Download NAMI Phone Email Responder Manual Training 2014

Crisis Responder Manual Training
Pilot: February 27, 2014
Helping You Do a Better Job of Handling
Phone and Email Crisis Calls
Bob Nassauer, Bill Leadford, Barb Higman,
Rachel Luchs, Patricia Doyle, Ann Hendrick,
Alison Paine, and Mark Creekmore
“Start where you are by being kind to others –
if it is done properly, with proper understanding –
we benefit as well. So the first point is that
we are completely interrelated.
What you do to others, you do to yourself.
What you do to yourself, you do to others.”
Pema Chodron
American Buddhist nun
Our Mission Statement
• NAMI (National Alliance on Mental Illness) Washtenaw County is a
non-profit organization that aims to improve the lives of persons affected
by and recovering from mental illness.
• We provide support, education, and advocacy to people with mental
illness, their families and friends, mental health professionals, and the
broader community.
• The Family-to-Family program is one of the best evidence based
treatments available to families who live in support of a loved one with
mental illness. We are bringing Peer-to-Peer, a 10-week education
class to our community.
Purpose of This Manual
The purpose of this manual is to give people tips and
techniques on how to handle phone and email crisis calls
(e.g., first listen with empathy) and to complement, not
replace, already existing listings of community resources.
This is an electronic-constantly-being-updated data base.
While not specifically intended for handling face-to-face crisis
situations (See Crisis Intervention Training and Mental
Health First Aid Training) much of the information in this
manual will be helpful.
Agenda
1. Welcome, Brief Intros, Agenda and Opening
Activities
2. Getting to Know the Manual
3. Review of Important Tips and Techniques
4. Case Studies
5. Next Steps
Please feel free to ask questions at any time.
5
Opening Activity
Directions:
Take a few minutes to write in “newspaper
headline” format on a 3X5 card one or two of the
most difficult phone or email crisis calls you
have experienced.
After the report out please turn them in for our
FAQ’s and possible use later in this workshop.
Thank you.
What is Most Important?
1. As you handle a phone or email crisis call what do you think is going to be the
most important thing to do?
(listen)
2. As you handle a phone or email crisis call what do you think is going to be the
most difficult thing to do?
(listen)
“There is only one way to make people talk….listen. Listen with hungry
earnest attention to every word. In the intensity of your attention, make little
nods of agreement, little sounds of approval. You can’t fake it. You have to
really listen. In a posture of gratitude. And it is such a rare and startling
experience for them… to find a genuine listener, that they want to prolong the
experience. And the only way to do that is to keep talking. A good listener is
far more rare than an adequate lover.”
John D. MacDonald, Nightmare in Pink
Opening Practice Question 1
“Can you recommend a good psychiatrist for my
20-year old daughter who has a diagnosis of bipolar disorder?
(We don’t recommend specific psychiatrists but we can give
people the listing of resources from the manual – and Peace
of Mind Brochure 3 - and this information is not currently in
many existing community resources.)
Opening Practice Question 2
"My son is over 18 and in the hospital being evaluated
and is going to be in front of a judge on Wednesday
morning. If the judge determines that my son needs
treatment and will be put on an Assisted Treatment
Order (ATO) for up to 90 days, will this be on my
son's/daughter's record?“
(The answer is yes - gets put into LEIN (Law Enforcement Information
Network) - but it can be complicated and is not specifically in the manual
– we will have to rely on each other to research when appropriate - we
contacted an attorney and the judge’s office. Another example is: How
do I encourage someone to get help?)
Getting to Know the Manual
• All information included is subject to change. Updates will be made
frequently.
• Manual contains hyperlinks!
• Most of the community resources information is in the hard copy
pamphlets and booklets.
• Manual is intended to supplement what is not in the hard copies, e.g.,
listing of lawyers. There may be some overlap.
• Manual has been created in Word 2007 and is available electronically
so making updates and personal notes are relatively easy to perform.
In the Manual: Page 6
Getting to Know the Manual
The manual was originally written for NAMI Washtenaw
County but we quickly learned that others in the community
could use it.
You may want to consider tailoring some of the information to
your organization, e.g., see pages 7-9: “NAMI WC is not a
service provider…” maybe your organization is.
Listing of Existing Resources Examples
• A Resource Guide for Families Dealing with Mental Illness
• Peace of Mind Series - 11 Brochures
• Community Mental Health Partnership of Southeastern Michigan Guide
to Services
• Ann Arbor/Ypsilanti Street Survival Guide – from the Project Outreach
Team (PORT)
• Various brochures, e.g., NAMI WC Fall 2013 Programs, NAMI WC Fall
2013 Support Groups, Family-to-Family, Parents and Teachers as Allies
Monograph
• Beyond Psychotropics: A Practical Introduction to Non-Drug Therapies
and Wellness Basics for the Treatment of Adult Mental Illness http://goo.gl/NFpHI8
• Navigating the Mental Health System – A Process Flowchart
• Call Log Sheets
In the Manual: Page 6
HOW TO HANDLE CRISIS CALLS
• Goal is to provide empathy and information.
• A crisis is unique to the person experiencing it.
..listen non-judgmentally.
• You are not expected to know all the answers.
When the call is complex it is important and helpful
to involve other volunteers or NAMI board
members.
In the Manual: Page 7
HOW TO HANDLE CRISIS CALLS
Where to Begin
• Tell your name and what you do.
• Take a deep breath and be prepared to listen patiently. In the midst
of a crisis the person wants to be heard, understood, validated and
valued as a human being. Sometimes, this is the most important thing
you can do.
• Use QLC: Question, Listen, and Confirm active listening skills.
In the Manual: Page 7
Things to Remember
• Be sure to maintain confidentiality.
• Gather information before providing information.
• Try to remain objective; there are often two sides to the story.
• Do not give specific medical advice or judgments regarding diagnosis,
specific recommendations regarding treatments.
• If individual is in danger contact community mental health (Access:
734.544.3050 or 1.800.440.7548) or the police (911).
• Document the call – see contact log.
In the Manual: Page 7
MORE TIPS ON HANDLING
CRISIS CALLS
•
Set a calming tone for the call.
•
Create a connection with the caller.
•
Speak slowly, clearly and distinctly.
•
Reflect back: In an authentic manner, respond to what you are
hearing e.g., “It seems you are very worried” or “It sounds very
frustrating.”
•
Make authentic, positive, and affirming comments.
In the Manual: Page 8
MORE TIPS ON HANDLING
CRISIS CALLS
•
Do not make promises or assurances that can’t be fulfilled.
•
Maintain appropriate boundaries. In some situations you may have
to set limits. Briefly explain why you are doing this and be firm about
it.
•
Take care of yourself. Know your own limitations and practice
healthy self-care.
•
Following Up. If your follow up work on a crisis call involves
contacting local service providers it is best to establish, build, and
maintain a collaborative relationship.
In the Manual: Page 8
RESPONDING TO EMAILS
• Read the entire email carefully.
• Consider the questions or concerns that are both
expressed and implied.
• Acknowledge the email as quickly as possible.
• Address each topic mentioned in the email.
In the Manual: Page 9
RESPONDING TO EMAILS
• Ask clarifying questions.
• Offer solutions.
• Thank the person for the email and its contents.
• Other ideas?
In the Manual: Page 9
IMPORTANT CRISIS CONTACT
INFORMATION
• Psychiatric emergency
services (PES)
• Community Mental Health
Access
• Washtenaw County Sheriff’s
Office
• NAMI of Washtenaw County
• The NAMI National
Information HelpLine
• R U OK? Michigan
• Partners
• City of Ann Arbor Police
Department
• CRISIS HOTLINES
• City of Ypsilanti Police
Department
• Critical Incident Stress
Management
• Ann Arbor Veteran
Administration Hospital
In the Manual: Pages 10-13
Any Questions on the Manual?
Summary: Some Best Practices
• Take a deep breath and focus on listening.
• Ask clear and concise questions.
• Do a key word or phrase search.
• Include other responders when the request is complex.
• Commit to learning about community resources.
• Other Best Practices?
Case Studies
Directions:
• Working in small groups with your assigned case
study take five minutes to discuss and then prepare
for a brief role-play “skit” to demonstrate how to
handle.
• After each role-play we will discuss what was done
well and what are other ideas for handling.
Case Studies
1. How do I sign up for health care?
2. What is the number for the Ypsilanti police department?
3. What substance abuse services are available in our community?
(Need to look at printed booklets too.)
4. Incarceration 1: My daughter is in jail for shoplifting but she has
bi-polar and is in a manic phase. What should I do?
5. Incarceration 2: My son is being abused in jail. How can I get it
to stop?
6. I’m being evicted – as we speak. Can you help me?
Case Studies
7. Is there someone independent in our community that can help
me create my person centered plan?
8. Part 1: I am getting older… what can I do financially to make
sure my loved one is taken care of but not lose their disability
benefits? (Special needs trust – contact a lawyer.)
9. Part 2: I told my son that I created a special needs trust for him
and now he is mad at me because he wants full access to the
money claims he is fully recovered from his mental illness (I
don’t think he is.).
Case Studies
10. “I think my child needs special help in school.”
11. Can’t afford medical costs, what should I do?
12. Residential treatment for adolescents?
13. Respite care for child – 8 years old on the spectrum.
14. Is there someone independent in our community that can help
me create my person centered plan?
Case Study
Father is angry and frustrated and wants mom to get help – feels 15year old son who lives with the mom and attends Starfish (21-day
program for people with serious life challenges in another county) is
in danger (suicidal) – a close friend lost his son to suicide. Father
thinks son is not medicated properly (150 mg effexor) and now is
concerned because mom is allowing some relatives who abuse
alcohol and drugs to come live in the home. Has contacted several
social services agencies and is very frustrated with their poor
response. He is working on himself too – attends Stonecrest
Behavioral Health Center for counseling. He has a Personal
Protection Order (PPO) from former wife (He has to stay away from
her.), PTSD (maybe) and anxiety. Is married. Lives in Wayne
County.
Next Steps
• Email additions to [email protected] and/or [email protected] –
please edit and consolidate before sending
• Anyone willing to volunteer to help with community dissemination plan,
e.g., school counselors, churches, homeless shelters, treatment
facilities.
• Other trainings?
• Other ideas?
Presentation Evaluation
Please list three strengths of this session:
Please list three ways this session could be even more effective:
What other training topics would suggest?
Please give the session an overall rating using the following scale:
5
4
3
2
1
excellent
good
fair
marginal
poor
Additional Comments: you!
“Never doubt that a small group of
thoughtful committed citizens can change
the world: Indeed it’s the only thing that
ever has.”
Margaret Mead
Thank you.
Extra Slides and Background
Information
Remaining slides in this file are optional
and/or for your background information.
There is Hope
• The diagnosis of mental illness can be devastating for the person affected and
their loved ones.
• Serious brain illnesses such as bi-polar disorder, depression and schizophrenia
interfere with a person’s thoughts, moods, motivations, and one’s sense of self.
• Mental illness can strike anyone.
• Society has stigmatized and discriminated against mental illness for thousands
of years. Only recently have we come to think of brain disorders as serious
medical conditions.
• This breakthrough in knowledge and understanding has improved the lives of
those affected and opened the door for important research.
• With treatment and support persons affected by mental illness lead productive
and fulfilling lives.
32
How We Came to Be
• National: In April 1979, in Madison, Wisconsin, 6 independent support
groups for parents of adults with mental illness joined forces and formed
NAMI.
• State: 30 people from Michigan were among the 284 present.
• This pattern of joining together continued as advocacy groups
throughout the state of Michigan formed NAMI Michigan with
incorporation on January 10, 1986.
33
How We Came to Be
• Local: NAMI Washtenaw County started in 1984 and was originally
called, “Friends for Mental Health: Association for the Mentally Ill of
Washtenaw County.”
• “It was quite a wrench – but generally liberating – to learn … to think of
mental illness as a no-fault brain disorder. So we asked questions, told
our stories, got better acquainted, and pondered the views and
suggestions offered for discussion. Eventually it was decided to form
an organization with the general aim of improving conditions for persons
with mental illness.”
“History of NAMI Washtenaw County” by Carol Rees.
• We are one of 32 NAMI Michigan Affiliates.
34
Our Organization
• Approximately 275 Members
• Primary sources of revenue come from:
Washtenaw County Health Organization (WCHO)
– Membership Dues
– Charitable Gifts
–
• Two part-time office staff and many volunteers.
• Like the national and state organizations, NAMI Washtenaw County is a
grass-roots organization. We turn to each other for support.
35
Examples of What We Do
•
Information: 734-994-6611 – website: namiwc.org (Has links to NAMI
National and NAMI Michigan websites.) On Facebook and Twitter.
•
Quarterly newsletter
•
“Mental Health Matters” period public education/awareness programs
•
Family education
•
Annual conference: “Paths to Recovery”
•
Four monthly support groups
•
Parents and Teachers as Allies
•
Advocacy
36
Facts about Mental Illness: There is
Hope
People who have mental illness can and do recover.
“Things are getting better. This is the best time in the history to have
this disorder, not that it is a good thing to have, but it is a lot better now
than it would have been 15-20-50 years ago.”
Frederick J. Frese, Ph.D.
Increasingly, people with mental illness and their loved ones are
learning to live rich, full lives with support and effective therapies.
37
Facts About Mental Illness
What are some examples of mental
illness/serious brain disorders?
o
o
o
o
Bipolar Disorder
Schizophrenia and Schizoaffective Disorder
Major depressive Disorder
Borderline Personality Disorder
38
Facts About Mental Illness
• Brain disorders are common in the United States and
internationally. What is the percentage of people in the U.S. who
suffer from some form of mental illness in a given year as defined
by the Diagnostic and Statistical Manual of Mental Disorders
(DSM)?
• An estimated 26.2 percent of Americans ages 18 and older — about
one in four adults — suffer from a diagnosable brain disorder in a given
year according to the National Institute of Mental Health (NIMH).
• According to the 2004 U.S. Census residential population estimate for
ages 18 and older, this figure translates to 57.7 million people!
• Mental illness impacts everyone in our society.
39
Facts About Mental Illness
Prevalence of Mental Illness in the U.S. Among Adults in
a Year
Total U.S. Population:
Adult Population:
311+ Million
235+ Million
Major Depressive Disorder
Bi-Polar Disorder
Schizophrenia
6.7%~15.75 Million People
2.6%~6.11 Million People
1.1%~2.59 Million People
Source: NIMH and U.S. Census
40
Facts About Mental Illness
The Impact of Mental Illness on Society is Immense
• The burden of mental illness on health and productivity (“disease
burden”) in the United States and throughout the world has long been
underestimated.
• According to a massive “Global Burden of Disease” study, mental
illness, including suicide, accounts for over 15 percent of the burden of
disease.
• This is more than the disease burden caused by all cancers.
41
Facts About Mental Illness
• The stigma of mental illness affects those who are ill and their loved ones.
• Mental Illness is an Equal Opportunity Brain Disorder.
• Many people in all walks of life recovering from mental illness do not “go public.”
42
Facts About Mental Illness
The Stigma and Discrimination of Mental Illness is Very Real
“People come up to me after my speaking and say I have the same condition as
you but I would never tell anyone.” - Frederick J. Frese, Ph.D.
Despite her very public "coming out," Kay Redfield Jamison still counsels
caution to those considering revealing their illness to employers and others.
Her emphasis is on encouraging people to acknowledge their mental disorders
to themselves, and to get treatment. Says Jameson:
“There's no excuse in this day and age for seventeenth-century notions of
mental illness… If you don't discuss it and don't seek treatment, you can die,
and ruin a lot of lives around you.“
Unfortunately, the longer one goes without treatment the harder it is to fight
back.
43
Facts About Mental Illness
Approximately what is the life expectancy for people with major
mental illness?
• The life expectancy for people with major mental illness is 56 years
(The average life expectancy in the U.S. is 77.7 years.).
• Each year, there are nearly twice as many suicides (33,000) as
homicides (18,000) and more than 90% of people who kill themselves
have a diagnosable mental disorder.
• Mental disorders and substance abuse are the leading cause of
disability in the United States and Canada.
• To this list we can now add another statistic…
44
Facts About Mental Illness
• According to the Treatment Advocacy Center (TAC), people with mental
illness are three times more likely to be in the criminal justice system
than hospitals.
• There are several complicated reasons for this, but perhaps most of all
this statistic reveals the lack of available beds for people with mental
illness requiring hospitalization.
• According to the TAC report, “America’s jails and prisons have become
our new mental hospitals.”
“It is time to turn the corner, not the key.”
Dr. Thomas Insel, Director, National Institute of Mental Health
45
Children and Adolescents: Why is
Mental Illness Difficult to Diagnose?
• Mental illness in youth is a “moving target.”
• Especially with children, defining what is “normal” or typical
for each child.
• Hard to differentiate between willful behavior and
symptoms.
• No conclusive blood tests or x-rays.
• Mental Illness treatment is an inexact science.
46
Today’s Situation
• 21 % of youth aged 13-18 live
with a mental illness severe
enough to cause significant
impairment in their day-to-day
lives. (About 8% have serious
mental illness that substantially
limits their day-to-day
functioning.)
• 50% of all lifetime cases of
mental illness begin by age 14
and 75% by age 24.
• The average delay between
onset of symptoms and
interventions is 8-10 years.
• Only 50% of youth with mental
illness receive treatment (2/3 of
adolescents do not receive
treatment).
47
Today’s Situation
• Untreated mental illness can lead to drug and alcohol
abuse, violence, school failure, involvement with criminal
justice, social isolation, homelessness and suicide.
• Approx. 50% of students aged 14 and older with mental
illness drop out of high school – the highest dropout rate of
any disability group.
• 70% of youth in state and local juvenile justice systems
have mental illness, with at least 20% experiencing severe
symptoms.
• This is what can happen for many youth when they
aren’t connected with mental health services.
48
Suicide Prevention is Critical
•
•
3rd leading cause of death in youth and young adults aged 15-24
90% of those who commit suicide had an underlying mental illness.
Common Suicide Warning Signs:
• Talking about hopelessness, worthlessness, being a burden to others, feeling
trapped or having no reason to live.
• Having no motivation or losing interest in activities once enjoyed.
• Withdrawing or feeling isolated.
• Sudden change in personality or behaviors.
• Giving away possessions, behaving recklessly.
• Talking about death or not being here tomorrow. Looking for ways to kill
oneself such as searching online or buying a gun.
These signs require immediate action. Take them seriously to save a
life. Call Access 734.544.3050 or 800.440.7548 (On handout).
Today’s Situation: Summary
•We need action and a national
commitment to early identification and
intervention.
Early identification and early intervention
improves lives. Treatment works.
Families need access to an array of
effective mental health services.
Children represent 100% of our
future.
Parents
• It’s not your fault.
• Trust your instincts.
• Seek many resources.
• Be there as an advocate.
Teachers/Schools/Service
Providers
• Remove feelings of blame.
• Acknowledge denial and anger (from parents and students) as normal.
• Communicate empathy and compassion for the parents’ dilemma.
• Help de-stigmatize mental illness.
• Emphasize that early intervention and treatment are essential protective
steps for their child.
• Be particularly sensitive to parents with special needs and concerns.
• Provide parents with resources: Tell them education is the key to
understanding.
10 Common Warning Signs of a
Mental Illness
1. Feeling very sad or withdrawn for more than 2 weeks (e.g., crying
regularly, feeling fatigued, feeling unmotivated).
2. Seriously trying to harm or kill oneself or making plans to do so.
3. Severe out of control, risk-taking behaviors that can cause harm to
self or others.
4. Sudden overwhelming fear for no reason, sometimes with a racing
heart, physical discomfort or fast breathing.
5. Not eating, throwing up or using laxatives to lose weight; significant
weight loss or weight gain.
10 Common Warning Signs of a
Mental Illness
6. Severe mood swings that cause problems in relationships.
7. Repeated use of drugs or alcohol.
8. Drastic changes in behavior, personality or sleeping habits (e.g.,
waking up early and acting agitated).
9. Extreme difficulty in concentrating or staying still that puts a person in
physical danger or causes school failure.
10. Intense worries or fears that get in the way of daily activities like
hanging out with friends or going to classes.
Summary: Pay attention to severity and duration.
What Should You Do?
• Connect with parents and consider recommending that they start with
the student’s family physician.
• Inform appropriate school personnel.
• Educate Yourself
– Be aware of available community resources
– Learn how you can best respond to help your child and yourself
• You are not expected to be a diagnostician nor a treatment provider.
• Parents: Consider wellness practices that may help relieve symptoms
Wellness Practices to Consider
• Decrease Stimulation
Emotional – Criticalness, anger
– Environmental – screen time (APA recommends limiting to 1 hr/day)
–
• Sleep/naps
• Outdoor activity and exercise – “think of it as medication”
• Diet - many studies show good diets may decrease symptoms
Reduce refined sugar, “Junk food”, caffeine
– Ensure adequate protein.
– Vitamin D is considered neuroprotective
– Gluten or dairy allergy? – common and may cause symptoms
–
Our Organization, Programs and
Services
Comments from NAMI Members
• “The NAMI people helped me cope with a very difficult situation.”
• “Helped me learn more about what is happening to me.”
• “The group interaction was comfortable.”
• “I learned a lot about the importance of medications and other
therapies.”
• “I particularly liked the chance to be with other people in similar
circumstances.”
57
Hope is Everywhere
• Mental Illness can affect anyone and it impacts all of us.
• NAMI Washtenaw County remains steadfast in our efforts to
improve lives.
• Please help us continue to continue to educate and inspire
acceptance and understanding of mental illness.
• Thank you.
58
59
Helpful Websites and Resources
• NIMH.NIH.gov (National Institute of Mental Health – National Health
Institute – also has link to current research projects
• HealthyPlace.com
• MindsontheEdge.org
• TreatmentAdvocacy.org
• PeteEarley.com
• Samhsa.gov (Substance Abuse and Mental Health Services
Administration
• National Suicide Prevention Hotline – 1800-Suicide
60
For More Information
• Contact NAMI Washtenaw County…
• On Line: [email protected]
• Or call Barb Higman, Office Manager @ 734-994-6611
61
"Our Greatest Glory Consists Not In Never
Falling; But In Rising Every Time We Fall."
~ Emerson
62
“The deepest principle in human nature
is the craving to be appreciated.”
William James
63