PSRT 4271: The Family Role in Rehabilitation Week Four 1

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 “…disruption of psychological homeostatis…”  “…usual coping mechanisms fail…”  “…distress and functional impairment…” 3

 “…subjective reaction…”  “…to stressful life experience…”  Functioning “…seriously compromised...” 4

 Threat  Incapacity  Fear  Discomfort  Disequilibrium 5

There is such a thing… 6

7. Follow up. 6. Make an action plan. 5. Explore alternatives. 4. Deal with feelings. 3. Identify major problems. 2. Establish rapport. 1. Assess lethality. 7

5 determinants: 1. Triggering events 2. Severity of disability 3. Personal influences 4. Contextual influences 5. Stigma; societal reactions 8

 Denial  Grief  Guilt  Isolation  Anger  Depression  Coping  Acceptance 9

 Meaning  Support  Validation  Information  Balance 10

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 Acknowledge; connect; engage  Offer coping mechanisms  Comprehensive involvement at discharge  Instill hope 12

13 (The Raft of Medusa, by Theodore Gericault, 1791–1824)

 Medical  Cultural?...  Political?... 14

“Emotional Anomie” Bewilderment Confusion Denial Diagnosis Clarity Empathy Initial optimism Heroic efforts Obligation Frustration: Role? Reciprocity? Illness Permanency Doubts, “surrender” to reality Frustration, anger, resentment Sadness, grief Diminished expectations Isolation Acceptance Didn’t cause it Can’t control it Can’t cure it Can only cope with it 15

 Disenfranchisement “When parents try to assume responsibility for an ill adult-child with schizophrenia, the law, 16 mental health prac- titioners, and often the ill person reject their right to do so.”

 Feelings  Powerless, voiceless, anxious, frustrated, isolated, tired, desperate, trapped, guilty, worried, scared, sad, grief, confused  “Internal factors”  Sense of safety  Perception of care ability  Contingencies and consequences  Maternal love and obligations 17

1. Reflection on roles 2. Devastation and vulnerability 3. Sadness and loss 4. Frustration with the system 5. Admiration for the child 6. Personal growth and learning 18

One step removed…  Reactions to illness  Strategies for coping  Whether, how to intervene?  Setting limits?  Resentment, anger, hopeless?  Efforts to obtain services  Wish for validation  Efforts to help themselves 19

What happens when ill child has children?  Custodial, co-resident, nonresident…  Child’s exposure to mother’s illness  Financial impact  Isolation  Role conflicts  Divided loyalties 20

21 “Anticipating” Parent Marginalization Disenfranchised parent “Embracing the collective” Re-enfranchised parent Evaluating my life Emancipated parent

22 Bellevue Inside Out Trailer

Jim Romer, Monmouth County Crisis Screening Center 23 > 30 years of experience. County Services Director for Monmouth Medical Center (Long Branch, NJ) Former Director of Screening Services for Ocean County at Kimball Medical Center in Lakewood, NJ President of the Mental Health Emergency Screening Association NJ Certified Screener No. 1 Monmouth Youth Council. Special interests: kids in crisis. youth suicide issues. Bachelors of Arts from Seton Hall University.

 James Romer, Monmouth County Services Director, Monmouth Medical Center (Howell, Monmouth), Member, NJ SAFE Task Force  James Romer is a mental health professional with more than 30 years of experience. He currently serves as the Monmouth County Services Director for Monmouth Medical Center in Long Branch, New Jersey. He previously served for nearly 20 years as Director of Screening Services for Ocean County at Kimball Medical Center in Lakewood, between 1991 and Romer is President of the Mental Health Emergency Screening Association, was the first certified screener in New Jersey and serves on the Monmouth Youth Council. Romer has been proactive reaching out to law enforcement regarding issues of kids in crisis. His current work includes health screening for individuals, providing evaluations for the danger they pose to themselves or others, kids and adults alike. Romer has also experience working with school populations on youth suicide issues. He obtained his Bachelors of Arts from Seton Hall University. 24