Who is this
. . . individuals
who, through no fault of their own or their families,
suffer from one of several diseases affecting the brain, the
most complex of human organs. The causes remain unknown, but are
probably multiple. There is no cure, but we do have effective
treatment. In addition to having a brain disease, people with
serious mental illness are (by definition) significantly
functionally impaired by the illness for an indefinite period of
time (diagnosis, disability, duration). At least 1% of
the population are seriously mentally ill. The problems of
victims and their families are compounded by stigma, one
of the cruelest and most prevalent forms of bigotry that exists.
chronic/serious mental illness:
symptoms (at least one of these usually present, at least
during an exacerbation of illness):
Distorted perceptions; loss
of contact with reality;
Disordered, disorganized and
Unstable and inappropriate
Bizarre behavior; impaired
("negative") or deficit symptoms (several of these
usually present most of the time):
Vulnerability to certain
kinds of stress.
(sometimes combined with hostility).
Deficient coping skills.
Poor transfer of learning;
fear of new situations.
response and lack of enjoyment.
Reduced speech and impaired
Reduced ability to pay
Apathy; lack of motivation;
phobic avoidance of situations.
Sensitivity to over- (and
depression, demoralization, social breakdown syndrome,
medication side effects, or alcohol/drug abuse).
to serious illness:
are common in anyone who realizes they have a serious, chronic
(incurable) illness, and may progress through stages (like the
mourning process). Some of these characteristics are often
present and can be mis-diagnosed as positive or negative
General stress response
("fight, flight, fright").
Grief; denial and impatience
(lack of acceptance).
Anger and striking out.
Guilt and self-blame.
helpless feelings; demoralization.
Regression to earlier levels
.Preoccupation with "self"
(apparent disinterest in others).
.Interruption of normal
This includes loss
of normal role functioning and varying degrees of extrusion (or
exclusion) from normal family/community functioning.
Characteristics are similar to the negative symptoms and also
resemble institutionalization syndrome. Social breakdown
syndrome can be a side effect of any treatment that removes the
client/patient from his/her usual social environment (or excuses
him from usual role expectations) (e.g., prolonged
hospitalization or too much "overprotection" on the part of
clinical staff and/or family members).
This is the hoped
for and very possible outcome of treatment, rehabilitation,
family support and self-help.
Acceptance and hope;
curiosity about the illness and its treatment, and/or
efforts to be "like everyone else."
and active collaboration with treatment and rehabilitation.
lifestyle modifications (including more realistic goals and
Full participation in life
("love" and "work").
CONTINUITY of care (includes
continuity of relationships with staff as well as smooth
transition between, and coordination among, programs and
.Patient EDUCATION about the
illness and its treatment (leading to informed consent;
responsible patient role).
Safe and comfortable
SURROUNDINGS with adequate privacy and desired amount of
contact with others.
Contingency PLANS for crises
(to avoid "walking on eggshells").
INVOLVEMENT, support and
education of family and/or significant others (with
elimination of guilt!).
An approach which identifies
and builds on STRENGTHS.
OUTREACH - help and support
provided in "natural" settings.
A gradual, realistic,
"step-wise", LONG TERM approach, recognizing various phases
and stages of illness and recovery.
To deal constructively and
positively with STIGMA (starting with self-stigmatization,
then family stigma, and finally stigma from broader social
network). This often involves working through grief and
BIO-PSYCHO-SOCIAL APPROACH TO TREATMENT AND REHABILITATION:
Psychiatric care with
appropriate MEDICATION by a physician (and treatment team)
who understands the illness and its treatment.
Careful MONITORING of
intended effects and side effects.
Identification of NEW
physical and mental/emotional problems as they emerge.
Attention to BOTH active
(positive) and deficit (negative) symptoms.
ELIMINATION OF TOXIC
CHEMICALS and unnecessary drugs (alcohol, caffeine,
marijuana, "cold" medicine, etc.).
EARLY DETECTION of "danger
signals"--symptom monitoring by patient and others.
Adequate REST and regular,
planned, aerobic EXERCISE.
A balanced, nutritional
A therapeutic ALLIANCE with
a person (or "team") which involves "titrated" support
(varying degree of support depending on need), respect,
Dealing with "NORMAL"
REACTIONS to serious illness (listed above).
Being actively, comfortably
and USEFULLY BUSY.
A BALANCE between over- and
under-stimulation (everyone has a "window" of optimal
stimulation; this tends to be constricted in serious mental
A RELAXED (non-"rat race")
A regular daily ROUTINE
(including evenings, weekends and holidays).
Substitution of RESPONSIBLE
ADULT BEHAVIOR for inappropriate behavior (behavioral
approach using natural consequences, with some similarity to
"tough love" concept. This should be done in an empathic and
Minimization of handicap;
emphasis on strengths; INDEPENDENCE AS TOLERATED.
If alcohol/drug use a
problem, appropriate attention to dependencies should be
integrated with other treatment.
Learning "SURVIVAL SKILLS";
psychosocial and occupational rehabilitation.
COMMUNICATION and PROBLEM
SOLVING skills for patient and significant others.
Construction of supportive
SOCIAL NETWORK; prevent or reverse social breakdown
Instrumental help with daily
living (money management, transportation, housing, etc.)