It Takes a Village: Mental Health Care and the Role of the
Family Jeffrey Rakofsky, MD Assistant Professor Emory University
Mood and Anxiety Disorders Program
Slide 2
External Industry Relationships *Company Name(s)Role Equity,
stock, or options in biomedical industry companies or publishers**
None Board of Directors or officerNone Royalties from Emory or from
external entity None Industry funds to Emory for my research
AstraZeneca, Novartis, TakedaPrincipal Investigator OtherNone
*Consulting, scientific advisory board, industry-sponsored CME,
expert witness for company, FDA representative for company,
publishing contract, etc. **Does not include stock in
publicly-traded companies in retirement funds and other pooled
investment accounts managed by others. Dr. Jeffrey Rakofsky,
Personal/Professional Financial Relationships with Industry
Slide 3
Todays Agenda: I. Mental Health Care and the Role of the Family
II. Exciting Research Conducted by Department of Psychiatry faculty
at Emory University
Slide 4
Mental Health Care and the Role of the Family
Slide 5
Learning Objectives 1.To understand why families must get
involved in the psychiatric care of their loved ones 2. To
appreciate the different phases of illness and most appropriate
behaviors from family members 3. To appreciate the dynamic nature
of healthy family involvement throughout the different phases of a
loved ones illness
Slide 6
Families must be involved! Psychiatric illness, unlike medical
illness, affects judgment. - Psychosis - Depression - Mania -
Addictions
Slide 7
Families must be involved! Staying well costs money and
requires resources: - Hospitalization - Doctors appointments -
Transportation - Medications
Slide 8
Families must be involved! Regardless of psychiatric illness,
the fewer relapses that occur over time, the better a person will
do over the long run.. So, give your loved one the best chance of
staying well by getting involved (appropriately)!
Slide 9
Phases of Care: I. BEFORE TREATMENT II. ACUTE TREATMENT III.
RECOVERY
Slide 10
I. BEFORE TREATMENT
Slide 11
Before Treatment 1)Getting a loved-one to treatment 1)Historian
Family has 2 essential roles:
Slide 12
Getting a loved-one to treatment Involuntary Meets 1013
criteria Voluntary Doesnt meet 1013 criteria 1013 Criteria: a)Has
mental illness AND a)Is an imminent threat to self or others, OR
b)Is too disorganized to care for self **At this point, firearms
should be removed from the house.
Slide 13
Involuntary-Options Call the police (Crisis Intervention Team)
Call Georgia Crisis and Access Line (Mobile Assessment) Get a court
order Dont be handcuffed by threats of suicide. Doing nothing could
ultimately be worse..
Slide 14
Voluntary-Options Talk to the loved-one Dont yell or argue or
blame Be empathic Share your concerns (I statements) Help your
loved one identify his/her perceived barriers to getting mental
health care
Slide 15
Voluntary-Options Consider hiring an Interventionist Consider
tough-love approach Can wait until rock-bottom, but dont get pulled
down too!
Slide 16
Dont bring stigma home with you Stigma can be toxic and
undermine your loved ones recovery Muster up the courage to talk to
people you trust (e.g. clergy, your primary care doctor) and ask
for help and resources.
Slide 17
Know your options! Voluntary Private practices Day treatment
hospitals Medical or psychiatric emergency rooms Involuntary
Medical or psychiatric emergency rooms
Slide 18
Historian Be ready to provide clinicians with information about
the loved-one: - Behaviors - Concerns - Medical history -
Psychiatric history - Medications
Slide 19
II. ACUTE TREATMENT
Slide 20
Facilitating the process Visit loved-one in the hospital
Provide transportation to outpatient appointments, pharmacy,
phlebotomy clinic Help with medication and outpatient visit co-
pays
Slide 21
Treatment adherence Consider dispensing medication to loved one
Consider watching loved-one take medicine daily Organize daily
medicines in a 7-day pill box.
Slide 22
Be Vigilant! Look out for signs of worsening symptoms Look out
for signs of adverse drug reactions If present, first encourage
loved-one to notify doctor
Slide 23
Communications with therapist/psychiatrist Call clinician with
concerns/updates but dont expect clinician to return your call or
provide details of the loved-ones care. Do not expect the clinician
to hold secrets for you about the loved one.
Slide 24
STOP YELLING!!!!! Reduced expressed emotion among families is
linked to better outcomes for patients Consider Family-Focused
Psychotherapy to help improve communication skills between family
members and improve attitudes about mental illness.
Slide 25
Avoid avoidable stress Stress is a trigger for most psychiatric
illnesses Consider the effects on the loved-one of upcoming family
events within or outside the homereschedule!
Slide 26
Shoulder the burden Consider taking over some of the loved-ones
tasks around the house May have to take on extra work to compensate
for loved-ones inability to work Consider hiring a
caretaker/housekeeper to help compensate
Slide 27
Stay Healthy! Individual psychotherapy/NAMI support groups
Exercise Take a break and engage in activities that you enjoy
Remind yourself that youre not to blame for your loved one being
ill or not healing quickly enough. Keep an eye on the health of
other family members as well
Slide 28
III. RECOVERY
Slide 29
Reduce Vigilance Too much for too long can be taxing for you
and loved-one Need to restore power-balance The loved-one needs to
learn self-monitoring May develop naturally for you
Slide 30
Support a return to work/school The loved one (and their
families) have to learn what patients can and cant do by trial and
error Crucial for a patients self esteem and sense of
competence
Slide 31
Communications with therapists/psychiatrists Time to stop!
Continuing may undermine the loved ones recovery and jeopardize the
doctor-patient relationship
Slide 32
Model healthy behaviors Avoid drinking/drug use in front of
loved-one Regularly attend your own doctors appointments Keep
regular sleep/wake cycle
Slide 33
Loss of caretaker identity Monitor for your own emotional
reactions May be unconscious for some Individual psychotherapy
Slide 34
Beware of your resentments This is usually when they tend to
emerge Understandable given the disruption to your life/work/family
but can be very toxic Couples therapy/Individual therapy
Slide 35
Stay Healthy! So youll be emotionally and physically ready to
respond if theres a relapse Individual psychotherapy Exercise Thank
yourself for your efforts and sacrifices to keep your loved-one
safe and healthy
Slide 36
Conclusion Families matter! Stay healthy so you can endure the
ups and downs Phase-appropriate behavior from family members is key
to the success of your loved one!
Slide 37
Exciting Research Opportunities at Emory University!
Slide 38
Emory Psychiatry is a Translational Research Enterprise
Slide 39
..Throughout Atlanta
Slide 40
.Unlocking the mysteries behind the most severe mental
illnesses! Schizophrenia Bipolar disorder Major depressive disorder
Specific phobias Autism Generalized Anxiety Disorder Post-traumatic
stress disorder
Slide 41
Our Stats.. The Emory University Department of Psychiatry has
received $22 million in research funding for the first 11 months of
the 2012- 2013 fiscal year Ranked # 19 among all (@120) psychiatry
departments nationwide in NIH research funding
Slide 42
HERES A SAMPLING.
Slide 43
Bipolar disorder 2 clinical trials using a sublingual form of
Ramelteon: 1.Is it better than placebo in the treatment of bipolar
depression? 2.Can it prevent new episodes of depression or mania
better than a placebo?
Slide 44
Major Depression 4 clinical trials (neurostimulation): 1)Does
Deep Brain Stimulation (DBS) improve treatment-resistant
depression? 2) Does Transcranial Direct Current Stimulation (tDCS)
improve depression? 3) Does Rapid Low FrequencyMagnetic Stimulation
(RLFMS) improve treatment- resistant depression? 4) Does Repetative
Transcranial Magnetic Stimulation (rTMS) improve depression?
Slide 45
Major Depression Biological study: 1)What markers of
inflammation and hormonal changes are associated with major
depression, sleep problems and cognition?
Slide 46
Posttraumatic Stress Disorder 2 Clinical trials: 1)Is a
medication that blocks the Cortisol- Releasing Hormone receptors in
the brain better than placebo for women with PTSD? 2)Is a
psychotherapy approach that involves skills training, affective
regulation and narrative therapy better than treatment as usual for
women with PTSD?
Slide 47
Posttraumatic Stress Disorder Biological study: What genetic
markers are associated with PTSD among patients living in
inner-city Atlanta?
Slide 48
Autism 5 year, $9.5 million grant to study Oxytocin: 1) What is
the impact of oxytocin on brain activity, social perception and
attunement on rhesus monkeys? 2) What is the impact of oxytocin on
brain activity and social cognition in patients with Autism?
Slide 49
Generalized Anxiety Disorder Clinical trial: 1)Is 6 weeks of
Swedish massage therapy better than light touch in the treatment of
Generalized Anxiety Disorder? 2) What changes in markers of
inflammation and oxytocin occur as a result of massage
therapy?
Slide 50
Specific phobia Clinical trial: 1) Is 8 weeks of prolonged
exposure therapy using virtual reality technology effective in
reducing a fear of flying? 2)Does a genetic marker associated with
learning and memory predict who will improve?
Slide 51
Stress response Clinical trial: Does 12 weeks of meditation
training affect overall quality of life, and affect physiologic,
hormonal and inflammatory markers of stress?
Slide 52
GET INVOLVED! Help advance psychiatric research for you and for
those who will come after you! Consider a clinical trial or a
biological study .but talk to your psychiatrist first! A win-win
situation
Slide 53
Questions? Call 404-727-MOOD (6663) or visit
Emoryclinicaltrials.com for more information!