Myths and stigma about ADHD contribute to poorer mental health for those affected


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David Coghill, The University of Melbourne; Alison Poulton, University of Sydney; Louise Brown, Curtin University, and Mark Bellgrove, Monash UniversityAround one in 30 Australians (or 3.4% of the population) have attention-deficit hyperactivity disorder (ADHD). Yet it remains a poorly understood and highly stigmatised disorder.

Our new paper, which reviews the research on community attitudes about ADHD, found misconceptions are common and affect the way people with ADHD are treated and see themselves.

Stigma is an underestimated risk factor for other negative outcomes in ADHD, including the development of additional mental health disorders such as anxiety, depression, alcohol and substance abuse, and eating disorders.

Stigma is also likely to contribute to the increased risk of suicide, with people with ADHD three times more likely than the rest of the population to take their own life.

Early recognition and treatment of ADHD significantly improves the physical, mental and social outcomes of people with the condition who, like everyone else, deserve to live full and rewarding lives.

No, ADHD isn’t caused by too much TV

Our review of the research found many people erroneously attribute ADHD symptoms – particularly in children – to exposure to TV or the internet, lack of parental affection, or being from a broken home.




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Rather, ADHD is a complex disorder that results from inherited, genetically determined differences in the way the brain develops.

People with ADHD have persistent patterns of hyperactive, impulsive and inattentive behaviour that are out of step with the rest of their development. This can affect their ability to function and participate in activities at home, at school or work, and in the broader community.

Boy looks at computer screen with hand in hair, thinking.
ADHD can affect your ability to concentrate.
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There are clear criteria for diagnosing ADHD, and a diagnosis should only be made by a specialist clinician following a comprehensive medical, developmental and mental health review.

No, ADHD isn’t routinely overdiagnosed

Our review of the research found three-quarters of Australian study participants believe the disorder is overdiagnosed.

Based on the international research, an estimated 850,000 Australians are living with ADHD.

Yet current rates of diagnosis are much lower than this, particularly in adults where fewer than one in ten have received a diagnosis.

There is also widespread scepticism in the community about the use of medicines to treat ADHD.

Medication is only one part of the management of ADHD which should always include educational, psychological and social support.

Clinical evidence does, however, support the use of prescription medications as a key part of the treatment for ADHD. And there is evidence to show these medications are seen as helpful by those who take them.




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My child has been diagnosed with ADHD. How do I make a decision about medication and what are the side effects?


Although rates of medication treatment have increased over the years, less than one-third of Australian children with ADHD and fewer than one in ten adults with the condition are currently receiving medication. This is much lower than expected, based on international guidelines.

How this stigma feels

People with ADHD can struggle with day-to-day things other people find easy, with little understanding and acknowledgement from others.

Typical examples include butting in to others’ conversations and activities, leaving tasks half done, being forgetful, losing things, and not being able to follow instructions.

The response to these behaviours from family, teachers and friends is often negative, critical and relentless. They’re constantly reminded of just how much they struggle with the day-to-day things most people find easy.

Teenage boy in a hoodie stands against a wall, looking down
People with ADHD know they’re being judged.
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Our review found young people are particularly affected by this judgement and stigma. They’re aware they’re viewed by others in a negative light because of their ADHD and they commonly feel different, devalued, embarrassed, unconfident, inadequate, or incompetent.

Some respond to this constant criticism by acting out with disruptive and delinquent behaviours, which of course usually just escalates the situation.

Stigma can be a barrier to treatment

The perception and experience of stigma can influence whether a parent decides to have their child assessed for ADHD, and can leave parents underestimating the risks associated with untreated ADHD.

The confusion about what parents should believe can also affect their ability to make informed decisions about the diagnosis and treatment of their child. This is concerning because parents play a vital role in ensuring health professionals properly recognise and support their child’s health needs.

When diagnosis is delayed until adulthood, people with ADHD are four times more likely to die early than the rest of the population. This not only reflects the increased risk of suicide, but also an increase in serious accidents which arise due to impulsive behaviours.




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ADHD in adults: what it’s like living with the condition – and why many still struggle to get diagnosed


When we treat people with ADHD, many of these problems dramatically improve. It’s not uncommon for someone who has recently started on treatment to say, “wow, I didn’t know life was meant to be like this”.

Treatment also improves the physical, mental and social well-being for children and adults with the disorder.


If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14 or visit Headspace.The Conversation

David Coghill, Financial Markets Foundation Chair of Developmental Mental Health, The University of Melbourne; Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney; Louise Brown, PhD candidate, Curtin University, and Mark Bellgrove, Professor in Cognitive Neuroscience, Director of Research, Turner Institute for Brain and Mental Health; President Australian ADHD Professionals Association (AADPA, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Best evidence suggests antidepressants aren’t very effective in kids and teens. What can be done instead?


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Sarah Hetrick, University of Auckland; Joanne McKenzie, Monash University; Nick Meader, University of York, and Sally Merry, University of AucklandEven before COVID-19 lockdowns, school closures and strict social distancing, depression was on the rise in children and teenagers around the globe.

By the age of 19, around 25% of adolescents are estimated to have experienced a depressive episode. By the age of 30, this figure grows to 53%.

A number of studies point to an increasing use of antidepressants in young people.

So, what do we now know about how well antidepressants work in children and young people?

Our new Cochrane review, published today, found that on average, antidepressants led to only small improvements in depression symptoms compared with placebo in children and adolescents (ranging in age from six to 18 years old).

Antidepressants shouldn’t be the first port of call

Our findings highlight antidepressants are no panacea for depression in young people. The small improvements might be so small as to not be very noticeable to the individual person. What’s more, we can’t say to any one young person whether antidepressants will definitely improve their symptoms.

But it’s critical to note there are multiple and complex pathways that lead to the distress and demoralisation that are key in depression.




Read more:
What causes depression? What we know, don’t know and suspect


Different people’s responses to antidepressants are therefore quite specific, and young people may experience anything from marked improvement to deterioration.

Another important finding is that antidepressants are associated with an increased risk of suicidal thinking and self-harm.

These are not necessarily new findings, but they represent the best evidence we have so far. They remain a key consideration for GPs and other health professionals who are considering medications for children and young people.

Boxes of fluoxetine, an antidepressant medication
Our new Cochrane review found, on average, antidepressants lead to only small improvements in depression symptoms compared with placebo in kids and teens.
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What is new is our findings on how different antidepressants compare with each other. Many current guidelines recommend fluoxetine as the only first-line medication that should be tried. This is commonly sold under the brand name Prozac.

Fluoxetine is what’s called a “selective serotonin reuptake inhibitor” (SSRI). Serotonin is a neurotransmitter in the brain linked to positive emotions. After it’s used by nerve cells, serotonin is reabsorbed, which is known as “reuptake”. These types of antidepressants work by blocking the reuptake of serotonin, therefore increasing its availability to pass messages between nerve cells.

Our review shows three other antidepressants, including sertraline, escitalopram, and duloxetine, had similar effects to fluoxetine. Though, there’s the caveat that all of these led to only small reductions in depression on average.

However, this finding may extend treatment options for young people with depression. For example, one of these antidepressants may suit one person better than another in terms of side-effects experienced, and the time it takes to work or to wash out of the system.

What other options are there?

Against a backdrop of a global pandemic, there’s a risk we may start to consider depression as the “norm”, passing it over as a given or as insignificant.

But as those with depression, and their parents, families and friends know, depression is anything but. It impacts every facet of life and is often accompanied by a fear it may never improve.




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Youth anxiety and depression are at record levels. Mental health hubs could be the answer


Depression varies substantially between people with multiple factors at play, so it’s important a range of support and treatments are available for people.

Antidepressants have been, and will remain, only one of many options for young people with depression. Guidelines continue to highlight that antidepressants should not be the first port of call.

When used, they should be used in combination with evidence-based talking therapy, the most common being cognitive behavioural therapy (CBT), and there must be a commitment to ensure close monitoring of their impact.

Kids exercising
Antidepressants should only be considered alongside talk therapy, as well as increased exercise, adequate sleep and good nutrition.
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There’s a range of ways in which young people can and need to be supported. There’s good evidence for regular physical activity, good nutrition, and adequate sleep. Support from family, schools and the broader community is also important.

A decision to use antidepressants should be on the basis of shared decision-making. This refers to conversations where the risks and benefits of all treatment options are described to the young person, and their family, who are then meaningfully involved in making the decision.

If the decision is made to use an antidepressant, it’s critical to ensure health professionals conduct regular (weekly at first) checks on depression symptoms and adverse effects. This is particularly important in terms of monitoring the emergence of suicidal thinking and self-harm.

Treatment with an antidepressant should be in the context of talking therapy, and a holistic approach to well-being.

Ensuring access to support and treatment and conveying a sense of hope is crucial.


If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Sarah Hetrick, Associate Professor of Youth Mental Health, University of Auckland; Joanne McKenzie, Associate Professor, Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University; Nick Meader, Research Fellow, Centre for Reviews and Dissemination, University of York, and Sally Merry, Professor and Cure Kids Duke Family Chair in Child and Adolescent Mental Health, University of Auckland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why the TGA should reschedule MDMA and psilocybin for the treatment of mental illness


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Sarah-Catherine Rodan, University of Sydney and Samuel Banister, University of SydneyThe Therapeutic Goods Administration (TGA) is considering rescheduling psilocybin and MDMA from their current classification as Schedule 9 prohibited substances to Schedule 8 controlled substances.

This would allow psychiatrists to use these drugs in combination with psychotherapy for the treatment of conditions such as depression and post-traumatic stress disorder (PTSD).

Here’s why we believe that would be a good idea.




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A bit of background

On February 3, the TGA announced an interim decision to retain psilocybin and MDMA as Schedule 9 drugs.

The TGA cited limited evidence of therapeutic benefit, safety concerns, potential for abuse, and lack of suitably trained psychiatrists.

But the final ruling, which was expected on April 22, has now been delayed while the TGA seek independent expert advice on the “therapeutic value, risks, and benefits to public health” of the change.

A man sits on the couch during a therapy session.
If MDMA and psilocybin are reclassified, they would be administered in a supervised environment.
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The case for MDMA and psilocybin

Research on psychedelic substances such as LSD and psilocybin first began in the 1960s.

The number of clinical trials involving psilocybin or MDMA has increased steadily in the past decade, with more than 70 studies completed since 2010.

Around 60 trials are underway in Europe and the United States involving MDMA or psilocybin.




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The results of completed studies are very promising.

For example, last month, a study of 59 patients with major depression showed just two sessions of psilocybin-assisted therapy was as effective as a six-week course of the antidepressant escitalopram. The proportion of patients who no longer qualified for a major depression diagnosis after treatment was twice as high in the psilocybin group.

This month saw results of one of the largest trials of MDMA-assisted psychotherapy for PTSD published. The phase 3 study used MDMA-assisted psychotherapy to treat 90 patients with severe, chronic PTSD. After three sessions, 67% of participants no longer qualified for a PTSD diagnosis, compared to just 32% of participants undergoing therapy alone.

These latest studies add to a growing number of trials from around the world showing the therapeutic benefit of psilocybin or MDMA in depression, PTSD, anxiety associated with terminal illness, obsessive-compulsive disorder, alcohol and tobacco dependence, and social anxiety in adults with autism.

Scientists are now investigating the use of psilocybin in other conditions for the first time, such as anorexia nervosa, general anxiety disorder, and opioid and cocaine dependence.

A woman appears unhappy.
Studies are showing MDMA and psilocybin can be effective in treating a variety of mental health problems.
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Are MDMA and psilocybin safe?

Unlike many Schedule 8 medicines, psilocybin- or MDMA-assisted psychotherapy treatments are not taken regularly. The substance is usually used just two or three times with trained specialists as part of a psychotherapy program.

Despite the safety concerns cited by the TGA, there haven’t been any serious adverse reported events due to psilocybin or MDMA from dozens of clinical trials. Less serious effects can include temporary anxiety, paranoia, fear, nausea, post-treatment headaches, or mild increases in blood pressure and heart rate.

Of course, these trials use pharmaceutical-grade drugs administered by a doctor.

However, one of the most comprehensive studies of the harms of commonly used illegal drugs found even illicit forms of psilocybin and MDMA are among the least harmful. In fact, “mushrooms” containing psilocybin had the lowest overall harm score, while illicit forms of clinically-used Schedule 8 substances like cocaine, cannabis and ketamine were all more harmful than psilocybin or MDMA.

We don’t know what dose of psilocybin would be lethal to humans, but it’s estimated to be about 1,000 times greater than the therapeutic dose. No overdose deaths due to psilocybin toxicity alone have ever been reported.

Use of illicitly manufactured MDMA — which often contains other drugs or impurities — has occasionally caused deaths. An estimated 600,000 Australians use illegal MDMA each year, and an average of about three deaths per year since 2000 have been associated with MDMA toxicity alone.

But illicit use of MDMA of unknown dose and purity is much more dangerous than administration of pharmaceutical MDMA under medical supervision in a clinical environment.

A growing field

In recent years, respected academic and medical institutions around the world have launched dedicated centres for psychedelic and MDMA research, including Johns Hopkins University and Imperial College London.

And research into the therapeutic effects of psilocybin and MDMA has recently started in Australia. St Vincent’s Hospital in Melbourne is conducting a clinical trial using psilocybin-assisted psychotherapy to treat anxiety and depression in terminally ill patients. A clinical trial at Monash University is looking at psilocybin-assisted psychotherapy for generalised anxiety disorder and MDMA-assisted psychotherapy for PTSD.

The Australian government recently announced A$15 million in funding for research into the medical potential of psychedelics and MDMA.




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Psychedelics to treat mental illness? Australian researchers are giving it a go


It’s hard to reconcile the TGA’s interim decision to retain Schedule 9 for substances with demonstrated benefit in several mental health conditions and fewer safety concerns than many existing Schedule 8 medicines.

The US medicines regulator recently granted MDMA and psilocybin “breakthrough therapy” designation; a special status for highly promising drugs that speeds up their path to the clinic.

The down-scheduling of psilocybin and MDMA could have enormous medical benefit for Australian patients, especially when Australia spent A$10.6 billion on mental health between 2018-2019.The Conversation

Sarah-Catherine Rodan, PhD candidate, University of Sydney and Samuel Banister, Team Leader in Medicinal Chemistry, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As boundaries between work and home vanish, employees need a ‘right to disconnect’


Mick Tsikas/AAP

Barbara Pocock, University of South AustraliaIf you have been in a children’s playground recently, you may have seen a distracted parent absorbed in an intense phone conversation, swatting a child away.

Sure, some are ordering tickets for The Wiggles, but most are not — they are working. They might have officially knocked off, be on leave or it might be a weekend. But as surely as if they were in the office, they are at work.

Many of us know that tug of double consciousness: the child’s pressing need pitted against a complex issue on the other end of the phone demanding every neurone we can muster.

You do not have to be a carer to feel this tug. It still finds plenty of people who just want some quiet time, an uninterrupted run, a life beyond work.

It’s the growth of this tug, affecting more and more women and men, which has fuelled the push for a “right to disconnect” from work. This includes a recent significant victory for Victoria Police employees to protect their time away from work.

Availability creep

Our forebears would not recognise the ephemeral way we work today, or the absence of boundaries around it. But powerful new technologies have disrupted last century’s clearer, more stable, predictable limits on the time and place of work.

This is called “availability creep”, where employees feel they need to be available all the time to answer emails, calls or simply deal with their workload.

Sydney CBD skyline with headlights on the freeway.
Australians did even more unpaid overtime during COVID than before the pandemic.
Mick Tsikas/AAP

And that was well before a pandemic that piled revolution upon revolution on the way we work. A 2020 mid-pandemic survey showed Australians were working 5.3 hours of unpaid overtime on average per week, up from 4.6 hours the year before.

These longer hours are often associated with job insecurity. In a labour market like Australia’s, where insecure work is widespread, there are strong incentives to “stay sweet” with the boss and work longer, harder and sometimes for nothing.

Health implications

So, work is now untethered from a workplace or a workday, and our workplace regulation lags well behind. This has serious implications for our mental health, work-life stress, productivity and a fair day’s work for a fair day’s pay.

Of course, flexibility is not all bad. As a researcher collecting evidence for decades about the case for greater flexibility for employees, I see silver linings in a pandemic that achieved almost overnight what decades of data-gathering could not: new ways of working that can suit workers (especially women) and their households.




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However, this change has a dark side. Digital work and work-from-home have shown themselves to drive long hours of work, and to pollute rest and family time. Poor sleep, stress, burnout, degraded relationships and distracted carers are part of the collateral damage.

Disconnecting in Australia and internationally

A growing international response attests to the importance of disconnection. And it has now reached our shores.

Last month, Victoria Police’s new Enterprise Bargaining Agreement (EBA) included the “right to disconnect” from work. It directs managers to respect leave and rest days and avoid contacting police officers outside work hours, unless in an emergency or to check on their welfare. The goal is to ensure that police, whose jobs are often stressful, can switch off from work when they knock off and get decent rest and recovery time.

Swimmers at Bondi Beach pool.
There is a growing push to protect employees’ time outside work hours.
Bianca De Marchi/AAP

The “right to disconnect” has taken several forms internationally in recent decades. At individual firm level, some large companies such as Volkswagen, BMW and Daimler now simply stop out-of-hours or holiday emails or calls.

Goldman Sachs has also recently re-stated its far from radical “Saturday rule”, under which junior bankers are not expected to be in the office from 9pm Friday to 9am Sunday.

The French example

Some countries now regulate the right nationally.

Since 2017, French companies employing more than 50 people have been required to engage in an annual negotiation with employee representatives to regulate digital devices to ensure respect for rest, personal life and family leave. If they can’t reach agreement, the employer must draw up a charter to define how employees can disconnect and must train and inform their workers about these strategies.

While enforcement of the French law has attracted criticism (as penalties are weak), it has fostered a national conversation —now reaching other countries like Greece, Spain and Ireland. In early 2021, the European Parliament voted to grant workers the right to refrain from email and calls outside working hours, including when on holidays or leave, as well as protection from adverse actions against those who disconnect.

What’s next for Australia?

The Victoria Police EBA has encouraged a new level of discussion in Australia. The ACTU has backed a right to disconnect, especially for workers in stressful jobs.

Individual businesses will now be examining their obligations to ensure maximum hours of work are adhered to and “reasonable” overtime and on-call work is managed to avoid possible claims for unpaid work.




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This week, The Sydney Morning Herald reported that supermarket giant Coles is trying to prevent out-of-hours work.

The consequences for companies can be expensive when digital work is not well managed. In 2018, the French arm of Rentokil was ordered to pay an ex-employee the equivalent of $A92,000 because it required him to leave his phone on to talk to customers and staff.

Beyond fair remuneration, a duty of care to provide a safe and healthy workplace is also implicated in digital work that leaks beyond working hours.

What needs to happen now

Large public sector workplaces are likely to follow Victoria Police’s example. However, EBAs now cover just 15% of workers, so this pathway won’t help most workers, many of whom are instead covered by one of the 100 or so industry or occupational modern awards.

These awards could be amended to include a right to disconnect. But more simply and comprehensively, the National Employment Standards (which apply to all workers regardless of whether covered by an award or an EBA) could be amended to provide an enforceable right to disconnect with consequences for its breach, alongside existing standards of maximum hours of work, flexibility and other minimum rights.

Given many women, low paid, private sector, un-unionised and relatively powerless workers in smaller workplaces have little chance of negotiating or enforcing a right to disconnect, it is vital the right to disconnect applies across the whole workforce.The Conversation

Barbara Pocock, Emeritus Professor University of South Australia, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Depression, burnout, insomnia, headaches: how a toxic and sexist workplace culture can affect your health


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Xi Wen (Carys) Chan, Griffith University and Paula Brough, Griffith UniversityAs allegations of rape and sexual assault engulf Australian federal politics, several current and former female staffers and politicians have come forward to share their stories of a culture of toxic masculinity within Australia’s political bubble.

It’s unfortunate that while gender roles are evolving at home, gender inequality and overt sexism remain prevalent in Australian political culture and in many workplaces across the country.

While the effects of a culture of toxic masculinity are most detrimental for the victims, other employees in workplaces and the wider community can also be negatively impacted.

This opens up a broader question: how does a toxic and sexist workplace culture affect the health and well-being of employees and organisations?

What does a toxic and sexist workplace look like?

A culture of toxic masculinity is a hostile work environment that undermines women. It’s also known as “masculinity contest culture”, which is characterised by hyper-competition, heavy workloads, long hours, assertiveness and extreme risk-taking. It’s worth noting this type of culture isn’t good for men, either.

Such workplaces often feature “win or die” organisational cultures that focus on personal gain and advancement at the expense of other employees. Many employees embedded in such a culture adopt a “mine’s bigger than yours” contest for workloads, work hours and work resources.

These masculinity contest cultures are prevalent in a wide range of industries, such as medicine, finance, engineering, law, politics, sports, police, fire, corrections, military services, tech organisations and increasingly within our universities.

Microaggressions are common behaviours in workplaces steeped with a masculinity contest culture. These include getting interrupted by men in meetings or being told to dress “appropriately” in a certain way. There are also overtly dominating behaviours such as sexual harassment and violence.

These behaviours tend to keep men on top and reinforce a toxic leadership style involving abusive behaviours such as bullying or controlling others.

Boss upset with employee
A hyper-masculine work environment might look like huge workloads, long hours, hostility, assertiveness, dominance and an extremely competitive culture.
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At a very basic level, workplaces should afford women safety and justice. But women’s issues are left unaddressed in many workplaces, and many fail to provide women employees with psychological safety or the ability to speak up without being punished or humiliated.

This might be because leaders in the organisation are ill-equipped to deal with these issues, feel uncomfortable bringing them up or, in some cases, are sadly not interested at all.




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How does a toxic culture affect our health?

Evidence suggests a toxic workplace culture can negatively affect employees’ psychological, emotional and physical health.

Emotional effects include a higher likelihood of negative emotions such as anger, disappointment, disgust, fear, frustration and humiliation.

As these negative emotions build, they can lead to stress, anxiety, depression, burnout, cynicism, a lack of motivation and feelings of self-doubt.

Research also points to increased chances of physical symptoms, such as hair loss, insomnia, weight loss or gain, headaches and migraines.

Employees in toxic workplaces tend to have poorer overall well-being, and are more likely to be withdrawn and isolated at work and in their personal lives. Over time, this leads to absenteeism, and if problems aren’t addressed, victims may eventually leave the organisation.

For some victims who may not have advanced coping skills, a toxic culture can lead to a downward mental and physical health spiral and contribute to severe long-term mental illness. They may also engage in displaced aggression, in which they bring home their negative emotions and experiences and take out their frustrations on family members.

Woman stressed and isolated at work
Employees in toxic work environments are more likely to be withdrawn and isolated, both in the office and outside of work.
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How can workplaces change?

Workplaces aiming to make a real change should start by promoting an open culture where issues can be discussed via multiple formal and informal feedback channels.

One option is formal survey mechanisms that are anonymous, so employees can be open about their concerns and feel less intimidated by the process.

A good first step is having leaders trained to address these issues.

Traditionally, workplace interventions have focused on victims themselves, putting the onus on them to do the work and come forward. However, a healthy workplace culture should see leaders actively seeking feedback to make sure any forms of toxic masculinity are stamped out.

It’s a shared responsibility, and the onus shouldn’t be solely on employees, but leaders, too.




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The Conversation


Xi Wen (Carys) Chan, Lecturer in Organisational Psychology, Griffith University and Paula Brough, Professor of Organisational Psychology, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Youth anxiety and depression are at record levels. Mental health hubs could be the answer


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Christine Grové, Monash UniversityThe COVID pandemic has shone a light on the ongoing decline in young people’s mental health. Psychologists have warned if we don’t start to address the mental health emergency of young people’s anxiety and depression, it may become a “trans-generational disaster”.

Paediatricians have said they are seeing growing numbers of young people coming to the emergency room because of a lack of other treatment options.

In an effort to address the rising rates of anxiety and depression in children, Victoria trialled mental well-being coordinators in ten schools last year. The initiative is now expanding to 26 primary schools in 2021.

Meanwhile, the royal commission into Victoria’s mental health system has recommended youth mental health hubs, some of which will soon be rolled out in priority areas across the state.

Developing specialist youth mental health hubs is one of several strategies also suggested by the Australian Psychological Society to the federal government in a recent budget submission.

So, what are youth mental health hubs, and will they work to stem the tide of mental health issues young people are experiencing?

Everything in one place

Australia’s National Strategy for Young Australians defines youth as young people between 12-24 years of age. Evidence shows half of mental disorders first emerge by the age of 14, and 75% by the age of 24.

Left untreated, these mental health problems have high rates of recurrence and cause negative outcomes for the individual, including reduced economic productivity, as well as social costs.




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We’ve been tracking young people’s mental health since 2006. COVID has accelerated a worrying decline


Youth mental health hubs provide mental health and social services in one location. This is partly because a range of risk behaviours come with mental health difficulties including tobacco, drug and alcohol use, sexual risk taking, reduced levels of physical activity and poor nutrition. Evidence also suggests young people prefer to have their needs met in one place, rather than across a number of locations and will then be more likely to seek help when they need it.

Youth hubs should therefore have a range of specialists on site, such as trained mental health clinicians, sexual health support counsellors and psychiatrists.

Young people also want and need access to mental health information and resources. So a youth hub should be a safe place for young people to get the information they need.

Youth hubs would be connected physically and/or in partnership with schools, community organisations (such as homelessness services) and with medical specialists.

They are ideally co-designed by experts and youth with lived experience, on equal grounds. Ideally, the hubs are a youth friendly, one-stop-shop for support ranging from referrals, assessment, therapies and intervention.

Don’t we already have youth hubs?

Traditionally, mental health services, including some youth services, have not been accessible to a range of youth needs, instead targeting children or adults. Others are geared towards specific certain types of conditions.

In Australia there are two youth-specific hubs: Orygen and Headspace.

Orygen is co-designed with young people. But it specialises in youth who have had an episode of psychosis, mood disorders, emerging borderline personality disorder, and youth at high risk for a psychotic disorder.

Headspace centres provide early intervention mental health services to 12-25 year olds. The service was created to provide youth with holistic mental health support. But there are shortcomings with the model. It has been described by some experts as not being able to support some youth with complex presentations such as those with personality disorders, schizophrenia and/or substance abuse issues.




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Budget funding for Beyond Blue and Headspace is welcome. But it may not help those who need it most


Many other services restrict youth access to support depending on age, diagnosis or additional illness.

Youth engagement in non-youth focused specific services is low, and transitioning youth between and across services is often unsuccessful.

Young people also prefer services that include young people as staff members, which is not common in traditional mental health support. Youth participation as staff was found in only just over half of the mental health services available in Australia.

A young woman talking to a young psychologist.
Young people prefer mental health support that is youth led.
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So, what is the ideal youth hub?

There are youth hubs available across the world, including in Ireland, New Zealand, UK, Canada, France and Australia. All of these provide different services and care. However none provide a single example of best practice yet.

Key elements of youth mental health hubs identified in the World Health Organisation framework include:

  • a co-designed youth-focused approach that is flexible and adapted to youth’s changing mental health needs
  • an accessible, central location (close to shops or transport), with extended spread of opening hours as well as opportunity for self-referral and drop-in services
  • a place that responds to all young people quickly
  • youth working in the hub
  • services and support types personalised as needed by the context.

Research also suggests the hubs should be an informal space, as opposed to clinical looking, such as a shop front or café design. They should also:

  • provide recreational or arts activities, as well as a hang-out space
  • be included and known by the community
  • keep ongoing evaluation of the services provided and provide feedback back to young people.

Keeping all services in one location works well, but it doesn’t necessarily mean a coordinated, collaborative approach to care is provided. Some hubs may house a range of services in one spot but continue to work in a separated way. This defeats the purpose of coordinated care.




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Stressed out, dropping out: COVID has taken its toll on uni students


We need better investment to improve current hubs or co-design new ones to enact the WHO guidelines of best practice. This is critical to ensuring more young people access the care they need, for the success of current and future generations.The Conversation

Christine Grové, Senior Lecturer and Educational and Developmental Psychologist, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Floods leave a legacy of mental health problems — and disadvantaged people are often hardest hit


Sabrina Pit, Western Sydney UniversityYet again, large swathes of New South Wales are underwater. A week of solid rain has led to floods in the Mid-North Coast, Sydney and the Central Coast, with several areas being evacuated as I write.

As a resident of the NSW Far North Coast, which has had its share of devastating floods, many of the tense scenes on the news are sadly familiar.

Unless you have lived through it, it is hard to understand just how stressful a catastrophic flood can be in the moment of crisis. As research evidence shows, the long term impact on mental health can also be profound. And often it is the most disadvantaged populations that are hardest hit.

Disaster risk and disadvantage

In many places, socio-economic disadvantage and flood risk go hand in hand.

In a study published last year, led by the University Centre for Rural Health in Lismore in close collaboration with the local community, colleagues and I looked at population data following Cyclone Debbie in 2017. We found people living in the Lismore town centre flood footprint experienced significantly higher levels of social vulnerability (when compared to the already highly vulnerable regional population). This study would not have been possible without the support of the Northern Rivers community who responded to the Community Recovery
after Flood survey, nor without the active support, enthusiasm and commitment of the Community Advisory Groups in Lismore and Murwillumbah and community organisations.

Notably, over 80% of people in the 2017 Lismore town centre flood-affected area were living in the lowest socio-economic neighbourhoods. The flood-affected areas of Murwillumbah and Lismore regions included 47% and 60% of residents in the most disadvantaged quintile neighbourhoods.

By examining data from the 45 and Up study, we also showed that participants living in the Lismore town centre flood footprint had significantly higher rates of smoking and alcohol consumption. They were also more likely to have pre-existing mental health conditions such as depression and anxiety, as well as poorer general health.

Research from Germany and the US has shown flood risk is often a significant predictor of lower rental and sale prices.

So even before disaster strikes, residents in flood-prone areas may be more likely to battle with financial and health issues. Our study showed disaster affected people also had the fewest resources to recover effectively. When floods arrive, the impact on mental health, in particular, can be acute.




Read more:
Underinsurance is entrenching poverty as the vulnerable are hit hardest by disasters


Floods and mental health

A flood can be extremely stressful in the moment, as one rushes to protect people, property, pets and animals and worries about the damage that may follow. Can you imagine clinging to a rooftop in the rain in the middle of the night and waiting to be rescued?

The damage caused by floods causes enormous financial pain, and can lead to housing vulnerabilities and homelessness, especially for those without insurance — and research reveals a pattern of underinsurance in disadvantaged populations across Australia.

Even if you are lucky enough to have insurance, waiting to have your claim assessed and approved, then dealing with a shortage of tradies can take a real toll on your mental health. The waiting and the uncertainty can be especially hard.

Other flood research by colleagues and I, led by the University Centre for Rural Health, showed business owners whose homes and businesses had flooded were almost 6.5 times more likely to report depressive symptoms. Business owners with insurance disputes were four times more likely to report probable depression.

Flood affected business owners whose income didn’t return to normal within six months were also almost three times more likely to report symptoms of depression.

Lack of income can clearly cause stress for the individual, their family and their larger network. Small businesses play an important role in rural communities and employ a large number of people so the sustainability of local businesses is crucial.

We also found the higher the floodwater was in a person’s business, the more likely the person was to experience depressive symptoms.

People whose business had water above head height in their entire business were four times more likely to report depressive symptoms. Those who had water between knee and head height in their business were almost three times more likely to report probable depression. All this adds up to an increase in mental health issues that often follows a flood.

Six months after the flooding, business owners felt most supported by their local community such as volunteers and neighbours. However, those that felt their needs were not met by the state government and insurance companies were almost three times more likely to report symptoms of depression.

Preparedness and awareness

So, what can be done?

Firstly, we can boost preparedness. Risk and preparedness education may be especially needed for people who have recently moved to flood-prone regions. Many who have moved to regional areas recently may not be aware they live in a flood zone, or understand how fast waters can move and how high they can reach. Education is needed to raise awareness about the dangers. People may need help to prepare a flood plan and know when to leave.

Secondly, supporting people and local businesses after a disaster and assisting the local economy in its recovery could help reduce the mental health burden on people and the business community.

Thirdly, mental health services must be provided. A chaplaincy program was implemented in Lismore by the local government to assist business owners with emotional and psychological support after Cyclone Debbie and ensuing floods. This program was largely well received by business owners for having provided psychological support and raising mental health awareness.

However, the ongoing lack of mental health support remains an issue, especially in rural areas, and is exacerbated by disasters.

Fourthly, insurance disputes and rejection of insurance claims were among the strongest associations with likely depression in our research. We must find ways to improve the insurance process including making it more affordable, improving communication, by making claims easier and faster and boosting people’s understanding of what’s included and excluded from their policy.

No single organisation, government or department can solve these complex problems on their own. Strong partnerships between organisations are crucial and have been shown to work, as is direct and real-time support for flood-affected people.




Read more:
You can’t talk about disaster risk reduction without talking about inequality


This story was updated to add more detail about the author’s research funding, collaborative partners and affiliation. It is part of a series The Conversation is running on the nexus between disaster, disadvantage and resilience. You can read the rest of the stories here.The Conversation

Sabrina Pit, Honorary Senior Research Fellow at the University of Sydney, Honorary Adjunct Research Fellow, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID’s mental health fallout will last a long time. Here’s how we’re targeting pandemic depression and anxiety



Shutterstock

Richard Bryant, UNSW

Although Australia is now largely COVID-free, the repercussions of the pandemic are ongoing.

As the pandemic enters its second year, many people will be continuing to suffer with poor mental health, or facing new mental health challenges.

The effects of recurrent lockdowns, fears about the effectiveness of the vaccines, restricted movement within and beyond Australia, and the bleak economic outlook are taking their toll on psychological well-being.

Now is the time to think about sustainable, evidence-based mental health programs that will serve Australians as we confront the mental fallout of the pandemic in 2021 and beyond.

The evidence is in

We now have incontrovertible evidence mental health has deteriorated during the pandemic. Large studies that assessed people’s mental health before and during COVID-19 have reported marked increases in anxiety, depression and post-traumatic stress since the pandemic began.

Although many experts predicted people with pre-existing mental disorders would be most vulnerable, we’ve seen even greater increases in psychological distress among those without a history of mental illness.

Unemployment and financial stress have exacerbated psychological problems during the pandemic. The major concern is that the increase in mental health problems will persist for years because of the economic downturn facing most nations.

Importantly, suicide rates increase during economic downturns. One study showed each 1% increase in unemployment was associated with a 1% increase in suicides.

The impact of unemployment and financial hardship on mental health is relevant for many Australians, as fears of reduced support from the JobSeeker and JobKeeper schemes loom. Although the government this week announced the JobSeeker payment will go up, welfare groups have warned it’s still not enough.




Read more:
Greater needs, but poorer access to services: why COVID mental health measures must target disadvantaged areas


So what can we do?

The question now facing many nations is how to manage the unprecedented number of people who may need mental health assistance. There are several challenges.

First, lockdowns, social isolation, and fear of infection impede the traditional form of receiving mental health care in clinics. These obstacles might now be greater in other countries with higher infection rates, but we’ve certainly seen these challenges in Australia over the past year.

Second, many people who have developed mental health conditions during the pandemic would never have had reason to seek help before, which can impede their motivation and ability to access care.

Third, many people experiencing distress will not have a clinical mental disorder, and in this sense, don’t require therapy. Instead, they need new skills to help them cope.




Read more:
Stressed out, dropping out: COVID has taken its toll on uni students


Since the pandemic began, there’s been widespread promotion of smartphone mental health apps as a remedy for our growing mental health problems.

While these programs often work well in controlled trials, in reality most people don’t download health apps, and even fewer continue using them. Further, most people who do use health apps are richer, younger, and often in very good health.

Evidence does suggest apps can play a role in delivering mental health programs, but they don’t represent the panacea to the current mental health crisis. We need to develop more effective programs that can be scaled up and delivered in an affordable manner.

One approach

A few years ago, the World Health Organization and the University of New South Wales (UNSW) jointly developed a mental health treatment program.

The program consisted of face-to-face group sessions teaching people affected by adversity new skills to manage stress more effectively. It has been shown to reduce anxiety and mood problems in multiple trials.

A young woman is on her laptop at home.
We’ve tailored a program to address the mental health challenges of the COVID pandemic.
Brooke Cagle/Unsplash

My team at UNSW has adapted this program during COVID-19 to specifically address the mental health needs of people affected by the pandemic. A clinical psychologist leads weekly sessions via video-conferencing over six weeks, with four participants in each group. The sessions cover skills to manage low mood, stress and worries resulting from the pandemic.

Typically, mental health programs have attempted to reduce negative mood and stress by using strategies that target problem areas. A newer approach, which we use in this program, focuses on boosting positive mood, and giving people strategies to optimally experience positive events and pleasure when faced with difficulties.

In controlled trials this strategy has effectively improved mental health outcomes, even more than a traditional program.

Trialling this tailored program around Australia in recent months, we’ve found it effectively improves mood and reduces stress. Although we haven’t yet published our results in a peer-reviewed journal, our preliminary data suggest the program results in a 20% greater reduction in depression than a control treatment (where we give participants resources with strategies to manage stress and mood).

This raises the possibility agencies could provide simple but effective programs like these to people anywhere in Australia. Delivering a program by video-conferencing means it can reach people in remote areas, and those not wishing to attend clinics.




Read more:
Is your mental health deteriorating during the coronavirus pandemic? Here’s what to look out for


One of the common patterns we’ve seen in previous disasters and pandemics is that once the immediate threat has passed, governments and agencies often neglect the longer-term mental health toll.

Now is the time to plan for the delivery of sustainable, evidence-based mental health programs.


Australians experiencing distress related to the pandemic can express interest in participating in the trial program here.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.The Conversation

Richard Bryant, Professor & Director of Traumatic Stress Clinic, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How to outsmart your COVID-19 fears and boost your mood in 2021



It’s all about emotion.
Charles Postiaux/Unsplash, CC BY-ND

Laurel Mellin, University of California, San Francisco

After a year of toxic stress ignited by so much fear and uncertainty, now is a good time to reset, pay attention to your mental health and develop some healthy ways to manage the pressures going forward.

Brain science has led to some drug-free techniques that you can put to use right now.

I am health psychologist who developed a method that harnesses our rip-roaring emotions to rapidly switch off stress and activate positive emotions instead. This technique from emotional brain training is not perfect for everyone, but it can help many people break free of stress when they get stuck on negative thoughts.

Why the stress response is so hard to turn off

Three key things make it hard to turn off stress-activated negative emotions:

  • First, our genes make us worrywarts. Our hunter-gatherer ancestors survived by assuming every rustle in the grasses was a lurking hungry lion, not harmless birds hunting for seeds. We’re essentially programmed to be hyperaware of threats, and our brains rapidly launch stress chemicals and negative emotions in response.

  • Second, the chemical cascade of stress hormones in the brain associated with negative emotions impairs cognitive flexibility, goal-directed behavior and self-control.

  • Third, our tendency to avoid dealing with negative emotions puts people in a perpetual cycle of ignoring unpleasant feelings, which amplifies stress and the risk of emotional health problems.

Brain illustration
Thought vs. emotion in the brain.
Laurel Mellin, CC BY-ND

Traditional approaches for coping with stress were based on cognitive-behavioral therapy, which focuses on modifying patterns of thinking and behavior. It was developed before our modern understanding of stress overload.

Researchers at New York University discovered a paradox: Although cognitive methods were effective in low-stress situations, they were less effective when dealing with the high stress of modern life.

Emotional brain training works with these high-stress emotions in an effort to tame them, releasing negative emotions as the first of two steps in preventing stress overload.

Step 1: Release negative emotions

The only negative emotion in the brain that supports taking action rather than avoidance and passivity is anger.

Studies have shown that the suppression of anger is associated with depression and that suppressing anger doesn’t reduce the emotion. Healthy release of anger instead has been found to reduce other stress-related health risks.

Our technique is to switch off stress overload by using a controlled burst of anger to help the brain exert better emotional control and allow emotions to flow rather than become chronic and toxic. After that first short burst, other feelings can flow, starting with sadness to grieve the loss of safety, then fear and regret, or what we would do differently next time.

You can talk yourself through the stages. To experiment with the process, use these simple phrases to express the negative feelings and release your stress: “I feel angry that …”; “I feel sad that …”; “I feel afraid that …”; and “I feel guilty that …”

Step 2. Express positive emotions

After releasing negative emotions, positive emotions can naturally arise. Express these feelings using the same approach: “I feel grateful that …”; “I feel happy that …”; “I feel secure that …”; and “I feel proud that …”

Your mindset can quickly change, a phenomenon that has many potential explanations. One explanation is that in positive states, your brain’s neural circuits that store memories from when you were in the same positive state in the past can be spontaneously activated. Another is that the switch from negative to positive emotions quiets your sympathetic nervous system – which triggers the fight-or-flight response – and activates the parasympathetic system, which acts more like a brake on strong emotions.

Here’s what the whole stress relief process might look like like for me right now:

  • I feel angry that we’re all isolated and I can’t see my new grandson Henry.

  • I hate it that everything is so messed up! I HATE THAT!!!

  • I feel sad that I am alone right now.

  • I feel afraid that this will never end.

  • I feel guilty that I am complaining! I am lucky to be alive and have shelter and love in my life.

Then the positive:

  • I feel grateful that my daughter-in-law sends me photos of Henry.

  • I feel happy that my husband and I laughed together this morning.

  • I feel secure that this will eventually pass.

  • I feel proud that I am doing the best I can to cope.

After a daunting year, and with more challenges ahead in 2021, upgrading your approach to emotions can be a drug-free mood booster. Our COVID-19 fears need not consume us. We can outsmart the brain’s fear response and find moments that sparkle with promise.

[Get our best science, health and technology stories. Sign up for The Conversation’s science newsletter.]The Conversation

Laurel Mellin, Associate Professor Emeritus of Family & Community Medicine and Pediatrics, University of California, San Francisco

This article is republished from The Conversation under a Creative Commons license. Read the original article.