Mental Health and Mental Illness Basics Part 2: Treatment Strategies and Recovery Concept

hey there everybody and welcome to part two of 
mental health and mental illness fundamentals today we're going to review prevention 
strategies for mental illness identify   the fundamentals benefits and drawbacks of the 
most common treatments psychodynamic behavioral   humanistic and pharmacological we'll identify the 
factors that can enhance utilization of services   including providing culturally responsive services 
addressing unique coping styles looking at the   role of fam the family in treatment and exploring 
ways to address cultural barriers including   mistrust and stigma and finally we'll explore the 
recovery concept and its impact on mental health   and mental illness across the lifespan so let's 
start out with prevention because as they say   an ounce of prevention is worth a pound of cure 
prevention has been conceptualized as primary   prevention secondary or tertiary so in primary 
prevention we stop a problem from ever happening   or we delay the onset of a problem but ideally 
we want to stop it from ever occurring so let's   take a medical example cancer i mean ideally 
we prevent somebody from ever getting cancer   but at the very least we help them stay 
cancer free until they get you know 65 75 85   secondary prevention prevents something from 
recurring or worsening so again with cancer   we'll stay with that for the moment we don't want 
to have the cancer to come out of remission or get   worse and metastasized for example and tertiary 
prevention reduces the impact of the problem   so tertiary prevention would keep the 
person from developing major depression and   any kind of other health problems as a result 
of the cancer so let's talk about that in terms   of mental health we want to stop people from ever 
becoming depressed i mean ideally stave that off   now we all experience depressive times in our life 
you know you'll have times where you're grieving   or you're depressed about something that's 
normal um but we want to prevent people from   developing major depressive disorder you know 
whether two three four weeks they just are having   a hard time functioning secondary prevention you 
know if they get a depressive episode okay well   we want to prevent it from recurring if possible 
or worsening we don't want them to become suicidal   if they have um called dysthymia or persistent 
depressive disorder is what we call it now   you know that's kind of like a mild depression 
think like eeyore um and we don't want people to   get worse we don't want them to become severely 
depressed so that's secondary prevention they   already have the issue but let's prevent it from 
getting worse and tertiary prevention reduces the   impact so if they get depression yeah that is or 
become depressed if you want to put it that way   that's unfortunate and it's unpleasant i get it 
but we want to help reduce the impact on their   work on their family life on their self-esteem 
while they deal with depression so those are   the three main types of prevention now we can 
engage in prevention activities by strengthening   knowledge attitudes and behaviors that promote 
emotional and physical well-being so if people   are taking care of themselves if we educate them 
about positive health behaviors we're going to   help them prevent negative health outcomes 
and promoting institutional community and   government policies that further physical social 
and emotional well-being in the community so for   example when you're when we're talking about 
institutional policies that think about school   what kinds of things can schools do to help 
prevent depression they can address bullying   they can provide units in health class on 
coping skills and cognitive restructuring   they can interface with the family and the 
community to identify any particular needs   that may need to be addressed communities 
can do the same thing they can interface with   other agencies mental health agencies and 
schools and businesses to identify the types   of services that people in that community 
need in order to stay happy and healthy   and government policies often revolve more 
around funding for all of these things prevention is based it's not just let's just pull 
it out of thin air sort of thing prevention is   based on theory and research so we do know that 
there are things that we can do that prevent   mental illness prevention addresses the individual 
as well as the micro macro and exo system and if   you think um back to broffen brenner's theory 
if you've gone through that class that i talk   about child development um broff and brenner talk 
talked about the ecological model of counseling   the microsystem you have the individual and all of 
their you know personal traits their temperament   their abilities and disabilities their microsystem 
you know the people that they live with the   then you go out to the macro system and you 
start talking about you know the businesses   and the community that they live in and then 
the exo system is talking about the culture in   general like the country that we live in and 
how all of these things impact the individual   and you're thinking well things on the country 
level don't impact the individual oh yes they   do um political stresses impact the individual 
what is in the media whether it's news media or   on you know prime time television impacts 
the individual and our attitudes about   um other people our attitudes about what we should 
do our attitudes about how we should look you know   all of these things are affected on the macro 
micro and exo system okay so prevention premise   prevention activities need to focus in all of 
these areas not just on the one person because one   person doesn't live in isolation we're impacted 
by lots of different things a person who lives   in the middle of chicago is going to be impacted 
by very very different things than a person who   lives in the middle of rural tennessee they both 
have their stressors but we need to address those   issues that's that macro system that we need to 
look at in order to provide effective prevention   for both people prevention focuses on strengths 
development and enhancing protective factors   instead of trying to get rid of depression we want 
to prevent it from occurring which means we have   to help people have the skills tools and building 
blocks to do what they need to do to prevent it   from happening we do want to reduce risk factors 
i mean prevention means reducing the risk factors   so people don't develop depression but we want 
to reduce those risk factors as much as possible   many mental health problems share some of 
the same risk factors for initial onset   so targeting those factors can result in positive 
outcomes in multiple areas so for example ptsd   anxiety and depression all have some similar risk 
factors including abuse and neglect and this can   be direct abuse where the person is abused 
or indirect where they see their their parent   being abused or they see their sibling being 
abused it doesn't matter either one of those is   very stressful and traumatic to the person family 
discord including just an air of hostility i mean   there doesn't have to be any overt violence 
but if there's a lot of hostility and fighting   and bickering and people are always grumpy 
that contributes to high levels of anxiety and   depression not only in children but also in 
the adults domestic violence obviously can be   traumatic and in some cases divorce can 
be a trigger for depression and anxiety   they identified that as one of the risk factors in 
adverse childhood experiences that are associated   with the development of depression and anxiety low 
self-esteem is another one of those things that   underlies depression anxiety and um you know 
potentially the development of addiction   lack of supportive family or peers we're not 
meant to live in isolation we are meant to   be around other people now we are in large part 
an independent society not an interdependent   society so we don't rely on others for everything 
but as humans you know we crave some sort of a   connection that's why we have an entire hormone 
called oxytocin that's our bonding hormone   so people need to have supportive peers and 
family that they can rely on when especially   when the going gets tough a lack of school 
or work success can lead to people feeling   stuck hopeless helpless anxious and depressed and 
a lack of involvement in pro-social activities   when we get involved in those activities it 
gives us a different perspective it gives it   enhances our sense of self-esteem there are 
a lot of benefits from that so we do want to   ensure people have opportunities to engage 
in pro-social activities that can be   volunteering that can be engaging and 
participating in a book club going to   the gym any of those things can help people 
be around other positive healthy individuals   so protective factors remember i said we 
want to focus on those more than eliminating   deficits self-regulation if children are able 
to self-regulate or if we work with adults who   have difficulty with emotional dysregulation and 
we teach them skills and tools to regulate their   emotions that's a huge protective factor because 
they will feel a greater sense of control over   their life and their you know what's going on 
so they'll there will be likely less anxiety   and less depression secure attachment 
you know that happens in early childhood   but it affects all of our relationships now 
people's attachment styles can be changed but it   often requires going through counseling and 
understanding attachment issues and working   through those abandonment and attachment issues 
before they can securely attach with another adult   human being people need effective communication 
skills and effective interpersonal skills in   order to get that social support we need to be 
able to communicate and play nice in the sandbox   you know we need to understand creating a win-win 
and compromise and empathy and all those things   we need to encourage family and peers to be 
supportive of one another we need to educate   people about different temperaments and different 
love languages so they can be supportive of one   another in meaningful ways consistent discipline 
and rules also creates an environment that is   less chaotic and less stressful which leads to 
less depression and anxiety if with children if   their caregivers are responsive then children 
feel less afraid and less anxious about things   everybody needs a safe environment you need 
to be able to go to sleep whether you're   2 or 62 you need to be able to go to sleep and not 
worry you need to be able to get deep restful and   sleep you need to be able to be in an environment 
that is emotionally and physically safe so you're   not feeling condescended to or criticized all 
the time that's important it doesn't matter what   age you are if you don't feel emotionally and 
physically safe it's going to increase stress   it's going to increase feelings of helplessness 
and hopelessness which translate to depression   support for learning needs to be there you know 
we all learn i learn every day i learn something   new today you know i try to learn something 
every day and sometimes i learn multiple   things but there needs to be support for people 
to learn and grow even into their elder years   there needs to be good school or work engagement 
you know we need to feel like wherever we're   spending the brunt of our waking hours we belong 
and we matter and we have a voice there have to   be positive parent and teacher expectations for 
children and there have to be positive family   and employer expectations for adults you know we 
want employers to believe that their employees   are going to succeed not uh you know let's see 
how long this will this one will last no we   want employers to go we've got a great person 
let's see how we can help that person develop   we want teachers to see children and all of their 
potential instead of seeing children as a number   and a test score we need to make sure that 
people have access to wrap around services   and that's everything but counseling basically 
when we talk about wrap around services and   counseling we're talking about everything 
else that helps the person reduce stress   and achieve their goals and be happy and 
healthy child care financial counseling   employment counseling transportation legal 
legal assistance you know you can name off   two dozen things these are all essential to have 
in your community and we're going to talk about   we're going to talk about it later but this can be 
referred to as a recovery oriented system of care   in a recovery oriented system of care or rosk 
for short the community bonds together and they   say okay what types of resources and services 
do people in our community need in order to be   happy healthy fulfilled yada yada like i said 
in in downtown nashville or downtown chicago   that's going to be different than in downtown 
rural america or even downtown suburban america   we need to take each community specifically and 
figure out what needs they have good coping and   problem solving skills are essential for emotion 
regulation and dealing with life on life's terms   because sometimes life just throws us a pile of 
crap and we got to figure out how to deal with it   so these skills we're not born with them we learn 
them we need to be educating children in school   about how to cope and problem solve we need 
to provide resources online we need to provide   you know coaching resources potentially at your 
employer maybe you have an eap on call that can   answer problems these are all protective 
factors that can help people solve a problem   before it becomes overwhelming and 
untenable and leads to a mental health issue   there need to be opportunities for 
engagement and pro-social activities   the ability to develop high self-esteem and 
self-efficacy so self-esteem is how you feel   about yourself and helping people feel good about 
themselves and say you know what i'm not perfect   but i am a really good person that's what 
we're striving for because nobody's perfect   and self-efficacy is people's individual belief 
that they can achieve their goals self-efficacy   is their that can do attitude if they believe 
that nothing they do is gonna make any difference   then they're going to feel helpless and hopeless a 
lot of times so self-efficacy helps people believe   that they can achieve their goals and change 
their situation as needed appropriate empathy   is a necessary protective factor that ability to 
understand where another person is coming from   and that's part of interpersonal skills but i felt 
it was worth breaking breaking that out because   that is another thing that you know we don't need 
to overtly learn but we do learn as we're growing   up we learn to be empathetic to other people 
and we need to have a little bit of a future   orientation i'm not saying we want to live in the 
future you know i really encourage people to live   in the present and be mindful and say okay i have 
a certain amount of energy let's call it a gallon   i've got a gallon of energy i can either pour a 
bunch of it in the past and pour a bunch in the   future and then have a quarter gallon for 
right now or i can use that gallon to make   right now the best it can be because 
if right now is the best it can be   and helps me move towards my goals then guess what 
the future is going to be pretty daggone bright but we can't eliminate risk factors because 
sometimes or avoid dealing with them because   sometimes they exist so we want to look at 
these and say how can we mitigate these things   neurophysiological deficits which is you know   encompasses a whole bunch of stuff like 
autism epilepsy and cerebral palsy okay   you've got these issues that children may develop 
or adults may develop adults can develop them too   and if they happen they happen there are 
some things we can do to help prevent them   but we don't know for example all of the 
causes we don't know what causes autism   we don't necessarily know what causes epilepsy so 
we may not be able to prevent it from happening   but we can mitigate its impact on people's mood 
so if somebody has autism early intervention   is a way of working with them to prevent the 
development of mental health issues to prevent   the development of depression and anxiety 
later in life where they yes they still are   dealing with their autism diagnosis but they're 
not developing other diagnoses on top of it   a difficult temperament is another risk 
factor that you know some some people are more   difficult to soothe and more you know some 
babies are fussier and you know that it is   what it is but we can work with those people as 
they grow to help them develop self-regulation   skills chronic illness we want to help people 
feel empowered if they've got for example   multiple sclerosis or cystic fibrosis or hiv or 
anything that's some kind of a chronic illness   yes they've got that illness let's prevent that 
from also becoming you know that diagnosis plus   depression plus anxiety so let's help them figure 
out how to live a rich and meaningful life with   their chronic illness below average intelligence 
or learning disability early intervention helps a   lot with both of these things if we can intervene 
research has shown that when students start to   fail in school or people start to flounder 
at work their self-esteem and goes down and   their risk for depression goes way up so we 
do need to make sure that we identify learning   disabilities early so if a student is having 
difficulty reading then because they're they're   dyslexic we can get them early intervention so 
it doesn't impact their self-esteem or their mood   and below average intelligence we want to help 
people make the best of what they've got and   provide reasonable accommodations in order to make 
sure that they are able to function as optimally   as possible family dysfunction is another 
risk factor and we can provide all kinds of   services for family counseling through churches 
through community centers through counseling   but it's important that if family dysfunction 
exists we recognize that we identify it and we   have resources available so the people living 
in that household don't also start developing   mood disorders or addictions abuse and neglect 
you know again we need to have outlets we need to   have things because abuse and neglect can lead to 
post-traumatic stress disorder anxiety depression   a whole range of things social disadvantage 
can lead to having a lack of a stimulating   environment it can lead to high stress in the 
household because parents are worried about money   or you know family members are worried about 
money if we're talking about adults that high   stress level can wear on you over a while after a 
while and turn into anxiety and then depression so   we need to look at in communities how can we 
help people have adequate social advantages   overcrowding or large family size you know when 
you've got six children sleeping in the same room   it can be stressful even if you're an extrovert 
that can be stressful so what can we do to help   families who feel like they're you know 
living like sardines family members with   mental health or addictive disorders can bring 
a lot of stress on the family it can also their   behaviors and the way they communicate can also 
rub off if you will we call it social learning   on other people in the family so we do want 
to make sure that anybody in that household   with a mental health or addictive disorder 
has access to treatment so the other people   in the household are not negatively impacted 
admission to foster care is a risk factor   for the development of anxiety and depression i 
mean think about it if you're a kid and all of a   sudden you're taken from home and put somewhere 
else yeah you're probably going to be anxious   if you feel like you've got no control over 
anything you know you may feel anxious and   depressed there may be some ptsd that just kind of 
goes with your life being suddenly turned upside   down and feeling you have no control so we do need 
to look at ensuring that foster care parents are   adequately prepared to deal with these issues 
reducing the factors that lead to foster care   as much as possible living in a high in an 
area with a high rate of disorganization so   if people are moving in and out constantly that 
can be a risk factor for mood disorders because   you're not able to develop stable relationships 
with people because you're meeting them and then   three months later they're gone and you've got to 
meet somebody else or if there's a high rate of you know people just becoming homeless or whatever 
it is we do need to pay attention to that because   people need to feel a sense of community and 
belonging and finally inadequate schooling   um schools that are not able to meet the needs 
of children especially children who have special   needs can contribute to their development of 
anxiety and depression because that those children   are failing which impacts negatively impacts 
their self-esteem and their sense of self-worth okay so we talked about the different 
risk factors and protective factors and   you know you can brainstorm all kinds of ways that 
you can make these things happen in your community   and it's really i've been on some of 
these steering committees before it's   actually really kind of a energizing process to 
develop a plan for a recovery oriented community   in order to figure out what do we need and where 
are the gaps and see it all come together and have   you know you can look at your community 
and it's just one great big safety net   but so moving on from prevention let's talk about 
treatment because treatment is sometimes necessary   psychodynamic treatment kind of came out of 
psychoanalysis and the role of the past in   shaping the present is emphasized so for example i 
use some psychodynamic approaches when i'm working   with clients we may be talking about their current 
relationship with their their spouse and i may   ask them about prior relationships you know 
maybe with their first love or what their parents   relationships were like things that they learned 
when they're a chuck they were a child and say you   know how is that impacting how you're acting 
in this relationship what did that teach you   and how is that playing out in this relationship 
we may not do a bunch of stuff to address the past   but we want to address the past in 
terms of how it's impacting the present   if when i'm working with trauma victims 
if they were abused when they were a child   okay if they still have a high level of anxiety 
and abandonment and all that kind of stuff   we'll talk about why they're still holding on 
to that they were unsafe when they were six   now they're 26 they're living in their own house 
they have their own rules they have their own keys   so are they still unsafe or are they still 
feeling the way they felt when they were six   psychodynamic approaches believe in the 
unconscious so there's much from the past   that influences our behavior that we're not aware 
of which is why in psychodynamic theory our goal   is to make the unconscious conscious you 
know i start trying to draw connections about   you know well i'm wondering um my mother was 
recently diagnosed with cancer and my stepfather   is you know really struggling with that and you 
know as anyone would but he had had a loss when   he was much younger with his first family with his 
first wife passing on and now that my mother has   potentially got a terminal disease it is bringing 
up that past and opening those old wounds for him   again so you know i pointed out that connection 
and she's like oh i hadn't thought about that   so those are things that we want to be aware 
of and sometimes as clinicians since we are not   in stuck in the midst of it we can see 
things that clients aren't able to see   right then so psychodynamic is can be 
really effective and really awesome   it can be challenging and totally not appropriate 
for clients who have significant cognitive issues   or who have a psychotic disorder and they're you 
know not grounded in our reality at the moment   behavioral approaches focus on current behavior 
and observable actions a strict behavioral   approach does not care about emotions or thoughts 
anything that can't actually be seen and measured   is irrelevant so you know that's a benefit and a 
drawback you don't get distracted by things but   there's a lot about the human experience you miss 
if you don't consider thoughts general principles   of learning are applied to the learning of 
maladaptive as well as adaptive behaviors   so in behaviorism they believe that by 
controlling what's rewarded and what's punished   we can basically help somebody unlearn 
an old behavior and learn a new behavior cognitive behavioral takes that aspect that 
behavioral is not paying attention to i   don't want to say lacking because it's 
you know a very well researched theory   but cognitive behavioral takes those thoughts 
and adds them to the behavior so we look at how   are your thoughts influencing your behaviors and 
your emotions and we call that the cognitive triad cognitive behavioral explores how thoughts and 
environmental stimuli shape the behavioral and   learning and how learning shapes thoughts so for 
example and i use this example a lot so forgive me   but you know if you when you were a kid there was 
a dog that chased you and nipped at your heels   when you were riding your bike now when you see 
a dog that's running and barking you might feel   afraid because that's what you learned you you had 
a bad experience so that was you know unpleasant   so you may have a stress reaction whereas i've 
grown up around animals all my life and you know   have never had such an experience so when i see 
a dog running and barking i'm like oh the puppy   wants to play um we're seeing the same dog we're 
seeing the same dog do the same thing but we have   different thoughts about the situation which 
leads to different emotions about the situation   cognitive behavioral therapy strives to alter 
faulty cognitions or thoughts and replace   them with thoughts and self-statements that 
promote helpful behavior so instead of saying i   can't do this having them say i choose not to that 
gives them an element of choice yes it's semantics   and we also look at unhelpful thoughts like all or 
nothing thinking like this always happens well we   address that by looking at what are the exceptions 
when when does this sometimes not happen   or jumping to conclusions without 
having all the information   there are several cognitive distortions is 
what we call them that we look at when we're   working with people who have anxiety and 
depression issues again this is not a great   approach for somebody who is actively psychotic 
or who has significant cognitive deficits   but for most people cognitive 
behavioral is a good approach and going back to behavioral behavioral approach 
although it doesn't address thoughts is extremely   useful with small children even with adults and 
um with people who who do have cognitive issues   because we're not dealing with cognitions 
we're dealing with rewards and punishments and finally the humanistic approach and that's 
what most of us are trained in as clinicians   when we go through college the central focus of 
humanistic therapy is the immediate experience   of the client what is going on with you right 
now how do you feel and there's an emphasis   on feelings and emotions the emphasis is on the 
present and the potential for future development   rather than on the past and we emphasize immediate 
feelings rather than thoughts or behaviors so   i want to know how you're feeling right now 
what's going through your mind and how can we   help you start feeling better it is rooted in 
the everyday subjective experience of the person   seeking assistance and is much less concerned 
with mental illness than it is with human growth   humanistic approach believes that if people are 
given a warm environment filled with unconditional   positive regard that means the therapist provides 
positive support for people just for being people   not for what they do but just because they're 
humans unconditional positive regards says   i love you for being a good person you know for 
being you not for anything you do or don't do   and that can open the doors a humanistic approach 
to child discipline for example is to remember to   separate the child from the behavior so telling 
the child i love you i did not like this behavior   you know that's a very humanistic approach 
to parenting but we want to help people   grow and humanistic approach believes if we 
create this supportive warm rewarding environment   that people will naturally grow because people 
naturally want to move forward a critical aspect   of humanistic treatment is the relationship 
between the therapist who serves as a guide   in an exploration of self-discovery so you know if 
somebody's feeling bad we might talk about why are   you feeling depressed right now and you know tell 
me about times when you haven't felt depressed you   know how do you think um you can go about feeling 
less depressed what do you think needs to change   so we're using a lot of socratic questioning and 
asking the person to really get in touch with   themselves and their needs humanistic is very warm 
and supportive but it tends to be a lot slower in   providing relief and progression than 
behavioral or cognitive behavioral   and finally pharmacological and you know most 
therapists use a range of approaches we're   not just purely humanistic or purely cognitive 
behavioral or purely pharmacological we use a   range and it's important to know which approaches 
are out there and which tools are out there so you   have the right tool for the right job you don't 
want to use a hammer when you need a screwdriver   so pharmacological treatments include 
antidepressants these are your ssris selective   serotonin reuptake inhibitors which increases 
the amount of serotonin in people's brains   snris your selective norepinephrine reuptake 
inhibitors which increases the amount of   norepinephrine in people's brains norepinephrine 
is helps us with motivation energy and focus   and your tricyclic antidepressants 
which are used a lot less   generally the first line is your ssris or your 
snris but these can be used for depression anxiety   and compulsive behavior like in ocd or you know 
addiction or eating disorders your anxiolytics or   your anti-anxiety medications obviously address 
anxiety and those are your benzodiazepines your   xanax and your valium and those sorts of things 
your antipsychotics you have two types typical and   atypical your atypical or your newer ones these 
are typically used for schizophrenia and psychotic   disorders sometimes you may see them used to help 
address some of the manic symptoms in bipolar   stimulants are used to address add and adhd 
pretty much nothing else mental health-wise   and then anti-manic medications such as lithium 
or anti-convulsant medications like depakote   are used to address mania one thing to be 
aware of is if somebody has bipolar disorder   and they start taking antidepressants 
it can trigger a manic episode so   differential diagnosis of depression 
versus bipolar is super important now this was one thing i learned about doing 
this presentation ethnopsychopharmacology   ethnic and cultural influences alter an 
individual's responses to medications these   differences are both genetic and social in nature 
so you know you're like they range from genetic   variations in drug metabolism due to genetic 
variations in drug metabolism metabolizing enzymes   and that can also um affect people who are 
elderly as well the the levels of enzymes in   their system changes as well so we do need to be 
aware that some people are going to metabolize   stuff faster than others and you may even see 
this you know in day-to-day life for example   you know i know people who take the average adult 
dose of benadryl and they're fine i mean they're   a little groggy but they're fine i take half of an 
adult dose of benadryl and i'm drooling on myself   you know i'm you know i always refer to myself 
as a lightweight but basically i have fewer drug   metaboli metabolizing enzymes for that particular 
drug in all probability so i don't need as much   in order to get a significant effect 
cultural practice practices may affect diet   so you know genetic variations we can understand 
but you're like where does culture come in well   people who eat certain foods or don't eat certain 
foods may respond to medication differently   and i didn't know whether to put it under 
cultural practices or medication adherence   when i worked at the clinic in in florida every 
summer our crisis stabilization unit would have   a super influx of homeless people with 
psychotic symptoms whenever it got hot   and we finally had an attending 
physician that identified the fact that   people who are homeless are not staying adequately 
hydrated and antipsychotics are extremely   sensitive to changes in blood levels 
so changes in hydration alter the blood   level of the antipsychotic which alters its 
effectiveness so in order to keep people stable   one of the things we had to do is make sure they 
stayed adequately hydrated too much hydration or   too little hydration would throw the dosage out 
of whack and they would start becoming symptomatic   so that was an interesting 
thing that i learned back then   but cultural practices can also affect 
diet medication adherence is important   some cultures don't believe in medication so 
getting people to take it you know might be   challenging obviously a lot of that is also 
the client's choice but we need to make sure   that medication is available culturally some 
people may not have access you know they may   financially not have access to certain medications 
or something so we need to make sure that have   availability of the medications and they can 
maintain blood level stability i worked with   another client who was schizophrenic a sweet man 
but and and was very you know on point because   he came in one day to the detox unit and you know 
obviously was under the influence and i i told him   i was really concerned because using the drugs he 
was using with the drugs he was supposed to be on   um was you know really really dangerous and he 
said oh don't worry dr snipes i quit taking my   prescribed medications um on friday so i 
could party all weekend i was like okay well at least you had the forethought 
to do that but that's a problem   so we needed to talk about that sorry y'all okay and the simultaneous 
use of traditional and alternative   healing methods can also um alter levels of 
medications for example certain herbs that   people may take from eastern medicine can 
increase or decrease levels of hormones or   neurotransmitters so if people are also taking 
medication for hormones or neurotransmitters   they could be working against each other or they 
could be exponentially intensifying one another one third of african americans and asian americans 
are slow metabolizers of antipsychotic and   antidepressant medications which means it's easier 
for them to od or experience serotonin syndrome   or on antipsychotic medications they may   experience what we call extra pyramidal side 
effects which are the really bad side effects   from your antipsychotic medications like 
clicking your lips and shuffling your feet where you know a caucasian american may take one 
dose and be fine if you give that same dose to   some african americans it will cause significant 
negative side effects and a lot of times   doctors may not understand this especially general 
practitioners who are prescribing as opposed to   psychiatrists they may not be educated about 
the differences in metabolism between the two   ethnicities so it's really important for 
clients to understand so they can advocate   for themselves and we can advocate for them if 
necessary a lot of times um african americans   and asian americans are started on a lower dose 
than caucasian americans for this very reason   barriers to treatment include demographic factors 
you know some people can't afford it it's just   it's too expensive and they don't have enough 
insurance or their deductible is too high so   they still be paying for it out of out of pocket   ethnicity is a big barrier some people don't want 
to go in if they don't feel like the clinician   they're going to be seeing understands their point 
of view from an ethnicity point of view and age there are only certain people who feel comfortable 
and who are trained to work with children   especially young children and there's there's 
special training to work with an older population   and a lot of people who are older adults want 
to work with somebody who is not the same age   as their grandchild they want to work with 
someone who you know went through the great   depression or something and can understand their 
values and their points of view a little bit more   so we do need to make sure that even if we don't 
have people on our staff that are reflective of   everyone's ethnicity and age group and everything 
that our staff is educated about the special needs   of those particular populations other barriers 
include patient and cultural attitudes such as   shame and stigma we want to dispel shame and 
stigma we want to get out in the community we   want to you know sing it from the rooftops that 
people get depressed people develop anxiety people   have ptsd it doesn't mean they're broken it means 
that they are you know struggling with something   some people believe they don't have the time well 
with the advent of e-therapy that excuses quickly   going out the window because what used to be 
a three-hour ordeal for some people getting   getting to the appointment sitting in the 
appointment and then driving back home   after the appointment having to get child care 
and all that kind of stuff that kind of goes out   the window when you can call your therapist at you 
know two minutes before your appointment have your   appointment and then you know hang up and go give 
your kid a bath so time is less of a barrier now   many people still have a fear of being 
hospitalized you know they're afraid if i tel   if they come in and they tell us that they 
are thinking about committing suicide that we   are going to automatically commit them or if they 
tell us that they've been using cocaine that we're   going to have them arrested or hospitalized so we 
do need to be very clear at the outset about the   limits of confidentiality but also let them know 
you know it is a safe place to talk about things   and along with that kind of goes 
mistrust some people who have been   exposed to this the system for lack of a 
better phrase um have had bad experiences   where people have told them one thing and then did 
something else or they felt manipulated or lied to   so it's really important that from jump 
we are as transparent and open as possible   some people think they can handle it alone and 
you know they have to get to the point where   they're ready to receive help and a lot of times 
it's a balancing act of you know would it be nice   to get another opinion yes but i don't have the 
time and i don't want to fork over the 60 bucks   if we can find ways to provide affordable 
early intervention services that are easily   accessible such as hotlines and you know drop-in 
e-therapy that can help dispel some barriers   sometimes people think that nobody can help 
you know nobody understands or nobody can   make it better and you know there are 
times when people feel really stuck   i have yet to experience working with a client 
who wasn't able to make some progress to improve   things i'm not saying that i can fix everything or 
that clients can fix everything for themselves but   generally there is somebody out there if it's 
not me it's you know this clinician over here who   knows this other technique or this psychiatrist 
over here or an attorney or whatever um   that their problem is so asking for help 
asking for in counseling getting in counseling   can help people connect with the resources that 
can help um and and again as clinicians we need   to make sure we don't bear the weight of the 
world on our shoulders we can't fix everything   we can't fix a lot of things we know what we can 
fix but then we can refer out to for other issues   and a lot of cultures identify mental health 
issues as medical they feel fatigued loss   of appetite irritable not much pleasure 
and stuff change in sleeping habits you   know those are all symptoms of depression 
but they may present to their physician   as being sick or having a thyroid issue or 
something and want it to be something medical   because in that culture mental health 
issue maybe issues may be stigmatized and we've got a fragmented system and that's 
another barrier to use because it can be difficult   to figure out how do i get help do i have 
to get a referral from my primary care   um can i just walk in where do i get it 
from who do i go to and basically we've   got four sectors in the system the specialty 
mental health sector that's us the counselors   the general medical primary care sector that's 
your primary care physicians the human services   sector and those are your case workers those are 
your people who help people get signed up for food   stamps and you know vocational rehabilitation 
and then there's the voluntary support   network sector which is all of your self-help 
groups and support groups but a lot of times we   don't talk very well and we don't communicate 
very well so it's important to recognize what   sector you're in but also be aware of all of the 
other sectors so you can make referrals as needed remember that 28 to 47 percent of the population 
have a diagnosable mental health or substance   abuse disorder in any in in any given lifetime 
only about one third of people who needs treatment   receives treatment in any given year so two-thirds 
of those people are suffering on their own when we talk about culture we need to 
remember that the term culture is used   loosely to denote a common heritage and set 
of beliefs norms and values most people have   multiple ethnic or cultural identities 
for example i'm a caucasian i'm a female   i'm a catholic so those are three different 
cultures right there the level of acculturation   differs between individuals so the values of 
being a woman for example that i embrace may   be different than what somebody else embraces and 
this is a little bit clearer when we talk about um   ethnicities and people who immigrate 
into this country so for example my um uh   stepfather was italian or is was italian 
he still is i guess um and you know he is   relatively fully acculturated to american 
culture now he still eats italian food and   stuff but he does not adhere to the same 
mores and beliefs that his family does over   in italy so he is more acculturated to american 
culture than to italian culture we do need to be   cognizant of that because every person has 
multiple cultures and but very rarely do   people fully embrace the entire culture and for 
them for their own personal you know definition culture impacts how people identify mental health 
issues whether they identify it as shameful   or just a thing whether they identify it as mental 
health or physical culture impacts the meaning   assigned to mental health issues such as is 
it a punishment from god or is it um you know   what caused it culture impact coping skills not 
every culture uses the same coping skills some   pray some use avoidance activities to just try 
not to dwell on it some actively address it   and culture impacts appropriate treatment 
modalities not everybody is going to be   appropriate for group counseling some cultures 
are very opposed to that some cultures   believe that the family should be involved in the 
whole treatment process which is going to affect   your selection of treatment approaches so we do 
need to talk with people about you know how do you   see this best being handled what coping skills do 
you have where do you believe this issue came from   and what are your feelings about 
having a mental health issue finally cultures vary in their use 
of family and community as resources   ties to family and community especially in 
african latino asian and native american   communities is often pretty strong due to the 
need to assist arriving immigrants provide a   sanctuary against discrimination provide a sense 
of belonging and affirm a centrally held cultural   or ethnic identity so they can get together 
and go okay this is this is what we believe   and they can feel a part of something 
they can feel a sense of connectedness   families often play an important role in providing 
support to individuals so we need to engage   the family however that person defines their 
family it may not be their blood relatives   a strong sense of family loyalty means 
that despite feelings of stigma and shame   families are an early and important source 
of assistance in efforts to cope so in some ethnicities in some cultures where it is very 
family-centric and interdependent then this   strong sense of family loyalty will make it even 
more important to engage the family as a resource   minority families may expect to continue to be 
involved in the treatment of a mentally ill member   like i said they may expect to be invited into 
sessions they may expect to be read in on the   treatment plan obviously we need releases of 
information and everything to do these things   but if they're wanting to be involved and 
the patient is wanting them to be involved   then we need to figure out how to make that happen and lastly we're going to talk about this 
recovery concept and in the past few years   it started to become referred to as a 
rosk or recovery-oriented system of care   recovery is a process it can be thought of 
as an outlook a vision or a guiding principle   but it doesn't refer to any specific services 
recovery is sort of a overarching concept   a person with mental illness can recover even 
though the illness is not cured recovery is a way   of living a satisfying hopeful and contributing 
life even with the limitations caused by illness   recovery involves the development of a 
new meaning and purpose in one's life   as one grows beyond the catastrophic 
effects of mental illness now i don't   exactly like that quote but basically it's saying 
recovery is living a rich and meaningful life   despite the fact that you have whatever this is 
going on depression um pain or whatever it is when we use a recovery concept consumers have a 
more optimistic attitude and their expectations   may improve the course of their illness so if 
they have this optimistic attitude and they're   looking at how to create a rich and meaningful 
life and they're seeing positive forward movement   then it's likely going to help 
them in their recovery process   the most common factors associated 
with recovery are medication   for some medication works in about 35 percent of 
the cases community support and case management   self-will or self-monitoring so we need to improve 
mindfulness vocational activity helping people   engage in those pro-social activities and this 
can be volunteer work paid vocation or school   and spirituality again as the person defines 
it not necessarily organized religion   the recovery-oriented system of care has the 
basic principles of using a multi-disciplinary   so you know you have medical you have social 
services you have legal you have financial   counselors you have counselor counselors you 
know everybody and his brother is available in   the safety net so it's multidisciplinary episodic 
system of care so people come in you know they're   in crisis or whatever they come in they get 
into the system they get to a point where   they're stable and maybe they decide okay i need 
to take a break from treatment for a while so they   leave treatment and or whatever you want to call 
what they're going through and they're fine for a   while and then maybe life hands them lemons and so 
they need to come back in so we're looking at this   episodic system we don't need to keep people in 
treatment for years and years and years a lot of   times people can come in reach maximal gains leave 
and then come back when they either need a tune up   or additional skills and this multi-disciplinary 
episodic system of care has no wrong door which   means no matter where the person enters the system 
whether they present at their primary care's   office or they present for counseling or they 
present at social services or even at the jail   they are identified as having a mental health 
issue that needs addressing and the referrals   can be made adequately and expediently emphasis 
is on achieving goals versus removing death   defects so we're really helping people 
achieve that rich and meaningful life   because if they have that then they're likely 
not going to feel as depressed or anxious etc so mental health issues are mediated by brain 
function we learned that um in in part one and   mental disorders are defined by signs symptoms and 
functional impairments so how the person presents   as opposed to causes because we don't 
know what causes depression or anxiety   we know some things that are related remember 
correlated like we talked about in part one   twenty percent of americans experience 
a mental disorder in any given year   but a range of treatments including counseling 
and psychopharmacology are available for most   disorders so if one treatment doesn't work we 
can try another treatment or try a different   combination of treatments and it's important 
to help clients understand that mental health   treatment is part art part science so they need 
to communicate with us about what's helping   so we can keep those parts and what's not helping 
so we can replace those with something else   the consumer movement has increased 
the involvement of individuals with   mental health disorders and their families in 
mutual support services consumer run services   and advocacy so we've got people coming 
out in that self-help sector saying   you know we're going to kind of help fill the gaps 
between what the professionals do and you know   provide some free for free and freely accessible 
services the recovery concept reflects renewed   optimism about the outcomes of mental illness and 
the opportunities for persons with mental illness   to participate to the full extent of their 
abilities in the community of their choice in this presentation we also reviewed prevention 
strategies from mental illnesses and we talked   about in enhancing self-esteem and self-regulation 
communication and interpersonal skills you know   we talked about all those things and we identified 
the fundamentals the benefits and the drawbacks of   psychodynamic behavioral humanistic and 
pharmacological treatments and talked a   little bit about ethnopsychopharmacology which 
if you remember was the use of pharmacological   interventions with people of different 
ethnicities and then we've ended by   identifying factors that enhance utilization 
of services including providing culturally   responsive services responsive not only to race 
and ethnicity but also to age and specific issues   addressing unique coping sky styles 
especially as they relate to the   person's particular ethnicity so if prayer is one 
of their things and they use a spiritual leader   in their treatment then we need to integrate that 
we talked about engaging the family in treatment   to remove some barriers and enhance services 
if they feel like they're working together   and in harmony with their culture and addressing 
cultural barriers including mistrust and stigma thank you for being with me today 
and i will see you next week if you enjoy this podcast please like and 
subscribe either in your podcast player or on   youtube if you want to attend and participate in 
our live webinars with dr snipes you can subscribe   at https when slash slash all 
ce use dot com counselor toolbox   this episode has been brought to you in part by providing 24 7 multimedia continuing   education and pre-certification training to 
counselors therapists and nurses since 2006.   you can use coupon code counselor toolbox 
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