Warning Signs of a Mental Health Problem
Any of the following signs may indicate that a serious mental health problem exists. An assessment or evaluation conducted by a qualified mental health professional may be needed.
• Unexplained changes in personality.
• Unable to cope with problems and daily activities.
• Strange, grandiose, or paranoid ideas.
• Excessive anxiety or worries.
• Depression that persists for several days.
• Changes in eating or sleeping patterns.
• Thinking or talking about suicide.
• Thinking or talking about hurting someone.
• Mood swings with extreme highs and lows.
• Excessive or uncontrolled feelings of anger or hostility.
• Crying spells.
• Suicidal, violent behaviors, or self-harm.
• Excessive risk taking.
• Abuse of drugs or alcohol.
• Sudden changes in peer groups.
• Cruelty to pets or animals.
• Isolating from family or friends.
• Absenteeism from school, work, or family activities.
• Involvement with gangs or criminal activities.
• Violent or depressing artwork.
• Persistent disregard for following the rules.
• Secretive behavior.
• Running away or threats
There are many ways to get help once you know whom to call. Any of the persons listed below can help you identify a mental health professional or program.
• A Physician
• A Psychotherapist
• A Church Counselor
• A School Counselor
• A Medical Hospital
• An Emergency Room
• A Psychiatric Hospital
• An Insurance Company
• An Employee Assistance Program
• A Mental Health Association like Mental Health America or NAMI Gulf Coast
Deciding Which Type of Professional to Call
Determining which type of mental health professional to call is important. There are many different types of mental health professionals. Each type has specific credentials that identify their training and area of expertise. Be sure to ask the mental health professional what areas of mental health is his or her expertise; even those who have the same licensure. On the following page are the most common mental health credentials.
A Psychiatrist or MD is a Medical Doctor who specializes in mental functioning. They have the legal authority to prescribe medications for their clients. They can treat clients for any type of mental health problem.
A Psychologist or Ph.D. is a Doctor of Psychology. They can provide counseling or psychotherapy for any type of mental health problem. They often train or teach other therapists and conduct evaluations or psychological testing on clients to help identify / clarify thinking, emotional or educational problems.
A Licensed Marriage and Family Therapist or LMFT is licensed by the state to conduct marriage and family therapy. They work with individuals and families in order to overcome family problems.
A Licensed Master Social Worker or LMSW is licensed by the state to provide therapy for individuals with mental health problems. They work with individuals and families to overcome their problems. They also assist clients in accessing other services that may help return the client to the best possible mental health.
A Licensed Professional Counselor or LPC is licensed by the state to counsel individuals or families. They help clients overcome any mental health related problem.
A Licensed Chemical Dependency Counselor or LCDC is licensed by the state to work with individuals and families to overcome problems with drugs and alcohol. Their expertise is limited to substance abuse and the problems that often accompany substance abuse.
Learn all you can about the disorder and medications – and keep learning.
Choose (or steer your loved one to) doctors and therapists who are willing to work with the family.
Speak calmly, in an organized manner, focusing on the two or three most immediate issues. When talking to mental health professionals about the individual, don’t vent. This is about helping the individual, not about expressing your feelings and anxieties. Keep it as simple as possible.
Stay focused on the issues. Keep it simple, focused and factual.
Talk to the doctor/therapist – by fax or email if necessary. If the individual is over 18, the doctor/therapist won’t be able to talk with you unless you have guardianship or the individual gives permission. However,you can still talk to the doctor/therapist – it may be a one-sided conversation, but you can give them the information they need. You can do it by fax or email if you can’t do it in person.
Send a privacy information form, if the individual will sign one, to all doctors/therapists and the insurance company. NAMI GC has a consent form if you need a copy. Keep a copy for your crisis file.
Keep a file of information about the individual: dates of diagnoses, hospitalizations, names of doctors and medications, insurance/Medicare information. Keep a telephone/contact log when dealing with caseworkers, doctors, therapists, etc. Be sure to get names. This will be helpful during the inevitable follow-up.
Medicine and Mental Health Professionals
Medications are a starting point which may allow other therapeutic strategies to work. Medications can strongly affect behavior. They can bring enough calm to allow other therapeutic work to be done. Positive effects will continually need to be weighed against the negative. Know the medications: what they do, side effects, interactions with food or other medications, how sensitive the medication is to non-compliance.
Some suggestions are: weekly pill dispensing boxes, alarm clocks and wristwatch alarms. Be aware that some individuals need closer supervision. Lock up extra medications, especially if you have 90-day supplies and particularly if your loved one suffers from depression or has a history of substance abuse.
Monitor how well the medication is working and any side effects. It is especially important to keep notes when there is a change in medication or dosage. You can help the Doctor in treating symptoms by logging behaviors and medication.
Use hospital provided caseworkers. If going through a hospitalization, ask about caseworkers or social workers available through the hospital. Be sure to get their names and contact information. They can listen to you and help with finding doctors, therapists and living facilities for after hospitalization. If your loved one is hospitalized and they have no source of income, they may be eligible for follow-ups with their local MHMR. Call NAMI GC for more information.
Ideas That Can Help Individuals with Mental Illness
Daily structure is essential. This includes regular times for sleeping, eating, productive activities, social interactions and exercise.
Find regular activity outside the home. Too often, the individuals have their symptoms cared for but have an empty life. The treatment plan needs to include something to keep the individual engaged and active. Ideas: appropriate volunteer activities, work for family members, classes (like the Peer-to-Peer class from NAMI). One member’s son helps with a neighbor’s lonely dog, and they both benefit.
Get good nutrition. Make nutritious food and drink easily available. Drink plenty of water. Some of this may help chemical imbalances.
Partnerships, a free course offered by NAMI GC, can provide information on helping your family member while maintaining your own well-being.
Taking Care of Yourself
Stay hopeful. Don’t be discouraged. There is help through support and education (like the Partnerships education class and support chapter meetings from NAMI Gulf Coast).
Acknowledge your own feelings of confusion, anger and depression. Recovery is a slow process. It takes a long time.
Guilt is a common response. We may try to hide the situation from neighbors and friends because of shame and embarrassment. We can let go of this when we understand that the bizarre behavior is due to a biochemical imbalance in the brain.
Allow yourself to grieve the loss of your expectations for the individual with mental illness. Acceptance entails recognition that mental illness is a chronic disorder – that previous expectations may not be achievable. Allow yourself to grieve the loss of those possibilities. Focus on what is realistically possible now.
Set limits on what you expect of yourself. Live one day at a time. Set realistic limits on what you as an individual can actually control or accomplish.
Positive self-talk is effective. Replace negative self-talk with positive. If you can’t change the circumstance, consider changing the way you think about it. “If life hands you lemons, turn it into lemonade.”
Try to live as balanced a life as possible. Avoid letting your individual’s problems take over your life. Don’t make all your conversations about the individual. So often, we give up all or much of our regular life and live with this person as the focus of our everyday existence. This may be necessary during a crisis, but when there is some stability, try to return to some balance and pursue your regular activities as much as possible.
Make sure you get respite. As a caregiver, you need a rest. Give yourself daily time away from the individual. Do something you need or want to do. Making this part of your daily life will help you continue to care for the individual.
Don’t sacrifice relationships with other family.
Be grateful for the wisdom you gain. In the process of coping with this illness, you will have discovered much more about yourself and about the vagaries of the human condition than you could ever have imagined.
Remember, this is a “long haul” event – pace yourself.
Accept that there will be bad times and better times, but that a quick one-time-for-all treatment is most likely not possible.
Learn to be flexible. Flexibility and adjustments in dealing with these issues can help you to cope.
Keep yourself healthy. Eat right, get enough sleep, and try to fit in some exercise. Respond to the aches and pains of your body, mind and soul. Encourage others in your family to do the same. Care-giving is intensive, over-whelming work, especially during crises. Just as the individual needs a long recovery time, so do you.
Paying For Help
Self-Pay clients pay the provider directly for their help. Many of these providers receive funds from various government agencies and have sliding scale fees.
Private insurance companies will often cover mental health care. However, there are usually restrictions and limitations to what they will pay for.
Managed Care Companies act as middle men between clients and the insurance companies. They determine what medical care the insurance company will pay for or not pay for based on “medical necessity”.
Mental Health and Mental Retardation Clinics offer mental health care on a sliding scale fee system and accepts Medicaid, Medicare, or health insurance.
Medicare is a federally funded health insurance program for senior citizens, and the disabled.
Medicaid is a state funded health insurance program for low income families.
The Children’s Health Insurance Plan or CHIP’s is a federal and state funded health insurance program for children who do not qualify for Medicaid but do not have any other type of insurance coverage.
Planning for Your Family Member’s Future
Help the individual obtain Social Security benefits. He or she may be eligible for SSI or SSDI.
You may want to consider creating a Special Needs Trust to support your individual long-term. There are financial planners and lawyers who are experienced in this area.
Keep your will up-to-date.
Learn about housing options. Your individual does not necessarily need to live with you, and, at some point, won’t be able to. Explore personal care facilities, government supported housing for the disabled, group homes and the like.
Consider current guardianship. If your individual needs a guardian, you may wish to divide the job between a financial guardian and a personal guardian.
Plan for long-term care-giving and guardianship. Your individual cannot depend on you indefinitely. Talk with family members to educate them on how to deal with someone with mental illness and discuss future care-giving possibilities. Again, responsibilities can be divided among two or more people. People outside the family can be engaged to carry out these responsibilities. Don’t put this off; no one knows what tomorrow will bring.
Rights for Individuals with Mental Illness
The Advisory Commission on Protection and Quality in the Health Care industry has identified the following expectations for health care providers:
- Individuals have the right to emergency health care services when needed regardless of the ability to pay.
- Individuals have the right to accurate and easily understood information in order to fully participate in their health care decisions.
- Individuals have the right to have all information kept confidential as required by law.
Evaluating Therapy for Children
It is important in child therapy to evaluate the progress of the treatment and the relationship with the therapist. After your child has been in therapy for a while, ask yourself the following questions to determine if therapy is working. If the answer to most of them is “yes,” then you should be confident that therapy is helping. If the answer to most of them is “no,” then you may want to get a second opinion from another mental health professional and consider making a change in your child’s treatment.
• Does our child seem comfortable with the mental health professional?
• Is there open communication between the mental health professional and us, the parents?
• Has the mental health professional diagnosed the problem our child is having?
• Are the professional and our child working toward the goals which we set together? Has our relationship with our child improved?
• Are we, as the parents, being given guidance to work on the problem at home?
Know When Your Child Should Stop Therapy
Your child may be ready to stop therapy when she/he: is much happier; is doing better in school, and is making friends, and when you understand and have learned how to deal more effectively with those factors that led to the problems for which you sought help. Sometimes ending therapy will be an anxious time for children and parents. Problems may reappear temporarily. The mental health professional should be available to provide counsel and support for a period of time after your child is finished with therapy.
It is a good idea to give yourself some time to adjust before considering going back into therapy. You and your child may benefit from support groups. Just remember the path to recovery includes knowing when your child needs help, choosing the right professional, evaluation and knowing when your child can stop therapy. Support is the key.
Practical Tips for Parents
How to Care for Your Child’s Mental Health
- Know your family’s medical history so you can identify early warning signs.
- Trust your instincts and pay attention to a child’s complaints, such as “I don´t feel well.”
- Stay attuned to changes in your child’s behavior or activities.
- Educate yourself on the signs and symptoms of mental health disorders. Separate “fact from fiction” by using credible sources. Ask your family doctor if you have questions.
- Knowing that your child may need help is hard to accept. Don’t blame yourself. Mental health problems are not a symptom of bad parenting. They are common and very treatable.
- Seek help if your child shows signs of a mental health problem. Start with your pediatrician since ruling out any physical health problem should be the first step of your child´s care.
- Advocate for your child. If his or her provider does not recognize telltale signs, seek a second opinion. If your spouse cannot admit your child has a problem, continue to assert the truth: that s/he has an illness, but can get better. If you meet insurance hurdles, don’t be deterred from getting your child help.
- Discuss all available treatment options with your child’s doctor, and carefully weigh all the risks and benefits associated with each treatment.
- Stay attuned to how your child responds to treatments. Make sure s/he receives a thorough evaluation, continual follow-up and careful monitoring-particularly in the first several weeks – by your doctor.
- Educate yourself about the warning signs of both mental disorders and suicide. Act quickly if you are concerned.
- Do not abruptly discontinue or change treatments—it can lead to significant side effects.
- Know that your child will get better.
- Remember that the worst possible situation for a child with a mental health problem is to go without any treatment at all.
Working with the Schools
There are many avenues for working with the schools. Listed below are suggested step by step actions that can help at school.
A teacher conference is a good first step. Request a conference with the classroom teacher or teachers where the problems are occurring. Go to the meeting with specific questions and concerns. Keep in mind that most Teacher conference periods last 45 minutes. Discuss the specific concerns and agree on specific interventions and the length of time the interventions will be monitored for improvement.
If improvement is not achieved then request a second meeting with the school counselor. Ask if there are any other school professionals, such as the principal, social worker, reading specialist etc. that can attend in order to discuss solutions.
Once again, be prepared to discuss the specific concerns, interventions, and length of time the interventions will be monitored for improvement. If problems continue then request additional assessment to determine the eligibility for Special Education or for Section 504 Services.
Once the required forms are completed an in-depth evaluation will be conducted by the school. Next, a meeting will be held with all parties to discuss the needs of the student. If Special Education is needed then an Admission, Review, and Dismissal (ARD) meeting will be held. If Section 504 Services are needed then a 504 meeting will be held. At the meeting all parties will discuss, and ultimately agree on, what is required to meet the needs of the student.
Annual meetings are held to monitor the progress of the student. Once a student qualifies for the special programming, he/she is entitled to receive the appropriate educational services without cost to the parents. Remember to document all meeting discussions, etc, This must be done in writing.
NAMI GC can offer ARD assistance /mediation and/or education to help with the ARD process.
Dealing with Mental Illness in Your Child
Don’t wait to intervene, when you suspect something is wrong. The fewer bad experiences, the better the prognosis. Don’t waste time in denial or guilt. Many intervention strategies are very helpful whether or not the child turns out to have a mental illness.
Don’t blame yourself. Mental illness is not caused by poor parenting; it is a biological illness.
Good treatment works – find the best you can afford. This won’t necessarily cure the suspected illness, but will enable the child to experience success and learn to manage the illness.
Foster self-sufficiency. The goal is to get the adolescent to the point where he or she can manage the illness on his or her own. Aim for the line between supporting and enabling – helping the child/adolescent grow towards independence. The line will move of course as the child ages. As the adolescent gets older, move from direction to consultation. For example: “How do you think you should handle this?” “How can I help?” “Let’s brainstorm about the issue.” Don’t let feelings of guilt interfere with your child’s journey towards independence.
Learn and practice effective communication techniques. I-statements (expressing how you feel rather than blaming), reflective listening (understanding how the other feels), and expression of core emotions (many times fear is behind anger) are effective. They help to reduce defensiveness and guilt of all parties and to reach real communication about feelings, boundaries, etc.
Model a good patient/doctor relationship. Find a doctor who treats you and your child respectfully. When accompanying the child to the doctor, model good patient to doctor behavior by presenting documentation (like a list of medications, a mood chart), preparing written questions, making sure you understand medications, what they are supposed to do, and possible side effects. As the child ages, step more into the background, letting the child/adolescent take the lead and interact with the doctor, but making sure your information gets heard too — without demeaning the child.
Consider family therapy to help identify your family’s system for interacting, allowing siblings to voice their feelings, helping the parents present a consistent message, etc.
Take care of yourself. This is not an indulgence: it is necessary to lead your family to coping with the illness. Remember what flight attendants say about using airbags: “Put your own oxygen mask on first.”
Get involved in a support organization that can provide your family with education (like the Visions-for-Tomorrow education class from NAMI Gulf Coast), support groups and resources. Families who reach out to each other for support, ideas and information often have better results in helping their children.
Join a support group. Don’t isolate yourself. Go to the group regularly; don’t wait for a crisis. Realize you have support to give others in crisis. The group will be in place if you do have a crisis. You are not alone. You can find upcoming NAMI Support Groups throughout the community for both individuals (18 and over) and family members here!
Share thoughts about your family member’s illness only with those who are supportive. Friends and family members who are not knowledgeable about mental illness can unintentionally make hurtful comments about our individuals or how we are managing the situation.
Be grateful for the wisdom you gain. In the process of coping with this illness, you will have discovered much more about yourself and about the vagaries of the human condition than you could ever have imagined.
Ask for information. Don’t be shy about contacting NAMI members, doctors, hospitals, and programs for more information. Get education from our free education workshops, Partnerships, Visions for Tomorrow, etc. Also, use www.namigulfcoast.org
Coping with a Crisis
Don’t try to reason with the individual when s/he is in the turmoil of a crisis.
Talk in a calm, quiet voice, focusing on practical, workable, short-term solutions.
During a crisis, it is natural for us to become agitated, worried and upset – and to talk a lot in an effort to stabilize things, telling the individual what to do. However, this can escalate the problem. Take a minute to calm yourself – and to let the individual calm a bit. Take a deep breath and focus on the major immediate issue. Keep your voice calm and look for practical, short-term solutions.
Take action immediately if you feel you might be in physical danger from an out-of-control individual. At the first sign, call for help. Protect yourself. You cannot help anyone if you are hurt.
Trust your judgment about when it is time to intervene. You learn to recognize when some kind of intervention is necessary.
Make a crisis plan now. It is helpful to have a one-page summary of basic information about the individual. Make copies to give, by fax or in person, when needed. You may wish to include: the individual’s name, address, telephone number, driver’s license number, social security number, diagnoses, where and when hospitalized, recent medications (whether adhered to or not), any suicide attempts or violence, and the name, telephone and fax numbers of the most recent doctor. Include the name and telephone number of the family caregiver. (See sample crisis sheet at the end of this section.) Keep this summary with you or put it in a quickly accessible place.
Make a list in advance of the hospitals that have emergency treatment, and those which will take the individual’s insurance/Medicaid/Medicare. If the individual doesn’t have insurance, know the name and phone number of the county hospital. One option is to call the insurance company beforehand – they will often walk you through the admission process.
Assess whether your individual is a danger to himself or others. When trying to hospitalize your individual for psychiatric care, you will be asked, “Is this person a danger to himself or others?” Answering “yes” to this with specific reasons is the key to getting the individual hospitalized. Don’t lie, but documentation can be helpful. Consider all aspects of the situation. One father recognized that his son was so out of touch with reality that he was likely to walk into a busy street without regard to safety, and thus was a danger to himself.
If police intervention is needed, identify the emergency as mental health-related and ask for a Crisis Intervention Team or a Mental Health Deputy. Keep this phone number in your wallet. These numbers can be found on the Crisis Numbers page.
CRISIS INFORMATION PAGE
Fill out the following form and keep duplicate handy.
Please take this person to___________________________ Hospital.
This person is not a criminal. He/she has a mental illness.
Please treat with compassion and dignity. Thank you.
Social Security No.____________________________________
Is receiving SSI ______________ Is receiving SDI__________
Military/VA status? ___________________________________
Eye Color _______ _____ Hair Color ____________________
Blood type _________________________________________
Other identifying marks_________________________________
Current Primary Diagnosis ______________________________
Secondary Diagnosis _________________________________
WARNING SIGNS OF SUICIDE
• IRRITABLE, ANGRY, OR DEPRESSED MOOD
• POOR SLEEP
• SUDDEN CHANGES IN BEHAVIOR
• LOSS OF A FRIEND/ RELATIONSHIP
• DECLINE IN SCHOOL/WORK PERFORMANCE
• SUICIDAL THREATS
• FEELING HOPELESS ABOUT THE FUTURE
• REMARKS ABOUT DYING OR SUICIDE
• PREVIOUS SUICIDAL THOUGHTS OR ATTEMPTS
• ALCOHOL OR SUBSTANCE ABUSE
• ACCESS TO GUNS AND OTHER LETHAL MEANS OF HARM
Sample HIPAA Authorization
This form is a sample HIPAA Authorization Form used by doctors and therapists to gain permission to discuss clients with another member of a treatment team.
This from is modeled on a form from the American Academy of Family Physicians (www.aafp.org).
Patient / guardian must be provided with a signed copy of this authorization form.
PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
By signing, I authorize _______________to use and / or disclose certain protected health information (PHI) about me to ____________________________________________
(Specifically describe the information to be used or disclosed, such as services and consultations)
This authorization permits ________________ to use and/or disclose the following individually identifiable health information about me:
The information will be used or disclosed for the following purpose:
The purpose(s) is/are provided so that I can make an informed decision whether to allow release of the information. This authorization will expire on ________________________.
I do not have to sign this authorization in order to receive treatment. In fact, I have the right to refuse to sign this authorization. When my information is used or disclosed pursuant to this authorization, it may be subject to disclosure by the recipient and may no longer be protected by the federal HIPAA Privacy Rule. I have the right to revoke this authorization in writing except to the extent that the practice has acted in reliance upon this authorization. My written revocation must be submitted to the privacy officer at:
SIGNATURE OF PATIENT OR LEGAL GUARDIAN _______________________________________________________
RELATIONSHIP TO PATIENT
PRINT PATIENT’S NAME
PRINT NAME OF PATIENT OR LEGAL GUARDIAN, IF APPLICABLE