Blog: Shiawassee County Community Mental Health

September is National Recovery Month

One in five people are affected with a mental illness at some point in their life. Colleges and universities nationwide are experiencing increased numbers of students suffering from mental illness and surging demand for mental health services. The prevalence of serious mental health conditions is highest among young adults, yet this group is the least likely to receive help due in part to stigma associated with mental illness and the false assumption that once you have a mental illness, you will have it for life. This is not always the case. At Shiawassee County Mental Health Authority (SCCMHA), we know that recovery is possible. We encourage everyone to be supportive of family and friends who are experiencing mental illness. It is imperative that friends and family understand how to help those coping with mental illness, including students and young adults, by encouraging them to seek treatment and connecting them to mental health resources. The same as influenza affects the lungs and norovirus affects the intestinal track, mental illness such as depression, bi-polar disorder and schizophrenia are illnesses that affect one’s mental health. All of these illnesses, both physical and emotional, are treatable with proper medication, therapy and peer support. Recovery month promotes the societal benefits of prevention, treatment, and recovery for mental and substance use disorders, celebrates people in recovery, appreciates the contributions of treatment and service providers, and promotes the message that recovery is possible. This month, let’s spread the positive message that behavioral health is essential to overall health, that prevention works, treatment is effective and people can and do recover. Let’s continue to be supportive and promote recovery for ourselves, our loved ones, friends, and neighbors on their personal journey to wellness and recovery.

PTSD in the Elderly

Many people know someone who has experienced a shocking event. Some individuals may have even experienced a traumatic event. Traumatic events can be life altering and may even lead to post-traumatic stress disorder (PTSD). PTSD is a mental health condition in which some traumatic event leaves a severe psychological impact on a person to the extent that it impairs their ability to function normally. The traumatic event is usually experienced directly by the person involved such as a serious injury, death or the threat of harm or death. It is also true that a person doesn’t have to experience the traumatic event directly; at times just witnessing a disturbing event is bothersome enough to have a long term effect. Sometimes an elderly person may not experience symptoms until years after the fact. It is important to recognize the symptoms and respond by helping your loved one or friend obtain the proper treatment.

A common reason the elderly may experience PTSD is witnessing the death of a loved one or friend, even if the death is anticipated. This can happen at any point in their life. Although emotional shock, fear, anxiety, sadness and even anger may ease shortly after the painful event, the residual effects are seen as PTSD and can persist for decades. The symptoms can be intermittent and can be so severe that a person may be unable to function normally in that PTSD can affect one’s occupation, interpersonal relationships and everyday tasks. The condition can persist through the senior years in some form or the other, particularly in the elderly who served in armed forces and went to war earlier in life. PTSD can arise with various other traumatic events in life, including being a victim of crime, violent physical assault, sexual assault or abuse, serious accidents, natural or man-made disaster, diagnosis of a life threatening illness.

PTSD symptoms usually begin within 3 months of the traumatic event, while some symptoms may be delayed until much later in life. Symptoms commonly seen are repeatedly experiencing the traumatic event as nightmares and flashbacks, avoidance of trauma-associated circumstanced (phobic anxiety), and increased arousal (generalized anxiety). Other associated symptoms may include emotional numbing, avoiding activities which were previously enjoyable, a sense of hopelessness, difficulty in concentrating, not being able to maintain close relationships, irritability, anger, excessive feeling of guilt or shame and self-destructive behavior such as alcoholism, difficulty sleeping, easily feeling frightened or startled and hallucinations.

If you recognize PTSD symptoms in a loved one or friend, encourage them to call their family physician or Shiawassee County Community Mental Health at 989.723.6791 for an evaluation. Additionally, it may be helpful to offer transportation and/or to accompany them to the appointment. Although early intervention is preferable, PTSD is treatable at any stage of the diagnosis.

Children: Exposure to Traumatic Events and Behavioral Health

Too many children have been exposed to one or more traumatic events over the course of their lives. Some of these children develop reactions that persist and affect their daily lives after the traumatic events have ended. Many are diagnosed as having post traumatic stress disorder (PTSD) or acute stress disorder. Additionally, many will further meet the criteria for attention-deficit/hyperactivity disorder, mood disorders such as depression, and oppositional defiant disorder. Children and youth who had been exposed to multiple types of traumatic events have higher levels of depression and anxiety (internalizing symptoms), and were more aggressive and broke more rules (externalizing symptoms). As the number of traumatic events increase, so do the clinical levels of symptoms.

Studies show that at least one in five children have a mental health disorder. Often sigma or misconceptions about treatment prevent families from seeking assessment or services. Much like physical problems, mental health disorders may be mild and others may be more intense.

Some children and adolescents indicate signs of mental health problems that signal for help. These signs or symptoms may be the child is troubled by feelings of sadness, feeling angry, worthlessness, anxiety, having grief and other signs that are persistent. Those close to the child may notice a big change in the child’s demeanor such as problems at school, losing interest in activities they once enjoyed, change in sleeping or eating patterns, avoiding friends and family as well as experiencing suicidal thoughts.

Every child’s mental health is important. Many children have mental health problems that range from mild to severe; however, most can be treated once it is recognized. Family physicians, school personnel and the Shiawassee County Community Mental Health Authority can provide information, assessment, treatment and referrals. Visit us at shiacmh.org or call 989.723.6791.

RECOGNIZING THE SIGNS AND RISK FACTORS OF SUICIDE

Suicide is a major, preventable public health problem. There are four male suicides for every female suicide, but three times as many females as males attempt suicide. According to the 2012 Shiawassee County Health Needs Assessment Report, 3% of Shiawassee County adults considered attempting suicide, 2% of adults made a plan about how they would attempt suicide. In December 2012, Shiawassee County Central Dispatch reported 15 suicide attempts.

Although there are suicides that occur without any warnings, most people who are suicidal do give warnings. By learning to recognize the signs of someone who is at risk of taking their life, you may be able to prevent the suicide of someone you care about.

Some risk factors vary with age, gender, or ethnic group and may occur in combination or change over time. Some observable warning signs of suicide are:

· Loss of interest in school and regular activities

· Withdrawal from friends and family

· Feelings of hopelessness, worthlessness, self-blame, or guilt

· Unexpected rage, anger, irritable mood

· Anxiety, psychic pain and inner tension

· Feeling that there is no way out; need to escape

· Talking about not being around–nothing matters anymore and there is nothing to live for

· Sleep problems

· Talking about death and threats of suicide

· Prior suicide attempt

· Prior family history of mental disorder or substance abuse

· Prior family history of suicide

· Family violence, including physical or sexual abuse

· Incarceration

· Exposure to the suicidal behavior of others, such a family members, peers

· Make a plan: Giving away prized possessions, sudden or impulsiveness to obtain a means of killing oneself such as poisons, medications or firearms.

If you notice signs of behavior change and think someone is suicidal, acknowledge that you are aware of a change and do not leave this person alone. Try to get the person to seek immediate help by either talking to their doctor or take them to the nearest hospital emergency room. If necessary, call 911 or Shiawassee County Community Mental Health Authority Crisis line at 1.800.622.4514. All calls are confidential.

POST TRAUMATIC STRESS DISORDER: WHO IS AT RISK?

You don’t have to be a victim of a traumatic event to experience post-traumatic stress disorder (PTSD). You may be the person who witnessed a violent act or who has been repeatedly exposed to life-threatening situations. Traumatic events may include:

· Combat exposure

· Rape or sexual assault or abuse

· Children who are neglected or sexually, physically, or verbally abused, or adults who were abused as children

· Physical attack or being threatened with a weapon

Other traumatic events that may lead to PTSD include fire, natural disaster, major catastrophic events such as a car accident, plane crash or terrorist act, physical assault such as mugging, robbery or carjacking, kidnapping, diagnosis with a life-threatening illness, other random acts of violence such as those that take place in public, in schools, or in the workplace.

A person with PTSD may experience symptoms such as flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. At times the mind will use a coping mechanism that does not allow you to consciously remember the trauma. However, the subconscious mind retains the details and will continue to react to them until treatment occurs. PTSD can be very disruptive and make daily tasks difficult or impossible to complete.

Shiawassee County Community Mental Health Authority, CEO, Scott Gilman states “PTSD is treatable, but it is imperative for survivors to take the steps to get help. You do not have to suffer in silence. Receiving treatment soon after symptoms develop may prevent long-term PTSD.” There are programs available to prevent, diagnose, treat, and rehabilitate those who have PTSD. It is important to remember there is no set time for healing. Everyone’s healing journey varies based on desire, determination and access to help. Therefore healing can take as little as one month or as long as a few years. If you believe you are experiencing PTSD, contact your family doctor or Shiawassee County Community Mental Health Authority.

MENTAL ILLNESS PREVENTION AND EARLY INTERVENTION

Safeguarding you and your loved ones’ quality of life is extremely important during tough economic times. Shiawassee County Community Mental Health Authority (SCCMHA) can be your lifeline to lead a healthy life. Taking steps to control stress and boost low self-esteem may help keep your mental health symptoms under control. Mental illness prevention and early intervention begins with recognizing the warning signs, such as:

· Recent social withdrawal and loss of interest in others

· An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school, or difficulty performing familiar tasks

· Problems with concentration, memory, or logical thought and speech that are hard to explain

· Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations

· Loss of initiative or desire to participate in any activity; apathy

· A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality

· Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult

· Fear or suspiciousness of others or a strong nervous feeling

· Uncharacteristic, peculiar behavior

· Dramatic sleep and appetite changes or deterioration in personal hygiene

· Rapid or dramatic shifts in feelings or “mood swings.”

If you or your loved one are experiencing these warning signs, talk to your doctor or contact SCCMHA for an assessment by our team of professionals by calling 989.723.6791 or 800.622.4514. When diagnosed early, mental illness is easier to treat and can prevent a possible relapse of symptoms. Additionally, it is extremely important to take care of yourself by getting adequate sleep, participating in routine physical activity and eating healthy. Get the help when you need it. Together we can establish a treatment plan and improve your quality of life.

Coping with Stress and Tragedy

With the holidays behind us, we begin to think about returning to “normal,” but what is normal? Within the past several weeks, our society has experienced some life-altering, traumatic events which may trigger our fears. As a result we become frightened, confused, anxious and may experience feelings of helplessness. These are all normal responses in the aftermath of horrific tragedies. As we return to work, school and other routine activities, these fears may resurface. It is important to process heartache and move on from trauma.

Begin by caring for your personal basic needs, such as eating well-balanced meals and getting plenty of rest. Once you have taken care of yourself by establishing healthy patterns, check on family, neighbors and close friends to be sure their basic needs are being met. Don’t be afraid to seek professional help.

When children have questions about a traumatic event, the most important thing a parent can do is to be honest with them about the tragedy. The response should be age appropriate in terms the child will understand and then listen. Often, grieving children want to share their feelings by telling their story. Additionally, let them know that schools, law enforcement, and government workers have been working on safety plans. Reassure them with a hug and calm support. It may take a child longer to process the information you have shared; however, repeat explanations and acts of comfort as many times as necessary. It might take a little time to heal and therefore, it is important to continue doing the normal, everyday family activities like regular meals, bedtimes, and play times.

Immediately following a tragedy, both parents and children should keep media, including social media, to a minimum. Too much exposure could have a harmful impact on physical and psychological health. Instead, use the information you have to find positive ways of coping with the disaster by helping others.

Although we may never have an explanation or all the answers to our questions about the tragedy, it is important to acknowledge our emotions and share feelings with people we trust or with a professional. If you, your child or a loved one are experiencing disruptions in sleep, appetite, and social interests that extend beyond four weeks, contact your family doctor or Shiawassee County Community Mental Health Authority at 989.723.6791 or 800.622.4514.

Penny Corbin, Public Relations & Prevention Specialist

STIGMA OFTEN PREVENTS MENTAL HEALTH AID, BUT HELP IS AVAILABLE

The National Institute of Mental Health reports that mental health is how you think, feel and act as you cope with life. It also helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important at every stage of life, from childhood and adolescence through adulthood.

According to the Centers for Disease Control, one in four people is affected by mental health issues and that nearly fifty percent of U.S. adults will develop at least one mental illness at some point in their life. Medications and counseling may help if treatment is sought; however, more than 75 percent of people with mental illness receive no treatment. Mental illness covers a wide range of disorders, including: anxiety disorders, bipolar disorders, depression, personality disorders, thought disorders, including schizophrenia, and organic disorders, including dementia. Autism and Asperger’s are developmental disorders. A number of recent media reports have suggested a link between Asperger’s syndrome (a high functioning form of autism spectrum disorders) and violent behavior. According to the Autism Alliance of Michigan, there is no evidence that suggests persons with Asperger’s are any more likely to engage in planned, violent attacks on others than those from the general population without this disorder. In fact, persons with autism tend to be victims of bullying and victimization due to their social awkwardness and inability to understand and appropriately respond to social cues. For more information about Autism, contact the Autism Alliance of Michigan.

It is extremely unfortunate that some people do not seek the necessary treatment. Many times because they are embarrassed or ashamed. Negative attitudes about mental illness often underlie stigma, which can cause affected persons to deny symptoms; delay treatment; be excluded from employment, housing, or relationships; and interfere with mental health recovery. Stigma refers to attitudes and beliefs that lead people to reject, avoid, or fear those perceived as being different. Stigma about mental illness is a major reason people do not seek treatment. Furthermore, there are many misconceptions about mental illness and mental health treatment. Mental illness, like many other illnesses, IS treatable. We can help those we care about by encouraging them to seek mental health treatment. If you are a family member or friend, show support for your loved one by assisting with the initial call to a mental health provider, getting them to and from the scheduled appointment, become a part of the treatment plan, and most important, accept them as a person, just as they are.

The Shiawassee County Community Mental Health Board and staff offers deepest condolences to the families, friends and loved ones of the Sandy Hook Elementary School shooting victims, and the entire community of Newtown, Connecticut. Tragedies such as this, especially involving children, take an immeasurable emotional toll on the citizens throughout the nation. Scott Gilman, CEO states “It is normal to grieve following a traumatic event and I encourage you to talk about your feelings and responses with loved ones, friends, and if necessary, to seek professional help.” Shiawassee County Community Mental Health Authority is here for you because you matter to us. For services and crisis intervention, please call 989.723.6791 or 1.800.622.4514. Counseling is available 24-hours-a-day, 7-days-a week. You will be connected to trained and caring professionals who will provide confidential counseling, referrals, and other needed support services.

Autism Insurance Reform

The CDC estimates that 1 in 88 children has been identified with an autism spectrum disorder. This is a 23% increase since their last report in 2009. ASD's are almost five times more common in boys, 1 in 54, than in girls, 1 in 252!

Applied Behavioral Analysis (ABA) is an 'evidence-based treatment' that has demonstrated success for children with autism, especially those who are younger. It has its origins in behavioral therapy and teaches social, motor, and verbal behaviors as well as reasoning skills.  ABA treatment is especially useful in teaching behaviors to children with autism who may not otherwise "pick up" these behaviors on their own as other children would.

ABA has been around for quite some time, but there has been barriers from accessing it. First, it took many years of research for autism to be recognized as it is now. Second, insurance companies haven't historically covered 'specialty treatments' for behavioral health. ABA is a specialty treatment and very costly. However, the long-term savings is great. Lastly, even if this were a covered service there is a lack of professionals competent to deliver the service. Very few areas in Michigan have a Board Certified Behavioral Analyst.

This week the Michigan House of Representatives overwhelmingly approved a series of bills that, if signed into law, would compel insurance companies to cover autism diagnoses and treatments for children, specifically Applied Behavioral Analysis (ABA).  Governor Snyder is also setting aside funding for children on Medicaid or MI Child that need this treatment. Additionally, there is a plan to develop provider networks and increase the number of certified professionals.

Shiawassee County Community Mental Health Authority is a strong advocate for young children and supports any reform that improves behavioral health care for this population. Focusing on people's needs when they are young significantly improves their quality of life and in the long-term reduces cost. However, as advocates will agree, it requires care that is 'gold standard' and evidence-based treatment proven to be successful.

Representatives from SCCMHA have been involved in a state level work group that will make recommendations regarding evaluation and covered ABA services for children with autism receiving Medicaid.  Focus will also be on increasing the number of providers across the state. This role is an honor and a responsibility that is taken seriously.

Due to the increasing number of young children being referred for services and in preparation for the future, SCCMHA is recruiting a behavioral assistant to increase our capacity to serve young children with behavioral needs.  We are also recruiting a Certified Occupational Therapy Assistant to assist our Occupational Therapist in delivering much need sensory services to the increasing number of children being served in the Sensory Clinic.  One of the reasons for developing a robust team of professionals to provide ancillary specialty services is to more effectively serve children with complex issues, i.e. autism and other disorders on the spectrum.

Shiawassee County Community Mental Health Authority looks forward to being a partner and playing an active part in treatment reform for children with autism.

Duplication of Services

Throughout the country, duplication of mental health service is a major problem.  In graduate school, mental health professionals are taught that consumers seeing multiple therapists can be detrimental.   It tends to confuse consumers and doesn't create for a therapeutic alliance and promotes "splitting"and limits effectiveness. That said, in accord with sound ethical practice, SCCMHA doesn't generally provide ongoing services to someone actively receiving such care elsewhere.

Throughout the human service industry, some believe "more is better." However, the more services in one's home, the greater chance duplication will occur--primarily due to the lack of collaboration and coordination among service providers.

Human service systems, by nature, operate in silos. Good coordination and collaboration is difficult among agencies. In part, due to the differning idiologies. But also because staff are burdened due to job responsibilities.  "Doing more with less" is the culture of most industries, providing little to no time for consulting and sharing information. Unfortunately, this doesn't benefit anyone and generally costs more in the end.

One of Shiawassee CMH's values is "teamwork." This includes continuity of care among the service spectrum. Teamwork is ensuring that consumers aren't tangled in the confusing web of duplication, coordinating and collaborating with other service providers, and advocating for what the consumers should expect.

During the intake and assessment process, it is important that our staff obtain information regarding other services being provided to consumers.  We are then able to sort out what, if any, duplication of services may be occuring.  During this process, it may be important for our staff to collaborate with those from other agencies. Or during the treatment process, this may also occur.

Most recently, Shiawassee CMH, Shiawassee Regional Education School District (SRESD), DHS, and Public Health have partnered with the goal being to reduce duplication of services for children ages 0-5. It is our intent to improve continuity of care by increasing coordination and collaboration among early childhood providers. Therefore, these staff have co-located in the same building hoping to dismantle silos among agnecies.

When multiple agencies are serving the same family, clarifying treatment boudaries, goals, and developing a unified approach is best-practice. Anything less is not providing appropriate care.

Peer Support Services

Peer Support services provide individuals with opportunities to support, mentor and assist consumers with a mental illness to achieve community inclusion, participation, independence, recovery, resiliency and/or productivity. Peer are individuals who have a unique background and skill level from their experience in utilizing services and supports to achieve their personal goals of community membership, independence and productivity. Individuals receiving peer support services must participate in choosing the peer who will be providing the service. Services may be provided on an individual basis or in a group format and must be tied into the consumers identified outcome in their Person Centered Plan.

Peer Support Services include an array of services that include vocational assistance to support consumers seeking education, training and/or employment activities; housing assistance to find and maintain independent living, move to less restrictive living situations, and applying for housing vouchers; person centered planning; self determination; sharing recovery stories, accessing entitlements, developing wellness plans, developing advance directives, pursing alternatives to guardianship, supporting consumers in crisis; and developing, implementing and providing ongoing guidance for advocacy and support groups.

The Peer Support Program is intended to serve adult consumers of SCCMHA who have a diagnosis of a serious mental illness or a co-occurring disorder of a mental Illness and a substance use disorder who are receiving Supports Coordination or Case Management, Assertive Community Treatment or Outpatient Services.

Consumer-provided services arose from a number of problems with traditional mental health services including:

Consumers falling through the cracks,
Lack of opportunity for consumers to develop competencies, autonomy, involvement and relatedness with others,
Need for supports for rehabilitation, and
Professional lack of knowledge, theory and techniques that lead to Recovery.

Peer Supports evolved from the consumerism movement that includes self-help, mutual support and consumers as providers. At the same time, there has been a shift from the medical model to the recovery model in the delivery of mental health services, a move that parallels the system transformations efforts are associated with integrating mental health, substance abuse and physical health care interventions, person-centered planning, and the emphasis on self determination as basic value in service delivery. Many direct services now provided by professional staff, can be more effectively provided by peers.

Peer Supports, one of a number of peer delivered services, benefit consumers who receive the service, consumers who provide the services, and the agency. For consumers who receive peer support services, benefits include:

Increased social supports and nurturance,
Increased opportunities for decision making, choice and increased independence,
Increased sense of hope,
Increased sense of empowerment, and
Opportunities for development of a network based on friendships.

Ensuring That Our Veterans Are Provided Mental Health Services

There seems to be a misconception that community mental health doesn't offer many services to our veterans. Contrary to this belief, Shiawassee County Community Mental Health Authority has served veterans for many, many years.

There are many veterans that have medical benefits allowing them mental health treatment through the Veterans Administration.   However, the service array is limited. That said, community mental health does try to link and coordinate with the Veterans Administration for those services that are covered and can be obtained through that system. Generally, this is psychiatry, outpatient therapy, an limited case management.

As you may recall from earlier Blog entries, Shiawassee County Community Mental Health provides services to those diagnosed with a severe and persistent mental illness. This applies to all, whether or not the consumer has no insurance, has Medicaid, private insurance, or happens to be a veteran. Services provided mostly include community-based, e.g. Assertive Community Treatment, Targeted Case Management, Home-Based, etc. These community-based services are not covered by private insurance companies, nor the VA, and therefore wouldn't be available unless provided by the public mental health system.

That being said, there are many veterans served by Shiawassee CMH. Depending on the symptoms, functioning status, resources, and supports, veterans are enrolled in our community-based services and many times see our psychiatrist.  Emergency mental health, outreach and education, and linking and collaborating with the VA are also available.

It is important that our veterans obtain the needed assistance. SCCMHA is dedicated to ensuring that this is done...either directly or through the VA. In both cases, SCCMHA staff are willing to help and make sure that the appropriate services are in place.

Compassion Fatigue and How To Stay Healthy

Written by: Lorri Wilkerson, Peer Support Specialist, SCCMHA

Compassion Fatigue

Anyone who works in a field that requires one to care for others, such as a therapist, nurse, peer, or other, can become burned out over time. Even healthy workers or helpers with an optimal balance of life and work can experience compassion fatigue when faced with an overloaded work schedule, dealing with a client with a lot of traumatic content, or finding the caseload suddenly filled with a lot of people who are in a major crisis.

Compassion is a limited resource; one that needs refilling from time to time. Listening to people who are suffering and not being able to do enough for them puts tremendous pressure on the caregiver.

Compassion fatigue can affect anyone; the most caring and dedicated nurses, social workers, physicians, or psychiatrists alike are at risk. These problems can affect professional and personal lives. Some symptoms include difficulty concentrating, intrusive thoughts, loss of hope, anger, exhaustion, irritability or thoughts of suicide. It can make you feel cynical at work, make more clinical errors, violate client boundaries, and lose respect towards your clients. It makes it harder to empathize with someone. You may simply stop caring. You may find yourself avoiding one of your clients. Or avoiding work all together. If you are someone in recovery, compassion fatigue can be harder to deal with. The feelings of guilt over not feeling compassionate or "right" towards others can overwhelm you.

It is important that you recognize the signs of compassion fatigue, and take the steps needed to help yourself. Take the time to inventory your life, both personal and professional. What is demanding of your time? Work? Family? Home? Volunteering? List them all, try to make the list as detailed as you can.

Once you have your list, look at it. What jumps out at you? What factors are making your plate too full? What would you like to change the most?

Overcoming compassion fatigue means coming to terms with anger, fear and self-doubt. This requires honest self-reflection, a process that some find quite painful. Yet, if you're compassion fatigued, getting in touch with yourself is perhaps the most important step in the recovery process. Without it, the lifestyle changes you're trying to make may not be enough to sustain you. Make sure you have someone you can talk to about this; a close friend or counselor who will listen non-judgmentally.

Start gathering ideas for self care.

Maybe include some co-workers or friends in this. Gather as many ideas as you can and place them in a list. Include them all, even if you don't think you would use them. You never know.

Make time for yourself every day.

Can you think of simple things you could do for yourself? Maybe a 10 minute cat-nap during your lunchtime. Maybe close your office door and listen to 5 minutes of your favorite music. Or at home, turn the TV off early and spend some quality time before bed. Even small changes can make a difference in a busy life.

Learn to say "No" more often.

Do you always volunteer your time? Are you the crisis go-to person for your family and friends? It can be exhausting! Can you set realistic limits for your time? Find the reasons why you can't say no. Is it because of issues such as self-esteem or some other personal issue? Take a moment to think about this. Also, have you stopped saying yes to family, friends and new opportunities?

Get enough sleep

When people are stressed, it is easy to forget to eat, take breaks, get exercise, or get enough sleep. These are all important to over-all health. Pay close attention to your habits. Maybe start a journal to keep track.

Know your "ABC's"

Awareness

Journal writing, therapy, and talking with a supervisor or friend are examples of good habits that build self awareness.

Balance

Maintain healthy boundaries between work and home. Develop new interests and hobbies. Do something relaxing, such as meditation or reading a book.

Connection

Having supportive colleagues or peers at work can help reduce isolation and give opportunities to share. It is also an important way to develop and nurture more trust in relationships.

All together, these things will help you get back on track with the goals you have set for the future. You can feel better about yourself, if you take the time to nurture yourself. It may not happen overnight, but you CAN do it.

If you are having thoughts of suicide, PLEASE talk to someone or call a hotline. Don't give up on yourself or on life.

RESOURCES

*Workshops for the Helping Professions

www.compassionfatigue.ca

*wiseGEEK search engine

www.wisegeek.com/what-are-the-best-tips-for-treating-compassion-fatigue.htm

*Wikipedia

www.wikipedia.org/wiki/Compassion_fatigue

*Overcoming Compassion Fatigue

http://www.aafp.org/fpm/2000/0400/p39.html

Other Resources

Professional Quality Of Life Test

www.proquol.org/uploads/ProQOL_5_English.pdf

(They assess compassion fatigue as well as levels of satisfaction.)

DBT...An Evidence-Based Practice

Over the past several years, the focus of public mental health treatment and support has increasingly been on “evidence based practices.” Evidence-based practices are treatments that have been shown through clinical research to produce positive outcomes.

In recent years, Shiawassee County Community Mental Health Authority has implemented many evidence-based practices. One that SCCMHA started using in 2005 is Dialectical Behavior Therapy (DBT). DBT was designed as a treatment for individuals who are diagnosed with Borderline Personality Disorder but is currently being studied to treat many other diagnoses including anxiety disorders, substance use disorders as well as eating disorders.

Individuals who have a diagnosis of Borderline Personality Disorder often have multiple other psychiatric diagnoses and often experience suicidal ideation, self harm behaviors and have multiple psychiatric hospitalizations. Historically, it has been a challenge to find a treatment modality that is effective in improving the quality of life and reducing high risk behaviors for these individuals.

DBT treatment is meant to improve the individual’s ability to regulate intense emotions and behaviors in order to create a life worth living. The modes of treatment that DBT uses to accomplish this is weekly individual therapy, weekly Skill Training Group, availability to DBT Phone Coaching, as well as access to a DBT trained Peer Support Specialist.

The DBT team at SCCMHA has been intensively trained and is certified by the Department of Community Health. The team consists of Emergency Services workers, Case Coordinators, DBT therapists and a Peer Support Specialist and are required to meet for weekly consultation in order to maintain the certification. In 2007, the team began collecting data. This data demonstrates that DBT treatment has a significant impact on reducing targeted behaviors such as self harm incidences.

Similar to DBT, SCCMHA offers many other services that are evidence-based. The future of public mental health is demonstrating that intervention is successful. Without using evidence-based treatment, one runs the risk of providing a mediocre service.

Contributed by: Stacy Fisher, LMSW, CAADC, Supervisor for Adult Community Services