Communication With Someone in Crisis National Alliance on Mental Illness of Greater Des Moines 2016 Iowa Community Action Association Conference Tuesday, June 14, 2016 WDM Sheraton Hotel 1800 50 th St.
Big Unanswered Question: Why Do People Have Mental Illnesses? Biological Susceptibility Disrupted Neural Circuits Well Environmental Factors
What Is a Mental Disorder? A mental disorder or mental illness is a diagnosable illness that: Affects a person s thinking, emotional state, and behavior Disrupts the person s ability to Work Carry out daily activities Engage in satisfying relationships 2
Signs and Symptoms of Depression Physical Fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, headaches, irregular menstrual cycle, loss of sexual desire, unexplained aches and pains Behavioral Crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation, slow movement, use of drugs and alcohol Psychological Sadness, anxiety, guilt, anger, mood swings, lack of emotional responsiveness, feelings of helplessness, hopelessness, irritability Frequent self-criticism, self-blame, pessimism, impaired memory and concentration, indecisiveness and confusion, tendency to believe others see one in a negative light, thoughts of death and suicide
Signs and Symptoms of Anxiety Physical Cardiovascular: pounding heart, chest pain, rapid heartbeat, blushing Respiratory: fast breathing, shortness of breath Neurological: dizziness, headache, sweating, tingling, numbness Gastrointestinal: choking, dry mouth, stomach pains, nausea, vomiting, diarrhea Musculoskeletal: muscle aches and pains (especially neck, shoulders and back), restlessness, tremors and shaking, inability to relax 40
Signs and Symptoms of Anxiety Behavioral Avoidance of situations, obsessive or compulsive behavior, distress in social situations, phobic behavior Psychological Unrealistic or excessive fear and worry (about past and future events), mind racing or going blank, decreased concentration and memory, indecisiveness, irritability, impatience, anger, confusion, restlessness or feeling on edge or nervous, fatigue, sleep disturbance, vivid dreams 40
Risk Factors for Depression & Anxiety Distressing and uncontrollable event Stressful or traumatic events Difficult childhood; history of childhood anxiety Ongoing stress and anxiety Another mental illness Previous episode of depression or anxiety Family history More sensitive emotional nature 22
Risk Factors for Depression & Anxiety Illness that is life threatening, chronic, or associated with pain Medical conditions Side effects of medication Recent childbirth Premenstrual changes in hormone levels Lack of exposure to bright light in winter Chemical (neurotransmitter) imbalance Substance misuse; intoxication, withdrawal 22
Suicide Risk Assessment Gender Age Chronic physical illness Mental illness Use of alcohol or other substances Less social support Previous attempt Organized plan 106
Warning Signs of Suicide Threatening to hurt or kill oneself Seeking access to means Talking or writing about death, dying, or suicide Feeling hopeless Feeling worthless or a lack of purpose Acting recklessly or engaging in risky activities Feeling trapped Increasing alcohol or drug use Withdrawing from family, friends, or society Demonstrating rage and anger or seeking revenge Appearing agitated Having a dramatic change in mood 25
Questions to Ask Ask the person directly whether he or she is suicidal: Are you having thoughts of suicide? Are you thinking about killing yourself? Ask the person whether he or she has a plan: Have you decided how you are going to kill yourself? Have you decided when you would do it? Have you collected the things you need to carry out your plan? 106
How to Talk with a Person Who Is Suicidal Let the person know you are concerned and are willing to help Discuss your observations with the person Ask the question without dread Do not express a negative judgment Appear confident, as this can be reassuring Check For Two Other Risks Has the person been using alcohol or other drugs? Has he or she made a suicide attempt in the past? 107
Keeping the Person Safe Provide a safety contact number 1-800-273-8255 Help the person identify past supports Involve them in decision making Call law enforcement if the person has a weapon or is behaving aggressively Do Not Leave an actively suicidal person alone Use guilt and threats to try to prevent suicide You will go to hell You will ruin other people s lives if you die by suicide Agree to keep their plan a secret 107
Reasons for Self-Injury To escape unbearable anguish To change the behavior of others To escape a situation To show desperation to others To get back at other people To gain relief from tension To seek help 109
. How to Help with a Person Who Self-Injures Recognize that self-injury is usually a symptom of serious psychological distress Avoid any negative reactions to the self-injury Discuss the situation calmly Focus on ways to stop the distress Do Not Focus on stopping self-injury Trivialize the feelings or situations that have led to self-injury Punish the person Threaten to withdraw care 109
Listening Nonjudgmentally Key attitudes to make the person feel respected, accepted, and understood: Acceptance Genuineness Empathy Key nonverbal skills to show you are listening: Attentiveness Comfortable eye contact Open body posture Being seated Sitting next to the person rather than directly opposite Not fidgeting 27
Give Reassurance and Information Treat the person with respect and dignity Do not blame the person for his or her symptoms Have realistic expectations Offer consistent emotional support and understanding Give the person hope for recovery Provide practical help Offer information 28
What Isn t Supportive Do not just tell the person to snap out of it Do not be hostile or sarcastic Do not adopt an overinvolved or overprotective attitude Do not nag the person to do what he or she normally would do Do not trivialize the person s experiences Do not belittle or dismiss the person s feelings Avoid speaking with a patronizing tone Resist the urge to try to cure the person 29
Crisis Card If you encounter someone in a mental health crisis Slow Down Give Them Space Be Calm Do s Speak Slowly and Softly Use Short, Simple Sentences Avoid sudden or quick movements Be helpful Give Firm, Clear Directions Respond to Delusions or Hallucinations by talking about the person s feelings. Listen to their story Don t take control Don t argue Don t stare Don ts Don t confuse the subject Don t touch the subject Don t shout Don t give them multiple choices Don t Whisper, Joke or Laugh Don t Arrest a person for mentally ill behavior not criminal in nature Don t join into behavior with person
Don t buy into the stigma Mental Illness is not A defect in someone s personality Or a personality flaw, or A sign of weakness, It is not a sign of laziness, or A lack of willpower, or A sign of poor moral character. It is not a sign of lack of faith, nor that the person is a failure. They are ill, medically ill. Please treat the person with respect and dignity.
Know where MH services are Process started in 2011 Changed from county-based to regions State given responsibility for Medicaid match Regional system in operation 7-1-14 14 Regions Polk Co is 1 county region others 3 to 22 co s Find regional information at: http://dhs.iowa.gov/mhdsproviders/providers-regions/regions Map, regional Executive Directors, disability coordinators Core and Core plus services
1 in 5 (20%) have mental illness/sa disorder 4.1% have severe mental illness Iowa 127,000 people 721 staffed acute care hospital beds Des Moines 500,000 population 21,000 w/smi 142 staffed acute care hospital beds Iowa is 47th in the nation for # of hospital beds/100,000 We now use our jails and prisons for the mentally ill. We build prisons instead of recovery centers. DOC statistics: 40% + of male inmates have mental illness 60% + of female inmates have mental illness 70% + have a substance use disorder
Statewide Shortage of Multiple Levels of Care Crisis Acute care (hospital beds) - days Subacute - days Crisis Residential 60-90 days Long term aggressive and/or violent Geriatric Transitional Group homes Supportive living community supports for ex: Habilitation services Assertive Community Treatment teams (ACT) Outpatient care/visits independent living Higher level of care More independence
Iowa Mental Health Workforce Rankings 47 th for # of psychiatrists/100,000 46 th for # of psychologists/100,000 44 th in overall MH workforce availability Less than 300 prescribers (123 psychiatrist, 117 ARNP, 28 PA) 4.1% serious mental illness 127,000 721 acute care hospital beds including MHI beds 195 psychiatrists 31 child psychiatrists Private practice 123 Teaching 53 Federal 18 Comm. Health 14 State 11 Student Health 3 Hospitalist 2 Administration 2
Always remember oyou are Not Alone othe illness is not your fault onever Give Up Hope www.namigdm.org click on Resources, the Iowa Mental Health System page will be the first screen to appear there are at least 6 reports available which reference MH workforce shortage and other mental health issues. Thank You!