Crisis Responder Manual Training Pilot: February 27, 2014 Helping You Do a Better Job of Handling

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 ChodronAmerican 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.

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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.

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 bi-polar 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


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.


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.


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.


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.


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.


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.


RESPONDING TO EMAILS

• Ask clarifying questions.

• Offer solutions.

• Thank the person for the email and its contents.

• Other ideas?


IMPORTANT CRISIS CONTACT INFORMATION

• Psychiatric emergency services (PES)

• Community Mental Health Access

• Washtenaw County Sheriff’s Office

• City of Ann Arbor Police Department

• City of Ypsilanti Police Department

• Ann Arbor Veteran Administration Hospital

• NAMI of Washtenaw County

• The NAMI National Information HelpLine

• R U OK? Michigan

• Partners

• CRISIS HOTLINES

• Critical Incident Stress Management

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 15-year 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 1excellent 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.

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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.

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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.

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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.

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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.

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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

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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.

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Facts About Mental Illness

What are some examples of mental illness/serious brain disorders?

o Bipolar Disordero Schizophrenia and Schizoaffective Disordero Major depressive Disordero Borderline Personality Disorder

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• 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.

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Prevalence of Mental Illness in the U.S. Among Adults in a Year

Total U.S. Population: 311+ Million

Adult Population: 235+ Million

Major Depressive Disorder 6.7%~15.75 Million People

Bi-Polar Disorder 2.6%~6.11 Million People

Schizophrenia 1.1%~2.59 Million People

Source: NIMH and U.S. Census

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Facts About Mental IllnessThe 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.

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• 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.”

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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.

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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…

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• 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

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Children and Adolescents: Why is Children and Adolescents: Why is Mental Illness Difficult to Diagnose?Mental Illness Difficult to Diagnose?

• Mental illness in youth is a “moving target.”Mental illness in youth is a “moving target.”

• Especially with children, defining what is “normal” or typical Especially with children, defining what is “normal” or typical for each child.for each child.

• Hard to differentiate between willful behavior and Hard to differentiate between willful behavior and symptoms.symptoms.

• No conclusive blood tests or x-rays.No conclusive blood tests or x-rays.

• Mental Illness treatment is an inexact science.Mental Illness treatment is an inexact science.

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Today’s SituationToday’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).

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Today’s SituationToday’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.

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 We need action and a national commitment to early identification and commitment to early identification and intervention.intervention.

Early identification and early intervention Early identification and early intervention improves lives. Treatment works.improves lives. Treatment works.

Families need access to an array of Families need access to an array of effective mental health services.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

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Our Organization, Programs and ServicesComments 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.”

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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.

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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

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For More Information

• Contact NAMI Washtenaw County…

• On Line: [email protected]

• Or call Barb Higman, Office Manager @ 734-994-6611

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"Our Greatest Glory Consists Not In Never Falling; But In Rising Every Time We Fall." ~ Emerson

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“The deepest principle in human nature is the craving to be appreciated.”

William James

Documents

Crisis Responder Manual Training Pilot: February 27, 2014 Helping You Do a Better Job of Handling