Transcript Homeless and Mentally ill In our Public Libraries

The Homeless and Mentally
ill In our Public Libraries
1
GOALS
By the end of this presentation you will be able to:
•
•
•
•
Recognize and understand the symptoms of
major mental illness.
Improve your ability to communicate effectively
with mentally ill patrons.
Communicate effectively with mental health
providers and law enforcement.
Reduce fear of mentally ill patrons, but also
know when fear is a signal for self-preservation.
2
Mental Illness: a working
definition
• A mental illness is a condition that impacts a person's
thinking, feeling or mood and may affect his or her ability
to relate to others and function on a daily basis. Each
person will have different experiences, even people with
the same diagnosis.
• Biology vs. environment: Diathesis Stress Model:
Diathesis–stress model asserts that if the combination of
the predisposition and the stress exceeds a threshold,
the person will develop a disorder. Gun and Trigger: Gun
(genetic predisposition)-Trigger (environmental stressor)
3
Types of Mental illness
THOUGHT DISORDERS:
Schizophrenia:
-Hallucinations: auditory, visual, olfactory, tactile, gustatory.
-Delusions: Persecutory, guilt, having a special mission,
being controlled by outside forces, grandeur.
-Negative symptoms: Blunted emotions, loss of drive,
difficulties: concentrating, memory, planning, reasoning,
communicating, tasks of daily living.
4
Types of Mental illness
THOUGHT DISORDERS (cont.):
Schizoaffective disorder: Combination of
Schizophrenia Symptoms and Mood
Disorder.
Delusional Disorder: Fixed Delusions
5
Types of Mental illness
MOOD DISORDERS:
Bi-Polar Disorder: Extreme mood swings. Mania, followed by
depressive episode.
-Elevated mood
-Psychosis
-Grandiose delusions
-Rapid thinking and speech
-Irritability and Aggression
-Increased libido
-Decreased need for sleep, seemingly unlimited energy.
-Reckless behavior: sexually, money, physically.
-Depression-suicidality
6
Types of Mental illness
Mood disorders (cont.):
Major Depressive Disorder:
-Predominant sad mood: duration and intensity
-Anhedonia.
-Loss of energy.
-Feelings of worthlessness, guilt though not really at fault.
-Poor concentration.
-Insomnia/hypersomnia.
-Loss or gain in appetite.
-Preoccupation with death/suicide.
7
Types of Mental illness
Anxiety Disorders:
-PTSD: Response to experiencing or witnessing a distressing
or catastrophic event: war, assault: physical or sexual, family
violence, severe weather events, horror, etc.
-Re-experiencing trauma: recurring dreams, flashbacks, intrusive
memories.
- Avoidance behaviors
- Emotional numbing
- Reduced interest in others and external world
- Hyper vigilance
- Rage
- Insomnia
8
Types of Mental illness
Anxiety Disorders:
OCD: Obsessive thoughts, compulsive behaviors
accompany feelings of anxiety. Obsessive thoughts
are recurrent impulses and images that are
experienced as intrusive, unwanted, inappropriate
and cause intense anxiety
Examples: fear of contamination, need for symmetry
and exactness, safety issues, sexual impulses,
aggressive impulses, religious preoccupation.
9
Types of Mental illness
Anxiety Disorders (cont.)
Panic Disorder: intense fear inappropriate for the
circumstances in which it is occurring, symptoms similar to heart
attack: racing thoughts, sweating, shortness of breath, chest pain,
dizziness, derealization, depersonalization, fear of losing control.
Agoraphobia: avoidance of situations where person fears
having panic attack. Focus on escaping situations leading to
embarrassment from attack, lack of help: shopping malls, enclosed
spaces, driving, etc.
Social Phobia: Fear of any situation where public scrutiny may
occur. Fear of embarrassment and humiliation: public speaking, dining
out, dating, social events, approaching the librarian.
Specific Phobia: Librarians, snakes, spiders, blood, flying,
driving, mice, heights, etc.
10
Types of Mental illness
PERSONALITY DISORDERS
• An enduring pattern of inner experience
and behavior that deviates markedly from
the expectations of the individual’s culture,
is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable
over time, and leads to distress or
impairment.
11
Types of Mental illness
NARCISSISTIC PERSONALITY DISORDER
• Person feels they are at the center of the
universe; displays lack of empathy for others
• Grandiose sense of self-importance
(exaggerates achievements and talents)
• Requires excessive admiration
• Has sense of entitlement
• Is interpersonally exploitive (takes advantage of
others)
12
Types of Mental illness
BORDERLINE PERSONALITY DISORDER
• Pervasive pattern of instability of interpersonal
relationships, self image and mood.
• Marked impulsivity.
• Frantic efforts to avoid real or imagined
abandonment
• Chronic Feelings of emptiness
• Intense inappropriate anger
• Recurrent suicidal behavior, gestures or threats,
self-mutilating behavior.
13
Types of Mental illness
ANTI-SOCIAL PERSONALITY DISORDER
• Violates the basic rights of others
• Repeated acts that are grounds for arrests
• Deceitfulness, repeated lying, use of aliases,
conning others for personal profit or pleasure
• Irritability and aggressiveness
• Reckless disregard for the safety of others
• Lack of remorse for behavior
14
Types of Mental illness
OTHER PERSONALITY DISORDERS
SCHIZOID
SCHIZOTYPLE
HISTRIONIC
DEPENDENT
AVOIDANT
15
WHAT IS A CRISIS?
• A time of intense difficulty, trouble or
•
•
•
danger.
A time when a difficult or important
decision must be made.
The turning point, for better or worse, in a
challenging situation.
Chinese character for crisis, is the same
as that for opportunity.
16
Crisis Situations
• Patron becomes angry, belligerent and/or
•
•
verbally/physically aggressive
Patron has severe mental health issues
(paranoia, hallucinations, anxiety,
depression, mania) and is behaving
erratically.
Patron becomes isolative, withdrawn,
catatonic, suicidal.
17
Why do People
Fall into an
Emotional Crisis?
18
They can occur when
individuals …
• Have a legitimate Mental Health
Problem
• May be under the Influence of
Drugs and/or Alcohol
• Are angry about something
• Are being manipulative
• Are just having a bad day!
19
As Service Providers, we must always treat Patrons in a
respectful, calm and professional manner, EVEN if they
are not treating us respectfully.
• This can be VERY difficult to do at times…why do you
think that is the case?
20
Primary Goals of Crisis
Intervention
• Staff And Patron Safety
• De-Escalation of Crisis
•
Support and Referral to Meet the
Patrons Needs and Institutional
Needs.
21
How To Effectively Deal
With an Individual in
Crisis:
22
Initial Contact
• Establishes an initial connection
with client
• Identifies the ultimate goal to
resolve the situation with zero or
minimal harm to any person
23
Initial Contact …
Allows the patron to respond with her
immediate thoughts, structuring a
dialogue. Examples:
“Talk to me”
“ I want to help you resolve whatever
concerns you have and I want to understand
what you need”.
“Together we should be able to find some
solutions to your problem”.
24
Identify Thought
Content
• Preoccupations or obsessions
• Delusions
• Suspicious
• Paranoid
• Suicidal/Homicidal Ideations
• Irrational/Nonsensical Thought
25
Identify Affect
or…Prevailing Emotional
Tone
•
•
•
•
•
•
•
Happy
Elated
Sad
Irritable
Angry
Fearful
Flat Affect
26
COMMUNICATION
How to Communicate Effectively
with Individuals in Crisis
27
LISTENING
(3 Levels)
• Listening to words
• Listening to whole message
(content, feelings, reason)
• Non-Verbal (observe)
28
Barriers to Active Listening
•
Arguing- avoid creating a conflict.
•
Criticizing- avoid making the person feel worse.
•
•
•
Jumping to Conclusions- don’t tell the person what you think the problem
is.
Pacifying- don't minimize the situation.
Derailing- don't change the subject too abruptly unless there is a need to
distract.
•
Moralizing- avoid using moral obligations to manipulate the situation.
•
Name Calling- putting the person down will make matters worse.
•
Ordering- an authoritative approach may create resistance.
29
Reflecting Statements
•
•
Encourages Communication
Neutral responses to statements made by the
individual encourages him to continue
talking
•
Examples:
-
“ I see….”
“Tell me about it…”
“That would be one option…”
“What other options do you have?”
30
Reflecting the whole
message
• “You seem to be feeling ______ when
_____ happens because________”.
• “You seem to be feeling frustrated
when you hear these voices because
the medications don’t seem to be
helping you”.
31
Calming Techniques:
• Show understanding/empathy to help calm
an agitated individual
• Use Modeling
• Reassure
• Calm the agitated individual by easing their
fears; assure them that they will be safe
• Allow individual to vent
32
Aggressive vs. Assertive
• What is aggressive communication?
• How does aggression typically affect a
situation where there is a conflict?
• What is assertive communication?
• How does this change the dynamic of a
conflict?
• Role Play Each One
33
Communication
Interaction Skills for dealing with persons with
Mental Illness:
•
•
Engagement is pivotal – keep trying
Don’t underestimate the power of hallucinations
or delusions, they are real from the individual’s
point of view and can be very frightening-try to
be understanding
34
Communication
•
•
•
•
•
•
Never argue about a delusion-arguing only solidifies the
conviction, simply accept it and move on.
Don’t try to match mania- you will lose. Slow and steady wins the
day. Keep coming back and stay on point. You head may be
spinning but stick to main points with as little verbiage as possible.
Ask about treatment in the past- sometimes that can help with the
offering potential solutions to the current situation
Don’t express disapproval
Remember that psychiatric medications have side effects that
can impact communication
Persons in mental health crisis need more personal space,
watch for cues
35
More Communication and
Intervention Skills
(Continued)
•
•
•
•
Ask questions that are open ended beginning with WHO,
WHAT, WHERE, WHEN, HOW. Avoid asking WHY as this
tends to make an individual make faulty judgments and justify
behavior instead of giving solid facts and information.
Double check the information given by restating what you
hear.
Use the individual’s name in talking to him or her.
Give instruction or directives one at a time and allow extra
time for the person to absorb and respond.
36
Communication
• Stay Calm- breath deeply to become
•
•
calmer. 2x2
Be Patient- avoid “crowding” the individual
and give the individual a chance to calm
down
Keep language straightforward and
direct - avoid abstractions and jargon.
37
Controlling our Reactions
•
•
Fight or Flight Response
(Adrenalin Surge)
Human Nature (Retaliation)
38
Getting the Person Help Is
Key!
•
•
•
•
•
•
Psychiatric Referral
Counseling/Therapy
Anger Management Group
Group Counseling
Other types of support groups, AA, NA, PTSD,
Trauma, etc.
5150: PERT, Police
39
KNOW YOUR ROLE AND
LIMITATIONS
•
•
•
•
You cannot be expected to be Mental Health
professionals.
Communicate with and ask for help and support from
colleagues.
Access community resources when necessary: PES,
PERT, Police C.I.T, Community Mental Health Clinics.
“Small fire”- you can extinguish vs. “House Fire”Appropriate response call the Fire Department.
40
Have an Organizational Plan
• Policies in place: acceptable vs.
unacceptable behaviors and
consequences such as 86’d for day, week
vs. permanent (TRO), etc.
• When to intervene and when to call Mental
Health professionals or Police Dept. 5150:Homicidal/Suicidal/Gravely Disabled.
• Expect the unexpected….It just might
happen!
41
Connections with Allies
Make Personal Connections NOW: With
Law Enforcement and Mental Health
Community, so that they can be readily
utilized when crisis situations arise that are
beyond your scope/skill set.
42
INSTINCT/SAFETY
•
Trust your instincts: They have been developed over the millennia
for your survival.
•
“Only human beings can look directly at something, have all the
information they need to make an accurate prediction, perhaps even
momentarily make the accurate prediction and then say it isn’t so.”
•
“Denial is a save now, pay later scheme.”
•
“Intuition is always right in at least two important ways, it is always in
response to something and It always has your best interest at heart.”
•
“No is a complete sentence.” If this is violated, the person has
shown you who they are, believe it the first time.
Gaven DeBecker
“The Gift of Fear”
43
“What we have done for ourselves alone dies with
us, what we have done for others and the world
remains and is immortal”.
Albert Pike
44
Thank you for your
participation
Matt Sweeny, MFT
Clinical Director
Mateo Lodge Inc.
45