1. Mental Health Basics Ann-Marie Bandfield MSW Clinical Supervisor Psychiatric Crisis Center Marion County Health Dept

2. Please describe your experiences with persons who have a Mental Illness

3. Working with Mental Health Crisis Mental Health vs Psychiatric Crisis Some basics Defining Crisis (Urgent vs Emergent) Basics on Mental Illness Three Major Axis 1 Mental Illnesses Schizophrenia, Bi Polar Disorder & Depression & Exercise

4. Mental Health vs Psychiatric Crisis Mental Health Relational Issues -parents -children - roommates/friends - acquaintances Situational Stressors Health Employment Psychiatric/Psychosis Irrational behaviors Strange responses (latent) States hears or sees things Paranoid Bizarre Appearance Possible Drugs & Alcohol Overdose

5. Some Basics This work is unpredictable Listen to your gut Treat Clients with Dignity & Respect Use Common Sense Set aside your preconceived ideas & personal biases, It’s about the Client

6. Defining Crisis Webster’s definition Crisis Work is containing the immediate issue/s Be careful of opening up emotional wounds and leaving them gaping. Over 50% of the people who come to the crisis center are a one time visit. Mental Health Crisis Not everyone deals with crisis in the same way Beware of Hang nails/ Icebergs

7. Mental Illness Mental illness is a Chemical Imbalance (Our chemical balances are changing all the time) People experience a certain set of symptoms that creates a diagnosis. No 2 people with a shared diagnosis are the same. Approx 30% of population experience mild MI 3% of the population have a Severe and Persistent Mental Illness (Oregon approx. 90,000; 7,500 Salem area). These are intelligent people and they know they are not like you.

8. Some Things to Remember There are many ways to treat these symptoms, not just the medical model. There is no law stating clients must take medications. - Self medicating - Diet & Exercise - Alternative Options Quality of Life is Important Hospitals can be a hindrance for our clients People can remain safe in their community There appears to be a genetic / hereditary connection

9. Schizophrenia Signs & Symptoms: Loose Associations Ideas of Reference Flight of Ideas Racing Thoughts Unpredictability Delusions (Belief Systems) –Paranoia –Religiosity –Grandiosity –Hyper Sexual Hallucinations (all 5 senses) Responses: Never assume you know how this person will react Safety & Information are key (Who, what, when, where) Respect & Dignity Always ask first, decide second

10. Bi Polar Disorder Mania: Signs & Symptoms Racing Thoughts Rapid, pressured speech Lack of rest needed Irritability Grandiosity/Euphoria Change in Eating Habits

11. Bi Polar Cont. Impulsive Behaviors: Binge Drinking Shopping/ Spending Drug Binging Promiscuity Fast Driving Others?

12. Responding to Bi Polar Behaviors Respect & Dignity Always Check in, How do they feel? Is there a problem? How would they like to resolve it? What has happened in the past? If a danger then what? Why does PCC let them go? Difficulties of this Disorder –Most easily medicated –Believe they are recovered –The dip of depression is deep. –They like the Euphoria

13. Depression Most difficult for the Community to Understand and Respond to. Signs & Symptoms: Decreased interest in Daily Activities Decreased Motivation Decreased Hygiene Anger (Men & Children) Lack of Self Esteem Social Isolation Change in eating habits Unable to Rest (Either sleeping all the time or not at all) Thoughts of Self Loathing Thoughts of Self harm Attempts to Harm Self Suicide

14. Responding to Depression Respect & Dignity Need to be taken seriously Be a good listener / Slow to offer remedies You cannot rescue them Become more danger as they lift out of the depression This is an on going problem, things will not simply get better, they haven’t for some time. They need a long term counselor and commitment to change. If unsure about safety get them to PCC.

15. Engaging Clients What do you want to accomplish? Quick assessment and referral to appropriate service. Building rapport & sense of “same team” will move the encounter along much more quickly than confrontation. PCC vs Hospital Not everyone will engage well. You will still need to follow all your protocols. A bit more time at the front end, could save you hours on the back end.

16. Self Care – It’s IMPORTANT Know your own history and how this work will effect it. Find ways to debrief when the works get to be too much. Secondary Trauma – this stuff rubs off. Remember to be who you want to be. Find ways to celebrate healthy lives and healthy lifestyles. Your OWN and those around you. This work is hard and Will eat you up. You and your family Deserve the best of you When you arrive home. Not what’s left over.