Wellness Self Management Workbook 635l2m

Personal Workbook

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Wellness Self-Management Personal Workbook Developed by The New York State Office of Mental Health (NYSOMH) & The Urban Institute for Behavioral Health (UIBH)

Workbook Development Team Anthony Salerno, Ph.D. (Chairperson), Co-Director, Evidence-Based Practices Initiative, NYSOMH Paul Margolies, Ph.D., Director of Rehabilitation Services, Hudson River Psychiatric Center, NYSOMH Andrew Cleek, Psy.D., Director, UIBH

© New York State Office of Mental Health, 2008, 2nd edition. All rights reserved.

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Wellness Self-Management

ACKNOWLEDGEMENTS The Wellness Self-Management (WSM) Personal Workbook was created as a t effort between the New York State Office of Mental Health (NYSOMH) and the Urban Institute for Behavioral Health (UIBH). The initial development of the WSM Personal Workbook was made possible through the provided by Sharon Carpinello, R.N., Ph.D., former NYSOMH Commissioner. Its continued development, finalization and dissemination have been made possible by the active leadership of Michael Hogan, Ph.D., NYSOMH Commissioner. The Workbook Development Team is grateful for the efforts of Sheetal Rayancha, UIBH istrative assistant, whose help with the initial draft of this Workbook was indispensable. We also give special thanks to Robyn Katz, former Director of the Bureau of Adult Community Services, for her extensive editing of the initial draft. Appreciation is also extended to the following individuals for their contributions: Peter Beitchman, D.S.W., Executive Director, The Bridge, Inc. Peter C. Camli, Psy.D., President & CEO, The Institute for Community Living, Inc. (ICL) Cathy Cave, L.C.S.W., Director of Cultural Competence, NYSOMH Amy Colesante, Office of Recipient Affairs, NYSOMH Rosa M. Gil, D.S.W., President & CEO, Comuni­ life, Inc. Sharon Gold, L.C.S.W., Director of Continuing Day Treatment, The Bridge, Inc. Chris Keane, F.N.P., ICL Harvey Lieberman, Ph.D., Consultant to ICL Benjamin R. Sher, M.A., L.M.S.W., Director of Training, ICL Tony Trahan, Office of Recipient Affairs, NYSOMH

Caren Weingart, L.C.S.W., Clinical Supervisor, The Postgraduate Center for Mental Health This Workbook has been piloted at ten agencies d with UIBH and at Hudson River Psychiatric Center in Poughkeepsie, New York. The Workbook has been shaped by provided by the consumers, staff and leaders of these organizations. Without their efforts, the Workbook could not have been developed. The Workbook includes material that has been reprinted or modified with permission from: OMH Office of Recipient Affairs. (2005). Recommendations: Infusing Recovery Principles in the Illness Management & Recovery Resource Toolkit. Albany: New York State Office of Mental Health Ryan, S.W., Littrell, K.H., Sowers, C., & Peabody, D.D. (2003). Solutions for Wellness (2nd ed.) (© Eli Lilly and Company). Available at www.treatmentteam.com Weiden, P.J., Scheifler, P.L., Johnson McCrary, K. et al. (2003). Team Solutions (3rd ed). (© Eli Lilly and Company). Available at www.treatmentteam. com This Workbook also includes material reprinted or modified from sources in the public domain. These include: Mueser, K., and Gingerich, S. (2003). Illness Management & Recovery Implementation Resource Kit. Washington, DC: United States Department of Health and Human Services, Substance Abuse and Mental Health Services istration. Available at http://.ncadi.samhsa.gov/ ken/pdf/toolkits/ illness/ 02.IMR_s.pdf Onken, S., and Dumont, J. (2002). Mental Health Recovery: What Helps and What Hinders? A National Research Project for the Development of Recovery Facilitating System Performance Indicators. Alexandria, VA: National Technical Assistance Center for State Mental Health Planning.

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The Workbook represents an adaptation of existing open-source reports and educational materials, as well as considerable new material created by the Workbook Development Team. Adaptations generally involved changes in language, format, sequencing of topics and organization of lessons. Furthermore, the Workbook was designed to reflect the principles of recovery, recognize the role of cultural and religious values, highlight the connection between mental and physical health and address the challenges of providing WSM services in a group modality. Most notably, we are indebted to the work of Kim Mueser, Ph.D., and Susan Gingerich, M.S.W., who developed the comprehensive Illness Management and Recovery (IMR) practice and related resource kit. The WSM Workbook incorporates many of the topic areas from the IMR resource kit. In addition, the IMR emphasis on a comprehensive curriculum and key clinical practice competencies, such as motivational, educational and cognitive behavioral approaches, served as the conceptual foundation for the WSM Workbook and related training materials. The Workbook development team was also influenced by the Psychiatric Rehabilitation approach

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developed by Dr. William Anthony and colleagues at Boston University. An adaptation of the ROPES teaching technique forms the foundation for the format utilized in the Workbook’s lessons. We are grateful for the contributions of the participants in the Illness Management and Recovery dissemination project, which received from NYSOMH and the Substance Abuse and Mental Health Services istration and funds from the Robert Wood Johnson Foundation. Participants’ work and heavily influenced the development of this Workbook. Additionally, we appreciate the thoughtful and constructive of the of several focus groups who reviewed these materials as they were developed. We also wish to acknowledge the contribution of Eli Lilly and Company, which developed the Solutions for Wellness and Team Solutions educational materials, disseminated through the University of Medicine and Dentistry of New Jersey. Some of the material was directly incorporated into the Workbook, and the development of new material was guided by the simplicity and clarity of language of the Lilly material.

Please note: No person or agency may reproduce, reprint or distribute the WSM Workbook without the prior written approval of the New York State Office of Mental Health. Requests for approval should be directed to [email protected]

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WELCOME! Congratulations on your decision to take more control over your life! As current and former recipients of services, we know it takes a lot of courage and hard work to make changes. The effects of mental illness can make even the simplest of tasks seem very difficult and drain us of our energy and resources. However, as you will learn in the first chapter, everyone can recover from mental illness and you are in control of your own recovery. You are the expert on yourself and no one can tell you what your path to recovery will look like. You will have to decide what works for you and what doesn’t. Your Workbook is designed to help you with these decisions. For many of us traditional treatment has been only a part of our recovery. To get the most out of this program, we encourage you to develop real, authentic relationships by listening to and learning from people in your group and from others; to share your experiences with your peers; to co-lead the group; to find a buddy and to follow through on your Action Steps. Real life happens outside of the clinic and your Action Steps will help to make it real for you. You are about to start on an adventure. What you do now will determine who you will become. We wish you well on the journey, The Bureau of Recipient Affairs New York State Office of Mental Health

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WELLNESS SELF-MANAGEMENT (WSM)   PERSONAL WORKBOOK

Table of Contents Introduction Topic 1: What Is Wellness Self-Management (WSM) and How Can It Be Helpful to You? Lesson 01 Wellness Self-Management Program Overview. . . . . . . . . . . . . . . . . . . 8 Lesson 02 WSM: Important Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Topic 2: Getting the Most Out of the WSM Program Lesson 03 What Is Your Role in the Program?. . . . . . . . . . . . . . . . . . . . . . . . . 14 Lesson 04 Understanding Positive and Negative Thinking . . . . . . . . . . . . . . . . . . . 17 Lesson 05 Getting to Know Each Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

C h a p t e r 1 : R e c o v e r y Topic 1: What Is Recovery? Lesson 06 Visions of Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Topic 2: Setting Goals Helps Recovery Lesson 07 Exploring Your Personal Life Goals. . . . . . . . . . . . . . . . . . . . . . . . . 24 Lesson 08 Understanding Barriers that Get in the Way of Achieving Goals. . . . . . . . . 27 Lesson 09 Using Strategies to Overcome Barriers that Get in the Way of Achieving Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Topic 3: Understanding What Helps and What Hinders Recovery Lesson 10 What Helps Recovery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Lesson 11 What Hinders Recovery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Lesson 12 Choosing Your Own Recovery Strategies. . . . . . . . . . . . . . . . . . . . . . 40 Topic 4: Your Cultural Background and the WSM Program Lesson 13 How Your Cultural, Religious and Family Background Affects the Decisions You Make about Mental Health Treatment. . . . . . . . . . . . . . . 44 Topic 5: Personal Strengths and Outside Resources Help Recovery Lesson 14 Recognizing and Using Your Personal Strengths. . . . . . . . . . . . . . . . . . 48 Lesson 15 Recognizing and Using Your Cultural and Community Resources . . . . . . . . 52 Topic 6: Social, Cultural, and Community s Help Recovery Lesson 16 Social s Help Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Lesson 17 Using Self-Help and Peer . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Lesson 18 Connecting to Your Community . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Lesson 19 Meeting New People. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Lesson 20 Getting Closer to People. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

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C h a p t e r 2 : M e n t a l H e a l t h W e l l n e s s   and Relapse Prevention Topic 1: Practical Facts about Mental Health and Mental Illness Lesson 21 Introduction to Practical Facts about Mental Health and Mental Illness . . . . 69 Lesson 22 Symptoms of Mental Illness—Part I. . . . . . . . . . . . . . . . . . . . . . . . . 71 Lesson 23 Symptoms of Mental Illness—Part II . . . . . . . . . . . . . . . . . . . . . . . . 75 Lesson 24 How Is Mental Illness Diagnosed? . . . . . . . . . . . . . . . . . . . . . . . . . 79 Lesson 25 Understanding the Causes of Mental Illness. . . . . . . . . . . . . . . . . . . . 83 Lesson 26 Coping with the Stigma of Having a Mental Illness Diagnosis. . . . . . . . . . 87 Topic 2: Coping with Stress and Symptoms Lesson 27 What Is Stress? Why Is It Important to You? . . . . . . . . . . . . . . . . . . . 91 Lesson 28 Identifying Your Personal Signs of Stress. . . . . . . . . . . . . . . . . . . . . . 95 Lesson 29 How to Prevent Stress in the First Place. . . . . . . . . . . . . . . . . . . . . . 98 Lesson 30 Coping with Stress: What Works? What Doesn’t?. . . . . . . . . . . . . . . . . 101 Lesson 31 Using a Step-by-Step Formula to Improve a Problem. . . . . . . . . . . . . . . 106 Lesson 32 Thoughtfully Choosing a Mental Health Problem to Work On . . . . . . . . . 109 Lesson 33 Choosing Strategies for Coping with Specific Problems and Symptoms. . . . . 112 Lesson 34 Checking on Your Progress in the WSM Program. . . . . . . . . . . . . . . . . 120 Topic 3: Making Treatment and Mental Health Services Work for You Lesson 35 Choosing Types of Mental Health Services that Are Right for You . . . . . . . 123 Lesson 36 Practical Facts about Medication. . . . . . . . . . . . . . . . . . . . . . . . . . 128 Lesson 37 Understanding Side Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Lesson 38 Coping with Side Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Lesson 39 Using Medication Effectively . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Lesson 40 Working Effectively with Your Doctor. . . . . . . . . . . . . . . . . . . . . . . 142 Topic 4: R elapse Prevention: Developing and Using Your Wellness Self-Management Plan Lesson 41 Relapse Prevention: What Is It? Why Is It Important to You?. . . . . . . . . . 145 Lesson 42 Understanding Your Personal Triggers for Relapse . . . . . . . . . . . . . . . . 148 Lesson 43 Knowing Your Early Warning Signs. . . . . . . . . . . . . . . . . . . . . . . . . 150 Lesson 44 Completing Your WSM Plan: Relapse Prevention. . . . . . . . . . . . . . . . . 154 Lesson 45 Completing Your WSM Plan: Managing a Relapse. . . . . . . . . . . . . . . . 156

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C h a p t e r : 3 L i v i n g a H e a l t h y L i f e s t y l e a n d   Mental Health Recovery Topic 1: What Is a Healthy Lifestyle and Why Is It Important? Lesson 46 What is the Connection between a Healthy Lifestyle and Mental Health Recovery?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Topic 2: Using Physical Healthcare Services to Stay Healthy Lesson 47 Identifying and Using Your Healthcare Resources. . . . . . . . . . . . . . . . . 162 Lesson 48 Getting Help for Your Physical Health Problems . . . . . . . . . . . . . . . . . 166 Lesson 49 Understanding the Most Common Serious Physical Health Problems. . . . . . 169 Topic 3: Exercising: Fun, Health and Fitness Lesson 50 Exercise and Mental Health Recovery . . . . . . . . . . . . . . . . . . . . . . . 172 Topic 4: Healthy Food and Nutrition: Practical Tips Lesson 51 Learning Healthier Eating Habits and Mental Health . . . . . . . . . . . . . . 175 Topic 5: Avoiding and Reducing Unhealthy and Dangerous Activities Lesson 52 Understanding How Smoking, Alcohol, Drugs and Unsafe Sex May Hurt Your Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Lesson 53 Understanding Pros and Cons: Deciding if Smoking, Alcohol, Drugs and Unsafe Sex is a Problem. . . . . . . . . . . . . . . . . . . . . . . . . 181 Lesson 54 Making a Decision to Change Unhealthy and Dangerous Activities. . . . . . . 184

WSM Wrap-Up Topic 1: Wellness Self-Management Plan Lesson 55 My Wellness Self-Management Plan. . . . . . . . . . . . . . . . . . . . . . . . 188 Topic 2: Review of What Has Been Learned Lesson 56 Endings and New Beginnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Lesson 57 What Have I Learned? How Has It Affected My Life? . . . . . . . . . . . . . . 194 Appendix A: Quality of Life Progress Checklist. . . . . . . . . . . . . . . . . . . . . . . . 197

Good News “Long-term studies have consistently found that half to two-thirds of people diagnosed with major mental illness go on to a significant or complete recovery. Data show that even in the second or third decade, a person can still go on to a complete recovery. I believe you can be one of the ones to recover.” Patricia Deegan, Ph.D. Presentation: “I Don’t Think It Was My Treatment Plan That Made Me Well”: Self-Directed Recovery and the Role of the Mental Health Professional, 2005

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I nt r od u ction WELLNESS SELF-MANAGEMENT (WSM) PROGRAM OVERVIEW LESSON 01 I M P O R TA N T I N F O R M AT I O N

• Wellness Self-Management (WSM) is a program for people who have had experiences with mental health problems that have resulted in disappointments in life. People who participate in this program are looking to improve their success and satisfaction in important areas of life. • Throughout this Workbook, you will see the word RECOVERY. This word is often used to mean overcoming drug and alcohol problems. In this Workbook, you will learn that the word RECOVERY means something different when applied to mental health problems. • As human beings we are all involved in managing our mental and physical well-being. Handling stress, solving problems, getting along with others, coping with disappointments and keeping a balanced life are part of everyone’s day-to-day challenges. • It’s important that we don’t spend too much time and energy managing our mental and physical health. If we do, then there is not much time and energy left to accomplish goals and enjoy life. • Learning how to manage mental health problems frees up time and energy to pursue goals and enjoy life. • For some people, managing mental health problems and trying to stay healthy take up a lot of time and energy. In fact, a person’s mental health problems could become the center of his or her life. A person may for-

get that he or she is a person with goals, values, strengths, needs, dreams, desires and talents. Instead, a person may think of him or herself as a mentally ill person first and foremost. • Sometimes, the mental health system may focus too much on a person’s mental health problems and not pay enough attention to the person’s wants and goals. • In the WSM Program, the focus is on you as a complete person first and foremost. • Many of the topics in the WSM Program are based on research findings. These findings show that learning about these topics and applying what is learned can make a difference in people’s lives.

The eight goals of the Wellness SelfManagement Program • Learning about recovery and what it can mean for you • Making the best use of your mental and physical health services • Learning how mental health and physical wellness will help you to achieve your goals and your personal recovery • Staying well by decreasing symptoms of a mental health problem • Learning how to manage day-to-day stress and prevent relapse • Staying well by connecting with others.

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• Staying well by living a healthy lifestyle • Recognizing and building on your cultural values and experiences to your personal recovery. Wellness Self-Management can be used in individual or group meetings. These meetings happen at least once a week and usually last at least 30 minutes.

How this Workbook is organized The Workbook has 57 brief lessons that are divided by topic area into three major chapters: • Chapter 1: Recovery

Each of the 57 lessons in the Workbook is divided into three parts: • Important Information: The first section of each lesson introduces the topic and the key facts for thought and discussion. • Personalized Worksheet: The worksheet helps you think in more detail about the information and apply it to yourself and to your own life. • Action Step: The Action Step box asks you to write down a small step to take that will help you learn more about the topic area or apply it in your own life.

• Chapter 2: Mental Health Wellness and Relapse Prevention • Chapter 3: Living a Healthy Lifestyle and Mental Health Recovery

Ve r y I m p o r t a n t P o i n t ! WSM is a program that covers many different topics. Some of the topics will be very important to you. You may want to discuss these topics in greater detail than the WSM group can offer. Bringing these topics up in meetings with other mental health professionals may help you get the most out of the WSM program.

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P E R S O N A L I Z E D W O R K S H E E T: Choosing goals important for you Here are the eight goals of the WSM Program. Please check the boxes next to the goals that are important for you. It is OK to check as many goals as you like: o Learning about recovery and what it can mean for you o Making the best use of your mental and physical health services o Learning how mental health and physical wellness will help you to achieve your goals and your personal recovery o Staying well by decreasing symptoms of a mental health problem o Learning how to manage day-to-day stress and prevent relapse o Staying well by connecting with others o Staying well by living a healthy lifestyle o Recognizing and building on your cultural values and experiences to your personal recovery.

Discussion Point: How would accomplishing any of these goals make a difference in your life?

“Forget past mistakes. Forget failures. Forget everything except what you’re going to do now and do it.” —William Durant, American philosopher

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WSM IMPORTANT POINTS LESSON 02 I M P O R TA N T I N F O R M AT I O N What Wellness self-management is about Building on your personal strengths

• Personal strengths are your skills, knowledge, talents, interests, intelligence, values, personal qualities and physical characteristics that you can build on to help your recovery. • In WSM you learn how to use your personal strengths to your recovery.

Making informed decisions

• In WSM you learn information that may help you make decisions that work for you.

How your cultural background affects your recovery

• Your family background, religious upbringing, life experiences and the language that you speak may have an effect on how you experience and deal with mental and physical health problems. • Understanding the connection between your cultural background and the WSM program will help you make decisions that work for you.

Overcoming negative thinking

• It is very common for people to hold beliefs and ideas that stop them from taking steps to improve the quality of their lives. • In the WSM program, you will have opportunities to identify and change ideas and beliefs that may be holding you back.

Taking small Action Steps • The WSM Program is designed to help individuals take small steps that may result in important changes. • Taking small steps can often make a big difference in a person’s life. • In this program, you choose which steps you want to take. • Some topic areas will be more important to you than others. However, the more steps you take, no matter how small, the more you will get out of the program. • Having an action plan will increase the chances that you will follow through on taking a step that will your recovery. • Some Action Steps help you continue your learning between group meetings.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking more about Action Steps Below is a long list of possible Action Steps you may choose to take as you participate in the WSM Program. Check the steps that apply to you. If you decide to complete an Action Step after a lesson in the WSM Program, this menu may help you decide which Action Step to try.

MENU OF ACTION STEPS When your Action Step is to better or find out more about the topic in the WSM Program

I’m interested in trying this kind of Action Step

Read written materials related to the topic. Re-read the Workbook material on your own. Find out more about the topic through the internet. Talk to a professional person (case manager, counselor, psychiatrist, nurse, pharmacist, etc.) to learn more about the topic. Talk to a family member or friend to get his or her opinion about the topic. Talk to a peer (someone who is also working on their mental health problems) about his or her experiences and opinions. Talk to a pastor, priest, rabbi or other spiritual counselor in your community to learn more about the topic.

When your Action Step is to practice something you learned in the WSM Program

I’m interested in trying this kind of Action Step

Ask someone you trust to you in practicing a new skill. Pick a time and place where you can practice your new skill without distractions. Write down the steps of the skill and carry the steps with you to read before you try it out.

When your Action Step is to express your thoughts and feelings about the topic in the WSM Program Express your thoughts and feelings about the topic through creative activities such as writing a poem or an essay, drawing a picture, playing a song that relates to the topic, etc.

I’m interested in trying this kind of Action Step

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When your Action Step involves getting from others

I’m interested in trying this kind of Action Step

Talk to one or more people you trust about your involvement in the WSM program. Invite them to learn about the program and let them know how they can be helpful.

When your Action Step involves connecting with resources in your community

I’m interested in trying this kind of Action Step

Make a phone call to set up a meeting. Ask someone to you in visiting community resources, such as self-help and advocacy groups, cultural programs, educational programs, religious or spiritual groups, social clubs or other groups in your community.

When your Action Step is to practice leadership

I’m interested in trying this kind of Action Step

During the WSM group, you may be offered an opportunity to lead or co-lead a lesson of interest. You would meet with the WSM group leader and work out a plan to lead one or more of the lessons in the WSM Program.

Discussion Point: What Action Steps are you most interested in trying?

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WHAT IS YOUR ROLE IN THE PROGRAM? LESSON 03 I M P O R TA N T I N F O R M AT I O N This lesson focuses on ways to get the most out of the WSM Program. Some ways to do so are described below. Be an active participant.

• You can do a number of things to get the most out of this program. – Take your participation very seriously. – Attend scheduled group meetings. – Follow your program’s policy for learning the material if you miss a group. Depending on the program, this may include attending a make-up group, covering the material in an individual session, reviewing the material with another group member or reviewing the material on your own. – Complete the Action Steps at the end of each lesson. It isn’t enough to learn something in the group. It is important to take what you have learned and then use it in real life. The more Action Steps that you complete, the more that you will learn. – Think about how your cultural values and beliefs influence what you are learning.

Learn from each other.

• WSM group have an opportunity to learn from each other. • Group have a great deal of knowledge and experience to share that adds a lot to the information printed in the Workbook.

Follow the ground rules. • For everybody to benefit from the group, ground rules are needed. • Ground rules allow everybody to feel safe and learn together. • Some common ground rules are listed here. Your group may want to make additional ground rules. – Treat people with respect. – One person speaks at a time. – Stay on topic. – What is said in here stays in here. Choose to practice leadership in the WSM group.

• In many WSM groups, you may be offered a chance to be the group leader for a lesson of interest to you. Usually, two group choose a topic that they are interested in leading. The group leader meets with these and s them in planning a lesson.

Involve others.

• Most people accomplish important things in life with from others. Research has shown that getting from people you trust, such as family , friends or peers who are also dealing with mental health problems, may help your recovery. • You may want to invite at least one important person in your life to your work in this program. What kind of you want is up to you to decide. Per-

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haps you just want others to know about the positive steps you’re taking to improve your life. • Here are some ways a person can be a : – Reading the Workbook with you – Helping with your Action Steps – Giving you encouragement to stick to the program – Asking about your progress from time to time. NOTE: In some programs, your group leader or another mental health professional may be able to talk to the person you want involved

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over the phone or in person. The group leader may be able to provide: • Information about the WSM Program and answers to questions about the program • Ideas on how this person might be a to you in the WSM Program • Information about resources in the community that may be of value to this person. If you would like the group leader to meet with or speak directly to the person that you want involved, please arrange to discuss this with your group leader. In many programs, a brief WSM brochure is provided as a way of explaining the program to others.

P E R S O N A L I Z E D W O R K S H E E T: Choosing and inviting others to you in the WSM Program In this worksheet, you may want to write down the name of one person you are thinking about inviting to you in the WSM Program. You may also think about how you want that person to help. The person that you choose to invite may be a relative or friend or a peer who is also involved with mental health services. Please write the name of one person you would like to invite to your work in the WSM Program. Then, check all the ways that you might want the person to you in the program. The person I want to invite is_______________________________________________________ I would like this person to me in the following way(s): o Reading the Workbook with me o Helping with my Action Steps o Giving me encouragement to stick to the program o Asking me about my progress from time to time o I just want this person to know I’m involved in the WSM Program o Other ways:_________________________________________________________________ .

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A ction S tep : Invite a person to you If you have decided to invite a person to your work in the WSM Program, please talk to that him or her. You may want to tell this person about your involvement in this program, the goals that are important to you and how accomplishing these goals will make a difference in your life. Many programs will provide you with a brochure explaining the WSM Program and/or a copy of the Workbook to give to the invited person. Who will you ask?______________________________________________________________ When will you ask?____________________________________________________________ Where will you ask?____________________________________________________________ What information will you give? o o o o

The WSM brochure A complete copy of the WSM Workbook I’ll share my copy of the WSM Workbook I’ll explain it in my own words

What might keep you from completing this Action Step?__________________________ How will you remind yourself to do it?___________________________________________

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UNDERSTANDING POSITIVE AND NEGATIVE THINKING LESSON 04 I M P O R TA N T I N F O R M AT I O N • The way we think affects the way we feel and act. Our thoughts come from our life experiences and how we make sense of these experiences. There is usually more than one way to understand the things we experience. Some ways of thinking may move us forward in life. We refer to these as positive thoughts. • Negative thoughts, however, may get in the way. These negative thoughts make us feel bad, bring us down and stop us from taking steps to improve our lives. The big problem with negative thoughts is that we often accept them as true even when they’re not. • This lesson gives us an opportunity to figure out: – What kinds of negative thoughts might be getting in the way of moving forward. – How to replace negative thoughts with thoughts that are positive and real and that move us forward in life.

Why is changing negative thinking important? • Sometimes we accept some ideas and beliefs as true even though we haven’t looked at them very closely. • It’s common for people who have had disappointments in life due to mental health problems and other problems to get stuck on negative thinking. This may get in the way of recovery.

• It may be especially helpful to pay attention to thoughts that lead to feelings of guilt, shame, hopelessness, anger and fear. • Thoughts that lead to these feelings can keep us from taking steps to improve our lives. • When we act on negative thoughts, we are more likely to make poor decisions.

Why is positive thinking important? • People who focus on the positive are more likely to accomplish their goals. • Positive thinking is important because it helps people work through difficult times. • Positive thinking builds a person’s confidence and motivation even when the going gets tough. • When people focus on the positive they are more likely to take the steps that will lead to more success and satisfaction.

How do we overcome negative thinking? The 3 Question Test A good start to overcoming negative thinking is to be aware of your thoughts. Take a close look at your thoughts and apply the 3 Question Test. • Question 1: Are these thoughts really true?

• Question 2: Are they helping me or holding me back? • Question 3: What other things could I say to myself (positive thoughts) that would be closer to the truth and helpful?

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about negative thoughts that could get in the way of your recovery Below is a list of common negative thoughts. These negative thoughts are beliefs and ideas that may get in the way of recovery. These ideas and beliefs may seem true at first. But when you examine them more closely you may find that they are not so true. In fact, holding on to these beliefs as true may be one of the most important barriers to your personal recovery. As you read the list of negative thoughts, check off those that you believe are true. Examples of common negative thoughts o I can’t do this. I’m different from people without mental health problems. o Recovery is for other people, not for me. o I can’t change who I am. o I can’t trust anyone. Don’t be real with others; they’ll use it against you. o I’m to blame for the problems I have, I don’t deserve to succeed. o Normal people wouldn’t want to get to know me. o I’m too sick to work or go to school or live on my own. o I don’t have mental health problems so I can’t get anything out of mental health services. o The worst thing is having people not like me. o I should never try something new unless I know I will succeed. o There’s not much I like about myself so people aren’t going to like me. o Failing is the worst possible thing. o Taking small steps is a waste of time. o If I can’t do it perfectly, then it’s not worth doing. o There’s no way I can learn to manage my stress and symptoms. o Better not to learn about my mental health issues. It will just depress me. o There’s no way I will be able to reduce drinking or taking street drugs. I’ve got no will power. o Nobody really cares about me. This is all a waste of time.

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Discussion Points Which statements did you check?

Are any of the statements you checked something you would like to change? What feelings seem to go along with some of these thoughts?

A ction S tep : Choose a negative thought that you most want to change Negative thought that I want to change is:_______________________________________ ______________________________________________________________________________ What feelings go along with this thought?_______________________________________ ______________________________________________________________________________ Take some time to examine this thought very closely with a friend, family member, counselor or your WSM group. ______________________________________________________________________________ Put your thought to the 3 Question Test: Question 1: Is this thought really true? ______________________________________________________________________________ Question 2: Is this thought moving me forward or holding me back? ______________________________________________________________________________ Question 3: What other things could I say to myself (positive thoughts) that would be closer to the truth and helpful? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

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GETTING TO KNOW EACH OTHER LESSON 05 I M P O R TA N T I N F O R M AT I O N • Getting to know each other is one of the most important ways to benefit from the Wellness Self-Management Program. • The more we get to know each other the more we can each other’s efforts toward recovery.

• It’s important to follow the ground rules so that people feel safe and trust each other. • Many different things influence who we are. They include:

• Getting to know each other takes time.

– Our personal experiences – Our cultural background.

• We get to know each other by sharing our thoughts and feelings and by how we behave with one another.

P E R S O N A L I Z E D W O R K S H E E T: Thinking about personal experiences, beliefs and traditions The questions below relate to your personal experiences and your cultural background. Answer at least one question you feel comfortable sharing with the group. It’s OK to decide not to share your answers to any of these questions. Perhaps there is something you want to share with the group that is not on the list of questions below. That would also be OK. The choice is yours. What important values, beliefs, and traditions did you grow up with? _________________________________________________________________________________ What role does religion/spirituality play in your life? _________________________________________________________________________________ _________________________________________________________________________________ In what way does religion/spirituality play a role in your mental health wellness? _________________________________________________________________________________ _________________________________________________________________________________ What language do you speak? (At home? At work? With friends?) ________________________

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Describe the neighborhood you live in_ ______________________________________________ _________________________________________________________________________________ Describe one important memory of growing up in your family? _ ________________________ _________________________________________________________________________________ What beliefs and traditions are important to you now? _________________________________ _________________________________________________________________________________ Are there family who are helpful to you in your recovery? ______________________ _________________________________________________________________________________ Where and how much schooling did you complete? ____________________________________ _________________________________________________________________________________ What do you enjoy doing? (hobbies, interests, talents, skills, etc.) ________________________ _________________________________________________________________________________ What has been your work experience? _______________________________________________ _________________________________________________________________________________ What’s most important for people to know about you?_________________________________ _________________________________________________________________________________

A ction S tep : Help the group to know you better Consider bringing in something that is important to you that will help the group get to know you better (examples: music, art, poetry, literature, photos, flags, trophies, certificates, etc.). What will you bring in?_________________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ What might keep you from completing this Action Step?__________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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C hapte r 1 : Recove r y VISIONS OF RECOVERY LESSON 06 I M P O R TA N T I N F O R M AT I O N Visions of recovery The statements below are some examples of how different people describe recovery from their own point of view. As you read them, please circle any words or phrases that mean something to you. 1. “Recovery is a process, a way of life, an attitude and a way of approaching the day’s challenges.” (Patricia Deegan) 2. “One of the elements that makes recovery possible is the regaining of one’s belief in oneself.” (Judy Chamberlin) 3. “Recovery involves hope, courage, adaptation, coping, self-esteem, confidence, a sense of control or free will.” (Andy Blanch and others) 4. “Recovery for me is having good relationships and feeling connected. It’s being able to enjoy my life.” (Anonymous) 5. “Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” (William Anthony)

6. “Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. (President’s New Freedom Commission on Mental Health) 7. “Recovery for me is a series of steps. Sometimes the steps are small, like fixing lunch, taking a walk, following my daily routine. Small steps add up.” (Anonymous) 8. “For a long time, I looked at recovery as something that was possible for others, but not for me. I didn’t believe I would ever be able to hold a job or be in a relationship. I pictured myself as someone who would have to be in and out of the hospital for the rest of my life. Now I know that it is possible because I live recovery every day. I have been out of the hospital for three years and couldn’t be happier! (Anonymous) 9. “In my family no one talked about mental illness, so I didn’t know about recovery. I didn’t know I could live better, work or have friends in my neighborhood.” (Anonymous)

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P E R S O N A L I Z E D W O R K S H E E T: Yo u r p e r s o n a l v i s i o n o f r e c o v e r y Write down the words or phrases you circled from the previous page. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Choose the word or phrase that means the most to you and explain its importance to you. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ How do these words or phrases relate to your recovery? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

A ction S tep : Express your thoughts and feelings about recovery Consider expressing your thoughts and feelings about recovery. For example, write down your own personal statement about what recovery means to you: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ You may also want to express your thoughts and feelings through other creative activities, such as art, music, poetry, dance, etc.

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EXPLORING YOUR PERSONAL LIFE GOALS LESSON 07 I M P O R TA N T I N F O R M AT I O N What are life goals? • One purpose of the WSM Program is to offer you opportunities to improve the quality of your life. • Life goals are the important things people accomplish that give them a sense of success and satisfaction. • People differ on what is important to them and what will bring them a sense of success and satisfaction. • For most people important life goals include: – Staying well, physically and mentally – Avoiding unhealthy and dangerous habits – Getting and keeping a job that you like – Completing school or a training program that teaches wanted skills – Having a good relationship with family and friends – Having a romantic partner or getting married – Having children to raise – Living in a place that is comfortable and safe – Enjoying recreational and social activities – Contributing to your community (volunteering and other contributions) – Having spirituality in your life, including being part of a religious community.

• Goals are not exactly the same as wishes, hopes or dreams. • Our wishes, dreams and hopes can be a good starting point to figure out what’s important to us. • We start having goals when we turn our dreams, hopes and wishes into a step-bystep plan of action.

Why is it important to explore life goals? • Choosing and working toward goals gives a person a sense of purpose and focus. Goals provide people with opportunities to improve the quality of their lives. • Having mental or physical health problems may get in the way of choosing, getting or keeping important goals. • People with serious mental and physical health problems may lose confidence in being able to achieve goals and improve the quality of their lives. • Most people in the process of recovery report that it is important to set and work toward goals. • Whether the goals are small or large, there is a sense of success and satisfaction in achieving goals that recovery. • Learning to better manage mental health problems in the WSM Program builds confidence and hope. This often leads a person to take steps to pursue life goals.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about goals Please go to the last page of this Workbook to review the Quality of Life Goals Progress Checklist. This checklist can help you figure out what areas of your life you might want to improve as you participate in the WSM Program. The checklist can also help you keep track of your progress. For now, look over the life goal areas in the first column that is labeled Time 1. Please check the boxes for the areas you would like to improve as you participate in the program. Afterward, you will have an opportunity to discuss your choices.

Discussion Points: Which of these areas would you like to see improve as a result of participating in the WSM Program? Which areas are the most important to you at this time?

In what way do you believe the WSM Program may help you improve the quality of your life?

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A ction S tep : Give some more thought to choosing goals You may want to continue giving more thought to what you want to improve as you participate in the WSM Program. Some steps you may take include: • Discussing your goal areas with others • Re-reading this lesson • Choosing the MOST important goal you want to accomplish and discuss with your counselor or doctor to make it a part of your service plan • Learning more about a quality of life goal area that’s important to you • Learning more about a quality of life goal area that you’re not sure is right for you. What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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UNDERSTANDING BARRIERS THAT GET IN THE WAY OF ACHIEVING GOALS LESSON 08 I M P O R TA N T I N F O R M AT I O N

What does “barriers to achieving goals” mean? • There are many reasons why a person might have a hard time choosing, getting or keeping a goal. The reasons are called “barriers” because they stand in the way of a person choosing, getting or keeping goals. • Some barriers are directly related to symptoms of a mental health problem. • Some barriers are problems that are associated with having a mental health problem, such as stigma. • Some barriers are just part of what all people face when they make an important change in life.

Why is it important to understand barriers? • Most people who make steady progress in their recovery report that it is important to set goals and work toward them. Having a direction in life gives us all a sense of purpose and meaning. It doesn’t matter so much if the goals are small or large. • When a person has a big goal, he or she can get sometimes get discouraged because it seems too hard or too far in the future. It’s important to that all goals, big or small, start with ONE STEP! • Very often, people have to try over and over again to achieve an important goal. People often change their mind about a

goal and choose to go in a different direction. That’s OK. The important point is not to lose hope that you can make changes in your life even if things have not worked out so well in the past. • Accomplishing important goals is not easy. It is not unusual for barriers to get in the way. It may be helpful to understand what is getting in your way. This lesson gives you an opportunity to identify and better understand the barriers that give you the most problems. It’s the first step in finding ways to reduce those barriers.

What common barriers are experienced by people with physical or mental health problems? • My mental health symptoms make it hard to achieve goals. • I can’t figure out what’s important to me. • I don’t think it’s possible for me to achieve goals. • I try to make a change but I experience stigma and discrimination because I have a mental health problem. • I’m afraid to take a chance. It would be harmful to fail. • I don’t have the knowledge to accomplish goals (I don’t know how). • I don’t have much to change from family, friends and others. • My physical health problems make it hard to achieve goals.

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P E R S O N A L I Z E D W O R K S H E E T: Understanding barriers Below are some barriers to achieving goals. Check the boxes that apply. If you check both boxes for a barrier, it means that it is true for you AND it’s a barrier you want to learn more about. This is true for me

Barriers to achieving goals

I want to learn more about this

My mental health symptoms make it hard to achieve goals. I can’t figure out what’s important to me. I don’t think it’s possible for me to achieve goals. I try to make a change but I experience discrimination because I have a mental health problem. I’m afraid to take a chance. It would be harmful to fail. I don’t have the knowledge to accomplish goals (I don’t know how). I don’t have much from family, friends, community and others to change my current situation. My physical health problems make it hard to achieve goals.

Discussion Points: Which of these barriers has been most difficult for you?

Which barrier would you most want to learn more about?

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A ction S tep : Choose a barrier to learn more about Write down a barrier you want to learn more about. Barrier:________________________________________________________________________ What step will you take to learn more about it? ______________________________________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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USING STRATEGIES TO OVERCOME BARRIERS THAT GET IN THE WAY OF ACHIEVING GOALS LESSON 09 I M P O R TA N T I N F O R M AT I O N

What does overcoming barriers mean? • Pursuing and achieving important goals is not easy. There are usually people, places or things that may help us move forward, but at times they may get in the way. Sometimes barriers include our own thoughts, feelings or behavior. Sometimes the barriers are outside of us. Overcoming barriers means figuring out what gets in our way and then taking healthy and effective steps to deal with it.

Why is it important to overcome barriers? • People who keep moving forward to accomplish goals usually encounter barriers that they need to overcome. • When we feel stuck in our efforts to accomplish goals, it may be helpful to figure out what is getting in our way. • It’s hard to keep moving forward when we don’t have strategies to overcome barriers. • There are many helpful strategies or tips for overcoming barriers. • Sometimes the barriers we face are imagined barriers. We may believe something is a barrier when it’s not. Negative thinking is one the most harmful barriers of all.

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P E R S O N A L I Z E D W O R K S H E E T: Choose strategies to help you overcome one or more barriers Below is a long list of tips or strategies that may help you reduce or overcome an important barrier. Check off any that you believe may be helpful and that you are comfortable trying. Barrier 1: My mental health symptoms make it hard to achieve goals. Tips: o Ask people you trust and who know you pretty well what strengths they notice in you. o Think about activities or experiences that make you feel satisfied and successful. o Identify your skills, talents and interests and write them down. o Engage in conversations with other people with mental health problems who have achieved one or more personal goals and ask about what they did to overcome barriers. o Find out about peer self-help and advocacy programs where you will meet people who have first-hand experience with mental health problems and with overcoming barriers. o Read literature about people with serious mental health problems who have moved forward in their recovery. o Stick with the WSM Program and use it as an opportunity to learn more about yourself and to learn how to manage mental health symptoms. Barrier 2: I can’t figure out what’s important to me. Tips: o Make a list of small and large goals you have achieved in your life. o Make a list of any dreams, hopes and wishes that are important to you. o Explore more of your community: places to live, work, learn and socialize with others. The more information you have about your community, the better your chances of choosing goals that suit you. o Make a list of important areas of your life where you are dissatisfied or unsuccessful. o Make arrangements with your counselor to take an interest inventory (this is usually related to work goals). o Talk to your counselor about taking a values inventory (this is a list of values that may help you clarify what’s really important to you). o Discuss this barrier with your counselor, peer or family member. Talking things out can sometimes help you figure out what’s really important to you.

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Barrier 3: I don’t think it’s possible for me to achieve goals. Tips: o Make a list of the reasons why you believe it’s not possible for you to make changes. o Share this list with your counselor. Closely examine each reason and make a plan to reduce these barriers. o Check your thoughts for signs of negative thinking. It’s very common for us to think change is not possible, when it is. o Go over the lesson about personal strengths on page 48 and remind yourself of your strengths. o Spend more time with people who believe in you and are a positive influence in your life. o Make and keep a list of your strengths where you can look at it every day. o Talk to your counselor, therapist, doctor or peer about your concern that it’s not possible for you to achieve goals. o Read about people with mental health problems who have been able to overcome one or more barriers. o Read self-help or other inspirational books o Use prayer in a way that inspires you to take steps to achieve goals that are important to you. Barrier 4: I try to make a change but I experience discrimination because I have a mental health problem. Tips: o Educate yourself about the laws that protect your rights. o Identify government agencies that can help you determine if your rights have been violated. o Discuss these concerns with your counselor. Barrier 5: I’m afraid to take a chance; it would be harmful to fail. Tips: o Talk to others about your fears—peers and/or professionals. Talking about your worries may be a first step in overcoming fear. It’s very hard to build confidence and hope when we keep worries and concerns to ourselves. o Make a list of what you think will happen if you fail. Ask yourself: “Will this really happen?” and “Is it as bad as I think?” o Write down an encouraging or inspirational message and keep it with you. Read it when you feel discouraged.

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Barrier 6: I don’t have the knowledge to accomplish goals (I don’t know how). Tips: o This barrier is the focus of the WSM Program. Sticking with the program is one way to gain knowledge and use your strengths to manage your mental health problems. o Knowledge and skills can be learned. Once you choose a goal, professionals, peers and others may help you figure out what skills and knowledge you need to accomplish your goal. o Sometimes it is best to start with your current skills and knowledge. People often fail to recognize their strengths. Review your personal strengths inventory on page 49. Barrier 7: I don’t have much from family, friends and others to change my current situation. Tips: o Identify whose is really important and ask directly for their . o Ask questions, listen and honestly consider the reasons why one or more people don’t your goal. o Strengthen your commitment to the WSM Program by writing a statement why the program is important to you and read it to others in the group. o Talk to people whose you would like and let them know how they can be helpful. o On pages 14–15 of this Workbook is a section on inviting others to your work in the WSM Program. You may want to read those pages again and consider inviting someone you trust to you. o Educate people who matter to you about the WSM Program and explain to them how it is designed to help you accomplish important goals. You will have an opportunity to do more of this in the next lesson. o Explain to people who matter to you that having goals is an important part of your recovery. Barrier 8: My physical health problems make it hard to achieve goals. Tips: o Make a list of the physical health problems that are barriers for you. Share it with your counselor to make sure you get the right medical services. o Jump to page 162 of this Workbook and complete the Action Step on page 165. o Talk to your counselor or psychiatrist, who is a medical doctor, about physical health concerns. o Go to Chapter 3 (pages 159–187) in this Workbook and read about the importance of taking care of physical health problems.

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Discussion Points: Which barrier is most important to you?

Which of the many tips listed would you be comfortable trying? Are there other tips you thought of that are not on the list?

A ction S tep : Choose a tip to try Write down one of the tips you want to try to overcome barriers. Make a plan to use it before the next meeting. Tip:___________________________________________________________________________ ______________________________________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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WHAT HELPS RECOVERY? LESSON 10 I M P O R TA N T I N F O R M AT I O N Many different things can affect your mental health recovery. Knowing what helps and what hurts recovery is an important first step in making decisions that work for you. The best source for information about what helps and what hurts recovery is from people who have experienced mental health problems and have taken steps to improve their lives. All of the information in this lesson is based on the experiences of people with mental health problems who have made big improvements in their lives. Below are some things that they have found helpful to recovery.

Things that help recovery • Have a positive attitude. – For example: remind yourself that many people with mental health problems have been able to improve their lives and make use of the help that is available. • Rely on yourself. – Make a decision to handle more and more of day-to-day activities. • Get information about your mental health problems.

• Stand up for yourself. – Know your rights and make your needs known in a respectful and effective manner. • Pay close attention to symptoms. • Learn how to cope effectively with symptoms. • Have meaningful goals. – Understand that having goals and taking steps, even small ones, helps recovery. • Have spirituality. – For many people, exploring their spiritual side provides comfort, companionship and courage. • Recognize your personal strengths. – Remind yourself that above all you are a person first—a person with talents, skills, knowledge, interests and positive qualities. • Have close relationships. • Contribute to your community by being involved in work, school or volunteer activities. • Connect to cultural resources. • Learn new things.

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P E R S O N A L I Z E D W O R K S H E E T: What will help you in your recovery Please check items that are true about you and the items you would like to develop. This helps in my recovery

This is true about me

I would like to do more of this

Keep a positive attitude Rely on myself more Know about my mental health problems Stand up for myself Pay close attention to my symptoms Find ways to cope with symptoms Have meaningful goals Have spirituality and be part of a spiritual community Appreciate my personal strengths Have close relationships Contribute to my community Care about others Be involved in work Connect to cultural s and resources Be open to learning new things

Discussion Point: Please share with the group one area that is true of you and one area you would like to develop further.

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A ction S tep : Choose an area to develop further Look at your responses on the Personalized Worksheet and write down one area you would like to develop further_______________________________________________ ______________________________________________________________________________ What will be your first step?____________________________________________________ When will you take this step?___________________________________________________ Where will you take this step_ __________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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WHAT HINDERS RECOVERY? LESSON 11 I M P O R TA N T I N F O R M AT I O N Many different things can affect your mental health recovery. In this lesson we are going to talk about many of the things that can hinder

(hold back) recovery. All of the information in this lesson comes from mental health consumers.

P E R S O N A L I Z E D W O R K S H E E T: Thinking about what hinders you in your recovery Below are some things that can hinder recovery. Please check items that are a problem for you and items you would like to change. This hinders my recovery

Self-defeating (negative) thoughts Not taking personal responsibility A lack of information about recovery Health problems Putting down my dreams, goals, desires A lack of understanding from mental health professionals A lack of community resources Stigma, prejudice, discrimination Sense of hopelessness Self-stigma (self-blame) Mental health problems Personal isolation A lack of coping skills Substance abuse

This is a problem for me

I want to change this

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Discussion Point: Please share with the group one area that is a problem for you and one area you would like to change.

A ction S tep : Change something that hinders you Look at your responses on the Personalized Worksheet and write down one area you would like to change to help your recovery. Area:_________________________________________________________________________ What will be your first step?____________________________________________________ When will you take this step?___________________________________________________ Where will you take this step?_ _________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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CHOOSING YOUR OWN RECOVERY STRATEGIES LESSON 12 I M P O R TA N T I N F O R M AT I O N

Understanding and managing mental health problems • Good mental health doesn’t just happen. There are many different strategies people use to their recovery. Recovery strategies are the important things you do to keep yourself mentally and physically well. They are the things you do that mean the most to you. You may think of these as your most important personal values.

Why is it important to choose strategies? • Knowing what matters most to you helps you figure out what strategies will work. • There is no single strategy that works for everybody. • Learning about strategies that have worked for other people may give you ideas about what may work for you. • Recovery is helped when you are able to use strategies that keep you physically and mentally well. Below are strategies to maintain mental and physical health as described by people with mental health problems. Maintain physical health

“When I’ve been eating junk food or not getting any exercise, it makes me feel sluggish, both physically and mentally. So I try to eat things that have decent

nutrition and I try to get at least a little exercise every day. It makes a lot of difference.” – Exercise (staying active) – Healthy diet – Good sleep habits – Make time for recreation – Prayer – Talking with family or friends. Develop healthy relationships

“It helps me to have friends and family I can do things with and talk things over with. Sometimes I have to work on these relationships and make sure I stay in touch. It’s better for me not to rely on just one person.” – Help others – Clear, open and direct communication with friends and family – Use s outside the mental health system (like friends and family). Seek out spirituality

“Being in touch with my spirituality is essential to me. I belong to a church, but I also find spirituality in meditation and in nature.” – Express creativity – Seek out and connect with nature – Attend religious or spiritual activities in the community (for example, in a church, mosque or temple).

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Attend self-help groups and activities

“I belong to a group which is part of a selfhelp program. Everyone in the group has experienced mental health problems. I feel very comfortable there. The other people understand what I am going through. They also have good ideas for solving certain problems.” – Peer activities – 12-step self-help meetings in the community (for example, Alcoholics Anonymous, Narcotics Anonymous, Emotions Anonymous or Nicotine Anonymous meetings, Double Trouble Groups) – Other community self-help groups. Why attend self-help groups?

• When people come together in a self-help setting, they share common experiences that help them form social relationships. • Self-help provides a meaningful structure for people that is not imposed from the outside, but rather is developed by the themselves. • Self-help group who successfully cope serve as role models for people who have difficulty coping. • In self-help groups, people share specific ways of coping based on experience.

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• Self-help assists people to move from the role of always being helped to the role of helping. The role of being a helper is very valued in our society and leads to self-esteem. There are many, many other strategies that people use to maintain their mental and physical health including: • Work toward important goals such as: – Getting a job or volunteering to contribute to one’s community – Going to school or getting more education – Finding a place to live that suits me – Making friends or getting closer to people I care about. • Find ways to reduce stress and relax more. • Solve problems step by step with or without the help of others. • Express and deal with feelings. • Ask for help when needed (from friends, peers or professionals). • Keep a journal to figure out what works and what doesn’t. • Find ways to reduce or stay away from street drugs, alcohol and unhealthy relationships.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking more about recovery strategies Review these recovery strategies and check the boxes that apply to you. Strategy

Use stress management techniques, such as relaxation exercises. Use problem-solving skills. Express and deal with feelings. Ask for help when needed. Exercise regularly. Follow a healthy diet. Get a good night’s sleep. Use prayer. Make time for recreation. Help and others. Spend time with friends and family. Use s outside the mental health system. Express creativity. Attend religious or spiritual activities. Connect with nature. Attend peer activities or self-help groups. Focus on accomplishing goals related to working, getting more education or finding a satisfying place to live. Avoid harmful situations, including street drugs, alcohol and unhealthy relationships. Other:

I already use this strategy

I would like to try this strategy or develop it more

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A ction S tep : Choose a recovery strategy to develop further Write down one strategy you would like to develop further. Strategy:______________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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HOW YOUR CULTURAL AND FAMILY BACKGROUND AFFECTS THE DECISIONS YOU MAKE ABOUT MENTAL HEALTH TREATMENT LESSON 13 I M P O R TA N T I N F O R M AT I O N What is meant by the term “culture”? Culture is a way of describing the thoughts, languages, practices, beliefs, values, customs and traditions of a racial, ethnic, religious or social group. People often see themselves as belonging to a number of different cultures. For example, a person may have an African background (race), grow up in Haiti (ethnicity), follow the Catholic faith (religion) and be a recent immigrant to the United States (social). Some parts of your culture may be easy to recognize, such as skin color or the language that you speak. Other parts of your cultural background are hard for others to know about unless you choose to tell them or they ask you. This includes one or more of the following: • Spiritual practices • Healing practices • Family customs, including the roles expected of mothers, fathers, sons, daughters, grandparents, etc. • Types of foods and drinks you like • Holiday celebrations • Values related to privacy and disclosing of personal information

• Customs related to marriage and intimate relationships • Music and art preferences • Preferred ways of leisure or recreational activities • Sexual orientation (this is an example of a social group). Most people learn cultural beliefs, attitudes, values and traditions from parents, other family and people in their local community. For many people, religious and cultural traditions influence their ideas about many parts of life. This is also true for beliefs and attitudes about mental health and mental illness.

Why is understanding your cultural/ religious background important? The connection to your cultural background will often influence: • Your decisions about treatment for mental health problems • How you feel about your mental health problems • Your comfort with the people you meet in mental health programs • Your interest in seeking help for your mental health problems.

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Being aware of your cultural and religious beliefs and values may recovery by helping you: • Find community connections and build a sense of belonging that matches your cultural beliefs and values • Make other people, including mental health professionals, aware of your beliefs about mental health problems and treatment so you can form a helpful relationship

• Find ways to improve your mental health that respects your cultural beliefs and values • Better understand the sometimes confusing messages that you may get from family, friends, or other community AND the messages you may get from mental health professionals.

Discussion Points: What ideas do people in your community (family, friends, neighbors, people in your religious community) have about the questions below? Are some of their ideas different from ideas you get from your doctor, therapist, mental health professional, or this Workbook? • What is mental illness? • What causes mental health problems? • What is the best way to help someone with mental health problems?

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P E R S O N A L I Z E D W O R K S H E E T: Understanding your cultural background Below is a list of YES or NO statements designed to increase your awareness of the connection between your cultural, family and religious background AND mental health decisions. Consider each statement and circle YES or NO. My religious beliefs affect: 1. The decisions I make about taking medication and receiving treatment for my mental health problems 2. How I feel about my mental health problems

YES YES

NO NO

My preferred language affects: 1. Who I want to help me with my mental health problems 2. How I get along with the staff and clients in the mental health program

YES YES

NO NO

The customs and beliefs of my family affect: 1. The decisions I make about taking medication and receiving treatment for my mental health problems 2. How I feel about my mental health problems 3. Who I want to help me with my mental health problems

YES YES YES

NO NO NO

My sexual orientation affects: 1. Who I want to help me with my mental health problems 2. How I feel about my mental health problems 3. How I get along with the staff and clients in the mental health program

YES YES YES

NO NO NO

My gender affects: 1. Who I want to help me with my mental health problems (Do you have a preference for a male or female mental health provider?)

YES YES

NO NO

YES

NO

YES

NO

My racial or ethnic background affects: 1. Who I want to help me with my mental health problems (Do you have a preference to work with a mental health provider who shares your racial/ethnic background?)

If you answered YES to any of these questions you may choose to complete an Action Step to learn more about how your cultural background affects the decisions you make about mental health treatment.

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A ction S tep : Learn more about how my cultural background affects my decisions Choose one of your YES responses and learn more about it by talking to someone or getting more information about how this aspect of your cultural, religious and family background affects the decisions you make. I want to learn more about:_____________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ ______________________________________________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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RECOGNIZING AND USING YOUR PERSONAL STRENGTHS LESSON 14 I M P O R TA N T I N F O R M AT I O N

People with mental health problems who are moving forward with their lives are often helped by recognizing and building on personal strengths. The goal of this lesson is to help you recognize and use your strengths to help your recovery.

What are personal strengths? • Personal strengths are your skills, knowledge, talents, interests, values, personal qualities and physical characteristics that you can build on to help your recovery. When we are struggling with life problems, our strengths often help us cope. Our personal strengths give meaning and purpose to our lives.

Why are personal strengths important? • Sometimes people don’t recognize their personal strengths or can’t figure out how

to use them to improve their lives. People who experience serious mental health problems can lose confidence in their ability to get and stay well. Sometimes people may lose confidence in their ability to sort out what’s real from what’s not real. They may have doubts about their chances to lead a satisfying and successful life. When mental health problems get in the way of achieving goals, such as working, completing school, making friends or living in a safe and comfortable place, it’s easy to forget about one’s strengths. In fact, because of past experiences, many individuals with mental health problems think mostly about their weaknesses and illness. They may blame themselves for their problems or experience other people blaming them. The mental health system may also lose sight of the importance of helping people recognize and use their strengths.

Discussion Points: Why would people with mental health problems have a hard time recognizing their strengths? In what ways have mental health problems affected your confidence to accomplish goals?

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P E R S O N A L I Z E D W O R K S H E E T: My Personal Strengths Inventory Below is a list of strengths that may or may not describe you. Please check the boxes that apply to you. Personal Strengths

I’m motivated to learn and work on my recovery. I know what goals I want to accomplish. I’m a good listener. I can carry on conversations with people. I read and ask questions to improve my mental health. I’m comfortable sharing my ideas and feelings. I have a spiritual side to me. I enjoy listening to music. I enjoy art, movies or TV. I enjoy reading. I enjoy writing. I have a positive connection to my family. I have friends. I speak more than one language. I am involved in my community. I am involved in self-help/advocacy activities. I participate in the cultural s and resources in my community. I like to take walks. I play a musical instrument. I know how to meditate. I like to exercise. I like to go to museums, concert and plays. I eat healthy foods. I see my medical doctor, dentist, eye doctor, etc., on a regular basis.

This is a This is a strength strength of mine I want to develop

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This is a This is a strength strength of mine I want to develop

Personal Strengths

I like to play sports. I have hobbies. I enjoy raising children. I stay away from drugs and alcohol. I don’t hang out with negative and harmful people. I practice yoga, martial arts, Tai Chi or other physical activities. I like to dance and/or sing. I am active in a religious community. I like to play table games. I like to cook. Other: Other:

Discussion Point: Share one of your most important strengths and one area you want to develop as a strength.

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A ction S tep : Choose a strength to develop Choose one strength you would like to develop and complete one Action Step toward that goal. Strength:______________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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RECOGNIZING AND USING YOUR CULTURAL AND COMMUNITY RESOURCES LESSON 15 I M P O R TA N T I N F O R M AT I O N What are community and cultural resources? • Community resources are the people and places that help you meet your needs and accomplish your goals. • Community resources include places to live, work, volunteer, go to school, socialize, engage in fun activities and follow spiritual interests. • Community resources include places and people who can help you with mental health and physical health problems. • Community resources include people and places that protect your personal safety and property, such as the police and fire stations. Affordable and convenient transportation is another type of community resource. • Social, political and religious organizations focusing on the needs of a particular culture are also community resources.

Why is it important to know about community and cultural resources? • It’s important to know about and use community resources because they provide you with opportunities to improve the quality of your life. Recovery is helped by connecting to people who are ive. Recovery is helped by having others in your life to rely on during good times and difficult times. All people have a basic need to belong to a community. Being a part of your community may be important for several reasons. Many people find that learning about and using community resources helps them to: – Deal with daily stresses – Get help with day-to-day problems – Organize their day with satisfying activities – Get information and assistance to accomplish goals – Get their needs met for companionship and positive relationships.

Discussion Points: What resources do you use in your community?

Do you have any resources that reflect your ethnic/racial, cultural or spiritual background?

In what way does your cultural background influence the choices you make regarding your use of community resources?

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P E R S O N A L I Z E D W O R K S H E E T: My Community Resources Inventory Below is a list of community resources that you may or may not have in your life right now. Read each statement and check the box that applies to you. This worksheet will help you recognize resources in your community and help you identify which resources you want to have. Community resources

I have this right now

I don’t have this but want it

I have reliable and affordable transportation. There is a spiritual community where I feel comfortable. There’s a social club I can get to that I enjoy. There are mental health programs in my community that I use. There are groups and organizations in my community that share my cultural background and language. There are groups and organizations in my community that share my sexual orientation. I have friends I can rely on for help. I have one or more family I can rely on for help. There are places in my community where I can work. There are places in my community where I can volunteer. There are self-help and advocacy organizations in my community. I have places where I can easily shop for food, clothing, etc. There are places in my community I can go to relax. There are recreational facilities in my community. Other: Other: NOTE: As you participate in the WSM Program, you will often go back to your personal strengths and community resources as TOOLS you can use to manage mental health and other life problems.

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A ction S tep : Choose a community resource to use Write down one community resource you don’t have but would like to. Resource______________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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SOCIAL S HELP RECOVERY LESSON 16 I M P O R TA N T I N F O R M AT I O N What is social ? • “Social ” refers to having relationships that are rewarding, enriching and helpful. Relationships can be considered “ive” when both people trust and respect each other. Having social means that you feel connected and cared for by other people. • Sometimes even very caring relationships have problems. Differences in opinions are natural in any relationship. A ive relationship can involve disagreements from time to time. In ive relationships, disagreements are handled respectfully and can usually be resolved. • Social can come from relationships with a variety of different people, including family , friends, peers, spouses, boyfriends/girlfriends, co-workers, of religious or other spiritual groups, classmates, mental health practitioners, of peer groups, roommates and neighbors.

Why is social important? • Social relationships are an important part of people’s lives. For many people, the quality of their relationships is a major factor in their happiness. ive relationships make people feel good about themselves and more hopeful about the future. Having ive relationships can also help people reduce stress. • Social relationships play a very important role in recovery. People with mental health problems who have made big improve-

ments in their lives often point to the importance of social . Below is a list of some reasons they have given: – Social provides a safe way to vent feelings. – People can help you figure out what is real and what is not. – People can help with day-to-day needs and problems such as money, housing and transportation. – People can offer comfort and reassurance during tough times. – Other people can help you watch out for signs of relapse. – You can talk over problems and get advice from other people. – Being with other people is one way of getting to know yourself better. – “Belonging” to a social group is a basic human need.

How do mental health problems affect social ? • When a person develops a serious mental health or physical health problem it also affects the people who care about him or her. • Unlike physical health problems that may be easier to understand, mental illness may be very confusing. • Very often family and friends, as well as the person affected, are not sure what’s going on. This may easily lead to misunderstandings and sometimes conflicts.

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• Over time, families may grow further and further apart from the family member with a mental problem.

mation and guidance. For example, family , friends and others may benefit from:

• When a loved one has a mental health problem, friends and family may not know how to be helpful.

– Having important information about your mental health problems

• For many families, getting information about their loved one’s mental health problems and guidance on how to be helpful can make a big difference.

What are two of the most important messages to convey to everyone involved? • Mental health problems are no one’s fault. • Recovery is possible.

What steps can I take to improve my social s? • Social is sometimes improved when family , friends and others who are important to you are given infor-

– Having information on treatment and causes of mental health problems – Learning that mental illness is not anyone’s fault – Learning that recovery is possible – Getting some guidance on how to be helpful – Getting and advice from others who also have a loved one with mental health problems. NOTE: In some programs, you may request that a mental health professional provide information and guidance directly to family or friends over the phone or in person. Ask if this service is available in your program.

Discussion Points: What kinds of social do you have in your community (family, friends and others)? In your culture, how do people show to one another?

In your culture, how do people usually get help for problems?

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about your social s In the boxes below, write the names of people you have a ive relationship with and people you would like to have a more ive relationship with. People

Family Friends/peers Spouse/partner Co-workers of religious or other spiritual groups Mental health practitioners of peer groups Roommates of a group in your community Neighbors Other:

I have a ive relationship with

I would like to improve my relationship with

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A ction S tep : Choose a person to develop a ive relationship with Write down the name of a person you would like to develop a ive relationship with. Person:________________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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USING SELF-HELP AND PEER LESSON 17 I M P O R TA N T I N F O R M AT I O N What is self-help? • Self-help provides a structure for people to come together and help each other. • Self-help is often provided in a group format and is always peer led. • Self-help is about sharing common experiences among people with common problems—in this case, people with mental illness. • Self-help provides a social network based on common experience. • In self-help groups, people share specific ways of coping based on their personal experience. • Those who successfully cope serve as role models for others. • Self-help is completely voluntary. You choose whether or not to participate and what you will take away from it. • Common self-help groups include: – Double Trouble in Recovery: a 12-step program for people who have substance abuse and mental health problems – Alcoholics Anonymous (AA): a 12-step program for people who have a problem with alcohol

– Depression and Bi-Polar Alliance: a group for people who have either depression or bi-polar disorder – Schizophrenia Anonymous: a group for people with schizophrenia – National Alliance on Mental Illness (NAMI): an organization for family of people with mental health problems

Why is self-help important? • Research has shown that people who participate in self-help are less likely to be hospitalized, are less likely to harm themselves, show a reduction in symptoms and substance abuse, use fewer formal treatment services, and have improved social s and self-esteem. • People with mental health problems can become isolated due to stigma and discrimination. • When people come together in a self-help setting, they share common experiences, which can lead to friendship. • Self-help can give role models of other people who are moving towards recovery.

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Discussion Points: What has been your experience with self-help?

Have you found self-help to be helpful in your recovery? Does self-help sound like a good idea to you?

P E R S O N A L I Z E D W O R K S H E E T: Make an informed decision about being involved in self-help If you choose to be involved in self-help, check the steps you would like to take: o Talk to someone in a self-help group o Talk to a counselor about self-help programs o Read articles about self-help o Attend a self-help group o Get information about self-help groups (from newspapers, internet, community clubs and a spiritual community). o Other________________________________________________________________ .

A ction S tep : Choose to become involved in self-help Choose one step you checked and complete an Action Step. Step:__________________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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CONNECTING TO YOUR COMMUNITY LESSON 18 I M P O R TA N T I N F O R M AT I O N Increasing social • People are often interested in increasing their social and improving their relationships with others. • Two general strategies can be used (for many people, a combination of both strategies is most helpful): – You can increase the number of people you know and trust. – You can improve the quality of your relationships with others.

Ways of meeting people • Connecting with new people is often the first step toward increasing social . To connect with people, you need to: – Find places to meet people. – Have something in common to talk about. – Take an interest in what is important to other people.

Finding places to meet people • Although you can meet people in all kinds of places, there are some places where meeting people may be easier. These tend

to be public places where people naturally gather for recreation, to pursue an interest or to take care of business. • Some examples include: – School or class – groups – Workplace and volunteer programs – Religious and spiritual communities (churches, synagogues, temples, mosques, etc.) – Peer drop-in center or clubhouse – Your treatment program – Where you live – Health or exercise club (YMCA or YWCA) – Parks, museums and art shows – Concerts, community theater and libraries – Special interest groups (politics, hobbies, sports, pets) – Bookstores and coffee shops – Cultural organizations (social clubs, cultural centers, immigration assistance centers) – On the internet.

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P E R S O N A L I Z E D W O R K S H E E T: Connect to your community Use this checklist to identify places you might want to meet new people. Check the boxes that apply to you: Places in your community

Peer drop-in center or clubhouse School groups Workplace and volunteer programs Religious and spiritual communities (churches, synagogues, temples, mosques) Health or exercise clubs (YMCA or YWCA) Parks, museums and art shows Concerts, community theater and libraries Special interest groups (politics, hobbies, sports, pets) On the internet Cultural organizations (social clubs, cultural centers, immigration assistance centers) Bookstores, coffee shops Where you live Other:

I have gone to I would like to go this place to to this place to meet people meet people

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A ction S tep : Choose a place in your community to meet people Write down one place you would like to meet people. Place:_________________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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MEETING NEW PEOPLE LESSON 19 I M P O R TA N T I N F O R M AT I O N Starting conversations, the first step in meeting new people To get to know someone or to get to know someone better, it is helpful to be able to start conversations. Starting and maintaining enjoyable conversations involves a combination of skills. These skills include choosing someone who might be interested in a conversation, having something interesting to say, and showing interest in the other person. Some specific tips for conversation are provided below: • Find someone who is interested in having a conversation. Choose someone who isn’t busy. If the person is in the middle of doing something, he or she may not want to stop in order to talk to you. • Choose an interesting topic. The topic you choose could be related to something that you are doing when you are starting the conversation. For example, if you are at an art show, you could start a conversation about the paintings on display. • Look at the person. Eye is important when you are talking to people because it shows them that you are interested in what they have to say. If you feel uncomfortable looking into someone’s eyes, you can look somewhere close to their eyes, such as their forehead or nose. • Smile and nod your head to show you are listening. Let the person know that you are listening and are interested in what he or she has

to say. Showing an interest in other people and that you are open to their ideas and point-of-view will help to keep the conversation going. • Listen to what the other person is saying. Asking questions about what the other person says and responding to their comments lets them know that you are interested. If the person seems uninterested, consider changing topics or politely ending the conversation. • Avoid telling very personal things about yourself when you first meet someone. When you are just getting to know someone, avoid telling the person very private information about yourself. Such information too early in a conversation can make the person feel uncomfortable and make it harder to form a connection with him or her. When you get to know the person better, he or she will feel more comfortable talking about more personal topics.

Cultural considerations in getting to know people Cultures often have different customs about when, where and how to meet new people. For example, eye , physical and physical distance can have different meanings in different cultures. It is important to keep these customs in mind when you meet new people.

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Discussion Point: What are the customs in your culture, family, or community when meeting new people? P E R S O N A L I Z E D W O R K S H E E T: Skills for starting conversations Read the items below and check the boxes that apply to you. Skills

I already do this

I want to practice more of this

Identify someone who is open to having a conversation. Choose an interesting topic. Make good eye . Smile and nod your head to show you are listening. Listen to what the other person is saying. Avoid telling very personal things about yourself. Other:

A ction S tep : Choose a conversation-starting skill to practice Write down one of the skills for starting a conversation you want to practice. Skill:__________________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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GETTING CLOSER TO PEOPLE LESSON 20 I M P O R TA N T I N F O R M AT I O N Ways of getting closer to people Getting closer to other people is an important goal for many people. The most rewarding close relationships are ones in which each person cares about the other person’s well-being. To be close to other people, it is important to be able to share personal things about yourself. It also means being open to others sharing with you. It is also important to be willing to do things to help the other person.

Things you can say to develop closer relationships • Express positive feelings and give compliments. Telling other people how positively you feel about them can bring you closer. This can include expressing and showing affection, but it is not limited to that. For example, you can tell the person that you ire certain qualities that he or she has. • Disclose personal information to develop closer relationships. “Disclosure” refers to telling someone personal information about yourself. As people get closer to each other, they tell more about themselves. Deciding how much to tell someone can be a tricky decision. If you tell too much too soon, the other person may feel uncomfortable. If you disclose too little, it may be difficult to have a really close relationship.

In deciding how much to disclose about yourself, it is helpful to keep in mind that when two people are close to each other, they tell each other about the same

amount of personal information. For example, if one person tells about their family background, the other person will usually follow by telling about the same amount about their own family background. You can start by matching the other person’s level of disclosure, and then gradually trying to increase the level as you get to know each other better. • Ask people questions about themselves. Getting to know people and developing closeness involves trying to understand more about their thoughts and feelings. Ask people about what they are thinking and feeling, try to understand their point of view and tell them that you are interested in knowing more about them.

Things you can do to develop closer relationships • Do things together. Identifying activities that you can do together can provide rewarding experiences for both of you. Explore the interests you have in common in order to think of things you can do together. • Be willing to compromise. In close relationships, neither person can always have their own way. When you are willing to compromise, it shows that you care about the other person. • Show by your actions that you care about the other person. Caring feelings can be expressed by actions as well as words. You can let people know

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that you care by being helpful or spending time with them. • Be there for the person and help out. “Being there” for someone means being available during a time of need. Everyone has times of need. Recognizing when someone needs help and being able to and assist him or her is an important sign that you care.

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• Take pride in your appearance. Personal hygiene plays an important role in building relationships with people. Examples of personal hygiene include brushing your teeth, changing your clothes regularly, wearing clean clothes, bathing (showering regularly), and shaving.

P E R S O N A L I Z E D W O R K S H E E T: Thinking more about things you can do to increase closeness Please check all that apply to you. Types of things you can do

Express positive feelings about others. Give compliments. Ask others questions about themselves. Tell others something about yourself. Show interest in the other person’s point of view. Invite someone to do something together. Be willing to compromise. Show interest in another person’s culture. Show you care by your actions. Take pride in your appearance. Be there for the person when he or she needs you. Other:

I do this well

I want to improve this

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A ction S tep : Choose something you can do to increase closeness Pick one area you want to improve Area:_________________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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C hapte r 2 : M ental H ealth W ellness and Relapse P r evention INTRODUCTION TO PRACTICAL FACTS ABOUT MENTAL HEALTH AND MENTAL ILLNESS LESSON 21 I M P O R TA N T I N F O R M AT I O N This section is about gaining a better understanding of your mental health problems and strengths. It is designed to help you use knowledge about mental illness to make better decisions about treatment, goals and personal lifestyle.

What will you learn in this section? • You will receive basic information about mental illness and mental health. • You will learn to identify the symptoms associated with your mental health problems. • You will learn to identify your mental health strengths. • You will learn about common treatments for mental illness. • You will learn about how mental illness is diagnosed. • You will learn about the early warning signs of mental illness. • You will learn how your cultural background influences your experience of mental illness.

Why is knowledge about mental health problems important? • Gaining knowledge about your mental health problems is an important step in making decisions that work for you. • Having incomplete or wrong information about mental illness often leads people to make poor choices. • Knowledge is a first step in dealing with the stigma associated with mental illness. • Hope is enhanced by recognizing that we are learning more and more each day about mental illness, its causes, treatment and recovery. • Recovery is helped by having practical information about your mental health problems. • Understanding how your cultural background shapes your thoughts and feelings about your mental health and treatment helps you make decisions that work for you.

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P E R S O N A L I Z E D W O R K S H E E T: Ask questions about mental health and mental illness One of the most important goals of this chapter is to provide answers to questions you have about mental health and mental illness. In the spaces below, consider writing down all the questions you want to have answered about mental health and mental illness. Question:_________________________________________________________________________ Question:_________________________________________________________________________ Question:_________________________________________________________________________ Question:_________________________________________________________________________ As you listen to the questions asked by others in your group, please write down the ones that are also important to you. Question:_________________________________________________________________________ Question:_________________________________________________________________________

A ction S tep : Choose a question and take a step toward an answer Choose the question most important to you. Question:_____________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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SYMPTOMS OF MENTAL ILLNESS—Part I LESSON 22 I M P O R TA N T I N F O R M AT I O N Mental health problems are based on different symptoms that people have. If you are attending this group it is likely that you either have or previously have experienced symptoms of a mental health problem. It is very important to understand the symptoms you have had in the past and the symptoms you have now. Knowing about your symptoms will help you to better control them and move toward recovery. Today’s lesson focuses on common symptoms.

Symptoms that affect a person’s feelings and mood Symptoms of mania

Extremely high moods can be part of a manic episode. People often report that they sleep very little and have very high levels of energy. Some people report having thoughts that are racing all the time. Manic symptoms lead some people to make quick decisions without thinking of the consequences. It is also very common for the person having a manic episode to not recognize his or her own symptoms. The problem is often noticed first by others who know the person well. Symptoms of depression

Feeling depressed can be normal. Depression may occur after a setback like losing a job or breaking off a romantic relationship. However, when depression lasts a long time or becomes so severe that it takes over your life, it’s considered to be a mental health problem. Some symptoms of depression include:

• A persistent depressed mood: Depressed moods caused by setbacks usually tend to last less than two weeks. So, if you’re feeling depressed for more than two weeks, it may be a symptom of clinical depression. • Hopelessness: Even people who go through very difficult and painful experiences, such as the death of a loved one, usually feel hope for the future. Feeling hopeless is usually a symptom of depression. • Suicidal thoughts: Like hopelessness, suicidal thoughts are a common symptom of depression. Wishing for death, thinking of ways to kill yourself and not wanting to live anymore are some signs of being depressed. Symptoms of anxiety

Anxiety symptoms refer to having a sense of fear or danger that does not fit the situation. For example, it is normal to be frightened or anxious when you are in a car accident. But if you’re always so worried about getting into an accident that you can’t drive a car, then you have an anxiety symptom. One important thing to keep in mind about anxiety symptoms is that they can often be caused by other kinds of symptoms such as depression or psychosis. For example, if you hear threatening voices that others don’t hear, you might feel very anxious.

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Symptoms that affect a person’s thinking Cognitive symptoms

Cognitive symptoms refer to problems with learning and concentration. It may be harder for you to concentrate on things like reading a

book or watching TV. Also, you may find it hard to learn new information the first time—like getting directions to go some place new. You may find it hard to focus on what someone else is saying. Or it may be hard for you to get your thoughts together to explain how you feel.

P E R S O N A L I Z E D W O R K S H E E T: Recognizing your symptoms Do you know what symptoms have bothered you the most? Identifying these symptoms may be the first step in gaining control over them. The next few pages are designed to help you recognize symptoms you’re having now or those you may have had in the past. Not all of these symptoms will apply to you, or you may have other symptoms not listed here. Check the box if you’ve ever had that symptom described.

Symptoms that mostly affect a person’s feelings and mood

o Eating too little or too much

Symptoms of mania (extremely high moods)

o Feeling tired and low energy

o Feelings of extreme happiness or excitement o Feeling irritable o Feeling unrealistically self-confident

o Sleeping too little or too much o Feeling helpless, hopeless, worthless o Feeling guilty for things that aren’t your fault o Suicidal thoughts or actions

o Sleeping less

o Trouble concentrating and making decisions

o Talking a lot

o Other:_ __________________________

o Having racing thoughts o Being easily distracted o Being extremely active

Symptoms of anxiety

o Feeling anxious much of the time

o Having bad judgment

o Having fears about being harmed or killed

o Other:_ __________________________

o Believing someone is watching me

Symptoms of depression (extremely low moods)

o Sad mood

o Being frightened that I’m losing my mind o Other:_ __________________________

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Symptoms that mostly affect a person’s thinking Having trouble concentrating

o It’s hard to pay attention for long periods of time. o At times, I have too many thoughts. o My thoughts are sometimes jumbled or confused. o At times, I have trouble reading books or following movie plots. o It’s sometimes hard to focus on what people are saying to me.

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Recording your symptoms Look at the boxes you’ve marked. Which symptoms have bothered you the most over the past month? List them. 1.______________________________________ 2.______________________________________ 3.______________________________________ How do your symptoms affect the quality of your life? _______________________________________

o At times, it’s hard getting my thoughts together.

_______________________________________

o I can’t hear well over background noises.

_______________________________________

_______________________________________

o Sometimes I lose my train of thought.

Which symptoms have gotten better within the past month?

o Other:

1.______________________________________ 2.______________________________________ 3.______________________________________

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A ction S tep : Learn more about your symptoms Learn more about your symptoms through talking to people you trust and who have knowledge about symptoms, getting information from books or the internet, etc. What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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SYMPTOMS OF MENTAL ILLNESS—Part II LESSON 23 I M P O R TA N T I N F O R M AT I O N As we discussed in the last lesson, mental health problems are based on different symptoms that people have. If you are attending this group it is likely that you either have or previously have had symptoms of a mental health problem. It is very important to understand what symptoms you have had in the past and what symptoms you have now. Knowing about your personal symptoms will help you to better control them and move toward recovery. Today’s lesson focuses on some additional commonly experienced symptoms.

Symptoms that mostly affect a person’s motivation Negative symptoms

Negative symptoms may be described as lack of energy or motivation. You don’t feel like doing the things you used to do when you were well. They are symptoms that may be hard to explain to other people. Some examples include: • You don’t feel like talking to other people. • You don’t have much energy to do things. • You don’t care much about how you look.

Symptoms that affect a person’s thinking

Symptoms associated with a history of trauma or abuse

Positive symptoms

Trauma and abuse refer to experiences that are extremely stressful and frightening, such as being the victim of violence or of sexual or physical abuse, witnessing or being the victim of a crime or being involved in war. These experiences may lead to symptoms that have a big impact on a person’s work, relationships and general well-being. These symptoms often include the following:

Positive symptoms do not refer to symptoms that are “good.” They refer to symptoms such as thoughts, beliefs and sensations that you may experience but are not real. You might experience sounds, voices or images that other people don’t experience. These are called hallucinations. Noises may seem louder than usual. It might be hard for you to focus on a conversation or to understand what other people are saying. Colors may seem brighter than usual or you might see shadows. Delusions (believing things that are not true or real) are another type of positive symptom. You might feel afraid of being followed, harmed or killed and not know why. People sometimes describe delusions as “my mind playing tricks on me.”

• Re-experiencing the traumatic event in thoughts and feelings: flashbacks, nightmares, intrusive memories and over-reacting to people, places and things that are associated with the traumatic event • Emotional numbness (being numb to both good and bad feelings) • Avoiding situations that are associated with the traumatic event • Being overly emotional: having difficulty sleeping and concentrating, being easily irritated, being on guard and being overly sensitive.

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P E R S O N A L I Z E D W O R K S H E E T: Recognizing your symptoms This worksheet continues the work that you began last lesson. Do you know what symptoms have bothered you the most? Identifying these symptoms may be the first step in gaining control over them. The next few pages are designed to help you recognize symptoms you’re having now or those you may have had in the past. Not all of these symptoms will apply to you, or you may have other symptoms not listed here. Check the box if you’ve ever had the symptom described.

Symptoms that mostly affect a person’s thinking Having hallucinations

o I catch glimpses of someone following me. o I see ghost-like figures. o I hear a voice that no one else can hear. o I hear two voices talking about me. o I hear a voice telling me to do things. o My food or drink tastes as if it has been poisoned. o I smell sickly sweet odors. o It feels like something is crawling on my skin. o Other:

Being overly suspicious

o I have many fears about being harmed or killed. o I think that people are plotting against me. o I believe someone is watching me.

o People are talking about me or making fun of me. o My neighbors are bothering me. o Someone goes through my things and moves them. o Other: Over-stimulated senses

o Certain colors bother me—they seem too bright or intense. o There are too many noises and sounds. I can’t focus on what I want to hear. o Noises are louder than usual sometimes. o Lights really bother me—they are too bright. o Other:

Having delusions

o I believe I have special powers or knowledge. o At times, I can hear other people’s thoughts.

o Someone is trying to poison me.

o Others can hear or read my thoughts sometimes.

o People are following me.

o People on TV talk directly to me.

o Someone is playing tricks on my mind.

o At times, my thoughts or actions are controlled by others.

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o There is something inside my body moving or trying to get out.

o Emotional numbness (being numb to both good and bad feelings)

o I have a special relationship with a famous person.

o Avoiding situations that are associated with the traumatic event

o Other:_ __________________________

o Being overly emotional: difficulty sleeping and concentrating, being easily irritated, being on guard and being overly sensitive

Symptoms that mostly affect a person’s motivation Negative symptoms

o Often it’s hard to relate to other people. o Usually I’d rather be alone than with other people. o I just don’t feel like planning or beginning any tasks.

o Other:_ __________________________

Recording your symptoms

o Often I feel like staying in bed all day.

Look at the boxes you’ve marked. Which symptoms have bothered you the most over the past month? List them.

o I don’t feel like washing myself, combing my hair or getting dressed.

1.______________________________________ 2.______________________________________

o I seldom feel like talking with others.

3.______________________________________

o Few things give me pleasure.

How do your symptoms affect the quality of your life?

o People have told me I don’t show emotion in my face or voice.

_______________________________________

o I just don’t feel like doing anything.

_______________________________________

o Other:_ __________________________

_______________________________________

Symptoms associated with a history of trauma or abuse o Re-experiencing the traumatic event in thoughts and feelings: flashbacks, nightmares, intrusive memories and over-reacting to people, places and things that are associated with the traumatic event

_______________________________________ Which symptoms have gotten better within the past month? 1.______________________________________ 2.______________________________________ 3.______________________________________

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A ction S tep : Learn more about your symptoms Learn more about your symptoms through talking to people you trust and who have knowledge about symptoms, getting information from books or the internet, etc. What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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HOW IS MENTAL ILLNESS DIAGNOSED? LESSON 24 I M P O R TA N T I N F O R M AT I O N How does a person get diagnosed? The primary tool that is used by mental health professionals to diagnose someone with a mental health problem is a book called the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition, or DSM-IV. The DSM-IV provides a list of mental health diagnoses based on the symptoms a person reports and on the symptoms observed by others. Diagnosis starts with a clinical interview conducted by a specially trained professional, usually a doctor, but sometimes a nurse, psychologist, social worker or other mental health practitioner. In the interview, there are questions about symptoms you have experienced and how you are functioning in different areas of your life, such as relationships and work. Selecting a diagnosis is based on a combination of different symptoms, how long they have been present and how severe they are. Each diagnosis has its own set of symptoms. There is currently no blood test, X-ray or brain scan that can be used to diagnose mental health problems. To make an accurate diagnosis, however, the doctor may also request a physical exam and certain lab tests or blood tests in order to rule out physical causes for symptoms. You may be wondering how your doctor has identified your diagnosis. It is complex and can change over time as symptoms change. There

are several factors doctors consider in making a diagnosis.

Symptoms are most important By far, your symptoms provide the most important clues in diagnosing your mental health problems. Your doctor and other mental health professionals may consider the following: • The types of symptoms you’re having • How severe your symptoms are • How long you’ve had your symptoms • What your life was like before your symptoms appeared • If you’ve ever had medication to treat your symptoms • If you did take medication: – Did the symptoms improve? – If your symptoms improved, how soon after you started treatment? – Did any of your symptoms disappear completely?

Other factors in making a diagnosis The types of symptoms you’ve described make up only part of the diagnosis. Other factors include: Your age when your symptoms first appeared

For many people mental health symptoms start in their teenage years or early twenties. Sometimes symptoms may begin in childhood or later adult years.

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Your family history

Sometimes mental health problems seem to be genetic (run in families). You may have family who have been diagnosed with the same mental health problem or who have experienced similar symptoms. Lab tests

Your doctor may use blood tests and brain scans to eliminate other possible causes for your symptoms. Tests to identify alcohol or street drugs are also used because these substances can cause symptoms that resemble mental health problems such as schizophrenia. Your doctor may need to check for the presence of drugs or alcohol as a possible cause for your symptoms. NOTE: The important thing to is that knowing your diagnosis is part of being an informed consumer. You have a right to know what diagnosis you have received and how that diagnosis was determined.

Serious mental health problems There are a number of serious mental health problems that have a big impact on a person’s life. These problems usually last a long time and need very careful diagnosis. Below is a description of several of these serious mental health problems, including schizophrenia, bipolar disorder (often called manic depression) and depression. Your diagnosis may not appear below or you may have had different diagnoses at different times in your life. • People who have been diagnosed with schizophrenia usually have these symptoms: – Hallucinations (hearing, seeing, feeling or smelling something that is not there) – Delusions (having a strong belief that is firmly held in spite of contrary evidence)

– Communication problems (difficulty with thinking and expressing oneself clearly) – Cognitive (thinking) difficulties (problems with concentration, memory and reasoning) – Decline in social, work or school activities (avoiding people, having problems at work or school) – Disorganized or catatonic behavior (confused behavior or remaining motionless) – Negative symptoms (lack of motivation, pleasure and expressiveness). • People who have been diagnosed with bipolar disorder usually have symptoms of mania and symptoms of depression. Sometimes people have symptoms of psychosis. Symptoms of mania – Feeling extremely happy or excited – Feeling irritable – Feeling unrealistically self-confident – Not being able to sleep – Talking a lot – Having racing thoughts – Being easily distracted – Being extremely active – Having faulty judgment leading to reckless behavior (for example, spending large sums of money). Symptoms of depression – Sad mood – Eating too little or too much – Sleeping too little or too much – Feeling tired and low energy – Feeling helpless, hopeless, worthless

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– Feeling guilty for things that weren’t your fault – Suicidal thoughts or actions – Trouble concentrating and making decisions. Symptoms of psychosis – Hearing, seeing, feeling or smelling something that is not actually present – Confused thinking – Having very unusual or unrealistic beliefs that are not shared by others in your culture.

• People who have been diagnosed with depression usually have these symptoms: – Sad mood – Eating too little or too much – Sleeping too little or too much – Feeling tired and low energy – Feeling helpless, hopeless, worthless – Feeling guilty for things that weren’t your fault – Suicidal thoughts or actions – Trouble concentrating and making decisions.

Discussion Point: How will knowing your diagnosis be helpful in your recovery?

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P E R S O N A L I Z E D W O R K S H E E T: Understanding your diagnosis This worksheet will help you develop an Action Step to better understand your diagnosis. You can learn about your diagnosis in many ways. Check the ways that you would like to try: o advocacy groups or self-help groups o Talk to peers o Research your diagnosis on the internet o Research your diagnosis in the library o Talk to a mental health professional about your diagnosis o Other:_ _____________________________________________________________________

A ction S tep : Find out and research your diagnosis Step 1: Find out your diagnosis (ask a mental health professional involved in your personal treatment) and write it below: ______________________________________________________________________________ Step 2: Research your diagnosis Check all ways you will try to learn about your diagnosis: o Peers o Internet o Mental health professional

o Library o Self-help and advocacy groups o Other:________________________________

Choose one area you checked above and complete the following: What will be your first step?____________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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UNDERSTANDING THE CAUSES OF MENTAL ILLNESS LESSON 25 I M P O R TA N T I N F O R M AT I O N

Understanding the causes of an illness means understanding what factors play a big part in how an illness develops. Some illnesses are caused by a single factor, such as catching a cold from a virus. Other illnesses, such as heart disease, are caused by many factors. Serious mental health problems (mental illnesses) are usually caused by many factors.

Factors involved in the development of mental illness • There is no simple answer to the question: “What causes mental illness?” • The causes of mental health problems are very complex. • There is no explanation of mental illness that is accepted by everyone. How a person understands the causes of mental illness is influenced by: – Culture, religion, education and a person’s experience with mental health treatment providers. • There are many factors that can lead a person to have a mental health problem. These factors include biological, psychological and social influences. • For some people the biological factor may be the most important and for other people the psychological or social factor may be the most important. • Usually all three factors play a role in the development of mental health problems.

Biological factors

One theory of mental illness states that people are born with—or develop very early in life—a biological sensitivity or vulnerability that increases the chances they will have a mental health problem. However, having the vulnerability is just part of the story. Scientists think that whether or not that vulnerability leads to a mental health problem may be connected to how much stress a person experiences and how they cope with stress. People with serious mental health problems are often very sensitive to stress. For some people, even the common stresses in life, such as getting a job, going to college or living alone, can bring on symptoms of a mental health problem. In future lessons you will learn more about stress and its connection to mental health. One important question is: How does a person develop a biological sensitivity or vulnerability to have mental health problems? Scientific research has shown that the following biological factors could affect the development of mental health problems: • Genetics: A person may inherit genes from his or her parents that increase the chances of developing a mental health problem. • Complications of pregnancy: Some events during pregnancy can influence the

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development of mental health problems. These events include: – Using drugs or alcohol while pregnant – A mother’s illness during pregnancy – A baby being born early – Complications during delivery. • Head injury: Any injury that affects the brain can increase the chances of developing serious mental health problems. • Excessive use of drugs and alcohol: It is not clear if drugs alone can cause a mental health problem. However, research has shown that drugs and alcohol can trigger a mental health problem or make existing symptoms worse. Psychological factors

Psychological factors refer to a person’s ability to cope with stress and day-to-day problems. The ability to cope with stress and difficulties is affected by a person’s psychological strengths, including intelligence, attitudes, knowledge, sensitivity to stress and social skills. People differ in their ability to handle stressors (this is often referred to by scientists as stress vulnerability). People who handle stress more easily often have skills that help them to cope. The WSM Program provides you with an opportunity to learn skills for coping with stress. Social factors

Social factors refer to all the positive and negative forces in a person’s environment. Several social factors that may have an impact on mental health problems are listed below. Abuse or trauma: Mental health problems may develop from a person’s history of abuse or trauma. Trauma may lead to new mental health problems or lead to a relapse of symptoms of an existing problem. Some examples of traumatic experience that can lead to mental health problems include:

– Domestic violence – Being the victim of childhood physical or sexual abuse or neglect – Witnessing or being the victim of a violent crime – Experiences of being in a war. Cultural influence: Different cultures have different explanations about the causes of mental health problems. For example, in some cultures, unusual or strange behaviors are thought to be the result of evil spirits, a curse or possession by the devil. For some people, moving to another country (immigration) with different cultural demands can be a very stressful experience. This experience may be extremely difficult for people who don’t have community s and other resources. Social, economic and political stressors: Social, economic and political conditions play an important role in an individual’s mental health. For example, people who experience ongoing poverty, stigma, discrimination, isolation and physical disabilities may have a greater chance of developing a mental health problem. In addition to these stressors, many people don’t have access to social and mental health services.

Why is it important to know that mental health problems are affected by biological, psychological and social factors? • The decisions you make about your mental health problems are affected by what you believe is causing these problems. • Treatment has three goals: (1) to reduce the biological influence on mental health problems, (2) to reduce stress and (3) to help a person cope with stress. Knowing about the biological, psychological and social

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influences on mental health problems can help a person choose the best treatment. • Knowing about the causes of mental health problems can help you make decisions about treatment that works for you. • The most effective path to recovery involves addressing all the factors that may influence your mental health problems.

Discussion Points: What factors do you think have contributed to your mental health problems? • What explanations about your mental health problems are related to your cultural or religious background?

P E R S O N A L I Z E D W O R K S H E E T: Thinking about factors Consider answering the following questions about the factors you believe may have contributed to your mental health problems. You may not be clear or definite about your answer. That’s OK. What factors do you think have contributed to your mental health problems? Please consider each of the following factors: Biological factors (close relative with mental illness, drugs, alcohol, medical illness, head injury, birth complication, etc.) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Psychological factors (lack of knowledge and skills to cope with and solve day-to-day problems) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Social-cultural factors (adjustment to American culture, immigration, poverty, limited education, lack of social s, loneliness, isolation, disconnected from one’s culture or religious affiliation, homelessness, etc.) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

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A ction S tep : Review your factors and choose one to learn more about What would you like to learn?__________________________________________________ ______________________________________________________________________________ What will be your first step?____________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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COPING WITH THE STIGMA OF HAVING A MENTAL ILLNESS DIAGNOSIS LESSON 26 I M P O R TA N T I N F O R M AT I O N

What is stigma?

What is self-stigma?

The word “stigma,” means the negative opinions and attitudes that some people have toward people with mental health problems. Sometimes these negative opinions may lead to discrimination in housing, jobs and other areas of life. A person’s cultural background may also influence how much stigma he or she attaches to mental health problems.

Due to the stigma associated with mental health problems, many people have found that they lose their self-esteem and feel a sense of shame for having mental health problems. A national research project called “Mental Health Recovery: What Helps, What Hinders” stated that people who are recovering from mental health problems often feel shame, self-blame and fear. Overcoming this feeling of shame, or self-stigma, is an important step toward recovery.

If you became ill you would go to a doctor, and once you got better you would expect to get on with life as usual. However, life does not always fit back into place for people who have mental health problems. Everyone has the right to fully participate in their community. Individuals struggling with mental health problems often find themselves facing rejection. Individuals with mental health problems may experience stigma in many important areas of their lives. Some people have been denied adequate housing, loans, health insurance and jobs due to their history of mental illness. It is important to know that there are two major laws that protect people with physical or mental health problems from discrimination. The Americans with Disabilities Act (ADA) makes it illegal to discriminate in the areas of employment, transportation, communication or recreation. The Fair Housing Act (FHA) prohibits housing discrimination.

Sometimes people who experience symptoms of a mental health problem do not know the facts about mental illness. They may blame themselves for their symptoms. They may think that they can’t take care of themselves or that they can’t be part of the community. It is important to fight self-stigma, because it can make you feel discouraged and lose hope in your recovery. One way to fight self-stigma is to learn about the symptoms of mental health problems so you can separate facts from fiction. For example, knowing that people can’t cause schizophrenia can help you to stop blaming yourself or others.

Strategies for responding to stigma Stigma is a complicated problem, and there are no easy solutions. Research has shown that the public’s negative beliefs about people with mental health problems decrease when they

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get accurate information about mental health problems. It may be helpful for you to develop some personal strategies for responding to stigma. There are advantages and disadvantages to each strategy. What you decide to do depends on the situation and what you feel comfortable with. Some possible strategies include: • Correct wrong information without disclosing anything about your own experience. A co-worker might say, “People with mental illness are all dangerous.” You might decide to reply, “Actually, I read a long article in the paper that said that the majority of people with mental illness are not violent. The media just sensationalizes certain cases.” • Choose to tell people you trust about your experiences with a mental health problem. Disclosing information about your own experience with symptoms of a mental health problem is a personal decision. It’s important to think about how the other person might respond. It’s also important to weigh the risks and benefits to yourself, both in the short term and in the long term. Talking this over with somebody before you disclose information to others might be a useful strategy.

People vary widely in whether they choose to disclose information about themselves, and if so, how much. You may decide to disclose personal information only to family or close friends. Or you may disclose information to people only when it becomes necessary. For example, you might need a specific accommodation in order to perform your job. You may feel comfortable disclosing information in a wide variety of settings. You may even be

willing to speak publicly about mental illness for educational or advocacy purposes. • Become aware of your legal rights. – It’s important to educate yourself about the laws against discrimination. Two major laws that protect against unfair treatment are the Americans with Disabilities Act (ADA) and the Fair Housing Act (FHA). – You are entitled to language-specific services free of charge. – The Americans with Disabilities Act makes it illegal to discriminate against people with physical or psychiatric disabilities in employment, transportation, communication or recreation. – The Fair Housing Act prohibits housing discrimination because of race, color, national origin, religion, sex, family status or disability (physical or psychiatric). – It is worthwhile to take some time to understand the basic principles of these laws and how they might apply to you. If you feel that your legal rights have been violated, there is a range of possible actions you might take, depending on the situation. – Sometimes it is most effective to speak directly to the person involved. For example, it is usually preferable to approach your employer about the need to provide a reasonable accommodation on the job. An example of a reasonable accommodation would be asking to move your desk to a quieter area in the office to improve your concentration. – Sometimes it may be more effective to talk to an expert to get advice, , advocacy, mediation and even legal help. For example, if a landlord refused to rent you an apartment because of psychiatric symptoms, you may need

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to the Office of Fair Housing and Equal Opportunity (FHEO) in the Department of Housing and Urban Development (HUD) for advice and assistance. – If an employer was unresponsive to your request for accommodation on the job, you might want to the Equal Employment Opportunity Commission (EEOC).

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Discussion Points: How have you usually responded to negative attitudes toward you or others with mental health problems? • What strategies have you used or would you like to use to reduce stigma?

P E R S O N A L I Z E D W O R K S H E E T: Thinking about strategies for reducing stigma You can use this checklist to identify the strategies you have used to reduce stigma and strategies you would like to use. Strategy

Educate yourself about mental health problems Correct others who give the wrong information about people with mental health problems Tell someone you trust about your own experience with mental health problems Become aware of your legal rights Learn about people who are living productive and satisfying lives with mental health problems Participate in self-help and advocacy activities Other: Other:

I have used this strategy

I haven’t but would like to use this strategy

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A ction S tep : Choose a stigma-reducing strategy to use Strategy:______________________________________________________________________ What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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WHAT IS STRESS? WHY IS IT IMPORTANT TO YOU? LESSON 27 I M P O R TA N T I N F O R M AT I O N

What is stress? “Stress” is a term people often use to describe a feeling of pressure, strain or tension. People often say that they are “under stress” or feel “stressed out” when they are dealing with changes, difficult situations or losses. Everyone experiences stress. Sometimes stress comes from something positive (like a new job, new apartment or new relationship) and sometimes from something negative (like being bored, having an argument with someone or being the victim of a crime). Stress is part of life. In fact, many of the things that make life satisfying and meaningful are stressful. For example, having a job, going to school, starting a business, raising a family, caring for an elderly person, planning a vacation or having a close romantic relationship is often stressful. It is important to understand that stress and how people react to stress are influenced by life experiences, religion, gender, age, sexual orientation and cultural background.

Why is understanding stress important? Nobody has a stress-free life and probably nobody would want to! Stress is a natural part of life. In fact, to pursue important personal goals, you need to be willing to take on new challenges, which can be stressful. Being able to cope with stressful situations can lower the

effects of stress on you and your symptoms. This can help you to continue to pursue your goals and get more out of life. Understanding the effect of stress on your mental health is an important part of staying well. People with mental health problems may be more sensitive to stress. Stress that is not managed well can make symptoms worse and lead to relapses. By learning how to prevent harmful stress you can continue to pursue life goals and find more success and satisfaction in life. Too much stress can worsen symptoms

For many people, stress plays a big role in the way they feel. Too much stress can make people feel anxious and depressed and may cause sleep problems. Too much stress can affect your concentration—it might be harder for you to focus on things you’re doing. For some people, stress may even TRIGGER symptoms of a mental health problem. Stress may also result from the good things that happen in our life, such as moving, getting a new job or starting a new relationship. All of these stresses (good or bad) can affect your system over time.

What makes people feel stressed? Different people find different things stressful. For example, some people enjoy the hustle and bustle of a big city, while others don’t like the crowds and noise and find it stressful. Some

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people enjoy going to a party and meeting new people, while others find it stressful. Knowing what you personally find stressful will help you cope better. • Two main sources of stress are life events and daily hassles – Life events: Life events refer to major life experiences, such as changes in your housing situation, getting married, the death of a loved one or having a baby. Some life events are more stressful than others; for example, getting a divorce

is usually more stressful than changing jobs. – Daily hassles: Daily hassles are the small daily stresses of everyday life that can add up if they are not handled well. Examples include dealing with long bus rides, working with unpleasant or critical people, having conflicts with family or close friends, living or working in a noisy chaotic place and being rushed to do things.

P E R S O N A L I Z E D W O R K S H E E T: Thinking about stress Both life events and daily hassles can TRIGGER early warning signs or full-blown symptoms. As you complete the Life Events Checklist and the Daily Hassles Checklist, try to identify situations that can trigger intense stress or symptoms.

LIFE EVENTS CHECKLIST Please check off each event that you have experienced in the past year. o Moving

o Victim of a crime

o Getting married

o Legal problems

o Partners moving in together

o New boyfriend or girlfriend

o New baby

o Broke up with a boyfriend or girlfriend

o Divorce or separation o Injury o Illness o New job o Loss of a job o Inheriting or winning money o Financial problems o Injury or illness of a loved one o Death of a loved one

o Stopped smoking o Went on a diet o New responsibilities at home o New responsibilities at work o No place to live o Hospitalization o Drinking o Using street drugs that caused problems

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o Change in treatment team o Violence in the home o Head of household o Experience of prejudice based on language, illness or sexual orientation o Other:_ __________________________

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Now that you have checked off life events, have any of these events TRIGGERED a relapse for you and/or an increase in symptoms? If yes, please write them down: _______________________________________ _______________________________________ _______________________________________

The following checklist will help you identify daily stressors in your life and which stressors could trigger symptoms of a mental health problem:

DAILY HASSLES CHECKLIST Please check each event you have experienced in the past week. o Taking medication

o Noisy situation at work

o Taking part in a treatment program

o Not enough privacy at home

o Not enough money to take care of necessities

o Minor medical problems

o Not enough money to spend on leisure

o Lack of order or cleanliness at work

o Crowded living situation o Crowded public transportation o Mental health stigma o Long drives or traffic back-ups o Feeling rushed at home o Feeling rushed at work o Arguments at home o Arguments at work o Doing business with unpleasant people (sales clerks, waiters/ waitresses, transit clerks, toll booth workers) o Noisy situation at home o Mental health housing

o Lack of order or cleanliness at home o Unpleasant chores at home o Mental health treatment o Unpleasant chores at work o Living in a dangerous neighborhood o Dealing with your treatment team o Dealing with children o Other:_ __________________________ Now that you have checked off a number of daily hassles, have any of these experiences TRIGGERED a relapse or an increase in symptoms? If yes, please write them down: _______________________________________ _______________________________________ _______________________________________

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A ction S tep : Write down daily stressors or stressful life events Being more mindful of day-to-day stresses is important. In the next week be mindful of daily stressors or life events that are stressful. Consider writing down up to 3 stressful situations that have come up during the week: 1._____________________________________________________________________________ 2._____________________________________________________________________________ 3._____________________________________________________________________________ It is best to select a time and place when you will write down the information. When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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IDENTIFYING YOUR PERSONAL SIGNS OF STRESS LESSON 28 I M P O R TA N T I N F O R M AT I O N

What are signs that you’re under stress? When people are under stress, it affects them physically and emotionally. It also affects their thinking, mood and behavior. Some people show only physical signs of stress, such as muscular tension, headaches or sleep problems. Others have trouble concentrating or become irritable, anxious or depressed. Still others may pace or bite their nails. Each person’s response to stress is individual. What causes stress for one person may cause little or no stress for someone else. That’s because a large part of stress depends on how you view the situation. Being aware of your own personal signs of stress can be very helpful, because once you realize that you’re under stress you can start to do something about it. The signs of stress can be physical or emotional. The way people express stress may be affected by age, gender, culture or religion. For example, in some cultures people are more likely to express stress through physical complaints rather than emotional complaints.

Common physical and emotional signs of stress include the following: • Physical signs of stress – Rapid heartbeat – Rapid breathing – Headache – Sweating and sweaty palms. • Emotional signs of stress – Becoming irritable (even little things bother you) – Feeling jumpy or exhausted all the time – Finding it hard to concentrate – Worrying too much about small things – Fearing the worst – Feeling that you are missing opportunities because you cannot act quickly – Doubting your ability to do things – Experiencing early warning signs of mental health problems – Being suspicious.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about signs of stress You can use the following checklist to identify your own personal signs of being under stress.

SIGNS OF STRESS CHECKLIST Check the physical and/or emotional signs you notice when you are under stress. o Anger over relatively minor things o Headaches o Sweating

o Anxiety

o Increased heart rate

o Feeling restless or “keyed up”

o Back pain

o Tearfulness

o Change in appetite

o Forgetfulness

o Difficulty falling asleep

o Prone to accidents

o Increased need for sleep

o Using alcohol or drugs

o Trembling or shaking

o Wanting to use drugs or alcohol

o Digestion problems

o Being suspicious of others

o Stomach aches

o Other:_ __________________________

o Dry mouth

o Other:_ __________________________

o Problems concentrating

Discussion Points: What are your personal signs of stress? Are these signs of stress related to your age, gender, religion, or culture?

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A ction S tep : Write down signs of stress you experience In the next week, be mindful of your personal signs of stress. Please write up to 3 signs of stress that come up during the week: 1._____________________________________________________________________________ 2._____________________________________________________________________________ 3._____________________________________________________________________________ It is best to select a time and place when you will write down the information. When will you write down these signs?__________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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HOW TO PREVENT STRESS IN THE FIRST PLACE LESSON 29 I M P O R TA N T I N F O R M AT I O N

Strategies for preventing stress Putting energy into preventing stress can pay off. If you can get rid of some of the negative stress in your life, it frees you up to enjoy yourself more and to meet more of your goals. Most people find it helpful to learn about prevention strategies, like the ones described below and listed in the “Strategies for Preventing Stress Checklist” on page 99. Be aware of situations that have caused stress in the past. Situations that caused stress in the past will probably cause stress in the future. Knowing that a situation has been stressful will allow you to think of different ways to handle it so it won’t be as stressful. For example, if you notice that you become irritable whenever you catch the bus at rush hour, try catching it at a less busy time. Or try practicing deep breathing if you become tense on a crowded bus. If large holiday gatherings with your family make you feel tense, try taking short breaks away from the larger group. Or try getting together with family at times other than holidays, in smaller groups. Schedule meaningful, enjoyable activities.

Having activities that you enjoy reduces stress. For some people, their work is meaningful and enjoyable. Other people look to volunteering,

hobbies, music, sports or art for meaning and enjoyment. It all depends on what you find most important. Schedule time for relaxation.

It’s important to take time to relax each day, to refresh your mind and body from the tensions of the day. Some people find exercise relaxing, while others find relaxation in reading or doing a puzzle, watching TV, listening to music, surfing the internet, etc. Create balance in your daily life.

Being active and involved is important to keeping stress low. However, too much activity may lead to stress. It’s important to leave time for sleep and for restful, relaxing activities, such as reading or taking a walk. Develop a system.

Seek out people who are encouraging and ive, rather than critical and pressuring. It’s very helpful to have relationships with people you trust. Common systems include friends, family , peers, professionals and of one’s religious, spiritual or cultural group. Take care of your health.

Eating well, getting enough sleep, exercising regularly and avoiding alcohol or drug abuse helps prevent stress. These healthy habits are not easy to maintain, but they really pay off.

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Talk about your feelings or write them down in a journal.

Holding in your feelings can be very stressful. It helps to have an outlet for your feelings so that you don’t keep them bottled up. These may be positive feelings, like being excited about a new job. On the other hand, you may have negative feelings, such as being angry at someone. Having someone to talk to, such as a family member, friend or professional, can help. Or you might find it helpful to keep a journal of your thoughts and feelings.

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Avoid being hard on yourself.

Some people increase their stress by putting themselves down. Putting yourself down or blaming yourself is one of the most harmful negative thoughts that gets in the way of recovery. Try to be reasonable about what you expect from yourself. It’s important to give yourself credit for your efforts. It can be helpful to identify and remind yourself of your strengths.

P E R S O N A L I Z E D W O R K S H E E T: Thinking about strategies for preventing stress Below are some strategies to prevent stress from becoming a problem. Check the boxes that apply to you. Strategies for Preventing Stress Checklist Strategy

Be aware of situations that have caused stress in the past. Schedule meaningful activities. Make time for relaxation. Develop my system. Take care of my health. Talk about my feelings with friends or family. Talk about my feelings with my mental heath professional. Write down my feelings in a journal. Avoid being hard on myself. Identify positive features about myself. Other: Other:

I already use this strategy

I would like to learn about this strategy or do more of it

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A ction step : Choose a stress prevention strategy to learn about or use more often Choose one strategy you want to learn about OR one strategy you want to use more often. Strategy:______________________________________________________________________ ______________________________________________________________________________ What will be your first step?____________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself?__________________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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COPING WITH STRESS: WHAT WORKS? WHAT DOESN’T? LESSON 30 I M P O R TA N T I N F O R M AT I O N

When people experience stress, they naturally try to reduce the tension or upset they feel. Some ways of coping work well and others may cause more harm than good. A strategy that works well is one that relieves tension and doesn’t cause other problems. A strategy that doesn’t work well is one that may relieve tension for a short time but ends up causing more problems in the long run.

Use positive self-talk.

In this lesson you will (1) learn about some successful coping strategies as described by various people, (2) have an opportunity to learn and practice some simple relaxation techniques and (3) learn about coping strategies that typically cause more harm than good.



How can you cope with stress effectively? Coping effectively with stress is a key to living a successful and rewarding life and being able to pursue your personal goals. Some strategies for coping with stress are described below in the words of people who have used them effectively. Talk to someone about the stress you are experiencing.



“When I was packing up my stuff to move to a new place, I started having headaches and trouble sleeping. I called my sister and told her how stressed out I felt. She told me she felt the same way when she moved the last time. She even offered to help me pack. It made a huge difference.”



“Before when I was under stress, I used to blame myself and think that there was no way out. Now I try to think more positively. I say to myself, ‘This is hard, but I can do it,’ or ‘If I take this one step at a time, I’ll be able to handle it.’ Thinking more positively is hard to do sometimes, but it makes me feel better about myself.”

Maintain your sense of humor.

“For me ‘laughter is the best medicine.’ When I’ve been on a subway ride that lasted two hours instead of 45 minutes, I feel very tense and agitated. I have some funny videos at home, and I’ll pull one out and have a good laugh. Believe it or not, it helps me to watch a Monty Python movie or one starring Adam Sandler.”

Participate in religious or spiritual activity.



“I grew up in a religious home. Although I’m not sure I believe every aspect of that religion, I still find it comforting to go to services. And sometimes instead of going to services I go for a walk in the park and see how beautiful nature can be. That’s very spiritual for me.”

Exercise regularly.



“I like to ‘work off ’ my stress by getting some exercise. Sometimes I go for a run and sometimes I just do some jumping jacks until I calm down.”

Write in a journal.



“I’ve started keeping a journal to write down my thoughts and feelings. I don’t care about the grammar or spelling—I just write down what

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comes into my head. Sometimes I write about stressful things and that seems to help. Writing helps me think things through.” Make or listen to music.



“I’m a music person. I put on my headphones and blow away the stress of the day. I can even do it on the train, to distract myself on the long ride.”

Do art or go to see art.



“I like to sketch. I especially like drawing cartoons. I must it I sometimes make some unflattering cartoons of people who are bugging me.”

Play games or develop a hobby.



“I like playing card games. When I don’t have anyone to play with, I like solitaire. It’s relaxing to me.”

Use relaxation techniques.



“If I’ve had a stressful day, it helps me to do some deep breathing. I put on some relaxing music, and sit in my favorite chair. Then I start by taking ten deep, slow breaths. I let my breath out very slowly. As I exhale, I try to imagine that when I let out my breath, I’m letting out the tension in my body. Then I take about 20 or 30 more breaths. Sometimes I try to imagine a peaceful scene, like the ocean, when I’m breathing. I usually feel more relaxed after that.”

Practicing relaxation techniques Two simple relaxation techniques are described below. 1. Muscle tension–relieving exercise 2. Deep-breathing exercise. Muscle tension–relieving exercise

When we are stressed, the tension we feel is usually in the muscles of our face, shoulders, arms, hands and neck. These simple exercises can help to relieve the tension in those areas where you feel the most tension. They can be

Wellness Self-Management

done when you are sitting, walking or lying down, and they only take a minute or two. • Tilt your head backward and try looking right up, feel the tension in your neck. Then allow your head to return to its normal balanced position. Notice the difference. • Try hunching up the shoulders as far as they will go, and then let them go. Notice the difference. • Try clenching your teeth or opening your mouth as wide as possible, then let the tension go. Notice the difference. Let all the expression go from your face. Look straight ahead and into the distance or, if you prefer, close your eyes. • Try stretching your hands and fingers and then let them fall to your side or on your lap. Deep-breathing exercise

One of the easiest ways to relieve tension is deep breathing. Under stress, people often take short breaths or breathe in a shallow manner. Deep breathing can be very effective in relieving tension. Here are some tips for breathing deeply. • Find a comfortable place to lie down or just sit in a comfortable chair. • Slowly breathe in through your nose. Your stomach should feel like it’s rising. • Exhale slowly through your mouth, emptying your lungs completely and letting your stomach fall. • Repeat several times until you feel calm and relaxed. Practice daily. Once you are able to do this easily, you can practice this technique almost anywhere, at any time.

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Ineffective coping strategies People sometimes do things to cope with stress that do not work well. • Using drugs and alcohol to relieve tension or increase energy • Getting into fights to resolve arguments • Taking advantage of others • Arguing with others or threatening others who may be causing your stress

• Shutting yourself off from people and activities • Avoiding day-to-day responsibilities • Coping in a way that gets you into legal trouble • Harming yourself • Eating excessively • Buying things you can’t afford.

Discussion Points: What coping strategies work for you?

Which coping strategies have not worked for you?

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about strategies for coping with stress Check the strategies that apply to you. Strategies for Coping with Stress Checklist Strategy

Talk to someone about upsetting events. Use relaxation techniques. Keep my sense of humor (seek out humorous movies, books and people). Participate in religion or other forms of spirituality. Exercise regularly. Write in a journal or diary. Listen to music that is relaxing or uplifting. Get involved in social and recreational activities. Get involved in a hobby or creative activity. Other: Other:

I already use this strategy

I would like to try this strategy or develop it further

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A ction S tep : Create your plan for coping with stress The last several lessons included checklists to help you identify stressful situations, signs of stress and strategies for coping with stress. It may be helpful to put this information together as an individual plan for coping with stress. Individual Plan for Coping with Stress Stressful situation that I want to cope with more effectively: 1._____________________________________________________________________________ 2._____________________________________________________________________________ 3._____________________________________________________________________________ Signs that I am under stress: 1._____________________________________________________________________________ 2._____________________________________________________________________________ 3._____________________________________________________________________________ My strategies for coping with stress: 1._____________________________________________________________________________ 2._____________________________________________________________________________ 3._____________________________________________________________________________

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USING A STEP-BY-STEP FORMULA TO IMPROVE A PROBLEM LESSON 31 I M P O R TA N T I N F O R M AT I O N

Problem solving Problems are a natural part of life. Everyone encounters some problems along the way, no matter how well they are managing their lives. Some problems are easily solved and cause very little stress. Other problems are more challenging and can result in significant stress. When stress builds up, it can cause symptoms to worsen and can lead to a relapse. Developing strategies for coping with problems can help reduce stress. In this lesson you will learn a step-by-step method for solving problems.

Step-by-step method for solving problems When trying to solve a problem it is important to have a step-by-step plan. The following step-by-step method can be a useful tool for solving problems and achieving goals. The more you use this method for solving problems and achieving goals, the easier and smoother it will become. Step 1

Define the problem you want to solve. Be as specific as possible. Step 2

List some possible solutions (at least 3). This step is for brainstorming. Don’t judge whether the solutions are good or bad yet.

Step 3

For each solution, list at least one advantage (pro) and one disadvantage (con). Be brief, but give each solution a chance. Step 4

Choose the best solution or combination of solutions. Which solution is most likely to solve the problem? Which solution can be easily carried out? Step 5

Plan how to carry out the solution. Answer these questions: • Who will be involved in carrying out the solution? • What step will each person do? • What is the time frame for each step? • What resources are needed? • What might get in the way and how could it be overcome? Step 6

Set a date to check how the solution is working. First focus on the positive: What has been accomplished? What went well? Then decide if the solution was successful or if you need to change it or choose another one.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about a problem Step-by-Step Approach to Problem Solving

You can use this worksheet to develop a plan for solving a problem. It is best to choose to work on a problem that you will face in the coming weeks. 1.  Define the problem as simply as possible: _________________________________________________________________________________ _________________________________________________________________________________ 2.  List 3 possible strategies to solve this problem: a.______________________________________________________________________________ b._ ____________________________________________________________________________ c.______________________________________________________________________________ 3.  For each possibility you listed in #2, list one advantage and one disadvantage: Advantages/pros:

Disadvantages/cons:

a._____________________________________

a._____________________________________

b._ ___________________________________

b._ ___________________________________

c._____________________________________

c._____________________________________

4.  Choose the best strategy to solve the problem: _________________________________________________________________________________ _________________________________________________________________________________ 5.  Who can help you with this strategy?_ _____________________________________________ 6.  Set a date for evaluating how the solution is working.

Follow-up will be on this date:____________________________________________________

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A ction S tep : Choose a problem-solving strategy Write down the strategy you will try. Strategy_______________________________________________________________________ What is your first step?_________________________________________________________ When will you try it?___________________________________________________________ Where will you try it?_ _________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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THOUGHTFULLY CHOOSING A MENTAL HEALTH PROBLEM TO WORK ON LESSON 32 I M P O R TA N T I N F O R M AT I O N

Common mental health problems This lesson focuses on identifying common symptoms of a serious mental health problem that you have experienced and would like to work on. Deciding which problem area or symptom of a mental health problem to change is up to you. You may want to consider a number of things as you decide which problems you want to start working on now. For example: • Which problem causes you the most upset? • Which problem gets in the way of accomplishing your most important goals? • Which problem area has gotten you into the most trouble? • Which problem area are you most likely to change successfully?

Why is it important to thoughtfully choose a mental health problem to work on? • When mental health problems and symptoms are not managed well, a person may find it difficult to work on goals and handle day-to-day responsibilities. • Thoughtfully choosing a problem area ensures you will make changes that really matter to you and that may make a big difference in your life. • It’s not easy to make important changes. It’s important to remind yourself about the benefits of solving the problem even when it gets tough. It is important to understand how life will be better once the problem is more manageable.

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P E R S O N A L I Z E D W O R K S H E E T: Identifying mental health problems People often experience problems in the following categories. Take some time to identify problems that bother you. COMMON PROBLEMS CHECKLIST Category of problem

Thinking problems

Specific problem areas

I experience this problem

Difficulty paying attention Difficulty concentrating

Mood problems

Anxiety (nervousness) Depression Anger Sleeping difficulties

Negative symptoms

Lack of interest in most things Lack of pleasure and enjoyment Lack of expressiveness Social withdrawal

Psychotic symptoms

Delusions Hallucinations

Drug and alcohol abuse

Drug abuse Alcohol abuse Abuse of other substances

Other problem areas:

Discussion Points: What types of problems do you cope best with?

What types of problems do you need better coping strategies to cope with?

What strategies have you tried to cope with your mental health problems?

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A ction S tep : Make a list of how your life would be better without the problem area you want to change Write down a mental health problem that you identified on the worksheet. Problem:______________________________________________________________________ ______________________________________________________________________________ Before the next group consider making a list of how your life would be better if you had coping strategies for the problem. When will you make the list?___________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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CHOOSING STRATEGIES FOR COPING WITH SPECIFIC PROBLEMS AND SYMPTOMS LESSON 33 I M P O R TA N T I N F O R M AT I O N

The last lesson focused on identifying symptoms of a mental health problem that get in the way of your life. Part two focuses on choosing strategies that work for you. Being

able to cope with mental health symptoms can help you live a more enjoyable life and accomplish life goals.

P E R S O N A L I Z E D W O R K S H E E T: Thinking about coping strategies for common problems For each problem listed in the “Common Problems Checklist” from the previous lesson, several coping strategies are suggested below. This list will enable you to choose strategies that might work. If you want to try a strategy, check the box next to it. It is important to keep in mind that if any of these problems begin to worsen or interfere significantly with your life, it may be a sign of an impending relapse. In such situations, it is best to your doctor or practitioner to help you evaluate what steps to take. There are many strategies for coping with problems and symptoms. It’s important to choose the ones you believe will help you the most. In this worksheet, spend the most time focusing on the problem that you chose in the last lesson.

Thinking problems and coping strategies Difficulty paying attention

o Choose an interesting activity that requires attention. Start out by spending a brief time on the activity and then gradually increase the amount of time. o Ask someone to you in an activity that requires attention, such as a board game, card game or a jigsaw puzzle. Many people find that doing something together helps them focus better.

Difficulty concentrating

Sometimes people have problems staying focused on conversations or activities. o Minimize distractions, so there is only one thing to concentrate on.

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o Ask the person with whom you are talking to slow down or repeat things that you are unsure of. o Check to make sure you understand by summarizing what you heard. o Break down activities or tasks into smaller parts and take frequent breaks.

Mood problems Anxiety

When people are anxious, they usually feel worried, nervous or afraid. They often feel physical symptoms of anxiety, such as muscle tension, headaches, heart racing or shortness of breath. o Talk with someone in your system to let him or her know about your feelings. o Use relaxation techniques, such as deep breathing or progressive muscle relaxation, to stay calm. o Identify situations that tend to make you anxious and make a plan to do something about them. o Work with your practitioner on a plan for gradually exposing yourself to situations that make you feel anxious. Depression

When people are depressed, they may have one or more of the following problems: feeling bad about themselves, not doing the things they used to enjoy, sleeping too much or too little, low energy, poor appetite, and having trouble concentrating and making decisions. If you get severely depressed and start thinking of hurting yourself or ending your life, you should your practitioner immediately or seek emergency services. However, if you are not having severe symptoms of depression, you can try the following coping strategies to help improve your mood: o Set goals for daily activities. Start with one or two activities and gradually build up to a full schedule. o Identify things that you still enjoy and build your strengths in those areas. o Schedule something pleasant to do each day, even if it’s a small thing. This will give you something to look forward to. o Talk to someone you like and trust and let him or her know how you’re feeling. Sometimes another person has good ideas you can try. o Ask people to you in activities. You may be more likely to follow through with plans when someone else is involved. o Deal with loss of appetite by eating small portions of food that you like and taking your time. o Practice relaxation exercises on a regular basis. o Remind yourself of the steps you have accomplished and avoid focusing on setbacks.

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Anger

Some people find that they feel angry or irritable much of the time. They feel very angry about situations that other people would not ordinarily get very angry about. Because this is a common problem, there are programs for anger management, which many people have found helpful. Some of the strategies taught in anger management classes include: o Recognize the early signs that you are starting to feel angry (for example, heart pounding, jaw clenching, perspiring), so that you can keep things from getting out of control. o Identify situations that commonly make you feel angry and learn how to handle these situations more effectively. o Develop strategies for staying calm when you’re angry, such as counting to ten before responding, distracting yourself, temporarily leaving the situation or politely changing the subject. o Learn how to express angry feelings briefly and constructively. The following steps are helpful: – Speak firmly but calmly. – Tell the person what he or she did to upset you. Keep it short. – Suggest how the situation could be avoided in the future. Sleeping difficulties

Sleeping too much or too little can be very disruptive. It’s hard to accomplish things when you don’t get enough sleep. Trying some of the following strategies may help: o Go to sleep and get up at the same time every day. o Avoid caffeine after 6 p.m. o Exercise during the day so you’ll feel tired at night. o Do something relaxing before going to bed, such as reading, taking a warm shower, drinking warm milk or herbal tea or listening to music. o Make sure that your room is dark and that the temperature is comfortable. o Avoid watching violent or distressing programs on television or video just before going to bed. o Avoid having discussions about upsetting topics just before going to bed. o Avoid napping during the day. o Avoid spending more than 30 minutes lying awake in bed. Instead, try getting up, going to another room and doing something relaxing (like reading or listening to music) for at least 15 minutes before returning to bed.

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Negative symptoms Lack of interest and lack of pleasure

It’s very difficult to stay active when things don’t seem interesting to you or when you don’t enjoy things you used to enjoy. It’s also difficult to pursue goals when you feel this way. The following strategies may be helpful to gradually increase your interest and enjoyment of activities: o Be patient with yourself. Changes will happen slowly. o Take one small step to getting back to an activity you previously enjoyed. o As you gain more confidence in short activities, slowly plan longer activities. o Ask people in your system to do things with you. o Regularly schedule enjoyable activities. o Investigate new interests such as the following: – – – – –

Computers (games, e-mail, websites, chat rooms, word processing, etc.) Doing artwork or crafts Visiting museums (art, science, natural history, history) Games (chess, checkers, cards, etc.) Cooking (different varieties such as microwave specialties, Chinese, Italian, French, cookies, cakes, etc.) – Exercising (bicycling, swimming, calisthenics, aerobics, dance-based exercises) – Gardening (indoor or outdoor) – Walking and running – Humor (reading jokes, telling jokes to others, humorous movies or television shows) – Listening to music – Watching or playing sports – Reading (fiction, non-fiction, humor, mysteries, poetry, plays) – Writing (journal, poetry, newsletter, articles, stories, novels) – Yoga (class or video) – Singing (by yourself or with others) – Playing musical instruments – Science-related interests (astronomy, math, weather) – Sewing, knitting – Other:___________________________________________________________________ Be willing to try something several times in order to get used to it. The more comfortable you feel with an activity, the more likely you will enjoy it.

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Social withdrawal

Everyone needs time alone. But withdrawing from people and avoiding with others may create problems in your relationships. The following strategies may be helpful in coping with social withdrawal: o a group. o Explore jobs or volunteer work that involves with other people. o Schedule with someone every day, even if it’s for a short time. o If you find it stressful to be with people, practice relaxation techniques (see page 102) before or after your with them. o If it’s too stressful to have in-person , call people on the phone and talk for at least a few minutes. o Arrange for errands that involve with people, such as going to the library. o Make a list of people in your system with whom you feel most comfortable. Call them when you are feeling that you are starting to withdraw. If possible, make a plan to meet with them. o Sometimes it’s more comfortable to spend time with people when you are engaging in an activity together. Try planning activities with someone, such as going to a museum or a musical performance.

Psychotic symptoms Delusions

Sometimes people develop beliefs that are firmly held even though there are no facts to back them up. For example, they might start to believe that the FBI is monitoring their phone calls. Or they might believe that people are talking about them or staring at them. For some people having this kind of belief, which is called a “delusion,” is an early sign of a possible relapse. For some people, however, these kinds of beliefs do not go away between episodes of their illness, and unless they get worse than usual, they are not necessarily a sign that an evaluation is needed. If this is your situation, you might try one or more of the following coping strategies: o Distract yourself from the disturbing belief by doing something that takes your mental attention, such as doing a puzzle or adding up rows of numbers. o Check out your beliefs by talking to someone you trust. o Distract yourself with a physical activity, like going for a brisk walk. If you try the strategies listed above but still feel distressed or distracted by beliefs, it may be helpful to talk to someone in your system. Keep in mind that you may need to your mental health professional if you become so convinced of your belief that you are thinking of acting on it. If you can’t reach your mental health professional, seek out emergency services.

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Hallucinations

Sometimes people hear voices or see things when nothing is there. They might even feel, taste or smell something when nothing is there. These experiences are called “false perceptions” or “hallucinations.” For some people, these hallucinations do not go away even with treatment. If this is your situation, you might want to try one or more of the following coping strategies: • Distract yourself by doing something that takes your attention, such as talking to someone, reading or taking a walk. Some people who hear voices hum to themselves or listen to a Walkman to drown out voices. • Check out your experiences with someone you trust. For example, one person who thought he heard voices outside his window asked his brother to listen and give an opinion. • Use positive self-talk. Some people tell themselves things like “I’m not going to listen to these voices,” or “I’m not going to let these voices get to me,” or “I’m just going to stay cool and the situation will .” • Put the hallucinations “in the background.” Some people say they acknowledge what they are hearing or seeing, but they don’t pay any further attention to it. • Use relaxation techniques. Some people find that the voices or visual hallucinations get worse when they are under stress. NOTE: If the voices start to tell you to do something to hurt yourself or someone else, you need to your mental health professional or emergency services.

Drug and alcohol abuse If you have a problem with alcohol, drugs or over-the-counter medications, you are not alone. These problems are called “substance abuse” and are very common. It’s especially common for people with mental health problems to use alcohol or drugs in a way that hurts their mental health and recovery. If someone has both a mental health problem and a substance abuse problem, the two problems are often referred to as “dual disorders” or “dual diagnosis.” Drugs and alcohol can make the symptoms of mental illness worse and can interfere with the benefits of prescribed medication. The coping strategies described below can be very helpful, but it is important to keep in mind that most people need extra help to overcome serious alcohol or drug problems. Programs that combine treatment for mental health problems with treatment for substance abuse have the most positive results. Self-help programs such as AA (Alcoholics Anonymous), NA (Narcotics Anonymous), Dual Recovery and Double Trouble (for people with both substance abuse and mental illness) may also be helpful. Whether or not you are participating in a combined treatment program or a self-help group, it is important to develop strategies that you can use for dealing with drug or alcohol problems, such as the following:

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o Talk to peers about drug and alcohol use. o Educate yourself about the scientific facts about drugs and alcohol. o Identify the advantages and disadvantages of using drugs or alcohol. What are the pros and cons of using drugs or alcohol? o Develop alternatives to using drugs or alcohol. What are other ways of getting some of the positive effects that you look for when using drugs or alcohol? What are some other ways of getting your needs met? o Practice how to respond to people who offer you drugs or alcohol. Some examples of possible responses include: – “I tell people I’m on my way someplace else and can’t stop.” – “I have to be direct with Maria and say, ‘I don’t drink anymore so don’t ask me to go to the bar with you.’ ” – “If one of those pushers tries to come up to me on the street, I just walk by quickly and don’t make eye .” o Use positive self-talk to keep in mind the benefits of avoiding or reducing your use of drugs and alcohol, for example: – – – – –

“I’ll be able to save money.” “I’ll be less depressed in the long run.” “I’ll stay out of the hospital.” “I’ll be able to keep my job.” “I won’t have as many arguments with my family and others who are important to me.”

Discussion Point: Share the problem you identified and which coping strategies you would be interested in trying out.

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A ction S tep : Tr y a c o p i n g s t r a t e g y f o r a c o m m o n p r o b l e m Write down one of the problem areas you want to try to improve by using one or more coping strategies. Area:_________________________________________________________________________ List all the coping strategies you may want to try: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Choose one strategy and make a plan to try it during the coming week. What strategy will you try?_ ____________________________________________________ When will you try this strategy?_________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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CHECKING ON YOUR PROGRESS IN THE WSM PROGRAM LESSON 34 What does checking on your progress mean? When we set goals for ourselves it may be helpful to check on the progress we are making from time to time. This means taking the following steps: • Step 1: Review what areas of life you are working to improve. • Step 2: Ask yourself: – Have you achieved your goal? – Are you making improvements? – Is this area still important to you? – Are there other life areas that are now important to you? • Step 3: Figure out actions you can take to make progress.

Why is it important to check on your progress from time to time? • People who make improvements in their lives often keep track of how they are doing. • By checking on your progress, you can then decide if it’s best to keep doing what you have been doing or to try something else? If you have been making progress this means you are on the right track. • If you are not making progress then you might want to: – Give it more time. Sometimes progress needs more time. – Ask yourself if the area is still important to you? Sometimes people change their minds or find other areas that are important. – Find other steps you could take to make progress.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about your progress Go to the Quality of Life Progress Checklist on the last page of the workbook. At this point in the WSM Program, you have an opportunity to: • Add goal areas that are now important to you by checking those goal areas in column 1 in the gray shaded section. • Check on your progress in areas that were important to you when you first started in the WSM Program as well as the new areas that you have added today. In the areas that are important to you, check the boxes in the column labeled TIME 2 that apply to you. Your choices are the following: o No improvement (Nothing has changed at all, no progress in this area.) o Improvement (You are moving in the right direction and have made progress in ways that matter to you. You clearly see that you have changed in ways that show progress.) o I’ve achieved this (A really big improvement and you are very satisfied with what you have achieved.)

Discussion Points: In what areas did you improve?

In what areas did you achieve your goal?

What areas have not improved and continue to be important to you?

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A ction S tep : Choose an area that has not improved and take action Write down one area that has NOT improved and continues to be important to you. Consider steps you may take to begin making progress in this area (for example, talk to your counselor or others you trust, make this goal a part of your service plan). Goal area that has not improved: What will be your first step?____________________________________________________ When?________________________________________________________________________ Where?_ ______________________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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CHOOSING TYPES OF MENTAL HEALTH SERVICES THAT ARE RIGHT FOR YOU LESSON 35 I M P O R TA N T I N F O R M AT I O N

This lesson is ing mental health services and resources that meet your needs and wants. To use services effectively means getting informed about the pros and cons of treatment and other services. It also means understanding what the provider will do and what is expected of you to get the most out of the services. Choosing what works best for you involves making informed decisions with the help of others who have information and who can provide a needed and wanted service.

Why is it important to get informed about services? • Gaining knowledge about mental health services is an important step in making decisions that work for you. • Having incomplete or wrong information about mental health services often leads people to make poor choices. • People are more hopeful about the future when they learn to use services that work for them. • Knowledge is the first step in using mental health programs to meet your wants and needs. • For many people with mental health problems, recovery is helped by learning about and getting involved with self-help. • Understanding how your cultural background shapes your thinking and feelings about medication and other treatments

can help you make decisions that work for you.

Types of services offered by mental health programs Mental health programs (or agencies that are d with them) usually provide a wide range of services. If they do not provide the services you are looking for, they may be able to give you information on where to find what you need in your community. The needs of people with mental health problems differ from one person to the next. Mental health programs often offer many services to meet each person’s needs. You may have already used some of the following services and may be interested in trying others: Medication services: If you choose to take medication, a doctor will work with you to find medication that works best for you. You may decide to try several kinds of medication before you are satisfied with the outcome. Medication services also include medication education. This is an opportunity for you to ask questions about medication. Medication is used to improve your concentration and relieve symptoms such as insomnia, nervousness, depression, fears, voices, feelings of suspicion and confused thinking. Case management: A case manager is a person with experience in mental health who works with you to help further your

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personal, vocational and/or housing goals. He or she may also help with practical things like applying for benefits and helping you to access transportation. A case manager is also a person who can help connect you to mental health services and help you to use s in your community. Peer and consumer-run programs: Peer and consumer-run programs are recovery services designed and led by people who have experience with mental health problems themselves, which helps them understand what you are going through. This type of service gives you the opportunity to be with people who really connect with you through common experiences. It also gives you the chance to help other people. Helping others and finding a common bond can make you feel much more confident and hopeful about the future. Individual therapy: In individual therapy, a trained mental health professional talks to you about issues in your life. This person may help you sort out relationship problems, encourage you to pursue your goals and/or help you develop ways to improve the quality of your life. Group therapy: In group therapy, individuals talk about feelings and different ways to cope with situations that come up in their lives. This occurs in a group setting with other consumers and a trained mental health professional. Social skills training: This is a service that can be delivered in an individual or group setting. It may help you to connect or stay connected to people in your life or in the community. For example, if you have a hard time making friends, social skills training may teach you how to start conversations and keep them going. Family education and other family services: This is a service that focuses on improving the relationship between you and

Wellness Self-Management

your family by offering education about mental health problems and providing an opportunity to open up lines of communication between you and your family . Day treatment or partial hospitalization program: This is a service that provides you with some daily structure and a place to see people you know or meet new people with similar experiences. Educational groups and leisure groups may be a part of the program’s structure. Mental health housing: Sometimes mental health agencies offer housing or residential services. In addition to providing a place to live, staff may provide housing and/or case management services as needed. groups: groups are services that occur in a group setting that provide an opportunity to connect with people who share common experiences. This often involves sharing your experiences with others and trying ideas that other group may suggest. Assertive community treatment (ACT): ACT is a team of people who work with you on a variety of issues to help you to avoid relapse. For example, they may help with housing, medication education and wellness management. ACT teams also work with you in your home or at other community settings. Clubhouses: Clubhouses are designed to provide structure and in the community. They rely on people helping each other and the value of community. Many clubhouse programs assist individuals to return to school, find jobs, and engage in traditional mental health services. They also provide a place for meaningful recreational and leisure activities. Emergency services: These are 24-hour services that are set up to help you deal with

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crisis situations. These services may include a crisis phone line that you can call to get in a crisis, crisis housing that gets you away from a crisis and provides staff and/or a mobile crisis team that comes to your house to evaluate your situation and help you in a crisis. Occupational therapy (O.T.): Working with an occupational therapist may help you to develop the basic thinking, feeling and action skills and strategies to manage daily life activities, including living in the community, education and work. Recreational therapy (R.T.): Recreational therapy is a service that helps you to connect or reconnect with hobbies and/or interests, such as music, art, gardening and/or sports. In recreational therapy, you may discover interests and opportunities to improve your social relationships.

Creative arts therapies: The creative arts therapies (art, music, drama, dance and literature) help in the treatment of mental health problems. People may work on communication skills, problem solving, selfexpression, control and mastery. The creative arts often help people find hidden talents and abilities, leading to self-awareness, selfconfidence and goal clarification. Integrated mental health and substance use treatment: This is a service that provides treatment for substance use and mental health problems together so both issues are addressed at the same time. This is often called Integrated Dual Disorders Treatment. Employment services: Employment services offer assistance with finding and keeping a job of your choice. This service is usually provided by someone who has knowledge and experience with financial and insurance benefits and is a trained ed employment specialist.

Discussion Points: What experience have you had with these mental health services? What were the most helpful?

Which services do you want to learn more about?

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P E R S O N A L I Z E D W O R K S H E E T: Thinking more about services Use this chart to record which mental health services you want to learn more about. Mental Health Services Checklist Service

Medication services Case management Peer and consumer-run programs Individual therapy Group therapy Social skills training Family education and other family services Day treatment or partial hospitalization program Mental health housing groups Assertive community treatment (ACT) Clubhouses Emergency services Occupational therapy Recreational therapy Creative arts therapies Integrated mental health and substance use treatment Employment services Other:

Currently use

I would like to learn more about this service

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A ction S tep : Choose a mental health service you want to learn more about Choose one service area you would like to learn more about. Service area:___________________________________________________________________ ______________________________________________________________________________ How will you learn about this service?___________________________________________ Where and when will you do it?_________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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PRACTICAL FACTS ABOUT MEDICATION LESSON 36 I M P O R TA N T I N F O R M AT I O N How do medicines work to relieve your symptoms? Brain chemicals affect the way we think, feel and act. When brain chemicals get out of balance, your brain receives only bits and pieces of information—like pieces of a puzzle. This may cause symptoms of a mental health problem. Medicines work by balancing the chemicals in the brain.

What to expect from your medicine Your medicine is designed to help reduce symptoms of a mental health problem. For example, you may be bothered by fears, depression and frightening sights, voices, sounds, thoughts or beliefs. With the right medicine, these symptoms may improve or they may disappear completely. Your thinking may become clearer, so you can concentrate better. You may find it easier to be with other people. But all of this won’t happen overnight. Treating symptoms such as these take time. Your symptoms will probably improve slowly with the right medication. It may take several weeks or months to figure out what medication works best for you. Finding the right medication or combination will also take time. To find the right medication, it is very important to work closely with your doctor. This means letting your doctor know about how the medication affects you. Once you find the medication that works for you it is best to continue taking it. It is important to discuss any changes you want to make with your doctor. Continuing your

treatment is one of the most important things you can do to keep your symptoms from returning.

What could happen if you stopped taking your medicine? Deciding to stop taking your medication is a very serious step. For many people with mental health problems, stopping medication leads to a return of symptoms and relapse. How long a person will need to take medication to manage symptoms depends on each person. It is important to work with your doctor and other mental health professionals to make informed decisions about your medication.

Taking medication as prescribed To figure out what medication works best for you, it is important to take it as prescribed. Here’s why: • For your medicine to work the right way, there must be enough of it in your system. If your dosage is too low, or if you miss doses, there may not be enough medicine to keep the brain chemicals balanced. Your symptoms may not improve. Or, if they have improved and you stop your medicine, your symptoms could come back again or get worse. • If your dosage is too high, you may get more side effects from your medicine. (But some unwanted effects can happen even at the right dosage). • Some nonprescription medicines can interfere with the prescription medicine(s)

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you’re taking for your mental health problems. Some can make your illness worse. If you need to take a medicine for another health problem, such as a cold, talk to your doctor or pharmacist first. Your doctor or pharmacist can help you find a medicine that won’t cause problems for you. • Some people also seek help for symptoms by using remedies common in their culture. This may include herbs, tonics or other remedies. It is important to make sure that everyone providing you with treatment for your mental health problems knows everything that you are taking. To make an informed decision about medications, it is important to look at the pros and cons of taking medication.



Purposes of taking medication Medications are used to improve mental health problems.

Medication has been found to be helpful in two important ways: • Reducing current symptoms • Reducing the chances of having symptoms in the future. Different kinds of medications help different types of symptoms. There are four major kinds of medications to treat mental health symptoms: antidepressants, mood stabilizers, anti-psychotic medications, and anti-anxiety medications. The medications and their expected benefits are listed in the following chart.

Medications and Their Expected Benefits Kind of medication

Expected benefits

Antidepressants

Help reduce the symptoms of depression, including low mood, poor appetite, sleep problems, low energy and difficulty concentrating. They can also be helpful in treating anxiety.

Mood stabilizers

Help reduce extremes of moods, including mania and depression.

Anti-psychotic medications

Help reduce symptoms such as hallucinations, delusions and disorganized speech or behavior.

Anti-anxiety medications

Help reduce anxiety, excessive worry and related sleeping difficulties.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking more about medications Step 1: In the table, list some pros and cons of taking medication. Step 2: As other group share their pros and cons, write down the ones that also have meaning for you. Pros and Cons of Taking Medication for Mental Health Problems Pros

Cons

Discussion Points: What are the most important Pros and Cons of taking medication? Does taking medication fit in well with your cultural and religious values?

Are there any herbs, tonics, or other remedies you use to improve mental health symptoms?

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A ction S tep : Write down the medications you take The first step in making informed decisions about medication is to know exactly what medications you are taking and why. You may need to talk to your treatment team to complete this list. In the spaces below, write the name of your medicine(s), the dose(s), when you are taking each one, and why you are taking it: Name of medicine:____________________________________________ Dosage:______________________________________________________ When you take it:_____________________________________________ What’s the purpose_ __________________________________________ Name of medicine:____________________________________________ Dosage:______________________________________________________ When you take it:_____________________________________________ What’s the purpose_ __________________________________________ Name of medicine:____________________________________________ Dosage:______________________________________________________ When you take it:_____________________________________________ What’s the purpose_ __________________________________________ Name of medicine:____________________________________________ Dosage:______________________________________________________ When you take it:_____________________________________________ What’s the purpose_ __________________________________________ Name of medicine:____________________________________________ Dosage:______________________________________________________ When you take it:_____________________________________________ What’s the purpose_ __________________________________________ Name of medicine:____________________________________________ Dosage:______________________________________________________ When you take it:_____________________________________________ What’s the purpose_ __________________________________________

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UNDERSTANDING SIDE EFFECTS LESSON 37 I M P O R TA N T I N F O R M AT I O N When people use the term “side effects,” they usually mean the unwanted effects of medications.

Some types of side effects can be long-lasting and may not go away.

Side effects of medication

If you are having side effects, it is important to talk to your doctor as soon as possible. Your doctor will help you decide how serious the side effects are and what can be done. It is up to you to decide what side effects you can live with and what risks you are willing to accept.

It is important to understand the possible side effects of your medication. Medications for mental health problems, like drugs for treating other illnesses, can cause side effects. Medication affects people in different ways. Some people may have only a few side effects or no side effects at all. Others may have more side effects. Your response to medication depends on many things, including your age, weight, sex, ethnicity, and other medicines you are taking. In most cases, the side effects improve over time as your body adjusts to the medication.

When you have side effects, your doctor may advise you to try one of the following: • Reduce the dose of the medication. • Add another medication for the side effect. • Switch to another medication. • Learn ways to cope with your side effects.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking more about side effects You may not get any side effects from your medicine. But it’s good to know about those that can happen. Listed below are some possible side effects. Check the ones that have bothered you during the past month. Possible Side Effects of Medications Mouth

o Dry mouth

General

o Increased appetite

o Drooling

o Weight gain

o Movements of the tongue and mouth that you can’t control (the medical term for this is tardive dyskinesia)

o Dizziness

Skin

o Skin rash o Increased sensitivity to the sun (sunburn)

Muscle/nervous system

o Tremors or shaking o Muscle stiffness o Muscle spasms o Movements of the hands, fingers, feet or toes that you can’t control (the medical term for this is tardive dyskinesia) o Being forced to look upward o Neck spasms o Difficulty walking o Restlessness (the medical term for this is akathisia)

o Drowsiness o Feeling slowed down (the medical term for this is akinesia) o Blurry vision o Constipation o Difficulty urinating o Lack of energy Changes in sexual function

o Less sexual desire (men and women) o Difficulty having orgasm (men and women) o Difficulty with erections or ejaculating (men) o Leaking of milk from breasts (women) o Missed menstrual periods (women)

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A ction S tep : Report a side effect that bothers you If you have any of the side effects in the list above, it is important to report them to your mental health professional. List any side effects that have bothered you. Side effect(s):__________________________________________________________________ I will report this side effect(s) to:_ _______________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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COPING WITH SIDE EFFECTS LESSON 38 I M P O R TA N T I N F O R M AT I O N Medicines affect different people in different ways. Some people may have a few side effects (unwanted effects) from taking a medicine. Others may not have any side effects at all, even though they are taking the same medicine at the same dosage.

Side effects

Drowsiness

The kind of response you have to any medicine depends mostly on how your body reacts to it. The amount of medicine you’re taking (your dosage) can also be a factor. Below are some side effects and possible coping strategies.

Coping strategies

•  Take a brief nap during the day. •  Get some mild outdoor exercise. •  Ask your doctor about taking medications in the evening.

Increased appetite and weight gain

•  Eat healthy foods, such as fruits, vegetables and grains. •  Cut down on sodas, desserts and fast food. •  Exercise regularly.

Extreme restlessness

•  Find a physical activity that you enjoy, such as jogging, skating, exercise, gardening, swimming or bicycling.

Muscle stiffness

•  Try doing regular muscle stretching exercises or yoga.

Dizziness

•  Avoid getting up quickly from a sitting or lying down position.

Blurry vision

•  For mild blurry vision, talk to your doctor about getting reading glasses (can be bought without a prescription).

Sensitivity to the sun

•  Stay in the shade, use sun screen and wear protective clothing. •  Avoid going out during the sunniest part of the day.

Shakiness or tremors

•  Avoid filling cups and glasses to the brim.

Dry mouth

•  Chew sugarless gum. •  Suck sugarless hard candy. •  Take frequent sips of water.

Constipation

•  Drink 6–8 glasses of water daily. •  Eat high-fiber foods. •  Do light exercise.

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Very serious side effects Neuroleptic malignant syndrome

Look out for the following symptoms associated with this syndrome: • Muscles get very stiff over one to three days and you may feel very confused • A high fever develops. If you start to feel these symptoms, get medical help immediately. Go to the emergency room if you cannot reach your doctor. Seizures

Some medicines make people more likely to have a seizure. This is especially true for people who already have seizure problems and those who are taking certain other medications. If you have a seizure, get medical help immediately. Uncontrollable muscle spasms (the medical term for this is dystonia)

Also referred to as a “dystonic reaction,” this side effect feels like a charley horse or writer’s cramp. It may start with a neck spasm that leads to a stiff neck and stiff tongue. The eye muscles may also be involved—the eyes may roll up and back. This reaction can be relieved within minutes with another medicine. If this side effect happens to you, call your doctor immediately or go to the emergency room. Your doctor may want to prescribe another medicine to prevent this reaction from happening again.

A word about medication interactions One of the most dangerous things that can happen with medicines is when you take two or more drugs at the same time that produce a bad reaction. Before you start a new medication it is important to check with your doctor or pharmacist to make sure there is no interaction with your other medications. Problems can occur when people start taking medicines their doctors didn’t prescribe. If you are getting prescription medicines from more than one doctor or from an alternative medicine

Wellness Self-Management

provider, be sure to tell each doctor about all of the medicines you are taking. You can also talk to your pharmacist about this. Some drugs you can buy without a prescription can affect the way your medicine works. This can happen even with mild drugs like those you buy in the supermarket, such as cold medicine and diet aids. It’s important to talk to your doctor or pharmacist before taking any other drugs with the medicines your doctor prescribed for you. Many people seek help for physical or mental health problems that are based on cultural traditions and beliefs. The use of herbal medicines is common in many cultures to treat a wide variety of health conditions. People may obtain these herbal medicines through a practitioner or directly from a store. If you are taking any of these herbal medications, it’s important to tell your doctor and pharmacist to make sure there are no harmful effects.

Medication interactions with alcohol and street drugs Alcohol and street drugs may be harmful when combined with your medicine. They not only block the way your medicine works but can cause bad side effects such as: • Extreme drowsiness, lethargy • Shakiness, spasms and muscle movements you can’t control • Very low blood pressure leading to dizziness and fainting • Return of your mental health–related symptoms (because alcohol and street drugs can stop your medicine from working). If you use alcohol or street drugs it is important to discuss this with your mental health professionals. Understanding how your use of alcohol or drugs affects your health is important in order to make decisions that your recovery.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking more about side effects and strategies to cope with them Review the Important Information section of this lesson.

It may be helpful to: 1. List the side effects that have bothered you recently. 2. Choose one coping strategy that you would like to try for each side effect. I experience these side effects

Coping strategies I would like to try

1. 2. 3. 4.

A ction S tep : Choose a coping strategy for a side effect Choose one coping strategy to try in the next week and write it down. Coping strategy:_______________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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USING MEDICATION EFFECTIVELY LESSON 39 I M P O R TA N T I N F O R M AT I O N What are your personal beliefs about medication? People have different beliefs about medication based on their culture, their family background and their own experience. Below are some examples in the words of people who have the beliefs: “My uncle is diabetic and takes insulin. He leads a normal life. I have a mental illness and take medication for it. It’s the same thing to me.” “It’s a matter of will power. I shouldn’t need a drug to make me feel better.” “My medicine helps get rid of the symptoms I was having. It’s made a world of difference to my peace of mind.” “I tried everything I could on my own—exercise, relaxation techniques, counseling. I was still miserable and depressed until I tried some medicine.” “In my culture, we don’t believe in Western medicines. I only want to use herbal remedies.” “I’m afraid of the long-term effects on my body of using medications.” A decision to use medication is often influenced by the following: • Your personal beliefs about medication • The beliefs of family, friends and others who matter to you • The beliefs about medication found in your culture and/or spiritual community • The experience of others who take medication • The advice of treatment providers.

Discussion Point: Who or what has influenced your decisions about medication? How do you make an informed decision about medication? Making informed decisions about all treatment options, including medication, will your recovery. In making decisions about medication, it is important to learn as much as you can about the possible pros and cons. Your doctor and other mental health professionals are important resources for making informed decisions. It is important for you to be very active in making decisions about medication. After all, you are the expert about your own experience of your mental health problem and what makes you feel better or worse. Therefore, the best method for making a decision involves a partnership between you, your doctor and other mental health professionals. It may also be helpful to talk to other people you trust, including family, friends and peers.

If you decide to take medications, how can you get the best results? Many people find that it can be difficult to to take medications regularly. There are steps you can take to fit taking medications into your day-to-day routine. Since everyone

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has a different routine, it is important to find those strategies that work for you. Steps to to take medications:

• Simplify your medication schedule as

much as possible.

Talk to your doctor(s) and other mental health professionals about making your medication schedule as simple as possible without losing any of the benefits.

• Take medication at the same time every

day.

Taking your medication at the same time (or times) every day makes it easier to .

• Build taking medication into your daily

routine.

It is often easier to to take medication if it is done with another daily activity, such as brushing your teeth, showering or eating a meal.

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• Use reminders to help yourself

.

Many people have developed their own reminders to help to take their medications regularly, such as using a pill container that is organized into daily doses, using a calendar, keeping the pill bottle next to an item that is used daily or asking a relative or other er to help them .

• Keep the benefits in mind. Sometimes it helps to remind yourself of the reasons that you have decided to take medications. As one person put it, “When I start to think that it’s a pain in the neck to keep taking medications, I remind myself why I decided to take them in the first place. I don’t want to get depressed again, and the medication helps me to prevent that.”

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P E R S O N A L I Z E D W O R K S H E E T: Identifying possible stumbling blocks to taking medication regularly If you’re the type of person who doesn’t like to take medicine, you’re not alone! Many people who take medicines for other health problems (such as high blood pressure or diabetes) feel this way too. There are many reasons why people don’t (or can’t) always take their medicine the right way. Below are some of the reasons people have mentioned. Check any that may apply to you: o “I don’t want anyone to know I’m taking medicine—I feel embarrassed.” o “I forget to take it sometimes.” o “I get confused about which medicine to take at what time.” o “My medicine causes side effects that really bother me.” o “I feel like a zombie when I’m on medicine. People say I look like I’m out of it.” o “My family (or friends) told me to stop taking the medicine.” o “The medicine is too expensive.” o “I can’t get to the pharmacy to get my prescription refilled.” o “I don’t know how to get my medicine.” o “Sometimes I like to go drinking with my friends and I know I shouldn’t mix medicine with alcohol.” o “There’s an alternative treatment I’d like to try instead.” o “I don’t know why I have to take medicine.” Write down the biggest stumbling block for you: _________________________________________________________________________________ _________________________________________________________________________________ The following is a list of strategies that you might find helpful in overcoming your biggest stumbling block. Check all of the strategies you believe will work for you. Strategies to Overcome Your Personal Stumbling Blocks o Build taking medication into your daily routine. o Use reminders to help yourself to take medication. o Keep the benefits in mind. o Talk to people you trust, including family, friends and peers.

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o Talk to your doctor or other mental health professionals. o Simplify your medication schedule. o Take medication at the same time every day. o Explain the importance of medication to family . o Figure out how to get your medication. o Figure out how to pay for your medication. o Make decisions about drinking and taking your medication. o Manage side effects that are embarrassing. o Make decisions about alternative treatments.

A ction S tep : Tr y a s t r a t e g y f o r r e m e m b e r i n g to take medication Write down one strategy you would like to try in the coming week. Strategy_______________________________________________________________________ What will be your first step?____________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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WORKING EFFECTIVELY WITH YOUR DOCTOR LESSON 40 I M P O R TA N T I N F O R M AT I O N

To get the most out of mental health services it is important to work well with your doctor. In this lesson you will have an opportunity to learn about and practice ways to work well with your doctor.

Tips on meeting with your doctor There are things to keep in mind when meeting with your doctor. Here are some helpful tips on how to build a good relationship: • Be respectful. • Tell your doctor about side effects. • Have a plan (write down the questions you want answered). • Share feelings about medical decisions. • Keep it short and to the point. • Disagree respectfully. • Speak calmly.

• Express appreciation. • Take notes if it would be helpful.

Why is it helpful to keep these tips in mind? • A good working relationship with your doctor will your recovery. • Some people get nervous when talking with their doctor and end up not getting answers to their questions. • Some people lose their cool when talking with their doctor or other mental health professionals. • Sometimes sessions are very short and keeping these tips in mind will make the most of the time you have. • Having a plan before you meet with your doctor is one way to get the most out of your session.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about the meeting with your doctor Working effectively with your doctor means getting answers to questions about your treatment. Here are some possible questions for you to consider in your meeting with your doctor. Check the boxes that apply to you. Question

1. How will this medication benefit me? 2. How long does it take the medication to work? How long before I feel some of the benefits? 3. What side effects might I get from the medicine? Are there any side effects from longterm use? 4. What can be done if I get side effects? 5. Will I need blood tests to make sure that I have the right level of the medication in my bloodstream? 6. What if the medication doesn’t work for me? 7. How will herbal medicines interact with the medication you prescribe? 8. Why have you chosen this particular medication? 9. How long will I have to take it? 10. Is the lowest effective dose being prescribed? 11. Can I take a low dose and increase it when necessary? 12. Why am I on different types of medication? 13. How often will my medication be reviewed? 14. What will happen if I stop the medication? 15. Do you have any written information about this medication? 16. Does this medication affect me differently as an African American, Asian American, etc.

I have the answer to this question

I want an answer to this question

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Discussion Point: It is often helpful to practice asking your doctor questions. You may want to use some of this lesson to role play with other group .

Your group leader will organize this opportunity for you.

A ction S tep : Write down your top 3 questions and develop a plan to speak to your doctor Question 1.____________________________________________________________________ Question 2.____________________________________________________________________ Question 3.____________________________________________________________________ When will you speak to your doctor?____________________________________________ Where will you speak to your doctor?___________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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RELAPSE PREVENTION: WHAT IS IT? WHY IS IT IMPORTANT TO YOU? LESSON 41 I M P O R TA N T I N F O R M AT I O N

What is a Wellness Self-Management Plan for relapse prevention? • A Wellness Self-Management (WSM) Plan is a written plan to help you stay well and prevent a relapse of symptoms. • It is a plan you develop when you are doing well to use during those times when your symptoms are getting worse. • Your WSM Plan is designed to reflect your personal wants, needs, strengths and cultural values and beliefs. Each WSM Plan is different because each person is different. A WSM Plan often identifies other people who can help out during difficult times. This may include friends, family , neighbors, mental health professionals, employers and religious s (for example, a priest, minister, rabbi, imam, etc.). It is important to talk to the people you include in your WSM Plan about how they can help. You may also want to let them know who else is involved in your WSM Plan. To make sure your WSM Plan is complete and practical, it is important to work on the plan with your doctor, other mental health professionals and the WSM group.

Why is having a WSM Plan important to you? A WSM Plan is important because it may help prevent a relapse of serious symptoms and help you stay well. A relapse is usually difficult and upsetting. It sometimes results in

hospitalization or emergency treatment that may be necessary but unwanted. Most people with mental health problems prefer to remain in their community and manage symptoms effectively. Having a plan increases the chances that you will be able to take steps to stay well and avoid a relapse. If a relapse does happen, the plan spells out how a relapse should be handled. In this way, your wishes are met and you have a say in what happens to you.

Why do people have relapses? The symptoms of a mental health problem can change over time. Sometimes the symptoms may be absent. Sometimes they may be mild or moderate. Sometimes they may be strong. When symptoms of a mental health problem become severe, it is usually referred to as a “relapse.” Some relapses can be managed at home, but other relapses require hospitalization to protect the person or other people. Mental health problems affect people in very different ways. Some people have a milder form of a mental health problem that happens once or a few times in their lives. Other people have more serious problems that happen more often.

What can cause a relapse? • An increase in stress • Stopping medication that was working • Using drugs or alcohol

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• Having physical health problems

Discussion Point:

• Taking the wrong medication • Some people may experience a relapse even if they do all the right things.

What has caused a relapse in your life?

P E R S O N A L I Z E D W O R K S H E E T: Thinking about how you prevented a relapse It is important to recognize your strengths to prevent a relapse. A good starting point for creating your WSM Plan is to understand what has worked for you in the past. Think about a time when you were able to prevent a relapse. Write down one or more things you did that helped. What you did to prevent a relapse: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

Discussion Point: Please share what you did with other group . In the section below, write down any of the ideas that other group found helpful in preventing a relapse: o  ___________________________________________________________________________ o  ___________________________________________________________________________ o  ___________________________________________________________________________ o  ___________________________________________________________________________ o  ___________________________________________________________________________

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It may be helpful to continue learning about things you can do to prevent a relapse. There are a number of ways to learn more about how to prevent a relapse. Consider one or more of the following ways: • Talk to peers who have experienced relapses. • Talk to friends and family who know you well. • Talk to a mental health professional who knows you well. • Get information from the internet. • Read material on relapse prevention.

A ction S tep : Learn more about a way to prevent relapse Choose one way to learn more about how to prevent a relapse and write it down. A way to prevent a relapse:_____________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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UNDERSTANDING YOUR PERSONAL TRIGGERS FOR RELAPSE LESSON 42 I M P O R TA N T I N F O R M AT I O N

What are triggers?

– Moving to a new place

Triggers are those life events that may lead to an increase of symptoms or a relapse.

– Starting a romantic relationship

• Triggers can be negative life events that are very stressful such as: – Being evicted

– Graduating from school – Attending a family gathering – Graduation from a treatment program – Getting married

– Running out of money

– Regaining custody of your children.

– Going to jail

• Triggers can also be a build-up of day-today stressors such as:

– Being rejected – Losing a person close to you

– Difficulty with transportation

– Getting physically ill

– Living in an unsafe neighborhood

– Being the victim of a crime – Getting into a fight or serious argument – Losing a pet. • Triggers can also be positive life events that are stressful: – Having a baby

– Getting a job

– Going to a program you don’t like – Noise at home – Being bored – Being alone – Caring for your children or others.

Discussion Point: Think of the last time your symptoms got worse.

Were there any triggers associated with that change?

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P E R S O N A L I Z E D W O R K S H E E T: Identifying your triggers Each person is different. What is a trigger for you may not be a trigger for others. It is very important to know what may trigger a relapse. This worksheet will help you identify the triggers you will include in your Wellness SelfManagement Plan. Please list the most important triggers for you. (You may want to refer to the Important Information section in this lesson or the Personalized Worksheet in the lesson called “What Is Stress? Why Is It Important to You?” on pages 91–93.) 1._________________________________________________________________________________ 2._________________________________________________________________________________ 3._________________________________________________________________________________ It may be helpful to continue learning about things you can do to identify important triggers. Consider one or more of the following ways: • Talk to peers who know you well. • Talk to friends and family who know you well. • Talk to a mental health professional who knows you well. • Get information from the internet. • Read material on triggers for mental health problems.

A ction S tep : Choose a way to learn more about your triggers Write down a way to learn more about your personal triggers. A way to learn more_ __________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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KNOWING YOUR EARLY WARNING SIGNS LESSON 43 I M P O R TA N T I N F O R M AT I O N What are early warning signs? Even when people do their best to avoid it, their symptoms may start to come back. This is called a relapse. Some relapses may occur over short periods of time, such as a few days, with very little or no warning. However, most relapses develop gradually over longer periods of time. There are often changes in the way a person thinks, feels and acts when a relapse is starting. For some people, the changes may be so small at first that they may not seem worth noticing. For others, the changes are more obvious and upsetting. When people look back after a relapse, they often realize that these early changes, even the small ones, were signs that they were starting to have a relapse. These changes are called “early warning signs.”

example, you might not realize that you are feeling unusually irritable. Instead, it may seem that other people are being especially annoying. Friends, family , co-workers, mental health professionals and other ive people often notice when someone seems different. They can often be helpful in recognizing early warning signs. If you ask them, your family , friends and mental health professionals can be your “extra eyes and ears” for noticing early warning signs. You can tell them some possible early warning signs to look for. You can let them know that you would like them to tell you when they notice these signs. You can also include them in your WSM Plan to help you take action to keep early warning signs from becoming relapses.

Do people always know that they are having early warning signs? People do not always know when they are having an early warning sign of relapse. For

Discussion Points: Have you experienced any relapses of your symptoms?

If you did, did you notice any early warning signs of your relapses?

Are there other people likely to be aware of your early warning signs?

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about early warning signs This checklist contains a list of common early warning signs. Check the signs that you have experienced. Early Warning Signs Checklist Early warning signs

My mood shifted back and forth. My energy level was high. My energy level was low. I lost interest in doing things. I lost interest in the way I looked or dressed. I felt discouraged about the future. I had trouble concentrating or thinking straight. My thoughts were so fast I couldn’t keep up with them. I was afraid I was going crazy. I was puzzled or confused about what was going on around me. I felt distant from my family and friends. I had the feeling that I didn’t fit in. I felt afraid that something bad was about to happen. I felt that other people had difficulty understanding what I was saying. I felt lonely. I was bothered by thoughts I couldn’t get rid of. I felt overwhelmed by demands or felt that too much was being asked of me. I felt bored. I had trouble sleeping. I felt bad for no reason. I was worried that I had physical problems. I felt tense and nervous. I got angry at little things.

I have experienced this early warning sign

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I have experienced this early warning sign

I had trouble sitting still. I had to keep moving or pace up and down. I felt depressed and worthless. I had trouble ing things. I was eating less than usual. I heard voices or saw things that others didn’t hear or see. I thought that people were staring at me or talking about me. I had a decreased need for sleep. I was more irritable. I was overconfident about my abilities. I increased my spending or shopping. Other: One way to make sure you have identified all of your early warning signs is to talk to people you trust and who know you well. Write down the names of people who could help you recognize early warning signs. Friends: Family : group : Mental health professionals: Co-workers: Spouse or significant other: Others:

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A ction S tep : Ask another person about your early warning signs Ask a person on your list help you better understand your early warning signs. Who will you ask?______________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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COMPLETING YOUR WELLNESS SELF-MANAGEMENT PLAN RELAPSE PREVENTION LESSON 44 I M P O R TA N T I N F O R M AT I O N

Your Wellness Self-Management Plan has two parts: (1) Relapse Prevention and (2) Managing a Relapse. Today’s lesson focuses on relapse prevention.

Relapse prevention: creating your Wellness Self-Management Plan Relapse prevention is figuring out how to stay well and prevent symptoms from getting worse. Preventing relapse involves putting together a written plan with specific Action Steps to take before you experience an increase of symptoms or a crisis. This written plan is the relapse prevention part of your Wellness SelfManagement (WSM) Plan. Your WSM Relapse Prevention Plan includes the following parts: • Day-to-day activities and people that help you stay well • Knowing and coping with: – Mental health symptoms – Physical health problems – Early warning signs – Triggers.

Why is having a plan important? • Preventing relapse is one way to stay on track with your goals. • Having a WSM Plan helps you and your mental health service providers take action early before the situation gets worse. Family , friends, practitioners, etc., may help you to identify early warning signs. • A WSM Plan makes it more likely that your choices will be respected if symptoms get worse or you experience a mental health crisis. • A WSM Plan helps to organize many of the steps you learned in the WSM Program to help your recovery. • Developing and implementing a WSM Plan builds confidence and hope. • Having a WSM Plan that includes the role of other helpers makes it more likely everyone will be working together.

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P E R S O N A L I Z E D W O R K S H E E T: Creating your WSM Relapse Prevention Plan My Wellness Self-Management Plan: Relapse Prevention What do you have or do in your life that helps you stay well (people, places, things)? What are things you don’t do now but could do regularly (usually day-to-day) to keep yourself feeling well? (Examples: exercise, get a good night’s sleep, eat nutritious food, listen to music, keep to a schedule of activities, take medicine, visit friends or family, attend social activities, stay away from drugs and alcohol, etc.)

What are the most important symptoms you should be watching out for? (These are the symptoms that cause you the most upset and make it difficult to manage day-to-day activities and work toward your personal goals.) Refer to the list of symptoms and problems on pages 72–73 and 76–77.

What steps could you take to cope with the symptoms? What physical health problems could make your mental health problems worse? What steps could you take to cope with your physical health problems? What triggers may lead to a relapse? What steps could you take to cope with these triggers? What early warning signs are important to look out for? What steps could you take to cope with early warning signs?

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COMPLETING YOUR WSM PLAN MANAGING A RELAPSE LESSON 45 I M P O R TA N T I N F O R M AT I O N

Your Wellness Self-Management Plan has two parts: (1) Relapse Prevention and (2) Managing a Relapse. Today’s lesson will focus on managing a relapse.

Why a relapse prevention plan might not have prevented a relapse • There weren’t any early warning signs, and the relapse just suddenly happened. • The time between the first warning signs and the relapse was so short that there wasn’t time to do anything. • You thought the warning signs weren’t serious, and you just decided to wait and watch. • You worked hard on relapse prevention, but the relapse happened anyway.

How you know you’re in a relapse • You see the early warning signs become more serious problems. • Things begin to take a turn for the worse. • You find yourself saying: “Uh-oh. Here we go again,” because you know from experience that the situation will get out of control in a matter of time. • Other people express serious concern about your well-being and safety.

Parts of the Wellness Self-Management Plan: Managing a Relapse • People you want involved • Things that need to be taken care of • Treatment preferences • Medical problems to be aware of • information.

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P E R S O N A L I Z E D W O R K S H E E T: Creating your WSM Plan: Managing a Relapse Wsm Plan: Managing a Relapse Identify the people you want involved in helping you manage a relapse:***

How do you want them involved?

1._______________________________________ 1._______________________________________ 2._______________________________________ 2._______________________________________ 3._______________________________________ 3._______________________________________ List the things that need to be taken care of by others when you have a relapse:

Person assigned:

1._______________________________________ 1._______________________________________ 2._______________________________________ 2._______________________________________ 3._______________________________________ 3._______________________________________ Indicate your treatment preferences:

Indicate what type of treatment setting you do not want:

1._______________________________________ 1._______________________________________ 2._______________________________________ 2._______________________________________ 3._______________________________________ 3._______________________________________ Are there any medical problems that your mental health practitioner should know about?

information for individuals you want involved during a crisis:*** Name:____________________________________________________________________________ Phone ___________________________________________________________________________ Address:__________________________________________________________________________ Relationship to you:________________________________________________________________ ***Make sure you sign a release of information for those you want informed.

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Make a list of the people you need to talk to about your WSM Plan (this includes people you have listed in your Plan and others who are

important to you). For each person, complete an Action Step to let them know how they can help you.

A ction S tep : Let a person in your plan know how to help you Name:________________________________________________________________________ What will be your first step? ______________________________________________________________________________ ______________________________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

A ction S tep : Let another person in your plan know how to help Name:________________________________________________________________________ What will be your first step? ______________________________________________________________________________ ______________________________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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C hapte r 3 : L iving a H ealth y L ifest y le and M ental H ealth Recove r y WHAT IS THE CONNECTION BETWEEN A HEALTHY LIFESTYLE AND MENTAL HEALTH RECOVERY? LESSON 46 I M P O R TA N T I N F O R M AT I O N What is a healthy lifestyle? A healthy lifestyle refers to making choices and taking actions that keep you physically and mentally fit. A healthier lifestyle can prevent or improve many serious health problems, such as diabetes, high blood pressure and asthma. A healthy lifestyle includes the following actions: • Get regular medical check-ups. • Manage physical health problems (for example, diabetes, heart disease, high blood pressure, high cholesterol). • Find ways to relax and have fun. • Maintain good personal hygiene. • Exercise regularly. • Eat healthy meals and manage your weight. • Get a good night’s sleep. • Avoid unhealthy activities (for example, drinking, smoking, using street drugs, unsafe sex)

Why is a healthy lifestyle important? • People can improve their physical health in ways that their mental health and recovery.

• People benefit from information about their own physical health and take steps to improve it. • Poor physical health takes energy away from activities that your recovery. • Good physical health helps you to better manage stress and other life problems. • An unhealthy lifestyle could make your mental health problems worse. • A healthier lifestyle may help relieve problems, such as depression and anxiety.

Mental health benefits of living a healthy lifestyle • Helps people avoid situations that may trigger a relapse (for example, drugs or alcohol, unsafe sex) • Reduces depression and worry • Reduces stress • Gives a person more energy to pursue goals • Keeps a person’s mind active and clear • Helps manage side effects of medication.

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Discussion Points: Which of these benefits are most important to you?

How have physical problems interfered with your mental health recovery? P E R S O N A L I Z E D W O R K S H E E T: Thinking more about healthy lifestyle choices You can use this chart to figure out your strengths and needs regarding healthy lifestyle choices. “an ounce of prevention is worth a pound of cure.” Healthy Lifestyle Choices Healthy choices

Going to the doctor regularly Going to the dentist regularly Going to the eye doctor regularly Getting help for my medical problems Going to my Ob-Gyn regularly Knowing how to check myself for common medical problems Taking my medication as prescribed Exercising Drinking 8–10 glasses of water a day Eating healthy foods Finding time to relax Maintaining good personal hygiene Keeping my weight under control Practicing safe sex Not smoking Not using street drugs Not drinking and driving Not taking dangerous chances Not hurting myself physically Getting enough hours of sleep Other: Other:

I do this now

I want to do more of this

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A ction S tep : Choose a lifestyle area to improve Write down one lifestyle area you would like to improve. Lifestyle area__________________________________________________________________ What will be your first step?____________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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IDENTIFYING AND USING YOUR HEALTHCARE RESOURCES LESSON 47 I M P O R TA N T I N F O R M AT I O N

What types of healthcare services do people use to stay healthy? Medical care, dental care and vision care are common needs that many people have. Medical care includes services to prevent illness, such as getting a flu shot. Getting regular checkups is also a way to prevent illness by catching problems early. Regular checkups involve checking your heart, blood pressure, weight and lungs. Sometimes the doctor will get a blood and/or urine sample to check your overall health. This allows the doctor to identify and treat problems very early, before they get serious.

Why is it important to receive regularly scheduled medical care? • Research has shown that people with serious mental health problems are more likely to die many years earlier than people without serious mental health problems. • They are more likely to develop serious medical conditions at an earlier age. • They are less likely to receive high-quality physical health care. • Some of the side effects of medications for mental health problems can lead to medical problems.

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P E R S O N A L I Z E D W O R K S H E E T: Thinking more about healthcare Write down the names of your medical doctor, dentist and other healthcare providers. If you go to a clinic and see different healthcare providers, name the clinic.

My healthcare providers Medical doctor: Name ____________________________________________________________________________   o  Don’t have Where do you receive medical healthcare (private office, clinic, hospital/emergency room)? _________________________________________________________________________________ Dentist: Name____________________________________________________________________________   o  Don’t have Where seen?______________________________________________________________________ Ob-Gyn doctor (for women): Name ____________________________________________________________________________   o  Don’t have Where seen?______________________________________________________________________ Other healthcare providers (for example, an eye doctor or the person who gives you a prescription for eyeglasses): Name ____________________________________________________________________________   o  Don’t have Where seen?______________________________________________________________________ Who do you get medication for physical health problems from? _________________________ _________________________________________________________________________________ Where do you go if you have a medical emergency?_ ___________________________________

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My recent s with healthcare providers Last time you had a medical checkup:________________________________________________    If more than a year ago, check this box.  o Last checkup with a dentist:_ _______________________________________________________    If more than a year ago, check this box.  o Last checkup with an Ob-Gyn:______________________________________________________    If more than a year ago, check this box.  o Last checkup with an eye doctor or optometrist    If more than a year ago, check this box.  o

My recent physical complaints Do you currently have any physical complaints or worries?   o  Yes Do you currently have any dental complaints?   o  Yes Do you currently have any vision complaints?   o  Yes If you checked any of these boxes, you may want to take an Action Step. Some possible Action Steps include: • Talk to a case manager or therapist about getting an appointment with a medical provider. • Talk to a psychiatrist about getting an appointment with a medical provider. • Make an appointment on your own. • Talk to peers and family about healthcare providers that they would recommend. • Make a list of all your medications and give a copy to all your healthcare providers.

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A ction S tep : Address a physical complaint Write down one step you want to try to deal with a physical complaint. Step:__________________________________________________________________________ ______________________________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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GETTING HELP FOR YOUR PHYSICAL HEALTH PROBLEMS LESSON 48 I M P O R TA N T I N F O R M AT I O N

This lesson is about knowing and getting the right help for your physical health problems. Few people are free of health problems, especially as they get older. Some of these problems are important but not very serious, such as having a cold. Other health problems are more serious, such as diabetes, high blood pressure and asthma. These problems need to be watched and treated on a regular basis. When ongoing health problems such as diabetes, high blood pressure, asthma and other conditions are not treated and managed well it can result in serious harm to you. The stress of getting physically ill and how it disrupts your life may interfere with your mental health. Getting help for physical health problems involves three steps: 1. Check how well you’re doing. 2. Get medical help when you’re not doing well.

3. Make sure your medical doctor is aware of medications you take for mental health problems. Sometimes people don’t check how they are doing medically until the situation gets really bad. Sometimes people stop keeping a close eye on how they’re doing.

Why is it important to know about your health and health problems? • The more you know about your health, the more likely you will get help when you need it and when the situation is more easily treated. • Not knowing about your health needs and not getting help right away can lead to problems. • Most physical health problems can be successfully treated when you get help early and regularly.

Discussion Points: What are some reasons why people don’t check on their physical health? Have you ever had a time when you didn’t get help for a physical problem until the situation got very bad? What did you learn from that experience?

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about reasons for not getting the healthcare you need What gets in the way of getting physical health care when you need it? Check all the reasons that are true for you: Reasons why people don’t use healthcare resources

Don’t have money to pay for care Fear of doctors Fear of medical tests Don’t want bad news Don’t know how to make an appointment Bad experience in the past Lack of from others Language barriers Don’t trust medical people Transportation problems Religious beliefs Don’t believe in using Western medicine In my culture we use other remedies for physical health problems Mental health problems get in the way Drugs and alcohol get in the way Don’t want to get a lecture Don’t have insurance

This is true for me

I want to do something about this

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A ction S tep : Identify a reason for not getting care Write down one thing that stops you from getting healthcare when you need it and that you want to do something about. Reason________________________________________________________________________ What will be your first step?____________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself?__________________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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UNDERSTANDING THE MOST COMMON SERIOUS PHYSICAL HEALTH PROBLEMS LESSON 49 I M P O R TA N T I N F O R M AT I O N

People with mental health problems are more likely to have serious physical health problems People with mental health problems are more likely to have serious physical health problems. These problems are more likely to happen earlier than they happen to people without mental health problems and to be more serious. Knowing about these medical conditions is very important.

There are several reasons that people with mental health problems are more likely to have serious physical health problems: • Lack of consistent medical care • Lack of access to medical care • Side effects from medication • Research has shown that people with limited financial resources and from certain cultural backgrounds are less likely to receive high-quality and consistent medical care. • Some symptoms of mental health problems may make it difficult for people to manage their physical health.

P E R S O N A L I Z E D W O R K S H E E T: Thinking more about serious physical health problems Below is a list of common serious health problems we all need to be aware of. Check any boxes that apply to you. just because you have one of these symptoms does not mean you have a serious medical problem. However, it would be smart to have any symptoms checked by a medical professional. Diabetes is a rise in blood sugar levels that results when the body does not produce enough insulin. Diabetes can increase the risk for other medical problems, including heart disease. Symptoms o Thirst o Hunger o Frequent urination

o Changes in mood o Changes in vision o Weight loss

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High blood pressure (sometimes referred to as hypertension) is when your blood pressure rises above normal levels. It can increase your risk for heart attack and stroke. Symptoms o o o o o

Dizziness Sleeplessness Fatigue Weakness Headaches

Asthma is a lung disease in which airways may be blocked, obstructed or swollen, which causes difficulty in breathing. Several things can trigger asthma, such as allergies, pollution and stress. Symptoms o Wheezing o Shortness of breath o Recurrent cough Skin infections are caused by harmful bacteria. Skin infections can be contagious. Symptoms o o o o o

Swelling Redness Irritation Inflammation Any discharge

Stomach disorders (sometimes referred to as gastrointestinal disorders) are problems relating to the stomach or intestines, such as acid reflux, an ulcer or gastritis. Symptoms o Severe heartburn o Loss of appetite or nausea o Severe stomach ache

Cancer is a group of diseases, not one specific disease, caused when cells grow in an uncontrolled way. In some cases it can spread. Symptoms o o o o

Unusual bleeding or discharge A lump A sore that will not heal Change in a wart or mole

Coronary heart disease is caused by a thickening of the artery walls. This can decrease blood flow and can also cut off the supply of nutrients and oxygen to the heart. If the blood supply is cut off completely, a heart attack will result. Symptoms o Shortness of breath o Chest pain o Uncomfortable change in heart beat (palpitations) o Pressure in the chest o Lightheadedness Stroke is the result of either a blood vessel bursting in the brain or an interruption in the blood flow to the brain. This causes the brain cells to stop receiving nutrients and oxygen and results in the cells dying. Symptoms o Sudden weakness or numbness in the arm, leg, face or one side of the body o Sudden trouble in speech o Sudden trouble in vision o Sudden dizziness

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A ction S tep : Make a plan to get symptoms checked List any symptoms you checked. Make a plan to get these symptoms checked out. Symptom(s):___________________________________________________________________ What will be your first step?____________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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EXERCISE AND MENTAL HEALTH RECOVERY LESSON 50 I M P O R TA N T I N F O R M AT I O N Exercise and mental health Exercise is good for your physical health. Exercise may help prevent or improve a number of physical heath problems, such as diabetes, high blood pressure and heart disease. Recently it has been found that exercise is also good for improving mental health. Physical activity can ease symptoms of anxiety and depression along with improving mood. How can exercise make you feel better?

• Taking a walk in your neighborhood • Taking stairs instead of elevators • Getting off the bus or subway one stop early and walking the rest of the way • Dancing • Swimming • Playing sports • Yoga • Aerobics

• After exercising, mood is elevated.

• Running

• Exercising is a healthy distraction from life stressors.

• Riding a bike • Participating in an exercise program on TV

• Exercising gives you more energy.

• A job that involves physical labor.

Benefits of exercising

• Anxiety symptoms decreased • Stress decreased • Depression symptoms decreased • Elevated mood • Self-esteem improved • Increased feelings of physical and psychological well-being • Restful sleep.

Inexpensive ways to exercise

Gyms can sometimes be costly and timeconsuming. There are other methods of exercising that do not involve going to a gym: • Lifting heavy household products, such as bottles or cans • Doing housework

Getting started

Before you start exercising, it is important to get your doctor’s ok. Sometimes getting started is the hardest step. It is important not to think of exercise as a chore. Here are a few tips if you are having trouble getting started: • Start slowly. • Do something that is enjoyable for you; make exercising fun. • a team. • Exercise with a friend. • Exercise by doing various activities—don’t always do the same activity. • Give yourself credit for every step in the right direction no matter how small. • Don’t give up if you get off track.

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Discussion Points: Honestly, how do you feel about exercising?

What makes it hard for people to make exercise part of their day-to-day routine?

P E R S O N A L I Z E D W O R K S H E E T: Thinking more about ways to exercise Please read the following worksheet and check those that apply to you. Simple and Practical Ways to Exercise Ways to exercise

Lift household products, such as bottles and cans Do housework Take a walk in your neighborhood Take stairs instead of elevators Get off the bus or subway one stop early and walk the rest of the way Dance Swim Play sports Yoga Aerobics Running Ride a bike Participate in an exercise program on TV Do a job that involves physical labor Other: Other:

I already do this

I would like to do more of this

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A ction S tep : Choose and try an exercise Choose one exercise you would like to try. Exercise:_______________________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself?__________________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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LEARNING HEALTHIER EATING HABITS AND MENTAL HEALTH LESSON 51 I M P O R TA N T I N F O R M AT I O N What are healthy eating habits? Eating habits refer to what you eat and drink, how much, how often, and how the food is prepared. Healthy eating habits include eating a balance of foods that are nutritious and satisfying. Healthy eating habits also include avoiding foods that are low in nutrition and high in calories. A person’s eating habits are affected by family, culture, religion, income and community. Here are some tips for healthy eating: • Eat vegetables in a rainbow of colors. • Don’t skip meals. • Eat balanced meals. • Avoid fried foods. • Eat baked, broiled or steamed foods. • Cut down on fast food. • Snack on fruits and vegetables instead of sweets and salty foods. • Read food labels. • Become familiar with recommended portion sizes.

• Learn about good nutrition (some insurance companies will pay for a nutritionist, so talk to your doctor).

Why is it important to eat healthy? • What you eat and how much you eat can affect how you feel, both emotionally and physically. • Poor nutrition can lead to weight gain. Being overweight increases a person’s chance of developing diabetes and heart disease. • Some medications for mental health problems increase weight gain. Good eating habits are one way to manage this side effect. • For some people, eating or drinking a lot of sugar or caffeine can affect mood. • Good eating habits are associated with reducing or preventing disease. • Overeating or undereating can be a sign of a mental health problem. • Good eating habits include staying away from foods that you are allergic to. • Good eating habits include knowing whether there are any foods that may not work well with your medication.

Discussion Point: What gets in the way of eating healthy?

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P E R S O N A L I Z E D W O R K S H E E T: Thinking more about healthy eating Healthy eating habits

I do this now

I want to do more of this

Eat vegetables everyday. Eat fruit everyday. Don’t skip meals. Eat balanced meals. Avoid fried foods. Eat baked, broiled or steamed foods. Cut down on fast food. Snack on fruits and vegetables instead of sweets and salty foods. Read food labels. Become familiar with recommended portion sizes. Learn about good nutrition. Other:

A ction S tep : Choose a healthy eating habit and try it out Write down one healthy eating habit you would like to do more of. Healthy habit:_ ________________________________________________________________ What will be your first step to try it?_____________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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UNDERSTANDING HOW SMOKING, ALCOHOL, DRUGS AND UNSAFE SEX MAY HURT YOUR RECOVERY LESSON 52 I M P O R TA N T I N F O R M AT I O N

Activities that harm your physical and mental health People often do things that may harm their physical and mental health. Examples include smoking cigarettes, abusing alcohol, abusing drugs and having unsafe sex. People sometimes don’t think carefully about these activities. They may be unaware of the consequences. Some may think that doing these things will reduce their stress or help with their symptoms. Although this may seem to be the case at first, these activities often do more harm than good. Sometimes the use of substances such as alcohol, drugs and nicotine (cigarettes, chewing tobacco, cigars and pipes) becomes a habit. A habit can be very hard to stop even when the person decides to stop. Some habits, like the overuse of alcohol, drugs and nicotine, can become so strong habit that the person becomes addicted. Because of an addiction a person may use alcohol, drugs or nicotine even when doing so results in very serious health, social, financial and legal problems. Understanding how these activities may hurt your recovery means learning about the pros and cons of each activity and making informed choices. It also means learning what steps you can take to begin to change unhealthy activities and replace them with healthy ones. For most

people, changing habits is hard to do alone. Getting and help from others is often a good place to start. Some people are not involved in unhealthy and dangerous activities. They do not abuse alcohol or drugs, do not use tobacco and engage safely in sexual activities (for example, using a condom). These people are more likely to achieve their personal recovery.

Why is it important to avoid unhealthy activities? • An unhealthy lifestyle can harm a person’s recovery by increasing stress and symptoms. • Unhealthy lifestyles are often to blame for relapse and re-hospitalization. • Unsafe sex practices can lead to diseases that seriously harm one’s physical and mental health. • A person who engages in unsafe sex practices may cause disease in others. • Unhealthy activities can be changed. It takes making a decision to change and getting help from others. • The use of alcohol, drugs or nicotine can effect how well medicine for mental health problems works.

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Discussion Point: Why do people engage in unhealthy and dangerous activities?

P E R S O N A L I Z E D W O R K S H E E T: Thinking more about unhealthy activities Very often, people who are involved in unhealthy and dangerous activities don’t see a problem until it gets very bad. The following questions could help you figure out if there are things that you are currently doing that might interfere with your recovery. Drugs and alcohol

1. Have you ever decided to stop your drug use or drinking and been unable to stop for any length of time?

YES  o   NO  o

2. Are other people bothered by your intake of drugs or alcohol?

YES  o   NO  o

3. In the past year have you been in trouble at school, work or with the law as a result of drinking or drug use?

YES  o   NO  o

4. In the past year has your drug use or drinking caused problems at home with your family, children, parents, spouse, friends or room mates? YES  o   NO  o 5. Have you ever felt that if you could only quit using or drinking that your life would be much better?

YES  o   NO  o

Cigarette smoking

1. Have you ever decided to stop your tobacco use and been unable to do so for any length of time?

YES  o   NO  o

2. Are other people bothered by your use of tobacco?

YES  o   NO  o

3. Do you find yourself getting very upset when you can’t get a cigarette when you want it?

YES  o   NO  o

4. Do you have strong cravings for cigarettes?

YES  o   NO  o

5. Do you want to reduce or stop smoking?

YES  o   NO  o

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1. Have you had sex without the use of a condom?

YES  o   NO  o

2. Do you need to get more information about sexually transmitted diseases, including HIV or AIDS?

YES  o   NO  o

3. Do you have sex with people you hardly know?

YES  o   NO  o

4. Do you usually NOT discuss safe sex practices with sexual partners?

YES  o   NO  o

5. Do you wish you had more information and guidance when it comes to safe and healthy sexual activities?

YES  o   NO  o

Answering YES to any of these questions may mean: • There are things that you are doing that might harm your physical and mental health. • You may benefit from more information about drugs and alcohol use, smoking reduction and/or healthy sexual activities. Now that you have had an opportunity to think about lifestyle choices that may harm your mental and physical health, you may choose to learn more about them by completing an Action Step. Some first steps to making an informed decision are listed here. You may think of other examples. Action steps you may choose to take to change an unhealthy activity:

• Talk to your doctor or mental health professional to discuss your concerns and questions.

• Talk to someone you trust and get his or her opinion. • Find out more information on the internet or through written materials. • Talk to someone who has made a change in this area. • Talk to your sex partner about safe sex practices. • Talk to a doctor or nurse about safe sex practices. • Check out programs for people with alcohol or drug problems. • Check out ways to reduce or stop smoking.

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A ction S tep : Ta k e a s t e p t o c h a n g i n g a n unhealthy behavior Write down one step you want to try. Step_ _________________________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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UNDERSTANDING PROS AND CONS: DECIDING IF SMOKING, ALCOHOL, DRUGS AND UNSAFE SEX IS A PROBLEM LESSON 53 I M P O R TA N T I N F O R M AT I O N

Understanding pros and cons to help change an activity Understanding the pros and cons of using drugs, alcohol and/or cigarettes or engaging in unsafe sex means figuring out if these activities are doing more harm than good. The pros are the positive parts or benefits of these activities. The cons are the negative parts or harmfulness of these activities. When a person is considering changing a behavior, it may be helpful to list the pros and cons of changing and not changing. People sometimes don’t think carefully about these activities. They may be unaware of the consequences. People sometimes think that use of street drugs, alcohol or cigarettes provides real benefits. They may think that these substances reduce stress, help with symptoms and improve mood. Although this may seem to be the case at first, these activities often cause more harm than good in the long run. Sometimes the use of substances such as alcohol, drugs and nicotine (cigarettes) becomes a habit. Some habits can become so strong that the person becomes addicted. An addiction may cause the person to use alcohol, drugs or nicotine even when it results in very serious health, social, financial and legal problems. These negative consequences are the cons.

Why is it important to understand pros and cons?

• Unhealthy activities can be changed. It takes making a decision to change and getting help from others. • People who make a decision to reduce or end their drug, alcohol or cigarette use often make their decision by understanding the pros and cons of changing and not changing. • A person is serious about making a change in unhealthy lifestyle activities when he or she is convinced that these activities are causing more harm than good. • When a person understands the benefits that use of drugs, alcohol or cigarettes provides, he or she can figure out healthy ways of achieving these benefits. • Sometimes people continue unsafe sex practices because they don’t see the down side of having unprotected casual sex. This is often because they do not have information about the cons. Having information about the pros and cons of safe sex practices helps a person make the decision to avoid unhealthy sex practices.

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Discussion Points: Have you had the experience of changing unhealthy or dangerous behavior? How did you make a decision to change?

P E R S O N A L I Z E D W O R K S H E E T: Making a list of pros and cons Choose one lifestyle area that is of interest to you: o Smoking cigarettes o Using alcohol o Using street drugs o Having sex without a condom Make a list of the pros and cons of this lifestyle area. Pros (positive parts/benefits)

Cons (negative parts/harmful)

Discussion Points: What lifestyle area did you choose?

What are some of the pros and cons of this lifestyle area? What conclusion do you come to when you compare the pros and cons side by side?

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Action steps to help you add to the list of pros and cons

To gain more understanding of the pros and cons of the lifestyle area that is important to you, there are a number of steps you may take:

• Write down the pros and cons that other group reported. • Talk to your doctor or mental health professional. • Talk to someone you trust (family, friends or of your group) and ask him or her about pros and cons.

• Find out more information on the internet or through written materials. • Ask a doctor or nurse about the pros and cons of safe sex practices.

A ction S tep : Continue learning about pros and cons Write down one step you want to take to continue learning about the pros and cons of a lifestyle area. Step:__________________________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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MAKING A DECISION TO CHANGE UNHEALTHY AND DANGEROUS ACTIVITIES LESSON 54 I M P O R TA N T I N F O R M AT I O N

What does making a decision to change unhealthy activities mean?

People change at their own pace and in their own way

Some people are not involved in unhealthy and dangerous activities. They do not abuse alcohol or drugs, do not use tobacco and they engage safely in sexual activities. People who avoid unhealthy and dangerous activities are more likely to achieve their personal recovery.

Experts have found that although a person may be involved in unhealthy and dangerous activities, that person may not be ready to make any changes at the present time. Some people are just beginning to think about making changes. Others have decided that the time to change is now, and they want to take steps. Some people have already made big changes and want to make sure they don’t slip back.

Some people are involved with one or more of these activities in a way that harms their mental and physical health. The good news is that with some guidance and , a person can learn to reduce or end the harm that is caused by the use of alcohol, drugs or tobacco or unsafe sex. Even though there are treatments and programs that can make a big difference in a person’s life, many people don’t seek help. In fact, many people don’t get help even though they have serious life problems because of use of drugs, alcohol or cigarettes or unsafe sex practices. Changing these habits takes hard work, but it is possible. It’s important not to give up if you don’t succeed right away in changing harmful habits. In fact, research shows that people who reduce or stop habits such as smoking, drinking alcohol or using street drugs often try over and over again before they are successful. Every time you make a real effort to change harmful habits, you’re getting closer to making a change that works for you.

Before you seek help, it is important to know how you feel about making changes in activities that may be unhealthy and dangerous. The type of help that will benefit you the most will depend on how ready you are to make the change.

The four major stages of readiness to change Research has found that when it comes to change, people can be divided into four different “readiness categories.” These are described below. Stage 1: Not Ready (sometimes called the Pre-Contemplation Stage)

In this stage, the person doesn’t see a real need to change even if others do. This person doesn’t think much about his or her use of alcohol, drugs or cigarettes.

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What might be helpful to a person at this stage? • Talk to a mental health professional you trust who doesn’t argue or pressure you. Focus on your goals and develop a trusting relationship with a helper. • Talk to peers who have made some changes in their use of alcohol, drugs or cigarettes. Stage 2: Getting Ready (sometimes called the Contemplation and Preparation Stage)

In this stage, a person is beginning to think about and discuss making a change BUT not completely convinced that a change is needed. This person is just beginning to be open to discussing the use of alcohol, drugs or cigarettes. What might be helpful to a person at this stage? • Talk to a mental health professional you trust who doesn’t argue or pressure you.

• Talk to a trusted friend or relative who has expressed concerns. • Talk to peers who have made changes in their use of alcohol, drugs or cigarettes. • Gather more information through the internet, library or bookstore. • Complete a pros and cons worksheet to figure out if your use of drugs, alcohol or cigarettes is doing more harm than good. Stage 3: Ready to Take Action (this is sometimes called the Action Stage)

In this stage, a person understands that a habit is causing more harm than good. This person goes from thinking about making a change to taking steps to change. A person at this stage is seeking treatment, services and s to help reduce or end habits unhealthy habits.

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What might be helpful to a person at this stage? • Work with your mental health professional to identify resources and treatments that may work for you. Some resources you may want to consider are listed below as Action Steps. Action steps for problems related to alcohol and/or drug use

• Double Trouble: Self-help groups for people with both mental health problems and harmful use of alcohol and/or drugs • Alcoholics Anonymous: Self-help 12-step programs • Special programs for people with both mental health and addiction problems (MICA: Mental Illness and Chemical Addiction programs, or IDDT: integrated dual disorders treatment) • Medications to help with withdrawal symptoms or to reduce cravings • Detox unit of a hospital • Outpatient and inpatient rehabilitation programs.

Action steps for problems related to tobacco use

• Smoking cessation programs

• Nicotine patches, nicotine gum or other medications. Action steps for problems related to unsafe sex practices

• Talk to counselors at Planned Parenthood. • Talk to medical professionals (doctors, nurses).

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Stage 4: Ready to Maintain Gains (sometimes called the Maintenance Stage)

In this stage, a person is ready to take steps to keep from slipping backwards. This person understands that avoiding unhealthy and dangerous habits takes day-to-day work. This person has taken steps that have been successful and actively seeks to make sure that he or she stays healthy and avoids a relapse. What might be helpful to a person at this stage?

lapse because they believe they don’t need help any longer. Research has shown that people who stay connected with treatment and a group are the most likely to stay healthy over time. • Develop a relapse prevention plan to keep a close eye on any early signs of relapse. This plan is like the Wellness Self-Management Plan where you and others work together to take action if you find yourself involved with unhealthy activities.

• Remain in treatment even when you have achieved success. Sometimes people re-

P E R S O N A L I Z E D W O R K S H E E T: How ready are you? For each of the following unhealthy and dangerous activities, please identify whether you believe that it is a problem for you. Then indicate your readiness to make a change. You may want to refer to your notes from last session. Is this an unhealthy or dangerous lifestyle area for you?

Tobacco

YES  NO

Alcohol

YES  NO

Drugs

YES  NO

Unsafe sex

YES  NO

Stage 1: Not Ready to discuss this. Don’t spend much time thinking about need to change

Stage 2: Ready to think about and discuss unhealthy activities with others

Stage 3: Ready to take steps to make changes to address unhealthy activities

Stage 4: Ready to take steps to maintain gains

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Discussion Points: Why would you want to make this change? How will your life change if you reduce or end your use of alcohol, drugs or cigarettes? How will your life change if you engage in safe sex practices? In what way would making changes in these lifestyle areas help you achieve your goals?

A ction S tep : Ta k e a s t e p t o i n c r e a s e your readiness to change This Action Step gives you an opportunity to increase your readiness to reduce or end unhealthy or dangerous activities. What lifestyle area concerns you most? o o o o

Alcohol use Drug use Cigarette use Unsafe sex practices

At what stage of readiness are you? o Stage 1: Not ready to spend much time on this. Willing to talk about this area but only with someone who won’t pressure or argue with me o Stage 2: Ready to talk to others about this area o Stage 3: Ready to take action to change o Stage 4: Ready to take steps to prevent relapse What will be your first step?____________________________________________________ When will you take this step?___________________________________________________ Where will you take this step?_ _________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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W S M W r ap - Up MY WELLNESS SELF-MANAGEMENT PLAN LESSON 55 I M P O R TA N T I N F O R M AT I O N • You have been working on your Wellness Self-Management (WSM) Plan throughout this program. • Your WSM Plan uses what you have learned to help you to stay well and cope with stresses and symptoms when they arise. • It is a good idea to review your plan every so often to update it. This should continue even after this program is over.

• Find your most recent plan in the Workbook and review it. The Personalized Worksheet in this lesson (WSM Plan: Managing a Relapse) provides an opportunity for you to make any changes and updates in your plan that make sense for you now. Be prepared to discuss your changes in the group.

P E R S O N A L I Z E D W O R K S H E E T: Outlining your WSM Plan My WSM Plan: Prevention What do you have or do in your life that helps you stay well (people, places, things)? _________________________________________________________________________________ What are things you don’t do now but could do regularly (usually day-to-day) to keep yourself feeling well? (for example, exercise, get a good night’s sleep, each nutritious food, listen to music, keep to a schedule of activities, take medicine, visit friends or family, attend social activities, stay away from drugs or alcohol, etc.) _________________________________________________________________________________ What are the most important symptoms you should be watching out for? (Refer to the list of symptoms in Lessons 22 and 23. These are the symptoms that cause you the most upset and make it difficult to manage day-to-day activities and to work toward your personal goals.) _________________________________________________________________________________ What Action Steps could you take to cope with the symptoms? _________________________________________________________________________________ What physical health problems could make your mental health problems worse? _________________________________________________________________________________

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What Action Steps could you take to cope with your physical health problems? _________________________________________________________________________________ What triggers may lead to a relapse? _________________________________________________________________________________ What Action Steps could you take to cope with these triggers? _________________________________________________________________________________ What early warning signs should you be looking out for? _________________________________________________________________________________ What Action Steps could you take to cope with the early warning signs? ______________________________________________________________________________ WSM Plan: Managing a Relapse Identify the people you want involved in helping you manage a relapse:***

How do you want them involved?

1.______________________________________

1.______________________________________

2.______________________________________

2.______________________________________

3.______________________________________

3.______________________________________

List the things that need to be taken care of by others when you have a relapse:

Person assigned:

1.______________________________________

1.______________________________________

2.______________________________________

2.______________________________________

3.______________________________________

3.______________________________________

Indicate your treatment preferences:

Indicate what type of treatment setting you do not want:

1.______________________________________

1.______________________________________

2.______________________________________

2.______________________________________

3.______________________________________

3.______________________________________

Are there any medical problems that your mental health practitioner should know about?

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information for individuals you want involved during a crisis:*** Name:____________________________________________________________________________ Phone:_ __________________________________________________________________________ Address:__________________________________________________________________________ Relationship to you:________________________________________________________________ ***Make sure you sign a release of information for those you want informed.

A ction S tep : Use your WSM Plan Find an opportunity to use your plan and identify a person who can help you. Person:________________________________________________________________________ What will you do?_____________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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ENDINGS AND NEW BEGINNINGS LESSON 56 I M P O R TA N T I N F O R M AT I O N Ending the WSM Program but not the work Endings lead to new beginnings. People usually have strong feelings when things come to an end. It’s not unusual for people to feel proud about accomplishing and finishing a project but also sad that it’s coming to an end. This is especially true when people have been sharing very important and deeply personal parts of their lives. It is very common for people to have a mix of feelings when a program like WSM is coming to an end. The following feelings are associated with endings: • Anger • Sadness • Worry • Disappointment • Relief. Making the most of the WSM Program also means using what you have learned to continue making progress in improving your mental and physical health AND pursuing important goals.

Even though the WSM group may be coming to an end, the work continues. What you have learned may help you to continue making progress toward recovery.

Why is it important to recognize endings as well as beginnings? • The WSM group is not an end in itself but one approach to helping individuals gain knowledge and skills to manage mental health problems and pursue important goals and to enjoy life. • People who get the most out of the WSM Program are likely to see the ending as an accomplishment. They are likely to see it as an opportunity to use what they have learned to improve the quality of their lives. • Sometimes a person may have strong feelings of sadness as the group is coming to an end. It’s important to recognize that this is a common human experience. It’s also a sign that the people in the group are important to you.

Discussion Points: What feelings do you have as this WSM group is coming to an end? What has been the most important part of being in this group?

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about how to make the most of what you have learned There are a number of steps you may take to continue learning and using what you have learned. Check the steps you may want to take to continue the work you’ve begun in the WSM group. • Continue relationships with people you got to know in the WSM group. • Take what you’ve learned and use it to pursue goals that are important to you: – Obtaining paid work – Getting a volunteer job – Pursuing educational goals – Changing where you live – Making new friends – Pursuing new interests – Getting closer to family and friends • Continue to read those parts of the Workbook that are important to you. • Seek out additional material on the internet or in a library or bookstore. • Bring the information in the WSM Workbook into meetings with professionals to enhance your individual work. • Continue sharing the material with friends, family or others. The topics in the WSM Workbook may be helpful to others. • Start a self-help group around wellness (get together with others on your own without professional involvement). • In some programs, it may be possible to start an alumni group that meets occasionally for . • In some programs you may have an opportunity to be involved in co-leading a new WSM group.

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A ction S tep : Continue the work you started in the WSM group Write down one step you will take to continue the work. Step_ _________________________________________________________________________ When will you do it?___________________________________________________________ Where will you do it?__________________________________________________________ How will you remind yourself to do it?___________________________________________ Who could help you complete your Action Step?_ ________________________________ What might get in the way of completing your Action Step?______________________ ______________________________________________________________________________

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Wellness Self-Management

WHAT HAVE I LEARNED? HOW HAS IT AFFECTED MY LIFE? LESSON 57

Congratulations! You have completed the Wellness Self-Management Program! I M P O R TA N T I N F O R M AT I O N We have covered a lot of material in the past year.

The three major chapters are: • Chapter 1: Recovery • Chapter 2: Mental Health Wellness and Relapse Prevention • Chapter 3: Living a Healthy Lifestyle and Mental Health Recovery

The eight goals of the WSM Program are: • Learning about recovery and what it can mean for you • Making the best use of your mental and physical health services • Learning how mental health and physical wellness will help you to achieve your goals and your personal recovery • Staying well by decreasing symptoms of a mental health problem

• Learning how to manage day-to-day stress and prevent relapse • Staying well by connecting with others • Staying well by living a healthy lifestyle • Recognizing and building on your cultural values and experiences to your personal recovery. You may have chosen to complete a number of Action Steps. Choosing to take these steps means that you made a commitment to getting the most out of the program. You may have chosen to involve at least one important person in your life to your work in this program. You may have thought about how your cultural values and beliefs influence what you are learning. You have accomplished a great deal!

Personal Workbook

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P E R S O N A L I Z E D W O R K S H E E T: Thinking about the eight goals of the WSM Program Please look at the program’s eight goals, and check those that were the most meaningful to you. o Learning about recovery and what it can mean for you o Making the best use of your mental and physical health services o Learning how mental health and physical wellness will help you to achieve your goals and your personal recovery o Staying well by decreasing symptoms of a mental health problem o Learning how to manage day-to-day stress and prevent relapse o Staying well by connecting with others o Staying well by living a healthy lifestyle o Recognizing and building on your cultural values and experiences to your personal recovery.

Discussion Points: Share what this experience has meant to you with the group. What goals were most useful or important to you?

A ction S tep : C E L E B R AT E Y O UR A C C O M P L I S H M E N T ! !

Personal Workbook

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A ppendi x A : QUALITY OF LIFE PROGRESS CHECKLIST TIME 1

TIME 2

TIME 3

Quality of life areas I want to improve as I participate in the WSM group

Mid Point in the WSM Program

At the end of the WSM Program

o  Work at a paid job (part-time or full-time) that I like

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Contribute to my community in a useful way (e.g., volunteering, ing a self-help or peer advocacy group)

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Work toward an academic degree, continue my education or learn a trade in school

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Live in a place that I like and can manage successfully

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Enjoy hobbies, leisure and recreational activities

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Engage in creative activities (music, art, writing, dance, etc.)

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Be confident that I can handle my mental health problems and not relapse

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Be hopeful about my future (confident that I will find success and satisfaction in important areas of my life)

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Stop or reduce my use of alcohol, drugs or cigarettes

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Use medication in a way that works for me.

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Improve my physical health (by healthy eating, getting exercise and getting regular checkups for medical, dental and vision problems)

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Add your own:

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this

o  Add your own:

o  No improvement o  Improvement o  I’ve achieved this

o  No improvement o  Improvement o  I’ve achieved this