1. Presentation at Missions Interlink ConNEXTions 2013 by: Dr Katherine Thompson Mental Health Social Worker BA, BAppSci(Hons), PhD(PsychMed), BTheol, BSW 164a Warrandyte Rd North Ringwood Vic 3134 0402 343 029 katherinethompson@guitech.com.au katherinethompson@guitech.com.au

2. Mental Health First Aid for Missionaries and the Need to Focus on Prevention Dr Katherine Thompson

3. That was then and this is now… Globalisation Internet, email, mobile phones, etc. Transport changes Normalisation of cross cultural work Health focus on prevention and intervention

4. Social Readjustment Rating Scale The Stress Scale – a scientific scale used to assess the stress load we carry over the past 12-month period » "The Social Readjustment Rating Scale", Thomas H. Holmes and Richard H. Rahe, Journal of Psychosomatic Research, Volume 11, Issue 2, August 1967, Pages 213- 218.Journal of Psychosomatic Research

5. Life Event Value Check if this applies 1Death of spouse100 2Divorce73 3Marital separation65 4Jail term63 5Death of close family member63 6Personal injury or illness53 7Marriage50 8Fired at work47 9Marital reconciliation45 10Retirement45 11Change in health of family member44 12Pregnancy40 13Sex difficulties39 14Gain of new family member39 15Business readjustment39 16Change in financial state38 17Death of close friend37 18Change to a different line of work36 19Change in number of arguments with spouse35 20A large mortgage or loan31 Life Event Value Check if this applies 1Death of spouse100 2Divorce73 3Marital separation65 4Jail term63 5Death of close family member63 6Personal injury or illness53 7Marriage50 8Fired at work47 9Marital reconciliation45 10Retirement45 11Change in health of family member44 12Pregnancy40 13Sex difficulties39 14Gain of new family member39 15Business readjustment39 16Change in financial state38 17Death of close friend37 18Change to a different line of work36 19Change in number of arguments with spouse35 20A large mortgage or loan31

6. 21Foreclosure of mortgage or loan30 22Change in responsibilities at work29 23Son or daughter leaving home29 24Trouble with in-laws29 25Outstanding personal achievement28 26Spouse begins or stops work26 27Begin or end school/college26 28Change in living conditions25 29Revision of personal habits24 30Trouble with boss23 31Change in work hours or conditions20 32Change in residence20 33Change in school/college20 34Change in recreation19 35Change in church activities19 36Change in social activities18 37A moderate loan or mortgage17 38Change in sleeping habits16 39Change in number of family get-togethers15 40Change in eating habits15 41Vacation13 42Christmas12 43Minor violations of the law11 Your Total 21Foreclosure of mortgage or loan30 22Change in responsibilities at work29 23Son or daughter leaving home29 24Trouble with in-laws29 25Outstanding personal achievement28 26Spouse begins or stops work26 27Begin or end school/college26 28Change in living conditions25 29Revision of personal habits24 30Trouble with boss23 31Change in work hours or conditions20 32Change in residence20 33Change in school/college20 34Change in recreation19 35Change in church activities19 36Change in social activities18 37A moderate loan or mortgage17 38Change in sleeping habits16 39Change in number of family get-togethers15 40Change in eating habits15 41Vacation13 42Christmas12 43Minor violations of the law11 Your Total 394

7. If you fill out the Stress Scale according to common experiences faced by people going to work cross-culturally it generally adds to + 300 score This indicates the person has a high or very high risk of becoming ill in the near future.

8. What happens when we change cultures? Eco-maps are a method of plotting how well someone is functioning socially, how much support they have, and how many resources they have. A healthy life that supports good mental health will have a broad range of activities and people within this map.

9. Eco-map Katherine Close Friends Church Pets Mentors Other Family Jack Ian Mother Neigh- bours People in my neighbour- hood Jack’s School Other Friends Ian’s work Work 2 Work 1 Pilates Draw -ing Other Hobbies Garden- ing

10. Cross-cultural Work Exposes Staff to a higher risk of mental illness because it takes away their normal protective factors, and exposes them to high stress.

11. Total People aged 16-85 years 16 015 300 100% Any lifetime mental disorder 7 286 600 45% Any 12-month mental disorder 3 197 800 20% No 12-month mental disorder 4 088 800 25% No lifetime mental disorder 8 728 700 55% Mental Illness in Australia http://www.abs.gov.au/ausstats/abs@.n sf/Latestproducts/4326.0Main%20Featur es32007?opendocument&tabname=Sum mary&prodno=4326.0&issue=2007&nu m=&view= National Survey of Mental Health and Wellbeing 2007

12. Any 12-month mental disorder 20% Anxiety disorders 14.4% Affective disorders 6.2% Substance Use disorders 5.1%

13. High Prevalence Disorders 1.Anxiety Disorders 2.Affective Disorders 3.Substance Use Disorders

14. K10 For all questions, please fill in the appropriate response. In the past 4 weeks:None of the time A little of the time Some of the time Most of the time All of the time 1About how often did you feel tired out for no good reason? 2About how often did you feel nervous? 3About how often did you feel so nervous that nothing could calm you down? 4About how often did you feel hopeless? 5About how often did you feel restless or fidgety? 6About how often did you feel so restless you could not sit still? 7About how often did you feel depressed? 8About how often did you feel that everything was an effort? 9About how often did you feel so sad that nothing could cheer you up? 10About how often did you feel worthless?

15. K10 Scores: score under 20 are likely to be well score 20-24 are likely to have a mild mental disorder score 25-29 are likely to have moderate mental disorder score 30 and over are likely to have a severe mental disorder 13% of the adult population will score 20 and over » For further information on the K10 please refer to www.crufad.org or www.crufad.org » Andrews, G Slade, T. Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health: 2001; 25:6: 494-497.

16. Anxiety Disorders Types: – Panic disorder – Agoraphobia – Social phobia – Generalised anxiety disorder – Obsessive compulsive disorder – Post-traumatic stress disorder

18. Anxiety is based on the body’s normal stress response When we are under threat we either “fight” or “flight” Anxiety is a problem when it causes us to avoid things and starts to impact how we live our life

20. Affective Disorders Types: – Major Depression – Dysthymia – Bipolar Affective Disorder

21. Symptoms of Depression (+ 2 weeks duration): – Unusually sad mood – Loss of enjoyment – Lack of energy – Feeling worthless and guilty – Thinking about death – Difficulty making decisions – Moving slowly or becoming agitated – Sleep difficulties – Loss appetite or eating too much

22. Depression Compression Healthy Relationships Spiritual Satisfaction

24. What happens when people have existing mental illness? Insight/Acceptance of illness Medication History of the illness and personal management

25. Prevention is better than cure

26. Self-Care Sleep: – Routine – Constant amount – Constant time – No naps – Strategies for dealing with insomnia

27. Exercise: – Burns off stress – Improves mood – Assists with sleep

28. Foster Creativity: – Reading – Craft – Gardening – Cooking

29. Social connection: – Thoughts and feelings – Hospitality – Connectedness – Meaning – Belonging

30. Relaxation: – Prayer – Meditation – Silence – Stretching – Relaxation exercises

31. Luke 4.42 – At daybreak he departed and went into a deserted place. And the crowds were looking for him… Luke 5.15-16 – But now more than ever the word about Jesus spread abroad; many crowds would gather to hear him and to be cured of their diseases. But he would withdraw to deserted places and pray.

32. Are there any people who should not be allowed to work cross culturally? Families with children who have: – Autism Spectrum Disorders or other disabilities? Families with adolescents who have: – Eating disorders, anxiety, depression, self-harm? Adults with Personality Disorders: – Borderline Personality Disorder – Dependent Personality