The words you are searching are inside this book. To get more targeted content, please make full-text search by clicking here.

Connect 5 Session 2 Handbook Nov 2019

Discover the best professional documents and content resources in AnyFlip Document Base.
Published by richardjohnson, 2019-12-05 05:27:50

Session 2 Handbook Nov 2019

Connect 5 Session 2 Handbook Nov 2019

Mental Wellbeing in Everyday Practice

Session 2

Trainer Handbook

Connect 5 Session 2

Mental Wellbeing in Everyday Practice

Welcome to Connect 5 Connect 5 is a transformative training programme
created to:
Who has developed Connect 5?
Connect 5 has been developed by a unique partnership 1. C onnect with the population, to make every contact
of academic, clinical and public mental health expertise count – integrating active promotion of mental health
based primarily in Greater Manchester. and wellbeing into everyday practice.

What is Connect 5? 2. C onnect with individuals experiencing subthreshold
Connect 5 is a workforce training programme, created or low levels of common mental health problems:
to upskill non-mental health staff to better understand helping them help themselves.
and successfully address mental health issues within
their everyday practice. 3. C onnect with individuals experiencing high levels of
mental distress and/or suicidality: so, they get the
What does Connect 5 aim to change? right help at the right time.
Connect 5 aims to improve population mental wellbeing
by changing the way people have conversations about 4. C onnect with frontline staff: facilitating peer–to–
mental wellbeing with the public “Mental wellbeing peer training and spreading of innovation through
conversations” includes a lot of different types of established networks.
conversation. The 3 Connect 5 sessions target three
types of conversation. 5. C onnect with local systems: harnessing local
resources, energy and assets to drive and sustain
Conversations in which you suggest ways a person social change.
can take action to improve mental wellbeing.
Who is Connect 5 for?
Conversations in which you and the person you are Connect 5 is relevant to a wide range of non-specialist
talking to develop a shared understanding of that frontline staff who work with people at risk of poor
person’s mental wellbeing needs. mental health. It uniquely optimises opportunities for
building a culture of self-management, prevention
C onversations that empower a person to make and improved access to psychological approaches for
changes that address their mental wellbeing needs. mental health and wellbeing.

What does Connect 5 teach? How does Connect 5 work?
Connect 5 content provides an evidenced based
collaborative prevention toolkit that promotes 1. Direct Delivery to the front facing workforce.
psychological knowledge, understanding and awareness
and the development of skills, which empower people Connect 5 is an incremental three-session programme,
to take proactive steps to build resilience and look escalating skills though each session. The programme
after themselves. underpins the principle of ‘Making Every Contact Count’
and supports the aim of making the best use of the skills
What is the Connect 5 mission? and local contacts of frontline staff. Some staff will just
Change the way we have conversations about undertake session 1, some session 1 & 2 whilst others
mental wellbeing. go on to do all three sessions.

Understand mental health and wellbeing as an 2. Train the trainer delivery
everyday experience. Prospective trainers attend the Connect 5 Train the
Trainer programme delivered by a “Lead Trainer” - an
Empower people to make changes to protect, experienced Connect 5 trainer who also has expertise in
maintain and improve mental wellbeing. teaching training skills for Connect 5.

The four-and-a-half-day programme consists of two
and a half days of direct delivery content and two days
of Train the Trainer instructor module. During the Train
the Trainer participants are taught the underpinning
frameworks, principles, values and approaches of the
Connect 5 programme, as well as skills on how to deliver
Connect 5 sessions 1, 2 and 3 to peers.


Session 2 Connect 5


Outline training plan
Delivery plan
Information and further reading
to support delivery


Connect 5 Session 2

An introduction to...

Connect 5 Session 2

The aim of Connect 5 is to improve population mental wellbeing by
changing the way we have conversations about mental wellbeing.

Session 2: Brief mental wellbeing intervention

The intended outcome of session 2 is to change the way we have mental wellbeing conversations
so that we have conversations in which we and the person we are talking with develop a shared
understanding of their mental wellbeing needs.

The purpose of Connect 5 session 2 is to:

Apply the five areas model to a wellbeing I dentify steps that can be taken to improve
conversation. mental wellbeing.

Practice the 3Cs of connected conversation. L ocate services and resources that support
people to improve mental wellbeing.
Assess the nature and extent of the mental
wellbeing issue being presented to ensure
people get the right help at the right time.

Training Timings

Time Activity Lead

10 mins Pre-course evaluation, intros, housekeeping, learning

15 mins Recap and outline of the session.
50 mins Five areas model revisited. Balloon game and life situation game.

45 mins 15 minute break
20 mins The 3Cs of connected conversation.
1st practice. Having a go at connected conversation.

40 mins 45 Lunch
35 mins 2nd practice. Applying the model. Co-creating the questions.
30 mins 3rd practice. Applying the model. Using BATHE.
4th practice. Applying the practice: mix and match.


Session 2 Connect 5

40 mins 10 minute break
15 mins 5th practice. Exploring intensity and impact.
10 mins Stepping up, signposting, services and resources.
10 mins Round robin.

Delivery Plan

Date Tutors
Layout Location
Start time Finish time

Session Topic: Brief wellbeing intervention.
Pre-session activity:
attend session 1 within last 6 months.

Time Teaching activity Delegate Checks on Resources
and support activity Slide 2.
Slide 3.
10 Welcome. The group members
co-design their
mins Pre-course own ground rules.
evaluation. Participants are
invited name the
Housekeeping. things they need to
create and maintain
Introductions. an effective learning
Ground rules.

Aim & learning
objectives of the


Connect 5 Session 2

Delivery Plan (continued)

Time Teaching activity Delegate activity Checks on Resources
and support learning

15 Icebreaker In pairs 5 minute Use open Slides 4-8.
Small group activity: discussion about what questions to
mins participants discuss remember from last reinforce, build on
what they remember session. and extend the
about session 1. participants
Invite feedback feedback.
from the small
groups. Engage with
participants and ask
open questions.

Learning Objective
Five areas model revisited:

Apply the five areas cognitive behavioural model to a range of situational experiences.
Recognise the universal processes underpinning emotions.
Identify ways to break cycle in order to improve mood.

30 Layer the Play balloon game Participants Slide 9.
understanding of five utilising participants’ generate content, Balloons/pin.
mins areas model direct experience to and apply Flip chart.
by using participants’ build five areas model. to five areas Pens.
direct experience Whole group feedback model.
to build the five draw out participants’ The learning is
areas model. experience to map out extended when
and relate to five areas participants
model. appreciate ways
to break the cycle.

20 Apply learning: Play Through discussion Coaching small Slide 10.
the situation card participants map their groups, checking Situation
mins game. imagined reactions on progress. cards.
Divide large group to blank five areas map. Blank five
into groups of 4. Give Facilitator supports areas.
each group blank fives learning in the small Pens.
areas handout and a groups.
situation from the card Whole group reflection,
deck. Instruct small what did the exercise
groups to discuss help them learn?
their reactions to the
situation and record
them on the five areas


Session 2 Connect 5

15 minute break

Learning Objective
Discuss the factors that make it difficult to have mental wellbeing conversations.

D escribe the 3Cs of connected conversations: conversational feel, compassionate care
and communication skills.

practice the 3Cs of connected conversation.

Recognise the importance of self-reflection and self-awareness to the on-going development
these skills and attitudes.

Time Teaching activity Delegate activity Checks on Resources
and support learning

45 Whole group feedback Even number of groups. Observe the Slide 11-12.
Divide group into equal 5-minute discussion. discussion to
mins number of small groups. Half groups discuss check in on
Instruct half of the what gets in the way participation.
small groups to discuss of us having wellbeing Be willing to
what gets in the way of conversations. work with
initiating mental wellbeing Half discuss what gets discussion
conversations. Half discuss in the way of us as groups that
what gets in the way of individuals talking about haven’t taken
being open and honest our mental wellbeing off.
about our own struggles challenges. Work with
and difficulties. group, ask
Bring the whole group Feedback the questions that
back together to share the discussion from the encourage
small group discussions. small group into the deeper thinking
Building understanding whole group dialogue. and connection
from the group to participants’
contributions how stigma experience.
- fear of being negatively
evaluated - has a direct
impact on our willingness
and ability to talk openly
and honestly about our
troubling and difficult
Sum - up slide 12: stigma
1. We fear judgment

(we wear a mask).
2. Our own fears and

beliefs act as barriers
(can of worms).


Connect 5 Session 2

Delivery Plan (continued)

Time Teaching activity Delegate activity Checks on Resources
and support learning
Slides 11-20.
Teach 3Cs Slide 13-19 - reconnecting Observe the Flip chart.
connected with learning from session group to check Pens.
conversation. 1. engagement
In order to Connected conversation. levels. Use
have wellbeing Human minds need to be open questions
conversations we connected for health and to develop
need to create the wellbeing. and deepen
conditions that 1. Highlight the differences participants’
allow us to work learning.
round the barriers between conversation
i.e. Connected and controlled discussion
conversation. or interviewing.
1. Conversation feel. Highlight the beneficial
2. Compassionate mental wellbeing effects
of attuning, attending fully,
care. being with a person, helping
3. C ommunication them explore and generate
new thinking.
skills. 2. Compassion: noticing
Sum -up: Its not and acting.
complicated we Why is it hard to notice -
already know how to monkey business illusion
have conversations. (if not attending then won’t
Compassionate attributes
– a number of related
attributes that make up
3. Developing our skills -
reminder from session 1.
Margaret Wheatley quote :
Simplicity on the other side
of the complexity.


Session 2 Connect 5

Time Teaching activity Delegate activity Checks on Resources
and support learning Slide 21.

20 Apply learning Delegates work in pairs one Checking and
First practice. is A and one is B. using reflection
mins This gives Each person thinks of a to support and
participants first problem/issue at home extend the
go at connected or at work (not a big learning.
conversations 3Cs in overwhelming problem,
practice. more like a moderate
Your role is to create concerning problem).
the climate that First off A talks to B about
allows the learners their problem.
to ‘have a go’. Its B has a go at holding a
not so much about connected conversation
getting it right, (conversational feel,
but more a case compassionate care and
of seeing what communication skills).
happens. Facilitator stops and invites
Instruct the feedback on how it went,
group to get into how it felt.
pairs, encourage A and B swap over.
participants to Whole group reflects on
find a partner that the experience, what went
they don’t know well, what didn’t, what habit
or haven’t as yet did they find themselves
worked with. falling into?
Allow 7 minutes for
each conversation.
Allow time between
and after practice for
reflection. Ask what
happened? How did
it go? What did it feel
like ? What did you

15 minute lunch

Learning Objective
Practice five areas mapping.

Apply five areas model.
Construct questions needed to draw out five areas map.
Practice skills needed to draw out a five areas map.
Identify actions to break the cycle.


Connect 5 Session 2

Delivery Plan (continued)

Time Teaching activity Delegate Checks on Resources
and support activity learning

40 Practice 1 Whole group Co-create open Slide 22.
Apply the five areas in questions that can be Character
mins practice. Co-produce the used in the practice. story 1.
Facilitate the whole questions needed Observer
group to think together to draw a five areas Learning will differ sheet.
about the questions map. I.e. Their depending on the Blank five
that could be asked to Situation, thoughts, role they are playing areas map.
draw out the five areas feelings, physical (being the character
information use slide 22 and behaviours. gives insight into how
to summarise the kind it feels to be receiving
of information you are Practice triads the intervention; the
trying to collect. Groups of 3 worker role provides
Set-up practice sessions. (character, worker insight into applying
Coach the practice triads and observer). the learning and
(groups of 3 character,
worker and observer). The worker has a go the observer role
Time the practice. at asking questions provides insight into
At the end of practice, and mapping out the intervention as a
ask the observer to the characters whole.
feedback the skills
they observed and experience on the The aim of the worker
any suggestions for blank five areas map role is to:
development. and explaining how
Bring whole group back experience links Practice applying
together and ask for together. 3Cs of connected
overall reflections on the Character role play conversation.
learning activity using the formation Try out the co-
What worked, what on the handout. designed questions.
didn’t, what went well
what needs changing. Observer uses the Construct a five areas
observer sheet map which captures
to document the the character
skills they observe experience.
in the practice and Explain the vicious
use in reflective cycle.
feedback at end of Help the character
the practice. think though ways
they might break the
cycle in order to feel


Session 2 Connect 5

Time Teaching activity Delegate activity Checks on Resources
and support learning

35 Practice 2 Teach an evidence Playing (being the Slide 25.
Teach the BATHE based set of questions; character gives BATHE
mins technique. BATHE technique. insight into how it technique.
Rotate roles in the Return to the same feels to be receiving Handout.
practice triads. triads and change roles. the intervention; the Character
Time the practice. Another participant worker role provides story 2.
Coach the takes the worker role insight into applying Observer
practice triads. and practises using the the learning and sheet.
Facilitate whole BATHE technique to the observer role Blank five
group reflection. map out a characters provides insight into areas.
five areas of experience. the intervention as a
Small group and whole whole.
group reflection The aim of the
provides opportunity to worker role is to:
deepen the learning. Practice applying
3Cs of connected

Try out the BATHE

Construct a
five areas map
which captures
the character

Explain the vicious

Help the character
think though ways
they might break
the cycle in order to
feel better.


Connect 5 Session 2

Delivery Plan (continued)

Time Teaching activity Delegate activity Checks on Resources
and support learning

30 Practice 3: practice Return to the practice Participating Character
allowing participants triads. in the practice study 3.
mins to choose which Open to the group to groups. Observer
they want to try out choose to use either the co- Learning sheet.
(co-created created questions, BATHE depends Blank fives
questions, BATHE or to mix and match. Draw on role. areas.
or a mix ). out five areas map for the Worker
Rotate roles. third character. practises
Coach the communication
practice triads. Small group reflection. skills to capture
Facilitate whole Whole group reflection. characters
group reflection. experience as
Invite participants to written on the
reflect on the overall sheet.
practice process. Observer
The different Identify skills
learning gained being used.
from the different Character
perspective of the learns from the
worker, character experience of
and observer. receiving the
Encourage the intervention.
learners to reflect
on how the learning
developed over
the three practice

15 minute break
Learning Objective
Explore intensity and impact.

Examine professional boundaries.
Recognise when you need to help a person access specialist help and support.
Identify levels of distress that require safeguarding.
Locate relevant resources and services and how to signpost effectively.


Session 2 Connect 5

Time Teaching activity Delegate Checks on Resources
and support activity learning

40 Exploring intensity and Whole group Whole group Slides 26-31.
recognising suicidal discussion discussion,
mins distress check learning Steve (months
When would a five through the later) handout.
Boundaries (safeguarding areas intervention feedback
and referral). When not be appropriate? and build on Intensity and
would five areas not be participants flowchart
appropriate? What situation What would you see, understanding handout.
might someone be in? hear to alert you to to convey
What would you be seeing, distress beyond your session aims.
hearing? What cues would role and prompt you
you be picking up on? to encourage onward
Exploring intensity
presentations and aspects Input rationale for
of mental distress that being prepared
would trigger mental health to ask the suicide
service intervention. question.

Duration. Practice in pairs
Pairs discuss how
How generalised the they would respond
distress is. to Steve. Use the
stepping up flow
Impact and coping. chart to explore what
they need to offer
When encountering intense Steve.
levels of distress we need to
prepared to ask the suicide Whole group
question. reflection
What does steve
Teach the process of need?
suicidal experience (slide
27) and the stepping up flow Link to local
chart (slide 29). resources.

Introduce meeting
Steve again who is now
experiencing more intense

Instruct group to get into
pairs to apply the learning to
Steve’s experience.

Learning Objective
Stepping up support and using resources:

L ocate local services to support mental health and wellbeing.
Recognise the importance of self-help resources in promoting mental health and wellbeing.


Connect 5 Session 2

Delivery Plan (continued)

Time Teaching activity Delegate activity Checks on Resources
and support learning

15 Accessing services Range of local services and Slide 32.
resources Resource
mins and resources Hard copies. page in the
Internet links. participant
Resource guides. notes.
Use the expertise in the group
to extend knowledge of all the
relevant services.
Refer to the resources in
participants handbook (free to
access CBT booklets , on-line
courses, suicide prevention
and suicide prevention practice
Encourage participants to
engage with and explore
the resources.

20 Sum-up: Round Learners are encouraged to
robin. reflect on their learning and
mins Invite the commit to putting one things
participant to share into practice.
one thing that they
will change/do

Comments/suggestions/modifications for next time

Actions to be carried out before next session


Session 2 Connect 5

Slide 9

The balloon game

Safety talk The aim of the balloon game is to arouse emotion in
The purpose of the balloon game is to participants in order to elicit descriptions of each of the
manufacture a vivid and memorable experience. five areas of experince (changes in their situation, thinking,
The exercise needs to generate this so that behaving, feeling, and physical sensations).
enough participants can recall and describe their
experience in the whole group feedback. The feedback illustrates how different interpretations:
The aim is to use this whole group feedback to
build a shared understanding of the five areas T rigger different patterns of changes in thinking, feeling,
that combine to create our felt experience. physical feelings and behaviour.
We bring the five areas model to life though
experiential learning. C reate different reactions; some vicious cycles and
some not.
The experience must be memorable and vivid
so that the aspects of experience are easily Instructions
accessible to reflection. You would expect your
adults to respond across a spectrum. At one Give each participant a balloon. You should also blow
end some of your learners will be unmoved, one up too.
unbothered and relaxed others will have various
shades of experience through to the other end To Participants: “Please blow up your balloon, and if you
where they may experience feelings of fear and can tie a knot (participants might have to help each other).
panic. Note this is important learning in itself i.e. Then stand in a circle.”
we interpret events in different ways which in turn
generate different reactions. Facilitator: Stands in the middle of the circle.

To mange this in a way that best supports your To Participants: “Now hold your balloon up against your
adults to learn you need to trust in all the work you nose with your eyes closed.”
have already done to create an effective learning
space that can contain the intensity of all your Facilitator: Waits a few moments.
learners experience : the co-created and dynamic
ground rules, modelling a non-judgemental To Participants: “Now please open your eyes”
accepting stance, giving space for learners to
voice their fears and responding compassionately. Facilitator: Shows the group the pin and asks them to close
your eyes again. Walks around the circle and after a moment
When you set up the exercise negotiate with or two gently knocks a selection of balloons, avoiding those
your adults: does anyone need to sit out? of the participants who have expressed anxiety. After
Leave the room? balance this with gentle but another few moments facilitator bursts own balloon, low
firm encouragement and reassurance. Some of down away from people’s faces.
the best learning is when participants have very
vivid reactions. Your trainer skill is to harness Everyone sits back down.
everyone’s experience to layer and enrich
the learning to bring the five areas model
to life though the actual live experience of
your participants.


Connect 5 Session 2

Mental Wellbeing in Everyday Practice

Slides 10 Life situations card game

In small groups:
Select one of the life situations cards
you have been given.

Imagine what your reaction would be.

Map your reactions onto the five areas template.

Life situation Connect 5 Session 2 Slide 10
card game

Coaching small groups to meet individual learning needs.

Common issues which can be used to develop learners understanding and aid learning

Individuals in the groups have different These provide a good opportunity for coach
reactions (moving house one might be excited to reinforce the message that we all have
one might be worried). unique ways of interpreting, reacting and
Individuals in groups have same reaction but experiencing life, which is why we need to not
different experiences (can’t find parking space make assumptions and to develop our skills to
both might get agitated but one cries and the work along people to find out what their unique
other shouts). experiences are made up off.

Participants often put thoughts as feelings or We can think of thoughts as a statement or
feelings as thoughts. put it in inverted comas. Feelings are usually
one worded.

Confuse physical and behaviour, e.g., is crying a On one level it doesn’t really matter where you
behaviour or physical? put something as long as the person sees it that
way. However, a way to distinguish them might
be to follow up the description with:
Physical is something you don’t choose to do
it’s an automatic reaction you find yourself
doing it e.g. heart beating faster, tensing

A behaviour is more what you choose to do,
you might follow it up with ‘what would you see
me doing’ e.g. shouting, banging doors, walking
fast etc.

Opportunity to support the participants to see
how their reactions work in a vicious cycle
each one reinforcing the other.


Session 2 Connect 5

Slide 23-28

Why is it hard to be open about
your state of mind or your
difficult struggles with life?

Two types of stigma These range from largely automatic biological
reactions to linguistically-based or consciously
1. P ublic Stigma: the judgement from others, selected responses such as holding suspicious
that they will see us as weak or failing and if thoughts, self-blame, shame, rage, self-harm
it is our children who have mental illness, it and controlling our eating. The latter are likely to
reflects our failure as parent. appear later in developmental terms, to be more
open to shaping by local meanings, and hence to
2. S elf-stigma: the judgement, criticism be more culture-specific.
people turn against themselves.
The power threat meaning framework https://
Three concepts in the
understanding of stigma: Policy%20-%20Files/PTM%20Main.pdf

1. S tereotypes defined as positive, but more
frequently, negative social knowledge
structures that predetermine our attitudes;
e. g. people with MH issues are weak, dangerous,
can’t hold down a job, unreliable.

2. Prejudice which is the cognitive and affective
response that develops when a person or
group endorse negative stereotypes;
e.g. feeling uncomfortable being with or talking
to someone with MH difficulties, thinking they
can’t understand you, feeling unsure of how to
speak to them, thinking they will get upset etc.

3. D iscrimination which is the behavioural
reaction once prejudice sets in. e.g. avoiding,
excluding, treating differently.

The stigma, the fear of being devalued and cast
out of society, means threat is likely to be an
interwoven experience within our mental health
difficulty the learned and evolved threat responses
that an individual (or family, group or community)
may need to draw upon in order to ensure
emotional, physical, relational and social survival.


Connect 5 Session 1

Some of the ways stigma makes it hard to talk openly
about our experience

Shame, and stigma Not knowing how to initiate the
Are huge barriers to talking about mental health When should you do it? Where? With who? It can
issues? Contrast with how easy it is to talk about feel like the right time just never comes up.
physical problems ie the physical problem does
not define you in the same way and can often Wanting to hold something back
elicit caring responses. To talk about emotional - to be used only as a last resort
problems is much harder. Telling someone that The thought of opening up and the situation
you are struggling with your state of mind feels not improving can be scary. Its like you run
like admitting that there is something defective out of options, It is like not wanting to take a
about you as a person. paracetamol until your headache gets really
bad. The problem with this approach is that, by
It’s just so easy, and tempting, the time the pain is bad enough to warrant that
to say nothing paracetamol, it might have become a migraine.
And by then it’s a lot harder to deal with.
When it comes to things going on in one’s mind
it’s much easier, on the face of it, to keep quiet. Fear of passing on problems to
“No one can see what’s going on. If I just try to someone else
act normal, then maybe in time it will go away.” People can believe that they will contaminate
others with their mental health experiences
Fear of making things worse
Fear of the thoughts getting worse if you say talking-about-mental-health_b_7088502.
them aloud. If you have not shared how you are html?guccounter=1&guce_referrer
feeling when you imagine putting how you feel
into words it can sometimes feel like you will be
emotionally overwhelmed

Fear of not being understood

It’s tricky to put how you feel into words and
easy feel you won’t be able to clearly articulate
what’s going on in your mind and so you won’t
be understood. For many the prospect of
attempting, and failing, to communicate how
you are feeling is frightening. The best strategy
can feel is to try and make sense of experiences


Session 1 Connect 5

The fear of initiating mental
wellbeing conversations

For over ten years we have been asking Connect 5
participants to get into pairs and discuss ‘what gets in the
way of having wellbeing conversations’. We have asked
this question to participants from all parts of the system,
social workers, health workers, probation officers, police,
third sector, advice workers, etc. There is of course a
great deal of variation in the answers but the same time
there is a consistency in the themes. This huge non-
mental health helping workforce share a strong sense of
not being confident in their ability to have conversations
that invite in psycho-emotional experience. They believe
they do not have the necessary skills and fear risking
opening a ‘can of worms’.

Metaphorically speaking, to open a can of worms is to examine or attempt to solve some problem,
only to inadvertently complicate it and create even more trouble. Literally speaking, opening a

can of worms, as most fishermen can attest, can also mean more trouble than you bargained for.

We can see here, how the stigma is at work...

The stereotype = our knowledge system The prejudge = feeling uncomfortable or
that forms our beliefs is that, if we are not unqualified. Thinking it’s not my job someone
specially trained, inviting conversation into how else does this work.
someone is feeling or how they are struggling
risks complication. Potentially making things Discrimination = not engaging, avoiding.
worst by unleashing negative emotion that
can’t be contained which could damage the
person further.


Connect 5 Session 2

Slide 11-20

The 3Cs of connected
conversation: the conditions
that make mental wellbeing
conversations possible

Connected conversations are not the kind of conversation you have all the time and are not designed
to replace normal practice. Rather they are an addition to the practice tool box, to be used when the
occasion calls and then when the need has passed, to put back in the practice tool box until the next
time it is needed. Connected conversation are like ‘pop up’ conversations. When the need arises,
a temporary space for a connected conversation can be created within everyday practice (just like
a pop-up restaurant might be in a house, and yet for a short space of time the house becomes a
restaurant before returning back to being a house).

What is a mental wellbeing conversation
(connected conversation)?

It is a conversation contained in a compassionate space that is both safe and energetic.
The compassionate space needs to contain the intensity of a person’s life and generate new thinking.
The dialogue needs stay open to allow the person to explore what they don’t already understand.
The purpose is to gain fresh insight and understanding and provide a new basis from which a person
can think, feel and act.

The 3Cs of Connected Mental Wellbeing in Everyday Practice
3CsCreating the best conditions for
1. Conversational feel
2. Compassionate care mental wellbeing conversations ocofncvoenrnseatcitoend
3. Communication skill
1. Conversational feel
For a CC we need to move away from CARE
controlled discussion toward open discovery
dialogue. We contrast controlled discussion 3Cs © Elysabeth Williams 2019 Slide 13
with open dialogue discussion in order to Connect 5 Session 2
highlight the unique aspects of a CC.


Session 2 Connect 5

FEELCONVERSATIONAl Mental Wellbeing in Everyday Practice

moving away from controlled
discussion toward and open
discovery dialogue

Controlled discussion is designed to Open discovery dialogue helps to surface
get a person to choose between one or the alternatives and lay them side by side,
two alternatives. so they can be seen in context.

Aims to fix a problem. Reaches new understanding, from which to
think and act.
Tends toward either/or thinking.
Evokes new insight (reordering knowledge
Focuses on closure and completion. and assumptions).

The agenda is controlled by the worker. Power is shared: people think together,
the content is co-produced and unfolds
Only sees parts of a person . within the space.

Sees the whole person.

Connect 5 Session 2 Slide 14

What does open discovery dialogue safeness in our everyday lives. These feelings
offer for mental wellbeing of soothing from kindness and support help us
conversations? feel safe and they work through brain systems
similar to those that produce peaceful feelings
Connecting (attuning) though conversation. associated with fulfilment and contentment.
We’re all in it together. Substances in our brain called endorphins are
important for the peaceful, calm sense of well-
Providing a safe but energised space which being. These are also released when we feel
makes it possible to think together and kindness. There is also a hormone called oxytocin
generate new thinking that create possibilities which links to our feelings of social safeness
for action and change. and affiliation. This hormone (along with the
endorphins) gives us feelings of well-being that
1. C onnecting (attuning) though flow from feeling loved, wanted and safe with
conversation. We’re all in it together others.

There’s a phenomenon known as “entrainment”. For a connected conversation we need to offer a
when two people are emotionally connected, person our total attention and listen fully.
“…the brain that has the most coherent wave We seek to understand the other person rather
patterns - patterns associated with calm, than just making our own point. This kind of
relaxation, and peace - seems to “pull” less open dialogue experience in conversation
coherent brains into synchrony with it.” (Martha can only take place amongst equals. If anyone
Beck, Finding Your Way in a Wild New World). feels superior, it destroys the openness of
the conversation. Words become tools to
This means that if you can drop in, remain dominate, coerce, manipulate. Those who act
grounded, and stay calm, you can literally attune superior can’t help but treat others as objects to
others to you. You can help them relax, see more accomplish their causes and plans. When we see
clearly, and feel seen and understood. If you’ve each other as equals, we stop misusing them. We
ever been around someone who is fully present are equal because we are human beings.
and noticed that you also felt less frenzied and
more relaxed, then you know what this is like.

Affection and kindness from others also help
soothe us adults too when we’re distressed.
When we feel soothed, we have feelings of


Connect 5 Session 2

“When we’re brave enough to risk conversation, 2. Providing a safe but energetic
we have the chance to rediscover what it means
to be human. In conversation, we practice good space a place to think together which
human behaviours. We think, we laugh, we cry, we
tell stories. We become visible to one another. We has the possibility of generating new
gain insight and new understandings. As we stay in
conversation, we may discover that we want to be ways of thinking and acting
activists in our worlds. We get interested in what
we can do to change things. Conversation wakes ‘Dialogue is a conversation in which people think
us up…we become people who work to change our together in relationship. Thinking together implies
situation”. (Margaret wheatley 2009). that you no longer take your position as final….
you relax your grip on certainty and listen to
By being emotionally attuned, you offer a person the possibilities that result simply from being in
the gift and solace of not being alone. That you relationship with others-possibilities that might
get what it is like for them at that moment. otherwise not occur. The intention of dialogue is to
This offer of emotional connection at a time reach new understanding, and in doing so, to form
of another’s vulnerability is really what makes a totally new basis from which to think and act.’
us humans, feel connected and face moments (William Issacs (1999) Dialogue and the Art of
and periods of life’s challenges and unwilled Thinking Together).
aloneness more tolerable.
Blog providing summary of dialogue art of
Read more about role of attunement in thinking together
conversation dialogue-the-art-of-thinking-together/

Conversation on its own isn’t enough for a mental wellbeing conversation,
as well as talking there has to be caring i.e. compassionate care.

CARECOMPASSIONATE Mental Wellbeing in Everyday Practice the science of

Compassion compassion: the

a sensitivity to a commitment to components of
others or your try and relieve and
own suffering prevent suffering compassionate practice

Notice and engage + Act (do something about it) Paul Gilbert’s compassionate mind
Develop your understanding and approach integrates affiliative behaviour
skills (e.g. doing Connect 5) (evolved innate care giving and receiving
abilities) with use of compassion in health
Paul Gilbert: The compassionate mind foundation care settings.
He argues that compassion is essential
Connect 5 Session 2 Slide 15 for care in practice because of the way
we have been built though the process of
We have a difficult and complex brain
with a range of powerful emotions and
urges. We have an old brain capacity for
powerful desires (like love, sex, status
and belonging) and our related emotions
(such as anger, revenge, anxiety and
depression) were built by evolution over
millions of years.


Session 2 Connect 5

We also have new brain abilities to use our Watch this video showing playful,
attention, imagination and ability to fantasise, affectionate interactions between a
think and reason. These new brain abilities can dog and an orang-utan
also cause us serious problems and distress
Basically, our new brain capacities can be Helping us see that these capabilities and
hijacked and directed by old brain passions, enjoyments have also evolved and operate in the
desires, threats and fears. brains of animals:

We did not choose to have a brain like this – we
did not choose to have the capacities for anger orangutan-and-hound-dog-b_n_299010.html
or anxiety – we did not choose to have a brain
where it is so easy for anger and anxiety to take This natural inbuilt capacity for kindness and
hold of our thinking. So Paul Gilbert argues compassion for ourselves and others helps us
that the key issue is how we can learn to stop deal with many of our more unpleasant feelings
blaming ourselves (i.e. become compassionate) such as anxiety, anger, and even despair.
for what we feel or how we’re reacting, become
aware that this is the working of a brain that’s Dalai Lama, defines compassion as ‘a sensitivity
been designed for us, but that we can take more to the distress of self and others with a
responsibility for our minds so that we don’t just commitment to try and do something about it and
end up like a boat without a oar being rushed prevent it’ .
along on rivers of desires, disappointments,
passions or emotions. The two aspects to compassion
therefore are:
Paul gilbert also points out that we mustn’t be
too one sided, and only focus on unpleasant 1. Notice and engage: i.e. awareness,
emotions, because our brains have also evolved attention and motivation.
great capacities for enjoyment and happiness,
for caring and peacefulness. Kindness has 2. Act: skilled intervention involving
evolved to be especially important for humans commitment, courage and wisdom.
because from the day we are born to the day
that we die the kindness of others will have The attributes and
a big impact on us - as will our own kindness qualities of compassion
for ourselves.
One way of seeing compassion (they are many)
Mental Wellbeing in Everyday Practice is that, because it is an essential element of
our humanity, it is made up of different aspects
CARECOMPASSIONATE Connected conversations: of our mind.
Compassionate components
Paul gilbert distinguished between the attributes
Resisting judging a person’s pain, Resisting Motivation Motivation/commitment and qualities that make up compassion and the
distress or situation and simply accepting judgement (care of others): to be caring, skills of being compassionate. Both need to be
and validating their experience supportive and helpful to others cultivated and practiced.

Emotional aspect recognise another’s Empathy Sensitivity the capacity to maintain an open Six key compassionate qualities and attributes
feelings, motivations and intentions; Sympathy attention, enabling us to notice that enable us to notice, engage and take action
Distress when others need help with the suffering of others:
thinking aspect make sense of tolerance
another’s feelings and our own Motivation, Sensitivity, Sympathy, Distress
responses to them Tolerance, Empathy, Resisting the urge to judge

our ability to bear difficult feeling in others The ability we all have to be moved All together, these six attributes form a powerful
and ourselves emotionally by another’s distress orientation toward suffering, which unfolds from
awareness to action.
Connect 5 Session 2 Slide 17


Connect 5 Session 2

Slide 16

Monkey business illusion

Attention W ithout attention learning is very hard even
with lots exposure.
We only have limited attention.
Often in work we have numerous things we are
When it is focused on one thing it misses focused on (paper work, target, time) which
other things; If we attend to this we can’t might mean we do not attend to cues.
attend to that.
W ellbeing conversations challenge us to use
We tend to focus attention on what we think our attention in a particular way. To focus fully
is important. on the person: attentive listening.

Attention is the gate keeper to perception
and knowledge.

Learn more about attention

Watch the visual attention experiments

Mental Wellbeing in Everyday Practice

The Monkey Business Illusion

Connect 5 Session 2 Slide 16


Session 2 Connect 5

The skills of compassion

Involve learning to direct our attention in a compassionate and helpful way; learning to think and
reason in a compassionate and helpful way; and learning to behave in a rational and compassionate
way. We need to do each of these with the feelings of warmth, support and kindness. Connect5 aims
to develop these skills.

Compassionate qualities and attributes

Motivation (GIVE) Distress Tolerance
The motivation to be caring, supportive and This is our ability to bear difficult feeling in others
helpful to others. The ‘commitment to try and and ourselves. This is a challenge for many of us.
do something about it’ The motivational system People who feel overwhelmed or distressed by
provides the focus, the purpose and the point of another’s distress will tend to evaluate emotional
all the other abilities. experience as a bad thing and will either:

NB individuals who are motivated to help others F eel unable to face it and so have to turn away
rather than ego-focused have better social (escape the uncomfortable emotions).
relationships, less conflict and greater wellbeing
(5 ways to wellbeing: GIVE). Or

Sensitivity (Take Notice) F eel compelled to act as rescuers, trying to
Sensitivity means the capacity to maintain turn off the others distress as fast as possible.
an open attention, enabling us to notice when
others need help. it is the opposite of ‘turning a Being able to bear distress and cope with it allows
blind eye or being too preoccupied with us to ‘be’ with the distress; to remain present to
other tasks. actively listen and be able to work out with the
other person what might be helpful.
The ability we all have to be moved emotionally If we are not able to deal with our own feelings
by another’s distress. An emotional it will undermine compassion, lower morale and
connectedness from which we spontaneously make us vulnerable to burn out.
feel the need to help I.e. sympathy is linked to
sensitivity plus the urge to help. Find out more: Understanding distress
intolerance and how to cultivate distress
tolerant skills


There are two aspects to empathy: emotional
and thinking. The emotional aspect to helps
us recognise another’s feelings, motivations
and intentions. The thinking aspect helps
us make sense of another’s feelings and our
own responses to them. The process is less
automatic and spontaneous than sympathy and
requires effort and time to imagine what it might
be like for that person in their predicament (to be
in their shoes).


Connect 5 Session 2

Non condemning: Resisting the urge to judge

This means trying not to add judgement to a Compassionate Mind Training involves a range
person’s pain, distress or situation (it’s like this of skills and attributes. We can train ourselves to
because of that, that’s good /bad, it shouldn’t attend to things that are helpful to us and others,
happen, you should do this or that) and simply to focus our thinking on things that are helpful
accepting and validating their experience. to us and to others and to behave in ways that
are helpful to us and to others. This develops
“With compassion, we notice suffering, we are a compassionate orientation, motivation and
moved by it, and we want to help. In order to do abilities to be open to and tolerant of distress.
this, we must work to tolerate distress, and to From here we can work on whatever problems
resist judgment and empathically understand we need to work on – from an understanding,
the causes and conditions that contribute to the kind and compassionate position.
suffering and difficulty,” ( Paul Gilbert and Alys
Cole-King). Another idea from Paul gilbert is the flow of
compassion. Whether compassion is developed
in self, given to others or received from others all
sources interact to build compassion within and for
ourselves and others.

Mental Wellbeing in Everyday Practice Compassionate care: the theory and reality. Paul
Gilbert and Alys Cole-King
SKILLSCOMMUNICATION Connected Keeping it open
conversations: Compassionate%20care%20ACK%20and%20PG.
Using open questions invites in the pdf
the skills that make it possible persons experience as it is for them.
Who What When Where Why Training Our Minds in, with and for Compassion
(use ‘Why’ sparingly). An Introduction to Concepts and Compassion-
Focused Exercises
Picking up and empathically responding to the cues
Maintaining an open non-judgemental attention enables you to pick up and respond to cues beyond words;
to be present, to listen and help work out with the other person what’s helpful to them. Watch Professor Paul Gilbert explores the science
“That sounds really difficult, I can hear how upset you are”. of compassion and how we can put this into
practice to create happier lives
Collaborate (keep sharing the power) - for ourselves and others around us
Checking out with the person at every step, helps maintain safety and involvement ensuring you only go where the
person wants you to.
“Are you OK talking about this with me today?”
“Would you like us to think together about where you might get some more help with this?”

Reflection These skills keep the dance of the communication going. They help co-create a new understanding,
& summary keeps you checking-in whether you are hearing accurately and help the person get an outside
perspective on their experience.

Connect 5 Session 2 Slide 18

Communication Skills:
how to use your communication skills to have connected conversations

Use Open questions

Closed questions compared to open questions, narrow down the possible answers and are usually
based on the askers assumptions which narrow down the field of enquiry. Open questions are fuelled
by interest and curiosity creating an open space for the person to fill with their own experience, as
it is for them. A good question gets a person to think and draws out information. Open discovery
questioning is the best way of going from what we don’t know to what we do know.


Session 2 Connect 5

How, What, Where, When, why (use why Reflection and summary
sparingly, as a Why question risks getting into Using these skills are ways to keep the dance of
fixing and judgment) Open directives can help communication going.
narrow down the field of inquiry, whilst at the
same time still ensure it is coloured with the Reflection Using this skill gives a person the
person’s own experience. chance to hear what they have said from
the outside. This can be helpful in furthering
Share the power understanding and giving it a different
(learn to collaborate) perspective.
Open discovery communication can only be
achieved collaboratively. It doesn’t work if you It also gives the person a chance to refine and
are ‘doing to’ or ‘telling’ since it doesn’t help the correct it. It might be you have misinterpreted or
person discover for themselves. Negotiating it might be that when they heard it said back to
and sharing power is all about using your skills to them they see they didn’t quite mean it that way.
ensure the other person fully engaged in
co-creating the dialogue. Summarising This is a process of giving an
overview of what has been said in your own
Would you like to talk about this with me now? words. Summarising reinforces that you have
been listening closely to what has been said and
Is this something you feel happy it can also help to:
exploring further?
E ncourage the person to begin to talk.
What’s the most useful thing we can focus
on today? Introduce and expand on a particular issue.

It is also a way for you to be clear about the B ring focus and clarity when a person has
process whilst leaving the content free to lost focus.
be theirs:
E nd a discussion and introduce the need
W e have 20 minutes today, what do you want for action.
to use that time for?
Provide a bridge after a break.
You’ve talked about a lot of things today,
we have 15 minutes left what is the most See more about key skills at the Charlie Waller
important thing you want to focus on in the memorial trust learning portal
time we have left.

Respond to cues: empathic
So much of what we communicate is non-verbal.
Picking up on the cues and responding to them is
an effective way of showing the person you are
listening, showing the person you are attending
to them, signalling to the person that you are
caring and compassionate toward them. This in
turn will help them to open up and discover and
share their experience.

If you are able to do this, you will be also be able
to pick up:

If someone doesn’t want to get into things
(what would you see, what would you hear).

Too upset, or getting upset by talking (what
would you see, what would you hear).


Connect 5 Session 2

Simplicity is on the other side of complexity

Connect 5 is not trying to teach a technique, it is “Everything has become quite complicated. Things
not a therapy or counselling course. Ultimately, that were simple, like neighbourly conversation,
there is no “technical solution”, no step by step have become a technique, like intergenerational,
process we can teach. Rather, open discovery cross-cultural dialogue.
dialogue is about being. It is intuitive and must
be mastered. It is already within us and must be Once a simple process becomes a technique, it can
learned inductively. grow more complex and difficult. It never becomes
simpler. It becomes the specialised knowledge
We are leaning into what us humans already of a few experts, and everybody else becomes
know how to do well i.e. hold conversations that dependent upon them. We forget we ever knew
allow us to think together. Connect 5 is merely how to do things like conversation, planning or
reminding people about what they already know. thinking. Instead, we become meek students of
The complexity is in taking apart what we do difficult methods.”
naturally and reminding ourselves of the parts
before we put it back together and get on with (Margaret Wheatley (2009): Turning to one
doing what we do. We are not trying to teach another. Simple conversations to restore hope
a technique rather we see a value in helping for the future).
participants pay attention to creating the
conditions that are enabling or disabling,
helpful or unhelpful when it comes to having
wellbeing conversations.

Mental Wellbeing in Everyday Practice

side of complexity

“Everything has become quite complicated. Complexity
Things that were simple , like neighbourly
conversation, have become a technique, like
intergenerational, cross-cultural dialogue.

Once a simple process becomes a technique, it can Simplicity
grow more complex and difficult. It never becomes
simpler. It becomes the specialised knowledge of a
few experts, and everybody else becomes dependent
upon them. We forget we ever knew how to do things
like conversation, planning or thinking. Instead,
we become meek students of difficult methods.“


Margaret Wheatley (2009) : Turning to one another.
Simple conversations to restore hope for the future.

Connect 5 Session 2 Slide 19


Session 2 Connect 5

Mental Wellbeing in Everyday Practice

Practising conversational skills in pairs

Person ‘A’ Person ‘B’

Think of a difficult work/home situation Use the skills to open the conversation and
you have recently faced that you are let the person know you are really hearing
comfortable talking about now. what they are saying.

Connect 5 Session 2 Slide 21

Slide 21

Putting it all into Practice

Applying the Five Areas model and the skills needed to have a wellbeing conversation
The first step is to think about and have ready some well-designed questions that participants can
use to work with a person to draw out their unique five areas map which accurately represents their
current experience.
The facilitator works with the whole group to co-design questions that would map out the five areas.

Writing the agreed questions on the flip chart

What question would you ask to What questions would you ask to
understand the situation? draw out the person’s physical
What’s going on for you at the moment?
What brings you here? S ince this has been happening what changes
What’s troubling you at the moment? have you noticed in your body?
How have you been feeling physically since this
What question would you ask to has been going on?
draw out the person thoughts in
response to that situation? What questions would you ask to
draw out the person’s behaviour?
W hen x happens what goes through your mind?
W hen x happens what kind of things do you What have you noticed doing differently since
tell yourself? x has been happening?
What kinds of things have you been doing to
What questions would you ask to cope since x has been happening?
draw out their feelings in response
to that situation?

W hat feelings do you have in response to x?
How would you describe your feelings when
x happens?


Connect 5 Session 2

Slide 24

Structure for practice

The co-produced questions are used in the first It is generally, especially on the first practice,
practice. This is done in the spirit of see what quite a challenge for some of the participants to
happens, rather than trying to get it ‘right’. stick to the questions, to gathering and exploring
Setting the tone so that the practice groups are information and fill in the five areas.
supportive and encouraging and sense of trying
it out and learning together. As the practice finishes, allow time for the small
group to feedback to each other, as a source of
It is also an opportunity for the facilitator to reflective learning. The worker and the character
coach the small groups. Sensitively and gently have an opportunity to describe what the
listening in to the practice, offering positive process felt like, and the observer can feedback
encouragement and gentle challenge. The kinds what they observed during the process.
of things that you might want to challenge are:
The facilitator invites whole group feedback by
When participants have jumped to or are sliding asking how did it go? Did the questions work, did
into fixing. This can be very obvious e.g. when you need follow-on questions? What happened,
they have got into telling the character what to what did you notice? Opening up a space for
do, or it can be very subtle e.g. when they are further reflection and learning.
leading the character away from exploration of
their experience and into questioning about what
they are doing or what they could be doing.

When participants are psychologising Mental Wellbeing in Everyday Practice
(generating theories to explain why) rather than
gathering and exploring experience as relates Structure for practice
to the five areas. This similarly can mean the
character is lead away with leading questions Opening question (how are you? how are things?)
into exploring a particular aspect of their Quick exploration of the situation
experience (their past, or relationships, etc.) Introduce the 5 areas map
rather than focusing on drawing out the five Negotiate with the character about having a go
areas experience. Ask questions so that each area is covered, and fill in the map,
so that the character can see it; if the worker is not sure
which area to put something, ask the character where they
want to put it
Help the character to make the links between the 5 areas and
see how they form a vicious cycle

Connect 5 Session 2 Slide 20


Session 2 Connect 5

Slide 25

BATHE technique

Practice no2 Give time for whole group feedback. This is an
opportunity for the large group to learn from
Rather than use own questions the BATHE each other and from the different experiences
technique gives participants the opportunity to and opinions in the group, not a matter of right
try out an evidenced based set of questions and and wrong but of what works best for different
see whether they prefer this or whether they people. Different styles can be different ways
prefer their own questions. Participants feel very of getting the same outcome . Here are some
differently about this. Some like the support reflective questions you might ask:
and assurance of a ready made set of questions
whereas other feel that it is to prescriptive and How did it go? Did the BATHE questions draw out
takes away the natural flow. There is no right all the Five areas? Did you need other questions
or wrong we are just giving participants the up your sleeve?
opportunity to try out different methods and
learn by their experience.

Background = situation Third practice

Affect = feelings (could be thoughts) Participants in the practice group change roles
again and this time leave it up to the group to
Trouble = thoughts (feelings) mix and match. Use which ever method they feel
comfortable with.
Handle = behaviour
Final opportunity for the facilitator to move
Empathy = is essential to keeping the around the groups and pick up on opportunities
conversation going. to support and coach the small groups.

It’s good to remind participants about the BATHE Technique Mental Wellbeing in Everyday Practice That must be very difficult for you
importance of empathy and compassion.
They have a lot to think about when What’s been happening What troubles you most I can see how upset you are
practicing and often forget about empathic since I last saw you? about the situation?
acknowledgment. I can hear how angry you are
What is going on in your life? about that
Once again it is an opportunity for the facilitator
to coach the small groups. To pick up on fixing, Your reaction makes sense to me
leading questions, psychologising as well as
encouraging and reinforcing good practice such B A T H E
as attentive listening, use of skills, empathetic

Give time for the triad practice group to reflect How do you feel about it? How are you handling it?
back to each other. What helps you to handle it?

From: Stuart, M.R. & Lieberman, J.R. ‘The Fifteen Minute Hour: applied Psychotherapy for the Primary Care Physician. New York: Praeger, 1993

Connect 5 Session 2 Slide 21


Connect 5 Session 2

Mental Wellbeing in Everyday Practice

Exploring intensity questions

It would be useful for us to get a better understanding of
the difficult feelings that you mentioned:

How long have you been feeling like this?
What seems to set off these feelings?
(where, with whom, when)
What effect is this having on your life? How is it impacting
on your personal relationships, occupation/study, social life?

Slide 26 Connect 5 Session 2

Exploring impact
and intensity

The aim of this section is to explore the 2. Exploring intensity and impact
boundaries of what we are teaching; we are
not teaching participants to be mental health When you are drawing out a five areas map,
workers. Nor should Connect 5 intervention you are gathering lots of information that could
be done with everyone, or replace all of alert you to a person needing more specialist
existing practice. intervention. If someone was describing e.g. lots
of very bleak thoughts or not being able to cope,
So we want to explore: not going out etc.

1. W hat circumstances would you not The slide 26 documents the kinds of experiences
want to do connect 5 intervention that should alert us that the person needs
mental health intervention.
What would you be seeing or hearing that would
alert you that this was not the right intervention 1. D uration: if the person has been suffering
at this time? difficulties for some time and things haven’t
changed or are getting worse.
E.g. people in:
2. H ow generalised the feelings are i.e. there is a
Crisis difference between feelings that are occurring
Chaotic all the time in lots of circumstances or
Very distressed that only occur in specific or particular
Under influence drugs alcohol circumstances.
Violent or Angry
Non cooperative 3. T he impact of the difficulty on a person’s
home, work and social life. We should
particularly concerned if someone’s life is
being to get smaller and particularly if they are
stopping work.


Session 2 Connect 5

Slide 27-29

Suicide as a process

Although suicide sometimes appears to be an Patient Health Questionnaire - 9 (PHQ-9)
impulsive or sudden act, it is more usually a
process. Which means if we are more open and ‘Thoughts that you would be better off
able to explore experiences of hopelessness dead or hurting yourself in some way’ is the
and thoughts of suicide we will be able to slow 9th question on the PHQ; this is the NHS
down and intervene in this process by helping assessment tool for diagnosing depression.
the person access help and support and thereby
prevent suicide in our community. AssessmentTools/14-PHQ-9%20overview.pdf

Slide 22 This means that thoughts about ending your life

The Connect 5 tool kit gives us insight into a
person’s experience. If we find that a person has are a widely recognised symptom of depression
been suffering distress for some time, triggered and much more common than we think. The
by and affecting different aspects of their life e.g stigma that still surrounds suicide mean that
personal relationships, occupation, study and/or there is plenty of misunderstandings and myths
e.g. some of us still believe that by talking about
social life then we need to:
it you could put the idea into someone’s head.

1. Help them access more specialist mental help

and support.

2. Be prepared to explore whether they also
have feelings of hopelessness and thoughts
about ending their life.

Mental Wellbeing in Everyday Practice Mental Wellbeing in Everyday Practice

The pro=cess of suicide SHuoicpiedlaeslsCnoensstinuumUcPdrnriirssoeitlsrsoeoanslngsvdee/ddor aSpuoictiednetibalescoolmuteison aAnsdkisnugictihdealpetrhsoounghatbsout hopelessness“yfS“oeWeYoeuvomlreuoshanYeethrocIoioftnldacpfuiygmveeeersosesxxlreeu.spoplmIss’ifillefdoeskwuenrrleaiirnidheesktnt;enheatwidooncetphnhiropbneeeaheugartvdesoih?sledolk”tepphtnrhlyheaotoiosthhupuyeeaemogyvxhu-peaobterhtrsrehreaeiaeevaaabnelktbsochobotuiohneuetuegetxegnhcpinnhhoefdtteawresinieiennatglnsihnnrteceidgshiaanefivcsnegiertdeafrioo/elffyionwneelrog,nlcipswnstlarigiyfnoafesoegnlo.uogdIynsfuhohghatauaehrov?vddiepseItdessdhsiloetestehmatssrpircsseteerneositrbesdhskes?oiydnsdon“rgaitunahnynknoedidenuysegbcuhduaimacintvlidoodesarabtfelaoebtriuhnrtpinodtrtdoeuhgpgeeahtrtoes.d

+ The Five Areas ExperienceApic.cebroo.osmtpehtefeeonarctcnthte,diienvongoeffasfebtfrlheahaotconptpeoreotrvosideIntensed/iustnrbeessarable Death Connect 5 Session 2

SaCsonSRoocdeelpivnafliiirnlsngiseeggiounoaspndnfkps/iidslonlsptprtrirrionitbsuilacelmwbeolriethfsPlanning deathAttempting suicide Slide 24

Thoughts about death Self harm behaviour process” Goldney & Burvil, 1980
Suicide lies at the continuum “a common suicidal
end of a

FHWeooperetlhleilensssgnsnesessss BWSSAetDitotcohrhptipdninatrksagaivenlwkregiieinkonc/iggnkutgtla/eorkhnsispnesoelgltypogd/portluiaengkgsinogurtisks T““I“I“hIj“hu’ImMaosawntvyaiudseclhibangfneuneIohrc’vittsdoehtgeourisonnvlwdgeotaogrntk”oo”eelvtiuvoepers”yfloeoenr pe“ ” PDMeNhrCxeaohhyinnarmtoesuadnosillycitt/ceiaavwpdanliattdiihonponhuytseicnaellrygy
Guilt Slide 23

Connect 5 Session 2

Keith Hawton (Ed) (2006) Prevention and Treatment of Suicidal Behaviour: From Science to Practice. Oxford University Press: Oxford
Centre for Suicide Research. University of Oxford


Connect 5 Session 2

It is important that everyone is confident and has Mental Wellbeing in Everyday Practice
the skills to ask specific questions about suicide.
If there are indictors that a person may be at STEPPING UP FLOWCHART
risk. The flow chart on slide 29 combines a set of
simple questions with a decision making tree to YES LOW NO
guide the conversation.
HHHEoooxwwwpliolonofnttergeennhsaheIvnaaevtreyeeoyntuohseubitsebyeeentehnfoehueaglivnhigntsgtfhtoihsreywtoahuyo??ughts? yIWWfIodthuhheaaidntntogmktaseiafnwekydpeewsrspeyhtrohtooouinwctsgoehasuafcbelntde?giyvtetoeewurhtfoaeartlclw?wtooorurslesd?
The latest thinking in suicide prevention is HIGH
that we will only prevention suicide if we all get pBsArauogifltdereeocitenniveceaxlifusaptdcilntiaongnrgsp:feorsronsatal ying
involved. It is worth noting that only about 1/3 of yHMoauevemthyigoohudtgdoontehsiso?far as to think about how mSPiregonnvtpiadoleshtreetaoleltvkhaesnyutcpsopenoltfrahtcetlspfroersources
people who die by suicide are in touch with the
mental illness services. It is the single biggest gIPjoultasatnnpnelaienndgintomcihnedcfko.rI?s it something you’ve
killer of men under 55 in UK.
UFaKFrnnueodirimvttehThrrSHesecriaatieyrtwemnPtacoredeennisntt(soEgo:dPOf)rSxa(u2fcoi0ctri0icdd6ea).lPOBrexehfvoaervndiotiuorn: hyI’oomwurtteooallgelyeatwveyoohrureiertehdrtaoobudogauhytwwyohiteuhroaeunytdoadupoalnar’ent want Emergency Action Arrange help
You will need to know for Inform the person’s GP
now. Inform Manager Follow protocol
National Suicide Prevention Strategy Connect 5 Session 2
attachment_data/file/772184/national-suicide- Slide 25

Your local suicide prevention strategy and local
facts and figures.

Your local suicide prevention services and

Be familiar with the recommended on line
resources below.


Session 2 Connect 5

Resources in participant notes

Free to access wellbeing resources

Download the new economics five ways to wellbeing cards

Five steps to mental wellbeing
Evidence suggests there are five steps we can all take to improve our
mental wellbeing.
If you give them a try, you may feel happier, more positive and able to
get the most from life.
Body. Mind. Spirit. People. Place. Planet. Welcome to the Wheel of Well-
being. If you’re interested in health and happiness - from a personal or a
professional perspective - we hope you’ll find the WoW website a good
place to start, and you’ll come back and visit often.
Build happiness, resilience, connection and more with research
backed tools.
Some top tactics for implementing the five ways to wellbeing
in your life, right now.
Action for Happiness helps people take action for a happier and more
caring world.


Connect 5 Session 2

Free to access self-help resources

Every Mind Matters
How are you taking care of your
mental health? Get expert advice,
practical tips and a personalised
action plan with Every Mind Matters.

Watch the advert

Living Life to the Full : helping you help yourself How to... How to...
Free online courses covering low mood, stress
and resiliency. Work out why you feel as you do,
how to tackle problems, build confidence,
get going again, feel happier, stay calm, tackle
upsetting thinking and more.

A range of self-help guides from the OvaenrdcaonmxeiefteyarLmooenktaafltheeraylothur
mental health foundation

Self Help Leaflets - Northumberland, Tyne and 1 1
Wear NHS Foundation
Self help guides produced by Northumberland,
Tyne and Wear NHS foundation Trust titles cover
a range of mental health issues.

Reading Well
Reading Well helps you to understand and manage your health and
wellbeing using self-help reading. The books are all endorsed by health
experts, as well as by people living with the conditions covered and their
relatives and carers. Available in all libraries.

NHS Choices Moodzone
Whatever you need to know about coping with stress, anxiety or
depression, or just the normal emotional ups and downs of life.
It offers practical advice, interactive tools, videos and audio guides to
help you feel mentally and emotionally better.

Check your mood with our mood self-assessment quiz

Mindfulness for Wellbeing and Peak Performance
Free 4 week course. Learn mindfulness techniques to reduce stress
and improve your wellbeing and work/study performance in this
online course.


Session 2 Connect 5

Free to access suicide prevention support

Free e-learning & suicide prevention web resources

Free e-learning We need to talk about suicide: helping everyone to feel more confident to talk
about suicide” is an e-learning programme
that has been developed for the wider public
health workforce including voluntary sector,
emergency services, prison staff and prison
listeners and all staff in health and social care.
The learner will be able to complete the
entire programme at once, which takes
approximately between 60 and 90 minutes, or
complete at their own pace in smaller sections.

Safety Plan guidance tools with
easy to print / online templates and suicide-prevention/

guidance video tutorials Online resources including self
purposefully designed to help people help booklets, dvd’s, helplines,
through the process of writing their
advice and support.
own Safety Plan to build
hope, identify actions and strategies

to resist suicidal thoughts and
develop positive ways to cope
with stress and emotional distress.


Connect 5 Session 2

It’s safe to talk about suicide

Suicide is rare, but... What are the
warning signs?
it happens.

there are over 6,000 deaths by suicide in the There may not be any. An emotional crisis is not
UK every year – an average of 16 per day. like a heart attack or a stroke, where there are
visible warning signs.
Don’t think: “It couldn’t happen to us.”
It can happen in any family. People who have reached rock bottom can be
very skilled at hiding their thoughts and feelings.
Intense emotional strain and mental exhaustion
can cause people to behave in uncharacteristic They MAY be: They may ALSO be:
and unpredictable ways. Q uiet
B usy
Don’t think: “He’s not the suicidal B rooding
type.” There isn’t one. C hirpy
W ithdrawn or distant
Some things that drive people to think about L iving life as normal
suicide are: N ot making eye
contact G oing to work
Personal catastrophes, such as being made
redundant, the collapse of their own business, A gitated L aughing and joking
the break-up of a relationship or being refused
access to children. I rritable or rude T alking about future
A persistent sense of worthlessness or D rinking a lot
failure; uncertainty about sexual identity T elling you not to
or personal goals. T alking about suicide worry about them
or saying it’s all
Good things happening to other people, hopeless
such as friends getting married, going off to
university or getting new jobs, and feeling left So how will you know if
they’re thinking about suicide?
A combination of the above. A whole series The safest way is to ask them.
of little setbacks can sometimes be more
devastating than one big thing.

I can’t go on

There’s no I’m fine
way out


Session 2 Connect 5

Why it’s important to ask What to say

If someone is suicidal, they are likely to It can be really scary starting this kind
be feeling: of conversation.

cut off from everyone around them. Step 1: Explore how they’re feeling.

frightened and ashamed about wanting to die. If something bad has happened to them, ask,
“How has it made you feel?” They may shrug
desperate for help but afraid to ask. and say, “I’m OK.” If they don’t seem OK to you,
keep trying, quietly and gently.
They need someone to start the conversation
for them. This shows them that they have Listen attentively. Try to keep the dialogue open
permission to talk about it and that they don’t by asking questions like, “How bad is it?” or
have to wrestle with their dark and terrible “What’s that like?”
thoughts alone.
Don’t deny what they’re telling you, and don’t
Some common fears pretend you know how they feel.

“Won’t talking about suicide ✘
put the idea in her head?”
No you’re not
No. If a person is suicidal, the idea is
already there. If they aren’t suicidal, I’m a totally ✔How long
it won’t do any harm. useless person
have you
“What if I say the wrong thing? been feeling
It could damage our relationship.”
like that?
Showing a person you care about them
won’t damage your relationship. Saying Step 2: Ask the ‘S’ question.
nothing could result in losing them forever.
If they give any indication that they’re feeling
It’s important to trust your gut instincts.
If something about the person doesn’t look hopeless or can’t see the point in going on, ask
or feel right, say something.
clearly and calmly, “Are you having any thoughts
Saying something is safer than of suicide?”
saying nothing.
Don’t be too quick to accept denials
Saying the word won’t make
it happen. or joking responses. ✘

Phew, that’s
a relief

Don’t worry, ✔
I’m not going to We should
still think about
top myself
getting you
some help


Connect 5 Session 2

What to do next Confidential helplines
and sources of support
Here are some suggestions and sources of
support. If at first you don’t find the help you Samaritans116 123
need, persist. Try all avenues and don’t give up. (24 hours, free to call)
If someone tells you they’re feeling
suicidal... PAPYRUS: Prevention
of Young Suicide
M ake sure they’re not left alone. 0800 068 41 41
(Mon–Fri 10am–10pm; weekends
R emove anything they could use to take their 2pm–10pm; bank hols 2pm-5pm)
own life, e.g. tablets, firearms, rope.

G et medical help immediately.

Get medical help CALM: Campaign Against Living
P hone your GP surgery (outside normal 0800 58 58 58
surgery hours, you’ll be directed to an out-of- (7 days a week, 5pm–midnight)
hours service).

C all 999 or take them to A&E and stay with SANE Mental Health Helpline
them until they are seen by a member of the 0300 304 7000
mental health team. (7 days a week 4.30pm–10.30pm)

Even if it’s only a hunch, MIND
share your concerns with others 0300 123 3393
(Mon–Fri 9am–6pm)
D on’t be afraid to involve their family, friends
or colleagues.
Maytree: A sanctuary for
S hare this leaflet with others and plan together the suicidal
how you are going to keep the person safe. 020 7263 7070

Take care of yourself

T alk to your own GP about your feelings.

C onfide in a trusted friend.

F ind a support group for carers of people with
mental health problems.

I f the person does take their own life, don’t feel

I t is not always possible to prevent suicide.


Session 2 Connect 5



Connect 5 Session 2






Connect 5© 2018 Rochdale Borough
Council on behalf of Public Health
England (PHE), Health Education
England, The Royal Society of Public
Health (RSPH) and the Greater
Manchester Authorities of Stockport,
Manchester and Bolton.

Acknowledgement to the following
partners and stakeholders who have
collaborated in the development
of this community resource;

Stockport Together
(Stockport council); Buzz Manchester
Health and Wellbeing Service; Bolton
Council Public Mental Health Team

The Royal Society for Public Health

The North West Psychological
Professions Network

Elysabeth Williams
National Connect 5 lead
& Public Mental Health advisor

Jackie Kilbane
Alliance Manchester Business School,
University of Manchester

Clare Baguley
Mental Health Lead Health Education
England - North

Martin Powell
Principle Educational Psychologist
Stockport Council

Graphic Design

Connect 5

Mental Wellbeing in Everyday Practice

Click to View FlipBook Version