NAMI Provider Education – Week Two

Yesterday I attended the second class of NAMI’s Provider Education. Here I summarize, paraphrase, and quote the handouts from the NAMI Provider Education Course Participant Manual 2013:

THEORETICAL BASIS: Basic principles of secondary prevention/intervention in mental health care in community psychiatry as devised by Gerald Caplan, MD (1974) and Erich Lindemann, MD (1944). Community theory proposed protective interventions of crisis counseling, grief work, support networks, practical help in adaptive coping, and education.

Clinical strategies (secondary interventions) for responding to psychological trauma which both individuals with mental illness and their families experience:

1. Recognize crushing burden of catastrophic events
2. Quickly preserve social supports & strengthen coping skills
3. Understand normalcy of trauma response
4. Anticipate needs based on process of adaptation

Impact of mental illness on the family – predictable emotional reactions among family members:

1. Stage I – Dealing with Catastrophic Event – Adaptation Model
   • Crisis/chaos/shock
   • Denial
   • Hoping against hope
   • Trauma Response: Use of denial to avoid reality & protect self from being overwhelmed
   • Families need: Support, comfort, empathy for pain & confusion, crisis intervention, prognosis, NAMI support and information
2. Stage II – Learning to Cope – Adaptation Model
   • Anger/guilt/resentment
   • Recognition
   • Grief – chronic sorrow
   • Trauma Response: Use of anger and projection to avoid feelings of guilt
   • Families need: Vent feelings, keep hope, education, self-care, networking, skill training, letting go, co-operation from system, NAMI support groups
3. Stage III – Moving into Advocacy – Adaptation Model
   • Understanding
   • Acceptance
   • Advocacy/Action
   • Trauma Response: Practice of advocacy as an antidote to loss. Wish to heal by helping others.
   • Families need: Activism, restoring balance in life, responsiveness from system, NAMI

Adaptive Process: through pain and grief to acceptance and hope

~ NAMI Provider Education Course Participant Manual 2013

Individual stages of recovery – BRIDGES Consumer Stages of Recovery – I covered the BRIDGES handout here and here when I learned about it in NAMI‘s Peer to Peer program.

• Event 1 – Crisis: Psychosis, suicide attempt, mania, episodes of severe depression
• Stage 1 – Recuperation: Stage of dependence. After trauma of mental illness episode ~ exhaustion of body, mind and spirit.
• Emotions: Denial, Confusion, Depression, Humiliation, Isolation, Self-hatred, Resentment, Anger
• Needs:
  • Safe place to rest – a lot of sleep
  • Someone to take care of me
  • To provide basic needs: Nutritious food, personal hygiene.
  • I am unable to take on even the simplest task of daily living
  • Medications (probably)

• Event 2 – Decision: “Time to get going” – I must make it for myself. If I rush it, I may have a setback. If I resist it; I will feel bored and empty.
• Stage 2 – Rebuilding: Rebuilding independence, ability to do things for myself. I need help to learn and practice living skills. I feel “up” when I succeed and “down” when I don’t.
• Emotions: Hope, Grief, Discouragement, Boredom, Self-doubt, Trust, Fear, Excitement, Anxiety, Frustration with setbacks, Pride in success
• Needs:
  • Tell my story: To have others hear my pain and despair
  • Learn about mental illness: “What is happening to me and why?”
  • Persons who believe in me: Mentor/teacher/friend
  • Getting and managing: Money, food, clothes, a good place to live
  • Learning (relearning) social skills and working skills

• Event 3 – Awakening: “I am somebody. I have a dream!” Coming to know “the new me.” Starting to dream about who I am and who I can be. I am the Phoenix rising from the ashes.
• Stage 3 – Recovery/Discovery: Building healthy interdependence: Starting to know, “Who I am and what I want to be, who I care about and who cares about me”
• Emotions: Self-acceptance, Appreciation of others, Confidence, Anger at injustice, Assertiveness, Helpfulness to others
• Needs:
  • A personal vision: A dream to strive for
  • People who appreciate me
  • Intimacy: Someone to love
  • Meaningful work: A chance to leave footprints
  • To advocate for self and others

Source: BRIDGES, Building Recovery of Individual Dreams and Goals through Education and Support, (2006)