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2020-winter-recognizing-a-person-in-crisis

Recognizing and Responding to a Person in Crisis

When working in the mental health field, it is not uncommon to interact with an individual in a crisis state.  For those who do not work in the mental health field, it is also likely at some point, you may come across someone in your personal life who is struggling to cope with the stressors […]

When working in the mental health field, it is not uncommon to interact with an individual in a crisis state.  For those who do not work in the mental health field, it is also likely at some point, you may come across someone in your personal life who is struggling to cope with the stressors of everyday life.  When these stressors become unmanageable, a person could go into a crisis state.  So, what is a crisis state?  A crisis state is defined as a temporary state of disorganization, characterized by an individual’s inability to cope with internal or external stressors using common methods of problem-solving.  There are 3 stages of the cycle to achieve a crisis state: the emotional trigger, the escalation, and the crisis state.  A person begins the crisis cycle by first being exposed to an emotional trigger.  The death of a loved one, a divorce, or losing one’s job are all some common examples of emotional triggers that we see in everyday life that may be very difficult for someone to cope with.  When an individual is unable to cope with these emotional triggers, the situation begins to escalate.

Some common reasons an emotional trigger can escalate into a crisis are because the individual may not understand “why” the trigger is happening to them; they may misperceive a situation, have not yet developed healthy coping skills, or are easily overwhelmed.  What does this escalation stage look like in terms of a person’s behavior?  They may become loud or threatening, refuse to cooperate, defiant, aggressive, withdrawn/run away, and talk about self-harm or suicide.  There are not only behavioral signs that a person is in the escalation stage of a crisis cycle but also physical warning signs as well.  These physical changes may include dilated pupils and direct stares, clenched fists and muscle constriction, flushed and angry appearance, invasion of other’s personal space, and rapid, deep breathing.  These are all warning signs that an individual is entering a crisis state and will need either intervention or professional support.  Once the trigger has occurred, and the emotional response escalates to the inability to manage that trigger effectively, the crisis state is realized.   

How do we respond to a person who is now in a crisis state? 

There are both physical and behavioral ways that we can respond to a person in crisis in the hopes to deescalate the situation.  In terms of your physical response, first, begin by using a calm and soothing voice.  Manage your volume not further to escalate the situation.  Use a relaxed and open body posture to appear non-threatening. Maintain soft gestures and facial expressions.  Finally, keep a safe distance from the person to not endanger yourself.  Behaviorally, we want to attempt to verbally deescalate the individual to prevent any physical harm to them or anyone else present.  Use empathy statements to validate the feelings of the individual.  Reflect on the emotion that you hear.  Use encouraging and soothing words.  Don’t lead with the rules or consequences of the individual’s behavior.  Also, do not use critical language or express your own negative emotions.

In summary, whether you are a professional in the mental health field or just a normal person in everyday life, you will most likely encounter a person in a crisis state at some point.  The number one priority is to maintain the safety of everyone involved, including the individual in crisis.  If you find yourself in such a situation and the above suggestions are not useful in deescalating the individual please, reach out to the authorities or dial 911.  We always want everyone to remain safe in a crisis situation.

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2019-got-anxiety

Got Anxiety?

Odds are, you or someone you know probably does.  Anxiety disorders are the most common mental health diagnoses in the United States, affecting 40 million adults, or roughly 18% of the population (aada.org).   So, what is anxiety?  Anxiety is a healthy and normal emotion.  The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings […]

Odds are, you or someone you know probably does.  Anxiety disorders are the most common mental health diagnoses in the United States, affecting 40 million adults, or roughly 18% of the population (aada.org).   So, what is anxiety?  Anxiety is a healthy and normal emotion.  The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”  Anxiety can remind us of our “to do” list, upcoming deadlines, or help us focus before that big presentation.  These are not necessarily negative things.  So, then what’s the concern with anxiety?  A person goes from feeling normal healthy anxiety levels to having a psychological disorder when they feel disproportionate levels of distress, worry, or fear over an emotional trigger.

Anxiety is an overarching, general term that includes several psychological disorders.  Some such disorders are: Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, Phobias, and Obsessive-Compulsive Disorder.  These disorders are treated with a variety of methods.  Many are traditional, and some are newer concepts in the field of psychology.  The first traditional method of treating anxiety is with medication.  Several types of medications are used to treat anxiety, such as Selective Serotonin Reuptake Inhibitors (SSRIs), Benzodiazepines, and Beta-Blockers.  These medications can be prescribed by your primary care physician or a psychiatrist.  Another traditional method to treat anxiety is through outpatient therapy.  Therapy methods could include the use of Cognitive Behavioral Therapy, Exposure Therapy or even Hypnosis.

The treatment methods listed above may not come as news to many of you, as they have been in use for several years in the mental health field.  There are, however, some very new and interesting methods for people to learn to manage their own anxiety without the help of a doctor or therapist.  The first of which is through proper diet and nutrition.  There is ample evidence of causal links between certain vitamin and mineral deficiencies and anxiety.  Studies have shown lack of vitamins D, B6 and B12, magnesium and zinc can all be related to increased levels of anxiety.  Adding these vitamins to your diet through supplements or food intake can help reduce anxiety levels.  Other nutrients shown to help reduce anxiety include tryptophan, vitamin E, and omega 3 fatty acids.  Exercise is another effective way to manage your own anxiety.  When the body is active, the brain produces endorphins which are hormones that promote feelings of wellbeing and improve mood.   20 minutes of cardio 3 times a week can do great benefits for one’s mental wellbeing.  Higher level activities that require concentration such as playing an organized sport can also keep the mind occupied and limit racing thoughts.

Meditation is also an excellent strategy to manage one’s anxiety levels independent of a mental health professional.  Meditation is the practice of engaging in contemplation and reflection.  Through meditation, one tries to focus their thoughts in a specific direction and not allow the mind to wander.  Many people find the practice of meditation difficult at first, but with practice, it becomes easier over time.  In the fast-paced modern world, there are many distractions for our minds and many opportunities for thoughts to wander, but this practice can have great benefits in helping us to control the directions of our thoughts.  There are many options to help one who wants to begin the practice of meditation.  One of the most recent options is the use of smartphone apps.  These apps are convenient as your phone is always with you making them readily available to use over a lunch break or before bed to help you put your mind at ease.

Overall, anxiety is becoming much more prevalent in our society.  In the information age, we are aware of so much happening around us that it is not uncommon to feel overwhelmed and anxious.  If you or someone you know is experiencing unhealthy levels of anxiety, please do not feel ashamed or stigmatized, these feelings are all too common.  Please consult your physician and discuss the treatment options to find what method will work best for you.

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Peer Services, the Future of Mental Health

To be successful in business, it is imperative to evolve and adapt to meet the changing needs of your customers over time.  The mental health field is no exception.  I have seen many changes in the mental health field over my 15-year career.  One of the most exciting changes in Pennsylvania was the addition of […]

To be successful in business, it is imperative to evolve and adapt to meet the changing needs of your customers over time.  The mental health field is no exception.  I have seen many changes in the mental health field over my 15-year career.  One of the most exciting changes in Pennsylvania was the addition of Peer Support Services for adults.  Peer Support Services is an individualized, recovery-focused service that allows individuals the opportunity to manage their own recovery and advocacy process.  Peer Support staff serve to enhance the natural supports in the client’s life and improve their coping and self-management skills.  Peer Support Services began in the Lehigh Valley back in 2008 with few providers.  Peer Support Services are a radical departure from a traditional mental health service.  In a traditional mental health service, you have a professional often with advanced education and credentialing or licensure providing a clinical service to a person struggling with a mental health diagnosis.  Often times this professional is perceived by the client as an authority figure, with formal educational training, and can create an imbalance in the client/provider relationship.  The client does not and will not perceive the clinician as equals.   The fault in this dynamic is that clinicians often have no or limited personal experience with mental health struggles.  This is where the need for a new service was identified.

Peer Support Services are provided by Certified Peer Support (CPS) staff.  To be eligible to become a CPS staff you must have at least a high school diploma and a documented mental health diagnosis yourself.  You must be progressing well in your own mental health recovery.  This is quantified by having at least 12 months of employment or volunteer experience in the last three years.  If a CPS candidate does not meet the vocational requirements, they may also have 24 credit hours of post-secondary education in the previous three years.  If a candidate meets these requirements, they are eligible to register for the two-week Peer Support Certification course.  Upon successful completion of the course, they are eligible to be hired by a Peer Support provider and begin providing Peer Support Services to clients.

The Peer Support/client relationship is much different than the traditional provider/client dynamic seen in other mental health service lines.  Due to having their own mental health diagnosis, peer staff can say “I’ve been there,” or “I’m doing well, so can you” and are living proof that recovery is possible.  They can serve as a role model, mentor, and support to assist a client in managing their mental health symptoms.  This is much different than the traditional provider/client dynamic.  Clients often perceive their CPS worker as an equal through shared experience.  This creates a stronger bond and often better results than a traditional mental health service.

Peer support services are also much more cost effective than a traditional mental health service.  Due to the reduced educational requirements of the staff versus a service like outpatient therapy, the state can offer the provider a lower reimbursement rate for services rendered.  Therefore, this service is cheaper to operate from the state government’s perspective and often more effective than other mental health services geared toward serving adults.  Many agencies have decided to invest in Peer Support Services and also in their Peer Support Staff over the past few years.  The state has followed suit and done the same.  In December 2017, Pennsylvania began allowing providers to offer Peer Support Services to transitional-aged youth (ages 14-21).  We are now also seeing specialized Peer Support Services such as forensic Peer Support that works with clients involved in the criminal justice system, or Drug & Alcohol Peer Support which works with dually-diagnosed individuals who have a mental health diagnosis and co-occurring substance abuse problem.  Peer Support Services are growing exponentially. It is exciting to see where this service can go in the future and the positive changes these staff can help make in the lives of those they serve.

If you or someone you know is interested in becoming a CPS staff or would benefit from receiving Peer Support Services, please contact Pennsylvania MENTOR at (610) 867-3173, or visit our website at www.pa-mentor.com.

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America’s Continuing Autism Epidemic

Merriam-Webster’s dictionary defines autism as: “a variable developmental disorder that appears by age three and is characterized by impairment of the ability to form normal social relationships, by impairment of the ability to communicate with others, and by repetitive behavior patterns.”  On April 26th, 2018 the Center for Disease Control and Prevention released its most […]

Merriam-Webster’s dictionary defines autism as: “a variable developmental disorder that appears by age three and is characterized by impairment of the ability to form normal social relationships, by impairment of the ability to communicate with others, and by repetitive behavior patterns.”  On April 26th, 2018 the Center for Disease Control and Prevention released its most updated autism prevalence estimates for America’s children.  These estimates are pulled from data in a biennial report based off of the evaluation of medical and education records.  1 in 59 children are now estimated to have an Autism Spectrum Disorder.  Let that sink in.  1 out of every 59 children.  This new ratio is an increase of 15% from the last reported estimate in 2016.  This most recent increase in prevalence continues the trend that researchers have seen over the last twenty plus years.

When I began my career in the mental health field in 2004, the autism prevalence ratios were estimated to be 1 in every 166 children.  Throughout my career, I have witnessed this drastic increase in autism cases create the need for a plethora of new services and supports for children to address the social and behavioral needs associated with autism.  Many providers decided to implement autism specific variations of existing mental health programs.  One of the most popular of these services is Behavioral Health Rehabilitative Services or commonly referred to as BHRS.  BHRS services are intensive mental health therapies that are provided in the child’s home, in community settings and occasionally in the classroom.  These services are focused on identifying interventions to help achieve a child’s behavioral treatment goals and to transfer those skills from the provider to a parent, teacher, etc.  The increase in autism diagnoses has also created the opportunity for providers to create new programs to address this need such as afterschool groups that focus on improving social skills.  They have also begun to create support groups for parents and siblings of those with an autism diagnosis.

The mental health and developmental disabilities fields have successfully evolved and adapted over the years in an attempt to meet the growing needs of children diagnosed with autism.  There are additional supports in the home, community and the classroom for these children.  There are also government and private grants available to families to help manage the additional cost of needed sensory and adaptive communication devices for these children.  But what will happen to these children when they grow up, or “age out” of educational and children’s mental health services?  What supports are available for adults diagnosed with autism?  What supports are available to families to help with their adult child with an autism diagnosis?  The answers to these questions are pretty alarming.  Depending on your location, there are very few if any supports tailored to adults with autism in these fields.

For our nation to fully manage the continued autism epidemic; there will have to be some significant changes in our government and to the adult mental health system.  Our legislators and representatives will have first to acknowledge that the lack of supports, services, and funding for adults with autism is a current problem.  Second, they will have to acknowledge that the problem will only get worse in the future as the ever-increasing ratios of children with autism age out of services.  These adults will need assistance with housing, life skills, employment supports, and socialization.  Our legislators and representatives will need to increase funding for mental health services to allow providers to develop programs to meet the needs of these adults.  Providers will need to step up and use the increased funds to develop new programs, thinking outside the box to support this unique population.  Staff in these fields will have to become more educated on providing supports to adults with autism.  They say it takes a village to raise a child.  In order to support individuals with autism throughout their entire life, not just their childhood, we as a society will have to pull together to help our nation manage this continuing autism epidemic.

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