UNDERSTANDING AND MANAGING COURT USERS WITH MENTAL HEALTH ISSUES Samantha Sim & Valerie Chua Senior Court Counsellor (Psychologist) Centre for Specialist Services
CONTENT Part 1 1. Understanding common mental health issues • Depression, Anxiety, Schizophrenia, Obsessive Compulsive Disorder, Dementia • Causes and triggers 2. Debunk myths associated with mental health 3. Living with a mental health disorder • Short stories of people with mental health issues • Mental health stigma • Having empathy Part 2 4. Recognising common mental health disorders • How do people with mental health issues act? 5. Being there for someone with a mental health issue 6. Managing Court users with mental health issues 7. Centre for Specialist Services
WHY TALK ABOUT MENTAL ILLNESS? • Australia (National Survey of Mental Health and Wellbeing) • 1 in 5 (20%) Australians aged 16-85 years old experience a mental illness in 2017 • Hong Kong (Mental health review report) • 1 in 7 people in Hong Kong will develop a common mental disorder in their lifetime • Singapore (Singapore Mental Health Study) 1 in 7 people has experienced a mood, anxiety or • alcohol use disorder in their lifetime • Top 3 conditions are major depressive disorder, alcohol abuse and obsessive-compulsive disorder.
SOME COMMON MENTAL HEALTH CONDITIONS • Mood disorders • Major Depressive Disorder • Bipolar disorder • Anxiety disorders • Generalised Anxiety Disorder • Panic Disorder • Obsessive-Compulsive Disorder • Schizophrenia • Dementia
SOME COMMON MENTAL HEALTH CONDITIONS • Mood disorders • Major Depressive Disorder • Bipolar disorder • Anxiety disorders • Generalised Anxiety Disorder • Panic Disorder • Obsessive-Compulsive Disorder • Schizophrenia • Dementia
DEPRESSION A psychiatric disorder in which a person feels intense sadness, worthlessness and hopelessness for long periods of time; thereby affecting that person’s ability to function.
Source: Queensland Brain Institute
BIPOLAR DISORDER • Formally known as manic depression • A mental health condition that causes extreme mood swing that include emotional highs (mania or hypomania) and lows (depression).
CASE EXAMPLE Mdm Tan filed a neighbour dispute case against her neighbour, Mdm Lee. She claimed that there were issues with the piping in Mdm Lee’s house causing a huge leak that affected her wardrobes. After she left the Tribunal Hearing Room, she squatted down and reported feeling dizzy. After the whole episode, she was brought to a room where she was given the time to calm down. She was crying and repeatedly stated that she didn’t understand. Only about 45 minutes into the session that she calmed down and stated that she could think ‘clearer’. She started sharing about her marital issues and feeling ‘useless’ and ‘guilty’ as she could not fulfil her duties as a housewife in providing a ‘nice home’ for her husband.
SCHIZOPHRENIA • Changes in thinking patterns • May have difficulties concentrating, follow a conversation or remember things. Thoughts may be jumbled, or they may not connect in a way that makes sense. • Unusual or false beliefs • Delusions – A person may be truly convinced of a belief that is not shared by others. • E.g. believing that one is being followed by others, or being monitored by cameras, or believing one’s thoughts are being controlled by an outside force.
SCHIZOPHRENIA • Changes in perception • Hallucinations - Hear, see, smell, taste or feel something that is not actually there • Negative symptoms • Reduced emotional expression • Loss of motivation • Lack of social interest • Lack of pleasure • Withdrawal
CASE EXAMPLE Mdm Goh filed a neighbour dispute case claiming that her neighbours living below her were making banging noises, a boy shouting vulgarities and girls playing drums and placing surveillance in her home. Mdm Goh claimed that the noise started even before the respondents moved in and that the previous owner had ‘polluted [the] respondent’ to continue disturbing her. She further insisted that the respondent has ‘a way to track her movements, from switching off her lights, to stepping into the bedroom’.
DEMENTIA • Dementia is an illness that leads to the decline of the brain and its abilities in judgement, language, planning, and behavior. It can affect adults of any age, although it is more likely to occur in those above 65 years old. • Damage in brain cells interferes with the ability of brain cells to communicate normally. Hence, thinking, behavior and feelings can be affected. • Common signs and symptoms: • Memory loss • Difficulties in abstract thinking • Inappropriate behavior • Disorientation to time and place • Neglect of personal care and safety • Hallucinations, paranoia and agitation
CASE EXAMPLE Mdm Chu is an elderly lady who appeared in court as SP services filed a small claim against her for failing to pay her bills. She was wheelchair bound and was observed to be in a daze. She was unresponsive when the attempts were made to engage her. The respondent was asked if she knew why she was in court and where she resided, she appeared stressed and did not respond. When she did, she shared that her ‘mind is blank’ and was visibly anxious. She was not orientated to time, date, and place, with significant deficit to her recent memories. For example, she was unable to remember how she came to court or who she was living with.
WHAT ARE SOME OF THE CAUSES OF MENTAL ILLNESS? • No single cause for mental illness • Biological • Chemical imbalance in the brain • Brain damage • Genes and family history • Psychological • Severe psychological trauma suffered as a child • Loss of someone dear • Environmental/social • Changing jobs or school • Social or cultural expectations
MYTH OR FACT?
LIVING WITH A MENTAL HEALTH DISORDER “I hide in the stacks until well after midnight, sitting on the floor muttering to myself. It grows quiet. The lights are being turned off. Frightened of being locked in, I finally scurry out, ducking through the shadowy library so as not to be seen by any security people. It’s dark outside. I don't like the way it feels to walk back to my dorm. And once there, I can't sleep anyway. My head is too full of noise. Too full of lemons, and law memos, and mass murders that I will be responsible for. I have to work. I cannot work. I cannot think. The next day, I am in a panic, and hurry to Professor M., pleading for an extension. "The memo materials have been infiltrated," I tell the center cannot hold him. "They're jumping around. I used to be good at the broad jump, because I'm tall. I fall. People put things in and then say it's my fault. I used to be God, but I got demoted." I begin to sing my little Florida juice jingle, twirling around his office, my arms thrust out like bird wings.” - The Center Cannot Hold by Elyn Saks
LIVING WITH A MENTAL HEALTH DISORDER • How would you feel? Scared Suspicious Confused Withdrawn Angry Frustrated
PART 2
CONTENT Part 1 1. Understanding common mental health issues • Depression, Anxiety, Schizophrenia, Dementia • Causes and triggers 2. Debunk myths associated with mental health 3. Living with a mental health disorder • Short stories of people with mental health issues • Mental health stigma • Having empathy Part 2 4. Recognizing common mental health disorders • How do people with mental health issues act? 5. Supporting someone with a mental health issue • Basic attending skills 6. Managing Court users with mental health issues • Case Scenarios
24 WHAT DOES A MENTAL HEALTH CONDITION LOOK LIKE? Footer Text 16/11/20
25 WHAT DOES A MENTAL HEALTH CONDITION LOOK LIKE?
SOME COMMON MENTAL HEALTH CONDITIONS • Mood disorders • Major Depressive Disorder • Bipolar disorder • Anxiety disorders • Generalised Anxiety Disorder • Panic Disorder • Obsessive-Compulsive Disorder • Schizophrenia • Dementia
27 “If she doesn’t stop burning incense, my whole family Hyperventilating will all fall sick and where to find money to pay all the Rapid hospital bills” Speech Catastrophizing GENERALIZED ANXIETY DISORDER Constant and Flustered excessive worrying “He didn’t answer my call, he must have gotten into an Poor accident” concentration
28 Poor eye “I am alone, my contact family doesn’t care “This is hopeless, I don’t about me” know what to do” Poor MAJOR DEPRESSIVE concentration DISORDER “I’d rather just die” Crying Irritable “I am worthless” Footer Text 16/11/20
29 Disorganized “People are speech spying on me” SCHIZOPHRENIA “The police are manipulating me through the “The voice told me cameras” to take that item Distracted from the shop” Struggles to focus Monotonous on questions posed speech/emotions Footer Text 16/11/20
Prolonged sadness Extreme fatigue “I have failed again. Life is not “I am not tired, I can keep on working.” worth living.” BIPOLAR DISORDER Racing thoughts “This is a risk worth taking, and talking I want to expand my business and make excessively millions!”
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