UNDERSTANDING AND MANAGING COURT USERS WITH MENTAL HEALTH ISSUES - - PowerPoint PPT Presentation

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

• bserved 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

• utside. 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

Confused

Angry Frustrated Suspicious Withdrawn

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

WHAT DOES A MENTAL HEALTH CONDITION LOOK LIKE?

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WHAT DOES A MENTAL HEALTH CONDITION LOOK LIKE?

25

SOME COMMON MENTAL HEALTH CONDITIONS

• Mood disorders
• Major Depressive Disorder
• Bipolar disorder
• Anxiety disorders
• Generalised Anxiety Disorder
• Panic Disorder
• Obsessive-Compulsive Disorder
• Schizophrenia
• Dementia

GENERALIZED ANXIETY DISORDER

27

Rapid Speech Hyperventilating

Poor concentration

Flustered Constant and excessive worrying “If she doesn’t stop burning incense, my whole family will all fall sick and where to find money to pay all the hospital bills”

Catastrophizing

“He didn’t answer my call, he must have gotten into an accident”

MAJOR DEPRESSIVE DISORDER

“This is hopeless, I don’t know what to do”

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Crying

Poor eye contact Poor concentration

“I’d rather just die” Irritable “I am alone, my family doesn’t care about me” “I am worthless”

SCHIZOPHRENIA

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“People are spying on me” Disorganized speech

“The police are manipulating me through the cameras”

“The voice told me to take that item from the shop”

Distracted Struggles to focus

• n questions posed

Monotonous speech/emotions

BIPOLAR DISORDER

“This is a risk worth taking, I want to expand my business and make millions!” “I am not tired, I can keep on working.”

Extreme fatigue

Racing thoughts and talking excessively

Prolonged sadness “I have failed again. Life is not worth living.”

DEMENTIA

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Disorganized Repetitions in speech

Inconsistent accounts

• f past events

Difficulties retaining information/ instructions given

Forgetful Confused Poor memory

TYPES OF COURT USERS

• Emotional/Anxious
• Disorganized/Disorientated
• Frustrated/Angry

CASE SCENARIO 1

Ms Lim appeared in court as she was advised by the police to file for a protection order against her boyfriend, who was verbally and physically abusive towards her. Ms Lim was noted to have her head down and was crying uncontrollably. It was hence difficult to hear what she was saying. She expressed fear towards her boyfriend, but was also hesitant to proceed as she did not wish to get him into trouble. What would you do?

16/11/20 Footer Text 33

EMOTIONAL/ANXIOUS

Coping strategies:

• Give privacy if possible
• Use silence to allow court users to gain back

composure

• Speak in a gentle and slow manner
• Ask if the person needs a break
• Reflect the emotions they had expressed without

necessarily agreeing with his/her position

• Don’t assure the person by making promises that may

not be fulfilled (e.g. everything will be okay)

• Be clear and firm about what you can or cannot do

REFLECTING FEELINGS

• Reflecting feelings allows the listener to reflect the

speaker's experiences and emotional response to those

• experiences. It links the content and feeling

components of what the speaker has said.

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• worried
• suspicious
• lonely
• confused
• disappointed
• furious
• afraid
• hopeless
• rejected
• angry
• frustrated
• sad
• anxious
• guilty
• stressed
• isolated
• helpless
• verwhelmed

HELPFUL PHRASES

• “I can tell that this is really upsetting you, would you like to

step out of the room to take a breather?”

• “I’m glad that you came today, this sounds like a terrifying

situation…”

• “I would like to help you, it would be really helpful for me if

you could take a breath, and then tell me slowly what has

• happened. This way, I can understand you better.”
• “It sounds like you are feeling conflicted…”
• ”I would like to request for ______(the other party) to leave

the room for a short while”

• “I am concerned for your emotional well-being and safety,

would you like to speak to a court counsellor to see how else you can keep yourself safe?”

36

CASE SCENARIO 2

An compliant was filed against Mdm Lily. Her neighbours complained of excessive smoke in the corridor due to her incense burning, and also presented evidence of Mdm Lily scolding and gesturing towards the neighbours. Mdm Lily, on the other hand, believes that it is her right to carry

• ut her religious prayers, and that her neighbours are the
• nes who are “out to get her”.

During the court session, Mdm Lily was observed to be in a daze and needed repetitions before she could respond. While drafting a settlement agreement, it was noted that she also had difficulties understanding and remembering what was being discussed. What would you do?

DISORGANIZED/DISORIENTATED

Coping strategies

• Speak slowly
• Use simple, short sentences
• Clarify if necessary
• Give them simple choices and short instructions
• Ask them to write down information, or key in their

handphone

• Ensure that they understood by asking them to repeat

the points back to you

• Engage a family member (if present)

HELPFUL PHRASES

• “I am _____, the mediator for this case” (Introduce self)
• “Do you know why you are here?” (if no, explain in simple

language)

• “Don’t worry, take your time to answer” (avoid bombarding with

further questions)

• (To reduce anxiety, ask neutral questions) “Have you eaten your

lunch?”, or “How did you come here?”

• “Are you here alone?”
• (if family member/friend is not present) “I will postpone the case

to a later date. I have arranged for a court counsellor to see how we can help you.”

• (if a settlement agreement is drafted, provide) “Here’s a copy for

your reference. Let’s go through the points together and you can ask me any questions” (provide hard copy and go through one by one, get court user to repeat to ensure understanding)

CASE SCENARIO 3

Mr Ang (the applicant) and Mdm Tan (the respondent) got into a heated argument during a mediation session. Mr Ang accused Mdm Tan of harassing him and his wife by making derogatory comments about his wife. Mdm Tan maintained that Mr Ang was the instigator, and that he would make rude gestures and threaten her. Mr Ang expressed frustration and questioned the purpose

• f coming to court if things “would always remain the

same”. What would you do?

40

FRUSTRATED/ANGRY

Common things a frustrated court user might say:

• 1. What can you do for me?
• 2. This is wasting my time! We have done this before.
• 3. You are not giving me a straight answer about what I

should do. If you cannot solve me problem, what is this mediation for?

• 4. Why should I compromise if it is his/her fault?

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WHY ANGER?

Displacement The transfer of negative emotions from their original source to someone/something that has nothing to do with the original conflict.

WHY ANGER?

Anger as a Defense Mechanism Anger functions as a defense mechanism for

• ur psyche. It is a way

to prevent us from feeling deeper emotional pain.

FRUSTRATED/ANGRY

Coping Strategies

• Stay calm and control feelings of fear or anger
• Speak clearly and confidently
• Avoid arguing
• Avoid raising your voice or talking too fast
• Use positive phrasing “stay calm”, instead of negative phrasing “don’t

shout”

• Give them a little time to ventilate
• Ask questions to get them to focus on the problem
• Consider taking a break from the conversation until the person cools

down

• Try not to threaten
• Be firm and set boundaries if they start to get abusive or violent

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HELPFUL PHRASES

• “It is difficult for me to understand you if you’re shouting, I

need you to calm down and speak clearly for me so that I can understand you”

• ”Please address me instead of speaking directly to the other

party”

• “As much as we want to help you in this matter, there are

clear limitations to what we can and cannot do…”

• “I can see that this is frustrating for you. The purpose of

mediation is _(share how can mediation help)_.”

• “I can see that this is a stressful situation for you, have you

ever received any help from family/friends/professional help?” (ask in private)

• “I am concerned for you and would like to arrange for a

court counsellor to speak you to see how this situation can be managed. Sometimes, it can be helpful to talk the struggles you’re experiencing.”

SYMPTOMS OF ILLNESS VS “BAD BEHAVIOR”

SYMPTOMS OF ILLNESS VS “BAD BEHAVIOR”

• Have an understanding on what the mental health

condition entails and distinguish them from bad behaviors

• Set clear boundaries to address “bad behaviors”
• Hold the court user responsible for his behavior and lay
• ut clear consequences
• Address contemptuous/rude behavior directly and

firmly

• If uncertain, alert a Court Counsellor for more detailed

assessment

STATE COURTS CENTRE FOR SPECIALIST SERVICES (CSS)

• A multi-disciplinary team consisting of psychologists,

counsellors, and social workers.

• Our services include:
• Psychological assessments
• Brief counselling support
• Referrals to community agencies

• Crisis management – distressed/suicidal
• Suspected mental health issues
• Emotional support
• Family violence
• Intimate partner violence
• Social issues – poor social support, homelessness,

employment/financial struggles

STATE COURTS CENTRE FOR SPECIALIST SERVICES (CSS)

REFERRAL TO CENTRE FOR SPECIALIST SERVICES

• Notify registry staff
• State the reason for activation
• Email Court Counsellor Activation Request form to

STATECOURTS_CENTRE_FOR_SPECIALIST_SERVICES@STAT ECOURTS.GOV.SG

• For urgent cases, you may state the reason for

activation in the email *Note: If court user is violent or expresses threats, activate security.

RESOURCES

• Mental health
• Institute of Mental Health
• Singapore Association for Mental Health
• Singapore Mental Health study
• https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releas

es/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf

• Suicide prevention
• Samaritans of Singapore
• Dementia
• Alzheimer’s Disease Association
• Videos on mental health
• https://www.imh.com.sg/wellness/video-gallery/
• https://www.youtube.com/watch?v=ZxGowUJVjfw
• https://www.youtube.com/channel/UC_zQoiPtBDvsThGroagm

3ww

THANK YOU! ANY QUESTIONS?