Webinar Notes: Recognizing Mental Health Disorders in Others

Pre-webinar survey (0:25)

  • Why did you register for the webinar?
    • Both law enforcement and probation stated that they deal with the public that might have mental health issues.
  • How often do you encounter a person that seems to be struggling with mental health issues?
    • Often – more than half of respondents
    • Sometimes – about a third
  • Have you had an encounter that could’ve gone differently?
    • Yes, I would like to understand mental health better – two-thirds of respondents

 

Webinar Focus (01:58)

  • The webinar will not necessarily enable you to diagnose a mental disorder, it can help you recognize some basic symptoms
  • How to interact with individuals manifesting such symptoms

 

Resource Speaker (00:46)

  • Amy Morgan
    • Founder/Owner – Academy Hour
    • Master of Science in Counseling, BS Behavioral Sciences
    • Earning Doctorate of Educ. – Global Training & Curriculum Development
    • Member, Mental Health Committee: Int’l Public Safety Association
    • Curriculum Development/Instructor for International Public Safety Association
    • Curriculum Development/Instructor for Justice Clearinghouse
    • Previously Training Officer for OSBI
    • Curriculum Developer & Instructor for CLEET
    • Instructional Systems Designer/Trainer for FAA
    • Writer of published therapy resource workbooks & training curriculum/books on Amazon
    • Certified trainer: ASIST‐Applied Suicide Intervention Skills Training
    • Certified trainer: QPR‐Question Persuade Refer
    • CPI Non‐Violent Physical Crisis Intervention Trainer
    • Oklahoma Supreme Court Mediator
    • Mensa USA & Mensa Oklahoma achievement

 

Overview (05:35)

  • What mental illness is?
  • What disorders are?
  • Determining if someone does or doesn't have a diagnosable mental concern.
  • Recognizing mental disorder and illnesses in others
    • Photo 1 – man lost in thought, watching the sunset in solitude
    • Photo 2 – happy man looking directly to the camera
    • Someone’s outward appearance isn’t enough to demonstrate what goes on in their minds.
  • DSM-5 / Diagnostic and Statistical Manual of Mental Disorders
    • Book used to diagnose mental disorders
    • Very specific and detailed
    • List of diagnostic criteria
    • Factors considered
      • When the symptoms began
      • How long it’s been going on
      • Situational/ongoing
    • Key phrase in the criteria list is that the symptoms interfere with a person’s ability to function in normal life

 

Phobias (06:47)

  • Having a phobia doesn’t mean you have a mental disorder. You just have a specific fear of something.
    • E.g., Ophidiophobia – The fear of snakes
  • The diagnostic criteria for phobias according to DSM-5
  • List of phobias
    • Only agoraphobia is listed in the DSM-5, where the individual fears:
      • Using public transportation
      • Being in open spaces
      • Being in enclosed spaces
      • Standing in line
      • Being in crowds
  • Some people can have an intense fear that you might not understand why they're acting the way they are.
  • When dealing with such people, it is best to practice patience, compassion, and understanding when they’re trying to avoid interacting with something (i.e., their fears)

 

Most common disorders and illnesses (11:11)

  • Schizophrenia
  • PTSD/Trauma
  • Bipolar
  • Depression
  • Personality Disorders
  • Phobias
  • Obsessive‐Compulsive
  • Narcissism 
  • Anxiety/Panic
  • Suicide

 

Schizophrenia (11:48)

  • Typically begins in early adulthood (age 15‐30)
  • Criteria list
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Grossly disorganized or catatonic behavior
    • Diminished emotional expression
      • Lack of facial expression a.k.a. "flat affect"
  • How to interact
    • Don't argue.
      • Ask questions about the person's fears
      • Talk to the person about the paranoia if the person wants to listen to you
      • If someone is threatening you, don’t antagonize or pursue conflict.
    • Use simple directions, if needed. 
      • Tell the person that no harm will come to him or her and that you can help. 
      • E.g., "Sit down, and let's talk about it."
    • Give the person enough personal space 
      • Stay with the person but at a distance that is comfortable for him or her and you. 
      • Stay more than an arm's reach away.
    • Call for help if you think anyone is in danger.
    • Move the person away from the cause of the fear or from noise and activity, if possible. 
      • Ask the person to tell you what is causing the fear. 
      • Make a direct statement that you are not afraid
    • Focus the person on what is real.
    • Tell the person everything you are going to do before you do it.
      • E.g., "I'm going to take out my cell phone.”
    • To help with situations that may cause paranoia
    • Help the person avoid things he or she fears. 
      • E.g., If the person is afraid of dogs, avoid them.
    • Keep lights turned on if the person tells you that this makes him or her less scared
    • Talk about the person's fears when he or she is not paranoid,
    • Plan for handling the fears when they occur.
    • Help the person make a list of his or her fears.


Bipolar Disorder (15:16)

  • Criteria list
    • Extreme mood swings
    • Severely depressive
    • Manic (up/hyper)
    • Suicidal
    • Psychosis- hallucinations, etc.
  • Wide range of emotional extremes are experienced by people with bipolar disorder
    • From happy and euphoric to a depressed state
  • Scenario/Case Study
    • Mother and daughter, daughter is in a hospital for treatment
    • Scene 1
      • Mother tries to be logical, but daughter isn’t capable of doing so
      • Mother inadvertently puts blame on daughter
      • Daughter wants to leave the hospital and get an apartment – mother responds that it couldn’t be done
      • Daughter accuses mother of alcoholism – mother reacts emotionally
    • Scene 2
      • Mother empathizes with the daughter
      • Daughter wants to leave the hospital and get an apartment – mother asks daughter for alternatives
      • Daughter accuses mother of alcoholism – mother responds calmly, understanding that it is only an effect of the daughter’s paranoia
  • How to interact
    • Don’t let yourself get caught up in the mood swing.
    • Remind yourself this is a disorder, and the mood swing is the current issue, not the words the person is actually saying.
    • Keep the person safe

 

Depression (23:32)

  • There are various disruptive mood dysregulation disorders
  • The differences between the types are issues of duration, timing, or presumed etiology.
  • Types
    • Major depressive disorder
    • Persistent depressive disorder (dysthymia)
    • Premenstrual dysphoric disorder
    • Substance/medication-induced depressive disorder
    • Depressive disorder due to another medical condition
    • Other specified depressive disorder
    • Unspecified depressive disorder
  • Major depressive disorder is the most common type
    • Criteria list
      • Depressed mood most of the day, nearly every day, as indicated by either:
        • Subjective report (e.g., feels sad, empty, hopeless)
        • Observation made by others (e.g. appears tearful)
        • (Note: In children & adolescents, can be irritable mood.)
      • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
      • Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.
      • Insomnia or hypersomnia nearly every day
      • Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
      • Fatigue or loss of energy nearly every day
      • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
      • Diminished ability to think or concentrate, or indecisiveness, nearly every day
      • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
  • Specific depression rating
    • Mild, moderate or severe
    • With psychotic features
    • Full or partial remission
    • Anxious
    • Mixed features
    • Melancholic features
    • Atypical features
    • Catatonia
  • Consider
    • Medications
    • Other disorder on top of depression
      • Co-morbidity – If there is more than one disorder simultaneously
    • Other medical conditions
  • Common symptoms of Depression
    • Feelings of helplessness and hopelessness.
    • Loss of interest in daily activities. Y
    • Appetite or weight changes.
    • Sleep changes
    • Anger or irritability
    • Loss of energy
    • Self‐loathing
    • Reckless/escapist behavior
    • Concentration problems
    • Unexplained aches and pains
  • Interacting
    • They could be experiencing
      • Major depressive disorder/Chronic depression
      • Situational depression
    • Be patient
    • Help with daily tasks
    • Don’t say “don’t be sad”

 

Posttraumatic Stress Disorder (PTSD) and/or Trauma (29:35)

  • Events or incidents that can cause TRAUMA
    • Feared for life or safety
    • Watched or heard about such an incident
    • Had a close relationship with someone involved
    • Shocking or unexpected
    • Against social expectations (murder, rape, etc.)
    • Any situation faced that causes
      • Distressing, dramatic or profound change 
      • Disruption in physical or psychological function
  • Reactions to Trauma
    • Shock
    • Denial
    • Anger
    • Rage
    • Sadness
    • Confusion
    • Terror
    • Shame
    • Humiliation
    • Sorrow
    • Suicidal or homicidal ideation
    • Restlessness
    • Fatigue
    • Frustration
    • Fear
    • Guilt
    • Blame
    • Grief
    • Sleep disturbance
    • Eating disturbance
    • Muscle tremors
    • Reactive depression
    • Nightmares
    • Profuse sweating episodes
    • Heart palpitations
    • Vomiting
    • Diarrhea
    • Hyper‐vigilance
    • Paranoia
    • Phobic reaction
    • Problem with concentration or anxiety
    • Flashbacks and mental images of traumatic events and startle responses
  • Psychophysiological Effects
    • Fight or flight response
    • Mind and body reacting as if they’re back to the traumatic event
    • When triggered
      • Elevated blood pressure (BP)
      • Increased heart rate
      • Increased respiratory rate
      • Sweating
      • Dissociation
        • Disconnecting from one's thoughts, feelings, memories or sense of identity.
        • Types
          • Dissociative Amnesia
          • Dissociative Fugue
          • Depersonalization Disorder
          • Dissociative Identity Disorder
            • Multiple personality disorder
    • To reverse these effects
      • Purposely breathe more slowly and deeply
      • Relax all muscles, one by one
      • Cool air to reverse sweating
      • Talk through the responses
      • Purposefully connecting and acknowledging what you were thinking about
        • Show patience and compassion
        •  
  • Triggers of trauma
    • Noises
    • Smells
    • Weather
    • Situations

 

Personality Disorders (34:54)

  • Paranoid Personality Disorder
    • Distrust / Suspicious of others
  • Schizoid Personality Disorder
    • Pattern of detachment from social relationships, restricted range of expression of emotions in interpersonal settings
  • Schizotypal Personality Disorder
    • Social & interpersonal deficits marked by acute discomfort with close relationships, cognitive or perceptual distortions and eccentricities of behavior
  • Antisocial Personality Disorder
    • Disregard for, and violation of the rights of others
    • A lot of people in the jail system have this
  • Borderline Personality Disorder
    • Instability of interpersonal relationships, self-image, affects
    • Marked impulsivity
  • Histrionic Personality Disorder
    • Excessive emotionality and attention seeking
  • Narcissistic Personality Disorder
    • Grandiosity (fantasy or behavior), need for admiration, lack of empathy
    • A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts:
      • Grandiose sense of self-importance (e.g. exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
      • Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
      • Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people
      • Requires excessive admiration
      • Has a sense of entitlement (i.e. unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations)
      • Is interpersonally exploitative (i.e. takes advantage of others to achieve his or her own ends)
      • Lacks empathy, is unwilling to recognize or identify with the feelings and needs of others
      • Often envious of others or believes that others are envious of him or her
      • Shows arrogant, haughty behaviors or attitudes
    • Interacting
      • Impossible to persuade them that their thinking is skewed
      • Individuals with a narcissistic personality disorder will not get treatment – they don’t see an issue to be treated.
  • Avoidant Personality Disorder
    • Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
  • Dependent Personality Disorder
    • Excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
  • Obsessive-Compulsive Disorder (OCD)
    • A pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
      • Preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
      • Shows perfectionism that interferes with task completion
      • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
      • Over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values
      • Unable to discard worn-out or worthless objects even when they have no sentimental value
      • Reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
      • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
      • Shows rigidity and stubbornness
    • Interacting
      • Small steps, small changes
      • Provide options
      • Talk about “what’s the worst that could happen?”

 

Anxiety Disorders (41:19)

  • Feelings of worry, fear, or anxiousness
  • Symptoms similar to PTSD
    • Mild & temporary
      • Feeling threatened
      • Taking a test
      • Making a decision
    • Continuous
      • Anxiety disorder where anxiety does not go away
      • Gets worse over time
      • Anxious feelings interfere with daily activities
  • Signs of anxiety
    • Excessive worry
    • Sleep Issues
    • Irrational Fears
    • Tense Muscles
    • Chronic Digestive Problems
    • Self-Consciousness
    • Panic Attacks
    • Perfectionism
  • Calming situational anxiety
    • Breathe slowly and deeply
    • Stretch your muscles
    • Think calming thoughts, imagine yourself in a peaceful place
    • Quick exercise – your body is physically prepared for high energy

 

Suicidal Behavior Disorder (43:50)

  • Suicidal ideation is one of the criteria for much mental health disorder
    • Just thinking
    • Planning
    • Complete plans
      • Timing
      • Method
      • Means
      • Suicide note
  • The Stress-Stack of books analogy leading to suicide
  • Reasons for suicide
    • Pain
    • Loss
  • Warning Signs to Watch For
    • Withdrawal/isolation
    • Talking about death/suicide
    • Depression/mental illness Knowing someone who has died by suicide/Loss
    • Previous attempt
    • Giving away personal possessions
    • Making final plans/tying up loose ends
    • Feeling hopeless, without options
    • Feeling like a burden
  • Interacting
    • Listen without judgment
    • Listen to everything that's going wrong/feels hopeless
    • Keep listening
    • Ask what else is going on, “What else?”
    • Say things like, “That does sound very difficult,”
    • Help find resources and set up help
    • National Suicide Prevention Lifeline 800‐273‐8255

 

Other cases (52:35)

  • Traumatic Brain Injury
    • You may see these symptoms in people that may be misconstrued as mental disorder when what it really is a traumatic brain injury
    • Someone may experience:
      • Cognitive
        • Amnesia
        • Inability to speak or understand language
        • Mental confusion
        • Difficulty concentrating
        • Difficulty thinking and understanding
        • Inability to create new memories
        • Inability to recognize common things
      • Behavioral
        • Abnormal laughing and crying
        • Aggression
        • Impulsivity
        • Irritability
        • Lack of restraint
        • Persistent repetition of words or actions
      • Whole body
        • Balance disorder
        • Blackout, dizziness, fainting
        • Fatigue
      • Mood
        • Anger
        • Anxiety
        • Apathy
        • Loneliness
      • Eyes
        • Dilated pupil
        • Raccoon eyes
        • unequal pupils
      • Gastrointestinal
        • Nausea
        • Vomiting
      • Sensory
        • Sensitivity to light or sound
      • Speech
        • Slurred speech or impaired voice
      • Also common:
        • Persistent headache
        • Temporary moment of clarity
        • Bleeding
        • Blurred vision
        • Bone fracture, 
        • Bruising
        • Depression
        • Loss of smell
        • Nerve injury
        • Post‐traumatic seizure
        • Ringing in the ears
        • Stiff muscles
  • Drug use
    • Someone affected by drugs may likewise exhibit symptoms similar to a mental disorder
      • Unpredictable
      • Violent / Dangerous
      • Hallucinating
      • Paranoid
      • High level of risk
    • Interacting
      • Caution
      • Patience
      • Compassion
      • Distance

 

Other mental health disorders (54:59)

  • Do your research if you frequently come across a symptom and unsure what the disorder may be.
  • Learn, identify and understand how the person if being affected by their disorder.

 

Poll Question

  • Have you met someone who seems to display the characteristics of bipolar disorder on a regular basis
    • Yes, someone, I knew personally
    • Yes, on the job
    • Yes, numerous people – personally and on the job
    • No.
  • Did you put the national suicide prevention hotline on your phone?
    • Yes      80%
    • No       20%

 

Resources:

DSM-5 / Diagnostic and Statistical Manual of Mental Disorders

Bipolar Disorder

Bipolar Disorder on Youtube

Schizophrenia

Depression

Traumatic Brain Injury

Safe Call Now

 

For questions and clarifications, contact:

AMY MORGAN, MSC

Academy Hour

405-326-4116

AMorgan@academyhour.com

http://academyhour.com/

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