Mental Health Specialty Training October 2008 Basic Training for Managers and Caregivers Acknowledgements Mental Health State Stakeholders: Specialty Training Vicki Anensen-McNealley Valerie Armstrong Cheri Baker Gary Brunson Jan Curtis Mary Gould Deb Johnson Nora Laughlin Nancy Mohrman Carla Schneider Alice Semingson \ Icons to Help Guide You Through the Materials Classroom Additional Supplemental Share With Caregiver Activity Material Readings Families Tips Mental Health Table of Contents Specialty Training Module 1 – Introduction to Mental Disorders What Do You Know About Mental Disorders (Activity) ...............................................................3 Overview - Mental Disorders ......................................................................................................... 4 Diagnosing Mental Disorders.......................................................................................................... 4 Stigma and Mental Disorders ......................................................................................................... 5 Differentiating Forms of Mental Disorders..................................................................................... 6 Anxiety ........................................................................................................................................... 7 Depression ................................................................................................................................... 10 Bipolar Disorder............................................................................................................................ 12 Schizophrenia ............................................................................................................................... 14 True/False – What Do You Know About Mental Disorders (Activity) ...................................... 16 Module 2 – Culturally Compassionate Care Overview of Culture and Ethnicity……………….........................................................................21 The Iceberg ....................................................................................................................................22 Getting to Know You (Activity) ...................................................................................................23 Impact of Culture on Mental Health Care ......................................................................................24 Stigma and Mental Disorders .........................................................................................................25 Providing Care................................................................................................................................26 Guiding Principles when Providing Care to Individuals with Mental Disorders ...........................27 Module 3 – Respectful Communication Communicating and Mental Disorders...........................................................................................31 The Importance of Listening .........................................................................................................32 Listening Skills...............................................................................................................................32 General Tips for Communicating with a Person with a Mental Disorder ......................................33 Tips for Communicating with People with Anxiety Disorders (Activity) .....................................35 Tips for Communicating with People with Depression (Activity) ................................................36 Tips for Communicating with People with Bipolar Disorder (Activity)........................................37 Tips for Communicating with People with Schizophrenia (Activity) ...........................................40 Communication Tips for Handling a Crisis ...................................................................................41 Module 4 – Creative Approaches to Challenging Behavior Creative Approaches to Challenging Behaviors ........................................................................... 45 Framework for Action .................................................................................................................. 46 Framework for Action (Activity)................................................................................................... 49 The “ABC” Technique ................................................................................................................. 50 The “ABC” Technique (Activity).................................................................................................. 52 Dealing with Challenging Behaviors ............................................................................................ 54 Module 5 – Decompensation and Relapse Planning Baseline ........................................................................................................................................ 61 Decompensation ........................................................................................................................... 62 How to Help a Person Who is Decompensating............................................................................ 63 Relapse .......................................................................................................................................... 64 Relapse Plan .................................................................................................................................. 65 Personal Relapse Management Plan.............................................................................................. 66 Mental Health Directive (Sample)................................................................................................. 67 Module 6 – Suicide Prevention Facts About Suicide....................................................................................................................... 85 Risk Factors ................................................................................................................................... 85 Suicide and Mental Disorders........................................................................................................ 86 What to Do If a Person is Suicidal................................................................................................. 88 What to Do If a Person is Suicidal (Activity)................................................................................ 90 Caregiver Grief After Suicide........................................................................................................ 91 Module 7 – Medications and Mental Health Introduction .................................................................................................................................. 95 Medications Used with Mental Disorders ..................................................................................... 96 Anti-psychotic Medications .......................................................................................................... 97 Anti-manic Medications/Anticonvulsants .................................................................................... 98 Anti-anxiety Medications ............................................................................................................. 99 Side Effects ................................................................................................................................. 100 Reporting Side Effects ................................................................................................................ 100 Extrapyramidal Side Effects ....................................................................................................... 100 Medications to Treat Mental Disorders and Their Side Effects ................................................. 103 Module 8– Getting Help and Self Care Dealing with Mental Health Issues ............................................................................................. 107 Dealing with Crisis ...................................................................................................................... 107 Dealing with the Risk of Violence............................................................................................... 109 Crisis Resources .......................................................................................................................... 110 Crisis Resources (Activity).......................................................................................................... 110 Your Mental Wellness ................................................................................................................. 111 Strategies to Cope........................................................................................................................ 112 Who to Get Help From and What they Do .................................................................................. 113 Mental Health MODULE 1 Specialty Training Introduction to Mental Disorders Introduction to Mental Disorders Aging and Disability Services Administration 1 Introduction to Mental Disorders 2 Aging and Disability Services Administration What Do You Know About Mental Disorders? Check “True” or “False” for each of the questions below to see what you know about mental disorders. True False 1. Bad parenting causes mental disorders. 2. Mental disorders are rare. 3. Only uneducated and poor people develop mental disorders. 4. People with mental disorders are usually dangerous. 5. Culture can influence whether a person with a mental disorder decides to seek treatment. 6. When communicating with a person who is actively hallucinating, it is important to find out what the hallucination is about. 7. A person with a mental disorder who is physically aggressive should not be physically restrained. 8. A person with a mental disorder who is decompensating will always experience a relapse. 9. Talking to a person with depression about suicide increases the risk that he or she will do it. 10. Medications can cure mental disorders. Check to see how you did on page 16. Introduction to Mental Disorders Aging and Disability Services Administration 3 Understanding Mental Disorders Module Goals: To provide caregivers and managers: • A general overview about mental disorders. • More information on four of the most common mental disorders. Mental disorders are biologically based brain disorders that can Overview of Mental greatly interfere with a person’s thinking, feelings, mood, the Disorders ability to relate to others, and the capacity to cope with the demands of life. In any given year, an estimated 1 out of 4 adults age 18 and older have a diagnosable mental disorder. In fact, mental In any given year, an disorders are the leading cause of disability in America. estimated 1 out of 4 adults age 18 and older have a In spite of these statistics, many people remain unaware of the diagnosable mental disorder. significant number of adults who have a mental disorder. And, many adults who would benefit from treatment, never get it. This, in part, is because: • Mental disorders are challenging to diagnose. Continuum - A broad • The symptoms of a mental disorder vary along a range. continuum and there is no exact line that separates health from disorder. • Often, people tend to focus on the far end of the continuum and define mental disorders only by the most severe symptoms. • A mental disorder can be difficult to acknowledge. Many people wait until their symptoms are severe before they seek help. Some people will never seek treatment. Many factors make a mental disorder challenging to diagnose. Diagnosing Mental • Unlike other medical issues, there is no medical test or Disorders physical exam that can determine if a person has a mental disorder. • The fact that symptoms vary along a continuum, change often, and are not always visible. • The health care provider does not always witness symptom(s). • The person may not always be fully open, truthful, or aware of what is happening. • Each person’s tolerance of symptoms varies. Introduction to Mental Disorders 4 Aging and Disability Services Administration How a Mental Disorder is Diagnosed To diagnose a mental disorder, the person has to discuss his or her symptoms with a health care provider. The person needs to inform the health care professional of the intensity of his or her symptoms, how often they last, and what functional impairment the person is experiencing because of the symptoms. The clinician will perform a mental status exam and observe the person’s behavior. The clinician studies the person’s symptoms and behavior to determine if they can be grouped into a pattern or syndrome. If this pattern or syndrome meets the criteria for a specific diagnosis, a diagnosis is made. There is a long history of stigma, misunderstanding, and Stigma and Mental confusion surrounding mental disorders. Disorders Stigma related to mental disorders can greatly impact whether a person will seek treatment. Many people feel too ashamed or Stigma — a sign of shame embarrassed to talk to anyone about what is happening and may or disgrace. try to conceal symptoms. Stigma also affects how a person with a mental disorder is treated by others. Evidence that stigma exists can take many forms, such as: • Treating the person with the disorder as the disorder. For example, thinking and talking about the person as a schizophrenic, not as a person who is living with schizophrenia and has family, hopes, dreams, and abilities. • Thinking there is something essentially wrong, bad, dangerous, or weak about the person because he or she has a mental disorder. • Thinking the person is personally responsible for his or her condition. • Using language to refer to the person that is offensive or insulting, such as lunatic, nuts, crazy, or psycho. • Thinking bad parenting causes mental illness. Introduction to Mental Disorders 5 Aging and Disability Services Administration Stigma and Caregiving Stigma can prevent caregivers from providing the best care they are capable of giving. If you believe some of the misinformation about people with mental disorders, you may: Stigma can prevent caregivers • Be uncomfortable assisting the person. from providing the best care • Treat the person differently from people with other they are capable of giving. illnesses, such as cancer or heart disease. • Let the fear of the person’s mental disorder stop you from finding new ways to understand and relate to the person. It is important not to allow any of these things to happen. The best way to help you challenge stigma is to: • Learn the facts about the various mental disorders. This course will give you a good start at this. • Talk and think about mental disorders in the same way you talk and think about any other illness. • Challenge and question your attitude towards mental disorders. • Challenge people around you who reinforce myths, stereotypes, and misunderstanding about mental disorders. • Be supportive of people who have been diagnosed with a mental disorder. Differentiating Forms There are five general categories of mental disorders. They of Mental Disorders are disorders of: • Mood—such as depression and bi-polar. • Anxiety—such as generalized anxiety disorder and Post Traumatic Stress Disorder. • Perception—such as schizophrenia and delusional disorders. • Memory—such as Alzheimer’s and vascular dementia (covered in the Dementia Care Specialty Training). • Personality—such as borderline and antisocial (not covered in this class). Information will be presented in this class on some of the more common mental disorders including Anxiety Disorder, Depression, Bipolar Disorder, and Schizophrenia. Introduction to Mental Disorders 6 Aging and Disability Services Administration