Serving Survivors with Mental Health Disabilities

Olga Trujillo, JD 
Program Manager
Center on Victimization and Safety
Vera Institute of Justice
May 25, 2021
				
A Note About my Perspective
Goals of this Webinar
•	Explore the challenges survivors who have mental health disabilities face accessing safety and healing services;
•	Examine the complexities mental health disabilities can present; and
•	Strategize what advocates and service providers can do to support survivors who have mental health disabilities.
What We Know
•	According to the National Institute of Mental Health, 51.5 million people in the United States have a mental health disability. 
•	80% of women who experienced rape, stalking, or physical violence by an intimate partner reported significant short- or long-term effects including posttraumatic stress disorder. Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
What We Know (2)
•	In one study, approximately 20% of survivors of interpersonal violence (defined to include domestic violence and sexual assault) reported experiencing a new onset of psychiatric disorders. 
Poll Question
Have you worked with a survivor that had a mental health disability?

•	Yes
•	No
•	I don’t know 
Question 1 – answer in the chat
Survivors with Mental Health Disabilities Face Barriers
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
Disclosures can be rare because there is a lot of stigma around mental health disabilities: 
•	The words we use (crazy, nuts)
•	Portrayal by the media, movies, TV
•	Experience from previous disclosures
•	Preconceived notions about people with mental health disabilities from service providers and advocates 

Credibility
Survivors may not disclose a mental health disability because:
•	Their disability has been used as part of their abuse – gaslighting, threats of disclosure…
•	Their credibility and knowledge is often discounted because of their disability
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 other negative consequences of disclosing including:
•	Employment
•	Housing
•	Losing custody or CPS involvement
•	Unwanted psychiatric services involvement, including forced medication conditions, and
•	The impact disclosure may have on future civil and criminal court involvement

Question 2 – answer in the chat
Complexities for Advocates and Service Providers 
Behaviors 
You may encounter behaviors from survivors with mental health disabilities that are difficult to understand or are unfamiliar, such as: 
•	Talking all the time
•	Being unable to remember what you talked about
•	Being withdrawn
•	Not seeming to pay attention
•	Getting frustrated and short tempered
•	Not following through
•	Tensions with other survivors

More Behaviors
•	Difficulties planning and organizing 
•	Stamina and fatigue (including sleeping and staying awake)
•	Difficulties tolerating stress
•	Erratic/inconsistent behavior

It is vital that you develop strategies to overcome these challenging behaviors to work with survivors to provide healing services and justice.                    
Things to Remember
•	People with mental health disabilities are more likely to be victimized than to be violent.
•	The abuse, its aftermath, and trauma may exacerbate a mental health disability. 
•	Behavior is not always a choice; it can part of the person’s disability.
Does Diagnosis Matter? 
Diagnosis Doesn’t Matter 
•	These don’t really matter for your purposes
•	What helps is usually helpful regardless of diagnosis
•	Focus on the needs of a person, not their diagnosis – everyone is different 

What You Can Do
Create an Accessible Space 

It is important that you create: 
Create Accessible Space (2) 

Create Physical Safety 

•	Physical environment
•	Who has access to the survivor or their information?
•	How are survivors treated in your program by staff and other survivors?
Create Emotional Safety 

•	Intertwined with physical safety but goes further
•	A lot of your effort will be spent here
•	Build Rapport
•	Be Patient
•	Build Trust
•	Be Transparent
•	Remember people have been telling them they are a problem or hard forever, whether they say it or act like it.
Create Emotional Safety (2)

•	Plan for more time
•	Keep things simple
•	Limit chaos to the extent possible
•	Repeat things as often as needed
•	Provide information in different modes of learning

Different Modes of Learning

•	Walk them through it
•	Use videos
•	Provide information in writing
•	Use drawings or fotonovela

Other Things You Can Do to Help
•	Help create a checklist
•	Provide written or drawn instructions
•	Provide reminders
•	Provide noise canceling headsets or sound machines
•	Suggest the use of calendars or planners 
Be Structured…

•	Make things as predictable as possible
•	Help survivors know what to expect
•	Create routine for survivors

But also, be Flexible
•	Survivors with mental health disabilities often experience decreased stamina, or fatigue
•	Flexible schedule
•	Flexible sleeping arrangements
•	Periodic breaks
•	Break tasks down
Plan for Triggers

•	Talk with survivors about challenges they experience 
•	When they happen
•	How they come about
•	What helps them
•	What you can do to help

Learn about Grounding Techniques

•	Help to soothe and calm a person when triggered
•	Practice grounding techniques with others before you need them
•	Discuss beforehand with survivors
•	Common techniques that help

Ask Questions About Needs
•	Is there anything we can do to help you while you are here?
•	If they disclose help them figure out whether they need to tell others.
•	If they want to tell others, 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 is anything we can do to help you manage these can you let us know?
Ask Questions About Needs (3)
Ask Survivors How You Can Help
Questions? 
Olga Trujilo 
otrujilo@vera.org 

Join me for an Ask Us Anything session on June 10th! 
Register for your one-on-one session at: https://calendly.com/centeronvictimizationandsafety/ask-us-anything-serving-survivors-with-mental-health-disabilities