Mental Illness

101 – Children &

Teens Building the Heart of Successful

Schools Conference

December 12, 2014

Defining Mental Health

“Mental Health is a state of well being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” (World Health Organization)

Mental Health

Problems vs.

Mental Illness

What’s the

difference?

1. Clear trigger (often situational) 2.Coping skills relieve symptoms 3.Defined period of time

Defining

Mental Illness Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, behavior and ability to relate to others, and causes the person distress and difficulty in daily functioning. (The Science of Mental Illness. National Institutes of Health; National Institute of Mental Health)

How common is mental illness? 1 in 4 adults –

approximately

65 million Americans

• Mental illnesses can affect persons of any age, race, religion, or income.

• Mental illnesses are NOT the result of personal weakness, lack of character, or poor upbringing.

• Mental illnesses are treatable.

ADDICTION and MENTAL ILLNESS

Two problems, One person

If you don’t treat them together,

you can’t beat either – integrated treatment

is essential.

What causes mental illness?

Biological

Genetics Environmental exposures before birth (viruses, toxins, alcohol, drugs)

Social/ Environmental

Negative life experiences including trauma, stress and loss Adverse childhood experiences

Chemical Biochemical changes Hormonal imbalances Neurotransmitters

Stigma Hurts

Stigma: 1950’s – 2000’s

Stigma

Knowledge and

Understanding of the Brain and Mental

Disorders

“Person First” Language

Instead of: “She’s bipolar” Use: “She has bipolar disorder”

Instead of: “Crazy” or “Insane” Use: Wild, outrageous, extreme, silly, idiotic, senseless, etc.

The Impact of Mental Illness

All together, America’s cumulative mental health issues are costing the U.S. economy

about a half-trillion dollars.

(That’s more than the government spent on all of Medicare during the last fiscal year)

Scope of the issue: Poverty Mental health problems in adults occur across

all levels of income and education

and within all cultural and racial groups

But…

Children living in poverty are six times as likely to develop mental illness, regardless of genetics. (CDC data)

41% of families in which there is parental mental illness are living in poverty. (nmha data)

Less than a quarter of those parents have had steady employment in the last month. (nmha data)

The “chronic illness” of the young… CDC Wisconsin 2013: 1 in 5 children/teens

½ by age 14 and ¾ by age 24

Childhood Mental Illness Local Prevalence

(US Census Data 2009)

Children between the ages 5 – 18

Outagamie County – 31,711 6,342 w/ MH Diagnosis Winnebago County – 24,865 4,973 w/ MH Diagnosis Calumet County – 8,679 1,736 w/ MH Diagnosis

“Over 50% of students with a mental disorder age 14 and older drop out of school – the highest dropout rate of any disability group.” U.S. Dept. of Education, 2006

More than 90% of those who die

by suicide have a diagnosable mental disorder

NAMI Fox Valley is here to help

Suicide is the cost of undiagnosed, untreated

and undertreated mental illness

Children and Mental Illness

Youth Risk Behavior Study Wisconsin 2007 Wisconsin Youth Risk Behavior Survey

Suicide

12.8

15.3

17.2

14.1

12.3

9.910.5

8.7

0

2

4

6

8

10

12

14

16

18

20

9th 10th 11th 12th

Grade

Pre

cen

tag

e

considered

suicide

made a

plan

15% of WI high school students “seriously considered” attempting suicide in the past year

7.3% indicate that they “attempted suicide” at least once in the last year

People with mental illness live, on

average, 29 years less than other

Americans

People with mental illness AND substance

use live, on average,

42 years less than

other Americans

Co-Morbidity = Risk of Early Death

More than 50% report being a victim of a crime in the past year. 5x more likely to experience physical or sexual assault (women = 10x)

Studies have found that reports to police were often dismissed or not believed.

People with Mental Illness are FAR more likely to be victims than perpetrators

“A state of being in

which the demands,

responsibilities, and

requirements of daily

life are PERCEIVED to

outweigh the resources

with which to manage

them.”

Mental health problems

may inhibit the ability

to maintain balance by

eating away at resources

Demands

Resources

Good Stress vs. Bad Stress

Good Physical Performance

Mental agility

Bad Irritable

Poor health

Panic

Depression

Paranoia

Impact & Prevalance of Trauma

The Trauma Continuum Acute Trauma

Adult-onset

Single incident

Adequate child development

No co-morbid psychological disorders

Complex Trauma Early onset

Multiple incidents

Extended over time

Highly invasive

Interpersonal

Significant amount of stigma

Vulnerability

Mediating or Exacerbating Factors Person

Age/developmental stage Past experiences Strengths and coping skills Cultural beliefs

Environment Supportive responses from significant others and

community Access to safety and resources

Event Severity & chronicity Interpersonal vs. act of nature Intentional vs. accidental

Immediate Impact

Fight / Flight / Freeze

Fight: resist

Flight: run away

Freeze: stay still

Impact of Trauma on World View

The world is an unsafe place to live in

Other people are unsafe and cannot be trusted

My own thoughts and feelings are unsafe

I expect crisis, danger and loss

I have no self-worth and no abilities

Trauma & the Brain The chemicals generated by “toxic stress”

impact brain development. Damage the hippocampus – area of the

brain responsible for learning and memory. Can result in a “smaller” brain (less mass) For Girls – reduction was in the area

associated with emotional regulation For Boys – reduction was in the area

associated with impulse control

Collaboration between Dr. Vincent Felitti at Kaiser Permanente Insurance and Dr. Robert Anda at Centers for Disease Control and Prevention (CDC).

More than 17,000 participants had a standardized physical examination and completed a confidential survey that contained questions about childhood maltreatment and family dysfunction.

The ACE Study was originally

designed to assess for

“scientific gaps” in the origins

of risk factors.

33

ACE – Adverse Childhood Experiences

Abuse:

Psychological (by parents)

Physical (by parents)

Sexual (by anyone)

Physical neglect

Emotional neglect

Household with:

Substance abuse

Mental illness

Separation/divorce

Domestic violence

Imprisoned household member

Fellitti & Anda

39%

21%

15%

25%

1 ACE 2 ACEs

3 ACEs 4+ ACEs

Figure 1. Distribution of ACE Scores among Those with Any ACEs

35

58% of Wisconsin

adults reported

growing up

experiencing at

least one ACE of

those 25% of

Wisconsin

Residents reported

having 4 or more

ACEs.

Impact of Trauma Over the Life Span

Effects of adverse childhood experiences: •Neurological •Biological •Psychological •Social

Center for Disease Control

Adverse Childhood Experience (ACE)

Study www.acestudy.org

Wisconsin ACE Study http://wichildrenstrustfund.org/files/WisconsinACEs.pdf

Center for Disease Control http://www.cdc.gov/ace/questionnaires.htm http://www.cdc.gov/nccdphp/ACE/

MYTH: Self-injury is a failed suicide attempt.

Understanding Behaviors Explanation vs. Excuse

Outward Expressions

Anger/defiance

Violence toward others

Truancy

Criminal acts

Perfectionism

Inward Expressions

Withdrawal

Substance use

Eating Disorders

Violence to self

Spacing out

Understanding Maladaptive Coping Skills What is self-injury?

Self-injury occurs when someone intentionally and repeatedly harms herself/himself.

Methods include cutting, burning, punching or drinking something harmful.

Who does it? More than 2 million people in the U.S. The majority are teenagers or young adults with

young women outnumbering young men.

Why? To express emotional pain or feelings they can’t put into words. To have control over your body when you can’t control anything

else in your life. Although they usually aren’t trying to kill themselves, sometimes

they’re unable to control the injury and die accidentally.

Eating Disorders Include extreme emotions, attitudes, and behaviors

surrounding weight and food issues.

Eating disorders are real, complex and devastating conditions that can

have serious consequences for

health, productivity, and relationships.

They are not a fad, phase or lifestyle choice.

Eating disorders affect males and females.

20 million females, 10 million males

By age 6, girls especially start to express concern about their weight/shape. 40-60% of girls aged 6-12 are concerned about their weight.

Suicide – Death by Mental Illness

The Veteran suicide rate just jumped from 18 to 22 per day or one suicide every 65 minutes

- 38,364 people completed suicide in 2010 (792 in Wisconsin) - Suicide is the 10th leading cause of death. - Approximately 101 people died by suicide every day.

•That’s one person every 15 minutes or a jumbo jet crashing EVERY DAY.

- 90% who died by suicide have a diagnosable psychiatric disorder.

Youth & Suicide Youth Risk Behavior Study (2010)

15% of WI high school students “seriously considered” attempting suicide in the past year

7.5% indicate that they “attempted suicide” at least once in the past year.

6th leading cause of death among 5-14 year olds.

3rd leading cause of death 15-24 year olds.

2nd leading cause of death for college students.

“Ask a question, save a life.”

QPR

Question

Persuade

Refer

Why do MI & SA Co-occur Self-medication

Substance abuse begins as a means to alleviate symptoms of mental illness

Causal effects

Substance abuse may increase vulnerability to mental illness

Common/correlated causes

Risk factors that give rise to mental illness and substance abuse may be related or overlap

Treatment Success Rates:

60-80% MI – significant reduction of symptoms and improved quality of life (varies by disorder 60% for schizophrenia vs. 80% for anxiety & depression)

40-60% surgical/medical interventions for heart disease

Good News! Treatment Works!

SO…if Treatment WORKS, Why Don’t People Get Treatment? Stigma

Self stigma

Community stigma

Cultural stigma

“Time will heal” – mental health problems are perceived as less “real” than physical health problems

Barriers to Treatments Scientific knowledge

Diagnostic tools

Lack of knowledge about available treatments, evidence-based treatments

Needed treatment is not available (i.e. trauma specific, eating disorders, etc.)

Cost/coverage

Shortage of providers esp. psychiatrists

Recovery “A process of change through which

individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

Building Resiliency

Resilience is described as “bounce back” ability

Process encompassing positive adaptation within the context of adversity.

Resiliency A dynamic process

encompassing positive adaptation within the context of significant

adversity

Protective Factors Risk Factor Resiliency

Resiliency Research Why do some children genetically at risk for

developing mental illness who experience stress or adversity languish, while others flourish?

Norman Garmezy developed three categories of protective factors for “thriving” trauma survivors: 1. Child’s “inherent” disposition: Felt good about

themselves, self-reliant and believed they were in control of themselves and their lives.

2. Family cohesion & warmth: The support of a caring, loving adult.

3. Availability and use of “external” supports – other adults, children and community.

Building Protective Factors Caring and healthy adult and peer relationships

Healthy habits – eating, sleep, exercise

Developing hobbies and interests

Encouraging and supporting learning and “learning to learn”

Building healthy and “active” coping skills

Developing and supporting self-esteem

Developing and supporting healthy social skills

Creating an “internal locus of control”

Teaching a balance between seeking help and autonomy

Capitalize on opportunities to reduce risk and enhance resiliency

Protect and enhance the attachment relationship

Focus on child’s adaptive skills, self regulation, and capacity for relationship building

Compassionately engage with Mom/Dad around their desire to parent well

How Caregivers Can Help Understanding fears: Will the event will happen again? Will my family be hurt? Will I be separated from family? The importance of security and routine: Provide reassurance of safety and that s/he is loved, cared

for and protected Keep distractions to a minimum Provide extra physical reassurance (hugs, cuddles) Give comfort objects Be available for talking, listening and comfort

Communication with Children Open, thoughtful communication

Use active listening skills to reflect and encourage feelings

Try to be patient when your child asks the same question many times. Children often use repetition of information as a source of comfort. Try to be consistent with answers and information.

Talk with your child about your own feelings, but try to find other adults to talk with about your anxieties and frustrations.

Shield your child from graphic details and pictures in the media.

Tools for Recovery Peer support

Education

Healthy coping skills

Art/creative outlets

Exercise

Meditation

Healthy diet

Spirituality, etc.

Wellness Plans vs. Treatment Plans (WRAP)

Relapse prevention planning

The

“Neuroplastic

” Brain

“Current perspectives suggest a dynamic brain, physically changed by both internal and external factors…The concept of neuroplasticity is opening the doors to new ways of understanding illness and recovery, as well as how these processes can be utilized to influence and direct outcomes.”

http://www.mentalhealthscreening.org/screening/NEW

Free, online, anonymous, confidential

screening tool for mood disorders,

anxiety, AODA and eating disorders.

Q: What makes NAMI unique?

A: Building better lives,

shaping perceptions,

raising awareness and hope,

people helping people

Hope. Help. Recovery.

Want to Learn More? Visit our website for descriptions and dates of our program offerings: www.namifoxvalley.org Call (920)954-1550 Join our mailing list! (Post and/or Electronic) For more resources, check out www.nami.org