mental health final

Grief

loss of a relationship, job, person, experience - emotional reaction to loss

Can be experienced as Physically, Emotionally, Cognitively, Socially, Behaviorally, Spiritually

Bereavement

Reaction to loss that encompasses the emotional and physical reactions of grief and mourning - can be months to years

psychological process of letting go

DSM5 exclusion - Argument — Removing bereavement exclusion will “medicalize” ordinary grief orrr No clinical basis to exclude patients from diagnosis of depression simply because it occurs shortly after death

Mourning

behavioral action and integration of grief and bereavement - culturally driven experience and occupations that foster healing

Routines or tasks that can be a health part of coping with death

4 stages of grief

Emotional Numbing and Disbelief

Yearning and searching

Disorganization and Despair

Reorganization

not linear - can move in and out of stages or overlap

emotional numbing and disbelief - stage 1

cognitive and emotional protective measure - may last short time and becomes a barrier to engagement

typically 1 month after death

Yearning and searching phase 2

mood swings, catatonic/emotional, high energy

preoccupation with thoughts of a loved one

Disorganization and despair - stage 3

death becomes reality - isolate, fatigue, depression - it “hits” them

anger peaks at 5 months post and depression peaks at 6 months

Reorganization - stage 4

gradual and difficult process of reorganizing the deceased place in ones life - making sense and creating new life patterns

all negative symptoms were on the decline 6 mo post

Complicated and prolonged grief

Departure from the normal grief patterns in duration or intensity of emotion, psychological, or physical symptoms of grief— Intrusive thoughts can interfere with daily activities

emotional responses last longer, high anxiety and depression

unexpected death, suicide, law enforcement

OT role in grief

Addressing the psychosocial impact

VALIDATE the client and his/her concerns, Establish client-centered goals, Be honest about what lies ahead, Provide factual information, Create a partnership, Provide resources for psychosocial healing

Grief interventions

Adults- roles and routines to honor dead, prepare their fav meal, memory walk, foster new self-efficacy (IADLS, support group, coping skills)

Children- open communication, allow questions, give choice to attend funeral, determine support system, encourage artwork, movement, music

Person w mental illness- assist in mourning rituals, evaluate support system, evaluate coping skills and support avoiding substances, referrals to other disciplines

Mental Health Practice Settings

Reference textbook chapters 35, 38-45

Permanent Supportive Housing

individuals who are chronically homeless AND have a serious mental health diagnosis

housing-first model, indefinite lease (federal funding), Rental assistance paired with supportive services

OT- clients are experiencing a significant life transition, variety of complex personal, environmental and occupational factors

Rapid- Re-housing

individuals who are homeless and may or may not have a disability

short-term assistance with intention to move homeless persons and families as rapidly as possible into permanent housing

Time-limited financial assistance, Supported services, Avoid near-term homelessness with emphasis on connecting to long-term resources

Peer-led services

programs and organizations led by individuals who have a mental health or substance use disorder

support for recovery is provided by peers who are in recovery Experience using community, social, and clinical resources

Self-help, community services, peer professional programs, peer-led organization

modeling, self-management strategies, coping skills, problem-solving

Psychosocial clubhouse

community of individuals who share a lived experience with mental health and recovery

similar to peer-led services but consumers and practitioners work together

Emphasis on community, Consumers have opportunities for friendship, housing, education, and employment

OT work closely w clubhouse peers, client centered intervention

Criminal Justice settings

individuals with mental health concerns who have committed a crime

Incarcerated individuals may not find occupations meaningful if they feel no sense of control over their routine or cannot associate cultural meaning to task, Interventions should address community reintegration, Introduce new hobbies for unoccupied time

State hospitals

individuals with serious mental illness; individuals who make direct threats to harm themselves or others, may demonstrate uncontrolled behavior

general public may view them dangerous - treatment mall approach, milieu therapy approach, sensory interventions

voluntary/involuntary admission

Inpatient Mental Health Settings

Acute: patient is hospitalized for a physical health concern, but care is impacted by mental health concerns. possible move to a behavioral health floor for more specialized care

Inpatient Hospitalization: hospitalized on a behavioral health unit to stabilize MH symptoms and discharging into a less restrictive care environment

Specialized Hospitalization: standalone hospitals or hospital units that offer specialized care based on life stage (Ex: child, adolescent, young adult, adult, geriatric or crisis stabilization, co-occurring disorders)

Partial Hospitalization Programs and Intensive Outpatient Programs

individuals with mental illness who can receive care in less restrictive environments - Consumers must be considered safe to live outside the hospital - practice coping skills

HW is beneficial, provide education, address social supports

Inpatient Substance Use and Rehabilitation Facilities

individuals with substance use or co-occurring disorders

Co-occurring disorder: mental health and substance use disorder Comorbidity: presence of one or more diseases

Description: consumers receive intense therapy and other tools for managing addiction

OT should seek additional training in substance abuse, anticipate withdrawl, draw connection between substance abuse and MH

Community-Based Case Management Assertive Community Treatment

individuals diagnosed with mental illness and recovery - case management is a method for providing consumer with needed services

Highly individualized, Advocate for community resources, Multidisciplinary team provides services 24/7, Team is primary service provider to minimize need for numerous providers, Practitioners have small caseloads because demands are high

Facilitate new learning skills, home visits, strengths-based

Integrated Behavioral Health and Primary Care

consideration of mental health and substance abuse conditions, along with any other health conditions within the same episode of care, as well as across a person’s lifespan

mental health and substance abuse is considered “behavioral health”

focus on prevention and focus, social determinants of health, expand chronic disease management

MH eval

client-centered and occupation-focused

occupational profile, baseline level of function, subjective interview, observation, standardized assessments, screenings

Eval- mental capacity, insight, motivation, performance - cognition, mood and affect, home environment, support system, daily routine, functional performance, strengths, motivators

choosing the best source of information

self-report- client preferences or expectations

observation- informal, structured, or standardized assessments

proxy report- info gathered from family, friend, caregiver

dynamic assessment- engage in activities to assess what the person is able to do on their own and where performance can be improved

Resilience

ability to recover and thrive in the face of trauma, stress, adversity

enduring stressful situations without suffering physiological or psychological

Problem-solving, influencing, organization, managing resources

Protective features

work collaboratively with individuals to foster protective features

Positive qualities and skills, Perceived social supports, Safe environment, Ability to problem solve, Physical activity, Connection to community resources, Sense of meaning or purpose, Spirituality or religious values

Benefits of CBT

cant find the powerpoint

Examples of thought distortions or errors in thinking

cant find the powerpoint

Methods for cognitive restructuring

cant find the powerpoint

Dialectical Behavior Therapy (DBT)

mindfulness, emotional regulation, distress tolerance, interpersonal effectiveness - pairs radical acceptance and validation with teaching transformative skills

non-judementally observing experiences without labeling them as good or bad - fully present and not lost in the past

Definition of trauma-informed care

empathy for the lived experience of our patients, recognizing that our interactions with patients are shaped by their unique history,

doesn’t require us to directly address traumas in our patient interaction

Trauma-informed care as a universal precaution (rather than targeted individual interventions)

Instead of focusing interventions only on the internal resources of the person doing the coping, the trauma-informed and healing-centered provider works to address the systems and narratives that discriminate and cause the need to cope

Trauma informed care interventions

Offering information and choice, Identifying strengths, Collaborative approach to treatment and plan of care, Letting go of expectations-progress isn’t linear

Six key principles of trauma informed care

safety (attend to signs of discomfort), trustworthiness and transparency, peer support, collaboration (recognize stage of change), empowerment voice and choice, humility and responsiveness (adjusting approach and address biases)

Substance Use Disorders (SUD)

History- thought to be acute and fixed w detox, residential rehab, short-term outpatient therapy — NOW know it it long-term and chronic

Prevalence- overall population 15-20% - higher for individuals with SMI because symptoms of MI worsen from use, decreased resilience, and cognitive function - risk increases when substances consumed alongside prescribed meds

Levels of care - SUD in SMI

determined by - biomedical conditions, readiness to change, recovery/living environment, relapse/continued use, withdrawal potential, emotional, behavioral conditions

Evidence-based practice for substance use disorders (6 types)

Building and maintaining motivation to abstain or reduce use

Constraints (contingency management)

Peers/family

Behaviors to manage cravings/urges

Building a balanced life of meaning with long-term goals and rewards

Twelve Step Programs

Building Motivation to Abstain or Reduce Use -1

motivational interviewing, intervention style not protocol

express empathy, develop discrepancy, avoid argumentation, roll with resistance, support self-efficacy

Constraints -2

Contingency management- recovery housing, self-help meetings, breathalyzer, drug testing

OT- address the overlooked barriers to assist in client in being able to manage contingency

Peers and family -3

Behavioral Couples Therapy (BCT), Theoretical Background - Social Modeling, Family Involvement in Treatment, Community Reinforcement Approach (CRA)

OT- Social skills training, Developing routine surrounding ability to access positive support network, Promoting ability to engage in specific treatment

Managing urges/cravings -4

Distraction: reading, hobbies, exercise, eating, etc., Contact with sober support, “Urge Surfing”

OT- Development of important leisure pursuit, Increase knowledge of preparing health food to use as replacement or craving strategy, Educating on relaxation or exercise routines

Building a balanced life -5

engage in activities that hold meaning and purpose

OT- assess and train in meaningful life skills - develop healthy relationships, taking care of their home, returning to a job

Twelve step programs -6

self-help groups, AA, [Substance Name] Anonymous, Dual Diagnosis Anonymous

WRAP

Wellness recovery action plans - identify triggers and wellness tools and help people create a daily management plan

OT- strength based - incorporate coping strategies, sensory processing, task analysis, habits, routines

Discharge key points

The client/patient should be discharged to the home and community, not just from the facility or therapist

Follow-up and continued support in the community are the keys to ensuring a successful transition

Difference between SSI and SSDI

Discharge financial resources

Third Party Payee- court ordered, individual or organization who assist w managing money

ABLE accounts and trusts

Discharge housing options

Skilled Nursing Facility, Intermediate care facility, residential care facility, permanent supportive housing, supportive housing, independent housing

most intensive to least intensive

Ethics and discharge planning