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Managing your mental health

Managing your mental health

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Common mental health challenges

The toolbox contains many strategies to help manage the following mental health challenges.


Grief is a natural and a common reaction. Grief can leave you feeling angry, anxious, sad, or strange.

Research shows that it helps to accept that grief is a normal response following your injury, but don’t mistake grief for depression. There is no right or wrong way to grieve and everybody can experience grief differently. When grieving, it is important to stay connected with family and friends and to take care of your health by managing your stress and still doing things that you enjoy.


As you learn to live with your spinal injury it is important to remember feelings of grief will often be experienced over the long term, and that this is quite normal! The effects of your injury on your life will change over time as you have new life experiences.  You may feel your life is more challenging at certain times and other times less so.


Anxiety is the body’s physical response to a threat or perceived threat.

Anxiety can be normal in stressful situations, such as speaking in public. Anxiety is a problem when your feelings are overwhelming and interfere with daily life. Anxiety presents in different ways. This may include feeling worried, nervous or tense, panicky, restless or fidgety. You may get a sense of doom, think the worst will happen or avoid social situations.


The traumatic nature of spinal cord injury and the huge change it brings can increase the chance of experiencing depression.

Depression can make everything harder to deal with. If depressed, you may begin to feel helpless, neglect to look after yourself, and begin to have thoughts of self-harm or suicide. Depression is linked with a higher chance of urinary infections and pressure injuries, increased pain, sleep difficulties, relationship hassles, and increased social isolation. Taking care of your mental health is therefore critical for enjoying a good quality of life.

Sleep disturbance

It is quite common for sleep patterns to become disrupted for many people with a spinal injury.

Your injury can make it harder to get to sleep. This may include sleep interruption from obstructed sleep disorder, pain and spasticity. Feeling sleepy during the day can also be a problem. Sleep disturbance can disrupt your ability to work and be productive.

Relationships and life satisfaction

Physical impairments and health problems can introduce challenges to relationships and social participation.

Relationship roles may change including learning different ways to be intimate. Efforts to create positive personal and social relationships involve communication, listening skills, understanding your body and being open to change. See Section 6 of the Toolbox for more information and resources.

“A meaningful life well lived is an essential component when considering the place of ‘hope for better than now’ in the lives of newly-injured individuals.”

Person with C4 tetraplegia

Substance misuse

Substance abuse/misuse can be dangerous to all of us, especially when combined with mental health problems, and also when taking prescribed anti-depressant or pain medications. Alcohol and substance abuse will also damage your physical health.

If you believe you are using harmful amounts of alcohol, medication, or recreational drugs, then you most likely are. It is best to seek a referral for professional help or seek support from family or friends. The skills presented in Section 4 will help you manage this problem.


Not all problems are experienced by everyone or are inevitable.

Other mental health challenges

like problems with memory

Cognitive problems

Cognitive function includes brain activities like memory, attention and language. 

Fatigue, sleep disturbance, chronic pain, anxiety and/or depression affect your brain function. Even taking multiple medications can be problematic. If you notice forgetfulness or poor decision making and/or concentration, it is best to seek professional assessment and help.

Post-traumatic stress

If you sustained your injury as a result of a traumatic accident that was potentially fatal, such as a motor vehicle crash, a fall or assault, then this has the potential to cause post-traumatic stress, a condition than can develop into post-traumatic stress disorder (PTSD).

If you are experiencing high levels of stress related to your injury and symptoms such as nightmares, depression, high anxiety, avoidance of social contexts, numbness of emotions, then strategies for managing post-traumatic stress can be found in the Mental Health Toolbox.

Suicidal thinking

If you are having thoughts or ideas that life is no longer worth living and the possibility of ending one’s own life. Help is available, speak with someone today. 

Staying on track

Staying on track with your mental health

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Mental health checklist

It is important that you maintain your mental health management plan, so that you thrive into the future. This includes continuing to practise the skills and strategies presented in the Toolbox.

You should also evaluate and re-evaluate your goals and plan every now and then, and don’t neglect to discuss any changes with family, friends or a professional if needed. Continue to reward yourself when you successfully complete your goals.

Remember, you will most certainly continue to experience stressful life events that will challenge you. The important thing to remember is that coping in the face of difficult circumstances proves you can be resilient and maintain balanced mental health.  

Resilience relies on self-mastery (or self-efficacy).

Medical research has shown the way you think about your life and about your problems will help protect you from distress and depression. This is called self-efficacy.

A strong self-efficacy will help you deal better with anxiety and pain and you strengthen your self-efficacy by practising your skills regularly.

Mental Health self-efficacy test

Select a point on the line below that you believe to be mostly true for yourself at this time in relation to the below statement.

“I can control and resolve most difficulties I experience in my life”

1 = not at all, 5 = somewhat, 10 = always


Well done

Your selected answer suggests you have strong self-efficacy.

Seek help

Your selected answer suggests you have little self-efficacy.

The earlier you are aware of a problem, the quicker and the better it is to act and find a suitable solution.

Check your mental health regularly, just like you monitor the health of your eyes or skin. The earlier you are aware of a problem, the quicker and the better it is to act and find a suitable solution.


Checklists can help you monitor your mental health. They provide a way for you to assess your mental health status. Relying only on your memory to assess your mental health status will result in memory gaps and may result in you focussing more on bad times.

Use the following exercise to monitor your mental health. You could ask yourself these questions at the same time every week to start a healthy monitoring habit. For example, you could add up the number of times you answer “agree” and compare week by week. This checklist may also provide direction for better self-management.

Your answers to the 10 questions below will help you focus on where in this module you can seek answers.

Mental Health Checklist

I enjoy my life

Please select one answer below

I rarely feel sad or depressed

Please select one answer below

I can manage my problems like pain or anger

Please select one answer below

I feel relaxed about things most of the time

Please select one answer below

I do not depend on alcohol/illicit substances to get through the day

Please select one answer below

I sleep well most nights

Please select one answer below

I think life is worth living

Please select one answer below

I am happy with my ability to remember things

Please select one answer below

I look forward to mixing socially with friends and family

Please select one answer below

I rarely dwell on what I have lost following my injury

Please select one answer below

Well done!

Your answers indicate you are not likely to be experiencing any mental health issues.

This is intended as a guide only, so if you are concerned about your mental health, or that of a family member, please get in touch with your GP ASAP to seek professional support.

Your answers indicate you may be experiencing

Alert! icon  Suicidal thinking

It is recommended that you seek professional help immediately.

Depression: refer to the following areas for more information on dealing with and managing depression:

Readiness to change, Managing your thinking, Improving your knowledge, Scheduling pleasant events, Relationships & other social resources

Sleep disturbance: refer to the following areas for more information on dealing with and managing sleep disturbance:

Managing your thinkingGoal setting & developing a planScheduling pleasant events

Cognitive problems like troubles with memory: refer to the following areas for more information on dealing with and managing cognitive issues:

Managing your thinkingGoal setting & developing a planProblem solvingScheduling pleasant eventsRelationships & other social resources

Adjustment, personality, relationship problems: refer to the following areas for more information on dealing with and managing these issues:

Readiness to changeManaging your thinkingGoal setting & developing a planRelationships & other social resources

Grief: refer to the following areas for more information on dealing with and managing grief:

Readiness to change, Managing your thinking, Goal setting & developing a plan, Scheduling pleasant events, Relationships & other social resources

Substance misuse: refer to the following areas for more information on dealing with and managing substance misuse:

Readiness to change, Goal setting & developing a plan, Problem solving,  Relationships & other social resources

Please remember this module is only intended as a guide so if you are concerned about your mental health, or that of a family member, please get in touch with your GP ASAP to seek professional support.

Warning signs

How do I know if my mental health status is normal or problematic?

While it is normal to feel angry, irritable, and sad from time to time, there are RED FLAGS to watch out for. RED FLAGS indicate possible worsening of a mental health problem. A list of potential red flags is found below.

You may use the following red flags as additional aides to regularly monitor your mental health.

1. Constantly feeling stressed, sad and irritable

When you feel stressed and sad a lot of the time, you can be at greater risk of developing elevated anxiety and increased depressive mood symptoms. When people are anxious or depressed, they tend to see the negative side of things which can make them more irritable.

Feeling irritable is a state where you become easily frustrated, angry and upset. If you often feel irritable it could mean that you are using a lot of mental and/or physical energy to deal with stressful life events, leaving little energy for other things.

2. Fatigue and sleep problems
If you are tired a lot of the time, you should first see your GP to rule out any medical cause such as iron deficiency, sleep apnoea (excessive snoring and gasping for air during the night) or unwanted medication side-effects. If you are tired despite eating and sleeping well, this could mean you have problems with anxiety and a depressive mood.
3. Losing interest in activities that were once enjoyable
Losing interest in things that you enjoyed in the past is a possible symptom of depression. It could also mean an activity is not suitable for your age or energy levels. However, if you find yourself having little pleasure in almost all your activities then this is a red flag and needs to be addressed.
4. Problems with concentration and making decisions
Mental confusion and poor concentration can be symptoms of depression and anxiety. Increasing age, taking multiple substances or drugs (e.g. pain killers such as opiates/opioids, Lyrica, alcohol, cigarettes, and so on) will also cause these problems. If you find you are experiencing memory lapses, reduced concentration and attention, difficulty making decisions and so on, then this can be a red flag.
5. Withdrawing from people or activities
Avoiding and withdrawing from your social networks can be a red flag for mental health problems. You may have a good reason to withdraw for a time, but always withdrawing from family, friends and work is often a symptom of depression. If you believe this is happening, then address this quickly.
6. Thoughts of self-harm or suicidal ideation
See the 'Managing your mental health' page for more helplines on issues of self-harm and suicidal ideation. Suicidal ideation involves a person constantly thinking about self-harm. If this occurs, it is a serious red flag that requires you to talk to trusted family and/or friends, and if required, immediate referral to a mental health professional.


Adjustment to spinal cord injury

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What is Adjustment

Simply put, adjustment is the process of becoming used to a new situation. Life following a spinal injury is often very different to your life before your injury and involves a great deal of adjustment as you negotiate a number of new challenges.

For everyone adjustment involves a process of appraisal and re-appraisal. Appraisal refers to how you think about and evaluate yourself, your situation, challenges and solutions. Appraisals can be optimistic and realistic leading to good mental health through adopting positive coping strategies. Appraisals can also be pessimistic, leading to poor mental health through adopting poor coping strategies. The appraisal and coping process is called the “engine room” of adjustment and for maintaining good mental health because it is very important.

Good news!

The way you perceive the world is not fixed - different situations can be viewed from a variety of perspectives. Research has found that how we explain events in our lives impacts how well (or poorly) we deal with those events.

“Having a high quality of life following a spinal injury involves a sense of balance between your body, mind and your social context and environment. Understand your condition, take control and introduce order and predictability into your life. Learn what is possible, set goals, develop values that make sense of your disability, and search out resources to manage your life better.”

Person with C4 tetraplegia

The following figure shows the relationship between a challenging situation, a positive appraisal/re-appraisal and coping process, and positive adjustment outcomes. Many things can challenge your resilience (time since injury, level of injury, negative thinking, poor social support, pain), however, your engine room is very powerful, and can help you adjust well regardless of what life can throw at you.       

Diagram of mental health engine room

Adjustment case studies

man in wheelchair describing something to his therapist using hand gestures
Neuropathic pain and mindfulness / thought training


You are prescribed pain medication, which causes side effects, like confusion, fatigue and weight gain. You decide to try something different to cope.

Your doctor suggests reducing the dosage in combination with an online mindfulness App.

Positive adjustment

Learning the new mindfulness techniques gives you another strategy to manage pain.

Reducing medication improves your ability to think and you have more energy.

Reappraising your new situation you realise you have more positive resources than you realise


This new approach to managing your pain allows you to focus on other activities such as hobbies and socialising.

You also have improved self-esteem due to the way you dealt with this challenge

friends consoling man in a wheelchair
Onset of anxiety and relaxation techniques


You are beginning to experience serious anxiety and feelings of panic about dealing with your injury in the coming years. This has caused feelings of helplessness, sleep disturbance and a reluctance to mix socially. There is also an embarrassment and reluctance to talk to family and friends about it.

You try to cope, hoping it will go away however it gets worse to cause nausea, fatigue, and depression.

Positive adjustment

The risk of not doing anything about your situation is a serious threat to your mental and physical health. You get advice from a trusted friend who has a spinal cord injury too.

It is agreed that you must focus more on optimistic activities such as an online relaxation course, and regular exercise


You begin to develop positive coping strategies, that encourage further positive changes, such as changes to medications, diet and social activities.

Note to self...

Get a GP referral to a psychologist if these strategies are not working.


Transitioning from hospital back into the community can feel liberating. It will also be very challenging as you learn to be independent again. You will strengthen your adjustment if you set achievable goals, keep active, eat well, think optimistically and realistically, seek help when needed and maintain strong social ties.

Take home messages

man with head in hand crying

is a normal reaction to change

yellow toolbox

in this module to increase your overall wellbeing

asian woman with hand on chin thinking

and learn to manage your thinking

man in a wheelchair holding a folder looking straight ahead

of your symptoms

clipboard with pen and paper

a mental health management plan

doctor standing with arms crossed

with your GP to discuss medication options

Be proactive and take responsibility for managing your own health risks

This involves:

  • Educate yourself so that you understand how your spinal cord injury affects your mental health
  • Keep you up-to-date about the latest research findings.
  • Become a partner in decision-making and learning to problem solve with your family and health professionals.
  • Develop an individual mental health self-management program that works for you.
  • Engage in ongoing health and wellness activities. This includes:
    • Exercising regularly
    • Maintain a healthy weight to reduce load on your shoulders, arms and hands
    • Use medications only as instructed by your doctor(s)
    • Incorporate regular relaxation and mindfulness techniques into your daily life.


Mental health toolbox

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Mental health toolbox

Improving your ability to self-manage your health is an important objective of the Health Maintenance Tool. Self-management helps you be ‘in control’ of your behaviour, thoughts and emotions, placing you in the best position to look after your mental health.

The mental health toolbox shown below includes a range of strategies and activities to assist you in developing a personalised program that will support your mental health and wellbeing.

Each strategy is focussed on a particular set of skills that have an evidence-base as an effective psychological therapy. The key idea of this toolbox is to help you develop a sense of balance between your body, mind and your social and environmental context.


People often experience different issues and challenges with their mental health and a range of factors may be contributing. There is no one-size-fits-all approach!

mental health toolbox diagram

The seven strategies

An important starting point is to explore how ready you are to plan and take action to make positive changes in your life.

Which of the following statements best fits your current level of readiness to change? 


Managing your mental health is an ongoing process not a destination and for this reason it requires consistent attention and care.

“In terms of resistance to MH issues, we don’t want to have to deal with pain, but I suddenly had to. We don’t want to have to deal with different bowel and bladder issues but now we have to. AND I didn’t want to feel like this, but now I do. So some people will just not want to confront it, but other people will and having something that helps them confront mental issues is great.”

Person living with a spinal cord injury

Values and personal responsibility

To help reflect on your readiness to change, and adjust to your injury, it may help to explore what things are important to you, and the type and size of any changes that might be required to ensure you live according to the values that matter to you.

Personal values are the things that we hold as most important to us. They can guide our actions and decisions. Values help to keep us grounded at times when we’re struggling with decision-making. This is a struggle between doing what you know you need to do and what you want to do. An example is: I know I need help to manage my anxiety but the embarrassment makes me reluctant to do so.

An important personal value is acknowledge personal responsibility for one’s behaviour and actions. If you are interested in change, but not entirely sure you want to change, this inner conflict needs to be resolved. To help you resolve this conflict answer the following questions and reflect on your answers.

  1. What kind of person do I want to become?
  2. What do I really care about? What matters to me?
  3. What is stopping me from taking action to improve my mental health?
  4. What in my life is most meaningful?
  5. Are these barriers to me becoming more responsible for my mental health?
  6. If I decide take personal responsibility for the way I live, what inner changes can I make?

You will find below some simple steps that will help you begin to build personal responsibility and resilience (the ABCDE of resilience):

  1. Acceptance: You have to accept things in your life which are beyond your control with optimism. This does not mean you are giving up. It means going forward to change things that can be improved.
  2. Belief: There is always some area of freedom in your life in which you can act responsibly. It involves upholding your values and personal strengths.
  3. Commitment: this means taking action and moving forward, carrying out those things you are responsible for, regardless of your feelings or conditions.
  4. Discovery:Involves learning about yourself and discovering your strengths and resources.
  5. Evaluation and self-management.Involves monitoring and making necessary adjustments so you can move forward. If this is difficult and is not working, then make adjustments (re-appraise and employ new coping strategies).

Did you know

Beyond Blue provides many personal stories from people who have had to deal with their personal values and learn to adopt a responsible attitude toward their health. Use the following link to explore these encouraging stories: https://www.beyondblue.org.au/personal-best/pillar/wellbeing

The way you think about life will influence your mood and frame of mind for better or worse. You need to ensure you are aware of whether your thoughts are helpful.

Are your thoughts (optimistic, realistic, confident) or unhelpful (negative, irrational, pessimistic)? Helpful thinking will boost your mental health. Unhelpful thinking will chip away at your mental health.

A helpful thought could be:

“This is really challenging!  Its great though that I have lots of help and I seem to be managing well”.

An unhelpful thought could be:

“This is really terrible! It’s my fault I’m struggling deal with this anymore. It is all too much.”.


While it is completely expected for people to have a range of positive and negative feelings, it is important that you do not allow too many unhelpful thoughts to take over and interfere with your adjustment.

Three useful strategies for managing your thinking

Catching unhelpful thinking traps

As humans we are all prone to thinking in ways that are unhelpful and can fall into “thinking traps”. By recognising these traps we can begin to manage our thinking more positively.

Let’s look at some examples of common thinking traps:

It’s easy to see a situation as all good or all bad instead of a more balanced view of a situation. You may be better at some things than others and are able to improve.

Example: I’m neither ‘perfect’ nor a complete ‘failure’.

It’s easy to see a situation as all good or all bad instead of a more balanced view of a situation. You may be better at some things than others and are able to improve.

Example: I’m neither ‘perfect’ nor a complete ‘failure’.

Sometimes we think we know what another person might be thinking (mind-reading). Or that we can predict what will happen in the future (predictive thinking).

Example: Knowing some else’s thoughts or predicting the future is not possible, so it can be a mistake to accept such thinking is based on facts.

You believe that what has happened or will happen will be so awful and unbearable that you won’t be able to stand it. Sometimes we predict the worst possible outcomes about the future.

Example: If we overestimate the likelihood of a negative event occurring and underestimate our ability to cope, we can feel very anxious and depressed.

This type of thinking happens when we adopt a single-minded approach. The information we see matches our existing beliefs and information that offers a different perspective is filtered out as if it doesn’t exist.

Example: A tendency towards tunnel vision doesn’t let you see other points of view.      

You attribute a lot of the blame to yourself for your problems and fail to see that certain things are can be caused by others.

Example: “It was all my fault the marriage ended.”

You focus on the other person as the source of your unhelpful thinking and you refuse to take responsibility for changing yourself.

Example: “She’s to blame for the way I feel now” or “My parents caused all my problems.”

You interpret events in terms of how things should be rather than simply focusing on what is.

Example: “I must do well. If I don’t, then I’m useless and a failure.”

Regulating your emotions

To better regulate our emotions, it helps to take control of your thinking. With improved control of our thoughts, we improve awareness of our emotional state (see illustration below).

diagram of ways to regulate your emotions

You need to be aware of your emotional state.

Check in from time to time and ask yourself how you are feeling: hopeful, anxious, happy, contented, angry, sad, or hopeless. Make sure you then explore these emotional states. Name the specific emotions that you can feel at that moment.

You need to be aware of your emotional state.

Check in from time to time and ask yourself how you are feeling: hopeful, anxious, happy, contented, angry, sad, or hopeless. Make sure you then explore these emotional states. Name the specific emotions that you can feel at that moment.

Try one of the mindfulness techniques with your slow breathing to achieve an internal calmness.

For more details see section on Relaxation techniques: slow breathing and mindfulness.

Try to use your ‘engine room’ process to manage your thoughts. This involves appraisal and re-appraisal of your thinking. See if you can direct those thoughts to become helpful and optimistic.

Try to become more adaptable. Attempt a straightforward problem-solving strategy to your current problem.

Try to use the ‘pleasant events’ strategy and set aside time each day to enjoy yourself. This is a good way to build emotional regulation skills. Remind yourself of your talents and virtues and focus on these for a while each day.

Try to seek positive social and emotional support to help you regulate your emotions. With improved self-awareness it is possible to seek emotional support from within yourself. Of course, you may seek external help by engaging with others in a positive way.

“Learning to regulate my emotions helped me to grieve. And through grieving, through a process of acceptance, there was light at the end of the tunnel.”

FG3: participant E

Relaxation techniques: slow breathing and mindfulness

Relaxation can help to reduce your anxiety or irritability and help you to manage and tolerate the stressful things that frequently happen.

There are many variations of relaxation exercises. It is important to find one that suits your preference. One of the simplest and effective relaxation exercises is slow diaphragmatic breathing. 

Follow the instructional video below to learn this technique.

Play Video

You do this by:

  1. Placing one hand on your stomach and one hand on your chest.
  2. Slowly breathing in through the nose, drawing the breath from your stomach.The hand on your stomach should rise with your breath and your hand on your chest should not move.
  3. When you exhale let the stomach fall and focus on letting your breath out through your nose as slowly as possible.
  4. Using this strategy, slow down your breathing rate to 6 times a minute, that 4 seconds breathing in (through the nose) and 6 seconds breathing out (through the mouth with pursed lips).
  5. You should practice this breathing exercise for 5-10 minutes, at least twice a day and try using this skill before a stressful event.

Another very effective relaxation strategy is called mindfulness.

Mindfulness builds on your slow diaphragmatic breathing. Mindfulness involves giving your attention to what is going on within you (your breathing) and around you, moment by moment. You focus on and enjoy feedback provided by your five senses: touch, smell, sight, sound and taste. You remain fully aware of your surroundings.

Positive thinking exercise

Sometimes we can find ourselves ‘emotionally stuck’ in harmful thinking patterns. This may prevent us from engaging in helpful action.

The following exercise explores Cognitive Defusion. Cognitive Defusion is a skill that, helps you to let go of negative thinking. It requires regular practice!

Use the below video ‘Leaves on a stream’ to focus on your mindfulness.


You are the observer and the boss of your thoughts, not the thoughts themselves. You can learn to give each thought a little bit of the attention it needs, allowing it to “float in and out” of your mind

Play Video

An example of a mindfulness exercise is to wheel into a garden where you are safe and in which you can enjoy multiple sensations: while slowing your breathing, smelling flowers, listening to birds signing, feeling the sun or breeze on your skin, observing all the colours around you.

During a mindfulness exercise, you learn to deliberately block any sad or stressful thoughts. You allow your senses to dominate. For example, distract yourself with the smell of a flower, focus on its colour, feel the leaves, and so on. We recommend this type of mindful exercise once a day as well as your slow breathing exercises.

Having a good understanding about your mental health is the foundation of self-management.

Check out

Connecting with other people who live with spinal cord injury, and their family and friends, can be a really valuable way for sharing your experience and learning practical tips on living well with your spinal cord injury. Check out: https://scia.org.au/peer-support/

You can learn so much more by accessing the information about mental health and tips for supported change:

Grief and loss

Griefline: Tips, tools and articles to help you manage grief and loss. Supported by Rotary District 9800 as part of the G’day Network initiative.

Bare: Grief counselling and support Services Australia: resources for helping deal with grief and loss

Depression, Anxiety and Stress Management


Moodgym: is like an interactive self-help program that helps you to learn and practise skills which can help to prevent and manage symptoms of depression and anxiety. Moodgym has been shown to be effective in medical research by research groups around the world. Supported by Australian National University

This Way Up: Learn a step-by-step way of tackling feelings of stress, anxiety, and low mood with our clinically proven online courses. Select a course that is relevant to the difficulties you’ve been having or take our anonymous online test to see which course is for you. You can get instant access for $59 or speak with your clinician (GP or psychologist) to enrol for free. Supported by UNSW and St Vincents Hospital NSW.


myCompass: allows you to track your thoughts, feelings, and behaviours in four areas – depression, anxiety, stress, and sleep. It provides graphical feedback to recognise patterns and triggers that impact your mental health. Designed and developed by researchers at the Black Dog Institute (UNSW), myCompass has been shown to significantly reduce mild-to-moderate symptoms of anxiety, depression, and stress, and significantly improve levels of work and social functioning in just seven weeks.

The Generalised Anxiety (GAD) Program: is designed to help you understand the nature of anxiety and worry and to learn the skills and strategies that help manage anxiety and improve overall mental health and wellbeing. This program has been developed by psychologists and researchers from the National eTherapy Centre, Swinburne University of Technology.

Beyond Blue: provides information and support to help people achieve stable mental health.

Substance misuse


SMART (Self Management and Recovery Training) Recovery: a free group program assisting any problematic behaviours, including addiction to drugs, alcohol, cigarettes, gambling, food, shopping, Internet and others. SMART Recovery is a registered health promotion charity and a non-profit organisation.

Health Direct Australia: Free health resource; Australian government-funded service, providing quality, approved health information and advice



Relationships Australia: a leading provider of relationship support services for individuals, families and communities.  It offers services that include counselling, family dispute resolution (mediation) and a range of family and community support and education programs. We are a federation of service providers in each Australian state and territory and have a national office based in Canberra


There are many prescribed medications that may help you to manage your mental health symptoms. But medications only is not always ideal. What appears to work best is the combination of medication and sensible changes to your behaviour, thinking and lifestyle. Below, you will find the major medications used for mental health management. You will need to weigh up the benefits versus the risks of taking medications. This exercise will help you make a more informed decision about what is right for you.

Types of medications used for mental health management

Selective serotonin reuptake inhibitors (SSRIs): Citalopram (Cypramil); Escitalopram (Lexapro); Fluoxetine (Lovan, Prozac); Paroxetine (Paxil, Aropax); Sertraline (Zoloft) Fluvoxamine (Luvox)

Used to treat:
Depression Anxiety
Obsessive compulsive disorder
Post-traumatic stress disorder

Possible side effects
Sexual dysfunction (including reduced sex drive, difficulty having an orgasm, problems ejaculating), nausea, loss of appetite, diarrhoea, insomnia


Selective serotonin and norepinephrine reuptake inhibitors (SNRIs): Venlafaxine (Effexor); Desvenlafaxine (Pristiq); Duloxetine (Cymbalta)

Used to treat:
Depression Depression
Nerve pain
Anxiety disorders

Possible side effects
Headache, sweating, sexual dysfunction (including reduced libido, difficulty having an orgasm, problems ejaculating), nausea, diarrhoea, reduced appetite


Selective norepinephrine reuptake inhibitors (NRIs): Reboxetine (Edronax)

Used to treat:
Depression Depression

Possible side effects
Insomnia, tiredness, nausea, constipation


Agomelatine (Valdoxan)

Used to treat:
Depression (can also help sleep)

Possible side effects
Tiredness, dizziness. Blood tests are needed to check liver function


Tricyclic antidepressants (TCAs): Amitriptyline (Endep); Dothepiepin (Dothep); Clomipramine (Anafranil, Placil)

Used to treat:
Severe depression
Chronic pain
OCD can be treated with clomipramine

Possible side effects
Dry mouth, blurred vision, constipation, sexual dysfunction (including reduced libido, difficulty having an orgasm, problems ejaculating), weight gain, sleepiness


Tetracyclic antidepressants: (Avanza); Mianserin (Lumin, Tolvon)

Used to treat:
Major depression
depression with anxiety

Possible side effects
Tiredness, dry mouth, constipation, weight gain. Blood tests needed with Mianserin, given its use has a very rare risk of causing blood disorder


Benzodiazapine or anti-anxiety drugs (eg. Valium, Xanax, Rohypnol, Mogadon, Temaze, Serepax, Normison)

Used to treat:
sleep disturbance

Possible side effects
Highly addictive with prolonged use, withdrawal effects; drowsiness, confusion


Mood stabiliser: Lithium

Used to treat:
Bipolar disorder

Possible side effects
Tremor, hypothyroidism, weight gain, sedation, lithium toxicity, arrhythmia


Mood stabilisers/ anticonvulsants: Sodium Valproate (Epilim) and Lamotrigine (Lamactil)

Used to treat:

Possible side effects
Drowsiness, nausea, abdominal pain, diarrhea, vomiting, low platelet count, tremors, tiredness, and hair loss


Anti-psychotics: Quetiapine (Seroquel); Clozapine (Clozaril); Risperidone (risperdal); Olanzapine (Zyprexa)

Used to treat:
Sleep disorder
Bipolar disorder

Possible side effects
Weight gain, sweating, confusion, fast or uneven heartbeats, tremors, uncontrolled muscle movements, feeling light-headed, blurred vision, eye pain, increased thirst and urination, excessive hunger, fruity breath odor, weakness, nausea and vomiting


+ Effectiveness shown by clinical trials; the more + the more effective generally

An abrupt stop of your anti-depressants may cause serious withdrawal symptoms. If you want to stop a medication always reduce the dose slowly and in discussion with your specialist or GP. Always discuss possible alcohol and medication interactions too.

An abrupt stop of your anti-depressants may cause serious withdrawal symptoms. If you want to stop a medication always reduce the dose slowly and in discussion with your specialist or GP. Always discuss possible alcohol and medication interactions too.

Setting goals can be a great way to improve your mental health and help you adjust to living with your injury. Goals provide you with targets and outcomes to work towards. Targets can motivate you to work harder to achieve those outcomes.

What is a goal?

A goal is an idea or a picture of where you would like to be in the immediate, near, or distant future. Your early or initial goals don’t require great detail. But it is important to think about the direction you want to head in. Goals can be set for short, medium, and long-term periods.

Short, medium and long-term goals

Short-term and medium-term goals refer to what you want to achieve now or in the next 6-12 months or so. Short-term goals help you to get where you would like to be in the distant future (long-term goals). It is important to be able to set long-term goals, but not at the expense of shorter-term goals. If your initial goals are achievable the success you experience may motivate you. And your achievements may help you adjust to your injury and so improve your mental health.

Writing goals down

If you write down your goals you are more likely to remember them and so achieve them. It is rewarding to achieve you goals and may give you back some sense of control over your life. In the table below, write down your short, medium, and long-term goals, and how you may achieve them.

Making a plan

Once you develop your goals you may find it helpful to create a plan. You can do this by dividing those goals into smaller steps. Write down each step, put it into your plan and set a deadline for its completion.

It is important to review your plan every month or so. When you complete a step along the way take a moment to acknowledge the milestone. Celebrate your progress and re-evaluate your plan. For example, is it still relevant or practical? Do I need to make any adjustments? The process of goal and plan completion can be very rewarding.

Goal planning exercise

Create your own personalised goal-setting plan using this downloadable interactive pdf.

Image of SCI HMT Goal Planning Interactive Pdf

This section provides strategies to help you change your behaviour and so improve your mood and quality of life.

Problems are an inevitable part of life. It is tempting to avoid problems because avoidance brings immediate relief. Facing problems can be difficult especially when you are in despair or overwhelmed. It can be hard to see problems clearly enough to consider effective solutions. We all have tendencies to see things a certain way that can cloud our thinking. This ‘bias’ can get in the way of effective problem solving. For this reason, a structured system can help.

The steps of structured problem solving are:

  • Define the problem. Rather than a general statement like, “My carers change too often and no one knows what they’re doing.” Try to be specific with something like, “I have had three carers change this month which has made it hard to establish a consistent approach to my personal care routine”.
  • Try to identify factors that contribute to the problem and those that maintain it. Was the change in the care team related to relationship factors? Are these going to continue to be a problem? Were there factors beyond your control like a change in management at the level of the care provider? Are these types of changes infrequent or regular? 
  • The third step involves brainstorming. Try to think of as many possible solutions as possible. This is not a time to evaluate your solutions because you will rob yourself of ideas as you go. You just need to get as many ideas as you can think of onto paper or recorded using your voice on your laptop or mobile. You are not solving it all yet!
  • Once you have those potential solutions written down or recorded, you can do a pros and cons analysis of each potential solution. Consider the positive and negative outcomes that could result if you implemented each solution.
  • Pick a solution that has a higher number of pros than cons. Then develop a step-by-step plan to trial that solution. If a potential solution was to explore possible changes to your care provider you would list the steps involved in this: i) have a meeting with my care coordinator, ii) research or speak to others to find alternatives, etc.

Problem solving exercise

We have created a template for your problem-solving cases. Please download and use to document your injury recovery journey. This form may help you to separate any problems into manageable pieces, work out what’s causing any problems and make it easier to decide on solutions.

You may wish to use this form for personal reflection. Also, to share with others to help them understand your situation (For example, your doctor, family members or friends).

SCI HMT Problem solving solution interactive pdf

Problem-solving is also the basis for resolving conflicts with others. Resolving conflicts will also require you to:

  • Listen and not jump to conclusions
  • Identify the problem and apply the above problem-solving strategy
  • Regulate your emotions or behaviour that might make things worse, like anger, shouting, pointing your finger. 
  • Be prepared to negotiate and agree on concessions.
  • Work together to ensure positive outcomes for all parties.

Quick Link

Use this link to help you develop a pleasant event weekly calendar:

An obvious symptom of poor mental health is a reduced ability to enjoy oneself. An effective way to counter this is to develop a ‘pleasant events schedule’. Choose from a list of activities that are generally considered enjoyable. The creation of such a schedule may lead to greater enjoyment in life.

With planned pleasurable activities each day, you will realise that you can still enjoy yourself. By doing these activities, you can gain a sense of control over your mood and other aspects of your life.


List activities you enjoy doing. For example, visiting friends, going to the beach, shopping, fishing, reading, having a cup of coffee, listening to music, gardening, having a BBQ, movies, exercise, planning a holiday, going for a drive, and so on.

Make sure your list has something for every day, every week, every month and every 6 to 12 months. Even though you may not always feel like it, it is important to go ahead and do the chosen activity. You can learn how to enjoy yourself. For this strategy to help, frequency is key. Make sure you do some pleasurable activity every single day.

If you have trouble with ideas use the following link for a long list of things you may want to try these fun activities.

Your spinal cord injury didn’t happen to you alone. Your injury affected a wide range of people, especially your family and close friends. Your injury may affect your wider social networks. You may need to renegotiate pre-injury relationships as roles can change.


People often say that learning a new understanding of relationships is a journey and takes time. Clear communication and an openness to learning can help enormously.

Setting healthy boundaries

Boundaries are guidelines, limits, or rules about what you consider to be acceptable behaviour from other people.  People who don’t have boundaries might be considered ‘push-overs’ whereas people who have very strict boundaries might be considered aloof.

Look at the following chart and consider where you fit. Are your boundaries too tight, too loose; or just right?

Healthy boundaries
Loose boundaries
Strict boundaries
  • Aware of your emotional needs and wants.
  • Can tolerate disagreement and difference of opinions.
  • Respect your own opinion as well as the opinions of others.
  • Share personal information without over-sharing (e.g., telling everyone everything about yourself) or under-sharing (e.g., questioning others to avoid sharing anything about yourself).
  • Inclined to accept abuse or disrespect.
  • Become overly involved in other people’s problems.
  • Depend too much on what other people think of you and being quick to change what you do or think to please others, often to your own hurt.
  • Fear rejection if you don’t do what others ask/want you to do.
  • Find it difficult to say no to others.
  • Avoid close relationships or being uncomfortable with intimacy.
  • Become overly protective of your personal information; not open or trusting.
  • Have few close relationships.
  • Solve problems on your own rather than asking for help when appropriate.
  • Keep others at a distance to avoid the possibility of rejection.
Healthy boundaries
  • Aware of your emotional needs and wants.
  • Can tolerate disagreement and difference of opinions.
  • Respect your own opinion as well as the opinions of others.
  • Share personal information without over-sharing (e.g., telling everyone everything about yourself) or under-sharing (e.g., questioning others to avoid sharing anything about yourself).
Loose boundaries
  • Inclined to accept abuse or disrespect.
  • Become overly involved in other people’s problems.
  • Depend too much on what other people think of you and being quick to change what you do or think to please others, often to your own hurt.
  • Fear rejection if you don’t do what others ask/want you to do.
  • Find it difficult to say no to others.
Strict boundaries
  • Avoid close relationships or being uncomfortable with intimacy.
  • Become overly protective of your personal information; not open or trusting.
  • Have few close relationships.
  • Solve problems on your own rather than asking for help when appropriate.
  • Keep others at a distance to avoid the possibility of rejection.

To work on setting healthy boundaries, try these three steps.

Define your limits.
Examine past experiences that involved you feeling angry, resentful, or uncomfortable.
  1. What was the situation? Who was involved? Which personal standards or values were violated in these instances?
  2. You feel awkward discussing certain topics or when people do things that affect you without first consulting you or asking for your opinion.
Determine how you know when your boundaries have been crossed.
How do you feel about this (e.g., anger, annoyance, irritability, resentment)? Watch out for these negative feelings and when you are aware of them. Check whether one of your boundaries may have been violated.
Practice assertiveness when you become aware of a boundary violation.
This will mean you will state how you feel, what objective facts contributed to these feelings, and request an alternative you consider to be more acceptable (e.g., I felt uncomfortable when you said I was being unreasonable the other day. So in the future it would be great if we could work towards accepting our differences).

Life with support workers

Some people following spinal injury need to negotiate a new type of relationship. That of community support workers or carers. Support workers play a critical role to enable people with spinal injuries to live a meaningful life. They are often employed to assist with domestic tasks and personal care. Tasks may include dressing, grooming, food preparation, travel, work, hobbies, and care of children and/or pets.

However, working together with support workers is much more than just completing tasks. There are many demanding factors at play, including trust, familiarity and privacy. To learn to ask for help can be weird and a huge challenge. People can feel awkward “asking carers to do stuff”.


Clear and respectful communication has been identified as one of the most important aspects in determining successful support worker relationships. This may be communicating the details of tasks you need assistance with, and your general expectations regarding the scope and role of a support worker.

The quality of the relationship between you and your support workers can impact your quality of life (and that of your family). For best advice discuss this topic with your spinal cord injured peers. Or you may find community support group websites or social media platforms helpful. Check out https://scia.org.au/

Reaching out and developing a support network

Strong relationships you can count on are vital for your mental health. Develop a support network to include the people in your life that help you achieve your personal and professional goals. Tips on who can be part of your support network might include:

  • Family
    Family is an important support network for you. If family are not an option, then it is important you develop networks from the following five sources.
  • Friends
    Think about your friends, someone with whom you have an established relationship. Such a person is ideal for your support network. Do not be embarrassed about seeking support.
  • Colleagues
    If you work, then colleagues can be a great source for social support.
  • Neighbours, acquaintances and friends of friends
    Use your existing network to identify and build further connections with neighbours, acquaintances and friends of friends.
  • Social Media and Facebook/ Meet-Up Groups
    The internet provides many social support opportunities.
  • Local community and advocacy groups
    Become actively involved in your local community. It is a great way to develop social connections. Examples include community clubs, sporting groups and volunteer organizations. Of course, there are great opportunities within advocacy groups such as Spinal Cord Injuries Australia and Forward Ability Support.

Intimate relationships

It is common for intimate relationships to change after your injury. Interest in one’s ability to have sex and be intimate raises big questions that are important. The impact of each spinal cord injury is different for each person. It is important to seek answers to your questions. With the right knowledge you can have a meaningful, pleasurable, and rewarding sex life.

Check it out

Listen to a podcast by Spinal Cord Injuries Australia who interview psychosexual therapists Candice Unger and Arlyn Owens from Royal Rehab’s Sexuality Service in Sydney:

Quick Link

To learn about intimacy, spend time getting used to your body after your spinal cord injury. See how it responds to touch and allow yourself to be open. To learn more, check out these resources and information:



Keeping a Mood Diary will provide you and your healthcare professionals with a good understanding of your mental health and factors affecting it to be able to manage it better. It is recommended that you complete the mood diary for a minimum of 14 days to identify any pattern or trend.

In addition, your level of pain can affect your mood. If you find that your pain is interfering with your mood also keep a Pain diary. Sleep is another important factor to consider. Keeping a Pain Diary and/or Sleep Diary will help to inform your treatment. For example, if you think the worst will happen (called catastrophising) you may underestimate your ability to cope with pain, making you more anxious and depressed.

It is recommended that you complete the diary for a minimum of 14 days to identify any pattern or trend.

You can download an editable pdf version of the diary or create a digital diary on your device using the SCI Health Toolkit app.

[ Pain diary image and link to be applied once approved ]

Please note: Diaries must be downloaded to be completed – they cannot be filled in online

The SCI Health Toolkit App

The SCI Health Toolkit app provides you with a bladder and fluid diary in your pocket, along with all of the other diaries available on The Health Maintenance Toolkit website.

You can quickly and easily track and monitor key bodily functions and activities using the interactive and simple to use diaries.

SCI Health Toolkit app showing diary on screen

Your mental health

Know about your mental health and wellbeing

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Spinal cord injury and your mental health

Living with a spinal cord injury can be a huge challenge, testing your resilience and ability to cope with daily challenges. Following your injury, you may find that life roles have dramatically changed. Learning to live with your spinal cord injury involves a new and different way of life that can sometimes be challenging and confronting.

Most people with a spinal cord injury adjust and cope well, becoming more resilient. Being resilient means you get on with life, dealing with the injury as best you can in a positive manner. However, being resilient means you will still experience threats to your mental health, which is a normal reaction to SCI.

“Life with a spinal cord injury is challenging but challenges can be rewarding, satisfying and fun. Lean into the discomfort and you will find your way, there are so many opportunities to find beauty and enjoyment.”

Person with L1 paraplegia

Possible challenges

Following a spinal cord injury people can experience increased challenges with their mental health. This might include sleep disturbance, cognitive problems, grief and depression.

Good news!

It's important to remember that many of these experiences are very common and many people adjust and experience positive well-being over the long term.