a person handles everyday stress, emotions, relationships, and daily life. A person can experience sadness, anxiety, grief, or loneliness and still have good mental health.

A mental health disorder affects a person’s ability to cope with or adjust to stress. It can affect thinking, mood, behaviour, and daily functioning.

When supporting a client with a mental health disorder, respect and acceptance are central. The client is a person first and should never be defined by a diagnosis.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Mental Health and Mental Health Disorders

Mental health is a state of mind in which a person can cope with and adjust to everyday stress in socially acceptable ways.

Three factors influence mental health:

1. Inherited characteristics
2. Childhood nurturing
3. Life circumstances

Good mental health does not mean a person never feels difficult emotions. A mentally healthy person may sometimes experience anxiety, sadness, grief, or loneliness.

A person with good mental health can usually:

• handle normal amounts of stress
• express and control emotions appropriately
• feel capable and competent
• understand their own needs
• form stable and satisfying relationships
• live independently
• recover after difficult situations

A mental health disorder is a disturbance in a person’s ability to cope with or adjust to stress. It can affect thinking, mood, behaviour, and functioning.

The terms mental illness, mental disorder, emotional illness, and psychiatric disorder can also refer to a mental health disorder.

Mental health disorders can result from a combination of genetic, biological, personality, and environmental factors.

They can affect people of any age, culture, education level, or income level. Most mental health disorders begin during adolescence or young adulthood.

Numbers and Facts to Recognize

How Common Are Mental Health Disorders?

Some important figures include:

• 20% of Canadians, or one in five, will personally experience a mental health disorder during their lifetime.
• More than one million Canadians live with a severe or persistent mental health disorder.
• Schizophrenia affects about 1% of Canada’s population.
• About 8% of adults in Canada will experience major depressive disorder during their lives.
• Anxiety disorders are described as the most common mental health issues, with an estimate of one in 10 Canadians affected.
• Suicide rates in some Indigenous communities are among the highest in the world. Rates are five to seven times the national average among First Nations youth and 11 times the national average among Inuit youth.

Economic Impact

Mental health disorders also have major financial effects. Mental illness costs the economy at least $50 billion.

Without changes in programs, policies, investment, business practices, and health care practices, projections include:

• more than 8.9 million people in Canada living with mental illness by 2041
• costs of mental health challenges and illness growing sixfold over the next 30 years to $306 billion
• a cumulative present-value cost exceeding $2.5 trillion over 30 years

Factors That Can Contribute to Mental Health Disorders

The causes of mental health disorders are complex. Several factors may contribute.

Biological Factors

Chemical imbalances in the body can cause mental health disorders. Some disorders also run in families, suggesting they can be inherited from parent to child.

Childhood Experiences

Childhood trauma or conflict can contribute to mental health disorders, particularly when painful memories are repressed.

Repression means keeping unpleasant or painful thoughts outside the conscious mind.

Social and Cultural Factors

Contributing factors can include:

• poverty
• discrimination
• social isolation
• physical isolation

Stressful Life Events

Too much stress can cause serious health concerns when it is not handled in a healthy way.

Sources of stress can include:

• family situations
• workplace pressures
• major changes
• the death of a loved one
• divorce

Loss and other major changes can contribute to physical and mental health issues.

Poor Physical Health or Disability

People with serious illnesses, injuries, or disabilities can be at risk for certain mental health disorders.

Recognizing When Mental Health Problems Affect Daily Life

A mental health disorder can cause changes in thinking, mood, behaviour, or a combination of these areas.

A person may experience:

• high levels of distress or fear
• problems coping with everyday life
• difficulty keeping a job
• difficulty staying in school
• difficulty forming strong family or social relationships
• difficulty completing daily routines

Symptoms can range from mild to severe.

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) is used throughout North America to classify mental health disorders. It describes mental health problems in terms of distress or impairment that is serious enough to affect important areas of life, such as social or work functioning.

A person who thinks they may have a mental health disorder should be evaluated by a doctor as soon as possible. The person should explain how they are feeling as completely as possible.

The doctor may:

• take a medical history
• check for physical conditions that could be contributing
• advise avoiding alcohol and nonprescribed medications or drugs
• advise eating properly and reducing sugar and caffeine
• recommend exercise and at least 8 hours of sleep
• prescribe medication
• suggest another treatment
• refer the person to a mental health professional

Early treatment is encouraged.

Treatment and Community Living

Mental health disorders can be treated successfully in the vast majority of circumstances.

Until the 1960s, many people with chronic or severe mental health disorders lived in psychiatric facilities. Today, people with mental health disorders commonly live in the community.

Depending on their needs, people with chronic or moderately severe disorders may live:

• in their own homes
• in group homes
• in assisted-living facilities

Community support may include treatment, life-skills assistance, and employment assistance.

Once depression is recognized, treatment and support can make a difference for about 80% of affected people and help them return to regular activities.

Some people with mental health disorders become homeless. Contributing situations can include being too ill to work or apply for financial assistance, fearing treatment, or not recognizing their illness.

The Health Care Team

Care planning for a client with a mental health disorder may involve several health care team members. The plan may address physical safety, emotional needs, and other individual needs.

Team members may include:

• a family physician
• a nurse
• an occupational therapist
• a social worker
• a support worker
• mental health specialists

An occupational therapist helps a person learn or relearn skills needed for life tasks.

A social worker may provide assistance with concerns such as employment problems.

A physician may order medication based on the person’s disorder, signs, and symptoms.

Mental Health Specialists

Psychiatrists are physicians who specialize in mental health disorders. They can prescribe medications for treatment.

Psychologists and psychotherapists are health care providers educated in treatments for mental health disorders that do not involve prescribing medications.

Indigenous mental health providers can include elders, healers, cultural counsellors, and other mental health and wellness staff. Some use traditional Indigenous healing methods. Others combine traditional approaches with Western health care methods.

Psychotherapy

Psychotherapy is a type of therapy in which a client explores thoughts, feelings, and behaviours with guidance from a mental health specialist.

Several forms are described.

Psychoanalysis

Psychoanalysis explores unconscious conflicts and reasons behind a person’s mental health problems.

Behaviour Therapy

Behaviour therapy focuses on changing behaviour using different techniques. The focus is the behaviour rather than the underlying reason for it.

Cognitive Behavioural Therapy

Cognitive behavioural therapy is practical and short term. It focuses on day-to-day challenges and is problem-focused and goal-oriented.

It teaches strategies and skills for coping.

Group Therapy

A group of people meets regularly to discuss concerns with guidance from a mental health specialist.

Family Therapy

Family members meet regularly with a mental health specialist to discuss problems or conflicts.

Stigma and Discrimination

Stigma means social shame connected with a circumstance, quality, or person.

People with mental health disorders may face discrimination because others do not understand mental health disorders. Some people may fear them, believe they are dangerous, blame them for their difficulties, or avoid them.

These attitudes can leave people feeling:

• ashamed
• rejected
• isolated

Stigma can also discourage a person from:

• seeking treatment
• taking prescribed medication
• attending counselling

Stigma affects a person’s reintegration ⓘ into family and society. It can also affect employment. Stigma has been reported to affect men more than women.

Open discrimination against people with mental health disorders is against human rights legislation ⓘ, although discrimination still occurs.

The Canadian Alliance on Mental Illness and Mental Health works to prevent stigma and discrimination. Its educational programs promote greater understanding and acceptance of people with mental health disorders.

How Stigma and Mental Health Disorders Affect Families

Mental health disorders can place major pressures on families.

Family members may need to make difficult decisions involving:

• care
• treatment
• housing

They may also experience:

• anxiety about the future
• financial strain
• guilt
• self-blame
• risk of depression

Families can experience stigma too. Friends and acquaintances may withdraw or fail to offer the support they might offer when someone has a physical illness.

Culture and Mental Health

Culture can include more than ethnic background. It can also involve groups of people who share learned characteristics or experiences, including families and groups of friends.

Culture can influence how people understand mental health disorders and treatment.

For example:

• one culture may accept seeking medical attention for a mental health problem
• another may see seeking help as a sign of weakness
• some families may openly acknowledge a mental health disorder
• others may refuse to acknowledge it
• some cultures may distrust traditional medicine and prefer local healers or herbal treatments

The interpretation of behaviour and symptoms can also differ between cultures and between individuals.

A behaviour viewed as appropriate by one group may be viewed as unusual by another. Past experiences can also affect behaviour. For example, someone who experienced severe poverty may hesitate to throw away even small items.

Understanding a client’s cultural background helps the CCA respect the client’s differences and preferences.

Mental Health Challenges Among Marginalized Populations

Some marginalized populations can face an increased risk of mental health challenges.

These can include people who:

• are not fluent in an official language and may be less likely to seek help
• belong to a visible-minority group, including members of Indigenous communities, some ethnic groups, or the LGBTQ2 community
• are geographically isolated
• have a physical or intellectual disability
• live with a mental health disorder
• have or previously had a substance abuse problem
• work in the sex trade and may be rejected by mainstream society

Marginalized populations can also include inmates and refugees.

Refugees are people who had to leave their former country and seek safety elsewhere. Some have experienced imprisonment, torture, the murder of loved ones, extreme hunger, or poverty.

They may also need to:

• adjust to life in a new country
• learn new customs
• learn a new language
• adjust to new laws

Because of difficult circumstances, many marginalized people have higher rates of depression, anxiety, and stress. They may also distrust the support care they receive.

A support worker should know when observations need to be reported to a supervisor.

Types of Mental Health Disorders

Mental health disorders include many different groups and conditions.

Common types include:

• acquired brain injuries
• schizophrenia spectrum disorders
• bipolar and related disorders
• major depressive disorders
• anxiety disorders
• trauma and stressor-related disorders
• obsessive-compulsive and related disorders
• feeding and eating disorders
• sleep-wake disorders
• suicidal behaviour disorder
• disruptive, impulse-control, and conduct disorders
• substance-related and addictive disorders
• personality disorders

Respect the Person, Not the Label

A client is not defined by a diagnosis.

Remember the DIPPS ⓘ principles when supporting clients with mental health disorders and their families.

Dignity: Treat clients with mental health disorders as you would any other client. Show respect and promote dignity.

Avoid labelling a person by a condition. For example, describe a person as having or living with schizophrenia rather than calling the person “a schizophrenic.”

The same principle applies to substance-dependence disorders. Describe the condition rather than making the condition the person’s identity.

Acceptance: Be patient and understanding. Do not patronize or talk down to the client.

Do not take the client’s remarks or actions personally. A client may have difficulty relating to other people.

Treat the client as a valued and worthy person.

Support Independence and Choice

Clients with mental health disorders have the right to autonomy. They should be encouraged to be as independent as is safely possible.

A person may have difficulty in some areas without having difficulty in every area. For example, a client with schizophrenia usually has no problems with walking.

Client-centred care must be planned or adapted to fit the client’s:

• choices
• physical strengths and limitations
• cognitive strengths and limitations
• personality
• care plan

Allow clients to make choices about their care according to the care plan. Options can give the client a greater sense of control.

Encourage clients to express:

• wishes
• likes
• dislikes

Loss of control can cause some people with mental health disorders to withdraw.

Protect Privacy and Boundaries

Discuss the client only with the health care team.

Respect the privacy and confidentiality ⓘ of both the client and the family.

Clients also have a right to boundaries. Respect a client’s refusal to discuss certain parts of their life with you.

Build Trust

Trust is important when supporting clients and families.

Do what you say you will do. Being reliable can help build trust and reduce anxiety.

This includes:

• being on time
• providing care as promised
• explaining procedures

Listen when clients share their thoughts and feelings. A client who trusts you may be more willing to talk about emotions and behaviour.

Observe Changes Carefully

Watch for changes in the client’s:

• behaviour
• mood
• thinking

Also observe for signs and symptoms involving:

• fatigue
• stress
• anxiety
• fear
• frustration
• illness

Report and record all observations according to employer policy.

Stress, fatigue, and physical illness can make mental health disorders worse and may trigger episodes. Report signs of stress or illness at once.

Support Safety

Provide a calm, stress-free, and safe environment.

Clients with mental health disorders may have a greater risk of falls or injury if they cannot focus on their surroundings.

The care plan will list activities and situations that should be avoided. Follow the care plan.

Safe care also includes protecting the client from harm. When necessary, advocate for the client’s safety.

When a Client Talks About Harm

A client may share private information because they trust the support worker.

Safety: If a client says they intend to harm themselves or someone else, you must report this immediately to your supervisor or the appropriate person.

You must then accurately record the conversation in the client’s records.

The client should also be told that health care workers are required to report this information.

Protect Your Own Safety

Your personal safety is also a priority.

Keep a safe distance from a client who might strike you, whether intentionally or unintentionally.

Do not enter premises where unlocked firearms or weapons are present. If you are already there, leave.

Always keep a clear route available so you can leave the premises quickly. Immediately notify the appropriate person by cell phone according to employer policy.

Ten Principles for Supporting Clients

These principles guide care and support for clients with mental health disorders and their families.

1. Follow the care plan. Tell your supervisor if support measures are not working.
2. Do no harm. Provide safe care and protect the client from harm. A safe, quiet, and neat setting can help calm the client.
3. Accept the whole person. Accept the client without judgement.
4. Be patient and supportive. Speak calmly. Avoid a loud or sharp tone.
5. Develop mutual trust. Keep your promises, be reliable, and explain procedures.
6. Explore behaviours and emotions. Listen carefully when clients share what they are thinking and feeling.
7. Observe carefully. Watch for changes in behaviour, mood, thinking, stress, fatigue, anxiety, fear, frustration, or illness. Report and record observations according to employer policy.
8. Encourage responsibility. Taking responsibility for their own actions can help clients build self-worth, dignity, and confidence.
9. Encourage effective adaptation. A mentally stressed client may behave in socially unacceptable ways or become harmful to themselves or others. It is often the support worker’s responsibility to intervene when this behaviour happens and help the client find better ways of coping.
10. Provide consistency. Routines and reliable care can provide control, security, and stability while reducing stress and anxiety.

Supporting the Family

Mental health disorders affect people differently, and people with mild disorders tend to have fewer challenges than those with more pronounced mental health issues. Severe mental health disorders almost always cause distress for both the affected person and their family.

A support worker may provide reassurance and support to both.

Clients and families may be sensitive to verbal or nonverbal signs of disapproval because they may have experienced negative attitudes before.

Pay attention to:

• your words
• your tone
• your body language

Communicate respect, acceptance, and a nonjudgemental attitude.

All clients and their families have the right to caring, nonjudgemental support and to be treated with dignity and respect.

Common Mix-Ups

Wrong Idea	Better Idea
Good mental health means never feeling sadness or anxiety.	Mentally healthy people can still experience difficult emotions.
The client’s diagnosis defines the person.	The client is a person first and should not be reduced to a diagnosis.
Confidential information can never be reported.	An intention to harm self or others must be reported immediately.
Psychiatrists and psychologists have the same medication role.	Psychiatrists can prescribe medication. The psychologists and psychotherapists described here use treatments that do not involve prescribing medication.