Moving from STIGMA to SUPPORT

Wendy Burch, NAMI-NYS Executive Director Shaniqua Jackson, NAMI-NYS Programs

Coordinator

!  What is NAMI? !  Overview of mental illness !  De-escalation techniques and additional

resources to assist you in a crisis

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!  WHAT IS NAMI? "  The National Alliance on Mental Illness is one of the

largest grassroots advocacy groups dedicated to building better lives for the 1 in 4 Americans and 1 in 5 Children affected by mental illness. NAMI advocates for access to services, treatments, support, and research and is steadfast in its commitment to raising awareness for all of those in need at the Local, State, and Federal levels.

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!  NAMI-NYS has 46 affiliates across NYS !  Our affiliates are dedicated in providing

education, support, advocacy and ending the stigma associated with mental illness.

!  For more information on NAMI-NYS and to locate your local affiliate visit our website

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!  Mental health is a person’s condition with regards to psychological or emotional well-being

!  Mental illness refers to a wide range of mental health conditions/disorders that affect a person’s mood, thinking and behavior

!  Some examples are: "  Depression "  Anxiety Disorder "  Schizophrenia "  Bipolar "  Eating Disorder "  PTSD "  Addictive behaviors (using drugs and/or alcohol)

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!  1 in every 4 adults (nearly 60 million Americans) experience a mental health condition every year

!  1 in every 17 Americans lives with a serious mental illness, such as Schizophrenia, Bipolar Disorder, depression or anxiety

!  50% of mental health conditions begin by age 14 !  75% of all mental health conditions occur by age 24 !  Mental illness affects everyone i.e. family

members, spouses, children and friends

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!  Knowing how to identify the warning signs can be difficult.

!  Remember there is no easy test that will let you know if a person is suffering from a mental illness or if their actions and thoughts might be typical behavior or the result of a physical illness.

!  All illnesses have their own set of symptoms but they can present as common signs of mental illness in both adults and adolescents

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!  Signs to watch for in adults: "  Excessive worrying or fear "  Feeling excessively sad or low; thinking of suicide "  Confused thinking or problems concentrating and

learning "  Extreme mood changes, which can include uncontrollable

“highs” or feelings of euphoria "  Prolonged/strong feeling of irritability or anger "  Avoiding friends and social activities "  Difficulties understanding and relating to others "  Changes in sleeping and eating patterns "  Difficulty perceiving reality (Delusions or hallucinations) "  Abuse of substances (alcohol and/or drugs) "  Inability to handle daily problems and stress

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!  Signs to watch for in adolescence/children "  Changes in school performance "  Excessive worrying or anxiety (fighting to avoid bed

or school) "  Hyperactive behavior "  Frequent nightmares "  Disobedience "  Aggression "  Temper tantrums

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Verbal Cues Illogical thoughts !  Sharing a combination of unrelated or abstract topics !  Expressing thoughts of greatness !  Indicating ideas of being harassed or threatened !  Exhibiting a preoccupation with death, germs, guilt, or other similar ideas

Unusual speech patterns !  Nonsensical speech or chatter !  Word repetition !  Pressured speech !  Extremely slow speaking

Verbal hostility or excitement !  Talking excitedly or loudly !  Being argumentative, belligerent, or unreasonably hostile !  Threatening harm to self or others

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Behavioral Cues Physical appearance !  Inappropriate to environment !  Bizarre clothing or makeup (taking into account current trends)

Bodily movements !  Strange postures or mannerisms !  Lethargic, sluggish movements !  Pacing, agitation !  Repetitive, ritualistic movements

!  Seeing, smelling, or hearing things that cannot be confirmed !  Confusion about or unawareness of surroundings !  Lack of emotional response !  Causing injury to self !  Nonverbal expressions of sadness or grief

Inappropriate emotional reactions !  Overreacting to situations in an overly angry or frightening way !  Reacting with the opposite of expected emotion 12

Environmental Cues Decorations !  Strange trimmings, misuse of household items Waste matter/trash !  “Pack ratting” – accumulation of trash !  Presence of feces or urine on the floor or walls !  Childish objects

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!  Also an anxiety disorder that can develop after a person is exposed to one or more traumatic events "  Major stress "  Physical or Sexual assault

or Abuse "  Warfare "  Accidents "  Disasters

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!  Common among those suffering from other mental or physical illnesses, including alcohol and substance abuse

!  Several types of anxiety disorder "  Panic disorder "  Obsessive-compulsive disorder

(OCD) "  Post-traumatic stress disorder

(PTSD) "  Social Phobia or social anxiety "  Generalized anxiety disorder (GAD)

!  Each have different symptoms, but all symptoms cluster around excessive, irrational fear and dread

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!  Can interfere with your ability to study, sleep, eat and enjoy activities or people

!  Depression can happen to anyone – it’s not a sign of weakness and it cannot be “willed” away

!  Some symptoms of depression include: "  Sad or hopeless feelings "  Tired and/or trouble concentrating "  Poor appetite or overeating "  Recurring headaches and body pain "  Thought or attempts of suicide

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!  If someone is experiencing changes in personality i.e. sad, withdrawn, irritable, anxious, tired, indecisive etc.

!  Signs of changes in behavior, sleep pattern, fear of losing control, feelings of overwhelming guilt, shame and/or self-hatred.

!  Loss of religious faith, nightmares !  Suicidal impulses, statements, plans, giving away

favorite things, previous attempts of suicide !  Agitation, hyperactivity, restlessness may indicate

masked depression

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!  Bipolar disorder is a chronic mental illness that causes dramatic shifts in a person’s mood, energy and ability to think clearly

!  People with bipolar have high and low moods, known as mania and depression.

!  Mania can cause people to feel extremely irritable or euphoric, causing sleeplessness and talkativeness or sadness and hopelessness. Even periods of extreme pleasure-seeking or risk-taking behavior.

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!  A misunderstood condition with many aspects !  Characterized by intense & stormy

relationships, low self-esteem, self-sabotaging, mood fluctuations and impulsivity

!  Difficulty handling personal, social and employment relationships

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!  Is a chronic, severe, and disabling brain disorder. Causes those suffering with this disorder to hear voices that others don’t hear. Many believe they are being controlled by their thoughts, someone is reading their minds, or plotting to harm them.

!  Symptoms fall into three categories: positive, negative and cognitive

!  Schizophrenia is treatable and people living with this disorder cope with symptoms throughout their lives, but can live rewarding & meaningful lives in their communities.

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!  Positive symptoms “disturbances added to the personality” "  Delusions "  Hallucinations "  Disordered thinking and speech

!  Negative symptoms “capabilities lost from the personality” "  Social withdrawal "  Extreme apathy "  Lack of drive or initiative "  Emotional unresponsiveness

!  Cognitive symptoms “difficult to recognize” "  Leads to poor “executive functioning,” making it difficult to absorb

& interpret information "  Trouble focusing or paying attention "  Cognitive symptoms often make it hard to lead a “normal” life and

earn a living

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!  Paranoid schizophrenia -- a person feels extremely suspicious, persecuted, or grandiose, or experiences a combination of these emotions.

!  Disorganized schizophrenia -- a person is often incoherent in speech and thought, but may not have delusions.

!  Catatonic schizophrenia -- a person is withdrawn, mute, negative and often assumes very unusual body positions.

!  Residual schizophrenia -- a person is no longer experiencing delusions or hallucinations, but has no motivation or interest in life.

!  Schizoaffective disorder--a person has symptoms of both schizophrenia and a major mood disorder such as depression.

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!  Schizoaffective disorder is a condition in which a person experiences a combination of schizophrenia symptoms — such as hallucinations or delusions — and mood disorder symptoms, such as mania or depression.

!  The mood disorder is either bipolar disorder or depression

!  Signs & Symptoms may include "  Delusions/hallucinations "  Major depressed mood episodes "  Periods of manic mood/or sudden increase in energy &

behavior "  Impaired occupational & social functioning "  Paranoid thoughts & ideas etc.

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!  Difficulties in regulating emotions !  Can lead to severe, unstable mood swings, impulsivity

and instability, poor self-image and stormy personal relationships

!  May make repeat attempts to avoid real or imagined situation of abandonment

!  Can also manifest into destructive behavior, such as self-harm (cutting) or attempts of suicide

!  Symptoms of BPD are: "  Frantic efforts to avoid being abandoned by friends and family "  Unstable personal relationships "  Suicidal & self-harming behavior "  Periods of intense depressed mood, irritability or anxiety "  Chronic feelings of boredom or emptiness

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!  According to the Substance Abuse and Mental Health Services Administration (SAMHSA): "  20-25% of the homeless population in the United

States suffer from some form of severe mental illness "  That’s in comparison to only 6% of Americans who

are severely mentally ill (National Institute of Mental Health, 2009)

"  In 2009, Mental Illness was the third largest cause of homelessness for single adults (mentioned by 48% of cities)

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Do:

!  Collect as much information as possible from all possible sources prior to intervening.

!  Take your time and eliminate noise and distractions. !  Ask permission first. !  Treat them with dignity and respect as you would a family member. !  Keep your distance and respect personal space. !  Talk slowly and quietly. Identify yourself and others and explain your

intentions/actions. Your actions should be slow, and prior warning should be given if you intend on moving about the room.

!  Explain in a firm, but gentle, voice that you want to help. Ask how you can be of assistance.

!  Develop a sense of working together: “Help me to understand what is happening to you.”

!  Give choices whenever possible to allow some level of control.

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Do not: !  Deceive—be honest and open in all situations.

You are reality. !  Challenge. !  Tease or belittle. !  Forget the pain and fear they are experiencing.

Remember that emotions can be painful. "  Their pain & emotions are real

!  Violate personal space. !  Forget to ask about medications used.

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!  Defined as an emergency psychological care aimed at assisting individuals in a crisis situation to restore equilibrium to their biopsychosocial function and to minimize the potential for psychological trauma.

!  CIT are program initiatives designed to improve the way law enforcement and the community respond to people experiencing mental health crisis.

!  Partnerships are between local law enforcement, mental health provider agencies, individuals and their families.

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!  To reduce the intensity of an individual’s emotional, mental , physical and behavioral reactions to crisis

!  To help individuals return to their level of functioning before crisis

!  Aid in improving and re-teaching new ways of coping with stress and everyday life

!  The overall purpose of Crisis Intervention is to assist the individual in recovering from crisis and to prevent serious long-term problems from developing. Improving problem solving & decrease stress

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A crisis can refer to ANY situation where the individual

is faced with sudden loss of his/or her ability to use

effective problem solving and coping skills.

Examples of a crisis: • Natural disasters (earthquake or

tornado) • Sexual assault or criminal

victimization • Medical/mental illness (thoughts of

suicide or homicide) • Loss or drastic changes in

relationships (death of loved one or divorce)

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!  Unfortunately, Crisis Units are not available in every county, but there are community agencies that offer the support from someone on-call i.e. The Care and Crisis Helpline

!  Crisis Units by County: "  Albany County – 518-549-6500 "  New York City (Bronx, Kings, Queens & Richmond

Counties – Helpline 212-532-2400; LIFENET 1-800-543-3638 or 212-995-5824; Spanish Line 1-877-298-3373

!  A full list by County is located in the resource folder

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!  Law Enforcement or CIT should be involved when there is a situation/crisis where there is a concern or threat of harm to one’s self or others.

!  In cases where there are not crisis units available in your area in which you reside, call 911.

!  It is important to let the officers know what the situation consists of (give them as many details as possible) so when they arrive they know what to expect and how to better handle the crisis.

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!  Often times a person will only become aggressive if they are intoxicated or on another drug.

!  No matter your work or education; healthcare, human services, business or any field, you might deal with angry or hostile individuals. It’s important to handle any situation with understanding, while knowing your response to defensive behavior is often the key to avoiding a physical confrontation with someone who has lost control of their behavior.

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!  Speak slowly and confidently, using a gentle and caring tone of voice

!  Do not respond in a hostile, disciplinary or challenging manner

!  Do not argue, threaten, as this may increase the fear or prompt aggressive behavior

!  Avoid raising your voice and/or talking fast !  Be aware as they may overreact to negative

words; only use positive words, such as “stay calm” instead of negative words, such as “don’t fight”

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!  Do not restrict the person’s movement: if they want to pace, allow them while setting limits

!  Remain aware that certain acts, such as involving law enforcement, might exacerbate the situation

!  Consider taking a break from the conversation to allow the person a chance to calm down

!  Allow silence for reflection; this gives them a chance to reflect on what’s happening

!  Allow time for decisions; if a person is upset, they may not think clearly, it’s ok for them to take a few moments to “think” (According to the Mental Health First Aid USA training)

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!  Training available for adults and youth, offered in an 8 hour course

!  Mental Health First Aid aims to teach members of the public how to respond in a mental health emergency and offer support to someone who appears to be in emotional distress "  Signs of Addiction and Mental Illnesses "  5-step action plan to assess a situation and help "  Impact of mental and substance use disorders "  Local resources and where to turn for help "  For more information on the training course and where

the course is offered please visit: Mental Health First Aid USA

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