James Reinhard, M.D., Medical Director/Associate Director for Psychiatry for the Thomas E. Cook Counseling Center, Virginia Tech University

Transcription

1 Webinar: VIOLENCE AND MENTAL ILLNESS: MYTHS, FACTS, AND HOW MENTAL HEALTH FIRST AID CAN HELP February 26, 2013 James Reinhard, M.D., Medical Director/Associate Director for Psychiatry for the Thomas E. Cook Counseling Center, Virginia Tech University

2 What Is Mental Health First Aid? Help offered to a person developing a mental health problem or experiencing a mental health crisis Given until appropriate treatment and support are received or until the crisis resolves Not a substitute for counseling, medical care, peer support or treatment

3 What You Learn Overview of mental health problems Depressive/Mood disorders Anxiety disorders Disorders in which psychosis occurs Substance use disorders Eating disorders Mental Health First Aid for crisis situations Mental Health First Aid for non-crisis situations

4 Program Milestones Created in Australia in 2001 (University of Melbourne) Currently in 17 countries Piloted in the U.S. in 2008 Youth program Pilot in 2012

5 Evidenced Effectiveness Four published randomized control trials and a qualitative study (in Australia) Increases mental health literacy Expands individuals knowledge of how to help someone in crisis Connects individuals to needed services Reduces stigma Study on 33 US college campuses Increased mental health literacy Reduction in social distance (decreased stigma)

6 Why Mental Health First Aid? Mental health problems are common Stigma is associated with mental health problems Professional help is not always on hand Individuals with mental health problems often do not seek help Many people are not well informed about mental health problems do not know how to respond

7 Spectrum of Mental Health Interventions

8 Nearly 100,000 First Aiders in the US trained by 2,500 Instructors Reported through September 2012 WA 2,073 (67) OR 1,042 (30) CA 9,567 (433) AK 533 (11) NV 21 (2) ID 385 (7) UT 177 (16) AZ 2,755 (86) MT 178 (2) WY 13 (1) CO 4,401 (165) NM 2,456 (65) ND 190 (3) SD 1,024 (20) NE 361 (12) KS 2,557 (68) OK 1,226 (52) TX 3,344 (143) MN 1,407 (19) IA 4,567 (87) MO 5,296 (251) AR 221 (9) WI 243 (8) LA 82 (4) IL 4,208 TN 668 (16) MS 421 (38) MI 2,765 (66) IN 134 (9) (83) KY 261 (5) AL 433 (10) VT 137 (26) OH 271 (16) WV 0 (1) ME 122 (3) NY 1,466 (45) PA 2,695 (139) VA 1,357 (54) NC 1,332 (20) SC 71 (3) GA 1,742 (64) FL 750 (21) MD 2,745 (205) MA 472 (19) RI 288 (5) CT NJ 1,245 (25) 346 (14) DE 16 (3) NH 10 (1) DC 330 (34) HI 0 (1) PR 138 (2)

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10 MHFA Public Policy MHFA in President Obama s Report: Recommendations from the Gun Violence Prevention Task Force Make Sure Students and Young Adults Get Treatment for Mental Health Issues: Three quarters of mental illnesses appear by the age of 24, yet less than half of children with diagnosable mental health problems receive treatment. To increase access to mental health services for young people, we should: Provide Mental Health First Aid training to help teachers and staff recognize signs of mental illness in young people and refer them to treatment. Support young adults ages 16 to 25, who have the highest rates of mental illness but are the least likely to seek help, by giving incentives to help states develop innovative approaches. Help break the cycle of violence in schools facing pervasive violence with a new, targeted initiative to provide their students with needed services like counseling. Train 5,000 more social workers, counselors, and psychologists, with a focus on those serving students and young adults. 10

11 MHFA Public Policy Mental Health First Aid Act 2013 (H.R. 274) (S.153) 112 th Congress: Mental Health First Aid Higher Education Act Toolkit for State Legislative Options 11

12 Mental Health First Aid in the News October 10, 2011 Morning Edition by Kelly Weiss Mental First Aid: How To Help In An Emotional Crisis October 18, 2011 Talk of the Nation by Neal Conan Mental Health First Aid in the Workplace January 23, 2011 by Michael Winerip Positives With Roots In Tragedy On Campus October 18, 2011 For Your Health January 18, 2011 by Rachel Saslow Shooting in Tucson Sparks Interest in Mental Health First Aid' Courses March 12, 2012 by Kim Painter Classes Teach First Aid' for Mental Health Crises

13 Vision By 2020, Mental Health First Aid in the USA will be as common as CPR and First Aid.

14 Mental Illness and Violence Myths Individuals with mental illness, as a group, are much more likely to engage in violent behavior than the general population. Mental health professionals can precisely predict which person will be the next to act violently.

15 The Research McArthur Violence Risk Assessment Study Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods Steadman, Mulvey, Monahan, Robbins, Appelbaum, Grisso, Roth, Silver Archives of General Psychiatry, May 1998

16 Study Design 1,136 patient discharged from hospitals at 3 sites Monitored violent behavior every 10 weeks for one year after discharge Relied on: Self-Reports Collateral informants Police and Hospital Records Compared to 519 people in Community

17 Percent violent Discharged Patients (after 1 st 10 week interview) Community Sample (Reported past 10 weeks) Substance Abuse No Substance Abuse 22.0% 4.7% 11.1% 3.3%

18 Summary of McArthur Study No significant difference in violence by patients not using substances compared to others living in the same neighborhoods not using substances Substance Abuse significantly raises the rate of violence in both patients and the community Higher portion of patients use substances than those in the community

19 Three predictors of violence History of past violence, whether or not a person has a serious brain disorder Drug and alcohol abuse, whether or not a person has a serious brain disorder Failure to adhere to treatment/take medication

20 Other indicators of potential violence Antisocial personality disorder Neurological impairment Type of delusions (i.e., paranoid delusions - feeling that others are out to harm the individual and a feeling that their mind is dominated by forces beyond their control or that thoughts are being put in their head) Type of hallucinations (i.e., command hallucinations)

21 Violence and Mental Illness How Strong is the Link? Richard A. Friedman, M.D. Nov.16, 2006 The challenge for medical practitioners is to remain aware that some of their psychiatric patients do in fact pose a small risk of violence, while not losing sight of the larger perspective that most people who are violent are not mentally ill, and most people who are mentally ill are not violent. It is far more likely that people with a serious mental illness will be the victim of violence.

22 Clinicians ability to predict violence Because rate of violence in individual with mental illness is low: Current screening approaches can prevent the violent acts of a few only by detaining many. - Buchanan, A; Psychiatric Services; Feb. 2008; 59(2)

23 Is predicting the next violent person possible? To be clear, clinicians actually can predict violence with reasonable certainty they just need to consider their patients as a group, the way a public-health epidemiologist would. - Swanson, J; Psychiatric Services; Feb.2008, 59(2)

24 Specific predictions are not expected in other areas of health care. A primary care physician cannot predict which individual patient will have a heart attack or get cancer but is rightfully expected to do something to prevent early deaths from these diseases across a panel of patients: -screen for risk factors/early signs of disease -reduce modifiable risk factors, -intervene promptly when worrisome signs of pathology are detected. - Swanson, J; Psychiatric Services; Feb.2008, 59(2)

25 What is Recovery? A vision we began to hear about in mid s Harding s (1987) Vermont Longitudinal Study showed the course of severe mental illness was NOT inevitable deterioration. Several first person accounts of recovery Deegan (1988) Fisher (1992) Copeland (1994)

26 Myth: Individuals with Serious Mental Illnesses, like Schizophrenia, do not do well

27 DMHMRSAS Commonwealth of Virginia Department of Mental Health, Mental Retardation The President s New Freedom and Substance Abuse Services Commission on Mental Health Vision Statement: We envision a future when everyone with a mental illness will recover

28 Consumer Feedback: Themes of Recovery Narratives (Torrey and Wyzik) Recovery is characterized by growth out of: Hopelessness Powerlessness Illness dominated sense of self

29 Recovery Vision Implementation: (Torrey and Wyzik) Promoting Hopefulness The restoration of morale Supporting consumers efforts to take personal responsibility for their health Helping Consumers develop broad lives that are not illness-dominated

30 Traditional Approach Swaddles Patients with Services Culturally Specific Services Vocational Specialized Housing Client Case Manager Crisis Services Psychotherapy ADL Inpatient

31 Recovery Oriented System Supports But Does Not Surround Consumer HOUSING consumer groups family & friends INCOME Person WORK mental health services generic community services & groups Trainor, Pomeroy and Pape,1993 Canadian Mental Health Association EDUCATION

32 Process of Recovery The Person The Illness The Person The Illness

33 Process of Recovery The Person The Illness Leisure Activity Employment Friends Family

34 The Disease Centered Model Professional Role Hierarchical Paternal In-charge Holds the important knowledge Responsible for treatment Disease is focus Patient s Role Subservient Obedient Passive Recipient of knowledge Responsible for following treatment Host of the disease

35 Recovery: Person Centered Model Person s Role Personal power Personal knowledge Personal responsibility Person in context of life is the focus Person is selfdetermining Professional Role Power sharing Exchange information Shared decisionmaking Co-investigator Professional is expert consultant on journey

36 How Mental Health First Aid Can Help Demystifies mental illness, including realistic information about violence, which helps reduce stigma Helps people understand the various kinds of illnesses and how to approach individuals with mental illness without fear Emphasizes the hopefulness of recovery in Mental Illness - especially with a more informed and engaged society

37 How Mental Health First Aid Can Help Demystifies mental illness, including realistic information about violence, which helps reduce stigma Helps people understand the various kinds of illnesses and how to approach individuals with mental illness without fear Emphasizes the hopefulness of recovery in Mental Illness - especially with a more informed and engaged society

38 Mental Health First Aid in your Community Custom Training Solutions for organizations available Visit for further information on the course and to find an instructor near you. Become a fan of Mental Health First Aid USA on Facebook & get updates and information on a variety of mental health topics. For any further questions, contact Bryan Gibb at bryang@thenationalcouncil.org. 38