Understanding Mental Illness For Huda (mental Case)

Understanding Mental Illness A Review of the Disorders

Defining Mental Illness Clinical definition : • Clinically significant behavioral problems • Associated with distress (painful symptoms) • Causes disability (impairment in functioning) • A biological illness that responds to treatment • Not to be confused with weakness of character

Facts about Mental Illness  Has nothing to do with intelligence Can happen to anyone Chronic but not contagious Difficult to diagnose and to treat Treated but not cured

Mentally ill are not all dangerous Should not be confused with terms psychopath or sociopath

General Signs of Mental Illness • • • • • • • • •

Observable Confusion Disoriented Darting looks Talking to self Poverty of Speech Pressured speech Poor hygiene Inappropriate attire

• • • • • •

Behavior Changes Flat Affect Withdrawn Sad or anxious mood Panic Psycho somatic complaints

Schizophrenia Symptoms • Brain disease • Includes psychosis • Impacts 1 out of every 100 people. Does not differentiate across SES • Onset is late teens, early adulthood. • Positive Symptoms include : – hallucinations – delusional thinking • Negative symptoms include – apathy – withdrawal.

Schizophrenia Symptoms in Jail  May appear non compliant  Agitated by voices and delusions -may look and act dangerous  Command hallucinations may actually be dangerous  More likely to respond to clear directions, and reassurance in a kind tone of voice  Poor hygiene - Not aware of their surroundings enough to know that they are not clean

Mood Disorders Major Depression Symptoms • • • • •

Affects 5 percent of the general population Sad mood that lasts 2 weeks Loss of interest or pleasure in daily activities Changes in sleep, appetite, decreased energy Thought problems affect concentration, memory, decisions, feelings of guilt, worthlessness • Risk of suicide is high • Important to differentiate mental health from physical problems • Responds well to treatment

Mood Disorders Major Depression Symptoms in Jail Loss of interest in food and self care May not care about legal situation Suicide risk is real and must be monitored Risk of suicide may increase after medication

Symptoms

Mood Disorders Mania/ Bipolar Disorder

 Euphoric Mood (elevated, high or happy)  Irritable Mood (touchy)  Three Stages of Mania Hypomania, Acute Mania, Psychosis

 Bipolar Disorder - mood swings from depression to mania  Can be Rapid Cycling

Mood Disorders Mania/ Bipolar Disorder Symptoms in jail Jail may be the consequence of the disorder Jail Mood can swing from entertaining to hostile Mood Talkativeness can be irritating Talkativeness If depressed, often cry, feel hopeless, become suicidal If Can be restless, pacing, demanding and destructive Can Often non-compliant Often Can be professional and well-educated Can

Anxiety Disorders Panic Disorders

Symptoms  Prevalence is 1 to 2 percent of the population; Women twice as high as men.  Panic attacks occur without warning  Symptoms include intense fear, heart palpitations,chest pain, shortness of breath, dizziness  Person is concerned that the attacks will strike again

Symptoms in Jail  Jail environment and structure of holding can induce symptoms  Referral is indicated

Anxiety Disorders Obsessive-Compulsive Disorder Symptoms  Obsessions are recurrent thoughts, images, impulses that cause anxiety. They are illogical,at times repulsive and/or center on violence or harm. Compulsions are behaviors that are repetitive - attempts at reducing the Compulsions anxiety created by the obsessions.

Symptoms in Jail Rarely seen in jail and do not pose high risk Rarely

Post Traumatic Stress Disorder Symptoms Exposure to an extremely stressful event. Exposure Painful memories, nightmares,, suspicion, anxiety, depression, feelings of Painful guilt and sleep difficulties Symptoms worsen with exposure to similar events Symptoms Substance abuse is a common method to cope Substance Symptoms in Jail Jail environment can trigger symptoms Jail Jail inmates and personnel can trigger symptoms Jail Lack of privacy and loss of control are issues Lack

Personality Disorders  Inflexible, maladaptive, ways of coping and relating Difficulty in holding steady work and relationships Difficult to change Can co -exist with other mental illnesses Behavior problems precipitate jail

 Antisocial Narcissistic Borderline Avoidant Paranoid Dependent Schizotypal Schizoid

Personality Disorders  Predominant disorders in jail are Antisocial and Borderline Jail environment heightens symptoms Effective management requires consistent limit-setting Suicidal risk is real and must be monitored Jail personnel must professionally manage housing unit, inmates and themselves

Substance Abuse Symptoms  85% of jail population have substance abuse problems High correlation of substance abuse and other mental illnesses High Symptoms in Jail • Monitor risk of OD or withdrawal • Monitor abuse of prescription drugs • Can mimic other Mental illnesses • Long term abuse can cause dementia

Co-occurring Disorders  Presence of both a mental illness and substance abuse disorder High prevalence rates 60% of persons with a mood disorder also have a substance abuse disorder 50% of persons with schizophrenia also have a substance abuse disorder In Jail - More prone to violence, impulsivity, paranoia and anxiety

Common Factors of Mental Illness and Substance Abuse Brain disorders Lack of Insight Chronic Impacts Family Shame and guilt Needs Treatment

Dementia and other Cognitive Disorders Symptoms • Memory problems • Confabulations • Impaired thinking • Impaired Judgement

Symptoms in Jail • Poor memory and may not follow directions • Treat individual as you would any with a disability

Mental Retardation Symptoms  Poor adaptive functioning from birth Related to intelligence, not thoughts, feelings and behaviors Symptoms in Jail  Not to be confused with mental illness Requires patience

Effective Communication

Keys to Communication Empathy Warmth Genuine

Promoting Communication Listening:attend to both verbal and nonverbal cues, hear and observe, and avoid distractions Clarification: Restate.Repeat, Clarify, Question Dealing with Silence

Respond Effectively Maintain Personal Space Open ended questions Non verbal Cues

Basic Communication Guidelines

Low stimulation level  Don’t take actions or reactions personally  Short, clear direct sentences Simple Be consistent force content communication  Don’t

Basic Communication Guidelines Simple content Short, clear direct sentences

Low stimulation level Don’t force communication Be consistent Don’t take actions or reactions personally



Basic Communication Guidelines

patient Person may not “get” all the information  Praise Practice cooperative reflective listening behavior Know your non verbal communication  Be

Basic Communication Guidelines Person may not “get” all the

information

Be patient

Praise cooperative behavior Practice reflective listening Know your non verbal communication 

Basic Communication Guidelines Short, clear direct sentences Simple content Low stimulation level Don’t force communication if person is withdrawn Be consistent Don’t take actions or reactions personally

Person may not “get” all the information you provide Be patient Be pleasant and firm Praise cooperative behavior Practice reflective listening Know your non verbal communication

Types of Non-Verbal Communication

Body Posture Facial Expression Eye Contact Gestures

Crisis Management

Crisis Management Crisis defined What is crisis intervention Recognizing a person in crisis – behavioral and verbal cues

Violence The incidence of violence is no greater in persons with mental illness than it is in the general population Incidence increases 60% if the illness is untreated.

Substance use greatly increases violence Greatest risk, males in late teens to early 20’s Past behavior best predictor

Warning Signs Tremors Hyperactivity Rigid Posture Clenched jaws and fists Pulsing arteries Verbal abuse/profanity

Effective Crisis Intervention  Reduce Stress Force as the last resort Force Consider the symptoms of mental illness Consider Identify precipitating factors Identify Goal is to de-escalate Goal

5 Stages of Successful Interventions  Immediacy- Intervene as soon as possible. Goal is to reduce anxiety. Assume Control - via providing the structure the person needs, not be overwhelming them

Assess the situation- let the person talk, watch for nonverbal cues, be a guide and avoid judgements and putdowns Situation Management Post crisis intervention

5 Stages of Successful Interventions Immediacy- Intervene as soon as possible. Goal is to reduce anxiety. Assume Control - via providing the structure the person needs, not be overwhelming them

Assess the situation- let the person talk, watch for nonverbal cues, be a guide and avoid judgements and putdowns Situation Management Post crisis intervention

Suicide and Suicide Prevention

Facts about Suicide Jail suicide is 9 times higher than general pop. Jail 8 of 10 have given prior warnings 8 Ambivalent about death Ambivalent Ambivalence is not the same as manipulation Ambivalence Most jail suicides are not impulsive Most Risk does not increase with discussion Risk

Facts about Suicide Prior attempts increases risk by 33% Mental illness increases the risks 61% have major depression 48% have personality disorder 40% Alcohol use 10% Anxiety 6% Schizophrenia

Understanding SI behavior increases prevention!

Why Jails are Suicide Prone Settings Authoritarian environment Loss of control over future Isolation Shame Dehumanizing aspects of incarceration

Fears Police and Jail staff immune to arrest and incarceration Officers and jail staff overlook or misunderstand symptoms

Terms related to Suicide Ambivalence Ideation Lethality Attempt Gesture

Evaluation Tool The Sad Persons Scale

 Sex Age Depression

 Previous Attempts Ethanol Rational Thinking Loss Social Support Losses Organized Plan No Spouse Sickness

Why Do People Die by Suicide? Impulsive Depressed Escape from suffering Communication Loss of a loved one

Understanding Suicidal Thinking  Suicide is a solution to a problem, what is the problem ? Most suicides are acts to end intolerable feelings Coping Patterns Fail “Tunnel Vision” interferes with seeing alternatives Person feels “unheard” Ambivalence

Recognizing Suicidal Risk In Jail ◆Psychological Factors ◆Social Risk Factors ◆Behavioral Warning Signs

Special Features of Jail Suicide Risk  Legal Status Factors Time of the year Long Term Factors

Intervening Create a safe environment Only one person communicate Talk about plan Emphasize positives

Evaluate potential Refer for treatment Do not lie

Prevention Admission Screening Utilize a formal screening worksheet Develop tiered assessments - intake, supervisor, mental health professional referral Observe for risk factors, even after intake Assure treatment

Collaboration and The Team Approach

Shared Goals Diversion of inmates from jail to appropriate community care Assure adequate mental health care while incarcerated Assure Continuity of Care for those inmates at the time of their release.

Steps to Meeting Shared Goals  Screening and identification EvaluationClassification Diversion Crisis Prevention

Provision of emergency mental health services Assure care Supervision Suicide Prevention Pre release planning

Team Approach Options  Employ Mental Health Staff Formal Contractual Agreements with Providers Informal Agreements (MOA)

Characteristics of a good Working System  Shared Vision, mission and values Involvement of all stakeholders Established written documentation Formal and informal verbal communications Ongoing Commitment

Formal Agreements

 Purpose Range of Services Time Frame Remuneration, if applicable Expectations of the jail re documentation, referrals, medication administration, etc Confidentiality Mechanism for review, evaluation and modification

Comprehensive Service Array Diversion Timely and effective treatment Placement in programming Linkage with support groups Housing assistance Educational Assistance Entitlements Other supports

Systematic Planning Cooperation Coordination Collaboration Integration Key Issues Identification of problems, barriers and solutions

Technical Assistance Resources • National Institute for Corrections (Jail Center) 1800-995-6429 • The GAINS Center for People with Co-Occurring Disorders in the Justice System 1-800-311-GAIN

To contact me: Ray Sabbatine - [email protected] Cell 859-806-0935 Office 502-868-5595 Fax 502-868-5364