Last exam of year 2

Intoxication

• temporary significant state that develops rapidly after using a substance

• causes changes to consciousness, cognition, perception, affect, behaviour, or coordination.

Tolerance

• happens when the brain is repeatedly exposed to a substance over time; neurotransmitter systems (e.g. GABA, dopamine, serotonin) adapt and become less responsive, so more of the substance is needed for the same effect.

Dependence

• can be physical and/or psychological

• key feature is that withdrawal symptoms occur when use stops or is reduced after a sustained period.

Withdrawal

symptoms and behaviours (varying in intensity/duration) that occur when someone who is dependent stops or cuts down their use

Harm reduction

reducing the short- and long-term harms associated with substance use (or gambling), without being judgmental or insisting the person stop altogether.

Feedback

Giving feedback about personal risk/level of harm (from screening)

Responsibility

For choice and change sits with the person — respect their autonomy

Advice

Increasing awareness of costs/consequences and offering advice to support change

Menu

Outlining options/strategies to support change, help with goals/action planning

Empathy

Listening, reflecting, maintaining rapport, empathetic communication

Self-efficacy

Conveying optimism and strengthening the person's belief they can change

Symptoms of alcohol withdrawal

tremors, anxiety, nausea, vomiting, headache, high blood pressure, increased heart rate, sweating, irritability.

Symptoms of delirium tremens in AWS

severe autonomic instability, hallucinations, seizures, and confusion

Realise

how common trauma is

Recognise

trauma affects everyone including staff

Respond

by putting knowledge into practice

Reflect

on biases, history and organisational culture

Emotional

rapid shifts in moods, problems with anger

Interpersonal

chaotic relationships, fear of abandonment

Self

absent sense of self, unsure of self, feelings of emptiness

Cognitive

disassociation, paranoid thinking

Behavioural

impulsive, self-harm

Symptoms of trauma

- hypervigilance, disassociation, fragmented memory, flashbacks, avoidance, insomnia  

What is a traumatic event

Any experience that overwhelms one’s ability to cope where one is confronted with death, serious injury or threat  

Historical/intergenerational trauma

Trauma passed down across generations (e.g. from colonisation), affecting descendants who didn't directly experience the original event.

Acute trauma

Trauma from a single, one-off event (e.g. an accident or assault).

Complex trauma

Trauma from repeated or prolonged exposure (e.g. ongoing abuse or neglect).

what is Co-existing problems (CEP)/dual diagnosis

When a person has both a mental health problem and a substance use problem at the same time.

Criteria for compulsory treatment under the SACAT Act 2017

• They have a severe substance addiction.

• They can't make informed decisions about their treatment.

• Compulsory treatment is necessary (voluntary treatment won't work).

• Suitable treatment is actually available.

what is stress

a response to an external pressure or demand (a trigger you can usually identify)

what is anxiety

a feeling of worry/fear that can persist even without a clear external trigger.

what is eustress

"good" stress that motivates you (e.g. excitement before a flight, meeting a deadline).

what is distress

"bad" stress that causes dread, avoidance, and negative physical/mental effects.

what is adjustment disorder

Low mood/worry/withdrawal triggered by a specific life stressor (e.g. illness)

What is PTSD

Flashbacks, hyperarousal, avoidance, and mood/cognitive changes following trauma

what is neurodiversity

variations in brain function and behavioural traits (like autism, ADHD, dyslexia) are natural differences in the human population, rather than "deficits" that need to be fixed.

what is applied neurodiversity

adapting workplaces or schools (flexible seating, noise-cancelling headphones, alternative exam formats) to support neurodivergent people rather than expecting them to "fit the mould."

what is clinical neurodiversity

Neurodivergent conditions that are formally diagnosed using clinical criteria — e.g. Autism Spectrum Condition (ASC), ADHD, dyslexia, dyspraxia, Tourette's syndrome.

what is acquired neurodiversity

Neurodivergent traits that develop later in life due to injury or illness, rather than being present from birth — e.g. brain injury, stroke, or epilepsy causing changes in attention, processing, or behaviour.

What is binge eating disorder

Recurrent episodes of eating large amounts of food with a sense of loss of control, without compensatory behaviours (no purging/excessive exercise). Often followed by guilt or shame.

What is ARFID

Limited food intake or avoidance based on sensory sensitivity, fear of choking/vomiting, or lack of interest in eating — not driven by body image or weight concerns. Common in children and autistic individuals.

What is orthorexia

an unhealthy obsession with "clean" or "healthy" eating, becoming so rigid and consuming that it impairs daily life and wellbeing — despite being framed around health rather than weight.

What is HEEADSSS

Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety, Spirituality

What is Listen

Give the young person space to share what's happened without judgement or immediately jumping to solutions

What is Inform

Give them accurate information about cyberbullying, their rights, and available support options

What is act

• Take practical steps together — e.g. saving evidence, blocking the bully, adjusting privacy settings

What is empower

• Help them feel in control rather than helpless — involve them in decisions about what happens next

What is check

• Follow up over time to see how they're doing and whether the bullying has stopped

What is report

• Tell the relevant platform, school, or authorities if needed, especially if safety is at risk

What is likelihood

How probable is it that the risk behaviour (e.g. suicide, violence, self-harm) will occur? This considers current mental state, history, and known risk factors to estimate probability.

What is adverse outcome

What is the severity or nature of the potential harm if the risk occurs? A minor risk (e.g. superficial scratching) is different from a high-lethality risk (e.g. access to firearms or overdose on dangerous medication). This considers how bad the outcome could be.

what is time

Over what timeframe is the risk relevant? Is this an immediate risk (next few hours/days) or a longer-term risk (weeks/months)? Risk isn't static — it can escalate or reduce depending on circumstances, so the assessment needs a time frame attached.

What is positive risk taking

Recognising that eliminating all risk often comes at the cost of the person's autonomy, dignity, and quality of life — and that some risk-taking is a normal, healthy part of growth and independence.

Step 1 of SAFE-T framework

Identify Risk Factors
Gather information on factors that increase risk: history of attempts, mental illness, substance use, recent losses, access to lethal means, etc.

Step 2 of SAFE-T framework

Identify Protective Factors
Identify factors that reduce risk: strong social support, engagement with treatment, religious/cultural beliefs against suicide, responsibility to children, future-oriented thinking.

Step 3 of SAFE-T framework

Suicide Inquiry (Assessment)
Directly ask about suicidal thoughts, plans, behaviours, and intent — including specifics like whether they have a plan, access to means, and timeline.

Step 4 of SAFE-T framework

Determine Risk Level
Based on the above, clinically judge the level of risk (e.g. low/moderate/high) and decide the appropriate intervention (e.g. outpatient follow-up vs hospitalisation).

Step 5 of SAFE-T framework

Document
Record the assessment, rationale for the risk level determined, and the safety/treatment plan — ensuring continuity of care and accountability.

Questions about specific suicidal thoughts

• How often are they thinking about suicide? How intense/intrusive are the thoughts?

• Ask directly: "Are you having thoughts of ending your life?" "How long have you been feeling this way?"

• Explore the content: are the thoughts vague ("I wish I wasn't here") or specific ("I've been planning how to do it")?

Questions around lethality/likelihood of plan

• Has the person thought about a specific method?

• How lethal is that method? (e.g. overdose on paracetamol vs. a firearm — very different lethality)

• Have they rehearsed or practiced any part of the plan?

• The more detailed and lethal the plan, the higher the risk.

Questions about availability of means

• Do they actually have access to the method they've described? (e.g. do they own a firearm, do they have access to a large quantity of medication, do they live near a location they've mentioned)

• Ask specifically: "Do you have access to [the means they mentioned]?"

• Availability turns a thought into an actionable risk.

Questions about proximity or intent

• How close are they to acting on the plan? Have they set a date or time?

• Do they intend to act, or do they have reasons holding them back (ambivalence)?

• Have they taken any preparatory steps (e.g. writing a note, giving away belongings, saying goodbye)?

• Ask: "Do you intend to act on these thoughts?" "What has stopped you so far?"

What is least restrictive practice

using the minimum level of intervention or restriction necessary to keep a person and others safe, while preserving as much of their autonomy, dignity, and freedom as possible.

What is seclusion

placing a person alone in a room/area they cannot freely leave, to contain behaviour that poses a risk to themselves or others.

what is personal restraint

A staff member physically holding a part of a person's body to restrict their movement (e.g. holding an arm) — typically brief, used to manage an immediate risk.

what is physical restraint

Using bodily force or mechanical devices (e.g. restraint straps/cuffs) to restrict a person's movement more broadly — usually more prolonged/intensive than personal restraint.

what is chemical restraint

Using medication (not for treating a diagnosed condition, but specifically to sedate/subdue behaviour) to restrict a person's movement or behaviour.

what is an enabler

A device or support that helps a person do something safely or comfortably that they otherwise couldn't — it supports independence and function, not restricts it. E.g., bed rails to help person to sit up

What is a restraint

A device or action that restricts a person's movement or freedom, typically for safety, but can limit autonomy. e.g., Bed rails to trap someone in bed against own will

Physical risks associated from seclusion and restraint

• Injury from struggling (bruising, fractures, skin tears)

• Positional asphyxia (breathing difficulty from restraint position, especially prone restraint)

• Cardiac stress — increased heart rate/blood pressure, risk in those with pre-existing conditions

• Deep vein thrombosis (DVT) from prolonged immobility

• Musculoskeletal injury (dislocations, sprains)

• Aspiration risk (if restrained after eating/vomiting)

• Death in severe or prolonged cases (rare but documented risk)

Psychological risks from seclusion and restraint

• Retraumatisation — especially for those with prior trauma or abuse history

• Increased fear, distrust, and anger toward staff/services

• Feelings of humiliation, powerlessness, and loss of dignity

• Worsening of existing mental distress (increased agitation, paranoia)

• Damage to therapeutic relationship — may avoid seeking help in future

• Increased risk of PTSD-like symptoms from the experience itself

What is sensory modulation

using sensory input (touch, sound, movement, smell, sight) in a structured way to help a person regulate their emotional and physiological state — calming an overstimulated nervous system or alerting an under-stimulated one.