70X7 MENTOR TRAINING TOOLS:

Walking with Someone through Mental Illness

PRESENTED BY: MAYA KOOPMAN, MD. BOARD CERTIFIED PSYCHIATRIST

PRESENTED AT MENTOR TRAINING, JANUARY 14, 2016

THE INFORMATION PRESENTED HERE IS FOR GENERAL EDUCATIONAL USE ONLY AND MAY NOT BE USED FOR THE DIAGNOSIS OR TREATMENT OF MENTAL ILLNESS.

THE FACTS

ANXIETY DISORDERS ARE THE MOST COMMON

FORM OF MENTAL ILLNESS

MENTAL HEALTH PROBLEMS IN INMATES:

ARE SLEEP MEDICATIONS ADDICTIVE?Yes:• most new generation like Ambien (zolpidem)

• all old generation benzodiazepines like Valium, Xanax

• These are all “controlled substances”

No:

• sedating antidepressants

• Rozerem (ramelteon)

• With consistent use ALL build dependence over time like alcohol and addictive prescription medications

• Once dependent, MUST taper or will go into withdrawal.

• In this case dependence results in drug seeking behavior even at personal cost

• Abuse and Addiction

• 1:5 people can develop this on stopping antidepressants suddenly or even more with beta-blockers

• Unclear why some develop this and some do not

• Looks like the flu and scattered thinking

• Best to taper when you stop them to avoid the syndrome

• No High

• No drug seeking behavior

• No Abuse or Addiction

CONFUSION: DEPENDENCE AND ADDICTION?

Drug Discontinuation Syndrome Drug Addiction

ALCOHOL CAUSES INSOMNIA?• “night cap”

• It is a diuretic so wakes you to urinate earlier.

• With on-going frequent use people fall asleep initially and wake up a few hours later.

• In that person, if alcohol is not given they have symptomatic insomnia.

• Sleep quality is completely disrupted.

CONCEPT OF “SELF-MEDICATING”• Someone who has psychiatric symptoms and uses their

substance of choice to find relief.

• PROBLEM: Alcohol is a depressant so if someone is depressed and drinks they will become more depressed and may even become more of a suicide risk because they are less in control of their behavior.

• Depressed people can’t sleep. If you drink to sleep---we know that alcohol leads to insomnia and more drinking.

WALKING WITH SOMEONE THROUGH MENTAL ILLNESS:

Recognition

WHAT ARE WE LOOKING FOR?

• Anything new? A psychiatric symptom? A change.

• Change in a physical problem?

• Problems at work?

• Problems in the Mentor Relationship?

• More conflict in relationships that had been going well…family, significant other…

• New stressors?

• Suicidal thinking: passive or active?

WHAT DO WE DO?

• It is not up to you to diagnose. Just to be alert that there may be a problem that needs to be looked into.

• Help the person get a referral to a doctor that is covered by their insurance.

• If you think there is any chance of danger to themselves or others get them to the ER or call 911

MAJOR DIAGNOSIS CATEGORIES:

• Anxiety

• Major Depression

• Bipolar

• Schizophrenia

• Personality Disorders

WALKING WITH SOMEONE THROUGH MENTAL ILLNESS:

Advocacy

GATHERING INFORMATION:• Are they in Mental Health Court?

• Do they have: a diagnosis? treatment? medication? history of substance abuse?

• Do they know how to access care?

• Are they stable on their current treatment?

• Are they keeping appointments?

• Do they take their medications? Do they let them run out? Do they stop them on their own? Do they understand what each one is for?

• Have they had a physical exam?

• Did they stop the medication on their own?

• Did they run out?

• Are they missing many doses?

• Medications need to be tapered

DID THEY STOP THEIR MEDICATION?

Discontinuation Syndrome:

Help Compliance:

Use a weekly medication strip.

Helps to see if you have taken that day’s medication

Time saver.

Helps to see when you are running low on medication.

SELF-ADVOCACY• Keep a regular schedule

• Exercise*and eat a healthy diet

• Set alarms for medications AND to go to bed!

• Get a notebook for keeping information for doctor visits

• Write down questions for the mental health provider

• Note a list of side effects before appointment

• Make a list of prescriptions that you need refilled

• MAKE SURE to tell the provider if you have an addiction problem and ask that you not receive any habit forming medications. No controlled substances.

GOOD MENTAL HEALTH BEGINS WITH GOOD SLEEP

• Keep a regular daily and sleep schedule

• Leave at least 7-9 hours of time to sleep

• No late eating/caffeine

• No “night caps”

• Avoid artificial light from computers, TV, phones etc. the last few hours before sleep because they keep your brain “alert”

• Don’t sleep in