How to Spot People Who Need Help (and how to help them)

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Gervase Stanley
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How to Spot People Who Need Help (and how to help them) 2nd Edition (Updated February 2015) A primer on common mental wellness issues and suggested resolutions, prepared for PAX [E]nforcers by the

is a 501 (c) (3) non profit charity that seeks to inform our community about mental health issues, to provide education about mental disorders and mental illness prevention, and to reduce the stigma

1 How to Spot People Who Need Help (and how to help them) 2nd Edition (Updated February 2015) A primer on common mental wellness issues and suggested resolutions, prepared for PAX [E]nforcers by the volunteers of Take This, Inc. info@takethis.org Russ Pitts, Executive Director russ@takethis.org Mark Kline, Psy.D., Clinical Director mkline@takethis.org Take This, Inc. is a 501 (c) (3) non profit charity that seeks to inform our community about mental health issues, to provide education about mental disorders and mental illness prevention, and to reduce the stigma of mental illness. Russ Pitts is the co founder and Executive Director of Take This, Inc. Dr. Mark Kline is the co founder and Clinical Director of Take This, Inc. and Clinical Director at The Human Relations Service (HRS), a private, non profit community mental health agency in Wellesley, MA. 1

2 What is Mental Illness? Mental Health Issues You May See at PAX Anxiety Social Competency/Processing Issues ADHD Mood Disorders Inappropriate Sexual Behavior Contributing Factors Crowding Excitement Sense of immediacy Competition Stimulation What to Look For How to help Listening Support networks Taking a break The Take This AFK Room Remember, you are not a therapist Avoid lengthy debates Authoritative response Pull the alarm 2

3 What is Mental Illness? The term "mental illness" is pretty broad. It's used to discriminate disorders that affect how people think and feel from those with more physical symptoms, like the flu. And it includes a wide variety of emotional difficulties and behavioral issues which are not all the same. At Take This, we try to avoid using the term, as many may find it alienating. We use the term emotional disorder to describe specific conditions, or emotional issues to describe a general state of being mentally unwell. Mental Health is a positive term that means the opposite of mental illness, but addresses many of the same topics. Treatment of emotional disorders can vary from person to person as well as from illness to illness, and many mental health issues have a broad range of severity. Some people who suffer may be in need of immediate, prompt assistance, or act out in severely disruptive ways. Others may have relatively mild symptoms and appear to be in perfect health. We don t generally think of people in this latter category as having an illness per se, but nevertheless, their emotional and behavioral challenges may be significant. As the most visible representative of PAX, you will be the first and in some cases, only official representative of the event attendees see. You are therefore in the position to most directly help those who need it and ensure that all PAX attendees have a safe and comfortable experience. The good news is it's not important to know everything about mental health in order to help people. Generally, being observant and willing to help is the first step in making sure people who are struggling can find the help they need. The next step is knowing what help actually means. 3

4 Mental Health Issues You May See at PAX While a comprehensive review of all mental disorders is beyond the scope of this primer, there are some common conditions you may recognize at PAX: Anxiety A person suffering from anxiety may show a wide range of symptoms, from simple nervousness and stress, to intense worry, agitation and even panic. Anxious people can also seem quick to anger, impatient, or easily frustrated. Panic disorder involves a more acute reaction that includes significant physiological signs such as racing heartbeat, dizziness, shortness of breath, excessive sweating, and even fainting. Obsessive worrying, repetitive, ruminative thinking, and behavioral compulsions are potential signs of another anxiety disorder, called OCD. Social Competency/Processing Issues People suffering from social competency issues have difficulty processing and responding to social expectations. They may have difficulty understanding or having empathy for the emotions of other people, and can act in ways that seem obnoxious or overly absorbed by their own interests. They can be inflexible in their thinking and have limited social problem solving skills. ADHD People suffering from ADHD may have poor impulse control, trouble delaying gratification, and low frustration tolerance. They may also have difficulty following rules. They may have trouble keeping still, being quiet, and focusing their attention. Others may simply seem spaced out and detached. Mood Disorders People suffering from mood disorders may react to situations in ways that seem out of proportion. They may appear to take things personally and react to relatively benign situations in seemingly unreasonable ways. Depressed people may appear sullen, angry, or withdrawn, whereas those with bipolar disorder can be elevated, agitated, and expansive. 4

5 Substance Abuse In any public event, the possibility exists that some attendees may be altered due to alcohol or other substances. While the effects of most common substances are commonly understood and relatively easy to spot (slurred speech, disorderly behavior, impaired motor control), some may exhibit more subdued behavior like difficulty understanding or responding to direction. Inappropriate Sexual Behavior People with poor impulse control or those who suffer from any of the above conditions may create discomfort for other attendees through inappropriate sexual behavior. Some of those exposed to this may react with appropriate indignation or anger. Others may be confused, overwhelmed, frightened, or even paralyzed when subjected to this kind of attention. This can be exacerbated by authority figures, through action or inaction, who inadvertently empower harassers or contribute to the confusion and stress of victims. 5

6 How The Event Can Contribute PAX is the largest gathering of game players and enthusiasts in the world. There's nothing else quite like it. And to many attendees, it is the one time each year when they can be exposed to and enjoy the variety of interests many attendees share and see friends they might not get to be around at other times of the year. The unfortunate other side to that coin is that PAX also puts many thousands of people, some of whom may suffer from or be prone to suffering from various emotional disorders, together in one place for relatively long periods of time. Crowding The sheer numbers of attendees alone may trigger anxiety or panic attacks. The long lines in the Queue Room and at vendors booths and tables may exacerbate irrational behavior. Excitement Many emotional issues present as an inability to behave appropriately or control impulses. The excitement of a positive event like PAX can often trigger bad behavior. Sense of immediacy The fact that each PAX is a once in a year phenomenon may heighten the emotions associated with many emotional issues. Attendees may forsake basic hygiene or nutrition in order to "take it all in," which can contribute to loss of control or more acute mental health symptoms. Competition The raised emotional stakes of competitive environments like the gaming areas can contribute to an increased likeliness of inappropriate behaviors, whether through the highs and lows of winning or losing or simply as a result of heightened aggression through competition. 6

7 Stimulation Gaming in general, and the PAX environment in particular, can create tremendous sensory stimulation to the point of overload, increasing the likelihood of symptomatic behavior in some individuals. Some people may be more reactive to visual overload, while others may find the noise and hubbub of PAX problematic. It may seem odd that people who desperately want to be at PAX have this experience, but the very stimulation they crave can easily be overdone, leading to problems coping. In addition to the ways in which the event may exacerbate various mental health issues, the energy and excitement of the event may simply make to harder to spot those who are legitimately suffering, as their symptoms might appear to be relatively normal behavior, for PAX. 7

8 What to Look For Mental Health issues are not always easy to spot, and in reality they are not always necessary to spot. The heightened emotions and variety of personalities on display at PAX can often mask underlying emotional difficulty. And an elevated emotional response may be absolutely normal for many who attend PAX. This guide will help you recognize when someone s emotional response might be causing them more distress than they can cope with, or be presenting a hazard to themselves or others. Common symptoms of emotional distress include: hyperventilating dizziness increased perspiration confusion fatigue rapid speech inability to make eye contact obsessive behaviors impatience withdrawal failure to observe or obey instructions anger irritability While these symptoms are not necessarily indicative of a mental disorder, and while we don t expect PAX staff to make diagnoses, if you see attendees exhibiting such behaviors, it may well be cause for concern. If you are able to determine that someone is in need of help, it may be possible to prevent their suffering from becoming more severe, or contributing to a disruption of the event for others. 8

9 How to help The most appropriate way to respond to various issues will vary. In the event of any immediate health crisis mental health related or otherwise that could result in harm to an attendee or a disruption of the event should be reported to EMS or the event security staff immediately. In cases where a person's immediate safety and health do not appear at risk, knowing how to respond can more complicated. These three steps can help in almost any situation: 1. Be aware. 2. Be responsive. 3. Be compassionate. And follow these guidelines: Listening Often, just hearing someone out or responding sympathetically can help "re set" a person's own ability to cope. It is also the first necessary step to identifying larger issues. Support networks Encouraging a person to contact friends, family members or companions can help those who are suffering, whether they are coping or not. Simply reminding them they may have a person they can call, or directing them to a phone if they do not have one, is often necessary and helpful. Taking a break Often, a person who is overwhelmed or overstimulated may simply need time 9

10 away from the event. A quiet moment with a trusted companion or attentive staff member can help. The Take This AFK Room For some participants, a longer break or more directed attention may be helpful. The Take This AFK Room is a place where attendees can get a breather from the bustle of the show and regain their calm. Most visitors simply want this kind of brief rest, but others may need more support, or have questions about mental health issues. Our volunteers can provide this information and also help with additional emotional assistance if needed. Remember, you are not a therapist Exploring a person's pain and trauma in a public setting can be harmful. If you need to help, do so by focusing on support and identifying next steps so that the person can determine if they are able to continue enjoying the event or must remove themselves. Avoid lengthy debates Some attendees may prefer to engage in lengthy debates over their behavior, or attempt to justify it rather than seek help or follow direction. While it may be tempting to engage them in a dialogue, this can be problematic. A brief hearing followed by a clear, authoritative message is often most effective. Authoritative response If confrontation of inappropriate behavior becomes necessary, a clear firm tone, free of hostility, judgment or threat is often most useful. Most attendees greatly value their PAX experience and will respond to clear messages about conduct. Responses that are more authoritarian in style or too permissive may yield undesirable outcomes. Pull the alarm In today s environment, concerns about mental stability, aggression, abusiveness and being out of control, as well as anxiety about whether someone is self destructive can not be taken too seriously. If you become aware of this kind of situation, call the Red Coats better too soon than too late. 10

Information and research provided by Take This, Inc. Take This, Inc. 8311 Brier Creek PKWY STE 105176 Raleigh, NC, 276176 www.takethis.org @takethisorg info@takethis.

11 Information and research provided by Take This, Inc. Take This, Inc Brier Creek PKWY STE Raleigh, NC, Russ Pitts, Executive Director Mark Kline, Psy.D., Clinical Director Take This, Inc. is a 501 (c) (3) non profit charity that seeks to inform our community about mental health issues, to provide education about mental disorders and mental illness prevention, and to reduce the stigma of mental illness. Russ Pitts is the co founder and Executive Director of Take This, Inc. Dr. Mark Kline is the co founder and Clinical Director of Take This, Inc. and Clinical Director at The Human Relations Service (HRS), a private, non profit community mental health agency in Wellesley, MA. 11

Mr. Stanley Kuna High School

Mr. Stanley Kuna High School Stress What is Stress? Stress is - The mental, emotional, and physiological response of the body to any situation that is new, threatening, frightening, or exciting. Stress