A drama about young people and mental health produced for
4Learning by Resource Base with support from the Wellcome Trust
Medicine in Society Programme.
This section has been specially designed to offer support for
teachers in schools and colleges. However, it contains information
that will be of interest for anyone wanting to find out more about
mental health issues.
England.
Losing It is designed to be used in PSHE at Key Stage 4. In
broad terms, the drama and these notes can support work on the
following guidelines:
In science at Key Stage 4, there are elements in the drama and in this section of the website that touch on:
Wales.
There are elements in the drama and in this section of the website
that support work in the following areas of PSHE, designed to help
students to:
As a drama, Losing It can also offer a specific emotional journey through some of the issues that feature in a number of post-16 syllabuses in biology, chemistry and psychology.
Scotland.
Losing It is designed to support guidance teachers and
others who are involved in the delivery of personal and social
education (PSE) lessons, especially where there is an emphasis on
health and healthy living issues. It is relevant for the delivery
of Higher Still courses in PSE - in particular, the personal
awareness and development units - and may also be of interest to
those delivering Higher Still psychology courses.
The programmes support:
Losing It is a drama developed from the raw material of
personal experience. It was created over a six-month period of
practical research with young people in and out of schools. Some of
these young people had first-hand experience of mental health
problems and the mental health services. Others had not but could
relate a range of experiences that had caused emotional pressure
for themselves and their friends.
After talking to teachers, youth workers, counsellors,
psychotherapists and other professionals in the mental health
field, three characters and a storyline were gradually developed,
which hopefully will have resonance for a range of young people in
different circumstances.
The first aims of a drama are clearly to engage, involve and move the audience. We hope this drama fulfils these primary aims and goes further. We would like Losing It to help young people and those who live and work with them to:
Cracked is a Theatre-in-Education show about teenage depression produced by the Y Touring Company. It has toured successfully for several years and is accompanied by a comprehensive mental-health education resource for secondary schools, available from Y Touring.
Cracked is going on tour again in spring 2001. For information about the production, venues and dates, go to the Y Touring website: www.ytouring.org.uk/cracked.html.
Mental health problems are not unusual. Just like physical
health, mental health is variable, often depending on what is
happening in our lives and on how we respond or react to this.
Depression, for example, is very common. Over a lifetime, there is
a 60-70% chance that a person will suffer some kind of depression
or worry bad enough to affect his or her daily life.
Episodes of mental illness or disorder can come and go throughout
our lives. Some people experience a mental disorder only once and
fully recover, while for others, it recurs or is something they
have to learn to live with. However, unlike physical illness, there
is still a stigma attached to the term 'mental illness'.
From a problem to an illness.
When does a mental health problem - for instance, stress from
examinations or distress following the break up of a relationship -
become a mental disorder or illness?
The DSM-IV - the Diagnostic and Statistical Manual produced by the
American Psychiatric Association, the standard reference book used
to diagnose psychiatric disorders - makes clear that the boundary
between normality and mental disorder is not clear cut. The DSM-IV
emphasises that a mental disorder is 'a condition which causes
someone clinically significant impairment or distress', but it
admits that 'clinical significance' is likely to vary according to
cultures and the availability and interests of psychiatrists and
other health professionals.
The causes of mental disorder.
Although many mental disorders are linked to chemical changes in
the brain, what exactly triggers these changes is unknown. However,
various factors can increase the risk of having a mental disorder.
These fall into three main categories:
Psychotic and non-psychotic disorders.
Mental disorders can be separated into two main categories:
Psychotic disorders. These include schizophrenia and bipolar
affective disorder (frequently called manic depression). A
psychosis is a major mental disorder in which the personality is
very seriously disorganised and the person's sense of reality is
usually altered. Brain function is affected, causing changes in
thinking, emotion, behaviour and perception.
During the acute phase of a psychotic disorder, a person may become
very frightened, developing delusions (fixed false beliefs - for
example, that they are being persecuted, or are very special in
some way or worthless and deserve to die) or experiencing
hallucinations (false perceptions, where they see, hear, smell,
taste or physically feel things that are not there). They may also
be depressed or elated in a completely irrational way.
Non-psychotic disorders. These include anxiety and related
conditions (such as panic attacks, phobias and obsessive-compulsive
disorders), depression (unipolar affective disorder - that is,
depression without mania), eating disorders and physical symptoms
involving tiredness or pain.
Treatment of mental illness.
It is rarely possible for someone to 'just snap out of it', and
suggesting this is not helpful. However, most mental disorders can
be effectively treated with a combination of medication and
'talking treatments'.
The first line of action is usually to see the family doctor (GP).
The GP may offer some form of drug treatment, such as
antidepressants to decrease anxiety in the short term. They may
suggest seeing someone to talk to, such as a counsellor,
psychotherapist or clinical psychologist, or may refer the patient
to a psychiatrist for more specialist help and treatment. The
doctor may also put the person in touch with the local community
mental-health team or social services or an appropriate voluntary
agency.
Helplines can sometimes be a way to get further support. The
Samaritans are perhaps the best known of these (see Find out more). Self-help
organisations can also provide a great deal of support, as well as
advice on appropriate treatments.
There is an increasing use of alternative and complementary
therapies - such as meditation, massage, aromatherapy, homoeopathy,
art therapy and creative therapy - sometimes in addition to more
orthodox treatments.
People with a mental illness are often rejected and discriminated
against, although they need the same understanding and support as
if they were suffering from a physical illness.
Depression.
Clinical depression is not the same as the temporary unhappiness or
sadness that all of us feel at some time in our lives, which we
often describe by saying, 'I'm depressed.'
The common symptoms of clinical depression include:
People who are clinically depressed may seem simply lazy or
difficult to others, when, in fact, they may need professional help
and treatment in order to recover. Some, especially men, also find
it hard to admit to feeling emotionally bad, especially when they
are not sure of the reasons for it. Instead, they may go to the
doctor complaining of physical problems, commonly headaches,
stomach problems or general pain.
Bipolar affective disorder is a particularly severe and frequently
recurrent type of depression that may be associated with extreme
swings in mood. It is also known as manic depression because of the
extreme highs (mania) and lows (depression) in mood that a person
with the illness can experience.
Common symptoms of mania include:
The times of depression can bring despair and thoughts of
suicide. The person may lose interest in things that were once
enjoyable, may become withdrawn and may sometimes find it
impossible to get out of bed.
What causes depression?
It is still not known for certain why some people lack the
resilience to cope with stressful events and get depressed, or why
depression sometimes seems to happen for no apparent reason. There
are often many interrelated factors:
Heredity. The tendency to develop depression runs in families.
This may not necessarily be genetically based but could be the
result of early life experience.
Biochemical imbalance. Depressive episodes are thought to be
partly due to an imbalance of chemical transmitter substances in
the brain, especially the 'amines', which include serotonin.
Outside life events .Depression may be brought on by a
bereavement or by problems with money, work, housing or
relationships. Ongoing problems may make recovery harder.
Physical illness. This may trigger or maintain depression.
It is likely to result from direct effects on brain chemistry and
indirect effects of the illness on physical and social functioning.
Some prescribed drugs such as steroids (and illegal drugs such as
ketamines) may also cause depression.
There are two other specific relationships between physical causes
and depression:
Treatment of depression.
Clinical depression is a serious condition and requires
professional help. A combination of drug treatments and talking
treatments is often the best way forward. The first step is to
visit a family doctor (GP) who may offer treatment or refer the
patient to a psychiatrist.
Anti-depressant drugs aim to increase levels of certain
neurotransmitters - the natural chemicals by which brain cells
communicate. There are three types of anti-depressants currently in
use:
Bipolar affective disorder is most commonly controlled by the
drug lithium carbonate, which stabilises mood.
'Talking treatments' give people a chance to express their
feelings, to take greater control of their lives and to be treated
as a whole person rather than as a group of symptoms. There are
specific kinds of talking treatments or psychotherapies used in the
treatment of depression. These are generally short term (about 16
weeks) and structured and focus on current problems. One is
cognitive behavioural therapy (which aims to change self-defeating
thought patterns and overcome a lack of energy and motivation), and
another is an interpersonal approach (focusing on problematic
relationships and life difficulties). Counselling can also be
helpful.
Family therapy is often appropriate where a young person is
concerned. This gives an opportunity to explore the dynamics and
social interactions of the family rather than assuming that it is
just the young person who has a problem.
For their own safety, people with particularly severe depression
may need to spend some time in hospital. Most are admitted
informally and are free to leave when they wish. If they are so ill
that they have to be admitted for their own safety without their
consent, there are legal safeguards under the 1983 Mental Health
Act (and the 1984 Mental Health [Scotland] Act) to ensure that
nobody is kept in hospital indefinitely against their wishes if
they are no longer a danger to themselves or others.
A different form of treatment for people who are severely depressed
and may be actively suicidal is electro-convulsive therapy (ECT),
usually as two treatments per week for three to six weeks.
What schools can do.
Schools have an important role to play in raising issues about
mental health and in reducing the stigma attached to mental health
problems. In addition, a school, like any organisation, can promote
the mental health of those working there (both students and staff)
or it can add to their distress. It can also help to prevent mental
health problems and support those who are already experiencing
problems.
To promote mental health effectively, there needs to be a wide
range of interventions, from those involving the whole school
community to those involving a minority of students who need
clinical treatment. Everyone in a school benefits from a healthy
environment, one that promotes psycho-social skills and well-being.
Education about mental and emotional health is an important part of
the general curriculum. Young people can be helped to be more
emotionally literate.
However, 20-30% of adolescents are likely to need additional help
with specific problems - for example, bullying, bereavement or
problems at home. And a small minority of students may have severe
emotional and psychological problems - such as eating disorders or
panic attacks - requiring treatment by professionals working
outside the school.
1 Working in single sex groups, brainstorm all the ways
in which young people of your gender deal with stress. Write down
as many as possible without worrying whether they are 'good' ways
of coping or not. Compare the lists compiled by the different sexes
- are they similar or do they differ? Which are the most common
ways of coping? Could any of the strategies lead to more problems?
Which ways do you think are most effective for you?
2 Fill in Worksheet 1 and then compare your answers with those
given. Is there anything that surprises you or that you would like
to know more about?
3 Having seen Losing It, think about the three main
characters involved: Jude, Tom and Muna. Work in small groups, with
each group considering a different person. Talk about:
Feed your answers back to the other groups. Alternatively, one
person from each group could be asked to take on the role of a
character and to answer questions about him or her.
4 Having seen Losing It and read Worksheet 2, discuss the
following questions in small groups and record your answers.
Share your answers with other groups. Was it easy to answer the
questions? Did you need more information and if so, about what? Did
some questions lead to differences of opinion?
5 Research and present one of the mental illnesses on
Worksheet 3. You can
get more information by clicking here.
6 Look at the four postcards (below) produced by MIND to
raise awareness and change people's perceptions of mental health
and mental illness. How effective do you think they are in reaching
their audience? If you were setting up a mental health awareness
campaign for a specific target audience, which medium would you
regard as most important? Television, radio, print or a mixture of
all three? What key messages would you want to put across to
increase understanding of mental health issues and reduce stigma
and prejudice?
Click on the thumbnails above to see larger versions.
7 Design a poster, leaflet or web page - which you think will appeal to young people - showing various helplines and where individuals can go for support if they have a mental health problem.
Close window to return to graphical version.
