The purpose of these notes is to provide some guidance on how to explain some of the key concepts in the MHW Training and also how to conduct the activities and case studies.
Contents / Page NumberExplaining the Mental Health Continuum / 2
Activity 1- The Frame of Reference / 4
Activity 2- Attitudes in the Workplace / 6
Activity 3- A Mentally Healthy Workplace / 7
Case Study 1 (John) / 8
Explaining The Wellness Recovery Action Plan (WRAP) / 11
Explaining The Human Function Curve / 13
Activity 4- The Six Key Risk Areas / 15
Activity 5- Dealing with the causes of stress / 17
Activity 6- The CIPD / H&S Executive Competencies / 18
Case Study 2 (David) / 24
EXPLAINING THE MENTAL HEALTH CONTINUUM
Show the slide of the MH Continuum and explain that it is based on the work of Keith Tudor (1996). ‘Mental Health Promotion: Paradigms and Practice.’
Explain that the continuum is a way of helping us to understand that Mental Health and Mental Illness are two different but interlinked things. Explain that Mental Health is represented on the vertical axis and Mental Illness is represented on the horizontal axis.
Explain each of the quadrants as follows:
The top right quadrant represents a situation where the person has positive mental health and no diagnosis of a mental illness. This is a good place to be and normally when we are in this quadrant life is good and things are going well.
The bottom right quadrant represents a situation where the person still has no diagnosed mental illness but has poor mental health. Ask the group what situations or life events might cause us to be in the bottom right quadrant. They will normally come up with bereavement, relationship breakdown, stress, redundancy, financial problems etc. Make the point that we all find ourselves in the bottom right quadrant from time to time.
The top left quadrant represents a situation where the person has a diagnosis of a mental health problem but positive mental health. This may be a difficult concept to grasp so it is sometimes useful to ask the group to think about someone who has a diagnosis of a physical illness like diabetes or asthma – it is still possible for that person to have a good quality of life. Similarly if a person with a diagnosis of a mental health problem has the right treatment, support and coping strategies they can have a good quality of life.
The bottom left quadrant represents a situation where the person has a diagnosis of a mental health problem and also poor mental health. This may be due to not having found the right treatment yet, not having the right support, using alcohol or drugs or not having the right coping strategies. It may also be due to the same issues that affect us in the bottom right quadrant.
Having explained the four quadrants check that the group have understood the continuum and ask if there are any questions.
Ask the group to comment on the implications of the continuum for them as individuals?
If they don’t mention it suggest that where we are on the continuum at any given time depends on our circumstances and it is a fluid situation. Remind them that in the past when we have been in the bottom right quadrant we have managed to find a way out of it either by ourselves or with help from others.
Ask the group to comment on the implications for them as managers?
If they don’t mention it suggest that it is useful for us as managers to know where we are on the continuum so that we can look after ourselves.
Suggest that it is also useful to know where individual team members are on the continuum. Ask how we would know where a team member is at any given time? The group will normally come up with specific behaviours or performance issues – remind them that we are not about diagnosing people and that as a manager our role is to provide support when appropriate.
Ask for any examples of situations the group have come across where they have supported a colleague or team member.
Bring the discussion to a close by reminding the group that we are all on the continuum and have the potential to have good or poor mental health and from time to time to be affected by mental illness. We also know what we need to do to look after our own mental health – even though we don’t always do it.
ACTIVITY 1
FRAME OF REFERENCE (15minutes)
The Frame of Reference is the term used by Jacqui and Aaron Schiff to refer to our individual filter on reality. They defined the Frame of Reference as:
‘A framework which is used to define the self, other people and the world.’
Our individual Frame of Reference is influenced by a range of factors from our upbringing and experience. These include our family situation, education, culture and life experiences. This can be shown as our ‘window on the world’ by taking a flipchart and drawing a square in the middle surrounded by the factors that have moulded our values and beliefs. The example below shows the kind of factors that can be included:
FRAME OF REFERENCE
Place of Birth / early childhoodFamily Situation – size etc
Education
Cultural InfluencesAchievements
Work ExperienceWINDOWFurther Education
ON THE
WORLD
Role Models
Setbacks Hobbies / Interests
Gender
Values
SpiritualityRelationships
AspirationsAgeLikes / Dislikes
Suggestions for using the Frame of Reference
Purpose
The purpose of this activity is to help participants understand how their values and beliefs have influenced their views about a range of topics including mental health.
Method
Start by asking the group to reflect on the big messages they got from parents, grandparents or the community they were brought up in. Give examples such as ‘respect your elders’, ‘always tell the truth’, ‘you don’t get anything for nothing’
After people have given a few examples refer to the Frame of Reference in the participants pack and explain how the various factors affect our values and beliefs. You may want to draw your own Frame of Reference in advance on the flipchart and give some examples to show the group how it works.
Ask the group to think about their own ‘Frame of Reference’ and jot down any significant people / events that influenced their attitudes and beliefs. Allow a few minutes and then ask for examples from the group.
Explain that our Frame of Reference affects our attitude towards a range of things including mental health / mental illness. Give an example of how your own attitude towards mental health / mental illness was influenced by your frame of reference and ask the group for examples of how attitudes to mental health / mental illness have been influenced by their Frame of Reference
Round off the activity by explaining that our own attitudes and those of others have a profound affect on how we deal with mental health issues.
Activity 2
ATTITUDES WITHIN THE WORKPLACE (15 minutes)
Aims:
This activity is designed to allow people to reflect on the attitudes within their own workplace in relation to mental health.
Method:
- Ask pairs to take a few minutes to reflect on their own workplace attitudes, beliefs and culture and how this affects employees (positively or negatively). It may be helpful to give some examples of what we mean by attitudes / beliefs and culture as shown below:
Attitudes / Beliefs
Ask the group to think about the attitudes in their workplace towards:
Working hours - are people expected to work long hours?
- are people expected to take work home?
-are people encouraged to take proper breaks?
Colleagues - Do colleagues generally support each other?
- Is there a team working spirit?
Management - Are managers respected and trusted by staff?
- Is communication open and honest?
- Do staff feel their work is appreciated?
Culture
Culture is often described as the “way we do things around here”.
It may be useful, therefore to ask individuals to think of examples that might sum up the culture in their part of the organisation.
- Discuss in large group any similarities and differences.
- Summarise the impact of positive / negative attitudes and beliefs on mental health in the workplace. Acknowledge that the collective attitudes in a workplace may place expectations on staff / managers to behave in a way that doesn’t sit comfortably with their individual Frame of Reference.
ACTIVITY 3
FEATURES OF A MENTALLY HEALTHY WORKPLACE (15 minutes)
Aims:
This activity is designed to get participants to think about the kinds of things that make up a Mentally Healthy Workplace.
Method:
Split into pairs / trio’s
Ask each pair / trio to come up with three features that would make a workplace a mentally healthy place to work. Invite them to think about creating a workplace from scratch without constraints.
Prompt them to think in terms of Communications, Relationships, Workload, Working conditions, Policies and Procedures and Values / Beliefs.
Ask each pair / trio to write their ideas on Post It’s – one idea per post it.
Allow about 5 minutes and then ask each group to put their Post It’s on the flipchart. Read out the Key Features and discuss
Summarise the key features and discuss the impact these would have on people’s mental health.
Show Slide 8 and confirm that the features the group came up with fall within one or more of the headings. Ask how many of the bullet points are within their influence as a manager – confirm that most if not all are within their influence.
Ask people to think of a time when they had a really good manager and to say what it was that made the person a good manager. Emphasise the importance of the manager in creating a mentally healthy workplace and then show Slide 9 and discuss.
Explain that we will come back to the key features later in the day to discuss which one’s currently exist in their workplace and which one’s require some work.
TRAINER NOTES FOR CASE STUDY - JOHN
Split the group into pairs and explain that we are going to explore a case study about supporting a team member.
Explain that the case study is in two parts and issue a copy of the case study (part 1) overleaf to each pair. Allow a short time for each pair to read the case study and then ask for feedback on how they would manage the situation.
Encourage participants to say whether or not they would contact John and if so when would they contact him and how. If people are adamant that they wouldn’t contact John, remind them that this was totally out of character and encourage them to think about how John might be feeling. Remember to be mindful of the organisations attendance management policy.
Discuss the steps they would take to establish what happened and check that they agree that nothing more can be done until you have heard John’s side of the story.
Issue part 2 of the case study and give the pairs time to discuss then ask for feedback.
Establish that we now have additional information regarding why John behaved in the way that he did. This does not change the fact that what he did was inappropriate but it does suggest that there were reasons why he reacted to his colleagues teasing.
In considering how we might support John - use the following checklist to ensure the key points have been considered.
- How does John feel about the incident?
- Does he understand / acknowledge that swearing at a colleague and walking out is inappropriate?
- What support has John had or is currently receiving?
- How does he feel about attending the team day / night out?
- How does he feel about coming back to work?
- What support would he find helpful?
- What does he want his colleagues to know (if anything)?
- How does he intend to handle the situation with the colleague he swore at?
- What thoughts does he have about coping strategies for the future?
Discuss what the group feel should happen about the person who reported the incident. This may generate some discussion about harassment and the need for people to be mindful that what one person thinks is a joke may be quite hurtful to someone else.
Summarise the discussion and refer to pages 16 and 17 in the participants pack.
CASE STUDY - JOHN (Part 1)
John has worked in your business as a Maintenance Officer for 5 years.
Yesterday John reportedly swore at a colleague in the office and walked out. Today his wife phoned in to say he is unwell and won’t be at work.
The colleague John swore at has reported the incident as he believes it was unprovoked. This member of staff is very popular at work and is well known for his jokes and sense of fun. He reports the incident as starting when he was pulling Johns leg about an upcoming team away day and night out. He says it was very light hearted and that Johns reaction was totally out of proportion. Staff who witnessed the incident confirm this report is accurate.
John is less well known to you. He is regarded as a dependable member of staff with no history of absence, disciplinary or medical problems. John has always seemed friendly but he’s quite reserved and private. John tends not to mix his work and social life so has never formed close relationships with his colleagues but has always appeared to get along with everyone.
There have been behaviour problems in this team in the past but not involving these two members of staff. You want to deal with this as quickly and effectively as possible.
1. Based on the information above how would you manage this situation – would you contact John? If so how and when would you contact him?
2. How would you go about finding out what actually happened – who
would you speak to, what information would you seek to obtain?
CASE STUDY - JOHN (Part II)
When the time is right you meet with John to discuss the incident.
At this meeting John confirms that he acted inappropriately. As an explanation John reveals that he suffers from Post Traumatic Stress Disorder which has resulted in Social Phobia following an incident 6 years ago.
John had been attacked when returning home from a night out late one evening. The attack was unprovoked and so brutal that John spent 5 days in hospital. Ever since this incident John has avoided all social situations.
John reveals he felt overwhelmed and pressurised by his colleague into attending the team night out and the overwhelming feeling of fear caused him to react angrily and to try and flee the situation. He’s been left with feelings of self loathing since the incident.
- Does this information change how you would deal with John?
- Would you consider offering support to John or making any reasonable adjustments to his job / conditions? What additional information would it be useful for you to find out from John?
- How would you deal with the other member of staff involved?
WELLNESS RECOVERY ACTION PLANNING (WRAP)
WRAPis a ‘self – management’ tool used to help individuals take more control over their own wellbeing and recovery. It was initially developed in the US by Mary Ellen Copeland together with a group of people who had lived experience of mental health problems.
A WRAP is something we can refer to on a daily basis as a reminder, as a guide, and as a reference to turn to – especially in times of difficulty. It is a tool for learning more about ourselves and the things that help us to recover and stay well.
GUIDE TO DEVELOPING A WRAP
The following guidance will be helpful in developing a Wellness Recovery Action Plan. It can be used by people who are experiencing mental health problems to develop their own guide, or by health care professionals or others who are helping someone to develop a Wellness Recovery Action Plan.
WRAPs can be divided into six sections which might set out how the person’s health might change and what we or they can do to work towards recovery. The plan can be laid out in whatever form the individual feels comfortable with. The six sections are as follows:
Section 1Daily Maintenance plan
Section 2 Triggers
Section 3 Early Warning Signs
Section 4 When things Are Breaking Down or Getting Worse
Section 5 Crisis Planning
Section 6Towards recovery and return to wellness
Section 1Daily Maintenance Plan
In this section it is useful to start by describing how you are when you are feeling all right. This can include how you feel physically and emotionally. It can also include things you are able to do.
Next, make a list of things you need to do for yourself every day to keep yourself feeling all right. This can include basic things like eating properly and getting enough sleep. It can also include speaking to neighbours or friends, taking some exercise, dealing with your finances and, if necessary, taking medication.
Section 2 Triggers
This section is useful for identifying those things that, if they happen, might cause an increase in your symptoms. These could include pressure at work, arguing with a relative or receiving an unexpected bill. It would be ideal if we could avoid the things that make us feel worse but this isn’t always possible so we need to be more vigilant when these situations occur.
It is useful to have some tools and techniques that you can use to deal with these situations. These may be things you have used in the past or things that others have used to help them.