Youth Mental Health Youth Mental Health AwarenessAwareness

Wisconsin Heights School District Wisconsin Heights School District Community PresentationCommunity Presentation

Nancy Pierce, MA, LCSWNancy Pierce, MA, LCSWAdvanced Clinical Practitioner Advanced Clinical Practitioner

Emergency Services UnitEmergency Services UnitJourney Mental Health CenterJourney Mental Health Center

What is YMHA*?What is YMHA*? Recognize signs of developing mental Recognize signs of developing mental

health problem requiring treatmenthealth problem requiring treatment Aware if youth is moving towards a Aware if youth is moving towards a

mental health crisis mental health crisis Acknowledge disruption in functioning at Acknowledge disruption in functioning at

school/job, homeschool/job, home SocialSocial PhysicalPhysical EmotionalEmotional MentalMental

*Youth Mental Health Awareness

Why YMHAWhy YMHA Mental health problems more common than we Mental health problems more common than we

thinkthink Mental health problems often develop during Mental health problems often develop during

adolescence and even youngeradolescence and even younger Youth mental disorders look and feel differently Youth mental disorders look and feel differently

than adults so may not be recognizedthan adults so may not be recognized Youth not informed about mental illness/disordersYouth not informed about mental illness/disorders Misunderstanding and discrimination associated Misunderstanding and discrimination associated

with mental health problemswith mental health problems Professional help for youth not always close byProfessional help for youth not always close by Early intervention = positive outcomesEarly intervention = positive outcomes

Myths, Stereotypes and Myths, Stereotypes and StigmaStigma

Myths and stereotypes about violence, Myths and stereotypes about violence, character weakness leads to stigma, denial and character weakness leads to stigma, denial and avoidanceavoidance

Major challenges to recognize and take actionMajor challenges to recognize and take action Difficult to talk about or disclose by Difficult to talk about or disclose by

youth/families because of fear, shame, youth/families because of fear, shame, humiliationhumiliation

Culture counts when it comes to mental illnessCulture counts when it comes to mental illness Feeling/being different especially difficult for Feeling/being different especially difficult for

youthyouth

Youth at RiskYouth at Risk Learning, social, emotional, behavioral Learning, social, emotional, behavioral

difficultiesdifficulties Physical pain, disability or challengesPhysical pain, disability or challenges Sexual identity, questioning, ambiguitySexual identity, questioning, ambiguity Victims of bullying and bulliesVictims of bullying and bullies Children placed out of homeChildren placed out of home Race and ethnicityRace and ethnicity Poverty, homelessnessPoverty, homelessness Parents living with mental illness/substance Parents living with mental illness/substance

abuseabuse

Adolescence ChangesAdolescence Changes PhysicalPhysical Mental Mental

Developing own beliefsDeveloping own beliefs Questioning authorityQuestioning authority

EmotionalEmotional More intense, quick to change, impulsive, More intense, quick to change, impulsive,

risk taking behaviors, test mortality/limitsrisk taking behaviors, test mortality/limits SocialSocial

Peer influencePeer influence Identity experimentation (social, cultural, Identity experimentation (social, cultural,

sexual)sexual)

How Can I Tell? How Can I Tell? Initially looks same, but lasts longer, become Initially looks same, but lasts longer, become

more severe so often interferes with more severe so often interferes with functioningfunctioning SchoolSchool HomeHome CommunityCommunity

Mental illness symptoms go un/underreportedMental illness symptoms go un/underreported Prior episodes/history or is this the first?Prior episodes/history or is this the first? Does your family have history of mental illnessDoes your family have history of mental illness Stressors or triggers = grades, break ups, Stressors or triggers = grades, break ups,

rejection, bullying, sexual identityrejection, bullying, sexual identity Substance abuse?Substance abuse?

Risk Factors for Mental Risk Factors for Mental DisordersDisorders

Exposure to stressful life events, Exposure to stressful life events, abuse/traumaabuse/trauma

Difficult or abusive childhoodDifficult or abusive childhood Medical illnesses or conditionsMedical illnesses or conditions

Life threatening or chronic illness with painLife threatening or chronic illness with pain Side effects of medicationsSide effects of medications Substance abuseSubstance abuse Brain injuryBrain injury Previous episode of mental illnessPrevious episode of mental illness Family history of mental disordersFamily history of mental disorders

Protective FactorsProtective Factors Healthy family lifestyle Healthy family lifestyle Good problem solving and coping skillsGood problem solving and coping skills Feeling control in lifeFeeling control in life SpiritualitySpirituality Avoiding drugs/alcoholAvoiding drugs/alcohol Consistent home, family, school routineConsistent home, family, school routine Parent/family support and monitoring of Parent/family support and monitoring of

activitiesactivities School/community connection or at least School/community connection or at least

one adultone adult

Major DepressionMajor Depression

Teen DepressionTeen Depression Longer-lasting changes in personality, mood or Longer-lasting changes in personality, mood or

behavior (sad mood, no joy nearly every day behavior (sad mood, no joy nearly every day for at least 2 weeks)for at least 2 weeks)

Extreme sensitivity to criticism due to feelings Extreme sensitivity to criticism due to feelings of worthlessness, vulnerable to criticism, of worthlessness, vulnerable to criticism, rejection and failure rejection and failure →→ withdrawal, not withdrawal, not socializingsocializing

May result in substance abuse, self-mutilation, May result in substance abuse, self-mutilation, risk behaviors, violence and suiciderisk behaviors, violence and suicide

How long, severe, different from child’s usual How long, severe, different from child’s usual or baseline behaviors? or baseline behaviors?

Remove all weapons from home and propertyRemove all weapons from home and property

Depression vs. Depression vs. MoodinessMoodiness

Looks more irritable/angry, hostile than depressedLooks more irritable/angry, hostile than depressed Not just bad mood or occasional sadnessNot just bad mood or occasional sadness

Sad, tearful, withdrawing from friends and familySad, tearful, withdrawing from friends and family Excessive anxiety, restlessness, agitation, recklessExcessive anxiety, restlessness, agitation, reckless Sleep/appetite changes, ↓ energy, ↓ motivationSleep/appetite changes, ↓ energy, ↓ motivation Difficulty with focus, concentration, learningDifficulty with focus, concentration, learning Unexplained aches and painUnexplained aches and pain Hopeless/helpless, desperationHopeless/helpless, desperation Worthlessness, guilt, self-loathingWorthlessness, guilt, self-loathing Thoughts of death, suicideThoughts of death, suicide

Depression in Young Depression in Young ChildrenChildren

Aggressive behaviorsAggressive behaviors Fearful of new situations and Fearful of new situations and

challengeschallenges Developmental delays or regressionDevelopmental delays or regression Sleep and appetite changesSleep and appetite changes Unsafe playUnsafe play Clingy or more dependentClingy or more dependent Unexplained aches and painsUnexplained aches and pains

Tips for Talking to Depressed Tips for Talking to Depressed YouthYouth

Offer supportOffer support Let them know you’re there for themLet them know you’re there for them Resist asking a lot of questionsResist asking a lot of questions Make it clear you’re ready/willing to provide Make it clear you’re ready/willing to provide

supportsupport Be gentle but persistentBe gentle but persistent

Don’t give up if your child shuts you out at firstDon’t give up if your child shuts you out at first Be respectful of comfort levelBe respectful of comfort level

Listen without lecturingListen without lecturing Resist urge to criticize, pass judgment, offer Resist urge to criticize, pass judgment, offer

adviceadvice Validate feelingsValidate feelings

Don’t try to talk teen out of their depressionDon’t try to talk teen out of their depression Acknowledge pain and sadness they are feelingAcknowledge pain and sadness they are feeling

Depression Becoming a CrisisDepression Becoming a Crisis Significant/sustained changes in mood, energy, Significant/sustained changes in mood, energy,

motivation, sleep, appetite so unable to functionmotivation, sleep, appetite so unable to function Apathy, disengaged, shut down, withdrawal Apathy, disengaged, shut down, withdrawal Coping by using drugs, alcohol, risk-takingCoping by using drugs, alcohol, risk-taking Talk or jokes about death, being dead, better off Talk or jokes about death, being dead, better off

dead, no longer being around, no way outdead, no longer being around, no way out Romanticizing dying, wondering how others Romanticizing dying, wondering how others

would react if dead, more love, admiration?would react if dead, more love, admiration? Writings, journal with about death and Writings, journal with about death and

dying/suicidedying/suicide Giving away possessions, saying Giving away possessions, saying

goodbyes/thanksgoodbyes/thanks

When Depression is a When Depression is a CrisisCrisis

Increased suicide risk to end unbearable Increased suicide risk to end unbearable pain and suffering or solve problempain and suffering or solve problem

Exhausted, hopeless and unable/unwilling Exhausted, hopeless and unable/unwilling to go on with no end in sightto go on with no end in sight

Youth struggle with depressionYouth struggle with depression ““I will always feel this way” depression I will always feel this way” depression

symptomsymptom Believe feelings = facts Believe feelings = facts

Suicide risk and medication assessment to Suicide risk and medication assessment to determine if safe at home/community or determine if safe at home/community or needs safe structure of hospitalneeds safe structure of hospital

Bipolar DisorderBipolar Disorder(Manic-Depressive (Manic-Depressive

Illness)Illness)

Bipolar DisorderBipolar Disorder Usual onset in late teens or early adulthoodUsual onset in late teens or early adulthood

Early-onset bipolarEarly-onset bipolar when develops in when develops in childhood, childhood,

Unusual, frequent mood swingsUnusual, frequent mood swings Not the same as normal ups and downs Not the same as normal ups and downs Co-exists with ADHD, substance abuse, anxietyCo-exists with ADHD, substance abuse, anxiety Carries increased risk for suicide and Carries increased risk for suicide and

aggressionaggression Treatment including medication to help Treatment including medication to help

manage symptoms, therapy, psycho-manage symptoms, therapy, psycho-educationeducation

Youth Bipolar DisorderYouth Bipolar Disorder EpisodesEpisodes lastlast 1-2 weeks, 1-2 weeks, symptomssymptoms all all dayday//every every

dayday Moods of intense feelings with extreme changes in Moods of intense feelings with extreme changes in

behavior and energy levelsbehavior and energy levels More mixed episodes of both manic and depressive More mixed episodes of both manic and depressive

symptoms than adultssymptoms than adults Manic: act silly/strange, short tempered/demanding, Manic: act silly/strange, short tempered/demanding,

intrusive, unable to focus, decreased need for sleep, intrusive, unable to focus, decreased need for sleep, risky, impulsive behaviorsrisky, impulsive behaviors

Depressive: feel sad, worthless, guilty, hopeless with Depressive: feel sad, worthless, guilty, hopeless with thoughts of death/suicide, sleeping/eating too much, thoughts of death/suicide, sleeping/eating too much, too little, low energy, no interest in activities too little, low energy, no interest in activities

Youth Bipolar CrisisYouth Bipolar Crisis Acute symptoms resulting in psychosisAcute symptoms resulting in psychosis

Symptom and medication evaluationSymptom and medication evaluation Safety monitoring for unpredictable behaviorsSafety monitoring for unpredictable behaviors HospitalizationHospitalization

Acute suicide risk from depressionAcute suicide risk from depression Suicide risk assessmentSuicide risk assessment Medication evaluationMedication evaluation Hospitalization or safety planHospitalization or safety plan

Aggression/violence or risk-taking of mania or Aggression/violence or risk-taking of mania or ragerage Violence risk assessmentViolence risk assessment Safety plan with monitoring or hospital Safety plan with monitoring or hospital

Anxiety DisordersAnxiety Disorders

Anxiety vs. Anxiety Anxiety vs. Anxiety DisorderDisorder

Anxiety phase as normal part of childhood is Anxiety phase as normal part of childhood is temporary and usually harmless temporary and usually harmless

Anxiety disorderAnxiety disorder Persistent/irrational worry or fear, irritabilityPersistent/irrational worry or fear, irritability Jitteriness, nervousness and more than Jitteriness, nervousness and more than

shynessshyness Avoidance of places, activitiesAvoidance of places, activities Headaches, stomachachesHeadaches, stomachaches

Persists despite reassurance and comfort Persists despite reassurance and comfort and may become chronic and interfere with and may become chronic and interfere with functioning at school and homefunctioning at school and home

Types of Anxiety Types of Anxiety DisordersDisorders

Generalized anxiety disorder: Generalized anxiety disorder: worry excessively about worry excessively about things they can’t control or meeting expectationsthings they can’t control or meeting expectations

Social anxiety disorder: Social anxiety disorder: yyouth worried about being outh worried about being judged by others or embarrassing themselves in publicjudged by others or embarrassing themselves in public

Panic attack: Panic attack: brief, sudden onset of intense anxiety brief, sudden onset of intense anxiety with fear/terror accompanied by physical symptomswith fear/terror accompanied by physical symptoms

Posttraumatic stress Posttraumatic stress feelings of horror, fear and feelings of horror, fear and hopelessness following perceived trauma event by hopelessness following perceived trauma event by re-experiencing and avoiding reminders of eventre-experiencing and avoiding reminders of event

Obsessive-compulsive:Obsessive-compulsive: irrational uncomfortable irrational uncomfortable thoughts and repetitive behaviors to stop thoughtsthoughts and repetitive behaviors to stop thoughts

Anxiety Becomes a Anxiety Becomes a DisorderDisorder

Anxiety becomes problem when interferes Anxiety becomes problem when interferes with everyday functioning = excessivewith everyday functioning = excessive

Unrealistic or irrational and far exceeds Unrealistic or irrational and far exceeds seriousness of causeseriousness of cause

Results in child having unrealistically high Results in child having unrealistically high expectations of self/perfectionismexpectations of self/perfectionism

Unwanted and uncontrollableUnwanted and uncontrollable Results in avoidance or inability to engage in Results in avoidance or inability to engage in

activities child would otherwise enjoyactivities child would otherwise enjoy Crisis might involve panic attacks, severe Crisis might involve panic attacks, severe

PTSDPTSD

Parent’s GuideParent’s Guide Be open & honest while listening to child’s concernsBe open & honest while listening to child’s concerns

Ask open-ended questions to learn about their anxietyAsk open-ended questions to learn about their anxiety Avoid judgment or dismissing feelings which may Avoid judgment or dismissing feelings which may

convey child is being silly or dramaticconvey child is being silly or dramatic Refrain from reinforcing fear by appearing anxiousRefrain from reinforcing fear by appearing anxious Avoid unintentionally reinforcing fear by allowing Avoid unintentionally reinforcing fear by allowing

avoidance behavior or school absenceavoidance behavior or school absence Anxiety increases when cause is unpredictable or Anxiety increases when cause is unpredictable or

unfamiliar so prepare child by discussing in advance unfamiliar so prepare child by discussing in advance what could happen, how they may feel, what they may what could happen, how they may feel, what they may do, especially if the worst were to happendo, especially if the worst were to happen

Anxiety TreatmentAnxiety Treatment If anxiety is excessive and negatively If anxiety is excessive and negatively

impacting child’s daily functioning, seek impacting child’s daily functioning, seek professional helpprofessional help

Cognitive-behavioral therapy is evidenced-Cognitive-behavioral therapy is evidenced-based treatment to help overcome anxietybased treatment to help overcome anxiety

Medications useful supplement to treatmentMedications useful supplement to treatment Family therapyFamily therapy Parent psycho-education where you can Parent psycho-education where you can

learn how to model good coping/problem-learn how to model good coping/problem-solving skillssolving skills

First Episode First Episode PsychosisPsychosis

First Episode PsychosisFirst Episode Psychosis Psychosis:Psychosis: mental state when there is a loss of mental state when there is a loss of

contact with reality so difficult telling what is real contact with reality so difficult telling what is real from what is not real from what is not real

Causes:Causes: depression, bipolar disorder, depression, bipolar disorder, schizophrenia, substance abuse, brain injury or schizophrenia, substance abuse, brain injury or illness, seizure disorder or extreme stressillness, seizure disorder or extreme stress

Onset: Onset: gradual changes over period of months to gradual changes over period of months to years before diagnosable symptoms (prodrome)years before diagnosable symptoms (prodrome)

EEarly changes: arly changes: odd behaviors, something doesn’t odd behaviors, something doesn’t “feel quite right,” withdrawal, trouble with “feel quite right,” withdrawal, trouble with concentration/focus concentration/focus

Functioning:Functioning: difficulties in school, decline in social difficulties in school, decline in social interactions, activities, self-careinteractions, activities, self-care

First Episode First Episode Psychosis/FEPPsychosis/FEP First time youth experiences psychotic First time youth experiences psychotic

symptomssymptoms Very frightening, confusing to youthVery frightening, confusing to youth

Negative stereotypes and misconceptions Negative stereotypes and misconceptions associated with psychosisassociated with psychosis

Psychosis is treatablePsychosis is treatable and many recover from and many recover from FEP and never experience another psychotic FEP and never experience another psychotic episodeepisode

Diagnostic evaluationDiagnostic evaluation is needed as well as labs, is needed as well as labs, psychological testing to make diagnosispsychological testing to make diagnosis

Early treatmentEarly treatment may prevent development of may prevent development of pronounced or disabling psychotic symptoms. pronounced or disabling psychotic symptoms. 

Psychotic SymptomsPsychotic Symptoms Hallucinations:Hallucinations: false perceptions of five sensesfalse perceptions of five senses

Hearing voices calling their name or talking to Hearing voices calling their name or talking to or about them in an abusive or critical manneror about them in an abusive or critical manner

Seeing something that is not really thereSeeing something that is not really there Experienced as real even though not happeningExperienced as real even though not happening

Delusions:Delusions: fixed/false beliefs held true by youthfixed/false beliefs held true by youth Seem bizarre or irrational to othersSeem bizarre or irrational to others Unable to talk someone out of a delusion Unable to talk someone out of a delusion

Confused thinking Confused thinking so unable to concentrate:so unable to concentrate: Trouble thinking clearly or logically and may Trouble thinking clearly or logically and may

speak in disorganized sentences or go off topic speak in disorganized sentences or go off topic

Other Difficulties with Other Difficulties with PsychosisPsychosis

Cognitive difficultiesCognitive difficulties Memory, attention, Memory, attention, Mental speed, planningMental speed, planning Organization of thoughts/Organization of thoughts/

Negative symptoms Negative symptoms Trouble with motivation/self-startingTrouble with motivation/self-starting Withdrawal from friends, family and selfWithdrawal from friends, family and self Reduced interest in social activitiesReduced interest in social activities Struggles to relate or communicate with Struggles to relate or communicate with

others others

Early Warning Signs of Early Warning Signs of PsychosisPsychosis**

Worrisome drop in grades or job performanceWorrisome drop in grades or job performance New trouble with thinking clearly or New trouble with thinking clearly or

concentratingconcentrating Suspiciousness/uneasiness with othersSuspiciousness/uneasiness with others Decline in self-care or personal hygieneDecline in self-care or personal hygiene Spending a lot more time alone than usualSpending a lot more time alone than usual Increased sensitivity to sights or soundsIncreased sensitivity to sights or sounds Mistaking noises for voicesMistaking noises for voices Unusual or overly intense new ideasUnusual or overly intense new ideas Strange new feelings or having no feelings at allStrange new feelings or having no feelings at all

*Important when new or have worsened*Important when new or have worsened

Early Detection and Early Detection and Intervention Intervention

Psychosis may be transient, intermittent, short-Psychosis may be transient, intermittent, short-term or part of a longer-term mental illnessterm or part of a longer-term mental illness

Early intervention has the potential to delay Early intervention has the potential to delay or even prevent the onset of psychosis or even prevent the onset of psychosis 

Early identification & evaluation improves the Early identification & evaluation improves the outcome of those youth who do develop a outcome of those youth who do develop a disorderdisorder

New program New program PROPs*PROPs* at Journey Mental at Journey Mental Health Center for youth and young adults ages Health Center for youth and young adults ages 15-25 who are experiencing early symptoms of 15-25 who are experiencing early symptoms of psychosis (program brochure available)psychosis (program brochure available)

*Promoting Recovery from Onset of Psychosis

Youth Substance Youth Substance Use/AbuseUse/Abuse

Youth Substance UseYouth Substance Use Drugs and alcohol used to increase feelings of Drugs and alcohol used to increase feelings of

pleasure or decrease feelings of distresspleasure or decrease feelings of distress Experiment vs. develop pattern of heavy use Experiment vs. develop pattern of heavy use

which may lead to dependence or which may lead to dependence or addiction/disorderaddiction/disorder

Harmful to developing brain and emotional healthHarmful to developing brain and emotional health Substance abuse: Substance abuse: repeated use resulting in legal, repeated use resulting in legal,

social, personal difficulties at school, home or social, personal difficulties at school, home or workwork

Substance dependence: Substance dependence: continued use despite continued use despite tolerance, withdrawal and compulsive usetolerance, withdrawal and compulsive use

Co-occurring mental health problems Co-occurring mental health problems

Substance Abuse Substance Abuse DisorderDisorder

Repeated use of substances that causes Repeated use of substances that causes youth to have difficulty fulfilling daily youth to have difficulty fulfilling daily responsibilities at home and schoolresponsibilities at home and school Academic decline, absenteeism, drop out of Academic decline, absenteeism, drop out of

schoolschool Family conflict with parents and siblingsFamily conflict with parents and siblings

Puts youth into dangerous situation causing Puts youth into dangerous situation causing legal, social and interpersonal problemslegal, social and interpersonal problems

Young people use substances to self-Young people use substances to self-medicate for existing/untreated mental medicate for existing/untreated mental health disordershealth disorders

Substance Abuse and Substance Abuse and RiskRisk

Physical injuriesPhysical injuries Increased risk of aggression and criminal Increased risk of aggression and criminal

actsacts High risk sexual behaviorsHigh risk sexual behaviors Vulnerable as victim of crimeVulnerable as victim of crime Increased risk of suicide/self injury when Increased risk of suicide/self injury when

more impulsive and disinhibited by alcohol more impulsive and disinhibited by alcohol and drugsand drugs

What Should I Do?What Should I Do? Express your concerns using “I” statements Express your concerns using “I” statements

so youth not on defensiveso youth not on defensive Use patience, empathy to understand Use patience, empathy to understand

youth’s point of viewyouth’s point of view Recognize it is scary and hardRecognize it is scary and hard Resist urge to avoid/deny, hope it goes Resist urge to avoid/deny, hope it goes

away, “not my child”away, “not my child” Get informed and involvedGet informed and involved Call PCP, clinic or local mental health Call PCP, clinic or local mental health

servicesservices Parent Addiction Network of Dane CountyParent Addiction Network of Dane Countywww.ParentAddictionNetwork.org

How to ApproachHow to Approach Ask about their perception of their substance useAsk about their perception of their substance use Ask about areas substance use may be affectingAsk about areas substance use may be affecting Use of “I” statements reduce defensivenessUse of “I” statements reduce defensiveness Identify behavior than the character or personIdentify behavior than the character or person Focus on substance use and don’t be drawn into Focus on substance use and don’t be drawn into

arguments or discussion of other issuesarguments or discussion of other issues If there is immediate risk to self/others associated If there is immediate risk to self/others associated

with substance abuse, consider calling for helpwith substance abuse, consider calling for help Treatment provider, crisis line or 911 Treatment provider, crisis line or 911

Youth Mental Health Youth Mental Health CrisisCrisis

Suicide, Violence, Mental Suicide, Violence, Mental DisordersDisorders

Depression, psychosis, substance abuseDepression, psychosis, substance abuse Suicide threats, acts, attempts Suicide threats, acts, attempts Escalated/aggressive, threatening, losing Escalated/aggressive, threatening, losing

controlcontrol Acute psychotic signs/symptoms Acute psychotic signs/symptoms

unpredictable, out of control so frightening unpredictable, out of control so frightening you and your child you and your child

Is there access to lethal means in your home? Is there access to lethal means in your home? Do you need police to restore safety and Do you need police to restore safety and

control?control?

Reduce Risk in Home Reduce Risk in Home SettingSetting

What you can do proactively for safety What you can do proactively for safety when child moving towards mental health when child moving towards mental health crisis:crisis: Remove firearms from home and propertyRemove firearms from home and property Lock up OTC and prescribed medicationsLock up OTC and prescribed medications Put away all liquor/beer Put away all liquor/beer Remove all poisons and other lethal meansRemove all poisons and other lethal means Monitor use of vehicles during crisisMonitor use of vehicles during crisis Share concerns with your child’s providers Share concerns with your child’s providers

and have them respond quickly with helpand have them respond quickly with help Recognize warning signs of suicidal crisisRecognize warning signs of suicidal crisis

Warning SignsWarning Signs Threatening suicide, making plans, preparations, Threatening suicide, making plans, preparations,

rehearsals including self-injuryrehearsals including self-injury Seeking out weapons, pills, or other ways to kill Seeking out weapons, pills, or other ways to kill

selfself Reckless behavior or accidents resulting in injuryReckless behavior or accidents resulting in injury Giving away prized possessions or saying Giving away prized possessions or saying

goodbye to friends/family as if for the last timegoodbye to friends/family as if for the last time Looking better/brighter and happier when Looking better/brighter and happier when

recently withdrawn, disengaged, angry, recently withdrawn, disengaged, angry, desperate as if all worries and problems have desperate as if all worries and problems have disppeareddisppeared

Mental Health Crisis Mental Health Crisis When…When…

You need help quicklyYou need help quickly Your child can’t calm downYour child can’t calm down Your child is uncontrollableYour child is uncontrollable Sudden danger of harming themselves or Sudden danger of harming themselves or

othersothers All of your energies demanded to care for All of your energies demanded to care for

your childyour child Safety is issue for your child or othersSafety is issue for your child or others Immediate need for action or interventionImmediate need for action or intervention

Signs of Mental Health Signs of Mental Health CrisisCrisis

Severe agitation, pacing, escalationSevere agitation, pacing, escalation Talking nonstop, not making sense, Talking nonstop, not making sense, Fearful of being harmed, losing touch with realityFearful of being harmed, losing touch with reality Hallucinations, delusions (fixed, false beliefs)Hallucinations, delusions (fixed, false beliefs) Threatening self/others, self injuring behaviorsThreatening self/others, self injuring behaviors Isolating in room, refusing to come out, Isolating in room, refusing to come out,

withdrawalwithdrawal Not eating or sleeping or sleeping too muchNot eating or sleeping or sleeping too much Likely mental health crisis is when your child is Likely mental health crisis is when your child is

behaving much differently or situation getting behaving much differently or situation getting out of control and you may not be able to de-out of control and you may not be able to de-escalate it, escalate it,

Answer Following Answer Following QuestionsQuestions

Do you feel your child is in immediate Do you feel your child is in immediate danger to themselves or others?danger to themselves or others?

Can you handle the situation yourself Can you handle the situation yourself or do you need help?or do you need help?

If you need help- what type of help do If you need help- what type of help do you need and from who?you need and from who?

Get Help Right AwayGet Help Right Away If child or others are in immediate danger, call 911If child or others are in immediate danger, call 911 Ask for officers trained in mental health responseAsk for officers trained in mental health response Recognize once police enter your home, they are in Recognize once police enter your home, they are in

charge and control what happens next including charge and control what happens next including where your child may be takenwhere your child may be taken

Another option is to call 24/7 crisis line 280.2600Another option is to call 24/7 crisis line 280.2600 Inform them child is having a mental health crisisInform them child is having a mental health crisis Give as many details about what is happening and Give as many details about what is happening and

any relevant background informationany relevant background information

Too Scared to Ask if Youth is Too Scared to Ask if Youth is Suicidal?Suicidal?

Research show asking/talking about suicide Research show asking/talking about suicide reduces risk by showing you care and can helpreduces risk by showing you care and can help

Tell your child what you have observed that is Tell your child what you have observed that is worrying you; be a patient empathic listenerworrying you; be a patient empathic listener

Let them know you love them and want to helpLet them know you love them and want to help Ask them as calmly and directly as possible if they Ask them as calmly and directly as possible if they

are thinking of killing themselvesare thinking of killing themselves Unless they answer with a strong no, ask about Unless they answer with a strong no, ask about

how they might do this or if they have a planhow they might do this or if they have a plan Call 911 or local crisis center or go to hospital Call 911 or local crisis center or go to hospital

emergency room for helpemergency room for help Call 911 for safe transport to hospital if neededCall 911 for safe transport to hospital if needed

No Immediate Risk?No Immediate Risk? If child convinces you they are not at If child convinces you they are not at

immediate risk and you feel same way, be immediate risk and you feel same way, be sure to contact therapist for risk sure to contact therapist for risk assessment or what to do nextassessment or what to do next

Provide your child with suicide hotline Provide your child with suicide hotline numbers and let them know they can come numbers and let them know they can come to you anytimeto you anytime

  If you are unsure what to do call local If you are unsure what to do call local 24/7crisis line 280.2600 or National Suicide 24/7crisis line 280.2600 or National Suicide Prevention Lifeline at 1-800/273.8255. Prevention Lifeline at 1-800/273.8255.

What Helps in Suicidal What Helps in Suicidal Crisis Crisis

Let your child know they are not alone and Let your child know they are not alone and you are there for them no matter whatyou are there for them no matter what

Reassure them many young people have Reassure them many young people have suicidal thoughts, but don’t act on themsuicidal thoughts, but don’t act on them

Try not to discount their feelings or Try not to discount their feelings or convince them they should not feel this convince them they should not feel this wayway

Let them know you want to help and will Let them know you want to help and will get them connected to services they needget them connected to services they need

You may be the protective factor that You may be the protective factor that lowers your child’s risk in suicidal crisislowers your child’s risk in suicidal crisis

No Immediate Danger, but No Immediate Danger, but Needs HelpNeeds Help

Can your handle situation yourself or need help?Can your handle situation yourself or need help? Contact therapist, treatment team since they know Contact therapist, treatment team since they know

child and historychild and history Ask if child needs in-person assessment at hospital Ask if child needs in-person assessment at hospital

ER or inpatient admission? ER or inpatient admission? Suggest you bring child to clinic if during business Suggest you bring child to clinic if during business

hours or to hospital ER or local crisis centerhours or to hospital ER or local crisis center If your child is not in treatment, call crisis center If your child is not in treatment, call crisis center

at Journey Mental Health Center 280.2600 for helpat Journey Mental Health Center 280.2600 for help If you are able, call ahead before transporting If you are able, call ahead before transporting

child directly to crisis center or hospital ERchild directly to crisis center or hospital ER

Self Injury BehaviorsSelf Injury Behaviors Self-limiting, nonlethal acts of cutting, burning, Self-limiting, nonlethal acts of cutting, burning,

picking, bruising, hitting body or headpicking, bruising, hitting body or head Deliberate self-harm used as coping mechanism for Deliberate self-harm used as coping mechanism for

overwhelming emotions like anger, anxiety, sadness overwhelming emotions like anger, anxiety, sadness To feel “real,” distract from old pain with new pain, To feel “real,” distract from old pain with new pain,

show or reenact pain, control or follow othersshow or reenact pain, control or follow others Unintended side effects of guilt and shame, can be Unintended side effects of guilt and shame, can be

“addictive” and difficult to stop, diminishing effects“addictive” and difficult to stop, diminishing effects Complications include infection, scars, body damageComplications include infection, scars, body damage Warning signs are scars, bruising, wearing long-Warning signs are scars, bruising, wearing long-

sleeve clothing or turtle necks during warm weathersleeve clothing or turtle necks during warm weather

Psychiatric Psychiatric HospitalizationHospitalization Hospitalization used when youth is at immediate Hospitalization used when youth is at immediate

risk of harm to self/others orrisk of harm to self/others or Psychotic especially if first-time or early relapsePsychotic especially if first-time or early relapse

Rapid use of medications needing inpatient settingRapid use of medications needing inpatient setting Refusal to take medications, becoming symptomaticRefusal to take medications, becoming symptomatic

Significant risk-taking behaviorsSignificant risk-taking behaviors Serious medical issues, alcohol or drug abuseSerious medical issues, alcohol or drug abuse Inpatient stays are brief with goals to reduce risk, Inpatient stays are brief with goals to reduce risk,

restore stability through medication, therapies, restore stability through medication, therapies, family meetings and discharge to family/communityfamily meetings and discharge to family/community

Chapter 51 Emergency Chapter 51 Emergency DetentionsDetentions

Used as last resort when youth refuses voluntary Used as last resort when youth refuses voluntary admission, there is immediate risk to self/others admission, there is immediate risk to self/others andand acute symptoms of mental illnessacute symptoms of mental illness

Involves law enforcement, crisis unit and courts Involves law enforcement, crisis unit and courts Youth is detained a local hospital or state institute Youth is detained a local hospital or state institute If probable cause is found at hearing, may result in If probable cause is found at hearing, may result in

civil commitment from 6 months up to one yearcivil commitment from 6 months up to one year Youth must follow 51 outpatient conditions which Youth must follow 51 outpatient conditions which

include keeping appointments following treatment include keeping appointments following treatment take prescribed medications, not using drugs or take prescribed medications, not using drugs or alcohol and not engaging is harm to self/othersalcohol and not engaging is harm to self/others

Youth Mental Health Youth Mental Health TreatmentTreatment

Deciding If Child Needs Deciding If Child Needs TreatmentTreatment

How often, how long it lasts or intensity of mood How often, how long it lasts or intensity of mood or behavior may help you decide if problemor behavior may help you decide if problem

Occurring more than few weeksOccurring more than few weeks Interfering with ability to function at Interfering with ability to function at

home/schoolhome/school Moods or behaviors interfering with ability to Moods or behaviors interfering with ability to

develop, keep friends or function in daily develop, keep friends or function in daily activitiesactivities

May be helpful to look at common May be helpful to look at common developmental milestones of your child’s age-developmental milestones of your child’s age-group to get feel for how they are doinggroup to get feel for how they are doing

Where to Get TreatmentWhere to Get Treatment Depends on child’s individual needs and Depends on child’s individual needs and

severity of conditionseverity of condition Type of treatment will depend on your child’s Type of treatment will depend on your child’s

individual needsindividual needs Your family’s public or private insurance will Your family’s public or private insurance will

determine where your child will get treatmentdetermine where your child will get treatment Locations:Locations:

Local community mental healthLocal community mental health Private therapist officePrivate therapist office Child and family agencies Child and family agencies

How to Access Mental Health How to Access Mental Health ServicesServices

Talk with your child’s pediatrician or family MD Talk with your child’s pediatrician or family MD oror

Contact local community mental health center, Contact local community mental health center, school or local health care clinic and ask for school or local health care clinic and ask for mental health assessmentmental health assessment

At assessment be prepared to share your At assessment be prepared to share your concerns about any behaviors, situations, concerns about any behaviors, situations, symptoms or emotional reactionssymptoms or emotional reactions

Report how long, how often has been happeningReport how long, how often has been happening Anything that makes child feel worse or helps Anything that makes child feel worse or helps

them to feel betterthem to feel better

After Mental Health After Mental Health EvaluationEvaluation

Professionals will share their impressions of Professionals will share their impressions of your child’s condition and discuss strengths your child’s condition and discuss strengths and needsand needs

Explain types of treatment/services or Explain types of treatment/services or supports available to your childsupports available to your child

This is your time to ask questions, clarify This is your time to ask questions, clarify information and request additional help with information and request additional help with accessing resources to help you best support accessing resources to help you best support your child in treatmentyour child in treatment

Questions About Questions About MedicationsMedications If medication is effective, how might it help my child?If medication is effective, how might it help my child?

How long does it take to work to help mood, behaviorsHow long does it take to work to help mood, behaviors What side effects might my child experience?What side effects might my child experience?

Which need immediate reporting and which can wait?Which need immediate reporting and which can wait? Is medication proven safe and effective for children?Is medication proven safe and effective for children? Does my child have to have any blood work or other Does my child have to have any blood work or other

testing while taking medication?testing while taking medication? Printed information about medication I can have?Printed information about medication I can have? What happens if we miss a does?What happens if we miss a does? How long do you feel my child will need to be on med?How long do you feel my child will need to be on med? Is there generic or lower cost option?Is there generic or lower cost option?

Additional QuestionsAdditional Questions If need to reach you afterhours or in an If need to reach you afterhours or in an

emergency?emergency? What can I do at home to support my child?What can I do at home to support my child? What are some resources can help me better What are some resources can help me better

understand my child’s diagnosis or need?understand my child’s diagnosis or need? What can I do to help myself cope in times of What can I do to help myself cope in times of

crisis or when I need more support?crisis or when I need more support? Does my child need a Crisis Plan, especially if Does my child need a Crisis Plan, especially if

he/she is at risk of experiencing crisis?he/she is at risk of experiencing crisis? Written plan of what to do if your child is in crisisWritten plan of what to do if your child is in crisis Specific steps to take and contact information of Specific steps to take and contact information of

people to call during a crisispeople to call during a crisis

Beginning TreatmentBeginning Treatment Let provider know you wish to be actively Let provider know you wish to be actively

involved in your child’s treatment & how you can involved in your child’s treatment & how you can best do thatbest do that

Ask what is goal of treatment and what new skills Ask what is goal of treatment and what new skills your child will learnyour child will learn What can I expect and see in child as result of What can I expect and see in child as result of

treatmenttreatment How will provider assess if treatment is working or How will provider assess if treatment is working or

adjustments when it is not workingadjustments when it is not working If you don’t have skills or knowledge to help, If you don’t have skills or knowledge to help,

request to be provided with training, informationrequest to be provided with training, information Ask provider to come to home to model strategies, Ask provider to come to home to model strategies,

provide feedback and support (videos, trainings) provide feedback and support (videos, trainings)

Who is Treatment TeamWho is Treatment Team Psychiatrist : doctor who diagnose, Psychiatrist : doctor who diagnose,

prescribes monitor medicationsprescribes monitor medications Psychologist: psychological testing, therapyPsychologist: psychological testing, therapy Therapist: who provides counseling, therapy Therapist: who provides counseling, therapy

for both child and familyfor both child and family Case manager or coordinator who organizes Case manager or coordinator who organizes

and coordinates your child’s treatment and coordinates your child’s treatment services and helps to navigate the systemservices and helps to navigate the system

Parents who are the “constants” and Parents who are the “constants” and “collaborators” with team because you know “collaborators” with team because you know what works and does not for your childwhat works and does not for your child

Tips for Talking with Child’s Tips for Talking with Child’s ProviderProvider

Prepare:Prepare: Write down questions and concerns beforeWrite down questions and concerns before Bring: Bring: Friend or family member to support youFriend or family member to support you Tell:Tell: What’s most important to you and answer What’s most important to you and answer

honestlyhonestly Ask:Ask: For explanations or more information including For explanations or more information including

pros and cons or recommendationpros and cons or recommendation Speak up:Speak up: About your concerns and ask for options, About your concerns and ask for options,

especially if worried about side effectsespecially if worried about side effects Check:Check: How to reach provider afterhours/weekendsHow to reach provider afterhours/weekends Remember:Remember: Write down what was said and what you Write down what was said and what you

and provider agreed toand provider agreed to Follow through: Follow through: Decisions you made and report backDecisions you made and report back

Resiliency, Recovery and Resiliency, Recovery and HopeHope

ResiliencyResiliency: most youth pass through adolescence : most youth pass through adolescence with relatively little difficulty despite challengeswith relatively little difficulty despite challenges ThriveThrive MatureMature Increase competenceIncrease competence

Recovery:Recovery: self-determination and self-direction self-determination and self-direction which emerges from which emerges from hopehope and belief people can and and belief people can and do overcome challenges, barriers and obstacles of do overcome challenges, barriers and obstacles of living with a mental illnessliving with a mental illness

Prevention and early detection and intervention Prevention and early detection and intervention programs, online parent/family resource programs, online parent/family resource networksnetworks

Local Mental Health Local Mental Health ResourcesResources

NAMI Dane County (Local Resources)NAMI Dane County (Local Resources)http://www.namidanecounty.org/resource-guide/ NAMI Dane County (Local Support Groups)NAMI Dane County (Local Support Groups)http://www.namidanecounty.org/support-groups/ Briarpatch Youth Services Helpline 608/251.1126Briarpatch Youth Services Helpline 608/251.1126 Solstice Warmline/Peer Support 608/422.2383Solstice Warmline/Peer Support 608/422.2383 United Way 2-1-1 or 246-HELP 24/7 community United Way 2-1-1 or 246-HELP 24/7 community

resource help line resource help line www.unitedwaydanecounty.org Recovery Dane #Recovery Dane #237-1661237-1661 provides assistance in provides assistance in

seeking mental health services in Dane County seeking mental health services in Dane County