1. Navigating the Mental Health System May, 18 th, 2013 1

2. Ian Lobell, L.C.S.W Regional Director, Southeast Area. Alma Family Services 2

4. Outline I.Types of Mental Health Services II.Special Issues to Consider III.Securing Mental Health Services 4

5. Part One 5

6. Types of Mental Health Services 6

7. NOTE: The services and interventions (treatment) recommended may be based on information gathered about the needs of the individual and the availability of the service

8. Initial Contact/Wait List Intake Referral / Pre-Screening / Phone Interview - Can be completed over the phone or face-to-face -Sometimes basic information is requested and at other times more detailed -You will need to provide identifying information: Name, Age, Address, Telephone Numbers, Insurance, Symptoms &Behaviors

9. - You should be told if they can accept the case or tell you that they will get back to you with the answer -If they can accept the case, you will be told about possible Wait List times and if you want to be placed on it -If they cannot accept the case, they will probably give you other referrals to go elsewhere. If they don’t, ask them for some referrals. You should be told whether they can accept the referral and how long the wait list is.

10. While on Wait List, they may occasionally check in to see if you are still interested in services. If you are, tell them. If you aren’t, please let them know so they can make room for other individuals. Once assigned, someone will call you to schedule your first appointment…often called and Initial Intake Assessment/Appointment.

11. Mental Health Referral Process Regional Center to Alma Family Services (Example) When making a referral please follow these steps: Step 1: Fill out Referral Form COMPLETELY Step2: Please include the following paperwork (check which applies): Psychological Evaluation Individual Education Plan (IEP, for children only) Individual Program Plan (IPP) Client Development Evaluation Report (CDER) Any other reports containing relevant information For consumer that is a ward of the court please include a copy of the Minute Order If your consumer is requesting psychiatric services and is a ward of the court, please include copy of the court ordered Psychotropic Authorization Form from previous psychiatrist For consumer that is conserved, please include court copy of Conservatorship Step 3: Have client and/ or parent/ legal guardian sign Consent to Release Information Step 4: Submit all items to Intake Department via mail, fax, or walk-in to: EXAMPLES OF QUESTIONS ASKED

12. Clinical Assessment What is the purpose? To gather the most information possible… in order to make the most accurate assessment of client’s needs…in order to provide the best treatment

13. Examples of these difficult questions include: -Chief complaint -History of presenting problem -Medical and Mental Health History -Substance Abuse History -Developmental History - School, Work, Legal, Abuse History -Family History (Biological & Current) -Mental Health Assessment Examples of these questions include:

14. SO WHAT NOW?

15. Types of Services Individual Therapy Group Therapy Family Therapy Psycho-educational Groups Social Skills Anger Management Substance Abuse

16. School based Services / Special Education Residential Treatment / Group Homes Medication Management / Psychiatry MDs, RNs, PTs, Case Managers Case Management Support Groups (Client or Family) Emergency Services Hospitalization

17. Part Two 17

18. Special Issues to Consider 18

20. 1/HOW TO RECOGNIZE COMMON SIGNS AND SYMPTOMS THAT INDICATE A NEED FOR A MENTAL HEALTH ASSESSMENT

21. What are they?

22. Behaviors & Symptoms May indicate a mental health problem, concern or illness with our loved one, our client, our consumer…or ourselves 22

23. Types of Behaviors or Clues Overwhelming fear or terror Change in ability to cope Change in behavior 23

24. Types of Behaviors or Clues #2 Decreased ability to handle stressful situations Increase in maladaptive behavior New onset/increase in self-injurious behavior 24

25. Types of Behaviors or Clues #3 Change in mood Loss of motivation Inability to express emotions Extreme overreaction to small things 25

26. Types of Behaviors or Clues #4 Extremely low self-esteem Suicidal thoughts Change in energy or sleep patterns Abuse of alcohol or drugs Excessive changes in appetite. 26

27. Types of Behaviors or Clues #5 More or Less: Hyperactivity Irritability Confusion Disorientation Lethargy Withdrawal 27

28. Types of Behaviors or Clues #6 Changes in Perceptions: Extreme sensitivity to light, color or noise Believing thoughts are controlled by others 28

29. Types of Behaviors or Clues #7 Fear of touching or being touched Changes in sense of self Sense of body boundaries changing Hallucinations-Auditory or Visual 29

30. 2/ Symptoms may obscure indicators of psychiatric disorders

31. What is often perceived as stereotypical D.D. traits or characteristics may be the indicator for mental illness Examples?

32. 3/ Impairment in cognitive and verbal skills make it difficult for many developmentally disabled to articulate abstract concepts like depression Examples?

33. 4 / Let’s talk about aggression or homicidal behaviors Is anyone at risk? Does anyone feel threatened or unsafe? Are aggressive behaviors increasing in severity and duration?

34. What have you done in the past? What could you do in the future? Call case worker, therapist, doctor, agency, or regional center worker What should you do if the situation is severe?

36. 5 / Let’s talk about self-injurious behaviors or suicidal behaviors Is individual at risk? Is individual threatening to harm him/herself? Does individual have access to a weapon or other means to harm themselves? Are self-injurious behaviors increasing in severity and duration?

37. What have you done in the past? What could you do in the future? Call case worker, therapist, doctor, agency, or regional center worker What should you do if the situation is severe?

39. Other considerations…. Inclusion of family members – Discussion Understanding the emotional needs and developmental needs of your loved ones or clients - Discussion

40. Part Three 40

41. Securing Mental Health Services 41

42. How to secure mental health services? -Call Regional Center for recommendations and assistance with making referrals -Call DMH - Department of Mental Health, L.A. County directly. They can link you to agencies that specialize (or are trained) in providing M.H. services for the D.D. population -Call treatment facilities or mental health agencies in your area. -Ask around; your friends, your peers..the people around you now.

43. FOCUS ON THE MENTAL HEALTH FOCUS ON THE BEHAVIORS FOCUS ON THE SYMPTOMS FOCUS ON THE PATTERNS FOCUS ON YOUR CONCERNS

44. Why do this?

47. Questions & Answers 47

48. Ian Lobell, L.C.S.W Regional Director, Southeast Area. Alma Family Services (562) 801-4626 (323) 881-3799 Intake 48