MentalMental IllnessIllness andand DevelopmentalDevelopmental Disabilities:Disabilities: SomeSome BasicsBasics

LaraLara Palay,Palay, LISWLISW --SS MentalMental Illness/DevelopmentalIllness/Developmental DisabilitiesDisabilities CoordinatingCoordinating CenterCenter ofof ExcellenceExcellence MIDDMIDD --CCOECCOE ThisThis materialmaterial isis sponsoredsponsored byby TheThe MentalMental Illness/DevelopmentalIllness/Developmental DisabilitiesDisabilities CoordinatingCoordinating CenterCenter ofof ExcellenceExcellence ““HelpingHelping OhioOhio ’’ss CommunitiesCommunities ServeServe PeoplePeople withwith DualDual DiagnosisDiagnosis ”” http://http:// www.midd.ohio.govwww.midd.ohio.gov

The MIDD -CCOE is funded by the Ohio Departments of Mental Health, Developmental Disabilities and the Ohio Developmental Disabilities Council

Mental Illness/Developmental Disabilities Coordinating Center of Excellence MentalMental IllnessIllness andand DevelopmentalDevelopmental DisabilitiesDisabilities

AboutAbout oneone --thirdthird ofof peoplepeople withwith developmentaldevelopmental disabilitiesdisabilities alsoalso havehave aa mentalmental illnessillness ofof somesome typtype.e.

InIn developmentaldevelopmental centerscenters oror otherother institutions,institutions, thethe numbernumber cancan bebe asas highhigh asas 77 outout ofof 10.10. (National(National CoreCore Indicators,Indicators, 2010)2010)

Mental Illness/Developmental Disabilities Coordinating Center of Excellence WhatWhat KindsKinds ofof MentalMental Illness?Illness?

ThisThis cancan meanmean aa moodmood disorderdisorder ,, likelike depression,depression, anxietyanxiety oror bipolarbipolar disorderdisorder (( ““manicmanic depressiondepression ””).). TheseThese disordersdisorders cancan makemake peoplepeople sad,sad, anxious,anxious, worried,worried, overlyoverly happy/excited,happy/excited, oror aggressive.aggressive.

BehaviorBehavior disordersdisorders cancan includeinclude thingsthings likelike conductconduct disorders,disorders, whichwhich cancan makemake peoplepeople impulsive,impulsive, notnot carecare aboutabout others,others, dishonestdishonest oror aggressive.aggressive.

Mental Illness/Developmental Disabilities Coordinating Center of Excellence MentalMental Illness,Illness, continuedcontinued

PersonalityPersonality disordersdisorders ,, likelike borderlineborderline personality,personality, cancan makemake peoplepeople seemseem needy,needy, overlyoverly dramaticdramatic andand emotional,emotional, oror manipulative.manipulative.

ThinkingThinking disordersdisorders includeinclude schizophreniaschizophrenia andand otherother psychoticpsychotic disorders.disorders. TheseThese disordersdisorders makemake itit hardhard forfor individualsindividuals toto knowknow whatwhat ’’ss realreal andand whatwhat isnisn ’’t.t.

Mental Illness/Developmental Disabilities Coordinating Center of Excellence CommonCommon MythsMyths aboutabout MentalMental IllnessIllness andand DevelopmentalDevelopmental DisabilitiesDisabilities PeoplePeople withwith aa developmentaldevelopmental disabilitydisability dodo notnot havehave mentalmental illnessesillnesses severesevere enoughenough toto needneed therapy.therapy. PeoplePeople withwith aa developmentaldevelopmental disabilitydisability cannotcannot participateparticipate inin oror benefitbenefit fromfrom psychotherapy.psychotherapy. PeoplePeople withwith developmentaldevelopmental disabilitiesdisabilities alreadyalready livelive inin aa therapeutictherapeutic environmentenvironment andand dodo notnot needneed mentalmental healthhealth services.services. -- CarrollCarroll Jackson,Jackson, LISWLISW --S,S, 20102010

Mental Illness/Developmental Disabilities Coordinating Center of Excellence RealityReality

LevelLevel ofof intelligenceintelligence doesdoes notnot predictpredict howhow wellwell someonesomeone willwill dodo inin psychotherapy.psychotherapy. MentalMental healthhealth treatmenttreatment cancan andand doesdoes improveimprove thethe overalloverall qualityquality ofof peoplepeople ’’ss lives.lives. RecoveryRecovery fromfrom mentalmental illnessillness ISIS possible.possible. - Carroll Jackson, LISW -S, 2010

Mental Illness/Developmental Disability Coordinating Center of Excellence CommonCommon TypesTypes ofof MentalMental IllnessesIllnesses AnxietyAnxiety DisordersDisorders

MoodMood DisordersDisorders

PersonalityPersonality DisordersDisorders

ThoughtThought DisordersDisorders

Mental Illness/Developmental Disability Coordinating Center of Excellence AnxietyAnxiety AnxietyAnxiety isis relatedrelated toto chemicalschemicals inin thethe brainbrain andand cacann bebe helpedhelped withwith medication.medication. TheThe rightright medicationmedication cancan ttakeake aa whilewhile toto figurefigure out,out, butbut shouldshould helphelp thethe anxietyanxiety gogo downdown withoutwithout leavingleaving someonesomeone tootoo ssedatededated oror ““zombifiedzombified ..”” AA primaryprimary carecare physicianphysician oror psychiatristpsychiatrist shouldshould workwork carefullycarefully toto reducereduce thethe anxiety,anxiety, andand ththee behaviorsbehaviors shouldshould subside.subside.

Mental Illness/Developmental Disabilities Coordinating Center of Excellence AnxietyAnxiety Disorders:Disorders: PTSD,PTSD, OCD,OCD, andand TraumaTrauma

OneOne typetype ofof disorder,disorder, calledcalled AnxietyAnxiety Disorders,Disorders, isis commoncommon withwith peoplepeople whowho havehave AutismAutism oror AutismAutism SpectrumSpectrum Disorders.Disorders. ObsessiveObsessive CompulsiveCompulsive DisorderDisorder (OCD)(OCD) isis anan anxietyanxiety disorder.disorder. PeoplePeople withwith ObsessiveObsessive CompulsiveCompulsive DisorderDisorder havehave frighteningfrightening thoughts,thoughts, likelike ““ssomethingomething terribleterrible isis goinggoing toto happen.happen. ””

Mental Illness/Developmental Disabilities Coordinating Center of Excellence ObsessiveObsessive CompulsiveCompulsive DisorderDisorder (OCD)(OCD)

ToTo trytry notnot toto havehave thethe thoughtsthoughts andand toto feelfeel better,better, peoplepeople withwith OCDOCD willwill feelfeel drivendriven toto dodo somethingsomething toto ““wardward offoff ”” thethe thought,thought, likelike washwash theirtheir hands,hands, checkcheck lockslocks oror lightlight switches,switches, count,count, oror manymany otherother things.things. Sometimes,Sometimes, thisthis behaviorbehavior getsgets outout ofof controlcontrol andand takestakes upup aa lotlot ofof time,time, oror disruptsdisrupts others.others.

Mental Illness/Developmental Disabilities Coordinating Center of Excellence ObsessiveObsessive CompulsiveCompulsive Disorder:Disorder: ‘‘HowHow toto HelpHelp ’’ SomeoneSomeone whowho isis engagingengaging inin aa compulsivecompulsive behaviorbehavior isis tryingtrying toto feelfeel safesafe andand calm.calm. BecomingBecoming angry,angry, oror tryingtrying toto makemake themthem stop,stop, doesndoesn ’’tt helphelp andand usuallyusually makesmakes themthem feelfeel worse.worse. SometimesSometimes gettinggetting intointo aa powerpower strugglestruggle overover aa compulsivecompulsive behaviorbehavior willwill eveneven makemake someonesomeone lashlash out.out.

Mental Illness/Developmental Disabilities Coordinating Center of Excellence ObsessiveObsessive CompulsiveCompulsive DisorderDisorder (OCD)(OCD)

TheThe bestbest thingthing toto dodo isis trytry toto thinkthink aboutabout thethe anxianxietyety underneathunderneath thethe behavior.behavior. CreateCreate aa safesafe spacespace thatthat willwill notnot disruptdisrupt othersothers (a(a roomroom wherewhere someonesomeone cancan countcount tilestiles oror turnturn thethe lightlight onon andand off,off, etc).etc). ThThenen trytry toto findfind outout whatwhat makesmakes someonesomeone feelfeel safe.safe. ThisThis maymay taketake aa longlong timetime butbut itit isis worthwhile.worthwhile.

Mental Illness/Developmental Disabilities Coordinating Center of Excellence Remember!Remember!

AsAs aa DDirectirect ServiceService Professional,Professional, youyou havehave somesome ofof thethe bestbest informationinformation aboutabout whetherwhether compulsivecompulsive behaviorbehavior oror ““scaryscary thoughtsthoughts ”” areare gettinggetting betterbetter oror worse.worse. YouYou cancan alsoalso noticenotice ifif someonesomeone seemsseems tootoo ““drugged.drugged. ”” BeBe suresure toto documentdocument andand shareshare whatwhat youyou noticenotice withwith thethe restrest ofof thethe treatmenttreatment team.team.

Mental Illness/Developmental Disability Coordinating Center of Excellence AnotherAnother CauseCause ofof Anxiety:Anxiety: TraumaTrauma TraumaTrauma isis anyany experienceexperience oror seriesseries ofof experiencesexperiences thatthat makemake thethe individualindividual feelfeel thatthat hehe oror sheshe isis inin dangerdanger ofof dying,dying, oror ofof beingbeing emotionallyemotionally ““wipedwiped outout ”” oror annihilated.annihilated. ManyMany peoplepeople experienceexperience trauma.trauma. PeoplePeople withwith developmentaldevelopmental disabilitiesdisabilities areare atat greatgreaterer riskrisk forfor beingbeing victimizedvictimized oror abusedabused (NCI,(NCI, 2010).2010). TheyThey areare alsoalso moremore likelylikely toto havehave ““everydayeveryday ”” stressesstresses oror losseslosses buildbuild upup andand becomebecome traumatic.traumatic.

Mental Illness/Developmental Disability Coordinating Center of Excellence PostPost --TraumaticTraumatic StressStress DisorderDisorder (PTSD)(PTSD) PeoplePeople whowho havehave beenbeen throughthrough aa traumatictraumatic experienceexperience maymay developdevelop shortshort --termterm symptomssymptoms (Acute(Acute StressStress Disorder)Disorder) oror longerlonger --termterm symptomssymptoms (Post(Post TraumaticTraumatic StressStress Disorder,Disorder, ““PTSDPTSD ””).). NotNot everyoneeveryone whowho experiencesexperiences traumatrauma willwill developdevelop aa stressstress disorder,disorder, butbut manymany peoplepeople willwill experienceexperience somesome symptoms,symptoms, andand somesome willwill experienceexperience almostalmost allall ofof them.them.

Mental Illness/Developmental Disability Coordinating Center of Excellence AA MMajorajor TraumaTrauma CCouldould Be:Be: SexualSexual Assault/PhysicalAssault/Physical AssaultAssault NaturalNatural oror manmademanmade disastersdisasters CatastrophicCatastrophic illnessillness LossLoss ofof aa lovedloved oneone HumiliationHumiliation BullyingBullying MovingMoving toto aa newnew homehome or significant change at home “EMDR Psychotherapy for or significant change at home People with I/DD DeprivationDeprivation andand powerlessnesspowerlessness Experiencing Trauma and Distress ”, toto actact onon oneone ’’ss ownown behalfbehalf Ford, Adler -Tapia, 2009

Mental Illness/Developmental Disability Coordinating Center of Excellence ““OrdinaryOrdinary ”” LLifeife EventEvent TraumaTrauma CCouldould Be:Be: FeelingFeeling differentdifferent NotNot beingbeing acceptedaccepted NotNot beingbeing ableable toto dodo whatwhat othersothers dodo KnowingKnowing thatthat oneone hashas aa disabilitydisability andand isis ““differentdifferent ”” thanthan othersothers NotNot beingbeing listenedlistened toto BeingBeing misunderstoodmisunderstood FailingFailing atat aa tasktask GettingGetting confusedconfused andand overwhelmedoverwhelmed “EMDR Psychotherapy for People with I/DD Experiencing Trauma and Distress ”, Ford, Adler -Tapia, 2009

Mental Illness/Developmental Disability Coordinating Center of Excellence TraumaTrauma SymptomsSymptoms TraumaticTraumatic stressstress symptomssymptoms comecome inin threethree clusters:clusters: HypervigilanceHypervigilance (always(always onon ““redred alertalert ””)) ConstrictionConstriction (avoiding(avoiding things)things) IntrusionIntrusion (having(having upsettingupsetting memories,memories, thoughtsthoughts andand dreams)dreams) These symptoms come from the brain being flooded with “fight or flight” chemicals. Sometimes the brain can be permanently changed after a severe or persistent trauma.

Mental Illness/Developmental Disability Coordinating Center of Excellence HypervigilanceHypervigilance

StartlingStartling easily/frequentlyeasily/frequently IrritabilityIrritability DifficultyDifficulty concentratingconcentrating DifficultyDifficulty relaxingrelaxing DifficultyDifficulty fallingfalling oror stayingstaying asleepasleep NeedingNeeding toto bebe nearnear oror inin sightsight ofof exits;exits; agitationagitation whenwhen blockedblocked

Mental Illness/Developmental Disability Coordinating Center of Excellence ConstrictionConstriction AvoidsAvoids activities,activities, places,places, people,people, thingsthings toto keepkeep ffromrom beingbeing reminded/reminded/ ””triggeredtriggered ”” (can(can rippleripple out,out, becomebecome moremore andand moremore removedremoved fromfrom obviousobvious triggerstriggers ofof incident)incident) CanCan ’’tt rememberremember importantimportant partsparts ofof thethe traumatrauma MuchMuch lessless interestinterest inin significantsignificant activitiesactivities FeelingFeeling detacheddetached fromfrom othersothers NarrowNarrow rangerange ofof emotions,emotions, numbnessnumbness LackLack ofof aa sensesense ofof futurefuture

Mental Illness/Developmental Disability Coordinating Center of Excellence IntrusionIntrusion

FlashbacksFlashbacks NightmaresNightmares DisturbingDisturbing images/thoughts/fantasiesimages/thoughts/fantasies PhysicalPhysical responseresponse (sweating,(sweating, shaking,shaking, freezing,freezing, lashinglashing out)out) toto internalinternal oror externalexternal triggerstriggers thatthat resembleresemble thethe eventevent (this(this isis veryvery common!)common!)

Mental Illness/Developmental Disability Coordinating Center of Excellence OtherOther WWaysays SymptomsSymptoms MightMight BeBe ObservedObserved ……

Physical:Physical: EatingEating disturbancesdisturbances (more(more oror lessless thanthan usual)usual) SleepSleep disturbancesdisturbances (more(more oror lessless thanthan usual)usual) SexualSexual dysfunctiondysfunction LowLow energy;energy; Chronic,Chronic, unexplainedunexplained painpain

Mental Illness/Developmental Disability Coordinating Center of Excellence Emotional:Emotional: Depression,Depression, spontaneousspontaneous crying,crying, despairdespair andand hopelessnesshopelessness AnxietyAnxiety PanicPanic attacksattacks FearfulnessFearfulness CompulsiveCompulsive andand obsessiveobsessive behaviorsbehaviors FeelingFeeling outout ofof controlcontrol Irritability,Irritability, angeranger andand resentmentresentment EmotionalEmotional numbnessnumbness WithdrawalWithdrawal fromfrom normalnormal routineroutine andand relationshipsrelationships

Mental Illness/Developmental Disability Coordinating Center of Excellence Cognitive:Cognitive: MemoryMemory lapses,lapses, especiallyespecially aboutabout thethe traumatrauma DifficultyDifficulty makingmaking decisionsdecisions DecreasedDecreased abilityability toto concentrateconcentrate FeelingFeeling distracteddistracted ADHDADHD symptomssymptoms (restless,(restless, agitated)agitated)

Mental Illness/Developmental Disability Coordinating Center of Excellence Remember!Remember! PeoplePeople withwith developmentaldevelopmental disabilitiesdisabilities maymay notnot bebe ableable toto verballyverbally expressexpress thethe thingsthings thatthat areare botheringbothering them.them. LookLook forfor nonnon --verbalverbal signalssignals ofof distressdistress andand anxiety,anxiety, especiallyespecially newnew oror increasedincreased complaints.complaints. NonNon -- verbalverbal distressdistress cancan bebe aa signsign ofof manymany problemsproblems besidesbesides trauma,trauma, andand aa medicalmedical evaluationevaluation maymay bebe needed,needed, butbut itit ’’ss aa goodgood indicatorindicator toto paypay closeclose attentionattention toto findfind outout more.more.

Mental Illness/Developmental Disability Coordinating Center of Excellence VisibleVisible SSignsigns ofof Anxiety:Anxiety: Tremulousness/shakingTremulousness/shaking SweatingSweating AgitationAgitation ExcessivelyExcessively uprightupright posture/stiffnessposture/stiffness TenseTense jawjaw musclesmuscles ChewingChewing nails/grindingnails/grinding teethteeth RapidRapid breathingbreathing - Julie P. Gentile, MD & Carroll Jackson, LISW -S, 2010

Mental Illness/Developmental Disability Coordinating Center of Excellence BehavioralBehavioral Changes:Changes: BehavioralBehavioral problemsproblems NonNon --compliancecompliance Aggression/screaming/etc.Aggression/screaming/etc. DisintegrationDisintegration ofof verbalverbal skillsskills BaselineBaseline exaggerationexaggeration RecurrenceRecurrence ofof ““institutionalinstitutional ”” behaviorbehavior (hoarding,(hoarding, stealing,stealing, etc.)etc.) - Julie P. Gentile, MD & Carroll Jackson, LISW -S, 2010

Mental Illness/Developmental Disability Coordinating Center of Excellence OtherOther verbalverbal andand nonnon --verbalverbal distressdistress signalssignals …… NewNew problemsproblems withwith controllingcontrolling bowelsbowels oror bedwettingbedwetting HeadachesHeadaches StomachStomach achesaches BackBack painpain RepetitionRepetition ofof statementsstatements aboutabout anan eventevent thatthat seemseem unrelatedunrelated toto thethe currentcurrent situationsituation ““PhobicPhobic mannerismsmannerisms ”” asas personperson avoidsavoids situationssituations SelfSelf --soothingsoothing behaviorsbehaviors (alcohol,(alcohol, food,food, otherother addictiveaddictive activities)activities) DeclineDecline inin skillskill developmentdevelopment - Focht -New, Clements et al, 2008

Mental Illness/Developmental Disability Coordinating Center of Excellence WhatWhat aa TreatmentTreatment TeamTeam ShouldShould DoDo …… LookLook forfor changeschanges inin baselinebaseline TalkTalk withwith thethe peoplepeople whowho knowknow thethe individualindividual bestbest RuleRule outout medical/psychiatricmedical/psychiatric issuesissues WatchWatch forfor ““diagnosticdiagnostic overshadowingovershadowing ”” (attributing(attributing everythingeverything toto DDDD oror MH)MH) BeBe concernedconcerned aboutabout losseslosses inin previousprevious skills,skills, especiallyespecially speech,speech, oror ‘‘regressiveregressive ’’ behaviorsbehaviors

Mental Illness/Developmental Disability Coordinating Center of Excellence ““IndividualsIndividuals withwith DualDual DiagnosisDiagnosis areare moremore vulnerablevulnerable toto anxietyanxiety disorders.disorders. TheyThey areare alsoalso moremore afraidafraid ofof failingfailing andand maymay notnot reportreport somethingsomething botheringbothering themthem oror someonesomeone hurtinghurting them.them. TheyThey areare oftenoften targetstargets forfor abuseabuse oror maltreatmentmaltreatment comparedcompared toto thethe generalgeneral population.population. HighHigh turnoverturnover ratesrates ofof staffstaff cancan makemake itit difficultdifficult toto feelfeel safesafe andand securesecure ””

-Julie P. Gentile, MD, 2010

Mental Illness/Developmental Disability Coordinating Center of Excellence TraumaTrauma ‘‘HowHow toto HelpHelp ’’ CheckCheck toto seesee ifif someonesomeone hashas aa historyhistory ofof traumatrauma (abuse,(abuse, neglect,neglect, frighteningfrightening experiences,experiences, lotslots ofof sstresstress andand loss),loss), oror aa diagnosisdiagnosis ofof PostPost --TraumaticTraumatic StressStress DisorderDisorder (PTSD).(PTSD). IfIf therethere isis nono historyhistory thatthat youyou areare awareaware of,of, rememrememberber thatthat itit ’’ss possiblepossible traumatrauma hashas notnot beenbeen reportedreported oror noticed.noticed.

Mental Illness/Developmental Disability Coordinating Center of Excellence TraumaTrauma --InformedInformed CareCare

PeoplePeople whowho havehave beenbeen traumatizedtraumatized oftenoften feelfeel unsafeunsafe andand outout ofof control.control. FindFind asas manymany waysways asas youyou cancan toto hehelplp peoplepeople feelfeel safe.safe. ThisThis couldcould meanmean changingchanging thethe environmentenvironment (leaving(leaving aa lightlight onon atat night,night, lettingletting themthem sitsit nearnear aa door),door), oror helpinghelping themthem figurefigure outout whatwhat soothessoothes themthem (a(a blankeblanket,t, music,music, stayingstaying nearnear staff,staff, etc).etc).

Mental Illness/Developmental Disability Coordinating Center of Excellence TraumaTrauma --InformedInformed CareCare NextNext toto safety,safety, controlcontrol isis thethe biggestbiggest issueissue forfor peoplepeople withwith trauma.trauma. YouYou cancan helphelp peoplepeople feelfeel inin controlcontrol byby givinggiving themthem thethe chancechance toto makemake asas manymany ofof theirtheir ownown decisionsdecisions asas possible.possible. Also,Also, makemake decisionsdecisions inin youryour settingsetting byby consensusconsensus --reachingreaching anan agreementagreement togethertogether ---- insteadinstead ofof powerpower (threats,(threats, yelling,yelling, ““II’’mm staff,staff, soso whatwhat II saysay goes,goes, ”” etc.)etc.)

Mental Illness/Developmental Disability Coordinating Center of Excellence TraumaTrauma --InformedInformed CareCare ResearchResearch suggestssuggests thatthat many,many, ifif notnot most,most, peoplepeople hahaveve somesome formform ofof traumatictraumatic eventevent inin hishis oror herher liveslives (SAMSHA,(SAMSHA, 2010).2010). ForFor peoplepeople withwith DDDD thisthis isis eveneven higher.higher. ItIt makesmakes sensesense toto treattreat EVERYONEEVERYONE asas ifif traumatrauma hashas possiblypossibly occurred.occurred. MakingMaking suresure someonesomeone feelsfeels safesafe andand inin controlcontrol ofof theirtheir ownown liveslives willwill hhelpelp someonesomeone withwith trauma,trauma, andand willwill notnot hurthurt anyoneanyone whowho doesdoes NOTNOT havehave aa historyhistory ofof trauma.trauma.

Mental Illness/Developmental Disability Coordinating Center of Excellence TraumaTrauma --InformedInformed Care:Care: AA UniversalUniversal PrecautionPrecaution JustJust likelike wewe treattreat bloodblood oror bodilybodily fluidsfluids asas ifif EVERYONEEVERYONE hashas aa communicablecommunicable diseasedisease byby usingusing universaluniversal precautionsprecautions (gloves,(gloves, bleach,bleach, etc.),etc.), treattreat EVERYONEEVERYONE asas ifif safetysafety andand controlcontrol areare importantimportant toto them.them. TheseThese areare thethe ““universaluniversal precautionsprecautions ”” forfor trauma.trauma. AfterAfter all,all, wewe allall wantwant toto feelfeel safe,safe, lovedloved andand inin controlcontrol ofof ourour ownown lives.lives.

Mental Illness/Developmental Disability Coordinating Center of Excellence BipolarBipolar DisorderDisorder

BipolarBipolar DisorderDisorder (sometimes(sometimes calledcalled ““manicmanic depressiondepression ””)) isis aa moodmood disorderdisorder withwith veryvery highhigh pointspoints (mania)(mania) andand veryvery lowlow pointspoints (depression).(depression). ItIt cancan bbee treatedtreated withwith medicationmedication andand counseling.counseling. PeoplePeople witwithh untreateduntreated bipolarbipolar disorderdisorder cancan havehave veryvery disruptivedisruptive behavior.behavior. MakeMake suresure toto letlet youryour treatmenttreatment teamteam knoknoww ifif youyou thinkthink someonesomeone isis sufferingsuffering fromfrom somesome ofof thesthesee symptoms,symptoms, oror ifif theirtheir symptomssymptoms areare notnot gettinggetting bettbetter.er.

Mental Illness/Developmental Disability Coordinating Center of Excellence BipolarBipolar DisorderDisorder andand DevelopmentalDevelopmental DisabilitiesDisabilities Sometimes symptoms of Bipolar Disorder look different in a person with dual diagnoses: He or she might have delusions, not of grandiosity, but of normalcy, and will describe themselves as a person that they see as having power or respect, such as a teacher, police officer, nurse, doctor, etc. They may also, developmentally, still have “imaginary friends ” that are not hallucinations. One indicator might be that the individual seems to be “directing the action ” in imaginary play or conversations. This is not unusual and is not a sign of mental illness.

Mental Illness/Developmental Disability Coordinating Center of Excellence SymptomsSymptoms ofof BipolarBipolar DisorderDisorder (Manic(Manic Episode)Episode) HowHow toto HelpHelp Symptom:Symptom: Elevated,Elevated, expansiveexpansive moodmood helphelp thethe individualindividual findfind positivepositive activitiesactivities Symptom:Symptom: IrritableIrritable moodmood EncourageEncourage inin aa positivepositive mannermanner AvoidAvoid beingbeing criticalcritical AllowAllow spacespace

Mental Illness/Developmental Disability Coordinating Center of Excellence ManicManic EpisodeEpisode

Symptom:Symptom: PhysicalPhysical agitation,agitation, restlessnessrestlessness FindFind constructiveconstructive waysways toto useuse energyenergy ––trytry bigbig musclemuscle exerciseexercise RecognizeRecognize agitation,agitation, allowallow thethe personperson toto leaveleave thethe activityactivity thatthat isis makingmaking thethe problemproblem worseworse Symptom:Symptom: IncreasedIncreased goalgoal --directeddirected activityactivity (drive(drive toto makemake plans,plans, accomplishaccomplish projects)projects) MakeMake suresure activitiesactivities areare notnot destructivedestructive oror dangerousdangerous

Mental Illness/Developmental Disability Coordinating Center of Excellence ManicManic EpisodeEpisode Symptom:Symptom: DistractibilityDistractibility MakeMake expectationsexpectations clearclear andand realisticrealistic –– oneone stepstep atat aa time,time, usingusing languagelanguage thethe personperson cancan understandunderstand KeepKeep taskstasks andand activitiesactivities focusedfocused ProvideProvide frequentfrequent promptsprompts UseUse smallsmall stepssteps MinimizeMinimize distractionsdistractions likelike tootoo muchmuch noise,noise, lightlight oror activityactivity

Mental Illness/Developmental Disability Coordinating Center of Excellence ManicManic EpisodeEpisode

Symptom:Symptom: DecreasedDecreased needneed forfor sleepsleep FindFind activitiesactivities thatthat allowallow thethe individualindividual toto bebe awakeawake withoutwithout disruptingdisrupting othersothers LimitLimit stimulationstimulation

Mental Illness/Developmental Disability Coordinating Center of Excellence ManicManic EpisodeEpisode Symptom:Symptom: ExcessiveExcessive involvementinvolvement inin pleasurablepleasurable activitiesactivities ProvideProvide supervisionsupervision asas neededneeded toto assureassure safetysafety SafeguardSafeguard resourcesresources suchsuch asas moneymoney LimitLimit otherother dangerousdangerous oror expensiveexpensive activitiesactivities suchsuch asas excessiveexcessive longlong --distancedistance phonephone calls,calls, internetinternet shopping,shopping, etc.etc. RedirectRedirect inappropriateinappropriate sexualsexual activityactivity

Mental Illness/Developmental Disability Coordinating Center of Excellence AboutAbout SexSex ThisThis cancan bebe anan uncomfortableuncomfortable topictopic anyany time,time, andand aa manicmanic episodeepisode cancan increaseincrease sexsex drive.drive. However,However, youryour settingsetting addressesaddresses sexualsexual behavior,behavior, itit ’’ss bestbest toto bebe directdirect andand unembarrassed.unembarrassed. Also,Also, helphelp makemake suresure othersothers areare notnot mademade uncomfortable.uncomfortable. OverlyOverly sexualsexual talk,talk, unwantedunwanted sexualsexual advances,advances, publicpublic nudity,nudity, publicpublic masturbation,masturbation, etc.etc. shouldshould bebe calmlycalmly andand firmlyfirmly redirected.redirected.

Mental Illness/Developmental Disability Coordinating Center of Excellence AppropriateAppropriate SexualSexual ActivityActivity

AA goodgood alternativealternative ifif someonesomeone isis notnot inin aa consensuaconsensuall adultadult relationshiprelationship isis masturbationmasturbation inin thethe privacyprivacy ooff oneone ’’ss ownown room.room. ThatThat means:means: NoNo roommateroommate presentpresent NobodyNobody elseelse presentpresent

Mental Illness/Developmental Disability Coordinating Center of Excellence ManicManic EpisodeEpisode

Symptom:Symptom: MoreMore talkativetalkative thanthan usualusual FindFind placesplaces wherewhere talkingtalking willwill notnot causecause aa problemproblem

Mental Illness/Developmental Disability Coordinating Center of Excellence Depression:Depression: TheThe LowLow PointPoint ofof BipolarBipolar DisorderDisorder

SometimesSometimes peoplepeople withwith bipolarbipolar disorderdisorder willwill havehave severalseveral weeksweeks oror monthsmonths ofof normalnormal mood,mood, thenthen slideslide intointo depression.depression. OtherOther peoplepeople willwill gogo rightright fromfrom maniamania toto depression.depression. TheThe symptomssymptoms ofof depressiondepression cancan alsoalso happenhappen withoutwithout mania.mania. ThisThis isis calledcalled UnipolarUnipolar Depression,Depression, oror MajorMajor Depression.Depression.

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive Symptoms:Symptoms: HowHow toto HelpHelp Symptom:Symptom: LossLoss ofof interestinterest inin activitiesactivities OfferOffer varied,varied, preferredpreferred activitiesactivities AllowAllow spacespace whenwhen neededneeded HaveHave favoritefavorite staffstaff workwork withwith thethe individualindividual MinimizeMinimize otherother unpleasantunpleasant distractionsdistractions oror sensationssensations ExploreExplore otherother possiblepossible reasonsreasons forfor sadnesssadness suchsuch asas grief,grief, lossloss oror traumatrauma HelpHelp givegive wordswords forfor feelingsfeelings andand encourageencourage talkingtalking withwith staffstaff andand friendsfriends

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: DiminishedDiminished IInterestnterest BeBe flexibleflexible andand findfind creativecreative waysways toto allowallow forfor participationparticipation toto thethe extentextent thethe personperson cancan managemanage PointPoint outout accomplishmentsaccomplishments ProvideProvide encouragementencouragement forfor participationparticipation DoDo notnot forceforce involvementinvolvement inin longlong activitiesactivities InIn thethe community,community, havehave staffstaff whowho cancan taketake thethe personperson homehome ifif theythey tiretire WaitWait forfor aa timetime andand trytry againagain

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: WeightWeight lossloss PreparePrepare preferredpreferred foodsfoods HaveHave foodfood availableavailable throughoutthroughout thethe dayday ReinforceReinforce anyany effortsefforts toto eateat ProvideProvide smallsmall portions/amountsportions/amounts easiereasier toto eat/swalloweat/swallow MakeMake eatingeating environmentenvironment pleasantpleasant (use(use favoritefavorite bowlbowl oror plate,plate, newnew cupcup oror spoon)spoon) ProvideProvide severalseveral smallsmall mealsmeals MonitorMonitor toto assureassure individualindividual isis healthyhealthy

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: WeightWeight gaingain DODO NOTNOT getget intointo powerpower strugglesstruggles aboutabout eating!eating! Instead:Instead: ProvideProvide healthyhealthy snackssnacks forfor thethe individualindividual whowho isis overeatingovereating ProvideProvide lowlow caloriecalorie substitutessubstitutes forfor favoritefavorite foodsfoods RemoveRemove excessiveexcessive highhigh caloriecalorie foodsfoods EncourageEncourage exerciseexercise (e.g.(e.g. walkwalk toto getget aa lowlow caloriecalorie snack)snack)

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: InsomniaInsomnia EncourageEncourage aa regularregular sleepsleep scheduleschedule MinimizeMinimize nighttimenighttime disruptionsdisruptions AllowAllow quietquiet activityactivity thatthat willwill notnot botherbother othersothers LimitLimit napsnaps duringduring thethe dayday OfferOffer lessless --stimulatingstimulating alternativesalternatives toto alcohol,alcohol, nicotine,nicotine, && caffeinecaffeine (including(including chocolate)chocolate) CaffeineCaffeine --freefree softsoft drinks,drinks, herbalherbal tea,tea, decafdecaf coffee,coffee, water,water, etc.etc. areare goodgood alternativesalternatives

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: InsomniaInsomnia contcont ’’d.d. EncourageEncourage exercise,exercise, butbut notnot latelate inin thethe eveningevening HelpHelp thethe individualindividual developdevelop aa sleepsleep ritualritual (getting(getting ready,ready, calmingcalming down,down, sayingsaying prayers,prayers, lookinglooking throughthrough scrapbook,scrapbook, etc.:etc.: samesame things,things, samesame orderorder everyevery night)night) HelpHelp thethe individualindividual gogo toto bedbed atat thethe samesame timetime everyevery nightnight

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: InsomniaInsomnia contcont ’’d.d. HelpHelp thethe individualindividual findfind waysways toto relaxrelax beforebefore bedtime:bedtime: readingreading (or(or beingbeing readread to),to), takingtaking aa warmwarm bath,bath, etc.etc. DiscourageDiscourage thethe individualindividual fromfrom goinggoing toto bedbed tootoo earlyearly DonDon ’’tt forceforce thethe individualindividual toto gogo toto bedbed EncourageEncourage thethe individualindividual toto sleepsleep inin aa cool,cool, dark,dark, quietquiet bedroombedroom

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: PhysicalPhysical agitation,agitation, restlessnessrestlessness FindFind constructiveconstructive waysways forfor thethe individualindividual toto useuse energyenergy RecognizeRecognize thethe restlessness,restlessness, allowallow thethe personperson toto leaveleave thethe situationsituation ifif itit seemsseems toto bebe makingmaking thingsthings worseworse

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: Fatigue,Fatigue, movingmoving slowlyslowly ProvideProvide briefbrief activitiesactivities RecognizeRecognize thatthat thethe personperson maymay bebe tiredtired AllowAllow thethe personperson toto leaveleave activitiesactivities whenwhen tiredtired AdjustAdjust activitiesactivities andand expectationsexpectations toto thethe levellevel ofof energyenergy youyou observeobserve DonDon ’’tt pushpush thethe depresseddepressed personperson toto taketake onon tootoo muchmuch tootoo soonsoon LimitLimit noisenoise andand racketracket AllowAllow timetime forfor recoveryrecovery

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: FeelingsFeelings ofof worthlessnessworthlessness RecognizeRecognize feelings;feelings; helphelp thethe individualindividual putput feelingsfeelings intointo wordswords LetLet thethe individualindividual knowknow thatthat youyou knowknow itit hurtshurts toto feelfeel thatthat wayway GentlyGently pointpoint outout thingsthings youyou thinkthink areare specialspecial andand importantimportant aboutabout himhim oror herher OfferOffer meaningfulmeaningful taskstasks ProvideProvide gentlegentle praisepraise andand encourageencourage thethe personperson toto recognizerecognize hishis oror herher accomplishmentsaccomplishments

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: FeelingsFeelings ofof hopelessnesshopelessness TheseThese soundsound likelike ““WhatWhat ’’ss thethe point?point? NothingNothing II dodo willwill helphelp ”” oror ““nothingnothing willwill getget betterbetter ”” ExploreExplore actualactual reasonsreasons someonesomeone mightmight feelfeel discourageddiscouraged andand seesee ifif thesethese cancan bebe addressedaddressed AskAsk thethe personperson toto thinkthink ofof timestimes thingsthings turnedturned outout betterbetter thanthan theythey thoughtthought HelpHelp thethe personperson figurefigure outout thingsthings theythey dodo toto helphelp others,others, oror waysways theythey areare importantimportant toto othersothers (finding(finding meaningmeaning inin life)life) MayMay alsoalso exploreexplore meaningmeaning inin religiousreligious beliefsbeliefs

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom: Feelings of helplessness These sound like “It ’s too big for me ” or “I don ’t know what to do ” Explore and address ways the individual may actually be made to feel helpless (others doing too much, lack of decision -making) Explore ways the individual can feel more powerful and competent in daily life (can include teaching to appropriately assert self) Break down big problems into small pieces Encourage the individual to find own solutions to “smaller pieces ”

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: FeelingsFeelings ofof guiltguilt EncourageEncourage thethe personperson toto realisticallyrealistically assessassess thosethose thingsthings forfor whichwhich theythey feelfeel guilt.guilt. IfIf therethere isis aa rereasonason forfor guilt,guilt, helphelp thinkthink aboutabout waysways toto makemake thethe situationsituation better,better, apologize,apologize, etc.etc. IfIf guiltguilt seemsseems unrealistic,unrealistic, helphelp talktalk aboutabout thatthat IndividualsIndividuals maymay bebe reluctantreluctant toto acceptaccept praise,praise, soso dondon ’’tt overdooverdo itit RememberRemember thatthat tootoo manymany demandsdemands cancan increaseincrease feelingsfeelings ofof failurefailure

Mental Illness/Developmental Disability Coordinating Center of Excellence AboutAbout SuicideSuicide ListenListen closelyclosely whenwhen someonesomeone talkstalks (directly(directly oror indirectly)indirectly) aboutabout feelingfeeling worthless,worthless, hopelesshopeless and/oand/orr helpless.helpless. One,One, twotwo oror allall threethree ofof thesethese feelingsfeelings cancan sometimessometimes leadlead peoplepeople toto considerconsider killingkilling themselvethemselves.s. ItIt isis aa mythmyth thatthat peoplepeople withwith developmentaldevelopmental disabilitiesdisabilities dodo notnot commitcommit suicide.suicide. IfIf youyou thinkthink ttherehere isis ANYANY riskrisk ofof this,this, letlet youryour supervisorsupervisor oror aa healthhealth professionalprofessional knowknow rightright awayaway ..

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressionDepression andand SuicideSuicide Symptom:Symptom: ThoughtsThoughts ofof deathdeath DoDo notnot ignoreignore talktalk aboutabout suicide.suicide. AskAsk questionsquestions calmlycalmly andand clearly:clearly: AreAre youyou thinkingthinking aboutabout doingdoing this?this? WhatWhat havehave youyou thoughtthought aboutabout doing?doing? SpendSpend timetime withwith thethe person.person. IfIf thethe personperson sayssays hehe oror sheshe isis activelyactively suicidal,suicidal, dodo notnot leaveleave himhim oror herher alonealone untiluntil therethere isis aa safetysafety plan.plan. DoDo notnot allowallow accessaccess toto harmfulharmful objectsobjects oror situationssituations untiluntil therethere isis aa safetysafety plan.plan. ConsultConsult withwith clinicalclinical staffstaff immediately.immediately.

Mental Illness/Developmental Disability Coordinating Center of Excellence Remember!Remember! NotNot allall ““thoughtsthoughts ofof deathdeath ”” areare aboutabout suicide.suicide. Often,Often, peoplepeople withwith developmentaldevelopmental disabilitiesdisabilities areare discourageddiscouraged fromfrom thinkingthinking oror talkingtalking aboutabout ““sadsad ”” thingsthings likelike deathdeath oror loss.loss. ItIt isis importantimportant toto encourageencourage expressionsexpressions ofof griefgrief andand sadnesssadness aboutabout aa loss,loss, oror nnaturalatural curiositycuriosity aboutabout death.death. ConsultConsult withwith aa mentalmental healthealthh professionalprofessional oror thethe treatmenttreatment teamteam forfor helphelp inin telltellinging thethe differencedifference betweenbetween grieving,grieving, depression,depression, andand suicidsuicide.e.

Mental Illness/Developmental Disability Coordinating Center of Excellence DepressiveDepressive EpisodeEpisode Symptom:Symptom: LessLess ableable toto concentrateconcentrate BeBe brief,brief, repeatrepeat questionsquestions oror concernsconcerns SpeakSpeak slowly,slowly, quietlyquietly AvoidAvoid givinggiving severalseveral directionsdirections atat onceonce ProvideProvide frequentfrequent andand briefbrief instructionsinstructions ProvideProvide praisepraise BreakBreak taskstasks intointo smallersmaller taskstasks NarrowNarrow thethe choiceschoices aa personperson hashas toto makemake

Mental Illness/Developmental Disability Coordinating Center of Excellence PersonalityPersonality DisordersDisorders PersonalityPersonality disordersdisorders areare notnot fullyfully understood,understood, butbut seemseem toto bebe presentpresent fromfrom aa veryvery youngyoung age,age, possiblypossibly fromfrom birth.birth. EnvironmentalEnvironmental factorsfactors cancan makemake PersonalityPersonality disordersdisorders betterbetter oror worse.worse. PersonalityPersonality disordersdisorders cancan bebe helpedhelped withwith therapytherapy andand somesome medications,medications, butbut areare notnot ““curedcured ”” thethe wayway somesome otherother mentalmental illnessesillnesses suchsuch asas moodmood disordersdisorders cancan be.be.

Mental Illness/Developmental Disability Coordinating Center of Excellence PersonalityPersonality DisordersDisorders CommonCommon disorders:disorders: BorderlineBorderline PersonalityPersonality DisorderDisorder HistrionicHistrionic PersonalityPersonality DisorderDisorder AntisocialAntisocial PersonalityPersonality DisorderDisorder LessLess CommonCommon Disorders:Disorders: SchizotypalSchizotypal PersonalityPersonality DisorderDisorder ParanoidParanoid PersonalityPersonality DisorderDisorder DependentDependent PersonalityPersonality DisorderDisorder

Mental Illness/Developmental Disability Coordinating Center of Excellence BorderlineBorderline PersonalityPersonality DisorderDisorder

CharacterizedCharacterized byby displaysdisplays ofof hostility,hostility, emotionalemotional dysfunction,dysfunction, moodmood labilitylability andand aggressionaggression (Wilson,(Wilson, 2001)2001)

SomeSome peoplepeople believebelieve thatthat BPDBPD occursoccurs inin peoplepeople withwith developmentaldevelopmental disabilitiesdisabilities momorere oftenoften thanthan inin thethe generalgeneral population.population. (Nugent,(Nugent, 1997)1997)

Mental Illness/Developmental Disability Coordinating Center of Excellence BPDBPD inin PeoplePeople withwith DDDD CanCan looklook like:like: OverOver --reactionreaction toto typicaltypical requestsrequests VerbalVerbal aggressionaggression thatthat isis personallypersonally upsettingupsetting toto victimvictim VerbalVerbal aggressionaggression thatthat leadsleads toto physicalphysical aggressionaggression OverOver --attachmentattachment toto somesome staffstaff andand devaluationdevaluation ofof othersothers (( ““splittingsplitting ””)) ExtremeExtreme changeschanges ofof mood,mood, leadingleading toto overover --reactionreaction toto environmentalenvironmental eventsevents SelfSelf --injuringinjuring ApparentApparent inabilityinability toto seesee connectionconnection betweenbetween behaviorbehavior andand consequencesconsequences -- Wilson,Wilson, 20012001

Mental Illness/Developmental Disability Coordinating Center of Excellence BorderlineBorderline PersonalityPersonality DisorderDisorder ‘‘HowHow toto HelpHelp ’’ DoDo notnot getget pulledpulled intointo crises.crises. StayStay calmcalm andand focusfocused.ed. BewareBeware ofof ““splitting.splitting. ”” DoDo notnot respondrespond toto accusationsaccusations aboutabout otherother staffstaff withoutwithout checkingchecking withwith thosethose staffstaff.. Also,Also, dodo notnot bebe swayedswayed byby manipulation;manipulation; ““youyou ’’rere mymy favoritefavorite …”…” etc.etc. HelpHelp thethe individualindividual withwith overwhelmingoverwhelming feelingsfeelings by:by: listeninglistening calmlycalmly notnot arguingarguing notnot gettinggetting upsetupset helpinghelping thethe individualindividual graduallygradually calmcalm downdown

Mental Illness/Developmental Disability Coordinating Center of Excellence ““InterruptInterrupt ”” thethe FeelingsFeelings WhenWhen feelingsfeelings areare overwhelming,overwhelming, itit ’’ss hardhard toto rememberremember copingcoping skillsskills BrieflyBriefly ““interruptinginterrupting ”” thethe feelingsfeelings inin smallsmall waysways (( notnot fixingfixing oror changingchanging them)them) cancan helphelp thethe personperson pausepause andand rememberremember skillsskills oror calmcalm downdown EncourageEncourage thethe individualindividual toto dodo somethingsomething thatthat hashas aa physicalphysical sensation:sensation: breathingbreathing slowlyslowly walkingwalking inin grassgrass holdingholding anan iceice cubecube eatingeating aa hothot cinnamoncinnamon candycandy

Mental Illness/Developmental Disability Coordinating Center of Excellence HowHow toto HHelpelp AnyAny injuriousinjurious behaviorbehavior shouldshould bebe addressedaddressed andand treatedtreated ifif needed.needed. DoDo notnot ignoreignore itit asas ““attentionattention -- seeking.seeking. ”” StayStay calm.calm. DoDo notnot makemake itit anan excitingexciting event.event. DoDo remindremind thethe individualindividual ofof positivepositive waysways toto getget attention.attention. ScheduleSchedule timetime frequentlyfrequently ““everyevery hourhour II willwill spendspend tenten minutesminutes talkingtalking withwith you,you, ifif youyou ’’rere upsetupset oror not.not. ”” ThisThis cancan helphelp thethe individualindividual meetmeet thethe intenseintense needneed forfor attentionattention oror reassurancereassurance withoutwithout resortingresorting toto actingacting out.out. DoDo notnot ““callcall theirtheir bluffbluff ”” onon threats.threats. ThisThis cancan escalateescalate thethe situation.situation. Mental Illness/Developmental Disability Coordinating Center of Excellence HowHow toto helphelp

CalmlyCalmly butbut firmlyfirmly addressaddress aggressionaggression toto othersothers BeBe consistentconsistent withwith structurestructure andand rulesrules IfIf anan individualindividual showsshows intenseintense symptomssymptoms ofof BPD,BPD, considerconsider gettinggetting specialspecial trainingtraining fromfrom aa supervisorsupervisor onon DialecticalDialectical TherapyTherapy TechniquesTechniques toto helphelp managemanage feelingsfeelings andand buildbuild copingcoping skillsskills

Mental Illness/Developmental Disability Coordinating Center of Excellence PsychosisPsychosis

PsychosisPsychosis isis thethe inabilityinability toto processprocess realityreality correctly.correctly. ItIt cancan bebe partpart ofof aa diagnosisdiagnosis ofof aa specificspecific disorder,disorder, likelike schizophrenia,schizophrenia, oror standstand alone,alone, likelike psychoticpsychotic disorderdisorder NOSNOS (not(not otherwiseotherwise specified).specified).

Mental Illness/Developmental Disability Coordinating Center of Excellence SomeSome classicclassic psychoticpsychotic symptomssymptoms include:include: HallucinationsHallucinations (seeing(seeing whatwhat isnisn ’’tt there;there; hearinghearing voices)voices) DelusionsDelusions (misinterpreting(misinterpreting whatwhat isis there;there; forfor example,example, thinkingthinking thethe newscasternewscaster onon TVTV isis thethe Devil)Devil) ParanoiaParanoia (thinking(thinking peoplepeople areare secretlysecretly tryingtrying toto huhurtrt oror controlcontrol them)them) OddOdd oror bizarrebizarre speechspeech

Mental Illness/Developmental Disability Coordinating Center of Excellence PsychosisPsychosis SomeSome psychosispsychosis isis aa symptomsymptom ofof anotheranother problem,problem, likelike aa severesevere moodmood disorder,disorder, andand willwill getget betterbetter oror disappeardisappear whenwhen thethe moodmood disorderdisorder isis treated.treated. OtherOther psychoticpsychotic symptomssymptoms areare partpart ofof longlong --termterm illnessillness likelike schizophreniaschizophrenia andand otherother thinkingthinking disorders.disorders. TheseThese ccanan alsoalso bebe treatedtreated withwith medication,medication, butbut thethe symptomssymptoms maymay bebe moremore persistent.persistent.

Mental Illness/Developmental Disability Coordinating Center of Excellence NegativeNegative SymptomsSymptoms AlongAlong withwith ““positivepositive ”” symptoms,symptoms, inin thethe sensesense ofof somethingsomething extraextra thatthat shouldnshouldn ’’tt bebe happening,happening, likelike hallucinations,hallucinations, somesome psychoticpsychotic disordersdisorders alsoalso causecause ““negativenegative ”” symptoms:symptoms: normalnormal qualitiesqualities thatthat areare missing.missing. PeoplePeople withwith severesevere schizophreniaschizophrenia oftenoften hahaveve lessless expressionexpression inin theirtheir facesfaces oror voices,voices, avoidavoid concontacttact withwith peoplepeople andand havehave ““flatterflatter ”” emotions.emotions. Frequently,Frequently, selfself --carecare andand groominggrooming areare neglected.neglected.

Mental Illness/Developmental Disability Coordinating Center of Excellence IsIs itit aa PsychoticPsychotic Symptom?Symptom?

ConsiderConsider otherother explanationsexplanations WishfulWishful thinkingthinking ImaginaryImaginary friendsfriends Stress/copingStress/coping mechanismmechanism FunctionalFunctional behaviorbehavior LackLack ofof understandingunderstanding

Mental Illness/Developmental Disability Coordinating Center of Excellence IsIs itit aa PsychoticPsychotic Symptom?Symptom?

ConsiderConsider PossiblePossible MisunderstandingMisunderstanding byby OthersOthers Failure/inabilityFailure/inability toto exploreexplore circumstancescircumstances Failure/inabilityFailure/inability toto exploreexplore meaningmeaning ofof responseresponse

Mental Illness/Developmental Disability Coordinating Center of Excellence Remember!Remember!

YourYour carefulcareful observationobservation overover timetime cancan provideprovide informationinformation thatthat helpshelps mentalmental healthhealth professionalsprofessionals andand doctorsdoctors distinguishdistinguish betweenbetween misunderstandingsmisunderstandings andand truetrue psychoticpsychotic symptoms.symptoms.

Mental Illness/Developmental Disability Coordinating Center of Excellence PsychoticPsychotic EpisodeEpisode ManyMany individualsindividuals withwith developmentaldevelopmental disabilitiesdisabilities seesee othersothers asas beingbeing moremore powerfulpowerful thanthan themselves.themselves. IfIf youyou areare askingasking aboutabout unusualunusual experiencesexperiences (seeing(seeing things,things, hearinghearing things),things), theythey maymay wantwant toto telltell youyou whatwhat youyou wantwant toto hear,hear, oror avoidavoid makingmaking youyou angryangry byby givinggiving thethe ““wrongwrong ”” answer.answer.

Mental Illness/Developmental Disability Coordinating Center of Excellence PsychosisPsychosis AvoidAvoid leadingleading questionsquestions (( ““YouYou ’’rere notnot hearinghearing voices,voices, areare you?you? ””)) AskAsk openopen --endedended questions,questions, notnot yesyes --oror --nono DonDon ’’tt givegive aa listlist ofof possiblepossible answers.answers. TheThe individualindividual mightmight simplysimply repeatrepeat thethe lastlast thingthing hehe oror sheshe heardheard AskAsk questionsquestions moremore thanthan once,once, andand inin moremore thanthan oneone way.way. SeeSee ifif thethe answeranswer isis consistentconsistent LetLet themthem knowknow anyany answeranswer isis OKOK

Mental Illness/Developmental Disability Coordinating Center of Excellence PsychoticPsychotic Symptoms:Symptoms: ‘‘HowHow toto HelpHelp ’’ DonDon ’’tt argueargue withwith thethe personperson ’’ss perceptionsperceptions DonDon ’’tt colludecollude (pretend(pretend thatthat youyou seesee thethe hallucinationhallucination too)too) HelpHelp thethe individualindividual feelfeel safesafe andand inin controlcontrol (universal(universal precautions!)precautions!) EducateEducate –– helphelp themthem toto understandunderstand thethe problemsproblems associatedassociated withwith thethe illnessillness andand howhow toto dealdeal withwith ththemem ManageManage thethe environmentenvironment TryTry toto minimizeminimize stressfulstressful things,things, peoplepeople andand situationssituations whenwhen possiblepossible

Mental Illness/Developmental Disability Coordinating Center of Excellence PsychoticPsychotic EpisodeEpisode Symptom:Symptom: DisorganizedDisorganized speechspeech AttemptAttempt toto clarify,clarify, butbut dondon ’’tt pushpush tootoo farfar Symptom:Symptom: Withdrawal,Withdrawal, NeglectNeglect ofof SelfSelf PromptPrompt forfor grooming,grooming, speech,speech, eyeeye contactcontact OfferOffer preferredpreferred activitiesactivities nearnear othersothers ProvideProvide opportunitiesopportunities toto interactinteract withwith safe,safe, reassuringreassuring people,people, butbut allowallow forfor spacespace ifif thethe individualindividual getsgets uncomfortable.uncomfortable. DonDon ’’tt forceforce interactioninteraction

Mental Illness/Developmental Disability Coordinating Center of Excellence DifferentiatingDifferentiating MentalMental IllnessIllness fromfrom ““BehaviorsBehaviors ”” CombinationCombination ofof factorsfactors makemake personspersons withwith DDDD vulnerablevulnerable to:to: MentalMental DisordersDisorders DemonstrationDemonstration ofof behaviorbehavior disturbancesdisturbances ExcitabilityExcitability ExplosivenessExplosiveness HyperactivityHyperactivity AgitationAgitation IrritabilityIrritability OtherOther destructivedestructive andand stereotypedstereotyped behaviorsbehaviors

Mental Illness/Developmental Disability Coordinating Center of Excellence MentalMental IllnessIllness vs.vs. LearnedLearned BehaviorsBehaviors

OddOdd oror disruptivedisruptive behaviorbehavior maymay reflectreflect anyany numbernumber ofof things:things: MentalMental disordersdisorders AbuseAbuse oror neglectneglect DevelopmentalDevelopmental levellevel farfar belowbelow chronologicalchronological ageage SeizureSeizure disorderdisorder oror otherother medicalmedical conditioncondition

Mental Illness/Developmental Disability Coordinating Center of Excellence BehaviorBehavior asas CommunicationCommunication

IndividualsIndividuals withwith developmentaldevelopmental disabilitiesdisabilities maymay notnot havehave thethe necessarynecessary skillsskills toto labellabel oror toto communicatcommunicatee feelings.feelings. ThisThis makesmakes itit harderharder forfor themthem to:to: IdentifyIdentify andand expressexpress emotionsemotions CommunicateCommunicate concernsconcerns ProblemProblem solvesolve DevelopDevelop optionsoptions

Mental Illness/Developmental Disability Coordinating Center of Excellence ThisThis meansmeans thatthat behaviorsbehaviors maymay veryvery oftenoften communicatecommunicate feelings.feelings. Fear,Fear, anger,anger, lonelinessloneliness oror powerlessnesspowerlessness maymay bebe feelingsfeelings thatthat resultresult inin annoying,annoying, disruptivedisruptive oror aggressiveaggressive behavior.behavior. TryingTrying toto stopstop oror controlcontrol thethe behaviorbehavior withoutwithout helpinghelping thethe feelingfeeling thatthat causedcaused itit doesndoesn ’’tt workwork forfor long.long.

Mental Illness/Developmental Disability Coordinating Center of Excellence BehaviorBehavior asas Communication:Communication: ‘‘HowHow toto HelpHelp ’’ StayStay calm,calm, andand trytry notnot toto reactreact beforebefore findingfinding outout moremore aboutabout whatwhat isis happeninghappening HelpHelp toto teachteach wordswords forfor feelingsfeelings ““YouYou feelfeel angryangry whenwhen someonesomeone takestakes youryour thingsthings ”” GiveGive permissionpermission andand encouragementencouragement toto expressexpress feelingsfeelings inin wordswords RememberRemember otherother thingsthings thatthat maymay bebe expressedexpressed withwith behavior:behavior: pain,pain, illness,illness, etc.etc.

Mental Illness/Developmental Disability Coordinating Center of Excellence IsIs itit MentalMental IllnessIllness ……..or..or Not?Not?

SometimesSometimes peoplepeople workingworking withwith someonesomeone withwith mentalmental illnessillness andand developmentaldevelopmental disabilitiesdisabilities maymay wonderwonder ifif difficultdifficult oror strangestrange behaviorbehavior isis thethe resultresult ofof aa mentalmental illnessillness (not(not deliberate)deliberate) oror isis anan efforteffort toto avoidavoid somethingsomething oror getget somethingsomething (in(in otherother words,words, deliberate).deliberate).

Mental Illness/Developmental Disability Coordinating Center of Excellence MentalMental IllnessIllness vs.vs. LearnedLearned BehaviorsBehaviors AskAsk yourself:yourself: WhatWhat purposepurpose doesdoes thethe behaviorbehavior serve?serve? WhatWhat makesmakes thethe behaviorbehavior worse?worse? WhatWhat makesmakes thethe behaviorbehavior better?better?

Mental Illness/Developmental Disability Coordinating Center of Excellence MentalMental IllnessIllness vs.vs. LearnedLearned BehaviorBehavior CluesClues thatthat thethe behaviorbehavior maymay bebe learned:learned: TheThe behaviorbehavior isis anan effectiveeffective wayway forfor thethe individualindividual toto avoidavoid somethingsomething thatthat theythey dondon ’’tt wantwant toto dodo oror getget somethingsomething thatthat theythey want,want, suchsuch asas attention.attention. TheThe behaviorbehavior oftenoften occursoccurs whenwhen thethe individualindividual isis askedasked toto dodo somethingsomething thatthat theythey dondon ’’tt wantwant toto do.do.

Mental Illness/Developmental Disability Coordinating Center of Excellence MentalMental IllnessIllness vs.vs. LearnedLearned BehaviorBehavior MoreMore clues:clues: TheThe behaviorbehavior isis effectiveeffective andand hashas beenbeen usedused forfor aa longlong time.time. TheThe personperson hashas spentspent longlong periodsperiods ofof his/herhis/her lifelife iinn placesplaces wherewhere thethe behaviorbehavior waswas reinforcedreinforced forfor oneone reasonreason oror anotheranother (for(for example,example, beingbeing aggressiveaggressive toto getget hishis oror herher wayway inin aa groupgroup home).home).

Mental Illness/Developmental Disability Coordinating Center of Excellence So,So, whatwhat ifif itit isis learned?learned?

WhetherWhether oror notnot aa behaviorbehavior isis learned,learned, isis aa resultresult ofof aa mentalmental illness,illness, traumatrauma oror grief,grief, oror isis simplysimply anan attemptattempt toto getget something,something, therethere areare aa fewfew thingsthings toto alwaysalways rememberremember ......

Mental Illness/Developmental Disability Coordinating Center of Excellence AlwaysAlways ……!! ThinkThink aboutabout whatwhat needneed oror desiredesire thethe behaviorbehavior isis tryingtrying toto meetmeet (safety,(safety, control,control, attention,attention, nurturinurturing,ng, excitement,excitement, predictability,predictability, etc.)etc.) ThinkThink aboutabout waysways thethe individualindividual cancan getget thatthat needneed metmet beforebefore usingusing thethe disruptivedisruptive behaviorbehavior (universal(universal precautions!)precautions!) ThinkThink aboutabout whatwhat elseelse thethe behaviorbehavior couldcould bebe communicatingcommunicating (feelings,(feelings, problemsproblems andand concerns,concerns, physicalphysical pain/illness)pain/illness)

Mental Illness/Developmental Disability Coordinating Center of Excellence AndAnd finallyfinally ………… Remember,Remember, whenwhen youyou taketake thethe timetime toto getget toto knowknow anan individual,individual, andand whenwhen theythey knowknow thatthat youyou carecare aboutabout helpinghelping themthem feelfeel safe,safe, inin controlcontrol andand caredcared for,for, youyou cancan helphelp withwith manymany ofof thethe scariestscariest partsparts ofof mentalmental illnessillness andand developmentaldevelopmental disabilitdisabilities.ies. ““ItIt isis thethe relationshiprelationship thatthat heals.heals. ”” - Irving Yalom

Mental Illness/Developmental Disability Coordinating Center of Excellence CreditsCredits MichaelMichael Schroeder,Schroeder, MSWMSW Ohio Department of Mental Health Some of this material was originally presented in “Working with Patients with ID/DD: A Guide for TWPs and PATs ” Dr.Dr. KathyKathy OlsonOlson Kansas University Affiliated Program Dr.Dr. JulieJulie P.P. Gentile,Gentile, MDMD Wright State University, Boonshoft School of Medicine CarrollCarroll Jackson,Jackson, MSW,MSW, LISWLISW --SS Dr.Dr. BetseyBetsey Benson,Benson, PhD.PhD. Nisonger Center, Ohio State University

Mental Illness/Developmental Disability Coordinating Center of Excellence ReferencesReferences

A Four -Stage Model for Management of Borderline Personality Disorder in People With Mental Retardation Susan R. Wilson, M.A.1Mental Health Aspects of Developmental Disabilities April/May/June 2001 Vol. 4, No. 2

Improving Lives: EMDR Psychotherapy for People with I/DD Experiencing Trauma and Distress Gail Ford, Associate Director Robbie Adler -Tapia, Ph.D., Psychologist, Certified EMDR Therapist, EMDRIA Approved Consultant EMDR HAP Trainer NASDDDS November 18, 2010

Mental Illness/Developmental Disability Coordinating Center of Excellence