Schizophrenia Ireland

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Schizophrenia Ireland

• Mental Health Information and Education to
  Trainee Garda

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Welcome

• Schizophrenia Ireland is the national
  organisation Dedicated to Upholding the rights of
  all those affected by the symptoms of
  Schizophrenia and related illness, through the
  promotion and provision of high quality services
  and working to ensure the continual enhancement
  of the quality of life of the people it serves.

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The course

• This course is designed to inform you as
  potential Garda the particular difficulties you
  may encounter when dealing with members of the
  general public who are experiencing mental health
  difficulties. It will also endeavour to offer you
  an insight into how the person with self
  experience and their carers relatives may feel
  when dealing with the Garda.

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Why the need for training

• The recent changes in how people with mental
  health difficulties needs are being met within
  the community, (vision for the future 2006) has
  led to an increased likely hood they may come in
  contact with the Garda and the justice system in
  general.

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Modules

• 2.5 hours
• 1 Introductions
  
• 1.1 Ground Rules
  
• As a result of such a large group we will
  present core rules such
• as confidentiality, respect of opinions,
  no personal attacks, right
• to speak, then ask for any thing else
  which participants may want
• to include
• General Overview on the Duties and Legal
  
• Responsibilities of the Gardai in
  Relation to
• Mental Health
  
  
• 3.0 Exploring Mental Health Issues.
• symptoms of schizophrenia, bipolar disorder
  and depression
• 
  
• 4.0 Person with Self Experience
  
• 5.0 Family Member/Carer
  
• 6.0 How to Approach a Person who may be
• Experiencing Loss of Reality
• Questions and answers
  

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Why the need for mental health training to Garda

• Barr Tribunal Report Chapter 15 - Recommendations
  
• Recommendation 5

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Recommendation V

•    The desirability that the training of garda
  recruits (and all officers by way of refresher
  courses) should include basic instruction on
  mental illness and how a person so afflicted
  should be dealt with, including the need for
  urgent consultation with his/her medical advisor
  and the importance of calming the subject.

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Judge Barr went on to say

• As already stated, I am of opinion that the
  review of Garda command structures and training,
  particularly in the context of utilising the ERU
  in siege and other comparable situations,
  including those having mental illness as a
  factor, is a subject which should have urgent
  attention.

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Time 2.5 hrs

• The program is divided into six main sections
  the format is flexible taking into consideration
  the large group of participants attending.
• 2.5 hours
• 1 Introductions
  10 min
• 1.1 Ground Rules
  5 min
• As a result of such a large group we will present
  core rules such
• as confidentiality, respect of opinions, no
  personal attacks, right
• to speak, then ask for any thing else which
  participants may want
• to include
• General Overview on the Duties and Legal
  10 min
• Responsibilities of the Gardai in
  Relation to
• Mental Health
  
  
• 3.0 Exploring Mental Health Issues.
• symptoms of schizophrenia, bipolar disorder,
  depression and recovery
• 
  
• 4.0 Person with Self Experience
  30 min
• 5.0 Family Member/Carer
  30 min
• 6.0 How to Approach a Person who may be
  20 min

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• General Overview on the Duties and Legal
  Responsibilities of the Gardai
  in Relation to Mental Health

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Legal definition of mental Illness under Mental
Health Act 2001

• ) In this Act "mental disorder" means mental
  illness, severe dementia or significant
  intellectual disability where
• (a) because of the illness, disability or
  dementia, there is a serious likelihood of the
  person concerned causing immediate and serious
  harm to himself or herself or to other persons,
  or
• (b) (i) because of the severity of the illness,
  disability or dementia, the judgment of the
  person concerned is so impaired that failure to
  admit the person to an approved centre would be
  likely to lead to a serious deterioration in his
  or her condition or would prevent the
  administration of appropriate treatment that
  could be given only by such admission, and
• (ii) the reception, detention and treatment of
  the person concerned in an approved centre would
  be likely to benefit or alleviate the condition
  of that person to a material extent.

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Legal definition of mental Illness under Mental
Health Act 2001

• (2) In subsection (1)
• "mental illness" means a state of mind of a
  person which affects the person's thinking,
  perceiving, emotion or judgment and which
  seriously impairs the mental function of the
  person to the extent that he or she requires care
  or medical treatment in his or her own interest
  or in the interest of other persons
• "severe dementia" means a deterioration of the
  brain of a person which significantly impairs the
  intellectual function of the person thereby
  affecting thought, comprehension and memory and
  which includes severe psychiatric or behavioural
  symptoms such as physical aggression
• "significant intellectual disability" means a
  state of arrested or incomplete development of
  mind of a person which includes significant
  impairment of intelligence and social functioning
  and abnormally aggressive or seriously
  irresponsible conduct on the part of the person.

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Powers of Garda Síochána to take person believed
to be suffering from mental disorder into custody

• Powers of Garda Síochána to take person believed
  to be suffering from mental disorder into
  custody.12.(1) Where a member of the Garda
  Síochána has reasonable grounds for believing
  that a person is suffering from a mental disorder
  and that because of the mental disorder there is
  a serious likelihood of the person causing
  immediate and serious harm to himself or herself
  or to other persons, the member may either alone
  or with any other members of the Garda Síochána
• (a) take the person into custody, and
• (b) enter if need be by force any dwelling or
  other premises or any place if he or she has
  reasonable grounds for believing that the person
  is to be found there.
• (2) Where a member of the Garda Síochána takes a
  person into custody under subsection (1), he or
  she or any other member of the Garda Síochána
  shall make an application forthwith in a form
  specified by the Commission to a registered
  medical practitioner for a recommendation.(3) The
  provisions of sections 10 and 11 shall apply to
  an application under this section as they apply
  to an application under section 9 with any
  necessary modifications.(4) If an application
  under this section is refused by the registered
  medical practitioner pursuant to the provisions
  of section 10, the person the subject of the
  application shall be released from custody
  immediately.(5) Where, following an application
  under this section, a recommendation is made in
  relation to a person, a member of the Garda
  Síochána shall remove the person to the approved
  centre specified in the recommendation.

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Persons who may apply for involuntary admission.9

•  Persons who may apply for involuntary
  admission.9.(1) Subject to subsection (4) and
  (6) and section 12, where it is proposed to have
  a person (other than a child) involuntarily
  admitted to an approved centre, an application
  for a recommendation that the person be so
  admitted may be made to a registered medical
  practitioner by any of the following
• (a) the spouse or a relative of the person,
• (b) an authorised officer,
• (c) a member of the Garda Síochána, or
• (d) subject to the provisions of subsection (2),
  any other person.
• (2) The following persons shall be disqualified
  for making an application in respect of a person
• (a) a person under the age of 18 years,
• (b) an authorised officer or a member of the
  Garda Síochána who is a relative of the person or
  of the spouse of the person,
• (c) a member of the governing body, or the staff,
  or the person in charge, of the approved centre
  concerned,
• (d) any person with an interest in the payments
  (if any) to be made in respect of the taking care
  of the person concerned in the approved centre
  concerned,

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Persons who may apply for involuntary admission.9

• (e) any registered medical practitioner who
  provides a regular medical service at the
  approved centre concerned,
• (f) the spouse, parent, grandparent, brother,
  sister, uncle or aunt of any of the persons
  mentioned in the foregoing paragraphs (b) to (e),
  whether of the whole blood, of the half blood or
  by affinity.
• (3) An application shall be made in a form
  specified by the Commission.(4) A person shall
  not make an application unless he or she has
  observed the person the subject of the
  application not more than 48 hours before the
  date of the making of the application.(5) Where
  an application is made under subsection (1)(d),
  the application shall contain a statement of the
  reasons why it is so made, of the connection of
  the applicant with the person to whom the
  application relates, and of the circumstances in
  which the application is made.(6) A person who,
  for the purposes of or in relation to an
  application, makes any statement which is to his
  or her knowledge false or misleading in any
  material particular, shall be guilty of an
  offence.(7) In paragraph (c) of subsection (2),
  the reference to a member of the governing body
  of the approved centre concerned does not include
  a reference to a member of a health board.(8) In
  this section"authorised officer" means an
  officer of a health board who is of a prescribed
  rank or grade and who is authorised by the chief
  executive officer to exercise the powers
  conferred on authorised officers by this
  section"spouse", in relation to a person, does
  not include a spouse of a person who is living
  separately and apart from the person or in
  respect of whom an application or order has been
  made under the Domestic Violence Act, 1996.

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Making of recommendation for involuntary
admission.10.

• Making of recommendation for involuntary
  admission.10.(1) Where a registered medical
  practitioner is satisfied following an
  examination of the person the subject of the
  application that the person is suffering from a
  mental disorder, he or she shall make a
  recommendation (in this Act referred to as "a
  recommendation") in a form specified by the
  Commission that the person be involuntarily
  admitted to an approved centre (other than the
  Central Mental Hospital) specified by him or her
  in the recommendation.(2) An examination of the
  person the subject of an application shall be
  carried out within 24 hours of the receipt of the
  application and the registered medical
  practitioner concerned shall inform the person of
  the purpose of the examination unless in his or
  her view the provision of such information might
  be prejudicial to the person's mental health,
  well-being or emotional condition.(3) A
  registered medical practitioner shall, for the
  purposes of this section, be disqualified for
  making a recommendation in relation to a person
  the subject of an application
• (a) if he or she has an interest in the payments
  (if any) to be made in respect of the care of the
  person in the approved centre concerned,
• (b) if he or she is a member of the staff of the
  approved centre to which the person is to be
  admitted,
• (c) if he or she is a spouse or a relative of the
  person, or
• (d) if he or she is the applicant.
• (4) A recommendation under subsection (1) shall
  be sent by the registered medical practitioner
  concerned to the clinical director of the
  approved centre concerned and a copy of the
  recommendation shall be given to the applicant
  concerned.(5) A recommendation under this section
  shall remain in force for a period of 7 days from
  the date of its making and shall then expire.

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Mental health a general Overview

• 3.0 Exploring Mental Health Issues.
• symptoms of schizophrenia, bipolar disorder
  and depression

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Schizophrenia

• Schizophrenia is a serious mental illness
  characterised by disturbances in a person's
  thoughts, perceptions, emotions and behaviour. It
  affects approximately one in every hundred people
  worldwide and first onset commonly occurs in
  adolescence or early adulthood although it can
  also occur later in life.
•  
• There are a number of signs and symptoms that are
  characteristic of schizophrenia. However, the
  expression of these symptoms varies greatly from
  one individual to another. No one symptom is
  common to all people and not everyone who
  displays these symptoms has schizophrenia (as
  some physical conditions can mimic
  schizophrenia).
•  
• Generally speaking, symptoms are divided into two
  groups, active symptoms (also referred to as
  positive or psychotic symptoms) that reflect
  new or unusual forms of thought and behaviour,
  and passive symptoms (also referred to as
  negative symptoms), which reflect a loss of
  previous feelings and abilities.  
•  
•  

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Symptoms

• Positive / Active Symptoms
• Delusions
• Delusions are false personal beliefs held with
  extraordinary conviction in spite of what others
  believe and in spite of obvious proof or evidence
  to the contrary. For example, a person
  experiencing delusions may believe that thoughts
  are being inserted into their mind or that they
  have special powers or are someone famous (for
  example Jesus Christ or Elvis). People may also
  think that they are being spied on, tormented,
  followed or tricked, or may believe that gestures
  or comments are directed specifically at them.
  Delusions will occur during some stage of the
  disorder in 90 of people who experience
  schizophrenia.
•  
• Hallucinations
• These are unusual or unexplained sensations,
  which are most commonly heard but can also be
  seen, touched, tasted or smelt. For example, the
  person may hear voices repeating or mimicking
  their thoughts, commenting on their actions
  (often in a critical manner), or they may hear
  voices arguing with one another. Auditory
  hallucinations occur in 50 of people with
  schizophrenia, while visual hallucinations occur
  in 15.
•  

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Symptoms

• Disorganised Thinking
• This is a change in patterns of thinking and is
  usually expressed through abnormal spoken
  language. For example, the persons conversation
  jumps erratically from one topic to another, new
  words may be created, the grammatical structure
  of language may break down, and speech may
  greatly speed up or slow down. Most people with
  schizophrenia will experience some degree of
  disorganised thinking.
•  
• Disorganised Behaviour
• A person with schizophrenia may display behaviour
  that is considered inappropriate according to
  usual social norms, such as wearing unusual
  clothing, muttering aloud in public, or
  inappropriately shouting or swearing.
•  

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Symptoms

• Negative / Passive Symptoms
• Withdrawal / Loss of Motivation
• This may involve lack of energy, apathy or
  seeming absence of interest in things which loss
  of motivations were once previously enjoyed.
  There may be feelings of isolation and
  difficulties keeping up with work, school or
  daily routine.
•  
• Loss of feelings
• This may manifest itself as an inability to
  experience pleasure in social and recreational
  activities or in close relationships. The ability
  to express or feel emotions can be greatly
  reduced, and consequently relationships can be
  severely affected.
• Poverty of Speech
• The amount of speech is greatly reduced and may
  sometimes be vague or repetitious. People may be
  slow in responding to questions or they may not
  respond at all.
•  

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Symptoms

• Flat Presentation
• This can be indicated by unchanging facial
  expressions, poor or no eye contact, reduced body
  language and decreased spontaneous movements. A
  person experiencing flattened affect may stare
  vacantly into space and speak in a flat toneless
  voice.
•  
• Cognitive Impairments
• Although not included in diagnostic criteria,
  cognitive impairments such as problems with
  attention, concentration and memory, are often
  present in people with schizophrenia.

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Depression

• It is a mental health difficulty that can take
  many forms
• The overwhelming feelings of sadness can affect
  concentration, saps energy, interest in food,
  sex, work and everyday activities.

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Symptoms

• Energy - Tired,fatigued,slow movements
• Sleep- Waking during the night, or too
  early,oversleeping
• Thinking slow thinking,poor concentration,forget
  ful
• Interest - loss of interest in food,work,sex
• Feelings Depressed,sad,anxious

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Bi-polar

• Bi-polar Disorder The depressed stage of
  Bi-polar disorder are identical to uni-polar.
• There is also times were elation happens.
• Elation is considered pleasurable but can be
  devastating to a persons life.

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Symptoms

• Value reduced self worth, low self esteem
• Aches headaches,chest pains,
• Live - not wanting to live
• If 5 signs are present for more than 2 weeks

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Symptoms elation

• Unrealistic belief in ones ability,grandioise
  plans
• Thinking one can live forever , taking reckless
  physical risks.
• Elated ,Over- enthuasiastic,excited angry
• Great energy never felt better,over talkative
• Reduced sleep
• Racing thoughts ,indecisiove,poor concentration
• New Adventures ,sex ,Street drugs

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Recovery

• What Recovery May Look Like
• Most of the definitions of recovery include the
  following processes. Note while this list
  pertains to those who have schizophrenia, it
  pertains just as much to family members seeking
  their own recovery from the effects of this
  illness.
• Accepting that which is unacceptable (Farr and
  Hurley, 1997). It means accepting that one has a
  disease of the brain called schizophrenia. It
  also means letting go of denial as well as
  misplaced guilt and blame --- believing that
  whatever one has is the result of taking street
  drugs, a dysfunctional family or anything other
  than a chemical imbalance in the brain. This is
  far from easy! Acceptance is one of the harder
  tasks in the recovery process (Spaniol, Gagne
  and Koehler, 1998). Acceptance requires
  support, they add. One cannot do this alone.
• Finding someone who will hold the candle of hope
  for you. A common denominator of recovery
  writes Dr. Bill Anthony, one of the primary
  advocates of the recovery process, is the
  presence of people who believe in and stand by
  the person in need of recovery. The times I
  have felt the most useful to my son and to my
  daughter, who has severe depression, are when
  they have independently asked me, Do you have
  hope for me? Yes! I have answered each time.
  In saying this, it not only became true for me.
  Each of them decided to keep on keeping on, to
  continue seeking recovery, and they do so still.

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• Refusing to be called schizophrenic. Every one
  of us is a person, not an illness. If
  individuals with schizophrenia remind others that
  they are more than their illness, they will also
  remind themselves.
• Hanging in there through the long, often slow
  process of healing. Recovery is a process, not
  an end-point or a destination, writes Pat
  Deegan. In many ways, everyone who seeks healing
  is in transit always trying to move forward. The
  journey itself may be what heals us, not whether
  we reach a set destination.
• Changing ones attitudes about schizophrenia.
  Anthony (1993) states this so beautifully
  Recovery is a deep personal, unique process of
  changing ones attitudes, values, feelings,
  goals, skills and/or roles. I think my son
  explained what this change in attitude might look
  like when he told me one day, Ive decided not
  to collaborate with the illness. Im not going
  to stay in bed all day. Pat Deegan adds,
  Recovery is a way of approaching the day and
  challenges I face.
• Regarding one s self not as an illness but as an
  individual with strengths, even gifts, who also
  happens to have an illness.

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Impact on family

• Anxiety
• Family friction
• Blame and Guilt
• Embarrassment
• Burden
• Health
• Managing difficulties

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Impact on family

• Isolation
• Depression
• Aggression
• Stress
• Over involvement
• Communication Issues

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• 4.0 Person with Self Experience
  5.0 Family Member/Carer
  

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6.0 How to Approach a Person who may be
Experiencing Loss of Reality . Rethink,UK


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How to approach someone in difficulty

• the person concerned may reach a point of
  crisis, and this section has been included to
  raise awareness and provoke thought about what to
  do in such a situation. However, it is important
  to emphasise two points
• people experiencing mental health problems are
  very rarely violent towards others and

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How to approach someone in difficulty

• crisis situations are extremely rare and can be
  prevented. This highlights the importance of
  adopting a pro-active approach in the area of
  mental health and the law.
• A crisis situation occurs when a persons's
  feelings have become outside their control. These
  emotions might express themselves in a number of
  ways, for example self-harming, talking about
  suicide or having persistent suicidal thoughts,
  having no sense of reality and exhibiting
  behaviour which is out of character. However,
  many crises occur in private rather than in
  public. In all crisis situations, assuring your
  safety and that of others, including the person
  involved, is paramount. These guidance notes may
  help you

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How to approach someone in difficulty

• Try to remain calm and adopt a non-threatening
  approach (in most cases calm behaviour by others
  is all that is required). Do not approach the
  person from behind without warning, nor stare at
  them, as this could be interpreted as
  threatening.
• If there are other students about, calmly ask
  them to leave the area.
• Some situations can be very frightening and
  distressing. If you do not feel confident to
  approach the person, then go and get help.
• If you stay with the person, give the person room
  to breathe, and do not touch them unless you are
  sure that they do not feel threatened by you.

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• Explain your actions before you act and continue
  to reassure the student, without being
  patronising, about what is happening.
• Take threats of suicide seriously - do not ignore
  them - it is a myth that 'those who talk about it
  don't do it'
• Ensure appropriate people are contacted. If a
  person becomes severely disorientated or
  dangerous to themselves or others it may be
  necessary to call a GP, the local hospital
  accident and emergency service, In all
  situations, whether they are crises or not, each
  case must be treated individually. A person's
  mental health problems may fluctuate from week to
  week or even from hour to hour and the level of
  support needed will vary from person to person.
  

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Who to contact

• If possible, Family Member, carer, Persons GP,
  Community Mental health Nurse, Social worker,
  Local Mental health unit, someone the person asks
  for within reason, advocate.
• For further information contact mmatthews_at_sirl.ie

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References

• Barr Tribunal Report (2006) the Barr
  Tribunal Jameson Building, Bow Street Dublin 7,
  Ireland Email contact_at_barrtribunal.ie, Chapter
  15 Section V Department of health and children,
  (2006), A Vision for Change. Government
  Publications.
• Dublin Simon Community (2006),
  http//www.dubsimon.ie/
• Journal of Psychological Medicine
  (2006), Cited In issue 23 Emergency services
  Ireland
• Schizophrenia Ireland publications
  (2003), the Schizophrenia Hand Book
• World Health organisation (2004)
  promoting mental Health Concepts, Emerging
  Evidence, Practice. Geneva
• Rethink, registered in England as National
  Schizophrenia 28 Castle Street,
  Kingston-Upon-Thames, Surrey, KT1 1SS.
• www.rethink.org/