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Mental Health Counseling:

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Presentation on theme: "Mental Health Counseling:"— Presentation transcript:

1 Mental Health Counseling:
What is it and how can Officers benefit? Mental Health Counseling – What is it and how can Officers benefit from going.

2 Session Objectives Why LEO’s, CO’s and First Responders?
What types of treatment are out there? Who provides treatment? What happens during hospitalization? What is recovery? How can you support emotional and mental health? Key Message: The following section will explain the recovery process from mental health issues, including what recovery means, and the treatment approaches that facilitate the recovery process. The Sessions objectives include Why LEO’s, CO’s and First Responders? What types of treatment are out there? Who provides treatment? What happens during hospitalization? What is recovery? How can you support emotional and mental health? Background Information: N/A Interactivity: N/A Notes:

3 The Law Enforcement Experience
Physical Emotional Mental Spiritual High Stakes Injuries Chronic Stress Mandates / Overtime Bosses Burnout LE Culture Missing Holidays / Events Shift work The Media The Public Key Message: Dimensions of a whole person- Physical Emotional Mental Spiritual The Police Experience however places a lot of demands on all of the dimensions that make a person whole. These demands such as chronic stress, overtime, the public, the media, bosses, injuries, shift work, high stakes, missing holidays and events start to chip away at our foundation and eventually the whole person begins to disappear. Background Information: N/A Interactivity: N/A Notes: Dimensions of a Whole Person

4 Isn’t there someone else you can talk to?
How do we respond when someone is struggling? Not my circus. Not my monkeys. Polish Proverb Is that smoke? Isn’t there someone else you can talk to? Bull#$!% How do we respond when someone is struggling We want it to be okay We think we don’t have time We think it’s bullshit

5 It Starts With Recognition
“Calling for Backup: Changing LE culture so officers are not afraid to ask for help” Don Weaver, Police One 9/26/19 “It is not enough to merely tolerate asking for help. We must strive for a culture that actively encourages people to ask for help, whether in the form of backup, specialized resources, advice or sometimes even professional counseling.” “As leaders, we will not be able to eliminate the deep-rooted pride that keeps certain officers from asking for help or the deeply held belief that asking for help is a sign of unacceptable weakness. But we can and should do something.” Key Message: It starts with recognition, this comes form Calling for Backup: Changing LE culture so officers are not afraid to ask for help- Don Weaver Police One 09/26/19. “It is not enough to merely tolerate asking for help. We must strive for a culture that actively encourages people to ask for help, whether in the form of backup, specialized resources, advice or sometimes even professional counseling.” “As leaders, we will not be able to eliminate the deep-rooted pride that keeps certain officers from asking for help or the deeply held belief that asking for help is a sign of unacceptable weakness. But we can and should do something.” Background Information: N/A Interactivity: N/A Notes:

6 Maintenance/Recovery
Prevention Acute Incident Intervention Crisis Postvention Maintenance/Recovery Counseling can be beneficial at many different points in a person’s life. Prevention – before something happens Acute incident- following an acute incident Intervention-when the stresses are beginning to accumulate Crisis- during an acute crisis when stressors are too overwhelming – may need more intense counseling or inpatient therapy i.e.. hospitalization Postvention- following an acute incident or crisis Maintenance/Recovery- on going to help stay on track

7 Treatment No “one size fits all” approach, but there are many effective ways to treat mental health… Lifestyle Changes Peer Support Psychotherapy / Counseling Other Evidence Based Treatment Medications Alternative Therapies In-patient Services There is no perfect universal treatment, but there are many different approaches for managing the symptoms of mental illness Lifestyle Changes- exercise, healthy diet, adequate sleep, etc. Peer Support Psychotherapy / Counseling-inpatient or outpatient; family, group, or individual sessions Evidenced Based Treatment- EMDR Medications Alternative Therapies – yoga, acupuncture, massage Inpatient Services

8 Therapists Prescribers Who provides treatment?
Licensed Social Workers (LMSW, LCSW, LCSW-R) Licensed Mental Health Counselors (LMHC) Licensed Marriage and Family Therapist (LMFT) Licensed Creative Arts Therapist (LCAT) Psychologists (PhD, PsyD) Credentialed Alcoholism and Substance Abuse Counselor (CASAC) Therapists Nurse Practitioners (NP, NPP) General Practitioners (MD, DO) Psychiatrists (MD, DO) Prescribers Therapists Social Workers (LMSW, LCSW, LCSW-R) Licensed Mental Health Counselors (LMHC) Creative Arts Therapist (CAT) Marriage and Family Therapist Prescribers Nurse Practitioners (NP, NPP) General Practitioners (MD, DO) Psychiatrists (MD, DO)

9 Different formats (group, individual, family, telehealth)
Outpatient Therapy Different formats (group, individual, family, telehealth) Different methods (psychoanalysis, behavioral, cognitive, solution-focused, holistic, exposure, EMDR) Different formats (group, individual, family) Different methods ( psychoanalysis, behavioral, cognitive, humanistic, holistic, exposure, EMDR)

10 Psychoanalysis In depth talk therapy designed to help person develop insights into their behavior Main goal is to bring unconscious material into consciousness and enhance functioning Think Freud and id, ego, and super ego In depth talk therapy designed to help person develop insights into their behavior Main goal is to bring unconscious material into consciousness and enhance functioning Emphasis the importance of childhood experiences and how you behave the way you do now Explains defense mechanisms and why every person reacts differently to similar situations

11 Cognitive Behavioral Therapy (CBT)
Most common type of talk therapy Main goal is to help you become aware of inaccurate or negative thinking so you can view situations more clearly and respond more effectively Cognitive Behavioral Therapy (CBT) for short is one of the most common type of talk therapy, Main goal is to help you become aware of inaccurate or negative thinking so you can view situations more clearly and respond more effectively. The premise is that if you change the way you think, you can change the way you react to certain situations and experiences. Focuses on how peoples thinking can change feelings and behaviors. Brief in nature and oriented towards problem solving

12 Dialectic Behavioral Therapy (DBT)
Four Main Skill Modules Mindfulness Distress Tolerance Emotional Regulation Interpersonal Relationships Dialectic Behavioral Therapy-is a form of CBT that focuses on four skill modules that focus on helping people who tend to have extreme emotional reactions interact with the environment around them in a less emotional healthier way. Focuses on individual and group therapy sessions. Learn and practice mindfulness and being in the present, distress tolerance and emotion regulation(dealing with very strong emotions) and interpersonal relationships. This type of therapy is common for individuals with borderline personality disorder and individuals who have a history of trauma in their lives.

13 Exposure Therapy Specific Cognitive Behavioral Therapy
Often used in PTSD or phobias Main goal is to help person face and gain control of the fear or distress of the trauma Specific Cognitive Behavioral Therapy Often used in PTSD or phobias Helps person face and gain control of the fear or distress of the trauma Involves exposing the person to the anxiety source or its context without the intention to cause danger

14 Solution Focused Therapy
Future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought clients to seek therapy Main goal is directed toward developing and achieving the client’s vision of solutions Brief therapy SFBT is future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought clients to seek therapy. Main goal is directed toward developing and achieving the client’s vision of solutions.

15 Holistic or Integrative Therapy
Main goal is to provide education on lifestyle changes and self-care for optimal health Treats the whole system- takes into account the body, mind, spirit and emotions Involves integrating various elements of different theories to the practice Treats the whole system- takes into account the body, mind, spirit and emotions Provides education on lifestyle changes and self-care for optimal health Mindfulness Meditation Yoga Guided Imagery Aromatherapy Acupuncture

16 Eye Movement Desensitization Reprocessing EMDR
Interactive technique typically broken down over several sessions Used for PTSD or trauma Therapist treats targeted memories & will have person do specific eye movements Interactive technique typically broken down over several sessions- 8 specific phases – requires 8-12 sessions ususally 1.History and Treatment Planning 2. Preparation 3.Assessment 4.Desensitization 5.Installation 6.Body Scan 7.Closure 8.Reevaluation Used for PTSD or trauma Therapist treats targeted memories and will have person do specific eye movements

17 Eye Movement Desensitization Reprocessing EMDR
EMDR video here Interactive technique typically broken down over several sessions- 8 specific phases – requires 8-12 sessions ususally 1.History and Treatment Planning 2. Preparation 3.Assessment 4.Desensitization 5.Installation 6.Body Scan 7.Closure 8.Reevaluation Used for PTSD or trauma Therapist treats targeted memories and will have person do specific eye movements

18 Finding the Right Therapist
First, decide on EAP, insurance or private pay Ask for referrals from people you trust Decide what type of treatment is right for you Check out provider on-line Call to schedule an appointment If you don’t feel comfortable try again Give it three sessions to establish a relationship Set goals Adapted from Robbie Adler-Tapia, Ph.D. 2011

19 Questions to Ask a Provider?
Are you licensed in New York State? How long have you been in practice? What is your degree? What is your experience in treating LEOs, COs and First Responders? What kind of therapy do you practice? What kind of trauma therapy do you practice? What is the cost?

20 Inpatient Therapy (Hospitalization)
Voluntary vs. Involuntary What to Expect Time Limited Structure (groups, individual therapy) Treatment Team Medications Limited Visitors Locked Unit Inpatient Therapy or hospitalization Private hospitals vs public hospital….typically there is a lot of structure to the day in the form of groups and individual therapy Private hospitals are expensive and insurance does not always cover Time limited- especially in public hospitals 3-7 days on average- longer stays in private hospitals. Treatment Team- nurse, dr/psychiatrist, social workers, assistants Medications Limited visitors Can be potentially on a locked unit especially in a public hospital

21 Pharmacotherapeutics
Medications Antidepressants Antianxiety Antipsychotics Mood Stabilizers Pharmacotherapeutics Antidepressants (Zoloft, Prozac, Lexapro, Paxil) Anti-Anxiety (Buspar, Xanax, Valium) Antipsychotics (Zyprexa, Geodon, Haldol, Prolixin, Abilify) Mood Stabilizers (Lithium, Depakote, Tegretol, Lamictal)

22 SAFE Act MHL 9.46 requires mental health professionals to report to their local director of community services ("DCS") or his/her designees when, in their reasonable professional judgment, one of their patients is "likely to engage in conduct that would result in serious harm to self or others.”   NY SAFE Act FAQ's Q: When does the new reporting requirement under MHL 9.46 become effective? A: The reporting requirement becomes effective on March 16, 2013. Q: What does the new MHL 9.46 require be reported? A: MHL 9.46 requires mental health professionals to report to their local director of community services ("DCS") or his/her designees when, in their reasonable professional judgment, one of their patients is "likely to engage in conduct that would result in serious harm to self or others." Q: Who is required to report under MHL 9.46? A: The reporting requirement extends to "mental health professionals," defined in the law as four professions – physicians (including psychiatrists), psychologists, registered nurses, or licensed clinical social workers. Q: Who is potentially a subject of an MHL 9.46 report? A: All persons receiving mental health treatment services from any of the four types of mental health professionals identified in the law, regardless of the setting in which they work, may be subjects of 9.46 reports. Q: Does the reporting requirement apply to mental health professionals working in private practice, on general hospital wards, or other locations outside of psychiatric wards? A: Yes, the requirement to report is not dependent upon the location of the treating professional or the patient. Q: Are there exceptions to this reporting requirement? A: Yes. A report is not required when, in the mental health professional's reasonable professional judgment, a report would endanger him or her or would increase the danger to the potential victim or victims. Q: What if there are several mental health professionals treating a particular individual – are all of them required to make a report? A: Reports under MHL 9.46 are made using a clinician's reasonable professional judgment. Different clinicians treating the same individual may not agree, which should not prevent any one, or all, of them from making a report. Q: What information about the patient should be reported by mental health professionals? A: Mental health professionals should convey information necessary to allow the DCS to review the matter and determine if a report to the NYS Division of Criminal Justice Services (DCJS) is required (e.g., what clinical evidence, history, and risk factors have caused the mental health professional to conclude that the patient is likely to engage in conduct that would result in serious harm to self or others). Q: Are such reports in compliance with HIPAA? A: Under HIPAA, because these informational disclosures are required by law, they can be made without the patient's consent. HIPAA permits disclosures of protected health information without the authorization or consent of the individual to the extent that such disclosure is required by law and the disclosure complies with the requirements of that law. Q: When should a mental health professional make a report? A: The mental health professional should make a report as soon as possible. Q: What information will a local DCS report to DCJS, and what can DCJS do with such information? A: A local DCS may only disclose a patient's name and other non-clinical identifying information (e.g., date of birth, race, sex, SSN, address) to DCJS, and that information can be used by DJCS to determine if the patient has a firearms license. If the patient has a firearms license, DCJS will report that information to the local firearms licensing official, who must either suspend or revoke the license. The information may also be used in connection with a determination of firearms license eligibility should the subject of the report apply for a firearms license in the subsequent five years. Q: How long will DCJS retain the personal information they receive? A: DCJS must destroy information received five years after receipt. Q: Mental health professionals must make reports when, in their professional judgment, it is believed that the patient is "likely to engage in conduct that could seriously harm the patient him/herself or others." What does that mean? A: The standard "likelihood to result in serious harm" means threats of, or attempts at, suicide/serious bodily harm to self, or homicidal/violent behavior towards others. This standard justifies the need for immediate action, as a public safety measure, to prevent harm. Mental health professionals must use reasonable professional judgment when making this determination. In general, a MHL 9.46 report would originate if the clinician determines the person is likely to engage in conduct that could seriously harm the patient and/or others (which could thus also trigger a MHL 9.45 emergency assessment). It is not, however, necessary to establish that the patient has a gun before making the report. Q: Can mental health professionals who make a determination to report or not to report be held liable? A: The new law specifically provides that if a mental health professional uses "reasonable professional judgment" and "good faith" when making a determination, this decision cannot be the basis for any civil or criminal liability on the part of that professional. Q: IS MHL § 9.46 applicable to OASAS certified treatment programs? A: It depends on what type of service is being provided. MHL § 9.46 applies if the mental health professional is providing mental health services in an OASAS certified program. These reports must be made consistent with the federal confidentiality rules (42 CFR Part 2) which prevent disclosure of information that would identify an individual as receiving substance use disorder services without consent. No confidentiality concerns are raised if the mental health professional is able to make the report without identifying that the patient is receiving substance use disorder services. MHL § 9.46 does not apply to services provided in an OASAS certified program when a mental health professional (as defined in the law) is solely providing substance use disorder services to the patient. Q: Can Physician's Assistants submit a report? A: For now, Physician's Assistants should not submit, but if they are aware of a threat, should locate a member of the treatment team that is permitted to submit and notify them of the threat. Q: Under what Profession Type should Nurse Practitioners submit? A: Nurse Practitioners are always licensed as registered Nurses by the NYS Education Department and should submit as a Registered Nurse with their RN license number. Q: How should a Mental Health Professional record on a person's race if they are Hispanic? A: They should check the "Other" box. For more information and to submit any questions or concerns on the MHL 9.46 reporting requirements, please contact your professional association directly.

23 Licensed Mental Health Professionals
SAFE Act- Licensed Mental Health Professionals Physician Psychologist Registered Nurse Licensed Clinical Social Worker Safe Act- Mental Health Professional? Physician Psychologist Registered Nurse Licensed Clinical Social Worker

24 Person judged to be “dangerous” by treating “MH professional”
Report to County OMH via online portal County agrees with dangerous determination? NO YES Report made to NYS DCJS DCJS checks database; firearm permit? Name remains in database for 5 years NO YES DCJS reports to “appropriate licensing official” (County Clerk) License is revoked; firearms required to be returned to police If guns not turned in, police remove them

25 Peer Support Services The goal of peer support is to provide individuals the opportunity to receive emotional and tangible support through times of personal or professional crisis and to help anticipate and address potential difficulties. Peer support programs are usually developed and implemented under the organizational structure of the department, however some programs may partner with outside agencies to obtain peer support.

26 Help and support is available
Employee Assistance Programs (EAP) The National Police Suicide Foundation www. psf.org Peer Services Help and support is available National Resources The National Police Suicide Foundation Blue HELP Safe Call Now COPLINE Crisis Text line Text Blue to 1st Help Suicide Prevention Lifeline talk 26

27 Horizon Health Services – multisite - Western NY
Outpatient/Telehealth MH/SA, Veterans, Therapy Dog, Women’s River Hospital - Alexandria Bay, NY Intensive Outpatient, Active Duty, PTSD Tully Hill Treatment & Recovery – Syracuse, NY In-patient Addiction, Uniformed Professionals Rehabilitation Sierra Tucson – Tucson, Arizona In-patient, Addiction & Mental Health, PTSD Brattleboro Retreat – Brattleboro, Vermont In-patient, Uniformed Professionals Program Additional Resources:

28 Additional Resources SAMHSA Resource Locator
OMH Resource Locator- “Find a Mental Health Program” Find your local NAMI

29 How Can Counseling Help?
Learn to recognize that exposure to trauma and stress, directly or indirectly, affects us Develop a variety of coping strategies and a foundation of emotional wellness can lessen the impact that stress has on you Recognize that exposure to trauma directly or indirectly affects us Being aware of your response to traumatic events is key to maintaining a sense of wellness and success Having a variety of coping strategies and a foundation of emotional wellness can lessen the impact that it has on you

30 Take Care of Yourself First!
“Taking care of yourself is the most powerful way to begin to take care of others.” Bryant McGill “Taking care of yourself is the most powerful way to begin to take care of others.” – Bryant McGill “Self-care is never a selfish act - it is simply good stewardship of the only gift I have, the gift I was put on earth to offer others. Anytime we can listen to true self and give the care it requires, we do it not only for ourselves, but for the many others whose lives we touch.” – Parker J. Palmer

31 Resilience The capacity to prepare for, recover from, and adapt in the face of stress, challenge, or adversity You can learn to build your resilience capacity and sustain your energy Resiliency is the capacity to prepare for, recover from, and adapt in the face of stress, challenge, or adversity You can learn to build your resilience capacity and sustain your energy

32 Schedule “time out” Promoting Wellness Develop a Wellness Routine
Do something good for yourself Get rid of “I usta” Develop a Wellness Routine Mix physical activity & periods of quiet reflection to provide stability and promote resiliency Plug Energy Leaks Depleting emotions Learned helplessness Foster Wellness Develop a Wellness Routine Mixing physical activity & periods of quiet reflection provides stability and promotes resiliency Scheduling a time out for yourself- take the time just for you. Plug Energy Leaks Work related resistance Depleting emotions Learned helplessness Do Something good for yourself- get rid of the I usta syndrome- go fishing, go hunting or hiking

33 Responsibility, Reflection & Relationships
You are in control of you and only you Establish priorities in your life Learn to say NO! Know your stress triggers Manage your stress symptoms Check your balance in life What’s Important Now (W.I.N.) Nurture and maintain supportive relationships Manage your relationships Improve your relationship with yourself Responsibility and Reflection You are in control of you and only you Establish priorities in your life Learn to say NO! Know your stress triggers Be aware of stress symptoms Check your balance in life W.I.N. (What’s Important Now)

34 Fostering Your Mental Health
Mental Health issues are not due to lack of will power or low intelligence Individuals can benefit from: Counseling Support and encouragement from family, friends, peers & community People can manage their health, and have meaningful relationships and careers Recovery from Mental Health Issues Mental illness =/= character flaw, low IQ, hopeless Like diabetes, mental illnesses are medical conditions that can be managed (but not cured) through treatment No one size fits all solution, but variety of different treatment approaches that can be used to promote recovery/ manage symptoms Lifestyle changes can help (i.e. more exercise and sleep, better diet, increased socialization) but often are not enough Therapy can help, but person has to be willing to go and stable enough to put the work in Medication can help stabilize symptoms, but… Will not cure the person (rather it manages symptoms) May have unintended negative side effects

35 https://www.youtube.com/watch?v=VMhVK723zbU Beneath the Vest video

36 Thank You! Stay Safe Raná Meehan, LMHC, MPA Or Carrie Ann Wong, LMSW


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