Module 5

IDIS 199
THE SCIENCE OF WELL-BEING, MENTAL HEALTH, AND RESILIENCY
MODULE 05
MENTAL HEALTH AWARENESS:
PREVENTION,EARLY RECOGNITION, AND
SUPPORT
Please note: This course was designed to be interacted and engaged

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the online modules. This Module Companion Guide is a resource
created to
complement the online slides. If there is a discrepancy between
this guide and
the online module, please refer to the module.
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MODULE 05 COMPANION GUIDE
IDIS 199
TABLE OF CONTENTS
INTRODUCTION ......................................................................
............................................................................... 5
Module 05: Mental Health Awareness: Prevention, Early Recognition, and

Support ............................... 5
Mental Health Awareness: Prevention, Early Recognition, and

Support.................................................... 5
Video: Introduction to Module

05 ................................................................................
................................... 5
Module Learning
Outcomes ..........................................................................
.................................................. 5
Module
Assessments .......................................................................
................................................................. 5
Final
Exam ..............................................................................
........................................................................ 6
Discussion With
Peers .............................................................................
..................................................... 6
Course
Icons .............................................................................
......................................................................... 6
Module
Outline ...........................................................................
....................................................................... 7
SECTION 01: Resiliency and Managing

Distress...........................................................................
...................... 8
Introduction to Resiliency and Managing

Distress ..........................................................................
.............. 8
The “Tipping
Point” ............................................................................
................................................................ 8
Stress Diathesis
Model .............................................................................
........................................................ 8
Managing Distress, Resiliency, and Mental
Health ............................................................................
........... 9
Stress and Allostasis-Induced Brain

Plasticity ........................................................................
....................... 9
Stress Diathesis Model and

Adaptation ........................................................................
...............................10
The Brain and Perceived

Stress ............................................................................
.....................................11
Physiologic
Responses..........................................................................
......................................................11
Allostatic
Load ..............................................................................
...............................................................12
Genotype x Environment Interactions and

Stress ............................................................................
..........12
Section 01:
Summary ...........................................................................
...........................................................13
SECTION 02: Early Indicators of Common Mental Health

Concerns .............................................................14
Introduction to Indicators of Mental Health

Problems ..........................................................................
....14
Common Mental Health Problems in

Canada ............................................................................
.................14
Identifying Signs and

Symptoms ..........................................................................
.........................................15
Signs and Symptoms Associated with

Anxiety ...........................................................................
.............15
Signs and Symptoms Associated with

Depression ........................................................................
.........16
Question: At What Point do Signs and Symptoms Become a

Disorder? ..................................................17
Indicators Differentiating Stress from Mental Health
Disorders ...............................................................17
Aspects of a Mental Disorder

Diagnosis .........................................................................
..............................18
Diagnostic Assessment of a Mental

Disorder ..........................................................................
....................18
Question: Lily and Identifying Early Warning

Signs .............................................................................
........19
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IDIS 199
Lily and Jasmin: Navigating Early Warning

Signs .............................................................................
............19
Section 02:
Summary ...........................................................................
...........................................................20
SECTION 03: Resources and Barriers to Mental Health

Support ...................................................................21
Introduction to Mental Health

Resources .........................................................................
...........................21
Circle of Mental Health Care: Student First

Contact ...........................................................................
........21
Circle of Mental Health Care: Primary care

provider ..........................................................................
....21
Circle of Mental Health Care:

Psychiatry ........................................................................
..........................22
Circle of Mental Health Care: Self-Help and Peer

Support ....................................................................22
Circle of Mental Health Care:

Counselling........................................................................
........................22
Circle of Mental Health Care: Psychological

Therapy ...........................................................................
..22
Concept of Stepped
Care ..............................................................................
.................................................23
Who provides Mental Health

Support? ..........................................................................
..............................24
Mental Health Supports: Occupational

Therapist .........................................................................
..........24
Mental Health Supports:

Counsellor ........................................................................
................................25
Psychotherapist ...................................................................
............................25
Mental Health Supports: Clinical

Psychologist ......................................................................
..................25

Psychiatrist ......................................................................
.................................26
Activity: Mental Health

Spectrum ..........................................................................
........................................26
Resources for Student Well-

being .............................................................................
....................................26
Queen's University Student Wellness

Resources .........................................................................
...........27
Ideal Mental Health System

Model .............................................................................
..................................27
Current Campus Resources at

Queen’s ...........................................................................
.............................28
Community-Based
Services ..........................................................................
.................................................29
Barriers to Mental Health

Care ..............................................................................
........................................30
Stigma-Related Barriers to Mental Health

Care ..............................................................................
........30
Attitudinal Barriers to Mental Health

Care ..............................................................................
................31
Practical Barriers to Mental Health

Care ..............................................................................
....................32
Question: Barriers to Mental Health

Care ..............................................................................
......................32
Section 03:
Summary ...........................................................................
...........................................................33
SECTION 04: Prevention and Early
Intervention ......................................................................
........................34
Introduction to Prevention and Early

Intervention ......................................................................
...............34
Question: Preventative Self-Help - Health

Promotion .........................................................................
.......34
Self-Help Resources
Available .........................................................................
...............................................35
U-Flourish & Nurture-U: University Student Well-being and Mental Health

Research...........................36
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IDIS 199
Social
Approaches ........................................................................
...................................................................36
Psychological
Approaches ........................................................................
......................................................37
Psychological Approaches: Spotlight on

CBT................................................................................
................37
Psychological Approaches: Spotlight on

Mindfulness .......................................................................
.........38
Medical and Pharmacological

Approaches ........................................................................
..........................38
Section 04:
Summary ...........................................................................
...........................................................39
CONCLUSION ........................................................................
...............................................................................40
Module 05:
Conclusion ........................................................................
...........................................................40
Module
Outline ...........................................................................
.....................................................................40
Credits............................................................................
...................................................................................
40
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IDIS 199
INTRODUCTION
MODULE 05: MENTAL HEALTH AWARENESS: PREVENTION, EARLY RECOGNITION, AND

SUPPORT
Please see the online learning module for the full experience of interactions
within this document.
MENTAL HEALTH AWARENESS: PREVENTION, EARLY RECOGNITION, AND SUPPORT
This content was retrieved from Introduction Slide 2 of 7 of the online learning
module.
Module 05 builds on previous learning and explores further differences in student

mental needs and
maps this to resources available. The aim of this module is to provide you with the
knowledge about
early indicators of mental health problems and familiarity with mental health
support services.
The goal is not to make you a mental health expert, but to orient you to resources
and help you
navigate what can seem like a complex system of support. While specific services
may differ over time
or between institutions, the fundamentals of social, psychological, and medical
approaches and
providers and how these intersect should be relatively consistent.
VIDEO: INTRODUCTION TO MODULE 05
module.
Watch the video for an introduction to Module 05 from one of the course authors,
Simone Cunningham.
Introduction to Module 05. (0:40)
Page Link:
https://player.vimeo.com/video/521414332
MODULE LEARNING OUTCOMES
module.
By the end of Module 05, students will be able to:
• Describe how resiliency and managing distress relate to mental health.

• Become familiar with early warning signs and symptoms of a potential
mental health problem.
• Demonstrate awareness of the mental health resources available and
identify potential
barriers to accessing care.
• Develop an awareness of different psychosocial and medical approaches to
prevention and
early intervention.
MODULE ASSESSMENTS
module.
These assessments are associated with Module 05.
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IDIS 199
Continue to view details.
Final Exam- Refer to page 6
Discussion With Peers- Refer to page 6
Activities Throughout the Module:
Note that text responses and interactions within the learning module will not be
graded unless
otherwise noted. However, interactions such as true or false questions are recorded
in the module and
viewable by your instructors. Text responses and reflection questions will not be
recorded. Upon
submission, students will be provided with a few points to consider from their
instructor and are
encouraged to use these interactions to reflect on their own experiences and well-
being.
FINAL EXAM
Subpage of Introduction Slide 5 of 7– Final Exam 1/1
Students are required to write a final exam. This exam will be comprised of
multiple choice and short
answer questions.
The questions will ask students to apply the course content to fictional or
hypothetical scenarios.
Material in the modules, including the student stories* and audio/video content,
are testable material
unless otherwise noted. You will not be tested on external readings, although they
might be helpful in
providing you with context.
Definition*:
Student Stories: A set of fictional student characters. These are not real
students, but rather fictional
students who represent a composite of student experiences helpful to bring to life
what you are
learning.
DISCUSSION WITH PEERS
Subpage of Introduction Slide 5 of 7– Discussion with Peers 1/1
Students will participate in a discussion with their peers about content presented
in the course.
Students will apply and extend course concepts related to either a student story or
other interactive
learning opportunities presented in the module.
For specific details, visit the assessment page in the online learning environment.
COURSE ICONS
module.
As you navigate these course modules, you should watch out for specific icons.
Continue to learn about their function.
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IDIS 199
Listen Up!: This icon indicates the presence of an audio clip on the slide from
your instructor or other
content experts. To play the audio clip, click the play button. Full transcripts
and closed captions are
available.
Reference: This icon lives in the sidebar of the slide. Clicking it will reveal the
references for content
and/or images on the slide.
MODULE OUTLINE
module.
Section 01: Resiliency and Managing Distress
Section 02: Early Indicators of Common Mental Health Concerns
Section 03: Resources and Barriers to Mental Health Support
Section 04: Prevention and Early Intervention
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IDIS 199
SECTION 01: RESILIENCY AND MANAGING DISTRESS
INTRODUCTION TO RESILIENCY AND MANAGING DISTRESS
This content was retrieved from Section 01 Slide 2 of 9 of the online learning
module.
A normal part of life involves being faced with various disappointments and
stressful life events. It’s
important to be able to adapt and cope within reason with your ever-changing
environment.
Developing approaches to coping with stress and building resiliency can be helpful.
Continue to view the definitions of resiliency and managing distress.
Resiliency
Recall from Module 01 that resiliency is the ability to adjust or recover from a
stressor, threat, or
adversity.
Managing Distress
Being able to manage distress refers to learning how to cope with negative or
difficult emotional states
(e.g. feeling upset or angry). Learning how to manage distress is a form of self-
regulation, which you
learned about in Module 02.
THE “TIPPING POINT”
module.
Recall the idea of adaptive versus problematic stress from Module 02 - a small
amount of stress can be
adaptive, but too much stress can become harmful. There is a certain level of
pressure or stress that
results in optimal performance. However, sometimes the challenges and cumulative
stress exceed
this point and become too great to manage. This is referred to as the tipping
point.
Continue to learn about the tipping point.
Tipping Point
The tipping point is the point at which someone begins showing signs and symptoms
of the
strain/burden of perceived stress. The tipping point will be different for each
individual; what might
be your tipping point will be different than others.
Reference:
Schematic: Egerton, J. (2017, April). 3 Ways to Beat Exam* Anxiety. Retrieved

November 2020, from:
https://jamesegerton.wordpress.com/2017/04/29/3-ways-to-beat-exam-anxiety/
STRESS DIATHESIS MODEL
module.
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IDIS 199
One way to conceptualize the idea of this tipping point is through the stress
diathesis model*. You
may recall the stress diathesis model from Module 01. In order to understand the
stress diathesis
model, you must first understand the two components of the model: stress and
diathesis.
Continue to view descriptions of the terms stress and diathesis.
Stress
Stress triggers several interconnected biological systems. The process by which the
body adapts to
changes in the body, such as stress, is called allostasis.
Recall from Module 02 that allostasis is essential for maintaining balance in the
face of challenges.
Diathesis
Diathesis refers to the concept of vulnerability. Specifically, a person’s

predisposition or vulnerability
to a medical condition.
A diathesis can be biological through genetic inheritance, a psychosocial

vulnerability created by
exposure to a stressor early in life, or a vulnerability created by the interaction
between hereditary
(genetic) and environmental factors (GxE).
MANAGING DISTRESS, RESILIENCY, AND MENTAL HEALTH
module.
Genetic factors interact with the environment to determine your individual response
to stress.
Stress effects everyone differently. That is, the "tipping point" can be different
for different people
owing to genetic make-up and current and past experiences.
So, what happens when someone is close to or reaches their “tipping point”? Section
02 will provide
more information on signs and symptoms associated with emergent mental health
problems and
illness.
Reference:
McEwen, B., & Gianaros, P. (2011). Stress- and allostasis-induced brain plasticity.
Annual Review of
Medicine, 62(1), 431–445. Retrieved January 2021, from:
https://doi.org/10.1146/annurev-med-052209-
100430
STRESS AND ALLOSTASIS -INDUCED BRAIN PLASTICITY
module.
Results from a study by McEwan and Gianaros (2010) indicate that stress can trigger
allostasis-induced
brain plasticity*. This suggests that stressful experiences can affect brain
structure and function.
Continue to view the findings from the publication “Stress- and Allostasis-Induced
Brain Plasticity” by
McEwan and Gianaros.
PAGE 9
IDIS 199
1. The Brain & Regulation
The brain is central in the stress diathesis model. The brain determines what are
threatening/adverse
and what are positive experiences/exposures. The brain is responsible for
regulating an individual's
physical, emotional, behavioural, and cognitive response to stressors, events, and
experiences.
2. Stress
Stress must be balanced. Stress, if manageable, can lead to positive growth and
adaptation (steeling
effect*, you will learn about this idea later in this section) which promotes
resilience and good health.
3. Stress and Health
Too much stress, either chronic (cumulative) or acute overwhelming stress, takes a
toll on the brain
and body, and is associated with poor mental and physical health outcomes.
4. Brain Structure
When stressed, the brain changes its structure in an adaptive or maladaptive way in
response. In fact,
the loss of resilience (physiologically, neurologically, and behaviourally) is a
key feature of disorders
related to stress (i.e. anxiety and depression).
Definition*:
Steeling Effect: Refers to evidence of more resistance to later stress having

successfully coped with a
stress or challenge.
References:
McEwen, B., & Gianaros, P. (2010). Central role of the brain in stress and
adaptation: Links to
socioeconomic status, health, and disease: Central links between stress and SES.
Annals of the New
York Academy of Sciences, 1186(1), 190–222. Retrieved November 2020, from:
https://doi.org/10.1111/j.1749-6632.2009.05331.x
Mateos-Aparicio, P., & Rodríguez-Moreno, A. (2019). The Impact of Studying Brain

Plasticity. Frontiers in
Cellular Neuroscience, 13. Retrieved November 2020, from:
https://doi.org/10.3389/fncel.2019.00066
STRESS DIATHESIS MODEL AND ADAPTATION
module.
According to the stress diathesis model, stress influences how you think and feel
both emotionally and
physically. Typically, the system has checks and balances and adapts. However, too
much stress can
cause signs of wear and tear. Everyone is different in how reactive they are to
stress.
Continue to learn more about this adaptation process.
Perceived Stress- Refer to page 11
Physiologic Responses- Refer to pages 11-12
Allostatic Load- Refer to page 12
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IDIS 199
References:
McEwen, B. and Gianaros, P. (2010). Central role of the brain in stress and
socioeconomic status, health, and disease. Ann N Y Acad Sci. 1186 (1): 190-222.
Retrieved November
2020, from: https://doi.org/10.1111/j.1749-6632.2009.05331.x
McEwen, B. and Gianaros, P. (2011). Stress- and allostasis-induced brain

plasticity. Annual Review of
Medicine. 62: 431-445. Retrieved November 2020, from:
100430
THE BRAIN AND PERCEIVED STRES S
Subpage of Section 01 Slide 7 of 9 – Perceived Stress 1/1
The brain processes information from your internal (e.g. level of hydration,
hormonal state) and
external (work, friends, family) environment.
Given your genetics and life experience, your brain reacts differently to the same
stress. Taken
together, these factors determine your individual perceived level of stress.
References:
Retrieved November

100430
PHYSIOLOGIC RESPONSES
Subpage of Section 01 Slide 7 of 9 – Physiologic Responses 1/1
The brain then controls and coordinates the physiological, psychological, and
behavioural response to
perceived stress. Some of these responses include influencing metabolism, heart
rate, anxiety levels,
emotions, what you tell yourself, and how you behave.
The responses result through signalling of various systems including the HPA axis*
(recall from Module
02), the autonomic nervous system, the metabolic system, the gut, and the immune
system.
Definition:
HPA axis: The hypothalamic-pituitary-adrenal axis, an important part of the

biological stress response
system.
References:
Retrieved November
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IDIS 199

100430
ALLOSTATIC LOAD
Subpage of Section 01 Slide 7 of 9 – Allostatic Load 1/1
Recall from Module 02, that the allostatic load refers to the wear and tear on the
body and brain
resulting from chronic dysregulation or overactivity/strain related to the process
of allostasis (allostatic
mediators).
Interventions that alleviate allostatic load include a healthy diet, regular

cardiovascular exercise, social
support, connectedness (sense of belonging), and good quality sleep.
Participating in ways to alleviate allostatic load may also help develop resilience
in the event of
adversity.
References:
Retrieved November

100430
GENOTYPE X ENVIRONMENT INTERACTIONS AND STRESS
module.
You learned in Module 01 that your genetic make-up interacts with your life
experience to determine
your individual sensitivity to certain experiences.
Continue to learn how G x E interactions appear to influence susceptibility to all

experiences, good and bad.
Reduces Risks
Your genetic make-up interacts with life experiences good and bad to determine
resiliency and
sensitivity to stress, respectively. Developing healthy ways to cope with stress
and adversity can reduce
the risk of feeling overwhelmed and developing symptoms.
Flourish
Young people are at a particularly important time in development when a healthy

lifestyle together
with accelerated brain development increases the likelihood of positive effects on
well-being.
References:
McEwen B. S. (2008). Central effects of stress hormones in health and disease:

Understanding the
protective and damaging effects of stress and stress mediators. European journal of
pharmacology,
583(2-3), 174–185. Retrieved November 2020, from:
https://doi.org/10.1016/j.ejphar.2007.11.071
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IDIS 199
Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington,
H., ... & Poulton, R. (2003).
Influence of life stress on depression: moderation by a polymorphism in the 5-HTT
gene. Science,
301(5631), 386-389. Retrieved November 2020 from
https://doi.org/10.1126/science.1083968
Rutter, M. (2012). Resilience as a dynamic concept. Development and

psychopathology, 24(2), 335-344.
Retrieved November 2020 from http://doi.org/10.1017/S0954579412000028
SECTION 01: SUMMARY
module.
Challenges, disappointments, and setbacks are an unfortunate but important part of

the human
experience and provide the opportunity to learn healthy ways of coping and
consolidating our sense of
self-effectiveness and competence. However, chronic, unpredictable,
overwhelming/severe, and/or
uncontrollable stress has been linked to a variety of physical and mental health
problems and
conditions.
One model to understand how stress negatively impacts our psychological and
physical health comes
from the “stress diathesis” model in which the wear and tear of unrelenting or
overwhelming
psychological stress has a negative impact on the brain and body through a number
of shared
neurochemical and hormonal mediators.
In Section 02, you will learn about early warning signs associated with emergent
mental health
problems and illness.
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IDIS 199
SECTION 02: EARLY INDICATORS OF COMMON MENTAL HEALTH CONCERNS
INTRODUCTION TO INDICATORS OF MENTAL HEALTH PROBLEMS
module.
In this section, you will review some of the available statistics describing the
scope
and trends in common mental health concerns and disorders in young people in Canada
and
worldwide.
You will also learn in more detail important indicators of mental health problems
or emergent illnesses
that should be taken in psychosocial context and try to understand how these differ
from normative
short-lived feelings when stressed.
Finally, you will catch-up with our fictional students introduced in earlier
modules to illustrate some of
the concepts of indicators of stress, distress, and mental health problems.
COMMON MENTAL HEALTH PROBLEMS IN CANADA
module.
The two most common mental health disorders in Canada are

anxiety disorders (e.g. generalized anxiety disorder, social anxiety, phobias,
panic disorder) and
depressive disorders (e.g. major depressive disorder).
Continue to learn about how prevalent these conditions are in Canada.
Prevalence in Canada
In 2013, an estimated 3 million Canadians (11.6%) reported that they live with an
anxiety and/or mood
disorder. Almost a quarter (23%) of these individuals reported that they have not
sought treatment in
the last 12 months. These rates are similar to those reported in the UK and other
Western countries.
Comparing Depression & Anxiety
The rates of depression and anxiety are similar among Canadian youth and the
general population.
One study found that 10.2% of Canadian youth have experienced a depressive disorder
and 12.1%
have experienced an anxiety disorder.
Comparing Males & Females

Depression and anxiety disorders are more prevalent in females compared to males.
References:
Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England,
2014. (n.d.). NHS
Digital. Retrieved November 2020, from: https://digital.nhs.uk/data-and-
information/publications/statistical/adult-psychiatric-morbidity-survey/adult-
psychiatric-morbidity-
survey-survey-of-mental-health-and-wellbeing-england-2014
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IDIS 199
Mood and anxiety disorders in Canada—Canada.ca. (n.d.). Retrieved November 2020,

from:
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/
mood-anxiety-
disorders-canada.html
Nguyen, C. T., Fournier, L., Bergeron, L., Roberge, P., & Barrette, G. (2005).
Correlates of Depressive and
Anxiety Disorders among Young Canadians. The Canadian Journal of Psychiatry,
50(10), 620–628.
Retrieved November 2020, from: https://doi.org/10.1177/070674370505001008
IDENTIFYING SIGNS AND SYMPTOMS
module.
Anxiety and depression are common mental health concerns in young people. There are
a variety of
early warning signs and symptoms of emergent mental health problems. In this
module, you will focus
on signs and symptoms associated with anxiety disorders and depressive disorders,
as these are the
most common conditions in the university student population.
Please note that this information is to increase your general knowledge and should
not be used as a
substitute for medical advice for yourself or others. Experiencing these signs and
symptoms does not
mean there is a problem, but that it might be worth getting checked out by a
professional like your
family doctor or a counsellor.
Continue to view the signs and symptoms of anxiety and depressive disorders.
Signs and Symptoms Associated with Anxiety- Refer to pages 15-16
Signs and Symptoms Associated with Depression- Refer to pages 16-17
SIGNS AND SYMPTOMS ASSOCIATED WITH ANXIETY
Subpage of Section 02 Slide 4 of 11 – Signs and Symptoms Associated with Anxiety

1/1
Many of the signs and symptoms of anxiety disorders, like other mental health
conditions, are
emotional/cognitive, physical, and behavioural in nature. For a disorder, these
symptoms tend to
persist and are associated with distress and/or impairment.
Continue to view some of the most common signs and symptoms associated with anxiety
disorders.
Emotional Signs and Symptoms
• Feeling on edge
• Feeling irritable
• Not fully enjoying things
Physical Signs and Symptoms
• Restlessness
• Chest tightness
• Muscle tension
• Shortness of breath/hyperventilation
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IDIS 199
• Gastrointestinal upset
• Headaches
• Sweaty palms
• Butterflies
• Changes in appetite
• Blushing/flushing
• Fatigue or low energy
• Rapid pressured speech
Behavioural Signs and Symptoms
• Avoidance of feared situations (i.e. public speaking)

• Short temper and at times angry
• Difficulty sleeping (falling and/or staying asleep)
• Difficulty concentrating, distracted by worries, forgetfulness (mind goes
blank)
Cognitive Signs and Symptoms
• Apprehension (i.e. a sense something unpleasant is going to happen)

• Over-worry
• Distracted
Note that the symptoms of anxiety can overlap with other types of problems and
present
sometimes like ADHD, depression, or cardiovascular problems.
Reference:
Diagnostic and statistical manual of mental disorders : DSM-5. (5th ed.). (2013).
American Psychiatric
Association.
SIGNS AND SYMPTOMS ASSOCIATED WITH DEPRESSION
Subpage of Section 02 Slide 4 of 11 – Signs and Symptoms Associated with Depression

1/1
Much like anxiety, there are some common signs and symptoms associated with major
depression
which typically persist, representing a chance from normal functioning and are
associated with distress
and/or impairment in functioning.
Continue to view the signs and symptoms associated with depression.
Emotional Signs and Symptoms
• Feeling sad
• Non-reactive mood
• Feeling despair
• Loss of enjoyment of normally enjoyable experiences
Physical Signs and Symptoms

• Changes in sleep (sleeping a lot less or a lot more than is usual for you)
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IDIS 199
• Changes in appetite (eating a lot less or a lot more than is usual for
you)
• Feeling slowed down in your movements, or agitated and restless
• Pain, headaches
Behavioural Signs and Symptoms
• Withdrawing from friends and family

• Staying in more, missing work or university
Cognitive Signs and Symptoms
• Feelings of guilt
• Suicidal thoughts
• Feelings of hopelessness
• Difficulty concentrating
• Dwelling on the negative (i.e. glass half empty rather than half full)
• Thinking over past bad memories and experiences
• Difficulty making decisions
• Negative thinking (e.g., negative judgements about self, world, future)
Reference:
Diagnostic and statistical manual of mental disorders : DSM-5. (5th ed.). (2013).
American Psychiatric
Association.
QUESTION: AT WHAT POINT DO SIGNS AND SYMPTOMS BECOME A DISORDER?
module.
You have reviewed early warning signs and symptoms that may indicate a concern or
disorder, but
symptoms can also be normative, short-lived responses to stress and common in
everyday life.
Answer the question considering the signs and symptoms presented for anxiety and
depression.
Question: If you have several challenging final exams ahead, what physical and
emotional symptoms
might you experience?
Feedback:
If you have several challenging final exams ahead and you find yourself worrying
and experiencing
some physical symptoms of anxiety, this can be a normal reaction in the face of
stress. Overall,
experiencing some of these signs and symptoms does not mean that you have a problem
or clinical
disorder but rather it shows that you care about the outcome of the exams, which is
normal. Next, you
will learn some of the main indicators that differentiate normative stress/distress
from
problems/disorders.
INDICATORS DIFFERENTIATING STRESS FROM MENTAL HEALTH DISORDERS
module.
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IDIS 199
There are four main indicators that may suggest a concern or problem.
Continue to learn about the four main indicators that point to a mental health
disorder.
Disproportionate Reaction
Severity or intensity of symptoms and level of distress are disproportionate to the

situation.
Time
Symptoms persistent for an extended period of time (past the stressor).
Impairment
Symptoms are associated with impairment and interfere with day-to-day life.
Out of Character
Others notice that the person does not seem themselves or is "off".
ASPECTS OF A MENTAL DISORDER DIAGNOSIS
module.
While symptoms may indicate a concern or problem, making a clinical diagnosis is

not the same as
checking off a list of symptoms. Mental health concerns and conditions require
assessment by a
mental health professional who takes into account the whole person (i.e. life
course, family history,
current context, and symptoms).
Bullying, academic problems, relationship problems, substance misuse, family

history, recreation,
and exercise are all taken into account during the assessment and diagnosis of a
mental health
concern or disorder.
DIAGNOSTIC ASSESSMENT OF A MENTAL DISORDER
module.
In addition to the psychological and social context of the presenting symptoms, a

diagnostic
assessment considers all other predictive information.
Continue to learn about the information that is important to assessing mental

health status.
Developmental History
The developmental history of the individual (i.e. learning problems, motor

problems, childhood
trauma, or abuse)
Family History
The family history of mental disorders to identify a predisposition, or genetic and

familial vulnerability.
Symptoms
PAGE 18
IDIS 199
The clinical course of distressing and impairing symptoms, in terms of onset and
nature (i.e. chronic or
episodic) and relationship to context/stressors.
Treatment
The response or paradoxical worsening to any treatment tried to date and other
physical or medical
problems that might be contributing.
Other Factors
The use of alcohol and/or recreational or illicit drugs and/or current stressors.
Relational and Social Factors
The nature of the relationships, social connectedness, and environment.
QUESTION: LILY AND IDENTIFYING EARLY WARNING SIGNS
module.
Recall the fictional student, Lily. While volunteering at the International Student
Association, Lily noted
that her friend Jasmin seemed unusually quiet and withdrawn. Lily asked Jasmin how
she was doing.
Initially, Jasmin shrugged and said: “Okay, I guess” but Lily noted a change.
Jasmin seemed sad in her
demeanour. She was more slow moving, sighed a lot, and her posture was hunched
over. At times, she
seemed to be holding back tears. This reminded Lily that Jasmine has seemed down
and not herself
over the past few weeks.
Answer the question about Lily and Jasmin.
Question: What early warning signs of a mental health concern is Jasmin showing?
Feedback:
Jasmin is showing some distress and low mood which has persisted and not obviously
linked to her
immediate environment. She also seems withdrawn or disengaged.
LILY AND JASMIN: NAVIGATING EARLY WARNING SIGNS
module.
Lily offers to make Jasmin some tea. She notices (without judgement) that Jasmin
seems low and tries
to ask Jasmin open ended questions to gently enquire about how she’s feeling about
life at university.
Jasmin shares that she has been worried about her grades and feels very homesick
and lonely. She
also shares that she has trouble feeling motivated to make meals, eat, and get out
of bed.
Lily suggests that Jasmin make an appointment with a counsellor or family physician
at Student
Wellness Services, and offers to walk Jasmin over to make the appointment. Lily
explains that it is
important to get these symptoms checked out and that Student Wellness Services are
confidential and
set up to help students manage health and emotional health problems or concerns.
PAGE 19
IDIS 199
Jasmin thanks Lily for her concern and agrees that she will call to make the
appointment. Jasmin feels
relieved and thankful to Lily for her thoughtful and caring advice and no longer
feels alone in her
struggle with her symptoms.
SECTION 02: SUMMARY
module.
In this section, you learned about the early warning signs and indicators of an
emerging mental health
concern or problem, and how this may differ from normal transient distress or
symptoms related to a
specific stress that subsides.
In addition, you have been introduced to the idea that assessment and diagnosis of
a possible mental
health problem or concern is more than running through a checklist or rating of
symptoms - this is a
good starting place or for a first screen to identify symptoms that ideally should
be assessed by a
mental health professional.
Finally, in this section you have been provided a high level overview of what a
mental health
assessment might entail so as to familiarize you with information that is needed or
maybe asked for in
an assessment.
PAGE 20
IDIS 199
SECTION 03: RESOURCES AND BARRIERS TO MENTAL HEALTH SUPPORT
INTRODUCTION TO MENTAL HEALTH RESOURCES
module.
Understanding the complex landscape of mental health support can be confusing and,
thus, a barrier
to accessing help.
In this section, you will be provided with an overview of the types of resources
and services and a brief
overview of the different mental health professionals that provide these services.
Next, you will explore
different barriers to accessing support. You will be introduced to a model of
rationalized service
delivery based on level of need - called “stepped care”.
The aim of this section is to equip you with the necessary level of knowledge so
that the available
resources and health care system organization are familiar to you and more
accessible in case you or
someone close to you has a need for accessing help.
CIRCLE OF MENTAL HEALTH CARE: STUDENT FIRST CONTACT
module.
Typically university students with a mental health concern should reach out for
help on campus at
Student Health or Wellness Services or through their local family practice. Less
commonly, students
may be referred to specialized psychological therapy or psychiatric
consultation/care.
Continue to learn about each care option.
Primary Care Provider- Refer to pages 21-22
Psychiatry- Refer to page 22
Self-Help and Peer Support- Refer to page 22
Counselling- Refer to page 22
Psychological Therapy- Refer to pages 22-23
Reference:
Duffy, A., Saunders, K. E. A., Malhi, G. S., Patten, S., Cipriani, A., McNevin, S.
H., MacDonald, E., &
Geddes, J. (2019). Mental health care for university students: a way forward?. The
lancet. Psychiatry,
6(11), 885–887. Retrieved February 2023, from: https://doi.org/10.1016/S2215-
0366(19)30275-5
CIRCLE OF MENTAL HEALTH CARE: PRIMARY CARE PROVIDER
Subpage of Section 03 Slide 3 of 13 – Primary Care Provider 1/1
Your primary care provider (family doctor or nurse practitioner) should be thought
of as central to
coordinating (or quarterbacking) your health and mental health care. Primary care
providers are a first
line for assessment of a mental health concern and provide continuity and
coordinate your care. As
PAGE 21
IDIS 199
such, ideally your primary care provider should be kept up to date with any health
or mental health
support or care you receive.
Primary Care Provider
• Psychiatry
• Psychological Therapy
• Self-Help and Peer Support
• Counselling
CIRCLE OF MENTAL HEALTH CARE: PSYCHIATRY
Subpage of Section 03 Slide 3 of 13 – Psychiatry 1/1
Psychiatry is particularly well-suited for assessing and treating moderate to

severe mental health
conditions or disorders that require a combined psychological and pharmacological
treatment
approach.
CIRCLE OF MENTAL HEALTH CARE: SELF -HELP AND PEER SUPPOR T
Subpage of Section 03 Slide 3 of 13 – Self-Help and Peer Support 1/1
Peer support
Being able to talk to other students who are going through - or who have been
through - similar
experiences as you can be helpful for support. Many universities have peer mentor
schemes, a 'buddy'
system, and/or a confidential listening service where you can talk to other
students. Peer mentors are
student volunteers and can help by empathising, sharing information and resources
and sharing their
own personal experiences. It can sometimes feel easier and less daunting to speak
to a fellow-student
and they can guide you where to go for further help if needed.
Self-help
Self-help refers to using available resources, such as books, websites, or apps, to

work through a
problem or difficulty. It can be very effective for many different types of problem
and is accessible and
convenient to work through at a time and pace that suits you. There are a number of
good self-help
guides. For example the digital platform Silvercloud is a self-help programme using
cognitive
behavioural therapy for low mood and anxiety; the 'Overcoming...' series of self-
help books offer
information and exercises to work through for many different problems.
CIRCLE OF MENTAL HEALTH CARE: COUNSELLING
Subpage of Section 03 Slide 3 of 13 – Counselling 1/1
Counselling provided through Student Wellness Services is often short-term and

problem-focused,
addressing healthy coping during periods of stress, strengthening problem-solving
skills, and managing
emotional responses to an identified stressor.
CIRCLE OF MENTAL HEALTH CARE: PSYCHOLOGICAL THERAPY
PAGE 22
IDIS 199
Subpage of Section 03 Slide 3 of 13 – Psychological Therapy 1/1
Psychological therapy or psychotherapy services are often well-suited to help with

and support young
people with emotional, social, and mental health problems, typically of moderate
severity.
CONCEPT OF STEPPED CARE
module.
A stepped care approach aims to match individual patients to the level of service
indicated based on
intensity of need.
Listen to Dr. Anne Duffy explain the concept of stepped care.
Start of Audio Transcript:
The concept of stepped care is often visualized using a pyramid. At the bottom,
there are entry level services.
Entry level services or care refer to the lowest intensity, it has nothing to do
with the quality of effectiveness, it
just means that this is the lowest intensity required to meet the individual’s
needs. Each step in the pyramid
represents a progressive increase in the level or intensity of treatment and the
expertise brought to bear into
that treatment. It’s often as you step up that you’re looking at a smaller subgroup
of patients.
The figure shows this concept of stepped care as it applies to the university
experience. So in terms of
university student mental health care and support, at the bottom of the pyramid,
usually we’re talking about
campus-based health promotion and self-guided well-being resources. And then as you
move up, you get
into more student mental health care teams or family medicine, and then the next
step would be actually
speciality mental health services located in the community, and then finally,
usually hospital-based service
such as emergency and urgent care services. So the key to safe and effective
stepped care is (1) the level of
care an individual receives matches the indicated clinical need and (2) the steps
represent evidence-based
effective treatment.
The model and the effectiveness of the model also assumes that:
(1) The minimally required intervention has itself benefits and gains. So in other
words, every step is
evidence-based and effective, and should be appropriate to match the need of the
patient.
It also assumed that (2) this is a way to rationalizes and economize healthcare
resources that are often
limited, so that we want individuals to have the indicated level of treatment but
not more than they need. In
other words, reserving the highest intensity treatments and the most specialized
treatments for those
patients with more serious or chronic illnesses.
Finally and thirdly, that the care provided is acceptable to patients so that it
each level is convenient,
accessible, and has flexibility so that if the clinical need should change
individuals can move up and down
levels of care.
End of Audio Transcript.
References:
PAGE 23
IDIS 199
Espie, C. (2009). Stepped Care: A Health Technology Solution for Delivering

Cognitive Behavioral
Therapy as a First Line Insomnia Treatment. Sleep (New York, N.Y.), 32(12), 1549–
1558. Retrieved
November 2020, from: https://doi.org/10.1093/sleep/32.12.1549
Bower, P., & Gilbody, S. (2005). Stepped care in psychological therapies: access,
effectiveness and
efficiency: Narrative literature review. British Journal of Psychiatry, 186(1), 11–
17. Retrieved November
2020, from: https://doi.org/10.1192/bjp.186.1.11
Emergent & Urgent Care Services Icon: Icon by Pexel Perfect from flaticon.com
Student Mental Health Care Team Icon: Icon by Freepik from flaticon.com, direct
link:
https://www.flaticon.com/free-
icon/group_681392?
term=team&page=1&position=69&page=1&position=69&related_id=681392&origi
n=search
Community Mental Health Services Icon: Icon by Freepik from flaticon.com, direct
link:
https://www.flaticon.com/free-icon/community-
manager_3713064?term=community&page=1&position=19&related_item_id=3713064
Campus-Based Health Promotion Icon: Icon by Smashicons from flaticon.com, direct

link:
https://www.flaticon.com/free-
icon/school_2231696?term=university&page=1&position=1&related_item_id=2231696
WHO PROVIDES MENTAL HEALTH SUPPORT?
module.
Let’s delve into the concept of stepped care, and how different mental health
professionals can meet
the spectrum of student mental health care needs.
Continue to learn more about the mental health professionals that can support you.
Occupational Therapist-Refer to pages 24-25
Counsellor- Refer to page 25
Psychotherapists- Refer to page 25
Clinical Psychologist- Refer to pages 25-26
Psychiatrist- Refer to page 26
MENTAL HEALTH SUPPORTS: OCCUPATIONAL THERAPIST

Subpage of Section 03 Slide 5 of 13 – Occupational Therapist 1/1
Occupational therapists (OTs) are regulated healthcare professionals who specialize

in assessment and
intervention focused on helping people resume or maintain participation in a
variety of activities,
including work, school, recreation, and activities of daily living.
PAGE 24
IDIS 199
In university settings, OTs are particularly well-suited to help with learning

approaches and improving
performance in the context of learning activities, and achieving a healthy
schedule/study-life balance.
Reference:
What Occupational Therapists (OTs) Do. (n.d.). Retrieved November 2020, from:
https://www.coto.org/you-and-your-ot/what-occupational-therapists-do
MENTAL HEALTH SUPPORTS: COUNSELLOR
Subpage of Section 03 Slide 5 of 13 – Counsellor 1/1
Counsellors have variable training, which may include a graduate degree in

educational counselling.
Counselling provided is often short-term and problem-focused.
Counsellors can support healthy coping, emotional and behavioural regulation, and
healthy lifestyle
choices, as well as achieving a good study-life balance.
Most Student Wellness Services have counsellors on site or “embedded” in academic

programs.
Counselling is provided free of charge and often limited to a specific number of
sessions.
Counsellors are mental health professionals that routinely are part of a university
wellness team.
MENTAL HEALTH SUPPORTS: PSYCHOTHERAPIST
Subpage of Section 03 Slide 5 of 13 –Psychotherapist 1/1
Psychotherapists are licensed healthcare professionals with training in group and

individual
psychological talking therapies. There are different “schools” or models of
psychotherapy including
cognitive behaviour therapy (CBT), interpersonal psychotherapy (IPT), and
psychodynamic
psychotherapy. You will learn about CBT, IPT, and psychodynamic psychotherapy in
Section 04 of this
module.
As previously mentioned, psychotherapy services are often well-suited to support

individuals with
emotional, social, and mental health problems of mild to moderate severity.
MENTAL HEALTH SUPPORTS: CLINICAL PSYCHOLOGIST
Subpage of Section 03 Slide 5 of 13 –Clinical Psychologist 1/1

In Ontario, clinical psychologists are registered healthcare professionals
regulated by the College of
Psychologists of Ontario (CPO). Becoming a psychologist in Ontario usually requires
a PhD in an
accredited clinical psychology graduate program, but it is also possible for
Master’s degree level
psychologists to transfer from other provinces and apply to practice in Ontario.
Psychologists receive extensive training in psychological, cognitive, and

psychoeducational assessment,
and in providing manualized effective group and individual therapeutic approaches
(you will learn
more about these later in the module) to help with a variety of mental health
problems and conditions.
Psychologists are particularly well-suited to provide psychological support and
treatment for mild to
PAGE 25
IDIS 199
moderate mental health problems and disorders and to work as part of a

multidisciplinary team
supporting patients with more moderate to severe mental disorders.
MENTAL HEALTH SUPPORTS: PSYCHIATRIST
Subpage of Section 03 Slide 5 of 13 – Psychiatrist 1/1
Psychiatrists are medical doctors with extensive speciality training in the

diagnosis and treatment of
mental disorders, integrating pharmacological treatment (i.e., medication) with
other aspects of
educational, psychological, and social and family care.
Psychiatric assessment, rooted in the medical approach, takes into account

developmental and family
history, psychosocial context, early adversity, onset and clinical course and
nature of symptoms, and
any contributing risk factors (stress, substance use, comorbid medical illness,
medication). As medical
specialists, access to psychiatric consultation occurs through a referral from a
responsible family
doctor.
ACTIVITY: MENTAL HEALTH SPECTRUM
module.
You should be familiar with the mental health resources available to you.
Use the drop down menus to match the different types of healthcare available to
their definition.
Terms:
• Primary Care Provider

• Counselling
• Psychiatry
• Psychological Therapy
DefinitionS
a) Assess, treat, provide continuity and coordinate all aspects of mental

health care
b) Provide short-term problem-focused support
c) Assess and treat moderate to severe mental disorders
d) Provide psychological treatment for moderate emotional, social, and
mental health problems
Feedback:
Correct Answers: a) Primary Care Provider b) Counselling c) Psychiatry d)

Psychological Therapy
RESOURCES FOR STUDENT WELL -BEING
module.
Navigating the mental health system can be challenging. All universities will have
student support and
wellness services. You are encouraged to research the resources available to you at
your institution.
Continue for links to specific mental health and wellness services at your
institution.
PAGE 26
IDIS 199
University of Exeter: Well-being Resources- Refer to page 27
QUEEN'S UNIVERSITY STUDENT WELLNESS RESOURCES
Subpage of Section 03 Slide 7 of 13 – University of Exeter: Well-being Resources

1/1
Continue to access resources for student well-being.
Student Wellbeing Services
Video: Introduction to Wellbeing Services
Emotional and Mental Health Support
Education Welfare Support
Disability Advisor
Student Wellness Services
Page Links:
https://www.exeter.ac.uk/students/wellbeing/
https://youtu.be/yXtI4Pt1onE
https://www.exeter.ac.uk/students/wellbeing/resources-and-services/appointments/
https://www.exeter.ac.uk/students/wellbeing/talk/welfare/
https://www.exeter.ac.uk/students/wellbeing/bookanappointment/
https://www.queensu.ca/studentwellness/
Reference:
What Occupational Therapists (OTs) Do. (n.d.). Retrieved November 2020, from:
https://www.coto.org/you-and-your-ot/what-occupational-therapists-do
IDEAL MENTAL HEALTH SYSTEM MODEL
module.
An ideal model would start with a welcoming clinic visit to determine each
student’s support need,
followed by referrals to the appropriate level of service and support. This is a
stepped care model.
Ideally there would also be a seamless flow between levels of service and between
community-based
and campus-based services.
This is one proposed model of organized student mental health care. However, this
model has yet to
be implemented in Ontario.
Listen to Dr. Duffy discuss the ideal mental health system model.
PAGE 27
IDIS 199
Start of Audio Transcript:
So this is a figure that brings together an ideal world scenario according to the
evidence and according to
student feedback and clincial need. This actually was published by myself and
colleagues recently in The
Lancet Psychiatry as part of a conversation about how can we bring together all of
the individual and often
times siloed or fragmented services and resources into some sort of cohesive system
of well-being and
mental health support tailored for students. And first and foremost, it seems
important to have a single point
of entry or a single point of contact for all help-seeking students. Another way to
say that is entering through
a single door no matter what the problem. And the other part of that is what we
call, the technical term is
triage, but it’s sorting out what is going on, what's the nature of the problem,
and what the indicated level of
care should be. When you do triage, it should have a clinical therapeutic value
from the first point of contact.
So, in other words, it shouldn’t be just what’s your name, what’s your age, and
taking of administrative
information, but triage should be delivered by seasoned mental health professionals
who are empathetic
and can really reassure students, and can immediately point them to what's needed
at the first contact. So
that clinical, humanistic, therapeutic first contact is really, really important.
And then from there, students
would ideally be matched to the level of care or service required. And again,
remember our stepped care
model that we went through - those services could either be housed on-campus within
student wellness or
student health services, and/or they may represent, actually, campus services that
are not related to
specifically health directly, so they may be more about peer support or academic
advice, or you know,
something to do specifically with academic programs, which can liaise with student
health services. Or
depending on the nature of the problem and the intensity, it may be to facilitate
students to be seen in
community-based speciality services and then welcoming students back to the
umbrella of student health
services when students are well enough and have received the appropriate level of
care that they needed
outside in the community. So the idea is to bring all of these services and
resources together under a
cohesive system of coordinated and complimentary, effective, and student-friendly
mental health services.
Note: Currently, Queen’s Student Wellness Services (QSWS) is developing a first

contact triage
service to assess and direct students to the right level of care. However, students
can also
request to see a family doctor at student services or a counsellor directly.
Reference:
Duffy et al. (2019). The Lancet Psychiatry. 6(11),885-887. Retrieved November 2020,
from:
https://doi.org/10.1016/S2215-0366(19)30275-5
CURRENT CAMPUS RESOURCES AT QUEEN’S
module.
There are multiple resources that provide different types and levels of support
provided to students at
Queen’s University.
Continue to learn about on-campus resources at Queen's University.
Queen's Student Health and Wellness Services (QSWS)
PAGE 28
IDIS 199
QSWS supports the personal, academic, and social health development of students at
Queen's
University by providing a range of programs and services, including physical and
mental healthcare.
Continue to learn more about this resource.
Queen’s Student Wellness Services (QSWS)
Queen’s Student Accessibility Services (QSAS) (part of QSWS)
QSWS supports the personal and mental health of students, and their academic
success through
providing a range of resources and services.
Queen’s Student Accessibility Services (QSAS) (part of QSWS)
Psychology Clinic at Queen’s University
The Psychology Clinic provides psychological assessments, treatment, and

consultation for Queen’s
students and members of the Kingston community. Unlike QSWS, the Psychology Clinic
operates on a
fee-for-service model. However, a sliding scale is offered based on family income.
Psychology Clinic at Queen’s University
Page Link:
https://www.queensu.ca/studentwellness/
https://www.queensu.ca/studentwellness/accessibility-services
https://www.queensu.ca/psychology/psychology-clinic
COMMUNITY-BASED SERVICES
module.
Community-based services can be categorized as hospital-based services, publicly

funded community-
based services, and private or fee-for-service options.
Continue to learn about three different types of community-based services.
Hospital-Based Services
Hospital-Based Services: Hospital-based services include emergency or urgent care

(walk-in basis)
and various subspecialty programs (i.e. eating disorders, early psychosis) which
typically have defined
criteria for admission.
Publicly Funded Community-Based Services
PAGE 29
IDIS 199
Publicly Funded Community-Based Services: High demand plus limited funding often
means that
publicly funded community-based services have long waitlists and prioritize the
most ill people. Often
hospital-based services and publicly-funded community services do not line up with
the university
student demographic or the specific needs of university students.
Private and Fee-for-Service Options
Private and Fee-for-Service Options: Because many provincial health plans such as
OHIP do not
cover psychotherapy outside of what is offered on campus, many people have to rely
on private and
fee-for-service options. As noted previously, some insurance companies offer
coverage, and for those
under 25 years you might qualify under your parents’ coverage, but in many cases
this coverage is
limited.
Reference:
Image adapted from macrovector [Freepik]. (2020). City buildings horizontal

illustration Free Vector.
https://www.freepik.com/free-vector/city-buildings-horizontal-
illustration_9386926.htm#query=city%20with%20hospital&position=37
BARRIERS TO MENTAL HEALTH CA RE
module.
Young adults face a number of barriers to accessing and receiving mental health
care, including
stigma-related barriers, attitudinal/personal barriers, and practical barriers.
Continue to learn about each type of barrier.
Stigma-Related Barriers- Refer to pages 30-31
Attitudinal Barriers- Refer to pages 31-32
Practical Barriers- Refer to page 32
References:
Vanheusden, K., Mulder, C., van der Ende, J., van Lenthe, F., Mackenbach, J., and
Verhulst, F. (2008).
Young adults face major barriers to seeking help from mental health services.
Patient Educ Couns.
73(1): 97-104. Retrieved November 2020, from:
https://doi.org/10.1016/j.pec.2008.05.006
Canadian Mental Health Association. (n.d.). Stigma and Discrimination. Retrieved

November 2020,
from: https://ontario.cmha.ca/documents/stigma-and-discrimination/
Thorley, C. (2017). Not by Degrees: Improving student mental health in the UK’s
universities. Institute
for Public Policy Research. Retrieved November 2020, from:
https://www.ippr.org/files/2017-
09/1504645674_not-by-degrees-170905.pdf
STIGMA-RELATED BARRIERS TO MENTAL HEALTH CARE
Subpage of Section 03 Slide 11 of 13 – Stigma-Related Barriers 1/1
PAGE 30
IDIS 199
Stigma and fear of being evaluated negatively as a result of a mental health

problem presents a
significant barrier in accessing mental health services and supports. Recall from
Module 01 that one
research study found that only one third of students entering university with a
mental health condition
actually intend to disclose it.
The Canadian Mental Health Association is working to combat mental health stigma by
educating the
public of outdated terms and encouraging person-first language.
Continue to visit their webpage and learn about what you can do to help stop stigma
and discrimination
related to mental health.
Canadian Mental Health Association: Stigma and Discrimination
Page Link:
https://ontario.cmha.ca/documents/stigma-and-discrimination
References:
Patient Educ Couns.

November 2020,
ATTITUDINAL BARRIERS TO MENTAL HEALTH CARE
Subpage of Section 03 Slide 11 of 13 – Attitudinal Barriers 1/1
It is not uncommon for people to invalidate their own or others’ mental health
concerns or diagnosis as
there is not a clear diagnosable test such as an x-ray or lab test to provide clear
objective proof and
validation of a mental health disorder.
For example, some people may feel that they should just “try harder” or that they
can “get over things”
independently. Often, misunderstandings about mental health or fears about others'
reactions can get
in the way reaching out for help.
References:
Patient Educ Couns.

November 2020,
PAGE 31
IDIS 199
PRACTICAL BARRIERS TO MENTAL HEALTH CARE
Subpage of Section 03 Slide 11 of 13 – Practical Barriers 1/1
Practical barriers include problems related to things such as cost, time, or

availability of services.
Continue for more details on three examples of practical barriers.
Long Wait Times
High demand plus limited funding for resources often means that there are long wait
times for
accessing mental health services.
Financial Barriers
Finance can limit timely access and access to certain specialized services.
Challenges Navigating the System
It can be difficult to know what level of services you need and where you can best
access those
services. This can make it confusing and challenging to navigate the mental health
system, creating
additional barriers in accessing services.
References:
Patient Educ Couns.

November 2020,
QUESTION: BARRIERS TO MENTAL HEALTH CARE

module.
Take a moment to reflect on any barriers that might stop you from accessing mental
health support if
you needed it.
Answer the question about potential barriers to mental health care.
Question: If you had a friend with a mental health concern, how would you help them
overcome any
barriers?
PAGE 32
IDIS 199
Feedback:
There is no right or wrong answer to this question. The barriers you experience are
individual to you,
and could be stigma-related, attitudinal, and/or practical barriers, as was
discussed on the previous
slides.
It’s important to reflect and identify any barriers you may be experiencing, so you
can make a
conscious effort to work around these barriers and get the care you need.
SECTION 03: SUMMARY
module.
In this section, you have become familiar with how health services are organized
and about how a
stepped care model of mental health servies can help to match the appropriate level
and type of
treatment and provider to the nature of the mental health concern or disorder.
In addition, you have been introduced to the different providers of mental health
care and how they
overlap and intersect.
You also learned about the different kinds of barriers to mental health care and
how these might delay
or prevent timely help. Through self-reflection, you have identified any of our own
potential barriers
that might prevent access to care should it be indicated and helpful.
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IDIS 199
SECTION 04: PREVENTION AND EARLY INTERVENTION
INTRODUCTION TO PREVENTION AND EARLY INTERVENTION
module.
In this section, there is an overview of different evidence-based health care

approaches for mental
health concerns. This will give you an overview of the different types of treatment
offered and when
they might be appropriate.
For the purposes of this course, the severity of symptoms and/or distress have been
divided into four
categories.
Continue to view the four categories.
No symptoms - Prevention and health promotion
Mild symptoms - Self-Help for Targeted Signs and Symptoms
Mild to Moderate symptoms - Social and/or Psychological Approaches
Moderate to Severe symptoms - Pharmacological and Psychological Approaches
QUESTION: PREVENTATIVE SELF -HELP - HEALTH PROMOTION
module.
There are responsibilities that rest with both students and the university in terms
of creating a healthy
and compassionate university experience.
Answer the question about preventative self-help strategies.
Question: Thinking about what you have learned in the course so far, what do you
think would be
important to promote your well-being?
Feedback:
Continue to hear Dr. Anne Duffy’s response to this question.
Start Audio Transcript:
There are many steps that we can take to support our own well-being and mental
health, and you've listed a
few. Some of the ones you may or may not have thought of include: getting enough
good quality sleep. I
know we’ve gone over this in earlier modules but it’s so important for our well-
being, our ability to
emotionally self-regulate, and to actually really seize the potential of our minds
and brains and perform
optimally, cognitively. So getting enough good quality sleep is super important and
its protective against
mental health problems.
Also, regular exercise and recreation. So we’ve also talked about this – getting
your heart rate up into a
cardiac training zone so it’s comfortable and can still talk, but doing that
regularly for a minimum or 20-30
minutes several times a week. There is a wealth of evidence to show that that’s
very important for
PAGE 34
IDIS 199
maintaining your well-being, your emotional mental health, and your academic
performance.
Along with that, as we’ve talked about in the social prescribing model, taking time
out to spend time on
activities and with people that you care about. So recreational activities, whether
that’s arts and culture,
whether it’s playing on an intramural team – whatever it is. Taking the time to get
a really healthy study-life
balance.
We haven’t talked extensively about this, but maintaining a healthy diet. Getting
the nutrients you need in
order to fuel your body and your brain in order to work optimally. So if you’re on
some sort of limited diet,
making sure you get those minerals and getting what you need from your diet every
day. Developing a
healthy relationship with food, because food is your fuel.
Also, what’s really important and our studies show (and other studies show)
developing a good social
support network. So staying connected to people. People including your family and
friends, your classmates.
Just being part of the world. And that, actually, is very protective research shows
against developing anxiety
and depressive symptoms under stress.
Now again, limiting drug and alcohol use. So we know, and we’ve learnt this in
previous modules, your brain
is underdoing accelerated growth and development, and it’s really, really super
important that you don’t
derail that development by regular use of recreational drugs or overuse (binging)
on alcohol.
And then, of course, there’s other things such as managing your stress as much as
you can, accepting what
you can’t mange and managing what you can, and using healthy, positive coping
strategies and skills that
you can develop, such as mindfulness, meditation, and others to help manage those
things that we can
change, but so that we don’t allow them to wear us down or cause us emotional
distress.
SELF-HELP RESOURCES AVAILABLE
module.
There are a variety of available self-help resources for people experiencing mild
mental health
symptoms or problems. In particular, workbooks and apps that allow for self-
directed treatment can
be useful for managing these types of symptoms or problems. Additionally, this list
is meant to
provide examples and is certainly not exhaustive.
Continue to view some examples of widely-used evidence-based self-help workbooks

and apps.
Workbooks
Mind Over Mood (2nd Edition) by Dennis Greenberger and Christine A. Padesky
Apps
Headspace
SilverCloud
iSpero
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IDIS 199
Page Links:
https://www.mindovermood.com/
https://www.headspace.com/
https://www.silvercloudhealth.com/
https://www.queensu.ca/u-flourish/u-flourish-digital-well-being-resources
Reference:
Cook, L., Mostazir, M., & Watkins, E. (2019). Reducing Stress and Preventing
Depression (RESPOND):
Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral
Therapy for High-
Ruminating University Students. Journal of Medical Internet Research, 21(5),
e11349–. Retrieved
November 2021, from: https://doi.org/10.2196/11349
U-FLOURISH & NURTURE-U: UNIVERSITY STUDENT WELL-BEING AND MENTAL HEALTH RESEARCH
module.
As part of the U-Flourish and Nurture-U University well-being and mental health
research, funded by
the Canadian Health Institutes of Research and the Medical Research Council
respectively, teams
across Canada and the UK will be collaboratively testing out digital interventions
to reduce anxiety,
stress, and low mood and to tackle worry, self-criticism, and low confidence.
Resources will be offered
free of charge to interested, eligible, and consenting students across Canadian and
UKuniversities in
research trials.
A student-controlled electronic tool will also be offered to help monitor your own
well-being and
behaviour, support your own well-being plans, and that can signpost you to relevant
sources of help.
Reference:
Queen’s University Student Wellness Services. Welcome to U-Flourish: Student Well-

being Research.
Retrieved August 2020, from:
https://www.queensu.ca/studentwellness/research/welcome-u-flourish-
student-well-being-research/what-u-flourish-research-project
SOCIAL APPROACHES
module.
Mild mental health symptoms may benefit from social approaches. Social approaches
include a variety
of supports that can improve your social support and well-being. Some of these
resources and
supports may include social skills workshops, interest groups and clubs, health
promotion, and
support groups.
As you learned in Module 04, social prescribing as a term is also gaining

popularity as a strategy for
well-being support. The idea is that getting out in nature, spending time with
others, investing in
interests, and taking part in recreation activities all support your well-being and
mental health - two
components necessary for effective and efficient learning.
PAGE 36
IDIS 199
PSYCHOLOGICAL APPROACHES
module.
If mental health symptoms persist or worsen then this might indicate the need for
assessment and
additional support. Psychological approaches and treatment can be effective in
reducing and managing
moderate symptoms of anxiety, depression, and sleep problems. Psychological
services can be
delivered individually or in a group setting, and may include a variety of therapy
modalities.
Continue to view a (non-exhaustive) list of examples of therapy modalities and

their areas of focus.
Mindfulness-Based Stress Reduction:
Recall mindfulness from Module 02. Mindfulness-based stress reduction and other
mindfulness
approaches are useful for being mentally present, focused, and relaxed.
You will learn about mindfulness in more detail on the next slides.
Behavioural Activation:
Behavioural activation is an evidence-based treatment based on increasing your

activity level,
especially in pleasurable activities to combat low mood.
Psychodynamic Therapy:
Unconscious thought processes can manifest in feelings, thoughts, and behaviour.

Psychodynamic
theory focuses on unpacking our thoughts and feelings.
Interpersonal Psychotherapy (IPT):
Interpersonal psychotherapy focuses on relieving symptoms by improving

interpersonal functioning. It
focuses on understanding and strengthening your relationship with yourself and
others.
Cognitive Behavioural Therapy (CBT):
Recall cognitive behavioural therapy from Module 01. It has been shown to be
effective in treating
mild-moderate sleep problems, anxiety, and depression.
You will learn about CBT in more detail on the next slides.
Cognitive Processing Therapy (CPT):
Cognitive processing therapy is another type of CBT that focuses on evaluating and
changing upsetting
thoughts. It has been used for reducing symptoms of Post Traumatic Stress Disorder.
PSYCHOLOGICAL APPROACHES: SPOTLIGHT ON CBT
module.
Cognitive behavioural therapy (CBT) is an evidence-based therapy that involves

addressing and
changing maladaptive* thinking patterns (cognitions) as well as modifying
behaviour. CBT and CBT-
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IDIS 199
based therapies can be effective treatment options for a variety of mental health
disorders, including
anxiety, depression, eating disorders, and trauma.
As mental health disorders become more severe, CBT is often especially useful when
combined with
other psychosocial and educational approaches including medication.
Definition*:
Maladaptive: Not adjusting appropriately or in a healthy way to a situation or

stress
PSYCHOLOGICAL APPROACHES: SPOTLIGHT ON MINDFULNESS
module.
Practicing mindfulness has been shown to have sustained positive effects on student
well-being and
resilience to stress. A 2020 study found that students at the University of
Cambridge who participated
in an 8-week mindfulness course had improved well-being and distress tolerance,
especially during
stressful exam time, compared to students who did not participate in the course.
This effect lasted
over the 1-year of observation.
These results suggested that mindfulness had beneficial effects on students’

average level of
psychological distress and, further, that these effects lasted for at least a year.
Continue to access mindfulness exercises.
Focusing on an object
Focusing on your breathing
Page Link:
https://youtu.be/z2Eo56BLMjM
https://youtu.be/wfDTp2GogaQ
Reference:
Galante, J., Stochl, J., Dufour, G., Vainre, M., Wagner, A., & Jones, P. (2020).
Effectiveness of providing
university students with a mindfulness-based intervention to increase resilience to
stress: 1-year
follow-up of a pragmatic randomised controlled trial. J Epidemiol Community Health.
0: 1-10. Retrieved
November 2020, from: http://dx.doi.org/10.1136/jech-2020-214390
MEDICAL AND PHARMACOLOGICAL APPROACHES
module.
In addition to psychological approaches, a medical approach (i.e. pharmacological

intervention or
medication) is an important component of assessment and treatment. Family doctors
and psychiatrists
are trained to assess the whole person. That is, assessment of the symptoms in the
psychosocial,
family, and medical context of the individual.
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IDIS 199
Continue to learn about some of the considerations involved with medical and
pharmacological approaches.
Alternative Medical Explanation
It can be important to consider whether there might be a medical explanation for

symptoms. For
example, thyroid problems can have a significant impact on well-being, mood, and
energy, and may
cause depression-like symptoms. In addition, family history (genetic
predisposition) is an important
lens to understand emerging symptoms taken together with other risk factors such as
psychosocial
context and risk exposures (substance use, trauma/abuse).
Medication
Medication can be an important, and sometimes central part of treatment for

specific disorders and
severity of disorders. Family doctors often work in collaboration with
psychiatrists to identify when
medication is required and to assess the tolerability and treatment response.
Physical and Mental Health Interaction
It is important to consider the interaction between physical and mental health.

Often physical illnesses
are associated with mental health problems and vice versa. When thinking of
assessment and
treatment, it is important to take a holistic approach and develop a care plan that
considers the whole
person.
SECTION 04: SUMMARY
module.
In this section, you were provided with an overview of the different mental health
professionals in
terms of their expertise, approach, and the services and resources they provide to
support the varied
mental health needs of university students.
It’s important to note that these services should not be offered in isolation. For
example, medical
approaches are not devoid of psychosocial approaches, rather, they are used in
combination with
other social and psychological services to help care for the individual.
You learned about resources available to promote and support student well-being and
mental health
as well as resources and services to address mild, moderate, and more severe
symptoms, problems,
and concerns. Remember that your mental health exists on a spectrum, and at any
given time, your
mental health needs may change. The purpose of this overview is to help familiarize
you with mental
health promotion and support and access should this be needed in the future.
PAGE 39
IDIS 199
CONCLUSION
MODULE 05: CONCLUSION
This content was retrieved from Conclusion Slide 1 of 3 of the online learning
module.
This concludes the content for Module 05. In this module, you turned your focus to
mental health
awareness and learned about the prevention of mental health problems, early warning
signs, and the
supports available to the university student population across the spectrum of
mental health needs.
The majority of students will experience manageable and short-lived symptoms in

response to stress,
and resiliency building and prevention will be the most relevant resources.
However, not uncommonly,
students experience symptoms of anxiety and depression which are distressing and
may benefit from
more structured support - either self-guided or in person (1:1 or in group
settings). Finally, for a smaller
but important proportion of students, persistent and distressing symptoms should be
assessed by a
mental health professional. This might be a counsellor or it could be a
psychologist, nurse, or your
family doctor. It may be that depending on your personal and family history and the
severity of
symptoms, some students are referred to see a psychiatrist to help with
recommending a course of
treatment. The key is to know what help is on offered on campus and provided by
caring and
interested educational support health professionals.
MODULE OUTLINE
module.
Section 01: Resiliency and Managing Distress
Section 02: Early Indicators of Common Mental Health Concerns
Section 03: Resources and Barriers to Mental Health Support
Section 04: Prevention and Early Intervention
CREDITS
module.
This course was created by the course authors, Dr. Anne Duffy and Dr. Simone
Cunningham, with grant
funding from the Mach Gaensslen Foundation and in collaboration with the Course
Development team
within the Office of Professional Development and Educational Scholarship at
Queen’s University.
The course has been subsequently adapted for the UK with funding from the Medical
Research Council
(UKRI) by course author, Dr. Anne Duffy, in collaboration with course reviewers,
Dr. Ed Watkins and Dr.
Louise Lawrence from the University of Exeter, and Dr. Lucy Robinson from Newcastle
University.
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IDIS 199

THE SCIENCE OF WELL-BEING, MENTAL HEALTH, AND RESILIENCY

Please note: This course was designed to be interacted and engaged

Do not distribute this Module Companion Guide to any students who

Module 05: Mental Health Awareness: Prevention, Early Recognition, and

Mental Health Awareness: Prevention, Early Recognition, and

Video: Introduction to Module

SECTION 01: Resiliency and Managing

Introduction to Resiliency and Managing

Stress and Allostasis-Induced Brain

Stress Diathesis Model and

The Brain and Perceived

Genotype x Environment Interactions and

SECTION 02: Early Indicators of Common Mental Health

Introduction to Indicators of Mental Health

Common Mental Health Problems in

Identifying Signs and

Signs and Symptoms Associated with

Signs and Symptoms Associated with

Question: At What Point do Signs and Symptoms Become a

Aspects of a Mental Disorder

Diagnostic Assessment of a Mental

Question: Lily and Identifying Early Warning

Lily and Jasmin: Navigating Early Warning

SECTION 03: Resources and Barriers to Mental Health

Introduction to Mental Health

Circle of Mental Health Care: Student First

Circle of Mental Health Care: Primary care

Circle of Mental Health Care:

Circle of Mental Health Care: Self-Help and Peer

Circle of Mental Health Care:

Circle of Mental Health Care: Psychological

Who provides Mental Health

Mental Health Supports: Occupational

Mental Health Supports:

Mental Health Supports: Clinical

Mental Health Supports:

Activity: Mental Health

Resources for Student Well-

Queen's University Student Wellness

Ideal Mental Health System

Current Campus Resources at

Barriers to Mental Health

Stigma-Related Barriers to Mental Health

Attitudinal Barriers to Mental Health

Practical Barriers to Mental Health

Question: Barriers to Mental Health

Introduction to Prevention and Early

Question: Preventative Self-Help - Health

U-Flourish & Nurture-U: University Student Well-being and Mental Health

Psychological Approaches: Spotlight on

Psychological Approaches: Spotlight on

Medical and Pharmacological

MODULE 05: MENTAL HEALTH AWARENESS: PREVENTION, EARLY RECOGNITION, AND

MENTAL HEALTH AWARENESS: PREVENTION, EARLY RECOGNITION, AND SUPPORT

Module 05 builds on previous learning and explores further differences in student

VIDEO: INTRODUCTION TO MODULE 05

Introduction to Module 05. (0:40)

MODULE LEARNING OUTCOMES

By the end of Module 05, students will be able to:

• Describe how resiliency and managing distress relate to mental health.

These assessments are associated with Module 05.

Continue to view details.

Final Exam- Refer to page 6