While we will not get into details of diagnoses in this training, we are offering some broad information below, as it’s important to be able to notice signs and know when to refer someone to a clinician.
It is important to remember that peer support always focuses on the connection and the relationship, rather than anything clinical or diagnostic.
If you notice unusual behaviour in someone you work with, talk to your supervisor about it as soon as you can.
If you suspect that someone could be a danger to themselves or others, please contact your supervisor and reach out for clinical support right away. It’s better to err on the side of caution, then miss an important warning sign.
Common Mental Health Conditions
The Mentalhealth.gov website shares this great definition of mental health:
Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood. (2022)
Throughout our lives, most of us will experience some kind of mental health struggle. It’s important to remember, however, that mental health struggles happen on a continuum and may look very different from person to person and from situation to situation. For some, that mental health struggle will lead to a mental illness diagnosis. Mental illness diagnoses can be complex and fluid. They are given by medical professionals who must work within strict criteria when making a clinical diagnosis. Remember that all mental health struggles are valid. Everyone experiences them a little differently, and it is so good and important to reach out for support when one feels like life is out of control.
As we mentioned you will never be in a position where you will be providing clinical support. However, it is important to know some basics so that you can refer someone to a professional if they need it.
The following are simple descriptions of some of the most common mental illness diagnoses. These descriptions are referenced from the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM 5). A reminder that only doctors can diagnose mental illnesses. There are no medical tests for mental illness diagnoses; all diagnoses are given based on assessments made by a doctor. Someone’s diagnosis can change many times throughout their life; diagnosing is not an exact science, and new or different symptoms can emerge over time.
If you personally have a diagnosis or someone you are working with has one, it’s important to know that recovery is very possible! We don’t have to be defined by a diagnosis; people are so much more than that. Mental illnesses are conditions that can be worked with. Medication is one of many tools that exist today to support individuals who are living with a mental health diagnosis. As peer supporters, we never offer our opinions about a potential diagnosis or clinical treatment (medications and therapy). We must avoid clinical diagnostic language in our work, as we are not trained to diagnose.
In the category of mood disorders. It’s called bipolar because moods fluctuate between extremes on either end of the spectrum. People will experience both mania and depression (described below). There are different ranges of bipolar. Not everyone will experience it in the same way. Some people will have a long time between episodes of mania and depression, and for others the episodes are closer together. It’s normal for everyone to experience some amount of highs and lows. It would only be considered bipolar if the moods have a significant impact on daily living.
A few signs of mania are:
- Decreased need for sleep
- Increased euphoria
- Racing thoughts
- Increased energy and, or agitation
- Thoughts of being invincible
- Talking faster than usual. Often the person can speak in a rambling way that is hard to understand and follow. Their speech might also be pressured (difficult to understand)
- Lower impulse control–for example spending excessively and thoughtlessly (money that the person doesn’t have)
- Extreme restlessness
Some signs of a depressive episode are:
- Changes in sleep, often sleeping more than usual, or insomnia
- Decrease of pleasure
- Fatigue and exhaustion
- Noticeable change in eating habits: increase or decrease in weight
- Lack of interest in life, sometimes shows up in being numb
- Increased sadness, tears, or irritability
- Changes in cognition, and ability to concentrate
- Thoughts of suicide
Major Depressive Disorder
Sadness is a normal part of life. Most people feel sad, and even depressed at some point in their lives. A person is diagnosed with major depression when their low mood has a huge impact on their daily life. Depression can have a negative impact on school, work, and relationships. Clinical depression is persistent and long-term. People may require long-term treatment.
The Mayo Clinic website says this about depression:
Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:
- Feelings of sadness, tearfulness, emptiness or hopelessness
- Angry outbursts, irritability or frustration, even over small matters
- Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
- Sleep disturbances, including insomnia or sleeping too much
- Tiredness and lack of energy, so even small tasks take extra effort
- Reduced appetite and weight loss or increased cravings for food and weight gain
- Anxiety, agitation or restlessness
- Slowed thinking, speaking or body movements
- Feelings of worthlessness or guilt, fixating on past failures or self-blame
- Trouble thinking, concentrating, making decisions and remembering things
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
The Canadian organization The Centre for Addiction and Mental Health (CAMH), defines schizophrenia this way on their website:
Schizophrenia is a complex mental illness that affects how a person thinks, feels, behaves and relates to others.
Schizophrenia involves psychosis and includes both “positive” and “negative” symptoms. When we say the word “positive” it just means that they are “added to” and distort the person’s usual level of functioning. When we refer to negative symptoms, it means that usual functioning is lost or reduced.
Positive symptoms can include :
- Hallucinations: Seeing, hearing, smelling, and/or feeling things that aren’t there (this can include hearing voices)
- Delusions: Beliefs that feel very real to the person and are easy for others to disprove (some examples are: believing that the TV is controlling them, or perhaps sending a message just for them, believing that they are someone else-perhaps a famous person or religious deity, or a persecutory delusion like a government agent is stalking them.)
- Confused thoughts and disorganized thinking: When speaking or writing words get jumbled up when speaking, and don’t make sense to the listener/reader
- Extreme difficulty concentrating
- Movement issues: including jerky movements, or being catatonic (not moving) for long stretches of time
Negative symptoms can include:
- Withdrawal from people and relationships they care about
- Flat affect (showing little to no emotion on one’s face)
- Lack of pleasure or interest in things the person previously enjoyed
- Not speaking much
- Lack of purpose and motivation
This mental health issue includes many of the symptoms of schizophrenia, combined with mania associated with bipolar disorder
Generalized Anxiety Disorder
Experiencing a certain level of anxiety is a normal part of the human experience. There are very often good reasons that we humans feel anxiety. Generalized anxiety disorder occurs when the worry grows out of proportion. People who struggle with this disorder find themselves anxious most of the time. The anxiety gets in the way of schoolwork, relationships, and other activities of daily living
Post-traumatic stress disorder (PTSD)
It’s normal for anyone to feel a certain amount of stress and anxiety after a traumatic incident. People who still experience acute symptoms even after a significant time has passed, are likely to be diagnosed with PTSD. Some things that people with PTSD may experience are flashbacks, distressing and frightening thoughts, panic attacks, and retraumatization.
Eating disorders (e.g. anorexia nervosa, bulimia nervosa etc.)
Eating disorders fall into a complex category, as they are mental disorders, and they involve both the medical system and the mental health system. People with eating disorders can sometimes fall through the cracks, because of this overlap.
It’s important to know that there are many supports and treatments available for all these issues. Recovery and wholeness is possible and accessible. Sharing and listening to people’s recovery stories is one thing that shares hope and encouragement to people who are struggling. This is why peer support is so powerful!
It’s also good to note that the mental illnesses mentioned above are serious mental health (medical) diagnoses from the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM 5). A person is more likely to get a diagnosis when the struggles are chronic in nature (each mental illness has a timeframe connected with it in the DSM 5).
Situational Mental Health Struggles
As we mentioned earlier, many people struggle with mental health issues on a continuum. Some people might be struggling because of very stressful situations that cause overwhelmingly distressing moods (sadness, fear, anxiety). This might include situations like a break-up, failing a course, experiencing a loss or grief, bullying or harassment. Other people may be struggling with unprocessed trauma. Not everyone who struggles with a mental health issue has a diagnosable mental illness. Some levels of sadness and anxiety are simply normal human reactions to stressful events in our past or present. It’s important that we don’t pathologize those difficult feelings and try to label them a mental illness when they are situational, and temporary in nature.
For example, anxiety is a common issue that many people deal with. There are many interventions and modalities that can support us when we deal with anxiety that we don’t have to receive from a medical practitioner. Your campus counseling department will be able to support people with tools to cope. Always refer to a professional if you feel like something is out of your scope.
In other words some people will receive a formal diagnosis, and be prescribed medication by a medical professional, others won’t. It’s highly likely that most of the people you work with in your campus peer support role will not have a formal diagnosis, as early adulthood can be a key time when some of these illnesses start to get in the way of a person living their lives.
However, anyone struggling with a mental health issue anywhere on the continuum must be taken seriously. When people ask for support, it is important to follow through with that support. Research tells us that receiving support and learning good coping mechanisms during the early stages of a mental health struggle can change a person’s trajectory so that they may not need psychiatric intervention in the future.
~Shery Mead & David Hilton (From Crisis and Connection, 2002)
Crisis as an Opportunity for Growth and Change
It’s likely that most people wish that life, and the process of getting back on one’s feet after a mental health crisis, was straightforward and linear.
In so many ways, society often promotes an expectation that life should be good or happy all the time. That toxic expectation often seeps into our worldview; we assume that our goal is to always be happy, fulfilled, and “successful” and that when we’re not, we must be doing something “wrong.”
However, we know that is just not the way life works; experience tells us that toxic expectation just isn’t realistic or helpful. Setbacks, ups and downs, uncertainty, loneliness, and crisis are all part of being human, even when we believe we are doing everything “right.”
When we are able to change our mindset about the expectations of “a perfect life” and accept that life will never be totally free from setbacks or crisis, we invite the opportunity to grow our resilience. We can learn to become more adaptable and sturdy–we can develop a strength that allows us to slowly get back up after a setback. We can let go of the debilitating shame that is so common when we experience crisis and setbacks, because we know that we are not alone, and that setbacks are par for the course. We can learn to offer ourselves compassion and kindness when we struggle.
Everyone experiences challenges. Crisis can happen to anybody–no one is immune. When we shift our mindset about crisis and setbacks, we can focus on creating stronger support systems and communities with others that we can lean on when we need to.
A crisis ALWAYS involves the worst kind of uncertainty, and as humans we really want to avoid uncertainty as much as we can. Hope comes in when we realize that uncertainty can also create an open door for a new possibility. We say this not to minimize the difficulty of the crisis or the sense of uncertainty, but to provide even just a crack where the light of hope can break through the despair.
As a peer support worker, you get to be a support for someone as they find their way through a crisis or a setback. Even if we just get the chance to talk to someone once, what we say can make a difference in their experience.
Peer support encourages a shift in perception about crisis to be accepting of the ups and downs of life. Sharing stories can be one of the most encouraging things we can do. Many peer support programs involve group work. With a skilled facilitator, this can be a perfect opportunity to share stories, and offer empathy and encouragement.
Things to remember when experiencing a crisis, or supporting someone through a crisis:
- When we embrace hope, we welcome the possibility for healing and growth
- When we understand that setbacks are part of the process of growth, and they come with being human, then we can get back on our feet quicker
- Reframing our thinking about crisis means that the progress we have made in our recovery journey does not have to be derailed
- Though a setback can be very serious, we can get back on our feet faster than we may have in the past when we have support, self-compassion, determination and a plan
Shery Mead’s article Crisis as an Opportunity for Growth and Change shares a new perspective for us:
Peer support is a culture of healing. As people practice new ways of “being” through even the most difficult times, possibilities for breaking old patterns and creating new opportunities are endless. Crisis then just becomes another word for redefining our experience and ourselves so that instead of needing to be locked up, we can begin to break free. (2014)