What makes NAMI Education Programs unique and effective? The Trauma Learning Model

1. What makes NAMI Education Programs unique and effective? The Trauma Learning Model

2. Once upon a time….. Historically, families have been blamed for causing mental illness in their loved ones. Historically, people with mental illnesses have also been blamed for their conditions.

3. Stigma- What we are up against One psychiatrist’s evaluation of a man diagnosed with severe and persistent psychotic mania, 1997: “He tests in the superior range of intelligence, but has a passive aggressive personality. It is based upon very infantile egocentric ideas in which he is maximizing the secondary gain related to his disability in quite a manipulative fashion. He is heavily enmeshed in patterns of family pathology, particularly in relationship to his mother. He is unlikely to benefit from therapy unless he is willing to disengage himself from this family and maintain an independent life style.”

4. Theories of family blame resulting from STIGMA • Overprotective parents (usually mothers) • Cool or indifferent parents • Families who enable the “bad” behavior • Families who sabotage treatment • The family is dysfunctional so the child never stood a chance • It must be the parent’s fault!

5. Psychiatrist’s evaluation of a man diagnosed with severe and persistent psychotic mania, 1997 “He tests in the superior range of intelligence, but has a passive aggressive personality. It is based upon very infantile egocentric ideas in which he is maximizing the secondary gain related to his disability in quite a manipulative fashion. He is heavily enmeshed in patterns of family pathology, particularly in relationship to his mother. He is unlikely to benefit from therapy unless he is willing to disengage himself from this family and maintain an independent life style.”

6. NAMI Education Programs break away from the notion that anyone is to “blame” for mental illness

7. What we DO believe: • Mental illnesses are biologically based brain disorders that can have environmental triggers. They are not the fault of the family, or the individual with the illness. 2. People with mental illness and their families are often stigmatized. 3. The onset of an episode of mental illness is deeply traumatic and disrupts every area of the life of the individual affected and their family. 4. Mental illnesses are catastrophic stressors.

8. What is a catastrophic stressor? • An unanticipated event • No time to prepare for it • No previous experience about how to handle it • Has a high emotional impact • Involves threat or danger to self or others

9. Typical responses to the trauma of a catastrophic stressor: • An unbearable compulsion to undo (“If I had just done __ maybe my child wouldn’t have gotten sick”) • Frozen in time; protective unwillingness to move forward; it might get worse! • Isolation from/by extended family, friends, community – mental illness is not a casserole illness • Embarrassment about talking to others about what is going on, but they are flooded with the need for support • An incessant fear that symptoms will recur or even get worse • A constant flood of mixed up feelings

10. Why NAMI Education Programs use the Trauma Model of Learning? • The experience of mental illness in the family is a catastrophic stressor that is deeply traumatizing to everyone involved • People going through trauma don’t absorb information the same way traditional adult learners do

11. Basic assumptions about traditional adult learners: Imagine that you have just signed up to take an astronomy course. You likely: • Have a genuine curiosity about the subject offered • Are willing to master a comprehensive range of materials • Are ready to learn all the content (This is an intellectual pursuit) • Have the time and energy to take the course

12. Why NAMI program participants are different from traditional adult learners 1) We are not simply curious. Our interest in and response to course topics are highly emotional; we understand the importance of the course but may not wish to be there. 2) We are not ready to learn everything there is to know about mental illness. We are emotionally overwhelmed by the what we already know, much less what we don’t!

13. 3) We are not taking this course as an intellectual pursuit. Our relationship to course topics is intensely personal. It is unlikely that we will be able to take in all of the information presented. 4) We don’t have the energy level or time traditional adult learners typically do. We use most of our time and energy just trying to survive and take care of our family.

14. Basic assumptions about traditional adult educators They have: • A teacherly concern that participants understand everything in the course. • Worry if people don’t understand all the materials presented • Use different teaching methods to accommodate a variety of learning styles (“It is my job to entertain the class.”)

15. Why teachers of NAMI Education Programs are not traditional adult educators 1) We don’t expect our peers to grasp everything that is presented. We are emotional guides. We allow families to take in only the material they are ready to absorb. 2) We fully expect that some folks will zone out, seem to not pay attention, or rest. It is our responsibility share the information we have and keep the climate comfortable for families to take what they need when they need it, recognizing that it is OK for their focus to fade in and out.

16. We don’t use a large variety of learning tools – our participants don’t have time to be entertained NAMI Education programs are purposely designed to be taught as simplistically as possible, so that all our volunteer teachers feel equally prepared and equipped to share vital information with participants while providing the support and safety necessary for people who often would rather be “anywhere but here!”

17. In other words, people dealing with trauma and stress learn differently from others To survive, we typically: • Have a narrow, personal focus • Develop tunnel vision and are very self absorbed • Have radar out only for information and support • Operate from fight or flight mode (look only at what might be helpful to us and leave the rest) • “I need to know X and that’s all” • We are unsure if we want to know what comes next. We are afraid of the unknown.

18. We understand that people taking the course are moving through experiences of trauma. This is NOT a group that can be reached through conventional adult education. We have to find other ways to help families learn what they need to know, and what no one else is telling them

19. Techniques used in NAMI Peer Education 1) Uses an easy to follow lecture and read-along format that, allowing people to take in as much or as little information as they wish 2) Provides Information linking brain illnesses to the body. 3) Teaches coping skills 4) Moves people toward a greater awareness and understanding of their own lived experiences

20. Techniques used in NAMI Peer Education 5) Normalizes thoughts, feelings, body sensations and behaviors connected to mental illness 6) Teaches that recovery is attainable 7) Shows that mental illness symptoms are REAL, not ‘just’ behavioral 8) Provides group support 9) Uses information overload to break through long-held stereotypes

21. Plus, the “comfort” of being read to .... 1) Someone else is in charge, taking the lead 2) Allows for concealment of emotions, and permits “zoning out” 3) Makes available a vast array of information to select from in building one’s personal mosaic 4) Plays into the ability to figure things out on one’s own 5) Eases people into the process of learning

22. Take-home messages 1) The experience of mental illness is deeply traumatic. 2) People attending the course will not approach it as traditional adult learners. 3) You are an emotional tour guide not an adult educator; it’s not your job to make sure they learn everything in your course; it is your responsibility to expose them to the material and show them how to take what they need 4) Don’t worry about teaching aids; trust the process

23. Take-home messages 5) Don’t worry if people space out; that is the plan! 6) Don’t work too hard to MAKE people talk; they’ll talk when they are ready. 7) Be aware of the pull of the group toward a support group format- wanting to” just talk”. This is a class even though we approach teaching in a unique way 8) There is a critical connection between using a scripted manual and our research eligibility. Fidelity, Fidelity, Fidelity!