Co-occurring Mental Illness

1
Co-occurring Mental Illness Mental Retardation
/ Developmental Disabilities

• A Perspective from Both Sides of the Fence

2
About Me

• I am a younger sibling
• I became my sisters guardian as a result of my
  mothers mental status (Alzheimer's)
• I am a Licensed Clinical Social Worker who has
  worked in community mental health and substance
  abuse settings for approximately 30 years
• I am sharing with you my experiences/thoughts
  along with those of other family members and
  colleagues.

3
Perspectives

• As a Family Member
• Parental
• Sibling
• As a Caregiver
• As a Professional

4
Parental Perspective

• Impact on Parents
• Financial
• High cost of care
• Emotional
• Stress
• Dealing with identified consumer
• Dealing with the System
• Self-perception
• Stigma
• Ability to parent other children
• All family events revolves around identified
  consumer

5
Sibling Perspective

• Psychological Effects of Childhood Trauma
• What is Trauma
• What the family member thinks is trauma!
• Examples may be
• Inappropriate acting out behavior
• Self-abuse
• Sexual
• Aggression
• Verbal
• Two Key Factors affecting Individual response
• Resiliency
• Vulnerability
• Traditional Family Relationships are Altered
• Parent / Child
• Child/Parent
• Sibling / Sibling

6
Sibling Perspective Continued

• Psycho-social Development of Individual
• Application of COA framework
• Common Problems
• Guilt
• Anxiety
• Shame
• Anger
• Depression
• Common Roles (Dr. Claudia Black)
• Responsible Child
• Adjuster Child
• Acting-Out Child
• Placater Child

7
Caregiver Perspective

• Understanding Navigating the System of Care
• Turnover of Case Managers
• Adequate Communication

8
Professional Perspective

• Loss of creditability related to self-disclosure
• A result of the consumer movement is that it is
  becoming safer to disclose
• Personal experience improves sensitivity to
  family/consumer perceived system barriers
• Professional expertise can assist with
  caregivers role.

9
Closing Thoughts

• Recognition of diversity of voices within the
  family and consumer community and recognition
  that oftentimes these voices do not agree with
  each other.
• Stigma affects the whole family

10
Closing Thoughts Continued

• Partnerships Each system has strengths that
  can be adapted
• ADA
• Educating and supporting family members
• Prevention and Early Intervention
• MRDD
• Person Centered Planning
• Psychiatric Services
• Expertise in differentiating diagnostic symptoms
  from behavioral issues

11
What is happening in Missouri?

• Psychiatric Services and MRDD is engaged in
  dialogue regarding those with dual diagnosis of
  MI/MRDD
• The two systems have reached agreement
• This cohort of consumers is a priority
• There should be joint funding
• There will be a joint pilot project