Mental Health Education Series: Mental Wellness

welcome to Washington Hospital today

dedicated to informing residents about

healthcare topics and issues through

programs featuring community forums and

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goal is to empower community members

with the information needed to make

informed health decisions Washington

Hospital has been providing health care

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past 60 years

[Music]

today's presenters are dr. Victoria

Leaphart and Michelle William Smith dr.

Lee part is board-certified in

obstetrics and gynecology and a member

of the Washington Township Medical

Foundation Michelle Williams Smith is a

family advocate with the Family

Education and Resource Center hello

everyone thanks for coming out this

evening you may wonder why gynecologist

is talking about depression and anxiety

since I am NOT a psychiatrist I'm really

not going to I'm going to touch briefly

on medication management for depression

and anxiety but mostly I'm going to be

talking about alternatives to medication

it's a question that I get asked a lot

by patients and I have a special

interest in lifestyle medicine which is

using nutrition and exercise and stress

management to prevent and treat disease

so I'm going to be focusing on that this

evening depression and anxiety are

incredibly common it is not as simple as

just feeling sad when you're depressed

and someone says you know don't worry be

happy it doesn't really work that way

people with a depressed mood don't

always just feel sad we think of

depression as an overwhelming sense of

sadness that is present all the time but

in fact most people who are depressed

have their predominance sensation is a

feeling of emptiness a lack of pleasure

or enjoyment and their normal activities

they may feel anxious they may feel

hopeless they may feel worthless they

may feel guilty or irritable or angry

the luck as I said the loss of interest

in previously pleasurable activities is

a hallmark symptom of depression and

people oftentimes have changes in their

appetite some people are stress eater

some people stopped eating some people

have trouble concentrating you can have

insomnia you can have excessive

sleepiness and a lot of people will have

physical symptoms with their depression

they will have digestive problems

headaches body aches and it presents as

many symptoms it's a large segment of

the population 17% of the population

suffers from depression 1/3 of women

will have depression at some point in

their lives this gives you the top gives

you the prevalence by age of depression

and as you can see it kind of Peaks in

middle age in people who are over 40 and

as you can see it's much more prevalent

in women than it is for men the bottom

section of the slide is how well drugs

work compared to placebos in a large

collection of studies they they gathered

together all the information from 37

different studies had more than 8,000

patients and they showed that for mild

depressive symptoms the drugs gave you

relief full relief of your symptoms half

the time but more than a third of the

time the placebo the sugar pill gave you

the gave you the same relief for more

severe depression it was 38 percent

versus 25 percent this does not show

that depression is all in your head what

it really shows is that we have the

power to heal ourselves the placebo

group for most of these studies was

different from no treatment at all

because the participants were meeting

with researchers to discuss their

symptoms

and there was one study that showed that

if you had a researcher who just gave

you a questionnaire but didn't talk to

you you didn't have as strong an effect

with the placebo but if you had a

researcher who talked to you who asked

you questions who treated you like a

human essentially then you got better

relief from both the drugs and from the

placebos so if your doctor has a good

bedside manner you're more likely to get

better and interestingly this is again

like I said it is not all in your head

people who take placebo morphine or

other opioids get good pain relief

because they're they create their own

morphine in their body those endorphins

and those go to the same receptors in

your brain as the as the as the morphine

if you give them blockers to block that

receptor morphine doesn't work and the

placebo doesn't work either so your own

body can create these drugs so the most

common class of antidepressant boost

serotonin in your brain your own body

can do that as well and I'm going to

talk about some of the ways that you can

boost the serotonin in your brain do

drugs work better or does psychotherapy

work better it turns out there's

actually no difference no difference

they work equally well the psychotherapy

takes longer but you were less likely to

relapse to have your symptoms come back

after you stopped either the drug or the

psychotherapy if you're happy and you

know it stick with your dosage and Lucey

trying to give psychotherapy don't let

Lucy give you psycho

let's see a trained psychotherapist the

combination of medication and

psychotherapy works better than each

alone you know who named me Eeyore who

does that to their kid you know what I

really love about the Pooh stories and I

love about a or E or clearly clinically

depressed there's no question about it

and his friends love him and accept him

and nurture him and don't judge him this

is what I get asked out asked about with

all of my patients they want to know

what supplements can they take instead

of drugs st. John's wort is the most

studied of all the over-the-counter

supplements and it works in the same way

that prozac Zoloft lexapro that whole

class of drugs does it works on the same

receptors it boosts serotonin in the

same way in some European studies it is

equally effective that has not held up

in the u.s. studies this is likely

because they have better quality control

for the supplement industry in in the in

Europe in Europe the supplements are

regulated in the same way that drugs are

regulated in this country they are

regulated as food and so all they have

to for in this country you just have to

prove that they're safe you don't have

to prove that they're effective and so

many of the supplements that you buy in

this country something on the order of

about twenty to thirty percent have no

measurable active ingredient and the

amount of of the suppose that active

ingredient varies tremendously based on

on brand but if you have good quality

control st. John's wort works well you

can't take them together because they

work the same way and you can get toxic

effects from overdosing on them

fish oil slide effect there

some evidence that getting more omega

threes in in may help with mood you get

more omega sixes in red meat more omega

threes in fish and there's little data

between having one or two servings of

fish versus taking fish oil every day

but that's a very modest effect

interestingly it may help with anxiety

in people who have a history of

substance abuse abuse sam-e also very

modest effect

there's you've all heard of seasonal

affective disorder and that light

therapy helps with that you've seen

pictures of the light boxes that people

use for for-4 sad there's evidence that

it may have a modest effect for non

seasonal mood disorders so particularly

in the winter time anxiety generally

generalized anxiety disorder is

characterized by excessive and

persistent worrying that's hard to

control it causes distress and

impairment it occurs on more days than

not for at least six months you can also

like depression experience your mood

predominantly as a physical symptom you

can feel apprehensive you can be

irritable you can have fatigue you can

have pain and if you have a panic

disorder as a part of your anxiety you

get chest pain you get shortness of

breath you feel as though you're having

a heart attack

I like able to jump to the worst

conclusion in a single bound

drugs versus therapy cognitive

behavioral therapy which is a form of

psychotherapy works just as well as

medication for the treatment of anxiety

you can add other drugs you can do

combination drugs but with anxiety in

general you want to limit add a van

which

lorazepam and other drugs in that class

because of the addictive potential

cognitive behavioral therapy is an

action-oriented therapy that assumes

that you have learned faulty thinking

patterns and that that leads to

maladaptive or faulty behavior and to

negative emotions and and that's

behavior that interferes with your

ability to conduct your life and the

treatment focuses on changing your

thought patterns so that you can then

change your behavior in your baseline

emotional state in this picture this is

desensitization therapy where you expose

somebody to what makes them anxious they

used to think that that was the way to

get people not to be anxious that's

really kind of been debunked but here if

you've got a fear of heights a fear of

the dark and a fear of snakes this would

be this would be how to desensitize you

for a while they thought you would just

learn to be anxious and that if you

could just learn a new behavior that

that would be all it would take but

there's there's again a shift to

thinking of it as a more of an imbalance

of the neurotransmitters in your brain

herbal remedies kava which has a small

effect but it's very sedating and

there's a risk of liver toxicity so we

definitely definitely recommend that you

avoid it st. John's wort valerian

chamomile

worked no better than placebo

interestingly if you add zinc

supplements to prozac it works better

for OCD than Prozac alone and if you add

vitamins A C and E ativan lorazepam it

works better for anxiety than ativan

alone it's been clearly demonstrated

that people who are anxious have lower

levels of B vitamins and vitamin D in

their bloodstream

there is apps

absolutely no data that giving them

supplements and replacing those levels

to normal treat their anxiety I'm gonna

mention this just very briefly there are

a couple of techniques that are FDA

approved for the treatment of depression

one is cranial electrotherapy

stimulation and it uses this little cell

phone device that that that delivers a

low electrical current to your brain and

there are all these videos online of how

you can go to RadioShack and fries and

buy this stuff and do it make one for

yourself but you can buy this you know

you can buy these devices

over-the-counter and then there's

another technique that that has to be

done in a doctor's office that is

magnetic stimulation rather than than

electrical stimulation and there's not

much data on these they're both

fda-approved but there's they're they're

very there is very little in the way of

clinical trials for these this is what I

really want to talk about exercise it is

the single best thing you can do to

treat anxiety and depression the the

absolute best thing you can do you if

you're exercising if you take there was

a big study in Germany where they had

people do two yoga classes a week for

three months and they saw 30% reduction

in anxiety and a 50% reduction in

depression and the mood elevation is

dose-related if you exercise more

you get a greater mood effect you also

can note a mood effect with as little as

ten minutes of exercise a day

interestingly exercise work better than

drugs six months out and it actually

works better than the combination of

exercise and drugs because people think

oh I'm taking medication I don't really

have to exercise thank you no and

but exercise works better than drugs if

you look at long-term data and again if

you continue to exercise you get a lower

relapse rate than you would if you just

stopped the medication cure your nd D

that's my term nature deficit disorder

there's a there's a Japanese term

shinrin yoku that means forest bathing

and there is excellent data that being

outdoors in green spaces gives you a

much greater mood effect than walking

the same distance on a treadmill or

inside a gym this is actually pleasant

and rich looking this is kind of the

back side of Pleasanton Ridge looking

toward the back side of Mission Peak we

just you know that's 15 minutes from

here we live in a place of incredible

natural beauty and we have no excuse not

to get out and see a tree there was a

New Zealand study that that showed that

for every 1% increase in green space in

a community that's within two miles of

your home if you look at the whole

community population you get a four

percent lower prevalence of anxiety and

mood disorders which is really kind of

an amazing idea that if you just plant

more trees if you have more parks if you

have more green spaces that you can

improve the health of not just one

individual but of your entire community

you can reduce the rate of depression

and anxiety within your entire community

there's a lot of data for other other

you know exposure to to natural light to

green spaces if you're a hospitalized

patient and you have a window in your

room you are discharged from the

hospital faster and you need

less pain medication if you are an

office worker and you have a window in

your office you're more productive

there's less aggressive behavior if

you're exposed to green spaces and to

natural light there's even some evidence

that that you can reduce the risk of

domestic violence by having windows that

look out onto green spaces some of this

is from light exposure and some of this

is is looking at nature because these

lights you know these these fluorescent

lights they don't come anywhere close to

the strength of natural light and that

mood elevating effect on your brain food

food affects your mood and it's not like

oh I eat a doughnut I feel good you know

that that is not what I'm talking about

I tell my patients all the time to

listen to their body and listen to how

their body feels you know that that

doughnut that piece of cake may

short-term makes you feel good but six

hours later you're gonna feel worse the

next day you're going to feel worse and

the data shows that that that you can

boost your mood the following day by

consuming more fruits and vegetables so

if you have a day where you eat more

fruits and vegetables your mood is

better the next day if you have a day

where you eat fewer food fruits and

vegetables your mood is worse the next

day there was a very big study it was

actually a corporate study Geico did

this with with their employees they

taught them they gave them classes on

how to eat a plant-based diet which is a

vegan diet they didn't really expect

people to eat a vegan diet but they were

hoping that they'd eat more fruits and

vegetables less processed stuff less

processed breads less meat less

processed meats as well and they then

followed the population you know of

their offices and on average

the people who had taken the class lost

10 pounds their waist size went down by

two inches their mood was better their

energy was better their productivity was

better they had less sick time they and

they they were just better employees and

so the corporate world is starting to

get wind of this there are some local

companies that I've given lectures to as

part of their like lunch and lunch

wellness series because the

corporation's save money on on

disability and illness by by encouraging

healthy behaviors another study had

participants increased their vegetable

consumption by three servings of

vegetables a week and the they found

that that reduced the risk of depression

by 60 percent 6-0 60 percent and there's

some evidence

there's an old antidepressant that's

really rarely used now called mao

inhibitors but this the there's

nutrients in kale and green tea and

grapes and sadly in tobacco that that

have that same effect on your on your

brain without the risk the the reason

mao inhibitors are really no longer used

is because you are very limited in what

what you could eat if you ate the wrong

foods you could get incredibly sick we

all think that chocolate enhances our

mood I am absolutely the first to

believe that what the studies show

however is that milk chocolate works

better than white chocolate that's not a

surprise but both of those work better

than taking a cocoa capsule where you

get all the

the nutrients that you get the pure

chocolate but not that mouthfeel and the

taste of the chocolate and so pure cocoa

which gives you the greatest

concentration of actual chocolate had no

effect on mood at all so when we think

oh it enhances our mood it's because we

like the taste and the flavor and all of

that and your other circumstances can

affect affect what you eat as well if

you watch a sad movie if you have a bowl

of popcorn and a bowl of grapes in front

of you if you're watching a sad movie

you eat more popcorn and fewer grapes if

you're watching a happy movie it's the

reverse you eat more grapes it'll and

less popcorn so don't get the Jumbo

popcorn if you're going to a weepy movie

this is one that most people are not

thinking about you know they they

underestimate the effect of mood of

sleep on their mood and we all know that

if we have a restless night of sleep

that were just a little more crabby the

next day but it significantly impacts

your risk of anxiety and depression it

also increases your risk for obesity

your cognitive function is declining and

you're just more likely to have a heart

attack or a stroke if you are not

getting enough sleep it's there's some

evidence that chronic sleep sleep loss

may actually be a cause of depression

and it certainly makes you more

emotional and reactive if something

happens to you that normally you would

just brush off you're much more likely

to overreact to it if you're

sleep-deprived you're also more just

emotionally negative in general if you

give word recall test to people who are

sleep deprived they'll remember more

negative words than they'll remember

positive words there's also some

evidence that that not only do we run a

24-hour circadian rhythm

we may actually run kind of a weekly

cycle there may be a real physiologic

benefit to having that day of rest and

you know if that's part of your

religious tradition then you can

continue with that but I would encourage

people to have a digital Sabbath where

they just turn off the TV and turn off

the computer for a day and just go out

into nature and just have a day that

that you take a mental-health break from

all of those concerns meditation and

mindfulness clearly work for depression

and anxiety

the most common meditation technique

taught in this country is mindfulness

based stress reduction it was created by

dr. Jon kabat-zinn

out of the University of Massachusetts

for the treatment of chronic pain

patients these were patients who

couldn't who didn't have a problem that

could be fixed surgically they were

going to have chronic pain for the rest

of their lives and it was a way to help

them learn how to manage their pain

rather than have their pain dominate

their lives and it was found to be

dramatically effective since then that

was the early 80s since then there's

been a just an enormous body of

literature on its effectiveness for

anxiety and depression works just as

well as Prozac and Zoloft for mild

depression and it's not just a

meditation technique it's it it's really

a way of thinking about the world of

learning how to be more in the moment

instead of worrying about your to-do

list and what you have to think about

next and and what you need to buy at the

grocery store and that work project

you're doing or instead of thinking

about oh I shouldn't have said that to

my mother or I shouldn't have done that

instead of thinking about the past and

thinking about the future which is where

you stop yourself and pay attention most

of the time you are not in the moment

you are thinking about your to-do list

or something that you've done and it is

a way of learning how to be more present

in your life by learning these

meditation techniques and one of the

things that most strongly correlates

with relief of depression and anxiety is

a gratitude practice and it it can be

just at the end of every day or at the

beginning of every day you sit and think

of you know three things that you're

grateful for and the studies show that

your rate of depression declines and

your rate of personal happiness

increases if you sit down and do that

every day and you can do that through

the day you can just take a moment to be

present like for example my girlfriend

loves to hike the Pleasanton Ridge with

me because I just stopped in the middle

of the trail and I say look at the light

filtering through and look at the

contrast of the blue against the dark

branches and she's like I didn't even

notice that I didn't even look up but

it's a way to be present and to be

grateful that we have the opportunity to

be out in the woods that we live in a

place of such natural beauty and it's

interesting my I was hiking mission peak

with a with a girlfriend today and just

as we got to the last like 100 feet of

the hike she says how I'm already

thinking now about what I have to do and

then she smiled and she said but for

most the hike I was able to let that go

but now that we're you know a hundred

feet from the car I'm thinking about all

the chores that I have to do I said yep

I just kicked into the same mode as soon

as we got to that where we could see the

gate to the car we both shifted into the

planning mode for what we were going to

do for the day but it we we had been

able to kind of let that go on the hike

but it's interesting you can you when

you do this more regularly you actually

feel your brain shift gears volunteer

this is not something that you think I'm

going to tell you to treat your

depression and anxiety but it turns out

that doing good is actually good for you

it some people even describe

volunteering as enlightened

self-interest as opposed to

self-sacrifice which is how you

typically think of volunteering because

it confers so much reward to the giver

to the person who's volunteering the

rewards are great you have greater

personal happiness you have better

health you even live longer and there's

a positive psychology researcher who

talks about you know reframing things to

think positively having a gratitude

practice but he he says that the that

doing a kindness produces the single

most reliable increase in well-being of

any exercise tested so volunteering

works better than drugs exercise sleep

food there's some evidence that doing

good is good for your mental and your

physical health people who volunteer

once a week volunteering once a week

increases your happiness the same amount

as moving from an income of less than

twenty thousand to more than

seventy-five thousand so going from

poverty to the middle class volunteering

is just as effective as that for for how

it how it contributes to your sense of

well-being

and my final slide is you know better

living through chemistry but you can

boost your neurotransmitters with

something other than ativan or prozac

you can boost it with meditation you can

boost it with kale you can boost it with

volunteering you can boost it with

walking outdoors there are plenty of

ways that you can alter your brain

chemistry your body has the capacity to

heal itself if you give it the

opportunity questions thoughts

you know there really does seem to be a

dose effect but you probably plateau at

about an hour to two hours a day but you

probably get continued benefit up to

that point if you're exercising

substantially more than that you

increase your risk of injury and you

know sort of beating down your body so

moderate exercise I tell my patients to

aim for an hour a day to get the the

sort of maximum mood effect you may get

more benefit if you get up to two hours

a day but more than that you're not

going to really notice any difference in

your in any difference in your mood you

might notice that you feel more tired

and more kind of beaten down as you as

you get into that overtraining range

so good evening everybody oh boy whoo

let's try that one more time good

evening okay let's take a nice big

breath hold it for a second and then

just let it out

let's try that one more time for me

thank you for letting me help me

de-stress right now

so thank you I want to thank everybody

for sharing their time with me this

evening what I like to do is thank Lucy

as well as Washington Hospital let me be

part of the mental health educational

series that's been going on for the last

few months so there's been a lot of

information given about mental health

and what I would like to do is today as

well as May 17th is actually is to kind

of sum up and say where can you find

some of that information so Who am I my

name is Michelle Williams Smith I'm a

family member but actually a family

advocate who works for the Family

Education and Resource Center and a lot

of people might have heard it as Burke

that's how we call Burke one of the

things that I would like to make sure

that you understand is that I do not

have those little letters behind my name

so we're not licensed clinicians we're

not therapist however we have lived

experience so my PhD is in lived

experience we are an advocacy program

that assists family members and

caregivers of those who have loved ones

with mental health challenges in Alameda

County so some of the things that FERC

and that's how long did it firk would do

is some of the things that how we can

help is education because we want to

learn a little more about what's going

on with mental health so we have

information that you might need to

understand

more about where certain diagnosis what

workshops are available presentations

programs that are going on also

sometimes when we go talk to providers I

know sometimes the food right over my

head so we might want to know a little

more of what they're saying so we might

be able to provide some of that

information to you as well helping you

out being your support also to some of

the things that we would do being your

support is at times we have families

that need to go to schools for our

children and get individual education

plan IEP s it's nice for us maybe to be

by your side because there's so much

information going on having someone else

there to talk to you and go over certain

things might be helpful going to the

courts we can be with you and be your

support at the court sometimes I love

ones do get picked up and they are going

to jail but let's hey let's talk about

they have mental health challenges we

want to make sure that certain people

know that information in court

we like to connect our families with the

appropriate information that's available

hopefully within a local surrounding and

local area another thing that is helpful

for us is assisting those family members

how to navigate through the mental

health system and that's one of the

important things there too is also for

our family members we have a voice

however sometimes we don't know how to

use our voice so that's why giving this

education giving you understanding where

the resources are at helps us to move

forward helps you also not to have not

to feel uncomfortable if we can give you

that support but also what it will do is

also put you into understanding that

there is hope

so who are our family members you are

our family members because what guess

what right now you're here you're here

to learn you have concern

and this is what's so important is

having that concern having that care so

the person that is maybe walking with

that loved one of yours that has the

mental health challenge we call them

loved ones not consumers loved ones

and we're sitting up there and you're

walking and you're saying gee I would

like to know a little more because I've

seen different behaviors happening how

do I find that out and you come to us to

talk to us where there you're part of

the family now

you could be a paraeducator you could be

the roommate and the roommate is now

saying oh I see changes I who do I talk

to to get a better understanding how do

I communicate we're here we want to help

so you're considered one of the family

members our locations at several places

I'm in Fremont and there are other

locations our main office is in Oakland

and then the satellite office Fremont

Livermore and San Leandro in these

offices you'll be very surprised we have

a lending library so we have books

wealth of information DVDs as well as

lots of brochures with a lot of

information in it we also have courtesy

phones and computers because guess what

there's times that a family member will

come in they want to make a phone call

to a provider get and we're there we can

help them through that conversation and

give them that support that they might

need how to reach us well we have what

we call a warm line you can also drop in

to but we have a warm line we have

family advocates that are Manning those

warm lines Monday through Friday through

Thursday from 9 to 5 as you can see and

then from 9 a.m. to 1 p.m. on Fridays

now on your I've put out earlier if you

don't mind me if you need to just check

us out a little more go on ask FERC the

website there and if you need to talk to

somebody someone does speak Spanish

German as well its Korean and then we do

have a language line so why am I here

today ok like I said you've had all this

information

coming to you for the last couple of

months now you're saying okay where do I

go to find out if there's any other

programs is there workshops where do I

go to get that information from well

that's what I'm here to do is to give

you some information aware you can find

that in that those thoughts that you

have in your mind but one thing I do

want you to think about is at this

moment is sometimes with all the

information that you receive lots of our

family members as well as our loved ones

we think about from here down that huh

well these are the things that need to

get fixed because I can see that

something's wrong here or here but here

I don't see that and there could be

stigma or shame or something like that

so I always ask my family members and

the loved ones if you're gonna go to a

primary care doctor ask them detect from

here from the top to the bottom your

whole body because guess what your head

is attached to the rest of your body we

tend to forget back so tonight we're

gonna focus on what we call wellness

recovery action plan not the cool rap

but to wrap this plan here I like to ask

everybody right now tell me how many of

you would a show enhance always always

feel good there's never stressful day

life is just wonderful by a show of

hands by show of hands oh okay alright

then so we do have those days that we

could feel a little uncomfortable could

be stressful well this is where rap

comes into rap is helping us to have a

little more control on our well-being

because guess what

I wonder if you have any tools or do you

have any action plans or any help to

work on your well-being do we have any

of that when we don't feel well

how many of you in here have some kind

of action

plan Oh no more hands of you oh we have

one yes okay a couple more great great

so maybe I can either give you some

infant more information on this or you

might be even able to give me some

information so let's talk about rap

wellness recovery action plan was

actually developed by Mary Allen

Copeland and a group of mental health

service users who wanted to work on

their recovery their wellness recovery

and this is basically what they came up

with that helped them in 2010 rap was

also recognized by the United States

substance abuse and mental health

services administration Samsom as that

evidence-based practice use worldwide

and that's for people that were dealing

not only with mental health but general

health as well and you'll also notice

that the National Registry of

evidence-based program and practice is

also part of giving that information and

saying that we're recognizing what rap

is about this plan helps you again this

plan is helping you feel prepared and

control when you find yourself in a

crisis or in stress but this plan is for

everybody now you'll notice that I kind

of made it bold when it says you because

guess what it's all about you so it's

telling you hey this is to help you

monitor yourself this is also helping

you when you're going through your

stress this is also helping you to

utilize your coping strategies and your

wellness too so it's about you this is

for you it's not what someone else

thinks you should do it's about how you

can work on your plan only one person

can write your rap program and that's

you because guess what you're the expert

of yourself correct you know about you

right so to write this plan up there's

all kinds of things that you can use you

can actually have a workbook when you do

go through the program we give you a

workbook and we give you information so

you can start writing your plan out

sorry about that

also too you can also use your computer

to put the information in or when we

give you your books they also have spots

in there where you can actually also

work on your plan we need to think about

this though are our bodies change our

lives change so most likely the

preparation of our rat will change as

well so you need to have it somewhere

where you can make those changes so as

we develop our rap it can be a practical

support for your well-being

it is designed as an aid for learning

about yourself what helps you or maybe

what doesn't help it also helps you do

going helps you with information on how

to guide other people that can help you

when you're not doing well how do you

share that information so let's get

started with rap let's start it off

right now so in the beginning we need to

know about what is recovery all about

this five keep five key concepts for

recovery so I'm going to talk about me

right now and let's see if you can

figure out what those recoveries are so

my my recovery I'm hoping I hope that I

what I want to see is a forward movement

in my recovery in my healing however I

understand that I might need to take

personal responsibility for me to heal

to meet for me to move forward that's

really important hmm

so I might have to listen to what that

doctor said I might have to go exercise

I might have to take this type of

medication but I have to take

responsibility to do those things but I

also want to make sure that I'm

understanding what that doctor is

telling me to do or what that make

medication is about what the side

effects are why am I taking so I want to

educate myself on that because there

could be treatments that I might choose

that I might want to do it a little

different or is there other medication

or other exercises that I can do so

guess what I might have to go

self-advocate and talk to the doctor

oh goodness so I have to get the

strength up and I have to learn how to

self-advocate to help myself but I guess

what I have friends and family around to

support me to give me that support that

will give me that strength and also

helped me in my hope in my recovery so

let's think about it it was hope is one

of the keys

it was personal responsibility

it was self advocating advocate and also

it was what did I miss as support and so

I got five right so we have hope

person's personal responsibility

education self-advocacy and support

that's for recovery okay so let's start

working on our rap let's start beginning

our rap with our wellness - we need to

identify in our lives what tools will

make me feel good

hopefully it's simple hopefully it's

free hopefully it's easy for that so hmm

if I'm not feeling well what do I have

in my toolbox let's work on our wealth

our toolbox right now so for me in my

wellness toolbox for my day-to-day to

try to de-stress myself one of the

things that I seem to love to have is a

cup of tea and one of the agencies that

are near my office the mom gives a

thermos to one of the young ladies of

tea but the tea for some reason has this

great aroma in it that smells with

spices

and love or whatever it is but the tea

is young so what happens is I will get a

little message saying do you want tea

now I know my energy is high in the

morning time so I know it's gonna be low

starting to be unfocused in the

afternoon plus I probably haven't really

gotten up and moved around as much as I

should have

so having a cup of tea is something that

makes me get up and have to go over

there to have the cup of tea now that

gets some pluses with me going and

getting my tea because of the door opens

up and everybody's smiling and they're

happy and then they said would you like

to join me

that is my toolbox for when I'm at work

I put that in my toolbox so if I'm not

having a good day and I see that little

would you like to join for tea that

boost is up my day that makes me happy

so there could be other things that you

like you might want to go for a walk you

might do as doctor said earlier and go

for a jog or meditation things of that

that could help so let's move on because

we're writing up our plan right now and

most of the things that you're doing is

you're making a list so daily

maintenance plan so the daily

maintenance plan describe myself when

I'm doing well hmm put a list down well

I think I'm usually calm I think I'm a

little focused I'm probably happier

that's how I feel so I'll jot it down

now that now you want me to do something

else

how and what can I write for a list for

my everyday maintenance daily

maintenance plan how can I help myself

feel good what do I do day to day

well the night before I always have to

get my clothes out ready for work

because if I don't the next morning I'm

like a little frantic person because

it's like who uh who what oh and I'm

pulling stuff out and it's not ironed

and so guess what my day has now been my

time for me to get ready has been

shortened because I did not get up there

and I might close ahead of time and get

my clothes out so guess what I'm already

coming into work stressed because of

what I just did so this helps me this

maintains my daily day

now there's optional things that you can

do to my thing would probably which I

probably should be drinking my water

however you do see that look how much

I've drunk so far all day so it's an

optional but probably should be part of

my daily plan and this should probably

be with you if you can keep it so you

can go back and forth to look at these

things the next thing is triggers and

action plans here this is the external

things that external events or

circumstances that are happening around

you that make you feel a little

uncomfortable so write a list of what

that could be maybe watching the news in

the morning is not such a good idea how

what action plan should I use to make my

wellness be better how can I respond to

that well maybe I shouldn't watch the

news in the morning time that's how we

would I would write what my triggers are

and then I would write down what

response can I do ahead of time so I can

keep that stress down low

early warning signs and action plans as

you know you see action plans and I will

tell you you should put action plans

when things are breaking down slash

action pants all these have action plans

so early warning signs those are the

subtle internal signs you are noticing

that are not things are not going well

so let's think about it

maybe I take a walk every day for two

and a half hours and I get a little so

twins in my leg here okay what action

plan what how do I respond to that well

maybe I need a pair of new sneakers

because I've been wearing these sneakers

for the last year maybe they're a little

worn out so that would maybe start my

action plan however when things are

breaking down we're starting to go maybe

into a crisis mode here things are

getting some getting a little severe we

want to prevent that what we're trying

to do is prevent that crisis so now that

little twinge is now really shooting up

and it's really hurting me

what action plan do you think I should

go ahead and do it might be nice for me

to go to a doctor before it gets worse

until I get things into a crisis plan

here and things are more severe so I

will have to put up on my action plan

there hello time for you to go to the

doctor the next thing is crisis planning

despite everything that I did we're in a

crisis situation now I tried my best but

it just happens at times so what does

this mean this means here the crisis

plan is a need for other people to help

me with dizzy some of my

responsibilities and some of my care and

maybe my decision makings when do I

write this crisis plan up when do you

think I should write it when I'm already

in the crisis or

before this crisis plan has nine parts

to it so it's going to take you a little

time so you should prepare yourself

ahead of time because this crisis plan

this part here is you're sharing it with

other people because those people are

going to be the people that are going to

help you through this crisis so let's

start with what's what if some of the

things are first of all you need to know

how I I am when I'm feeling well

you know you need to say okay well this

is how I look when I'm feeling well you

know you you usually see me I'm bubbly

or I'm pretty calm I'm focused I'm not

sleepy or tired and you write that list

down because you want that person to see

okay this is usually how that person is

in case things start to change then you

have signs that I'm not doing well and I

need a supporter now someone might have

to take over because I'm not doing well

because that's what we're going into a

crisis here so how does that look maybe

I'm starting to isolate myself maybe I'm

getting depressed I hurt my leg so bad

now I can't get up and run and do all

that exercising like the doctor says to

keep everything going so now I'm

starting to get a little depressed who

are my supporters this is an important

one

this makes you really sit down and think

who is around to support me who's able

to where I can trust them to do certain

things that can be I like and also let's

think about a supportive person or any

of these things either I want that

person or I want to avoid that thing

okay so I'm Suzy may make so Allah Vanya

that is oh not one of my comfort things

for her to bring but on Josephine who

she brings me something that is so yummy

so one of my supporters for my comfort

level would be aunt Josephine and I'll

let her

know that because she knows how to bring

my spirits up because she knows what

kind of food to bring for me

next thing is medication let's think

about medication

what medication is helpful to me and

maybe I also know what medications did a

bad reaction to me as well maybe I'm

allergic to certain things this should

be in my crisis books so we understand

in the future that we don't have any bad

reactions later on alternative treatment

may be me sitting down and sewing for an

hour helps me out maybe one on one

coaching helps me out but there's some

alternative treatment to help me move

forward my home and community do I want

to stay within my community and in

within my home or is there place that

respite that I might like to go to

treatment facilities what one would I

like there are some places are ok other

places mmm take me off that list I don't

want to go there once again these things

are being written down so whoever is

helping me through my crisis will be

able to see these things again help from

others let's think about it there's

times when things happen that just

happen okay are you prepared is there

someone around you that you might be

able to get up there and say go get my

checkbook

and come and you can write out a cheque

for me and I can sign it or is it to the

point where I can't do that and

financially this person would be able to

do it for you knowing that I will get

pay them back

think about these things these are real

important how about the person that's

coming to straighten up your house you

have things the way you like them I

don't want someone else coming in and

just change the whole place and then

when I'm feeling better I come down and

go oh no you know and I'm not feeling

good anymore because the whole house has

been che

used up on me but someone that's coming

in who can feed the dog the dog like

certain people we have to and then again

who's that person the next thing is

signs that my support I don't need those

supports anymore

this start no less I'm getting better

yeah how do I now I need to tell the

people okay I'm getting better so I can

tell who who and who

this is how I look when I'm getting

better remember before how do I look

when I get better so they can start

pulling back so let's move into post

crisis planning healing I'm starting to

heal yay and but you have a few

lingering symptoms still going on here

but I can create a time table for myself

now to say this is what I need to do

while I'm healing here maybe between the

doctor and I I can go into work

part-time maybe I can take that long

walk I'm not walking for before I was

walking for two hours now I can least

take a walk up the block and back I'm

giving myself a time line and this is

your wrap plan it takes work it takes

concentration it takes time guess what

we have an activity haha so we need to

do start off with our wellness toolbox

correct didn't we talk about that okay

the first step in developing our own

wellness recovery action plan is to

develop our wellness toolbox and

hopefully it's simple safe and free this

is for you I want you to remember that

the items are things you do to keep

yourself well and things that you do to

keep yourself feeling better so I was

walking around making sure everybody had

these little orange things here this is

a mini me

okay wellness recovery action plan its

LIF that you can have this is for us to

keep so let's get started here as you

notice when you see yours it will say

number one wellness toolbox but it goes

through everything we just talked about

as well so let's talk about some of the

books that Marianne Copeland had written

Mary Ellen Copeland I should say her

original book as I said started out for

mental health we have also one in

Spanish there's also you know that

you've want their own okay so the youth

have theirs we have one for vets and we

also have one for families there are

more this one for kids so Mary Ellen

Copeland has a lot of things a lot of

books that are written and she's talked

to other members that are going through

different types of situations and then

she has designed that book or that

information for what's going on with

that person or what a lot of people

where can we get the resources at here

you go and that's also in your your

paper that you have there there's even

an app now that you have so there's an

app you can go to there and also we

talked about if you wanted to get more

information on the evidence base the

last one here you can go find that but

you can go and get that information

there are workshops around that you can

check on one of the websites will tell

you where you can find a facilitator

someone can come and do a group thing

we're working on one to do for firk

where I work with family members and we

do what and it's usually for about eight

weeks that we do it some are ongoing so

that's just something for you to now

kind of see thank you

[Applause]

[Music]

you

you