Alicia Lillich University of Kansas Medical Center

Caring for the Mind: Providing Mental Health Information at Your Library
Alicia Lillich University of Kansas Medical Center Kansas Outreach and Technology Coordinator

Objectives: 1)Increase skills for providing mental health information for care providers and the public 2)Be informed of resources for mental health information 3)Develop strategies for interacting with emotional patrons While it is helpful to have a basic understanding of mental health disorders and symptoms, it is not our role to try to “diagnose” a mental disorder based on a patron’s behavior. Today we’ll instead learn the appropriate response to the behavior. For instance, knowing when to use de-escalation techniques, and when to call 911. We’ll talk about policies and resources all librarians should be aware of.

URL for Infographics and Factsheets (NAMI)
General MH Facts Let’s set the stage with some general mental health facts. Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease. Nearly 60% of adults with a mental illness didn’t receive mental health services in the previous year. Nearly 50% of youth aged 8-15 didn’t receive mental health services in the previous year. African American & Hispanic Americans used mental health services at about ½ the rate of whites in the past year and Asian Americans at about 1/3 the rate. URL for Infographics and Factsheets (NAMI)

Mental Illness: definition
A mental, behavioral, or emotional disorder Diagnosable currently or within the past year Of sufficient duration to meet diagnostics criteria specified within the DSM-5 Let’s take a moment to define mental illness. A mental illness is a mental, behavioral or emotional disorder diagnosable currently or within the past year. Mental disorders include eating disorders and substance abuse disorders in addition to depression, mood disorders and anxiety disorders. A complete classification of disorders is listed in the DSM 5—Diagnostic and Statistical Manual of Mental Disorders.

Factors Physical Social Financial Environmental Sexual Spiritual
Emotional Intellectual Occupational What influences your mental health? Every individual is influenced by many factors. These include, but are not limited to the factors listed on this slide. Think about what you eat and how physical activity affects how you feel Think about how different social interactions with family and friends make you feel Think about how your financial situation makes you feel Think about how your spirituality makes you feel. All of these factors are interrelated to our mental health. For persons coping with a mental illness, there might be times of severe illness, but there can also be periods of stability. The goal for someone living with a mental illness is generally to reach a period of stability and maintain a time of wellness as long as possible. Some mental illnesses are chronic disorders such as bipolar disorder and schizophrenia. In such cases periods of increased stress can elevate the symptoms of the disorder and lead to episodes. You may have individuals who use your libraries who suffer from a severe mental disorder. With careful attention to treatment and prevention, persons with mental illness can lead full, productive lives and reduce the severity of their illness, by taking advantage of all the proven ways to be healthier including medication management, therapy, alternative therapy, healthy eating and exercise, establishing healthy sleep and daily routines. URL for Source: University of North Carolina, Greensboro, Mental Health Literacy

Mental Health and Libraries
Public libraries have become “informal day shelters.” Many of the everyday people who visit your library may have symptoms of mental health issues and substance abuse disorders. Become a “Health Navigator” for your community. Learn to assist hard-to-help people with a variety of mental health issues. Consider partnerships and potential community outreach. As important community centers, libraries have critical roles to play in educating consumers and fighting stigma. Let’s discuss some of the ways mental health has been addressed in our communities and through our libraries. Health Navigator - An individual or organization that's trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.

What’s Your Initial Reaction?
Imagine these individuals are walking into your library. What are some of the words that came to mind? One of the things that we have to do is reflect on our personal bias in order to be able to react appropriately when confronted with what might be an uncomfortable situation. You never know what may have happened to these individuals to cause them to be in their current situation. Also, you can not assume that because they look a certain way that they have a mental illness or will simply behave a certain way.

Access to Mental Health Services: what barriers exist?
Cost Belief that treatment won’t help Time Unfamiliarity with services/resources Stigma Navigating insurance Confidentiality Medication Transportation Only 44% of adults with diagnosable mental health problems and less than 20% of children and adolescents receive needed treatment. Did we miss any barriers? URL for data source, URL for image source

Stigma Misconceptions portrayed by news & media
Inaccurate linking of mental illness with violent behavior Prompts subtle and overt prejudice, discrimination, fear, and stereotyping Results in avoidance to work, socialize, and live with persons with mental illness Impedes persons with mental illness to seek help Sources: NAMI and Mental Health America One of the greatest challenges for persons with mental illness is stigma. Stigma can lead to prejudice and discrimination and can prevent persons with mental illness from seeking the help they need. When we hear stories in the news and media that stereotype persons with mental illness as dangerous, that is stigma. That is completely inaccurate. There is no greater percentage of violent behavior among persons with mental illness when compared to the general public. Stigma can manifest itself in avoidance of a person. When coping with a major mental illness, it is harder to talk about it, and often not viewed as socially acceptable to talk about it as talking about a disease like diabetes, heart disease or cancer.

Poll 1: What percentage of people with mental illness have experienced stigma? Answer: 75% Stigma often brings experiences and feelings of shame, blame, hopelessness, distress, and reluctance to seek and/or accept necessary help. Approximately 75% of people with a mental illness report that they have experienced stigma. Every one of us has the ability to help reduce stigma and encourage compassion and tolerance. We can support people with psychiatric disorders and their families through recovery and social inclusion and by reducing discrimination. URL for data source

Poll 2: What percentage of violent acts can be attributed to people with severe mental illness? Answer: 5% Mental illness alone does not increase the risk of violence, but when mental illness is combined with other risk factors such as substance abuse, it does increase the risk of violence. Previous research has produced mixed results about the link between mental illness and violence. Other factors that predicted violent behavior included a history of juvenile detention or physical abuse, having seen parental fighting, recent divorce, unemployment, being victimized themselves, being younger, male, and low-income. URL for data source

Mental Illness and Crime
People with severe mental illness are over 10 times more likely to be victims of violent crime than the general population. Mental Illness and Crime Whether a person has a mental illness or not, one does not just "snap" as is often reported in the media. There is generally a progression of behaviors down a pathway toward violence and those behaviors often become noticeable as a person moves down that path. Remember that not just the homeless and the poor suffer from mental illness. Mental illness has no racial, economic or intellectual boundaries. You may be too busy at work to spend a lot of time with any one person, with a mental ill or not. Many people who you may consider "strange" have a right to seek your services and have a real need that you can meet within your job description. Try to limit your interventions to relatively short periods of time, but realize that taking time to try to communicate effectively with the person may save you a lot of time in the long run and help someone in the process.

“People with mental illness enrich our lives” [NAMI]
Abraham Lincoln Virginia Woolf Ludwig van Beethoven Robert Schumann Leo Tolstoy Tennessee Williams Vincent Van Gogh Isaac Newton Ernest Hemingway Sylvia Plath Michelangelo Winston Churchill Vivian Lee Patty Duke Charles Dickens Diane Sawyer Think of all the major works of art, literature, and music created by persons coping with mental illness. Truly persons with mental illness enrich our lives. Some mental illness such as bipolar disorder includes episodes of extreme creativity and grandiosity, which has contributed to many historical works of art, literature and music. A challenge for persons with bipolar disorder it to not “ride the high” and to keep a balanced mood. Do you know someone with a mental illness who has inspired you or enriched your life? I’m sure we all do.

Expressions: person-first language
Avoid expressions like: “a schizophrenic or an alcoholic” In favor of: “a person with schizophrenia” or “an individual with alcohol dependence” Every individual is much more than the illness. Illness does not define a person. So, we should be careful with our discourse, language and expressions. Making the shift in expressions to avoid calling someone a schizophrenic and alcoholic, a bipolar in favor of “a person with schizophrenia, a person with alcohol dependence, or a person with bipolar disorder empowers the individual to be so much more than the disease. This thoughtfulness in language empowers the individual beyond stereotypes of the illness, so that he/she identifies mental illness as a condition and not a personality trait.

Mental Health and Your Library
Let’s discuss some best practices and procedures for providing mental health reference and programming at your library.

Discussion What strategies might work when conducting a reference interview with someone who exhibits signs of having mental illness? How would you react when assisting someone who is searching for sensitive health information, including mental health issues?

Most Frequently Asked Reference Questions on Mental Health Topics
Anger Management Health care coverage for the uninsured Anxiety Medication and side effects Autism PTSD Bipolar Disorder Refusal to take medication Borderline Personality Disorder Relaxation Techniques Building self-esteem Schizophrenia Community re-entry Self-Abuse Depression Social Services Eating disorders Teenage suicide Family support In response to an informal posting to the Consumer and Patient Health Information Section listserv, librarians from the Medical Library Association responded to frequently asked topics on mental health questions. Most of these topics also have MedlinePlus health topic pages which we will discuss shortly.

Reference *Use the same approach as with any
Best practices Respecting confidentiality Active listening Be empathetic and patient *Use the same approach as with any other reference interview* Confidentiality: Respect confidentiality by lowering your voice or bringing patron to a quiet area Active listening: 1) Use open ended questions and neutral questions Be aware of your body language Let the patron finish their question before responding Be empathetic and patient: 1) Be aware that the consumer/patron may not be aware of the potential impact or seriousness of his/her disorder 2) Be prepared for emotional reactions Examples of possible reference interactions: Patrons may be stressed, nervous, upset, embarrassed Confusion with medical terminology Patron might have unreasonable expectations Patron may be confused about the role of the librarian Librarian may have the fear of providing the wrong answer Stereotypes / misconceptions of the mentally ill such as being more dangerous Interacting with persons who are hallucinating Examples of open-ended questions: “What kind of information on …are you looking for? “Would you tell me more about …?” “When you say…, what do you mean?” “What do you already know about …?” URL for image source

Interacting with Patrons with Mental Illness
Respect: Be polite and treat the person as you would any other patron. 2) Be aware and communicate: Yes, we are told not to judge, but we also need to be aware of our surroundings. If someone seems to be acting oddly, wait and observe. Let other staff know if necessary, they may be familiar with the person and know the best way to approach them, but often, the person will come and go without incident. 3) Set boundaries: The rules apply to all patrons, and some may need to have this reiterated. It’s also important not to allow staff to be bullied. Back each other up! 4) Use staff knowledge: If one staff member seems to be better at dealing with a patron, have them talk with him/her, or at least confer with each other on the best way of handling a given person/situation. 5) Consult the proper authorities: If faced with a new situation, don’t be afraid to ask what you can do to address it before calling on security to do so. Is there anything else that you can think of? “The topic of this post may be a sensitive subject, and one that is rarely addressed in library school, but should be. Every library worker, whether in a public or other library, has had interactions with mentally ill patrons”. Source: Public Libraries Online, Victoria Collie, September 15, 2014 URL for full article

ASCLA’s tips: Treat people with respect and consideration
Avoid making assumptions based on behavior Remember that mental illness is not the same as unusual, deviant, or criminal behavior, or a cognitive disability Respect the privacy of a patron Be aware of behaviors associated with mental health issues Help increase community awareness of mental illness Have sufficient signage This tip sheet is adapted from Guidelines for Library Services for People with Mental Illnesses, Association of Specialized & Cooperative Library Agencies,, released in This comprehensive and outstanding document is available from ALA. Treat people with mental health issues with the same respect and consideration as other patrons Avoid making assumptions based on behavior (remember that a patron is just as likely to be on the phone as talking to him-or herself) Remember that mental illness is not the same as unusual, deviant, or criminal behavior, or a cognitive disability Respect the privacy of a patron—have a discreet, but safe, place to talk if necessary Be aware of the wide range of behaviors associated with mental health issues Help increase community awareness of mental illness with displays, programs, books, and other materials Have sufficient signage to allow patrons to be independent URL for data source

ASCLA’s tips, continued:
Select titles on health issues based on community needs Do not share your anecdotal stories to demonstrate that you understand Form partnerships with agencies, professionals, and self- advocates Take care to correct negative stereotypes Set and enforce standards of tolerance Reach out to group homes, state institutions, mental health clinics, and facilities Select and recommend titles on health issues based on community needs and requests (do not assume) Do not share your anecdotal stories to demonstrate that you understand; this may convey the wrong message (each situation is different, respect that difference) Form partnerships with agencies, professionals, and self-advocates to assess and meet the needs of people with mental illness Take care to correct negative stereotypes Set and enforce standards of tolerance that reflect well on the library and serve as a model for the children and teens in your community Reach out to group homes, state institutions, mental health clinics, and facilities

Emotional patrons Four step approach: 1)STOP 2)BREATHE 3)REFLECT
4)CHOOSE Source: Spatz, M. Answering Consumer Health Questions. 2008 Interacting with emotional patrons – question for the class: does anyone have tips they’ve found helpful for interacting with emotional patrons? Michele Spatz outlines a four step approach to regain self control in tense situations. She shares this information in her book, "Answering Consumer Health Questions." (Neal Schuman 2008) Step 1, STOP: "Cut off the craziness in your mind. Tell yourself to stop any anxious thoughts or negative self-talk Step 2, BREATHE: "Take a deep breath to release tension and calm yourself..." Step 3, REFLECT: "Ask yourself, what is really going on here? What am I protecting? Do I need to?... What personal buttons of mine are being pushed? Do I need to distance myself emotionally from this situation in order to handle is responsibly? In reflecting, we are taking a moment to put the situation into perspective, briefly weighing whether our personal feelings are distorting the situation while asking a central question: "How important is this?" Step 4, CHOOSE: "Choose to respond rather than simply react. Now that you are calm and have more clarity about the situation, communicate that you are willing to find common ground to resolve the situation. "I'd really like to hear what you have to say" or "You're right; how can we work this out?" or "What do you need right now?" (Spatz M 2008)

Discussion What challenges you for the reference interview for mental health information?

Mental health information resources (you can trust)
Question: Where do you turn to for mental health information for your patrons?

MedlinePlus Health information for patients, families, and patient education Reliable, authoritative No ads Updated daily Strict quality guidelines Links to information in > 45 languages Easy-to-read information Directories and organizations Drug and supplements Videos Health news Medical dictionary / encyclopedia Magazine MedlinePlus.gov

Mental Health in MedlinePlus
Topics for Library Users Topics for Library Staff Topics for library users may include prescription drug abuse, Learning Disorders, Living with Cancer, Coping with Disasters, Depression, Stress, Self-Harm, Coping with Chronic Illness, Seasonal Affective Disorder, Substance Abuse Problems, and Personality Disorders Listed are some topics for library staff and in addition you can find information such as the following for your library users. Tip: You can look at the MedlinePlus Search Cloud (on the MedlinePlus About Us Page) to see the most popular 100 health information searches of the day.

Mental Health Information on MedlinePlus
Start with the health topics For basic information, use the medical encyclopedia Find providers and hospitals/facilities in the directories Find support groups in organizations section Learn more about drug information Learn about supplements Possible MedlinePlus searches: Dictionary = autism Search box – autism, health topics page, show ways to share info Show medical ency; show updates, show links, show spanish info Browse = depression – show health topics Homepage = show “Find an Expert”, mental health services locator (SAMHSA), substance abuse services locator, can search psychiatrists by specialty in DocFinder Drug Info = Ativan Supplements = Fish Oil Talk with your doctor about any supplements you want to take or are taking, tell you doctor about any alternative treatments you are interested in Organizations – schizophrenia Health Check tools = depression, mental disorders, panic disorders, child mental health Interactive Tutorials = Depression and managing stress

National Alliance on Mental Illness
NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. What started as a small group of families gathered around a kitchen table in 1979 has blossomed into the nation's leading voice on mental health. Today, we are an association of hundreds of local affiliates, state organizations and volunteers who work in your community to raise awareness and provide support and education that was not previously available to those in need. NAMI relies on gifts and contributions to support our important work. URL for NAMI

NAMI Chapters in Kansas
Support Groups Courses Free Programming Through education, support, advocacy and public awareness programs these chapters foster understanding about mental illness, confront stigma often associated with mental disorders, advocate for public policies that benefit those affected by mental illness, and promote research into the causes, treatment and recovery of mental health disorders. The NAMI HelpLine is a free service that provides information, referrals and support to people living with a mental health condition, family members and caregivers, mental health providers and the public. Crisis Text Line – Text NAMI to Connect with a trained crisis counselor to receive free, 24/7 crisis support via text message.

National Institute of Mental Health
The National Institute of Mental Health (NIMH) is the lead federal agency for research on mental disorders. NIMH offers expert-reviewed information on mental disorders, a range of related topics, and the latest mental health research. You can use their A to Z list to find basic information on signs and symptoms, risk factors, treatment, and current clinical trials.

SAMHSA The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Learn about the many topics that highlight SAMHSA’s efforts to prevent and reduce the impact of mental illness and substance use in America’s communities.

Search tips: Start out with a general site like MedlinePlus to get an overview of your topic Keep in mind there may be more than one term for the same condition Conditions may manifest in completely different ways Though inaccurate, many resources use terms like disease, disorder, spectrum and syndrome interchangeably Source: Anderson PF, Allee N. The Medical Encyclopedic Guide to Searching and Finding Health Info on the Web, 2004 Keep in mind that there may be more than one medical term for a mental health disorder throughout the history of the medical literature For example, bipolar disorder is sometimes still referred to as manic depression. Be aware that many persons have more than one disorder or comorbid disorders (multiple disorders) Be aware that a condition may manifest in completely different ways For example with dementia, dementia may one indicator of another problem and will pass when the underlying condition is treated or it may be a singular irreversible condition. Start out with a general web site such as MedlinePlus to get an overview of your search topic before researching According to the MLA Encyclopedic Guide to Searching Health Information on the Web, if you are searching a mental health diagnosis which uses one of these words, you may also try to search it by replacing any of these terms because often though inaccurate they are used interchangeably. Disease Disorder Spectrum Syndrome Anderson PF, Allee NJ. The MLA Encyclopedic Guide to Searching and Finding Health Information on the Web. New York: NY: Neal-Schuman Publishers, (vol. 2: Diseases & Disorders, Mental Health and Mental Disorders)

Libraries & Mental Health

URL for Well Dressed Librarian Blog
Well Dressed Librarian Dealing with Mental Illness (Blog, April 11, 2007) “When we leave the hallowed halls of Library School ™, we are ready to catalog, provide readers advisory, conduct a fairly decent reference interview - and some people even leave with a firm grasp of bibliometrics. Dealing with mental illness is not one of those subjects that most Universities deal with. And before you think I'm referring to your co-workers, let me assure you I am talking about customers”. Although 10 years old, this blog entry talks about how we are not taught customer service, but it’s assumed that we’ll know how to deal with this as library employees. The idea that we pass judgment almost immediately, some ignore and others run to get help without even waiting to see what’s going to occur. I’m not sure if library school curriculum has caught up yet. URL for Well Dressed Librarian Blog

Important Tip Work with your administrators to have an institutional plan and make sure that EVERYONE, including volunteers knows what to do if you need to address a situation with someone exhibiting signs of mental illness. So knowing that library school may not have prepared you, be sure to work with your administration to develop a plan. Being proactive is better than reactive. You need more than just a plan though. Keep the dialogue going at work and ensure that everyone is comfortable with addressing the issues that affect your particular library. It’s also a good idea to routinely update contact numbers and make sure your staff is familiar with the location of these numbers.

Take home points Fight stigma Be proactive about your mental health
Cultivate your knowledge of mental health resources Do your very best when assisting those with mental health issues Keep the dialogue going at your library Make a plan at your library Wrapping up, The MedlinePlus mental health page tells us: Mental health is how we think, feel and act as we 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. Staying mentally healthy is not always easy, especially during tough times. Here are some tips that can help: Get support from family and friends Find time to take care of yourself and relax Have a healthy lifestyle, with regular exercise It is also important to recognize when you may need help from a professional. Mental disorders are common, but treatments are available.

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