Practical tips for managing stress in the workplace



Most jobs have a certain level of stress that is beyond our control, whether it is the workload, deadlines or the workplace culture. Work-related stress often occurs when there is a discordance between the requirements of the job and your capabilities or available resources, resulting in unsustainable levels of pressure. In fact, a report by the Australian Human Rights Commission which surveyed over 5000 workers showed that 25% of workers took time off every year for stress-related reasons, with a total of 3.2 days per worker lost each year.

There are various work-related factors that may contribute to stress including:
  • Working long hours or working overtime
  • Not taking breaks or taking work home
  • Time pressure or unrealistic targets
  • Monotony or dullness of the job
  • A lack of control, support, communication or clarity
  • Job insecurity
  • Workplace conflict, bullying or discrimination

Although low levels of stress can be beneficial by increasing focus and productivity, prolonged or excessive stress can be extremely damaging to mental health by triggering or worsening mental health disorders such as anxiety and depression.

If you're feeling stressed from workplace pressures, try these strategies to manage your own stress levels and adopt a positive work-life balance.

Take regular breaks
It is important to take breaks regularly, particularly if you work at a desk. Make sure you get moving every hour as sitting down all day is bad for your physical and mental health. Get a change of scenery by going out for lunch or going for a walk, even if it only for 10 minutes. You'll come back feeling refreshed and more productive.

Get to know your colleagues
Your colleagues don't have to just be your co-workers, they can be a solid support system too. Reach out and be more sociable, engage with them during breaks and make the effort to chat about topics unrelated to work. They will likely understand the stress of the job and may be able to offer much needed support when you're under pressure.

Don't take work home
Leave work at work. Avoid taking work home with you, including checking emails or answering the phone outside of work hours. Restrict overtime hours as much as possible and if you regularly work late try to leave on time at least a couple of times a week.

Take control
Take back control by prioritising your work tasks, separating the 'shoulds' from the 'musts'. Organisation is key in creating a balanced work-life schedule. Break projects into smaller, more manageable tasks and delegate responsibility if necessary. Leave 10 minutes earlier to avoid frantically rushing in the mornings or set your clocks fast to prevent you from being late. If you're work desk is messy, clean it up and get organised!

Speak up
If you are struggling with unrealistic or unreasonable pressures and demands, talk to your manager. If you feel like you are taking on more than your job role requires, clarify your job description. Or, if you are finding your work days dull and monotonous ask for new duties.

Change your way of thinking
Stop thinking negatively and start being more positive. Praise yourself (and others) for accomplishments, however small they may be. Stop aiming for perfection and set realistic goals and if all else fails, try and find the humour in the situation. Learn to accept that you can't control all situations, but you can control how you react to them.

Maintain a healthy lifestyle
We can't always avoid stress, but an important part of managing it is to maintain healthy lifestyle. This includes having a good diet, drinking plenty of water and getting regular exercise. Relaxation techniques such as mindfulness, meditation or yoga can also be very beneficial in reducing stress levels. It is essential to get enough sleep to ensure you feel energised and ready to tackle the challenges that lie ahead.

How to support a colleague affected by mental health issues


Approximately 45% of Australians experience mental health issues at some point during their lifetime. The majority of workers successfully manage their illness without it impacting on their work, however some may require workplace support for a short period of time or even require ongoing workplace strategies. Recognising and promoting mental health is an essential part of creating a safe, supportive and healthy workplace.

Mental illness is often misunderstood and comes with a stigma which may lead to those affected being treated disrespectfully. Understand that if a colleague has confided in you that they have a mental health issue that it may have been difficult for them and it has taken a level of trust.

There are a number of ways that you can show your support and help your colleague on their road to recovery:

Listen
If the are confiding in you about their condition make sure you actually listen to what they are saying and be encouraging and supportive. Don't try to minimise the problem or make their mental health problem sound trivial – mental health conditions are often prolonged and difficult to cope with. Continue talking about their illness for as long as they feel comfortable and don't just change the subject. Always check whether they would prefer if you kept your knowledge of their condition to yourself and ask them to let you know if there is anything you can do to help.

Do your research
Take the time to learn about your colleague's condition, either through talking to them or through your own research. Understanding the basic facts, symptoms and how it affects them will help you appreciate what your colleague is going through. It makes a huge difference to those affected when others make the effort to understand and offer support.

Make sure they know that you are there for them
If someone is struggling with their mental health at work, be supportive and ask if there is anything you can do to help them remain at, or return to, work. Find out whether they have discussed with their manager or another colleague what the appropriate course of action should be and whether you can assist in any way. Avoid giving mental health advice (unless qualified to do so) but instead see if they have a contact number for their doctor or mental health service, or offer to let them know where they can get extra support.

Be inclusive
Unfortunately mental health issues often come with a stigma and the affected person may feel isolated, embarrassed or self-conscious. Make sure you include your colleague in meetings and work social events to support their recovery. Although it is important to be there to talk about their mental health issues if they need you, make sure this isn't your only topic of conversation. Their identity doesn't start and end with their mental health and involving them in other discussions like normal will remind them that they aren't defined by their illness.

Keep in touch
Ensure that you keep in touch if a colleague has taken some leave due to their mental health. Maintaining connections with colleagues will prevent them from feeling alone, make them feel valued and allow them to keep up to date with work if they wish to. It will also make their return to work easier for everyone involved. If you haven't remained in contact whilst a colleague has been away, don't avoid them on their return but also avoid prying into their personal business. Ask how they are doing and offer to fill them in on what has been happening whilst they were away.

Be patient
Recovering from a mental illness can be long and ongoing and often involve various setbacks. Make sure that your colleagues know that you are there for them and will support them in their recovery however long it takes.

Dealing with mental health issues in the workplace


Approximately 45% of Australians experience mental health issues at some point during their lifetime. The majority of workers successfully manage their illness without it impacting on their work, however some may require workplace support for a short period of time or even require ongoing workplace strategies.

Why providing mental health support in the workplace benefits everyone
An ‘unhealthy’ work environment or a workplace incident can cause considerable stress and exacerbate, or contribute to, the development of mental illness. A survey of more than 5000 workers reported in a guide by the Australian Human Rights Commission indicated that 25% of workers took time off every year for stress-related reasons, with a total of 3.2 days per worker lost each year. Preliminary research also suggests that Australian businesses lose over $6.5 billion each year by failing to provide early intervention/treatment for employees with mental health conditions.

Maintaining someone in a job whilst they have been unwell remains far less costly than losing them and having to hire and train someone new, with research suggesting that for every dollar spent on managing mental health issues in the workplace there is an almost 500% return in improved productivity due to increased output and reduced leave.

Recognising and promoting mental health is an essential part of creating a safe and healthy workplace. Understanding the effects of mental illness and undertaking simple modifications in the workplace to provide support ensures employees feel respected and cared for, improving workplace environment and productivity.

As a manager:
As a manager it is important to understand how to address and manage mental health issues in the workplace and ensure your staff are getting the support they need. This involves not only being personally supportive but also ensuring your workspace meets their needs.

Discussing the subject with the person concerned
If an employee has disclosed their mental illness it is important to show willingness to understand and support them. At the same time, you'll need to discuss any potential productivity issues and how you can work together to address these, focussing on strengths and identifying areas where additional support may be needed.
If the employee has not disclosed a mental health issue but you are concerned that they may be affected, approach the subject as you would with any other health issue. Plan a meeting in a quiet and private place and express your concerns, assuring them that you want to help address the issues and provide the support they need. Make sure you discuss confidentiality and know what policies your organisation has in place to assist employees experiencing mental health issues

Make an action plan
It is also important to determine a personal action plan for how to proceed should they become unwell at work. Having a plan put in place in advance of a time when they may not be coping as well takes the pressure off all parties involved and also facilitates an open dialogue. This action plan should cover symptoms, early warning signs and triggers; the potential impact on their performance; what support they need; and positive steps the individual can take.

Workplace modifications
Sometimes simple workplace modifications may be helpful in maintaining the wellbeing and productivity of the affected person. Employers should explore the specific needs of the individual and work together to develop solutions that benefit everyone.

Examples of possible modifications include:
  • Flexible working hours or a change in shifts
  • Change of workspace – quieter, more/less busy, dividing screens, closer to natural light etc
  • Option of part-time working or working from home (although regular phone calls should be encouraged to keep the person connected)
  • Changes to break times
  • Provision of quiet rooms or 'safe spaces'
  • Return-to-work policies such as phased return
  • Relaxing of absence rules and limits or increasing availability to take leave short notice to assist with need for appointments etc
  • Reallocation of certain tasks or duties

Plus additional support including:
  • Increased supervision or extra help to avoid becoming overwhelmed with workloads
  • Additional training or coaching
  • Mentor or 'buddy' schemes
  • More positive and constructive feedback
  • Debriefing sessions and regular opportunities to discuss, review and reflect on their achievements
  • Provision of self-help information and resources as well as knowledge of support services

Providing support such as the examples listed above increases the likelihood of aiding a quicker recovery and the affected person being able to continue in work.

Other resources

There are also important considerations for managers whilst an employee is off sick and upon their return to work, with detailed information available from Mind. Other useful resources include Sane Australia which provides a guide with case study examples of helpful ways to act in situations where a staff member is experiencing a mental health issue, and Mindful Employer – a unique workplace mental health program that helps organisations improve their culture of mental health and wellbeing.

Mental health communication challenges

Communicating with someone who struggles with a mental illness can be challenging, but there are a number of suggestions you can utilise that will help all people involved.

Establish rapport
Try to establish rapport with the person to help them trust and open up to you and confide in you what problem they are experiencing. They may be frightened, especially if they are experiencing paranoia, and may appreciate additional personal space.

Be respectful
Always be respectful to the person and really listen to what they are saying. When someone feels like they are being respected and heard they are more likely to extend the same courtesy to you, giving you a better chance of understanding the problem and how you can help. Additionally, do not assume that they are not intelligent and will believe anything you tell them, mental illness has nothing to do with intelligence level and lying to them will often break your rapport.

Adjust your language and tone
Some people with mental illnesses have difficulty concentrating, so using short, clear and direct sentences will give them clarity and make it easier for them to understand and respond. Remain pleasant and use reassuring language, acknowledge what they are saying and ask for clarification if you don't understand to avoid misinterpretations. Be patient and remain calm to try and diffuse stressful situations.
Body language is also important, try to maintain eye contact, show empathy in your facial expressions and keep your voice low and steady.

Stay with them
Passing people around unnecessarily just to get rid of them could create further problems and lead to added upset, anger or even violence. Setting limits such as 'I can only talk with you for 10 minutes' or 'if you lash out I will not be able to talk to you' may be helpful. If you do refer them to someone else, make sure it is an appropriate referral and try to ensure that they understand why you are referring them.

Respond to delusions or unexpected behaviour
People who are experiencing delusions or hallucinations believe that they are real and you will not be able to talk them out of their reality. Communicate that you understand that they are experiencing those events but do not pretend that you are also experiencing them. If you need assistance in de-escalating the person or feel physically threatened, call for help (police, security, or colleagues)

Offer further help
Suggest options for further help (if they need it) including community resources such as shelters, food programs and mental health services. Not everyone will accept the suggestion, but some will.
Anticipating triggers and recognising warning signs

Contrary to what is often reported in the media, people with a mental illness do not just 'snap', but proceed along a progression of behaviours that may worsen their condition or possibly lead to violence (against themselves or others). It is important to learn how to recognise behavioural warning signs and communicate concerns to others who may be more equipped to help.
Anticipating triggers
People with severe mental health conditions usually have times when they feel good and strong and can manage their symptoms effectively. However, they will also experience setbacks or 'relapses' when symptoms worsen and can lead to serious consequences or even hospitalisation. External circumstances, events or behaviours may act as triggers that produce uncomfortable emotional or psychiatric symptoms and trigger a relapse including:
  • Stopping medication, or not taking medication as prescribed – these are the most common causes of relapse
  • Using drugs or alcohol
  • Experiencing stress or being overwhelmed
  • Personal problems such as relationship conflict or the illness or loss of a loved one
  • Anniversary dates of traumatic events
  • Frightening current news events
  • Physical illness
Recognising warning signs
Reacting to triggers in normal, but recognising and responding to them appropriately is essential to prevent a downward spiral. Although some relapses happen quickly, most occur gradually over time and recognising the warning signs can help you get help early and avoid a more serious crisis. Possible warning signs include:
  • Stopping medication, taking it less regularly or not as prescribed
  • Changes in sleep patterns (too little or too much)
  • Social withdrawal and isolation
  • Decline in personal hygiene/appearance
  • Changes in performance at school/work
  • Nervous, tense or hostile feelings
  • False beliefs, paranoia, delusions or hallucinations
  • Increased risk-taking behaviours (often involving money, alcohol, drugs or sex)
If you identify signs of a possible relapse it is important to talk about your concerns and contact your doctor or mental health service provider as soon as possible.

Distinguishing between depression and bipolar disorder


Bipolar disorder is a chronic condition that affects approximately 2% of the Australian population. It was previously known as 'manic depression' which encompassed the extreme and uncontrollable mood swings between states of manic highs and depressive lows that are experienced by those with the disorder.

Symptoms of depression and bipolar disorder
Although a component of bipolar disorder is depression, depression in itself is unipolar – meaning that there is no 'manic' part of the condition. Depression affects nearly 1 million Australians each year and is characterised by an intense and prolonged lowering of mood and sadness that may be accompanied by other physical and psychological symptoms that interfere with everyday life. For example, people with depression may lose interest or pleasure in their usual activities.

Symptoms of depression include:
  • pervasive sadness
  • lack of interest in activities one would usually enjoy
  • extreme fatigue/loss of energy
  • inability to make decisions
  • sleep issues
  • low self esteem
  • feelings of worthlessness, hopelessness or guilt
  • thoughts of death or suicide

“I was suicidal, withdrawn, isolated, hating the world, thinking everyone hated me.”

In addition to the depressive symptoms described above, people affected by bipolar disorder also experience symptoms of mania including:
  • increased energy
  • rapid speech and thoughts
  • excessive excitement, irritability or anger
  • extreme elation
  • delusions of grandeur
  • decreased need for sleep
  • increased recklessness (may involve money, drugs, alcohol or sex)
  • hallucinations/delusions

“My brain has gone at a thousand miles an hour. I’ve had periods in my life when I virtually couldn’t sleep at night...because my brain was going mad. Not mad, it was creative. Millions of thoughts, millions of ideas.”

Cause of bipolar disorder
The precise causes of bipolar disorder remain unknown, however as with other mental illnesses a family history of bipolar disorder can increase the likelihood of someone developing the condition, suggesting a genetic contribution. Environmental factors such as stressful or traumatic events may then trigger the onset of bipolar symptoms in some people.


Bipolar I
To be diagnosed with Bipolar I, you need to have experienced at least one manic episode. Major depressive episodes are typical but are not required for diagnosis. Bipolar I affects both men and women equally.

Bipolar II
A Bipolar II diagnosis requires the sufferer to have experienced at least one major depressive episode, plus at least one hypomanic episode – similar to a manic episode, but less severe. Bipolar II is more common in women.

Cyclothymic Disorder
People with cyclothymic disorder experience bipolar symptoms but less severely, where episodes are less intense, shorter and less frequent.

Bipolar disorder otherwise not specified
When people experience the mood swings which indicate a bipolar disorder but don’t have episode patterns which fit into the other categories, they are classified as having a ‘bipolar disorder otherwise not specified.’ They may not meet the diagnosis criteria due to a shorter duration or lower severity of symptoms.

Distinguishing between depression and bipolar disorder
Although the cyclical nature of bipolar disorder is distinct from depression, along with the chemical profiles of the brain, clinically, the depression stage of bipolar disorder and depression itself look very similar. This can make bipolar disorder difficult to diagnose, especially if the person has experienced depressive episodes for many years without mania or hypomania symptoms. Therefore, an accurate medical history is essential in distinguishing between the two conditions. Ruth Wolever, PhD, a clinical health psychologist, research director at the Duke Center for Intergrative Medicine, and Everyday Health's Emotional Health Expert explains:

“unless the person with bipolar disorder is in a manic phase at the time he or she seeks medical help — or a hypomanic state, in the case of bipolar II — it's through the medical history that a clinician will be able to distinguish between the two mood disorders."

Treatment and support
Affective (or mood) disorders such as depression and bipolar disorder are treatable, with both psychological and medical treatments (or a combination) available to help manage and stabilise symptoms as well as help to deal with related problems.

For further information and support, visit the Beyond Blue, Black Dog Institute and SANE Australia websites.

Treating anxiety disorders

Effective treatments help you to control your anxiety so that it no longer controls you. There are multiple methods for treating anxiety and which works best for you depends on you as an individual and what type of anxiety you are experiencing. There are a range of mental health services and healthcare professionals who can offer you advice, information, treatment and support, as well as a number of techniques you can use to help yourself.

Treating mild anxiety
For mild symptoms, simple lifestyle changes such as a good diet, regular physical exercise, getting enough sleep and reducing your stress levels may help you manage your anxiety. Other complementary lifestyle changes such as learning mindfulness or meditation, taking up yoga, or relaxation training may also help you manage your anxiety.
There are also online 'e-therapies', many of which are free, anonymous and easily accessible, which offer similar services to psychological treatments but in a self-help manner. For people with mild to moderate anxiety e-therapies can be just as effective as face-to-face services. They help teach the user to identify and change patterns of thinking and behaviour that may cause or prolong your anxiety. E-therapies can be used alone, however some form of professional support is usually also available.

Treating moderate to severe anxiety
Moderate to severe anxiety usually requires professional healthcare support as well as psychological or medical treatment. Consulting with your GP or mental health service will help you determine which treatment course would be best for you.

Psychological treatments
Psychological treatments (or 'talking therapies') help you change your thinking patterns and reduce irrational thoughts and worries. The delivery of psychological therapies depends on the individual, some prefer one-on-one treatment with a healthcare professional, others prefer a group environment or using online services such as e-therapies.

Cognitive behavioural therapy
The most common psychological treatment for anxiety is cognitive behavioural therapy (CBT) which teaches you how the way we think (cognition) and act (behaviour) affects the way we feel. CBT is a structured treatment option where you work with a therapist to identify thought or behaviour pattens that contribute to your anxiety or prevent you from getting out of an anxious mindset. Recognising unhelpful patterns such as catastrophising (thinking the worst, anticipating things will go wrong) helps you replace them with more rational and realistic thoughts that reduce your anxiety and improve your coping mechanisms. Relaxation and breathing techniques may also be used in CBT to control your anxiety and reduce the physical symptoms.

Behavioural therapy
Behavioural therapy, although a component of CBT, doesn't try to change beliefs and attitudes but focuses on reversing patterns of avoidance and worry that perpetuate anxiety. By using 'graded exposure', behavioural therapy allows you to be slowly exposed to situations or things that make you anxious, giving you the opportunity to cope with fearful situations and feel a sense of satisfaction and reward.

Medical treatments
Psychological treatments are usually the most effective treatment for anxiety, however in severe cases medication may be helpful. Common medications used for managing anxiety include antidepressants and benzodiazepines.

Antidepressants
Anxiety disorders can cause changes in the brain's chemicals – serotonin, noradrenaline and dopamine. Some types of antidepressant medication can be used to help manage anxiety by correcting the imbalance of these chemicals.

Benzodiazepines
Another medication commonly prescribed in the short term for anxiety conditions are benzodiazepines (also known as minor tranquillisers and sleeping pills). Benzodiazepines reduce tension and promote relaxation and can help manage anxiety. However, they can only be used for a short period of time, or intermittently, and should be used as a secondary treatment as they can also be addictive.

Recovering from an anxiety disorder
The amount of time it takes for you to recover from the anxiety condition is different for everyone. Whilst psychological or medical treatment options will assist in your recovery there are also a number of ways you can help yourself get better and stay better.

For many people, experiencing anxiety can be scary, particularly when there is no obvious trigger. Numerous people who experience panic attacks believe they are having a heart attack and are going to die. Although anxiety is the most common mental health disorder in Australia, with over 2 million Australians affected, many people feel ashamed or embarrassed after being diagnosed with anxiety and struggle with feelings of denial. Anger and despair are also common feelings at being unable to control ones anxiety and its related difficulties.

However, by accepting the fact that you have an anxiety condition, and all the challenges that brings, you can receive support and discover new ways to deal with these changes. Treatment will help you manage the symptoms of anxiety, but recovery will allow you to accept and enjoy your life, even if it is different to before.

The most important thing to remember is that you are not alone. There are numerous avenues of support, from friends and family to mental health services to support groups of other anxiety sufferers. You need to find the right treatments and the right support team for your condition and situation.

Understanding anxiety


An overwhelming feeling of worry and fear, a racing heart, a trembling in my hands and knees that I couldn't cease... these are all experiences I went through on a near-daily basis before I learnt to manage my anxiety. The total feeling of being completely out of control, even of my own thoughts, was terrifying and heavily impacted my everyday life. But understanding anxiety is the first step to managing your anxiety, and I promise you, it can and will get better.

What is anxiety?
Everyone experiences feelings of anxiousness and worry in response to stressful situations or when we feel under pressure, but these feelings usually pass once the situation is over.
For people with anxiety disorders these feelings don't go away and they experience persistent and excessive worry that is so distressing it can interfere with their ability to enjoy everyday life. There may not even be an obvious or particular reason that has triggered the anxiety but the intense and uncontrollable feelings of worry and fear, even if these concerns are unrealistic or irrational, are very real.

Common symptoms of an anxiety disorder include:
  • Physical – racing heart, tight chest, rapid breathing, hot and cold flushes, restlessness, feeling tense and wound up or panic attacks (extreme episodes of intense anxiety and fear that develop abruptly and peaks within minutes)
  • Psychological – excessive fear and worry, catastrophising, obsessive thinking
  • Behavioural – avoidance of situations that make you feel anxious, impacting work, study or social life.

Cause
Anxiety is caused by a combination of factors, from genetics to life experiences to personality traits. Most people with anxiety were likely born with a genetic predisposition to developing an anxiety disorder, meaning they may be more vulnerable to developing anxiety following additional triggers. Common triggers may include work stress, family or relationship problems, major emotional shock following a traumatic event, abuse or grief.

Certain chronic physical illnesses can contribute to anxiety disorders such as diabetes, asthma or hypertension and heart disease. Others conditions may mimic the symptoms of an anxiety disorder. Therefore it can be useful to consult your doctor to determine whether there is an underlying medical cause for your anxiety. Additionally, other mental health conditions such as depression or substance can come hand in hand with anxiety so it is important to be assessed and receive help for all of these conditions.

Types of anxiety
Anxiety disorders come in many different forms including:
  • Social phobia – experiencing an intense fear of criticism, embarrassment and humiliation in everyday situations including public speaking, eating in public, making small talk or taking the lead at work.
  • Specific phobias – feeling intense fear about a particular object or situation and potentially going to great lengths to avoid it. There are many different types of phobia, for example needles or flying on a plane.
  • Obsessive compulsive disorder (OCD) – anxiety caused by persistent unwanted or intrusive thoughts and fears. People with OCD often perform certain behaviours or rituals in an attempt to relieve their anxiety.
  • Post-traumatic stress disorder (PTSD) – ongoing symptoms including difficulty sleeping and distressing flashbacks or dreams following a traumatic event such as war, assault, an accident etc.
  • Panic disorder – intense, overwhelming and uncontrollable feelings of fear and anxiety that develop suddenly and can peak within minutes. Panic attacks may also cause physical symptoms including shortness of breath, chest pain, dizziness and excessive perspiration. If a person experiences recurrent panic attacks or persistently fears having one, they are diagnosed with a panic disorder.

Treating anxiety
There is no 'one size fits all' for anxiety or its treatment. Which treatment option(s) will work best for you depends on what type of anxiety you are experiencing as well as you as an individual. It will take time, but you will be able to control your anxiety so that it no longer controls you.

What's it like living with anxiety - from personal experience

I'm sitting there, heart pounding in my chest, my breathing rapid and shallow and my shaking hands sweating under the desk. I want to be sick. Whilst reading out the attendance register my teacher pauses, glances at me, then skips my name and carries on down the list. The tightness in my chest relaxes ever so slightly and when my friends look at me confused that he missed my name again I laugh along with them that he must be getting old. What they don't know is that all of my teachers have been asked not to make me read aloud in class, not even to answer my name in the register.

I was 15 and I was suffering from severe social anxiety – an intense fear of being judged, ridiculed and humiliated in front of others, even in everyday situations. It was all I could think about, day and night – how would I get through the day without having to speak in class? I'm certain that it was triggered from being bullied for blushing, and believe I can even pinpoint the exact event that turned me from just another nervous public speaker into a teenager with an anxiety disorder.

I became consumed with a crippling fear, imagining and believing the worst possible scenario that could possibly occur. I was a straight-A student but my anxiety was affecting my studies. I would make an excuse to duck out of class whenever there was a chance that I might have to read aloud and would hide in the toilets in tears. I spent more time trying to make sure no-one noticed how much my hands were shaking than actually listening in my lessons. I didn't know I had an anxiety disorder at the time, I just knew that I was terrified and felt completely out of control of my own thoughts, feelings and body.

I lived like this for months before I got help from a therapist, and still struggled with it for many years. When I changed schools I had a fresh start, making new friends who supported me instead of bullying me and started to get my life back on track again.

It was during my second year at university that my anxiety reared its ugly head again. After my then-boyfriend cheated on me I couldn't stop obsessively worrying that it would happen again, and I would lie awake at night plagued by negative thoughts and fears. My anxiety was so strong that it leaked into many other areas of my life and I lost trust in everything, including myself. I didn't know whether what I was thinking and feeling was true or a product of my anxiety.
I had my first panic attack during a theatre performance of Dr Jekyll and Mr Hyde. My heart was racing, my chest was so tight I felt like I couldn't breathe, my hands were shaking so much that I couldn't hold the programme and I was overwhelmed with a feeling of utter terror. I had become so fearful of the anxiety itself and was trapped in what felt like a never-ending circle.

I made an emergency appointment with the doctor the next morning and was diagnosed with generalised anxiety disorder (GAD). Just getting a diagnosis helped me massively, I'm the kind of person that needs to understand something and it helped me feel like I had regained some control. I started CBT (cognitive behavioural therapy) the following week and was taught to identify thoughts and behavioural patterns that contributed to my anxiety and replace them with more rational ways of thinking to help me cope with and control my anxiety.

Anxiety disorders often run in families, suggesting that people may have a genetic predisposition towards anxiety making them more vulnerable to developing the disorders following an additional trigger, in my case bullying and later the breakdown of a relationship. Considering that many of my family members also struggle with these conditions I'm hardly surprised that I do too. It was a tough road but what I learnt through CBT altered my thinking patterns and allowed me to develop coping mechanisms to manage my anxiety.

I would now consider myself a generally confident person and would doubt that most people who meet me would guess that I have an anxiety disorder. To this day, having to give a talk still fills me with dread, but by preparing thoroughly I can now control my anxiousness and give the talk as if I was someone who found public speaking just slightly nerve-wracking. I do still have trust issues and insecurities and sometimes do struggle with over-worrying or obsessing over something, but it is no longer crippling me. I can now say 'I am feeling anxious' and understand that whatever I am thinking or feeling is being overblown and I can start to rationalise with myself. It doesn't always work, sometimes the fear is too strong and I may start catastrophising. But these feelings now pass and don't consume or control me.

Living with a mental illness like anxiety is nothing to be ashamed of and is much more common than you might think. You don't have to tackle it alone, there are so many services out there that can help depending on what suits your individual needs. I won't deny that learning to live with your anxiety is challenging, but I promise you it can and will get better.

Common mental health disorders affecting young Australians


Mental illnesses continue to be the third leading cause of disability burden in Australia despite vast improvements to treatment access and uptake. Approximately 45% of Australians aged 16-85 years will experience a mental disorder during their lifetime, with research suggesting that 75% of mental health illnesses emerge before the age of 25. Mental health is the number one health issue facing young Australians and this report provides a summary of the current statistics for mental health issues in this age group.

Common mental health disorders in young people
The National Survey of Mental Health and Wellbeing (NSMHWB) 2007 provided estimates of the prevalence of mental health disorders in the Australian population for an estimated two and a half million Australians aged 16 to 24. The results of this survey showed that one in four (26.4%) young Australians aged 16 to 24 experienced at least one mental health disorder in the last 12 months. The leading cause of disease burden in mental health issues for young people are anxiety, depression and substance use. In the preceding 12 months, one in six young people (15.4%) experienced an anxiety condition, one in 16 (6.3%) experienced an affective disorder, most commonly a depressive episode, and almost one in eight (12.7%) were affected by substance use disorders.

Differences with gender
Females were more likely than males to have experienced a mental disorder in the last 12 months (30.1% and 22.8% respectively). In particular, females were twice as likely to experience anxiety disorders than males (21.7% and 9.3% respectively) as well as affective disorders (8.4% and 4.3% respectively). The most prevalent types of anxiety condition were post-traumatic stress disorder and social phobia, accounting for 50% and 35% of the experienced anxiety disorders respectively.
On the contrary, males were more likely to suffer from substance use disorders than females (15.5% compared to 9.8% respectively), with the harmful use of alcohol accounting for almost 1/3 of all substance use disorders.

Personal psychological distress and concerns
The NSMHWB 2007 survey also indicated that 9% of young people aged 16-24 years had high or very high levels of psychological distress as measured by the Kessler 10 (K10) scale, a 10-item questionnaire covering feelings of nervousness, hopelessness, restlessness, depression and worthlessness. High K10 scores were more prevalent among those young people who had been diagnosed with a mental disorder compared to those who reported no mental disorder (21% and 4% respectively).

According to research from Mission Australia annual Youth Survey 2016, which had nearly 22,000 respondents making it the largest survey of its kind, for the first time in 15 years mental health concerns were listed in the top 3 issues facing Australia today. In addition, concerns over mental health having doubled since 2011. Since 2013 the top three issues of personal concern have consistently been (in descending order): coping with stress, school or study problems and body image, with mental health also being increasingly identified as a personal concern. The fact that mental health concerns have risen so dramatically and that issues of personal concern have not changed since 2013 suggests that more effort and resources are required to tackle these issues.

Suicide rates
An additional report from the Australian Institute of Health and Welfare (AIHW) also suggested that young people aged 12-24 continue to have a high rate of mental disorders. They are also at risk of experiencing stigma related to their mental disorder, with poor mental health in young people being a precursor to self-harm, suicidal thoughts and suicide itself. Suicide is the leading cause of death among young Australians aged 15 to 24, accounting for 31% of all deaths in this age group. In addition, Aboriginal and Torres Strait young people are four times as likely to die from suicide, and young people living in remote areas have higher overall death rates and are less likely to access GPs.

One participant in the Mission Australia Youth Survey 2016 quoted:

“I am concerned about mental health in rural areas, particularly suicide. I think there needs to be more help … particularly low cost or free help”.Female, 17, SA

Getting help
The NSMHWB 2007 survey also found that young people aged 16 to 24 were less likely to access mental health services compared to other age groups, with only 23% doing so compared to 38% of people aged 25 years and over. This is concerning considering the link between poor mental health and suicide rates in young people and indicates that further intervention is needed. The Australian government has been investing into improvements to mental health services including youth mental health services such as 'headspace' which provides early intervention for mental health issues and promotes wellbeing in 12-25 year olds. Although a step forward, the mental health of the young Australian population must still continue to be a priority.

The rising incidence of mental health issues in Australia

Mental illnesses are the third leading cause of disability burden in Australia and globally after cancer and cardiovascular disease.Despite vast improvements to treatment access and uptake, the incidence of mental health issues in Australia has not improved suggesting that a different approach may be required.

How does mental illness affect Australians?
Approximately 45% of Australians aged 16-85 years will experience a mental disorder during their lifetime, with about 1 in 5 (20%) Australians having experienced one of the most common mental disorders within the last 12 months. Anxiety disorders were the most common, affecting ~14% of Australians in a 12-month period, followed by depression (~6%) and substance abuse (~5%).

Psychotic illnesses such as schizophrenia or bipolar disorder are less common and affect approximately 3% of Australians. In addition, approximately 2% of Australians will experience eating disorders such as anorexia or bulimia in their lifetimes.

Prevalence of mental illness is greatest amongst those between 16-24 years old and decreases with age. There are also differences between genders, with the disability burden for depression and anxiety being nearly twice as high for females as it is for males. Likewise, women are 9 times more likely to develop an eating disorder than men. On the other hand, the burden for substance abuse is more than three times higher in males than females.

The 'treatment gap'
The first Australian National Survey of Mental Health and Well-being (1997) identified a problematic 'treatment gap' – a high number of people had mental disorders but were not getting treatment. Following this Australia has made a big effort in investing into improvements to mental health services over the last two decades. For example, from 1992-2004 the total spending on mental heath by the Commonwealth increased by 149%, with the states and territories increasing their spending by 67%. There has also been an increase in the number of psychological services funded by Medicare . Other initiatives include the government-funded 60 'headspace' youth mental health services, and other state-specific schemes such as WA's Statewide Specialist Aboriginal Mental Health Services.

Following this effort, the estimated treatment rate increased from ~35-37% in 2007 to ~46% in 2010. In addition, between 1997-2007 the number of people with mental disorders reporting that their needs were not met decreased. However, despite this various studies have shown no expected gains in decreasing the burden of mental health disorders have even demonstrated trends of worsening mental health within some subgroups.

What next?
Thus far the primary effort for tackling mental health has gone into improving treatment access. Although this is excellent progress the lack of gains in decreasing the disability burden for mental health suggests that a greater emphasis needs to be put on prevention to reduce the number of developing disorders before they require treatment. Prevention strategies are often more community-based rather than clinical. One success story is the National suicide prevention strategy, using the Living is for everyone (LIFE) framework, which has seen a steady decline in the suicide rate.  

A 'two-pronged' approach of continuing with better treatment access combined with an increase in effort aimed at the prevention of mental health issues would be the best way for effective change in reducing the disease burden for these disorders.

Other resources
National Survey Mental Health and Wellbeing (NSMHW) 2007
http://www.aihw.gov.au/publication-detail/?id=6442467990

Global burden of disease attributable to mental and substance use disorders
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61611-6/abstract

Understanding mental health issues

Mental illnesses are the third leading cause of disability burden in Australia. Approximately 45% of Australians aged 16-85 years will experience a mental disorder during their lifetime.

There are various kinds of mental health disorders. Anxiety disorders are the most common, affecting ~14% of Australians over a 12-month period, followed by depression (~6%) and substance abuse (~5%). Psychotic illnesses, such as schizophrenia or bipolar disorder, although less common still affect approximately 3% of Australians. In addition, approximately 2% of Australians will experience eating disorders such as anorexia or bulimia in their lifetimes.

Treatment options for mental health disorders can be very successful and if you have any concerns about yourself, a family member or friend you should contact your GP or other mental health services.

Anxiety and panic disorders
Anxiety disorders are characterised by persistent, excessive worry that is so distressing it can interfere with the person's ability to enjoy everyday life. There may not be an obvious reason for the anxiety being triggered but the person involved is likely to be experiencing intense and uncontrollable feelings of worry and fear, even if these concerns are unrealistic or irrational. Anxiety disorders can also trigger panic attacks, an extreme episode of intense anxiety and fear that develops abruptly and peaks within minutes.
Most people with anxiety were likely born with a genetic vulnerability to developing an anxiety disorder which may be triggered by personality traits or in response to stressful events.

Bipolar disorder
Bipolar disorder is a chronic mental health condition where the person experiences extreme changes in mood and energy, from feeling really euphoric ('manic') to feeling really low ('depressive'). During 'manic' episodes they may experience extremely high mood or activity, racing thoughts, rapid speech and little need to sleep, whereas depressive episodes are characterised by extreme sadness, feelings of hopelessness and a lack of pleasure or interest in things. The pattern of mood swings is different for each individual but it can affect our thoughts, behaviour and how we function in everyday life.

Depression
Clinical depression causes an intense lowering of mood and sadness over a long period of time. It is often accompanied by other physical and psychological symptoms that interfere with everyday life. For example, people with depression may lose interest or pleasure in their usual activities. Some people are likely to have a genetic predisposition for depression which can then be triggered by stressful situations. On other occasions there may not be an obvious trigger, yet the person may be affected so severely that they have trouble distinguishing between what is real and what is not.

Eating disorders
Eating disorders are characterised by obsessive thoughts and preoccupation over food and body weight and abnormal or disturbed eating habits. This includes people who limit the amount of food they eat (Anorexia nervosa), binge eat lots of food in a short period of time then purge (Bulimia) or overeat often (Compulsive overeating). Body image distortion is common and people with an eating disorder may not realise they have a problem or else if they do, they may go to extreme lengths to hide their behaviour.

Schizophrenia
Schizophrenia affects the normal function of the brain and interferes with the person's ability to think, feel and act, causing an altered experience of reality. People with schizophrenia experience persistent symptoms called psychosis which may involve confused and disordered thinking, delusions, hallucinations, abnormal motor behaviour (increased agitation, childlike behaviour, withdrawal from ones environment) or negative symptoms (being less able to experience pleasure, becoming less emotionally expressive). Contrary to popular belief, people with schizophrenia do not have a 'split personality'.

Substance Abuse & Addiction
Substance abuse and addiction is the harmful use of alcohol or drugs for non-medical purposes which becomes a physical and/or psychological need to continue using that substance. It is a complex, misunderstood disease and quitting takes more than a strong will or good intentions. The addiction is compulsive and difficult to control despite the harmful consequences. Repeated use often alters the brain and can affect self-control and interfere with the ability to resist intense urges as the user becomes dependent on the substance.

Resources
https://www.sane.org/mental-health-and-illness
https://www.beyondblue.org.au/
https://www.lifeline.org.au/get-help/facts-and-information
https://www.blackdoginstitute.org.au/mental-health-wellbeing

Popular Posts