Crisis Response Resources for Schools
Transcripción
Crisis Response Resources for Schools
Tragic Event Resources for Schools/Educational Settings and Parents Helpful Tools: Crisis Line Description: The Crisis Line is available 24 hours a day, seven days a week to anyone experiencing a mental health crisis. Serving Maricopa County and parts of Pinal County (ZIP Codes 85120, 85140, 85142 and 85143). Toll free: (800) 631-1314 Local: (602) 222-9444 TTY/TDD toll free: (800) 327-9254 TTY/TDD local: (602) 274-3360 For emergency situations always call 9-1-1 Partnership Hotline between Magellan Health Services and ADHS/DBHS Description: The Arizona Department of Health Services (ADHS)/Division of Behavioral Health Services (DBHS) and Magellan Health Services of Arizona have set up a 24hour toll-free hotline to help citizens process feelings of grief, sorrow and depression. The hotline is staffed by behavioral health professionals to offer counseling services to people outside Pima County. Arizona residents can call the hotline to connect with crisis response professionals who specialize in behavioral health. This information and more can be found on the ADHS/DBHS website. Phone Number: 1-800-203-CARES (1-800-203-2273) Mental Illness on Campus What You Can Do to Help Description: Tips on how to identify a person in trouble and what you can do to help. http://www.nami.org/Template.cfm?Section=Mental_Illness_Fact_Sheets&Template=/C ontentManagement/ContentDisplay.cfm&ContentID=85780 - MORE - The following are attached documents: 1. Crisis card Description: Crisis Response Network provides crisis services for central Arizona. Services include phone intervention and mobile crisis teams. 2. Mental Illness on Campus What You Can Do to Help Description: Tips on how to identify a person in trouble and what you can do to help. http://www.nami.org/Template.cfm?Section=Mental_Illness_Fact_Sheets&Templ ate=/ContentManagement/ContentDisplay.cfm&ContentID=85780 3. Magellan Bookmark Description: Bookmark provides a brief description of Magellan Health Services. Bookmark also contains Member Services and crisis contact information. 4. Safe Talk, Suicide Talk, and ASIST training Description: Document describing training to learn how to provide practical help to persons with thoughts of suicide. Website link to Achieve training website. 5. La Voz Spread – English Version Description: Article was featured in La Voz newspaper. Article highlights mental/behavioral health topics such as, crisis, accessing services, and signs and symptoms. 6. La Voz Spread – Spanish Version Description: Article was featured in La Voz newspaper. Article highlights mental/behavioral health topics such as, crisis, accessing services, and signs and symptoms 7. Handout: Tips on Calling an Agency for Mental/Behavioral Health Services Description: Document provides support and guidance to someone who is calling about mental/behavioral health services. 8. Arizona Response to Intervention Description: School achievement and success require that students be provided both academic and behavioral systems of support. A comprehensive system of behavioral supports ensures that students are ready and able to learn by creating environments conducive to learning and by addressing barriers to learning that students experience. Link: https://www.azed.gov/azrti/SystemofBehavioralSupports/RTISBS_FNL3.pdf - MORE - 9. School Safety: What Schools Can Do Description: A safe school is one that is free from violent and criminal behaviors and allows staff, students and community members to feel connected to the school and able to participate in its major functions – teaching and learning. Link also provides numerous references to examples, studies, and supportive documents. Link: https://www.azed.gov/sa/health/downloads/What_Schools_Can_Do__4_.pdf 10. Guide: Mental Health Crisis Planning for Families and Educators Description: Guide for parents to “Learn to Recognize, Manage, Prevent and Plan for Your Child’s Mental Health Crisis.” 11. Photonovela – English Version Description: Created by youth to help identify when someone might need help and how to access services. English version: http://www.magellanofaz.com/media/120454/fotonovela!%20englishversion_final. pdf 12. Photonovela – Spanish Version Description: Created by youth to help identify when someone might need help and how to access services. Spanish version: http://www.magellanofaz.com/media/120458/fotonovela!%20spanish_version_fin al.pdf 13. Children and Tragedy Factsheet Description: Factsheet with tips on what to look for while helping children recover from a tragic event. 14. Common Responses to Traumatic Events Factsheet Description: Factsheet with tips on some common reactions and signs/symtoms of trauma that may present themselves after traumatic events. 15. Coping with Children’s Reactions Factsheet Description: Factsheet with adviced to parents on how to cope with children’s reactions after a disaster. - MORE - 16. Overcoming Your Fears and Anxiety Factsheet Description: Factsheet with tips on what individuals can do to overcome feelings of anxietey. 17. Post-trauma Do’s and Don’ts Factsheet Description: Factsheet with tips on what to do and not do after a traumatic event. 18. Teenage Grieving Factsheet Description: Factsheet with tips on common reactions of teenagers who are grieving. 19. Tragedy Aftermath – Taking Care of Yourself Factsheet Description: Factsheet with tips on what common responses to a disaster and helpful tips on how to deal with them. The following are resources available on line: 1. How to Get Care through Magellan Health Services of Arizona/How to Refer to Mental Health Services Description: Magellan of Arizona's website provides people with additional information about how to access mental health services. Link: http://www.magellanofaz.com/mypage-en/program--services/how-to-getcare.aspx 2. Arizona State Legislature Description: Use this web site as a tool to track pending legislation, plus locate and contact individual legislators, and stay up-to-date on current issues. For an overview of the legislative process in Arizona, please feel free to explore this web site. Link: http://www.azleg.gov/ 3. How Do I Find or Contact my Legislator Description: Search for local legislator by address and zip code Link: http://www.azleg.gov/alisStaticPages/HowToContactMember.asp 4. National Center for Crisis Management Description: Site provides downloadable crisis documents to aid a school in the development of a crisis response plan. Link: http://www.schoolcrisisresponse.com/download.htm - MORE - 5. Title: Mental Health America - Tips for Educators, Students and Parents (after the Virginia Tech Tragedy) Link: http://www.nmha.org/go/coping-virginia-tech 6. Title: National Alliance on Mental Illness (NAMI) - The Virginia Tech Tragedy- Distinguishing Mental Illness from Violence Link: http://www.nami.org/Template.cfm?Section=April6&Template=/ContentManagem ent/ContentDisplay.cfm&ContentID=45403 The Crisis Line is available 24 hours a day, seven days a week to anyone experiencing a mental health crisis. Crisis Line Serving Maricopa County and parts of Pinal County (ZIP Codes 85120, 85140, 85142 and 85143) Toll free: (800) 631-1314 Local: (602) 222-9444 TTY/TDD toll free: (800) 327-9254 TTY/TDD local: (602) 274-3360 For emergency situations always call 9-1-1. ¿Qué es Magellan de Arizona? Magellan Health Services de Arizona es la Autoridad Regional de Salud Mental del centro de Arizona, que incluye todo el Condado de Maricopa y parte del Condado Pinal. Los fondos para proporcionar los servicios se obtienen a través de un contrato con el Departamento de Servicios de Salud/la División de Servicios de Salud Mental de Arizona y el Sistema de Contención de Costos de Atención de Salud de Arizona. ¿Cómo presta los servicios Magellan de Arizona? Magellan de Arizona maneja un sistema integral de Organizaciones de Red de Proveedores (PNO, por sus siglas en inglés) y Proveedores de Servicios Calificados (QSP, por sus siglas en inglés), que brindan una gran variedad de servicios para la salud mental y el tratamiento de abuso de sustancias para residentes elegibles dentro del Condado Maricopa y partes del Condado Pinal. Magellan contrata a los proveedores teniendo en cuenta los valores de las elecciones de los individuos que reciben servicios, la diversidad cultural, y la recuperación y el restablecimiento de los adultos, los niños y sus familias. Para obtener una lista completa de las agencias de proveedores, visite www.MagellanofAZ. com/Directory. ¿Cómo recibo los servicios? Después de la inscripción, usted deberá elegir una PNO o un QSP según sus necesidades individuales. Su proveedor le asignará un representante de salud mental que le asistirá en la coordinación de su atención. Para dar inicio al proceso de inscripción o para obtener más información, comuníquese con Servicios para Miembros de Magellan al (800) 564-5465 o a nuestra línea TTY al (800) 424-9831. S Magellan de Arizona (800) 564-5465 TTY (800) 424-9831 www.MagellanofAZ.com Si está en crisis, puede encontrar ayuda. Llame a la Línea de Crisis del Condado Maricopa al (800) 631-1314 o al TTY al (800) 327-9254. Para emergencias, siempre llame al 9-1-1. Who is Magellan of Arizona? Magellan Health Services of Arizona is the Regional Behavioral Health Authority for central Arizona, which includes all of Maricopa County and part of Pinal County. Funds for services are provided through a contract with the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) and the Arizona Health Care Cost Containment System (AHCCCS). How does Magellan of Arizona deliver services? Magellan of Arizona manages a comprehensive system of provider network organizations (PNO) and qualified service providers (QSP) who deliver a variety of behavioral health services such as medication, substance abuse treatment, crisis assistance and other support services for qualifying residents of Maricopa County and parts of Pinal County. Magellan contracts with providers around the values of service recipient choice, cultural diversity, and recovery and resiliency for adults, children, and their families. For a complete list of provider agencies, visit www.MagellanofAZ.com/ Directory. How do I get services? After enrollment you will choose a PNO or QSP depending on your individual needs. Your provider will assign you a behavioral health representative who will assist you in coordinating your care. To begin the enrollment process or for more information, contact Magellan Member Services at (800) 564-5465 or our TTY line at (800) 424-9831. Magellan of Arizona (800) 564-5465 TTY (800) 424-9831 www.MagellanofAZ.com If you are in a crisis, help is available! Call the Crisis Line at (800) 631-1314 or TTY at (800) 327-9254. For emergencies, always call 9-1-1. 22084 Mental Illness on Campus ~ What You Can Do to Help Times of anxiety and feeling down are common experiences in college, but did you know that they may be part of a treatable mental health condition? The latest research reports that feeling depressed to the point where students have trouble functioning impacts about 40% of students—while 15% have a serious clinical depression. Suicide is a serious problem in college---about 1,100 lives a year are lost to this largely preventable outcome. The 2005 National College Health Assessment (NCHA), a survey of nearly 17,000 college students conducted by the American College Health Association, revealed that 25% reported they “felt so depressed it was difficult to function” three to eight times during the past year and 21% reported they “seriously considered suicide” one or more times during the past year. In the NCHA survey, students also ranked depression as one of the top ten impediments to academic performance. While colleges and universities have a role in ensuring the health and safety of people on campus, students themselves are often the first to recognize when a problem might exist and are likely the first to be able to engage before the condition becomes a more serious issue. How can you tell if a Person is in Trouble? • Take conversations about suicide or homicide very seriously. A person who jokes about suicide or homicide may be struggling with a deeper sense of hopelessness. Most people who commit suicide have told someone, often in the days preceding the event. • Sleep problems are often a symptom of more serious health problems. Roommates who have big changes in sleep patterns may be at risk for psychiatric illnesses. For example, if a person who usually sleeps ten hours, midnight to 10 am, suddenly begins waking up at 5 am and acts agitated or begins pacing, this could be a sign that they may be experiencing a deeper problem that should be addressed. • Bulimia and Anorexia are eating disorders that often co-occur with anxiety and depression. Behaviors such as patterns of binge-eating, recurrent inappropriate behavior to control one’s weight, self-induced vomiting, excessive exercise, expressions of an intense fear of gaining weight, or an ongoing preoccupation with weight and food despite being may be signs of a more serious psychiatric illness that needs medical attention. • Alcohol and drug use compound all risk. Alcohol risk is higher in sororities and fraternities, but the risk remains for most college students as alcohol is often a part of acceptable campus social life. Guns are very high risk in combination with alcohol and other drugs; these two in combination are very dangerous. • Be aware of expectable life stresses. Relationship breakups, future career stress, exam pressure, peer pressure and judgment, loneliness, financial stress, and even graduation can compound all other risks. • Be mindful of other possible, less expectable but very real stresses--for instance the realization that one may be gay, that one is being bullied or discriminated against, the death of a parent of grandparent, or divorce can compound self harm risk. What to do if you suspect a person is in trouble or at risk. • Follow your instincts. People have been wired for Millennia to detect unusual or risky social situations, and your instincts can be a key to helping someone get the help they need. If you feel sad around the person, remember feelings can be contagious, and you may be sensing their own internal despair. If you want to avoid the person, note that, too. Do not hesitate to tell someone in authority on campus about your concerns. • Don't worry alone. If you live in on-campus housing, start with your Residential Assistant/Advisor who can offer more information and resources or will often know the best approach and services available to you. You can also go to the Campus Counseling Center for information and assistance about what is available on your campus community. • If you feel you can, approach the person with concern, not judgment. Easy comments such as “I sense you are (sad, troubled) etc.” can begin a discussion and possibly invite the person to talk about what they are experiencing. Gently suggest they get help, offer to go with them if you feel comfortable with that. However, safety should always come first— yours. • Offer information on college mental health services. Don’t be afraid to use them as they help people every day deal with the stresses of college life. • Offer information on web sites that might be helpful. Students rely on networking and the Internet as primary information sources. NAMI has a “NAMI on Campus” section at www.nami.org/namioncampus that also features discussion group networking options that may offer the person support and information to help them manage their own situations. Additionally, there are over 1,100 local NAMI affiliates in communities across the country. Visit www.nami.org to Find Support that is the most convenient. • Meetings and groups can offer hope and support to students. There are often dozens of campus student groups operating all days of the week, including support and networking groups for mental illness and stress management. Find out what may be available and encourage the person to attend. If you feel comfortable, offer to go to a first meeting with the person, or find another person who might offer to make the meeting more inviting. • Be gentle with yourself. Even the best doctor cannot predict all bad outcomes. People sometimes hide their feelings and behavior to avoid consequences. Remember that you are ultimately only responsible for your own behavior. Reviewed by Ken Duckworth, M.D., 2007 Permission is granted for this fact sheet to be reproduced in its entirety, but the NAMI name, service mark, and contact information must be included. NAMI on Campus – 3803 N. Fairfax Drive, Suite 100, Arlington, VA 22203, Ph: 703-524-7600, Email: [email protected], Website: www.nami.org/oncampus 4. Safe Talk, Suicide Talk, ASIST and Mental Health First Aid trainings Description: Please go to the website listed below for a full list of training. In particular: ASIST – Applied Suicide Intervention Skills Training Purpose: The goal of this two-day, highly interactive, practical, practiceoriented workshop is to provide skills to all individuals to apply first-aid suicide intervention in times of individual and family crises. Training Highlights: - Reduce fears about “suicide”. - Increase knowledge for utilization in effective intervention. - Increase competence and confidence in suicide first-aid skills. - Develop practical intervention skills to effectively deal with suicidal situations. - Understand that suicide is a preventable problem. Safe Talk, Suicide Talk - In only a few hours, you will learn how to provide practical help to persons with thoughts of suicide. Expect to leave safeTalk more willing and able to perform an important helping role for persons with thoughts of suicide. How does safeTalk help prevent suicide? - SafeTalk prepares you to be a suicide alert helper. You are aware that opportunities to help a person with thoughts of suicide are sometimes missed, dismissed and avoided. You want persons with thoughts to invite your help. You know the TALK steps (Tell, Ask, Listen and KeepSafe) and can activate a suicide alert. As part of the KeepSafe step, you connect persons with thoughts to persons trained in suicide intervention. Helpers trained in suicide intervention complete the helping process or connect the person with more specialized help. Why use safeTalk to learn to become alert? - A carefully crafted set of helping steps and the use of creative educational processes make it possible for you and up to 30 others in your community to leave safeTALK willing and able to be suicide alert helpers. safeTALK is the result of some twenty years of work at learning how to develop useful suicide prevention abilities in a short program. Mental Health First Aid - Mental Health First Aid is the initial help given to a person showing symptoms of mental illness or in a mental health crisis until appropriate professional, peer or family support can be engaged. In the 12-hour, two-day course, Mental Health First Aid training teaches people a five-step action plan to help someone in a mental health crisis or someone showing symptoms of mental illness. To help remember the steps, course participants learn a mnemonic, A-L-G-E-E: - A: Assess for risk of suicide or harm. - L: Listen non-judgmentally. - G: Give reassurance and information. - E: Encourage appropriate professional help. - E: Encourage self-help and other support strategies. In central Arizona, Mental Health First Aid trainers have reached more than 500 community members since the statewide initiative launched in spring 2011. Those who are interested in becoming trained in Mental Health First Aid should visit the Arizona Department of Health Services website dedicated to this initiative implementation, http://www.azdhs.gov/bhs/mhfa.htm. The website contains additional information on the program and a list of upcoming training sessions and contact information for instructors if anyone wants to host the training for their group or organization. Mental Health First Aid USA is disseminated by the National Council for Community Behavioral Healthcare, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health. To learn more about the Mental Health First Aid program, visit www.MentalHealthFirstAid.org. Sign up for these FREE trainings at the Achieve website: https://magellan.learn.com/az Magellan Health Services de Arizona está dedicada a fortalecer el sistema de salud mental del centro de Arizona. Verdades Sobre … La Salud Mental Aproximadamente uno de cada cinco adultos mayor de tiene un desorden de salud mental diagnosticable. 18 Mayo es el Mes de la Concientización dedicada a fortalecer el sistema de salud mental del centro de Arizona. Un sistema, de la Salud Mental, una excelente que además de brindar esperanza, recursos oportunidad para aprender más sobre y recuperación a aquellos en nuestro las enfermedades mentales y dónde cuidado, facilita el acceso de servicios a solicitar ayuda. Es un periodo en el que las comunidades más vulnerables elegibles profesionales, organizaciones, escuelas, para tratamiento de salud mental. comunidades, hospitales y medios de comunicación unen esfuerzos para crear En Magellan de Arizona creemos que conciencia sobre la importancia de la salud las personas que reciben servicios de mental y reducir el estigma que impide que salud mental deben recibirlos de manera las personas reciban la ayuda profesional respetuosa basado en sus preferencias que requieren. Para Magellan de Arizona, individuales, valores, necesidades, idioma esta labor es de todos los días tomando de preferencia y creencias culturales. Para en cuenta que en Estados Unidos, uno de lograr esto, apoyamos a nuestro personal Richard Clarke Presidente, Magellan de Arizona cada cuatro adultos y uno de cada cinco y red de proveedores para aseguranos de niños es afectado por una enfermedad mental sin importar proporcionar un servicio culturalmente competente. De esta raza, nivel de educación o estatus socioeconómico. manera, construimos relaciones más estrechas con la gente La falta de acceso a los servicios de salud mental y la comunidad que servimos, proporcionamos un mejor continúa siendo un problema serio entre las minorías en servicio y ayudamos a fortalecer la comunidad del centro de todo Estados Unidos. Si bien la falta de seguro médico Arizona en general. juega un papel importante en el acceso a los servicios de Como parte de nuestro esfuerzo por facilitar el acceso de salud, las creencias culturales, la falta de información y servicios de salud mental a las comunidades más vulnerables, entendimiento de las enfermedades mentales también son Magellan ha recopilado esta serie de información y recursos barreras claves que impiden que las personas se atiendan. de salud mental para ayudarle a entender mejor la causa y De acuerdo a la Asociación Americana de Psiquiatría, “Los síntomas de las enfermedades mentales y donde pedir ayuda. Hispanos o Latinos suelen tener diferentes percepciones al La mayoría de la información contenida en estas páginas solicitar servicios de salud mental y sentirse estigmatizados fue extraída de documentos del Instituto Nacional de Salud por hacerlo. Por ejemplo, algunos tienden a confundir la Mental (NIMH por sus siglas en inglés) y del Departamento depresión con el nerviosismo, cansancio o inclusive hasta de Salud y Servicios Humanos (DHHS por sus siglas en un malestar físico creyendo que se trata de algo temporal o inglés), quienes autorizan y fomentan la reproducción de pasajero. Como resultado, las personas afectadas por una sus publicaciones para mejorar la salud pública. enfermedad mental pueden no reconocer los síntomas como Por favor tome tiempo suficiente para revisar y compartir tales y que requieren la atención de un especialista en salud esta información con sus seres queridos. Si usted o alguien mental.” Si bien muchas de las barreras que impiden que que conoce requieren de servicios de salud mental o contra los hispanos soliciten tratamiento son comunes entre otros el abuso de sustancias, comuníquese con Magellan de grupos étnicos, la Asociación Americana de Psiquiatría Arizona llamando al (800) 564-5465. Magellan de Arizona señala que los hispanos utilizan los servicios de salud y nuestros proveedores brindan a las personas elegibles mental mucho menos que otros grupos étnicos. para AHCCCS y a sus familiares, una voz en el proceso de Como la Autoridad Regional de Salud Mental en el estado recuperación y la oportunidad de elegir dónde y cuándo (RBHA por sus siglas en inglés), Magellan de Arizona está solicitar ayuda. (National Institute of Mental Health) Las enfermedades mentales son más comunes que el cáncer, la diabetes o las enfermedades cardiacas. (American Surgeons General’s Report) Las enfermedades mentales afectan a cualquier persona, independientemente de su edad, estatus económico, raza, religión o cultura. Las enfermedades mentales afectan tanto a hombres como mujeres. (National Alliance for the Mentally Ill) Las enfermedades mentales suelen desarrollarse durante la adolescencia y juventud. Sin embargo, estas pueden presentarse a cualquier edad. Los jóvenes y personas de la tercera edad están más propensos a padecerlas. (National Alliance for the Mentally Ill) 4 10 de las causas principales de incapacidad (años perdidos de productividad) en Estados Unidos y otros países desarrollados son las enfermedades mentales, las cuales incluyen depresión crónica, trastorno bipolar, esquizofrenia, y el trastorno obsesivocompulsivo. Muchas personas sufren más de una enfermedad mental en algún momento de su vida. (National Institute of Mental Health) Con tratamiento y cuidado apropiado, 70 - 90% entre el de las personas con enfermedades mentales logran reducir los síntomas de manera significante y tener una mejor calidad de vida. (National Alliance for the Mentally Ill) 2/3 Más de de las personas con enfermedades mentales en Estados Unidos viven en la comunidad y mantienen vidas productivas. (National Mental Health Association) Los Hombres y la Depresión Instituto Nacional de Salud Mental Señales y Síntomas • Sentimientos de tristeza, ansiedad, irritabilidad o sentirse “vacío” • Pérdida de interés en el trabajo, la familia y actividades que antes disfrutaba incluyendo el sexo • Problemas de concentración o mala memoria • Dormir o comer demasiado o poco • Pensamientos suicidas o intentos de suicidio • Síntomas físicos persistentes tales como dolores de cabeza, trastornos digestivos y dolores crónicos que no responden a tratamientos • Problemas para cumplir con sus responsabilidades La Buena Salud Mental No Tiene Edad Departamento de Salud y Servicios Humanos Una mente sana es tan importante como un cuerpo sano. El tener buena salud mental no significa que usted nunca se sentirá triste, solo o abatido. Pero cuando estos sentimientos trastornan su vida o permanecen en su ser por mucho tiempo, puede ser que haya un problema más grande. Sentimientos inusuales de tristeza o depresión pueden ocurrir cuando tiene que mudarse de su hogar; sus seres queridos se enferman o fallecen, tiene que depender de otros para ir a lugares o para hacer cosas simples que usted solía hacer por sí mismo o sus problemas de salud física parecen abrumadores. Si su depresión o los cambios en su comportamiento duran más de dos semanas, hable con su médico u otro profesional que provee cuidados de salud. Explíqueles exactamente cómo usted se está sintiendo y aclare que es diferente de cómo usted solía sentirse. Ellos pueden diagnosticar algún problema y sugerir opciones de tratamiento. Comparta sus sentimientos con un amigo, algún miembro de la familia o con un consejero espiritual. A veces estas personas pueden distinguir cambios que usted no nota. Si usted o alguien que conoce requieren de servicios de salud mental o contra el abuso de sustancias, comuníquese con Magellan de Arizona llamando al (800) 564-5465. Los servicios de Magellan están disponibles para niños y adultos y son cubiertos por Medicaid o AHCCCS/KidsCare. Además de sentimientos de depresión, algunos de los siguientes cambios en el comportamiento pueden sugerir la existencia de otros problemas emocionales: • Afectarse o disgustarse fácilmente • Falta de energía para hacer las cosas que quiere hacer o las cosas que solía hacer • Cambios en sus hábitos de dormir • Creciente falta de memoria • Llorar mucho • Pasar mucho tiempo solo • Perderse con frecuencia • Sentirse con miedo a las cosas • Cambios en sus hábitos de comer • Tener problemas con el manejo de dinero • Creer que no puede hacer algo útil, algo que valga la pena • Sentirse confundido • Sentirse desalentado o abrumado • Pensar que no vale la pena vivir la vida • Pensar en hacerse daño a sí mismo La depresión es un trastorno médico serio para el cual existe tratamiento. Es una enfermedad cerebral que puede afectar a cualquiera incluyendo a los hombres. Tan solo en Estados Unidos más de seis (6) millones de hombres padecen de depresión cada año. Sea ejecutivo, empleado en construcción, escritor, policía, estudiante, rico o pobre, con muchos seres queridos a su lado o esté solo, no está inmune a sufrir depresión. Sin embargo, algunos factores como antecedentes de depresión en la familia, problemas de estrés, pérdida de un ser querido o alguna enfermedad crónica, pueden hacerle aún más vulnerable a padecer de depresión. Tanto los hombres como las mujeres pueden padecer de este trastorno. Sin embargo, los hombres suelen manifestarlo de manera diferente. Los hombres por lo general se quejan de fatiga, irritabilidad, pérdida de interés en el trabajo o pasatiempos favoritos y problemas de sueño, y no se quejan tanto de otros síntomas como sentimientos de tristeza, falta de auto estima y culpabilidad excesiva. Si bien las mujeres con depresión tienden a cometer más intentos de suicidio, los hombres tienen mayor probabilidad de morir por suicidio. Por ello y muchas más razones es importante aprender a reconocer los síntomas y buscar ayuda profesional. Tenga presente que no todas las personas que sufren depresión manifiestan todos los síntomas. Algunos tienen pocos síntomas, mientras que otros pueden tener muchos. La severidad de los síntomas varía de una persona a otra y también puede variar con el transcurso del tiempo. Investigaciones y hallazgos clínicos revelan que los hombres y las mujeres hablan distinto o en el caso de lo hombres, sencillamente no hablan sobre los síntomas de la depresión. Muchos no aceptan que tienen un problema de depresión, se reúsan hablar de cómo se sienten y pedir ayuda influenciados por sus creencias culturales u origen étnico. Por ejemplo, el rol tradicional del hombre en la comunidad Latina puede contribuir a que el hombre se reúse ha expresar sus sentimientos sobre la depresión. En lugar de reconocer sus síntomas, pedir ayuda o solicitar el tratamiento apropiado, los hombres con depresión independientemente de su origen étnico pueden recurrir al alcohol o las drogas cuando están deprimidos, frustrados, desanimados, enojados, irritados y algunas veces violentamente abusivos. Algunos hombres enfrentan la depresión dedicándose de manera compulsiva a su trabajo, tratando de ocultar la depresión a sí mismos, la familia y los amigos; otros hombres pueden responder a la depresión mostrando comportamiento temerario, es decir arriesgándose y poniéndose en situaciones peligrosas. La depresión al igual que otros trastornos emocionales no conoce género, nacionalidad, diferencias étnicas o culturales. Sin tratamiento, la depresión puede llevar a problemas personales, familiares y financieros. Afortunadamente, la depresión como la mayoría de las enfermedades mentales es una enfermedad real para la que existe un tratamiento. Con un diagnóstico y tratamiento apropiado, la mayoría de las personas pueden y suelen recuperarse. Trastornos de Ansiedad Instituto Nacional de Salud Mental Los trastornos de ansiedad afectan aproximadamente a 40 millones de adultos estadounidenses de 18 años de edad o más (aproximadamente 18%) cada año, llenando a las personas de miedo e incertidumbre. A diferencia de la ansiedad relativamente leve y transitoria causada por un evento estresante (tal como hablar en público o la primera cita amorosa), los trastornos de ansiedad duran por lo menos seis meses y pueden empeorar si no se tratan. Los trastornos de ansiedad son clasificados y divididos en diferentes tipos y categorías como el trastorno de pánico, el trastorno de estrés postraumático, el trastorno obsesivo-compulsivo y trastorno de ansiedad generalizada. Cada trastorno de ansiedad tiene diferentes síntomas, pero todos los síntomas se agrupan alrededor de un temor o pavor irracional y excesivo. Si bien es perfectamente normal preocuparse por la salud, el dinero o problemas familiares, las personas con trastornos de ansiedad pasan el día llenas de preocupaciones y tensiones exageradas por éstos y otros motivos todo el tiempo, incluso cuando hay poco o nada que las provoque. En ocasiones, el simple pensamiento de cómo afrontar el día les produce ansiedad. Los trastornos de ansiedad suelen desarrollarse gradualmente y puede comenzar en cualquier punto del ciclo de vida, aunque los años de mayor riesgo son aquellos entre la infancia y la mediana edad. Los síntomas pueden mejorar o empeorar con el tiempo, y generalmente empeorar en momentos de estrés. Las personas con trastornos de ansiedad pueden visitar a su médico varias veces antes de descubrir que tienen este trastorno. Pueden pedirle a su doctor ayuda con dolores de cabeza o problemas para dormir, los cuales pueden ser síntomas de un trastorno de ansiedad, pero no siempre reciben la ayuda que necesitan inmediatamente. Puede tomar tiempo para que un doctor determine que una persona cuenta con un trastorno de ansiedad y no algo más. Los trastornos de ansiedad suelen ser acompañados por otras enfermedades físicas o mentales incluyendo el abuso de sustancias lo que puede hacer más difícil detectar los síntomas y empeorarlos. En algunos casos, estas otras enfermedades necesitan ser tratadas antes que la persona responda favorablemente al tratamiento para el trastorno de ansiedad. Hoy en día existen tratamientos Magellan Health Services de Arizona, Inc. es la Autoridad Regional de Salud Mental del condado Maricopa y partes del condado Pinal. Los fondos para servicios son proporcionados por contrato con el Departamento de Servicios de Salud de Arizona/División de Servicios de Salud Mental de Arizona y el Sistema de Contención de Costos de Cuidado de Salud del Estado de Arizona (AHCCCS). Señales y Síntomas •Se preocupa demasiado por las actividades de cada día •Se preocupa mucho más de lo que debería •Tienen problemas para concentrarse •Se sobresalta con facilidad •Insomnio, despierta con frecuencia y no se puede relajar •Tienen dolor de cabeza, muscular, estomacal o dolores inexplicables •Temblores o tics (movimiento nervioso) •Está irritable, suda mucho y se marea o le falta el aire •Tiene que ir al baño seguido efectivos para los trastornos de ansiedad y se continúa descubriendo nuevos tratamientos que permiten a las personas vivir vidas productivas. Si cree que usted o alguien que conoce padece un trastorno de ansiedad, busque información y ayuda lo antes posible. Déficit de Atención e Hiperactividad (ADHD) diagnosticados y recibir tratamiento es mucho menor ya que a los padres se les dificulta reconocer los síntomas por diversos factores culturales. Instituto Nacional de Salud Mental El Déficit de Atención e Hiperactividad o Attention-Deficit/Hyperactivity Disorder (ADHD por sus siglas en inglés) es un trastorno común en la infancia y puede afectar a los niños de distintas maneras. El ADHD hace que ¿Qué causa el ADHD? a un niño le sea difícil concentrarse y Nadie lo sabe con prestar atención. Algunos niños pueden seguridad. Algunos estudios ser hiperactivos o tener problemas para tener Señales y Síntomas paciencia. El ADHD Falta de Atención puede hacer que a un Se distrae fácilmente, se le olvidan las niño le resulte difícil cosas o detalles, constantemente cambia desempeñarse bien en la de una actividad a otra y se le dificulta escuela o comportarse en seguir instrucciones su casa. Hiperactividad Diversos estudios han Habla demasiado, corre por todos lados, toca y demostrado que en los juega con todo lo que ve, constantemente está últimos años alrededor en movimiento o tiene dificultad para realizar de uno de cada 10 niños actividades tranquilas en los Estados Unidos ha Impulsividad sido diagnosticado con Se muestra impaciente la mayor parte del ADHD. Investigadores tiempo, hace comentarios inapropiados, expresa sus emociones y actúa sin importarle las del Centro para el consecuencias Control y Prevención de Enfermedades encontraron que del 2007 al 2009, nueve por ciento de sugieren que los genes juegan un papel los niños entre los 5 a 17 años fueron importante pero al igual que otras diagnosticados con este trastorno enfermedades, el ADHD probablemente comparado al 7 por ciento entre 1998 y se debe a la combinación de varios el año 2000. factores. Además de la genética, los Además de esto, algunos estudios investigadores analizan actualmente sugieren que aunque los niños Latinos cómo factores ambientales, algún daño tienen un alto riesgo de desarrollar cerebral, la nutrición y el entorno social ADHD, la probabilidad de ser pudieran contribuir al desarrollo de ¿Qué son los medicamentos siquiátricos y paraqué se recomiendan? ADHD. Instituto Nacional de Salud Mental Sobre las señales y síntomas Aunque es perfectamente normal que los niños se distraigan, sean hiperactivos y hasta impulsivos algunas veces, para los niños con ADHD este tipo de conductas son más severas y frecuentes. Para ser diagnosticado con este tipo de trastorno, el menor tiene que presentar los síntomas por lo menos durante seis meses y ser más comunes que en cualquier niño de su edad. Si detecta que su niño presenta uno que otro síntoma de vez en cuando, probablemente no es ADHD. Sin embargo, si manifiesta varios de los síntomas la mayor parte del tiempo, ya sea en casa, la escuela o al jugar, es recomendable atender este asunto. Mente Sana en Cuerpo Sano Relación entre su salud física y su salud mental Dra. Maritza Irizarry Sunshine Pediatrics las enfermedades mentales reside en que la mayoría del tiempo no queremos aceptar que sufrimos estas condiciones y si reconocemos los síntomas, nos reusamos a buscar ayuda por temor o vergüenza sin imaginar que la relación entre la salud física y la salud mental es fundamental para nuestra salud y bienestar en general. Enfermedades mentales ocasionadas por enfermedades físicas Muchas veces no nos damos cuenta cómo nuestra salud mental y nuestras emociones afectan todo lo que hacemos, cómo nos comportamos y hasta nuestra salud física. Si bien es importante cuidar nuestro cuerpo y las funciones de nuestro organismo, es igualmente importante, reconocer las señales de alerta que pudieran implicar la necesidad de una evaluación mental o psicológica sea para nosotros como padres o para nuestros hijos. Recordemos que la dificultad principal en el diagnóstico de A través de los años hemos visto que pacientes con enfermedades crónicas, como diabetes y asma, sufren trastornos mentales como depresión y ansiedad. Se estima que hasta un tercio de las personas con síntomas graves de una condición médica experimentan depresión. No obstante, tanto los pacientes como sus familiares generalmente ignoran los síntomas de la depresión pensando que el sentirse deprimido es normal para alguien que esta luchando con una enfermedad seria y crónica. Sin embargo, la depresión causada por la enfermedad crónica puede agravar el Enfermedades Crónicas Ligadas a la Depresión problema especialmente si • De las personas que sufren un ataque cardiaco la enfermedad causa dolor y entre el 40% - 65% también padece depresión fatiga, o limita la capacidad • Enfermedad de Parkinson 40% de la persona para interactuar con los demás. • Esclerosis Múltiple 40% • Derrame Cerebral, 10 – 27% • Cáncer 25% • Diabetes 25% • Síndrome de Dolor Crónico 30%-54% La obesidad y la depresión La obesidad es un problema de salud creciente, que además de predisponer a trastornos mentales produce Cuándo Solicitar Ayuda Profesional Si ha hecho lo posible por mejorar su salud mental y emocional y no logra sentirse bien, entonces es momento de buscar ayuda especializada. Las recomendaciones de un profesional dedicado podrían motivarlo a realizar cosas que quizá no podría hacer por usted mismo. Señales de alerta que pudieran requerir atención inmediata: » Sentir que no vale la pena seguir viviendo » Pensar constantemente en la muerte, tener ideas suicidas o planificar como suicidarse » Tomar riesgos que ponen en peligro su vida y la de otros a su alrededor » Pensar en lastimarse, lastimar a otros, destruir cosas o en cometer un crímen Departamento de Salud y Servicios Humanos (DHHS, por sus siglas en inglés) muchas complicaciones, problemas cardíacos, metabólicos y alteración en la salud en general. Al igual que las enfermedades crónicas, la obesidad ha sido relacionada también con el desarrollo de depresión y problemas de ansiedad. No podemos precisar qué ocurre primero, si el trastorno mental o el aumento de peso. Generalmente esto depende de factores personales. Lo que sí sabemos es que hay factores genéticos que predisponen tanto al desarrollo de obesidad como a trastornos mentales. Se estima que alrededor de un 61% de los estadounidenses tienen problemas de sobrepeso o son obesos. Encuestas indican que uno de cada cinco adultos mayores de 30 años se considera obeso. Independientemente de lo que suceda primero, la clave es reconocer que si está luchando contra una enfermedad crónica o problema de sobrepeso y está sufriendo depresión o algún problema de ansiedad por ello, consulte de inmediato con su médico. De esta manera se buscará un tratamiento que trate ambas condiciones de manera simultánea, como un programa para perder peso que incorpore asesoría psicológica, por ejemplo. Recuerde que en el caso de la salud mental existen agencias en el Valle, donde puede dirigirse sin necesidad de ser referido por su doctor, como por ejemplo Magellan de Arizona, llamando al 1-800-564-5465 donde se le atenderá en español si es necesario. Los medicamentos siquiátricos pueden ser una parte efectiva de tratamiento de enfermedades mentales como la esquizofrenia, depresión, bipolaridad, trastornos de ansiedad y déficit de atención e hiperactividad. En ocasiones los medicamentos son combinados con tratamiento como la psicoterapia. Con la ayuda de estos medicamentos muchas personas con enfermedades mentales pueden vivir vidas productivas. Sin ellos, algunas personas podrían experimentar síntomas mas graves hasta incapacitarlas. ¿Cómo se utilizan dichos medicamentos? Los medicamentos siquiátricos son utilizados en el tratamiento de enfermedades mentales. Si bien no curan la enfermedad, ayudan a reducir o eliminar los síntomas problemáticos y mejorar el funcionamiento diario de las personas con desórdenes siquiátricos. La efectividad de los medicamentos varía en cada organismo. Algunas personas obtienen excelentes resultados y los requieren solo poco tiempo. Por ejemplo, una persona que sufre depresión puede sentirse mucho mejor después de tomar medicamentos por unos meses y no necesitarlos jamás. Sin embargo, personas con problemas de esquizofrenia, bipolaridad, depresión o ansiedad crónica quizá requieran consumir medicamentos por más tiempo. ¿Qué debo preguntar a mi doctor si me receta algún medicamento psiquiátrico? Usted y su familia pueden ayudar a su doctor a encontrar el medicamento ideal para usted. El doctor debe conocer su historial médico, enfermedades prevalentes en su familia, si padece algún tipo de alergia, si está con otros medicamentos, suplementos alimenticios o hierbas medicinales y otra información sobre su salud en general. Después de tomar el medicamento notifique a su doctor como se siente, si experimenta algún efecto secundario o cualquier otra inquietud que tenga sobre el medicamento. Preguntas que usted o algún familiar debería hacer a su médico al recetarle algún medicamento ¿Cuál es el nombre del medicamento? ¿Para qué es el medicamento? ¿Cómo y cuando debe tomarlo? ¿Qué cantidad debe tomar? ¿Qué debe hacer en caso de olvidar tomarlo? ¿Cómo y cuándo debe dejar de tomarlo? ¿Si tendrá algún tipo de reacción con cualquier otro medicamento que este tomando? ¿Si es necesario evitar algún tipo de bebida o alimento mientras consume el medicamento? ¿Si debe tomarse antes o después de ingerir algún tipo de alimento? ¿Si es seguro consumir alcohol mientras tome ese medicamento? ¿Cuáles son los efectos secundarios y qué hacer en caso de experimentarlos? ¿Dónde puedo conseguir ayuda? Si usted o alguien que conoce requiere servicios de salud mental o contra el abuso de sustancias, comuníquese con Magellan de Arizona llamando al (800) 564-5465 o TTY (800) 424-9831. Los servicios de Magellan están disponibles tanto para niños como adultos y son cubiertos por Medicaid o AHCCCS/KidsCare. Para mayor información de cómo solicitar AHCCCS, los requisitos de elegibilidad/ ingresos, recursos, reglas de participación para los programas y lugares donde puede someter una solicitud en persona, comuníquese al 602-417-4000. Magellan de Arizona cuenta con personal que habla español para responder a sus llamadas y preguntas. Por favor comuníquese con Magellan para aprender más sobre los recursos disponibles para el cuidado de la salud mental o contra el abuso de sustancias en el centro de Arizona. Magellan lo conectará con el Servicios de salud mental cubiertos por AHCCCS proveedor de servicios en su • Evaluación y tratamiento área que más le convenga. • Servicios de salud mental y abuso de sustancias Si usted o algún familiar • Diagnóstico, terapia y consejería experimenta una crisis, y • Administración de casos requiere apoyo psicológico, • Transporte comuníquese con la Red • Servicios en localidades y medicamentos de Respuesta en Casos de Crisis. La Línea de Respuesta en Casos de Crisis es gratuita y está disponible las 24 horas del día, los siete días de la semana para cualquier persona que experimenta una crisis de salud mental en el condado Maricopa y partes del condado Pinal. Para emergencias, llame siempre al 9-1-1. ¡La información es poder! Si usted o alguien que conoce, fue diagnosticado con una enfermedad mental recientemente y le gustaría aprender más sobre su condición para ayudar en el proceso de recuperación, las siguientes agencias pueden enviar por correo material impreso sobre las enfermedades mentales más comunes a personas con acceso limitado a Internet o computadora. www.samhsa.gov • 1-877-726-4727 www.nimh.nih.gov • 1-866-615-6464 Depression and Bipolar Support Alliance www.dbsalliance.org • 1-800-826-3632 www.cdc.gov • 1-800-232-4636 www.healthyminds.org • 1-888-357-7924 www.nami.org • 1 (800) 950-NAMI www.familyinvolvementcenter.org 602-288-0155 Fast Facts About... Magellan Health Services of Arizona is dedicated to a strong behavioral health care delivery system for central Arizona. Mental Health 18+ About one in five adults has a diagnosable mental disorder. (National Institute of Mental Health) in our care, as well as access to services Dear Readers, to under served populations eligible for I wanted to reach out with a message mental health care. of hope and recovery for those you love At Magellan of Arizona we believe that might be living with a mental illness. that all behavioral health care recipients It can be anything from depression or must receive effective treatment in a schizophrenia to uncontrollable rage or manner that is respectful of individual abuse of drugs or alcohol. Mental illness preferences, needs and values and does not discriminate. In any given year, compatible with their preferred language one in four adults and one in five children and cultural beliefs. To accomplish in the U.S. is affected by a mental illness this, we support our staff and network regardless or race, level of education or providers to ensure delivery of culturally socioeconomic status. competent care. By doing so, we are Lack of access to mental health services Richard Clarke, Ph.D., CEO, building stronger relationships with the continues to be a serious problem among Magellan Health Services of Arizona people and the community we serve, minority populations across the U.S. providing better care and ultimately, help While lack of insurance plays a huge role in accessing health care, cultural beliefs and lack of strengthening central Arizona’s community as a whole. understanding of mental illness are also significant barriers As part of our ongoing effort to facilitate access to mental to care. health care to vulnerable populations, Magellan has compiled According to the American Psychiatric Association, this comprehensive review of mental health information to “Hispanics/Latinos often have different attitudes about help you better understand the cause and symptoms of accessing mental health services, and may feel highly mental illness and when and where to seek professional stigmatized for doing so. For example, Hispanics/ Latinos help. Most of the information included on these pages often mistake depression for nervousness, tiredness, or was retrieved from documents by the National Institute even a physical ailment, and may see it as something that of Mental Health and the U.S. Department of Health and is temporary. Affected individuals may not recognize their Human Services, which fully authorize and encourage the symptoms as those that require the attention of mental reproduction of their publications in an effort to improve health specialists.” Although many of the barriers that public health. deter minorities from accessing treatment are true for all Please take the time to review this handout and share populations, the American Psychiatric Association indicates the information with people you know. If the possibility of that Hispanic Americans use mental-health services far less mental illness or substance abuse is a concern for you or than other ethnic and racial groups. someone you care about please call Magellan of Arizona at As the Regional Behavioral Health Authority (RBHA) for (866) 564-5465. Magellan of Arizona and our provider Maricopa County and part of Pinal County, Magellan Health partners give AHCCCS eligible individuals and their families Services of Arizona is dedicated to a strong behavioral health a voice in the recovery process and choice to seek care when care delivery system for central Arizona. A system of care and where they need it. that not only provides hope, resources and recovery to those Mental illnesses are more common than cancer, diabetes, or heart disease. (U.S. Surgeon General’s Report) Mental illnesses can affect persons of any age, income, race, religion, or culture. Mental Illnesses affect both males and females. (National Alliance for the Mentally Ill) Mental illnesses often appear for the first time during adolescence and young adulthood. While they can occur at any age, the young and the old are especially vulnerable. (National Alliance for the Mentally Ill) of the 10 leading causes of disability 4 (lost years of productive life) in the United States and other developed countries are mental disorders, which include major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder. Many persons suffer from more than one mental disorders at any given time. (National Institute of Mental Health) With proper care and treatment, between 70 - 90% of persons with mental illnesses experience a significant reduction of symptoms and an improved quality of life. (National Alliance for the Mentally Ill) 2/3 More than of Americans who have a mental illness live in the community and lead productive lives. (National Mental Health Association) Men & Depression National Institute of Mental Health Signs and Symptoms of Depression in Men • • • • • • • • Good Mental Health is Ageless U.S. Department of Health and Human Services A healthy mind is as important as a healthy body. Being in good mental health doesn’t mean that you’ll never feel sad, lonely, or ‘down.’ But when these feelings disrupt your life or go on too long, there may be a bigger problem. Unusual feelings of sadness or depression can happen when you have to move from your home; people you love get sick or die; if you have to depend on others to get around even to do the simple things you used to do yourself or when physical health problems seem overwhelming. If depression or other changes in your behavior last longer than two weeks, talk with your doctor or other health care professional. Tell them exactly how you’re feeling, and let them know how this is different from the way you used to feel. They can check for any problems you may be having, and can discuss treatment options with you. Share your feelings with a friend, family member or spiritual advisor. These people can sometimes notice changes that you might not see. If you or someone you know needs mental health or substance abuse services, contact Magellan of Arizona at (800) 564-5465 or TTY (800) 424-9831. Magellan’s services are available for children and adults and are covered by Medicaid or AHCCCS/KidsCare. In addition to feelings of depression, some of the following changes in behavior may suggest other emotional problems: • Being easily upset • Changing sleep habits • Increasing forgetfulness • Being afraid of things • Changes in eating habits • Neglecting housework • Crying a lot • Being confused • Getting lost a lot • Having trouble managing money • Not having the energy to do the things you want to do, or used to do • Believing that you can’t do anything worthwhile • Staying alone a lot of the time • Spending little or no time with friends • Feeling hopeless or overwhelmed • Thinking life isn’t worth living • Thinking about hurting yourself Feeling sad or “empty,” hopeless, irritable, anxious, angry or very tired Loss of interest in work, family, or once-pleasurable activities, including sex Not being able to concentrate or remember details Not being able to sleep, or sleeping too much Overeating, or not wanting to eat at all Thoughts of suicide, suicide attempts Aches or pains, headaches, cramps, or digestive problems Inability to meet the responsibilities of work, caring for family, or other important activities Depression is a serious but treatable medical condition — a brain disease — that can strike anyone, including men. In America alone, more than six (6) million men experience depression each year. Whether you’re a company executive, a construction worker, a writer, a police officer, or a student; whether you are rich or poor; surrounded by loved ones or alone; you are not immune to depression. Some factors, however, such as family history, undue stress, the loss of a loved one, or serious illnesses can make you more vulnerable. Both men and women are affected by depression. But men can experience it differently than women. Men may be more likely to feel very tired and irritable, and lose interest in their work, family, or hobbies. They may be more likely to have difficulty sleeping than women who have depression. And although women with depression are more likely to attempt suicide, men are more likely to die by suicide. For this and many other reasons, it’s important to recognize the symptoms and seek professional help. Keep in mind that not everyone who is depressed experiences every symptom. Some people experience only a few symptoms; some people suffer many. The severity of symptoms varies among individuals and also over time. Research and clinical findings show that women and men may talk differently — or in the case of men, not talk — about the symptoms of depression. Many men do not recognize, acknowledge, or seek help for their depression. They may be reluctant to talk about how they are feeling based on cultural beliefs or ethnic origin. For instance, traditional gender roles in the Latino community may further contribute to an unwillingness to talk about feelings of depression. Men with depression, regardless of ethnic background, may be more likely to turn to alcohol or drugs, or to become frustrated, angry or irritable instead of acknowledging their feelings and asking for help. Some men may throw themselves compulsively into their work or hobbies, attempting to hide their depression from themselves, family, and friends; other men may respond to depression by engaging in reckless behavior. Depression and other mood disorders cross all national, cultural, ethnic, and gender boundaries. If left untreated, depression can lead to personal, family, and financial difficulties. Fortunately, depression, like most mental disorders is a real and treatable illness. With appropriate diagnosis and treatment most people can and do recover. The darkness disappears; hope for the future returns, and energy and interest in life becomes stronger than ever. Anxiety Disorders National Institute of Mental Health Anxiety Disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year, causing them to be filled with fearfulness and uncertainty. Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders can last at least six (6) months and can get worse if they are not treated. Anxiety disorders are classified and divided into different types or categories such as panic disorder, post-traumatic stress disorder, obsessive compulsive disorder and general anxiety disorder. Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread. Although it is perfectly normal to worry about things like health, money, or family problems, people with anxiety disorders are extremely worried about these and many other things at all times, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with anxiety disorders from doing everyday tasks. Anxiety disorders tend to develop slowly. They often start during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress. People with anxiety disorders may visit a doctor many times before they find out they have this disorder. They ask their doctors to help them with headaches or trouble falling asleep, which can be symptoms of anxiety disorders, but they don’t always get the help they need right away. It may take doctors some time to be sure that a person has an anxiety disorder instead of something else. Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder. Effective therapies for anxiety disorders are available, and research is Magellan Health Services of Arizona, Inc. is the Regional Behavioral Health Authority for Maricopa County and Parts of Pinal County. Funds for services are provided through a contract with the Arizona Department of Health Services/ Division of Behavioral Health Services and the Arizona Health Care Cost Containment System (AHCCCS). Signs and Symptoms • Worrying very much about everyday things • Trouble controlling their constant worries • Hard time concentrating • Easily startled • Trouble falling asleep or staying asleep • Feeling tired all the time • Headaches, muscle aches, stomach aches, or unexplained pains • Have a hard time swallowing • Tremble or twitch • Irritable, sweat a lot, and feeling light-headed or out of breath • Have to go to the bathroom a lot uncovering new treatments that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment right away. Attention-Deficit/Hyperactivity Disorder (ADHD) National Institute of Mental Health What Causes ADHD? Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood making it difficult for people to inhibit their spontaneous responses—responses that can involve everything from movement to speech to attentiveness. In recent years, Signs and Symptoms studies have shown Inattention that nearly 1 in 10 Easily distracted, misses details, forgets U.S. kids have been things, frequently switches from one diagnosed with ADHD. activity to another, and has trouble Researchers from the following instructions U.S. Centers for Disease Hyperactivity Control and Prevention Talk nonstop, dash around, touching or playing found that between with anything and everything in sight, constantly in motion, difficulty doing quiet tasks or 2007 and 2009, an activities average of 9% of children Impulsivity between the ages of 5 Very impatient, blurt out inappropriate and 17 were diagnosed comments, show emotions without restraint, with the disorder. This and act without regard for consequences compared with just under 7% between 1998 and 2000. In addition, limited available research suggests that Latino of factors. In addition to genetics, children are at a great or greater risk researchers are looking at possible for developing ADHD, although they environmental factors, and are studying are much less likely to be identified by how brain injuries, nutrition, and the their parents as displaying problematic social environment might contribute to behavior and subsequently are less ADHD. likely to receive proper assessment and treatment due to several practical and About Warning Signs Although it is normal for all children to cultural factors. be inattentive, hyperactive, or impulsive sometimes, for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age. If you spot just a few signs, or the symptoms appear only in some situations, it’s probably not ADHD. On the other hand, if your child shows a number of ADD/ADHD signs and symptoms that are present across all situations—at home, at school, and at play—it’s time to take a closer look. ADHD can lead to problems at home and school, and affect your child’s ability to learn and get along with others. It’s important for you as a parent to be able to spot the signs and symptoms, and get help if you see them in your child. Healthy Minds, Healthy Bodies The relationship between our physical health and our mental health People refuse to accept they have such conditions. Even when symptoms are present, shame and fear keeps a lot of individuals from seeking help. However, the relationship between our physical health and our mental health is vital to our emotional well-being and overall health. Dr. Maritza Irizarry Sunshine Pediatrics Often we forget how our mental health and our emotions affect everything we do, from the way we act to our physical health. Although it’s important to take care of our bodies, it’s also important to be able to recognize the warning signs that could imply the need of a mental or psychological evaluation, either for us as parents or for our children. Mental illness often goes under-diagnosed and under treated, primarily because of stigma. Mental Illness caused by Chronic Illness Throughout the years, we’ve seen how patients with chronic illnesses such as diabetes and asthma suffer from mental illnesses like anxiety and depression. It is estimated that one third of people with chronic illnesses in the U.S. experience depression. Yet, some of these individuals along with family members ignore the symptoms of depression thinking it’s perfectly normal to feel that way. If untreated, depression could make health problems worse, especially if individuals dealing with a chronic illness are experiencing pain, fatigue, or difficulty interacting with others. Chronic Conditions and their Link to Depression: • Of those who experience a heart attack, 40%-65% also experience depression • Coronary artery disease (without heart attack): 18%-20% • Parkinson’s disease: 40% • Multiple sclerosis: 40% • Cancer: 25% • Diabetes: 25% • Chronic pain syndrome: 30%-54% Obesity and Depression Obesity is a growing health problem in the U.S. In fact, it is estimated that about 61% of Americans are overweight or obese. National polls indicate that one in five adults 30 years or older considers When to seek Professional Help themselves obese. Obesity cannot only lead to chronic health conditions such as heart and metabolic problems, but it has also been linked to the development of mental illnesses, such as anxiety disorders and depression. We cannot determine which occurs first, the mental disorder or the weight gain—this probably depends on personal factors. However, we do know genetic factors put an individual at a higher risk of developing obesity and mental health disorders. Regardless of what comes first, the key to a healthy lifestyle is recognizing the signs and symptoms associated with a chronic illness, weight gain and mental illnesses (like anxiety disorder or depression). Take charge of your health and inform your doctor immediately if you experience any of these symptoms. By doing this, your doctor can help you find a treatment option that meets your physical and mental health needs. For instance, your doctor may recommend participating in a weight loss program that utilizes psychological support. Remember that there are agencies in the Valley where you can get mental health services without a referral from your doctor. Magellan Health Services of Arizona offers help in Spanish at (800) 564-5465. Overcoming stigma and expressing to your doctor how you feel without fear of being judged or criticized is key in helping you find the right treatment options that allow you to have a healthy mind and a healthy body. What are psychiatric medications and who gets them? National Institute of Mental Health Psychiatric medications are used to treat the symptoms of mental disorders such as schizophrenia, depression, bipolar disorder (sometimes called manic-depressive illness), anxiety disorders, and attention deficit-hyperactivity disorder (ADHD). Sometimes medications are used with other treatments such as psychotherapy. Many people with mental disorders live fulfilling lives with the help of these medications. Without them, people with mental disorders might suffer serious and disabling symptoms. How are medications used to treat mental disorders? Medications treat the symptoms of mental disorders. They cannot cure the disorder, but they make people feel better so they can function. Medications work differently for different people. Some people get great results from medications and only need them for a short time. For example, a person with depression may feel much better after taking a medication for a few months, and may never need it again. People with disorders like schizophrenia or bipolar disorder, or people who have long-term or severe depression or anxiety may need to take medication for a much longer time. What should I ask my doctor if I am prescribed a psychiatric medication? You and your family can help your doctor find the right medications for you. The doctor needs to know your medical history; family history; information about allergies; other medications, supplements or herbal remedies you take; and other details about your overall health. After taking the medication for a short time, tell your doctor how you feel, if you are having side effects, and any concerns you have about the medicine. Things you or a family member should ask your doctor when a medication is prescribed: What is the name of the medication? What is the medication supposed to do? How and when should I take it? How much should I take? What should I do if I miss a dose? When and how should I stop taking it? Will it interact with other medications I take? Do I need to avoid any types of food or drink while taking the medication? What should I avoid? Should it be taken with or without food? Is it safe to drink alcohol while taking this medication? What are the side effects? What should I do if I experience them? Is the Patient Package medicine available? Where Can I Get Help? If you or someone you know needs mental or substance abuse services, contact Magellan of Arizona at (800) 564-5465 or TTY (800) 424-9831. Magellan’s services are available for children and adults and are covered by Medicaid or AHCCCS. If you’ve made consistent efforts to improve your mental and emotional health and you still don’t feel good – then it’s time to seek professional help. Because we are so socially attuned, input from a knowledgeable, caring professional can motivate us to do things for ourselves that we were not able to do on our own. Red flag feelings and behaviors that may require immediate attention » You feel like life is not worth living anymore » You think a lot about dying, have thoughts of suicide, or have planned how to kill yourself » You are taking lots of risks that are endangering your life and/or the lives of others » You feel like hurting yourself, hurting others, destroying property or committing a crime Reprinted with permission from the U.S. Department of Health and Human Services (DHHS) For more information on how to apply for AHCCCS or questions regarding eligibility, income, resources, program participation rules, or the nearest branch to apply in person, please call (602) 417-4000. Magellan of Arizona has English and Spanish speaking staff available to answer your calls and questions. Please contact Magellan of Arizona to find out more about mental health and substance abuse resources available to you. Mental Health Services covered by AHCCCS Magellan will connect you • Evaluation and treatment to a service provider that • Services for mental disorders and substance abuse best fits your needs and is in your area. • Diagnosis, therapy and counseling If you or a member of • Case management your family is in crisis, • Transportation call the Maricopa Crisis • Services in facilities and medication Response Network at (800) 631-1314 or TTY (800) 327-9254 for immediate help. The Maricopa Crisis Response Network is available 24 hours a day, seven days of week to assist anyone experiencing a mental health crisis in Maricopa County. For emergencies always call 9-1-1. Knowledge is Power If you or someone you know was recently diagnosed with a mental illness or substance abuse disorder and wish to learn more about their condition to help with their recovery process, the following agencies can mail printed materials about the most common mental illnesses to individuals with limited access to the Internet or a computer. www.samhsa.gov • 1-877-726-4727 www.nimh.nih.gov • 1-866-615-6464 Depression and Bipolar Support Alliance www.dbsalliance.org • 1-800-826-3632 www.cdc.gov • 1-800-232-4636 www.healthyminds.org • 1-888-357-7924 www.nami.org • 1 (800) 950-NAMI www.familyinvolvementcenter.org 602-288-0155 TIPS ON CALLING AN AGENCY FOR MENTAL/BEHAVIORAL HEALTH SERVICES Step 1: Pick an agency you would like to call from the attached list. Step 2: Pick up the phone and dial the number. Step 3: Let the person on the phone know that you want to know more about their services. Step 4: Ask if they have (whatever type of help you need) services. Step 5: Ask about how much the services cost. Ask if they have a sliding fee scale (where you only pay what you can afford). Step 6: If they offer the services you need, ask to make an appointment. Step 7: Verify the time and day of appointment, the name of the person you will meet, and the address of where the appointment will be held. Step 8: Ask any other questions you may have then thank the person for helping you. AZ Response to Intervention (RTI) System of Behavioral Supports Overview School achievement and success require that students be provided both academic and behavioral systems of support. A comprehensive system of behavioral supports ensures that students are ready and able to learn by creating environments conducive to learning and by addressing barriers to learning that students experience. Response to Intervention (RTI) is a problem-solving model that utilizes prevention logic as its basis; that is, the proactive implementation of strategies at the school level, classroom level and/or student level prior to the development of academic or behavior problems. An effective system of behavioral supports will decrease the development of new problem behaviors and prevent the worsening of existing problem behaviors. The tiered levels within the RTI model provide for a continuum of behavioral supports for students. All students are provided the Universal Level (Tier 1) supports; approximately 80 percent of students will perform well under these conditions. Approximately 15 percent of students, those with more risk for problem behavior, will require Targeted Level (Tier 2) supports directed to the specific needs of the individual or small group of students. The remaining five percent of students that have already displayed problem behaviors require Intensive Level (Tier 3) supports. A primary component of a comprehensive system of behavioral supports includes the teaching of pro-social behavior skills needed to facilitated learning. At each level, pro-social skills are taught, monitored and acknowledged. Commonly addressed skills include the meeting of school behavior rules and expectations, communication skills, self control, responsibility and empathy. Support strategies also include the redesigning of environments to eliminate routines and physical arrangements that maintain problem behaviors and the involvement of families in efforts. A comprehensive system of behavioral supports utilizes data-based decision making and a continuous improvement process in which teams regularly, systematically, and honestly evaluate outcomes and areas for improvement. Success relies upon professional development that builds knowledge and skill in district and school personnel and facilitates the change process throughout the organization. This document describes in more detail the following components of a system of behavioral supports: • Data-Based Decision Making • Curriculum, Instruction and Strategies • Professional Development Data‐Based Decisions Data-based decision making is the collection, management, analysis, and utilization of relevant data to make informed decisions. This process is utilized at the school, classroom and student levels within a system of behavioral supports. It therefore guides the necessary system changes as well as student interventions. 1 Key features of effective data-based decision making processes include: data are accurate, valid and easy to collect; data are presented in user-friendly format (e.g., graph format); data are available when decisions need to be made; data collection staff understand the value of their work (how the information is used in decision making); the leadership team is trained in collecting and using data; and a team approach is used for decision making. Data-based decision making also requires the development of procedures that ensure proper analysis as to whether gains are being achieved and the actions that should occur next. (Sugai 2007) The process of implementing a system of behavioral supports begins with a school-wide needs assessment involving analysis of disciplinary, safety and climate data from multiple sources. This process aids the school (and district) in setting goals and creating action plans. These data sources are also used to determine appropriate strategies and programs for prevention and intervention, measure progress toward goals, and evaluate the effectiveness of the strategies. A system of behavioral supports utilizes a continuous improvement process, such as the US Department of Education’s Principles of Effectiveness, illustrated below. Needs Assessment Evaluation of Outcomes Measurable Goals & Objectives ResearchBased Strategies This process is also utilized for small groups of students and individual students receiving Targeted and Intensive Levels of supports. The primary sources of data needed for implementing a system of behavioral supports include the following: Universal Level (Tier 1) • School safety and disciplinary incident data in aggregate by student, location, time of day, referring individual, and grade level • Disciplinary action information in aggregate, including detentions, suspensions, and expulsions, as well as corrective actions taken, such as behavior intervention groups • Attendance data, dropout data and causal factors in aggregate • Student survey information (anonymous and in aggregate) capturing high risk behavior and school safety and climate perceptions • Staff and parent survey information (anonymous and in aggregate) capturing school safety and climate perceptions • School health office data in aggregate • Process data for evaluating the fidelity of implementation of the Universal system 2 Targeted Level (Tier 2) • School safety and disciplinary incident data by student • Individual and/or group data related to the Target Level intervention • Social competency rating scales • Teacher observation data • Process data for evaluating the fidelity of implementation of interventions Intensive Level (Tier 3) • Functional Behavior Assessment • Individual student data related to the Intensive Level intervention • Process data for evaluating the fidelity of implementation of interventions Additional information from parents and guardians, behavioral health agencies, social service agencies, juvenile justice, or law enforcement may be necessary for a correct summation of the conditions impacting student learning. Curriculum, Instruction and Strategies Curriculum within the comprehensive system of behavioral supports focuses on the pro-social skills students need to be ready and able to learn. Instruction focuses on how these skills are taught. The pro-social skills to be taught are determined by the needs of the student population but commonly include: meeting behavior rules and expectations, communication skills, self control, responsibility and empathy. Support strategies also include the redesigning of environments to eliminate routines and physical arrangements that maintain problem behaviors and the involvement of families in efforts. The diagram below shows the curricula and other supports most commonly utilized within the three-tier framework. Intensive Level of Supports (Few students, high‐risk) Tier 3 Intensive Level Tier 2 Targeted Level (some students, at‐risk) Tier 1 Universal Level (all students) • • • • • Intensive academic support Intensive social skills teaching Individual behavior management plans Family involvement Multi‐agency collaboration (wrap‐ around)services Alternatives to suspensions and expulsions Community and service learning • • Targeted Level of Supports • Increased academic support • Increased and targeted social skills teaching • Increased monitoring and reinforcement systems • Self management techniques • Family involvement • Mentoring programs • Alternatives to suspensions and expulsions • Community and service learning Universal Level of Supports • School behavior expectations instruction • Universal social skills training • Active supervision and monitoring • Positive reinforcement systems • Firm, fair, and corrective discipline • Effective classroom management 3 • Improved environmental arrangements • Family involvement Sprague, J. (Revised 2007). Effective Strategies for Creating Safer Schools and Communities - Creating Schoolwide Prevention and Intervention Strategies, Hamilton Fish Institute on School and Community Violence & Northwest Regional Educational Laboratory. Horner, R.H., & Supai, G. (2005). School-wide positive behavior support: An alternative approach to discipline in schools, in Bambara, L. & Kern, L. (Eds.) Positive Behavior Support, 359-390, NY: Guildford Press. Professional Development Professional development is a key component to implementing an effective system of behavioral supports that ensures that students are ready and able to learn. Success is largely dependent upon utilization of qualified and experienced professionals to lead district and school teams through the change process and development of knowledge and skills in the following areas: Context Standards • Leadership - requires skillful school and district leaders who guide system implementation and continuous improvement. • Resources - requires resources to support adult learning and collaboration. Process Standards: • Data-Driven - uses data (student, teacher, classroom, school-wide) to determine adult learning priorities, monitor progress, and help sustain continuous improvement. • Research-Based - prepares educators to apply research to decision making. • Design - uses strategies/interventions appropriate to the intended goal. • Learning - applies knowledge about human learning and the change process. • Collaboration/team building - provides educators with the knowledge and skills to effectively communicate and collaborate. • Evaluation - uses multiple sources of information to guide improvement and demonstrate its impact. • Long Term Focus – systems change takes time and perseverance (e.g., 3-4 years) before some desired outcomes become evident. Content Standards: • Equity - prepares educators to demonstrate appreciation for all of their students by establishing learning environments that are emotionally and physically safe and communicating high expectations for academic achievement and quality interpersonal relationships. • Cultural Competence - provides educators with the knowledge and skills to understand, communicate with, and effectively interact with people across cultures. • Quality Teaching - deepens content knowledge; provides educators with researchbased instructional strategies to assist students in meeting rigorous academic standards; and prepares them to use various types of classroom assessments appropriately. • Classroom Management and Behavioral Supports Strategies - provides educators with research-based strategies that build the knowledge and skills needed to support positive interaction, nurture students’ capacity for self-management, and develop proactive and preventive management techniques. • Child and Adolescent Development - deepens understanding of child and adolescent development and of how to support growth in the cognitive, social, emotional, and physical domains. 4 • • Data-Based Decision Making - provides educators with the knowledge and skills to collect, manage, analyze, and utilize relevant data to make informed decisions at the school, classroom, and student levels. Family and Community Involvement - provides educators with knowledge and skills to involve families and other stakeholders appropriately. Based on the National Staff Development Council (NSDC) Standards for Staff Development, Revised 2001 and the Arizona School Evaluation Tool (AzSET), PBISAz, Revised 2007. Web Resource List Positive Behavioral Interventions and Supports (PBIS) Basics • OSEP Technical Assistance Center on Positive Behavioral Interventions & Supports o Blueprint for SW-PBS Implementers o PBIS Tools o Training Resource o User Resources • PBISAz o PBISAz Basics o Downloads • Minneapolis Public Schools Positive School Climate Tool Kit Online Courses • Florida’s Postitive Behavior Support Project • Kansas Institute for Positive Behavior Support Interventions/Resources • Effective Educational Practices: Successful Schools • Decision Support System for Youth Well Being • Rhode Island Positive Behavioral Interventions & Supports • Technical Assistance Center on Social Emotional Intervention (TACSEI) for Young Children • George Washington University Hamilton Fish Institute Effective Program Strategies • Center for the Study and Prevention of Violence – University of Colorado at Boulder: Matrix of Programs • Substance Abulse & Mental Health Services Administration (SAMHSA) – United States Department of Health and Human Services • Centers for Disease Control and Prevention (CDC) Education – Department of Health and Human Services • Protective Schools Model • What Kids Need: Developmental Assets – Search Institute 5 School Safety: What Schools Can Do A safe school is one that is free from violent and criminal behaviors and allows staff, students and community members to feel connected to the school and able to participate in its major functions – teaching and learning. Violent or criminal behaviors at school compromise the learning environment and put health and safety in jeopardy. The question is often asked, “What can we do to make our schools safer?” Unfortunately there is no simple solution to creating safe environments or to prepare for all possible emergencies. However, the following is a list of ten action items for schools to consider. Appropriate physical features, campus layout, prevention programs, policies, and procedures of schools can minimize the impact of disruptions and intrusions. Utilizing multidisciplinary teams to discuss safety issues based on school and community needs unify efforts to support a safe learning environment. An attached bibliography provides the research that supports the effectiveness of these action items. 1. Include safety in the district and school mission statements17,18,19 • Reference a safe environment that is conducive to learning in the district and school mission statements • Support the mission by dedicating resources to safety 2. Develop a Comprehensive School Safety Plan2, 6, 8, 9, 11, 14, 17, 18 • Form a multidisciplinary school safety committee of key personnel that meet regularly to plan and implement prevention and safety efforts based upon data • Utilize a comprehensive and standardized safety and discipline tracking and reporting system • Base the safety plan on a comprehensive needs assessment that includes incident data, student prevalence data, crime statistics, and climate survey information • Develop measurable goals and objectives for the plan • Monitor data and evaluate programs and policies to ensure that goals and objectives of the plan are met • Share information with stakeholders 3. Ensure a Supportive Climate2, 6, 8, 13, 14, 17, 18, 21 • Make the campus welcoming to students, staff and visitors • Ensure that students are engaged in school work that is challenging, informative and rewarding • Display diligent and impartial behavior when supervising students • Respond to students in a caring and non-shaming manner • Establish an engaging system of extracurricular programs and services • Be proactive in connecting with students and parents 4. Implement Drug and Violence Prevention and Early Intervention Programs2, 3, 6, 16 • Target prevention efforts on the needs identified through a comprehensive needs assessment (Item 2) • Utilize research-based prevention curricula, programs and strategies that build knowledge and skills and are likely to change behavior • Emphasize school-wide (universal) approaches to prevention but also include strategies for at-risk and high-risk students (select and targeted) • Involve families and the community in drug and violence prevention trainings • Reinforce pro-social behaviors through adult modeling • Ensure prevention and intervention programs are sustained, coordinated, and comprehensive 5. Utilize a Threat Assessment Protocoll7, 10, 18, 20, 22, 23 • Form a well-trained threat assessment team that convenes as needed • Utilize the Arizona Threat Management Protocol or comparable protocol • Develop the capacity to evaluate information that is useful in determining whether a threat might materialize • Share information regarding potentially dangerous conditions or people with appropriate school personnel and service providers • Identify and provide resources or referrals for students with behavioral health needs 6. Collaborate with Community Agencies6, 8 11, 15, 18, 21 • Develop written agreements with community agencies to provide for a continuum of services for students and families • Coordinate with law enforcement, including advance coordination on type of student infractions that warrant their involvement and law enforcement access to students • Coordinate with juvenile justice on the needs of students on probation and for services for the general student population • Screen students for mental health concerns and refer to behavior health providers for services • Coordinate with social service and health service providers for the health and wellbeing of the school community • Coordinate for the provision of youth development programs, such as mentoring and recreation 7. Screen and Monitor Employees19 • Conduct a thorough background check and fingerprint clearance of potential new employees and volunteers that work directly with students but without certificated supervision • Establish job performance criteria and an equitable system of periodic observations and evaluations • Develop a system for recognizing and handling employees who are arrested for criminal offenses • Promptly remove staff who are incompetent or pose a risk to students 8. Secure the Campus2, 8, 9, 15, 17 • Conduct an annual school security site assessment that is based on Crime Prevention Through Environmental Design (CPTED) concepts • Utilize CPTED recommendations when possible • Control access to the campus • Ensure campus is clean and inviting • If utilizing security technology, ensure that it’s use will improve needs identified in your site assessment 9. Develop and Practice School Emergency Response Plans4, 5, 7, 8, 12 • Form a multidisciplinary emergency response team that includes first responders • Develop a multi-hazards plan based on the Arizona School Emergency Response Plan: Minimum Requirements and utilizes the state template • Train school personnel and practice the plan school-wide • Plan for the mental health needs of students and staff post-crisis so that learning can resume as quickly as possible 10. Implement Effective Policies and Procedures8, 11, 18, 21 • Develop policies and procedures that are consistent with state and federal law • Develop and consistently implement a school discipline code of student behavior that supports and rewards pro-social behavior • Train school personnel on policies and procedures including the need to take immediate and appropriate action on all reports of alcohol and drug use or sales, threats, bullying, weapon possession, or victimization • Train students and inform parents on discipline and safety policies • Utilize best practice approaches to safety situations which consider alternatives to disciplinary approaches and identify and support behavioral health needs of students • Incorporate Items 2 – 9 on this list into the school/district policies and procedures Bibliography 1. Adelman, H. & Taylor, L. Safe and Secure: Guides to Creating Safer Schools, Guide 7: Fostering, School, Family, and Community Involvement, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice & Northwest Regional Educational Laboratory, September 2002. 2. American Institute for Research & U.S. Department of Education (April 2000), Safeguarding Our Children: An Action Guide – Implementing Early Warning, Timely Response, U.S. Department of Education. 3. Arizona Department of Health Services, (2005), Framework for Prevention in Behavioral Health, Phoenix, Arizona. 4. Arizona Department of Education & Arizona Division of Emergency Management, Revised September (2006), Arizona School Emergency Response Plan: Minimum Requirements. 5. Arizona Department of Education (2009) Arizona School Safety Program Operational Plan Template. 6. Bosworth, K. Smith Endowed Chair in Prevention Education, Protective Schools: Linking Drug Abuse Prevention with Student Success, University of Arizona, 2000. 7. Department of Education, Office of Safe and Drug-Free Schools (2003), Practical Information on Crisis Planning: A Guide for Schools and Communities, Washington, D.C. 8. Department of Justice & Department of Education (October 1998), Annual Report on School Safety, Bureau of Justice Statistics Clearinghouse. 9. http://www.teachsafeschools.org/seven-steps.html, Seven Steps to a Safer School. 10. Jimerson, S.R. Brock, S.E. Cowan, C.C. Threat Assessment: An Essential Component of a Comprehensive Safe School Program, Student Counseling, October 2005. 11. Hutton, T. & Bailey, K. School Policies and Legal Issues Supporting Safe Schools, Effective Strategies for Creating Safer Schools, The Hamilton Fish Institute on School and Community Violence & Northwest Regional Educational Laboratory, Washington D.C. 2007. 12. Kutash, K. & Duchnowski, A. J. The Role of Mental Health Services in Promoting Safe and Secure Schools, Effective Strategies for Creating Safer Schools, The Hamilton Fish Institute on School and Community Violence & Northwest Regional Educational Laboratory, Washington D.C. 2007. 13. Mayer, J. E. Creating a Safe and Welcoming School Environment, International Academy of Education, International Bureau of Education, 2007. 14. North Central Regional Educational Laboratory (1996), Critical Issue: Developing and Maintaining Safe Schools, Learning Point Associates. 15. Schneider, T. Ensuring Quality School Facilities and Security Technologies, Effective Strategies for Creating Safer Schools, The Hamilton Fish Institute on School and Community Violence & Northwest Regional Educational Laboratory, Washington D.C. 2007. 16. Sprague, J. Creating Schoolwide Prevention and Intervention Strategies. Effective Strategies for Creating Safer Schools, The Hamilton Fish Institute on School and Community Violence & Northwest Regional Educational Laboratory, Washington D.C. 2007. 17. Stephens, R. P. Congressional Statement, Hearing on Understanding Violent Children, National School Safety Center, Westlake Village, California, April 28, 1998. 18. Stephens, R. P. Directors Message, National School Safety Center, Westlake Village, California, 2008. 19. Stephens, R. P. Ten Steps to Safer Schools, National School Safety Center, Westlake Village, California. 20. Taras H, Duncan P, Luckenbill D, Robinson J, Wheeler L, Wooley S: Health, Mental Health and Safety Guidelines for Schools, American Academy of Pediatrics & National Association of School Nurses, 2004. 21. U.S. Department of Education & U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, (September 1996), Creating Safe and Drug-Free Schools – Action Steps for Schools. 22. U.S. Secret Service & U.S. Department of Education (2002), Threat Assessment in School: A Guide to Creating Safe School Climates. 23. Meehling, O. Threat Management Protocol, April, 2008. Arizona Department of Education School Safety and Prevention www.ade.az.gov/sa/health July 2008 Mental Health Crisis Planning for Families Learn to recognize, manage, prevent and plan for your child’s mental health crisis 800 Transfer Road, Suite 31 St. Paul, MN 55114 Phone: 651-645-2948 Toll Free: 1-888-NAMI HELPS Fax 651-645-7379 E-mail: [email protected] Web: www.namihelps.org Mental Health Crisis Planning for Families Learn to Recognize, Manage, Prevent and Plan for Your Child’s Mental Health Crisis A mental health crisis is just as important to address as any other health care crisis. It can be difficult to predict just when a crisis will happen, and it can occur without warning. A crisis can occur even when a family has followed a crisis prevention plan and used techniques taught to them by mental health professionals. We all do the best we can with the information and resources we have available at the time of the crisis. Some days we can handle more than other days; this is normal and to be expected when raising a child with challenging behaviors. You may need help when you have exhausted all your tools or means of coping with the crisis. This booklet will help you understand what can cause a crisis, the warning signs of a crisis, the strategies to help de-escalate a crisis, resources that may be available and how to create a crisis plan. Information on communication and advocacy skills for families is included along with a sample crisis plan. The term child is used throughout the booklet and refers to both children and adolescents. RECOGNIZE What is a mental health crisis? Any situation in which the child’s behaviors puts them at risk of hurting themselves or others and/or when the parent isn’t able to resolve the situation with the skills and resources available. What causes a mental health crisis? Many things can lead to a mental health crisis. Increased stress, changes in family situations, bullying at school or substance use may trigger an increase in behaviors that lead to a mental health crisis. Medical illnesses can also affect mental health and can lead to a crisis. Any of these things can be difficult on someone, but they can be more difficult for someone with a mental illness, especially a child who probably doesn’t understand their illness and the symptoms which may appear suddenly. 3 Here are some examples of situations or stressors that can trigger a mental health crisis: their stress level, etc. Families may want to keep a journal or calendar documenting what preceded the behaviors that are of concern. Home or Environmental Triggers • Changes to family structure; parents separate, divorce or remarry • Loss of any kind, family member or friend due to death or relocation • Loss of family pet • Transitions between mom’s and dad’s home • Strained relationships with step-siblings / step-parents • Changes in friendships • Fights or arguments with siblings or friends • Conflict or arguments with parents Here are some warning signs of a mental health crisis: School Triggers • Worrying about tests and grades • Overwhelmed by homework or projects • Feeling singled out by peers or feelings of loneliness • Pressures at school, transitions between classes and school activities • Bullying at school • Pressure by peers • Suspensions, detentions or other discipline • Use of seclusion or restraints • Misunderstanding by teachers who may not understand that the child’s behavior is a symptom of their mental illness. Other Triggers • Stops taking medication or misses a few doses. • Starts new medication / new dosage of current medication • Medication stops working • Use of drugs or alcohol abuse • Pending court dates • Being in crowds / large groups of people • Changes in relationship with boyfriend, girlfriend, partner What are the warning signs of a mental health crisis? Sometimes families or caregivers observe changes in a child’s behavior that may indicate a crisis may be impending; while other times the crisis occurs suddenly and without warning. You may be able to de-escalate or prevent a crisis from happening by identifying the early changes in your child’s behavior, an unusual reaction to daily tasks, an increase in 4 Inability to cope with daily tasks • Doesn’t bathe, brush teeth, comb/brush hair • Refuses to eat or eats too much • Sleeps all day, refuses to get out of bed • Doesn’t sleep Rapid mood swings • Increase in energy • Inability to stay still, pacing • Depressed mood Increased agitation • Makes verbal threats • Violent out-of-control behavior • Destroys property • Cruel to animals Displays abusive behavior • Hurting other • Cutting self • Alcohol or substance abuse Loses touch with reality (psychosis) • Unable to recognize family or friends • Confused thinking, strange ideas • Thinking they are someone they are not • Not understanding what people are saying Isolation from school, family, friends • No or little interest in extra-curricular activities • Changes in friendships • Stops attending school, stops doing homework Unexplained physical symptoms • Eyes or facial expressions look different 5 • • Increase in headaches, stomach aches Complains they don’t feel well • • • Be patient and accepting Announce actions before initiating them Give them space, don’t make them feel trapped MANAGE What to do in a mental health crisis? When a mental health crisis or behavioral emergency occurs, parents often don’t know what to do. A crisis can occur even when a parent has used de-escalation techniques or other options to address the crisis. It’s often nobody’s fault. Children’s behaviors and crisis situations can be unpredictable and occur without warning. If you are worried that your child is in or nearing a crisis, you can seek help in a number of ways. Before choosing which option to pursue, assess the situation. Consider whether your child is in danger of hurting themselves, others or property. Consider whether you need emergency assistance, guidance or support. De-Escalation Techniques Children cannot always communicate their thoughts, feelings or emotions clearly or understand what others are saying to them during a crisis. As a parent it is important to empathize with your child’s feelings, help de-escalate the crisis, and to assess the situation to determine if you need emergency assistance, guidance or support. Seek outside resources or help when your actions are not helping. De-escalation techniques that may help resolve a crisis: • Keep your voice calm • Use short sentences • Listen to their story • Offer options instead of trying to take control • Ask how you can help your child • You may want to avoid touching your child • Remain calm, avoid overreacting • Move slowly • Don’t argue or shout • Express support and concern • Keep stimulation level low • Avoid eye contact 6 If you haven’t been able to defuse the crisis yourself you may want to seek additional help. Trained mental health professionals can assess a child to determine the level of crisis intervention required and may refer families to short-term crisis stabilization services or hospitalization if appropriate. Often a trained mental health professional can help a family de-escalate a crisis before it occurs. Remain as calm as possible and continue to seek guidance and support until the crisis is resolved. Most importantly – safety first! In a crisis situation, when in doubt, back off or get out. Not in immediate danger If you do not believe your child is in immediate danger, call a psychiatrist, clinic nurse, therapist, case manager or family physician that is familiar with the child’s history. This professional can help assess the situation and offer advice. The professional may be able to obtain an appointment or may be able to admit the child to the hospital. If you cannot reach someone and the situation is worsening, do not continue to wait for a return call. Take another action, such as calling your county mental health crisis team. If safety is a concern, call 911. Mental Health Crisis Phone Lines and Crisis Response Teams In Minnesota, each county has 24-hour access to mental health crisis phone assistance for both adults and children. Some 24 hour phone lines provide service to more than one county. These crisis lines are answered by trained workers who assist callers with their mental health crisis, make referrals, and contact emergency services, if necessary. There is no charge for this service which is available to all persons in Minnesota. In addition to 24-hour crisis phone lines, some counties are also covered by a mobile crisis response team. Some crisis teams cover more than one county. All children’s mental health county crisis teams may provide short-term intervention and stabilization services for children between birth to 21 years of age that are experiencing an emotional or behavioral crisis. A child does not have to have a mental health diagnosis to receive crisis services. 7 Crisis teams are available 24-hours a day, seven days a week, 365 days a year to help de-escalate the immediate crisis. Crisis teams help families develop a plan to provide practical behavioral strategies to address the short term needs of the child. They may assist the family in identifying the issues that led to the crisis and suggest ideas to avoid a crisis in the future. Crisis teams will also help identify possible resources and supports to help the child or family. County mental health mobile crisis response teams are expected to be mobile and meet families at their home, child’s school, community centers, library, clinic, anywhere the family feels most comfortable or where the child is. They can also help families develop and write a crisis plan, provide phone consultation and support, and help in nonurgent situations where their guidance can prevent a future crisis. Response times for mobile teams can vary depending on your location and the location of the mobile team staff. Crisis teams employ licensed mental health professionals and mental health practitioners who have bachelors and master’s level training. Each county mobile crisis team provides on-going training for staff and when needed consultation with outside mental health professionals. Counties vary in having staff who can speak languages other than English, but they all offer interpreter services. Families who need an interpreter may have to wait additional time to receive crisis services depending on the availability of interpreter services. When you call your county mental health crisis team they will triage the call to determine the level of crisis service needed. If the child is in immediate danger to themselves or others, the crisis team will refer to 911 and have law enforcement respond. If the situation is non-urgent the crisis team will assess the level of intervention required: information and referral, phone consultation, an emergency room visit or an immediate site visit. The crisis team will need to ask questions to determine how to best help you and your child. They may ask you for your name, a phone number to call in case you are disconnected, the nature of the problem, if safety is a concern, if the child has hurt himself, what caused the crisis, the child’s mental health or hospitalization history (if any), if you are currently using mental health resources and your medical insurance information. Crisis teams will respond and address the situation regardless if someone has insurance. If you have insurance the crisis team will bill 8 your insurance company for services they provide. Families will not be turned away or refused services for lack of insurance. When crisis staff make a site visit expect them to conduct a safety assessment to determine if the child is at risk of harm. They may decide to have law enforcement respond, that a child should be seen at the nearest emergency room or to direct admit the child to the sub-acute unit at Fairview Riverside for ongoing care and treatment. The crisis team may do a diagnostic assessment and make on-going recommendations for crisis stabilization services. Short-term interventions provided by the county crisis teams may include plans that help the family provide behavioral strategies to prevent future crisis, identify short-term safety needs, referrals to mental health providers and/or mental health agencies. Stabilization services may be available for up to 14 days after crisis intervention. Stabilization involves the development of a treatment plan that is driven by the diagnostic assessment and the family’s need for services. It must be medically necessary and must identify the emotional and behavioral concerns, goals and objectives. The treatment plan will also identify who is responsible for the interventions and services, the frequency or service intensity needed and the desired outcomes. Stabilization services may also include brief solution-focused strategies, referrals to long-term care agencies, crisis psychiatric appointments, coordinated crisis plans and a referral for the counties children’s mental health case management services. In Immediate Danger If the situation is life-threatening or if serious property damage is occurring, call 911 and ask for law enforcement assistance. When you call 911, tell them your child is experiencing a mental health crisis and explain the nature of the emergency. Telling the law enforcement agency that it is a crisis involving a child with a mental illness increases the chance that they will send an officer trained to work with people with mental illnesses. Be sure to tell them – if you know for certain – whether your child has access to guns, knives or other weapons. When providing information about a child in a mental health crisis, always be very specific about the behaviors you are observing. Instead 9 of saying “my son is behaving strangely,” for example, you might say, “My son hasn’t slept in three days, he hasn’t eaten anything substantive in over five days, and he believes that the someone is talking to him through his IPod.” Report any active psychotic behavior, huge changes in behaviors (such as not leaving the house, not taking showers), threats to other people and increase in manic behaviors or agitation (pacing, irritability). You need to describe what is going on right now, not what happened a year ago. Finally, in a crisis situation, remember: when in doubt, back off or go out. Do not put yourself in harm’s way. Law Enforcement Response When the law enforcement officer arrives, provide them with as much relevant and concise information about your child as you can, including the child’s: Diagnosis Medications Hospitalization history Previous history of violence or criminal charges If the child has no history of violent acts, be sure to point this out. Lay out the facts efficiently and objectively, and the officer will decide the course of action. Remember once 911 has been called and the officer arrives on the scene, you do not control the situation. Depending on the law enforcement officer involved, they may take your child to detention instead of to a hospital emergency room. Law enforcement officers have broad discretion in deciding whom to arrest, whom to hospitalize and who to ignore. You can encourage and advocate for the law enforcement officer to view the situation as a mental health crisis. Be clear about what you want to have happen without disrespecting the law enforcement officer’s authority. But remember, once 911 is called and law enforcement officers arrive on the scene, they determine if a possible crime has occurred and they have the power to arrest and take into custody a person that they suspect of committing a crime. Law enforcement can (and often does) call the county mental health crisis teams for assistance in children’s mental health crises. The crisis team may assist police in deciding what options are available and appropriate for the child and their family. The crisis team may decide to respond with law enforcement. The police may decide to transport the 10 child to the emergency room. Some counties have CIT Officers. CIT stands for Crisis Intervention Training. CIT officers are specially trained officers who have received additional education and training to recognize and work with individuals who have a mental illness. CIT officers have a better understanding that a child’s behaviors are the result of a mental illness and how to help de-escalate the situation. They recognize that those with mental illnesses are sometimes in need of a specialized response. Emergency Room When you bring your child to the Emergency Room, it is important to know it does not guarantee admission. The admission criteria vary and are dependent on medical necessity as determined by a doctor. County mental health crisis teams can assist with the triage process and refer a child to the hospital for assessment. It may be easier to have your child admitted to the hospital if the county crisis team makes the referral and assists in the triage process. County mobile crisis teams do not typically transport children to emergency rooms; if transportation is needed the crisis team may contact paramedics or law enforcement or request that you provide transportation. When families arrive at the emergency room they should be prepared to wait several hours. You may want to bring a book, your child’s favorite toy, IPod, game or activity if that helps the child stay calm. If parents have developed a crisis kit they should bring a copy with them to the emergency room or hospital. See page 16 of this booklet to learn about crisis kits. If your child is not admitted to the hospital and the situation changes when you return home, don’t be afraid to call the crisis team back. The crisis team will re-assess the situation and make recommendations or referrals based on the current situation. Your child may meet the criteria for hospital admission later. Emergency Holds (a term used under the commitment law) Sometimes a person with a mental illness creates such a risk of injury that he/she must be held in custody before a petition for commitment can be filed or before the pre-petition screening team can review the matter. In these cases an emergency hold can be placed to temporarily confine the person in a secure facility like a hospital. Emergency holds last for 72 hours each (not including weekends and holidays). An emer- 11 gency hold doesn't necessarily result in starting the commitment process it only serves as a way to assess the individual to determine if commitment is necessary. You should know that the commitment law is for people ages 18 and over. Minnesota laws are confusing about how commitment applies to teenagers ages 16 and 17. Some counties apply the commitment law to teenagers at these ages, providing all the due process requirements. Other counties may allow parents to consent to treatment, use juvenile courts or even use the CHIPS petitions for 16 or 17 year olds that are refusing treatment. Because the practice varies so much, check with your county. PREVENT It is possible for children who live with a mental illness to become ill even when they are following their treatment plan; however, the best way to prevent a crisis is to have a treatment plan that works and is followed. It is also important to understand that children change as their brains mature and medications that were working can suddenly stop working. Behaviors change. New behaviors occur. Parents can help prevent a crisis by noting changes in behaviors. Parents may want to document behaviors by keeping a journal, making notations on a calendar or listing common occurring behaviors. It is important to remember to note changes and early warning signs because they might be an indicator that a crisis could occur. In order to prevent a crisis, it’s also important to ask yourself: • What situations have led to a crisis in the past? • What has worked to help reduce my child’s stress or to avoid a conflict in the first place? • What steps can I take to keep everyone safe and calm? • Whom can I call for support in a crisis or to help calm the situation? • Should I consider a medic alert tag or bracelet for my child? • What skills could I or my child learn and practice to reduce the impact of future crisis? • Have I developed a crisis intervention plan? Does it need to be updated? • What can I do to reduce family stressors? • Have I utilized all available resources? LEAP Method Dr. Xavier Amador, in his book, I am Not Sick, I Don’t Need Help, outlines a communication skill that can be used in times of crisis and as a way of engaging your child in calming down during a crisis. It is called the L.E.A.P. method. LEAP stands for Listen, Empathize, Agree, and form a Partnership. It is a family-friendly version of a form of therapy called Motivational Enhancement Therapy. Listen – the goal is to listen to your child’s needs without making judgment, to understand their point of view and to use reflective listening to state back to your child that you understand (not necessarily agree) what they said or need. Example: I heard you say that you are not going to take your medication any more. I understand that your sister is being annoying and you want to hit her. I see that you are very angry with me and hear that you don’t want to talk right now. Empathize – if you want your child to consider your point of view, it is necessary for you to understand theirs. This is not the same as agreeing with your child; it’s about empathizing with them about how they feel. Example: I would be upset too if my sister played my video game without asking my permission. I would be mad if I got a C- on my test after I studied two hours for the test. Agree – find common areas on which both you and your child can agree. Acknowledge that your child has personal choices and responsibility for the decisions he/she makes about their behaviors and the consequences of those choices. Example: I heard you say that your sister is arguing with you and I heard you say that you want to hit her. Of course, you feel like hitting her, and I am glad you didn’t. Can you think of other options? Partner – form a partnership to achieve shared goals. This involves you and your child developing an action plan to meet agreed-upon goals. Example: We both agree your sister is bothering you and she 12 13 shouldn’t play your video games without asking you first. What can we do the next time she bothers you? Collaborative Problem Solving Dr. Ross Greene, in his book, The Explosive Child, outlines a collaborative problem solving (CPS) method in which the child and parent engage in finding mutually satisfactory solutions to a problem. The emphasis is on preventing problems before they occur by recognizing triggers that occur before the crisis. Dr. Greene believes that children do as well as they can and teaches families to identify their child’s lagging skills. Missing skills can be taught. All parents need strategies to work with their child’s behavior. The truth is, we need strategies to deal with problem behaviors. Fortunately, missing skills can be taught even when they are difficult to learn. But not overnight. The missing skills are what show up as “misbehavior.” Our children don’t know how to do better. We have to teach them the skills in ways that work for them. In the CPS approach you “lend” your child your frontal lobe by breaking down the problem solving steps in a way that helps them do better in the long run. Dr. Greene has some innovative ideas about helping children with challenging behaviors and understands what gets in the way of appropriate behavior. This book may be helpful for parents of children with persistent problem behaviors that don’t respond well to typical parenting strategies or “rewards and punishment” behavioral approaches such as sticker charts or time-outs. PLAN Learn to Create a Crisis Plan Children can experience a mental health crisis even when their families have utilized the best resources offered by mental health professionals, the local school system, advocacy agencies and social service organizations. A crisis plan is a short-term written plan designed to address behaviors and help prepare for a crisis. Preparing for a crisis is an individualized process. However, there are some common elements that can be found in a good crisis prevention plan. 14 • Child’s Information – name and age of child, mental health diagnosis, medical history, list of child’s strengths and interests. • Family Information – name of parents, step-parents, list of family members who live in the home. • Behaviors – things that trigger or antecedents (things that are present before the behavior occurs), a list of strategies that have worked in the past, a list of what may escalate the child’s behavior, (such as actions or people that are likely to make the situation worse), a list of what helps calm the child or reduces symptoms. • Medication – name and type of medication, dosage, prescribing physician’s name and phone number, pharmacy name and phone number, list of medications that have not worked in the past, and known allergies. • Treatment Choices – list of interventions or treatments that are being used, list of interventions that have not worked in the past, treatments that should be avoided, list of treatment preferences. • Professional Involvement - phone numbers of children’s crisis team, family doctor, therapist, social worker, psychiatrist, and hospitals with psychiatric units. • Supports – adults the child has a trusting relationship with such as neighbors, friends, family members, favorite teacher or counselor at school, people at church or work acquaintances. • Safety Concerns – access to guns, knifes or weapons, access to medication: both prescription and over-the-counter, safety plan for siblings or other family members, emergency contact names and phone numbers. • Resources – advocacy organizations, support groups. Developing a crisis plan involves active involvement of all team members, including involvement of the child when possible. A crisis plan should be written down and distributed to all persons who may be involved in resolving a crisis. It should be updated whenever there is change in the child’s diagnosis, medication, treatment or team members. Remember: • Talk with ALL family members and discuss “what to do, if this were to happen. • Contact your local police department; provide them with a copy of 15 the crisis plan. • Create a safe environment by removing any and all weapons and sharp objects. • Lock up all medications; both over-the-counter and prescription medications. • Create a plan that keeps other family members safe, especially younger children in the home. • Know the number of your county mental health crisis team. Be Organized You will receive a lot of paper and information and documents at meetings. The number one thing to be is to be organized. Use a three-ring binder, accordion file or manila folder to organize the paperwork, documents, medical history and progress notes. Organize the binder or accordion folder with divider tabs. It helps to have current information about your child all in one place. Create a Crisis Kit Parents whose children experience frequent crises may benefit from developing a crisis kit that includes their binder and a small tote bag or backpack with snacks, games, music or books that may help the child when waiting for long periods of time. • • • • • • This crisis tool kit should be kept in an easily accessible place in your home or in your car. You may want to consider packing an emergency bag that includes a change of clothes and basic hygiene supplies that can be kept in your vehicle in case a crisis occurs. ADVOCACY Parenting a child with a mental illness can be overwhelming. It is not easy to navigate the system or to obtain appropriate services for your child. You may need help to learn how to advocate for your child. Parents are their child’s best advocate. They know their child best and most of the time know what they need, but not always how to ask first. Learning to be an effective advocate and developing these skills takes time. You will be involved in many meetings concerning your child. These meetings are especially stressful the first few times. The more meetings you participate in the more comfortable and assertive you will feel and you will feel more on an equal power footing with others in the room. Recognize that your opinion matters and professionals want to hear from you. Presenting yourself and ideas in the following ways will help you gain credibility with professionals and can help you effectively partner with mental health providers to help your child. 16 In your binder include the following: • Current diagnostic assessment Copy of crisis plan Documentation of phone calls and meetings Hospitalization history List of medications and dosages Copies of all service plans, evaluations and progress notes including school IEP and 504 plans Names and phone numbers of mental health professionals and mental health agencies working with your child Take the binder with you to all meetings. It will help you keep track of discussions, your child’s progress, what questions to ask at a meeting, what actions have occurred or not occurred. Getting in the habit of writing things down will result in long term benefits. If you have documentation then it is less “he said, I said” and more “this is what I have in my notes of the conversation/email/text”. When you are at a meeting prioritize what is important. Putting too many concerns on the table can lead to confusion or a lack of focus. Go to the meeting with a list of the three things you want to accomplish. Having those items written down will help you remain focused. Clearly state your expectations and ideas, provide facts and not much emotion. Listen to what others are saying and take notes. Don’t be afraid to ask questions if you don't understand what is being said. You may want to bring a friend to help listen and take notes. Bringing cookies or a snack can help break the tension and create a friendly atmosphere. If you become overwhelmed don’t hesitate to ask for a break, or excuse yourself to make a phone call or to use the restroom. Give yourself time to gather your thoughts and gain focus. If you feel your objectives cannot be met, try to negotiate and work towards a compromise. Be 17 willing to meet in the middle. Nothing is gained if all parties refuse to listen and work towards a solution. Speak in terms of what is best for your child, not what you want the outcomes to be. Example: Johnny would really benefit from one to one support at school. Be Objective As hard as it can be – these are our children after all - try to keep the conversations and questions objective and unemotional. The more you can stay objective and unemotional, the more control you can have in the situation and the more you stay involved in the conversation and decisions about your child. Get Support To be an effective advocate parents need support and need to take care of themselves. You may want to join a support group. Support groups give you a way to help you take care of yourself. At a support group you meet with other parents with similar experiences and you benefit from the support they give you. You gain knowledge and learn skills. You also get a chance to support other parents by sharing your knowledge. By networking with other families, you create more support for yourself and your child, increasing your child’s chances to receive appropriate services. Be Effective Parents should understand that good communication can help them receive appropriate services for their child. Good communication involves verbal and nonverbal language and listening skills. It is a twoway process, so you should be aware of how your words and actions influence communication. By communicating well, you are ensuring that the other person understands you and you understand them. There are a number of skills that you can develop to enhance your ability to communicate well. This way you are tuned in not only to words, but how they are said and the nonverbal behavior that accompanies words. Some of these non-verbal techniques are: • use good eye contact • concentrate on your tone of voice • watch your nonverbal gestures and hand signals which can be misread • Sit next to the most important person at the meeting • Speak slowly and clearly You can also develop a number of verbal skills that will ensure you have understood what has been said and provide feedback to the other person that you are listening. Some of these techniques are: • • • • • Paraphrasing - Put into your own words what the other person has said. You do this by using fewer words and providing facts. Reflective Listening - focuses on the feeling or emotion of what has been said. You state back what you hear and see, taking note of the nonverbal communication as well and the words that are spoken. Summarizing - you sum up what the other person has said. You do this after a person has spoken for a long period of time. Questioning - ask open-ended questions to clarify what has been said. I-Statements - start sentences with “I”. Here you take ownership of what has been said and state back what you heard, “I heard you say . . . is that correct?” Listening is another part of the process that helps you advocate for your child. It requires that we listen to the other person attentively without letting our own thoughts and feelings interfere. Parents can increase the chance that they will be heard by providing information about their child that is current, in the here and now, instead of telling the whole story. When information is kept to what is needed now and based on facts, not feelings or emotions, you increase the chance of being heard. Remember to keep an open mind and listen to what the other person has said. They may have good ideas that you haven’t thought about. Verbal and nonverbal communication work together to convey a message. You can improve your spoken communication by using nonverbal signals and gestures that reinforce and support what you are saying. This can be especially useful when speaking to a large group of people. 18 19 Common Terms CHILD Short-Term Crisis Intervention Plan Child /Family Information: Child’s Name: Medications: Mother’s Name: D.O.B. Dosage: Phone(s) Diagnosis(s) Date of Plan: Physician Name / number Pharmacy Name / Number Father’s Name: Phone(s) Child - refers to both children and adolescents birth to age 18. Parent - means the birth or adoptive parent of a minor. Parent also means the child's legal guardian or any individual who has legal authority to make decisions and plans for the child. Psychosis - loss of contact with reality: a psychiatric disorder such as schizophrenia or mania that is marked by delusions, hallucinations, incoherence, and distorted perceptions of reality. Federal Resources Description of child/family strengths: Description of immediate child/family needs: Safety Concerns: Treatment Choices: Interventions preferred: Interventions that have been used: Interventions that should be avoided: Professional involvement: Psychiatrist Name / Phone: Therapist Name /Phone: School Contact / Phone: Case Mgr Name / Phone: Crisis Team Phone: Family Doctor Name / Phone: Hospital Name / Phone: Other: Supports to use in crisis resolution: Name / Phone: Name /Phone: Name/Phone: Name / Phone: Resources: Advocacy Group: 20 Support Group: MH Agency: About our Children www.aboutourkids.org Bazelon Center for Mental Health law www.bazelon.org Child and Adolescent Bipolar Foundation www.bpkids Children with Attention Deficit Hyperactivity-Disorder www.chadd.org National Alliance on Mental Illness www.nami.org National Child Traumatic Stress Network Center www.nctsn.org National Federation of Families for Children’ Mental Health www.ffcmh.org National Institute of Mental Health www.nimh.org Office of Juvenile Justice and Delinquency Prevention www.ojjdp.ncjrs.org U.S. Department of Education www.edu.org Social Security Administration www.ssa.gov Substance Abuse Mental Health Services Administration www.samsha.org Other: 21 State Resources Acronyms Used in Children’s Mental Health Arc of Minnesota www.arcmn.org Minnesota Association for Children’s Mental Health www.macmh.org Minnesota Children’s Mental Health Division www.dhs.state.mn.us/cmh Minnesota Autism Society www.ausm.org Minnesota Children with Special Health Needs www.health.state.mn.us/mcshn www.health.state.mn.us/suicideprevention Minnesota Council of Child Caring Agencies www.mccca.org Minnesota Department of Corrections www.doc.state.mn.us Minnesota Department of Education www.education.state.mn.us Minnesota Disability Law Center www.mndlc.org Minnesota Ombudsman for Developmental Disabilities and Mental Health www.ombudmhmr.state.mn.us Minnesota Parent Leadership Network www.mpln.org National Alliance on Mental Illness of Minnesota www.namihelps.org Parent Advocacy Coalition for Educational Rights (PACER) www.pacer.org ADHD ASFA CAFAS CHIPS CMHA CIT CR CTSS DD/ED DHS DSM-IV EBD EBP GAF IEP IIIP ITP MA MRJPP OHPP PMAP SED SSI TEFRA VFCA 504 plan Attention deficit / hyperactivity disorder Adoption and Safe Families Act Child and Adolescent Functioning Assessment Score Children in need of protection or services Minnesota Comprehensive Children’s Mental Health Act Crisis Intervention Training Custody relinquishment Children’s therapeutic services and support Developmental delay / emotional disturbance Department of Human Services Diagnostic and Statistic Manual of Mental Disorders Emotional behavior disturbance Evidence-based practices Global Assessment of Functioning Individualized education plan Individualized interagency intervention plan Individual treatment plan Medical Assistance Minnesota Rules of Juvenile Protection Procedure Out-of-home placement plan Prepaid Medical Assistance Plan Severe emotional disturbance Social Security Income Tax Equity and Fiscal Responsibility Act of 1962 Voluntary foster care agreement Section 504 of the Americans with Disabilities Act Funding for this booklet was provided in part by the Wasie Foundation and by the Metro Children’s Crisis Service (MetrCCS) partnership, a seven county, public-private partnership working to improve the children’s mental health crisis sys tem through community based crisis intervention. 22 23 ¿RECONOCES ESTA HISTORIA? Traida a usted por LOS HIJOS TAMBIEN RESIENTEN. LAS ENFERMEDADES MENTALES Y EL ABUSO DE SUSTANCIAS AFECTAN A PERSONAS DE CUALQUIER EDAD. EL PEDIR AYUDA PROFESIONAL NO ES SEÑAL DE DEBILIDAD SINO DE FORTALEZA. LAS SALIDAS FACILES SON SIEMPRE LA PUERTA DE ENTRADA A PROBLEMAS MAS COMPLEJOS. EL NO BUSCAR APOYO PROFESIONAL A TIEMPO PUEDE COMPLICAR LAS COSAS. LO MAS DIFICIL ES DAR SIEMPRE EL PRIMER PASO. ARREPIENTETE DE NO HABER LLAMADO Y NO POR HABERLO HECHO. MAGELLAN DE ARIZONA ESTA AQUÍ PARA AYUDARTE. MAGELLAN DE ARIZONA CUENTA CON PERSONAL QUE HABLA ESPAÑOL Y CLINICAS POR TODO EL VALLE. EL PERSONAL DE MAGELLAN ESTA AQUÍ PARA AYUDARTE. LA RECUPERACION ES POSIBLE Y DEPENDE DE TI. LA RECUPERACION Y RESISTENCIA VAN DE LA MANO Y TU ESFUERZO NO ES EN VANO. HAZ EL BIEN SIN MIRAR A QUIEN. LOS SERVICIOS DE MAGELLAN ESTAN DISPONIBLES TANTO PARA NIÑOS COMO PARA ADULTOS Y SON CUBIERTOS POR MEDICAID O AHCCCS. MÁS DETALLES AL REVERSO. Estimado lector, ¿Sabe usted cuántas personas a su alrededor padecen de una enfermedad mental? De acuerdo con el Instituto Nacional de Salud Mental, cada año, uno de cada cuatro adultos en los Estados Unidos experimenta un trastorno de salud mental. Además, la inestabilidad económica, altas tazas de desempleo, ejecuciones hipotecarias y otras aflicciones financieras han aumentado el número de personas sufriendo de altos niveles de estrés y de enfermedades psicológicas. Las enfermedades mentales pueden afectar a toda persona, a cualquier edad. ¡Necesitamos su ayuda! Como la Autoridad Regional de Salud Mental del Condado de Maricopa, Magellan de Arizona entiende que cuando una persona empieza a desarrollar síntomas de una enfermedad mental, ésta y su familia con frecuencia acuden primero con sus amigos, vecinos o líderes religiosos para un consejo o ayuda. ¿Que puede hacer? Por favor comparta esta fotonovela e información con sus conocidos para ayudarlos a entender que el buscar ayuda profesional no es una señal de debilidad, sino de fortaleza. Si usted o alguna persona que conoce requieren de servicios de salud mental o contra el abuso de sustancias, comuníquese con Magellan de Arizona llamando al (800) 564-5465 o al TTY (800) 424-9831. Los servicios de Magellan están disponibles tanto para niños como para adultos y son cubiertos por Medicaid o AHCCCS. Acerca de AHCCCS Para mayores informes sobre como solicitar AHCCCS, los requisitos de elegibilidad/ingresos, recursos, reglas de participación en los programas o para la ubicación mas cercana donde puede obtener y someter una solicitud de AHCCCS en persona, por favor llame al (602) 417-4000. Disponibilidad de Servicios Magellan de Arizona cuenta con personal que habla Español para responder a sus llamadas y preguntas. Por favor comuníquese con Magellan para aprender más sobre los recursos disponibles para el cuidado de la salud mental o contra el abuso de sustancias en el Condado de Maricopa. Magellan le conectará con el proveedor de servicios en su área que más le convenga. Línea de Crisis Si usted o un familiar experimentan una crisis y requieren de apoyo psicológico, comuníquese con la Línea para Casos de Crisis del Condado de Maricopa disponible en Español, llamando al (800) 631-1314 o al TTY al (800) 327-9254. La Línea para Casos de Crisis del Condado de Maricopa es gratuita y está disponible las 24 horas del día, los siete días de la semana, para cualquier persona que experimente una crisis de salud mental en el Condado de Maricopa. Para emergencias, siempre llame al 9-1-1. Magellan Health Services de Arizona, Inc. es la Autoridad Regional de Salud Mental del Condado de Maricopa. Fondos para servicios son proporcionados por un contrato con el Departamento de Servicios de Salud de Arizona/División de Servicios de Salud Mental de Arizona y el Sistema de Contención de Costos de Cuidado de Salud del Estado de Arizona (AHCCCS). DO YOU RECOGNIZE THIS STORY? Brought to you by CHILDREN UNDERSTAND MORE THAN YOU THINK THEY DO. MENTAL ILLNESSES AND SUBSTANCE ABUSE ISSUES AFFECT PEOPLE REGARDLESS OF THEIR AGE. GETTING PROFESSIONAL HELP IS NOT A SIGN OF WEAKNESS, BUT OF STRENGTH. EASY SOLUTIONS ARE THE GATEWAY TO LARGER PROBLEMS. WITHOUT TIMELY PROFESSIONAL HELP THINGS CAN GET WORSE. THE FIRST STEP IS ALWAYS THE HARDEST. MAKE THE CALL, YOU WON’T REGRET IT. MAGELLAN OF ARIZONA IS HERE TO HELP. MAGELLAN OF ARIZONA HAS BILINGUAL STAFF AND MANY CLINICS ACROSS THE VALLEY. MAGELLAN STAFF ARE HERE TO HELP YOU. RECOVERY IS POSSIBLE AND DEPENDS ON YOU. RECOVERY AND RESILIENCY GO HAND IN HAND AND YOUR EFFORTS WILL PAY OFF IN THE END. DON’T LET FEAR AND MISUNDERSTANDING KEEP YOU FROM GETTING THE HELP THAT YOU NEED. MAGELLAN’S SERVICES ARE AVAILABLE FOR CHILDREN AND ADULTS AND ARE COVERED BY MEDICAID/AHCCCS. SEE BELOW FOR MORE INFORMATION. Dear reader, Do you know how many around you struggle with mental health problems? What you can do? Please share this information with anyone who might need it to help them understand that seeking professional According to the National Institute of Mental Health, one help is not a sign of weakness, but a sign of strength. out of every four adults in the United States experiences a mental health issue in any given year. Furthermore, the If you or anyone you know needs mental/behavioral health current financial instability, increased unemployment or substance abuse services, contact Magellan of Arizona rates, foreclosures and other financial distress have led at (800) 564-5465 or TTY (800) 424-9831. Magellan’s services are available for children and adults and are to more people suffering from higher levels of stress and psychological illness. Mental illness can strike anyone covered by Medicaid or AHCCCS (for those who qualify). of any age, race/ethnicity or gender. About AHCCCS We need your help! For more information on how to apply for AHCCCS As the Regional Behavioral Health Authority (RBHA) for or questions regarding eligibility, income, resources, Maricopa County, we at Magellan of Arizona understand program participation rules or the nearest branch to that when someone begins developing the signs of mental apply in person, please call (602) 417-4000. illness, they often turn first to their friends, family, neighbors or a faith leader for advice and help. Service Availability Magellan of Arizona has bilingual speaking staff available to answer your calls and questions. Please contact Magellan of Arizona to find out more about mental/behavioral health and substance abuse resources available in Maricopa County. Magellan will connect you to a service provider that best fits your needs and is in your area. Crisis Line If you or anyone you know is in crisis, please call the Maricopa Crisis Line at (800) 631-1314 or TTY (800) 327-9254 for immediate help. The Maricopa Crisis Line is also available in Spanish, 24 hours a day, seven days a week to anyone experiencing a mental health crisis in Maricopa County. For emergencies always call 9-1-1. Magellan Health Services of Arizona, Inc. is the Regional Behavioral Health Authority for Maricopa County. Funds for services are provided through a contract with the Arizona Department of Health Services/Division of Behavioral Health Services and the Arizona Health Care Cost Containment System (AHCCCS). Children and Tragedy Tragedy may strike quickly and without warning. These events can be frightening for adults, but they are traumatic for children if they don’t know what to do. Children may become anxious, confused or frightened. It is important to help them reduce their fears after a traumatic event. Children and Their Response to Disaster 1 Children depend on daily routines. They wake up, eat breakfast, go to school and play with friends. When tragedies interrupt this routine, children may become anxious. They'll look to you and other adults for help. How you react to tragic events gives them clues on how to act. If you react with alarm, a child may become more scared. Feelings of fear are healthy and natural for adults and children. But as an adult, you need to keep control of the situation. Concentrate on your child’s emotional needs by asking what’s uppermost in his or her mind. Your response during this time may have a lasting impact. Be aware that following a tragic incident, children are most afraid that: The event will happen again. Someone will be injured or killed. They will be separated from the family. They will be left alone. Helping Children Recover from a Tragic Event Keep the family together. Keep the family together as much as possible. Make children a part of what you are doing to get the family back on its feet. Calmly and firmly explain the situation. As best as you can, tell children what you know about the event and what efforts are being undertaken in its aftermath. Encourage children to talk. Let children talk about the tragedy and ask questions as much as they want. Encourage children to describe what they’re feeling. Listen to what they say. If possible, include the entire family in the discussion. Help Is Available Call us using the phone number on your member identification card for more information, help and support. We are here to help you get and stay well. 1 Adapted from the Los Angeles City Fire Department at www.lafd.org/egindex.htm. This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2001 Magellan Health Services, Inc. Common Responses to Traumatic Events Trauma affects people in different ways. But there are some common reactions. The signs and symptoms may begin right away. Or you may feel fine for days or even weeks and suddenly have a reaction. It is normal for people to feel emotional “aftershocks” after a traumatic event. Some common responses are: Physical Reactions Sleeplessness. Fatigue, hyperactivity or “nervous energy.” Pain in the neck or back. Headaches. Heart pounding or chest pains. Dizzy spells. Appetite changes. Emotional Reactions Flashbacks or “reliving” the event. Feeling jumpy or easily startled. Feeling irritable. Anger. Feeling anxiety or feeling helpless. Feeling vulnerable. Usually, the signs and symptoms of trauma will lessen with time. If you are concerned about your reaction, note the specific symptoms that worry you. For each symptom, note the: Length—Trauma reactions should grow less intense and disappear within a few weeks. Intensity—If the reaction interferes with your ability to live your life normally, you may want to seek help. Tips for Coping after a Traumatic Event The suggestions below will help you cope with a traumatic event: Get physical exercise and relaxation to help relieve the stress. Talk to people. Talk is the most healing medicine. Spend time with others. Resist the tendency to be alone. Allow yourself to feel bad. Share your feelings with others. Keep a journal. Write your way through sleepless times. Get plenty of rest and eat regular meals, even if you don’t feel like it. Recurring thoughts, dreams or flashbacks are normal. They will decrease over time and become less painful. This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2001 Magellan Health Services, Inc. Help Is Available Call us using the phone number on your member identification card for more information, help and support. We are here to help you get and stay well. This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2001 Magellan Health Services, Inc. Coping with Children’s Reactions Fear is a normal reaction to any danger that threatens life or well-being. After a disaster, a child may be afraid of recurrence of injury or death. He or she may also be afraid of being separated from family or of being left alone. Parents sometimes do not recognize the emotional needs of the child once they are relieved that nothing “serious” has happened to the family. A child who is afraid is very frightened. A first step for parents is to understand the kinds of fear and anxiety a child experiences. Advice to Parents It is very important for the family to remain together. The child needs reassurance from your words as well as actions. Listen to what the child tells you about any fears. Listen when the child tells you how he or she feels. Listen to what he or she thinks about what has happened. Explain to the child, as well as you can, about the disaster and about the known facts. Again, listen carefully to him or her. Fears do not need to completely disrupt a child’s and family’s activities. Settling Down Parents should show the child that they are maintaining control. They should be understanding, but firm and supportive. Parents should make decisions for the child. It is natural for a child to want to cling to or be close to the parents and for the parents to want to have the child near them. Parents should also be aware of their own fears and uncertainties and the effect these will have upon the child. How Can Parents Recognize When To Get Professional Help? It is time to get help for your child if: A sleeping problem continues for more than a few weeks. The clinging behavior does not diminish. The fears become worse. Help Is Available Call us using the phone number on your member identification card for more information, help and support. We are here to help you get and stay well. This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2001 Magellan Health Services, Inc. Overcoming Your Fears and Anxiety Increased anxiety levels are normal during tragic events. There are ways to reduce the stress and keep normalcy in our lives. Anxiety can be a feeling of dread or fear over a real or imagined threat to your well-being. Some anxiety is normal. Mild anxiety helps people complete tasks or practice speeches or presentations. Feeling anxious can alert you when danger is present. But anxiety brought on by a tragic event can be overwhelming. It may get in the way of your daily life. Here are some tips to help you overcome anxiety1: Prepare for events. Get ready for events that may cause anxiety, such as speaking in front of a group or dealing with an uncomfortable situation. Imagine yourself feeling calm, confident and in control. Eat healthy foods. Eat at regular times. Don’t skip meals. Limit caffeine. Too much caffeine can make you anxious. Drink decaf coffee, tea, colas or other sodas. Avoid chocolate. Avoid nicotine and alcohol. They contain chemicals that can cause anxiety. Exercise regularly. Use relaxation exercises, such as deep breathing, visualization or meditation. Don’t over-commit. Don’t try to do too much with too little time. This is a sure way to bring on anxiety. Face your fears slowly and gradually. Face your fears a little bit at a time until you are ready to take on more. Anxiety is a real feeling. With patience, you can conquer it. Control the things you can. If you walk for exercise, continue to walk. You can change your walk to an inside location, but continue your daily routine. Limit viewing of television news. Tragic things feed news coverage. You don’t have to subject yourself or your family to repeated doses of it. Tune in for updates. Limit your exposure if it makes you or your family anxious. Keep family members close by if it makes you feel better. Being cautious about personal safety is good. Try not to overreact. Do something for someone else. Take the focus off your worries. Do something nice for someone else. This can improve our own frame of mind. Volunteer. Contact schools, hospitals or volunteer groups. Ask how you can help. Take action to be part of the solution. This is a helpful way to reduce your anxiety. Talk to someone. If you feel overwhelmed by your emotions, talk with a friend, family member, doctor, religious advisor or mental health professional. _______________________________________ 1 Adapted from the National Mental Health Association, Coping with Anxiety, at www.NMHA.org. This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2002 Magellan Health Services, Inc. Help Is Available Call us using the phone number on your member identification card for more information, help and support. We are here to help you get and stay well. This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2002 Magellan Health Services, Inc. Do’s And Don’ts After a Trauma People who have gone through a traumatic event often show changes in behavior. The information below may help avoid a long-term reaction to stress. Do’s Get enough rest. Maintain a good diet and exercise program. Find time and talk to friends and family about what happened. Take time for relaxing activities. Follow a familiar routine. Spend time with family and friends. Attend meetings about this traumatic event. Create a calming place to escape to, either visually or literally. Take one thing at a time. Expect the experience to bother you. Seek professional help if your symptoms continue for a long time. Seek medical help if your physical symptoms worry you. Don’ts Drink a lot of alcohol. Use drugs or alcohol to numb consequences. Withdraw from significant others. Reduce relaxing activities. Stay away from work. Increase caffeine intake. Look for easy answers. Take on new major projects. Pretend everything is OK. Make major changes if you don’t need to. Help Is Available Call us using the phone number on your member identification card for more information, help and support. We are here to help you get and stay well. This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2001 Magellan Health Services, Inc. Understanding the Teenage Grieving Process Grief is an emotion that accompanies many types of loss. When a teenager grieves, it can complicate a difficult and often confusing stage in his or her life. The following are common reactions of teenagers who are grieving. Shock/Disbelief Teenagers may show few signs of grieving at first. This form of denial is important for coping and should be respected. In months to come, the numbness will fade. Your teen will need you more than ever. Guilt Most people who grieve feel guilt, including teenagers. Arguments or unfinished business are part of life, especially during teen years. Because of this, teens often have extreme feelings of guilt. They feel responsible when there is a death or separation of some sort. They may feel like they are at fault. They may feel there was something they could have done to change the situation. Anger A teenager may feel abandoned after a death. Anger can become very powerful. It is important that teens have safe and healthy options for expressing their anger. Some suggestions include throwing cotton balls at a wall or screaming into a pillow. Drugs/Alcohol A grieving person is hurting. A natural response is to want to numb the pain. By drinking or using drugs, the person avoids dealing with the grief. Grieving teens are at high risk for self-destructive behavior. It is important to be open with teenagers. Let them know that masking their feelings or clouding their judgment will not change the situation. It will only prolong the grieving process. Be aware of any changes in your teen’s behavior or attitude that may come from drug or alcohol use. Tears Tears are natural and a necessary part of grief. If you do not see tears, do not assume they are not there. Many teens grieve in private. If a teenager shares tears with you, be quiet and listen. Don’t try to fix the pain. Help Is Available Call us using the phone number on your member identification card for more information, help and support. We are here to help you get and stay well. This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2001 Magellan Health Services, Inc. Tragedy Aftermath: Taking Care of Yourself If you have just gone through the shock and pain of a tragedy, you may be very shaken for the next few days or weeks. As the shock wears off, you will start to rebuild and put your life back together. You may experience many different emotions at this time. For months after experiencing a tragedy, it is common to feel let down and resentful. Some common responses to a disaster include1: Irritability/Anger. Sadness. Fatigue. Headaches or Nausea. Loss of Appetite. Hyperactivity. Inability to Sleep. Lack of Concentration. Nightmares. Increase in Alcohol or Drug Consumption. Many people who have gone through a tragedy will have at least one of these responses. Accepting your feelings is the first step in feeling better. Other helpful things to do include2: Talk about your experiences. Share your feelings rather than holding them in. This will help you feel better about what happened. Pay attention to your health and diet, and get adequate sleep. Relaxation exercises may help if you have a hard time sleeping. Prepare for future emergencies. This may help you feel less helpless and bring peace of mind. Help Is Available Call us using the phone number on your member identification card for more information, help and support. We are here to help you get and stay well. 1 2 www.lafd.org/eqindex.htm Ibid Adapted with permission from the National Mental Health Association at www.nmha.org This information is not intended to serve as medical advice. If you experience physical symptoms that cause you concern, please consult your physician. © 2001 Magellan Health Services, Inc.