1 General

1.1 ALGEE
Approach the Person, Assess and Assist with any crisis Listen non-judgmentally Give support and information Encourage the person to get appropriate professional help Encourage other supports

1.2 Mental disorders

Diagnosable illnesses Cause major changes in thinking, emotional state and behaviour Disrupt the persons ability to work and carry on their usual personal relationships

2 Depression
2.1 Major depressive episode (DSM-V)
5 or more symptoms for 2 weeks Depressed mood Loss of interest or pleasure Significant weight change/appetite change Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue Feelings of worthlessness or excessive or inappropriate guilty Diminished ability to think or concentrate, or indecisiveness Thought of death, with/without a specific plan, suicidal attempt Clinically significant distress or impairment in functioning

2.2 Symptoms of Depression

Emotions Sadness Guilt Anger Lack of emotional responsiveness Helplessness hopelessness Cognitions Frequent self-criticism Pessimism Impaired memory & concentration Indecisiveness & confusion Tendency to believe others see you in a negative light Thoughts of death & suicide Behaviors Crying spells

 Withdrawal from others Neglect of responsibilities Loss of interest in personal appearance Loss of motivation Drug use and alcohol use Physiological reactions Chronic fatigue Change in sleep pattern Change in appetite Constipation Weight change Irregular menstrual cycle Loss of sexual desire Unexplained aches & pains

2.3 Suicide
SAD Persons B Sex: Male > Female 4 times Age: old age Depression: yes Previous attempt: more likely to attempt in future Ethanol: substance abuse Rational Thoughts: Psychotic Social network: less social support Organized Plan: yes No spouse: yes Sickness: Chronic physical sickness Background: significant other suicide

2.4 Action 1: Assessment

Identify the risk (3 questions you MUST ask) Have you decided HOW you would kill yourself? Have you decided WHEN you would do it? Have you taken ANY STEPS to secure the things you would need to carry out your plan? Ask open-ended question non-judgmental address emotion

2.4.1 Signs a person may be suicidal Behavioral Threatening to hurt or kill themselves Look for ways to kill themselves Giving away possessions or putting affairs in order Written or spoken notice of intention to commit suicide

 Irrational or bizarre behaviour A dramatic change in personality or appearance Having difficulty in concentration Increase alcohol or drug use Withdrawn from friends, family or society A severe drop in school or work performance Physical Tiredness Unable to sleep or sleeping all the time Changed eating or sleeping habits Affective An overwhelming sense of shame or guilt Rage, anger, seeking revenge Felling trapped, like there is no way out Drastic changes in mood (feel good suddenly) Thoughts Thinking about death, dying and suicide Expressions of hopelessness or helplessness No reason for living, no sense of purpose in life A lack of interest in the future 2.4.2 In high risk situations Keep yourself safe Keep the person in company Try to stop further alcohol intake/substance use Try to ensure that the person cannot easily access to tools that can hurt himself/herself Encourage the person to express his/her feelings. Be patient and respectful. Do not invalidate his/her feelings Seek professional help

2.5 Action 2: Listen Non-judgmentally

Attitude Respect: respect the persons value and experience Genuineness Be consistent Empathy Put yourself in the persons shoes Donts Dont deny feelings Dont try to give glib advice Cheer up, Dont be unhappy Pull yourself together are not useful Avoid confrontation, except in high-risk situation Dos Show your concern to the person Ask questions Mirroring: keep appropriate pacing and volume, reflect to the person what you perceived You are NOT listening to me when You say your understand

 You say you have an answer to my problem, before Ive finished telling you my problem You cut me off before Ive finished speaking You finish my sentences for me You are dying to tell me something You tell me about your experiences, making mine seem unimportant You refuse my thanks by saying you really havent done anything Non-verbal communication Be patient Keep appropriate eye contact Open gesture If the person is standing, try to encourage the person to sit down to reduce the feeling of being threatened Sit next to the person instead of sitting opposite to the person Accept silence (if too long, ask what are you thinking now?)

2.6 Action 3: Give support and Information

No blame Depression is a real health problem Depression is a common illness Realistic expectations Depression is not a weakness or character defect Depression is not laziness Practical support Instill hope Effective help and treatments are available

2.7 Action 4: Encourage the person with depression to get appropriate professional help
Clinical psychologists Counselors Social workers Psychiatrists

2.8 Action 5: Encourage other supports

What helps for depression Antidepressants Electroconvulsive therapy Cognitive behaviour therapy (CBT)

http://www.depression.edu.hk/

3 Anxiety
Physical Cardiovascular: palpitations, chest pain, rapid heartbeat, flushing Respiratory: hyperventilation, shortness of breath

 Neurological: dizziness, headache, sweating, tingling and numbness Gastrointestinal: choking, dry mouth, nausea, vomiting, diarrhoea Musculoskeletal: muscle aches and pains (neck, shoulders), restlessness, tremor and shaking Psychological Unrealistic and/or excessive fear and worry (about past or future events) Mind racing or going blank Decreased concentration and memory Indecisiveness Irritability Impatience Anger Confusion Restlessness or feeling on edge or nervousness Tiredness Sleep disturbances Vivid dreams Behavioral Avoidance of situations Obsessive or compulsive behaviour, distress in social situations, phobic behaviour

3.1 Action 1: approach, assess and assist

People with anxiety disorders have a higher risk of suicide, particularly if they also have depression Highly anxious state (panic attack): crisis first aid for panic attacks

Symptoms of a Panic Attach Increased awareness of heart beat Sweating Trembling or shaking Feeling of choking, shortness of breath or smothering Chest pain or discomfort Nausea or abdominal distress Feeling of unreality or feeling detached from oneself or from the surroundings Feeling dizzy, unsteady, light-headed or faint Numbness or tingling sensation Chills or hot flushes Fear of losing control or going crazy Fear of dying Crisis First Aid for Panic Attacks If you are unsure if it is a panic attack, a heart attack or an asthma attack, call an ambulance If you are sure it is a panic attack, move the person to a quiet and safe place Help to calm the person by encouraging slow, deep and relaxed breathing Be a good listener, without judging Explain they are having a panic attack and it is not life threatening Explain that the attack will soon stop and they will recover

 Assure the person someone will stay with them and keep them safe until the attack stops Whatever type of attack it is, the first aid for a conscious person, is to keep them as calm as possible with slow, deep breathing Assist after a Panic Attack 1. Not everyone who has a panic attack needs professional help; usually they can calm down in 10~20 minutes 2. Explain that if panic attacks recur and causes them distress, they should seek professional help 3. Reassure the person that effective help is available 4. Ensure that the person know where help can be accessed

Crisis first aid for acute stress reaction Ensure safety and protection Accommodate immediate needs Legal considerations for assault or abusive situations Keep them accompanied Let people tell their story if they wish but do not push them to do so Be a patient and sympathetic listener and dont give a lot of advice Encourage regular routines and proper rests Advise the person not to use alcohol or drugs to cope If the stress reaction persists for more than a month, encourage person to seek professional help

3.2 Action 2: listen non-judgmentally

Attitudes Accept the person exactly as they are Make no moral judgment about the situation Verbal skills Listen to feelings and distress Dont interrupt Minimal prompts and long pauses are OK Keep simple Check you understand what is said restate, clarify Summarize facts and feelings Non-verbal skills (body language) Be attentive and allow silence Keep eye contact comfortable Open body, not directly opposite

3.3 Action 3: Give support and information

Set realistic expectations Show understandings Provide practical support Provide information on resources for treatment Dont encourage the person to avoid the things that provoke anxiety

Anxiety is a real medical condition An anxiety disorder is a common illness An anxiety disorder is not a weakness or character defect Effective help and treatments are available Skills can be learned to reduce anxiety Anxiety can be unpleasant but rarely harmful

3.4 Action 4: Encourage the person with depression to get appropriate professional help
Clinical psychologists Counselors Social workers Psychiatrists

3.5 Action 5: Encourage other supports

What helps for anxiety CBT self-help books Relaxation training Physical exercise

4 Substance Misuse
Substances of abuse Tobacco Marijuana Amphetamines Ecstasy Heroin

Five Important Concepts Intoxication Dependence Tolerance Withdrawal Disabling

4.1 Action 1: approach, assess and assist

How to help if a person has overdosed 1. The person is unconscious 1.1. Keep persons airway clear

1.2. Phone 999 for an ambulance 1.3. Try to find out what substances have been used 1.4. Keep the person warm 2. The person is conscious 2.1. Call 999 2.2. Do not give the person any food or fluids unless told to by a health professional 2.3. Reassure the person 2.4. Try to find out what substances have been used 2.5. Keep the person warm

4.2 Action 2: Listen Non-judgmentally

Listen without judging the person as bad or immoral Do not be critical of the person Dont give glib advice Avoid confrontation Do not argue with the person Try not to express frustration with the person

4.3 Action 3: Give support and Information

Tell the person you want to help them Substance use disorder is a real medical condition It is a common illness There are positives and negatives of SUDs Programs are available to help deal with SUDs Often depressive and anxiety disorders underlie SUDs and can be treated

4.4 Action 4: Encourage the person with depression to get appropriate professional help
GPs Drug and alcohol specialists

4.5 Action 5: Encourage other supports