Effectively 
Supporting 
Survivors 
with 
Mental 
Health 
Disabilities 


Leslie 
Myers, 
MS, 
CRC, 
CCDVC 
Senior 
Program 
Associate 
Center 
on 
Victimization 
and 
Safety 
Vera 
Institute 
of 
Justice 
March 
12, 
2019 




Goals 
of 
this 
Webinar 


1. 
Increase 
the 
comfort 
level 
of 
service 
providers 
who 
are 
working 
with 
survivors 
who 
have 
mental 
health 
disabilities 
2. 
Address 
the 
complexities 
and 
barriers 
that 
may 
arise 
when 
working 
with 
survivors 
who 
have 
mental 
health 
disabilities 
3. 
Provide 
strategies 
and 
resources 
for 
service 
providers 
when 
working 
with 
survivors 
who 
have 
mental 
health 
disabilities 

Perceptions 


“Depression” 


Using 
the 
chat 
box, 
make 
a 
list 
of 
the 
words 
that 
come 
to 
mind 
(be 
honest). 




Perceptions 
#2 


“Schizophrenia” 


Using 
the 
chat 
box, 
make 
a 
list 
of 
the 
words 
that 
come 
to 
mind 
(be 
honest). 




What 
We 
Know 


More 
than 57 million people 
in the 
United States 
(age 
18 
and 
older) 
have 
a 
mental 
health 
disabilities. 


Over 
50% 
of 
women 
who 
live 
with 
a 
mental 
illness 
have 
previously 
experienced 
some 
sort 
of 
trauma 
such as physical 
or 
sexual 
abuse 
(either 
during 
childhood 
or 
adulthood). 




What 
We 
Know 
(continued) 


Across 
studies 
of 
US 
and 
Canadian 
women 
receiving 
services 
for 
domestic 
violence: 


• 
Rates 
of 
depression 
ranged 
from 
17% 
to 
72%, 
• 
Rates 
of 
PTSD 
ranged 
from 
33% 
to 
88% 
(Warshaw 
& 
Barnes, 
2003). 

Working 
with 
Survivors 
with 
Mental 
Health 
Disabilities 




Mental 
Illness 
is 
Invisible 


• 
A 
survivor 
may 
not 
ask 
for 
assistance/accommodations 
because 
their 
disability 
cannot 
be 
seen. 
• 
A 
provider 
may 
not 
offer 
assistance/accommodations 
because 
they 
cannot 
tell 
that 
the 
person 
has 
a 
disability. 

Stigma 


The 
survivor 
may 
not 
disclose 
their 
mental 
health 
disabilities to 
protect 
themselves from 
the 
stigma 
that 
is 
rampant 
in 
our 
society: 


• 
The 
words 
we 
use 
(crazy, 
nuts) 
• 
Portrayal 
by 
the 
media, 
movies, 
TV 
• 
The 
news 
is 
quick 
to 
associate 
violent 
acts 
to 
those 
with 
mental 
health 
disabilities. 

Credibility 


Survivors 
may 
not 
disclose 
a 
mental 
health 
disability 
because: 


• 
Their 
abuser 
told 
them 
that 
no 
one 
will 
believe 
what 
they 
say 
because 
of 
their 
diagnosis. 
• 
Service 
providers, 
law 
enforcement 
and 
the 
courts 
may 
see 
the 
diagnosis 
as 
an 
indicator 
of 
the 
survivor’s 
truthfulness 
and 
credibility. 

Previous 
Negative 
Experiences 


A 
survivor 
that 
disclosed 
their 
mental 
health 
disabilities 
in 
the 
past, 
may 
have 
found 
that 
they: 


• 
Faced 
attitudinal 
barriers, 
stigma, 
and 
even 
verbal/emotional 
abuse. 
• 
Received 
unequal 
treatment. 
• 
Were 
excluded 
or 
otherwise 
discriminated 
against. 

Negative 
Consequences 


Survivors 
with 
mental 
health 
disabilities 
may 
also 
fear 
the 
negative 
consequences 
of 
disclosing 
including: 


• 
Involvement of 
social 
services, 
• 
Reports 
to 
children’s 
protective 
services, 
• 
Unwanted 
psychiatric 
services 
involvement, 
including 
forced 
medication 
conditions, 
and 
• 
The 
impact 
disclosure 
may 
have 
on 
future 
civil 
and 
criminal 
court 
involvement 

Handling 
Disclosures 


If 
a 
disclosure 
is 
made 
you 
will 
need 
to 
decide 
what 
other 
information 
you 
need. 


Using 
the 
chat 
box, 
let 
us 
know 
what 
information 
do 
you 
think 
would 
be 
useful 
to 
find 
out 
about 
the 
person’s 
mental 
health 
disability. 




Diagnosis 


While 
a 
diagnosis 
or 
label 
may 
give 
you 
some 
information 
it 
really 
will 
not 
tell 
you 
anything 
about 
how 
a 
person will 
present 
or 
act 
while 
receiving 
services. 


Everyone 
is 
different, 
so 
while 
one 
person 
with 
a 
mental 
health 
disability 
may 
not 
experience 
any 
limitations 
in 
their 
functioning, 
others 
may. 




Ask 
Questions 
About 
Needs 


• 
Is 
there 
anything 
we 
can 
do 
to 
help 
you 
while 
you 
are 
here? 
• 
Don’t 
feel 
that 
you 
have 
to 
tell 
everyone 
here 
about 
your 
mental 
health 
disability 
but 
if 
you 
feel 
that 
is 
best, 
is 
there 
anything 
we 
can 
do 
to 
support 
you in doing 
so? 
• 
It 
can 
get 
noisy 
and 
busy 
around 
here, 
if 
you 
think 
that 
will 
be 
a 
problem 
for 
you, 
what 
can 
we 
do 
to 
help? 

Ask 
Questions 
About 
Needs 
(2) 


• 
I 
provided 
you 
with 
our 
medication 
policy, 
do 
you 
have 
any 
concerns 
about 
what 
it 
says? 
If 
you 
have 
any 
concerns 
about 
your 
medications 
or 
if 
you 
feel 
that 
they 
are 
not 
working 
properly, 
feel 
free 
to 
talk 
with 
one 
of 
us 
and 
we 
can 
try 
and 
help. 
• 
I 
know 
that 
medications 
can 
have 
some 
side 
effects, 
like 
making 
you 
tired 
or 
feeling 
sick, 
if 
there 
anything 
we 
can 
do 
to 
help 
you 
manage 
these 
can 
you 
let 
us 
know? 

Ask 
Questions 
About 
Needs 
(3) 


• 
Sometimes 
we 
give 
you 
a 
lot 
of 
information, 
let 
us 
know 
if 
we 
are 
giving 
you 
too 
much 
at 
one 
time 
or 
ask 
us 
to 
write 
things 
down, 
or 
whatever 
you 
need 
from 
us. 
• 
We 
can 
have 
a 
pretty 
tight 
schedule 
of 
activities 
here, 
if 
you 
think 
that 
maintaining 
this 
schedule 
will 
be 
a 
problem, 
can 
you 
let 
us 
know 
how 
we 
can 
help? 
• 
I 
know 
that 
at 
this 
point 
you 
may 
not 
be 
aware 
of 
things 
you 
may 
need, 
I 
will 
make 
sure 
to 
check 
on 
you 
throughout 
your 
stay. 
But, 
remember 
you 
can 
reach 
out 
to 
any 
of 
us 
and 
ask 
for 
assistance. 

Making 
Accommodations 




Program’s 
Responsibility 
to 
Make 
Accommodations 


• 
Mental 
health conditions are 
considered 
disabilities under 
the 
Americans With Disabilities 
Act 
(ADA). 
• 
Title 
III 
of 
the 
ADA 
(which 
applies 
to 
places 
of 
public 
accommodations such as shelters and 
other 
DV/SA 
service 
providers) 
states 
that 
individuals 
with 
disabilities 
are 
entitled 
to 
reasonable 
modifications 
to 
policies, 
practices, 
and 
procedures. 

Common 
Functional 
Limitations 


Some 
common 
functional 
limitations 
you 
might 
see 
in 
a 
survivor 
with 
a 
mental 
health 
disability 
includes 
limitations 
in: 


• 
Executive 
function 
(i.e. 
attention, 
memory, 
behavior, 
planning 
and 
organizing) 
• 
Stamina 
and 
fatigue 
(including 
sleeping 
and 
staying 
awake) 
• 
Tolerating 
stress 
• 
Erratic/Inconsistent 
Behavior 
• 
Controlling 
anger 
and 
emotions 

Medication 
Side 
Effects 


The 
side 
effects 
of 
psychiatric 
medications 
may 
also 
impact 
functioning. 
Some 
common 
side 
effects 
include: 


• 
Drowsiness 
and 
fatigue, 
• 
Dry 
mouth 
and 
thirst, 
• 
Blurred 
vision, 
• 
Hand 
tremors, 
• 
Slowed 
response 
time, 
and 
• 
Difficulty 
initiating 
interpersonal 
contact. 

Executive 
Functions 


Executive 
functions 
are 
high-level 
mental 
processes 
or 
abilities 
that 
influence 
and 
direct 
more 
basic 
abilities 
like 
attention 
and 
memory. 


The 
term 
executive 
function 
describes 
a 
set 
of 
cognitive 
abilities 
that 
include 
the 
ability 
to: 


• 
Plan, 
• 
Organize 
and 
strategize, 
• 
Pay 
attention 
to 
and 
remember 
details, 
• 
Start 
and 
stop 
actions, 
and 
• 
Form 
concepts 
and 
think 
abstractly. 
• 
Executive 
functions 
also 
keep 
us 
from 
behaving 
in 
inappropriate 
ways. 

Possible 
Accommodations-Executive 
Functions 


• 
Checklist 
• 
Written 
instructions, 
• 
Electronic 
organizer. 
• 
Reminders, 
• 
Noise 
canceling 
headsets 
or 
sound 
machines 
• 
Calendars 
or 
planners 

Stamina/Fatigue/Sleeping/Staying 
Awake 


Decreased 
stamina, 
or 
fatigue, 
refers 
to 
one’s 
inability 
to 
exert 
oneself 
over 
a 
prolonged 
period 
of 
time, 
or 
across 
a 
certain 
amount 
of 
repeated 
activity. 
Having 
difficulty 
staying 
awake 
can 
result 
from 
fatigue 
or 
medication. 


Possible 
accommodation 
include: 


• 
Flexible 
schedule, 
• 
Periodic 
rest 
breaks, 
• 
Separating 
tasks 
into 
small 
segments, 
and 
• 
Apps 
for 
sleep/fatigue 

Tolerating 
Stress 


Stress 
can 
exacerbate 
the 
symptoms 
of 
individuals 
with 
a 
variety 
impairments. 
Providers 
may 
need 
to 
look 
for 
ways 
to 
reduce 
stress 
and/or 
remove 
stressors 
in 
the 
environment. 


Possible 
accommodations 
include: 


• 
Apps 
for 
anxiety 
and 
stress 
• 
Counseling/therapy 
• 
Using 
relaxation 
techniques 
• 
Flexible 
scheduling 
• 
Modified 
break 
schedules 
• 
Sound 
machines 
• 
Support 
animals 

Erratic/Inconsistent 
Behavior 


Erratic/inconsistent 
behavior 
is 
behavior 
that 
is 
unpredictable, 
or 
may 
be 
considered 
irregular 
or 
illogical 
for 
the 
situation, 
or 
not 
keeping 
with 
the 
standards 
of 
behavior 
for 
a 
given 
set 
of 
circumstances. 


Under 
the 
ADA, 
service 
providers 
can 
expect 
the 
same 
standard 
of 
behavior 
from 
all 
service 
users, 
even 
those 
with 
disabilities. 
However, 
the 
provider 
would 
be 
required 
to 
consider 
accommodations 
that 
would 
help 
the 
survivor 
with 
a 
disability 
meet 
the 
behavior 
or 
conduct 
standard. 




Possible 
AccommodationsErratic/
Inconsistent 
Behavior 


• 
Apps 
for 
control 
of 
anger 
and 
emotions 
• 
Counseling/therapy 
• 
Offering 
disability 
awareness/etiquette 
training 
to 
staff 
and 
other 
service 
users 
• 
Habit 
monitoring 
to 
build 
awareness 
and 
control 
of 
behavior 
• 
Reminders, 
• 
Periodic 
rest 
breaks 
• 
Sound 
machines/noise 
canceling 
headsets 
• 
Providing 
a 
private 
area 
• 
Flexible 
schedule 
• 
Support 
animal 

Controlling 
Anger 
and 
Emotions 


Strong 
anger 
and 
emotional 
responses 
can 
be 
a 
symptom 
of 
a 
wide 
range 
of 
disabilities 
and 
medical 
conditions, 
and 
can 
be 
the 
result 
of 
certain 
medicine 
regimens. 
Therefore, 
service 
providers 
may 
need 
to 
help 
alleviate 
triggers 
and 
provide 
solutions 
to 
keep 
these 
responses 
at 
bay. 


Possible 
accommodations 
include: 


• 
Apps 
for 
control 
of 
anger 
and 
emotions 
• 
Counseling/therapy 
• 
Relaxation 
and 
other 
techniques 
• 
Flexible 
schedule 
• 
Sound 
machines 
• 
Offering 
disability 
awareness/etiquette 
training 
to 
staff 
and 
other 
service 
users 

Safety 
Considerations 




Things 
to 
Remember 


1. 
People 
with 
mental 
health 
disabilities 
are 
more 
likely 
to 
be 
victimized 
than 
to 
be 
violent. 
2. 
The 
abuse 
and 
its 
aftermath 
may 
exacerbate 
a 
mental 
health 
disability. 
3. 
Erratic 
behavior 
is 
not 
a 
choice, 
it 
is 
part 
of 
the 
person’s 
disability. 

Prepare 


Consider 
engaging 
in 
conversation 
with 
the 
survivors 
and 
asking 
questions 
like: 


• 
What 
are 
situations 
that 
are 
particularly 
difficult 
for 
you 
or 
make 
you 
feel 
unsafe 
or 
upset? 
• 
What 
signs 
do 
you 
notice 
when 
you 
are 
beginning 
to 
feel 
stressed 
and 
out 
of 
control? 
• 
If 
you 
are 
anxious 
or 
angry 
and 
those 
feelings 
are 
getting 
so 
intense 
they 
may 
be 
impacting 
your 
safety 
or 
another 
person’s 
safety, 
how 
would 
you 
prefer 
that 
staff 
members 
assist you? 

Prepare 
(2) 


• 
What 
has 
been 
particularly 
helpful 
to 
you 
in 
the 
past 
when 
you 
had 
a 
difficult 
time 
with 
your 
thoughts 
and/or 
feelings? 
• 
What 
has 
not 
been 
particularly 
helpful 
to 
you 
in 
the 
past 
when 
you 
had 
a 
difficult 
time? 
• 
Is 
there 
a 
person 
who 
has 
been 
helpful 
to 
you 
when 
you 
were 
overwhelmed 
or 
distressed? 
Would 
you 
like 
to 
call 
that person 
if 
you 
get distressed 
here? 
Do 
you 
have 
that 
telephone 
number? 
Would 
you 
give 
us 
written 
consent 
to 
call 
this 
person 
if 
you 
are 
in 
great 
distress 
and 
we 
cannot 
seem 
to 
help? 

Prepare 
(3) 


• 
Have 
you 
noticed 
any 
triggers 
that 
you 
associate 
with 
being 
anxious 
or 
angry? 
If 
so, 
what 
are 
these 
triggers? 
• 
What 
has 
not 
been 
particularly 
helpful 
to 
you 
in 
the 
past 
when 
you 
had 
a 
difficult 
time? 
• 
Do 
you 
have 
coping 
strategies 
to 
deal 
with 
difficult 
memories? 
Group 
living 
can 
trigger 
difficult 
memories 
especially 
if 
you 
were 
ever 
hospitalized 
for 
mental 
illness 
or 
have 
been 
in 
treatment 
for 
substance 
addiction. 
Are 
there 
any 
situations 
that 
might 
trigger 
difficult 
memories 
for 
you 
here? 
Let 
us 
know 
if 
there 
are 
ways 
we 
can 
offer 
emotional 
support 
to 
you 
during 
your 
stay. 
The 
National 
Center 
on 
Domestic 
Violence, 
Trauma 
& 
Mental 
Health 




Crisis 
Response-Ten 
Essential 
Values 


1) 
Avoiding 
harm 
2) 
Person-centered 
3) 
Shared 
responsibility 
4) 
Addressing 
5) 
Personal 
safety 
6) 
Based 
on 
strengths 
7) 
The whole person 
8) 
The person 
as 
a credible 
source 
9) 
Recovery, 
resilience & 
natural 
supports 
10) 
Prevention 
US 
Substance 
Abuse 
and 
Mental 
Health 
Services 
Administration 
(SAMHSA) 




Suicidal 
Thoughts 
and 
Actions 


Remember 
that 
any 
talk 
of 
suicide 
should 
always 
be 
taken seriously. 


Most 
people 
who 
attempt 
suicide 
have 
given some 
warning—but 
this 
isn’t 
always 
the 
case. 


If 
someone 
has 
attempted 
suicide 
before, 
the 
risk 
is 
even 
greater. 




Responding 
to 
Suicide 
Crisis 


If 
you’re 
concerned 
someone 
is 
thinking 
about 
suicide, 
don’t 
be 
afraid 
to 
talk 
to 
them 
about 
it. 
Start 
the 
conversation. 
Focus 
on 
being 
understanding, 
caring 
and 
nonjudgmental, 
saying 
something 
like: 


• 
“You 
are 
not 
alone. 
I’m 
here 
for 
you” 
• 
“I 
may 
not 
be 
able 
to 
understand 
exactly 
how 
you 
feel, 
but 
I 
care 
about 
you 
and 
want 
to 
help” 
• 
“I’m 
concerned 
about 
you 
and 
I 
want 
you 
to 
know 
there 
is 
help 
available 
to 
get 
you 
through 
this” 
• 
“You 
are 
important 
to 
me; 
we 
will 
get 
through 
this 
together” 

Collaborate 




Mental 
Health 
& 
Disability 
Programs 


Mental 
health 
and 
disability 
programs 
can 
ensure 
they 
are 
identifying 
people 
who 
are 
experiencing 
abuse 
by: 


• 
Asking 
questions 
on 
a 
regular 
basis 
• 
Being aware 
of 
the 
domestic 
and 
sexual 
violence 
programs 
in 
their 
community 
• 
Training 
staff 
about 
the 
dynamics 
of 
abuse 
and 
prevalence 
of 
abuse 
within 
the 
disability 
community; 
• 
Provide 
information 
on 
domestic 
and 
sexual 
violence 
for 
service 
users 
and 
staff, 
• 
Making 
a 
plan 
for 
disclosures, 
and 
• 
Providing 
a 
safe 
environment 
for 
disclosure. 

Domestic 
and 
Sexual 
Violence 
Programs 


Domestic 
and 
sexual 
violence 
programs 
can 
ensure 
they 
are 
identifying 
people 
who 
have 
mental 
health 
disabilities: 


• 
Provide 
staff 
training 
on 
disability 
awareness/training, 
• 
Asking 
questions 
on 
a 
regular 
basis 
• 
Being 
aware 
of 
the 
mental 
health 
programs 
in 
your 
community 
• 
Providing 
a 
safe 
environment 
for 
disclosure. 
• 
Provide 
information 
on 
mental 
illness 
for 
service 
users 
and 
staff. 

Form 
a 
Collaboration 


• 
Get 
together 
with 
other 
programs, 
• 
Learn 
about 
what 
you 
each 
do 
and 
how 
to 
make 
referrals, 
• 
Serve 
on 
each 
other’s 
boards, 
• 
Provide 
in-service 
training 
to 
one 
another, 
• 
Stock 
up 
on 
each 
other’s 
brochures, 
• 
Share 
resources, 
and 
• 
Apply 
for 
funding 
together. 

Final 
Thought 


Collaboration 
means that 
we 
all 
do 
what 
we 
do 
best…we 
just 
do 


it together!

Resources 


The 
National 
Center 
on 
Domestic 
Violence, 
Trauma 
& 
Mental 
Health 


http://www.nationalcenterdvtraumamh.org/ 


Domestic 
Violence 
& 
Mental 
Health 
Collaboration 
Project 


https://endgv.org/projects/domestic-violence-mental-healthcollaboration-
project/ 
National 
Alliance 
on 
Mental 
Illness 
(NAMI) 
https://www.nami.org 
Bazelon 
Center 
for 
Mental 
Health 
Law 
http://www.bazelon.org/ 


Job 
Accommodation 
Network 
(JAN) 
https://askjan.org/ 
Top 
25 
Best 
Mental 
Health 
Apps 
https://www.psycom.net/25-bestmental-
health-apps 




Questions? 




Contact 


Leslie 
Myers, 
MS, 
CRC, 
CCDVC 
Senior 
Program 
Associate 
Center 
on 
Victimization 
and 
Safety 
Vera 
Institute 
of 
Justice 


lmyers@vera.org 




Survey 


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you 
for 
being 
a 
part 
of 
this 
webinar. 
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fill 
out 
a 
brief 
survey 
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