Friday, April 12, 2013

We Are On Our Own


Last week I was part of a group that was confronted with a psychiatric crisis in a visitor.  This group had never been called upon in this way.  But among our ranks we had enough experience of psychiatric crisis that:


1) We were determined we would help a stranger; and
2) We knew how to do it.

Part of the story was that inevitable series of telephone calls to offices in 24 hour institutions that were closed.  When flesh and blood was finally located, the response was rude, ineffective and dismissive.

When I debriefed with my therapist, she expected my frustration at calls for help that did not yield help.  That is one of my therapy themes -- a cognitive schema, as a former cognitive therapist called it.  I surprised my new therapist and surprised myself with my response.  No, I didn't expect help.  We are on our own.


It is what it is.

The debates rage on, but the ship has already sailed.  We fought two wars in the last decade, and put the bill on a credit card.  Now the bill has come due, it will not be paid by the people who became not just wealthy in that decade, but obscenely wealthy.  Instead, it will be paid by the old, the mentally ill, and ironically, by veterans who came home disabled in those very wars.  Congress will not ask their corporate sponsors to contribute a dime.

It is what it is.

Violence and Mental Health Funding

Somebody with schizophrenia shoots up an Arizona shopping market parking lot and a month later, Arizona slashes its mental health budget.

An elementary school shooting again raises concerns about our tattered mental health system and our reckless arming of America.  After all the marches, petitions, phone calls, pleading, we will do nothing that effectively stems the violence.  People with a serious mental illness account for 5% of the homicides in the US.  Yet we will take the hit for the whole enchilada.  There will be a lot of rhetoric about improving mental health services.  But bottom line, the most we can expect out of Sandy Hook will be a better data base of nut cases.

We are on our own.  It is what it is.

Well, like I said, last week a group of unpaid nonprofessionals did get the job done.

What Would Jesus Do? -- Something That Works

Where I am going to put my energy is in equipping as many people as I can to do what this nation does not have the will to do, to care for the least among us, to help veterans and elderly and children and those who are ill.  You know -- all that stuff Jesus and the Prophets said.  And screw those who would rather post patriotic sentiments on Facebook than pay the price.

The challenge is to know how.  It's one thing to want to help.  It's another actually to do it.  When it comes to psychiatric illness, we have done little to educate the public on how to do it.

In the absence of knowledge, many are scared.  So they withdraw.

But when we do know how, we can do very simple things that make a major difference.

So below, I repost a list from a previous post on mental health first aid.  The list first came to me as a laminated wallet-sized card.  When my group of friends later used it to debrief our efforts to provide help, we concluded that these were indeed the behaviors that helped.


MENTAL HEALTH FIRST AID

Proceed to interact as you:
 

1 - Be calm and give firm, clear instructions
2 - Assess the situation for safety
3 - Maintain adequate space between you and the person
4 - Respond to apparent feelings
5 - Respond to delusions and 
hallucinations by talking about

       the person's feelings rather than what is said
6 - Be helpful, encouraging and supportive


Avoid:
 

1 - Reinforcing behavior related to the person's illness
2 - Staring at the person (this may be interpreted as a threat)
3 - Confusing the person
4 - Giving multiple choices (this may increase confusion)
5 - Whispering, yelling, ridiculing, deceiving or touching

       (this may cause fear and lead to violence).

Someone with a psychiatric 

illness might...                      So you need to...

Have trouble with reality...................... Be simple, truthful
Be fearful.......................................... Stay calm
Be insecure........................................ Be accepting
Have trouble 
concentrating................... Be brief, repeat
Be over stimulated.............................. Limit input
Easily become agitated........................ Recognize agitation
Have poor judgment............................ Not expect rational discussion
Be preoccupied................................... Get attention first
Be withdrawn....... ............................. Initiate relevant 
conversation
Have changing emotions....................... Disregard
Have changing plans............................ Keep to one plan
Have little empathy for you.................. Recognize as a symptom
Believe delusions................................ Ignore, don't argue
Have low self-esteem and motivation..... Stay positive



When I first came upon this list, I read it, asking myself whether it was sufficient advice for dealing with me when I am in psychiatric crisis.  I concluded that one item was missing, and I added it for our discussion.

Someone with a psychiatric
illness might.............                  feel shame.

So you need to.............              show respect.

Resources for Mental Health First Aid

If you want to do what Jesus and the Prophets said, or if you have your own reasons, click here to learn more.

We are on our own.  So we better be in this together.

image of Good Samaritan from Christian clip art in public domain
photo of homeless vet by Matthew Woitunski, used under Creative Commons license
Red Cross graphic in public domain

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