Slide 1 Beyond Labels: Ensuring Access to Crime Victims with Symptoms of Mental Illness Part I Cema Mastroleo, M.Ed. Disability Services ASAP (A Safety Awareness Program) SafePlace (www.SafePlace.org) www.SafePlace.org Austin, Texas Slide 2 Mental health includes a person’s feeling that they: * are coping, * are fairly in control of their lives, and * can manage challenges and responsibilities. World Federation for Mental Health, 2006 Slide 3 A person who is mentally healthy has productive activities, fulfilling relationships with other people, and the ability to adapt to change. World Federation for Mental Health, 2006 Slide 4 “Mental disorders are health conditions that refer to changes in thinking, mood or behavior associated with distress and/or impaired functioning.” For more information, consult DSM-IIIR Diagnostic and Statistical Manual of Mental Disorders Slide 5 The brain is central to what makes us human and provides an understanding of mental health and mental illness. The brain is now known to be physically shaped by contributions from our genes and our experience, working together. This strengthens the view that mental disorders are both caused and can be treated by biological and experiential processes, working together. http://www surgeongeneral gov/library/mentalhealth/chapter2/sec1.html Slide 6 Domestic violence * Domestic violence is a pattern of behavior in any relationship that is used to gain or maintain power and control over an intimate partner (Note: The legal definition of domestic violence varies state to state.) * Domestic violence can include emotional, verbal, financial, physical, and sexual abuse. www.thehotline.org/get-educated/what-is-domestic-violence/ Slide 7 Sexual violence * Sexual violence is any sexual act that is perpetrated against someone's will. It encompasses a range of offenses, including a completed nonconsensual sex act, an attempted nonconsensual sex act, abusive sexual contact, and non-contact sexual abuse. * All types involve victims who do not consent, or who are unable to consent or refuse to allow the act. (Note: The legal definition of sexual violence varies state to state.) www.cdc.gov/violenceprevention/sexualviolence/definitions.html Slide 8 Trauma is an experience that overwhelms our capacity to: * have a sense of control over ourselves and our immediate environment; * maintain connection with others; and * make meaning of our experiences. Herman, J. (1992). Trauma and Recovery. Harper Publishing. Slide 9 The Adverse Childhood Experiences (ACE) Study: Bridging the Gap Between Childhood Trauma and Negative Consequences Later in Life. The ACE Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente. Led by Robert F. Anda, MD, MS, and Vincent J. Felitti, MD, the ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma and health and behavioral outcomes later in life. www.acestudy.org www.cdc.gov/ace/index.htm Slide 10 The Americans with Disabilities Act of 1990 guarantees that people with disabilities have the right to equal opportunity and equal access to the very same benefits and privileges enjoyed by people without disabilities in their own communities. Slide 11 For more information about the Americans with Disabilities Act: Department of Justice – Disability Rights Section Americans with Disabilities Act Office 1.800.514.0301 (Voice) 1.800.514.0383 (TTY) www.ada.gov Slide 12 Accessibility and the Americans with Disabilities Act Right to equal opportunity and equal access * Architectural * Programmatic * Attitudinal Describe one example practiced in your agency. Slide 13 Domestic and sexual violence programs Screen-in! by asking questions about diagnosis, medication, drugs and alcohol, only after the decision has been made to provide services and if relevant. Be familiar with your State regulations around medication. Create a variety of options: * Support groups on site * Peer or staff support person * Dialogue on topic * If needed to exit, consider re-entry at a later date Slide 14 A trauma informed organization and/or respondent recognizes that trauma is a widespread issue and that traumatic events - which threaten life and/or impact a person’s core beliefs about safety and trust - can have a serious impact on a survivor’s physical, emotional, mental health, and coping choices. Adapted from Harris and Fallot, 2001; Vermilyea, 2000; National Mental Health Center, n.d. Slide 15 Creating cultures of trauma-informed care core values: 1. Safety 2. Trustworthiness 3. Choice 4. Collaboration 5. Empowerment Creating Cultures of Trauma-Informed Care in Behavioral Health Settings, by Roger D. Fallot, Ph.D., 2011 Webinar 10X10 Wellness Campaign SAMHSA Slide 16 In ensuring access to crime victims with symptoms of mental illness, please describe some strategies to more effectively communicate and serve crime victims with symptoms of mental illness. Slide 17 A note on diagnostic labeling is that it can create barriers, follow survivors for years or a lifetime, be a misdiagnosis, shift focus away of the crisis, and create a filter through which the person is seen. Slide 18 Suggestions for creating access and a welcoming environment * Listen to the individual you serve * Seek training * Read literature on the topic * Have staff discussions * Hire employees with expertise on symptoms of mental illness * Coordinate trainings with other service providers Slide 19 A welcoming intake includes exploration of: * Previous barriers and supports to accessing services * Survivor’s understanding of their symptoms * Coping skills that have helped * Survivor’s trusted network of support * Concerns about confidentiality * Survivor’s need for privacy * Be clear, direct about who you are and your role * Structure meetings, explain what you will talk about and do and for how long. Slide 20 A welcoming intake includes exploration of: * Emotions, visual processes, and memories of trauma are located on the right side of the brain. Logic, language, and verbal skills are on the left side of the brain. We ask crime victims to access their left brain. * Support person to make decisions and be in control of the situation as much as possible. * Stair step goals to facilitate success. * Have agreements with each other. * If/when an agreement is broken, discuss it. * Ask what works for the person when they are in crisis. * Talk about your agency’s crisis management plan. Slide 21 Some of the qualities of safe and healthy relationships are communication, boundaries, trust, honesty, accountability, responsibility, support, and respect. web.wm.edu/sexualassault/swf/equality_wheel/equality_wheel.html Slide 22 Risks for violence and aggression increase when a person is treated disrespectfully and/or feels: * Frustrated * Dismissed * Degraded * Judged * Controlled * Trapped Slide 23 Crisis happens! * Preparedness * Response * Recovery * Mitigation * Prevention Slide 24 Lalemond Behavioral Scale 1. Agitated: “I am in distress.” 2. Disruptive: “Pay Attention, I need your help.” 3. Destructive: “I am losing control.” 4. Dangerous: “I have lost control.” 5. Threat of lethality: “Stop me.” Slide 25 If survivor is having delusions, you can contribute to the person’s feeling of safety in the moment by * Asking the person if they are hearing voices and what the voices are saying. * You can acknowledge the distress and fears without participating in a hallucination or delusion. * Asking what has been helpful to reduce their delusions in the past. * Encouraging the person to stay in the present, using statements that reflect what is happening now. Slide 26 We are witnesses to survivors’ experiences of trauma and of hope. Slide 27 Resources through domestic violence/rape crisis programs National Domestic Violence Hotline * 1.800.799.7233 * Hotline Deaf Advocates on duty * IM: ADWASHotline * Email: ADWAS@ndvh.org * Video Phone for Deaf Callers: 1.206.787.3224 National Sexual Assault Hotline * 1.800.656.HOPE Slide 28 Please complete evaluations. Thank you for your participation! Slide 29 Beyond Labels This presentation is based on information published in: Beyond Labels: Working with Abuse Survivors with Mental Illness Symptoms or Substance Abuse Issues, © 2007 SafePlace For more information, please visit the SafePlace website. www.SafePlace.org Slide 30 For information, www.safeplace.org/MovingForward Moving Forward in Challenging Times Exploring Our Collective Capacity for Trauma Informed Service Delivery 2011 Conference focusing on the intersection of domestic violence, sexual assault, mental illness and substance abuse * Recommended reading materials * Power Points and Handouts * List of Trauma Resources Slide 31 Cema Mastroleo, M. Ed. cmastroleo@SafePlace.org 512.356.1588 SafePlace is ending sexual and domestic violence through safety, healing, prevention, and social change for individuals, families and our community. 24-hour Hotline 512.267.SAFE (7233) 512.927.9616 TTY for the Deaf community www.SafePlace.org