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MENTAL ILLNESS AND RESPONDING TO THE MENTALLY ILL

MENTAL ILLNESS AND RESPONDING TO THE MENTALLY ILL.

lesley-levy
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MENTAL ILLNESS AND RESPONDING TO THE MENTALLY ILL

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  1. MENTAL ILLNESS AND RESPONDING TO THE MENTALLY ILL

  2. “How could you” began Mackey, “how could you, a mathematician, a man devoted to reason and logical proof .. how could you believe that extraterrestrials are sending you messages? How could you believe that you are being recruited by aliens from outer space to save the world? How could you …? “Because,” Nash said slowly … “the ideas I had about supernatural being came to me the same way my mathematical ideas did. So I took them seriously”. Nasar, S. (1998). A Beautiful Mind.

  3. CONTACT WITH MENTALLY ILL PERSONS Legal services may have contact with people with a mental illness as: • Victims of crime • Criminal defendants • Civil matters & general complaints

  4. MENTAL ILLNESS “A clinically significant disturbance of thought, mood, perception or memory”. • Risk to self/others • Symptom severity • Impairment • Includes: schizophrenia, bipolar affective disorder, major depression

  5. ASSESSMENT • Behaviour:-what is the person doing? is it appropriate to the setting/for that person • Appearance:- note self-care/unusual features • Speech: -does the person make sense? • Symptoms:- note possible signs/symptoms • Insight:- can the person appreciate their situation? • Communication:-can the person understand you? • Coping:-is the person’s mood and mental state stable? How are they coping with life?

  6. SIGNS OBSERVABLE INDICATORS OF MENTAL ILLNESS Talking to oneself Constant pacing Slumped posture Unusual repetitive behaviour Facial grimacing Inability to concentrate Disorganisation Reaction to non-existent stimuli The cluster of signs is more important than individual signs

  7. SYMPTOMSARE ONLY ACCESSED VIA VERBAL COMMUNICATION • hearing voices • feeling persecuted • misperception of events • thoughts being controlled or stolen

  8. QUESTIONS TO ASK: 1 • Have you had any strange or odd experiences lately that you can’t explain? • Do you hear things that other people can’t? • Do you see things that other people can’t? • Have people been trying to harm you? • Have people been taking too much interest in you?

  9. QUESTIONS TO ASK: 2 • Do you feel people talk about you • Do you feel people look at you? • How has your mood been? • Have you been depressed? • Have you ever felt you had a special purpose? • Have you felt your thoughts went so fast you could not keep up? • Have you ever had treatment for your nerves • Have you ever seen a psychiatrist?

  10. SCHIZOPHRENIA Persons may experience a gross impairment of understanding what is real. • Delusions • Hallucinations • Thought Disorder & thought interference • Negative symptoms

  11. MANIA • Elevated, grandiose mood • Irritability • Increased activity or restlessness • Rapid speech • Subjective feeling of racing thoughts • Reduced sleep • Disinhibited behaviour (sexual, financial overspending, reckless-impulsive behaviour) • Feeling of having excess energy

  12. DEPRESSION • Depressed mood - feels sad or empty most of the day, appears tearful • Loss of interest or pleasure in activities • Sleep difficulties • Weight loss • Agitation • Lack of spontaneous movement or expression of emotions • Fatigue or loss of energy every day • Recurrent thoughts of suicide/self self harm, hopelessness, worthlessness, negativity and/or guilt.

  13. BIPOLAR AFFECTIVE DISORDER This disorder is characterised by exaggerated mood swings from elevation (mania) to major depression, that usually endure for weeks or months.

  14. PERSONALITY DISORDER • A pattern of behaviour that differs from an individual’s culture, is stable over time and leads to distress or impairment. Characteristics could include: • Overly dramatic reactions • Detachment from others • Grandiose entitlement • Self-defeating behaviour & impulsiveness • Dependency & helplessness • Avoidance

  15. COMMUNICATION & ACTIVE SYMPTOMS • Your message may not be understood • Your message or behaviour may be misinterpreted • You may receive unpredictable responses • You may not be able to rely on the usual facial or behavioural cues

  16. TREATMENT Aims: • Reduce symptom severity • Restore functioning • Types of treatment • Medication • Psycho-social interventions • Support & practical assistance

  17. ARE THE MENTALLY ILL VIOLENT? • Active symptoms increases this risk • Only a small proportion of the mentally ill are violent. • Substance use increases this risk

  18. FACTORS THAT INCREASE VIOLENCE AMONG THE MENTALLY ILL • The same factors that increase the risk of violence among the general population (e.g anger, previous history of violence, intoxication) • Factors specific to mental illness (e.g psychotic symptoms)

  19. MENTAL STATE & VIOLENCE • Paranoia can cause people to believe others intend them harm. • ‘Voices’ may ‘command’ a person to act • A person may believe they have a special mission and react to perceived attempts to thwart this mission • Everyday events may be misperceived (a smile may be proof of a conspiracy) • Impaired judgment of actions/consequences (e.g stabbing to someone to save them from the Devil)

  20. COMMUNICATION CHECKLIST Useful to consider: • Is my message being understood the way it is intended? • What is interfering with the communication process? • Is my reaction helpful in the situation?

  21. CASE EXAMPLE • You are asked to speak to a 35 year old man who is pacing back and forward. He becomes irritable as people walk past. Initially he only gives single word replies to your questions. You change your strategy and he becomes more talkative. • He begins to voice concerns about a conspiracy by the World Bank and asks if you believe him. He wants your assistance in writing a petition to send to the Governor. He wants his neighbours to remove a television antenna that he believes is a listening device designed to steal his plans to generate an alternative source of power. He appears genuinely afraid and is becoming more restless as he feels you will not help him.

  22. DE-ESCALATION RESPONSES: • Non-threatening posture and speech • Maintain safe distance • Ascertaining what is wanted/concerns. • Acknowledge what is said (nodding, hmm) • Don’t persist with a line of questions if the person is becoming more distressed or irritable. Reframe • Be sensitive to your responses (laughing) • Offer reasonable reassurance

  23. COMMUNICATION: DO’ S • Defuse: calm or slow the person down (suggest deep breaths, slower speech) • Reduce stimulation (noise, people around) & distract from concerns • Listen & acknowledge the other’s point of view – • Keep it simple

  24. SOME MORE DO’S • Attend to body language • Check you are being understood • Treat the person how you would like to be treated. • Give options • Set limits if necessary (e.g what is acceptable)

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