Overview. Defining mental illnesses. What You Should Know About Working with People with Mental Illnesses

Transcription

1 MINNESOTA What You Should Know About Working with People with Mental Illnesses June 2016 MINNESOTA Overview The basics of mental illnesses Evidence-based treatment options Strategies for working with someone who is experiencing symptoms such as: Anxiety Anosognosia (lack of insight into the illness) Suicidal thoughts MINNESOTA Defining mental illnesses Biological brain disorder Disrupts all aspects of life: Thoughts Feelings Behavior Mood Ability to relate to others Daily functioning 1

2 MINNESOTA Causes and triggers Genetics Biology Hormones Nutrition Substance Use Stressors Major life changes Daily stressors Trauma MINNESOTA Prevalence of mental illnesses 1 in 5 adults in a given year 1 in 10 youth in a given year Symptoms appear by: Age 14 in 50% of cases Age 24 in 75% of cases MINNESOTA How did we get here? Problems with access to treatment, services and supports at the right time Stigma Research on brain disorders is behind Chemical and mental illnesses prevalent People with mental illnesses get deeper into poverty and legal issues once they are there 2

3 MINNESOTA How can this change? Stronger mental health system More community-based treatment and services More evidence-based options Cross-system collaboration Working with mental health providers? Working with social workers MINNESOTA Diagnoses and treatment MINNESOTA Major Depression Affects 1 in 15 adults per year Symptoms: Sadness, anxiety, guilt, anger, mood swings, lack of emotional responsiveness, feelings of helplessness, hopelessness, irritability Physical: Fatigue, lack of energy, sleeping too much/little, loss of appetite, overeating, unexplained aches and pains 3

4 MINNESOTA Post-Traumatic Stress Disorder Affects 1 in 28 adults per year Emotions/ Thoughts: Persistent re-experiencing (nightmares, flashbacks), difficulty concentrating, outbursts of anger, irritability Behaviors: Impulsivity, hyper-vigilance, increased startled response, physical anxiety symptoms (trembling, increased heart rate, blushing, gastrointestinal issues, etc.) MINNESOTA Borderline Personality Disorder Affects 1 in 50 adults per year Behaviors: Impulsivity, self-injury, recurrent suicidal behavior, pattern of intense personal relationships, frantic avoidance of abandonment Emotions/ Thoughts: Mood swings, intense emotions, paranoid thinking, unstable selfimage, black and white view MINNESOTA Bipolar Disorder Affects 2.6 percent of the population Symptoms: Mania: Extreme mood shifts, racing thoughts, increased talking, agitation, grandiose plans, risk taking, impulsivity, decreased sleep Depression: Coming down from mania, severe depressive symptoms, sleeping for multiple hours or even days 4

5 MINNESOTA Schizophrenia Affects 1 in 200 adults per year Symptoms: Delusions, hallucinations, lack of expression/emotional flatness, disorganized thoughts/speech, slow movement, impaired ability to relate to others, behavior that doesn t make sense, difficulty starting/following through with activities, anosognosia (lack of insight into the illness) MINNESOTA Dual diagnosis and cognitive issues Like mental illnesses alone, dual diagnoses can involve cognitive problems: Limited attention span Difficulty understanding and remembering Not recognizing consequences of behavior Poor judgment Disorganization Not respond well to confrontation MINNESOTA Strategies for working with someone who is experiencing symptoms 5

6 MINNESOTA Use person-first language What is it? Say A person living with (a mental illness, schizophrenia, bipolar disorder, etc.) Avoid labels, such as mentally ill, bipolar, etc. Do not use pejorative terms like crazy Why? Easier, less scary to identify as a person than a label The easier that is, the more likely someone will be to h l MINNESOTA Stigma Check! Don t stereotype Remember that everyone is different and there are varying degrees of mental illness Many variables working against them, as they are another minority, disenfranchised group Stigma delays people from seeking help! MINNESOTA Communication techniques Listen Empathize Agree Partner 6

7 MINNESOTA Applying Listen Drop your agenda Listen to learn. Turn off the wheels in your head. Remain non-judgmental. Use open-ended questions. Paraphrase what you heard ( reflecting ). Let the person correct you. Avoid advice, especially at this stage. Even discuss scary topics (e.g. delusions). MINNESOTA Try not to: Rush the conversation. Confront, argue, criticize or blame. Have an emotional reaction to what you hear. Take comments personally. Problem-solve. Go right to empathy. Use sarcasm, laughing or humor. MINNESOTA Applying Empathize Express empathy for feelings. This doesn t mean you need to agree. Normalize: It makes sense to feel stressed right now. Ask, What do you think? Let the person set the pace. 7

8 MINNESOTA Applying Agree Stick to perceived problems. Offer solutions instead of taking control. Ask Would you like to know what has worked for others in similar situations? Review the advantages of an idea from the client s view. Use this as a basis for a plan. Offer the person a face-saving way out. Affirm the person s positive qualities. It s okay to keep your boundaries. MINNESOTA Applying Partner Move forward with agreed-upon goals. Use phrases that support feelings of control and safety: Would that be all right? Do I have that right? How can I help? Would you mind if I I can see why you d feel that way. MINNESOTA When communication is difficult Respond to disorganized speech with short, simple sentences. Repeat things if needed. Allow plenty of time for responses. Know that just because the person may show a limited range of emotions, it does not mean that he or she is not feeling anything. Don t assume the person can t understand you, even if response is limited. 8

9 MINNESOTA If the situation has escalated De-escalate before you try to problem solve. Speak slowly and confidently with a gentle, caring tone of voice. Stay calm and take it slow. Avoid nervous behavior and speech. Use non-threatening body language. No touching, shouting or sudden movement. Use clear language. MINNESOTA More de-escalation techniques Do not challenge psychotic thinking Avoid intense questioning. Ask one question at a time and keep it simple. Announce actions beforehand. Don t restrict the person s movement. Try to be aware of what may worsen the person s fear and agression. Take a break. MINNESOTA No matter the diagnosis (or lack thereof): Ensure a good diagnostic assessment if one has not been done Check with your local community mental health center/provider for available evidence-based treatments. Understand that the person might lack insight into their illness because of their symptoms 9

10 MINNESOTA Crisis team/law enforcement collaboration Crisis teams can respond on-site, 24/7 Can assess the situation, call law enforcement if needed, provide an on-site mental health assessment, admit someone quickly to the hospital if needed Half of calls are resolved on-site MINNESOTA Crisis Intervention Team (CIT) model 40-hour training Mental health, law enforcement/ corrections & advocates work together Reduced use of force Improved connection to mental health resources MINNESOTA Mental health courts Direct eligible defendants to treatment & probation instead of incarceration Focus on treatment needs instead of criminal activity Very successful in gaining compliance Hennepin, Ramsey & St. Louis Counties 10

11 MINNESOTA Suggestions for lawyers and other staff Learn about mental illnesses and treatments (NAMI fact sheets are a good start). Get to know the various services and supports and how to access them. Get to know your local community mental health centers. MINNESOTA Resources Support groups Parenting with Mental Illnesses fact sheet Factsheet-Revised.pdf Mitchell-Hamline Parent Mentor program MINNESOTA NAMI Minnesota Contact Info 800 Transfer Rd. #31 St. Paul, MN namihelps@namimn.org 11