Supporting the Process of Recovery: EAST Multi Family Group Workshop

What you will learn today

• A definition of mental illness.

• Common false ideas about mental illness.

• Information about specific illnesses and warning signs.

• The importance of getting help and getting it early.

WHAT ARE SOME WORDS USED TO DESCRIBE MENTAL ILLNESS?

What is mental illness?

It’s an illness like any other, and is caused by changes that occur in the brain for a number of reasons.

What does the brain do?

• The brain receives information and makes decisions based on that information…think of a computer. • The brain manages our thinking, behaviors, personality, bodily functions…everything!

What influences our thoughts about mental illness?

Possible influences

• Movies • TV • Radio • Books • Newspapers • Magazines • Songs • Parents’ or friends’ attitudes • Experiences of our community cultures

Media stereotypes affect our behaviors

• People don’t seek help as early as they should due to the media’s negative portrayal of mental illness.

• The media tends to use the wrong words when describing mental illnesses. They often use: • Schizophrenia when they mean

split personality

• Psychopath when they mean

psychotic

• Mental illness when they mean

mental retardation

Real people with mental illnesses

Can you name any well-known people who have a mental illness?

• Artist • President • Author • Actor • Nobel Prize winner • Singer

Common false ideas about mental illness

• People who act strangely are “possessed”. • People with mental illness are violent. • Mental illness is caused by bad parenting. • Mental illness only exists in some cultures. • Kids with mental illness are stupid and “flawed”. • People with mental illness are lazy and can’t work

or learn.

Everybody experiences some symptoms periodically, but that doesn’t mean they have a mental illness…they might be having a bad day or week (vulnerability)

One important word to understand is “psychosis”

What is Psychosis ?

• Changes in the brain alter the way a person experiences the world.

• The person loses touch with reality and feels bombarded by sensations (the brain stops filtering information properly).

• The person may: – Hear and see things that others don’t (hallucinations) – Hold beliefs that are not true (delusions) – Have mixed-up thoughts and speech (disorganization)

Hallucinations

• Hearing or seeing things that aren’t there.

• They seem real and cause real feelings.

• They can be comforting or frightening.

• They can be caused by medical problems: fever, malnutrition, exhaustion, medications, street drugs, brain tumors, etc.

Delusions

• False beliefs • Often kept a secret • Can include ideas of: -being followed -having special powers/abilities -having changes in your body -being someone famous • Develop because the person is afraid.

thought disorder

• Skipping from topic to topic • Joining words because they sound alike • Responding to someone with a response that doesn’t make sense • Not making any conversation

Negative symptoms

• Having little or no emotional expression • Talking very little • Struggling with starting a new project • Struggling with completing goals • Thoughts about life not being worth living

Fact or Myth

Suicides are more likely to occur during the Christmas season than any other time of the year.

Neurocognitive Impairments

• Trouble remember directions or items in a list • Taking a long time to finish a chore or assignment • Very easily distracted Verbal learning, memory, psychomotor speed, vigilance • Often leads to school and work difficulty

RECEPTORS NEUROCHEMICALS RECEPTORS

Healthy cell

RECEPTORS NEUROCHEMICALS RECEPTORS

a brain cell affected with psychosis

Psychosis can develop in…

• Schizophrenia • Bipolar Disorder • Major Depression • Post Traumatic Stress Disorder (PTSD) • Substance use/abuse • Medical illnesses

Schizophrenia

• It is a brain illness that alters • It often starts in the teen years.

• It can be “disabling”.

• Symptoms make everyday tasks hard: – hearing voices that others don’t hear – seeing things that others don’t see – having false beliefs – having jumbled thoughts – acting oddly

Bipolar Disorder

• It is a brain illness that affects moods.

• It runs in families.

• It occurs in young people and adults.

• Moods swing from sadness to unusual levels of happiness and energy.

• The person usually has difficulties with school, work, friends, family members.

Major Depression

• It is a brain illness that affects moods.

• It is not a temporary sadness due to a loss (death of loved one, moving away, etc.).

• The symptoms make everything in life hard…school, work, activities, relationships.

Symptoms of Depression

• Sad, irritable mood • Loss of interest in many daily activities • Weight loss or weight gain • Problems with sleep • Feeling sluggish or tense • Low energy • Feeling worthless or guilty • Poor concentration • Difficulty making decisions • Thoughts of self-harm, death or suicide • Difficulty with school, friends, family, work

hamlet

Post Traumatic Stress Disorder

• Trauma • Re-experiencing • Avoidant • Mood changes • Sleep issues • Hallucinations

People who have schizophrenia, bipolar disorder, PTSD or depression

are at risk for

substance use and dependence.

cannabis

• Very popular with adolescents • Steady increase over the years • Binds to specific parts of the brain • Early cannabis users were more likely to develop a psychoses later in life • People with psychosis and cannabis use have more sympto ms and problems

methamphetamine

• Very addictive substance • Can permanently damage brain cells • Leads to psychosis that can stay for several months • Psychosis can come back even without using just by getting stressed

RECEPTORS NEUROCHEMICALS RECEPTORS

methamphetamine

Some facts about the early stages of psychosis

• The pre-illness period is called the “prodromal” phase.

• Symptoms may be quite obvious or hardly noticeable.

• Symptoms can occur for a few days or many months.

Early warning signs of psychosis

Symptoms occur in combinations, not alone:      Withdrawal from friends, family, activities Difficulty with school, activities, work Sleep and appetite changes Increasing difficulty with concentration Feeling overwhelmed by normal sights, sounds, smells, touch, or movement

Early warning signs of psychosis

(continued)

Marked changes in behavior, thoughts and emotions generally occur, such as:      Seeing objects or people differently, or hearing noises that no one else hears Suddenly feeling afraid for no good reason Having difficulty saying what you want to say because your thoughts are mixed up Acting strangely for no clear reason Having trouble talking with or being around people

What causes symptoms of a mental illness to get worse?

• a lot of stress • substance use and abuse • bad things happening

• waiting to get help

• on-going symptoms that don’t get treated

What helps decrease symptoms?

• getting help early • having good health habits – sleep – nutrition – exercise • keeping stress low • learning ways to deal with stress • staying away from drugs and alcohol • taking medications as prescribed

There are many benefits of identifying and treating symptoms early…

Benefits of early identification and treatment

• better outcomes

• more rapid recovery • healthier brain functioning • no breaks in routines and activities • good relationships with others (friends, family, co-workers, teachers) • less need for medication • less need for hospitalization

Personal experience with Psychosis

• “My Story” • “What I needed” • “What I didn’t need” • “My Recovery and Transition From EAST”.

• EAST Community Network

What Helps?

• The Mainstay of treatment is a Bio Psycho-Social Approach.

– Education – Support – Medications – General health – Occupation of time in a environment that facilitates your strengths – Employment/Education

What is a EAST Counselor?

1) Resource Advocate.

4 Health Care/Insurance 4 4 4 4 4 4 4 4 4 Housing Education/Employment Transportation Leisure/recreation Protection and Advocacy Peer Support Income Support Family Support Supportive Solution Focused Counseling

Emotional Support (Cycle of Emotional Response)

A. Dealing with Catastrophic Events A. Crisis/Shock/Chaos

B. Denial

C. Hoping Against Hope B. Learning to Cope A. Anger/Guilt/Resentment B. Recognition C. Grief C. Moving into Advocacy A. Understanding/Acceptance /Action A.

B.

C.

Needs A.

Support, comfort, resources, crisis intervention, empathy.

Needs A.

Venting, hope, self-care, education, networking, Cooperation from system.

Needs A.

Activism, Restoration of balance in life, responsiveness from system.

Emotional Support

• • • • • •

Ongoing with family even if client’s illness limits insight for treatment Prognosis is poor without support. Families are primary support.

Continue to offer hope…remember the success stories Focus on relationship building, strengths and informal supports Remember the effects of trauma and stigma, people with mental illness are victims of discrimination.

Help individuals live, love and compete in the world, as everyone else.

Stigma and Discrimination

• Less access to health care & education. More likely to be singled out based on stigma that under estimate their abilities.

• Cannot ask for help without others assuming they will need help with everything. Can expect to pay more for cars, homes and furniture due to increased risk of being exploited or mislead.

• Less likely to be taken seriously and more likely to be treated like children.

• More likely to segregated into living, education, work and sport programs, less likely to have access to accommodations necessary.

How to advocate

• • • • • • • • •

Become familiar with eligibility entitlements, the appeal process and agencies services.

Be Persistent.

Make connections early.

Make sure you are communicating with the correct person in the agency.

Be Persistent.

Develop a relationship with agency representative.

Be assertive vs. aggressive or argumentative.

Do Action Plans.

Be Persistent.

What do these medication do?

• Help keeps our body balanced • Interacts with specific chemicals in our brain • Protects our brain from damage • Improves mood, reduces symptoms, restores us to feeling good • Helps the Brain do what it is suppose to do.

RECEPTORS NEUROCHEMICALS RECEPTORS

Healthy cell

RECEPTORS NEUROCHEMICALS RECEPTORS

a brain cell affected with psychosis

RECEPTORS NEUROCHEMICALS RECEPTORS MEDICINE

a treated cell

What are some myths about medication

?

• It will make me a zombie.

• It will change my personality.

• I will be addicted to it.

• The side effects won’t go away.

• Medications are not natural and therefore harmful.

• I will have to take it forever.

• These medicines have never really been tested.

Common Side Effects

• Sleepiness • Fidgety • Weight gain • Lower energy level • Side effects do go away • Side effects are not dangerous in and of themselves • Treatment is a discussion

antidepressants

• Prozac, Lexapro, Wellbutrin • Safe with other medications • Easy to take • Helps sadness, anxiety in 2-8 weeks • Most helpful to take for at least a year • Try to avoid too much alcohol and NO drugs

Mood Stabilizers

• Lithium, Lamictal, Depakote • Safe with other medications • Helps moodiness and irritability in one week to 4 weeks • Most helpful to take for a few years (or longer) • Try to avoid too much alcohol and NO drugs

anti-anxiety

• Ativan, Klonopin • Safe with other medications • Easy to take • Helps anxiety and moodiness immediately • People get used to it and it does not work as well in the long term • NO to drugs and alcohol

atypical neuroleptics

• Abilify, Zyprexa, Risperdal • Easy to take, best at night • Helps moodiness and psychosis, focus and concentration • Safe with other medications • Most helpful to take for 2 to 5 years • No alcohol and drugs

The Role of Healthy lifestyles & Nutrition in Recovery

• Nutrition – Purpose: Fuels and Hydrates the body. It is necessary for tissue maintenance & healing.

– General Healthy Eating Habits • Eat 3 meals a day • Be careful the of the types of fat you eat • Follow a healthy diet • Beware of portion distortion

The Role of Healthy lifestyles & Nutrition in Recovery

• Nutrition (continued) • Be careful of your fluid intake • Water is the most important fluid you can take in.

• Milk is good for children, but should be limited in adults.

• Be careful of your intake of juices, fruit drinks and soda.

• Coffee acts as a diuretic & should not be considered fluid intake.

The Role of Healthy lifestyles & Nutrition in Recovery

• Activity – Purpose: Keeps our body and minds healthy, it reduces stress, improves mental & physical health.

• Children should be active 60 minutes on most days.

The Role of Healthy lifestyles & Nutrition in Recovery

• Vitamins, Dietary Supplements & Natural Substances – Be Careful and know what you are putting in your body and how it may effect you!

How do I get medications?!

• Samples – Short term solution • Insurance – Private, Oregon Health Plan, FHIAP, OMIP • Patient Assistance Programs – Who qualifies and what do I need to apply?

• Oregon Prescription Drug Plans – Can save up to 60% on medications.

Occupational Therapy

Supported Employment

• Job preparation • Job search • Job development • Help staying employed • Benefits counseling

Multi-family Groups

• Clinically proven to be most effective treatment for individuals with psychosis • Creates social networks and teaches skills essential for recovery.

• Reduces Expressed Emotion by teaching healthy and helpful communication.

• Will meet every other week for 1.5 hours for duration of time with EAST • Family Guidelines • The Problem-Solving Method

Effects of EE and medication on relapse in schizophrenia

60 50 40 30 20 10 0 44.3

57.7

High Expressed Emotion

Bebbington and Kuipers, 1994

AP Meds No meds.

18.4

27.9

Low Expressed Emotion

Effects of stress, in general populations

• The negative effects include, initially, – heightened arousal, anxiety and psychosis, then – withdrawal, apathy, depression and – diminished sense of self-worth and self efficacy • The absence of meaningful stimulation can be stressful as well; too little stress can lead to boredom and isolation.

Effects of stress, in general populations

• The positive effects of stress include – growth – reprioritization of goals – increased self-esteem – expanded or strengthened networks; – Other examples?

STRESS=STRAIN OVER AREA

Core Elements

of Multifamily Groups

• Joining • Education • Problem-solving • Multi-family contact

Benefits of Multi-Family Groups

• Networks buffer stress and adverse events.

• Networks and families determine treatment compliance.

• Social support predicts relapse rate.

• Social support is associated with coping skills and burden.

Benefits of Multifamily Groups

• Stigma reversal • Social network construction • Communication improvement • Crisis prevention • Treatment adherence • Anxiety and arousal reduction • Simple Guidelines to follow that work.

The Family Guidelines: Ways to hasten recovery and to prevent a recurrence

.

1. Believe in your power to affect the outcome: you can !

2. Make forward steps cautiously, one at a time.

Go slow. Allow time for recovery. Recovery takes time. Rest is important. Things will get better in their own time. Build yourself up for the next life steps.

3. Consider using medication to protect your future. A little goes a long way. The medication is working even if you feel fine. Work with your doctor to find the right medication and the right dose. Take medications as they are prescribed.3

The Family Guidelines: Ways to hasten recovery and to prevent a recurrence

4. Try to reduce your responsibilities and stresses, at least for the next six months or so.

Take it easy. Use a personal yardstick. Compare this month to last month rather than last year or next year.

5. Use the symptoms as indicators.

If they re-appear, slow down, simplify and look for support and help, quickly.

Learn and use your early warning signs and changes in symptoms. Consult with your EAST counselor or psychiatrist.

6. Anticipate life stresses.

The Family Guidelines: Ways to hasten recovery and to prevent a recurrence

7. Keep it Cool.

Enthusiasm is normal. Tone it down. Disagreement is normal. Tone it down too.

8. Give each other space.

Time out is important for everyone. It’s ok to reach out. It’s ok to say no.

9. Set limits.

Everyone needs to know what the rules are. A few good rules keep things clear.

The Family Guidelines: Ways to hasten recovery and to prevent a recurrence

10. Ignore what you can’t change.

Let some things slide. Don’t ignore violence or concerns about suicide.

11. Keep it simple.

Say what you have to say clearly, calmly and positively.

12. Carry on business as usual.

Reestablish family routines as quickly as possible. Stay in touch with family and friends

The Family Guidelines: Ways to hasten recovery and to prevent a recurrence

13. Solve Problems Step By Step.

Make changes gradually. Work on one thing at a time.

14. Keep a balanced life and balanced perspective.

Keep an outside occupation, but don’t work too hard for a while. Take time to cool out.

15. Watch out of the effects of street drugs and alcohol.

They make symptoms worse and may cause a relapse. Never use meth, cocaine, or hallucinogens! Keep alcohol, nicotine, and caffeine to a bare minimum as hard as it may be.

The Family Guidelines: Ways to hasten recovery and to prevent a recurrence

16. Explain your circumstances to your closest friends and relatives and ask them for help and to stand by you.

Learn to accept support from your network. Decide who you want to know about the situation. Dodge the bad scenes and look for good ones.

17. Don’t move abruptly or far away until stability returns.

If you have to move prepare well in advance. Keep a social network intact and do not try to change it without lots of preparation.

The Family Guidelines: Ways to hasten recovery and to prevent a recurrence

18. Attend the Multi-Family Groups.

Enthusiasm is normal. Tone it down. Disagreement is normal. Tone it down too.

19. Follow the treatment plan.

Follow the recommendations of all of the professionals on your team.

20. KEEP HOPE ALIVE.

The 1st and 2nd Groups

“Getting to know you” • A social group • share personal information • culturally normative introductions • begin to develop trust and understanding “Experience with mental illness” • co-facilitators will share. • personal stories of impact of M.I. are shared • continue to build relationships

Structure of Sessions Multifamily groups (MFG) and single-family treatment (SFT) MFG SFT 1. Socializing with families and consumers 15 m. 10 m.

2. A Go-around, reviewing- 20 m. 15 m.

a. The week's events b. Relevant biosocial information c. Applicable guidelines 3. Selection of a single problem 5 m. 5 m.

4. Formal Problem-solving 45 m. 25 m.

a. Problem definition b. Generation of possible solutions c. Weighing pros and cons of each d. Selection of preferred solution e. Delineation of tasks and implementation 5. Socializing with families and consumers 5 m.

5 m.

Total: 90 m. 60 m.

Types of problem solving



Based on clinical experience and family guidelines



Direct action and intervention by clinicians



Problem is agreed upon by all family members



Problem that is not agreed upon by all family members

Hierarchy for problem-solving

•

Medication concerns

•

Street drug and alcohol use

•

Life events

•

Problems generated by other agencies

•

Conflicts between family members

•

Conflicts with family guideline s `

WHEN & WHERE!?

• 1 st & 3 rd Tuesdays (11-15 years old) – Sheryl & Shawn • 2 nd and 4 th Mondays (16-21 years old) – Kem & John • 2 nd and 4 th Tuesdays (over 21) – Nina & John