Supported Education and Psychiatric Disabilities

By DeAnne Lonnquist, Karen Hughes, and Lauren Miller

Agenda

• What is a psychiatric disability?• What is supported education?• Classroom Challenges• Instructional Strategies

What is a psychiatric disability?A psychiatric disability is a medical condition that disrupts a person's thinking,

feeling, mood, ability to relate to others and daily functioning. They often result in a diminished capacity for coping with the ordinary demands of life.

Serious psychiatric disabilities include major depression, schizophrenia, bipolar disorder, posttraumatic stress disorder (PTSD) and borderline personality disorder. The good news about mental illness is that recovery is possible.

Psychiatric disabilities can affect persons of any age, race, religion or income. Psychiatric disabilities are not the result of personal weakness, lack of character or poor upbringing. Psychiatric disabilities are treatable. Most people diagnosed with a serious psychiatric disability can experience relief from their symptoms by actively participating in an individual treatment plan.

NAMI, 2014

General Statics on Mental Health in the United States

One in four adults approximately 61.5 million Americans have or will experience some form of a psychiatric disability in a given year. About 13.6 million Americans live with chronic psychiatric disabilities i.e. Schizophrenia, Bipolar, Depression, Anxiety, and PTSD.

Research indicates that with support individuals with psychiatric disabilities are able to improve and enhance professional and personal behaviors and return to work or school.

Supported Education allows individuals to trade the identity of mental patient for that of student and productive employee.

Schizophrenia

Schizophrenia is a brain disorder that is characterized by delusions, hallucinations, disorganized behavior and speech. These symptoms can cause disruptions in an individual’s ability to learn.

Positive symptoms

• Hearing voices (audio hallucinations)• Visual hallucinations• Active delusions (Do not buy into them)• Thought disorders (disorganized thinking)• Movement disorders (repetitive motions and

catatonia)

Negative symptoms

• Isolative behaviors• Guarded or extremely private• Blunted affect• Lack of pleasure • Lack of interaction

Schizophrenia is not to be confused with…

• Dissociative Identity Disorder (“split personalities”)

• Many people make this mistake • Schizophrenia is not a learning disorder, but it

can greatly affect the person’s ability to focus and absorb the material

Mood Disorder

Mood disorders are associated with mood swings ranging from extreme highs i.e. high energy, inability to maintain focus and/or concentrate and extreme lows i.e. feelings of despair, lack of motivation, inability to focus and/or concentrate. Mood disorders include

Major Depression, Bipolar Disorder

Mood Disorders

• Associated with extreme moods:• High mood, which can lead to irritability and

inability to maintain focus– Mania– Hypomania

Mood disorders, continued

• Low mood, which decreases member interest and motivation:Depression

Cyclothymia (milder form of Bipolar Disorder)

• When Schizophrenia and a mood disorder occur concurrently, it is called Schizoaffective disorder.

Anxiety Disorders

Anxiety disorders are defined as the inability to control feelings of anxiety or excessive worrying. Anxiety Disorders interfere with the ability to focus and concentrate. Anxiety Disorders include Post Traumatic Stress Disorder and Obsessive Compulsive Disorder.

Anxiety Disorders

• These disorders are under an umbrella in which symptoms cause the person extreme anxiety (to the point of physical discomfort and pain), as well as obsessive behaviors:

• Agoraphobia• Generalized Anxiety Disorder• Obsessive Compulsive Disorder

Well Known People With A Psychiatric Disability

• Professor John Nash, who won the Nobel Prize for mathematics in 1994.• Lionel Aldridge: Played for the Green Bay Packers in the 1960's, suffered from

schizophrenia.• Charles Dickens: author of A Christmas Carol, suffered from depression.• Leo Tolstoy: Author of War and Peace, Tolstoy told of his own mental illness in My

Confession.• Gaetano Donizetti, Singer suffered from bipolar disorder.• Kay Redfield Jamison, clinical psychologist and Professor of Psychiatry at the Johns

Hopkins University School of Medicine, who profiled her own bipolar disorder in her 1995 memoir An Unquiet Mind and argued for a connection between bipolar disorder and artistic creativity in her 1993 book, Touched with Fire.

• Margot Kidder, actress— self-described: "I have been well and free of the symptoms that are called manic-depression for almost five years, and have been working steadily and leading a happy and productive life since then."

Exercise

• We will now show you an exercise that will allow you to experience what it feels like to hear voices – both positive and negative. People who suffer from Schizophrenia often report hearing voices throughout the day, every day.

Exercise: There will be 4 Participants in each group. Each participant will have a role, which are teacher, learner, positive voice, and negative voice. The teacher will explain a lesson of “reading a passage from a book.” The “voices” will start talking in the learner’s ears, one saying positive things and the other saying negative things. A discussion will follow.

Supported Education

“Supported Education is a recovery-oriented practice that aids individuals with psychiatric disabilities who want to begin or return to school to complete their educational goals (Mowbray, et al., 2005).”

Bellamy, 2010

Supported Education is defined as enabling individuals to accomplish his or her educational goals that may have been interrupted due to experiencing behavioral health symptoms as a result of having a psychiatric disability.

SAMHSA, 2012

Classroom Challenges

Whether a person is suffering from anxiety, depression, or other disorders, he or she may bring to the classroom the following kinds of challenges to learning:

• Difficulty Maintaining Attention• Fatigue/Lack of Initiative and Motivation• Increased Anxiety• Behavioral outbursts or impulses

Instructional Strategies

• Build rapport• Comfort agreements• Introduce material slowly• Use interest to build lessons• Focus on strengths• Utilize learning styles• Encouragement• Constructive feedback

Difficulty Maintaining Attention1. Communicate that you are glad to see the person and acknowledge his or her goals.2. Take things one step at a time. 3. Offer lessons that are at or just above the learner’s current level of achievement.4. Help learners measure incremental progress, so they have visible evidence of their

accomplishments. 5. Encourage follow through on assignments, yet be flexible on deadlines.6. In the learning environment, help the learner identify sensible learning goals.7. Provide frequent, positive progress feedback to encourage sustained effort and

counteract discouragement.8. Use humor.9. Focus on the student as a person. Foster an environment of tolerance and

understanding. 10. As appropriate, find out what the person enjoys or has enjoyed in the past or what they’re good at.11. Take breaks as needed. 12. Modify seating arrangements.13. Minimize visual and auditory distractions. For example use a trifold board or allow the

student to wear headphones.14. Ask the person what works at home.

Fatigue/Lack of Initiative and Motivation1. Encourage the student to focus on one subject at a time. 2. Find out what inspires the person (don’t give up easily). Relate the response

to one or more of the student’s learning goals.3. Develop a realistic plan for achieving the student’s goals. Break it down into

small increments so the student can see results at each step.4. Discuss the best time to study for homework.5. Find another student to pair up with the low-energy student when possible.6. Look for ways to reward the student and increase hopefulness. 7. Help students recognize and acknowledge positive contributions and

performance.8. Keep a record of the student’s accomplishments so you can show it to him or

her occasionally.9. Ask the person what works at home.

Increased Anxiety

1. Try to establish a feeling of safety and acceptance in the learning environment.

2. Provide a consistent, predictable routine as much as possible.3. Allow the learner to take breaks as needed, including taking a walk or doing a

breathing exercise.4. Offer lessons that are at or just above the learner’s current level of

achievement.5. Break assignments into manageable pieces.6. Help learners measure incremental progress, so they have visible evidence of

their accomplishments. 7. In the learning environment, help the student identify realistic learning goals.

Behavioral outbursts or impulses

1. Rapport helps.2. Don’t placate, realize the root of the

behavior.3. If needed, let the member take a break.4. Take the time to listen to what they are

saying.5. Shorten sessions, if needed.

Accommodations

An accommodation is an adjustment in a classroom environment, or task, or requirement, that allows a person with a disability to participate equally with others.

Karen Unger, 1998

Accommodations/Helpful Tips• Quiet place for tests• Extended time for tests• Tests individually processed• Extended time for assignments• Alternative way to complete assignments• Books on tape • Seating modifications• Changes in courses of study• Wide range of adaptive technology• Incompletes rather than failures if the student needs a medical withdrawal

Karen Unger, 1998

Tutors’ experiences of working with individuals with Psychiatric disabilities

L: Sometimes, I forget that on top of age, they deal with all sorts of cognitive barriers i.e. hearing voices and impaired memories. I tailor my classes (for instance, make personal references for them) so that they will easily remember the concept I’m trying to teach. You would be surprised at how using them as an example helps them to focus on learning.

D: Sometimes my learners have difficulty with concentrating and staying on task. It can be frustrating. But when one of the learners answers a question correctly, or completes an assignment, it is worth all the frustrations I have experienced!

ResourcesSubstance Abuse and Mental Health Services Administrationwww.samhsa.gov

National Alliance of Mental Illnesswww.nami.org

National Institute of Mental Health (NIMH)Information and handouts on various topicswww.nimh.nih.gov

National Mental Health Association www.nmha.org

ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: American Psychiatric Publishing.

Bellamy, Chyrell. (2010). Recovery to Practice. Retrieved from http://www.samhsa.gov/RecoveryToPractice/Resources/rtp_enewsletter/enewsletter_final_10_29_10.html

Substance Abuse and Mental Health Services Administration. (2012). Supported Education Evidence-Based Practices (EBP) Kit Retrieved from http://store.samhsa.gov/product/Supported-Education-Evidence-Based-Practices-EBP-Kit/SMA11-4654CD-ROM

National Alliance of Mental Illness. (2014). What is Mental Illness? Retrieved on February 28, 2014, from http://www.nami.org/Template.cfm?Section=By_Illness

Unger, Karen. (1998). Handbook On Supported Education: Providing Services For Student With Psychiatric Disabilities. Baltimore, Maryland. Paul H. Brooks Publishing Co.