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 1 Handbook Nov 2019

Discover the best professional documents and content resources in AnyFlip Document Base.
Published by richardjohnson, 2019-12-05 05:25:47

Session 1 Handbook Nov 2019

Connect 5 Session 1 Handbook Nov 2019

Mental Wellbeing in Everyday Practice


Trainer Handbook

Connect 5 Session 1

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
Conversations 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 1 Connect 5


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


Connect 5 Session 1

An introduction to...

Connect 5 Session 1

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

Session 1: Brief wellbeing advice

The intended outcome of session 1 is to change the way we have mental wellbeing conversations so
that we are confident and skilled to have brief conversations in which we help a person think about
ways they can take action to improve their mental wellbeing.

The purpose of the session is to:

Extend participants skills and confidence to D escribe the 3Cs of connected conversations.
have mental wellbeing conversations within
everyday practice. Locate mental wellbeing services and
resources in area.
Explain two public mental health models
so that they can be used to frame mental
wellbeing conversations.

Training Timings

Time Activity Lead

20mins Pre-course evaluation, welcome, intros, housekeeping, learning
agreements and ice breaker exercise.

40 Ways of seeing and understanding mental health and mental illness.

mins How common are mental health problems.

10 To frame mental wellbeing conversations.
1. Wellbeing.
15 minute break
35 Public health models.
2. Cognitive behavioural model.
mins Creating the best conditions for mental wellbeing conversations:
the 3C’s of connected conversation.
Signposting, services and resources.
Round robin, evaluations and goodbyes.







Session 1 Connect 5

Delivery Plan

Date Tutors
Layout Location
Start time Finish time

Session Topic: working with mental health and
wellbeing in everyday practice.

Pre-session activity:

Put character posters on the wall.

Put five ways to wellbeing posters on the wall.

Display local service information and available
mental health and wellbeing resources.

Time Teaching activity Delegate Checks on Resources
and support activity Flip chart.
Slide 2.
20 Welcome. Introduce yourself Slide 3.
and invite group
mins Pre-course to introduce
evaluation. themselves to
each other.
Aim & learning expectations in
objectives of the terms of overall aims
session. of Connect 5.

Introductions. Co-produce working
agreement model
Working connect 5 approach.


Connect 5 Session 1

Delivery Plan (continued)

Time Teaching activity Delegate Checks on Resources
learning Post-it
and support activity

Icebreaker Write a skill, routine
Identify a skill, or habit on a post it.
routine or habit
that supports your This will be used
mental health and later in the session.

Learning Objective
Ways of seeing and understanding mental health and mental illness.

Explore participants understanding of mental health and wellbeing.
Recognise the complexity of mental health and wellbeing.
Discuss the assumptions we make around mental health and wellbeing.
Review the role we can play in supporting others mental health and wellbeing.

50 Small groups of 3/4 Discuss in Supporting small Slides 4-10
discuss character small groups: group discussion: Character
mins stories. stories
W hat is going on Opportunity for handout.
Facilitate whole for the character? trainer to support
group feedback and discussion e.g. if Flipchart
discussion for each W hat are the conversation is stuck & Pens.
character. reasons for their or if group struggling
difficulties and with differences or if Slide 11.
Facilitate whole troubling feelings? they have got off the
group reflection on subject.
what the discussion W hat response
reveals about mental would they likely Whole group
health and wellbeing. get from the feedback and
health service? reflection provides
Use the Sum up opportunity to
slide (11) to pull the Participate in: develop participants
learning together. Whole group learning in line with
The aim of the feedback and key objectives.
session is to raise discussion.
awareness about the
complex, contested
and subjective nature
of mental health.


Session 1 Connect 5

Time Teaching activity Delegate activity Checks on Resources
and support learning

10mins Quiz: How common Participate in whole Whole group work out Slide 12-13.
are mental health group discussion. the answers together.
issues? Learning is led from
the group knowledge.
understanding of the The whole group
prevalence of mental dialogue provides
ill-health. opportunity
to develop
Develop group understanding of
understanding the prevalence and
through discussion. range of mental health
issues, the complexity
Summarise learning of establishing facts
and highlight key and the limitation of
points on slide 13. mental illness services
to meet need.

Learning Objective
Identify two public health models that can be used to frame a mental wellbeing conversation .
1. Frame a mental wellbeing conversation using the crossed axis.

Apply the crossed axis wellbeing model to broaden understanding of mental wellbeing.
Recognise the role we all have to play in promoting wellbeing.
Identify the skills routines and habits needed to promote and maintain wellbeing.
Locate local and national resources that support mental health and wellbeing.

35 Introduce the Co-produce Ask open questions Slide 14-16.
rationale for speaking understanding of which invite learners
mins with someone wellbeing. What does feedback, follow- Post its.
about their mental it look like? Where up with more open
wellbeing. does it come from? questions to develop Five ways
How is it promoted a shared group to wellbeing
Teach crossed axis and maintained? understanding though posters.
model. the dialogue of the
Back in same small meaning of wellbeing. Wellbeing
Facilitate discussion groups - imagine resources.
about wellbeing. being in conversation
Start by checking with Steve/Rukshana/
out what group Dolores write on
already knows about post-it note an action/
wellbeing and build activity they could
understanding from encourage them to
this platform. try that could improve
their wellbeing.
Ask: How do you
create wellbeing in
your life, what kind
of things bring you

Apply model: small
group activity.


Connect 5 Session 1

Delivery Plan (continued)

Time Teaching activity Delegate Checks on Resources
and support activity learning

Reflect with the group Work with group to Appropriate Slide 17-18.
on the patterns of identify resources resources identified,
the post-its on the they already use or add web resources Free to access
5 ways posters. Use know about that refer to suggested wellbeing
these patterns to would support resources in resources
inform teaching the developing skills, participant pack. participant
evidence based five routines and notes.
ways to wellbeing and habits that create
the importance of wellbeing.
action and activity to
maximise wellbeing. Signpost learners to
the free to access
Identify wellbeing wellbeing resources
resources. in the participant

15 minute break

Learning Objective
Apply cognitive behavioral model to frame a mental wellbeing conversation.

Explain how the five areas cognitive behavioral model can be used as a life skill.
Recognise the universal processes that underpin all of our emotions.
Locate cognitive behavioral resources that can be used in practice.

45 Tell personal Use the participant’s Participants Prepared
catastrophe story, responses to the generate content, catastrophe
mins that ends with high catastrophe story participants extend story slide
emotional arousal. to co-produce the the learning with 19-20.
model and apply the ideas of how to
Whole group conceptualization of break the cycle. Flip chart.
feedback: facilitate Pens.
participants to relate
to the experience and
build the model.

Teach following
principles through
the model.

T he affect (felt
experience) is the
inter-relation of
the five areas of
experience brought
into play in response
to a situation
(internal or external).


Session 1 Connect 5

Time Teaching activity Delegate Checks on Resources
and support activity learning

Cycle can become self-
sustaining i.e. creating mood
(sad, agitated) or a state
(anxiety, depression, stress): a
vicious cycle.

Breaking the cycle at any
point can be the step to
feeling better. Change
situation, change thinking,
change behaviour etc.

No right or wrong.
Everybody’s cycle is unique.
We interpret the world in
unique ways.

Play the emotions game: Coach Opportunity Move around the Emotion cards.
for the trainer small groups, Slide 21.
participants to break down and to move respond to
understand the different aspects around the each small Yellow, blue,
of emotion. groups and group individual purple and pink
support need. Support cards.
Identify local and national and extend the learners
resources that they can use in participants to distinguish
practice to apply the five areas understanding between
model. of the model. thoughts,
physical reactions
Whole group reflection: how and behavior.
might you use this in Support groups
your professional/ to identify the
personal life? emotion.

Direct participant to the free
to access self help resources in
the participant notes.

Learning Objective
Examine the key elements necessary for mental wellbeing conversations
(connected conversations).

Discuss the factors that make it more or less likely that people are open about their mental
wellbeing experience.

Describe the 3Cs of connected conversations: conversational open dialogue, compassionate
attributes and communication skills.

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


Connect 5 Session 1

Delivery Plan (continued)

Time Teaching activity Delegate Checks on Resources
and support activity learning

20 Support participants In pairs have Observe the Flip chart
to reflect on own 3-minute group, observe to record
mins experience, and then conversation. the pairs check for feedback.
use these reflections participation. Be
to understand the What conditions prepared to intervene
conditions that: helps/hinders us to if participants not
be open and honest participating.
Make more likely we will about our struggles
talk about our mental and difficulties Use open discovery
wellbeing difficulties or with our mental questions to help
challenges. wellbeing. individuals explore
their own experiences
Make it less likely we Use the pair and views as well as
will talk. discussion, to build group shared
feedback and understanding.
Facilitate whole group participant /trainer
feedback. Use feedback dialogue to develop
to develop group shared understanding of
understanding of these enabling conditions
conditions. for wellbeing

Use pp slides to teach Ask open questions Observe the group, Slides 22-28.
3Cs of connected that invite the check on participation
conversation. group to add in and ensure
own experiences, engagement.
1. Conversation to ensure content
2. Compassion retains relevancy
3. Communication skills. and immediacy.

Encourage participation,
ask questions to
develop understanding
and ensure content
remains relevant to the

Learning Objective
Identify resources and services that support mental health and wellbeing including:

Care pathways for mental health support.
Stepped care approach.
Local services.
Accessible resources.


Session 1 Connect 5

Time Teaching activity Delegate Checks on Resources
and support activity

15 Stepped care Facilitate Build on participants Slide 29-30.
approach - how participants to existing knowledge
mins mental health explore the services of resources and Leaflets.
services work. and resources services, facilitate
to develop an participants to Local service
Physical copies of understanding: exchange knowledge resources.
local services. and experience
h ow they support of services and Web resources.
mental wellbeing. resources. Encourage
List resources participants to
(link up to internet h ow to signpost become effective
where possible). and support sign posters
access to mental and community
health services. navigators.

t o use them in

10 Sum - one thing they Opportunity to
are taking with them. apply learning from
mins the session to their
current practice; to
reflect on what it
has reinforced and

Comments/suggestions/modifications for next time

Actions to be carried out before next session


Connect 5 Session 1

Slide 2 Mental Wellbeing in Everyday Practice

Co-creating Welcome

the ground Introduction Housekeeping Ground rules

rules Connect 5 Session 1 Slide 2

Connect 5 provides a flexible and effective
learning space to meet the diverse needs
of adult learners. Participants will start the
course with very different perspectives.
They will have different personal
experiences, work experiences, assumptions
and misunderstanding about mental health.
The process of co-creating the ground rules
and gaining consensus acknowledges this
diversity. It sets the scene for a respectful,
inclusive, engaging learning atmosphere.
Providing a safe environment and creating
the potential for the learners to take a risk of
trying out new ways of thinking and doing.

Kinds of things to cover

Confidentially Time keeping and attendance
It is worth exploring both what this means and How the group and you feel about being on time,
what level of confidentiality participants require. coming back from breaks. What do the group and
you want to do about managing the distraction
Behaviours of mobile phones?
How participants would like each other to behave
e.g. listening, one person speaking, accepting importance of
difference, conflict etc. house keeping

Looking after yourself and others Starting your session with a good attention to
It is important that we give permission for housekeeping will ensure your learners know
people to take time out, should they need it where the amenities are, what they need to do
and emphasise that, because of the nature in an emergency, how the session will be run
and prevalence of mental health, most of us when they will get breaks and when it will finish.
will be affected in some way, either personally
or through family and friends; so there is the Laying this out at the top of the session will help
potential for some of the discussion to raise you maintain your learners attention and create
issues for each of us. Provide opportunity to the safety your adults need to take the risk of
think through what the groups needs to feel ok if learning.
and when this happens.


Session 1 Connect 5

Slides 4-10

Character stories

The aim of this exercise is to explore the group’s understanding of mental health and mental illness.
Through this discussion we aim to encourage an exploration of other ways of seeing and understanding
mental health. It is an opportunity to build a shared understanding that supports and encourages
participants to feel confident and able to promote mental health and wellbeing in their community.

Some points that are worth drawing out

How quick we are to label experience as illness W e are quick to make assumptions. Our
e.g. Steve is depressed. But what does that tell brains can’t help but fill in the gaps. We borrow
us about Steve? from our own experience to fill in the picture
which runs the risk of drawing out a personal
We use different mental health experience experience in the wrong shape, wrong colours
words interchangeably e.g. worry, anxiety, or tones.
stress, depression, sadness and we might all
have different understandings of these. W e tend to psychologise; use theories e.g.
Delores gives too much and doesn’t look after
When does experience become clinical e.g. herself; rather than really listen to what the
when does low mood become depression, person’s experience is.
when is depression clinical?

Mental Wellbeing in Everyday Practice

For each character…

Discuss what seems to be going on for this person.
What might be the reason for the person’s troubles and problems?
If they went to see a health professional, what might they be told?
What might they be offered?

Connect 5 Session 1 Slide 4


Connect 5 Session 1

Emotional experience is complicated, subjective, fluid, and episodic. A diagnoses is like a snap shot,
2 dimensional flat picture of a certain experience at a certain time. Real life experience is more like a
movie. It’s moving, changing and dynamic (is effected by outside events). It might be more useful to
move the focus of the conversation away from what’s wrong to what’s going on.

Experience is subjective which means we have to rely on what people report. This has a number of
complications: does the person reveal what’s really going on for them? Stigma means we often don’t.
Is the sufferer even aware of their experience? Does the person open up to some people and not
others? Does what they report depend on how they feel at that time and/or how we make them feel
during the conversation?

Further themes that may come up in the feedback are:


Gender Work and mental health

Can impact on help seeking behaviour (men are Fear of revealing mental health problems to
less likely to seek help for and receive a diagnosis employers still a barrier to seeking help, physical
of depression). Presentations of emotional health complaints are more commonly accepted
distress in men could be ‘masked’ by physical and adjusted for. This is an additional barrier for
ailments. Masculinity and gender stereotypes Steve.
remain a barrier to early identification and
diagnosis of mental health problems in men.

Physical health and mental health

Physical health and mental health are inter-
related. Poor mental health is likely to have
detrimental effect on someone’s physical health
- side effects of medication (weight gain - think
Dolores?), self-neglect etc. People with long
term conditions such as diabetes and heart
disease are more at risk of developing mental
health problems.


Session 1 Connect 5


Carers Stigma and discrimination

Carers experience many challenges - stress and Prevents people seeking help, and can affect
anxiety related to their responsibilities, worries how people recover as they can become socially
about money, the physical demands of caring and isolated when experiencing mental health
social isolation which can in turn impact on their problems due to the fear and discomfort of
mental health and wellbeing. others in talking about it.
helping-someone-else/carers-friends-family- stigma-and-discrimination

Culture & race

Attitudes to mental illness vary across cultures
with increased stigma in some cultures more
than others. Responses to the treatment of
mental health problems may also vary. Western
psychiatric medical approaches are not always
considered an appropriate response. Spiritual
interventions may be favoured.



People can live well with mental health problems.
Recovery is an individually defined construct that
doesn’t necessarily refer to ‘curing’ the problem, but
may be a state of acceptance and good management.
The individual becomes the expert in their own illness.
People with a diagnosis of a mental illness can achieve
flourishing mental wellbeing.


Connect 5 Session 1

Tips for extending the discussion

Rukshana - What made the group decide it is This draws out points about gender and the fact
mental health issue rather than physical health? that a diagnosis will depend on what information
is shared. You can also ask how professionals
Could Rukshana’s symptoms be the result of might assess/ decide if someone has a mental
her diabetes? illness- leading them to recognise that it is not an
exact science based on objective tests.
After all, people with diabetes can feel
emotional, lack energy etc. It can be useful to get An interesting question to pose is to ask the
the group to focus on what we know (what she is groups if their character would have mental
saying) as opposed to what is inferred from the health difficulties if their external problems
information. were removed. Useful way for them to consider
the role of environment and intrinsic factors
Why, given that Rukshana is under a number of in causing mental health difficulties/ affect on
health professionals, including a GP, her mental wellbeing.
health has not been considered? This is a useful
question, because the group will no doubt E.g. if Steve’s work improved and he had a better
have given a diagnosis- so why not the health job or was no longer under threat of redundancy,
professionals? This usually leads participants to what difference would that make to Steve?
think about some of the key issues about the way What does this tell us about the effect of work
physical and mental health is compartmentalised on wellbeing?
and the cultural issue.
If Delores managed to pay off her debts, what
As with Rukshana, you can also question the difference would that make? Would you still
groups thinking about Steve. Again, he is under be concerned about her mental health and
the GP but why hasn’t the GP identified mental wellbeing?
health as an issue?

Further reading to explore
the contested nature of mental health

and mental illness

The Power Threat Meaning Framework
Towards the identification of patterns in emotional

distress, unusual experiences and troubled or
troubling behavior, as an alternative to functional

psychiatric diagnosis.


Session 1 Connect 5

Mental Wellbeing in Everyday Practice

Summing up the whole person

Things around you Mind-Body partnership Things that
can be noticed
(adverse childhood Poor sleep
experience (ACE), Problem eating
genetics and upbringing, Irritability
traumatic past events) Lack concentration
Lack of energy
Triggers Struggle to solve
(transition, loss, change, problems
challenging and difficult Stop doing things
life events) Lack of pleasure
Ways we shape our world and Mood swings
Sustaining factors make sense of experience
(debt, poverty,
loneliness, violence)
Thoughts Personal resource

Kinderman, P. (2005) A psychological model of mental disorder. Beliefs Coping styles
Harvard Review of Psychiatry. 13: 206-217
(self, world & future) e.g. problem solving,
help seeking skill

Slide 11 Connect 5 Session 1 Slide 11

Summing up
the whole person

This slide sums up what we can draw out from the information about the three characters to try
and understand mental health and illness.

Things around you The ways we shape our world and
Past experiences will affect how people respond
to current situations; there may be triggers that make sense of our experience
make them feel bad (or good); there may be Even with similar experiences and triggers,
factors which maintain / sustain those feelings. people will respond differently - compared with
others and even compared with themselves at
Things that can be noticed different times. Ways of thinking, belief systems,
These are the symptoms which a person and personal motivation and resources all affect
will notice in themselves and/or which others people’s response to particular situations.
may notice. Equally, body responses, which generate the
‘felt sense’ (affect) dimension of experience, are
unique to the person and situation.

Notes about understanding the mind
and mental health / illness

The mental health debate continues to be social factors? Many people involved in mental
centred round gene-environment-experience health issues argue that individuals may have
interactions: what is it that makes our minds a susceptibility to a disorder but social factors
work the way they do? Are severe mental precipitate and maintain it. The susceptibility
illnesses caused by a genetically programmed many be derived from biological, psychological
disease of the brain; or are they rooted in and social factors in the past which need to be
psychological processes (there is much considered in order to understand why they are
disagreement about what psychological presenting with these particular symptoms at
processes are!) such as: intra-psychic conflict; this time in their life. Thus the emphasis in this
attachment problems; trauma; conditioning; model is on the multi factorial causation and
distorted cognition; or are they rooted in patient-centeredness.

Kinderman, P. (2005) A psychological model of mental disorder. Harvard Review of Psychiatry. 13: 206-217


Connect 5 Session 1

Despite 250 years of psychiatry and psychology we have not yet arrived at an agreed way of
understanding the human mind. Our understanding comes from making inferences about a mind from
observable factors such as behaviours and self reported symptoms and from studying associations
within the environment.

Environmental factors: we know that certain circumstances are associated with mental ill health, such
as factors in the person’s past, present and current social conditions. We know (social science, literature,
lay knowledge, history) that these present a risk to a person’s mental health. This is not straightforward
cause and effect as different people react in different ways and at different times. For those who do
suffer mental ill-health in the face of past and present stressors we don’t yet have an agreed theoretical
framework to understand what actually happens to that person, that is, we don’t know happens within
the mind/body of the person to produce the mental distress and/or cause person to experience
difficulties in living.

Signs and symptoms and diagnosis

From clinical observation we have come to these are symptoms of, for example, lung cancer,
agreements that certain symptoms are signs emphysema, asthma, pneumonia etc.
of syndromes /conditions such as depression,
bi-polar etc. The difficulty with using the illness Some radical thinkers (for example Szasz) argue
model is that unlike physical medicine a mental that while people may behave and think in ways
health diagnosis doesn’t draw upon a biological that are very disturbing, and that may resemble a
pathway. Most physical diseases are defined disease process (pain, deterioration, response to
by the biological processes that produce the various interventions), this does not mean they
symptom rather than the complaints/symptoms actually have a disease. He argued that psychiatry
that patients report. If this approach was used in actively obscures the difference between
physical medicine a “cough disorder” would be (mis)behaviour and disease. Unless there is a
diagnosed whenever the frequency, duration and biological cause/ something physical which can
severity of cough exceeded defined thresholds, be measured, then it is not really an illness. The
irrespective of the cause of the cough. However illness model actively encourages us to think that
physical medicine goes beyond the symptoms and the brain states, emotions and actions that define
further investigation of the biological processes mental illnesses are abnormal, that they reflect
(blood test, x-ray, lung capacity) might prove that processes that nature did not intend to be general
human characteristics.

Read more about what do and don’t know about mental health
Mental illness: is there really a global epidemic?

Read more about why we need a refocus on prevention
Prevention: the new holy grail of treating mental illness
Investment in keeping people well could save many lives and much money
Trauma-informed mental healthcare in the UK: what is it and how can we further its development? can we further its


Session 1 Connect 5

Read more about the role of psychological factors in the development of mental health problems

Read more about current thinking and evidence base for psychological disorders download psychology:
see chapter 15 psychological disorders[email protected]:[email protected]/What-Are-Psychological-Disorders

Notes on Diagnosis PHQ9: Depression

Over the last 2 weeks, how often have you been Not at Several More Nearly
bothered by any of the following problems? all days than half every
the week day

1 Little interest or pleasure in doing things
2 Feeling down, depressed, or hopeless
3 Trouble falling or staying asleep,

or sleeping too much

4 Feeling tired or having little energy
5 Poor appetite or overeating
6 Feeling bad about yourself - or that you are a

failure or have let yourself or your family down

7 Trouble concentrating on things, such as
reading the newspaper or watching television

Moving or speaking so slowly that other people

8 could have noticed? Or the opposite - being so
fidgety or restless that you have been moving
around a lot more than usual

9 Thoughts that you would be better off dead or
of hurting yourself in some way

Scoring: Mild = 5-9; Moderate = 10-14;
Moderate-Severe = 15-19; Severe = 20-27

There is not a slide for PHQ9 (depression) or In order to distinguish normal emotions from
GAD (anxiety) or other aspects of diagnosis. abnormal emotions requires close attention
The PHQ9 is an example of how depression is to the situation - negative emotions can be
currently assessed; the GAD-7 similarly uses the normal and useful in certain situations. eg, Pain
existence of a collection of symptoms and their is normal when its severity matches the amount
frequency and severity to make a diagnosis of a of tissue damage. Pain is pathological when
mental health condition. This is in comparison it is disproportionate to the cause. Therefore
to specific tests (blood tests, X rays, MRI decisions about normality and pathology depend
scanning, etc) which are used to make or confirm on the situation. The logic of this argument
diagnoses for many physical health conditions. would be to modify diagnostic criteria to take
situations into account. For example extend the
In the pursuit of scientific reliability the system current DSM- 1V grief exclusion for depression
has to ignore the fact that mental health is to other dire circumstances which can cause
derived from and contributes to a variety of normal symptoms of depression (losing job,
social conditions and process in which we exist. relationships etc).


Connect 5 Session 1

The Adult Psychiatric Morbidity Survey (APMS), which has been carried out every seven years since
1993, offers some of the most reliable data for the trends and prevalence of many different mental
health problems and treatments. The survey carried out in 2014 and published in 2016 is the source of
many of the prevalence figures cited in this section. We do not expect an update until 2021.

Slide 12

Facts and figures for
mental health prevalence

Mental Wellbeing in Everyday Practice

Mental Health Problems
how common do we think they are?

How many adults (over 16) do you think are 1 in 6 1 in 15 1 in 25
experiencing common mental health problems
at any one time?

How many adults do you think are experiencing 1 in 200 1 in 500
severe and enduring mental health problems at any 1 in 100
one time (schizophrenia and delusional disorders)?

How many children and young people are 1 in 10 1 in 25 1 in 50
experiencing common mental health problems?

Mental Health Foundation (2016). Fundamental Facts about Mental Health 2016.
Mental Health Foundation: London

Connect 5 Session 1 Slide 12


Session 1 Connect 5

Read the current facts and figures: about-mental- health-2016

Question 1
Prevalence of common mental
health problems

Fundamental facts uses data from the Adult Mental Wellbeing in Everyday Practice
Psychiatric Morbidity Survey. The 2014 APMS
highlights that, every week, 1 in 6 adults What have we learnt?
experiences a common mental health problem.
Common mental health conditions include 1 in 10 children and young people (aged
NB The first Fundamental Facts in 2007 was depression and range of anxiety disorders. 5-16 years) have a clinically diagnosable
the source of the statistic that ‘1 in 4’ people They are the most prevalent mental health mental problem. 20% of adolescents may
experience mental health problems in any year. problems in our communities. Rates over experience a mental health problem in any
Due to reliability issues with the ‘1 in 4’ statistic, time show upward trends. given year.
‘1 in 6’ is recommended with regards to reporting Severe and enduring mental health 50% of mental health problems are
figures of people who have experienced common problems are less frequent with data established by age 14 and 75% by age
mental health problems in any week. showing rates are stable over time. 24. This means common mental health
problems are showing up early in people’s
lives and if not addressed they become
long term conditions.

Mental Health Foundation (2016). Fundamental Facts about Mental Health 2016. Slide 13
Mental Health Foundation: London
Connect 5 Session 1

According to the National Institute for Health Question 3
and Care Excellence (NICE), common mental Prevalence of Children and young
health problems include depression, GAD, social people experiencing diagnosable
anxiety disorder, panic disorder, OCD, and mental health conditions
post- traumatic stress disorder (PTSD).
Prevalence rates for child and adolescent
Rates of anxiety are higher in women mental health in the British Isles are now out
(3x higher for young women 16-24) of date. In 2004, it was found that 10% of
children and young people (aged 5–16) had a
Rates of depression peak in middle age (45-54) clinically diagnosable mental health problem.
When we look at the adolescence age group
For those with common mental health problems, the prevalence increases to 1in 5 (20%). A
36.2% reported receiving treatment. The 2005 prevalence study carried out in America
proportion of people with a common mental predicted that 50% of mental health problems
health problem using mental health treatment are established by age of 14 and 75% by age 24.
has significantly increased. The most used The significance of this is that unlike physical
treatment for those with a common mental health, which generally shows up later in life,
health problem was medication, with only mental heath is appearing in adolescence
11.8% of people reporting receiving and then if not addressed it becomes a life
psychological therapies. long issue.

Question 2 Evidence also suggests that in the UK the
Prevalence of Schizophrenia and conditions in which our young people are
delusional disorder (psychosis) in growing up may be contributing to rising levels of
general population is 0.5% (1 in 200) mental ill health. In 2013, the UK ranked 16th out
of 29 developed countries in the UNICEF league
No difference in the rates between men and table of child wellbeing, where rankings are based
women but rates higher for black men and on child health and safety, education, behaviour,
people living alone. Peak 35-44 age group. housing conditions and material wellbeing.


Connect 5 Session 1

Mental Wellbeing in Everyday Practice

Flourishing wellbeing
Feeling good and doing well

High wellbeing Maximise Wellbeing High wellbeing
and no symptoms and symptoms
of mental illness of mental illness

No symptoms of Manage Stress Many/severe
mental illness symptoms of
mental illness

Low wellbeing Low wellbeing
and no symptoms and symptoms
of mental illness of mental illness

Languishing Slide 15
mental wellbeing

Keyes C.L.M. (2005). Mental illness and/or mental health? Investigating axioms of the complete
state model of health. Journal of Consulting and Clinical Psychology. 73:539–548

Connect 5 Session 1

Slide 15

Complete mental health:
crossed axis model

Complete mental health is more than the First click
absence of mental illness it also requires the This is the dimension of mental health we largely
presence of something positive i.e. wellbeing. focus on. I.e. has someone got mental health
The concept of Wellbeing comprises two main problem, clinical levels, diagnosis, medication,
elements: feeling good and functioning well. therapy etc?
Feelings of happiness, contentment, enjoyment,
curiosity and engagement are characteristic But imagine I suffer from anxiety. I go to my GP who
of someone who has a positive experience of refers me to IAPT service. I have some sessions of
their life. Equally important for Wellbeing is our CBT. I also do some relaxation, some yoga. I work
functioning in the world. Experiencing positive on my condition and it starts to alleviate. So as the
relationships, having some control over one’s life symptoms reduced does this automatically result in
and having a sense of purpose are all important me having good wellbeing? i.e. I feel good and doing
elements of Wellbeing. well in life? ‘Being/doing well’.

Keyes C.L.M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health.
Journal of Consulting and Clinical Psychology. 73:539–548


Session 1 Connect 5

Click 2 Click 6 Bottom left
Wellbeing and life satisfaction is another This is where many of us are. We don’t suffer
dimension of mental health. distress or stress at levels that would be
assessed as mental illness but we are not thriving
Click 3 Top left in life. We don’t feel life has meaning or purpose
To achieve complete mental health or resiliency. or perhaps that we are doing well in life. We
A person needs to continually develop, hone and perhaps experience more negative than positive
apply skills, routines and habits that minimize emotion, maybe even trapped in a negative
and lessen the impact of stress AND skills, perception of the world.
routines and habits that maximize wellbeing and
create a sense that life is going well. For example:

Click 4 Top right N ot knowing what your needs are or how to
Counter-intuitively it is possible to be someone meet them.
that despite suffering mental ill health even quite
severe mental ill health has also developed the N ot having clear boundaries.
skills, routines and habits to maximise wellbeing.
N ot relating to others with emotional literacy.
i.e. they are able to enjoy life, feel good about
things and function well. Indeed this is what M anaging conflict without resorting to
the current recovery agenda in mental illness manipulation or coercion.
services tap into. Service users have demanded
to be treated beyond their illness. Being B eing mean spirited.
supported to hope and dream and build a life
that is enjoyable and satisfying. None of these are clinical mental health issues
but all will impact on your wellbeing (your
capacity to feel good and do well in life).

Two equally important dimensions of resilience:
thriving and surviving.

Click 5 Bottom right Surviving: skills, capacity, ability to bounce back
No surprises for guessing that this is the worst from adversity ie. Ability to cope.
place to be. And traditionally this is where we
have put many of those suffering mental ill Thriving: intentional practices, routines and
health because of the stigma and discrimination habits that optimize how well you feel and how
surrounding mental illness. This community have much you get out of life.
often ended up in the worst housing, without
work and cut off from the community and from
the resources that create a sense of wellbeing.

More about resilience
Put down the self-help books. Resilience is not a DIY endeavour

What is resilience?


Connect 5 Session 1

Slide 17-18

5 ways to wellbeing

5 ways to Mental Wellbeing in Everyday Practice The five ways to wellbeing create good functioning, which
wellbeing means we get our needs met. APPS activity (achievement,
pleasure, physical and social) are the active ingredients within
Foresight Mental Capital and Wellbeing Project (2008). Final Project report. The Government Office for Science, London the five ways. Essential elements inherent within activity that
bind together to build self confidence, self esteem and efficacy,
t 5 Session 1 make life ‘feel good’ and create a sense of optimism and hope
for the future.
Slide 17
Wellbeing is a dynamic: what we do and think creates how we
feel and how we feel motivates us to do more.

So Wellbeing is a lot about what we do and think. When we feel
good we do well. Upward cycle.

Notice: what do we stop doing when we get down, feel stressed.
When we feel bad (down, low, stressed, depressed) we tend to
stop doing the things that bring us connection, pleasure and
achievement. This can become a vicious cycle that spirals down.

Mental Wellbeing in Everyday Practice Aioncfgtairvceetdiiveinttys Find out more

WTHHAITNWKE APAPcShievement As the evidence indicates, each action theme (connect, be active,
take notice, keep learning, give) positively enhances personal
WHAT WE WHAT WE Pleasure well-being. The model suggests that following the advice of these
Physical interventions enhances personal well-being by making a person
DO FEEL Social feel good and by bolstering his/her mental capital.

Connect 5 Session 1 The actions mainly influence well-being and mental capital by

Slide 18

interacting at the level of ‘functioning’. They may not be sufficient
to denote ‘good functioning’ in its entirety but, according to
the evidence base to date, they play an essential role in satisfying
needs for positive relationships, autonomy, competency
and security.

Read the new economics five ways to wellbeing evidence paper

Read about second wave of positive psychology

Wellbeing is a skill

Foresight Mental Capital and Wellbeing Project (2008). Final Project report. The Government Office for Science, London


Session 1 Connect 5

Slide 19

Personal catastrophe story

Preparing your story

The purpose of this activity is: to introduce and or not being able to find somewhere to park,
tease out the 5 areas before participants have but you have a really important meeting / job
even seen the model. It is NOT to try to fix the interview to get to) and reduce it (what could
issue / problem that you tell the story about. help someone to wind down / turn the vicious to
virtuous cycle)?
It doesn’t have to be a real story, or not exactly as
it happened, or it doesn’t have to have happened How will you introduce your story? Where will
to you. Keep yourself safe - don’t reveal things you stop so that you don’t reveal how you were
about yourself that you don’t want to. feeling, what you did, but leave the participants
with plenty to feed back to you? The less you say
Use an everyday example - think about whether the more the group will fill in.
the participants will be able to relate to it. For
example, would they go on holidays abroad? Will you be able to relate your reaction to each of
(lost passport, lost foreign money, being stuck the 5 areas?
in another country). Will they all have partners
/ children and/or might there be issues of Will you be able to draw out the vicious cycle,
domestic abuse / loss / grief if you use a story and show how you / someone in that situation
about personal relationships? (possibly with support of others) broke the cycle
and turned it into a virtuous cycle or how you /
Can you escalate the potential amount of someone in that situation could have done?
‘distress’ (eg, it’s not just a matter of losing keys

Mental Wellbeing in Everyday Practice

Understanding why
we feel like we do

Connect 5 Session 1 Slide 19


Connect 5 Session 1

When you present your story

Before you begin, assure people that it was all example if it wasn’t actually something you
right in the end, nothing bad happened. thought or felt or did, summarising, asking
‘what else?’, discouraging participants from
Invite people to think about how they might have trying to ‘fix the problem’ for you or asking you
responded in similar circumstances, as you share lots of questions).
your story.
Are you clear in which of the 5 areas you will write
When you pause/stop - ask them to consider the points that they feed back?
what might have been going on for you at that
point AND for anyone who was in a similar Include impact on situation as well as the other
situation, so don’t limit their feedback to what four areas - how what you did, felt, thought made
actually happened / don’t just relate it the situation worse or better.
to yourself.
Introduce the 5 areas model after you have
What (communication) skills will you use to draw mapped their responses. You can write each of
out information from the participants? (open the five headings on the flipchart sheet, and/or
questions, not rejecting any suggestions - for there is a slide showing the 5 areas.


Session 1 Connect 5

Slide 20

5 areasTM model
(cognitive behavioural approach)

The cognitive behavioural model (Five areas) gives us a way to conceptualise, describe and explain
experience. This way of conceptualising experience is used in therapeutic interventions as well as
more proactive interventions such as coaching, resilience building, decision making and teaching.
In this way the model is used as a more general life skill which can help a person understand why they
feel the way they do and what they can do to feel better.

Emotion is very important to us humans. They tell us what matters to us, underpin our decision
making and motivate us to action. Because they are so fundamental to our functioning they
command a number of different aspects of our experience (thoughts, feeling, body sensations and
urges to behave). The felt sense of our experience is the interrelationship of all these aspects of our
experience held in place and working together. Each thing feeds off the other and sometimes we can
get stuck in a vicious cycle which creates a mood or mind-body state.

Learn more: Chris Williams and Anne Garland: A cognitive-
behavioural therapy assessment model for
Chris Williams use in everyday clinical practice, Advances in Psychiatric Treatment, 2002, 8: 172-179

Cognitive Behavioural Therapy
- Explanation of Basic CBT Model Chris Williams: Use of written cognitive-
behavioural therapy self-help materials to treat
CBT coaching depression, Advances in Psychiatric Treatment, 2001, 7: 233-240

More in depth explanation

LLTTF™living Vicious Cycle From the:
life to Understanding your feelings/
Produced under licence © Five Areas Resources Ltd (2009-2018) www.llttf.comthe full
LLTTF is a registered trademark of Five Areas Resources Ltd. Why do I feel so bad resources.

What’s going on? Describe the situation: My feelings:
My body:
My thoughts: Altered Altered
Thinking Feelings Slide 20

Five Areas™ diagram used under My behaviour: Altered Altered
licence from Five Areas Ltd Behaviour Physical
Williams, C (2009) Overcoming Feelings
Depression and Low Mood. A Five
Areas Approach. 3rd Edition. Hodder
Education. London

Five Areas™ diagram used under licence from Five Areas Ltd. 27
Connect 5 Session 1

Connect 5 Session 1

Slide 21

Emotion card game

Emotions have certain functions and so different feelings direct our attention, thinking and
behaviour in different ways. i.e. our experiences of emotions emerge from the patterns they create
in our brains and bodies (moods are like patterns of our emotions). These emotions are part of our
being; they have evolved as part of our human nature. Because they are often unpleasant and painful
to us, we can see difficult emotions as problems and things to be got rid of. It is more helpful however
to understand that they were designed by evolution to defend us and help us – especially when we
are threatened.

Anger is an old, defensive emotion. Anger and Sadness is a universal emotion, and has a
frustration can arise from many sources, such common facial expression associated with it
as feeling thwarted and blocked or it can arise that is recognised in many different cultures.
from a sense of injustice or feeling criticized and Sadness is usually caused by loss of some sort,
put down by other people. Anger makes us want from a person to money. Sadness is closely linked
to approach the problem, do something about to a loss of attachment to a child or to a partner,
it, ‘sort it out’. Anger can also make us want to relative or close friend. Attachment is adaptive
retaliate against another person if he or she has from an evolutionary viewpoint, particularly in
upset us or upset someone we love. When anger relation to the bond between mother and child,
gets going our bodies feel a certain kind of way; and loss of this attachment, even briefly, can
our minds focus on and attend to things that cause sadness in young children and causes
annoy us. We have certain types of thoughts that them to search for the parent. Attachment is
go with anger (how dare they, how could they) . also important for couples and its loss promotes
It will also make us want to behave and do things sadness and the search for the partner. Sadness
in certain kinds of way (‘I’ll show them….’). Maybe can also result from other losses, ranging
we want to shout, swear, be aggressive, try to from money to lack of success at work, and
get our own back or withdraw. its biological and evolutionary function is to
motivate the individual to recover what has been
Anxiety is another very important and basic lost. Sadness drives us to restore attachment
defensive emotion which is focused on and is from an evolutionary point of view an
threats; it gives us a sense of important adaptive emotion.
urgency, prompting us to do
something. Anxiety can make Depression one evolutionary theory of
us want to run away and keep depression is that it serves to pull us away
ourselves safe and out of harm’s from the normal pursuits of life and focus us on
way. When anxiety gets going understanding or solving the one underlying
it pulls our thinking to focus on problem that triggered the depressive episode
dangers and threats. Again, we see say, a failed relationship. If something is broken
that this important emotion in your life, you need to bear down and mend
of anxiety can direct our it. In this view, the disordered and extreme
bodily feelings and emotions, thinking that accompanies depression, which
our attention, our thoughts can leave you feeling worthless and make you
and behaviour. catastrophize your circumstances, is needed to
punch through everyday positive illusions and
focus you on your problems.

Session 1 Connect 5

Love and affection These are emotions that indicate positive relationships between people
and tell our brain that we are safe. When we feel safe with other people and know we can turn to them
for help this tone down the threat system. These feelings help us build bonds and think about each
other when we are not currently in sight. When we feel cared about, this can help us experience the
important positive feelings of safeness and openness to those around us. Leaning to be sensitive and
caring of ourselves can also help us feel more positive in the world.

There are 4 sets of cards, each is a different emotion.

Pink = anger Yellow = fear /anxiety

Blue = sadness / depression Purple = LOVE

(not all emotions are negative).

1. Help participants identify the categories of experience
a. Thinking is a statement , put it in inverted comas.
b. Behaviour is what you would see someone doing.
c. Physical is automatic , you don’t chose to do it or have control over it.

2. Y ou might need to help participants understand what the feeling is.
Even to understand what it is we are asking. At this stage this is very new
learning for a lot of participants.

Mental Wellbeing in Everyday Practice Slide 21

Understanding feelings

Put the cards into three columns:
Physical symptoms

What feeling word might I use
to describe this experience?

Connect 5 Session 1


Connect 5 Session 1

Mental Wellbeing in Everyday Practice

3CsCreating the best conditions for

mental wellbeing conversations ocofncvoenrnseatcitoend



3Cs © Elysabeth Williams 2019 Slide 23
Connect 5 Session 1

Slide 23-28

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

Connected minds are essential for mental wellbeing
(remember connect is one of the ways to wellbeing)

We derive meaning from our emotional states Michael bond the power of others:
largely through contact with others. Biologists future/story/20140514-how-extreme-isolation-
believe that human emotions evolved because warps-minds
they aided co-operation among our early
ancestors who benefited from living in groups. “…adversity turns into trauma when
Their primary function is social. With no one you experience your mind as being
to mediate our feelings of fear, anger, anxiety alone. If you have good relationships,
and sadness and help us determine their they actually help you assimilate that
appropriateness, before long they deliver us a experience.”
distorted sense of self, a perceptual fracturing
or a profound irrationality. It seems that left Peter fonagy, anna Freud centre:
too much to ourselves, the very system that
regulates our social living can overwhelm us. peter-fonagy-refugee-child-psychologist-anna-


Session 1 Connect 5

Mental wellbeing conversations Suffering is not a question that
demands an answer;
Mental wellbeing conversation need to be
connected conversations. These are particular It is not a problem that demands a
kind of conversation that contain certain solution;
essential elements that create the conditions for
open discovery dialogue. It is a mystery that demands a

Anonymous quote cited by Brother Francis
(personal communication)

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 Conversation

1. Conversational feel
2. Compassionate care
3. Communication skill

1. Conversational feel
For a CC we need to move away from controlled discussion toward open
discovery dialogue. We contrast controlled discussion with open dialogue
discussion in order to highlight the unique aspects of a CC.


Connect 5 Session 1

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 1 Slide 24

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
1. Connecting (attuning) though that flow from feeling loved, wanted and safe
conversation. We’re all in it together with 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.
ever been around someone who is fully present We 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


Session 1 Connect 5

“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 1 Slide 25 for care in practice because of the way
we have been built though the process of
evolution. 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.


Connect 5 Session 1

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 1 Slide 26


Session 1 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 1

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
Mental Wellbeing in Everyday Practice in self, given to others or received from others all
sources interact to build compassion within and
SKILLSCOMMUNICATION Connected Keeping it open for ourselves and others. (this connects with self-
conversations: compassion learning in session 3 )
Using open questions invites in the
the skills that make it possible persons experience as it is for them. Compassionate care: the theory and reality.
Who What When Where Why Paul Gilbert and Alys Cole-King
(use ‘Why’ sparingly).
Picking up and empathically responding to the cues 20PG.pdf

Maintaining an open non-judgemental attention enables you to pick up and respond to cues beyond words; Training Our Minds in, with and for Compassion
to be present, to listen and help work out with the other person what’s helpful to them. An Introduction to Concepts and Compassion-
“That sounds really difficult, I can hear how upset you are.” Focused Exercises
Collaborate (keep sharing the power) COMPASSION-HANDOUT.pdf

Checking out with the person at every step, helps maintain safety and involvement ensuring you only go where the Watch Professor Paul Gilbert explores the science
person wants you to. of compassion and how we can put this into
“Are you OK talking about this with me today?” practice to create happier lives
“Would you like us to think together about where you might get some more help with this?” - for ourselves and others around us
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 1 Slide 27

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 1 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? I ntroduce 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
We have 20 minutes today, what do you want for action
to use that time for?
P rovide 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 1

Slide 25 Mental Wellbeing in Everyday Practice

Stepped-Care Public facing work force are in a position
Approach to identify poor mental wellbeing early on

NICE Clinical Guidance (CG123) Common mental Public facing work force are in a position to identify poor Step 5
health problems: identification and pathways to mental wellbeing early on and can offer help and support to Comlex and high risk
care. Clinical guideline. Published: 25 May 2011. improve wellbeing (five ways and self help resources). mental health
Stepped-care is a care delivery model used to Step 3 Step 4
organise the provision of services and to help. Step 2 Moderate to severe Severe and
Mild to moderate mental health enduring mental
people with common mental health disorders, to mental health problems health problems
have access to the most effective, least intrusive problems (e.g. bipolar
and most resource effective intervention. It Step 1 disorder/
includes regular monitoring of progress with the Early presentations of schizophrenia)
option for ‘stepping-up’ to intensive/specialist problems or distress
services as clinically required, i.e. “having the
right service in the right place, at the right time Find out more about the stepped care model Public facing workforce are also in position to:
delivered by the right person.” 1. Help people recognise they need specialist help.
2. Support people to access specialist help.
Slide 26 3. Take action to support people to implement self help strategies and/or

Resources support wellbeing once they have received specialist support.

Start building your resource list: Connect 5 Session 1 S

Local resources. Mental Wellbeing in Everyday Practice

Local mental health care pathways.

Local wellbeing services. Connect 5 Session 1 Slide 30

Get to know the online resources.


Session 1 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

Slide 29

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 1

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 1 Connect 5

Continue to learn
with MOOC courses

Massive Open Online Course is an online course provider aimed at unlimited participation
and free open access via the web.

Mental Health

5 weeks

Understanding Anxiety, Depression and CBT 3 hours cbt per week

Improve your understanding of depression and anxiety and find out more about an
effective and evidence-based treatment: CBT

6 weeks

Psychology and Mental Health: Beyond Nature and Nurture 3 hours well-being per week

Explore some of the current challenges and debates in the area of diagnosis and
treatment, and discover new ways of thinking psychologically about mental health.
Gain new perspectives on the “nature vs nurture” debate, and understand how we
are affected by life experiences. You will also discuss new research, which promises
to help us improve our own mental health and well-being.

Wellbeing and Resilience 4 weeks

Mindfulness for Wellbeing and Peak Performance 3 hours per week
Stressed by the pace of modern life? Mindfulness might be the answer. Research
shows that when you’re not deliberately paying attention to something, your
brain goes into default mode causing increased anxiety and poor communication.
Mindfulness can help end this unproductive behaviour. In this online course, you’ll
learn how to incorporate mindfulness practices into your life, to reduce stress and
improve your personal and professional life.


Connect 5 Session 1

4 weeks

Maintaining a Mindful Life 3 hours per week

Discover techniques to help you maintain a mindful life. Interest in mindfulness has
grown enormously over the last few years. It’s no surprise: mindfulness techniques
can improve your communication skills, relationships and emotional health. But
not everyone knows how to apply mindfulness in daily life.

Building upon the introductory Mindfulness for Wellbeing Peak Performance, this
course will show you how to incorporate mindfulness principles in your own life to
end unproductive behaviour, ensure your brain isn’t operating in ‘default mode’ and
improve your overall wellbeing.

Mental Health

6 weeks

The Social Context of Mental Health and Illness

This course explores how our understanding of mental health and illness has been
influenced by social attitudes and social developments in North America and
around the world. The course begins by situating our contemporary mental health
practices in historical context, then looks at different aspects of mental health,
mental illness and mental health services and their connections to what’s going on
in our social environment.

5 weeks

Positive Psychiatry and Mental Health

In this course, we will explore different aspects of good mental health as well
as provide an overview of the major kinds of mental disorders, their causes,
treatments and how to seek help and support. The course will feature a large
number of Australian experts in psychiatry, psychology and mental health
research, and we will also hear from “lived experience experts”, people who have
lived with mental illness, and share their personal stories of recovery.


Session 1 Connect 5

Wellbeing and Resilience 4 weeks

Positive Psychology: Resilience Skills 2.5 hours per week
In this course, you are exposed to the foundational research in resilience,
including protective factors such as mental agility and optimism. Several types of
resilience interventions are explored including cognitive strategies; strategies to
manage anxiety and increase positive emotions such as gratitude; and a critical
relationship enhancement skill. Throughout the course, you will hear examples of
individuals using resilience skills in their personal and professional lives.

5 courses

Positive Psychology: Well-being for life

The University of Pennsylvania and Dr. Martin E.P. Seligman welcome you to
Foundations of Positive Psychology. Our five-course specialization provides you
with the key theories and research in the field of positive psychology as well as
opportunities for application.

Positive Psychology 6 weeks
2-4 hours
This course discusses research findings in the field of positive psychology, per week
conducted by Barbara Fredrickson and her colleagues. It also features practical
applications of this science that you can put to use immediately to help you live a
full and meaningful life.

6 weeks

2-3 hours
per week

A Life of Happiness and Fulfillment

We now have a pretty good idea of what it takes to lead a happy and fulfilling life.
This course draws content from a variety of fields, including psychology,
neuroscience, and behavioral decision theory to offer a tested and practical recipe
for leading a life of happiness and fulfillment.


Connect 5 Session 1

Mental Health 4 weeks

Psychology - Course 5: Health and Behaviour 8-12 hours course-5-health-behavior- ubcx-psyc- 5x-0 per week
This psychology course is all about the relationship between health and
behaviour. We will examine stress as a concept and learn about its relation to
health and psychological adjustment. We will discuss abnormal behavior and how
psychologists assess it as well as a wide range of psychological disorders and
approaches to their treatment.

Wellbeing and Resilience 8 weeks

Becoming a Resilient Person - The Science of Stress Management 2 - 3 hours person-science-stress- uwashingtonx- per week
ecfs311x- 0
This course gives you the permission to take care of yourself by learning the skills
to manage stress and optimize wellbeing.

8 weeks

The Science of Happiness 4-5 hours uc-berkeleyx-gg101x-5 per week

The Science of Happiness teaches the ground-breaking science of positive
psychology, which explores the roots of a happy and meaningful life. Students will
engage with some of the most provocative and practical lessons from this science,
discovering how cutting-edge research can be applied to their own lives.


Session 1 Connect 5



Connect 5 Session 1






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