Creating and Maintaining a Safe and Comfortable Home

Transcription

1 Creating and Maintaining a Safe and Comfortable Home Crisis Prevention and Management Training for Limited Mental Health Assisted Living Facility Staff

2 Program Manager and Trainer MARGO FLEISHER

3 Acknowledgements Principles and Information for This Training from: Assisted Living Facility Training for Limited Mental Health Licensure

4 Contents What to expect in a Limited Mental Health ALF: The ALF Home, Stigma, Discrimination, Mental Illness Myths and Facts Suicide Risk in the LMH ALF, and How to Help Non-Suicidal Self Injury and How to Help Medical Emergencies Verbal and Physical Aggression, and De-Escalation Trauma Informed Care, Triggers, Veteran ALF Residents, and Traumatic Brain Injury

5 An ALF is a Home The residents and you are like family members. Receive each person as an adult. Treat each person how you would want to be treated by another adult. Accept each person s unique personality and challenges. Accept that everyone will make mistakes (residents and you), and mistakes are a vital part of learning for everyone.

6 Stigma People living with a mental illness say lack of acceptance is the biggest problem they face.

7 Discrimination What thoughts and feelings did you experience while you heard this story? Do you think the illness was reason enough for people to react differently toward them? Did you know that this scenario happens to thousands of Americans who have been diagnosed with a mental illness? Discrimination robs people of emotional and economical support, such as the jobs and housing needed to restore their lives.

8 Language Words are powerful. Language shapes our perception of the world. We are sensitive about words used to describe us, and so are the people that live in the ALF. People are not their diagnoses. Use person-first language. Be deliberate and thoughtful about the words you use.

9 Mental Illness Myths and Facts MYTH: Mental Illness is uncommon, so people with mental illness are different. FACT: While some disorders are less common than others, the prevalence of mental illness in any given year is one in five. The lifetime prevalence of a mental illness is nearly 50%.

10 Mental Illness Myths and Facts MYTHS: People with mental illness bring it on themselves. They damaged their brains with drugs and now they are sick. FACTS: Living with a mental illness has challenges that no one wants. Mental illness occurs due to the interaction of a combination of biological and environmental factors beyond the person s control. The National Comorbidity Surveys indicate that more than half of people with substance use problems have mental illness, and 90% of those people identify that they experienced symptoms of their mental illness before initiating drug or alcohol use. The median age of onset of an anxiety disorder is 11.

11 Mental Illness Myths and Facts MYTHS: People with mental illness don t want to take medication and do what it takes to get better. They are lazy. FACTS: Mental illness is more treatable and there are better outcomes than with other chronic illnesses like heart disease or cancer. People with mental illness are more adherent to their prescribed and recommended treatment than people with infections or many chronic medical conditions such as diabetes. Most people with mental illness do not become disabled, and continue to work and lead productive, fulfilling lives. Mental illness is a primary cause of homelessness for Americans, and 40% of people experiencing homelessness engage in some kind of employment.

12 Mental Illness Myths and Facts MYTH: People with mental illness are dangerous. FACT: People with mental illness are more likely to become victims of violence than to perpetrate it. Only about 4% of violence in our country can be attributed to mental illness.

13 Types of Possible Crises in the LMH ALF Suicidal Thoughts Non-suicidal Self-Injury Medical Emergencies Verbal and Physical Aggression

14 Suicidal Thoughts -- Risks A number of mental disorders including depression increase the risk of suicide. What other mental disorders? People without a diagnosis of a mental disorder attempt suicide also. Why? Substance use is associated with suicide attempts and deaths. What is this association? Suicide risk is higher in adolescents and young adults, and in the elderly. Why is that? Men die by suicide more often than women. Women attempt suicide more often than men. Why do you suppose? People with a history of suicide attempts have a higher risk of later attempts. Why is that?

15 Suicide Warning Signs Talking about killing themselves and death, directly or indirectly Preoccupation with music and art with suicide and death themes Appearing more withdrawn than usual Appearing more agitated than usual Seems to have no future plans or commitments Giving away important possessions, saying goodbye Collecting pills, ropes, or other means After a period of sadness or distress, suddenly seems happy and peaceful Why is this a warning sign?

16 How to Help Someone with Suicidal Thoughts TAKE ALL SUICIDAL STATEMENTS AND GESTURES SERIOUSLY Ask the Question: Are you thinking about killing yourself? Are you having thoughts of suicide?

17 Get Help for Someone If danger is immediate, call 911 Notify the supervisor with Suicidal Thoughts If the person does not have a plan for suicide, you can activate one or more of the following: o Contact the Sheriff s Department for a Crisis Intervention-trained officer o Contact the mobile crisis team and/or the resident s case manager o Help the person call TALK (8255) DO NOT Agree to keep their suicidal statements or plan a secret Use guilt or religion to try to talk them out of it Leave them alone

18 Non-Suicidal Self-Injury What is non-suicidal self-injury? Why do people use non-suicidal self-injury? What to do: Talk with the person about what the injuring is for, and do not focus on stopping the behavior. Get them medical attention if it is necessary.

19 Medical Emergencies Medication side effects o Neuroleptic malignant syndrome o Agranulocytosis o Toxicity Overdose Delirium Other medical emergencies GET MEDICAL HELP IMMEDIATELY

20 Verbal and Physical Aggression Aggression is not the expectation of people living in the LMH ALF, but we should be prepared for it. By knowing the residents, and their personalities and experiences, we can be aware of their triggers. By having good relationships with the residents and other staff, we can often de-escalate a crisis before it happens. Remember that If something can go well, it will.

21 Nonverbal Communication

22 Nonverbal Communication

23 De-Escalation Strategies Reduce the volume of your voice Use positive language instead of negative language ( Let s try this rather than don t do that ) Offer the person two to three options for how they can calm down Give the person physical and emotional space to blow off steam Take the person to a quiet area away from onlookers, or have other residents move away Encourage the person to sit down with you. Offer a drink or something else soothing. Your and residents safety is first priority. If the situation becomes unmanageable, get to a safe place and call 911.

24 Trauma Informed Care in the LMH ALF Trauma Informed Care guides the conversation: A trauma informed organization is a human services or health care system whose primary mission is altered by virtue of knowledge about trauma and the impact it has on the lives of consumers receiving services. Maxine Harris, 2004 Trauma-informed services are not designed to treat symptoms or syndromes related to violence, abuse, or neglect. Trauma-specific services are employed for treatment. Department of Children and Families, 2014

25 Know the Triggers

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27 Suicide in the U.S. Army 21% of the suicides in 2009 were by soldiers with multiple deployments, while 36% had never deployed and 43% had deployed only once. Army Health Promotion, Risk Reduction, Suicide Prevention Report, Page 102 Over 50% of the people that committed suicide in the Army National Guard in 2010 had never deployed. Major General Raymond W. Carpenter Acting Director, Army National Guard SUB 14 27

28 Trauma and Military Members Preexisting, or coexisting mental illness; or history of trauma in the past increase the risk of a serious reaction to trauma experienced in military service. There are more hospitalizations of veterans related to the psychological effects of service than for physical injuries related to service. Keep in mind that most military members, deployed or not deployed, do not develop PTSD or substance abuse. Keep in mind that service can have many positive impacts for military personnel and their families.

29 Conditioned and Linked Triggers For military and other survivors of trauma, stimuli seemingly unrelated to the original trauma can provoke a stress reaction, and the accompanying behavior can seem inappropriate or out of context. This can be due to fear conditioning IED Smell of Fried Chicken Fireworks Mother-in- Law

30 Traumatic Brain Injury (TBI) Mild TBIs can go undiagnosed and may look like a mental health issue. If a person is experiencing the above symptoms and may have been exposed to a blast, they should be screened by a medical professional experienced in working with TBI. Defense and Veterans Brain Injury Center Information and Referral Reference: Defense and Veterans Brain Injury Center SUB 22 30

31 Healing Happens in a Relationship Knowing your residents makes the difference in recognizing a developing crisis, and providing support toward the best outcome. You may know the people that live in the home as well as, or better than a family member. If there is no relationship, nothing else matters! YOU make a difference!

32 Thank Your for Training with Us! Margo Fleisher, Program Manager and Trainer , X222