Addressing Mental Health Needs in Families with Children

1. Addressing Mental Health Needs in Families with Children National Conference on Ending Family Homelessness Helene M. Rimberg, PsyD

2. Key Points • In order to be most effective, service providers need to understand the complexities of their clients • Families are systems • Families are part of multiple systems • Mental Health issues impact the individual, the family, how it interacts with other systems, and how other systems respond • Housing case managers can play a vital role in assessment, resource development and follow through

3. Fragmented Approach • Feel misunderstood • Feel disrespected • Feel like a problem not a person • Less likely to follow through • Service delivery is less effective

4. Integrated approach • Person feels understood • Problems are viewed in context • Person feels respected • Views provider as ally • Services are appropriate and likely to succeed • More likely to engage and follow through

5. Families as systems • A family is greater than the sum of it’s parts – creates a unique whole • Family members impact, and are impacted by, each other – ripple effect or interdependence • Have a defined set of rules • Have a defined structure • Have patterns of behavior that are resistant to change – • Seek to maintain status quo

6. Families are part of multiple systems

7. Add mental health issues • Mental health issues impacts • How members respond to each other • Family’s level of engagement • Family’s quality of engagement • Response from others

8. Low energy Hopelessness Fragility Suicidal Sleep problems Sadness Family members caretake, protect & neglect own needs Limited engagement with others Engagement marked by low motivation Others feel; frustrated, tend to take over Depression

9. Depression Mood swings Instability Impulsive Excessive involvement in pleasurable activities: drugs, gambling, sex, spending Grandiose Agitated Resistance to medications Family members response varies with phase – creates instability Engagement varies with phase – in manic state will avoid purposeful contact Others response will also vary based on phase – caretaking during depression, punitive during manic phase Bipolar Disorder

10. Starts in late adolescence or early adulthood Thought disorder Delusional Hallucinations Paranoid Nonsensical communications Poor self care Flat affect Disconnectedness Cognitive problems: memory, attention, organize Substance use Family members feel burdened, helpless, scared, embarrassed by bizarre behaviors Engagement with others is difficult; marked by communication difficulties Others are at a loss on how to engage – turf to more restrictive environment Schizophrenia

11. Pervasive instability in relationships, moods, behavior, self-image Highly sensitive to rejection Good/bad thinking Self-harming Impulsive Substance use Family members are overwhelmed, angry, fear upsetting the other, feel manipulated Engagement with others is unstable – good provider vs. bad provider Tend to disrupt systems, burn bridges Others feel manipulated, fear becoming the bad provider, not sure what to believe Borderline Personality Disorder

12. Role of Housing Case Manager • Thorough assessment of family to determine mental health issues, impacts and needed resources • Create system of support – utilize community resources to serve family within community • Resist what mental health issues pulls from you – respect the family, your boundaries • Be genuine – you are your best tool