Creating a Family Crisis

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Maria Lourdes Rosanna E. de Guzman, MD, MS Epi

University of the Philippines – Manila College of Medicine
And Philippine General Hospital
  Volunteer Psychiatrist, Witness Protection Program of
the Department of Justice
 Philippine National Survey for Mental Health and Well-being
 Bukas Puso at Isip Family Support Group – helping families in the
care of the chronic mentally ill in the community
Disclosures of  PGH Women’s Desk – A Crisis Center for VAWC Cases
interest  Multi-Disciplinary Training (DOH, PNP, DSWD) for Anti-VAWC
in collaboration with the Child Protection Network, Inc.
 Alliance of Filipino Families for the Mentally Health
 JANSSEN and Otsuka
NEW NORMAL

“merging behaviors, situations, minimum health standards, that will

be institutionalized in common and routine practices and remain
even after the pandemic while the disease is not totally eradicated”
 Need to explore ways in which the COVID-19
pandemic might adjust, shape. or reorder our lives
across multiple dimensions

After the 2 year lockdown of the country

everyone had to cope with unfamiliar new
surroundings
Projects, plan, travel
and activities
Health concerns Work from the home Unemployment suddenly halted
Hospitals overload Hybrid schooling Financial losses
Social distancing
  Depression
 Loneliness and isolation
Mental health  Anxiety
problems  Psychosis
 Alcohol and substance abuse
 Suicide and self-harm
  Why him/her?
 Why me?
 What went wrong?
Navigating a  Why is this happening now?
mental health  What did we do?
crisis  What didn’t we do?
 What can we do?
UNDERSTANDING
mental illness
 • Sitting and doing nothing for long periods
of time
• Losing friends, unusual self-centeredness and
Social self-absorption
withdrawal • Dropping out of previously enjoyed activities
• Declining academic, work or athletic
performance
  Deep sadness unrelated to recent events
or circumstances
 Depression lasting longer than two weeks
 Loss of interest in activities once enjoyed
Mood  Expressions of hopelessness
disturbance  Excessive fatigue, or an inability to fall asleep
 Pessimism; perceiving the world as gray or
lifeless
 Thinking or talking about suicide
  Inability to concentrate
 Inability to cope with minor problems
Thought  Irrational statements
disturbance  Use of peculiar words or language structure
 Excessive fears or suspiciousness, paranoia
  Hostility from one who is usually pleasant
and friendly
 Indifference to situations, even highly
Irregular important ones
Expression of  Inability to express joy
Feelings  Laughter at inappropriate times or for no
apparent reason
  Hyperactivity, inactivity, or alternating between the two
 Lack of personal hygiene
 Noticeable and rapid weight loss or gain
 Involvement in automobile accidents
 Drug and alcohol abuse
Changes in  Forgetfulness and loss of personal possessions
behavior  Moving out of home to live on the street
 Not sleeping for several nights in a row
 Bizarre behavior, e.g. skipping, staring, strange posturing,
grimacing
 Unusual sensitivity to noises, light, clothing
  Giving away personal possessions
 Talking as if they’re saying goodbye or
going away forever
When the  Taking steps to tie up loose ends, like
Crisis Involves organizing personal papers or paying off debts
the Risk of  Making or changing a will
Suicide  Collecting pills or obtaining a weapon
 Preoccupation with death
 Sudden cheerfulness or calm after a period of
despondency
  Dramatic changes in personality, mood and/or
behavior
 Increased drug or alcohol use
 Saying things like “Nothing matters anymore,”
When the  “You’ll be better off without me,” or “Life isn’t worth
Crisis Involves living”
the Risk of  Withdrawal from friends, family and normal activities
Suicide  Failed romantic relationship
 Sense of utter hopelessness and helplessness
 History of suicide attempts or other self-harming
behaviors
 History of family/friend suicide or attempts
  Start the conversation. Open the conversation by
What To Do If sharing specifics signs you have observed.
You Suspect  Then say something like:
✔ “Are you thinking about suicide?”
Someone is ✔ “Do you have a plan? Do you know how you would
Thinking do it?”
About Suicide ✔ “When was the last time you thought about
suicide?”
  Call a therapist or
psychiatrist/physician or
other health care
professional who has
been working with the
person
What to do  Remove potential
means such as weapons
and medications to
reduce risk
 Call the National Suicide
Prevention Hot Line
NCMH 0966-351-4518
  “You are not alone. I’m here for you”
 “I may not be able to understand exactly how
you feel, but I care about you and want to help”
Listen  “I’m concerned about you and I want you to
Express concern know there is help available to get you through
Reassure this”
 “You are important to me; we will get through
this together”
  Don’t promise secrecy
 Don’t debate the value of living or argue
that suicide is right or wrong
What not to do  Don’t try to handle the situation alone
 Don’t’ try to single-handedly resolve the
What not to situation
say
 Assuming that it will pass
 It is all in your head. Just stop thinking about it.
Please remember, a suicide
threat or attempt is a medical
emergency requiring
professional help as soon as
possible.
WHAT TO DO in a
mental health crisis
  Is the person in danger of hurting themselves, others
or property?
 Do you need emergency assistance?
Assess the
 Do you have time to start with a phone call for
situation guidance and support from a mental health
professional?
  ✔ Keep your voice calm
 ✔ Avoid overreacting
 ✔ Listen to the person
 ✔ Express support and concern
 ✔ Avoid continuous eye contact

Techniques to  ✔ Ask how you can help

respond to the  ✔ Keep stimulation level low

 ✔ Move slowly
crisis  ✔ Offer options instead of trying to take control
 ✔ Be patient
 ✔ Gently announce actions before initiating them
 ✔ Give them space,
 ✘ Don’t make judgmental comments
 ✘ Don’t argue or try to reason with the person
NEVER LEAVE THEM
ALONE.
WHAT TO EXPECT
from mental health
treatment
  Voluntary admission
 Involuntary admission
Hospital stay  Emergency holds
 Inpatient psychiatric units
  Psychosocial treatments
 Individual psychotherapy
 Psychoeducation
 Self-help and peer support groups
Treatment  Peer recovery education

 Medication
 Behavioral modification: cognitive –behavioral
therapy
PREPARING for a crisis
  Learn all about the illness your family has
 Keep communication lines open
 Avoid guilt and assigning blame to others
TIPS  Find out your support systems
 Learn to recognize early warning signs
 Talk to your family member.
  Don’t threaten
 Don’t shout or raise your voice
 Don’t criticize or make fun of the person
TIPS  Don’t argue with other family members
particularly if they are present.
 Don’t bait the person
 Don’t stand over the person.
Mental health
and wellness
for every
Filipino,
everywhere.
Social
Experiment
As health care workers, we think about the future health of the
people we care about.
Along with many other disciplines and services, we hope that
someday we can change this problem of society to make all
homes healthy, safe and free

Thank you very much.

medeguzman@up.edu.ph