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 

Parents Helping Other Parents

In recent years, the public mental health system has come to embrace the idea of parents helping others parents.  Specifically, a parent or primary caregiver of a child with emotional, behavioral and/or mental health challenges assisting another.  Shiawassee County Community Mental Health Authority is one of many public mental health agencies throughout the state that has integrated this into the service array.  This was done through a partnership with the Association for Children's Mental Health.

The purpose of Parent Support Partner's is to increase family involvement and engagement within the treatment process and to equip parents with the skills necessary to address the challenges of raising a youth with special needs thus improving outcomes for youth with severe emotional impairment involved in the mental health system.

Role of the Parent Support Partner:

§  Provides peer support to parents of children with mental health concerns

§  Facilitates access to appropriate services for children and families

§  Serves as a source of credible information about resources, programs, and services

§  Demonstrates effective collaboration

§  Assists parents in learning skills to obtain resources for their families

§  Becomes a trusted ally in whom parents can confide

§  Helps parents navigate a variety of systems including community mental health, schools,

   hospitals, child welfare, and juvenile justice programs

Peer support has been shown to improve outcomes for youth and their families. Having access to a peer who “has been there” improves caregiver engagement thus improving retention rates in treatment, decreases caregiver sense of hopelessness and isolation, and increases satisfaction with services. 

Parent Support Partner’s, serving as an equal member of the treatment team, assist families with identified goals within the Person-Centered Plan that support the parent to develop skills, knowledge, resources, and confidence in parenting a child with serious emotional disturbance.

The PSP service, provided by another parent who has first-hand experience navigating public child serving agencies and raising a child with mental health challenges, focuses on increasing confidence and competence in parenting skills, increasing the parent’s knowledge to better navigate systems and partner with service providers, and empower the parent to develop sustainable natural support networks after formal service delivery has ended.

 

Emergency Services/Crisis Intervention 101

In the previous Blog entry, I discussed the "pre-admission screening" that occurs prior to psychiatric hospital admission.  This is only one function of emergency services...the other is general crisis intervention.

In this day and age, the incidence of mental health issues seems to be increasing.  People are struggling in all areas of their life, putting more of a burden on families, causing depression to become more prominent.  That said, it is important that the public mental health system continue doing a better job educating the entire community about the accessibility of crisis intervention. 

Throughout Michigan, the public mental health system is required to provide emergency mental health services to the general public.  It's one service not dependent on certain criteria, i.e. income, residency, insurance, diagnosis, etc.  It's there to ensure that the mental health needs, in time of crisis, are met and people are supported.

No matter where people may be residing, visiting, or vacationing, the local community mental health should be able to provide crisis intervention, provided by licensed social workers, counselors and psychologists.  During business hours it's always available face-to-face, as well as telephone.  After regular hours, each community mental health has local protocols for delivering this service.  In Shiawassee County, mental health workers answer crisis calls after 5 p.m., weekends and holidays.    

People that are suffering from mental health symptoms or situational crisis, and require support and assistance, are encouraged to contact our agency day or night.  If the problem is serious and you may require psychiatric hospital admission, either contact our agency immediately or  go to the local emergency room.

Emergency mental health staff can be reached at 989-723-0710 or 723-6791. 

   



 



        

Psychiatric Hospital Admissions

Many people in the community aren't aware that public mental health is responsible for managing psychiatric hospital admissions for children and adults on Medicaid only, MI Child, ABW, or identified as meeting indigent status or no ability to pay.  Similiar to private insurance companies needing to authorize and manage inpatient care for their members, the Michigan Department of Community Health transfers this responsibility to community mental health for those on public assistance.

The primary method for managing psychiatric hospital admissions is the pre-admission screening process.  It's called "pre-admission" because it occurs before the admission.  This is simply a face-to-face assessment usually completed in the office or hospital emergency room.  But, it's not limited to these settings.  Our staff complete these pre-admission screenings in the school setting, jail, other community agencies, etc.

During the "pre-admission" screening, community mental health staff performs an overall evaluation.  They assess the level of crisis, degree of risk and safety issues, support system, symptoms, coping skills, etc.  If done in the emergency room, there is collaboration with the physician regarding possible medical or medication issues.

Many times during this type of assesment the consumer just needs someone to talk to and the crisis is resolved.  However, there are times when consumers do require hospital admission.  Their symptoms are too acute and risk and safety factors are high.  When this occurs, the "pre-admission" screener arranges it.  Our goal is to use the local hospital if appropriate.  That being said, children are more difficult to place due to the limited number of hospitals around the state.

If community mental health staff determine hospital placement is appropriate, they are approving payment for an initial number of days determined at the onset.  Once the person is admitted and treatment begins, hospital staff are required to contact community mental health each day to discuss improvement or lack thereof.  Continued authorization for payment is then determined on a daily basis.  That said, the community mental health hospital liaison is typically involved in the consumer's care and stays abreast of any changes.

Once consumers are ready for discharge, the hospital liaison ensures that appropriate outpatient care is arranged and follow-up appointments are scheduled.  Community mental health staff typically meet with these consumers soon after discharge, making sure that things are ok and supports remain in place.

Even though all community mental health agencies have this same responsibility, it is important to keep in mind that they all employ this process somewhat differently.  This can be frustrating for the community; however, processes are generally designed around available resources.  Some counties lack in this area and others are plentiful.

For more information on this subject, please call Emergency Services @ 989-723-6791.  

     

Consumer Run Drop In Centers

Consumer drop-in centers provide a wide range of services to consumers.  At their most basic, they offer a place that is accepting, safe, supportive, and normalizing; where consumers can feel needed and grow in self-worth, dignity, and self respect; and where they can learn about community support. Common characteristics include social and recreational programs, information and referral, and advocacy, with a strong emphasis on empowering and teaching consumers to be independent and involving them in providing support to other consumers.

New Directions Drop-In Center, Owosso, MI, was established in 1994 and is one of numerous Drop-In Centers in Michigan. While Drop-In Centers work in close cooperation with each county Community Mental Health, they are consumer run locations for self-help, advocacy, education, and a natural support towards recovery. Consumers develop their programs to supplement existing mental health services.

All persons with a mental illness, regardless of whether they are an open consumer, are eligible to become a member of New Directions. Persons interested in attending New Directions may call the center or “drop in” to talk to one of the staff about becoming a member. All persons accepted are assured of a lifetime membership.

At New Directions members come together to make friends, socialize or simply relax in a non-judgmental atmosphere of acceptance and understanding from others who have “been there.” It is often difficult to find these same qualities in clinical programs managed by professionals, or in their own families and the community at large.

Among the attractions found at New Directions are a lounge with big-screen satellite TV, a regulation size pool table, arts and craft room, and a complete equipped kitchen.  

A feature of New Directions, not found in all drop-in centers is a year round schedule of special events such as cook-outs, parties on all major holidays, and trips to various places of interest.  In January we are starting a monthly membership meeting where all members’ comments will be heard.  At these meetings we will also have our Birthday Recognition, recognizing everyone’s birthday for the month.  Once a month, we are having a Men’s Night and a Women’s Night with different activities according to what the members prefer.

Questions about New Directions: Peggy Smith @ 989-723-0875

Content Contributed By: Peggy Smith, Director, New Directions