Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Illness Management and Recovery Workbook
Chapter 3 Practitioner Guidelines for Handout #2:
Practical Facts About Mental Illness
There are three handouts to choose from:
2A: Practical Facts About Schizophrenia
2B: Practical Facts About Bipolar Disorder
2C: Practical Facts About Depression
Introduction
People are empowered by knowledge. The more they understand the basic facts
about their disorder, the better equipped they are to speak for themselves and
to take an active role in their treatment and recovery.
This module provides the opportunity to answer some of the common questions
people have about mental illness:
- How is mental illness diagnosed?
- What are the symptoms?
- What are the treatments?
- How common is it?
- What does the future hold?
This module also provides a chance for people to educate practitioners about
what they
have experienced.
Goals
1. Provide a message of optimism about the future.
2. Assure people that having mental illness is nobody’s fault.
3. Help people identify examples of symptoms they have experienced.
4. Introduce the stress-vulnerability model.
5. Familiarize people with examples of individuals who have mental illness and
lead productive, meaningful lives.
Number and Pacing of Sessions
“Practical Facts About Mental Illness” can usually be covered
in two to four sessions. Within each session, most people find that covering
one or two topics and completing a questionnaire is a comfortable amount.
Structure of Sessions
- Informal socializing and identification of any major problems.
- Review the previous session.
- Discuss the homework from the previous session. Praise
all efforts and problem-solve obstacles to completing homework.
- Follow-up on goals.
- Set the agenda for the current session.
- Teach new material (or review materials from a previous
session if necessary).
- Summarize progress made in the current session.
- Agree on homework to be completed before the next session.
Strategies to be used in each session
Motivational strategies
Motivational strategies in this module focus on helping people understand
the personal relevance of learning about their disorders. Practitioners can
help people identify how knowing more about their mental illness and its treatment
can benefit them personally. The overriding question is, “How might the
person use the information in this module to improve his or her life in some
way?”
The following suggestions may be helpful:
- For each major topic covered in the handout, help the person
to identify at least one way that information about that topic might be helpful
to him or her. For example, when reading the section “What are the symptoms
of schizophrenia?” you might ask a general question, such as “How
could it be helpful to you to learn how to recognize symptoms?”
- Keep in mind the goals that the person identified in the
first module (“Recovery Strategies”). Continue to help the person
identify goals. Also help the person identify information in the handout that
could help him or her achieve a personal goal.
- Show an appreciation for the person’s experience and
knowledge. Thank the person for his or her comments and clarifications. Show
the person that you appreciate what he or she is saying. Recognizing the person’s
expertise makes the relationship with the practitioner collaborative, reinforcing
and motivating.
Educational strategies
Educational strategies for this module focus on ensuring that people understand
basic information about their disorder. The best learning will take place when
people can relate this information to their own personal experiences. For example,
learning more about the specific symptoms of bipolar disorder might help a person
to understand a recent manic episode. Learning about hallucinations may help
someone understand their experience with hearing voices.
The following strategies were discussed in detail in Module 1:
- Review the contents of the handout by summarizing or taking
turns reading.
- Pause at the end of each topic to check for understanding
and to learn more about the person’s point-of-view.
- Allow plenty of time for questions and interaction.
- Pause to allow the person to complete the checklists and
questionnaires.
- Break down the content into manageable “pieces.”
- Find a pace that is comfortable for the person.
Cognitive-behavioral strategies
Cognitive-behavioral strategies focus on helping people learn how to use information
in the module to think differently or behave differently about their illness.
It is especially helpful for people to think of how learning about mental illness
can improve something in their own life or help them achieve personal goals.
- At the end of each session of this module, help the person
identify some key points that he or she found helpful. In addition, help the
person think of how he or she could use this information in a practical way.
For example, before this module, the person may have believed that something
he or she did caused the illness. After finding out that mental illness is
nobody’s fault, he or she could use that information to counteract self-blame.
In the session, the practitioner could help the person practice what he or
she could say to himself or herself to counteract self-blame, using the following
steps:
- The practitioner can help the person choose an alternative
self-statement such as, “No one is to blame for mental illness.”
- The practitioner can model saying the statement out
loud.
- The person can practice saying the statement out loud.
- The person can practice saying the statement to him
or herself.
- The statement could be written down and practiced as
part of homework.
- Before this module, people may not have understood that
some of their experiences were caused by symptoms. For example, people may
have thought that their lack of energy and motivation was caused by personal
weakness or “laziness” or that the voices they heard were some
kind of “punishment.” The practitioner can help people practice
reminding themselves that certain experiences are the result of symptoms of
their mental illness. Using the model above, the practitioner can start by
helping the person choose and practice an alternative self-statement such
as, “The voices I’m hearing are a symptom of my illness.”
- After completing the topic “What are the symptoms
of mental illness?” the practitioner could ask the person if it might
be helpful to be able to describe his or her symptoms to someone in their
support system, such as another practitioner or a family member. For example,
the person might find it helpful to talk to someone on their treatment team
about the symptoms he or she has experienced. In the session, the person can
practice what her or she might say to the treatment team member. Or it might
be helpful to talk to a family member about symptoms so that he or she can
better understand what the person’s experience has been. Talking to
the practitioner or family member or another member of the person’s
support system might be a relevant homework assignment.
Homework
As described above under “cognitive-behavioral strategies,” help
the person identify situations outside the sessions where newly learned information
about mental illness could be applied. Developing homework involves helping
the person plan how the information can be applied before the next session.
For homework, you could help the person select a specific individual to talk
to about the symptoms he or she has experienced. You could also go over a list
of symptoms from the educational handout to help the person plan what they will
cover. Some people find it helpful to role-play their conversation in the session
before they approach someone outside the session.
You could also help the person plan how he or she can practice positive self-statements
based on new information to combat self-blame.
Encourage homework that involves family members and other support persons.
This might include asking people to review the handout (or a section of the
handout) with someone from their support system.
Follow up on the homework by asking how it went. For example, you could ask,
“Were you able to talk to someone on your treatment team about specific
symptoms as you had planned? How did it go?” Or “Were you able to
practice self-statements as you had planned?”
If people do not complete the homework, you can gently ask what got in the
way. You can role play ways of overcoming obstacles to completing the homework.
Tips for common problems
People may be reluctant to acknowledge that they have a specific mental illness,
that they have particular symptoms, or that they have any mental illness.
Recognizing that one has a mental illness or a specific type of mental illness
can be helpful, but is not a prerequisite for participating in the Illness Management
and Recovery Program. The practitioner should respect the person’s opinion
and seek common ground to facilitate working together.
Practitioners can point out that psychiatric diagnoses are just a way of describing
a group of symptoms that occur together. Practitioners may choose to use different
words or phrases that are acceptable to the person, such as “having problems
with stress,” “having a nervous condition,” or “having
problems with anxiety.”
At times it may be more effective to link learning the contents of the module
to a goal that the person has previously identified. For example, you could
say, “I think working together on this handout will help you with your
goal of staying out of the hospital.”
Some people already know a great deal about their mental illness.
It is still desirable to go over the handout to check the person’s understanding
and to explore for opportunities to make sure that he or she is able to use
the information effectively. Sometimes people have received information in a
piecemeal fashion; going through this handout may help people synthesize what
they have previously learned. It may be possible to review the module in a short
period of time if people are already very familiar with the contents.
Review Questions
At the end of this module, you can use either open-ended questions or multiple
choice questions to assess knowledge of the main points. The following questions
need to be modified depending on the diagnosis covered in the module (schizophrenia,
bipolar disorder, major depression).
Open-ended questions
- What are some of the symptoms of ______________?
- Does everyone who has ___________ have the same experience
with symptoms?
- What causes ___________________?
- Who is a famous person that had ______________?
- What information would be helpful to someone who just received
a diagnosis of _____________________?
Multiple choice and true/false questions
- Which of the following is NOT a symptom of schizophrenia?
Being violent
Hearing voices that other people can’t hear
Having strong beliefs that no one else shares
OR
- Which of the following is NOT a symptom of bipolar disorder?
Being violent
Feeling extremely happy or excited
Feeling very sad
OR
- Which of the following is NOT a symptom of depression?
Being violent
Feeling very sad
Low energy level
- Everyone who has _________________ has symptoms all the time.
True or False.
- Scientists believe that ________________________ is caused by:
Chemical imbalance in the brain
Poor education
Weather conditions
- A famous person who had ____________is __________________.
- If someone receives a diagnosis of mental illness, it is very helpful
to know:
How to recognize the symptoms
Who to blame
What it is called in other languages
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