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Best Practice: Understanding Patrons with Psychiatric Disabilities Chris Peters, Ph.D., OTR/L Rachel Post, LCSW Nancy Henderson, MA, MLS Nona Clarke Corbett Monica, B.A., CADC II Elizabeth Scanlon, BS, OTS Lisa Canavan May 16, 2008
First thing that comes to mind.. • Write the first message that comes to mind when you think about people with mental illness… “They are……”
Vincent to Theo • “As for me, you must know that I shouldn’t precisely have chosen madness if there had been any choice” said Vincent Van Gogh, 1889, in a letter to his brother, written in the psychiatric hospital in St. Remy (Torrey, 2006/1983).
Workshop Overview • Part I: Understanding Stigma and Psychiatric Disabilities • Understanding Recovery and Empowerment: First Person Experiences • Part II: Best Practice for Librarians • Practical strategies • Library policies • Part III: Where do we go from here? A time for questions and answers.
Recent crimes link violence, mental illness “A man released from a Washington state mental hospital is accused of stabbing a teenage girl to death.” “Another man randomly snatched a child […] says he intended to throw the child in front of a moving train.”
“The thread connecting all those horrific tales? Past diagnoses of mental illness for each suspect” (Song, 2006).
Stereotypes and Stigma • 150 films were released with characters who have psychiatric disabilities between 1985 and 1995—the majority of characters were killers and villains (Arnold and Wienerth, 2003). • Now think about these names: Patty Duke, Carrie Fischer, Dan Rather, Ernest Hemmingway, Tennessee William, Leo Tolstoy
Psychiatric Disability and Violence • One out of four people may have a psychiatric illness in the general population (Torrey, 2006). • People with psychiatric disabilities are 2 ½ times more likely to be victims of crimes than the general population. • The likelihood of a person with a psychiatric disability harming a stranger is no greater than an individual in the general population (Hiday, Swanson, Swartz, Borum, & Wagner, 2001; SAMSHA, 2007).
Moral Treatment: Changes in Mental Health Attitude • Reformers in the United States: Humane Treatment • 1752: Quakers founded Pennsylvania House • Mid 1800s: Dorothea Dix • Purging of “idiots and lunatiks” Clifford Beers: Mental Hygiene Movement (1912)
Title? Dr. Pinel removes chains from an “insane woman” in a French “asylum” (1729).
20th Century Attitudes • Treatment developments (1940s- 1950s): Pre Frontal Lobotomies, insulin shock, electro convulsive therapy and psychopharmacology (Peters, in press)
Legislative Push toward Community • 1960: Patient’s Bill of Rights • 1963: Community Mental Health Act (deinstitutionalization) • 1990s: Americans with Disabilities Act • 1996: Mental Health Parity Act • 1999: LC v Olmstead • 2003: The President's New Freedom Commission on Mental Health: Achieving the Promise (recovery)
Definition of Mental Disorder: Medical View • Each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern (Cara & MacRae, 2005; Saddock, B.J. & Saddock, V.A., 2007).
Schizophrenia • Neurochemical and structural neuropathological changes in the brain (Torrey, 2006). • DSM IV-TR (2000): Symptoms present 6 months or more • Positive symptoms: Psychosis • hallucinations • delusions • bizarre behavior • Negative Symptoms: • affect flattening • poverty of speech (alogia) • loss of pleasure in activities (anhedonia)
White Dove: M. Wolsky When I was younger I could not fully negotiate all the things and ideas that I had, but three years ago that changed for me. Life for me is simple when all is complex and the tides turn to peace (Precin, 2002).
Mood Disorders • Unipolar and Bi-polar • Perception of self is distorted as well as self esteem. • Person may experience mood swings. (Saddock & Saddock, 2007)
They Call Me Crazy • I am comfortable with bipolar manic-depressive disorder but not everyone else is. It feels bad when people do not want to be my friend anymore, others call me names like crazy. S. Domina (Precin, 2002).
Substance Abuse • Extensive category • Alcohol, Cocaine, Hallucinogens, Inhalants, Opioids • Addiction impacts social and peer support, and everyday ability to function. http://www.methtaskforce.org/aboutmeth.htm
I really messed up this time: J. Chatman • My 7 year old son is very, very unhappy and very sad because of me. He used to have a beautiful and bright look on his face, a gorgeous look. Lord forgive me for all my sins, especially my kids. I do not want to go back to drugs (Precin, 2002).
Recovery Paradigm “gaining control over one’s life, appreciating and valuing the uniqueness of oneself, belonging[…] in a community and […] realizing hopes and dreams” (Brown, 2001, p.1).
References American Psychiatric Association (2000). Desk reference to the Diagnostic criteria from DSM IV-TR. Arlington, VA: author. Bing, R.K. (1981). Occupational therapy revisited: A paraphrastic journey. American Journal of Occupational Therapy, 35, 499-518. Brown, C. (2001). Recovery and wellness: Models of hope and empowerment for people with mental illness. New York: Haworth Press, Inc Cara, E. & MacRae, A. (2005). Psychosocial occupational therapy. Clifton Park, NY: Thompson Delmar. Hiday , V.A., Swanson, J.W., Swartz, M.S., Borum, R., & Wagner, R. (2001). Victimization: A link between mental illness and violence? International Journal of Law and Psychiatry 24, 559-572. Jones, J. (1993/1981). Bad Blood. NY: Free press. Precin, P. (2002). Client-centered reasoning narratives of people with mental illness. Boston: Butterworth Heinemann. Saddock, B.J. & Saddock, V.A. (2007). Kaplan & Saddock’s synopsis of psychiatry. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins. Substance Abuse and Mental Health Administration. (2007, April 20). Violence and mental illness: The facts. Retrieved May 1, 2008, from http://www.samhsa.gov/MentalHealth/understanding_Mentalllness_Factsheet.aspx Torrey, E. F. (1997). Out of the shadows: Confronting America’s mental illness crisis. NY: Wiley & Sons. Torrey, E. F. (2006/1983). Surviving Schizophrenia: A manual for families, patients and providers. NY: Harper Collins.
Understanding Recovery and Empowerment: First Person Experiences • Nona Clarke • Executive Director, Comfort Zone • Board of Directors, Washington County NAMI • Behavioral Health Committee, Washington County • Corbett Monica, B.A., CADC II • Founder and Executive Director of Dual Diagnosis Anonymous of Oregon, Inc. • Dually diagnosed and in recovery