ASHLEY BROMPTON: Again, my name is Ashley Brompton with the Center on Victimization and Safety at the Vera Institute of Justice. I would love to welcome you to today's webinar. We are pleased to bring this to you as part of our 2021 End Abuse of People with Disabilities webinar series. 

Before we get started today, I want to provide you with some information about the accessibility features of our Zoom webinar platform as well as how you can interact with us throughout the session today. You should be in listen only view only mode right now. That means you can hear us and you can see us. But we cannot hear you or see you. 

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We will be recording today's webinar. The webinar recording and materials will be posted on the End Abuse of People with Disabilities website within two weeks. A record of attendance and materials from today's session are available. I'm going to go ahead and post the link to the materials in the chat. We will ensure that is posted several times throughout the session so that you can have access to it. 

You can just click on that link and it should bring you to a folder that has the PowerPoint presentation, the record of attendance, and some other materials. And again if we use any links or all that makes any references to a resource, we'll make sure that is in there as well as for you. 

And our presenter today is Olga Trujillo. Olga is a project manager here at the Center on Victimization and Safety. They're also an attorney; trainer; internationally renowned speaker; and author, who has devoted their career to helping advocates; first responders; and others better understand the impact of trauma on survivors of sexual assault; domestic violence; child abuse; and human trafficking. 

They are one of a handful of speakers in the US to address the issue of dissociative identity disorder from a lived experience of diagnosis and healing. Olga intertwines the role of culture, and in particular Latino culture into every presentation; training; or technical assistance opportunity. Thank you for being with us today, Olga. And I'm going to turn it over to you. 

OLGA TRUJILLO: Thank you, Ashley. Hi, everyone. I'm Olga Trujillo. And I am non-binary person with very, this is the shortest my hair has ever been, short gray hair; glasses; and I'm wearing a blue shirt today with a white t-shirt. And I'm going to talk with you all for the next hour and a half about serving survivors with mental health disabilities. So I'm going to share my screen. And I have two screens. So sometimes I get a little confused with which screen I'm sharing. 

So let's get started. I'm going to start by just giving you a sense of the perspective that I'm bringing to this presentation. So as Ashley mentioned in my introduction, I have dissociative identity disorder that used to be known as multiple personality disorder. It impacts the way I learn and interact with others. It also impacts the way I move through the world. 

I mostly do fine. But if I experience a traumatic event or significant loss, I'm going to need help. And in getting that help, I'm going to struggle because of the way that disorder can show up. And so I've learned over the years how to move through the world fairly seamlessly. And what helps me is pretty universal. It helps other people with mental health disabilities. 

So I'm going to present the information from that perspective. And hopefully that's helpful. And if you have any questions, please enter in the chat and Ashley is going to help me field those as I go through. 

So I have some goals for us today. I'm hoping you guys are good for this. We're going to explore the challenges that survivors who have mental health disabilities face accessing safety and healing services. We're also going to examine some of the complexities that mental health disabilities can present. And we're going to strategize what advocates and service providers can do to support survivors who have mental health disabilities. 

So let's start with what we know. According to the National Institute of Mental Health, there are 51.5 million people in the United States that have a mental health disability. And these are the people that we know about. Not necessarily everyone that has one has been diagnosed or even knows that that's an issue for them. I know quite a few people that have DID who have not gotten a formal diagnosis or have gone through a healing process. So there are usually more people than what our statistics show. 

The other thing we know is that 80% of women who experienced rape; stalking; physical violence by an intimate partner reported significant short or long term effects, including post-traumatic stress disorder. What else do we know? One study approximately 20% of survivors of interpersonal violence, which is defined to include domestic and sexual violence. 20% of survivors have reported experiencing a new onset of psychiatric disorders. 

So this totally makes sense to me in the sense that, like I said I move through the world fairly seamlessly. But if something happens to me, my DID is going to show up and also post-traumatic stress; anxiety disorder; any of those things could get flared up. So this totally makes sense to me. And I imagine to you all as well. 

So I want to see, learn a little bit about your experience. So let's start with this poll question. Have you worked with the survivor that had a mental health disability? Possible answers are yes, no, and I don't know. So rather if you could pull up the poll, awesome. 

Thanks for those of you who are answering in the chat. I love this because we have a lot of questions for you in the chat. But let's see too if you can answer in the poll. And as we go through that, then we'll show what it is. 

Wow this is awesome. So many of you are working with people who have mental health disabilities. This is awesome so then because a lot of you have this experience-- Oh, yeah. So 93% of you work with people who've had mental disabilities. 

So we're going to crowdsource this. I'm going to ask you some different questions, please continue to use the chat. I really appreciate this. We're all going to learn from each other's experiences. 

So how did you know-- so in the chat, enter in how did you know that the survivor you worked with had a mental health disability? So did they tell you or did you find out another way? And for those of you-- and so that's like 93% of you. 

So client told me, wow this is really fast. So a lot of you talked about how they have disclosed. Yeah and then some of you saw signs of the mental health disability. And self disclosed behaviors observed, survivor told me. This is really amazing. 

Identified, whoops. Going too fast for me to keep up. Self-disclosure, observation as well. Many of the referrals came from mental health counselors. So this is super helpful because these are all good clues to someone who might be dealing with mental health disability whether they tell you or not. Hard to identify when drugs are an issue to, yeah totally. Family members and mention of medications. Self-disclosure mainly. 

So it looks like most of you the person disclosed or you picked up on some signs that there was an issue going on. Somebody has 20 years working with crisis intervention. So you can tell what you're seeing. In quote, "self-disclosure mostly." some people self disclose and sometimes they share they were receiving mental health services and it started a conversation. That's awesome. 

Perfect. So this is really fabulous. I have an audience. You all have a lot of experience with this. So again, I'm going to be asking you questions. But also please feel free to enter into the chat things that come up for you, that you want to share with folks as I go through this presentation because this is super helpful. 

So as many of you know, survivors with mental health disabilities face a lot of barriers. And that's of course, not surprising at all. A survivor may not ask for assistance or accommodations because their disability can't be seen. And a provider may not offer assistance or accommodations because they cannot tell that the person has a disability. 

Now clearly you are either that person felt that they could trust you and could disclose, or you knew enough to suspect there were some issues there. If it's not at all obvious that you're set up for people, so your organization; or your services; or your response is set up for people with mental health disabilities, then it's harder for people who have them to let you know. 

So to counter this if you make all your materials and spaces accessible to all, then people are less likely to notice that; feel more welcome; and disclose sooner. And so I'm super curious. I want to do a crowdsourcing webinar. But because I'm super curious how the disclosures came up. But let me proceed and then I'll come back to you on that. 

So one of the big things about disclosing a mental health disability is stigma. It's huge. And when I think about this, I think a lot about this because dissociative identity disorder is probably one of the most stigmatized mental health disabilities around. And in part because just like a lot of other ones, there are words that we use in our everyday vocabulary that are meaning and marginalizing for people who have mental health issues. The portrayal by the media, movies, and TV. 

I mean when you think about dissociative identity disorder or DID, whenever it's shown on television or in the movies, it's always someone who's a mass murderer; a serial killer. It's never this amazing lawyer that walks through the world as if she doesn't have it. So the experience from previous disclosures will make it more difficult for people, for survivors who have mental health disabilities. The way that people respond, sometimes the fear that people show, or the complete silence not knowing what to say and how to help. So they just distance themselves. 

And then there's preconceived notions about people with mental health disabilities from service providers and advocates. I work in a lot of circles. And routinely, I have service providers and advocates talking about how they're not set up to respond to people with mental health disabilities. 

But It comes from a place of, we're not set up and we don't have the capacity to do it. Where it really doesn't take a lot to do this. It's actually fairly easy. So there those preconceived notions they'll come across whether somebody says so or not. 

So the stigma around mental health disabilities, and in particular DID, is why I spend so much time telling people I have data and why I talk about the challenges as well as the super powers that come with it. And because I'm trying to destigmatize it still, with all that I talk about it. I will tell you that I have it if I'm trying to access services from you unless I have a sense that you will be able to respond to me in a way that doesn't make me feel less than or marginalized. 

So for example, you don't have to say anything bad to me. But if there's complete silence or a distancing that happens because I've let that I've let you know I have DID, that's going to tell me that you don't know what to do with me and that I've made you really nervous. And so at that point then I'm going to probably leave the services that you're providing me or withdraw if I can't leave the services. 

So just to kind of keep that in mind. For me asking questions about the DID and how it shows up and what I might need is how I'll feel. Like it's OK that I'm in your program and that I have this. And you might not know very much about it. 

So the other reason why a lot of survivors don't talk about this-- 

ASHLEY BROMPTON: Olga, this is Ashley. I'm sorry to interrupt. I realize you might not be seeing the chat. We do need to pause for a quick interpreter switch. It's about that time. 

OLGA TRUJILLO: Thank you. Yes. Thanks so much, Ashley. awesome. And I'll keep an eye on the chat. So the other thing that comes up for people with mental health disabilities and why they won't disclose is because of the issue of credibility. That survivors may not disclose a mental health disability because their disability has been used as part of their abuse, like in gaslighting ways. 

So by gaslighting I mean when people act as though things are not happening that are actually happening. When people make someone believe that something they did or said did not happen. And then also threats of disclosure. So if you have a mental health disability that is invisible and people can't tell and you don't want people to know, the threat of disclosure is huge. 

Their credibility and knowledge is often discounted because of their disability. And I find this happens in the most well-meaning ways. But for as much as I've accomplished in my career and in my life, I still struggle with people discounting some of the experiences that I have because I have DID. So people saying to me, Oh that you're just being too sensitive because you have parts, or that's the cause of your abused past. And it's very minimizing. And that impact makes it much harder to share your experience of the mental health disability with other people. 

So as soon as that happen to me I stop talking about having DID. And it took me years to start talking about it again. And again previous negative experiences are also a reason why people don't disclose. A survivor that disclosed their mental health disabilities in the past may have found that they faced attitudinal barriers, stigma, and even verbal and emotional abuse. That they received unequal treatment and were excluded or otherwise discriminated against. 

And this happens quite a bit. So if you think about it, people who have mental health disabilities have had this for a good part of their life if not their whole lives. And they have the impact of it by the people around them in their life, in their home, in their work, when they go to the doctor, when they go to the dentist, when they move through the world at all. And all of those reactions build up. 

Think about then people who live at the intersections of race and disability and all the added reactions that build up and it influences how we see and access safety and services. So it's a really important thing to sit and think about how you've worked with people and how you can work with people in the future from a place of privilege. Because if you're not dealing with something like this, then that's something that you don't understand as well as someone who is. So being curious and learning is really important. 

And then learning from some of the work that we do, from other programs that address these issues, and then being curious about that survivors experience in the context of providing them services. Not trying to learn everything you need to know about this from that survivor. 

So other negative consequences that have come up for people survivors with mental health disabilities may also fear other negative consequences of disclosing including employment, housing, losing custody, or CPS involvement. CPS being child protective services. Unwanted psychiatric services involvement, including forced medication conditions. 

A lot of people who have mental health disabilities have had encounters with mental health clinicians and other services that have not been positive. And so recognizing that and recognizing the clinical support isn't always what somebody wants. And also forcing someone to do that is not a good idea. 

The impact disclosure may have on future civil and criminal court involvement is also significant. so those are lots of reasons why people don't disclose and the things that they're walking through. And it might be why someone will show up at your program and then never come back or why you're not seeing very many people with mental health disabilities. 

So let's go back to your experience and see what you've done in your work. So have you seen survivors with mental health disability disclose this disability? And did that impact your perceptions of [AUDIO OUT]? 

So I know that 93% of you have worked with people with mental health disabilities. And a lot of you have known this because the person disclosed. So now think back to those disclosures and enter in the chat. How did that impact your perceptions of them? Did you did you experience nervousness or fear? Were you worried about how you were going to help them with the services that they needed to go through or what the system response that they were in? 

So we have yes. I'm going to read some of that information in the chat. Yes they disclosed. No it didn't impact my perception of them. I felt 1% [AUDIO OUT]. I felt wildly unprepared. And Thank you for your honesty there. Because it's hard to admit that they didn't know. Frustration with lack of services in my program. 

Let's see it another person says it didn't impact how I treat them. Everyone I work with has some difficulty. They're overcoming. My job is to be supportive. Somebody else said, I feel like I felt they needed even more care services. It can help me understand their actions and how they approach life, which is awesome. Exactly where [AUDIO OUT]? 

Other people are saying, it did not impact my perception of them. It helped me understand them. Yes, they disclosed. No, it didn't have an impact. So one person said to worried about how to help them. So awesome. 

It helps me figure out how to work with them, which is totally true. Awesome. I wanted to ensure I provided them quality services but was anxious about how to do this without going into the role of a mental health provider. Super, super great comments. 

Somebody here says, I have a mental health diagnosis as well. And so sometimes it was difficult to maintain boundaries. That is really great self-awareness. Awesome. Thank you so much for that. 

Yes. I would say yes that somebody disclosed to them and no that it didn't impact their perceptions of them. But in some instances, and I'm guessing you're saying in some instances, with some folks it did. But generally, no. 

Other people no, it did not impact. So another person saying afraid I might not have the knowledge and resources they needed. And let's see. It made me feel more lenient about credibility and a changing story. Yes. Awesome. And you work in the legal field. Yes. I do trainings for lawyers all the time about how to work with people with mental health disabilities. And this is one of the big things that I raise for them as well as for judges and prosecutors, is to recognize the normality of changing perceptions and stories when people have experienced mental health disabilities. And in particular, where when they have trauma related disorders. So super helpful. Thank you so much for that. 

With certain mental illness it did, for instance schizophrenia. So I think the person entering in the chat is yes, people did disclose to them. And when people had schizophrenia, it did impact their perceptions of them. And I'm guessing that that's because of your discomfort with what that means for how they show up in the work that you're doing with them. 

So a lot of people again no, no. So I just want to say you are a super unusual group. First of all, you're incredibly active in the chat. And I love this because I think it really creates more dimension in our training to hear from your experiences too that a lot of you have experiences working with survivors who have mental health disabilities and that they've disclosed to you. 

So that says a lot to me about how you work with people and also possibly how your program works with people that they feel comfortable enough to be able to disclose to you. And then, that so many of you did not change your perceptions of the people that you were working with. 

And then also what I really love here is that for those of you who did, that you felt comfortable enough in our chat and in our webinar to own that, to say yeah I did and some of the reasons why. So that's awesome. So thank you so much for that. 

So then other folks said, honestly it depends on the diagnosis. But once I know it lets me be aware of how to best help the client. So awesome. Really good. I was worried that my referral sources wouldn't be appropriate for them or treat them appropriately. But no. My perception wasn't a problem. Mental health issues are fairly common. Yes, exactly. 

Mental health issues are really common. And I think we're noticing that. I mean, I think in our field we've known that for a really long time. But I feel like we're noticing that more in our society. That mental health issues are fairly common. And the last year and a half of our pandemic and racial justice issues exploding everywhere has really brought that to the forefront. 

So other folks are talking about how they were unsure that they could support their needs. I don't think I treated them differently but more empathy toward them. We have somebody who says, I'm a licensed psychologist so when a person discloses I typically feel gives me more information and I feel equipped to deal with it. Yeah. Awesome. That is really great. 

I praise them for sharing their mental health disability and I know it didn't impact my perception. So this is awesome. We have somebody who works on a hotline and we have limits in what we can do. And it can be challenging to help folks who disclose mental health disabilities to access services beyond the limited support of the hotline. 

Yeah it's really hard when your program creates structures that don't allow you to really help somebody in the way that you feel that they need at the time. I know that feeling and I imagine that that's really frustrating for folks. 

So one person said their companion animal frightened me. That's really interesting. And then other people, frustration with overdiagnosing. So this is a really good point. Thanks so much, Arlene, for bringing this up. Because the thing about this is, there's a lot of diagnoses out there. And really that's not going to matter as much as what you can do in your services and in your program to make it more accessible for your work with those survivors. 

Because like I said, DID is a really, I think scary diagnosis for people who have it and for people who don't understand it. It can be scary to know that you're working with someone who has DID, just as an example. And you don't actually need to know that that's somebody's diagnosis. You just need to know how do you work with people in a way that enables people with DID or other mental health disabilities to move through your work with them, your program, the systems that you might be helping with more seamlessly. 

So I'm going to go ahead and move on, but thank you so much for your information. So and we're going to keep coming back to you and the chat. And let me just try to keep up with the chat here. Like I'm doing OK timelines, you guys are super, super. Yeah. OK. 

All right. So complexities for advocates and service providers. So what I want to do is I want to start looking at some of the behaviors that we see in people. And I'm going to come back to the chat, so be ready. 

So you may encounter behaviors from survivors, with mental health disabilities that are difficult to understand or are unfamiliar. And some of you have already mentioned some of these in the chat , which is why I love this so much. 

So one is talking all the time, and I notice that a few people noticed that in the chat and that's one of the things that identified for them, that they were working with someone who might have some mental health issues. 

Being unable to remember what you all talked about, being withdrawn. Not seeming to pay attention. A survivor getting frustrated or short tempered, not following through on things that you all have worked on together. Having tensions with other survivors in your program or your services or your response. 

Other behaviors that we see is difficulties in planning and organizing. A lot of people that have mental health disabilities have struggle with stamina and fatigue, which also includes issues with sleeping and staying awake. People have difficulties tolerating stress. And you might see erratic or inconsistent behaviors. 

OK. So I just want to check again let's go to the chat. Are there any other behaviors that you've seen that I haven't covered. So some of these are also similar to the effects of trauma and/or post-traumatic stress disorder exactly. 

Yep. And you'll see a lot of these behaviors can go with a lot of different diagnosis. You covered the most common ones that I see in my work. Thank you Deborah. Trauma survivors who have difficulty remembering appointments, court appearances, changing details of the assault, yes. 

Triangulation that's a really, really interesting one. Because I can see how that comes up for people, especially who've experienced trauma as children. In large part because the dynamics that they're being raised in, the dynamics that can stop some of the normal child development. So stuff that you learn as an adolescent or young adult. I'm going to stop here for an interpreter switch. 

OK. So other folks sometimes survivors might lash out at me, which can be difficult. I totally get that lesser and here's the thing. A lot of times that level of lashing out frustration, anger, it can come from two different perspectives. From one perspective of not being able to tolerate too much stress, and from the other perspective of being afraid to trust you. 

Because for a lot of folks that are survivors, they've had people in their lives who have said things, but have done different things. So those things don't match up. So now I'm working with you they're trying to trust you. And so then you need to pay attention to what you say, and what you do, and transparency really helps. 

So if those don't match up, if you noticed that, and you can bring it up and address it, then that's going to help with that. So what I try to tell people is when survivors lash out and then feel like it's about you, try really hard not to take that and be defensive. 

Think about a racquetball court. When you're hitting the ball up against the wall, so that's defensiveness. Putting up a wall is defensiveness. Then the ball keeps bouncing around in that racquetball court. But if you become the curtain, and you don't get defensive and you just see that as frustration because of the stress that they're under, or the fear to trust, then the ball doesn't bounce around in that room it drops. 

And it's easier to get behind that frustration or that lashing out. So just as a thought I'm not sure if other folks have had different experiences. OK. So verbal compliance without follow through of the task, yeah. So I'm going to give you some tips for how to address that. 

Because that comes across in lots and lots of different ways. For example, I'm the kind of person that if I'm working with you, I am incredibly compliant in the sense of I will accommodate. I will say I'm going to do something even if I'm not sure I can. 

And it depends on our relationship, and how it is that we're working together as to whether I can tell you I'm not sure I can do it. But I'm going to be very agreeable, and then I'm going to later maybe just not do it. 

So it's really important that you develop strategies to overcome these challenging behaviors to work with survivors in order to provide healing services and justice. And let me just check see if there's any other examples. 

So I'm mentioning trauma responses that are normal. Exactly Shirley thank you so much. Remember when you're working with survivors, if someone has abused them, then just by nature of that abuse, they have experienced trauma. So you're going to see some aspects of trauma in your work with them. 

All right. So things to remember is that people with mental health disabilities are more likely to be victimized, than they are to be violent. The abuse and its aftermath, and trauma, can exacerbate a mental health disability. And behavior is not always a choice. It can be part of the person's disability. So those are really important key things to frame the rest of our work. 

All right. So these are a list of just some of the diagnosis of people that you might be working with. ADD or ADHD which is attention deficit disorder or attention deficit hyperactivity disorder, bipolar disorder, dissociative identity disorder. 

PTSD is post-traumatic stress disorder, anxiety disorder, borderline personality, major depressive disorder, and schizophrenia. And these are just some of the labels that we put on people. 

But here's the thing, you don't need to know what people's diagnoses are. And a lot of people may not have any. These diagnosis don't really matter for your purposes unless you're a clinician, and working with them in therapy. 

So what helps is usually helpful regardless of diagnosis. So focus on the needs of a person not their diagnosis, because everyone is different. So for example I'm telling you I have DHD, and I show up a certain way. There are some common things that other people with DHD will have that I have, but they're going to show up differently. 

So what you want to do is be curious in terms of how you work with the individual in front of you. And then adapt your services so that it's accessible for anyone that comes, and you work with. 

All right. So Ashley let me stop there for a second and see are there questions in the chat that I'm missing because this chat is totally active and I love it, but I can't keep up. 

ASHLEY BROMPTON: This is Ashley. One of the questions that has come up a couple of times is we talk a little bit about validating a person's story and credibility. How do we balance that this fine line with validating experiences and enabling what could be delusions, or other symptoms of a mental illness. 

Like how do we balance that to make sure that we're being responsive without validating hallucinations, delusions, or other symptoms of a mental health disability? 

OLGA TRUJILLO: All right. So that's going to depend on what your job is with them. So I think hearing what people are telling you, and then exploring gently a little bit more into some of the things that might sound like delusion or something that might be coming up from the past, rather than something that's happening now, is an important teasing out. If that's important for the work that you're doing with them. 

So for example, if I'm a lawyer and I'm working with somebody and preparing them for court that is going to be important. It's important for me to work through what is stuff that happened now, that's related to what we're working on, and what's the other stuff that's coming up that doesn't sound quite right for me. 

So the way that I do that, is I listen, listen, listen, because people who have experienced violence or have taken in that violence. And at the end won't be able to put that in a linear logical order. 

So I listen, listen, listen, and then I try to order for myself what they're telling me. I pull out the little fragments and I'm like OK. And so when there is a nice pause, then I say, OK, so here's what I'm hearing, is that correct? 

And then they might go through and tell me the whole thing again. And then I'm pulling out more and more information. And if something doesn't make sense to me, then I'm going to be curious about that. So I don't need to dissect what people say, their experiences are. 

If it's not part of why I'm working with them or what I'm doing with them. Like I can hear stuff that people are telling me, and not worry about whether how accurate it is unless it's something that's affecting their safety, or that is part of the system responds, or affects how it is that I'm going to work with them. 

If it doesn't make sense to you, you can ask questions about it in a gentle and open ended way. But otherwise like think to yourself, do I really need to know if this is something that just happened a long time ago, or is part of a delusion that they're having part of their mental health disability. 

So that would be the way that I would approach that. Because I know that sometimes there are things that happen to me a long time ago, which is why I have DHD because I experienced a lot of abuse growing up that shows up in my life today. 

And because I've done a lot of healing, I know that the stuff that I'm experiencing is old, but somebody else may not. So teasing that out and asking questions about a little more information from them, and listen, listen, listen, because it's not going to be linear logical is your best bet. So I hope that's helpful. 

Yeah. So in the chat, Oh, my God you guys are so awesome. Is it harmful to ask clients to go in chronological order when chronological order is needed? Yeah. A lot of people are not going to be able to give you the information in chronological order. 

So what I would do, again, is just listen and try to pull it out from what they're saying, and then ask them. So this is what I'm hearing. And then again they might not be able to tell you in a chronological order. 

And the reason that I say do it that way instead of trying to get them to do it, is because in telling you the story. A lot of times people are reliving aspects of it, have been told or treated like it's not true. And that can be triggering. 

So you're not really causing harm, but you're harming your relationship and your rapport with them. So if you keep interrupting they'll get more agitated in trying to tell you the story. 

So let them tell you the story in that scattered manner and listen for the pieces and try to create a chronological order, and then gently go back. So here's what I'm hearing. It sounds like this happened, and this happened, and this happened, is that correct? And then listen again. OK Ashley, any other questions that I should take at this point? 

ASHLEY BROMPTON: There are a lot of questions coming in all over the place. We've got questions. I think I do want to elevate one comment that you may have missed in the chat that I think was helpful. 

Heather said it's helpful to remember that this person is experiencing something that you and I don't, but it is very real to them. Safety planning and helping them identify healthy supports is still important. 

OLGA TRUJILLO: Yep. That is awesome, thank you for lifting that up Ashley. Yeah I can't keep up with all the chat. 

ASHLEY BROMPTON: All right. 

OLGA TRUJILLO: I'm hoping. 

ASHLEY BROMPTON: Olga, do you want to answer the question right now or would you like me to hold them until the end for you. 

OLGA TRUJILLO: Yeah, I'm wondering-- what I'd like to do is do the what you can do because it's possible that in the what you can do I'm going to answer some of these questions. And then let's stop, so I'll try to get through this relatively quickly. So we have time for more questions at the end. 

All right. So what you can do. So think about this in two broadways. It's important that you create accessible space, and accessible space is something that's physically safe, and emotionally safe. 

So what kinds of things have you done in your work with people to create physical or emotional safety. So let's answer on the chat because I know you guys have been doing this. 

And I'll keep an eye on the chat and lift some of these up. So what kinds of things have you done that has created physical safety for someone or emotional safety. And it might just be what your program does. 

Don't write while a person is telling me their story yes, awesome. For emotional safety I have worked with clients Oops, I'm losing track of it. I have worked with clients on creating a self care plan awesome, mindfulness, toolkit, and grounding tech, awesome. 

Safety plans, active listening, have a staff member sit in in my meeting with them. I'm going to come back to that one, Bonnie. Informed consent, bedrooms with locking doors, Oh my God thank you so much for mentioning that Lisa that is awesome. 

In our residential program everyone has their own room where they can be alone if needed that is awesome Beth. We meet with them where they feel safe and comfortable. Don't touch survivors of sexual or intimate partner violence without their permission. You guys are awesome. 

Physical. We have separate spaces for privacy. We provide essential oils, blankets, emotional support dog. Again, I love your program, Christie. Like Olga mentioned, having the survivor tell their story and pull the pieces for that, say for a restraining order, for example. Also give them options of where to meet within the building, like a space with a door or window, et cetera. Options and choices are huge. 

I'm giving clients the option to end early if they need to, talking to survivors about what they perceive as safety concerns and addressing their issues not assuming what is important to them for safety. OK. Hannah that is really, really good, really, really good. How do they feel safe? What do they need? 

And there are certain things that it's helpful for everyone, but that's a great, great suggestion. We are a legal services organization and face some of the same challenges that Christie has flagged above, is it ever all right to make a referral to mental health services when this is not what the client has requested? Is there a way to do this that is not harmful? 

Yeah. So there are ways to do that and I'll get into that at the end, but there are ways to do that where you notice gently nonjudgmental noticing of some things and saying, that you know of a clinician. So sorry I said I was going to do it later, but there I was I did it there. 

Well, you know of a clinician, if they would like to see someone, but then don't push. OK. When we are working in the office asking a client how to keep the door open, partially closed, closed. So basically when you're working with someone examining how comfortable they feel in the surroundings. 

So these are really awesome. I feel like checking in and making sure they have a safety plan in place, go into court hearings with them. Yeah, super helpful. 

OK. Encourage clients to set boundaries with us and decide for themselves what they're ready for, that's awesome. All right. These are super, super helpful. 

So let me move through some suggestions. So you're going to look at the physical environment, you're going to look at who has access to the survivor or their information. And how are survivors treated in your program by other staff and other survivors. 

And then the issue about whether they are, so let's say it's a shelter or residential program, whether they can lock their door? Whether they have to share their room? Whether they can lock the bathroom? Whether they can leave the doors open? Whether they can sleep in a bed or not? It's possible that they can't sleep at night in a bedroom, they might need to sleep in a different common area. So being flexible is really important. 

Creating emotional safety is I think the trickiest thing. So I have some really big tips here. The emotional safety piece as you all noticed in the chat, meaning as you are put in into the chat. A lot of the things that you're talking about intertwines physical safety and emotional safety. 

A lot of times if someone feels emotionally safe they often feel physically safe. Because you've created some rapport with them that engages them in the services that you're working with them. So a lot of your effort is going to be spent here in the emotional safety. So building rapport. 

And this is a lot of what you all have already said. Being patient, building trust. And in order to build trust, you need to be transparent. So that's that thing where you pay attention to what you say and what you do. And if they don't match up to say something about it. 

And it's as simple as telling someone that you have a lot of time to work with them. But then you notice instinctively, just because it's what you do, you look at your phone to see what time it is, or you look at your watch to see what time it is. They're going to notice that. And its inconsistent with what you said earlier. Or it can be perceived as inconsistent to what you said earlier. So notice that and address it. 

You can say, Oh, yeah, I did tell you I had plenty of time. What I should have said is I have an hour and I realize that this is going to take long. So let me and then whatever your plan is. Or I'm fidgety, it's hard for me to pay attention sometimes. So I look at my phone just to refocus myself on what you're saying. So again, explain to them why it is. 

And remember that people have been telling the survivors' that they are a problem or hard forever. Whether they say it or act like it. So people won't necessarily say that you're problem but they'll treat you like you're a problem. And what happens is that inconsistency piece. 

So people say no it's totally fine. I want to support you and then they distance themselves. So let me stop there, and let's do an interpreter switch. Great. All right. So the key here is recognizing that you're working with someone who has a history of dealing with their mental health disability. And a history of people reacting to them. 

And oftentimes people don't react to them the way you react to them. People are frustrated, they get scared and they distance. And a lot of people don't want to be rude and don't want to be mean to people, so they don't tell the person. But the person still figures it out right, like if I tell somebody I have DHD and all of a sudden that person stops contacting me or refers me to someone else, or I'm going to perceive that as having been connected to the fact that I have DHD. 

So remember that you're working with someone who is going to be hyper vigilant in how you work with them, the things you say, and the things you do. So pay really close attention to that. And then circle back and talk about things that might be inconsistent. 

So creating emotional safety requires more time. So plan for more time. Keep things simple, limit chaos to the extent possible. So let's stop here for a second. A lot of domestic violence programs for example can't limit chaos if it's a shelter based. Or at least they don't have control over the chaos that happens in communal living. 

But what you can do is create quiet areas, where people can be when the communal living is too chaotic for them. So think about the areas that you have in your program, and try to limit how much stimulation is around them. Because what happens is when people have experienced violence, they are going to walk through the world assessing for safety. 

And when people have a mental health disability, they are oftentimes taking in everything around them, and their processing might be slower. So for me I am constantly assessing for safety. And when I'm under stress my processing of what I'm taking in is slower, much slower. 

And also sometimes I can't comprehend what I'm reading. There's lots and lots of ways that my disability will show up, and what you'll see is someone that looks overwhelmed, or someone that's dissociating, or someone who's checked out, because of all the things that they're taking in. 

So the more that you can limit that stimulation and chaos the better your work with them, or work with them in areas that are quieter and less stimulating. 

OK. Repeat things as often as needed. Try to just be OK with the fact that someone might not be able to remember, you might have just told them, or later that day they come and they don't remember any of what you talked about. Just go ahead and repeat what you need to repeat them as often as needed. Provide information and different modes of learning. 

So let's talk about what different modes of learning. So walk them through something. So let's say I'll give an example of a residential setting, you're showing them that setting, or shelter. You're walking them through here's where the kitchen is, here's where people can do laundry, here's the room that you can stay in, here's where the advocates are if you need help to walk them through. 

Another thing you can do is also use videos. Provide information in writing. And when I say provide information in writing, make sure that the writing is accessible. So don't make it super high level writing. And this is really tricky for lawyers and legal services. 

Try to create plain language materials for the survivors that you're working with. And then use drawings or what I call photo novellas, graphic novels. Because that actually helps with literacy issues. 

So different modes of learning so that people can remember what you've told them and understand it. So you walk them through, you give them something in writing and you might have access to videos or to graphic novels, that describe the process that they're in. 

Other things that you can do to help is to help them create a checklist. Again, provide written or drawn instructions. Provide reminders for them and work with quite a few advocates that will text a survivor, or a survivor will text them when they've done one step of a safety plan, and then they'll text the survivor back. 

Provide noise canceling headsets, or sound machines to help with some of the chaos. Suggest the use of calendars or planners. This is a really helpful thing being structured in how you do the work with folks, makes it easy for everyone. 

So make things as predictable as possible, not knowing what to expect. It's creates a lot of anxiety, and can get someone feeling more agitated. So help survivors know what to expect. Create routines for your work with survivors, and help survivors create routines for themselves. 

The way that our brains work it's called neuroplasticity. We can rewire our brain by doing things the same way every time. And if you work with survivors on a long term basis, this actually improves your work with them. So let me pause for a second. 

Rada: Hi Olga. This is Rada speaking. Sorry, I don't hear the Spanish channel. I just want to pause for a quick second if that's OK. 

OLGA TRUJILLO: Yes, totally. Thank you, Rada. 

Rada: OK, give me one moment while I check what's going on. Sorry, Sandra, are you on a moment? Can you log in for the Spanish channel? All right, great. Do you mind just taking over. It seems like Inez may have disconnected her internet. 

Thank you, Sandra. We are ready. You can go ahead, Olga. Thank you. 

OLGA TRUJILLO: Thank you. Thank you so much. OK, so being structured really helps survivors. And if you're working with them over a period of time, if you do things the same way each time, then when they come and they work with you, they'll settle in faster and faster into your work together. 

The other thing, though, I want you to be structured. But I also want you to be flexible. Survivors with mental health disabilities often experience decreased stamina and fatigue. So flexible schedules, flexible sleeping arrangements, taking periodic breaks, and breaking tasks down into little steps so that people can take those steps, feel a sense of accomplishment with those, take a break, and move on. So flexibility is really important here. 

The other thing is planning for triggers. Regardless of why someone has a trigger, people will oftentimes get triggered in our work together. So talk with survivors about challenges that they experience-- when they happen, how they come about, what helps them, and what you can do to help. People who know about their mental health disabilities will be able to have these conversations with you. Some people who are not as aware of their mental health disabilities may have a more difficult time answering these questions. 

So again, your work with them and observing is going to help a lot. You'll notice when there's a difference in the person you're working with. And you can ask them about that and maybe trace back to what happened before that. 

All right, so another thing is to learn about grounding techniques. These help to soothe and calm person when they're triggered. And when you learn about these, practice those grounding techniques with others before you need to use them with the survivors that you're working with. Discuss beforehand with survivors, if you can, about the grounding techniques that might work for them or ones that you're working on that you've learned. 

And there are a lot of common techniques that help and they may know which ones help them. And then also over time in your work with survivors, teach them how to ground themselves. And grounding themselves, what happens is when someone gets triggered they're going back into an experience that happened to them, whether it's a flashback. They may get agitated, angry, or withdrawn. 

And so noticing that and slowing things down, the grounding techniques help someone to come back to the here and now and be in their body. So that's why they're important. Other things are to ask questions about the survivor's needs. And we have a few slides of these questions. 

And I'm going to stop here because I really want to get to some of the questions that you all have. But we have some sample questions here, in the PowerPoint that you have, that you'll have. But again, recognizing that survivors are the experts of their experience. And so asking them what helps them, what they need, what they want is important. And we have some good examples here. 

So Ashley, I want to stop there because I really want to be able to address some of the questions and I know that we only have about 15 minutes left. 

ASHLEY BROMPTON: We do. And Olga, this might be a good opportunity to also let people know that there will be an opportunity to follow up with you and ask you some one on one questions in just a couple of weeks. And at the very last slide of this PowerPoint-- if you wouldn't mind just going forward a couple of slides-- there is information about our one on one session that we are hosting with Olga and a registration link for that. 

If you go to register and it is full, please email us at cbs@vera.org. We will have a wait list for potentially creating more opportunities to engage with Olga. So if your question is answered or you want to dive in more with Olga about a particular circumstance that you might be facing, feel free to do so. 

And with that, I'm going to transition right into the questions. We do have a lot of questions. And I don't anticipate we will be able to get to all of them. But here are just a few of them. 

The first one is, do you have strategies or recommendations to help survivors overcome cultural taboos related to mental health counseling and interventions. 

OLGA TRUJILLO: So I'm going to stop share, if that's all right, Ashley. 

ASHLEY BROMPTON: Absolutely. 

OLGA TRUJILLO: OK. Yeah, so cultural taboos around mental health disabilities. So I want to kind of get into that just a little bit. Because I feel that there is a notion out there-- that like Latinas for example, or Latinx people-- don't talk about mental health. Or that people in the Black community don't talk about mental health. And that's because they're not supposed to. There is a taboo. But I want to actually push a little bit on that. 

So think about our society and how it's set up. Our mainstream society is set up for certain people to walk through it fairly easily. So if you're white, if you're able-bodied, if you're hearing, if you have citizenship, if you have enough resources, and on and on and on, you can move through our society fairly seamlessly. 

And anyone else has to adapt. And as you adapt and as services are adapted for you-- so they're not always created for like Latinx, gender nonconforming, person with DID. They're not set up for someone like me. When I'm trying to move through the world and do all the things that I'm doing, then I feel less than if something is harder for me to do then for the people that it was set up for. 

And in that, I get constant messages of being less than. So our whole big communities in our society experience that every day. And if you're constantly reminded of how you're different or less than other people in our society, then you're not going to talk about the other things that you find challenging in your life that make you even more different. 

So that's a large part of what's happening in other cultural groups. Because they're not talking about mental health issues. They're not talking about mental health disabilities. They're not sharing that. Because oftentimes it's another way that you're different. 

Like when I was growing up, there were two words that my mom said to me over and over again. And in a home where there was lots and lots of violence, there were so many words that she could have shared with me. But the two words that she found most profound were assimilate and enunciate. And this is in a home where my mom's first language was Spanish and where we were different than the community around us. 

So if my focus is on being raised is to enunciate and assimilate so that I don't seem like I'm different, then when are we going to talk about mental health issues. I see this in the dissociative identity world as well. It's very, very hard to find people that will tell you they have DID. And for the most part, they are people who are white in mainstream society. 

If you're just barely surviving to get through everything in our society, then you're not going to have the luxury of exploring why your brain works differently or why you're struggling. So I just wanted to say that. So I think the way that we address these issues is by making our programs and services more accessible, having things in different languages for people to find themselves in. 

So I know we have a lot of questions, Ashley. And I didn't want to take too long. But just wanted to address that. I hope that's OK, and I hope that makes sense to everyone. 

ASHLEY BROMPTON: Thank you, Olga. We did have a lot of questions about the justice system not responding to people with mental health disabilities. We had questions about how to advocate for someone's credibility, how to talk to either the court or the law enforcement agencies involved and other sort of legal entities. And really how to get them to understand these issues and understand the impact that it might have on a survivor with a mental health disability. And people are asking if you have any suggestions. 

OLGA TRUJILLO: Yeah. So I'm going to stop here. Before I answer we have an interpreter switch. 

OK so, what was the question again, Ashley? 

ASHLEY BROMPTON: It was actually a bunch of questions that we have gotten and rolled into one just four time's sake. A lot of people asking questions about how to work with the legal system and entities in the legal system, such as ports and law enforcement, who might not understand mental health disabilities, how to approach it, the credibility issues, and how to advocate for clients or survivors that you're working with around this. 

OLGA TRUJILLO: OK, awesome. All right, so first of all, learning about this and sharing some of the things that we talked about in this webinar and sharing that information with the people that you work with in those other disciplines. 

Secondly is incorporate into your conferences, into your trainings at your organization, or in your community. Or ask state coalitions to incorporate issues around disability and how to work with people with mental health disabilities, physical disabilities, how to work with people in the deaf community. Incorporate this into every training that you do. And so then they're going to come across this information over and over and over again. 

And when I'm asked to do a training, I'll be asked to do something entirely different. And I'll accept only if they also let me do a training on DID. And I feel that if people learn about a lot of the issues that survivors are dealing with, if they learn it in those settings then when they come across someone who has a condition that shows up differently, then they're going to have an idea that, oh wait a second, they're not lying to me. They're dealing with a mental health disability. So let me adapt the way I'm working with them. Let me get an advocate to help me maneuver through this. Let me change the way I'm responding to them. 

So I think just more awareness about this and building this information into the trainings that you do. OK, Ashley do we have any more questions that you want to toss my way? 

ASHLEY BROMPTON: We have a lot of questions. We will run out of time before we run out of questions. And I did post in the chat for those of you whose questions don't get answered, we only have the capacity to answer so many questions in the time available. Please do email us. Olga does want to respond to your questions. We will make sure that any questions that come in do get to Olga. 

So the next question that has come in is really around what can short term agencies-- agencies that don't have ongoing contact with a survivor, like a rape crisis center who is providing immediate advocacy and services but not necessarily long term services-- what can they do to connect survivors to other services in their community? 

OLGA TRUJILLO: Yeah, so there's a lot you can do. I mean first of all, just recognize that your either crisis line response or your advocacy response, listening, helping someone to feel comfortable, to feel accepted, to recognizing that they are the experts on their experience, that goes a really long way. Then do pre-work. Try to figure out who in your area works with survivors who have mental health disabilities. 

So are their substance use disorder programs in your area that work with people at the intersections that have a sense of sexual violence and the dynamics of that. Are there clinicians in your area that work with mental health issues and trauma and dissociation that also understand the dynamics of sexual violence. And if they don't, then partnering ahead of time and doing trainings for each other would be really helpful so that they better understand the dynamics of sexual violence. 

So figuring out, also what culturally specific organizations are in your area, and partnering with them. Learning about ways that you can work together and refer clients to each other is also very helpful. Doing trainings, as well. So that's where I would start. And then all the things that I suggested earlier, being patient, being transparent, understanding where survivors are coming from, not needing to have a diagnosis but just having a way that you work with people, it's really important. That works no matter how much time you have with them. 

ASHLEY BROMPTON: Thank you, Olga. We've also gotten a few questions in the chat about the framing that we're using for today's sessions and why we're talking about mental health disabilities, rather than mental illness. And is there a difference between the two? 

OLGA TRUJILLO: Yeah, so that is a really good question. And I'm not really even sure how to answer that. Ashley, so you should jump in and help me here if you can. So the Americans with Disabilities Act covers people with all sorts of mental health disabilities, identifies different kinds of mental health as a disability. 

Now there are some issues that people have around that are considered kind of mental illness that stay with people forever, really. And in those words, those are disabilities. And then there are mental health issues that people might have for a short term, but with help are able to get past it. And in those situations, those would be more mental health issues rather than disabilities, if that makes sense. 

And Ashley, anything else you can add. 

ASHLEY BROMPTON: And this is also the way that we, at CBS think about disability. We try to avoid language that could be perceived as unnecessarily stereotyping, or that might have a negative connotation. And some people are really opposed to the language around mental illness. 

Heather makes a great point in the chat that it's important to mimic the language that a survivor uses. Some people don't identify as having a mental illness or they don't identify as having a disability. I think we are talking about many of the same things here. It's really just about using the language that the survivor preferences in a given situation. 

There are some legal nuances that Olga started to address that are not necessarily why CVS says mental health disability. We are just trying to say that having a mental health disability is the same as any other type of disability. It is the same as a person who has a physical disability and needs accommodations. And they should be treated sort of the same way. And people with disabilities in general face barriers and may need accommodations and support. 

And it's the same thing for people with mental health disabilities or mental illness. And so we sort of frame it that way intentionally to make that connection for folks. 

OLGA TRUJILLO: Cool, thanks Ashley. 

ASHLEY BROMPTON: And with that, we are at 12:30. I know there were a lot of questions we did not get to. Again, please let us know if you would like to have your question answered. We will do the best that we can to reach out to folks individually. We save the questions and the chat. So we will try to reach out to folks. If we don't have your email it might be difficult. So please reach out to us if you have a specific question that you want to make sure gets addressed. 

Thank you so much for participating in our session today. We really appreciate the time and energy that it takes to come to the space with us. And Olga, it was absolutely fantastic. Thank you so much for your time and your expertise here. And finally, we do ask that you complete a brief evaluation about this session. When you end the Zoom meeting today you will hopefully see it pop up on your screen. 

We do appreciate if you could take just a minute to share your thoughts with us. We want to continue to meet your needs and hear any concerns or challenges you might have faced. As a reminder, the recording of the webinar and PowerPoint materials and transcript will be posted to our end-of-use website. Give that about two weeks. But it will be posted there. 

If someone on my team could post the link to materials one more time just so folks have access to that. This session will end right away. We won't be in the room, in the space after the fact. So if you do have questions, again please email us at cbs@vera.org. Thank you all so much and have a really great afternoon.