Addressing Mental Health Needs in Addressing Mental Health Needs in Families with ChildrenFamilies with Children

National Conference on Ending National Conference on Ending Family HomelessnessFamily Homelessness

Helene M. Rimberg, PsyDHelene M. Rimberg, PsyD

Key PointsKey Points In order to be most effective, service providers In order to be most effective, service providers

need to understand the complexities of their need to understand the complexities of their clientsclients

Families are systemsFamilies are systems Families are part of multiple systemsFamilies are part of multiple systems Mental Health issues impact the individual, the Mental Health issues impact the individual, the

family, how it interacts with other systems, and family, how it interacts with other systems, and how other systems respondhow other systems respond

Housing case managers can play a vital role in Housing case managers can play a vital role in assessment, resource development and follow assessment, resource development and follow throughthrough

Fragmented ApproachFragmented Approach

Feel misunderstoodFeel misunderstood Feel disrespectedFeel disrespected Feel like a problem Feel like a problem

not a personnot a person Less likely to follow Less likely to follow

throughthrough Service delivery is Service delivery is

less effectiveless effective

Integrated approachIntegrated approach Person feels understoodPerson feels understood Problems are viewed in Problems are viewed in

contextcontext Person feels respectedPerson feels respected Views provider as allyViews provider as ally Services are appropriate Services are appropriate

and likely to succeedand likely to succeed More likely to engage and More likely to engage and

follow throughfollow through

Families as systemsFamilies as systems A family is greater than the A family is greater than the

sum of it’s parts – creates a sum of it’s parts – creates a unique wholeunique whole

Family members impact, and Family members impact, and are impacted by, each other – are impacted by, each other – ripple effect or ripple effect or interdependenceinterdependence

Have a defined set of rulesHave a defined set of rules Have a defined structureHave a defined structure Have patterns of behavior that Have patterns of behavior that

are resistant to change –are resistant to change – Seek to maintain status quoSeek to maintain status quo

Families are part of multiple Families are part of multiple systemssystems

ChildProtection

church

extendedfamily

legal

employment

medical

housing

schoollandlord

family

Add mental health issuesAdd mental health issues

ChildProtection

church

extendedfamily

legal MentalHealth

employment

medical

housing

schoollandlord

family

Mental health issues Mental health issues impactsimpacts How members How members

respond to each otherrespond to each other Family’s level of Family’s level of

engagementengagement Family’s quality of Family’s quality of

engagementengagement Response from othersResponse from others

DepressionDepression

Low energyLow energy HopelessnessHopelessness FragilityFragility SuicidalSuicidal Sleep problemsSleep problems SadnessSadness

Family members Family members caretake, protect & caretake, protect & neglect own needsneglect own needs

Limited engagement Limited engagement with otherswith others

Engagement marked Engagement marked by low motivationby low motivation

Others feel; Others feel; frustrated, tend to frustrated, tend to take overtake over

Bipolar DisorderBipolar Disorder DepressionDepression Mood swingsMood swings InstabilityInstability ImpulsiveImpulsive Excessive involvement in Excessive involvement in

pleasurable activities: drugs, pleasurable activities: drugs, gambling, sex, spendinggambling, sex, spending

GrandioseGrandiose AgitatedAgitated Resistance to medicationsResistance to medications

Family members response Family members response varies with phase – creates varies with phase – creates instabilityinstability

Engagement varies with phase Engagement varies with phase – in manic state will avoid – in manic state will avoid purposeful contactpurposeful contact

Others response will also vary Others response will also vary based on phase – caretaking based on phase – caretaking during depression, punitive during depression, punitive during manic phaseduring manic phase

SchizophreniaSchizophrenia Starts in late adolescence or Starts in late adolescence or

early adulthoodearly adulthood Thought disorderThought disorder DelusionalDelusional HallucinationsHallucinations ParanoidParanoid Nonsensical communicationsNonsensical communications Poor self carePoor self care Flat affectFlat affect DisconnectednessDisconnectedness Cognitive problems: memory, Cognitive problems: memory,

attention, organizeattention, organize Substance useSubstance use

Family members feel Family members feel burdened, helpless, scared, burdened, helpless, scared, embarrassed by bizarre embarrassed by bizarre behaviorsbehaviors

Engagement with others is Engagement with others is difficult; marked by difficult; marked by communication difficultiescommunication difficulties

Others are at a loss on how to Others are at a loss on how to engage – turf to more engage – turf to more restrictive environmentrestrictive environment

Borderline Personality DisorderBorderline Personality Disorder Pervasive instability in Pervasive instability in

relationships, moods, relationships, moods, behavior, self-imagebehavior, self-image

Highly sensitive to Highly sensitive to rejectionrejection

Good/bad thinkingGood/bad thinking Self-harmingSelf-harming ImpulsiveImpulsive Substance useSubstance use

Family members are Family members are overwhelmed, angry, fear overwhelmed, angry, fear upsetting the other, feel upsetting the other, feel manipulatedmanipulated

Engagement with others is Engagement with others is unstable – good provider vs. unstable – good provider vs. bad providerbad provider

Tend to disrupt systems, burn Tend to disrupt systems, burn bridgesbridges

Others feel manipulated, fear Others feel manipulated, fear becoming the bad provider, not becoming the bad provider, not sure what to believesure what to believe

Role of Housing Case ManagerRole of Housing Case Manager

Thorough assessment of family to determine Thorough assessment of family to determine mental health issues, impacts and needed mental health issues, impacts and needed resourcesresources

Create system of support – utilize community Create system of support – utilize community resources to serve family within communityresources to serve family within community

Resist what mental health issues pulls from you Resist what mental health issues pulls from you – respect the family, your boundaries– respect the family, your boundaries

Be genuine – you are your best toolBe genuine – you are your best tool