Resources

Returning to School

While the improving coronavirus situation is good news, transitioning back to on-campus classes presents another change in our daily lives, which might take some time to adapt to. This booklet primarily aims to help young people in Hong Kong cope with going back to school after the class suspension due to the outbreak.

Download our booklet here:

Resources

The mental health effects of COVID-19

This booklet discusses how teachers can support students and their own well-being during a crisis. It also touches on the role of E-learning and the important role it plays in maintaining communication between students and teachers. In addition, full interviews conducted with teachers in Hong Kong are included to get a first-hand perspective on the teachers’ role and perspective in the current situation.

Download the booklet here:

Resources

Staying Well during the Coronavirus Outbreak

With school cancelled and lots of news coverage on the coronavirus and its effects, it’s easy to feel overwhelmed. Whether you’re feeling anxious, lost, frustrated, or lonely, know that you are not alone. Experiencing these emotions are an understandable result of the current situation, and there are many ways to cope.

Download our booklet here:

Resources

Signs of Depression

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

Resources

Asking for help

When it’s time to talk about your mental health

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

Find out who’s best to talk to

You might already know who you want to talk to, perhaps a parent or a teacher you get on especially well with. If you’re not sure who to talk to then it’s worth thinking about who you trust and feel comfortable talking to. Have you talked to someone who has been particularly helpful before?

Think about what you want to say

Whilst you may have made the decision to talk to someone, you still need to decide what you want to tell them. You might want to think about:

  • Is there a problem you need to talk about?
  • How much are you happy to share?
  • How do you feel each day?
  • What has prompted you to ask for help now?
  • Is there anything you are finding hard to manage?

Practise saying what you need to say

It’s alright to be nervous, so it’s a good idea to prepare. It sounds a bit strange but you’ll feel much more confident talking to a parent or teacher if you’ve worked out what you want to say and tried saying it beforehand.

You can start by writing down bullet points, writing a text or using a free online resource called Doc Ready… You could give this to someone to read if you are not yet comfortable to talk.

It’s worth writing a list of what you want to say to take with you so you don’t forget anything. You could formulate your words into a letter, both to help you work out what to say and also as a back- up. That way if you find yourself unable to talk about your issues you could give the letter to the person you’ve chosen to talk to instead.

It’s ok to start small and say ‘I’m not having a good day’.

A good next step is to call an anonymous helpline (see ‘Sources of advice’ for local helplines) and practise talking to someone you don’t know – that can be easier than talking to someone you know and care about and can help you whilst you get ready to take the next step.

Find a quiet time

Make sure you start the conversation at a time when the person you’re talking to won’t be interrupted and has time to listen to you properly. It’s important not to rush the conversation. If they can’t talk now, it doesn’t mean they don’t care about you; ask them when would be a good time to talk and come back then.

Take it slowly

Don’t feel like you have to say everything in one breath, or even in that first conversation. Take it nice and slowly and don’t be afraid to pause to think about what to say next.

Don’t over-analyse their reaction

It’s perfectly normal to try and second guess what the person you’re talking to is thinking. You might have all sorts of ideas about what is going through their mind, but don’t try to second guess. They might be surprised, and thinking of ways and routes to help. Try to ask them rather than just guessing.

Remember that there are other people to talk to if the conversation doesn’t go as well as you hoped.

It’s okay to cry

However you react, it’s ok. It’s natural to cry or feel angry. None of these feelings are a bad thing.

Know your rights about confidentiality

If you talk to someone who you know through their professional role, one of the first things they’ll do is to tell you that they can’t keep confidentiality. That’s because they’ll need to ensure you get the support you need to help you to get on top of things.

You can talk to them about who needs to know what – but try to remember it’s a good thing that people understand what’s going on so they can help you, though it might seem a bit scary at first.

Think about what you want to happen next

It’s a big step to ask for help and it usually means that on some level you’re ready for things to improve. Do you have any idea of what you might like to happen as a result of the conversation you’re planning? This might include:

  • Support telling parents or a friend
  • First aid or medical help for injuries
  • Support to help you talk through and overcome underlying issues
  • Referral for specific treatment that you’re already aware of (or learn more about possible available treatments)
  • You’re not sure, you just can’t carry on with how things are

Even if you’ve gone looking for help, it can be hard to accept it – but try. Have faith in the person you’ve confided in to help you to take the first steps to make things better. They won’t be able to fix everything all in one go, but they can work with you to start to make things change.

“When I first started talking I realised I wasn’t so alone”

“From the moment I took that brave step I felt very much less alone.”

“I thought it was weak to ask for help, but I realised eventually that it was the ultimate sign of strength.”

“You’re not alone. Reach out… let yourself be loved.”

“Although it can be hard to take a first step there is help out there”

Sources of advice (Hong Kong)

Bilingual Telephone Hotlines

Samaritans Hong Kong 24-hour hotline: 2896 0000

Samaritan Befrienders Hong Kong 24-hour hotline: 2389 2222

Suicide Prevention Services 24-hour hotline: 2382 0000

Suicide Prevention Services “Youth Link” hotline (available 2pm-2am): 2382 0777

Hospital Authority Mental Health Direct hotline: 2466 7350

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 9088 1023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 2777 8899

Resources

Social media and teenagers

A practical approach

Dr John Coleman

Is social media damaging the mental health of young people? It’s important to look behind the headlines.

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

There is no doubt that today social media is seen by adults as representing a major threat to young people. There is much debate in the press and in public about the so-called “evils” of the digital world, and the [British] Government has tasked medical experts with drawing up advice on the maximum amount of time young people should spend on social media.

Parents and professionals worry about the time spent online, about the content that is seen by teenagers, and about the possible temptations that abound in the online world. Newspaper headlines such as ‘Social media fuels rise in self-harm’ (Evening Standard), and ‘Girls unhappy, stressed and addicted to web’ (The Times) are commonplace.

The striking thing is that this anxiety is not experienced in the same way by young people themselves. By and large they are aware of the risks in the online world and believe that they are able to manage them. In my work with young people I ask them whether they see themselves as experiencing stress. They agree that the teenage years are a time of high stress, but not because of social media. The things they identify as stressful are tests, exams and pressure from school. They also talk about parental expectations, and sometimes pressure from friends. The digital world comes low down in their list of things that create stress and anxiety.

Mental health and social media

As indicated by the [British] newspaper headlines, many adults link the rise in mental health problems to the use of social media but it is really important to note that there is no reliable scientific evidence to support this link. It does appear to be the case that, certainly among teenage girls, mental health problems such as depression are on the rise, but there is no clear link between this and the use of social media.

Of course we cannot ignore the fact that there are teenagers who are vulnerable. These individuals may be isolated, they may have to deal with difficult family situations, or they may have experienced trauma of one sort or another. For these young people the internet may provide an outlet, or a safe place to go for support. The online world may provide a way of sharing experiences with others who are facing similar adversity. These individuals may be less able to manage the risks of the digital world, or they may more easily be drawn to some of the more dangerous internet sites. Professionals should be alert to these vulnerabilities, and do all they can to provide extra support in the use of social media and other internet activities for this group.

Threats and opportunities

It is important to be clear that the internet provides many positive experiences, not just for teenagers, but for those of all ages. These include:

  • Instant access to information
  • Ease of communication
  • A means of sharing and networking with groups of friends
  • A medium for an extraordinary range of creative activities, including art, music, design, and a multitude of other possibilities
  • A way of meeting new people
  • Access to the buying and selling of goods

These are just a few of the many positive opportunities that have been made possible by the internet and the online world. Of course it is also possible to construct a list of the opposites, the threats posed by the digital world. These [may] be familiar to readers, but they include such things as access to pornography, excessive gaming, sexting, gambling, being groomed, and so on. We must be clear that, as with any new technology, there are both positives and negatives. The online world is not going to go away, so the challenge for us is to do all we can to make it as safe a world as possible for our young people.

The role of parents

The first thing to say is that parents do have a role, and this role does not stop when the child moves to secondary school. Many parents believe that once the teenage years kick in, they are no longer important. This is partly because the young person appears to be more interested in their friends than in their parents, and partly because it is more difficult to find a role if a teenager

is being rude, disrespectful and uncommunicative. However, the parent’s role is as significant during the teenage years as it is in the early years; it is just significant in a different way. All the evidence shows that outcomes for teenagers are better when the family remains involved, continuing to offer support and guidance during these sometimes difficult years.

There is another reason why parents are especially important at this time, and this is because it is not just the teenagers who are using social media! Parents too want to look at their phones at all times, they want to share images, purchase goods online, and generally access all the good things that the internet provides. Parents are digital role models, and their online behaviour is going to have an effect on the behaviour of their children and young people. You cannot expect your teenager to manage the digital world well if you are constantly looking at your phone!

Consider what is age appropriate

It goes without saying that the needs of children and young people will vary depending on their age. As a parent you are not going to treat a 16-year-old in the same way as you treat a 10-year-old. Broadly speaking we can say that the younger the child, the more support and guidance they need. However appealing online activities are, do try and restrict the use of screens for all ages, but particularly for the younger age groups. Do find alternative, non- technological activities, for children to enjoy.

It is useful to consider that there are particular ages where extra support may be necessary. One such group is the 10- to 13-year-olds as they first start to negotiate the online world on their own. Professionals have pointed out that the pressure to be popular, and to obtain as many “likes” as possible, is hard to resist at this stage when peer relationships are becoming especially important.

Although older teenagers may attempt to push adults away, it is critical that parents keep an eye on what is going on for this group. New and tempting games, sexual or violent content, pressure from certain websites, all these can in some circumstances lead to excessive use of the internet. Parents may feel it is hard to monitor online activities in this age group, but this should not hinder proper oversight. Even the most mature teenagers may sometimes find themselves pulled into behaviour that is not helpful. Parents should remain alert for any signs of inappropriate use of the digital world.

Screens at night

One of the most difficult challenges for parents relates to screens at night. However much the teenager protests, all the reliable advice is for parents to make sure that phones and other devices are switched off at night. In the best of circumstances all devices will be left outside the bedroom, and turned off about a half hour before bedtime. This gives the teenager time to wind down and prepare for sleep.

Scientific evidence shows clearly that good quality sleep is hugely important for young people. We now know that sleep is a time of memory consolidation, so that the quality of sleep will be directly related to the individual’s capacity to learn and memorise. We have also learnt that the body clock works slightly differently in teenagers than in adults, so many young people become sleepy later in the evening than their parents. Yet sleep is essential at this stage. The more parents can do to encourage good sleep routines, the better for the young person’s health and school work.

“Scientific evidence shows clearly that good quality sleep is hugely important for young people.”

A family digital strategy

Any approach by parents to the use of social media by young people has to involve the whole family. As I have noted, parents are role models, and it is no use making rules (such as no phones at mealtimes) if parents do not respect the rules themselves. It can be extremely helpful if the family as a whole works out some rules that everyone can get behind. Children and teenagers are more likely to accept structures that have been negotiated than ones that have been imposed.

Parents will make more progress if they accept that the online world has many opportunities to offer. Parents should work with their children to manage it sensibly. Many families find it helpful to have some non- technology time, sometimes called “digital detox”. Do try it – you may be surprised by the results.

Finally, remember the phase “digital resilience”. Too many adults think about the digital world as a threat. Yet this is not how it is seen by young people. It is the responsibility of adults, both parents and professionals, to help children and teenagers develop the skills they need to navigate the online world in safety. They need help to develop digital resilience. If we try we can all contribute to this. Good luck!

“It can be extremely helpful if the family as a whole works out some rules that everyone can get behind.”

Ten top tips for a digitally healthy household

  1. Remember – the younger the child, the more support and guidance they’ll need
  2. Be aware that extra support may be needed at certain ages, such as 10 – 13
  3. Find non-technological activities for children to enjoy
  4. Stay alert for any signs of inappropriate use of the digital world
  5. Make sure devices are switched off at night and for half an hour before bedtime
  6. Work out some rules together…
  7. …and respect the rules yourself!
  8. Be aware of the positives as well as the negative side of technology
  9. Have a regular family digital detox
  10. Aim for ‘digital resilience’

Dr John Coleman is a distinguished psychologist and co-author of the book ‘Parents and Digital Technology’.

Resources

Perfectionism: when striving for excellence becomes unhealthy

By Professor Roz Shafran

This leaflet is based on work conducted by Prof. Roz Shafran in collaboration with Prof. Tracey Wade and Dr Sarah Egan.

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

Some years ago Jessica Lahey wrote in the New York Times: “We all know perfection is an unreasonable burden to place on our children but we also reward them when they strive for that perfection.” Her article was an attempt to understand the complex nature of perfectionism in today’s world where achievement is valued at almost any price.

So what does unhealthy perfectionism look like and what is the distinction between such perfectionism and ‘healthy striving for excellence’? People with a healthy striving for excellence have very high standards but the standards are potentially achievable; when they do not reach their goals, people with healthy striving for excellence are able to stand back and reflect objectively on their mistakes so that they can learn from them. They are able to tolerate uncertainty and don’t react to their failure with intense self-criticism.

“People with unhealthy perfectionism react to mistakes in an extreme and highly self-critical manner and are very uncomfortable with uncertainty.”

“People with a healthy striving for excellence have very high standards but the standards are potentially achievable”.

‘Tyranny of the Shoulds’

People with unhealthy perfectionism often have the same very high standards but the standards are not realistic or only attainable with significant negative consequences; such people react to mistakes in an extreme and highly self- critical manner and are very uncomfortable with uncertainty. The self-esteem of such perfectionists is almost exclusively dependent on striving and achievement but they constantly perceive themselves to have failed and live in fear of such failure and what it means for them. Such perfectionism was described almost seventy years ago as the “Tyranny of the Shoulds” (Horney, 1950). A few years later, Hollender (1965) painted the following clinical picture of perfectionism:

“The perfectionist finds it difficult to sort out items in order of their importance or to maintain a sense of proportion. A small detail that has been missed may deprive him of gratification from a job otherwise well done. He is constantly on the alert for what is wrong and seldom focuses on what is right. He looks so intently for defects or flaws that he lives his life as though he were an inspector at the end of a production line.” (p. 95)

Spotting unhealthy perfectionism

It is not always easy to detect this unhealthy perfectionism and very often people themselves do not consider it to be a problem. Instead, it can cause difficulties for those around them. The area in which the perfectionism is expressed is also very important.

Unhealthy perfectionism applied in the domain of work may lead to someone being labelled as a ‘workaholic’ but the same type of perfectionism applied in the domain of dieting and weight loss may lead to an eating disorder. Typically such perfectionism is applied across many areas of life and can cause multiple difficulties. We know that perfectionism of this sort is associated with depression as well as other difficulties such as eating disorders, anxiety, chronic fatigue syndrome, obsessive compulsive disorder and low self-esteem. Unlike depression, ‘perfectionism’ is not a diagnosis and it can sometimes be difficult for an outsider to spot. Some questions to help spot when perfectionism is a problem are:

“Unhealthy perfectionism applied in the domain of work may lead to someone being labelled as a ‘workaholic’.”

  • How hard are you pushing yourself to meet your goals?
  • Do you tend to focus on what you have not achieved rather than what you have achieved?
  • Do other people tell you that your standards are too high?
  • Do you feel a failure as a person because you have not succeeded in meeting your goals?
  • Are you afraid that you might not reach your standards?
  • Do you raise your standards after meeting them?
  • Do you judge yourself on your ability to meet your standards?
  • Do you repeatedly check how well you are doing at meeting your standards (for example, by comparing yourself to others?)
  • Do you keep on trying to meet your standards even if you miss out on other things?
  • Do you react to small mistakes with intense self- criticism?
  • Do you avoid tests of your performance in case you fail?

These questions can help detect when perfectionism is interfering with functioning and is likely to be associated with low mood and anxiety.

Other types of perfectionism

There are other types of perfectionism that might also be posing a problem such has having high standards for other people and constantly feeling let down. Similarly, some people erroneously believe that other people have high standards for them and that they feel they are constantly letting other people down. In some cases, people are focused on the need to appear perfect and in others their perfectionism may predominantly be focused in an area such as sport or religion.

Treating perfectionism

Until relatively recently, no treatment for perfectionism had been developed, partly due to the suggestion that perfectionism was an unchangeable personality characteristic. However, in 2002 the Oxford Centre for Eating Disorders (where I was fortunate to be working) proposed a cognitive-behavioural approach to perfectionism (Shafran, Cooper & Fairburn, 2002). Although it was controversial, it paved the way for research and multiple studies have now shown that the treatment based on this approach is effective both in terms of reducing perfectionism but also with respect to the impact that the treatment has on other difficulties such as depression and anxiety.

The treatment can be delivered individually, in groups, using a self-help book or over the internet. Some of the key treatment strategies are:

  • Understanding what maintains the perfectionism. It is helpful to understand the causes of the perfectionism but, like other cognitive behavioural approaches, the focus is on the factors that keep the perfectionism going.
  • Dispelling myths. For example, many people believe ‘the harder I work, the better I will do’ but there comes a point at which over-working may backfire and cause a deterioration in performance due to tiredness (for example).
  • Conducting surveys to be able to get information about others’ standards to enable benchmarking.
  • Testing out beliefs using ‘behavioural experiments’. For example, if a person thinks that they will fail an assignment if they do less than eight hours work, he/she would be encouraged to do seven hours work and to use that extra hour to do something enjoyable instead; gradually the amount of work would be reduced and the person would learn that three to four hours is sufficient for that type of assignment.
  • Addressing ‘all-or-nothing’ thinking by helping the person realise the shades of grey between ‘success’ and ‘failure’.
  • Trying to rebalance attention so that it isn’t always focused on the negative.
  • Helping with self-criticism by increasing compassion towards oneself and having the same expectations for themselves and others.
  • Dealing with avoidance, procrastination and other related problems such as poor time management; problem-solving strategies such as the ones described by Christine and Arthur Nezu can be particularly helpful (and problem-solving is also an effective intervention for depression!)

The future

We have come a long way in our understanding of perfectionism and in developing interventions that work. However, there remains a great deal of work to do so that we can help people with a wide variety of forms of perfectionism and to see whether the interventions work for children and young people. We also need to make sure that people can access the treatments that they need in a timely way. I am hopeful that such ambition reflects healthy striving for excellence and an achievable goal, but only time will tell….

Further reading

Nezu, A. M., Nezu, C. M., D’Zurilla, T. J. (2007) Solving Life’s Problems: A 5-step Guide to Enhanced Well- being.

Shafran, R., Egan, S., & Wade, T. (2018). Overcoming Perfectionism 2nd Edition: A self-help guide using scientifically supported cognitive behavioural techniques. Robinson.

Shafran, R., Egan, S. & Wade, T. (2012) Changing Perfectionism: This booklet describes ‘clinical perfectionism’ and its link with how people evaluate themselves.

References

Hollender, M. H. (1965). Perfectionism. Comprehensive psychiatry, 6(2), 94-103.

Horney, K. (1950). The Collected Works of Karen Horney: Self analysis. Neurosis and human growth (Vol. 2). WW Norton.

Shafran, R., Cooper, Z., & Fairburn, C.G. (2002). Clinical perfectionism: A cognitive–behavioural analysis. Behaviour research and therapy, 40(7), 773-791.

About the author

Roz Shafran is a Professor of Translational Psychology at University College London and a Chartered Clinical Psychologist. She is a Trustee of the Charlie Waller Memorial Trust and founded the Charlie Waller Institute of Evidenced Based Psychological Treatment at the University of Reading.

She is also co-author of ‘Overcoming Perfectionism: a self-help guide using scientifically supported cognitive behavioural techniques’.

Resources

No Harm Done: Recognising and responding to self-harm

Next steps for staff working with young people

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

We would like to acknowledge the Charlie Waller Memorial Trust (CWMT) UK for these resources and for allowing us to adapt this. For the original version of this resource, please refer to the CWMT website: www.cwmt.org.uk

INTRODUCTION

Self-harm describes any way in which a young person might harm themselves or put themselves at risk in order to cope with difficult thoughts, feelings or experiences. It affects up to 1 in 5 young people and spans the divides of gender, class, age and ethnicity. As such, many people find themselves in the position of wanting to support a young person who is self-harming. This can be difficult due to lack of confidence or uncertainty about what to say or do. Here we’ve provided simple guidance for taking those first steps – your support can be life-changing.

“I was so alone and lost and desperate. I thought no one cared until my [social worker] encouraged me to open up. I remember that day so vividly – it was the first day of the rest of my life.”

SELF-HARM WARNING SIGNS

There are many signs you can look out for which indicate a young person is in distress and may be harming themselves, or at risk of self-harm, the most obvious being physical injuries which:

  • you observe on more than one occasion
  • appear too neat or ordered to be accidental
  • do not appear consistent with how the young person says they were sustained

Other warning signs include:

  • secrecy or disappearing at times of high emotion
  • long or baggy clothing covering arms or legs even in warm weather
  • increasing isolation or unwillingness to engage
  • avoiding changing in front of others (may avoid PE, shopping, sleepovers)
  • absence or lateness
  • general low mood or irritability
  • negative self-talk – feeling worthless, hopeless or aimless

“At first we thought he was just accident prone, it was easy to miss, he always had an explanation as to how he’d got hurt.”

THE FIRST CONVERSATION

The sooner we encourage a young person to disclose their self-harm, the sooner we are able to provide or seek appropriate support to help them break the cycle. We can do so by passing our concerns on to a [trusted adult/teacher] or by providing a safe space for the young person to talk to us.

“It was the hardest conversation of my life, but every word I spoke made the load feel a little lighter and for the first time in a long time, I felt hope.”

The most supportive first conversation is one where:

  • the young person is the sole focus of your attention
  • you spend most of your time listening, not talking
  • the young person tells their story, you never guess or assume
  • there is a feeling of acceptance and support, not judgement
  • self-harm is not dismissed as attention seeking
  • unrealistic promises are not made about confidentiality
  • this is recognised as the first step of a difficult journey
  • clear next steps are identified and followed up promptly
  • you recognise how hard this conversation must be for the young person
  • you respond calmly – even if you don’t feel calm

“I’m not looking for attention, it’s just the only thing that helps me control the wayI feel.”

WHEN A YOUNG PERSON ISN’T READY TO TALK

When a young person is more reluctant to disclose or discuss their self-harm, three important questions to consider are:

  1. Who is the best person to have this conversation? You can use your knowledge of the young person, or ask them who they feel comfortable talking to.
  2. How can you help the conversation flow? An informal environment or talking whilst carrying out another activity such as walking or drawing can really help.
  3. Would another medium work better? Some young people feel happier talking via instant messenger, text or email – be creative and use your knowledge of the child.

“I tried several times to talk to him to no avail; it was only when I texted him that the conversation finally started.”

If a young person still isn’t ready to open up, provide them with details of anonymous sources of support and regularly revisit the situation.

“The [phone] counsellor helped me get more comfortable talking about things and next time my teacher tried to talk to me, I felt ready.”

NEXT STEPS

If you have any concerns about a young person’s immediate safety, this is an absolute priority and should be treated as an urgent safeguarding issue in line with your policies. If you think a young person is at risk, they should not be left alone.

All discussions should be recorded and shared with a trusted adult/teacher who will keep these details on file and can provide support and direction on appropriate next steps. These might include:

  • Informing adults who need to know in order to keep the young person safe. This will usually include parents or carers.
  • Visiting the GP to seek further support and guidance.
  • Providing access to a school counsellor.
  • Setting up regular meetings with a trusted adult such as a class teacher who can provide practical support and guidance.

It is important that all wounds are appropriately dressed and cared for as infection is common. Provide the young person with information about wound care or access to a trained first aider or medical professional who can assess and dress any wounds.

“He didn’t want to show me his wounds but he was happy to have the school nurse assess and dress them as long as I told her not to ask any questions.”

PROVIDING PRACTICAL SUPPORT

If you find yourself in the position of providing regular support to a young person, here are some helpful things you can do:

Listen – provide a safe space for non-judgmental, supportive listening. Even a few minutes of high quality listening can make a huge difference to how supported a young person feels.

Address stressors – work with the young person to understand their triggers and stressors. Working

through a typical day and highlighting the tough bits can be a great way to start and then think creatively of ways you might address these.

Make a self-soothe box – work with the young person to collect a range of different things they can use to distract or soothe themselves when they feel the urge to self-harm. This might include music, colouring, books, bubbles, photographs or inspirational quotes.

Provide safe sources of further information – highlight sources of further information such as those listed at the end of this resource.

Safeguarding your own wellbeing – It can be emotionally challenging to support a young person who is self-harming so it’s important that you too receive regular support and confidential listening. Keep in regular contact with a trusted adult/teacher and if, for any reason, you feel you are unable to continue to support the young person, discuss this at the earliest opportunity.

“Things changed for me at home and I felt unable to provide the level of support she deserved. I was honest with her and we identified a different adult she could regularly speak to.”

WHOLE SCHOOL APPROACH

Whilst there is much that proactive, supportive individuals can do to help a young person within their school or organisation, this support is best provided within the context of a whole school approach in order to keep both ourselves, and the young person as safe as possible. Simple steps that your school could take include:

1. Developing and implementing a mental health policy

Clear guidance can give staff the knowledge and confidence they need to respond to issues appropriately. It is important to develop a policy that feels relevant and achievable within your setting and to ensure that all staff know who to refer to with concerns.

2. Providing training for all staff

Providing basic training for all staff on how to recognise and respond to self-harm will increase the confidence of both staff and students in making and responding to disclosures.

3. Addressing self-harm as part of the curriculum

Your school curriculum can provide a great opportunity to tackle myths and misunderstandings surrounding self-harm and to provide students with an understanding of how to keep themselves and each other supported and safe.

4. Looking after staff wellbeing

Before we can look after others, we must first look after ourselves. Supporting young people who are in emotional distress can be physically and mentally draining for staff; this needs to be recognised and appropriate support put in place, both in terms of training and supportive listening.

“Most importantly, the [professional training] day got us talking about self-harm. It was uncomfortable at first but we all grew in confidence throughout the day. It was really empowering – we’re no longer scared of disclosures, we feel confident we can help.”

FURTHER INFORMATION (UK-only)

YoungMinds: youngminds.org.uk Parents Helpline 0808 802 5544 (Monday to Friday 9.30am – 4pm)

YoungMinds provides information and free resources to help implement a whole school approach and self-harm, mental health and resilience training for professionals.

Charlie Waller Memorial Trust provides free self-harm training to staff working with young people.

Factsheet from The Royal College of Psychiatrists Childline: childline.org.uk 0800 1111 (24hr)

Helpline (24 hr): 08457 90 90 90 UK & NI

Email: jo@samaritans.org The Site: thesite.org

Self-Harm Alternatives: over 130 ideas for use in recovery suggested by young people, collated by Dr Pooky Knightsmith

Self-Harm and Eating Disorders in Schools: A Guide to Whole-School Strategies and Practical Support by Pooky Knightsmith. Available as a paperback or Kindle

A Short Introduction to Understanding and Supporting Children and Young People Who Self-Harm by Professor Carol Fitzpatrick. Available as a paperback or Kindle

No Harm Done:    film &     resource pack for parents

No Harm Done:    film &     resource pack for young people

“There’s no denying that it’s a gruelling journey and there are downs as well as ups; but once you’re out the other side and you see a happy, healthy young person ready to head out into the world it is the best feeling ever.”

Resources

Bipolar disorder symptoms

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • What is bipolar disorder
  • Sub-types of bipolar disorder
  • Symptoms of bipolar disorder
  • When to seek help for bipolar disorder
  • Key points to remember
  • Where to get more information

What is bipolar disorder?

  • Bipolar disorder is the name used to describe a set of ‘mood swing’ conditions, the most severe form of which used to be called ‘manic depression’.
  • The term describes the exaggerated swings of mood, cognition and energy from one extreme to the other that are characteristic of the illness.
  • People with this illness suffer:
  • Recurrent episodes of high, or elevated moods (mania or hypomania) and depression.
  • Most experience both the highs and the lows.
  • Occasionally people can experience a mixture of both highs and lows at the same time, or switch during the day, giving a ‘mixed’ picture of symptoms.
  •  A very small percentage of sufferers of bipolar disorder only experience the ‘highs’.

People with bipolar disorder experience normal moods in between their mood swings.

  • The mood swings pattern for each individual is generally quite unique, with some people only having episodes of mania once a decade, while others may have daily mood swings.
  • Bipolar disorder can commence in childhood, but onset is more common in theteens or early 20’s.
  • Some people develop ‘late onset’ bipolar disorder, experiencing their first episode in mid-to-late adulthood.

Distinguishing between bipolar I and bipolar II

  • Bipolar I disorder is the more severe disorder, in the sense that individuals are more likely to experience ‘mania’, have longer ‘highs’ and to have psychotic episodes and be more likely to be hospitalised.
  • Mania refers to a severely high mood where the individual often experiences delusions and/ or hallucinations. The severe highs which are referred to as ‘mania’ tend to last days or weeks.
  • Bipolar II disorder is defined as being less severe, in that there are no psychotic features and episodes tend to last only hours to a few days; a person experiences less severe highs which are referred to as ‘hypomania’ and depression but no manic episodes and the severity of the highs does not usually lead to hospitalisation.
  • Hypomania literally translates into ‘less than mania’. It describes a high that is less severe than a manic episode and without any delusions and/or hallucinations.
  • These highs don’t last as long. While they are officially diagnosed after a four-day duration, research has shown that they may only last a few hours to a few days.
  • Both women and men develop bipolar I disorder at equal rates, while the rate of bipolar II disorder is somewhat higher in females.

Symptoms of bipolar disorder

  • Diagnosing bipolar disorder is often not a straightforward matter.
  • Many people go for 10 years or more before their illness is accurately diagnosed.
  • It is important to note that everyone has mood swings from time to time. It is only when these moods becomeextreme and interfere with a person’s personal and professional life that bipolar disorder may be indicated and medical assessment sought.
  • There are two starting points for considering whether you might have bipolar disorder.
    • Firstly, you must have had episodes of clinical depression.
    • Secondly, you must have had ‘highs’, where your mood was more ‘up’ than usual, or where you felt more ‘wired’ and ‘hyper’.
  • If both depression and ‘highs’ have been experienced, then the next thing to consider is whether you also experienced any of the six key features of mania and hypomania outlined below.

Key features of mania & hypomania

While it can be difficult to identify what separates normal ‘happiness’ from the euphoria or elevation that is seen in mania and hypomania, researchers at the Black Dog Institute, have identified the following distinguishing features:

  • High energy levels – feeling ‘wired’ and ‘hyper’, extremely energetic, talking more and talking over people, making decisions in a flash, constantly on the go and feeling less need for sleep.
  • Positive mood – feeling confident and capable, optimistic that one can succeed in everything, more creative, happier, and feeling ‘high as a kite’.
  • Irritability – irritable mood and impatient and angry behaviours.
  • Inappropriate behaviour – becoming over involved in other peoples’ activities, engaging in increased risk taking (i.e. by over indulging in alcohol and drugs and gambling excessively) saying and doing outrageous things, spending more money, having increased libido; dressing more colourfully and with disinhibition.
  • Heightened creativity – ‘seeing things in a new light’, seeing things vividly and with crystal clarity, senses are heightened and feeling quite capable of writing the ‘next great novel’.
  • Mystical experiences – believing that there are special connections between events, that there is a higher rate of coincidence between things happening, feeling at one with nature and appreciating the beauty and the world around, and believing that things have special significance.
  • More extreme expressions of mania (but not hypomania) may have the added features of delusions and hallucinations.
  • A number of other symptoms can indicate whether there is a likely diagnosis of bipolar disorder, particularly for those under the age of 40. These include:
    • Racing thoughts (for example, feeling like you are watching a number of different TV channels at the same time, but not being able to focus on any)
    • Sleeping a lot more than usual
    • Feeling agitated, restless and/or incredibly frustrated.

When to seek help for bipolar disorder

  • If you have experienced an episode of mania or hypomania, or have taken the Black Dog Institute’s Bipolar Disorder Self-Test, linked under the resources at the end of this fact sheet, and are concerned about your results, it is advisable to seek professional assessment by a mental health practitioner.
  • The first step is to arrange a consultation with your doctor. They will provide an assessment and, where necessary, refer you to a psychiatrist for further treatment.
  • Bipolar disorder is not an illness which goes away of its own accord, but one which often needs long-term treatment. Accurately diagnosing bipolar disorder is a task for the mental health professional.
  • Some people with bipolar disorder can become suicidal. It is very important that talk of suicide be taken seriously and for such people to be treated immediately. In an emergency you can go straight to your local hospital’s emergency department for help, or dial 999.

Key points to remember

  • Bipolar disorder is an illness involving exaggerated swings of mood and energy from one extreme to the other, usually involving alternating periods of depression and mania or hypomania.
  • The pattern of mood swings for each individual is quite unique.
  • The six features of mania and hypomania are:
  1. High energy levels
  2. Positive mood
  3. Irritability
  4. Inappropriate behaviour
  5. Heightened creativity
  6. Mystical experiences
  • For people under the age of 40, other symptoms of bipolar disorder may include sleeping a lot more than usual, feeling agitated, restless and/or incredibly frustrated.
  • Accurately diagnosing bipolar disorder is a task for a skilled mental health practitioner.
  • If symptoms of bipolar disorder are suspected it’s best to first see a doctor, who will likely refer you to a psychiatrist.
  • People with bipolar disorder can become suicidal. Talk of suicide should be taken seriously and immediate help should be sought from a doctor or other mental health professional.

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more information and support

Black Dog Institute – “Bipolar Disorder Self-Test”

Mind Hong Kong – “What Is Bipolar Disorder?”

Bilingual Telephone Hotlines

Hospital Authority Mental Health 24-hour Hotline: 2466 7350

Social Welfare Department Hotline: 2343 2255

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 90881023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 27778899

Resources

Stress and its impact on you

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • What is stress?
  • Physical and mental health impacts
  • Factors that impact mental health
  • Recognising and managing stress

What is stress?

Stress is our body’s response to a demand placed on it. Stress is often confused with anxiety, but stress is not a diagnosable mental illness.

Stress is a normal condition, experienced by everyone. It involves an emotional, physical or mental response to events that cause bodily or mental tension. It can be thought of as a state of readiness – the ‘fight or flight’ response.

A small amount of stress from time to time is not a problem, it can even motivate us to get things done. But when stress is intense and ongoing, it can start to impact our physical and mental health.

Experiencing stress

When stressed, you might have thoughts like “I can’t cope with this”, “this is too much pressure for me”, “I don’t have enough time” and “how am I going to get this done”. In essence, your mind has decided you have ‘more on your plate than you can chew’.

At the same time, your body goes into ‘fight or flight’ mode. Your nervous system is activated, and hormones are released that enable you to react quickly. For example, when stressed you might notice your heart rate increases, pupils dilate, breathing rate increases and muscles tense. You might also notice changes in mood or emotions. These changes enable you to deal with the situation.

Stress has also been shown to affect the body’s immune response. This change in immune response and increased inflammation is a possible link between various physical diseases and stress, including cardiovascular disease, thyroid disease, and diabetes.  

Impact of stress on daily activities

Initially increasing stress, or arousal, increases performance; this is explained by the Yerkes- Dodson Law.

The ‘comfort’ zone allows you to work under stressful conditions.  Levels of stress arousal above the ‘comfort’ zone can however lead to impaired performance, reduced concentration, and fatigue.

If not addressed, prolonged chronic stress can lead to structural and functional changes inside the brain. These changes can play a role in the development of or trigger several physical and mental illnesses, such as:

  • Depression, anxiety, schizophrenia
  • Autism spectrum illnesses
  • Hypertension
  • Cardiovascular diseases
  • Endothelial dysfunction
  • Sleeping problems

How much stress is too much?

Stress is personal. What someone thinks is stressful, you might find satisfying and fun. For example, some people may find working 10 hours a day for long periods does not cause stress; for others, it will. Some people enjoy public speaking; for others, this is too stressful. There are many things that can cause stress. When they do, we call them ‘stressors’.

Potential stressors include:

  • Relationship difficulties
  • Work issues
  • Life changes (e.g. marriage, separation, retirement, moving house, starting a new job, being retrenched or becoming unemployed)
  • Illness
  • Study demands
  • Event planning (e.g. holidays and family events)

And the list goes on. Your stressors will also change over time as your life demands change.

Recent studies have found genetic differences in the genes that direct the production of stress hormones, and that there are differences in the way stress impacts on these genes. This may be the reason why people respond differently to stress, and why some are more vulnerable to the effect of chronic exposure to stress.

Stress and mental health

There’s a common misconception that there is a direct correlation between stress levels and mental health. There has been an assumption that if we want to improve mental health, and particularly mental health at work, we need to reduce stress. However, the research shows that the factors affecting our mental health are much more complex and interlinked than this simplistic model.

Our mental health and wellbeing are impacted by:

  • Individual factors: personal resilience, genetics, early life events, personality, mental health history, lifestyle factors
  • Home/work factors: conflicting demands, significant life events
  • Workplace factors: the design of our jobs, the teams we work in and the culture of an organisation

Managing stress

It’s important to remember that stress is more than just feeling overworked. We have become accustomed to feeling high levels of stress and hence are often unaware of or may not even know what it feels like to be relaxed. You need to be able to recognise stress to deal with it. By repeating these 4 steps regularly, you may start to recognise your stressors.

  1. Event: Describe to yourself one event this week that you found stressful. Consider where you were, when it was, who was there and what you were doing.
  2. Rating: On a scale of 1-5, how stressful was this event? (1 = mildly stressful, 5 = extremely stressful)
  3. Thinking: What were you thinking about this event? For example, were you thinking of the worst possible outcomes? Were you focusing on the stress itself?
  4. Feeling: Where did you feel the stress? For example, as a physical ache, or an emotional response such as being irritable? Did it change the way you were thinking, e.g. less able to concentrate or change your behavior, such as disturbing your sleep?

It is helpful to develop a range of responses to stress. Some tried-and-true strategies for dealing effectively with the stress that shows up in our lives include:

  1. Recharge activities: When we get stressed, we often stop making time for things that are nourishing, satisfying and refreshing to do.
  2. Daily routines: The human mind likes predictability and certainty. When life gets stressful, we can restore some order to the chaos by ensuring that we continue with simple daily routines.
  3. Circles of concern and influence: The problems, issues and difficulties we face generally fall into two ‘circles’:
    • Circle of concern contains things over which you have little direct control
    • Circle of influence contains those concerns that you can actually do something about – focus on making changes in this circle

Reality check: As mentioned before, stress has a large ‘thinking’ component, and certain types of thinking are likely to trigger stress and/or make your stress worse. Thought challenging is a useful strategy to ensure the way you are thinking about a situation is more balanced, realistic and helpful.

Key messages

  • Stress is a normal condition, not a mental illness
  • Everyone experiences stress, but we experience it differently and this changes over time
  • Prolonged stress can negatively impact physical and mental health
  • Learn to recognise your stressors so you can deal with them

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more Information and Support

The following resources have been produced by the HK Department of Health:

Joyful @ HK

Student Health Service – “Stress Management”

Student Health Service – “Exam Stress Management”

Additional resources:

MyCompass: an online self-help tool to keep track of and manage your mental health (English only)

Mind Hong Kong – “What Is Stress?”

Resources

Signs & symptoms of anxiety

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • When anxiety is a problem
  • Types of anxiety disorders
  • Signs and symptoms of anxiety

Everyone experiences anxiety

In Hong Kong,

  • Over half of the university students show symptoms of an anxiety disorder, according to research conducted by the University of Hong Kong in 2016
  • According to a 2018 survey by Hong Kong Playground Association, over a third of young people scored moderate to extremely severe on the Anxiety scale (of the DASS21)

When does anxiety become a problem?

It’s normal to feel anxious in high pressure situations such as:

  • A job interview
  • When you’re speaking in public
  • When you’re experiencing change in your life or work environment and you’re uncertain what the future will hold.

To a degree, this anxiety can help us, making us stay focused and alert.

When we’re very anxious, we have intense feelings of worry or distress that are not easy to control. Anxiety can interfere with how we go about our everyday lives making it hard to cope with ‘normal’ challenges.

Anxiety becomes a problem when you start to feel anxious most of the time and about even minor things, to the point where your worry is out of control and interfering with your day to day life.

What are anxiety disorders?

Anxiety disorders are a mix of:

  • Psychological symptoms: frequent or excessive worry, poor concentration, specific fears or phobias e.g. fear of dying or fear of losing control
  • Physical symptoms: fatigue, irritability, sleeping difficulties, general restlessness, muscle tension, upset stomach, sweating and difficulty breathing
  • Behavioural changes: including procrastination, avoidance, difficulty making decisions and social withdrawal

Severe anxiety is a feature of a group of mental health disorders including:

  • Generalised anxiety disorder
  • Social phobia
  • Specific phobia
  • Obsessive compulsive disorder (OCD)
  • Panic disorder
  • Separation anxiety disorder
  • Agoraphobia
  • Post-traumatic stress disorder (PTSD)

Other types of anxiety disorders include:

  • Substance/medication-induced anxiety disorder
  • Anxiety disorder due to a medical condition

It’s important to seek help to manage severe anxiety. There are many effective treatments for anxiety, and you can feel better.

Factors for developing anxiety

There is a range of contributing factors for developing anxiety. The factors could be:

  • Biological – genes (family history)
  • Personality traits
  • Brain chemistry
  • Life events, such as trauma and long-term stress
  • A combination of above factors

Signs and symptoms

While there are many types of anxiety disorder, there are some common signs and symptoms.

You might be feeling:

  • Very worried or afraid most of the time
  • Tense and on edge
  • Nervous or scared
  • Panicky
  • Irritable, agitated
  • Worried you’re going crazy
  • Detached from your body
  • Feeling like you may vomit

You may be thinking:

  • ‘Everything’ is going to go wrong’
  • ‘I might die’
  • ‘I can’t handle the way I feel’
  • ‘I can’t focus on anything but my worries’
  • ‘I don’t want to go out today’
  • ‘I can’t calm myself down’

You may also be experiencing:

  • Sleep problems (can’t get to sleep, wake often)
  • Pounding heart
  • Sweating
  • ‘Pins and needles’
  • Tummy aches, churning stomach
  • Lightheadedness, dizziness
  • Twitches, trembling
  • Problems concentrating
  • Excessive thirst

When these constant repetitive thoughts and feelings take over, we can:

  • Feel overwhelmed
  • Lose sleep
  • Feel exhausted
  • Start to avoid social situations

Some of these symptoms can also be signs and symptoms of other medical conditions, so it’s always best to see a doctor so they can check them properly.

There is an online Anxiety Self-test on the Black Dog Institute website.

Diagnosis

To be diagnosed with an anxiety disorder, a combination of symptoms

  • Is present on most days for more than six months
  • Interferes with your ability to function at work or at home

It is common to experience a low mood secondary to excessive worry and the two conditions – clinical depression and anxiety disorder – can occur at the same time.

It’s important to get help to treat anxiety disorders. Left untreated, anxiety can last for a long time. It can become exhausting, debilitating and get in the way of us living our everyday lives. There are a range of effective treatments for anxiety, and you can get better. Visiting a doctor or a mental health professional is a good starting point when seeking help for anxiety.

Key points to remember

  • Anxiety is normal, everyone experiences anxiety at some time.
  • Anxiety becomes a problem when it interferes with your day to day life
  • Anxiety disorders are a combination of psychological, physical and behavioural symptoms
  • A range of factors can contribute to anxiety disorders
  • Signs and symptoms of anxiety vary

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Resources

Seeking help for anxiety

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • Why seek help for anxiety?
  • Who to talk to
  • Treatment available

It’s important to get treatment for anxiety

Anxiety is physically and emotionally exhausting. Getting help early means you can start to get relief and recover sooner. There are many professionals who treat all kinds of anxiety.

There is a wide range of effective treatments for anxiety, e.g.

  • Cognitive behavioural therapy (CBT)
  • E-mental health tools
  • Relaxation techniques
  • Medications

There are also lots of things you can do to help yourself.

Often, it’s a combination of things that help us get better, such as:

  • A well-informed health professional you feel comfortable talking to
  • The right psychological and medical therapies
  • Support from family and friends
  • Exercising and healthy eating
  • Learning ways to manage challenges and stress, such as structured problem solving, meditation and yoga

How do I know it’s anxiety?

Severe anxiety can appear in ways that feel like other health issues, e.g.

  • Chest pain
  • A racing heartbeat
  • Dizziness
  • Rashes

Sometimes, anxious people think they’re having a heart attack.

When we’re anxious, we can also become hyper-aware of:

  • Our body
  • Aches and pains
  • Perceived threats and danger

Sometimes, once we’re aware of a problem, we can become ‘hyper-vigilant’ in checking on all the discomforts and pains we feel. This can spiral into feeling more concern and worry, making the anxiety more severe.

You should always see a doctor, so they can make a thorough check of your symptoms and rule out any other medical condition.

Who can provide help for anxiety?

As well as your doctor, there are other health professionals who can help with anxiety, including:

  • Psychologists
  • Psychiatrists
  • Counsellors
  • School and university counsellors
  • Social workers and occupational therapists trained in mental health
  • Mental health nurses

What type of treatment is available?

There are three broad categories of treatment for anxiety:

  • Psychological treatments (talking therapies)
  • Physical treatments (medications)
  • Self-help and alternative therapies

Psychological therapies are the most effective way to treat and prevent the recurrence of most types of anxiety. Depending on the type of anxiety, self-help and alternative therapies can also be helpful. They can be used alone or combined with physical and psychological treatments.

A thorough assessment by your doctor is needed to decide on the best combination of treatments for you.

Psychological treatments

Psychological treatments can be one-on-one, group-based or online interactions. Psychological treatments are sometimes called ‘talking therapies’ as opposed to ‘chemical therapies’ (i.e. medications).

Keeping health in mind

Talking therapies can help us change habits in the way we think, and cope better with life’s challenges. They can help us address the reasons behind our anxiety, and also prevent anxiety from returning.

There are a wide range of psychological treatments for anxiety, including:

  • Cognitive behaviour therapy (CBT)
  • Exposure therapy (behaviour therapy)
  • Interpersonal therapy (IPT)
  • Mindfulness-based cognitive therapy
  • Positive psychology
  • Psychotherapies
  • Counselling
  • Narrative therapy

Some of the above treatments can be accessed online. Evidence-based online treatments can be as effective as face-to-face treatments. These online treatments are often referred to as e-mental health programs.

Physical treatments

Your doctor should undertake a thorough health check before deciding whether medication is a good option for you. Taking medication for anxiety must be supervised by a doctor. If medication is prescribed as part of your treatment, your doctor should explain the reason for choosing the medication they’ve prescribed.

Your doctor will:

  • Discuss the risks and benefits, side effects, and how regularly you need check-ups.
  • Advise what treatments can work together with the medication, such as psychotherapy, lifestyle changes (e.g. exercise) and other support options.

Anti-anxiety medications are used for very severe anxiety in anxiety types such as:

  • Panic disorder
  • Generalised anxiety disorder (GAD)
  • Social phobia

Anti-anxiety medications, such as benzodiazepines, can:

  • Be addictive
  • Become ineffective over time
  • Have other side effects such as headaches, dizziness and memory loss

Anti-anxiety medications are not recommended for long-term use.

It’s important to know that not all anxiety needs medication. Many people respond well to lifestyle changes and psychological treatments.

Self-help and alternative therapies

There are a wide range of self-help measures and therapies that can be useful for anxiety. It’s good to know that there are things you can do for yourself to feel better.

Self-help and complementary therapies that may be useful for anxiety include:

  • Exercise
  • Good nutrition
  • Omega-3
  • Meditation
  • De-arousal strategies
  • Relaxation and breathing techniques
  • Yoga
  • Alcohol and drug avoidance
  • Acupuncture

Different types of anxiety respond to different kinds of treatments. Severe anxiety may not respond to self-help and alternative therapies alone. These can be valuable adjuncts to psychological and physical treatments.

e-mental health programs

e-mental health programs can be used in conjunction with a mental health professional or as a stand-alone option. e-mental health programs (also called ‘e-therapies’ or ‘online therapies’) are online mental health treatment and support services. You can access them on the internet using your smartphone, tablet or computer. The programs can help people experiencing mild-to- moderate depression or anxiety.

Some e-mental health tools, such as myCompass developed by the Black Dog Institute, have been found to be as effective in treating mild-to- moderate depression as face-to-face therapies.

e-mental health treatments are based on face-to-face therapy, positive psychology and behavioural activation. These therapies mainly focus on reframing thoughts and changing behaviour.

Key points to remember

  • Lots of professionals can help you with anxiety
  • There are many types of treatments for anxiety, and you can get better
  • Many people who have had anxiety have been able to seek help and live active, fulfilling lives

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more Information and Support

Black Dog Institute – “myCompass”

Student Health Services – “Understanding Anxiety Disorders”

OCD & Anxiety Support Hong Kong

Mind Hong Kong – “Anxiety and Panic Attacks”

The Mental Health Association of Hong Kong:

Phone: 2528 0196
Website: www.mhahk.org.hk



Resources

Helping someone who has a mental illness: for family and friends

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • How to tell if someone has a mental illness
  • What to do if you are concerned about a family member or close friend
  • How to behave with someone who is depressed
  • What to do if someone is suicidal
  • Self care for carers
  • Key points to remember
  • Further information and support

Someone with a mood disorder is like anyone with any other illness – they need care and support. Family and friends can provide better care if they are informed about the illness, understand the type of treatment and are aware of the expected recovery time.

How to tell if someone has a mental illness

Even if you know someone well, you will not always notice when they have changed. You are more likely to notice big or sudden changes but gradual changes can be easy to miss. It’s also true that people will not always reveal all their thoughts and feelings to their close friends and family.

For these reasons, family and friends cannot expect to always know when someone has a depressive illness and should not feel guilty that they ‘did not know’.

The best approach is to acknowledge that mental illnesses are common and to learn how to recognise the signs and how to offer help.

What to do if you are concerned about a family member or close friend

If you are worried that a family member or close friend has a mood disorder, try talking to them about it in a supportive manner and either suggest that they consult their doctor or another mental health professional.

Sometimes they may be reluctant to seek help. You might need to explain why you’re concerned and provide specific examples of their actions or behaviour that are worrying you. Providing them some information such as a book, fact sheets or helpful pamphlets might also help.

You could offer to assist them in seeking professional help by:

  • Finding someone that they feel comfortable talking to.
  • Making an appointment for them on their behalf.
  • Taking them to the appointment on the day
  • Accompanying them during the appointment if appropriate.

This level of help may be particularly appropriate if the person has a severe mood disorder such as psychotic depression or mania.

Young people, adolescents in particular, are vulnerable to mental health problems. If you are concerned about someone, try:

  1. Gently let them know you have noticed. changes and explain why you are concerned
  2. Find a good time to talk when there are no pressures or interruptions.
  3. Listen and take things at their pace
  4. Respect their point of view.
  5. Validate what they are experiencing, but don’t offer reassurance or advice too quickly
  6. Let them know that there is help available that will make them feel better.
  7. Encourage them to talk to a doctor or other health professional, and to find a trusted friend or family member that they can confide in.

There are also a range of services (e.g. telephone counselling and online resources) that are specifically designed for young people. You can find out more about what is provided in Hong Kong on the Coolminds website.

How to behave with someone who is depressed

Patience, care and encouragement from others are vital to a person who is experiencing depression. Someone experiencing depression is very good at criticising themselves and needs support from others, not criticism.

Clear and effective communication within the household or family is also important. Partners or families might find it helpful to see a psychologist during this time for their own support.

An episode of depression can provide an opportunity for family members to re-evaluate the important things in life and resolve issues such as grief or relationship difficulties.

Some Tips:

  • Avoid suggesting to the person that they “cheer up” or “try to get over it”. This is unhelpful as it is likely to reinforce their feelings of failure or guilt.
  • Another important part of caring is to help the treatment process – if medication has been prescribed, encourage the person to persist with treatment and to discuss any side effects with their prescribing doctor.
  • The person may also need encouragement and help to get to their therapy appointments or complete any online therapy exercises they have been asked to do.
  • During a depressive illness, counselling or psychotherapy often results in the person working through their life events and relationships; while this can be difficult for all concerned, friends and family should not try to steer the person away from these issues.

What to do if someone is suicidal

If someone close to you is suicidal or unsafe, try:

  • Talking to them about it and encourage them to seek help.
  • Remembering that if someone is feeling like their life is not worth living, they are experiencing overwhelming emotional distress.
  • Helping the person to develop a safety plan involving trusted close friends or family members that can keep the person safe in times of emergency.
  • Removing risks (e.g. take away dangerous weapons or items if that person is angry or out of control and threatening to disappear).

Self care for carers

(A carer is someone who provides support to a friend, family member, or neighbor in need of help because of their age, disability, or physical or mental health.)

  • Carers are also likely to experience stress. Depression and hopelessness have a way of affecting the people around them.
  • Therapy can release difficult thoughts and emotions in carers too. So, part of caring is for carers to look after themselves to prevent becoming physically run down and to deal with their internal thoughts and emotions.
  • Treatment has a positive time as well; when the person starts to re-engage with the good things in life and carers can have their needs met as well.

Key points to remember

  • If you are worried that someone is depressed or has bipolar disorder, try talking to them about it in a supportive manner and suggest that they see a mental health professional.
  • If they don’t want to seek help, explain the reasons for concern and perhaps provide them with some relevant information.
  • Young people are particularly vulnerable to depression.
  • Patience, care and encouragement from others are all vital to the person who is depressed.
  • If a loved one talks of suicide, encourage them to seek help immediately from a mental health professional.
  • Depression can take a toll on carers and close family members – it is important for these people to take care of themselves as well.

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more help and support

Bilingual Web Resources

Mind Hong Kong – “Am I A Carer?”

Mind Hong Kong – “What Can Friends and Family Do To Help?”

Student Health Service – “Understanding Depression”

Student Health Service – “Emotional Health”

English-Only Web Resources

Reach Out: a web-based support for adolescents

Headspace online: help for young people

Bilingual Telephone Hotlines

Samaritans Hong Kong 24-hour hotline: 28960000

Samaritan Befrienders Hong Kong 24-hour hotline: 23892222

Suicide Prevention Services 24-hour hotline: 23820000

Suicide Prevention Services “Youth Link” hotline (available 2pm-2am): 2382 0777

Hospital Authority Mental Health 24-hour Hotline: 2466 7350

Social Welfare Department Hotline: 2343 2255

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 90881023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 27778899


Resources

Depression in adolescents & young people

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com


Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website:
www.blackdoginstitute.org.au

What this fact sheet covers:

  • Signs of depression in adolescence
  • Where to get help for an adolescent
  • Key points to remember
  • Where to get more information

Introduction

  • A 2017 study by the Hong Kong Federation of Youth Groups found that of the 3,441 secondary school and university students surveyed, 51% displayed symptoms of depression and close to 40% experienced high levels of stress (7 on a scale of 10).
  • According to research done by the University of Hong Kong, more than two-thirds of Hong Kong’s university students experience symptoms of mild to severe depression.
  • The HKJC Centre for Suicide Research and Prevention observed that suicide rates for full-time students increased by 76% between 2012 and 2016.
  • Onset of depression is typically around mid-to-late adolescence, and it is important to recognise the early warning signs and symptoms. Early intervention can often prevent the development of severe depressive illness.

Developmental Impact

  • The teenage years are a time when individuals develop their identity and sense of self.
  • If depression is left to develop, it can lead to isolation from family and friends, risk-taking behaviours such as inappropriate sexual involvements and drug and alcohol abuse.
  • It can also impact on school performance and study, which can have downstream effects on later career or study options.
  • Both biological and developmental factors contribute to depression in adolescence. If bipolar disorder or psychosis is suspected, an assessment by a health professional is recommended. See our Fact Sheet “Symptoms of Bipolar Disorder” for more information.

Signs of depression in an adolescent

  • An adolescent who is depressed may not show obvious signs of depression.
  • It is often hard to distinguish adolescent turmoil from depressive illness, especially when the young person is forging new roles within the family and struggling with independence, and having to make academic and career decisions.
Signs of a depressed mood include:
  • Lowered self-esteem (or self-worth)
  • Changes in sleep patterns, that is, insomnia (inability to sleep), hypersomnia (excessive sleep) or broken sleep
  • Changes in appetite or weight
  • Inability to control emotions such as pessimism, anger, guilt, irritability and anxiety
  • Varying emotions throughout the day. For example, feeling worse in the morning and better as the day progresses.
  • Reduced capacity to experience pleasure: inability to enjoy what’s happening now, not looking forward to anything with pleasure such as hobbies or activities.
  • Reduced pain tolerance: decreased tolerance for minor aches and pains
  • Poor concentration and memory
  • Reduced motivation to carry out usual tasks
  • Lowered energy levels

Where to get help for an adolescent

  • If you think someone you are close to might be depressed, you should encourage them to seek advice from a professional. (At school – school counsellor, social worker. Outside school – doctor, counsellor, psychologist)
  • The first step is to speak to a professional who can conduct an assessment, provide options and discuss the next steps to take.
  • Other initial sources of help are school counsellors and trusted close family members to whom the young person feels comfortable talking.
  • If the young person does not want to seek help, it is best to explain your concerns and to provide them with some information to read about depression.
  • There are also some excellent websites designed for young people, as well as confidential online and telephone counselling services in both English and Chinese. Please see our list of services at the end of this fact sheet.
  • It’s important for young people to know that depression is a common problem and that there are people who can help.
  • If there is any mention of suicide this should be taken seriously, and immediate assistance is available by calling 999 or going directly to the nearest hospital.

Key points to remember

  • A 2017 study by the Hong Kong Federation of Youth Groups found that of the 3,441 secondary school and university students surveyed, 51% displayed symptoms of depression and close to 40% experienced high levels of stress (7 on a scale of 10).
  • Depression in young people is associated with social withdrawal, drops in performance at school, drug or alcohol use and engaging in risky behaviours.
  • It can be hard to distinguish depression from adolescent turmoil; if depression is suspected, an assessment should be sought from a doctor or other mental health professional.
  • Immediate help should be sought if a young person talks of suicide.

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more Information and Support

Mind Hong Kong – “What Is Depression?” 

Student Health Service – “Understanding Depression”

Student Health Service – “Emotional Health”

Bilingual Telephone Hotlines

Samaritans Hong Kong 24-hour hotline: 28960000

Samaritan Befrienders Hong Kong 24-hour hotline: 23892222

Suicide Prevention Services 24-hour hotline: 23820000

Suicide Prevention Services “Youth Link” hotline (available 2pm-2am): 2382 0777

Hospital Authority Mental Health Direct hotline: 24667350

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 90881023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 27778899

Resources

Causes of depression

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to the Black Dog Institute for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to the Black Dog Institute’s website: www.blackdoginstitute.org.au

What this fact sheet covers:

  • Factors involved in developing depression
  • Key points to remember
  • Where to get more information

Introduction

Unlike other illnesses or disorders, there is no simple explanation as to what causes depression. In general, depression can be due to a number of factors including stresses which can range from mild to severe, combined with vulnerability or predisposition to depression that can result from biological, genetic or psychological factors.

Each type of depression is associated with different mixtures of causes. For psychotic or melancholic depression, physical and biological factors are relevant. In contrast, for non-melancholic depression, the role of personality and stressful life events are important.

Genetic factors

There is strong evidence that genetic factors play a significant role in a person’s predisposition towards developing depression, especially melancholic depression, psychotic depression and bipolar disorder. No single gene is likely to be responsible, but rather a combination of genes.

The predisposition to develop depression can be inherited. The genetic risk of developing clinical depression is about 40% if a biological parent has been diagnosed with the illness, with the remaining 60% being due to factors within the individual’s own environment. Depression is unlikely to occur without stressful life events, but the risk of developing depression as a result of such an event is strongly genetically determined.

Biochemical Factors

Our knowledge of the human brain is still fairly limited, therefore we do not really know what actually happens in the brain to cause depression. It is likely that with most instances of clinical depression, neurotransmitter function is disrupted. Neurotransmitters are chemicals that carry signals from one part of the brain to the next. There are many neurotransmitters serving different purposes. However, three important ones that affect a person’s mood are serotonin, noradrenaline and dopamine.

In normal brain function, neurotransmitters interact with a series of nerve cells, with the signal being as strong in the second and subsequent cells as it was in the first. However, in people who are depressed, mood regulating neurotransmitters fail to function normally, so that the signal is either depleted or disrupted before passing to the next nerve cell.

Physical Illness

In a simple sense, physical illness can lead to depression through the lowered mood that we can all experience when we are unwell, in pain or discomfort, confined and less able to do the things we enjoy.

Illness can also change the body’s functioning in a way that leads to depression. Even if the illness isn’t making us feel down we can still suffer from depression. For example:

  • It is known that certain cancers can produce a depressive illness – in these cases a person might be quite unaware that they are suffering from depression.
  • Compromised immune functioning might play a part in the emergence of depression, although further research is needed to establish this link.
The ageing brain

As we age, our brain’s general functioning can become compromised and this can affect the neurotransmitter pathways which influence mood state. Three reasons for these changes are worth mentioning in relation to depression:

  • Late onset depression: Elderly people who develop dementia may also develop a severe depression for the first time; this type of depression is commonly of a psychotic or melancholic type and reflects the disruption of circuits linking certain basal ganglia and frontal regions of the brain.
  •  These brain changes can reflect an ageing process, particularly in people who are vulnerable to this kind of ‘wear and tear’.
  • In others however, high blood pressure or mini-strokes (often unnoticed by the individual and their family) may contribute. Good blood pressure control can reduce the chance of depression in some people.
Gender

Gender is a partial but incomplete explanation of why people may develop depression. Equal numbers of men and women develop melancholic depression. However, studies have shown that there is a much greater likelihood of women developing non-melancholic depression than men. Some of the explanations for this are:

  • Women are more likely than men to ‘internalise’ stress, thereby putting them at greater risk of developing depression.
  •  Women with unsatisfactory marriages or who are caring for a number of young children are also highly over represented among samples of depressed people.
  • Hormonal factors commencing in puberty may account for the increased chance in women of developing anxiety (a precursor to depression) or depression.
Stress

It is important to recognise that nearly every individual can be stressed and depressed by certain events. Most people get over the stress or depression within days or weeks while others do not. Ways that stress can lead to depression include the following:

  • Past or long-standing stresses can increase the chances of an individual developing depression in later years e.g. growing up in an abusive or uncaring family may increase the risk of developing depression in adult life.
  • Events that affect a person’s self-esteem such as the break-up of a close relationship or marriage
  • Feelings of ‘shame’ for example, thinking they have not lived up to their own or others’ expectations.
Personality

Our research has shown that people with the following personality types are more at risk of developing depression than others. Those who are high on the first four factors are at distinctly greater risk to depression (especially non-melancholic depression):

  1. High levels of anxiety, which can be experienced as an internalised ‘anxious worrying’ style or as a more externalised ‘irritability’.
  2. Shyness expressed as ‘social avoidance’ and/or ‘personal reserve’.
  3. Self-criticism or low self-worth.
  4. High interpersonal sensitivity.
  5. Perfectionism is somewhat protective against the onset of depression but if depression occurs, it can result in longer episodes.
  6. A ‘self-focused’ style is likely to be at greater risk for brief depressive episodes only

Key points to remember

  • There is no single cause for depression; rather it’s a combination of stress and a person’s vulnerability to developing depression.
  • The predisposition to developing depression can be inherited.
  • Other biological causes for depression can include physical illness, the process of ageing and gender.
  • Stress can trigger depression but understanding its particular meaning to the person is important.
  • Certain temperament and personality styles pose risks for developing non-melancholic depression.

Contact Us

Coolminds

Email: hello@coolmindshk.com

Black Dog Institute

Email: blackdog@blackdog.org.au

Where to get more information and support

Mind Hong Kong – “What Is Depression?”

Student Health Service – “Understanding Depression”

Student Health Service – “Emotional Health”

Cheer Centre: Interpretation services for Ethnic Minorities for use of public services

Bilingual Telephone Hotlines

Samaritans Hong Kong 24-hour hotline: 28960000

Samaritan Befrienders Hong Kong 24-hour hotline: 23892222

Suicide Prevention Services 24-hour hotline: 23820000

Suicide Prevention Services “Youth Link” hotline (available 2pm-2am): 2382 0777

Hospital Authority Mental Health Direct hotline: 24667350

Chinese-Only Telephone Hotlines

Youth Outreach 24-hour hotline service: 90881023

The Hong Kong Federation of Youth Groups “Youthline” hotline (available Mon-Sat, 2pm-2am): 27778899

Resources

Obsessive compulsive & related disorders + young people

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to Orygen for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to Orygen’s website: www.orygen.org.au

People use the word ‘obsession’ a lot in everyday conversation, and it can mean different things to different people. In terms of mental health, ‘obsessions’ are recurrent and persistent thoughts, urges, or images that are intrusive and unwanted. Obsessions become a problem when they affect a young person’s behaviour so much that they interfere with everyday life.

Obsessions often go together with compulsions – these are irresistible urges to behave in a certain way. Obsessive– compulsive (OCD) and related disorders are serious, anxiety-related conditions that affect a young person’s everyday life through things like stopping them from getting to school on time, finishing homework, or going out with friends.

What is normal and what is OCD?

Almost everybody experiences the type of thoughts that people with OCD have, such as wanting to double-check they have switched off the oven or double-checking they have locked the front door before they go out. While it’s also very common for people to repeat certain actions, most people can dismiss these thoughts or urges.

People with OCD can’t ignore unpleasant thoughts and pay undue attention to them. This means that the thoughts become more frequent and distressing. Over time, the thoughts can affect all areas of a person’s life, including their school or work activities, their family, and their social life. Young people often develop compulsive behaviours to manage their distress, but these behaviours tend to take up a lot of time – sometimes more than an hour a day.

What are the common obsessive-compulsive and related disorders?

Obsessive–compulsive disorder (OCD)

Young people living with this condition experience repetitive and upsetting thoughts and sometimes compulsive behaviours.

Body dysmorphic disorder (BDD)

A young person living with BDD has an obsession with a perceived defect in their appearance. If other people hardly notice the perceived defect, then the obsession is regarded as markedly excessive. Take a look at the Eating & body image disorders + Young People factsheet to find out more.

People with OCD can’t ignore unpleasant thoughts and pay undue attention to them.

Trichotillomania (compulsive hair pulling) and compulsive skin picking

These are two distinct but related disorders that have obsessive– compulsive features. Young people with these disorders experience a build-up of anxiety that’s relieved by either repetitive hair pulling or skin picking, which are done consciously or unconsciously. Feelings of depression or hopelessness often follow because the young person realises the damage caused by these behaviours. Even if there is no anxiety beforehand, the young person may find pulling or picking pleasurable, and this makes the behaviour difficult to stop.

If these behaviours are because a young person is concerned about their appearance, then the condition may be body dysmorphic disorder.

What are the symptoms of OCD?

Obsessions

Obsessions are unwanted, intrusive, or upsetting thoughts or images that come to mind over and over again. They are difficult to get rid of and can feel silly or unpleasant. Some examples of obsessions include:

  • fears about germs and disease
  • needing things to be in a certain order
  • ‘I must count to twenty or something bad will happen’
  • unwanted thoughts about sexual or violent acts.
Compulsions

Compulsions are the actions or rituals that a person carries out in order to get rid of, prevent or ‘neutralise’ the obsessions. People with OCD also carry out compulsions to try to relieve the anxiety caused by the obsessions. Often, people try to stop themselves from doing these things because they realise it’s illogical, but they feel frustrated or worried if they can’t finish them. Some examples of compulsions include:

  • washing hands again and again
  • repeatedly checking that the light is switched off
  • mental rituals, such as counting or repeating words in your head
  • hoarding or collecting things that are unnecessary or useless.

OCD and related disorders are treatable, and most young people can learn to stop performing their compulsive rituals and to decrease the intensity of their obsessive thoughts

Other problems

Young people living with OCD or a related disorder may also experience other mental health difficulties, such as depression, other anxiety conditions, an eating disorder, or alcohol and other substance-use problems. Young people with OCD often experience feelings of intense shame about their need to carry out compulsions. These feelings of shame often make the OCD worse. Shame and the consequent secrecy associated with OCD can lead to a delay in diagnosis and treatment. This can lead to long-term health, mental health and relationship problems. Seeking the right support for what’s going on can assist with recovery and planning for getting on with education, work and relationships.

Advice and referral

OCD and related disorders are treatable, and most young people can learn to stop performing their compulsive rituals and to decrease the intensity of their obsessive thoughts.

If you’re having difficulties with OCD

Talk about your concerns with someone you trust, such as a school counsellor, family friend, a parent or teacher. Your GP can help you sort out what is and isn’t OCD, and help with a plan for getting better if you need.

If you think a young person you know is having difficulties

Let them know you’re there to support them, and encourage them to get professional support. Try to avoid giving reassurance to a young person with OCD because as part of their recovery they’ll need to confront their fears without constant reassurance. Don’t involve yourself in the young person’s compulsions – helping them carry out compulsions only makes it more difficult for them to recover. Instead, working with a professional during treatment may give you a role in helping the young person to resist the completion of rituals.

Treatment for OCD and related disorders

OCD and related disorders are usually treated with the help of a professional using cognitive–behavioural therapy (CBT), with exposure and response prevention. CBT is based on the idea that moods and emotions are influenced by thoughts. It explores thinking patterns and how they affect our behaviour and emotions, such as fear.

Exposure and response prevention involves slowly and carefully supporting a young person to confront the feared situations without performing their compulsive behaviours. This helps the young person to learn to tolerate the immediate distress and leads to a reduction in anxiety over time. In certain instances medication may also be helpful.

Getting help

If you, or someone you care about, experiences symptoms of an obsessive– compulsive or related disorder, use these tips to seek help.

  • Talk to someone you trust help. Tell family or friends about what you’re feeling and thinking so they can support you.
  • Try to eat healthily, get some regular exercise, and find ways to relax by doing things you enjoy (e.g. listening to music, reading a book, or engaging in other hobbies).
  • Try to avoid alcohol and other drugs as they often make the anxiety associated with obsessions or compulsions worse over time, and can lead to other problems, such as dependency.
  • It can be useful to keep a diary of the frequency, intensity and types of unwelcome thoughts (obsessions). Resist completing rituals (compulsions) as much as possible.
  • Do some research to understand your treatment and recovery options – seeking professional help from a counsellor, psychologist, psychiatrist, or a doctor can be helpful.

Exposure and response prevention involves slowly and carefully supporting a young person to confront the feared situations without performing their compulsive behaviours

Further information

For further information regarding mental health, or for information in other languages, visit:

Australia / International

Hong Kong

Disclaimer: This information is not medical advice. It is generic and does not take into account your personal circumstances, physical wellbeing, mental status or mental requirements. Do not use this information to treat or diagnose your own or another person’s medical condition and never ignore medical advice or delay seeking it because of something in this information. Any medical questions should be referred to a qualified healthcare professional. If in doubt, please always seek medical advice.

Resources

Getting active + young people

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to Orygen for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to Orygen’s website: www.orygen.org.au

Being active helps maintain your health. We tend to think that the mind and body are separate, but what you do with your body can have a powerful effect on your mental health. And it’s easier to feel good about life if your body feels good.

As well as reducing the risk of physical health problems, like heart disease and diabetes, some of the potential benefits of being active are:

  • less tension, stress and tiredness
  • a natural energy boost
  • improved sleep or sleep patterns
  • a sense of achievement
  • less anger, irritability or frustration
  • meeting other people at gyms, clubs, etc.

Physical activity leads to chemical changes in the brain, which can improve your mood and lower anxiety. Being active may also lead to changes in how you view yourself and can reduce feelings of loneliness and isolation.

Being active and mental health

Being active is important for everyone. It can be hard, though, if you or someone you know is experiencing mental health difficulties. Evidence shows that getting active isn’t only great for physical health and fitness, but also can positively influence mental health.

Symptoms

Symptoms of some mental health difficulties include lower energy, problems with motivation, loss of enjoyment in activities, and problems with sleep. These symptoms can really get in the way of staying fit and healthy.

Regular exercise can boost your self-esteem and help you concentrate, sleep, feel and look better. Physical exercise, in conjunction with psychological therapy and medications, is an established treatment for depression and is effective for anxiety.

Physical activity leads to chemical changes in the brain, which can improve your mood and lower anxiety

Treatments and medications

Some treatments for mental ill-health may effect energy levels. Exercise can help improve functioning and physical health, prevent recurrences, and manage the side effects of some of these medications or treatments. Exercise is one way to ease the symptoms of psychosis, such as blunted emotions, loss of drive and thinking difficulties – it is, though, less helpful for delusions and hallucinations.

For some mental health difficulties, exercise is actually part of the problem. Excessive exercise for someone who has an eating disorder can be harmful. And increased exercise can sometimes be an early warning sign of a manic phase for those with bipolar disorder.

Before starting to exercise, speaking to a GP about a pre-existing medical concern can help find the best kind of exercise

Some things to think about

Regardless of mental health, everyone should be aware of the other factors that play into exercise. Here are some of the key things to keep in mind

Other medical conditions

Be careful if you have another medical condition. New exercise can effect that condition, like making asthma worse. Before starting to exercise, speaking to a GP about a pre-existing medical concern can help find the best kind of exercise.

Young people who smoke will generally be more puffed out when first starting physical activity. It’s important to keep at it – in only a few weeks the puffed-out feeling will get less and less.

Be practical

Plan exercise around a budget and support system. Is travel required to a sports centre? Who could take you, or how would you get there otherwise (car, public transport)? How much does the activity cost? Can someone do it with you? Does the activity require special equipment?

Get some support

Starting a new sport, joining a new gym or trying exercise for the first time can be a little intimidating. To help with nerves, have a chat to some friends, family and other supports who can help with ideas, encouragement, and motivation.

Tips to help you get active

Start small

Some activity is better than none. It’s as simple as walking or riding somewhere instead of driving. Or, if you take public transport, getting off one stop before your usual stop and walking the rest of the way. You can even take the stairs instead of the escalator or lift.

Make a plan

Planning a routine can help you become more active. Make sure some form of exercise is included each day. Try to stick to the plan as closely as possible, but be flexible because sometimes things comes up.

Choose something you’ll enjoy

… or at least something you won’t hate! Don’t go to the gym if you’ve never liked the gym. Instead, try walking, riding a bike to a friend’s place, throwing a Frisbee, or playing football at the park with some friends.

Choose a time of the day or week that works for you

Everybody is motivated at different times – morning, afternoon or evening. Just be careful about exercising too late in the evening because you may have problems getting to sleep.

Gradually build up physical activity

Increase the amount of time you exercise in a day, or the number of days in a week that you’re exercising. Aim for 30–60 minutes a day.

Ways to help you stick with it

Getting warm, sweaty or a bit puffed out doesn’t feel that great, but it means you’re working hard and getting fitter –it will get easier as you go! Here are some ways to help you stick at exercise in the long run.

Set achievable goals

For someone who hasn’t been exercising at all, exercising once a week for 20 minutes might be a good start. If you feel like even 20 minutes is too much, then start at 5 minutes and gradually build this up.

Don’t go it alone

Find a friend, family member or local group you can exercise with. It makes it more fun and helps you to keep on track if you know that you have this commitment to others. Letting them know what you’re working towards will help them motivate you, too.

Hang in there!

If you miss a day or a week, don’t give up. Try to get yourself going again.

Notice your progress

You can time yourself walking and try to beat it, or count how many push-ups you can do. Keeping track helps you notice your improvements and work out where you can go next with your exercise routine.

Try something new

If what you’ve been doing has gotten boring, you can try a few things to reinvigorate yourself. Like getting some coaching to develop your skills, getting a friend involved, or trying something completely different.

Find something flexible that you can do when you feel like it

Exercise isn’t just lifting weights in a gym, it involves all kinds of physical activities. Try a Zumba or dance class, go skating or jogging, throw a few hoops, kick a football in the park or go for a walk with a friend.

Use technology

Why not try exercise programs on your gaming console? Or you can try using exercise apps that help you to create routines and monitor your progress.

Keeping track helps you notice your improvements and work out where you can go next with your exercise routine

Top 5 reasons for not being active

  1. It’s too hot/cold/windy/rainy.
    Why not try doing something active inside – play an exercise video, or dance along to some music.
  2. I can’t be away from social media. Instead of connecting with friends on social media, try doing something active with a friend in real life, like going to the park with a ball.
  3. My shorts are dirty. Not all activities need sportswear. You can do yoga in round-the-house clothes, as well as walking in some exercise shorts and a t-shirt.
  4. I’m too busy/tired.You don’t have to spend a long time exercising – try exercising for just 20 minutes, or breaking it down into smaller time periods that add up over the day.
  5. I’ll do it tomorrow. It’s tempting to put off being active, but exercising regularly has so many benefits! If you’re having motivation troubles, try reminding yourself of all the reasons being active benefits you.

Top 5 reasons for being active

In the tough moments when you struggle to get going, here are the top five benefits that exercising has for you:

  • Better mood and more energy.
  • Less stress.
  • Better sleep.
  • More confidence in yourself and how you look.
  • Meet new friends.
Being active on a budget

Joining a gym, taking classes or visiting the swim centre can really add up, but this doesn’t mean there aren’t other forms of activity. If you’re on a budget, or want to watch your finances because you’re saving up for something, here are some of the ways you can still be active without forking out the cash.

  • Getting off one bus or MTR station earlier and walking the rest of the way.
  • Download a free exercise app or podcast, or browse YouTube for a yoga or exercise video.
  • Go to the park with a friend and a ball or Frisbee.
  • Put on some music for a 10-minute dance party in your bedroom!
  • Ditch the lift and use the stairs for less than four floors.
  • Get skipping! Jumping rope is a cheap and quick way to get some good cardio exercise.
  • Go hard when cleaning your room or doing household chores – turn up the music and have fun!
Get online

If you want to do something closer to home, here are some ways you can utilise the internet for exercise.

  • There are some great clubs, classes and groups out there just waiting for you to sign up and get involved. These can help motivate you, and might only be round the corner.
  • Try parks in Hong Kong, leisure and cultural centres, clubs from school or university, your local council, community centre, etc. for activities you might enjoy.
  • If you’ve got a smartphone, search for videos, apps or podcasts that can help you with exercise ideas. You can find apps or websites that can record how far you’ve walked, help plan a run, show you yoga, Pilates or abs workouts, or play an exercise music mix – whatever you’re interested in.
  • You might want to have a look at couch-to-5K www.c25k.com for help with taking up running.

Disclaimer: This information is not medical advice. It is generic and does not take into account your personal circumstances, physical wellbeing, mental status or mental requirements. Do not use this information to treat or diagnose your own or another person’s medical condition and never ignore medical advice or delay seeking it because of something in this information. Any medical questions should be referred to a qualified healthcare professional. If in doubt, please always seek medical advice.

Resources

Autism Spectrum Disorder (ASD) + young people

This resource booklet has been localised for the Hong Kong context and translated to Traditional Chinese by Coolminds, a mental health initiative run by Mind HK and KELY Support Group. For more information on Coolminds, please visit www.coolmindshk.com

Thank you to Orygen for donating their resources and for allowing us to adapt this. For the original version of this resource, please refer to Orygen’s website: www.orygen.org.au

Autism spectrum disorder (ASD) is a developmental condition that can be identified from early childhood onwards and can affect a person throughout their life. The cause is unknown, and there’s no specific medical or genetic test to diagnose it. Instead, diagnosis is based on the presence of: particular patterns of social communication and interaction, restricted interests, and rigid routines, repetitive behaviour (e.g., lining up objects) or repetitive speech.

The diagnosis of ASD has replaced three diagnoses that were previously used: autistic disorder, Asperger’s syndrome and pervasive developmental disorder – not otherwise specified. These disorders no longer exist as separate diagnoses. Instead, they are reflected in the autism spectrum by specifying whether a person has mild, moderate or severe symptoms and difficulties.

With early intervention and support, young people with ASD can begin to understand how their experience of the world is different from others, and can begin to make sense of what supports they might need to live the kind of life that they want.

Areas of difficulty

Social communication and interaction

People with ASD typically have some differences in the way that they communicate and socialise. People with ASD have difficulty understanding the feelings, thoughts and intentions of others and difficulty identifying and communicating their own feelings, thoughts and intentions to others.

While many young people with ASD speak fluently, they might have problems in the area of ‘pragmatic’ language – that is, using language appropriately in social situations. This might mean they find it difficult to hold two-way conversations. A tendency for making literal interpretations can mean figures of speech and sarcasm are misunderstood or misused. Problems with pragmatic language might also lead to people having trouble using the right language for a social situation – their language might be very formal, and their vocabulary might be very rich.

Young people with ASD might also prefer to be alone or seem uninterested in others. Difficulties in reading social cues or situations, expressing empathy and understanding others mean that they might need help to interact with others. They also might have difficulty with eye contact, facial expressions and body language and forming or maintaining social relationships.

Areas of difficulty for young people with ASD

With early intervention and support, young people with ASD can begin to understand how their experience of the world is different from others

Interests and behaviours

Young people with ASD often develop special interests that are unusual in their intensity and focus. Public transport, maps, physics and computers are all examples of the wide and varied special interests of people with ASD. Young people with ASD prefer situations to be consistent and may have special preferences with respect to routine and consistency. As a result, young people with ASD might experience difficulties managing change and transition. Activity participation, diet and clothing might be areas in which young people with ASD express unusual rigidity.

Thinking

Young people with ASD are often logical thinkers and can be good with facts, figures and details. This logical thinking may mean that they can have difficulty understanding non-concrete ideas.

ASD and the body

Young people with ASD might experience clumsiness and problems with body awareness that can lead to difficulties with sports, handwriting and other physical skills. Young people with ASD frequently have problems with sleep and can be very sensitive to different sensations – finding a particular noise disturbing, or a particular item of clothing very uncomfortable.

Young people with ASD often develop special interests that are unusual in their intensity and focus

What might not be so bad about it?

Whilst people with ASD might have difficulties in a range of areas, they might also present with admirable differences in perception, attention, memory and intelligence.

ASD, youth and mental illness

Youth is a tricky time. For young people with ASD, things like progressively more complex social demands, increasingly difficult skills to be learned at school or home and transitions, such as graduating, might all be stressful. It’s often at this time that young people with ASD and others around them might become more alert to their social differences. Young people with ASD might feel excluded, bullied and frustrated by their differences. These negative experiences can leave young people with ASD at risk of low self-esteem and at increased risk of developing mental ill-health, such as depression and anxiety.

When young people with ASD develop mental illness, diagnosis and treatment need to be tailored to account for the young person’s different personality style and their differences in the areas of socialising, communication and interests.

For some young people, it’s only during their treatment for mental health difficulties that they or their family may raise suspicions about ASD. Diagnosis of ASD is a reasonably lengthy process involving multiple health professionals. Diagnosis is important for young people because it provides effective treatment options and helps to better address their needs.

Treatment

Effective treatment will target any mental health difficulty, support the young person to adjust to the changes they have as a result of ASD and make use of the skills that they have. Many people with ASD might still find social situations, personal relationships and major life changes challenging, but with support and encouragement, many people go on to undertake further education, develop their interests through hobbies and membership of clubs, work successfully in jobs that interest them and find fulfilling friendships.

Young people with ASD are often logical thinkers and can be good with facts, figures and details

Supporting someone who lives with ASD

Here are some ways you can help someone you know who lives with ASD.

  • Any approach to support someone with ASD needs to be unique and individualised.
  • Encourage the person to talk about what’s going on for them, and any troubles or worries they have. It might be hard for them to find the right words or to express themselves, so be patient and try other preferred routes for communication (e.g. stories/drawings).
  • Help them build confidence through doing things that use their strengths.
  • Some people with ASD can find being around other young people who feel ‘different’ supportive. Groups at schools, local councils and health services might be options, and internet forums and chat rooms can also be helpful and accessible.
  • Have a routine and try to be consistent. It doesn’t need to be too rigid, but might mean that a young person with ASD can begin to take advantage of planned opportunities to talk to you about their worries or hopes.
  • Be patient. It takes a lot longer for people with ASD to get used to things and make changes in their lives.

Further information

For further information regarding mental health, or for information in other languages, visit:

Australia / International

Hong Kong

Disclaimer: This information is not medical advice. It is generic and does not take into account your personal circumstances, physical wellbeing, mental status or mental requirements. Do not use this information to treat or diagnose your own or another person’s medical condition and never ignore medical advice or delay seeking it because of something in this information. Any medical questions should be referred to a qualified healthcare professional. If in doubt, please always seek medical advice.