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The Family Crisis Moment The Impact of Mental Illness on Families

PSRT 4271: The Family Role in Rehabilitation

Week Four

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The Family Crisis Moment

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What is a crisis? (Roberts, 2005)

“…disruption of psychological homeostatis…”

“…usual coping mechanisms fail…”

“…distress and functional impairment…”

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A perception… (Bard and Ellison, 1974)

“…subjective reaction…”

“…to stressful life experience…”

Functioning “…seriously compromised...”

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Characteristics of those in crisis

Threat

Incapacity

Fear

Discomfort

Disequilibrium

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Crisis Theory

There is such a thing…

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Roberts’ Crisis Intervention Model(Roberts, 2000)

7. Follow up. 6. Make an action plan. 5. Explore alternatives. 4. Deal with feelings. 3. Identify major problems. 2. Establish rapport.1. Assess lethality.

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How people react to disability (Powers & Dell Orto, 2004)

5 determinants:

1. Triggering events2. Severity of disability3. Personal influences4. Contextual influences5. Stigma; societal reactions

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Effects: 8 “themes” (Power &

Dell Orto, 2004)

Denial Grief Guilt Isolation Anger Depression Coping Acceptance

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Needs (Power & Dell Orto, 2004)

Meaning Support Validation Information Balance

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Ways of Coping

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Providers: How to help? (Clarke & Windsor, 2010)

Acknowledge; connect; engage

Offer coping mechanisms

Comprehensive involvement at discharge

Instill hope

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Impact on Families(The Raft of Medusa, by Theodore Gericault, 1791–1824)

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Mental Illess: Decision Elements

Medical

Cultural?...

Political?...

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Stages of “Emotion Management”

(Karp & Tanarugsachock, 2000)

“Emotional Anomie”• Bewilderment• Confusion• Denial

Diagnosis Clarity• Empathy• Initial optimism• Heroic efforts• Obligation

• Frustration: Role? Reciprocity?

Illness Permanency• Doubts, “surrender” to reality• Frustration, anger, resentment• Sadness, grief• Diminished expectations• Isolation

Acceptance• Didn’t cause it• Can’t control it• Can’t cure it• Can only cope with it

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Overall (Milliken & Northcott, 2003)

Disenfranchisement

“When parents try to assume responsibility for an ill adult-child with schizophrenia, the law, mental health prac-titioners, and often the ill person reject their right to do so.”

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Mothers (Copeland & Heileman, 2011)

Feelings Powerless, voiceless, anxious, frustrated,

isolated, tired, desperate, trapped, guilty, worried, scared, sad, grief, confused

“Internal factors” Sense of safety Perception of care ability Contingencies and consequences Maternal love and obligations

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Fathers (Wiens & Daniluk, 2009)

1. Reflection on roles2. Devastation and vulnerability3. Sadness and loss4. Frustration with the system5. Admiration for the child6. Personal growth and learning

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Siblings (Lukens, Thorning & Lorher, 2002)

One step removed…

Reactions to illness Strategies for coping

Whether, how to intervene? Setting limits? Resentment, anger, hopeless?

Efforts to obtain services Wish for validation

Efforts to help themselves

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Grandparents (Seeman, 2009)

What happens when ill child has children?

Custodial, co-resident, nonresident… Child’s exposure to mother’s illness

Financial impact Isolation Role conflicts Divided loyalties

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Redefining parental identity (Milliken & Northcott, 2003)

“Anticipating” Parent

Marginalization

Disenfranchised parent

“Embracing the collective”

Re-enfranchised parent

Evaluating my life

Emancipated parent

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Our Presentation Topic…

Bellevue Inside Out Trailerhttp://www.youtube.com/watch?v=Ojd_fsHbGl8

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Our guest presenter…Jim Romer, Monmouth County Crisis Screening Center

• > 30 years of experience.

• County Services Director for Monmouth Medical Center (Long Branch, NJ)

• Former Director of Screening Services for Ocean County at Kimball Medical Center in Lakewood, NJ

• President of the Mental Health Emergency Screening Association

• NJ Certified Screener No. 1

• Monmouth Youth Council.

• Special interests: kids in crisis. youth suicide issues.

• Bachelors of Arts from Seton Hall University.

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Jim Romer

James Romer, Monmouth County Services Director, Monmouth Medical Center (Howell, Monmouth), Member, NJ SAFE Task Force

James Romer is a mental health professional with more than 30 years of experience. He currently serves as the Monmouth County Services Director for Monmouth Medical Center in Long Branch, New Jersey. He previously served for nearly 20 years as Director of Screening Services for Ocean County at Kimball Medical Center in Lakewood, between 1991 and 2009. Romer is President of the Mental Health Emergency Screening Association, was the first certified screener in New Jersey and serves on the Monmouth Youth Council. Romer has been proactive reaching out to law enforcement regarding issues of kids in crisis. His current work includes health screening for individuals, providing evaluations for the danger they pose to themselves or others, kids and adults alike. Romer has also experience working with school populations on youth suicide issues. He obtained his Bachelors of Arts from Seton Hall University.