NAMI Homefront Live Online Program: Participant Manual Class 2

NAMI Homefront
Live Online Program
Participant Manual
Class 2
Class 2: The Biology of Mental Health Conditions & Getting a Diagnosis
Class Objectives
By the end of this class, you will be able to:
1. Recognize that mental health conditions/mental illnesses are biologically-based physical conditions
2. Recognize the complexity of the brain and how mental health conditions can have an impact on
brain development and functioning
3. Identify how genetics, heredity, trauma and the environment are thought to be involved in the
development of mental health conditions
4. Explain the critical periods in mental health conditions related to obtaining a diagnosis,
stigma/discrimination, aggressive or challenging behaviors, as well as common myths and facts
5. Recognize they are not alone in this journey having heard the personal stories of the others
attending the course
NAMI Homefront Online 2017 2.1

Vocabulary/Pronunciation
adrenal: ah–dreen–al genomic: gen–nomic

alogia: a–loge–ya glutamate: glue–ta–mate
amygdala: a–mig–da–la hallucinations: ha–loo–si–nay–shuns
anhedonia: an–he–dohnya heterogeneous: hetero–gene–ius
anomaly: ah–nom–ilee hypo-frontality: hypo–fron–tal–ity
autism: ought–ism lesions: lee–shuns
autopsied: awe–top–seed metabolic: meta–bol–ic
avolition: avo–lishun metabolism: met–tab-bo–lism
basal ganglia: bay–zull gang–lia molecular: moe–leck–you–lar
Benes: ben–ess neuro: nurro
catatonic: catta–tonic neuronal: nur–rone–nal
cerebral: saira–brul, or sair–ree–brul neurophysiology: nurro–fizzy–ol–ogee
cerebrospinal: sair–ree–bro–spine–al nucleotide: new–cleo–tide
chromosome: kromo–soam parietal: pa–rya–tal
cingulate: sing–gue–late perinatal: perry–nate–al
circuitry: sir–cut–tree polymorphisms: polly-mor–fisms
COMT: compt prodromal: pro–drome–al
de novo: dee no–vo psychiatric: sy–kee–at–tric
disbindin: dis–bind–din psychoanalytic: sy–ko–ana–lit–ic
dopamine: dope–a–meen psychopathic: sy–co–path–ic
dysphoric: dis–for–ic psychosis: sy–co–sis
dystrophy: dis–tro–fee residual: ree–zid–yual
emphysema: em–fa–zee–ma schizoaffective: skiz–o–ah-fec–tive
encephalopathy: en–ceffa–lop–pathy stimuli: stim–you–lie
euphoric: you–for–ic synapses: syn–nap–sez
glial: glee–al tangential: tan–gen-shul
epigenetic: eppy–gen–net–ic temporal: tem–por–al
GABA: gab–ba temporo-limbic: tem-poro–lim–bic
Genome: gen–nome ventricular: ven–trik–cular

Key Events in Brain Development
3-4 weeks gestation Formation of a specialized fold of tissue called the neural tube; the
basis for all further nervous system development.
4-12 weeks gestation Neural tube differentiates into various components of the nervous
system—forebrain and facial structures develop at one end, the
spinal cord at the other.
At 12 weeks gestation Neurons, the nerve cells that handle information processing at the
cellular level, begin multiplying.
By 17 weeks gestation Cells are proliferating at a rate of 50,000/second. These cells are
not in the right place and only later they will they travel (cell
migration) from point of origin to destinations in the cortex,
moving along the glial cells. Glial cells provide support and
protection for neurons. They are known as the "glue" of the
nervous system. The glial cells do not communicate. Their main
function is to support the neurons. The glial cells, neurons,
capillaries and short nerve cell extensions (axons and dendrites)
collectively are referred to as “grey matter” of the brain.
After this busy time of neuron migration, a period of cell death

occurs reducing the neural number by half from week 24 of gestation to 4 weeks after the child is
born. This process of formation of new synapses while others are eliminated is called “pruning.”
Between birth and eight months, the synapses are formed more quickly. There may be 1,000 trillion
synapses in the brain at eight months. After the first birthday, pruning occurs more quickly.
Scientists believe that neuronal pruning follows a “use it or lose it” principle. The neural
connections or synapses that get exercised are retained, while those that don’t are lost. By ten
years a child has nearly 500 trillion synapses, which is the same as the average adult.
Lenroot, R.K. and Giedd, J.N. “Brain development in children and adolescents: Insights from anatomical magnetic resonance imaging,”
Neuroscience and Biobehavioral Reviews, 30 (2006), pp. 718-729.

The Human Brain
The cerebral cortex makes up 80 percent of the brain volume and covers the lower portions of the brain like
a cap. The cortex is divided in half into two hemispheres—the right and the left. Each hemisphere has four
lobes:
• The frontal lobe is responsible for:
• The occipital lobe is responsible for:
• The temporal lobe is responsible for:
• The parietal lobe is responsible for:
The front of the frontal lobe is called the frontal cortex and is the most developed portion of our brain.
Changes in this area of the brain have been detected into adolescence. The brainstem regulates basic body
functions that keep us alive: breathing and heartbeat.
Front of frontal lobe is most developed part of the brain. These two areas are often referred to as “old brain”
(brainstem) and the “new brain” (frontal cortex).

The Limbic System
Notes:

Traumatic Brain Injuries
CASE:
A young man was admitted to the hospital in crisis. Prior to this time he had been
a successful salesman, friendly, outgoing, with an engaging personality.
Following his hospitalization, he became remote and quiet. He made no friends
on the ward and spent most of his time smoking. He stayed up all night and slept
all day.
When asked, he would deny his illness, and claim the only reason he was not
working was that he was being held in the hospital by his doctors.
Notes:

Symptoms of Temporal Epilepsy
Frontal Cortex: The highest and most complex integration center in the human brain; the essential functional
area for “volition,” i.e. planning and carrying out meaningful, goal-directed activities. Lesions in the left frontal
cortex create deficits in attention, abstract thinking, foresight, mature judgment, integration of thought and
perception, reality-testing, initiative, perseverance and induce a state of depression characterized by apathy,
lack of motivation, withdrawal, loss of sexual interest. Lesions in the right frontal cortex have a disinhibiting
effect, revealed in wide mood swings, immature behavior, irresponsibility, inappropriate sexual behavior
and/or hyper sexuality.
Notes:

Comparison of Symptoms of Temporal Lobe Epilepsy and Common
Mental Health Conditions
Symptoms of Symptoms of Symptoms of Symptoms of

Temporal Lobe PTSD Mood Disorder Schizophrenia
Epilepsy
Emotionality    
Elation, euphoria    
Sadness    
Anger    
Aggression    
Altered sexual interest    
Guilt    
Hyper-moralism    
Obsessionalism    
Viscosity    
Sense of personal destiny    
Hypergraphia    
Religiosity    
Philosophical interest    
Passivity    
Humorlessness    
Paranoia    

Cortical, Temporal and Limbic System Irregularities in Mental Health Conditions
What differences do you see between the two images on the right of the picture?
Research on Ventricle-to-Brain (VBR) Differences in Twin Studies
Notes:

Emotional Processing Center of the Brain
 Linked to every major mental health condition!
Notes:

Concordance Rates in Biological Psychiatry
Genetic research indicates that an individual’s risk of developing mental illness correlates with his/her
genetic relatedness to a first-degree relative.
No Genetic Relationship
My risk of developing it is: My chances of not developing it are:
(Base Rate)
Schizophrenia 1% 99%
Bipolar Disorder 1.2% 98.8%
Panic Disorder 1.6% 98.4%
Depressive Disorder 5% 95%
First-Degree Relatives My risk of developing it is: My chances of not developing it are:
My brother or sister has:
Bipolar Disorder 12% 88%
One of my parents has

Both my parents have

My identical twin has

Bipolar Disorder 74-80% 26-20%
Note: Statistics cannot be used to predict the course of individual lives. They can be used as an estimated
risk guide, but they do not evaluate your particular situation. Any statement about risk is done on an
actuarial basis in the same way that insurance companies compile lists of features about people at risk for
automobile accidents.
E. Fuller Torrey, M.D., Surviving Schizophrenia, 5th Edition. NY: Collins Living, 2013.

Questions about the Critical Periods in Mental Health Conditions
1. Why can’t someone just tell us what the diagnosis is?
2. Why is the response to mental health conditions so different from the response to other
medical disorders?
3. Why do people change so drastically when they become psychotic? What are they actually
experiencing?
4. How can we sort out myths from facts? What about the times when our relatives are
assaultive or suicidal?
5. What do we need to know right now to help us cope with these critical periods?
#1: Why can’t someone just tell us what the diagnosis is?
Notes:
#2: Why is the response to mental health conditions so different from the response to
other medical disorders?
Notes:

#3: Why do people change so drastically when they become psychotic? What are they
actually experiencing?
Notes:
Symptoms of Psychosis
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior

#4: How can we sort out myths from facts? What about the times when our relatives
are assaultive or suicidal?
VS.
Notes:

#5: What do we need to know right now to help us cope with these critical periods?
Notes:

Sharing our Stories
Tell us about your family member’s history and their current status.
1) What branch of the military does your family member serve in, or did they serve it?
2) What symptoms are they experiencing (diagnosis if they have one)
3) How long have they been dealing with symptoms?
4) How are they doing now?
5) How are you doing now; what stage of response are you in?

Principles to Remember During Critical Periods in Mental Health Conditions
• In dealing with critical periods, it’s essential to set limits on psychotic behavior and to have a plan for
enforcing your boundaries
• Get help. Your plan should always involve other family members, public authorities, crisis workers, and
professional assistance—notified ahead of time, if possible.
• Trust your instincts. If you’re worried about violence or suicide, something is probably building up and
events are becoming overwhelming for your relative.
• Don’t ignore your concerns about violence and suicide. Tell your Service Member that their behavior is
making you feel afraid; ask directly if they are contemplating suicide. In crisis, honesty is essential. It
reduces tension, reveals secret plans and soothes a turbulent mind.
• Even though your Service Member is terrifying you or making you angry, you need to approach them
with respect. All good crisis intervention is calm, purposeful and respectful.
• Acting to protect our relatives with mental health conditions is the highest form of caring for them, even
if it involves utilizing law enforcement or involuntary commitment. To keep them safe, we must let them
go, even if they hate us for locking them up; even if they stop communicating with us, we move
decisively to ensure their well-being and safety. Mental health conditions can put people in mortal
danger. In this situation, love acts!
• Acting to keep ourselves clear of danger is the highest form of self-care. if danger looms, we’re ready to
remove ourselves from threatening situations.
Class 2 Wrap Up
• Additional Resources for Class 2 available online at http://www.nami.org/HomefrontResources
Notes:
Class 3 Information:
• DATE ______________ TIME _________________
Class 2 – Homework:
• Review the Crisis File and complete as much as possible before Class 3.

Helpful Websites
Search by suggested keywords
Center for the Study of Traumatic Stress (USU – Department of Psychiatry)

Search: resources, courage to care, joining forces, joining families
http://centerforthestudyoftraumaticstress.org/
Defense Centers of Excellence

Search: psychological health, TBI, service members, families
http://www.dcoe.mil/
Deployment Health and Family Readiness Library

Search: family readiness, when your son or daughter is deployed
http://deploymenthealthlibrary.fhp.osd.mil/Home
Justice for Vets

Search: find a veterans treatment court
http://www.justiceforvets.org/
NAMI (National Alliance on Mental Illness)

Search: mental illness, NAMI Homefront, Veterans & Military Resource Center
http://www.nami.org/
PTSD: National Center for PTSD (VA)

Search: PTSD and trauma, PTSD coach online, About Face, testimonials
http://www.ptsd.va.gov/
SAMHSA (Substance Abuse & Mental Health Services Administration)

Search: conditions, disorders, substances, treatment, prevention, recovery, behavioral health issues
among Afghanistan and Iraq U.S. war veterans
http://store.samhsa.gov/home
VA (U.S. Department of Veterans Affairs)

Search: veterans services, health & well-being, a-z health topic finder
http://www.va.gov/

Crisis File
Mental Health and Crisis Services in Your County
Crisis team phone # ___________________
Local mental health agency phone # ___________________
Local mental health caseworker services phone # ___________________
Local hospital phone # ___________________
Local law enforcement phone # ___________________
State law enforcement phone # ___________________
VA CBOC (clinic) phone # ___________________
VA Recovery Coordinator – CBOC ___________________
VA Medical Center phone # ___________________
VA Recovery Coordinator – Medical Center ___________________
Other contacts:
NAMI State Organization phone # ___________________
NAMI Affiliate office phone # ___________________
Local NAMI Support Group facilitator phone # ___________________
State Department of Mental Health phone # ___________________
NAMI Homefront 2017 Online Crisis File CF.1

Federal Mental Health and Support Services
Crisis Hotlines – 24/7
Veterans Suicide Prevention Hotline: (800) 273-8255 and Press 1 A free 24-hour hotline and online chat
available to Service Members and Veterans of all branches of the military and their loved ones in suicidal
crisis or emotional distress: 1-800-273-TALK (800-273-8255) and press “1” to be routed to the Veterans
Suicide Prevention Hotline. In Germany, Belgium, United Kingdom, Italy and the Netherlands call 001-800-
273-8255. Individuals on military bases can access the Lifeline with a 3-digit access code (118) through their
DSN system.
http://www.veteranscrisisline.net
Real Warriors Live Chat—A Real Voice with Real Answers 24/7 Offers trained health resource consultants who
are ready to talk, listen and provide guidance and resources. Real Warriors Live Chat is sponsored by the
Defense Centers of Excellence Outreach Center for Psychological Health & Traumatic Brain Injury. Call 866-
966-1020 or log on.
http://www.realwarriors.net/livechat
Safe Helpline (Sexual Assault Support for the DoD Community) provides confidential crisis intervention,
support and information to members of the DoD community who have been sexually assaulted recently or
long ago. Safe Helpline staff will listen to your needs and concerns and discuss your long and short-term
safety, resources and options. The Telephone Helpline is available 24/7, worldwide: The phone number is
the same inside the U.S. or via the Defense Switched Network (DSN): (877) 995-5247. DSN users can dial US
toll-free numbers by simply dialing 94 + the 10-digit toll-free number. Those unable to call toll-free or DSN,
can dial (202) 540-5962.
www.safehelpline.org
Other Support Services
Justice For Vets is a professional services division of the National Association of Drug Court professionals, a
501(c)3 non-profit organization based in Alexandria, VA. Justice for Vets believes that no Veteran or military
Service Member should suffer from gaps in service or the judicial system when they return to their
communities. As the stewards of the Veterans Treatment Court movement, we keep Veterans out of jail and
connect them to the benefits and treatment they have earned; saving their lives, families, and futures, and
saving tax dollars for the American public.
http://www.justiceforvets.org/
Military OneSource is a confidential Department of Defense-funded program providing comprehensive

information on every aspect of military life at no cost to active duty, Guard and Reserve Component
members and their families. Confidential services are available 24 hours a day via a call center and online
support for consultations on a number of issues such as spouse education and career opportunities, issues
specific to families with a member with special needs, health coaching, financial support and resources.
Military OneSource also offers confidential non-medical counseling services online, via telephone or face to
face. This personalized support is available 24/7 no matter where you live or serve.
www.militaryonesource.mil/

Veterans Affairs’ Caregiver Support Line provides immediate assistance and answers to questions about what
services for which you may be eligible. Calls are answered by caring licensed professionals who can tell you
about the services available from VA, how you can access them and how you can reach the Caregiver
Support Coordinator at a VA Medical Center near you. If you're just getting started with VA, calling the
Caregiver Support Line is a great first step to take to learn more about the support that's available to you.
VA's Caregiver Support Line 1-855-260- 3274 is toll-free Monday through Friday 8:00 am – 11:00 pm ET,
Saturday 10:30 am – 6:00 pm ET.
www.caregiver.va.gov
VeteranCaregiver is a bridge for caregivers and Veterans. It is a safe place to air questions and frustrations on
and offline, and it provides individualized assistance when needed. Avoid feeling isolated or alone, find
people that "get it," benefit from networking with peers and professionals, community health and recovery
resources, by visiting the only site of its kind.
www.Veterancaregiver.com
Air Force
Wingman Project provides training, awareness, and outreach to teach warfighters and their families how to
identify symptoms of impending suicide and then how to intervene to save a life. The multimedia website
provides geography-specific tools, resources and communities.
www.wingmanproject.org
Army
Army OneSource provides access to all family programs and services regardless of geographical location or
branch of service. This delivery system harnesses the resources that are already in place, using personal
contact and technology to improve on the delivery of service so that families get support closest to where
they live.
www.myarmyonesource.com
Army Suicide Prevention: This multimedia website is the official U.S. Army suicide prevention resource.
www.armyg1.army.mil/hr/suicide
Coast Guard
Suicide Prevention Program is a part of the U.S. Coast Guard Office of Work-Life Programs and applies to all
Coast Guard active duty and reserve personnel and appropriated civilian and non-appropriated fund
employees and their families. It also applies to other Uniformed Services Members and their families while
either serving\ with the Coast Guard or using Coast Guard facilities. Emergency suicide crisis services may
also be accessed 24 hours a day, seven days a week via the CG SUPRT Program toll free number 855-
CGSUPRT (855-247-8778).
http://www.uscg.mil/worklife/suicide_prevention.asp
Marine Corps & Navy
Marines Suicide Prevention website provides training guides, resources, and fact sheets about suicides and
depression in the Marine Corps.
www.usmc-mccs.org/suicideprevent

Navy and Marine Corps Public Health Center’s Minding Your Mental Health provides fact sheets and other
tools specifically relating to mental health concerns. The website covers topics including substance abuse,
anger, gambling, and family issues.
http://www.med.navy.mil/sites/nmcphc/wounded-ill-and-injured/Pages/minding-your-mental-health.aspx
Naval Center Combat & Operational Stress Control (NCCOSC) is dedicated to the mental health and well-being
of Navy and Marine Corps Service Members and their families. The website provides a variety of resources
and tools relating to post-traumatic stress disorder and traumatic brain injury.
www.med.navy.mil/sites/nmcsd/nccosc
Reserve and National Guard
Yellow Ribbon Reintegration Program is an organization with the mission to assist, collaborate and partner
with National Guard and Reserve components, services and agencies to ensure that Service Members,
Veterans and family members receive informational services, referrals and proactive outreach programs
throughout the phases of deployment.
www.yellowribbon.mil

The Crisis
Sooner or later, if a family member is diagnosed with schizophrenia or a major mood disorder, it is likely that
some sort of crisis will occur. When this happens, there are some actions which you can take to help
diminish or avoid the potential for disaster. Ideally, you need to reverse any escalation of the symptoms and
provide immediate protection and support to the individual with a mental health condition.
People seldom suddenly lose total control of thoughts, feelings and behavior. Family members or close
friends will generally become aware of a variety of behaviors that give rise to mounting concern:
sleeplessness, ritualistic preoccupation with certain activities, suspiciousness, unpredictable outbursts and
so on.
During these early stages a full-blown crisis can sometimes be averted. Often the person has stopped taking
medications. If you suspect this, try to encourage a visit to the physician. The more psychotic the patient, the
less likely you are to succeed.
You must learn to trust your intuitive feelings. If you are feeling frightened or panic-stricken, the situation
calls for immediate action. Remember, your primary task is to help your family regain control and keep
everyone safe. Do nothing to further agitate the scene.
It may help you to know that your loved one is probably terrified by the experience of loss of control over
thoughts and feelings. Furthermore, the “voices” may be giving life- threatening commands; messages may
be coming from the light fixtures; the room may be filled with poisonous fumes; snakes may be crawling on
the window. You have no way of knowing what they are experiencing.
Accept the fact that your loved one is in an “altered reality state.” In extreme situations he or she may “act
out” the hallucination, e.g., shatter the window to destroy the snakes. It is imperative that you remain calm.
If you are alone, contact someone to remain with you until professional help arrives. In the meantime, the
following guidelines will prove helpful:
• Don’t threaten. This may be interpreted as a power play and increase fear or prompt assaultive behavior
by the patient.
• Don’t shout. If the person with symptoms of a disorder seems not to be listening, it isn’t because he or
she is hard of hearing. Other “voices” are probably interfering or predominating.
• Don’t criticize. It will only make matters worse; it can’t possibly make things better.
• Don’t squabble with other family members over “best strategies” or allocations of blame. This is no time
to prove a point.
• Don’t bait your family member into acting out wild threats; the consequences could be tragic.
• Don’t stand over your Service Member if he or she is seated since this may be experienced as
threatening. Instead seat yourself. On the flip side, if your Service Member is getting increasingly upset
and stands up, consider standing up so that if they escalate to the point of becoming more threatening,
you can quickly leave the room.
• Avoid direct, continuous eye contact or touching your family member. Comply with requests that are
neither endangering nor beyond reason. This provides the Service Member with an opportunity to feel
somewhat “in control.”
• Don’t block the doorway. However, do keep yourself between your relative and an exit. If possible,
convey calm. Although no one should feel that they need to stifle their emotions at all times in order to

help a relative, research suggests that strong expressions of negative emotion may further destabilize
individuals with a mental health condition.
Ultimately, your Service Member may have to be hospitalized. Try to convince him or her to go voluntarily;
avoid patronizing or authoritative statements. Explain that the hospital will provide relief from the
symptoms, and that he or she won’t be kept if treatment can be continued at home or outside the hospital
in some other protected environment. Don’t be tempted to make ultimatums such as “either go to the
hospital or leave the house.” This invariably intensifies the crisis and may send the message that getting
treatment is a form of punishment. It is better to discuss the behavior and the treatment as two separate
results from the disorder getting worse which is no one’s fault. Being hospitalized often makes people feel
powerless and threatened so whenever it is safe to do so, point out where your family member can make
choices. For example, if there are safe alternative ways to go to the hospital, you may ask how they prefer to
get there. Or if there is more than one reasonable option, ask them which hospital they would prefer.
During these crisis situations try to arrange to have at least two people present. If necessary, one should call
the County-Designated Mental Health Professional while the other remains with the person in crisis.
If indicated, call law enforcement and a request a CIT (Crisis Intervention Team) officer with special training
to de-escalate mental health crises. Explain that your relative or friend is in need of a psychiatric assessment
and that you have called for help. Explain that your relative has served in the military, whether s/he has been
hospitalized before, and whether s/he has access to any weapons. In short, try to prepare the officers for
what to expect. Remember—things always go better if you speak softly and in simple sentences.
Long ago, when my son was little, our family had gone camping. In the middle of the night,
he developed a raging fever. As we raced through the dark, unfamiliar roads of the forest
looking for lights and searching for a hospital, a police station, a doctor, a telephone, I
clutched his burning body. I remember feeling terrified, helpless and overwhelmed with
panic. I thought that he was going to die in my arms and that there was nothing I could do to
stop it. Years later, during the terrifying days of his first psychotic episode, I felt the same
terror, the same helplessness, the same fear that he was dying, literally dying, in front of my
eyes, and there was nothing, nothing, nothing that I could do to stop it.
- Mother of a son with schizophrenia
NAMI Washington Connections, by Eleanor Owen.
Assistance with this section was provided by Al Horey, Western State Hospital, and Dr. Anand Pandya, MD,
NAMI member.

Identifying a Good Psychiatrist
Check with other families who have relatives with mental health conditions to see if they have had good
experiences with a particular psychiatrist, one who:
• Will make special efforts to communicate with the family; can speak using terms you can understand
• Won’t insist that your Service Member makes the initial contact, but rather recognizes that they may be
in crisis and unable to do so
• Will make special efforts to communicate. For instance, taking five minutes in the middle or at the end of
a session to ask the patient’s family in to learn their views on how things are going.
• Recognizes the condition is a no-fault brain disorder
• Is strong enough not to be threatened by views of the family or the individual on treatment; willing to
discuss openly symptoms, medications and side effects, and the limits of his/her knowledge, while
remaining in command of the treatment. While psychiatrists are trained to be vigilant about boundaries,
any psychiatrist who communicates the idea that there is a special mystique in psychiatry that you can’t
understand isn’t the kind of doctor you want.
• Is flexible enough to customize treatment for your relative and to enlist families as part of the treatment
team when that is indicated, e.g., as observers and reporters on the response to changes in treatment
• Is innovative enough to consider alternative ways to engage with people who don’t think they have a
mental health condition
• Is accommodating enough to schedule visits at less frequent intervals to match the family’s financial
ability; communicates that he/she is more concerned about finding outcomes that satisfy the entire
family than about maximizing their own income
• Takes seriously and respects the information communicated by the family regarding the status of the
patient
Modified by Carol Howe: NAMI Threshold, Bethesda, MD

Sample Questions to Ask the Psychiatrist
1. What is your diagnosis? What is the nature of this condition from a medical point of view?
2. What is known about how we can avoid future episodes or making this disorder worse in the future?
3. How certain are you of this diagnosis? If you’re not certain, what other possibilities do you consider
most likely, and why?
4. Did the physical examination include a neurological exam? If so, how extensive was it, and what were
the results?
5. Are there any additional tests or exams that you would recommend at this point?
6. Would you advise an independent opinion from another psychiatrist at this point?
7. What program of treatment do you think would be most helpful? How will it be helpful?
8. Will this program involve services by other specialists (i.e., neurologist, psychologist, allied health
professionals)? If so, who will be responsible for coordinating these services?
9. Who will be able to answer our questions at times when you’re not available?
10. What kind of therapy do you plan to use, and what will be the contribution of the psychiatrist to the
overall program of treatment?
11. What do you expect this program to accomplish? About how long will it take, and how frequently will
you and the other specialists be seeing the patient?

12. What will be the best evidence that the patient is responding to the program, and how soon will it be
before these signs appear?
13. What do you see as the family’s role in this program of treatment? In particular, how much access will
the family have to the individuals who are providing the treatment?
14. If your current evaluation is a preliminary one, how soon will it be before you will be able to provide a
more definite evaluation of the patient’s disorder?
15. What medication do you propose to use? (Ask for name and dosage level.) What is the biological effect
of this medication, and what do you expect it to accomplish? What are the risks associated with the
medication? How soon will we be able to tell if the medication is effective, and how will we know?
16. Are there other medications that might be appropriate? If so, why do you prefer the one you have
chosen?
17. Are you currently treating other patients with these symptoms? (Psychiatrists vary in their level of
experience with severe or long-term mental health conditions, and it is helpful to know how involved
the psychiatrist is with treatment of the kind of problem that your relative has.)
18. When are the best times, and what are the most dependable ways for getting in touch with you?
19. How do you monitor medications and what symptoms indicate that they should be raised, lowered or
changed?
20. How familiar are you with the activities of NAMI and of our NAMI State Organization?

Getting Satisfactory Results: Some Dos and Don’ts
Families need to know how to be effective in getting help for a person with a mental health condition. They
need to know what questions to ask, what people to see and where to go. They need to understand the
various parts of the system and how best to interact with each part.
Frequently, when a parent, relative or close friend becomes involved—especially during the early phases of
the condition—each person is so overwhelmed by the experience that vague information and “jargon” is
accepted as substantive. Families, at the time, want and need honest, direct information about the disorder.
They want specific, practical suggestions about how to cope during the acute as well as the stable phases of
the condition. To get this kind of information, there are some things which you must do. Following are some
hints to obtain positive results from “the system.”
Things to Do:
• Keep a record of everything. List names, addresses, phone numbers, etc. Nothing is unimportant. Every
date, time, etc., may come in handy. Make notes of what went on during conferences. Keep all notices,
letters, etc. Make copies of everything you mail. Keep a notebook or file of all contacts. Don’t throw
anything away.
• Be polite. Keep all conversations to the point. Ask for specific information.
• If your family member is 18 years of age or older, request their permission to review all documents.
Many places will request written permission from the person with the condition, so consider asking your
relative for this before symptoms affect their ability to cooperate with signing a release of information.
• Get the name of the physician who is coordinating the care. In some cases, you may have the right to
request a different doctor who has privileges at that hospital. Get the name of the staff member on the
ward who is working most closely with your family member. This is usually a psychiatric nurse, but may
be a therapist, a social worker, a psychiatric resident or a case manager. Ask for an appointment to meet
with this person; make it at their convenience. Come prepared with a list of specific questions. Some
sample questions are:
o “What are the specific symptoms about which you are most concerned?”
o “What do these indicate? How are you monitoring them? Who is documenting in the chart? How
often is the medication being monitored? What, specifically, is he/she getting? How much? How
often? Has the patient been informed on medication side-effects? When can I look at the record
book or chart? When can we meet to plan the transition back home?”
• Keep the meeting short. If you come with a list of questions you will be able to get all the information
you need in less than half an hour.
• Write letters of appreciation when warranted; write letters of criticism when necessary. Send these to
the head of the hospital (or unit, or both), and send copies to anyone else who may be involved,
including the Governor. Just as there are certain actions to take in order to be effective, there are some
things that tend to be counter-productive. Keep in mind that most professionals want to do a good job.
Most of the frontline staff (people who work directly with the patients—social workers, case managers,
hospital attendants, practical nurses, doctors, nurses, therapists, etc.) are over-scheduled. Usually, there
are too few staff for the number of community mental health centers, jails, etc. Thus, it is important to
maintain some perspective on what one can reasonably expect.

There are, however, some specific responsibilities for which you can hold staff accountable. The following
“don’ts” will help both you and the helping professionals.
• Don’t come late to appointments.

• Don’t accept repeated “cancellations.”
• Don’t make excessive demands on staff, i.e., don’t harass the staff with special requests, don’t have long
phone conversations filled with unnecessary details, etc.
• Don’t accept vague answers or statements that seem confusing. If a clinician says, “we are observing
your daughter carefully,” recognize that this is a statement which provides you with no information.
Don’t accept it without further clarification. Ask who is doing the observing, what is being observed
(exactly), how is the information being documented, when can you view the progress of the observation,
etc.
• Don’t feel that you “should know” and therefore inhibit yourself from asking for substantive information.
• If your loved one is in a state psychiatric hospital and you have permission to look at the record book, set
up an appointment with a staff member who can review what information they have recorded. Be clear
that you are not trying to find fault with their care, and that your only goal is to make sure that they have
the correct and complete information about your family member.
• Ask to review your relative’s Individualized Treatment Plan. This is legally mandated and must be carried
out. You can ask to participate in the development of the plan. The patient has the right to have his/her
wishes taken into account.
• When you ask how the staff is implementing the Treatment Plan, don’t accept answers which imply that
the patient is responsible for his/her own progress. Persist in finding out exactly what actions staff are
taking, i.e., how often are they taking the patient for walks, which staff person is in charge of group
therapy, how consistent is the treatment, i.e., does each member know what others are doing?
• Don’t allow yourself to be intimidated.
• If your relative is in a group home, critical care facility (CCF), individual care facility (ICF) or any facility
receiving public funds, you are entitled to inquire about personnel qualifications, etc. Don’t permit
unqualified personnel to continue to work without a formal complaint to the Department of Social &
Health Services.
• Don’t be afraid or ashamed to acknowledge that you are related to a person with brain disorder.
• Keep your family member informed about everything you plan to do. He/she might disapprove of your
action or may wish to modify your plan.
• Be assertive! As a taxpayer, you are entitled to information, respect, and courtesy. Your taxes go to
public employees. You’re not asking for freebies. You are simply helping to get the job done.
Source: NAMI Washington Connections, by Eleanor Owen

Dual Diagnosis and Integrated Treatment of Mental Health Conditions
and Substance Abuse Disorder
What are dual diagnosis services?
Dual diagnosis services are treatments for people who live with co-occurring disorders—mental health
conditions and substance abuse. Research has strongly indicated that to recover fully, a person with co-
occurring disorders needs treatment for both problems—focusing on one doesn’t ensure the other will go
away. Dual diagnosis services integrate assistance for each condition, helping people recover from both in
one setting, at the same time.
Dual diagnosis services include different types of assistance that go beyond standard therapy or medication:
assertive outreach, job and housing assistance, family counseling, even money and relationship
management. The personalized treatment is viewed as long-term and can be started at whatever stage of
recovery the person is in. Positivity, hope and optimism are at the foundation of integrated treatment.
How often do people with severe mental health conditions also experience a co-occurring substance abuse
problem?
There is a lack of information on the numbers of people with co-occurring disorders, but research has shown
the disorders are very common. According to reports published in the Journal of the American Medical
Association (JAMA):
• Roughly 50 percent of individuals with severe mental health conditions are affected by substance
abuse
• Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one
mental health conditions
• Of all people diagnosed with mental health disorders, 29 percent abuse either alcohol or drugs
What are the consequences of co-occurring severe mental health conditions and substance abuse?
For the individual, the consequences are numerous and harsh. Persons with co-occurring disorders have a
statistically greater propensity for violence, medication noncompliance and failure to respond to treatment
than people living with just substance abuse or a mental health condition. These problems also extend out to
the families, friends and co-workers of these individuals.
Purely health-wise, simultaneously having a mental health disorder and a substance abuse disorder
frequently leads to overall poorer functioning and a greater chance of relapse. These individuals are in and
out of hospitals and treatment programs without lasting success. People with dual diagnoses also tend to
have tardive dyskinesia (TD) and physical illnesses more often than those with a single disorder, and they
experience more episodes of psychosis. In addition, physicians often don’t recognize the presence of
substance abuse disorders and mental disorders, especially in older adults. Socially, people with mental
health conditions often are susceptible to co-occurring disorders due to “downward drift.” In other words, as
a consequence of their brain disorder people may find themselves living in marginalized neighborhoods
where drug use prevails. Having great difficulty developing social relationships, some people find themselves
more easily accepted by groups whose social activity is based on drug use. Some may believe that an identity
based on drug addiction is more acceptable than one based on mental health condition.
Individuals with co-occurring disorders are also much more likely to be homeless or jailed. An estimated 50
percent of homeless adults with mental health conditions have a co-occurring substance abuse disorder.

Meanwhile, 16 percent of jail and prison inmates are estimated to have severe mental and substance abuse
disorders. Among detainees with mental disorders, 72 percent also have a co-occurring substance abuse
disorder.
Consequences for society directly stem from the above. Just the back-and-forth treatment alone currently
given to non-violent persons with dual diagnosis is costly. Moreover, individuals with violent or criminal
tendencies, no matter how unfairly afflicted, are dangerous and also costly. Those with co-occurring
disorders are at high risk to contract HIV/AIDS, a disease that can affect society at large. Costs rise even
higher when these persons, as those with co-occurring disorders have been shown to do, cycle through
healthcare and criminal justice systems again and again. Without the establishment of more integrated
treatment programs, the cycle will continue.
Why is an integrated approach to treating severe mental health conditions and substance use problems so
important?
Despite much research that supports its success, integrated treatment is still not made widely available to
people. Those who contend with a mental health condition and substance abuse face problems of enormous
proportions. Mental health services tend not to be well-prepared to deal with patients having both
conditions. Often only one of the two problems is identified. If both are recognized, the individual may
bounce back and forth between services for mental health conditions and those for substance abuse, or they
may be refused treatment by one or the other system. Fragmented and uncoordinated services create a
service gap for persons with co-occurring disorders.
Providing appropriate, integrated services for these individuals won’t only allow for their recovery and
improved overall health, but can ease the effects their disorders have on family, friends and society at large.
By helping these individuals stay in treatment, find housing, gain employment and develop better social skills
and judgment, we can potentially begin to substantially diminish some of the most devastating societal
problems: crime, HIV/AIDS, domestic violence and more.
There is much evidence that integrated treatment can be effective. For example, research shows that when
individuals with dual diagnosis successfully overcome alcohol addiction, their response to treatment
improves remarkably. With continued education on co-occurring disorders, hopefully, more treatments and
better understanding are on the way.
Reviewed by Robert Drake, M.D.

Suicide: What You Can Do to Help
Recognize signs of depression and suicide risk
• Change in personality— such as sad, withdrawn, irritable, anxious, tired, indecisive, apathetic
• Change in behavior—can’t concentrate on school, work, routine tasks
• Change in sleep pattern—oversleeping or insomnia, sometimes with early waking
• Change in eating habits—loss of appetite and weight, or overeating
• Loss of interest in friends, sex, hobbies, and activities previously enjoyed
• Worry about money, illness (either real or imaginary)
• Fear of losing control, going crazy, harming self or others
• Feelings of overwhelming guilt, shame, self-hatred
• No hope for the future, “it will never get better, I will always feel this way”
• Drug or alcohol abuse
• Recent loss—through death, divorce, separation, broken relationship, or loss of job, money, status, self-
confidence, self-esteem
• Loss of religious faith
• Nightmares
• Suicidal impulses, statements, plans; giving away favorite things; previous suicide attempts or gestures
• Agitation, hyperactivity, restlessness may indicate masked depression
Don’t be afraid to ask: “Do you sometimes feel so bad that you think of suicide?”
Just about everyone has considered suicide, however fleetingly, at one time or another. There is no danger
of “giving someone the idea,” in fact, it can be a great relief if you bring the question of suicide into the
open, and discuss it freely, without showing shock or disapproval. Raising the question of suicide shows you
are taking the person seriously and responding to the potential of his/her distress.
If the answer is “yes, I do think of suicide,” you must take it seriously.
Have you thought about how you’d do it? Do you have the means? Have you decided when you would do it?
Have you ever tried suicide before? What happened then? If the person has a defined plan, if the means are
easily available, if the method is a lethal one, and the time is set, the risk of suicide is very high. Your
response will be geared to the urgency of the situation as you see it. Therefore, it is vital not to
underestimate the danger by not asking for detail.

How Can I Know if Someone is Suicidal?
Ask these questions—in this order—to find out if the person is seriously considering suicide. Many of the
answers to these questions may be upsetting, especially if your family member doesn’t not identify you or
other family members as a reason to live. However it is important to reserve judgment at least initially so
that you can continue to get candid answers.
1. “Have you been feeling sad or unhappy?”
A “Yes response” will confirm that the person has been feeling some depression.
2. “Do you ever feel hopeless? Does it seem as if things can never get better?”
Feelings of hopelessness are often associated with suicidal thoughts.
3. “Do you have thoughts of death?”
A “Yes” response indicates suicidal wishes but not necessarily suicidal plans. Many depressed people say
they think they’d be better off dead and wish they’d die in their sleep or get killed in an accident,
however, most of them say they have no intention of actually killing themselves.
4. “Do you ever have any actual suicidal impulses? Do you have any urge to kill yourself?”
A “Yes” indicates an active desire to die. This is a more serious situation.
5. “Do you have any actual plans to kill yourself?”
If the answer is “Yes,” ask about their specific plans. What method have they chosen? Hanging?
Jumping? Pills? A gun? Have they actually obtained the rope? What building do they plan to jump from?
Although these questions may sound grotesque, they may save a life. The danger is greatest when the
plans are clear and specific, when they have made actual preparations, and when the method they have
chosen is clearly lethal. If the person has access to whatever they need to execute their plan, the
situation is more dangerous. After you finish gathering information, one of your first tasks will be to limit
access to the things that they need to complete their plan. This may mean taking away a gun or the keys
to their car, or simply taking the person to the hospital where they wouldn’t be able to follow through
on their plans.
6. “When do you plan to kill yourself?”
If the suicide attempt is a long way off, say, in five years, the danger is less imminent. If they plan to
kill themselves soon, the danger is grave.
7. “Is there anything that would hold you back, such as the effect on a pet or someone in our family, or your
religious convictions?
If the person says that people would be better off without them and if they have no deterrents, suicide is
much more likely.

8. “Have you ever made a suicide attempt in the past?”
Previous suicide attempts indicate that future attempts are more likely. Even if a previous attempt didn’t
seem serious, the next attempt may be fatal. All suicide attempts should be taken seriously. Although
some mental health professionals differentiate between “suicide attempts” (where the person intended
to die) and “suicidal gestures” (where the person’s primary intention wasn’t to die but to send a
message or achieve some other goal), it is important to note that suicide gestures can be more
dangerous than they seem, since some people do accidentally kill themselves when attempting to only
make a gesture.
9. “Would you be willing to talk to someone or ask for help if you felt desperate? Whom would you talk to?”
If the person who feels suicidal is cooperative and has a clear plan to reach out for help, the danger is
less than if they are stubborn, secretive, hostile, and unwilling to ask for help. If they report a plan to
reach out to a specific person, make sure that they have the person’s telephone number and, if possible,
make sure that they have discussed the fact that they have suicidal thoughts at times with the person
who they identify as the one they would most likely talk to if they were desperate. If they haven’t felt
comfortable discussing these thoughts with that individual yet, or are reluctant to raise the subject at
this time, it is less likely that they will feel comfortable enough to broach the subject with that person
when they are in crisis.
Source: NAMI Family-to-Family

Preventing Suicide through Communication
A Checklist for Parents and Families of People Living with Mental Illness
to Assist in Communicating with Treatment Providers **
Created by the Oregon Council of Child and Adolescent Psychiatry in 2013, national statistics added by NAMI in 2017
Purpose
Statistics from the Centers for Disease Control and Prevention (CDC) indicate that more than 44,000 people
died by suicide in 2015 (the most recent year for which full data are available) making suicide the 10th
leading cause of death in the U.S. The highest rates of suicide occur among people ages 45 – 54 years and
second highest among people aged 55 – 64. While unintentional injury is the leading cause of death among
young people ages 10-14 years, suicide was the second leading cause of death among youth ages 15-19
years and those ages 20-34 years. In 2015 49.8% of deaths by suicide involved a firearm, 26.8% were by
suffocation and nearly 15.4% were by poisoning (CDC website).
According to the American Foundation for Suicide Prevention (AFSP), no complete count is kept of suicide
attempts in the U.S.; however, each year the CDC gathers data from hospitals on non-fatal injuries from self-
harm. 494,169 people visited a hospital for injuries due to self-harm. This number suggests that
approximately 12 people harm themselves for every reported death by suicide. However, because of the
way these data are collected, we are not able to distinguish intentional suicide attempts from non-
intentional self-harm behaviors. Many suicide attempts, however, go unreported or untreated. Surveys
suggest that at least one million people in the U.S. each year engage in intentionally inflicted self-harm.
Females attempt suicide three times more often than males. As with suicide deaths, rates of attempted
suicide vary considerably among demographic groups. While males are 4 times more likely than females to
die by suicide, females attempt suicide 3 times as often as males. The ratio of suicide attempts to suicide
death in youth is estimated to be about 25:1, compared to about 4:1 in the elderly (AFSP website).
Communication between family members of persons seeking treatment for mental illness and primary care
providers and/or mental health practitioners improves the quality of care provided to these persons,
reduces the risk of suicide and self-harm behaviors, and encourages the use of community resources to
improve overall outcomes for these persons. While confidentiality is a fundamental component of a
therapeutic relationship, it is not an absolute, and the safety of the patient overrides the duty of
confidentiality. Misunderstandings by clinicians about the limitations created by HIPAA, FERPA, and state
laws for preserving confidentiality of patients has caused unnecessary concern regarding disclosure of
relevant clinical information. Communication between family members or identified significant others and
providers needs to be recognized as a clinical best practice and deviations from this should occur only in rare
and special circumstances.
To address a perceived deficit of communication, the Oregon Council of Child and Adolescent Psychiatry
published a checklist for health providers in 2012. This companion checklist is designed to help family
members access information that might be essential to preserving the life of their loved one.
Definitions
Person involved in treatment – a person receiving care for a mental illness, which may include a child, sibling,
parent, or other person whom you wish to support in treatment services, herein abbreviated to “person.”
Treatment services – may include outpatient therapy, medication management, support groups, or other
treatment supports, partial hospitalization, hospitalization, or therapeutic residential treatment programs.

Provider – may include primary care providers, emergency room physicians, psychiatrists, nurse
practitioners, licensed clinical social workers, licensed professional counselors, or other qualified mental
health professionals.
Family – may include first-degree biological relatives, adoptive family, foster parent(s), spouse, or other
individuals who occupy a similar position in the life of the person involved in treatment.
**NOTE: If patient is a minor, parents may consult state statutes to determine when the provider may
or must disclose patient’s information to parents.
A Checklist for Parents and Families of People Living with Mental Illness
to Assist in Communicating with Treatment Providers
For all persons with mental health issues, families should request the following:
 Has the provider requested that the person sign an authorization to speak with the family? If not, why
not? If yes and the person refused, did the provider explain the therapeutic value of speaking with the
family?
 Has a comprehensive risk assessment including personal interview with the person, record review, and
solicitation of information from the family been completed by the provider or another qualified
professional?
 Has the provider or any other professional concluded that the person is at elevated risk of suicide?
 Has the provider reviewed the records of previous mental health providers, and communicated with all
others who are involved with the persons’ treatment and care (e.g., therapist, family physician, case
manager, et al.)?
 You should offer to provide additional history to the provider and tell the provider what you already
know about the family member’s illness and need for treatment, especially any episode that suggests
the potential for self-harm.
Where an elevated risk of suicide is identified in persons involved in treatment, families have a compelling
interest to learn the following:
 What are the diagnoses and treatment recommendations? How can the family best support the
provider’s recommendations? Where can one learn more about the illness which has been diagnosed?
 What is the provider’s evaluation of suicide risk in this case? What are the particular warning signs (not
the same as risk factors) for suicide in this person’s situation? What steps should the family take if they
see these factors occurring, such as taking the person to the hospital for reassessment? You may wish
to ask the provider to help create a plan to monitor and support the family member. What protective
factors exist, and how can these be expanded or enhanced for this person?
 What community resources are available to help the family and the person involved in treatment,
including resources for case management, peer and family support groups, and improving mental health
at home?

 What type of ongoing care is required? Who should provide that care? How can the family access that
care?
 What can the family do to best help the person involved in treatment? What should the family not do?
 When the person transitions from one level of care to another or from one provider to another, how will
provision of care be coordinated? You may wish to request that the provider assures that follow up is in
place with a specific timely appointment, that the accepting provider has full knowledge of history and
risk issues/records, and that the original provider confirms that family member has attended the follow
up appointment.
Where the person is at university or similar setting, the family may wish to ask the Dean of Students:
 What systems are in place to support students living with mental illness and avoid self-harm? Is peer
counseling available for the student with mental illness? Are the health service and/or counseling
services on call 24/7; if not what are their hours? Is there a 24-hour number to call in case of
emergency?
 Is there an office to intercede with instructors for the student who feels overwhelmed or highly
stressed? Will use of these resources imperil any scholarships the student might have?

Limit Setting
Behaviors that shouldn’t be tolerated:
Even if they are a result of the mental health condition, the following behaviors shouldn’t be tolerated:
• Physical abuse
• Sexual abuse
• Destruction of property (example: punching holes in walls)
• Setting fires or creating fire hazards (example: smoking in bed)
• Stealing
• Abuse of illegal and/or prescription drugs
• Severely disruptive or tyrannical behaviors (examples: walking around the house with a weapon;
blasting the stereo, intolerably loud screaming)
Allowing yourself or other members of your family to become a victim of any of these behaviors not only
poses danger, but sets up an atmosphere that is extremely stressful for everyone, especially your Service
Member.
Behaviors that are typical symptoms of a mental health condition:
A. Trying to stop any of the following behaviors in someone with a mental health disorder can be like
trying to stop someone with a cold from sneezing:
• Periodic departure from normal eating habits

• Unusual sleep/wake cycles. (Example: Sleeping all day and staying up all night)
• Delusions or disordered thinking
• Hallucinations
• Withdrawal to a quiet, private place
• Some inappropriate social behavior
B. The reasons for these behaviors are much more complicated than attempts to manipulate. They are
symptoms of a disorder or attempts to cope with symptoms in which manipulation may play only a
small role, if any.
C. Even if a behavior is a symptom or attempt to cope with a symptom, you shouldn’t tolerate it if it’s
destructive or severely disruptive (see above), or if it is driving you or someone else in the house to
absolute distraction.
Source: The Training and Education Center Network Mental Health Association of Southeastern Pennsylvania
Philadelphia, Pennsylvania

Managing Violent and Disruptive Behavior
What you can do to manage violent or disruptive behavior:
• When you and your relative are BOTH calm, explain to him/her what kinds of behaviors you will not
tolerate, as well as the specific consequences upon which you (and other family members) have decided
(and agreed) for specific violent or disruptive behaviors.
Example: “Next time you threaten to harm any of us, law enforcement will be called.”
• Get to know and recognize cues that your relative is becoming violent or disruptive (Your own
uneasiness or fear is usually a good cue).
• Tell your relative that his/her behavior is scaring you or upsetting you. This feedback can defuse the
situation, but proceed with the next suggestion if it doesn’t. Saying you are scared doen’ts mean you act
scared.
• If you (and other family members) have made a limit-setting plan, now is the time to carry out the
consequences. If you haven’t already warned your relative of the consequences when he was calm, use
your judgment and past experience to decide whether to warn him/her or to just go ahead with the plan
without saying anything.
• Give your relative plenty of space, both physical and emotional. Never corner a person who is agitated or
whose symptoms are escalating unless you have the ability to safely restrain him/her. Verbal threats or
hostile remarks constitute emotional cornering and should, therefore, be avoided.
• Give yourself an easy exit, and leave the scene immediately if he/she is scaring you or becoming violent.
• Get help! Just bringing in other people, including law enforcement if necessary, can quickly defuse the
situation.
• If you or someone else has witnessed your relative recently committing or planning a violent or
dangerous act, that is grounds for involuntary commitment.
What you should NOT do:
• Don’t try to ignore violent or disruptive behavior. Ignoring only leads your relative to believe that this
kind of behavior is acceptable and “repeatable.”
• Don’t give your relative what s/he wants if the way s/he is trying to get it is through bullying you. Giving
in reinforces this bullying behavior and makes it likely that s/he will use it again. Only give in if it is the
ONLY way out of a dangerous situation.
• Don’t try to lecture or reason with your relative when s/he is agitated or losing control.
• NEVER be alone with someone you fear.
o Example: Don’t drive him/her to the hospital by yourself.
Source: The Training and Education Center Network, Mental Health Association of Southeastern
Pennsylvania, Philadelphia, Pennsylvania

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NAMI Homefront Online 2017 2.1

adrenal: ah–dreen–al genomic: gen–nomic

NAMI Homefront Online 2017 2.2

After this busy time of neuron migration, a period of cell death

NAMI Homefront Online 2017 2.3

• The occipital lobe is responsible for:

• The temporal lobe is responsible for:

• The parietal lobe is responsible for:

NAMI Homefront Online 2017 2.4

NAMI Homefront Online 2017 2.5

NAMI Homefront Online 2017 2.6

NAMI Homefront Online 2017 2.7

Symptoms of Symptoms of Symptoms of Symptoms of

Altered sexual interest    

Sense of personal destiny    

NAMI Homefront Online 2017 2.8

Research on Ventricle-to-Brain (VBR) Differences in Twin Studies

NAMI Homefront Online 2017 2.9

 Linked to every major mental health condition!

NAMI Homefront Online 2017 2.10

First-Degree Relatives My risk of developing it is: My chances of not developing it are:

My brother or sister has:

One of my parents has

Schizophrenia 13% 87%

Both my parents have

Schizophrenia 36% 64%

My identical twin has

Schizophrenia 28% 72%

NAMI Homefront Online 2017 2.11

1. Why can’t someone just tell us what the diagnosis is?

NAMI Homefront Online 2017 2.12

4. Grossly disorganized or catatonic behavior

NAMI Homefront Online 2017 2.13

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NAMI Homefront Online 2017 2.15

2) What symptoms are they experiencing (diagnosis if they have one)

3) How long have they been dealing with symptoms?

4) How are they doing now?

NAMI Homefront Online 2017 2.16

NAMI Homefront Online 2017 2.17

Center for the Study of Traumatic Stress (USU – Department of Psychiatry)

Defense Centers of Excellence

Deployment Health and Family Readiness Library

Justice for Vets

NAMI (National Alliance on Mental Illness)

PTSD: National Center for PTSD (VA)

SAMHSA (Substance Abuse & Mental Health Services Administration)

VA (U.S. Department of Veterans Affairs)

NAMI Homefront Online 2017 2.18

Crisis team phone # ___________________

Local mental health agency phone # ___________________

Local mental health caseworker services phone # ___________________

Local hospital phone # ___________________

Local law enforcement phone # ___________________

State law enforcement phone # ___________________

VA CBOC (clinic) phone # ___________________

VA Recovery Coordinator – CBOC ___________________

VA Medical Center phone # ___________________

VA Recovery Coordinator – Medical Center ___________________

NAMI State Organization phone # ___________________

NAMI Affiliate office phone # ___________________