Transcript No Slide Title

Blue Roses and Jonquils:
The Stigma of Mental Illness*
34th Annual I&R Training and Education
Conference
New Orleans, Louisiana
Tuesday, May 22, 2012
2:15pm - 3:45pm
*With apologies to Tennessee Williams
John Plonski – Facilitator
Director of Online Supervisors
IMAlive National Hopeline Network
[email protected]
Paper-free
Workshop
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Some questions to start…
What would you like to take away from today’s
Psst…Keep in
session?
mind not having
an attitude is an
attitude!
What attitudes do we have
about those with mental health disabilities?
How do our attitudes affect those with
mental health disabilities with whom we
interact?
What questions do you have?
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Let’s look at some
numbers*.
Mental disorders are
common in the United States
• About 1 in 5 adult Americans ages 18 and older
suffer from a diagnosable mental disorder in a given
year.
• This figure represents 20% of the population and
translates to approximately 62 million people
nationally.
• Statistics show that only one-third of these
individuals seek treatment.
* Statistics derived from:Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV
disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.
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Some more numbers.
• 1 in 17 Americans suffer from a
serious mental illness.
• 45% of those with any mental
disorder meet criteria for 2 or more disorders, with
severity related to comorbidity.
• Mental disorders are the leading cause of disability
in the U.S.
• The cost of mental health services is approximately
$69 billion* in the United States.
• Indirect costs*, (lost productivity at the workplace,
school, and home) is an estimated at $78.6 billion.
* According to the National Alliance for Research on Schizophrenia and Depression (NARSAD).
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Some more numbers.
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As it relates to I&R you need to
realize…
• The numbers indicate that you will at
some time, interact with a consumer with
a mental disorder…In fact, you may know
someone with a mental disorder
• Mental illnesses are medical conditions. Just as
diabetes is a disorder of the pancreas, mental illness
is a medical condition affecting the brain making it
difficult to cope with the ordinary demands of life.
• They are biologically based brain disorders. They
cannot be overcome through "will power" and are not
related to a person's "character" or intelligence. 6
Let’s stop for a moment
and look at this list… Your
thoughts…
•
•
•
•
•
•
•
•
Avoidance
Delusions
Denial
Displacement
Dissociation
Hallucinations
Intellectualization
Isolation
•
•
•
•
•
•
•
Projection
Rationalization
Reaction Formation
Repression
Somatization
Splitting
Suppression
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While we may think
it is, the list is not a
list of mental
disabilities.
It is actually a list
of symptoms of
various mental
disabilities. And it
is also…
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Perhaps more
importantly…It is a
list of coping
defenses we all use
when confronted by
stress.
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• In our “normal” lives what we think, feel, and the way
we behave are in a homeostatic balance referred to as
the “Normal State”.
• In the Normal State there is a complimentary
balance between a person’s thoughts, feelings and
behaviors.
• In the crisis state there is imbalance between a
person’s thoughts, feeling and
behaviors triggering stress.
• Stress is the brain’s response to a
stimulus (change) characterized by
a physical and psychological arousal
response.
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Like this
brain?
Close…
But not quite.
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Confronted by stress we engage in basic
physical and psychological responses.
When a disruption of the Normal State triggered by
alarming experiences, real or imaginary. The body
reacts releasing epinephrine (adrenaline),
norepinephrine, cortisol and
cortisone. This leaves the
lower brain functions in control
inducing three possible
responses to the stressor…the
Primal Coping Defenses.
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Primal Coping Defenses…
Stressor induces one of three
responses
Fight
Flight
Freeze
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Then the brain engages in
what we will term
Autonomic Coping Defenses.
Autonomic Coping Defenses protect the
individual from consciously experiencing
anxiety and engage automatically when
the homeostatic balance is upset. 14
The Autonomic Coping
Defenses
•
•
•
•
•
•
•
•
Avoidance
Delusions
Denial
Displacement
Dissociation
Hallucinations
Intellectualization
Isolation
•
•
•
•
•
•
•
Projection
Rationalization
Reaction Formation
Repression
Somatization
Splitting
Suppression
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Yet only 1/3 of those
affected by mental
illness seek and receive
help. How can this
be?
Although there are
other issues, stigma is
the major factor
preventing people from
seeking the help
available to them.
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Stigma is a very real
problem for people who have
a mental illness.
• Based on stereotypes, stigma is
a negative judgment based on a personal
trait and myths accepted as fact — in this case,
having a mental health condition.
• It is a common perception that having a mental
illness is due to some kind of personal or moral
weakness or the person is not “normal”.
• Unfortunately stigma frequently blocks people from
getting the help they need.
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For the person with a mental
illness stigma has several
harmful effects including…
• Trying to pretend nothing is wrong
• Refusal to seek treatment
• Rejection by family and friends
• Work or school problems or discrimination
• Difficulty finding housing
• Being subjected to physical violence or harassment
• Inadequate health insurance coverage of mental
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illnesses
However…
• We now know that mental health
disorders have a biological basis and
can be treated like any other health
condition.
• Even so, we still have a long way to go to overcome
the many misconceptions, fears and biases people
have about mental health, and the stigma these
attitudes create.
• Let’s look at and debunk some of the myths
contributing to the sigma surrounding mental disability.
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Let’s do some myth/stigma
busting!
• Myth: Psychiatric disorders are not
true medical illnesses like heart disease
and diabetes. People who have a
mental illness are just "crazy.“
• Reality: Brain disorders, like heart disease and
diabetes, are legitimate medical illnesses. Research
shows there are genetic, environmental and
biological causes for psychiatric disorders, and they
can be treated effectively.
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• Myth: People with a serious mental illness, such as
schizophrenia, are usually dangerous and violent.
• Reality: Statistically the incidence of violence in
people with a brain disorder is not much higher than
the general population’s. Those with a psychosis are
more often frightened, confused and despairing than
violent. In fact, people with mental illnesses are much
more likely to be the victims of crime.
• Myth: Mental illness is the result of bad parenting.
• Reality: Experts agree that a genetic susceptibility,
combined with other risk factors, leads to a
psychiatric disorder. In other words, mental illnesses
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have a physiological cause.
• Myth: Depression results from a personality
weakness or character flaw. People who are
depressed should just snap out of it!
• Reality: Depression has nothing to do with being
lazy or weak. It results from changes in brain
chemistry or brain function, and medication and/or
psychotherapy often help people to recover.
• Myth: Depression is a normal part of the aging
process.
• Reality: Depression is not part of the aging
process. However, the elderly can have depression
and seniors and their family members should seek
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professional help if they suspect depression.
• Myth: Mental illnesses do not affect children or
adolescents. Any problems they have are just a part
of growing up.
• Reality: Just like seniors, children and adolescents
develop mental illnesses. One in ten youth has a
mental disorder. However, only about 20 percent of
these children receive needed treatment.
• Myth: Addiction is a lifestyle choice. People with a
substance abuse problem are morally weak or "bad“.
• Reality: Addiction is a disease that generally results
from changes in brain chemistry. It has nothing to do
with being a "bad" person.
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• Myth: Schizophrenia means split personality, and
there is no way to control it.
• Reality: Often confused with multiple personality
disorder schizophrenia is disorder that prevents clear
and logical thinking. Symptoms range from social
withdrawal to hallucinations and delusions. Medication
helps many to lead fulfilling, productive lives.
• Myth: If you have a mental illness, you can will it
away. Being treated for a psychiatric disorder means
you failed or are weak.
•Reality: A serious mental illness cannot be willed
away. Ignoring the problem does not make it go away,
either. It takes courage to seek professional help. 24
• Myth: People with mental illnesses cannot tolerate
the stress of holding down a job.
• Reality: All jobs are stressful to some extent.
Anybody is more productive when there's a good
match between the employee's needs and the
working conditions, whether or not the worker has a
mental health problem. Employers who have hired
people with mental illnesses report good attendance
and punctuality as well as motivation, good work,
and job tenure on par with or greater than other
employees.
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• Myth: Therapy and self-help are a waste of time.
Why bother when you can just take a pill?
• Reality: Treatment varies depending on the
individual. People work with therapists, counselors,
friends, psychologists, psychiatrists, nurses, and
social workers during the recovery process. They
also use self-help strategies and community
supports. Often they combine these with available
medications available.
• Myth: Mental illnesses don't affect me.
• Reality: Mental illnesses are surprisingly common;
they affect almost every family. Mental illnesses do
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not discriminate - they can affect anyone.
Myth: I can't do anything for a person with mental
illness.
Reality: You can do a lot, starting with how you act
and speak. You can create an environment that builds
on people's strengths and promotes understanding.
For example:
• Don't label people with words like “crazy”, “nuts”,
“wacko”, or “loony”.
• Don’t define them by their diagnosis. Use “People
First” language to separate the individual from their
diagnosis. For example a person is not “a
schizophrenic” they “have schizophrenia”.
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In Addition…
• Examine your own attitudes about mental illness
and how they may affect your interactions.
• Learn the facts about mental health and share them
with others - don’t be a myth spreader.
• Treat people with mental illnesses with the respect
and dignity you would accord anyone else.
• Respect the fact that just because some one has a
mental disability it does not mean they have no
abilities.
• Respect the rights of people with mental illnesses.
They have the same guaranteed rights to housing,
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employment, healthcare, or education as anyone else.
And to sum it all up…
• Most people diagnosed with a serious mental illness can
experience relief from their symptoms by actively participating
in an individual treatment plan.
• Mental illnesses are treatable! 70% - 90%
of those who receive pharmacological and/or
psychosocial treatment and support show a
major reduction of symptoms and an improved
quality of life.
• Medication need not always be part of the treatment.
Psychosocial treatment such as cognitive behavioral therapy,
interpersonal therapy, peer support groups, and other
community services can also be components of a treatment
plan and that assist with recovery.
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• Early identification and treatment are of vital importance.
So do I have to know about all the
different diagnoses!?! I need to be
able to do differential diagnosis?!?
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Not so much. But inquiring
minds … A list of the basic
disorders*.
Mood Disorders
• Mood disorders include major depressive disorder,
dysthymic disorder, and bipolar disorder.
• Approximately 20.9 million American adults have a mood
disorder.
• The median age of onset for mood disorders is 30 years.
• Depressive disorders often co-occur with anxiety
disorders and substance abuse.
* Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity
Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.
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Mood Disorders
Major Depressive Disorder
• It is characterized by an all-encompassing low
mood and low self-esteem, and by a loss of interest or
pleasure in normally enjoyable activities.
• It is the leading cause of disability in the U.S. for
ages 15-44.
• It affects approximately 14.8 million adults.
• Occurs at any age and is more prevalent in women.
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Mood Disorders
Dysthymic Disorder
• Characterized by a chronic, mild depression that
persists for at least 2 years (1 year in children).
• It affects approximately 3.3 million adults.
Bipolar Disorder
• Characterized by dramatic shifts in mood, energy,
and ability to function often with periods of normalcy in
between. Unlike the normal ups and downs the
majority of us experience, the symptoms of bipolar
disorder are pronounced and severe.
• Bipolar disorder affects 5.7 million adults.
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Schizophrenia
• Characterized by hallucinations, delusions, disordered
thinking, movement disorders, flat affect,
social withdrawal, and cognitive deficits. Individuals are
fearful and withdrawn and have difficulties when they try to
have relationships with others. Affects 2.4 million adults.
• Schizophrenia affects men and women with
equal frequency.
• Schizophrenia often first appears in men in their late
teens or early twenties. Women are generally affected in
their twenties or early thirties.
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Anxiety Disorders
• Anxiety disorders include panic disorder,
obsessive-compulsive disorder,
post-traumatic stress disorder, generalized anxiety
disorder, and phobias (social phobia, agoraphobia, and
specific phobia). Affects 40 million adults.
• Anxiety disorders frequently co-occur with
depressive disorders or substance abuse.
• Most people with one anxiety disorder also have
another anxiety disorder and nearly three-quarters of
those with an anxiety disorder will have their first
episode by age 21.
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Anxiety Disorders
Panic Disorder
• Characterized by repeated, unexpected
episodes of intense fear accompanied by physical
symptoms that may include chest pain, heart
palpitations, shortness of breath, dizziness, or
abdominal distress. Affects 6 million adults.
• Typically develops in early adulthood but the age of
onset extends throughout adulthood.
• About one in three people with panic disorder
develops agoraphobia.
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Anxiety Disorders
Obsessive-Compulsive Disorder
• Characterized by recurrent, unwanted
thoughts (obsessions) and/or repetitive behaviors
(compulsions) affecting 2.2 million adults.
• Symptoms often start in childhood or adolescence.
Social Phobia
• Characterized by overwhelming anxiety and
excessive self-consciousness in everyday social
situations affecting 15 million adults.
• Social phobia begins in childhood or adolescence,
typically around 13 years of age.
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Anxiety Disorders
Generalized Anxiety Disorder (GAD)
• Characterized by chronic anxiety,
exaggerated worry and tension, without little or
nothing to provoke it.
Agoraphobia
• Characterized by intense fear and anxiety of any
place or situation leading to avoidance of situations
such as being alone outside of the home; traveling in
a car, bus, or airplane; or being in a crowded area.
• Specific Phobias involve the persistent fear and
avoidance of specific objects or situations.
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Anxiety Disorders
Post-Traumatic Stress Disorder (PTSD)
• Characterized by persistent frightening
thoughts and memories of a traumatic event.
Individuals feel detached or emotionally numb,
especially with people they were once close to. They
may experience sleep problems, or be easily startled.
Affects approximately 7.7 million adults.
• PTSD can develop at any age, including childhood.
• Frequently follows violent personal assaults, natural
or human-caused disasters, accidents, or military
combat.
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Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder (ADHD)
• ADHD, one of the most common
mental disorders in children and
adolescents,
• It also affects an estimated 4.1%
of adults.
• ADHD usually becomes evident in
preschool or early elementary years, although the
disorder can persist into adolescence and
occasionally into adulthood.
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Autism Spectrum Disorders (ASD)
• Autism Spectrum Disorders (ASDs) cause
impairment in thinking, feeling, language, and the
ability to relate to others. ASDs vary in severity, with
autism being the most debilitating whilebother ASDs
produce milder symptoms.
• A recent study by the CDC reported the prevalence
of autism among 8 year-olds to be about 1 in 110.
• Autism and other ASDs develop in childhood and
generally are diagnosed by age three.
• Autism is about four times more common in males
than females though females tend to have more
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severe symptoms and greater cognitive impairment.
Eating Disorders
Anorexia Nervosa
• Anorexia nervosa is characterized by emaciation,
a relentless pursuit of thinness and unwillingness to
maintain a normal or healthy weight, a distortion of
body image and intense fear of gaining weight
• The mortality rate among females with anorexia
has been estimated to be about 12 times higher than
the annual death rate due to all causes of death
among females ages 15-24.
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Eating Disorders
Bulimia Nervosa
• Bulimia nervosa is characterized by recurrent and
frequent episodes of eating unusually large amounts
of food (e.g., binge-eating), and feeling a lack of
control over the eating. This binge-eating is followed
by a type of behavior that compensates for the binge,
such as purging (e.g., vomiting, excessive use of
laxatives or diuretics), fasting and/or excessive
exercise.
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Eating Disorders
Binge-eating Disorder
• Binge-eating disorder is characterized by recurrent
binge-eating episodes during which a person feels a
loss of control over their eating.
• Episodes are not followed by purging, excessive
exercise or fasting. As a result, people the disorder
often are overweight and experience guilt, shame
and distress leading to more binge-eating.
•Obese people with binge-eating disorder often have
coexisting psychological illnesses including anxiety,
depression, and personality disorders.
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Personality Disorders
Represent a pattern of behavior deviating from cultural
norms but the individual perceives these patterns as
appropriate affecting an about 9.1% of the population.
• Antisocial Personality Disorder is a disregard for social
rules and cultural norms, impulsive behavior, and
indifference to the rights and feelings of others.
• Avoidant Personality Disorder is characterized by
extreme social inhibition, sensitivity to negative evaluation,
and feelings of inadequacy.
• Borderline Personality Disorder is a pattern of instability
of interpersonal relationships, self-image and affects, as
well as marked impulsivity, beginning by early adulthood.
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Alzheimer's Disease
• Affects an estimated 4.5 million Americans. Since
1980 the number of those affected has more than
doubled.
• It is the most common cause of dementia among
people age 65 and older.
• Increasing age is the greatest risk factor for
Alzheimer’s. Usually symptoms first appear after age
65. One in 10 individuals over 65 and nearly half of
those over 85 are affected. Rare, inherited forms of
the disease can strike individuals as in their 30’s and
40’s.
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Alzheimer's Disease
The disease is manifested by both the impaired ability
to learn new or recall learned information and one or
more of the following cognitive disturbances:
• Aphasia (language disturbance)
• Apraxia (impaired ability to carry out motor activities
despite intact motor function)
• Agnosia (failure to recognize or identify objects
despite sensory function)
• Disturbance in executive functioning (i.e., planning,
organizing, sequencing, abstracting)
People diagnosed with the disease survive about half
as long as those of similar age without it.
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Mental Disorders and Suicide
• In 2008, 36,035 (approximately 12 per 100,000)
people died by suicide in the U.S.
• It is estimated the actual number of deaths by
suicide exceeds the reported number by 5% to 25%
(37,493 to 45,971 deaths for 2008).
• More than 90 percent of people who kill themselves
have a diagnosable mental disorder, most commonly
a depressive disorder or a substance abuse disorder.
• While a mental disorder is considered a risk factor
in assessing suicide lethality not all persons affected
by mental disorders are suicidal.
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Signs of Mental Health Disorders Can
Signal a Need for Help
A person is troubled by feeling:
• Sad and hopeless for no reason, and these
feelings do not go away.
• Very angry most of the time and
crying a lot or overreacting to things.
• Worthless or guilty often.
• Anxious or worried often.
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More Signs of Mental
Health Disorders Can
Signal a Need for Help
• Unable to get over a loss or death
• Extremely fearful or having unexplained fears
• Constant concern about physical appearance or
physical problems
• Fear that their mind is out of control or being
controlled
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Clues can be changes, such as:
• Declining performance at work or school.
• Losing interest in things once enjoyed.
• Experiencing unexplained changes in
sleeping or eating patterns.
• Avoiding friends or family and wanting to
be alone all the time.
• Daydreaming too much and not completing tasks.
• Feeling life is too hard to handle.
• Hearing voices that cannot be explained.
• Experiencing suicidal thoughts.
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If the person talks of experiencing
• Poor concentration and is unable to think straight
or make up their mind.
• An inability to sit still or focus attention.
• Worry about being harmed, hurting
others, or doing something "bad".
• A need to wash, clean things, or perform
certain routines hundreds of times a day,
in order to avoid an unsubstantiated
danger.
• Racing thoughts that are almost too fast
to follow.
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And …
• Persistent nightmares. Using alcohol or other
drugs.
• Eating large amounts of food and then purging, or
abusing laxatives, to avoid weight gain.
• Dieting and/or exercising obsessively.
• Violating the rights of others or constantly
breaking the law without regard for other people.
• Setting fires.
• Doing things that can be life threatening.
• Killing animals.
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So what does this mean to me
and my work?
• It is the stigma associated with mental illness that affects us
in our interactions.
• We tend to equate the individual with their illness. A person
is not bipolar. They have bipolar disorder.
• We sometimes assume a person with a mental health
disorder will behave a certain way…the classic assumption
being the person will be violent or dangerous because of their
mental health diagnosis.
• We have to overcome the many misconceptions, fears and
biases people have about mental health. Our own and our
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consumers.
What is our role in working with
people with mental illnesses?
• Our role is to remember the
fundamentals we talked about today in an effort to
overcome the stigma mental illness carries.
• Listen actively to engage the person we
are interacting with
• Be alert to the clues a person may need
help
•
• Enable the person to recognize the
need for help and to empower them to know
that help is available AND effective!
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Well that is all
interesting but I do
I&R…Unless someone
asks me specifically for
a mental health referral
I can’t give them one.
Well we might think that is so
but let’s look at the AIRS
Standards For Professional
Information and Referral And
Quality Indicators…In
particular Standard 4: Crisis
Intervention.
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Standard 4: Crisis Intervention
“The I&R service shall be prepared to assess and
meet the immediate, short-term needs of inquirers
who are experiencing a crisis and contact the I&R
service for assistance. Included is assistance for
individuals threatening suicide, homicide or assault;
suicide survivors; victims of domestic abuse or other
forms of violence, child abuse/neglect or
elder/dependent adult abuse/neglect; sexual assault
survivors; runaway youth; people experiencing a
psychiatric emergency; chemically dependent people
in crisis; survivors of a traumatic death; and others in
distress.”
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We started with a
few
questions…Anymore?
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