Understanding Mental Illness A Review of the Disorders

1. Understanding Mental Illness A Review of the Disorders

2. Defining Mental Illness Clinical definition : • Clinically significant behavioral problems • Associated with distress (painful symptoms) • Causes disability (impairment in functioning) • A biological illness that responds to treatment • Not to be confused with weakness of character

3. Facts about Mental Illness Has nothing to do with intelligence Can happen to anyone Chronic but not contagious Difficult to diagnose and to treat Treated but not cured Mentally ill are not all dangerous Should not be confused with terms psychopath or sociopath

4. General Signs of Mental Illness Observable Confusion Disoriented Darting looks Talking to self Poverty of Speech Pressured speech Poor hygiene Inappropriate attire Behavior Changes Flat Affect Withdrawn Sad or anxious mood Panic Psycho somatic complaints

5. Schizophrenia Symptoms • Brain disease • Includes psychosis • Impacts 1 out of every 100 people. Does not differentiate across SES • Onset is late teens, early adulthood. • Positive Symptoms include : • hallucinations • delusional thinking • Negative symptoms include • apathy • withdrawal.

6. Schizophrenia Symptoms in Jail • May appear non compliant • Agitated by voices and delusions -may look and act dangerous • Command hallucinations may actually be dangerous • More likely to respond to clear directions, and reassurance in a kind tone of voice • Poor hygiene - Not aware of their surroundings enough to know that they are not clean

7. Mood DisordersMajor Depression Symptoms • Affects 5 percent of the general population • Sad mood that lasts 2 weeks • Loss of interest or pleasure in daily activities • Changes in sleep, appetite, decreased energy • Thought problems affect concentration, memory, decisions, feelings of guilt, worthlessness • Risk of suicide is high • Important to differentiate mental health from physical problems • Responds well to treatment

8. Mood DisordersMajor Depression Symptoms in Jail • Loss of interest in food and self care • May not care about legal situation • Suicide risk is real and must be monitored • Risk of suicide may increase after medication

9. Mood DisordersMania/ Bipolar Disorder Symptoms • Euphoric Mood (elevated, high or happy) • Irritable Mood (touchy) • Three Stages of Mania Hypomania, Acute Mania, Psychosis • Bipolar Disorder - mood swings from depression to mania • Can be Rapid Cycling

10. Mood DisordersMania/ Bipolar Disorder Symptoms in jail • Jail may be the consequence of the disorder • Mood can swing from entertaining to hostile • Talkativeness can be irritating • If depressed, often cry, feel hopeless, become suicidal • Can be restless, pacing, demanding and destructive • Often non-compliant • Can be professional and well-educated

11. Anxiety DisordersPanic Disorders Symptoms • Prevalence is 1 to 2 percent of the population; Women twice as high as men. • Panic attacks occur without warning • Symptoms include intense fear, heart palpitations,chest pain, shortness of breath, dizziness • Person is concerned that the attacks will strike again Symptoms in Jail • Jail environment and structure of holding can induce symptoms • Referral is indicated

12. Anxiety DisordersObsessive-Compulsive Disorder Symptoms • Obsessions are recurrent thoughts, images, impulses that cause anxiety. They are illogical,at times repulsive and/or center on violence or harm. • Compulsions are behaviors that are repetitive - attempts at reducing the anxiety created by the obsessions. Symptoms in Jail • Rarely seen in jail and do not pose high risk

13. Post Traumatic Stress Disorder Symptoms • Exposure to an extremely stressful event. • Painful memories, nightmares,, suspicion, anxiety, depression, feelings of guilt and sleep difficulties • Symptoms worsen with exposure to similar events • Substance abuse is a common method to cope Symptoms in Jail • Jail environment can trigger symptoms • Jail inmates and personnel can trigger symptoms • Lack of privacy and loss of control are issues

14. PersonalityDisorders Inflexible, maladaptive, ways of coping and relating Difficulty in holding steady work and relationships Difficult to change Can co -exist with other mental illnesses Behavior problems precipitate jail Antisocial Narcissistic Borderline Avoidant Paranoid Dependent Schizotypal Schizoid

15. Personality Disorders Predominant disorders in jail are Antisocial and Borderline Jail environment heightens symptoms Effective management requires consistent limit-setting Suicidal risk is real and must be monitored Jail personnel must professionally manage housing unit, inmates and themselves

16. Substance Abuse Symptoms • 85% of jail population have substance abuse problems • High correlation of substance abuse and other mental illnesses Symptoms in Jail • Monitor risk of OD or withdrawal • Monitor abuse of prescription drugs • Can mimic other Mental illnesses • Long term abuse can cause dementia

17. Co-occurring Disorders • Presence of both a mental illness and substance abuse disorder • High prevalence rates • 60% of persons with a mood disorder also have a substance abuse disorder • 50% of persons with schizophrenia also have a substance abuse disorder In Jail - More prone to violence, impulsivity, paranoia and anxiety

18. Common Factors of Mental Illness and Substance Abuse • Brain disorders • Lack of Insight • Chronic • Impacts Family • Shame and guilt • Needs Treatment

19. Dementia and other Cognitive Disorders Symptoms • Memory problems • Confabulations • Impaired thinking • Impaired Judgement Symptoms in Jail • Poor memory and may not follow directions • Treat individual as you would any with adisability

20. Mental Retardation Symptoms • Poor adaptive functioning from birth • Related to intelligence, not thoughts, feelings and behaviors Symptoms in Jail • Not to be confused with mental illness • Requires patience

21. Effective Communication

22. Keys to Communication • Empathy • Warmth • Genuine

23. Promoting Communication Listening:attend to both verbal and nonverbal cues, hear and observe, and avoid distractions Clarification: Restate.Repeat, Clarify, Question Dealing with Silence Respond Effectively Maintain Personal Space Open ended questions Non verbal Cues

24. Basic Communication Guidelines • Short, clear direct sentences • Low stimulation level • Don’t take actions or reactions personally • Simple content • Don’t force communication • Be consistent

25. Basic Communication Guidelines • Be patient • Be pleasant and firm • Praise cooperative behavior • Practice reflective listening • Know your non verbal communication • Person may not “get” all the information

26. Basic Communication Guidelines Short, clear direct sentences Simple content Low stimulation level Don’t force communication if person is withdrawn Be consistent Don’t take actions or reactions personally Person may not “get” all the information you provide Be patient Be pleasant and firm Praise cooperative behavior Practice reflective listening Know your non verbal communication

27. Types of Non-Verbal Communication • Body Posture • Facial Expression • Eye Contact • Gestures

28. Crisis Management

29. Crisis Management • Crisis defined • What is crisis intervention • Recognizing a person in crisis – behavioral and verbal cues

30. Violence The incidence of violence is no greater in persons with mental illness than it is in the general population Incidence increases 60% if the illness is untreated. Substance use greatly increases violence Greatest risk, males in late teens to early 20’s Past behavior best predictor

31. Warning Signs • Tremors • Hyperactivity • Rigid Posture • Clenched jaws and fists • Pulsing arteries • Verbal abuse/profanity

32. Effective Crisis Intervention • Reduce Stress • Force as the last resort • Consider the symptoms of mental illness • Identify precipitating factors • Goal is to de-escalate

33. 5 Stages of Successful Interventions Immediacy- Intervene as soon as possible. Goal is to reduce anxiety. Assume Control - via providing the structure the person needs, not be overwhelming them Assess the situation- let the person talk, watch for nonverbal cues, be a guide and avoid judgements and putdowns Situation Management Post crisis intervention

34. 5 Stages of Successful Interventions Immediacy- Intervene as soon as possible. Goal is to reduce anxiety. Assume Control - via providing the structure the person needs, not be overwhelming them Assess the situation- let the person talk, watch for nonverbal cues, be a guide and avoid judgements and putdowns Situation Management Post crisis intervention

35. Suicide and Suicide Prevention

36. Jail suicide is 9 times higher than general pop. 8 of 10 have given prior warnings Ambivalent about death Ambivalence is not the same as manipulation Most jail suicides are not impulsive Risk does not increase with discussion Facts about Suicide

37. Understanding SI behavior increases prevention! Facts about Suicide • Prior attempts increases risk by 33% • Mental illness increases the risks - • 61% have major depression • 48% have personality disorder • 40% Alcohol use • 10% Anxiety • 6% Schizophrenia

38. Why Jails are Suicide Prone Settings Authoritarian environment Loss of control over future Isolation Shame Dehumanizing aspects of incarceration Fears Police and Jail staff immune to arrest and incarceration Officers and jail staff overlook or misunderstand symptoms

39. Terms related to Suicide • Ambivalence • Ideation • Lethality • Attempt • Gesture

40. Evaluation ToolThe Sad Persons Scale Sex Age Depression Previous Attempts Ethanol Rational Thinking Loss Social Support Losses Organized Plan No Spouse Sickness

41. Why Do People Die by Suicide? • Impulsive • Depressed • Escape from suffering • Communication • Loss of a loved one

42. Understanding Suicidal Thinking • Suicide is a solution to a problem, what is the problem ? • Most suicides are acts to end intolerable feelings • Coping Patterns Fail • “Tunnel Vision” interferes with seeing alternatives • Person feels “unheard” • Ambivalence

43. Recognizing Suicidal Risk In Jail • Psychological Factors • Social Risk Factors • Behavioral Warning Signs

44. Special Features of Jail Suicide Risk Legal Status Factors Time of the year Long Term Factors

45. Intervening Create a safe environment Only one person communicate Talk about plan Emphasize positives Evaluate potential Refer for treatment Do not lie

46. Prevention • Admission Screening • Utilize a formal screening worksheet • Develop tiered assessments - intake, supervisor, mental health professional referral • Observe for risk factors, even after intake • Assure treatment

47. Collaboration and The Team Approach

48. Shared Goals • Diversion of inmates from jail to appropriate community care • Assure adequate mental health care while incarcerated • Assure Continuity of Care for those inmates at the time of their release.

49. Steps to Meeting Shared Goals Screening and identification EvaluationClassification Diversion Crisis Prevention Provision of emergency mental health services Assure care Supervision Suicide Prevention Pre release planning

50. Team Approach Options • Employ Mental Health Staff • Formal Contractual Agreements with Providers • Informal Agreements (MOA)