Journey to Mindfulness Mental Health Workbook

JOURNEY TO MINDFULNESS

This Adolescent’s Workbook was developed by Akili Dada as a tool to be used when talking to adolescent girls about mental health and wellness. The contents of this guide are the sole responsibility of Akili Dada and do not necessarily reflect the views of their partner organizations, the Ministry of Health of Kenya or the Government of Kenya.

Acknowledgements This document has been developed by Akili Dada as a tool to be used by adolescent girls as a resource to navigate their mental health and wellness. It is part of Akili Dada's initiative to create a Mental Health Curriculum and draws from other adolescent health and youth-friendly publications including: •Depression: A teen’s guide to survive and thrive.

•Developing Adolescents: A reference for professionals.

•Helping Adolescents Thrive Toolkit: Strategies to promote and protect adolescent mental health and reduce self-harm and other risk behaviors.

•Mental health matters: Social inclusion of youth with mental health conditions.

•Sexuality and Life Skills; Participatory activities on sexual and reproductive health for adolescents and young people.

•Tuko Pamoja: A guide for talking with young people about their reproductive health.

A team of consultants developed content relevant to the Kenyan context and in line with national guidelines for mental health and adolescent health. This team included: Catherine Karega, Mental Health Consultant Wanjiru Ngunju, Public Health Consultant Lucy Futaki, Mental Health Consultant Key staff and stakeholders also reviewed and provided critical input, this includes: Sankara Caroline, Executive Director Joy Zawadi, Deputy Executive Director Angela Lagat, Advocacy, partnerships and branding manager Diana Njuguna, Head of programs Esther Ngunjiri, Hubs manager

Table of contents Glossary The first step of a lifelong journey How to use the book Why are we talking about mental health?

Self Identity

Social relationships

Becoming Women

1.

2.

3.

Talking about 4.

Anxiety and depression

Like a 5.

Withering Loss and grief Flower Self- harm and suicide

6.

7.

A Brief Note on Mental Disorders

PAY IT FORWARD RESOURCES REFERENCES

Glossary Anxiety - An emotional state defined by persistent, excessive worries that don’t go away even in the absence of a stressor Depression - Is a serious medical illness that affects the way you think, act or feel.

Disorder - An illness that disrupts normal physical or mental actions Grief - Deep sadness caused by loss Loss - A state of deprivation of someone or something one had Peer - Someone who is the same age, has same values or same social status Self- esteem - A person's overall subjective sense of personal worth or value Stress - Emotional response typically caused by an external trigger.

Self-harm - Deliberate injury to one-self Suicide - Intentional act of ending your own life

Mental Health Matters The first step of a lifelong journey Hi, welcome to the *Journey to Mindfulness*. This is an initiative of Akili Dada created to support adolescent girls to develop the skill to navigate their growth into wholesome individuals. At the beginning of the creation of this workbook, we spoke to a few girls in high school. We asked them about some of the things that affect their development psychologically and socially.

We talked about forming an identity, being part of a social community, recognizing our sexuality, dealing with feelings of anxiety, stress and depression, navigating through grief and self- harming behavior.

This book is not going to give you all of the answers you are looking for. It will assist you develop some life skills that will help you face life with confidence and pride. We also hope that even when you face challenges, you will use this book together with the many resources provided here.

More importantly, this book is not a substitute for professional help. Having a therapist and a trusted adult as a sounding board and guide is important.

How to use this workbook Read it. Take your time to read a section and pause to think about how it relates to you. As you read each chapter and think about the questions, feel free to discuss with your friends and get their views. You can also approach an adult that you trust and discuss these topics with them.

Keep a journal. At the end of each chapter, there is a journal section. This section is meant to help you think about and write down what you might have learnt or realized while reading the content. There are some questions to help guide your reflection while reading each section.

You might also want to keep a separate journal where you can write notes on what you find most helpful or surprising when reading this book.

Practice what you learn. The best way to implement a new habit into your life is to practice it regularly. We encourage you to practice the skills you learn here to improve your mental health.

Why are we talking about mental health?

Growth is about so much more than physical change. Have you noticed that as you grow, how you think, feel and behave changes? These changes are caused by the world we live in, the culture of our different communities and our relationships with family and friends.

Mental health includes our emotional, psychological, and social well-being. It includes our capacity to establish constructive relationships and cope with the ordinary demands and stresses of life. 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.

Our goal is to walk with you in this journey while equipping you with tools that will assist you in your Journey of Mindfulness. We believe that positive mental health allows girls to: 1. Realize their full potential 2. Cope with the stresses of life 3. Work productively 4. Make meaningful contributions to their communities

In a nutshell….

1. Mental health is your emotional, psychological and social well-being. It is freedom from extreme anxiety and overwhelming symptoms.

2. Read this book in chunks. Take your time to think about each section you read and what it means to you.

3. This book is not a substitute for professional help. It can be used alongside therapeutic help.

SELF-IDENTITY

“

“Without the possibility of being bad at something, you will never be extraordinary.” Pushing yourself to that limit “allows you to embrace vulnerability and surprise yourself… It doesn’t ever get comfortable. But it does Lupita Nyong’o get familiar.”

Discovering yourself Self- concept or self-identity is the image that we have of ourselves.

Your self- identity is a combination of your personality, abilities, physical attributes, interests, hobbies and social roles that you specifically use to identify yourself.

For example, beliefs such as “I am a good friend” or “I am a kind person” are a part of a self-identity. How would you describe yourself?

Your self- concept changes a lot when you are younger because you are still going through the process of self- discovery and forming an identity. As you become older and discover what’s important to you, you form a more detailed perception of yourself.

Here’s something interesting from the world of psychology; Some years ago, a psychologist named Carl Rogers suggested that your self-identity is made up of three different parts:

The ideal self- This is the person you want to be.

Self-image- How you see yourself, including your physical characteristics, personality traits and your role in society.

Self-esteem- This is how much you like, accept or value yourself. This can be impacted by things like how others see you, how you compare yourself to others and your role in society (Argyle M. Social encounters: Contributions to social interaction. 1st ed.

Routledge; 2008).

This means that who we are is determined by ourselves as well as the people around us like our family and friends. It also means that everyone goes through a journey to become their ideal self. We all aspire to become someone great as we grow up and we can look up to people we admire as our role models.

What do you want to be as you grow up?

What would it take for you to get there?

The journey to become your ideal self is not always easy. It is not always clear what path we should take. As young women, we can feel a lot of pressure when it seems that our friends already know what they want to be and that they have an easier time achieving their dreams. But there are many successful women in our world who did not always have a clear vision of what they wanted to do in the future.

Changes in your self-identity are impacted by many things happening within and around you. You can notice this by thinking about how different you are from childhood to this moment.

As a child, your identity was simple and greatly informed by your family and the environment you lived in.

“The embarrassment came from making a YouTube series while all of my friends were being doctors, lawyers, diplomats, all of those different things. There was no blueprint to do this. There was no one I could look to to be like, ‘Oh, so-and-so made some videos and then had a television show, and then did movies,’” she says. “You kind of just do it.” ~Issa Rae

As you become older, your experiences, responsibilities and values play a big role in your self- identity as well as the changes you make.

When I was small I just wanted to play with my friends. Now I’m older, I think about whether my parents will be able to pay rent and if we’ll have food to eat. Even when I am in school this is what I think about.There was a time when I couldn’t control my anger……I would just get angry at everyone for something small. Now I am trying to learn how to control my anger but it’s not that easy.

Self-esteem A big part of our identity is self-esteem. Self- esteem refers to a person's overall subjective sense of personal worth or value. It is how much you like and appreciate yourself regardless of3 the circumstances. Having confidence in your own value is an excellent way of boosting your mental health.

Self esteem can be high or low; and it changes as we continue to grow and gain more confidence in ourselves and our values.

How do people develop low or high self- esteem?

In many cases, people who receive constant disapproval from significant members of family and friends may develop feelings of low self-worth. A poor school environment can also cause one to have poor self-esteem. However, a healthy individual can overcome these off-putting remarks and develop a high self-esteem.

If you think about it, what are some of the things that make you feel bad about yourself?

Are there things that other people say or do to you to make you feel low?

Low self- esteem is not always clear but there are some things you can notice that are common in people with low self-esteem.

What are some things you do to boost your mood and feel good?

Adolescents deal with many different aspects of identity, from choosing a career path to cultivating moral beliefs to becoming a friend. This can cause some confusion and an inability to commit to one path.

Your world online Aside from growing up in the real world, you have the additional world of the internet. There are so many social media platforms that offer interesting and exciting content. Adults and young people are all intrigued by social media and the information various platforms offer.

Social media is a great place to explore your creative side, redefine yourself and see what other people across the world are interested in. Social media also allows you to meet new people and communicate with friends who are close and far.

What social media platforms are you on?

What do you use social media for?

Does your social media use affect how you see yourself?

Social media does have some positive and negative impacts in our lives.

Positive effects Access to other people’s health experiences and expert health information Emotional support and community building especially when addressing mental health issues Social media platforms are places to share creative content and express their identity These platforms are a useful tool to make, maintain and build on real world relationships and friendships

Negative effects Anxiety and depression- Unrealistic expectations set by social media may lead to feelings of self-consciousness, low self-esteem and feelings of anxiety Sleep- using social media on hones and laptops at night before bed is linked with poor sleep which leads to poorer state of mental health Body image- Many social media users especially girls feel that their bodies are not good enough and they need to add filters and edit them to be ‘perfect’ Fear of missing out(FoMO)- The connstant worry that ‘great things’ are happening online when you are not on your phone or social media

Is it possible to improve your self- esteem?

Improving confidence in yourself will take some practice, a few failures and constant effort. In addition, here are some helpful tips that can help you improve your self- esteem: Forget perfection; focus on your efforts and accomplishments! Recognize and be proud of the steps you have taken to accomplish a goal instead of always trying to be #1 Practice Positive self-talk by turning negative thinking into positive thinking.

Try statements like "I can do this. I've studied hard" instead of "I'm definitely failing that chemistry exam.”

Try new things and meet new friends. This can be a great way to boost your self-esteem.

Learn how to set goals and take steps to accomplish them.

In a nutshell……

Our self-identity is a work in progress that is built by our experiences and relationships with people in our environment.

Your perceived sense of value and worth continues to improve as you make more effort to learn about yourself and take active steps to be better at the things you enjoy.

Here are some questions to help you think about your identity

Do I say yes to make others happy?

What are my strengths?

What brings me happiness?

What are my values? Do I live accordingly?

Do my choices reflect my own interests or someone else’s?

SOCIAL RELATIONSHIPS

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ~Maya Angelou

Student

boyfriend

Introduction Every human being comes from a family which is the basic unit of a community. As you grow from childhood to adolescence your relationships increase to include relatives, neighbours, friends at home and school. Social relationships during adolescence plays an important role in how one will navigate challenges at an individual, communal and societal level.

Teacher

Priest

Importance of human connections Your physical and mental health is affected by the number and strength of social relationships you have.

Healthy relationships lead to; •Higher self confidence and self-esteem •Greater compassion for others •More trusting and cooperative relationships •Lower rates of anxiety and depression

When you have healthy relationships you will become happier and people around you will want to spend time with you. On the contrary, unhealthy relationships can lead one to loneliness.

Loneliness can lead to antisocial behaviour, depression and suicide.

Healthy Relationships

The Fear of Missing Out/ Do I need to always fit in?

An adolescent is more likely to spend less time with parents/ guardians and their family and more time with friends.

This is because they have a sense of belonging among friends. Peers therefore can have a strong effect on your choices, behavior or actions. The relationships that adolescents form can influence them in a positive way or a negative way.

Positive peer pressure ; This occurs when peers influence you to make morally upright choices. Positive influences include

•

Offering moral support During difficult times there are friends who will provide a shoulder to

lean on. Some friends who have gone through a challenging time will guide you through a similar challenge.

Inspiring positive choices Some friends can influence you to volunteer for services such as giving

time to children homes during weekends or school holidays or cleaning your place of worship.

•Choosing healthy habits Some friends who are athletic can influence you to join sports clubs or pick healthy nutrition. Other friends will be good role models and

influence you to refuse substances of abuse such as alcohol and drugs.

•Sharing new experiences Each person has life experiences that can encourage another person.

Some friends can encourage you to speak with confidence as you

present your school work. Others can invite you to join hiking expeditions.

Negative peer pressure This occurs when you are pressured into situations that are against your family values and moral standing. You can be negatively pressured through; •Being insulted which leads you to feel bad for not doing something that you are against.

•Being rejected by being denied friendships with peers.

•Being given reasons for doing something that you are against.

You can be negatively influenced to; •Taking alcohol and drugs •Engaging in sexual escapades •Skipping school •Cheating during examinations •Stealing

What are some of the signs someone might be experiencing peer pressure?

Adolescents who are undergoing peer pressure exhibit the following signs. You can observe them in your peers; Antisocial behavior Hostility towards others Use of alcohol or drugs Reduced school performance Over-eating or decreased appetite Reluctance to go to school or study Mood swings, tearful or feelings of hopelessness Lack of sleep, oversleeping or waking up earlier than usual Sudden changes in behavior, mostly for no obvious reason Verbal statements about wanting to give up, or life not being worth living Withdrawal from activities that the adolescent girl used to like and engage in Engaging in teenage sex or same-sex relationships as they attempt to fit into a group Being overly conscious about their image as they are quite concerned about what their peers have got to say about them Trying out new ways of dressing, hairstyles, or even jewelry some of which their parents may not afford Suddenly engaging in activities that did not interest them much before Reluctance to engage in family activities as they consider them a waste of their time Being overly irritable and likely to snap over little things such as being asked to tidy up their room or to get off the phone Spending more time with a new group of friends Increasingly comparing themselves to others. They may start wishing that they were more like someone else Changing the way in which they talk Exhibiting unusually aggressive or antisocial behaviour

Adolescents at risk of negative peer pressure Some adolescents are more at risk of negative peer pressure. They include adolescents; Who have few friends Who have poor self-esteem Who have special needs Those who feel rejected by family and friends Those who lack a strong support system at home and at school

How to deal with peer pressure It is not easy to say no to negative peer pressure. However, it takes courage to stand up against peer pressure and to be true to yourself. The following are ways in which you can deflect negative peer pressure; Understanding your core values and beliefs Have self-confidence and being able to say no to situations that make you uncomfortable Choosing your friends wisely, by keeping those who positively impact your life Get support by talking to a trusted adult Walking away from negative situations

'The most important thing in your life is to live your life with integrity and not to give in to peer pressure to try to be something that you are not.' ~Ellen DeGeneres, American comedian.

In a nutshell….

The friends we have are very important to us as adolescents because they provide us a sense of belonging and community.

There is always the desire to fit in which can lead us to feel either accepted or rejected depending on the experience we have within our friend and family groups.

Belonging to a community contributes to our self-perception and identity.

Therefore, it is important to evaluate your relationships and seek out peers who have a positive influence on your behavior.

Activity: Whenever you are undergoing negative peer pressure, use the guide below to help resist peer pressure.

Let’s Journal What are some of the things that you will start doing to enable you to grow into a confident young lady?

Which activities will you engage in to positively impact on the behaviours of your peers?

List the names of the people you trust and would go to when you are experiencing negative situations with your peers.

BECOMING WOMEN

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Menstruating women can and have competed in the Olympics, runmarathons, traveled to space, held leadership roles, served as judges and held religious offices.

Let’s talk, Period!

A great transition that every girl undergoes is the transition from being a girl to becoming a grown woman. This transformation happens both physically and mentally. In this section we will talk about parts of this transition and how they can impact our lives.

Menstruation, and menstrual health management (MHM) has always been an issue for girls and women. However, in many communities, periods and hygiene have always been discussed in secret.

So, what is a period?

A period, or menstruation, is a release of blood from a girl's uterus, out through her vagina. This normal vaginal bleeding occurs as part of a woman's healthy monthly cycle.

During each menstrual cycle, an egg develops and is released from the ovaries. The lining of the uterus builds up. If a pregnancy doesn’t happen, the uterine lining sheds during a menstrual period.

Then the cycle starts again.

Each body develops in its own time

When I got my first period it was okay for the first month but then it didn’t come the next month and I was afraid. I talked to my mum and she took me to the doctor who explained to me that my hormones were still developing and my periods would become more regular as I kept growing.

~High school student, 2021

Most girls get their first period when they are around 12. But some start as early as 10 years old while others get it later at 15 years old which is OK. Even though everyone will start their period at different times, here are some signs that it will start soon: -Most of the time a girl gets her period about 2 years after her breasts start to develop -There may be a vaginal discharge fluid (like mucus) that you might see or feel on your underwear -In some cases, some girls do not get their periods despite being the typical age when menstruation begins. It is important to see a doctor or a gynecologist if you do not get your period for proper guidance on what can be done.

Periods last from 3 to 5 days. Aside from bleeding, you might experience some of these things: -Abdominal cramps -Lower back pain -Bloating and sore breasts -Food cravings -Mood swings and irritability -Headacheand fatigue The actual flow of your period doesn’t feel like much when it’s happening. Chances are that you won’t even feel it coming out.

Myths and beliefs about periods Despite the fact that we understand how and why girls and women get their periods, there are still some communities and people who have some beliefs about periods that are not true. Myths and misconceptions related to menstruation are still running in many communities in the world. For example;

In some communities, girls who are on their periods are not allowed to sleep in their mothers’ houses because they are considered unclean. In some places, girls are confined in a shed away from the family when they get their first period. This leaves them exposed to the cold and even more dangerous conditions.

People also believe that women and girls on their period can spread misfortune or impurity. They are prohibited from attending religious ceremonies, visiting religious spaces and handling food.

In many places around the world it is believed that a girl’ first period is a sign of her readiness for marriage, sexual activity and childbirth. This is exposes girls to abuse such as early marriage, sexual violence an early pregnancy.

Women and girls also face stigma and mistreatment for not having periods. This can especially happen to women who do not experience regular monthly periods.

Some people believe that pads used by women when on their period can be used to bewitch others.

These misbeliefs may make some girls feel ashamed, be embarrassed forcing them to drop out of school and at times the girls may end up hating their periods yet it is a natural process that can be managed. These myths also encourage social injustice where women are discouraged from owning property and socio-economic empowerment (https://www.youthkiawaaz.com/2020/06/debunking-myths-and-stigma-a ssociated-with-menstruation/).

Aside from the exclusion of girls and women, such beliefs have also led to period poverty and period shaming.

Period poverty is the struggle experienced by women and girls while trying to afford menstrual products. Period shaming can come from being teased/picked on for being on your period. It can also come from being denied to use the toilet during class time.

Throughout this chapter we have emphasized that having a period is a natural and healthy part of being a developing girl. It is nothing to be ashamed about.

Period shaming - can come from being teased/picked on for being on your period.

Can also come from being denied to use the toilet during class time.

Adolescents may to bee embarrassed to explain why they need to be excused or why it might be an emergency.

Period poverty - the struggle many women and girls face while trying to afford menstural products.

Exclusion - Myths and misconceptions about periods has resulted in women being excluded from various roles and settings.

Sex and sexuality As you keep growing and changing, you might have found yourself thinking more about your physical and emotional changes and how they relate. Any adolescent is bound to start thinking about sex, attraction to the opposite sex and sexual relationships. In this section we will talk about sex and our sexuality so that you are better equipped to make proper decisions.

Let’s start by defining a few terms; Sex refers to whether a person is male or female. This is determined by their sexual organs and how people express their gender.

Sexuality is how people experience and express themselves sexually. It is about your sexual feelings, thoughts, attractions and behaviors towards other people.

Our sexuality is made up of a number of things including; Body image: How we look and feel about ourselves, and how we appear to others.

Gender roles: The way we express being male or female. The expectations people have for us based on our sex.

Relationships: The ways we interact with others and express our feelings for them.

Intimacy: Close sharing of thoughts or feelings in a relationship, may or may not involve physical closeness.

Love: Feelings of affection and how we express those feelings for others.

Sexual arousal: The different things that excite us sexually.

Social roles: How we contribute to and fit into society.

Genitals: The parts of our bodies that define our sex. They are part of reproduction and sexual pleasure.

Healthy vs Unhealthy Sexuality Sexual behaviors can be both healthy and unhealthy. It is important to be able to identify the difference before making the choice to engage in sexual behavior.

Healthy sexuality can be thought of as: Having appreciation for one's own body, Seeking out knowledge regarding reproduction, understanding that human development includes sexual development (i.e., reproduction, genital sexual experiences), Interacting with both genders respectfully and appropriately, Understanding and respecting sexual orientation, Appropriately expressing love and intimacy, Developing and maintaining meaningful relationships while avoiding exploitative or manipulative ones.

Having the ability to enjoy and control sexual and reproductive behavior without feelings of guilt, fear, or shame Some unhealthy sexual behaviors include: - Starting sex at a young age - Unprotected sex - Sex with multiple partners - Having sex with a high-risk partner (partner who has multiple other sex partners) - Exchanging explicit pictures and images online - Engaging in commercial sex work

Making decisions Deciding to have sex or engage in other sexual behavior is a big decision that only you can make. No one can or should make this decision for you.

However, you may feel overwhelmed and pressured to engage in sexual behavior because your friends or agemates are doing the same. It is important to talk to a trusted adult such as a parent or teacher before making this big decision.

You can also think about some of the consequences that risky sexual behavior can result in such as - Unintended pregnancies - Abortion - Contraction of Sexually Transmitted Infections - Higher risk of HIV/AIDS In some cases, we may make decisions to engage in sexual behaviors that later lead to feelings of regret and anxiety. It is still important to talk to a trusted adult about these feelings. It may be awkward or embarrassing but seeking help is nothing to be ashamed about.

In a nutshell….

Having periods is nothing to be embarrassed about. Instead, we can use this unique feature to learn more about and improve our health.

Our curiosity about sexuality is natural and healthy to our development. It is important to have conversations about our curiosity with trusted adults to learn more about our experiences.

Having our personal reasons for not engaging in sexual behavior can help us to make value judgements when in situations where we are pressured to engage in behavior, we are not ready for.

TALKING ABOUT ANXIETY AND DEPRESSION

I've seen so much pain and so much realness in other people. Exposing my own almost feels like second nature. It doesn't feel like if I say 'Hey, I've been suicidal before' someone could use that against me. I don't feel vulnerable when I'm saying these things …

It almost feels like having a superpower — of having iron just on me. Nothing penetrates that. ~Chika, Rapper

Stress and Anxiety Stress is an emotional response typically caused by an external trigger.

The trigger can be short-term, such as an assignment deadline or a fight with a loved one; or long-term, such as being unable to go to school, discrimination, or chronic illness.

Anxiety on the other hand, is an emotional state defined by persistent, excessive worries that don’t go away even in the absence of a stressor. It's the fear of what is going to happen. Anxiety is quite common especially in teenage girls as it is a period where one is going through different emotional, physical and social changes.

Stress and anxiety share almost the same symptoms such as: Lack of sleep Feeling tense or having frequent headaches Digestive problems Disrupted sleep.

It’s important to tackle the situation so that the stress can subside.

Physical activity, a nutritious and varied diet, and good sleep hygiene are a good starting point for dealing with mild stress and anxiety.

What are some of the situations that make you feel stressed or anxious?

How do you deal with these feelings?

If you are like most kids your age, you have probably heard of depression.

Sometimes, people can use the term “depression” to describe a momentary mood. For example, you might have heard someone say that they feel depressed because they missed a party or didn’t do well on their exam.

The same term is also used to label a more serious and long-lasting problem that can interfere with many aspects of your life.

Depression Depression is a serious mental health problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how you think, feel and behave; and it can cause emotional, functional and physical problems.

Sometimes, we may say that we feel depressed when we mean that we are sad. Can you tell the difference between sadness and depression?

Sadness is a temporary reaction to something that happens, like when a friend says something unkind or when you face some form of disappointment. Sadness gradually lessens with time.

When a person is depressed, they are likely to experience other emotions such as guilt, humiliation, self-loathing, or anger as well as sadness.

Depression is a mental disorder that involves: A lack of interest and pleasure in daily activities, Significant weight loss or gain, Insomnia or excessive sleeping, Lack of energy, inability to concentrate, Feelings of worthlessness or excessive guilt Recurrent thoughts of death or suicide.

Depression lasts longer and may worsen over time. When you are sad, you can point to a specific event that caused you sadness. However, it is harder to pinpoint what causes depression.

How do you know if what you are experiencing is normal sadness or a sign that you are depressed? A psychologist or therapist can work with you to give a proper diagnosis. Always seek help from parents, teachers and qualified professionals.

I learned that my sadness never destroyed what was great about me. You just have to go back to greatness, find that one little thing that's left. I'm lucky I found a glimmer stored away.

~Lady Gaga, Musician

Overeating or appetite loss

Suicidal Thoughts or Attempts Trouble Concentrating

Fatigue

Loss of interest in things that bring joy

Feelings of guilt and worthlessness

Insomnia

Irritability

Why are you experiencing feelings of anxiety or depression?

Most anxiety and depressive disorders run in families. Often, if a parent is naturally anxious or has experienced depression, there is a high chance that the adolescent girl might experience the same.

Expectations and pressure to be excellent in school or in other activities lead to girls feeling overwhelmed. Teachers and parents can also contribute to this because they expect them to achieve better results.

Girls are always looking to fit in with their classmates, peers or their neighbors. Social media also portrays images of people who seem to have it all going well. They want to fit in even if they know what they are doing is not right nor does it reflect on their values.

Trauma caused by sexual abuse, domestic violence at home, and loss of a loved one can also cause anxiety or depression in girls especially if they don't find ways to deal with the issues.

Change of social settings, being unable to adjust to a new environment, lack of a good support system.

What are ways of dealing with depression?

Talking is one of the best ways to deal with negative feelings. Find a friend or an adult; be it a parent or a mentor who can listen to you without being judgmental.

Since that day [I opened up about my emotions], it's just been so much easier to live and so much easier to enjoy life. ~Michael Phelps, Swimmer Participating in social and sport activities, for example joining a dance club or anything that has people around will boost your emotions and experiences.

Engage in activities which help you manage stress and that you love doing for example cooking, singing and exercising and you will find yourself feeling much more energetic.

Try to aim for at least 8 hours of sleep. Your sleep patterns may be affected but if you get your body moving, you will realize that it will be easier to attain a healthy sleeping pattern.

Be open to getting professional help. If you have taken self- help steps to improve your mental health and still find yourself getting worse. Sometimes the negative thinking can make you feel lost but depression can be treated.

Get some exercise

Eat a nutritious diet

Stay connected with others

Avoid drugs and alcohol

Self-Help strategies for teen depression

Vent in a healthy way

In a nutshell…..

Many things can make us feel sad and stressed in our daily lives. These feelings are temporary and typically pass after a sufficient amount of time.

Feelings of anxiety and depression that overcome our ability to function at home and in school are more serious and require the help of a psychologist to overcome.

Everyday activities such as regular exercise, talking to friends and family and getting sufficient sleep can help to alleviate feelings of anxiety or depression.

Journal Do I enjoy activities like I used to?

If not, then what is the reason?

Is there a change in your sleeping patterns or eating habits?

If yes, why?

Do you withdraw from your peers or family?

What makes you withdraw away from them?

LIKE A WITHERING FLOWER

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“All the art of living lies in a fine mingling of letting go and holding on.” ~ HavelockEllis

Girls and women experience loss at one point in their lives. They react to loss in different ways. There are different types of losses that can affect the mental health of an adolescent, these can include; Loss through the death of a parent(s), sibling, relative, friend Loss of a parent through separation or divorce Loss of friendships or interpersonal relationships with other such as classmates and schoolmates Loss of virginity Loss of confidence Loss of health due to chronic illnesses Loss of self-image due to an unhealthy self-perception Have you experienced loss?

What other losses do adolescents experience?

When one is undergoing loss, they grieve, which is described as the overwhelming pain following a loss. Elisabeth Kübler-Ross, a Swiss

American Psychiatrist, created the Kübler-Ross model, the theory of the five stages of grief and loss. The model is described below:

Kubler-Ross

Denial Avoidance confusion Elation Shock Fear

Information and communication

Anger Frustration Irritation Anxiety

Emotional support

Grief Cycle

Acceptance exploring options new plan in place moving on

Bargaining Struggle to find meaning reaching out to others telling one’s story Depression Overwhelmed Helpless Hostility Flight Guidance and direction

ANXIETY AND DEPRESSION

To Note: The process of grief by Elisabeth Kübler-Ross is a guide to understanding the motions that occur after loss. Some people may experience all the stages of grief as described above. However, some people may not experience all the stages.

The losses one experiences can lead to grief if; An adolescent girl is ignored consistently as she is growing up

She has grown in fear of her parents or guardian’s strict restrictions She has suppressed feelings of heartache that are ignored Her culture suppresses girls and women

She experiences demeaning, intimidating words, abrasive and hostile voice which is insensitive to her needs, feelings, and rights She is constantly threatened

She is body shamed for being thin or obese She is a teen mother

She has undergone childhood negligence

What does a grieving adolescent look like?

It is ok to grieve. Grieving may last for a few days, weeks, months or years. When one is undergoing grief they will exhibit some signs, they may include: Crying often

Being easily irritable

Loss of concentration

Feeling sad most times of the day

Withdrawal from friends and family

Being angry at everyone and everything

Poor school performance or missing school

Intense emotional reactions like anxiety attacks, chronic fatigue, anger and thoughts of suicide

Feelings of denial, shock and confusion

Extended depression with a loss of interest in daily activities and events

Inability to sleep, frequent nightmares, loss of appetite and a prolonged fear of being alone

Excessively imitating or asking questions about the deceased; repeated statements of wanting to join the deceased; inventing games about dying Humiliation or guilt over personal failure to prevent loss of life

Frequent physical complaints such as stomachaches and headaches

How have you and other adolescent girls around you reacted to loss?

I still feel, 20 years later about my mother, I still have shock within me . . . People say shock can't last that long, but it does. You never get over it. It's such an unbelievably big moment in your life that it never leaves you, you just learn to deal with it.

Prince Harry, April 2017

Coping with loss It is normal to attempt to cope with loss and grief.

One can cope with grief positively or negatively. Positive coping involves expressing your feelings and getting support, taking care of yourself, and finding meaning in the experience. Negative coping with grief can include drug abuse such as alcohol consumption, smoking as well as stealing to maintain these habits.

Coping with loss positively 1.Express your feelings A good way to express your feelings is by writing down what you feel in a journal. Most importantly write down how you are reacting to grief. Every time you write down your feelings, reflect on the feeling of thinking and writing about your feelings.

2.Find Support Think about the one person who can take time to listen to you share your feelings of loss and how this is affecting your normal functions. Create time to talk to this person.

Who are you comfortable talking to when dealing with loss?

3.Find Meaning To help you find meaning after loss (especially through death), reflect on the following questions; What did the person mean to you?

What did you learn from him or her?

What good has come from this difficult experience?

What have you learned about yourself, other people, or life?

Are there things you appreciate more?

Who are the people who have been there for you? Were they the people you expected? What have you learned about them?

In what ways have you grown or matured based on this experience?

4.Engage in self-care You can take care of yourself by: Getting adequate sleep, to have better sleep, try going to bed at the same time every night Exercising for example take walks outside, will help you get mental clarity Eating healthy meals: Nutritious meals contribute to your general wellbeing

Coping with grief negatively Sometimes grief can be intense leading to negative coping mechanisms.

These include; Giving up on life Alcohol and drug abuse Engaging in verbal or physical fights Physical or emotional isolation from family and friends Avoiding certain places that remind you of the loss Emotional eating, this includes indulging in junk food

In a nutshell….

Both adults and adolescents experience loss and grief as a part of life.

Grief develops from feelings of loss that are ignored or unaddressed for a long period of time.

Everyone processes grief differently. It is important to seek the help of parents, teachers, or a professional counselor when the grieving process becomes overwhelming.

Here is an activity that can help you during loss and grief The Grief Self-Exploration House activity will help you understand your grief.

You will need: A plain paper Pencil, pen Step 1: Draw a house with the following requirements: 4-story house A door on the ground floor A chimney A flag

Step 2: Fill in the parts of the house Foundation: On the floor, write the values that govern your life. These are the basic principles that influence your actions and decisions, for example, showing kindness to others, loving one another.

Walls: On the walls, write the people or things who support you.

Roof: On the roof, write the names of the people that protect you.

Chimney: Coming out of the chimney, write ways that you express yourself.

Flag: On the flag, write what you want people to know about you.

Door: On the door, write the things that you keep hidden from other people 1st Floor: On the 1st floor, write words that describe your grief journey.

2nd Floor: On the 2nd floor, write things that have helped you in your grief journey.

3rd Floor: On the 3rd floor, write anything positive that may come from your grief journey.

Top Floor: On the top floor, write a declaration of hope for your future.

Journal What kind of loss have you experienced in the last one year?

How have you been coping with the loss?

SELF-HARM AND SUICIDE

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"I say that publicly because I think it's really important to take the stigma away from mental health. … My brain and my heart are really important to me. I don't know why I wouldn't seek help to have those things be as healthy as my teeth. I go to the dentist. So why wouldn't I go to a shrink?" ~Keri Washington, Actor

Self-harm is a behavior where a person deliberately hurts themselves as a way of coping with difficult situations or difficult thoughts and feelings. It is an unhealthy coping mechanism for dealing with difficult situations.

Some people who are in treatment for self-harm have reported that it was a way of trying to get control over the feelings or get relief from them. Others self- harm to express feelings of hopelessness.

Acts of self-harm, however, only act as a temporary relief and are usually followed by feelings of shame and guilt. This is part of the cycle of self-harm shown below.

The cycle of self-harm Self-harm may start as a way to relieve pressure from overwhelming thoughts and feelings. This might offer some temporary relief but it does not address or change the underlying challenges that cause these feelings. The temporary relief from self-harm is usually followed by feelings of guilt and shame which causes overwhelming thoughts and feelings causing the cycle to repeat itself.

Emotional suffering Emotional overload

Shame/grief

Panic

Temporary relief Selfharm

What are some of the trigger factors for self-harm or suicide in teenage girls?

Bullying Poor family relationships and difficulties at home Peer pressure History of abuse Low self-esteem Family transitions E.g., having to stay with other relatives Grief Defilement When some of these experiences go unaddressed, they can lead to feelings of hopelessness leading to the individual seeking unhealthy ways out. It is possible to learn better coping mechanisms and overcome these feelings by working with a professional counsellor or psychologist.

What are some of the ways teenage girls can self-harm?

1.By cutting themselves. This can happen knowingly or unknowingly. Some teenagers have expressed that they have cut themselves unconsciously 2.Bruising or hitting yourself such as banging your head or punching yourself 3.Using drugs including overdosing

How can we help our friends who are self –harming?

I have had friends who hurt themselves and it is difficult to help them and they say that it is helping them to mask some form of emotional pain. I would really like to know how to help them.

High School Student 2021

Girls self-harming may get worried that they are being judged or assumed to be suicidal. This can cause them to withdraw even more. It is important to not be judgmental and instead be supportive in trying to make them get better Genuinely be interested in understanding how this helps them or why they do it. It might be helpful to know about the type of injury, the frequency and their willingness to seek help.

Don't dismiss or ridicule their actions especially if they are continuously talking about taking their own life.

Asking them to promise you they will stop hurting themselves might be even more distressing to them. It might also make them feel like they don't have control over the action anymore. Unfortunately, if they hurt themselves, they will end up with an additional guilt of disappointing you.

Try to be accepting and normalize how they feel as people cope differently, and gently encourage them to seek help. You can gently help them understand that this behavior is not working for them and offer to get help.

Suicide Suicide can be described as the act or an instance of taking one’s own life voluntarily and intentionally. When having suicidal thoughts, a person can feel overwhelmed by these thoughts and they may feel that they will last forever.

Suicidal thoughts are usually an indication of some underlying problems that have caused immense feelings of hopelessness and pain. Usually, someone thinking of ending their lives just wants the pain to end.

In the table below we show some myths people have about suicide as well as actual facts that could be more helpful.

MYTHS

FACTS

Talking about suicide encourages suicide attempts

Talking about suicide provides opportunity for communication and can act as a plea for help

Suicide attempts or death happen without warning

It is more likely that suicide victims laid out their warning signs but they were not recognized

After attempting and surviving suicide, another attempt will not be made

A suicide attempt is an indicator of further attempts

Once a person decides on suicide, there is no way of stopping them

Suicide can be prevented, and someone can recover from it if given proper assistance and support

If only you could sense how important you are to the lives of those you meet; how important you can be to people you may never even dream of. There is something of yourself that you leave at every meeting with another person. ~Fred Rogers, Psychoanalyst Are there some signs you know of that show someone is thinking about ending their lives?

Below is a list showing some warning signs to look out for. This list highlights some common signs but it does not include everything.

Individuals may have other unique signs.

- Talking about wanting to die - Looking for a way to kill oneself - Talking about feeling hopeless or having no purpose - Talking about feeling trapped or unbearable pain - Talking about being a burden to others - Increasing the use of alcohol or drugs - Acting anxious, agitated or recklessly - Sleeping too little or too much - Withdrawing or feeling isolated - Showing rage or talking about seeking revenge - Displaying extreme mood swings

What to do when you or someone is thinking of ending their lives Experiencing these emotions and encountering a friend or class mate who wants to end their lives can be scary and very overwhelming. The most important way to help is to talk to an adult such as a parent or teacher about these thoughts in order to come up with a plan that ensures your safety and those of others around you.

Talking to an adult also provides them the opportunity to involve a counsellor who is trained to help you overcome the feelings of being overwhelmed.

Other coping mechanisms that can help alongside getting therapy include; -Exercising- This supports mental health and can increase self-confidence -Getting social support in the form of family and close friends. Positive social relationships help us to alleviate the feelings of isolation, develop resilience, and have more people to lean on in times of distress and need.

-Expressing our feelings through creative activities such as writing, art, music, or dance. These can act as a better outlet for pent-up emotions.

-Learn some strategies to calm yourself when upset. These are activities that divert attention to a more positive environment and distract from negative thought patterns. With the help of a counsellor, these can be learnt and can be effective for many occasions when you feel overwhelmed by emotions.

In a nutshell…..

Self-harm can only provide temporary relief to overwhelming feelings but it does not address or change the underlying issues causing these feelings.

Better coping mechanisms can be learnt through therapy. These can be a way of addressing challenging feelings, changing unhelpful thought patterns and adopting better behavior.

Journal Do you feel hopeless, frustrated or angry?

What leads to such emotions?

Have you had thoughts of self- harming?

What situations lead to such thoughts?

A BRIEF NOTE ON MENTAL DISORDERS Introduction As mentioned, adolescence is a time of various and significant changes.

Part of this change is hormonal change that contributes to the physical, behavioral and emotional development that comes at this age. In addition, there are changes in the social environment and changes to the brain and mind (Blakemore, 2019).

Owing to these changes, this period is also the onset of some mental, emotional and personality disorders. It may be difficult to define mental health and mental health problems in adolescents because of the impact of changing subcultures on their behavior.

In this section we will briefly describe the term mental disorder and highlight some examples of the same that may be seen in adolescents. This is not an exhaustive list as there are other factors that contribute to the development of mental disorders other than age. This list CANNOT be used to diagnose any individual. Instead, treat this as a tool to create your awareness of the existence of mental health problems and possible reasons to seek and receive professional assessment, diagnosis and treatment by a qualified psychologist.

Defining mental disorder A mental disorder is a health condition involving changes in emotion, thinking or behavior (or a combination of these). Mental disorders are associated with distress and/or problems functioning in social, work or social activities (Parekh, 2018).

Although mental disorders reflect psychiatric disturbance, adolescents may be affected more broadly by mental health problems. These include various difficulties and burdens that interfere with adolescent development and adversely affect quality of life emotionally, socially, and vocationally (Michaud and Fombonne, 2005).

"

Risk factors during adolescence Stressful and negative environmental experiences make the adolescent age a more vulnerable period. Aside from hormonal changes and brain development these are some more risk factors that may increase chances of mental disorders in later life. ·Adverse childhood experiences such as abuse, neglect and extreme poverty ·Being the victim of bullying at school ·Hypersensitivity to social exclusion by peers ·Parental mental illness ·Experimenting with substances such as alcohol and cannabis

Distinguishing normal behavior and mental problems Adolescents typically have variations in their mood and behaviors as part of the development process and identity formation. These behaviors can be differentiated from serious mental problems by the duration, persistence and impact of the symptoms.

Symptoms or behaviors that might need assessment include; •Signs of overt mood depression (low mood, tearfulness, lack of interest in usual activities) •Somatic complaints such as headache, stomach ache, backache, and sleep problems •Self-harming behaviors •Aggression •Isolation and loneliness •Deviant behavior such as theft and robbery •Change in school performance or behavior •Use of psychoactive substances, including over the counter medications •Weight loss or failure to gain weight with growth

Some more notable mental disorders We have previously discussed Anxiety and Depression in Chapter 4. In that chapter we have noted some warning signs that indicate an adolescent may be experiencing depression or anxiety. We have also included some intervention strategies that can help adolescents to improve their mood and implement behavior changes that can help them to cope with the emotional and behavioral changes associated with anxiety and depression.

In this section we briefly mention Eating and Learning disorders. You are likely to see some emotional and behavioral patterns that relate to these disorders

Eating disorders These are behavioral conditions characterized by severe and persistent disturbance in eating and associated distressing thoughts and emotions.

Eating disorders are often associated with preoccupations with food, weight or shape or with anxiety about eating or the consequences of eating certain foods.

Behaviors associated with eating behaviors include; •Restrictive eating •Binge eating •Purging by vomiting or compulsive exercise Eating disorders are not to be confused with diets or food preferences. They can be very serious conditions affecting physical, psychological and social functions (Guarda, 2021).

Examples of eating disorders include anorexia nervosa, bulimia nervosa and binge eating disorder.

Learning Disorders These are characterized by a persistent impairment in at least one of three major areas: reading, written expression and/or math. Learning disorders are typically diagnosed in early school-aged children but in some cases, they may not be recognized until adulthood.

Learning disorders can be identified when the person exhibits the following; -Have continued difficulty learning for at least 6 months despite targeted help -Have academic skills that are substantially below what is expected for their age and cause problems in school, work or everyday activities -The difficulties start during school-age even if some people don’t experience significant problems until adulthood (when academic, work and day-to-day demands are greater).

-Learning difficulties are not due to other conditions, such as intellectual disability, vision or hearing problems, a neurological condition (e.g., pediatric stroke), adverse conditions such as economic or environmental disadvantage, lack of instruction, or difficulties speaking/understanding the language.

Types of learning disorders Dysgraphia and Dyscalculia.

include

Dyslexia,

Students with specific learning disorder often benefit from accommodations, such as additional time on tests and written assignments. Early intervention is key for people with specific learning disorder. If problems are identified early, intervention can be more effective, and children can avoid going through

PAY IT FORWARD

an expression for when the recipient of an act of kindness does something kind for someone else A note from those who were your age a slightly long time ago……

We asked a few ladies who were once teenagers about their own growing up journey and here's what they had to say.

“

I was born and brought up in the upcountry in a remote part of our country, Kenya, at a time when education of the girl child in my village was not strongly upheld. However, my father was determined that his girls would get quality education since he, himself did not go past primary level. For this reason, he took me to a boarding school and I got to interact with girls from all over the country. My father struggled through to manage the school fees despite being ridiculed by the village elders but this did not stop him. Seeing my history, I was also determined to shine and shame the villagers and I managed to score excellent grades in KCPE and I would later be admitted to a National School and then to University. I am where I am because my father believed in me, I believed in myself and we refused to be discouraged by the naysayers.”- (Esther -Akili Dada)

“

You must embrace change if you want to grow in life. A positive mindset will help you push your limits and discover new opportunities." These were words spoken to me by my mum when I entered the adolescent stage. So how can you start over with your life? I asked her. "When creating your dream life, start by clearing out the relationships, people, and things you won’t have use for and get your surroundings in order." This was her response. In my journey of life, I have learnt to value every person, environment and relationship I find myself in. I do not need to be in every space, but I always ensured I remained relevant in every space and relationship I found myself in. I learnt to say yes to new adventures, believe in new possibilities while keeping in mind that change is the only constant.

My mantra is: I close my eyes to old ends and open my heart to new beginnings. ( Vose- Akili Dada)

“

When I started out in my career journey I was just a naive girl oblivious to what was happening to the world. I was set out to cutting ranks and make a living for myself. Nothing exactly prepared me for what it would entail. In the next phase, I found myself in a trying environment, where to achieve I would have to give favors and where my presence was remotely recognized nor my efforts appreciated. In time I came to realize I was a small fish swimming with the sharks and I had to take a stand. To find my place in the corporate world without compromising my values or myself. To also take a stand for those who have fallen victim to the same environment. It has not been an easy journey but I keep reminding myself that I can achieve whatever I set my mind to do. Shakespeare's words 'To be or not to be', sum it up. You can do or be anything you want. You are strong and you are brave, step out stand by your beliefs and you will conquer.

The world is your oyster. ( Diana- Akili Dada)

“

I had a pretty normal childhood but I always struggled with self-esteem.

I was born with a condition called Lymphedema which affected both my legs. I had swollen legs almost every day. This greatly affected my self-esteem. I hated the attention and the questions that came my way almost daily. It limited the activities I could get involved in and my wardrobe as well! Now imagine high school! I had no option but to face my reality every day. It took me years to accept that I couldn’t change who I was. I eventually learnt to love my legs. This meant taking good care of them, buying appropriate shoes, dressing in outfits that made me feel confident and beautiful. For a very long time I never used to wear dresses.

Now I confidently wear whatever I want. I have learnt to love every part of my body. Positive self-image starts with me. Sandra Bullock has a very powerful quote that I often reflect on, “I have made peace with the fact that the things I thought were weaknesses or flaws were just me.

I like them.” ( Emma- Akili Dada)

“

Born where no one motivates you to go to school, I had to drive myself. Life was not easy, being at risk of all harmful practices and amid poverty. My curiosity and support from my teachers made me move a step, I managed to score good marks which helped me get a scholarship. I worked extra hard to secure space in university and now am about to graduate. Every journey of achievement starts with passion and determination to bring change. ( Sarafina – Akili Dada)

RESOURCES Hekima Wellness Center Amani counselling center and training institute Befrienders Kenya Beacon of Hope, Rongai Youth Alive Kenya Africa Youth Leadership Center Kakenya Dream Kenyatta National Hospital Rabai Youth Information Center Mtwapa Youth Resource Center Safe Community Youth Initiative *This is a list of places that offer youth- friendly mental health services. This is not an exhaustive list. These are independent organisations and are not affiliated or partnered with Akili Dada.

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Routledge Blakemore, S. J. 2019. Adolescence and mental health. The Lancet. 393(10185). https://doi.org/10.1016/S0140-6736(19)31013-X Cancer. Net. (2018, March). Helping grieving children and teenagers. Helping Grieving Children and Teenagers | Cancer.Net Firestone, R. W., Firestone, L. A., & Catlett, J. (2006). What Is Healthy Sexuality?

In R. W. Firestone, L. A. Firestone, & J. Catlett, Sex and love in intimate relationships (pp. 11–27). American Psychological Association. https://doi.org/10.1037/11260-001 Pontz, E. (2019). The positive side of peer pressure. Center for Parent and Teen Communication, The Positive Side of Peer Pressure (parentandteen.com) Stanford Children’s Health. (2021). Relationship development. Relationship Development (stanfordchildrens.org) Teens Health (2021). Death and Grief. Death and Grief (for Teens) - Nemours Kidshealth TheBodyPro (2003). Teens report peer pressure to have sex. https://www.thebodypro.com/article/teens-report-peer-pressure-sex Toner, B. J. & Freeland, C. A. B. (2016). Depression; A teen’s guide to survive and thrive. American Psychological Association Tuko Pamoja: A guide for talking with young people about their reproductive health. https://path.azureedge.net/media/documents/CP_kenya_pht_manual.pdf

United Nations program on AIDS/HIV. (2019). Educational show on how to talk with teenagers about health and sexual relations. .https://www.unaids.org/en/resources/presscentre/featurestories/2019/oct ober/20191021_how-to-talk-with-teenagers-about-sexual-relations United Nations (2014). Mental health matters: Social inclusion of youth with mental health conditions. https://www.un.org/esa/socdev/documents/youth/youth-mental-health.p df United Nations Population Fund (UNFPA). (2021). Menstruation and human rights https://kenya.unfpa.org/en/news/menstruation-and-human-rights-frequ ently-asked-questions-0 World Health Organisation. (2020). Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-h ealth World Health Organisation. (2021). Improving the mental and brain health of children and adolescents. Child and adolescent mental and brain health (who.int) Williams, J. (2018). Adolescent identity development: the factors of change. https://parentandteen.com/developing-adolescent-identity/