Building a Future session outline • Session One - Setting the Scene - developing a framework for understanding mental illness • Session Two - Recovery • Session Three – Understanding psychosis and exploring communication
Building a Future session outline • Session Four – Understanding schizophrenia and the mental health legal system • Session Five – Grief and trauma related to mental illness, understanding depression and anxiety • Session Six – Understanding bipolar disorder, how families can be part of the solution
Building a Future session outline • Session Seven – Understanding dual diagnosis, mental health systems and the National Disability Insurance Scheme • Session Eight - Understanding borderline personality disorder and taking care of yourself • Session Nine - Advanced communication skills
Building a Future session outline • Session Ten – Acknowledging grief and gaining strategies to continue the journey as a carer • Session Eleven – Managing the fear of suicide • Session Twelve – Developing a Wellness Recovery Action Plan (WRAP)
The stress-vulnerability coping model HIGH Risk of developing psychosis and Risk of having a relapse LOW Protective Factors good coping skills, social supports, appropriate medication, safety, cultural support Risk Factors learning difficulties, poor social skills, poor coping skills, drug/alcohol use, low social supports, major life events, family history of mental illness, no treatment, poverty, migration, cultural alienation
Mental illness and the brain • Learning about brain biology can: • give information from a biological and medical perspective (and some idea of its complexity) • help you understand and support treatment • assist you in dealing with the stigmas of mental illness • support the realisation that no one is to blame for the onset of mental illness
Cycling forward TIME
Key features of a recovery process • Personal growth • Hope • Understanding and acceptance • Active coping • Withdrawal to engagement and active participation in • life • Active experimentation • Rebuilding a sense of identity • Connecting and contributing • Recovery is a complex journey
Beliefs that support recovery • Recovery is always possible • Recovering is a truly unifying human experience • Each person’s recovery process is unique • Recovering is not a linear process • Recovering does not necessarily mean that symptoms cease • Developing a meaningful contributing life
Peer support ‘Recovery in peer support comes from seeing ourselves as human beings rather than as mental patients’. • ‘By building trust and sharing experiences we are able to move beyond our perceived limitations, old patterns and ways of thinking about our mental health and the mental health of others…. into a culture of health and ability’.
Wellness Recovery Action Plans • Plans cover aspects of: • Wellness toolbox (your collection of skills, habits, books & other helpful things) and daily maintenance plan • Important people to contact for support • Triggers and early warning signs • When and who to contact for medical intervention • Crisis and post crisis planning
Separating the illness from the person • Provides a framework for: • Not engaging with the illness • Avoiding conflict that can’t be resolved • Allows for more compassion towards a person • Allows for the expression of negative feelings about the illness • Allows you to be think in terms of strategies and be in more control of your actions and emotions
Substance induced psychosis • Positive symptoms of psychosis • Triggered by use of drugs or alcohol and occurs when withdrawing from the substance or soon after • Person recovers when substance is no longer in body • Increased vulnerability to psychosis in future if the drug is reused • Caused by heroin, cocaine, alcohol, marijuana, amphetamines and benzodiazepines • Diagnosis will not be altered until a significant drug free period has elapsed without symptoms abating
Biopsychosocialtreatment of psychosis • Medication may be used to manage and reduce symptoms • Hospitalisation may occur when a person is unsafe, others are unsafe and/or to treat serious physical conditions alongside symptoms of the psychosis • Rehabilitation and recovery orientated services include individual support in daily living, support to identify goals and aspirations in life, support to use personal resources and community supports to achieve these goals, support with identified need such as housing, employment, peer support
Antipsychotic medication • ‘Typical’ antipsyhotics: • Older form of antipsychotics • Generally less effective in treating negative symptoms • Reasons for being prescribed typical antipsychotics include: • Reluctance to take medication and hence a legal order binds a person to take (or be given) medication • Medication has not been reviewed in a long time
Antipsychotic medication • ‘Atypical’ antipsyhotics: • Newer form of antipsychotic • Generally has better results with different side effects • More successful in treating positive symptoms as well as negative symptoms
Taking antipsychotic medications • Trials of medication (alone or in combination) are often needed to determine what works best for each individual • Symptoms can remain even after medication has been started • Waiting to see if the medication is suitable can take time and can therefore be a challenging period
Taking antipsychotic medications • Other medication (often sedating) may be prescribed for problems such as agitation, anxiety and sleep disturbance • Medication may also be prescribed to reduce the side-effects of antipsychotics • Ongoing medication treatment is often recommended if a person has more than one psychotic episode or has not recovered fully from a first episode
Why use effective communication • To give clarity • To assert the rights and needs of yourself and other family members • To reduce conflict • To enhance relationships • To model skills • To develop skills which reduce stress and risk of relapse
Assertiveness • The right so say ‘no’ • The right to say ‘yes’ and ‘no’ • The right to say ‘I don’t understand’ and ‘I need some time to think about that’ • The right to make your own decisions • The right to change your mind • The right to hold your own opinions and beliefs
Issues that reduce effective communication • Lack of skills • Strong emotions • Indecision • Unhelpful Environment
Communication skills • Levelling - Effective communication can only occur when both parties know all the relevant information (thoughts, feeling and facts) • Listening - This skill not only involves hearing, but actively processing what others say • Validating - This skill involves communicating to the other person that you have heard their position or opinion • ‘I’ statements – When you communicate how you feel to someone, make a request, or say ‘no’ to a demand, begin what you say with the expression ‘I’.
Example of effective communication ‘I feel worried and frustrated when you don’t take your medication because it is an important aspect in the management of your illness (‘I…’ statement). I understand that you may have concerns about the side-effects of the medication (validation) and I am here to support you and listen if you need someone to talk to (willingness to listen).’
Communicating with professionals • Learn as much as you can about the service and how it functions • Offer any information that seems relevant • Plan your questions and what you want to say • Be familiar with confidentiality policies • Be factual and clear in your conversations • Request meetings to help with communication • Remember to thank people for their time and effort • Recovery from illness will take teamwork
Communicating with crisis teams • Describe the previous diagnosis (if any) and current symptoms • Describe the positive symptoms • Describe any suicidal thoughts or actions • Tell the crisis team about medication • Explain your experience of the illness in the past
Who to call when in crisis • The police respond to events in which there is any form of danger – along with the local crisis team. When you call the local crisis team on these occasions: • The local crisis team should take responsibility to engage the police if they think it is necessary • If there is extreme danger it would be sensible to call the police directly yourself • You might want to call the local crisis team after your call to the police to ask them to attend as well
Understanding the crisis team response • Is the response inappropriate for the symptoms? • Are the symptoms not severe enough? • If so, what would indicate that they were severe enough (or when would the local crisis team become involved?) • What should you do in the meantime? Are there other services that could be appropriate?
Tips for seeking service • If possible call services at non-crisis times, this allows you to think more clearly, relay the symptoms and describe the situation in a calmer way • Consider visiting your GP, they are able to make direct referrals to the crisis team • Consider taking the person to the emergency department of a general hospital
What to tell the police • That there is a history of mental illness • Of previous times of being taken to hospital by police, how it was done and how effective it was • Whether there is any danger to the police
If you are unhappy about your experiences with an area mental health service • Document your experiences to date • Request a meeting with the professionals involved and discuss the issues • If the issue is still unresolved you may consider taking further action
Home activity • Think about: • One area of communication that you have a problem with • What we have learnt about communication today • What communication strategy might be suitable • Attempt the communication • Report next week on the outcome
Positive symptoms of schizophrenia • Positive symptoms - the excess or distortion of normal functions. • These can include: • Hallucinations (distortions of the senses) • Delusions which are fixed and false beliefs • Disorganised thinking and speech • Disorganised behaviour, eg. dressing in an unusual manner
Negative symptoms of schizophrenia Negative symptoms reflect a loss of normal function. These can include: • Diminished range of emotional expressiveness most of the time • Reduced speech/quieter • Inability to initiate and sustain goal-directed activities • Feelings of emptiness, reduced sense of self worth • Lack of energy and reduced motivation • Flat mood (flattened affect)
Cognitive symptoms of schizophrenia • Cognitive symptoms reflect an impairment of a person’s usual level of thinking. These can include: • Impaired working memory • Impaired information processing • Problems with concentrating • Impaired ability to regulate behaviour based on social cues.
The pattern of schizophrenia • Most commonly schizophrenia develops in the following pattern: • Prodromal phase • Withdrawal and social isolation • Irritability • Change in usual behaviours/interests • 2. Active phase • Characterised by the development of the psychotic symptoms. • 3. Stable phase • Period where psychotic symptoms begin to remit and rebuilding of • functioning occurs
Outcomes of schizophrenia • 45% have complete or partial recovery after one or more episodes • 20% have unremitting symptoms and increasing disability • 35% have varying degrees of remission and exacerbation
Social effects of living with schizophrenia • Social stigma • Social isolation • Physical co-morbidities • Substance use • Socio-economic disadvantage • Increased risk of suicide
Violence and schizophrenia • There is a 0.1% increased rate of violence to others. • Risk factors for being violent to others include: • Being male • Substance use • Active psychotic symptoms • Previously violent • Previous victim of violence • Violent acts are often committed in private against people known to the perpetrator (commonly women).
Social impacts of schizophrenia on families • Social stigma • Financial strain • Emotional distress • Physical illness • Social isolation