Covenants of Protection
What will we (as individuals living with mental illness, family members and providers) need from each other during this course to create and sustain a totally protective environment?
Class 1: Chart 1 NAMI Provider Education Program: 2012
DEFINITION OF A CATASTROPHIC STRESSOR
AN UNANTICIPATED EVENT
NO TIME TO PREPARE FOR IT
NO PREVIOUS EXPERIENCE ABOUT HOW TO HANDLE IT
HAS A HIGH EMOTIONAL IMPACT
INVOLVES THREAT OR DANGER TO SELF OR OTHERS
Class 1: Chart 2 NAMI Provider Education Program: 2012
4 CORNERSTONES OF SECONDARY PREVENTION /INTERVENTION
1. Recognition that the catastrophic event deals a staggering blow and imposes sudden, overwhelming burdens.
2. Moving quickly to preserve social supports and fortify coping skills.
3. Empathizing with the normalcy of responses to trauma.
4. Anticipating what is needed based on a demonstrated process of adaptation.
Class 2: Chart 1 NAMI Provider Education Program: 2012
THE IMPACT OF MENTAL ILLNESS ON THE FAMILY
I. DEALING WITH THE CATASTROPHIC EVENT
Crisis/Chaos/Shock Denial ("normalizing"); Disbelief Hoping Against Hope
TRAUMA RESPONSE: Flight from recognition.
NEEDS: * Support * Comfort * Empathy for confusion * Help finding resources Crisis intervention * Prognosis * Empathy for pain * NAMI support and information
II. LEARNING TO COPE
Anger/Guilt/Resentment Recognition Grief
TRAUMA RESPONSE: Flight from fear, anguish and powerlessness.
NEEDS: * Vent feelings * Keep hope * Education * Self-care * Networking * Skill training * Letting go * Co-operation from System * NAMI Educational & Support Groups
III. MOVING INTO ADVOCACY
Understanding Acceptance Advocacy/Action
TRAUMA RESPONSE: Mastering loss/stigma through reparative work.
NEEDS: * Activism * Restoring balance in life * Responsiveness from system
Class 2: Chart 2 NAMI Provider Education Program: 2012
EMOTIONAL STAGES OF RECOVERY FOR INDIVIDUALS LIVING WITH MENTAL ILLNESS
EVENT 1) CRISIS: Episode of serious mental illness.
STAGE 1) RECUPERATION: A period of exhaustion and dependence.
Emotions: Denial, Depression, Humiliation, Resentment, Anger
Needs: Rest; Sleep; Someone to take care of me; Medications (probably)
EVENT 2) DECISION: “Time to get going”.
STAGE 2) REBUILDING: Learning to do things for myself.
Emotions: Hope, Grief, Self-doubt, Trust, Fear, Excitement, Frustration, Pride
Needs: Tell my story; Education about SMI; People who believe in me; Learning (relearning) social/working skills
EVENT 3) AWAKENING: “I am somebody. I have a dream!”
STAGE 3) RECOVERY/DISCOVERY: Building healthy Interdependence.
Emotions: Self-acceptance, Appreciation of others, Confidence, Anger at injustice, Assertiveness, Helpfulness
Needs: A personal vision; People who appreciate me; Someone to love; meaningful work; To advocate for self and others
Class 2: Chart 3 NAMI Provider Education Program: 2012
SYMPTOMS OF BURNOUT
Emotional and physical exhaustion: headaches, tension, depression, boredom, apathy, ambivalence.
Absenteeism; decline in performance
Emotional stress: insomnia, irritability, increased anxiety, hopelessness.
Increase in "escape" behaviors: smoking, over-eating, drinking too much.
Lowered self-regard: self-doubt, self- blame, blaming others.
Class 3: Chart 1 NAMI Provider Education Program: 2012
Stages of Medication Adherence
1. Lack of insight: "I’m not ill."
2. Protective denial: "I don't need them."
3. Avoiding the subjective pain, or boredom, of sanity: Experimentation “on-and-off" drugs.
4. Rebellion against patienthood: Sudden refusal to continue long-term drug therapy.
5. Reluctant, or partial, acceptance.
Class 3: Chart 2 NAMI Provider Education Program: 2012
EMPATHY
THE INTIMATE
COMPREHENSION OF
ANOTHER PERSON'S
THOUGHTS AND FEELINGS,
WITHOUT IMPOSING OUR
OWN JUDGEMENT OR
EXPECTATIONS
Class 4: Chart 1 NAMI Provider Education Program: 2012
DEFENSIVE COPING STRATEGIES USED TO
PRESERVE SELF-ESTEEM IN MENTAL ILLNESS
Self-absorption Apathy
Irritability Bargaining
Haughtiness Withdrawal
Controlling/manipulation Suspicion
Anger and attack Dependency
Rejection of friends and Envy family Running away Blaming others Refusing medication Defensiveness Quitting the job Drug and alcohol abuse Relapse Doing nothing Abusive criticism Resistance to change of others
Refusing services Sleeping
Denial "I don't want to talk about it" Class 4: Chart 2 NAMI Provider Education Program: 2012
STEPS IN FRAMING THE CASE
STEP 1: ASK THE CLIENT TO SIGN A WAIVER SO YOU CAN TALK TO THE FAMILY AS PART OF THE CLIENT'S TREATMENT.
STEP 2: DE-STEREOTYPE THE CASE.
STEP 3: DEFINE THE STRENGTHS OF EACH FAMILY MEMBER, INCLUDING THE CLIENT.
STEP 4: DETERMINE WHERE EACH FAMILY MEMBER IS IN THE FAMILY STAGE PROCESS. DETERMINE WHERE THE CLIENT IS IN THE CONSUMER STAGE PROCESS.
STEP 5: EMPATHETIC IMAGINING
STEP 6: THE CARDINAL RULE: LET THE FAMILY SET THE AGENDA
STEP 7: DEFINE THE CENTRAL CLINICAL ISSUE
STEP 8: FORMULATE A FOCUSSED CLINICAL PICTURE OF THE CLIENT AND HIS FAMILY AND A CLEAR SET OF CLINICAL TASKS.
Class 5: Chart 1 NAMI Provider Education Program: 2012