Unit Learning Support Material for

National 4 and 5

Coping Strategies and Resilience

The activities in this pack could be used to build up a portfolio of evidence, which
could be used to meet the outcomes and assessment standards for this unit.
Please read this additional support pack in conjunction with the Understanding
Mental Health Unit Specification.

© Scottish Qualifications Authority 2019

Contents
Unit Learning Support Material for National 4 and National 5 1
Outcome 1: Helpful and unhelpful coping strategies 2
Types of coping strategies 15
Emotionally Based School Refusal (EBSR) 21
Limit setting 23
What is resilience? 26
Cultural norms 28
Outcome 2: Promoting good mental health and wellbeing 30
Self-care 36
Sleep facts 36
Positive language promoting mental health and wellbeing 43
Growth mindset 48
Outcome 3: Different types of support available and ways to address barriers to
support 52
Accessing support 52
Informal and formal support 57
Glossary 59
Resources 62
Copyright acknowledgements 64
Unit Learning Support Material for National 4
and National 5
The following learning materials are optional teaching tools to support facilitation
of Unit 3 of the Mental Health and Wellbeing course. These materials should be
used based on the needs and abilities of the learners and their progression. The
learner’s readiness for assessment should be determined through the
professional judgement of the facilitator.

The material has been designed to provide a broad range of tools and knowledge
that support understanding National 4 and 5. However, the examples and
narrative provided is not exhaustive and, where possible, learning and teaching
should be personalised to the group of participants.

The pack is intended to support the facilitator of the course, much of the narrative
will require adaptation to accommodate the learner’s needs. It has not been
possible to cover every relevant area for discussion. It provides a small sample of
background information and guidance. Essentially, facilitators must have a good
understanding of the needs of their group of learners and the subject matter.

Please read this additional support pack in conjunction with the Coping
Strategies and Resilience Unit specification.

1
Outcome 1: Helpful and unhelpful coping
strategies
Definition of ‘coping strategy’

The most widely cited definition of coping is: ‘constantly changing cognitive and
behavioural efforts to manage specific external and/or internal demands that are
appraised as taxing or exceeding the resources of the person’ (Lazarus &
Folkman, 1984). In other words actions we take to deal with extreme emotional
responses which we struggle to process or contain in any other way. Coping
strategies are activities or behaviours that everyone has and participates in to
alleviate stress in our everyday lives. The previous units will have helped you to
explore the types of stressors that can affect us in our daily lives. As we grow and
develop, we learn to understand who we are as individuals and how to regulate
our emotions. The most important thing to remember is that we all cope in
different ways. This is, in part, because we all have different backgrounds,
beliefs, values, life experiences and personalities.

Coping strategies are developed through a process of learning what helps us to

feel better when we are stressed and angry. Sometimes we do this consciously
and other times it is unconscious. We adopt certain behaviours which help when
we are under stress. Sometimes we don’t recognise when our coping strategies
are potentially causing us and our relationships more harm than good. By
developing emotional literacy and self-awareness — recognising emotion,
understanding the context of our feelings and how this affects how we behave —
then we can feel more in control and have greater confidence in our thoughts,
feelings and responses. We can begin to make more informed choices about
learning to cope in ways that are of greater benefit to our wellbeing.

Every human emotion is normal, but it is what we do with these emotions that
can at times cause problems. Have you ever felt so sad or fearful that you have
not wanted to leave the house? Maybe you have felt so angry that you have
wanted to smash up a room. It is important to understand that everybody has felt
like this at some point in their life — emotion is part of the human condition.
Coping strategies are behaviours that help us to regulate how we feel, as
smashing up a room every week is generally not an option. Firstly, we would
quickly run out of stuff to smash, and it is likely to alienate us from others as they
may not want to be around someone who reacts violently every time they
become angry. This, however, does not mean that we don’t regularly get angry
about things that happen in our lives.

2
Group activity

Think about today, then list the range of emotions you have felt since you got
out of bed this morning.

Examples:

 Perhaps you are looking forward to a night out this evening with a friend.
 Maybe you forgot to pack something important this morning.
 Perhaps you were running late and could not find your mobile phone.

List:

Example: exhausted, refreshed, hungry, stressed, relaxed, focused, happy,

etc

Pick out an emotion you may have felt and describe how you behaved in
response to this feeling.

Example: Stressed — I moaned to my friend about how stressed I was and

what I was stressed about.

3
We often react to our circumstances unconsciously. In Unit 2, you will have
learned about the brain and how various interactions with people and stimulus
within our environment can affect us. Part of understanding how we cope and
regulate our emotions is to become consciously aware of them.

Often, our emotional responses to a situation are caused by a ripple effect. Have
you ever thrown a tiny pebble into a pond and watched the circles grow bigger
and bigger around it? Often, our emotional responses begin as a result of a small
thing, and it creates a chain of events. Much of this is determined by our
emotional responses and the choices we make.

4
Activity

Have you ever had a day where everything goes wrong? If you were to walk
back through the concentric circles and think about the core reason for those
emotions, can you see why that one incident caused a series of events? How
did this affect your relationships and your overall day?

Map the events that took you to the core reason for causing the ripple pool
effect.

Do the same activity for a good day.

Discuss

What did you discover?

5
Coping is how we manage our day-to-day lives and respond to stressful
situations. We all have good and bad days and we cope with the daily stresses of
life in different ways. Each person has their own repertoire, and how we each
deal with stress is often unconscious. In other words, we often don’t think about
the habits and the behaviour responses that we have developed. Our repertoire
is influenced by our environment, relationships, and life experience over a period
of time, so it can be often difficult to recognise when we are reacting to a stressful
situation.

6
 Group activity

Jake is 13 years old and doesn’t want to go to school. His mum asks him why
he doesn’t want to go, and he responds by saying that he doesn’t feel well and
that he has a sore stomach and a headache. This is the fourth time in the last
month that Jake has asked to take time off school. His mum has also received
texts from his teacher to let her know that Jake’s homework hasn’t been
submitted, and she has noticed that he doesn’t want to spend any time with his
family, even when he is at home, Jake prefers to stay in his room by himself.
Jake’s mum bumps into another mother at a social event, and she asks if Jake
is okay. When Jake’s mum enquires further, she discovers that Jake is being
bullied by a group of his peers on his way to and from school.

 Map Jake’s pattern of behaviour on the ‘ripple pool’ — place the initial
event at the centre.
 What is the effect on other aspects of Jake’s life?
 What coping behaviour is Jake displaying?
 Is there anything Jake could do differently to cope? What difference would
it make?

What we do on a day-to-day basis formulates how we manage our daily lives.

The routines we may have, the friends we call upon or fall out with, the family we
hug, the lists we make, the chocolate cake that we eat, all serve to meet a need
or a want. It is the balance between having our needs and, to an extent, our
wants met that often determine how well we manage our emotional wellbeing.

It can often be difficult to explain how we feel and what causes us to feel and
behave in a particular way. Sometimes behaviour can also be misinterpreted,
e.g. fear and anger can be felt and present in the same way. Have you ever
laughed uncontrollably, not because you are happy, but because you are
nervous?

Learning to understand our feelings, how to express how we feel and how to
manage our feelings is called emotional literacy.

7
Group activity

As a group, list as many emotions that you can think of.

Ideas:

Now list the emotions under the following headings:

 Positive
 Negative

Now order them in relation to their intensity.

Group them under types — Happy/Sad/Frightened/Frustrated

Describe where in the body you might physically experience these emotions

Create posters which express a range of emotions. These can be done with
paints, collage material, and/or images.

8
Learning how to cope is learning how to be emotionally literate. Coping and the
development of coping strategies is a constant navigation of our environment and
our relationships. How we respond is often based on instinct and reaction and
this can then become habit-forming as we start to see the benefit of certain
activities in helping to manage how we feel. It is a constant balancing act. Coping
strategies are also ‘culturally-defined’. This means that, in our society, there are
certain expectations which are accepted in relation to how we should behave in
certain social situations. One of the most obvious culturally defined norms is
rooted in gender differences.

In 2018, the World Health Organization reported that during adolescence

statistically, girls have a much more likely to experience depression, eating
disorders and engage more in suicidal ideation and suicide attempts than boys.
Boys experience more problems with anger, engage in high-risk behaviours
(such as criminal behaviour or drugs and alcohol) and commit suicide more
frequently than girls. In general, adolescent girls are more prone to symptoms
that are directed inwardly, while adolescent boys are more prone to act out. The
differences in gender are related to biology, environmental and social influences
and how they interact. The roles, responsibilities, status and expectations of boys
and girls, men and women are very different. This affects how we cope
personally with daily life. In Unit 1, you will have explored a range of social
factors which influence our mental health. Similarly, these factors which can
stigmatise, restrict, or limit an individual’s potential wellbeing will also influence
how they cope and an individual’s repertoire for coping.

(Adolescent mental health, WHO, published 18 September 2018)

https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

It is often trying to get the balance right in our life which is important.

9
Activity

Make a list of things that you do to help you feel better when you are unhappy
about something.

Types of coping strategies

Here are some types of coping strategies, many of which you probably do without
thinking, such as:

 Diversions — watching funny films on YouTube, having a bath, reading a

book, playing computer games, engaging in social media, listening to music,
etc.
 Social and interpersonal — talking to a friend, playing with a pet, helping a
friend in need, etc.
 Cognitive coping — making a pros and cons list, inspirational quotes,
brainstorming solutions, etc.
 Tension releasers — punching a punch bag, crying, humour, exercise, etc.
 Physical — healthy routines, healthy food, getting enough sleep, deep
breathing exercises etc.
 Spiritual — praying, meditating, getting involved in a worthy cause etc.
 Limit setting — prioritising important tasks, being assertive, building
confidence around responsibility, ‘me time’ etc.

The primary lesson to learn about coping and coping strategies is that we all
need them; we all need a range of them to maintain our mental health. Giving our
brain a detox and a workout is much the same as giving our bodies a detox and a
good workout. The difficulty is that we don’t necessarily prioritise our mental
health in the same way as we would prioritise our physical health. Much of this is
rooted in stigma and in not wishing to appear as ‘crazy’, ‘weird’ or ‘not quite with
it’.

10
Group activity

Think about your peer groups. Can you provide two examples of coping
behaviours that would not be culturally acceptable, and describe why?

1. __________________________________

2. __________________________________

Discuss

Can you think of reasons why culturally defined norms might be a problem?

List three reasons:

1.__________________________________

2.__________________________________

3.__________________________________

Discuss

11
Potential answers could include underage drinking, self-harming behaviour, boys
crying when upset etc.

Cultural defined norms can be problematic because:

 It can potentially affect a person willingness to share how they are really
feeling. They may feel guilty, ashamed or embarrassed.
 If a person does not feel as though they can express how they are feeling
then it may lead to bigger problems
 Other people may misunderstand what that person is expressing because
they only see a behaviour which makes them feel uncomfortable, or which is
perceived to be unusual, or not normal.

When we think about coping, it is important that we also consider age and stage
of development. Teenagers are more likely to engage in risk-taking behaviours.
Experimentation is part of developing identity and gaining a sense of autonomy
as teenager’s transition from childhood to adulthood. Some teenagers will be
more exposed to opportunity for greater risk-taking behaviours than others. This
is linked to:

 Social factors (such as peer group, environment and culture),

 Interpersonal relationships and personal factors (such as self-esteem
personality, resilience, emotional literacy and effective communication)
 Environmental factors (such as demographics and geographical location)
 Cultural factors (such as social norms, beliefs and values).

Other coping strategies include:

 illicit drug use

 excessive alcohol use
 self-harm, e.g. cutting, head-banging, hair-pulling and induced vomiting
 ignoring or bottling-up feeling
 bullying and violence towards others
 online bullying, trolling
 violence towards animals
 avoiding your problems, e.g. isolating yourself, not attending clubs and social
activities, non-attendance at school
 truanting from school
 spending excessive amounts of time using web-based media, e.g. obsessing
over other people’s social media profiles and posts, or gaming
 engaging in sexually promiscuous behaviours to gain favour from others
 denial, e.g. rejecting opportunities for support
 eating disorders, e.g. anorexia, bulimia, excessive or binge eating
 suicidal ideation, i.e. thinking about suicide, e.g. ‘Things would be better if I
wasn’t here’

12
It is important to have a range of coping strategies and also to maintain good
self-care. Sometimes extreme ways of coping can be harmful to us and others. If
we look after our wellbeing the less likely it is that we will engage in activities that
are likely to hinder or harm wellbeing in the long-term. It is can sometimes feel
like balancing a set of scales.

13
Group work

Use a set of balance scales, or create your own with string, a hanger and some
plastic cups. Use the scales with learners to visually look at how stress can be
balanced out by having a range of coping strategies.

Label coins (or create your own weights) with stresses and coping strategies.

Materials Needed

 A plastic hanger or a wooden hanger with notches. You'll want a hanger

that won't allow the strings holding the objects to be weighed to slide off.
 String
 A single-hole punch
 Two identical paper cups (Try to avoid wax bottom cups, as they add
uneven weight.)
 A pair of scissors
 Measuring tape
 Masking or packing tape

How to Make the Scale

1. Measure two pieces of string two feet long and cut.

2. Make holes to attach the string to the cups. Make a mark one inch below
the rim on the outside of each cup.
3. Use the single-hole punch to make holes in each cup. Punch a hole on
either side of the cup, along the 1-inch mark.
4. Attach the hanger to the wall, using a cup hook, doorknob or a level bar for
hanging clothes or towels.
5. Tie the string to each side of the cup and let it sit in the notch of the hanger.
The string should support the cup like the handle of a bucket.
6. Repeat this process with the second cup.
7. To steady the hanger to make sure the cups are hanging at the same level.
If they are not; adjust the string until they are even.
8. When they look even: use a piece of tape to secure the string in the
hanger’s notches.

https://www.thoughtco.com/kid-science-make-a-balance-scale-2086574

Learners may wish to discuss the variables that might tip the balance, for
example individual resilience, numbers of worries, effectiveness of coping
strategies, and types of coping strategies, i.e. some coping strategies might
create more stress.

14
Types of coping strategies
Self-harm

What is self-harm?

Self-harm is when someone intentionally inflicts pain or physical harm on

themselves. It is an expression of overwhelming psychological pain whereby the
person is unable to articulate or express how or why they feel the way they do in
any other adequate or meaningful way. For some, it is self-punishment. It can be
caused as a reaction to a person’s social, environmental and cultural
circumstances (see Unit 1). It can be psychological and linked to trauma (see
Unit 2).

Self-harm can be cutting, burning, inserting objects into the body, head-banging,
self-poisoning, intentionally engaging in fights and violence with the intention of
being beaten, punching walls, extreme exercise, starvation, self-induced
vomiting, scratching, biting or hyper-sexuality. It is basically any activity inflicted
upon oneself with the intention of harming oneself. Those who self-harm will tend
to become reliant on this type of behaviour as a mechanism to cope with stress,
trauma or psychological pain. It can become a coping strategy as the shame,
guilt and stigma associated with self-harm can cause the person to become
increasingly isolated, which escalates the behaviour.

According to Reuters, one in twelve young people self-harm in the UK. Self-harm
can occur at any age, but it is most common in 12-25 year olds. These figures
are likely to be much higher as they will only account for those who have sought
support from services. There is also a gender bias, suggesting that girls are
more likely to self-harm, however, there are likely to be greater numbers, as boys’

15
risk-taking behaviour is often viewed differently in society to females’, and not
necessarily classed as self-harming behaviour. Consequently, they are more
likely acquiring criminal charges for violence, drugs and alcohol use. In this
instance, cultural norms play a significant role in what society understands to be
self-harming behaviour.

Myths about self-harm

Self-harm is a difficult and contentious issue. People worry about how to deal
with it and those who self-harm feel stigmatised and unable to openly talk about
why they feel and behave as they do.

Myth: It’s just Fact: For most people self-harm is a very private and
attention-seeking personal thing. It is a way of showing others how bad
behaviour things are for them and how much they need help. People
generally feel ashamed of their injuries and will go to great
lengths to hide them. This isn’t attention seek behaviour.

Myth: Only Fact: Due to the private nature of self-harm it is not easy
teenage girls and to say who does it. Statistically speaking females are more
emo’s who self- likely to access support but anyone can self-harm
harm regardless of age stage and sexuality. People will not
necessarily present as depressed or morbid. For some
people it is not possible to express their emotional pain in
other ways.

Myth: When Fact: Self harm is about feeling something. Sometimes

people self-harm when people self-harm they are so distressed that they
they don’t feel the can experience what is known as a dissociative fugue or
pain “zone out”. People who self-harm describe feeling ‘numb
or dead inside’. The act of self-harm reminds them they
are alive and can still feel. Some people have expressed it
is a means of self-punishment.

Myth: People Fact: People who self-harm may feel suicidal, but they are
who self-harm are not necessarily related. Self-harm is a person’s attempt to
suicidal temporarily survive and feel better whereas suicide is a
permanent end to life. Childline advises many children who
self-harm are describing a cathartic and emotional release
from anger and frustration due to difficult family
circumstances. For others it is an expression of extreme
emotional pain and sadness.

Myth: The Fact: People self-harm for many reasons and this is linked
severity of the to resilience, self-care and the types of coping strategies
self-harm reflects they have learned works for them. Some people are able
the severity of the to cope with life and traumatic experiences better than
person’s problem others. This is based on variety of factors influencing
wellbeing including, social, personal, cultural and
environmental. All self-harm even if it appears superficial,

16
 should be taken seriously as that person is trying to say
they are struggling to deal with whatever is happening for
them

Myth: People Fact: Self-harm is an expression of extreme emotional

self-harm to hurt pain, it is unlikely the person is thinking about the impact
or manipulate on others during self-harm. They may feel regret after but it
others is ultimately a way of communicating an emotion which
they are unable to verbalise or express in any other way.

Myth: People Fact: Attempting to stop someone from self-harming could

who self-harm potentially escalate risk to that person. Self-harm is a
must be told to coping strategy which is keeping that person alive. It is
stop more important to try and understand the reasons why a
person is self-harming and support them to find other ways
of coping. Most services try to work with people on the
basis of risk minimisation.

Resources and sources for facts and myths

(Self harm myths and facts #talkingisharmless, Penumbra, 2019)

http://www.penumbra.org.uk/service-locations/north-area-
services/aberdeen/self-harm/self-harm-myths-facts-talkingisharmless/

https://www.samaritans.org.uk

DEAL: self-harm myths and facts- workshop materials

Recognising the signs

According to the NHS (2018), detecting self-harm can be difficult indictors can
include:

 unexplained cuts, bruises or cigarette burns, usually on their wrists, arms,

thighs and chest
 keeping themselves fully covered at all times, even in hot weather
 signs of depression, such as low mood, tearfulness or a lack of motivation or
interest in anything
 self-loathing and expressing a wish to punish themselves

17
 not wanting to go on and wishing to end it all
 becoming very withdrawn and not speaking to others
 signs of low self-esteem, such as blaming themselves for any problems or
thinking they're not good enough for something
 signs they have been pulling out their hair

(Self-harm, Signs of self-harm, NHS Direct, published December 2018)

https://www.nidirect.gov.uk/conditions/self-harm

These are only a few of the signs and symptoms. The stigma associated with
self-harm prevents people from having open conversations about how they feel
as they fear they will be judged or ridiculed. Not having open conversations can
increase internalisation of feelings of self-loathing, psychological distress, or
misunderstanding, which can then lead to structural stigma, and affect access to
the appropriate support.

Seeking support

Most people who self-harm want to be listened to without judgement. It is

important to acknowledge the seriousness of their pain and anguish and
recognise that the behaviour is a symptom of deep emotional distress. It is
possible to develop other coping strategies and eventually stop the self-harming
behaviours, however, it is always easier to start something than to stop. It will
take a lot of talking, self-exploration and support to learn alternative ways of
thinking, feeling and doing.

There are many support options available, including:

 Your Local NHS partnership

 Your general practitioner
 Child and Adolescent Mental Health Services (CAMHS)
 Social Work mental health team
 Local Accident and Emergency services

For information on ChooseLife and Suicide prevention in Scotland, visit

http://www.chooselife.net

Living Life to the Full: Offers free life skills training based on a CBT model for
people with anxiety and depression. http://www.livinglifetothefull.com

Mental Health Foundation: Provides information about mental health issues and
the work of the Mental Health Foundation. It links to other resources on mental
health in the UK and overseas. http://www.mentalhealth.org.uk

18
Mental Health in the UK: Created to reform people's ideas about everyone who
suffers from mental health problems by informing and enlightening them with
creativity, talent and imagination. http://www.mentalhealthintheuk.co.uk

MIND: The leading mental health charity in England and Wales and has
information on a wide range of topics including depression, self-harm and
suicide. http://www.mind.org.uk

Muslim Youth Helpline: A confidential helpline for young Muslims. Provides

counselling and befriending services to Muslim youths in need.
http://www.myh.org.uk

Support in Mind Scotland: Works to improve the wellbeing and quality of life of
people affected by serious mental illness.
http://www.supportinmindscotland.org.uk

No Panic: Is a charity whose aims are to aid the relief and rehabilitation of those
people suffering from anxiety disorders. http://www.nopanic.org.uk

Papyrus UK: UK resources and support for those dealing with suicide,
depression or distress — particularly teenagers and young adults.
http://www.papyrus-uk.org

Penumbra: Penumbra provides a range of person-centred support services for

adults and young people. http://www.penumbra.org.uk

Rethink: A mental health resource for young people under stress or worried
about their thoughts and feelings. http://www.rethink.org

Saheliya: A black and minority ethnic women's mental health organisation in

Edinburgh. http://www.saheliya.pwp.blueyonder.co.uk

Scottish Association for Mental Health: SAMH operates a range of services

across Scotland for people with mental health problems. It also strives to
influence public policy as which affects people with mental health problems.
http://www.samh.org.uk

Scottish Development Centre for Mental Health: The Scottish Development

Centre for Mental Health aims to improve mental health and wellbeing for
individuals and communities in Scotland and enhance services and support for
people with mental health problems by providing services that offer training,
information sharing and learning, research and evaluation, support for change
and development. http://www.sdcmh.org.uk

Survivors UK: Supports and provides resources for men who have experienced
any form of sexual violence. http://www.survivorsuk.org

19
Young Minds: The national charity committed to improving the mental health of
all children and young people (8–16 year olds). They also have a parent's
information service. http://www.youngminds.org.uk

Young Scotland in Mind: Launched in April 2006, led by Barnardo’s and funded
by The National Programme for improving mental health and wellbeing. This is a
forum for voluntary sector and non-government organisations with the aim of
improving the mental health and wellbeing of young people in Scotland.
http://www.youngscotlandinmind.org.uk

20
 Emotionally Based School Refusal (EBSR)
The statistics on EBSR are not accurate as there is no differentiation between
other non-authorised absences. It is estimated that approximately 5% of school-
aged children will experience EBSR. One of the harmful aspects of EBSR is that
once it starts, it is a vicious cycle of escalating anxiety. Avoiding a situation which
causes fear only makes it scarier the next time you are faced with it. In the long-
term, many teachers and professionals underestimate how damaging it can be.
Some studies have proven that the combined social isolation, loss of education
and loss of confidence and self-esteem leads to long-term mental health
difficulties as they progress into adulthood.

Reasons for EBSR

Separation anxiety.
Learning difficulties and/or Home-related worries.
ineffective Undiagnosed
Special Educational Needs
and Disability (SEND) support. Physical difficulties
navigating around school.

Sensorial difficulties.
Emotional developmental
Academic pressures,
Delay.
class testing and
Not feeling difficulties are
assessment. Bullying (by
understood or believed.
adults or children).

Unstructured break times.

Friendship issues or social anxiety.
Undiagnosed Special
educational needs and
Adolescent hormone
disability (SEND) or illness.
and brain Classroom disruption or
development. changes to routines and
staff.

‘School refusal occurs when stress exceeds support, when risks are greater than
resilience and when ‘pull’ factors that promote school non-attendance overcome
the ‘push’ factors that encourage attendance.’ – M. S. Thambirajah

https://senmagazine.co.uk/articles/articles/senarticles/the-roots-of-school-refusal

It is unhelpful to label school refuser’s as lazy, disrespectful or naughty. The

presenting behaviours often tell a story of much deeper issues which, at times,
the young person cannot explain.

21
How to get back to school

Mental health education: Supporting young people to have the vocabulary and
insight to be able to explain how they feel, what they feel, and why they feel that
way. Providing opportunities to learn about emotional literacy, explore good self-
care, and a range of coping strategies.

Having positive mental health policy in schools: Address the stigma

associated with mental health. Create an open culture of learning how to look
after the mind as well as the body and give the same priority as physical
education, sex education and social education.

Encouraging a growth mindset and using more positive language: Learning

Outcome 2 will give you much more information on this.

See the child, not the behaviour: Unit 1 and 2 of this course will have given you
a good understanding of the factors that influence mental health and how the
brain processes this information. Very often we misinterpret the behaviour of
others. It is important to remember that we all have different levels of resilience
and different ways of coping, and we should never assume that we understand
how another person/child/young person is thinking and feeling.

Working together: It is important to work with the whole family. Early

intervention is always best when dealing with anxiety, however, if the situation
becomes prolonged it is important to have good links with CAMHS and
educational psychology for specialist support when required.

Keeping the young person in the centre: Ultimately, mental health

professionals, teachers, parents and even other peers cannot force a child back
into school. They also cannot fix how they are feeling. It is important to have a
circle of support around the child that guides the child to make sense of their
feelings and how they might be able to feel more in control and start to find ways
to manage their feelings.

22
Limit setting

One of the best coping strategies that we can have is to set limits and ensure that
we have a good understanding of our needs. Learning to say ‘no’ or being clear
about what you are able to do is essential. Know your limits and when things are
likely to get to the upper end of stressful, then you can make better decisions in
relation to organising your life. This doesn’t mean you never push yourself out of
your comfort zone — we all need to be stretched to develop but if you over-
commit and you find yourself perpetually running in circles, the likelihood is that
you will continually feel dissatisfied with yourself. You may feel that you are
always tired, anxious and worried.

Setting limits, however, is an extremely difficult thing to do. It takes practice and
you also need to have a good understanding of what your limit is.

Reasons why limit setting is difficult:

 Fear of what others think.

When you fear what others think, you’re assuming the negative. You don’t
know what people are thinking and you cannot control what others think. That
provokes a sense of powerlessness, frustration and self-doubt. Everyone is
entitled to their own thoughts.
 Assuming they’ll be mad or upset.
Do not assume the outcome without knowing for sure, be careful to check out
any assumptions. If someone looks upset, ask them, it’s probably not you and
even if it is its best to talk about it and clear the air.
 Trying to avoid conflict.
Do you ever say yes to avoid a fight? Don’t assume that setting a boundary
will cause an argument. Most of what you fear never actually happens. Being
clam and clear about what you want and why it important is more likely to be
heard. It is important not to make unreasonable demands.

23
 Not wanting hassle.
It’s much easier to avoid the hassle and keep quiet. The problem is that if we
just go with what other people want all of the time, you start to feel devalued
and begin to lose your own identity.
 Thinking it’s not that important.
Feeling bad about yourself or that you don’t deserve to be heard keeps you
pleasing others and neglecting yourself. Everyone has needs and it’s up to
each of us to know what they are so that we can take responsibility to have
our needs met.
 Fear of being seen as selfish.
It is much easier to have confidence in setting limits when you are mentally
healthy. This is not selfish. It is looking after yourself so that you can be
responsible for other aspects of your life such as taking care of relationships,
work, school, etc.
 Not knowing where to start.

So how do you actually set a healthy boundary?

 speak up and ask for what you want

 be open for some negotiation
 be clear and specific in your request
 Stay calm and be reasonable and realistic

Identify three limits that would be helpful to you and how you might do this:

Example:

Not being accessible  Have set times to check your phone each day
on social media all the (morning, afternoon, evening). Limit this to half
time an hour.
 Explain to friends that if it is an urgent matter,
they should call you.
 Arrange to meet up with friends at times that are
convenient to you.
 Put your phone in another room half an hour
before bedtime so that you can switch it off.

24
Group task

Research a range of coping strategies. Create a poster (National 4) or leaflet

(National 5) giving information on coping strategies and how they might be
helpful or unhelpful.

25
What is resilience?
Being resilient does not mean being immune to stress; resilience is the ability to
adapt to, and cope with stressful situations. In other words, it is our ability to
bounce back from difficult and stressful events within our life. It is not an innate
(something we are born with) quality: it can be acquired through learned
behaviours, thoughts and actions Unit 1: Factors which Influence Mental Health
and Wellbeing addresses many of the issues which can affect how we think feel
and behave. Situations which are stressful to us and how we cope with them are
part of our life experience. The nature of our support, relationships and guidance
all have an impact on how well we cope. By better understanding the things that
influence how we feel, we can learn to deal with them. By learning from each
experience, resilience grows. Making sense of life, our relationships and the role
we play is a very important part of being able to ‘self-regulate’. This means being
able to act or behave in a way that is in our best interest and to be able to cheer
ourselves up when we feel sad or manage our anxiety when we feel stressed. It
does not mean we should never be exposed to difficulty or stress. To be resilient
we need to experience difficulty and change and learn how to work through it and
navigate it. Resilient people acknowledge that we must feel the full range of
emotions in order to be healthy and happy, and accept that it’s ok to feel sad,
angry or frustrated at certain times in our life. I

Learning to be resilient can involve using a range of factors to strengthen how we

cope emotionally. Maintaining good self-care is an aspect of this, these include:

Acknowledging the importance of relationships

No man is an Island’ is a very true expression. From the moment we are born we
are reliant on others to support and nurture us. The quality of our relationships
provide a bench mark for how we relate to others, how secure we feel and how
trusting we are of others. We need relationships in our life as it gives us both a
sense of belonging but also a sense of purpose. Other people are also important
for keeping us grounded and providing honest support and advice when we need
it. Other people can also remind us of the things we take for granted and that
give us happiness.

Taking a Holistic View of wellbeing

According to the World Health Organisation, mental health, social health and
physical health all go hand in hand. It is important that we keep physically active
and healthy to maintain our emotional wellbeing.

Time Out

Having space to ourselves and having the opportunity to wind down is often
something we don’t prioritise and can feel guilty and selfish for doing. This kind
of self-care is important. Every day we need to have some space to do the things
we need to do to unwind and relax. For some people this might mean going for
walk, it could be mediation, watching a good movie, listening to or playing music

26
or reading a good book. Whatever you do to take yourself away from the daily
stress helps to bring balance.

Self-Talk

Often, we can have a negative narrative rolling about our heads which can affect
our motivation and how we think. For example, we can often blame ourselves or
others when things don’t go as planned or when bad things happen. Sometimes
there may be wrongdoing by ourselves or others but it is important not to dwell on
the negative feelings. It is better to be honest and have a balanced view. For
example, instead of thinking ‘I failed that exam because I am stupid or because
the teacher never taught us properly’. You could say ‘I haven’t passed yet but I
didn’t get my study plan right, so I will learn from this and get some support to
understand how I can do better.’ It is often negative self-talk which affects our
motivation and emotional responses. It has a detrimental impact on our self-
esteem and how resilient we are as we don’t learn anything from the experience.

Remembering you always have a choice

Often when things are tough it can be difficult to see what choices we have. They
may be limited and we may feel at the mercy of others, but we always have a
choice. We can choose how to respond and deal with those difficult situations.
This is the first step to feeling in control.

Self-acceptance

We will explore this more in Outcome 2. Self-acceptance is about finding

happiness from within. It is acknowledging that you are comfortable with who you
are and appreciate all the things that make you unique and human!

Persevere

Building resilience takes time, and experience. It is important to feel the full range
of emotions and learn how to emotionally self-regulate. Self-regulation is learning
how to soothe ourselves and manage our emotions. This takes practice, self-
awareness, and honesty.

Is there a difference between coping strategies and resilience?

‘Coping strategy’ describes any behaviour that is designed to manage the

stresses and overwhelming feelings that comes from tough situations. By
learning and developing positive coping skills in teenage years, you will build
‘resilience’ and wellbeing and be set up with an important skill for life. It’s also
important to understand how these strategies can have very different long-term
results.

27
Cultural norms
Cultural norms are a set of standards within society which influence how groups
of people think and behave. They are also used to control the behaviour of
groups of people. Cultural norms can be unwritten rules or assumptions around
what behaviours are deemed acceptable and unacceptable within particular
groups in society. For example, people will queue in an orderly fashion in the UK
to get on a bus or waiting for the opening of a club or a shop. Cultural norms can
also change over time. According to Institute of Public Policy Research (IPPR)
(2014) explains the increased use of technology in recent years is changing the
sexual relationships and habits of teenagers. It is increasingly a cultural norm for
teenagers to engage in sexting and posting naked pictures of themselves online,
and that 7 out of 10 young people access pornography online while at school
between ages 13-15. 20 years before the use of SMART phones and regular
use of social media pornography was accessed on the top shelf of a news agents
or the back room of adult video shops. Sexual relationships where conducted on
the basis of private interpersonal relationships which were largely monitored by
parental supervision.

Cultures can exist within society at different levels.

There are cultural norms at:

 Country level
For example, the statutory school age for children in England, Northern
Ireland, Scotland and Wales is 5-16 years whereas if you lived in Sweden you
would not start school until age 7.
 Community level
In certain areas there are more prevalent cultural norms which are created by
other social factors. For example, gang culture and associated violence,
carrying of knives and retribution shootings.
 Cultural norms within families
Some families will sit and have a meal together every night at a table and
discuss the day’s events, others will prefer to sit in front of the TV or in
separate rooms.

This is a complex concept but ultimately there are certain rules which we
collectively abide by because it is acceptable practice within a particular context.
As much as we are all different we don’t want to be too different. For example,
being the new person in work or college can be daunting because we aren’t
certain what the ‘normal’ cues for certain behaviour might be, for example, when
do people have lunch? What does ‘flexible working’ really mean? In new
situations we often spend time observing and learning from others so that we can
be accepted and fit in.

Cultural norms are a very important concept when it comes to our mental health
and wellbeing. Cultural norms help us to feel part of the group and give us a
sense of security however; stress experienced by people in society can also be

28
related to the pressure to conform to cultural norms. For example, if you move
from one country to live in another, there will be certain practices and ways of
behaving which will be unfamiliar and strange. This can lead to feelings of
disorientation and even sickness this is called ‘culture shock’. Cultural norms can
also influence how we view what is acceptable and what is unacceptable ways of
coping. There has been very limited research in this area however there is some
evidence to suggest that cultural norms and values can affect how we perceive
difficulty, they influence our personal values and beliefs and they can also
legitimise what is acceptable and unacceptable ways of behaving and coping.
For example, prayer may be a cultural norm for your family and community, in
some secular cultures this may not be viewed with the same importance and
legitimacy.

To learn more about cultural norms, use the links below to watch the BBC
bitesize series on Radio 1, ‘Coping’, and a short documentary on gang violence
in London and how living in cultures of violence can affect a person’s mental
health, emotions and behaviour.

Coping

http://www.bbc.co.uk/programmes/b00zp0xc

How gang violence affects mental health — BBC News

https://youtu.be/CuneeOypj3U

Formative Assignment:

Group Activity

Poster Presentation

Create a poster that highlights the importance of understanding cultural norms

in relation to coping and resilience.

29
Outcome 2: Promoting good mental
health and wellbeing

We all have mental health and we all need to work at looking after it. There is so
much about our brain that we don’t know, but we do know that when we put our
brain under too much strain, much like our bodies, it will become ill. Our brain
and our body are also interdependent — they do not exist separately and if we
don’t look after our physical health then our mental health will suffer and vice
versa. This then affects our overall wellbeing and our ability to live and function to
the best of our ability. We all have insecurities and we all are guilty of not looking
after ourselves when we should.

These insecurities can sneak up on us when we least expect it, it can be

something we are not even always aware of. Maybe it is something we are
constantly worried about. It can be something that makes you feel insecure or
you believe ‘is not good enough’. It could be about physical appearance, it could
be a mannerism or relationship issue. Learning when we need self-care and how
then to look after ourselves can often be a challenge. Self-care is the action or
activities we can engage in ourselves in order to maintain and improve our
mental health and wellbeing. Often we are very good at looking after other people
and we are able to offer good advice and support to others in need but it is much
more difficult to do this for ourselves.

30
Group activity

List as many reasons as possible as to why you think self-care might be

difficult.

Discuss

Some of the reason might include:

 Fear
 Becoming so stressed that it’s often too difficult to identify what needs to be
done
 Worried about showing weakness
 Not wishing to take time out in case you let other people down
 Not being able identify the emotions you may be feeling
 Feeling ashamed
 Not knowing what to do
 Peer pressure
 The environment makes it difficult

Activity

Think of a time recently where you have been stressed, unhappy or frustrated.

Imagine you are giving advice to a good friend going through the same thing.
What support and advice would you offer this friend?

Self-care is all about giving you a break and being your own best friend.

Activity

Seeing yourself as you are

List five culturally valued traits that you are above average: e.g. ‘I am a
talented singer’, ‘I am a great runner’, ‘I try really hard to be kind to everyone’.

1._____________________________________

2._____________________________________

31
3._____________________________________

4._____________________________________

5._____________________________________

List five culturally valued traits for which you are average: e.g. ‘I am a pretty
average student’, ‘I am good at listening to others’, ‘I love running but I am
never going to be an Olympian!'.

1._____________________________________

2._____________________________________

3._____________________________________

4._____________________________________

5._____________________________________

32
 List five culturally valued traits for which you are below average: e.g. ‘I am not
especially trendy’, ‘I am terrible at telling jokes’, ‘I am never on time for
anything!’.

1.______________________________________

2.______________________________________

3.______________________________________

4.______________________________________

5.______________________________________

Consider all of the traits above. It is important to understand that being human is
about recognising all of the facets of ourselves and accepting that this is who we
are. Being human is complex, part of ‘being’ is about accepting our own diversity
and being comfortable and happy with ourselves. If we can do this then we can
have empathy for others and appreciate the diversity of others. We live in a
society where we are expected to be the smartest, to look our best, to be the
fittest, to be the slimmest, to have the latest product. These socially defined
norms are reflected onto each of us and add pressure on how we should be. It is
important to remember that none of us are perfect and that many of these
expectations are unrealistic. How boring would the world be of we were all
excellent at everything all of the time, we all had the same sense of humour, we
all wore the same clothes and we all looked physically the same? It is these
differences that can make us feel vulnerable but it is also these differences that
set us apart and give us strengths and talents that are unique.

33
Brené Brown, TED Talk: The Power of Vulnerability

https://www.ted.com/talks/brene_brown_on_vulnerability

List three key ideas that you have learned from Brené Brown’s TED Talk.

In small groups, share your learning points and why you felt these where
important.

1._______________________________________________

2._______________________________________________

3._______________________________________________

34
What is self-awareness?

Self-awareness is about being consciously aware of our traits, feelings and

behaviours. It is not something we tend to focus on, however, the more self-
aware we are, the more likely we will be to understand how we interact with our
environment and with others. Good self-awareness also means that we are able
to evaluate what we need to stay mentally healthy and maintain our wellbeing.

Further activities to explore self-awareness in more detail can be found in the

links below:

Understanding the Johari Window model

http://www.selfawareness.org.uk/news/understanding-the-johari-window-model

Daniel Goleman, Emotional Intelligence Definition

http://bigthink.com/videos/daniel-goleman-introduces-emotional-intelligence

Daniel Goleman, Emotional Intelligence and Compassion

https://www.ted.com/talks/daniel_goleman_on_compassion

Activities on Emotional Intelligence for Teenagers

http://ong.ohio.gov/frg/FRGresources/emotional_intellegence_13-18.pdf

35
 Self-care
Self-care is a range of actions that a person can take for themselves to maintain
and look after their wellbeing. Some of us are much better than others at looking
after ourselves. Taking some time to care for yourself does not mean that you are
selfish. If we neglect our own health then we cannot look after others and
participate and manage other responsibilities in our lives effectively.

One of the biggest things we neglect to do is get enough sleep! Sleep is one of
the most important things we can do to manage our mental health and wellbeing.

Sleep facts

Teenagers need 8–10

hours of sleep each
night. Young adults
need 7–9. Sleep is when your
brain consolidates the
Melatonin is a chemical in the day’s events. It also
brain produced to help promote helps us to problem
sleep. Teenagers don’t produce solve.
melatonin until later in the
evenings and it also does not
dissipate until much later in the
morning. Teenagers aren’t lazy
— they are tired!!!
Sleep promotes
memory making. So
cramming all night for
that exam won’t work!!

Lack of sleep
causes us to be
irritable,
irrational and Depression,
bad tempered. heart disease
and diabetes
are all linked
to sleep
deprivation.

36
Good sleep hygiene

Sleep hygiene is the steps or measures taken in order to help our bodies produce
melatonin at the correct time to help us to get to sleep. Sleep is one of the most
important activities we can do to help our bodies recover from physical or mental
illness, and depending on our lifestyle, some need more sleep than others.
Generally, between 7–9 hours sleep for the average person aged 18–64 is
considered to be healthy. Sleep is important as it helps muscle tissue repair, e.g.
athletes need a little more sleep to help their bodies recover from training. It is
during our sleep that our brains commit information to our short-term and long-
term memory. If you have a problem you can’t solve today, it really can be useful
to sleep on it! It is possible to sleep too much. There is now a body of evidence
that suggests that too much sleep could be linked to other mental health and
physical health problems, so if you find you are regularly spending 10 plus hours
a day in bed and still not feeling refreshed, then you should see your doctor.

One of the first things to suffer when we feel stressed or under pressure is often
our sleep pattern. According to the sleep council in 2012, the NHS spent £50
million on sleeping pills alone. However, we know that if we can maintain good
sleep then we can cope better with stress. Practicing good self-care is therefore
important for promoting sleep.

Things we can do to promote sleep:

Environment

 keep it dark — even ambient light suppresses melatonin production

 make sure the temperature isn’t too warm
 clear clutter
 have a comfortable bed
 have a blanket to keep your extremities warm

Put your mobile phone and other devices to bed in another room

 blue light from devices keeps your awake — fact!!

 make sure you come off devices at least half an hour before you go to sleep
 social media and fear of missing out will keep you awake — there is nothing
in your social life that can’t wait until tomorrow
 get an alarm clock — you don’t need a mobile phone to wake you up

37
Bedtime routine

Bedtime routine isn’t just for little kids. We need to let our bodies and brain know
that it’s time to sleep.

Working shifts can play havoc with your sleep pattern, so preparing our bodies
for sleep is even more crucial:

 Give yourself time to wind down.

 Don’t work, eat and watch TV in bed — make your bedroom a sanctuary.
 Don’t do strenuous exercise before going to bed.
 Have a bath, meditate, and/or read a book.
 Whatever you do, establish a routine as it prepares your body for sleep.

Worry

Worry steals our joy and steals our sleep.

 Managing social media and having a work/life balance is a crucial aspect of

managing worry, which comes with the increased expectation that we are
online and available 24/7.
 If you have other worries, write them down.
 Take control of the things you can make decisions about. Make a plan to
address them and share your worries with others who can offer support and
advice.

Diet

You have one body and one mind so don’t treat it like a bin.

 Eat a balanced diet.

 Don’t eat lots of sugar before bed.
 Minimise the use of stimulants such as caffeine or cigarettes, particularly
before bed.
 Alcohol may knock you to sleep, but you won’t get a good quality sleep, so
resist using alcohol to induce sleep.

Exercise

Healthy body = healthy mind.

 Exercise regularly.
 Try not to exercise intensely at bedtime. However, it is better to exercise even
if the evening is the only time you can fit it in.
 Exercise helps to regulate body temperature.
 Good fitness supports good sleep.

38
Relax

Don’t sweat the small stuff — it’s all small stuff!

Easier said than done, but all things pass: the worst things; the stressful things;
the worrisome things; and the happy things. It is a cliché, but time is a healer and
we spend much of our time worrying about things we can do very little about.

Try to gain perspective, focus on the things that are good and that
matter most.

Managing how we feel and inducing our body into a relaxed state takes training
and self-discipline. Having control over our emotional state and responses is
called self-regulation. You will have already covered many of these in class
discussions. Others might include:

 mindfulness
 meditation
 yoga
 breathing techniques

If you are really having trouble sleeping even after trying all these methods of
sleep hygiene or self-care, then you must seek support from a professional
person such as your GP.

Mind: Activity researching self-care

https://www.mind.org.uk/information-support/your-stories/getting-mental-healthy-
for-2015/#.WuDZPMgvzIU

Mind is a mental health organisation which provides online support, and

campaigns to promote a better understanding of mental health and wellbeing and
also addresses stigmas associated with mental illness.

Mind often publish the stories of others who have lived experience of mental
illness or mental health issues to share how they learned what works for them
and how they use self-care techniques to maintain positive wellbeing.

39
Activity

Read some of the blogs on the Mind website and identify four different types of
self-care highlighted by some of the bloggers who have discussed their own
lived experiences, and what works for them.

1.____________________________________________________________

2.____________________________________________________________

3.____________________________________________________________

4.____________________________________________________________

Are there any types of self-care that you would find useful?

40
In groups, identify four other types of self-care and explain how they foster
wellbeing and good mental health.

Types of self-care Benefits

Example: Poor sleep can lead to worry. If we are well

rested, we can think more clearly and we
A good sleep routine feel more relaxed.

41
An important aspect of self-care is that it is individual to every person. By
ensuring that our physical and social needs are met, then good mental health can
be sustained. Good mental health does not mean that we should always feel
happy and elated, it means that we are capable of feeling all emotions and that
we recognise how these emotions affect how we think and behave. On a daily
basis we can experience a range of emotions, each of us have different
personalities and social circumstances. Good mental health is a sense of
contentment. According to the mental health foundation, good mental health is
characterised by a person’s ability to fulfil a number of key functions and
activities, including:

 the ability to learn

 the ability to feel, express and manage a range of positive and negative
emotions
 the ability to form and maintain good relationships with others
 the ability to cope with, and manage change and uncertainty

https://www.mentalhealth.org.uk

42
Positive language promoting mental health
and wellbeing

Language and how we use language in relation to mental health and wellbeing is
one of the single most important issues when we are referring to stigma. Stigma
is when we brand a person and then shame them due to a set of identifying
factors which set them apart from others. The obvious thing to point out with
regard to this is that mental health is something we all have. However, we often
confuse terminology associated with mental health and mental illness and use
labels which can be misleading and upsetting to others. In Unit 1: Factors
influencing mental health and wellbeing, and Unit 2: Understanding mental health
and mental illness, you should have developed an understanding that many of
the negative attitudes associated with mental health and mental illness are based
on opinion rather than fact. Many of the myths that exist are used to perpetuate
much of the stigma that currently exists. Much of the negative self-talk that
people experience when they are anxious, stressed and worried occurs because
they are frightened to speak openly about their insecurities and anxieties, and
this can then lead to more serious mental illness.

Did I say too much? Maybe I Am I fat in this? I look really frumpy...I
didn’t say enough. I didn’t speak can’t wear this out...everyone will
clearly. People will think I don’t stare at me...I am really ugly...why
know what I am talking about...I would anyone want to be seen with
am really stupid...people will me...I can’t go out…if I go out
think I am stupid. everyone will just laugh at me.

43
By perpetuating stigma around mental health, people feel insecure and anxious
about sharing their feelings; this is often rooted in a fear of being labelled ‘mad’,
or ‘crazy’. The reality is that most of us experience these insecurities a lot of the
time, and actually some of these anxieties are socially normal. For example,
consider social media and how important other people’s validation of us through
‘likes’ and ‘shares’ are? How many of us have taken down a picture because it
didn’t get enough likes? Good mental health must start with us. We can’t send a
friend to the gym to exercise if it is you who wants to lose weight and be more
physically healthy. It is therefore reasonable to assume that we cannot expect
other people to make us mentally healthy. Other people can support us, just as a
personal trainer at a gym can advise on a fitness plan the suits, but seeking out
the right people to give you the right advice at the right time is important for
sustaining and maintaining good mental health. This doesn’t always need to be a
mental health professional — on the contrary — everyone should have a good
critical friend who they can trust to share how they feel. This could be a family
member, or someone from your peer group. Understanding the language we use
when we talk about mental health is a crucial aspect of addressing stigma. For
example, mental health is often used when talking about mental illness; mental
health does not mean mental illness. If we aren’t mentally healthy and sustaining
our mental health we can become mentally ill.

Using labels to refer to people such as ‘He’s a schizophrenic’, ‘She’s bipolar’,

‘He’s a depressive’, ‘She’s hyper’, ‘She’s a psycho’, or ‘He’s a junkie’, defines a
person by their illness or behaviours associated with underlying mental health
issues. It is not only offensive and disrespectful, but it further stigmatises people
with genuine illness. It isolates people who may not have any diagnosed
condition and shames them into not accessing support when they may need it.
We would never refer to a person with cancer as a ‘cancerite’, or a person with
eczema as ‘He’s eczema’. It sounds ridiculous and shocking, doesn’t it?
However, we do this all of the time when we talk about mental health. When we
stigmatise groups of people, we brand them. People do not actively use this
language to intentionally cause others to feel bad, but this lack of understanding
and recognition of the power which exists in the words that we use to describe
others creates barriers. It prevents people from having open conversations and
discussions about mental health and wellbeing. It is important therefore, that we
think and use language responsibly as words can be very damaging if used in the
wrong way.

I don’t have mental health! There is nothing

wrong with me!!

44
The media and much of society uses language and images that set the tone
when we talk about mental health. For example, when imagery is used in relation
to mental health and mental illness it is often the image of person with their head
in their hands, lonely, and in despair.

Mental health and maintaining a healthy life is of central importance to all of us.
We will all experience trials and tribulations throughout our life but we would not
wish to be defined by only the things that cause us pain and anguish. It therefore
does not make sense that we should define anyone experiencing a period of
mental illness and distress by those times when they feel at their worst. A person
with a physical illness will have good periods and bad periods. This will be the
same for a person who has a mental illness or experiencing mental health
difficulties. If we always focus on the negative aspects or the darker side of life
then we will never be able to see our strengths and move forward. Learning to
use more positive language and be able to see the positives, even in difficult
situations, takes time and the right support and guidance, but it is crucial if we are
to change attitudes and reduce stigma around mental health.

45
Read the following statements and consider how they reflect stigma:

 ‘She needs her head examined.’

 ‘What do you expect? This is the snowflake generation?’
 ‘You need to toughen up.’
 ‘You really do need to sort yourself out.’
 ‘Ignore him, he’s just a weirdo.’
 ‘He brought it on himself — once a junkie always a junkie.’
 ‘Ignore her, it’s just attention-seeking behaviour.’
 When people ask you how you are? Do they really want to know how you are
feeling and would you be okay telling a person how you were really feeling?
 How would respond if a peer said to you:
 ‘I’m feeling really tearful and mixed up today, I don’t really know why. I just
do.’
 ‘Have you ever felt like you don’t belong, like you are sitting outside everyone
else’s frame of reference? That’s how I feel.’
 ‘I am so angry; I actually don’t know what to do with myself. I am afraid I
might hurt someone or myself.’
 ‘I am so anxious that I could hide away for ever.’
 ‘Sometimes I think the world would be better off without me.’

Class activity

Put a range of statements on the wall. Give students some post-it notes and
ask them to write a response to each statement and stick their response on the
wall to the corresponding statement. Once everyone has written their
responses, have a discussion about the range of views expressed. How
easy/difficult was it to think of a response?

These feelings are common. If we are all honest with ourselves we can all relate
to some, if not all of these statements at some point in our lives. The most
important part of being mentally healthy is about recognising that we are all
thinking, feeling, doing, imperfect human beings and we all experience the full
range of emotions at every level of intensity. If we accept this as part of who we
all are, then immediately we all become connected. Not feeling alone and
isolated is essential to maintaining good mental health and wellbeing. Being able
to communicate without fear of prejudice is an important aspect of belonging.
Being able to be honest with ourselves is an extremely important part of learning
how to cope and develop the skills we need to be resilient.

46
In Unit 2, we talked about
the mental health and
wellbeing spectrum. You
will understand that we
move across this spectrum
throughout our lives. Our
social circumstances, life
experiences and personal
relationships all contribute
to our sense of wellbeing. If
our feelings become overtly
negative and we are finding
it difficult to cope and feel
content then it is important
to seek help and support.

Activity

Look at the sample poster below. They are public health posters designed to
promote positive images of health and wellbeing.

Design your own public health poster using positive language and images
around mental health and wellbeing.

47
Growth mindset
Dr Carol Dweck, a psychologist from Stanford University, coined the term ‘growth
mindset’ 30 years ago. Her research proved that the brain was malleable and
that the ability to learn and develop was influenced by self-talk which is often
reinforced from a very young age. She proved that young people who recognised
that learning and development required effort and overcoming challenge and
difficulty through perseverance. Psychologist, Angela Duckworth, has referred to
this as ‘grit’ which is ‘perseverance and passion for long-term goals.’ Angela goes
on to say that resilience is the optimism to continue when times are tough and
you’ve experienced some failures. The ability to learn and develop socially,
emotionally, cognitively and culturally is intrinsic to our wellbeing.

Watch TED talks by Carol Dweck and Angela Duckworth to learn more
about growth mindset:

https://www.ted.com/talks/carol_dweck_the_power_of_believing_that_you_can_i
mprove

https://www.ted.com/talks/angela_lee_duckworth_grit_the_power_of_passion_an
d_perseverance

Discuss in your groups what mindset you have.

Complete the quiz for fun:

https://studentsuccess.unc.edu/files/2015/08/MINDSET-Quiz.pdf

In your own words, define ‘growth mindset’.

Growth mindset vs fixed mindset

‘My work bridges developmental psychology, social psychology, and personality

psychology, and examines the self-conceptions (or mindsets) people use to
structure the self and guide their behaviour. My research looks at the origins of
these mindsets, their role in motivation and self-regulation, and their impact on
achievement and interpersonal processes.’ — Carol Dweck.

Carol Dweck’s studies focused primarily on students. She found that some
students were more open to learning than others. The reasons for this are a
complex combination of understanding how a person’s beliefs, values, and
outlook, i.e. how they see themselves in the world and how they believe others
see them. Dweck would argue that a person’s motivation to learning is then
influenced by expectation (which is linked to cultural norms), and personality. The
ability to self-regulate or, in other words, manage how we respond to challenges
and barriers to learning is an extremely important aspect of this.

48
Fixed mindset

Dweck’s studies evidenced that some learners believe that intelligence and talent
is an innate quality. These types of learners tend to have a mindset or attitude
that intelligence and, subsequently, opportunity to succeed is pre-determined and
therefore, no matter how hard you work, it won’t make any difference. They will
often avoid challenges, see effort as tiresome and pointless, give up easily when
they come across a barrier, really dislike constructive feedback and will often
seek to blame others for their lack of success. Those with a fixed mindset expect
to win and when they don’t they are bad losers.

Growth mindset

People with a growth mindset tend to be less certain of their abilities but are more
willing to give things a go. They will take risks, and they will be more resilient to
failure and mistakes. This of course does not mean that they are unaffected by
these experiences. They will still feel frustrated, and it can be painful. However,
they will reflect and choose to see what needs to be learned from the experience
and then try again. Growth mindset types will see the benefit of feedback, will
recognise that challenge is an opportunity, and that effort is essential to achieving
potential. They will be a problem solver and often very creative in how they think.

49
Dweck’s studies go on to prove that it is possible to nurture and support people to
have a growth mindset. In particular, she recognised the influence of schools and
expectations of caregivers; the language used to encourage; the cultural
expectation placed upon young people and children; and the fact that these can
be hugely influential in supporting a healthy mindset. By surrounding ourselves
with people who will challenge us and encourage us, we are more likely to grow
and develop.

The power of yet vs the tyranny of now

The power of yet was discovered when Carol Dweck noted that, instead of a fail
grade, a college gave its students a ‘not yet’ grade. This was designed not to
dishearten students but to let them see that they were on a learning curve,
reinforcing that success has to be developed over time through effort, feedback,
reflection and re-evaluation. It’s got to be deliberate and the ability to think
critically about how you learn, your motivation, and what you need to do to get to
where you want to be is a crucial part of this. Therefore, it is important that tutors,
teachers, or mentors are guides for learning providing the right scaffolding at the
right time to encourage. These learners will look to the future and will thrive on
the experience and recognition of effort. They will come to realise that work ethic
is much more important than the final outcome.

The tyranny of now is the fear and dread that overcomes learners who struggle
with the very thought of a challenge or a task that they believe can’t be achieved
immediately. This is a catastrophe and often they will feel angry and will become
quickly disillusioned. They will struggle to accept responsibility of their own
development choosing to view this as other people’s problem and will respond
defensively to guidance. It is important to nurture someone with a fixed mindset.
First, they need to know that they have choice. The environment must encourage
that opportunity to choose an alternative way. For example, if mistakes always
lead to punishment, then this sends the message that there is no scope for
growth because you are a failure. If mistakes and the language used around
mistakes and challenges changes to:

(Conversation between a student with a fixed mindset and a teacher trying to

support growth mindset).

Growth mindset: ‘Okay, that was difficult, but what did you learn from it?’

Fixed mindset: ‘I’m stupid and rubbish at this.’

Growth mindset: ‘Did you know that the most successful people have often
experienced major setbacks. Even Albert Einstein failed science! But he had a
passion and was determined to succeed.’

Fixed mindset: ‘You are a rubbish teacher.’

50
Growth mindset: ‘I am hearing that you feel that I have placed you in an unfair
position. Help me to understand what it is you are finding difficult and let’s work
together to find a solution.’

By changing the language we use with others and being consistent in our
approach, we can help to change expectations and, over time, change the
conversation. One of the important aspects of shifting mindset is also about
learners changing their own language and internal voice. This does take time and
practice.

Growth mindset = healthy mind

If we can have a more positive and encouraging internal narrative then we are
more likely to have a healthy mind, and we are more likely to adequately self-
regulate when under pressure or stress. People with a growth mindset won’t
have any less setbacks than a person with a fixed mindset, but how they choose
to deal with setbacks is a crucial aspect of learning resilience and appropriate
ways to cope. Choice and taking responsibility for our choices is a key part of the
learning.

Formative assessment (group work)

Organise a wellbeing event for your peers. Identify a range of activities that
you would want to include and think about how you will communicate the
benefits to others.

51
Outcome 3: Different types of support
available and ways to address barriers to
support
Accessing support
Accessing the right support at the right time is an essential part of managing our
mental health. If we have a sore throat, we will maybe try some home-based self-
care such as gargling saltwater and taking some paracetamol; taking time off
school/work/college and getting some rest. If it persists beyond a couple of days,
we may consult the pharmacist who might recommend other remedies. If we find
that, after a week, our throat is really not improving, we go to the doctor as it may
require a stronger treatment. If we find this isn’t working, the doctor may send us
to the hospital for further investigation and treatment. At no point in the process
would we feel silly seeking support or judged for having a painful throat.
Conversely, if it got worse, we would become more active in our pursuit of a
treatment to manage the pain and find the root cause so that the correct
treatment could be given.

When it comes to mental health issues it is always best to seek support as early
as possible. As with our physical health, most general physical and mental health
issues can be addressed either through positive self-care and early intervention,
the longer we let health problems go untreated, the more chance there is that
they will worsen and more invasive and intense intervention may be required.
Unfortunately, due to much of the stigma surrounding mental health, people will
generally minimise the effects of stress in their lives and avoid seeking support or
don’t actively engage in maintaining good self-care when they need it most.
Sometimes it is difficult to spot when you aren’t as mentally healthy as you
should be and there can also be limited access to formal support services.

See Me Scotland are funded by the Scottish Government and Comic Relief and
are managed by Scottish Association for Mental Health (SAMH) and the Mental
Health Foundation. See Me Scotland’s vision is to end stigma and discrimination
experienced by people who have had mental health problems.

52
Activity:

Click on the link below to find out more:

https://www.seemescotland.org/stigma-discrimination/understanding-mental-
health-stigma-and-discrimination/

Fill in the Blanks:

Stereotyping

Stigma Believing in prejudicial attitudes which may potentially

impact upon self-worth and emotional resilience, thus
creating a self-fulfilling prophesy.

Defining a person by stereotypical views about mental

illness.

Prejudice

Treating someone less favourably because of a prejudice

you may have about the person.

53
Answers:

Stereotyping A widely held but fixed and

oversimplified image or idea of a
particular type of person or thing.

Stigma Believing in prejudicial attitudes which

may potentially impact upon self-worth
and emotional resilience, thus
creating a self-fulfilling prophesy.

Labelling Defining a person by stereotypical

views about mental illness.

Prejudice Forming an opinion that is based on

myth or opinion rather than facts.

Discrimination Treating someone less favourably

because of a prejudice you may have
about the person

Stigma is the biggest barrier to addressing and supporting positive mental health.
It is stigma which leads to prejudice, discrimination, stereotyping and labelling.
Stigma is when we brand or disgrace an individual or group of individuals
because they look, think, feel or behave different to the ascribed societal norms.

Group activity

1. List as many stigmatised groups as you can think of.

2. Identify why you think these groups are stigmatised.

3. How does society treat these groups of people?

4. What is the impact on their physical and mental wellbeing?

The World Health Organization highlights the fact that stigma not only hampers a
person’s access to support but it is also abusive and impinges on a person’s
human rights.

54
There are three main types of stigma:

Self-stigma: Is when a person internalises negative social attitudes and begins

to believe that they are worthless and undeserving.

Social stigma: Is the discrimination of others based on their social attributes, this
could be gender, ethnicity, health, and/or culture. It is when one group in society
is devalued by others. Increased social stigma makes it very difficult for people to
feel that they can be open about the challenges they experience for fear of being
judged by others.

Structural stigma: Is when society’s norms, institutions and organisations reflect

the same preconceived social attitudes that exist with social stigma. This means
that often access to services, policy and practice can either perpetuate or, in
some cases, exacerbate stigma towards groups or individuals.

Class activity

Watch the TED Talk — Breaking the Stigma and Shame of Mental Illness |
Kitty Westin: https://www.youtube.com/watch?v=OsRF8xGgbPA

 What does Kitty highlight as the consequences of stigma?

 What does stigma look like?
 Have you ever witnessed or experienced stigma?
 How would you break the stigma around mental health?

Discuss

Barriers to support

There are many barriers to accessing support. These include personal, social,
cultural and structural reasons.

Personal: Stigma; internalised shame; fear; lack of insight/self-awareness; and

uncertainty.

Social: Stigma; prejudicial views of others; discrimination (for example, being

prevented access to support); harassment; fear of violence; and shaming from
others.

55
Cultural: Beliefs based on culture; lack of education; religious beliefs; and fear
due to repercussions (for example, living in cultures of violence or addiction).

Structural: Legislation and policy which limits access to services; and

organisational constraints such as referral processes which make it more difficult
for people to access services.

Group activity

Build a wall and write examples of barriers to accessing support that might
exist for your peer group.

Invite some agencies or service providers to come to class and talk about their
role.

Ways to address barriers

These can include: education; public policy and legislation; easier access to
services; public campaigns to address stigma; education; and advocacy.

Group activity

Research one way in which barriers have been addressed and present to the
group

56
Informal and formal support
Informal support

Types of support a person can access for support when mental health and
wellbeing becomes difficult to maintain on our own are wide and varied.

If we have a good network of support, we are likely to make use of informal

supports such as friends and family. Often, just having a sympathetic ear to listen
to you, an opportunity to rationalise our thoughts, or just the chance to let off
steam is enough. Peer support groups such as youth and interest groups also
benefit. An opportunity to feel socially connected and engage in other activities
can provide an opportunity for relief and to participate in activity that can alleviate
loneliness and isolation. Websites such as NHS, Living Life to the Full, MIND, etc
all provide excellent information. If you are not sure about how you are feeling
and are struggling to understand what mental health and wellbeing is, there is
now a range of well-informed, evidence-based media and literature available.

Formal support

At times, informal support is not enough and support form experts in the field of
mental health may be necessary to help a young person to address what they
are feeling and how this affects them.

Examples include:

 NHS-GP, CAMHS, Accident and Emergency, NHS24, Hospital

 psychologist
 psychiatrist
 third sector organisations such as- SAMH, Mental Health Foundation,
Clubhouse, Mind, Young Minds, etc
 pastoral support teacher
 local authority social work
 helplines such as Breathing space, Samaritans, Child line

57
Group task: Formative assessment

Research two/four formal and two/four informal types of support (National

4/National 5).

 Provide a brief description of the support

 Identify what support is offered
 Explain the benefit of this support

Present your findings in a five minute presentation to the class.

58
Glossary
Coping strategy — a behaviour or activity designed to alleviate, reduce or better
deal with adverse circumstances and stress in a person’s life.

Coping — is the ability to manage stress, responsibility and problems in a way

that is not detrimental to mental wellbeing.

Beliefs — are convictions or something that a person considers true.

Values — a set of principles that have worth and are important to a person, e.g.
honesty, faith.

Lived experience — refers to the past life opportunities of a person, including

where they lived, their relationships, the activities and opportunities they have
had, and how this shapes them, emotionally, socially and intellectually.

Identity — are the attributes that define who a person is, how they are viewed by
others and by themselves.

Emotion — the range of feelings we experience and their intensity, eg happy,

sad, angry, anxious etc.

Emotional literacy — the ability to articulate what we feel.

Resilience — the ability to adapt, and cope with stressful situations. In other
words, our ability to bounce back from difficult and stressful events within our life.

Cultural norms — are unwritten social rules which exist in society and define
socially acceptable ways of behaving.

Self-awareness — is being able to understand how we feel and behave and how
this affects our relationships and our ability to interact in the social world.

Mental health — is the state of persons psychological and emotional functioning.

Wellbeing — is being comfortable, healthy and happy.

Culture — ideas, customs and behaviours of particular groups in society.

Society — a large group of people who live together sharing the same laws,
rules and cultural norms.

Perception — how something is seen, heard or recognised through a person’s

senses, it is also how something is understood or interpreted.

Culture shock — the feeling of disorientation experienced by someone when

they are suddenly subjected to an unfamiliar culture, way of life, or set of
attitudes.

59
Self-care — actions a person can take for themselves to maintain and look after
their wellbeing.

Reflection — to be able to think deeply about an issue or experience and

develop a greater understanding.

Growth mindset — is being open to learning and recognising the value in the
challenge and being willing to try new things in order to grow and develop.

Fixed mindset — is assuming that you are born with fixed intelligence and talent
and you are resistant to challenge and trying new things to grow and develop.

Repertoire — is a set of skills behaviours that are used habitually by a person.

Prejudice — is forming an opinion that is based on myth or opinion rather than

facts.

Stigma — is identifying or branding a person or group of people by a set of

attributes which are often stereotypes.

Labelling — is to tag, identify or classify people based on a generalisation or

misinformation.

Discrimination — to behave in a negative or detrimental way towards another

person or group of people because of prejudice you may have towards those
individuals.

Structural barrier — an issue that is beyond a person’s control. The issues are
associated with the environment or social situation, e.g. organisational policy,
access to services, allocation of resources.

Cultural barrier — where people from different cultural backgrounds are unable
to understand each other, which creates misunderstanding and difficulties.

Environmental barrier — the physical environment can limit or prevent

opportunities which can create difficulties for the individual or groups of
individuals.

Personal barrier — issues pertinent to the individual which would limit their
ability to communicate their needs.

Legislation — laws created by the government which provide boundaries for

acceptable actions and behaviours in society.

Policy — is a proposed set of actions to be taken by an organisation.

Positive language — is constructive, supportive and effective language

underpinned with positive emotion.

60
Informal care — care provided by a friend, family member or peer where no
receipt of payment is received for the provision of care.

Formal care — care provided by a professional who is paid to provide a

particular type of service, e.g. a nurse, social worker, counsellor or support
worker.

61
Resources
Scottish resources

ChooseLife and Suicide prevention in Scotland: http://www.chooselife.net

Living Life to the Full: Offers free life skills training based on a CBT model for
people with anxiety and depression: http://www.livinglifetothefull.com

Mental Health Foundation: Site provides information about mental health issues,
the work of the Mental Health Foundation. Links to other resources on mental
health in the UK and overseas: http://www.mentalhealth.org.uk

Mental Health in the UK: The site was created to reform people's ideas about
everyone who suffers from mental health problems by informing and enlightening
with creativity, talent and imagination: http://www.mentalhealthintheuk.co.uk

MIND: is the leading mental health charity in England and Wales. Site has
information on wide range of topics including depression, self-harm and suicide:
http://www.mind.org.uk

Muslim Youth Helpline: is a confidential helpline for young Muslims. Provides

counselling and befriending services to youth in need: http://www.myh.org.uk

Support in Mind Scotland: works to improve the wellbeing and quality of life of
people affected by serious mental illness:
http://www.supportinmindscotland.org.uk

No Panic: is a charity whose aims are to aid the relief and rehabilitation of those
people suffering from anxiety disorders: http://www.nopanic.org.uk

Papyrus UK: UK resources and support for those dealing with suicide,
depression or distress particularly teenagers and young adults:
http://www.papyrus-uk.org

Penumbra: Penumbra provides a range of person-centred support services for

adults and young people: http://www.penumbra.org.uk

Rethink: A mental health resource for young people under stress or worried
about their thoughts and feelings: http://www.rethink.org

Saheliya: Black and minority ethnic women's mental health organisation in

Edinburgh. http://www.saheliya.pwp.blueyonder.co.uk

Scottish Association for Mental Health: SAMH operates a range of services

across Scotland for people with mental health problems. It also strives to
influence public policy as it affects people with mental health problems:
http://www.samh.org.uk

62
Scottish Development Centre for Mental Health: The Scottish Development
Centre for Mental Health aims to improve mental health and wellbeing for
individuals and communities in Scotland and enhance services and supports for
people with mental health problems by providing services that offer training,
information sharing and learning, research and evaluation, support for change
and development: http://www.sdcmh.org.uk

Survivors UK: supports and provides resources for men who have experienced
any form of sexual violence: http://www.survivorsuk.org

Young Minds: is the national charity committed to improving the mental health of
all children and young people (8-16 year olds). Also have a parent's information
service: http://www.youngminds.org.uk

Young Scotland in Mind: was launched in April 2006, is led by Barnardo’s and
funded by The National Programme for improving mental health and wellbeing.
This is a forum for voluntary sector and non-government organisations with the
aim of improving the mental health and wellbeing of young people in Scotland:
http://www.youngscotlandinmind.org.uk

Short films and Audio

Ted Talks: https://www.ted.com/talks

BBC (general mental health programmes):

https://www.bbc.co.uk/programmes/topics/Mental_health

BBC Radio 1: My Mind and Me: https://www.bbc.co.uk/programmes/p04pxgfk

BBC News: Gang Violence Affected my Mental health:

https://www.bbc.co.uk/news/health-35561113

Statistics and global information on mental health

World Health Organization: https://www.who.int/mental_health/en/

Reuters: https://uk.reuters.com

63
Copyright acknowledgements
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Positive thinking info text graphics, ID: 94087624

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