Process - Physician - Fraser Health Authority

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Task Two: ADVISE1. Provide meaning and supportExplain a Model of SuicideProvide a model to help the patient understand theirsuicidality, and to normalize their feelings. People thinkseriously about suicide when they experience the 3 I’s intheir life situation: Intolerable (meaning their life situationis so painful that it seems unbearable), Interminable (itseems like it’s going to go on like this forever), andInescapable (it seems like nothing they’ve tried haschanged or will change their experience).Provide Coping StrategiesProvide strategies for coping that target the 3 I’s: Intolerable(distress reduction/tolerance strategies); Interminable(cognitive challenging techniques); and Inescapable(effective problem-solving). Provide Coping with SuicidalThoughts, a document to help individuals decreasethoughts of suicide, develop a safety plan and connect withhelpful resources.Reinforce the Value of TreatmentTreatment (both therapy and medication) can help to reduceyour suffering. Therapy can help you to identify and addressunderlying issues that are contributing to you feeling thisway, and provide you new ways of dealing with your lifeproblems. Medication can help you with difficulties you arehaving with [depressed mood, anxiety, sleep, appetite].Address Ambivalence in Order to Instill HopeMany people have mixed feelings about suicide, and are justlooking for some way to get out of the pain they are feeling.There are ways you can find support to help with that painthat don’t include ending your life.Reinforce Positive Coping Used in the PastWhat has helped in the past when you’ve had these thoughts?2. Develop a safety planDevelop an interim, written safety plan with the patient tohelp them stay safe until they secure longer-termprofessional supports. Provide written safety plan to patient,primary care provider and family/significant other(s).Discuss with the patient how to make their environmentsafe (remove risky means of self-harm; have friend or familyon-site for the short-term).Generate with the patient adaptive means of self-soothingand coping with distress (calling a friend, going for a walk).Generate with the patient reasons they have for living, andmethods they have used to cope in the past. Work withthe patient on completing the Safety Plan provided in thepatient handout, Coping with Suicidal Thoughts.Indicate to patient that if they try these steps and still do notfeel safe, they should go to a hospital emergency room orcall 911.3. Provide informationProvide a written copy of a treatment plan, including detailsof medications (if applicable) and dates of follow-upappointments to patient, primary care provider and family/significant other(s).If the patient is prescribed antidepressants, explain thatthere may be temporary increased risk as symptoms ofdepression resolve at different rates, and improvement ofmood may be delayed in comparison to improvement inphysical symptoms such as energy or sleep.Provide contact numbers of primary care providers (familyphysician, psychiatrist, psychologist), local crisis lines(1-800-SUICIDE) and mental health centres.Instill hope. Most importantly, let the patient and theirfamily/friends know that there is help available. Indicate thatalthough you cannot guarantee that there will be no furtherattempts or difficult feelings, prognosis will be much betterif the patient adheres to the treatment plan. Indicate that itmay take time to find the right diagnosis and treatment, andtime for patient to make accompanying changes.4. Follow-upFollow-up with the patient and/or family or significantother(s) within 48 hours to answer any questions they have,and to offer further information, including providingreferrals.Copies of this document, as well as the document Coping with Suicidal Thoughts, can be downloaded at no cost from the B.C. Ministryof <strong>Health</strong> (www.health.gov.bc.ca/mhd) or from the Centre for Applied Research in Mental <strong>Health</strong> and Addiction (www.carmha.ca).152
SUPPORTED SELF‐MANAGEMENT FOR DEPRESSIONSTEP ONE: PRESCRIBE THE ANTIDEPRESSANT SKILLS WORKBOOKProblem SolvingBehavioural ActivationActions• Withdrawal• Reducedactivity• Poor self-careSituations• Loss• Conflict• IsolationRealistic ThinkingThoughts• Harsh self-criticism• Over-pessimistic aboutcurrent situation• Catastrophic about futurePhysiology• Altered sleep• Low energy• Changes in brainchemistryEmotions• Sadness• Despair• NumbnessSEE PAGE 6 Antidepressant Skills WorkbookKey messages:• We can work together to change how you feel• Others have found these ideas very helpful• You’ll need to do some reading and practice• I’m happy to work with you on this ‐‐ we’ll set some regular visits to checkhow you’re doing and work out problemsDoes this seem like something you’d like to try?153
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SteppedCareLevel 1PSP Mental Health
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Fold back this page before administ
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CBISCOGNITIVE BEHAVIOURAL INTERPERS
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Table of ContentsINTRODUCTION. . .
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IntroductionThe following modules h
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TipsTeachingSelling Strategies• E
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Flow ChartsThis module contains flo
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Patient NeedsTryThe Circle of Depre
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AnxiousSymptomsTryOverwhelmedChaoti
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Assessment ModuleThe Assessment Mod
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5 Energy levela. How would you rate
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15 Phobiasa. Any unrealistic or exc
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21 CAGEHow many drinks might you ha
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DIAGNOSTIC SCREENING WORKSHEET (CON
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Problem List Action PlanACTIVATIONR
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Self-Assessment QuestionnaireName:
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Self-Assessment ProfilePleaser: Hig
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Self-Assessment ProfileOver-Thinker
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Understanding Depression- Frequentl
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Depression: System-Wide CrashDepres
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Activation ModuleThe Activation Mod
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Depression’s Energy BudgetEvery d
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Small GoalsThe concentration, fatig
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Problem SolvingDepression can make
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Chunk the DayStrategies that give p
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Appreciation Exercise“Good for Me
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The Circle of DepressionCognitive-b
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Common Thinking ErrorsThe situation
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THOUGHT CHANGE PROCESS (CONTINUED)T
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Thought StoppingDepression often ma
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Good Guilt / Bad GuiltA world witho
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Setting LimitsMost of us like to be
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Is Anger a Problem for You?Tom arri
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Stress ResponseIntroduction to Rela
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Variation - Box BreathingABDOMINAL
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Body ScanPurpose• Body scan is a
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Stress BustersPurpose• Shorter te
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MindfulnessPurpose• Mindfulness i
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BreathMINDFULNESS MEDITATION (CONTI
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Healthy Habits for SleepingDepressi
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IT’S TRUE: YOU ARE WHAT YOU EAT!
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The Wellness WheelPHYSICALGROWTHSEL
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CBISCognitive Behavioural Interpers
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FLOW CHARTS……………………
Page 89 and 90: PANIC DISORDER• Anxiety “System
Page 91 and 92: The Many Faces of AnxietyPanic Diso
Page 93 and 94: Medical ConsiderationsMost Common M
Page 95 and 96: Anxiety“System-Wide Explosion”A
Page 97 and 98: Resources for Self-HelpOnline Resou
Page 99 and 100: GAD: Self-Assessment QuestionnaireN
Page 101 and 102: GAD: Self-Assessment ProfileHard Dr
Page 103 and 104: How Anxiety WorksTHOUGHTSBODYFEELIN
Page 105 and 106: Panic CircleEvent (public speaking)
Page 107 and 108: Your Emotional Thermometer• Imagi
Page 109 and 110: Anxiety EquationAnxiety arises out
Page 111 and 112: 2. When something bad happens, I wo
Page 113 and 114: Coping CardsAnxious people often ma
Page 115 and 116: Problem SolvingAnxiety is strengthe
Page 117 and 118: Example: Kelly begins by making a l
Page 119 and 120: D.E.S.C. ScriptAssertiveness doesn
Page 121 and 122: Application forPsychiatric Medicati
Page 123 and 124: APPENDIX 2: WOMEN’S MENTAL HEALTH
Page 125 and 126: Pharmacotherapy in the Perinatal Pe
Page 131: FAMILY PHYSICIAN GUIDE | ADDRESSING
Page 134 and 135: Olanzapine (Zyprexa)Tablets, wafers
Page 136 and 137: Consortium forOrganizationalMentalH
Page 138 and 139: 3. Gather details on current andpre
Page 142 and 143: SUPPORTED SELF‐MANAGEMENT FOR DEP
Page 144 and 145: TABLE OF CONTENTSIntroduction 1What
Page 146 and 147: INTRODUCTIONTake a moment now to as
Page 148 and 149: WHAT IS DEPRESSION?The two most com
Page 150 and 151: WHAT CAUSES DEPRESSION?People becom
Page 152 and 153: WHAT CAUSES DEPRESSION?ThoughtsEach
Page 154 and 155: WHAT CAUSES DEPRESSION?EmotionDepre
Page 156 and 157: WHAT CAUSES DEPRESSION?ActionDepres
Page 158 and 159: WHAT CAN YOU DO ABOUT DEPRESSION?MI
Page 160 and 161: MORE ABOUT MEDICATIONMedication is
Page 162 and 163: ANTIDEPRESSANT SKILLSIn this sectio
Page 164 and 165: REACTIVATING YOUR LIFEStep 1: Ident
Page 166 and 167: REACTIVATING YOUR LIFESmall DutiesE
Page 168 and 169: REACTIVATING YOUR LIFEStep 2: Choos
Page 170 and 171: REACTIVATING YOUR LIFEStep 3: Set r
Page 172 and 173: REACTIVATING YOUR LIFEStep 4: Carry
Page 174 and 175: THINKING REALISTICALLYNegatively di
Page 176 and 177: THINKING REALISTICALLYStep 1: Learn
Page 182 and 183: THINKING REALISTICALLYStep 4: Pract
Page 184 and 185: SOLVING PROBLEMS EFFECTIVELYStep 1:
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SOLVING PROBLEMS EFFECTIVELYStep 5:
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SOLVING PROBLEMS EFFECTIVELYStep 7:
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REDUCING THE RISK OF RELAPSEPlan ah
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Congratulations! You have now made
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SUGGESTED READINGON DEPRESSION AND
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DIETThe Canada Food GuideGuidelines
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SLEEPStress, anxiety, and depressio
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CAFFEINECaffeine stimulates the sym
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CHALLENGING DEPRESSIVE THOUGHTSSitu
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PROBLEM SOLVINGACTION ADVANTAGES DI
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AnxietyDementiaDementiaBipolar155
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Practice Support ProgramGeneralized
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Montreal Cognitive Assessment(MoCA)
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Serial 7s: Administration: The exam
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Appendix CNAME OF PATIENTStandardiz
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Item 11Scoring WORLD backwards (ins
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Appendix CStandardized Mini Mental
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SCORING THE MOOD DISORDERQUESTIONNA
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FORM 4MENTAL HEALTH ACT[ Sections 2
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CommunityMHSU ReferralFormBounceBac
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REFERRAL FORMMental Health and Subs
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MENTAL HEALTH AFTER HOURSPLEASE LEA
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DOCUMENTATION REQUIRED UPON REFERRA
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Adult Eating Disorders ProgramRefer
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Medical History:Medical causes of l
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Who Are We?This is a specialized pr
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Fraser South Eating Disorders Progr
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Fraser South Eating Disorders Progr
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Fraser East:This program is part of
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Fact SheetPanic Disorder GroupDoes
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Fact SheetGeneralized Anxiety Group
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4 th Floor Sherbrooke Centre Tel (6
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Early Psychosis Intervention Progra
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*Additional Resources*For Informati
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Mental Healthand Addiction… suppo
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Fraser Health Mental Healthand Addi
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ADDICTION SERVICESAddiction Service
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ADDICTION SERVICESYouth Addictions
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ADDICTION SERVICES6. Long-term Resi
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MENTAL HEALTH SERVICESMental Health
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MENTAL HEALTH SERVICESDelta Mental
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MENTAL HEALTH SERVICES4. Community
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MENTAL HEALTH SERVICESMinistry of E
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MENTAL HEALTH SERVICES7. Residentia
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Mental Health & AddictionsHEALTHY L
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Client name: ______________________
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Client name: ______________________
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Taking Wellness to Heart! Metabolic
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Mental Health and Substance Use Rev
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Collaborative Care Process Map-Epis
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Fax the Special Authority Request t
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o o o o o o o • • • o o o o o
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Process - Physician - Fraser Health Authority

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