Welcome New Employees

1. Welcome New Employees Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases& Co-Occurring Disorders

2. After this training presentation, you will be able to: • Explain the term Serious and Persistent Mental Illness (SPMI). • Discuss psychotic and chronic, serious anxiety and/or mood disorders that are associated with serious mental illness. • Identify signs and symptoms of schizophrenia and bipolar disorder. • Discuss addictive diseases and identify the signs and symptoms of substance abuse and dependence.

3. Serious and Persistent Mental Illness (SPMI) Overview and Definition • People that have serious and persistent mental illness are generally eligible for public mental health services. • They usually require ongoing, long-term treatment. People with severe and chronic mental illness often are coping with psychotic symptoms, severe mood disorders like bipolar disorder or major depression or severe anxiety disorders. • Many of these individuals also have substance abuse problems and some have also been diagnosed with personality disorders, in particular, borderline personality disorder. • When clients are identified as having serious persistent mental illness, they are entitled to specific treatment benefits and services by the state in which they live.

4. Wellness Management and Recovery Planning • Clients should be treated with respect and dignity. This means treating the client the way that you would like to be treated when receiving any type of professional service. • Treatment and services should be client-centered and client-directed. This means the work is focused on the client’s needs and the client is in charge. • Treatment goals are recovery focused. This means helping the client identify and achieve personal goals.

5. “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.”

6. The 10 FundamentalComponents of Recovery • Self-Direction: individual directs their own path of recovery • Individualized and Person-Centered: path to recovery directed by individual’s strengths, needs, preferences, experiences. • Empowerment: Individuals have the authority to speak for themselves and participate in all decision making that will affect their lives. • Holistic: recovery encompasses all aspects of an individual’s life: mind, body, and spirit. • Non-Linear: not a step by step process, but one based on growth, set backs, and learning experiences. • Strengths-Based: focuses on valuing and building on the multiple capacities, resiliencies ,talents, coping abilities and inherent worth of individuals. • Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays important role in recovery • Respect: Community, systems, and societal acceptance and appreciation of clients—including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. • Responsibility: Individuals have a personal responsibility for their own self-care and journeys of recovery. • Hope: Recovery provides the essential and motivating message of a better future—that people can and do overcome the barriers and obstacles that confront them. #11 Resiliency - the ability to “bounce back” after difficult experiences; everyone has the ability to develop resiliencySAMHSA

7. Individuals receiving services are considered to be full partners in the process of recovery from serious mental illness. • In client-centered services, the services are based on decisions made with the client and always in the client’s best interest. • In client-directed services, the services are based on decisions made and goals set by the individual receiving the services • The person receiving services decides which issues will be addressed by mental health services. The person sets the goals (outcomes) toward which the team is working. • Although the treatment team may develop a treatment plan that includes reducing symptoms, and managing the client’s mental illness and its effect on his or her life, these are not the main goals of the plan…only a way to achieve the real goals, which are the client’s goals. • It's not what we think is best for the client, but what the client wants for himself/herself.

8. Treatment Team Services are delivered through teams of individuals with different clinical and rehabilitation strengths and interests. Each team usually consists of: • The client • Case managers • Psychiatrists • Other mental health professionals (psychologists, therapists, social workers) • Other medical professionals (e.g., nurses, pharmacologists)

9. Treatment Services Medication Services • The use of medication is very often needed for clients with serious and persistent mental illness. • Effective treatment requires contact and coordination with medical services providers. • The primary medical care provider should also be informed and involved in the ongoing treatment of clients. This helps the client get and stay healthy. When primary care and psychiatric providers communicate, this avoids the prescribing of medications that do not work well together or might even harm the client. Psychotherapy • Individual, group, and family support/education models are all useful interventions for adults with serious mental illness. • Getting family members involved when appropriate can be an important part of providing support and care for a client, particularly if the client is in crisis.

10. Treatment Services • Research has demonstrated that clients with supportive, involved families have fewer psychiatric hospitalizations. Case managers need to remember that a model of family support and education about the effects of mental illness and the recovery process is an effective tool in working with clients. • Individual and group treatment can be helpful when provided at the client’s level of functioning and phase of recovery. • Clients who are low functioning often need structured, low-demand group treatment that provides support, reality orientation, and activities/recreation.

11. Treatment Services • Social skills training is valuable. Individual work should fit the client’s level of functioning. • This might mean, for example, 20-minute sessions, or perhaps a longer session when it is needed by the client to work on a particular problem. • Psychotherapy is generally best used with clients who can accept and benefit from talk therapy. This approach requires clients to understand how their thoughts, feelings and behaviors affect their ability to get their needs met.

12. Crisis The focus is on crisis prevention rather than crisis response! Crisis prevention is achieved through: • Assessments that look at the whole person and how he or she is functioning in all aspects of life. Understanding early warning signs and triggers for crisis should be part of the assessment process. • Services and contacts with clients should be on flexible schedules or as the need for assistance arises. Walk-in or drop-in appointments and phone lines should be available to a client who may be entering a crisis phase. • Frequent contact with all individuals receiving services. • Tracking and supervision that identifies individuals at risk for crisis (no-shows, anniversaries, etc.). • Adequate continuum of care.

13. Diagnoses It is important to rule out other causes, as sometimes people suffer severe mental symptoms or even psychosis due to undetected, underlying medical conditions or substance abuse. For this reason, a medical history should be taken and a physical examination and laboratory tests should be done to rule out other possible causes of the symptoms before concluding that a person has a particular disorder. Additionally, since commonly abused drugs may cause symptoms that look like a mental health disorder, blood or urine samples from the person can be tested for the presence of these drugs. Many times, one disorder may have similar symptoms to another disorder. Conducting a complete psychosocial history and assessment are also critical steps in making an accurate diagnosis.

14. Schizophrenia • delusions • hallucinations • grossly disorganized behavior and/or speech • catatonic behavior • negative symptoms (reduced emotional expression, social withdrawal, lack of motivation, lack of feeling pleasure, reduced personal self care)

15. Mood Disorders • Manic Episode (3 or more of these symptoms lasting at least a week) • Elevated mood • Inflated self-esteem • Pressured speech • Flight of ideas/racing thoughts • Distractibility • Increased goal directed activity • Expansiveness • Decreased need for sleep • Major Depressive Episode (Five or more of these symptoms lasting at least 2 weeks) • Loss of interest/pleasure • Change in appetite • Depressed mood • Poor sleep or increased sleep • Thoughts of death • Feelings of worthlessness or guilt • Fatigue/loss of energy • Poor concentration

16. Mood Disorders • Bipolar I Disorder • Mood disorder characterized by one or more manic episodes, possibly alternating with major depressive episodes. • Major Depressive Disorder • Mood disorder characterized by one or more major depressive episodes

17. Anxiety Disorders • Panic Disorder Must have had unexpected and recurrent Panic Attacks along with at least one of the following: • Persistent concerns of having more Panic Attacks. • Concerns about the meaning or consequences of the Panic Attacks.( E.g., lose of control, feelings of going "crazy", or of having a heart attack ) • Significant behavioral changes related from the Panic Attacks. • Obsessive Compulsive Disorder • Obsession: Thoughts or impulses that are distressful, persistent and recurrent. • Compulsion: Must show repetitive behavior physical or mental that can not be controlled. • Post Traumatic Stress Disorder • an anxiety disorder that develops after a severe traumatic event or experience.

18. Addictive Disease • When an alcohol or drug user can't stop using alcohol or drugs even if he or she wants to, it's called addiction. The urge is too strong to control, even if the person knows the drug is causing harm. • When people start taking drugs and alcohol, they don't plan to get addicted. However, drugs and alcohol change the brain. People start to need the drug just to feel normal. That is addiction, and it can quickly take over a person's life. • Addiction can become more important than the need to eat or sleep. The urge to get and use the drug or alcohol can fill every moment of a person's life. The addiction replaces all the things the person used to enjoy. Addiction is a brain disease.

19. Addictive Disease • Drugs and alcohol change how the brain works. • These brain changes can last for a long time. • They can cause problems like mood swings, memory loss, even trouble thinking and making decisions. • Addiction is a disease, just as diabetes and cancer are diseases. Addiction is not simply a weakness. People from all backgrounds, rich or poor, can get an addiction. Addiction can happen at any age. National Institute on Drug Abuse

20. Addictive Disease • Substance Dependence:a pattern of substance use leading to significant impairment within a one year period and evidence of three or more of the following criteria: • Increased need of a substance to attain the same desired effect • A markedly diminished effect over time with the same amount of the substance. • Withdrawal symptoms • The substance is taken in larger amounts over time than was intended. • Persistent desire or unsuccessful efforts to cut down or control substance use. • A great deal of time is spent thinking about and getting the substance. • Important activities related to socialization, recreation, work, school, family, etc. are given up in favor of using the substance. • Substance use is continued despite repeated or worsening effects in important areas such as health, family, work/school, financial, social, and legal.

21. Addictive Disease • Substance Abuse: Criteria is met if one or more of the following are experienced within a one-year period: • Repeated use of a substance that causes a person to fail at meeting obligations in major life areas such as work, school, home etc. • Repeated substance use in situations that could be potentially dangerous or lethal such as driving, operating power tools, machinery etc. • Recurrent substance-related legal problems such as arrests for DUI, disorderly conduct, etc. • Continued use despite ongoing social/interpersonal problems caused or exacerbated by the substance, such as fights or arguments with spouse or friends, loss of friends, or isolation.

22. Co-Occurring Disorders • When two disorders or illnesses occur in the same person, simultaneously or one after another, they are called co-occurring. • This also implies interactions between the illnesses that affect the course and prognosis of both. • In particular, many people addicted to drugs or alcohol are also diagnosed with other mental disorders and all illnesses must be treated. • Although substance abuse disorders often occur along with other mental illnesses, this does not mean that one causes the other, even when one comes first. National Institute on Drug Abuse

23. Co-Occurring DisordersCo-occurring disorders can present in a variety of ways. • Primary substance use disorder (with secondary mental health disorder) • Primary mental health disorder (with secondary substance use disorder) • Primary dual disorder (person has both a mental health and a substance use disorder, and they are both primary)

24. Child & Adolescent • Attention Deficit & Disruptive Behaviors • Attention Deficit Disorder • Combined Type • Predominantly Inattentive Type • Predominantly Hyperactive-Impulsive Type • Conduct Disorder • aggressive conduct that causes or threatens physical harm to other people or animals • non- aggressive conduct that causes property loss or damage • deceitfulness or theft • serious violations of rules • Oppositional Defiance Disorder • loses temper • argues with adults • actively defies or refuses to comply with adults' requests or rules • deliberately annoys people • blames others for his or her mistakes or misbehavior • touchy or easily annoyed by others • angry and resentful • spiteful or vindictive

25. Developmental Disabilities • Mental Retardation • Diagnosed during the developmental stage • Disability not disease Epilepsy • Cerebral Palsy • Autism • Asperger’s Disorder • IQ = 70 or lower • Impairments or deficits for that age group in functioning in at last two of the following areas: • Communication • Health • Leisure time • Safety • School • Self-care • Social • Taking care of a home • Work • The onset of impairment must be before the age of eighteen.

26. Questions?