The Human Experience - Part 1

SLIDE 1 TITLE SLIDE

Education and Resources

SLIDE 2
Let start out by telling you who I am and why you may consider possibly be listening to me at all on this
topic

INTRODUCTION:

Magickal name: Serafina

Magick background/credentialling:

• Solitary witch since about age 19

• Ran an online coven for about 2-3 years before finding my place among the BFC

• Kitchen witch and will practice this art until the day I am too old and too tired to lift my wooden
spoon and whisper to my ingredients

• Studied at the White Stag Seminary and was privledged to have been graduates before it part of
the last graduating class before it was retied

• 3rd Degree high presitess in the Black Forest Tradition, a member of good standing in the White
Stag Clan, Cofacilitator of the Coven of the Serpentine Hart alongside my extraordinary sister
Lady RiverHawk.

Mundane name: Natalie, happily married, 3 wonderful stepsons, a mama to my Piper (and Maisy) - a
daughter an sister an auntie a social worker and a mess :)

Mundane background/credentialing:

• Bachelor’s degree in psychology I obtained later in life

• Almost a decade of field work under my belt.

• Worked in home health going to homes and tending and caring to people who were very sick,
occasional pallitive - This was an important experience for me because at one point I was my
patients. I was disabled for 10 years - and that loss of independence and control is something I
learned firsthand. Its incredibly humbling. In my way it me coming full circle.

• Baker Victory Service - Father Bakers as a Mental Health Specialist in the RTF prgram - that is a
locked residential treatment facilty for traumatized adolecents/teenagers - my age groupe was
12-17
 • Trained under the Sanctuary Model - best training I have ever had in my life. ITs trauma informed
care - the idea is to heal rather than treat

• TIC physycal retraining training - which is trauma based physical internvention. Sometimes you
have a split second to make that decision in wheter or not to pyhsically intervene in a situation
to ensure the person does not hurt themselves or others.. If that decision is is made that
phsycial restarint needs to hapen - you really want to make your best effort to not re-traumatize
or trigger someone.

• next - i worked at DePaul - Worked with people who are struggling with at least 2 concurrent
DSM diagnoses (for example, Schizophrenia and Alcohol dependency)

• My time here was vast - in the medication room with the patients, teaching them their meds,
assisting with adminsitering them - teaching them daily living skills, taking them to court, doctor
appoints in the role of an advocate

• Residential Counselor at McKinley Square. Managed a caseload of 24 patients - sometimes more

depending on staffing

• Director of the Case management office at McKinley Square. During this time, I maintained my
caseload of 17 patients for residential counsleing, Supervised the medication room as well as the
other resientil counslors

• ran the HUD/ HAWNY (homeless alliance of WNY) and ran the program Mckinley working the the
patients - we assigned 20 beds to this program and I worked closely with these patients.

Found myself at a Crossroads:

I was offered the position of Assistant Director of Ebenezer Square - SRO and turned down the job after a
lot of soul searching -- I am not built for management/to create policy. I hate it. It is not for me. I am
built to be in the trenches, working among my people and helping where I can.

Accepted a job offer for less pay but more satisfaction.

• Just revamped my job - now senior engagment specialist over at Horizons Health Services - we
fill all the outpatient programs for both mental health and substance abuse

• Screen, assess, and place everyone throughout the company

• Also work to assess and fill our beds over at Terrace House - which is a Crisis Stabilization
program for people struggling with addiction. They've added the baility to screen, add, fill the
beds for the longterm resiential as well.

• Triage all calls and are the first interaction with anyone who come to horizons for services.

SLIDE 3
Disclaimer - read slide

ITs important to know my background because it is going to color my outlook and help you understand
where I am coming from in regard to the direction of this class.
 • NOT liscenced

• Paraprofessional - need to be supervised by someone who has the crednetiallng/liscencing

• The information I am providing is coming to you in a non-clinical way, sharing expeirnce,

knowledge and hoping to give you some tools on how to respond to some unique
situations/people we may come across as we serve in the role of our clergy to the community

• I am attaching the warning that I am not a doctor - you need to do the reaseacrh and consult a
credentialed provider if needed

SLIDE 4
What to expect tonight -- read slide

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. -- current

SLIDE 5
Trigger warning - IMPORTANT to know yourself Sensitive topics. If uncomfortable - step away, mute

I am asking for your honesty and transparency in this moment. Put your ego aside please.

Check in with me, with a loved one, a peer, with someone - my goal is not to hurt you, trumatize anyone
further. I need to know you have a safety plan in place.

**LET JUMP IN!!**

SLIDE 6
Common Sense Quote -- read slide

Everyone laughs at this -- but the truth is fundamentally it is true. Sometimes you are so immersesed ina
situation you really cannot see the forest through the trees right? IF you were never taught something -
how can you be expected to know it. IF you havent experienced something and the outcome - good or
bad - how to you know it? IF you do not communicate something -- no matter how trivial - how can you
be sure someone knows it? If you dont ask the question - Im not a mind reader - how can I help you?

SLIDE 7
So lets start by defining mental health/illness -- read slide
SLIDE 8
STIGMA -- Lets start byopening the door to talking to addressing the stigma that comes with it - with this
feild, with this population, with people.

Word association. From population:

Psycho, scary, crazy, nuts, dangerous, bad guy, criminal, lost cause, weak, drama queen, sensitive, lazy,
dont want to work

IMPORTANT POINTS:

• male vs. female weak, emotional, moody, not a real man, Buck up and face it , try harder ,
Everyone feels this way - everyone gets a dx - such babies

Reality is – stigma is the biggest barrier to any individual who is seeking treatment – therefore becoming
the biggest barrier to recovery. Fighting the stigma, shame, associated to mental illness can sometimes
be more difficult or just as difficult to battling the illness itself.

SLIDE 9
Types of Stigma - you cant lie tosomeone and say its not true

• Public stigma involves the negative or discriminatory attitudes - stereotypes that the outside
world has regarding mental illness.

• Self-stigma refers to the negative attitudes, including internalized shame of believeing those
stereotypes, and thise discriminatory attitudes that you, the person dealing with the illness. "i
dont want to be percieved that way" I dont want to be labeled" "im not like them" They are
weak Im not weak" "This is differnt"

• Institutional stigma, is more systemic, involving policies of government and private organizations
that intentionally or unintentionally limit opportunities for people with mental illness.

Some of the of stigma can inegative impact include:

• Reluctance to seek help or treatment

• Lack of understanding by family, friends, co-workers or others

• Lower funding for mental illness research or fewer mental health services relative to other
health care

• Fewer opportunities for work, school or social activities or trouble finding housing

• Bullying, physical violence or harassment - Individuals with serious mental illness are 11 times
more likely to be victims of a violent crime than the general public, AND Women with serious
mental illness are more at risk than men.

• Health insurance that doesn't adequately cover your mental illness treatment
 • The belief that you'll never succeed at certain challenges or that you can't improve your situation

Id love to tell you we live in a perfect world and these stigmas will not attach - but that would be
untruthful. And there are stigmas and they may impact you or the person you are working with. But
with education and advocacy we can lessen the blow. We can open minds and we can be there for each
other.

This is a really important topic and a really important slide - because by ignore the topic of stimga you
are perpetuating the cycle of suffering and you can lose people along the way - that you didnt have to
lose.

SLIDE 10
Mood Disorders: examples

• Depression - specrum disorder -- MDD , Depressive mood disorder, Depressive Mood disorder
unspecified - spectrum - mild depression

• Bipolar is on this list - you will see it again in the psychosis slide. Defined by highs and lows,
inability to stay on one side of the spectrum. Bouts of great depression, and ccyles of mania

• Ante natal/partem - while preggers

• Post partum depression - is after the paby is born until about the first year

• Perinatal -- becoming pregnant to about first year afterwards in supervision the number is 1 in 7
women

• Seasonal depression - SAD Seasonal Affective Disorder - related to changes in seasons — SAD
begins and ends at about the same times every year. Most people with SAD, your symptoms
start in the fall and continue into the winter months, hwever, less often, SAD causes depression
in the spring or early summer.

SLIDE 11
SXS - read slide

SLIDE 12
TX: BE mindful I am explaining what is out there - most of us do nothave the education/liscencing to
conduct some of these thigns

• Going to hear this multiple times throughout presentation -- Supportive counseling &
psychotherapy - provides a person with a safe place for talk therapy and emotional support - this
also includes a lot of education and teaching of problem solving skills - gives you an outside
perspective - out side of your own mind

• Physiological therapies- behavior therapy, CBT, DBT, IPT, MBCT

 • BEHAVIOR THERAPY : focuses on encouraging activities that are rewarding, pleasant or
satisfying, aiming to reverse the patterns of avoidance, withdrawal and inactivity that make
depression worse

• CBT cognitive behavioral therapy : focuses on the idea that psychologial problem you are facing -
are based in part by faulty or unhelpful ways of thinking, and learned patterns of unhelpful
behaviors. SO this type of counseling involves making the effort to change yout thinking patterns
- learning to recognize how your distortioned thinking can create problems or the phantom
problem - and then re-evaluating this issue under the scope of reality.

• DBT - Dialectical behavior therapy -- its acceptance vs. change -- teaches people how to live in
the moment, develop healthy ways to cope with stress, regulate their emotions, and improve
their relationships with others

• IPT - interpersonal therapy - focuses on problems in personal relationships and the skills needed
to deal with these.

• MBCT - mindlefulness-based cognitive therapy - centers on a lot of mindfulness meditation,

noticing your experience - positive or negative- without trying to change t at first. Then it moves
into teachs a person to be in the moment - can be helpful for depression because a person can
recognize thier feeelings/thoughts, negative thinking patterns as early warning signs -- before
they become fixed -- and respond accordingly hopefully more effectively

• Medical therapies - e.g ECT, TMS - for more sever spectrum cases, do work!

• Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain to
impact the function and effect of neurotransmitters in your brain to relieve depression. ECT is
usually used for people who don't get better with medications, can't take antidepressants for
health reasons or are at high risk of suicide.

• Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven't
responded to antidepressants. During TMS, a treatment coil placed against your scalp sends brief
magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and
depression.

• Drug Therapies

• Lifestyle and Complementary therapies - exercise, S-Adenosyl-L-Methionine (SAMe) - can be

purchased at drug store, St. John's Wort - herbal remedy - consult a doctor, self help books,
computerized therapies, aromatherapy, relaxation and mediation therapy, light therapy,
acupuncture

What can I do - so we can offer a safe and supportive, nonjudgmental talking space for those we are
working with - maybe not in a clinical way - but in a healing way. A healing space right? We can engage
the person in activities that take the ideas and techniques - thought changing patterns, mindfullness
from these therapies in a non clinical way and use them as supports and activites/lessons

We can also say to the person who may need more help than you can give and say look - I happy to be a
support for you - But maybe you need more than I can give you. Direct them to a clinical professional or
a medical professional who can really help them. Doesnt mean you cannot be supplemental support -
but if you think of recovery as a wheel - they may need more spokes then you can offer - and it is so
important you acknowledge that and know it is okay to say it.

Possible thoughts to share:

For anyone who has ever found themselves in this place. In a mood disorder.In it. ITs like you are so deep
in theswamp of it. you start to feel a part of it, like its a part of you. Like the void has swallowed you
whole. you cant see a way out and you start to accept it. you cant see where you stop and that
swampiness begins. Like an oils seeping into your skin. All the days become a hazy blur.

SLIDE 13
Anxiety disorders

• GAD - generalized anxiety disorder - characterized by persistent and excessive worry about a
number of different things. A general state of constant worry -- find it difficult to control their
worry. eg. money, health, family,

• Panic disorder - people with panic disorder have sudden and repeated attacks of fear that last for
several minutes or longer. Panic attacks. These are characterized by a fear of disaster or of losing
control even when there is no real danger.

• Phobic disorders - A phobia is an excessive and irrational fear reaction. One may experience a
deep sense of dread or panic when encountering the source of thatfear. It can be of a certain
place, situation, or object.

Unlike GAD, a phobia is usually connected to something specific --- The impact can
range from annoying to severely disabling. They may know their fear is irrational,
but they’re unable to do anything about it---- eg are snakes, heights, blood
common are agoaphobia, arachnaphobia - social phobia

• ASD - Acute stress disorders - ASD typically occurs within one month of a traumatic event. It lasts
at least three days and can persist for up to one month.

This an intense, unpleasant, and dysfunctional reaction beginning shortly after an

overwhelming traumatic event and lasting less than a month

• PTSD - post traumatic stress disorder -- . If symptoms persist longer than a month, people are
diagnosed as having posttraumatic stress disorder (PTSD).

• common sxs of ASD and PTSD --

detached - feeling numb

derealization - when your environment seems strange or unreal to you

 depersonalization -when your thoughts or emotions don’t seem real
or don’t seem like they belong to you,

dissociative amnesia - when you cannot remember one or more

important aspects of the traumatic event - your mind blocks it out

having recurring images, thoughts, nightmares, illusions, or flashback episodes of

the traumatic event, reliving the traumatic event, when something trigers it

• Obsessive compulsive disorder is a disorder in which people have recurring, unwanted thoughts,
ideas or sensations (obsessions) that make them feel driven to do something repetitively
(compulsions).

repetitive behaviors, such as hand washing, checking on things or cleaning

These repetitions significantly interfere with a person’s daily activities and social
interactions

eg. Checking, Contamination / Mental Contamination, Symmetry and ordering,

Ruminations / Intrusive Thoughts, Hoarding.

SLIDE 14
What does PAnic Disorder look like? Read slide

Looking over this slide - these are pretty serious sxs. Ad they have an awful lot in common with medical
concerns - like a possible heart attack. Ask the person what they want – should EMS be called. Chances
are if this a person who struggles with a panic disorder this is not thier first rodeo. So you really want to
listen to them and thier experience. Check for a medical alert bracelet – can often help direct your
actions YOU ARE NOT A DOCTOR, well maybe you are. But I am not :) Im not comfortable making that
decision - so it really is a culmination of taking in all the information making the best judgment call you
can in the moment.

SLIDE 15
Panic Attacks ---

How to handle. Remain calm, Use a reassuring but firm manner. BE patient. Speak clearly and
deliberately using slow, short, and clear sentences. DO not TOUCH the person without permission.
Rather than making assumptions about what the person needs – ask them directly what they think will
help. ASk them - so you need medical attention? Odds if they suffer from panic disorder - this is not thier
first go around. They may already have an action plan they have developed. And if that is the case - you
can assist them by asking them directly what they need you do do - you are going to follow thier lead.
DO not belittle the persons’ experience. Acknowledge that the terror they are feeling is very real – but
assure them that while this is frightening it is not life threatening. Reassure hem that they are safe and
these sxs will pass. A typical full-blown panic attack lasts approx. 10-15 minutes.
MYTH – breathe into a paper bag – actually can cause the person to pass out

SLIDE 16
TX Available

• Supportive counseling & Psychotherapy-- provides a person with a safe place for talk therapy
and emotional support - this also includes a lot of education and teaching of problem solving
skills

• PFPP - Panic-focused psychodynamic psychotherapy (PFPP) - a therautic method to uncover past

experiences and emotional conflicts that influence panic/anxiety. PFPP helps a person use early
recognition to help engage with less frightening and more adaptive ways to cope.

• Trauma therapy - will be looked into greater detail in a later slide

• Exposure therapy

• hynotherapy

• Drug Therapies

• Lifestyle and Complementary therapies - autogenic training, meditation, lavender oil, kava kava,
valerian (NOT A DOCTOR), acupuncture, exercise,

• Autogenic training : Follow these steps to practice autogenic training:Take a few slow even
breaths - from diaphram. Quietly say to yourself, "I am completely calm." Focus attention on
your arms. Quietly and slowly repeat to yourself six times, "My arms are very heavy." Then
quietly say to yourself, "I am completely calm."Refocus attention on your arms. Quietly and
slowly repeat to yourself six times, "My arms are very warm." Then quietly say to yourself, "I am
completely calm."Focus attention on your legs. Quietly and slowly repeat to yourself six times,
"My legs are very heavy." Then quietly say to yourself, "I am completely calm."Refocus attention
on your legs. Quietly and slowly repeat to yourself six times, "My legs are very warm." Then
quietly say to yourself, "I am completely calm." Quietly and slowly repeat to yourself six times,
"My heartbeat is calm and regular." Then quietly say to yourself, "I am completely calm." Quietly
and slowly repeat to yourself six times, "My breathing is calm and regular." Then quietly say to
yourself," I am completely calm." Quietly and slowly repeat to yourself six times, "My abdomen
is warm." Then quietly say to yourself, "I am completely calm."Quietly and slowly repeat to
yourself six times, "My forehead is pleasantly cool." Then quietly say to yourself, "I am
completely calm."Enjoy the feeling of relaxation, warmth, and heaviness. When you are ready,
quietly say to yourself, "Arms firm, breathe deeply, eyes open."

What can I do? Again we kinda talked about it - offer the safe supportive nonjudgmental healing space.
Non- clinical therapy practices, meditations - with panic disorders you really want to be a beacon of
calm. So much of thier world is chaotic and jittery - ecourage and help with lifetsyle changes. BE there.
SLIDE 17
Psychosis different types -

• Schizophrenia --- a chronic psychiatric disorder. People with this disorder experience distortions
of reality, often experiencing delusions or hallucinations. Estimates it impacts about 1% of the
poulation

Paranoid schizophrenia. Facts show its main characteristics — paranoia, suspicion, and fear of other
people’s intentions.

Catatonic schizophrenia. It causes people to shut down physically, as well as emotionally and mentally.

Undifferentiated schizophrenia. It displays different symptoms, like confusion, paranoia, or abnormal

behavior.

Schizoaffective disorder.

• Bipolar disorder -- this appeared on mood slide as well. People with this dx have moods swing
from very high to very low. When their mood is high and positive, psychos sxs my present as
believing they have special powers. When their mood is low or depressed, psychotic sxs may
present as paranoia thinking someone is trying to harm them.

• Psychotic depression - This is major depression with psychotic symptoms.

• Delusional disorder -- A person experiencing delusional disorder cannot distinguish between

waht is real or what is imagined These delusions are often non-bizarre in nature involving
situations that could occur in real life, such as being followed, poisoned, deceived, conspired
against, or loved from a distance. People with delusional disorder often can continue to socialize
and function quite normally, apart from the subject of their delusion, and generally do not
behave in an obviously odd or bizarre manner.

• Schizoaffective disorder - is a disorder where the person is marked by a combination of

schizophrenic sxs and mood disorder sxs

• Drug induced psychosis - Psychosis can be triggered by the use of alcohol or drugs -- both illegal
and prescribed. The break can also happen if they suddenly stop drinking or taking those drugs.

• Brief psychotic disorder - sometimes called brief reactive psychosis, can occur during periods of
extreme personal stress like the death of a family member. Someone experiencing brief reactive
psychosis will generally recover in a few days to a few weeks, depending on the source of the
stress.

SLIDE 18
SXS of - read slide
Somatic may be - beleiveing that thier internal organs are deomposing

SLIDE 19
Triggers for psychosis : Read slide -- Misc environmental factors, stress, death, trauma

SLIDE 20
Tx available

• Rapid tranquilization - During a pshychotic break -- one can be a danger to themselves or others
- and in this instance a medical professional is going to want to calm them down quickly. EMS or
medical personnel will administer a fast-acting injection or liquid medicine to quickly relax the
patient.

• Drug therapy -- Symptoms of psychosis can be controlled with medications called antipsychotics.
Some my only need to take antipsychotics for a short time to get their symptoms under control.
People with schizophrenia may have to stay on medications for life.

• Supportive therapy , CBT, family therapy

• Lifestyle and Complementary therapies: natural steroid dehydroepiandrosterone DHEA, glycine,

EPA (eicosapentaenoic acid), an Omega-3 fatty acid, folate, niacin and thiamine, vitamins, B, A, E-
spiritually/mindfulness based oriented group therapy/yoga, dietary changes (decreased intake of
saturated fats and gluten; increased intake of Omega-3 fatty acids; improved glucose control),
ginkgo biloba, mineral supplements (manganese, selenium, zinc), Based on some clinical studies,

• Eastern medicisne treatsschizophrenia very differently then Western - use herbal compounds ,
acupunture, massage, exercise, dietary changes

What can I do -Spectrum of ways- Obviously when someone is in the throes of a pshychotic break - you
can assist by getting them to a professional for tx immediately.

Remember your safety is important as well. SO for example - be aware of your placemnt in the room.
You always want to have access to an exit quickly Dont put yourself in a corner. Do not touch the person.
Stay by the door - keep the door open. Dont enter a room if you dont need to. Offer a seat to the person.
Try to keep something in between you - a desk - a table

Calling EMS, CRisis services. Remain calm. Talk to the patient.

Dont be dismissive - What they are experiencing is very very real to them. Do not mock. Wow - that
must be very frightening. I would be so scared. thats very instense.

BE honest - I am concerned about you. Youre safety is important to me.

Offer closed options if possible - I really wanna help you lets think about soe things we can do - I can call
an abulance and see if there is anything they can do to help? or we can reach out to Crisis services and
have them come down here and see if there is anything they can do to help? Really put yourself in that
persons shoes and how you would want to be treated - or how would you want someone to treat your
loved one. Dont add to thier stress if it is possible

How can you help in a non-extreme case - someone who has been dealing with this diagnosis for thier
lifetime and are educated on thier life:

Maybe do a reality check, question, challenge in a non-confrontational way. Simply ask the question. The
person has thier own checks and balances that have been established in therapy/tx so you are simply
guiding them back.

Remind them to stick with thier recovery plan, are they taking thier medications, keeping thier appts,
doing this thier meditations?

And honestly in Part 2 of this class - we are actually going to revisit this a little later in the class - discuss
some it a little further

***LISTEN TO THEM -- Story of Chris***

physically check on story, medically check on story, psychiatrically check on story

SLIDE 21
These 2 often go hand in hand but are not exclusive to eachother--

Body dysmorphia is the sense of dissatisfaction with one’s body, and the perception that their body is
flawed or defective. This can manifest in perceptions of “bad” skin or hair, or more commonly, the
perception that one is “fat” despite evidence to the contrary.

Eating disorders

• Anorexia nervosa -- typically weigh themselves repeatedly, severely restrict the amount of food
they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to
lose weight. Anorexia nervosa has the highest mortality rate of any mental disorder.

• Bulimia nervosa - recurrent and frequent episodes of eating unusually large amounts of food and
feeling a lack of control over these episodes. This binge-eating is followed by behavior that
compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics,
fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa are
difficult to visually see an issue with - because there is no distinguishing characteristic of this
body model.

• EDNOS (eating disorders not otherwise specified) – e.g. binge eating, rumination d/o
**i think it is important to note for Queer community - specifically our transgender population -- to
differentiate between 2 words you may come across. DYSMORPHIA and DYSPHORIA

Gender dysphoria is the feeling of distress or discomfort because of the difference between a person’s
gender (assigned at birth) and their gender identity. People with gender dysphoria are normally
transgender. However, there are cases of non-binary gender identities in which gender dysphoria is
present.

Body dysmorphia is the sense of dissatisfaction with one’s body, and the perception that their body is
flawed or defective. This can manifest in perceptions of “bad” skin or hair, or more commonly, the
perception that one is “fat” despite evidence to the contrary. Body dysmorphia is a common contributing
factor to mental health complications which can require anorexia nervosa treatment. Body dysmorphic
disorder is present in at least 25% of people with anorexia nervosa, and body image distortions are
almost always present in these cases.

SLIDE 22
What does an eating disorder look like?

Read slide

SLIDE 23
Tx available --

• Maudsley approach, where family/parents/loved one take responsibility for feeding their child,
appear to be very effective in helping people gain weight and improve eating habits and moods.

• Lifestyle and Complementary therapies - exercise, yoga, aromatherapy, tai chi, cooking classes

What can I do? Hold healing space, - employ non clinical CBT lessons, take cooking classes with the
person - DO not judge - encourage - be supportive heal. Encourage affirmations

SLIDE 24
Break until next week

SLIDE 25
Personality disorders

• A: These are characterized by feeling paranoid, distrustful and suspicious.

Examples of Eccentric Personality Disorder Symptoms -- Hold strange beliefs or are superstitious,
Introverted and obsessed with their own thoughts, Prefer to be alone and express few emotions,
Suspicious of people and believe they will be harmed
 • B: These are characterized by having difficulty controlling emotions, fears, desires and anger.

Examples of Dramatic Personality Disorder Symptoms, Aggressive and do not feel guilt for destructive
actions, Belief that they are better than others, Dramatic mood swings, Seek constant attention, Sexually
promiscuous

• Cluster C: anxious personality disorders, such as obsessive-compulsive, dependent and avoidant

personality disorders. These are characterized by experiencing compulsions and anxiety.

Examples of Anxious Personality Disorder Symptoms, Avoid social situations for fear of embarrassment,
Feeling or acting helpless, Sensitive to criticism, feeling inadequate, Perfectionism

**Dont forget to talk to Chimene about offering her paper she wrote**

SLIDE 26
• Lifestyle: be an active particpant in your care, keep your appts, take your meds, exercise, avoid
driugs and alcohol, wellness tools - gardening, medictation minfulness,

What can I do?

Educate yourself, show confidence in them, respect them, show support - focus that you care about the
person and not the behavior - especially after a conflict, identify thier strengths,

Set boundaries and stick to them

Very difficult disorder to manage even for professionals.

People with personality disorders are at increased risk for self-harming behaviours and suicide. They may
also have more difficulty getting along with others than do people without personality disorders

SLIDE 27
Substance use disorders - This is a disease. I know some people see that as a controvesal statement but
let me explain whereI am coming from. it is considered co-occurring - going along sid a mental health
disorder.

Call addiction a disorder or a disease because:

• Addiction changes how the brain responds in situations involving rewards, stress, and self-
control.

• These changes are long-term and can persist well after the person has stopped using drugs.

Comparing to heart disease:

• Both addiction and heart disease disturb the regular functioning of an organ in the body – the
heart for heart disease and the brain for addiction.
 • They both can lead to a decreased quality of life and increased risk of premature death.

• Addiction and many types of heart disease are largely preventable by engaging in a healthy
lifestyle and avoiding poor choices.

• They are both treatable to prevent further damage.

Another thought - predispostion:

PErson A can use marijuana, LSD, shrooms and not be impacted in any way from thier use that is
condiered unhealthy. And peron B can experiment with a drug and it triggers something that is different
in thier brain from person A - and person B is in full fledged addictions. I know that statement be
triggering. And if you are that person - I encourage education and taking the time to explore this topic
with a professional in the field can really help you understand and deal with the difficult intricacies of
this disease. And they can also help you estabish health boundaries to navigate it as well.

• Sedatives -- "Downers" --depressants also impact the body’s central nervous system - slow
down the operations of the brain and body

• Stimulants-- (or “uppers”) impact the body’s central nervous system by accelerating the heart
rate and elevate the blood pressure and "speed-up," or over-stimulate, the body.

• Hallucinogens --- cause the user to perceive things differently than they actually are.

• Dissociatives -- Dissociative anesthetics include drugs that inhibit pain by cutting off or
dissociating the brain's perception of the pain.

• Narcotic analgesics- (an el gee sics) -- relieve pain, induce euphoria, and create mood changes in
the user.

• Inhalants include a wide variety of breathable substances that produce mind-altering results and
effects

SLIDE 28
What does it look like? SXS of - read slide

SLIDE 29
Terminology and TX

Some terms you may want to eductae yourself on:

• MAT -- Medications are not limited to, Suboxone, Naltrexone, and Vivitrol.

• Suboxone is a slower acting opiate - helps with pain, when used correctly if taking - and they
woul use heroin/you wont get high, IF used incorrectly you will get a high - not as euphoric as
heroin.
 • Methadone, a long-acting opioid agonist, reduces opioid craving and withdrawal and blunts or
blocks the effects of opioids. relieve sxs of withdrawal and helps eliminate opiate cravings

• naltrexone/vivitrol - cant get euphoric high, commonly used for alcohol

SLIDE 30
What do I start the conversation?

1. Try to gage the person's perception of thier use

2. Gage the readiness of the person to talk, Although the person's use is impcting muliple areas of thier
life -- mood work relationships -- They may not be in a place where they are ready to face this. They may
be in denial or simply not have the ability to recognize the issue. You cannot force a person to
acknowledge a problem. By forcing an issue it can only result in conflict.

3. USe "i" statements. - Cannot stress this enough. Honestly this is best practice when dealing with any
issue head on

4. Recall events -- whendiscussing a person's use. Thier perception of events is likely dramtically different
than yours. Sometimes - when discussed in a nonjudgmental, fact based way - you may be help to help a
person recoginize the issue by recalling the eventwith them - or by possibly filling in the blanks for them.

5. Person must be sober

**you cannot do the work. The person needs to recognize the issue and do the work**

SLIDE 31
Harm reduction model -- meeting someone where they are at

As Clergy you can educate yourself to be mindful of signs. Behaviors to look for, things to notice. Offer
the help - give the resource - offer the safe space. Have healthy boundaries. You cannot do the work. you
cannot force someone to see that they have an serious issue. Sometimes you have to let someone fall
before they are ready to get back up. Sometimes it is being a support for the people around the person
with the diesease

Recovery is lifelong. it is every day. it is inches and seconds. it is bouts of recvovery and relapse. And
there is not always a happy ending.

If you have ever loved someone who struggles with addicition you know first hand sometimes it feels
impossible

STORY:

"I have to say my son had a very good experience with Horizons. He was at Delta Village for 3 months
before going to the 90th street Oxford. He stayed with outpatient through Horizons on Pine. He had an
amazing counselor. They were truly wonderful with him right up to the day he passed, from a fentanyl
laced overdose after many, many months of sobriety. I highly recommend them. I believe they kept Luke
alive for years longer than he would've been able to do on his own." - Horizon Parent

SLIDE 32
What is trauma?

Trauma

Let’s define trauma – An incident/event/series of events experienced by a person that is perceived to be

traumatic. Common examples of these experiences are accidents (traffic/physical), assault (physical,
sexual, mugging, robbery, family violence), being a witness to terrible event – terrorist attack, mass
shootings, severe weather events – hurricanes, floods, fires)

PLEASE NOTE People are not the same. One size does not fit all. One person may experience something
and perceive it as a deeply traumatic experience while another person may not – some types of trauma
impact an individual more than it does another, and a person who has a history of trauma making them
more susceptible – while others more resilient – not your place to judge.

Sometimes someone has been shown a behavior or been told a message so much - they have
internalized and made it thier own truth.Thier normal. And it is going to take repitiion of a different
message, a different behavior to change that.

Freeze, Fight, Flight - those are your trauma reactions. no one is better than another and they all are our
basic animal instinct to be honest. Survival instinct.

Schemas - deeply rooted, hard to break

SLIDE 33
Resileice is the idea of being able to bounce back from a traumatic event. Some of use show growth and
you become more than what you were before the trauma. Some are just reliience is getting back to
where you were. Impairment is the person just not being able to reccover and thier functioning is below
where they began

How do you achieve Resilience - Safety. Empowerment. Trustworthiness. Collaboration. Choice.

SLIDE 34
Tx available:

The trauma-focused psychotherapies with the strongest evidence are:

• Prolonged Exposure (PE) --Teaches you how to gain control by facing your negative feelings. It
 involves talking about your trauma with a provider and doing some of the things you have
avoided since the trauma.

• Cognitive Processing Therapy (CPT)-- Teaches you to reframe negative thoughts about the
trauma. It involves talking with your provider about your negative thoughts and doing short
writing assignments.

• Eye Movement Desensitization and Reprocessing (EMDR) -- Helps you process and make sense of
your trauma. It involves calling the trauma to mind while paying attention to a back-and-forth
movement or sound (like a finger waving side to side, a light, or a tone).

How can I help—Be genuine. Demonstrate genuine care and empathy. This is more important than
saying the “right thing” – because let’s be honest is there really ever a right thing to say? Ask them how
you can help. BE there. BE authentic – do not use clinical language – be an equal – I am no greater than
or less than the person in front of me. Supporting a person is not this complicated thing – you are simply
there. You are present. You are accessible.

Some things to consider -- Do not take things personally – it is not about you. Do not make it about you.
Do not assign expectations to the persons actions/reactions. You do not get to define it for them. Don’t
tell them how they are feelings BE aware of cultural and other differences. DO not force the person to
talk. You are not their therapist. AS clergy we are there if they want to talk. IF the person chooses to talk
– do not interrupt and share your feelings or opinions. Sometimes the person needs to talk repetitively
about the trauma, so you need to be aware and allow the person to talk about it on more than one
occasion. Do not trivialize the persons feelings or minimize the experience. Survivor guilt is another part
of trauma.

When the person is unpacked and move forward and asks for how to move forward - offer techniques
mindfullness, CBT - bainaural beats, aromatherapy - positive proactive movement.

Now yes some people are addicted to thier trauma - addicted to the illness - addicted to the role of
victim - and you can gage that - rely on your relationship with Sprirt to direct you. You can also refer to a
clinical professional to assist in helping the person move beyond this.

SLIDE 35
What is it?

Self-Harm : Some examples of self-injury that fall in this category cutting, scratching, pinching skin,
banging or punching on objects to the point of bleeding or bruising, ripping or tearing skin, carving
words or patterns on skin, interfering with the healing of wounds, burning skin with cigarettes, matches,
hot water, pulling out hair, deliberately overdosing on medications when it is NOT meant to be a suicide
attempt.

It is actually a coping skill vs a wellness tool - language is so important

• Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and
behaviors and replace them with healthy, adaptive ones
 • Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you tolerate
distress, manage or regulate your emotions, and improve your relationships with others

• Mindfulness-based therapies, which help you live in the present, appropriately perceive the
thoughts and actions of those around you to reduce your anxiety and depression, and improve
your general well-being

What can I do?

What to do if you interrupt someone engaging in these acts. Intervene in a supportive nonjudgmental
way. Remain calm and try to avoid expressions of shock or anger Express concern for their wellbeing. Ask
if you can do anything to alleviate their distress – and determine if medical attention is needed.

DISCERN YOUR SKIL LEVEL – it is absolutely okay and necessary to defer to a professional moving
forward - there is nothing wrong if that needs to be your boundary. IF not you can always help the
person in a non clinical manner -

• Identify underlying issues that trigger self-injuring behavior

• Learn skills to better manage distress wellness vs. coping

• Learn how to boost your self-image - affirmations

SLIDE 36
Suicide

• Discussion points: Say this, Instead of this, Died of suicide vs. committed/completed suicide,
Suicide death vs. Successful attempt, Suicide attempt vs. Unsuccessful attempt

Main risk factors for suicide are:

• prior hx, mental health disorders, SUD, Family history Family violence, including physical or
sexual abuse ACCESS to guns or other firearms in the home, being in prison or jail, Medical
illness, Being between the ages of 15 and 24 years or over age 60

Statistics :

• Women attempt suicide more (poison), men complete suicide more – Why do you think this is?
Men use more lethal means men (gun,asphixiation) = 79% of death by suicide in US

• Transgender population, More than 50% of transgender males have attempted suicide, 30% of
transgender females have attempted suicide -- 92% of them have had an attempt before the age
of 25

• More than 40 % of non-binary adults have attempted suicide

• LGTBQ youth are FIVE times more likely to have a suicide attempt over that of a heterosexual
 youth

• Our male vets are 1.5 times more likely to die by suicide - female vets 2x more like to complete
suicide

• Police officers are at a higher risk of suicide than any other profession. In fact, suicide is so
prevalent in the profession that the number of police officers who died by suicide is more than
triple that of officers who were fatally injured in the line of duty. Researchers are attributing
these statistics to the unique combination of easy access to deadly weapons, intense stress, and
human devastation that police are exposed to on a daily basis.

• Elderly persons death by suicide are suspected to be underreported by about 40% - these are
called silent suicides - and even with that statistic the elderly population is a high risk category
for suicide.

• Men 85 years and older are the highest rate of suicide completion

LEthality TRIAD - MH dx - SUD - access to a gun

Myth:

• talking about suicide plants the idea in the persons’ mind. A person who is talking about suicide
is not really serious

• It is ok to use the word. Are you thinking about killing yourself? Are you having thoughts of
suicide? Asking are you thinking of hurting yourself - is not always as cut and dry as you think. A
person comteplating suicide is already hurting so much - in many ways they cannot fathom
hurting anymore then they are now - so they have been known to answer no - honestly

SLIDE 37
Possible signs to be aware of - read slide

SLIDE 38
What should I do?? What should I not do??

Things you may want to ask when assessing someone’s lethality?

Are you having thoughts about killing yourself? DO you have a plan? What is your plan? Does the person
have access to the plan? Call Crisis Services together? DO you want to reach out to EMS so you can get
help? Call together to make a counseling appointment?

Even if the person does not agree you can reach out to 911 if imminent. You can reach out to Crisis
Services for them to reach out to assess. You can call the non-emergency police line and request a
wellness check.
Be honest. Tell the person you care about them and are concerned for them. DO not promise to keep
this a secret. Explain why you need to reach out for help. Provide options if possible.

SLIDE 39
VULNERABLE POPULATIONS: readslide - why?

Each of these particular populations have thier own unique challenges for MH and no one is immune -
however there are trends that leave certain poluations and groups vilnerable

LGBTQIA - Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual - MArginalized, dehumanized

POC - Person of Color - often suffer from poor mental health outcomes due to multiple factors including
cultural stigma surrounding mental health care, discrimination, and overall lack of awareness about
mental health, economic disparities, stigma, lack of diversity in the mental health profession, language
barriers, and distrust in the healthcare system.

Age - children/elderly

People with disabilities

Veterans/Soldiers

Marginalized populations - Educational levels - socioeconomic - cultural - religious

Gender - male/female unique challenges

In case anyone needs clarification:

Gender - The gender you are (binary, non-binary) (trans, cis)

Sex - biological markers based on xy and xx chromosomes

Sexuality - what you like to run your genitalia on (allosexual) or not (asexual) - This is complex. There is
also in between or emotion-based attraction

None of these are the same.

SLIDE 40
ALLY: Someone who actively works to make sure all individuals are treated well and have equal rights

How can I be an ally -- Use a person's prounouns they give you. Its such a simple act. ITs so empowering
to the individual

When working with someone in the role of Clergy - one aspect of that is offering consel a healing space.
When working with someone in a place of the growth it is the responsibility of the clergy to hold space
for the person they are working with. By holding that space you are allowing the person the room for
gorwth - but they are in charge of the growth

Fight. Advocate. EDucate.

SLIDE 41
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