 I wanted to see that there and please welcome Ms. Kathy Cunningham. Thank you. Glad you guys are here. Are you about conference doubt yet? Getting there? Yeah, okay. Please feel free to interrupt and ask questions or give me some of your information too. I'm really user-friendly here. So what we're going to be talking about is understanding cycle babble and how to talk to a mental health professional. Which if any of you have ever tried to talk to a mental health professional, you know that we are probably the area of medicine that is most resistant to talking to people in normal human being language. You know, every area of medicine has its own language and its own set of initials and its own abbreviations and all of that stuff. But we excel at that. I think it has a lot to do with sometimes people don't really know the answers to the questions that we're asked. So in order to not sound like we don't know what we're talking about, we just make stuff up. No, I'm kidding. We're going to be talking about some commonly used terms and what they mean. Some abbreviations that we'll see. Questions that you may need to ask if you're going to be seeking mental health care. Tips for making your concerns known to your professionals and the differences between mental health professionals. Y'all all know that there's different kinds, right? There's a difference between a psychiatrist and a psychologist. Pop question, who can prescribe meds? Yay, okay, good group. All right, the first thing I wanted to let y'all know is in the July issue of the Journal of American Medical Association, there was an article that talks about for the first time in 30 years children's mental health issues are bypassing physical disabilities in keeping kids from achieving their maximum potential. So we hear a whole lot about obesity. We hear a whole lot about a lot of physical things but we don't hear a whole lot about mental stuff. Well the mental stuff is going to be what keeps our kids from being the full-bloomed adults that they can be. So this is why we're going to start right there. Hopefully the person that refers you or that it refers a parent has a few people that they may suggest that you see. The referring person doesn't always know if you need to see a psychiatrist, a psychologist, or a therapist. And there's a whole boatload of therapists too that we'll get into. So that might be the first thing where you start asking them, well, you know, what is this about? What do you think it's going to be? Do you think we need to go for medications right away? That should be a not necessarily. Always, always, always should be not necessarily. Let's try therapy first. We want to start small, especially when we're talking with kids. We don't want to give them drugs if you don't have to. Your insurance company may offer some help also. A lot of times and a lot of places, a lot of providers in the mental health industry, probably more so than others, won't see you if you have insurance unless you agree to private pay. The insurance industry, as we all know, is getting just really crazy with regulations and things you have to fill out. And on the doctor side or the therapist side, the amount of time that these people spend trying to get authorization for the services that they're going to be providing is astronomical. Just as an example, at Clarity, if we have a kiddo that's in the hospital, we may get them approved to be admitted, but then we have to talk to the insurance company every single day that the child stays there. And the minute they ask us the question, is the kid suicidal right now? If we say no, boom, that's it. You need to get them out. Well, no, you know, hold on. Just because they're feeling okay right this second doesn't mean that we need to let them go because, you know, kids are kids. I mean, they change. So insurance companies will, some will suggest where to go, who in your area they work with. They are required to give you three names. Ask for more. Ask for more than three. Sometimes the three that they will give you are not necessarily the appropriate ones for you. Sometimes the providers will only see kids 12-year-olds and up. Sometimes they won't see kids at all. If you're asking specifically for somebody to see a kid, you kind of need to at least start out with the right bunch of referrals. A provider that is right for what you need. We kind of talked about that a little bit. The smaller or the younger child, the more specific type of therapist that you need. Play therapy comes into context there. Little kids, the smaller the child, they really don't have the verbal ability to tell you what's going on, right? They're going to tell you by behavior. That's usually how most kids get referred to us, is the school just can't take it anymore, right? Because they're getting kicked out of school, parents are getting called to the school constantly, so something's got to give. If kids don't have the language to tell us, we need to give them something to tell us what's going on. Either through play, sometimes it's just drawing, sometimes it's art, sometimes it's drums. It can be any number of things, but we need to find out what that is and we need somebody who understands where the kid is developmentally and how their brain works at that age to be able to go there. For an initial appointment, therapy is usually the best. Therapists can be social workers, they can be licensed professional counselors, they can be psychologists, they can be marriage and family therapists, they can even be nurses. Some psychiatrists actually still do therapy. I'm amazed every time I run into those. Is everybody so specialized? And the psychiatrists obviously are the medical doctors who specialize in the brain and they prescribe the medications. Okay, what's appropriate? Age, sex, issues, all of that's important. As we get more specialized, some of our counselors or therapists will only work with certain ages, they will only work with certain issues, they will only work with certain sex kids. It gets really complicated. All of that being said, what's important is what's going to work for the child or the person that's seeking therapy. Do they work better with men or women? You know that plays a huge part in the whole therapeutic process because you have to kind of create a relationship and a sense of trust. So if you have a kid or an adult that's seeking therapy that was abused as a child, they probably are not going to work real well with the same sex of their abuser. So that needs to be taken into account. Children who are under the age of 10 may do better with play therapy, which we talked about. Y'all know what play therapy is? Yeah? Okay, good. There's sand tray, there's all that kind of stuff. So, you know, sometimes little kids are very sophisticated and play therapy is too baby-ish for them, they think. Y'all know about experiential therapy, ropes, kind of like, well, okay, case in point, basketball. You put a basketball in a kid's hand and you get them out on a sports court, and get them to talk with you while you play basketball. They will tell you all kinds of stuff. You sit them down in a chair and expect them to talk to you. They're not going to tell you anything. What are you going to get? I don't know. Yeah, maybe. You need to get one word answers, is that? If you get a kid active, which is all experiential therapy is, ropes, horse therapy, dog therapy, whatever, you're going to get them to talk. Even the little kids, play therapy, that's what we're doing, is we're getting them active. They don't know that they're telling us what we need to know. Better with males and females, we talked about that, and it's okay to interview a therapist. Just like if you were going to hire somebody to come into your house, or you were going to hire somebody as an employee, you interview them. That's the same kind of relationship that we've got with every doctor, every nurse that we agreed to work with, every therapist. Therapists are usually pretty good about saying, well, you know, yeah, if you say, I just want to come talk and see if we're going to be a good fit. They're usually okay with that, because it's going to be frustrating for them, too, if it's not. And then they're going to have to go through all the trouble of referring you someplace else, which is not an easy task. And if the relationship doesn't work, sometimes people outgrow their therapist. Hopefully that happens a lot, through the course of a lifetime. Little kids will outgrow the play therapist. Bigger kids will outgrow their therapist now because they're looking for adult issues, so they'll need somebody that's more young adult motivated. And believe me, if you're 17 or 18 years old, or even 20, and you're trying to talk to somebody about what's going on with you, and the person sitting across from you has no idea how to use the internet or what social media is, you're done. Therapists need to match to where the person is that's seeking the care. And it's okay to say, you know what, this isn't working for me. I need to find somebody else and ask for a referral if that does happen. You know, if, for whatever reason, if it doesn't work out, always ask for a referral. A suggestion of where to go next. Mental health professionals should be able to answer your question usually, and have a good rapport with the patient. This is a weird aspect, okay. Remember I said that we kind of make stuff up if we don't know the answers? We don't really, of course I was being facetious, but if you notice if a therapist really is not sure what you're asking, they usually just talk a lot. You get a bunch of words that really don't mean anything. And that's when we start throwing in all the jargon. The stuff that no human being could understand unless they went to school for this stuff. That's when we stop them and say, okay, hold on. What are you telling me? What exactly is the answer? And press them. And press them for an answer that's in real-time understandable normal human being language. We work with parents a lot at Clarity. Our parents are frustrated. They're angry sometimes because they don't want to be there. They're concerned. The kids are pissed off, you know. They don't want to be there either. So everybody's stressed. The more stress you add to a situation, the lower the IQ level drops. This works for siblings and this also works for your spouses. Don't have a fight and expect somebody to be logical. Give them a time out. Walk away and then you can be logical later. Delayed reaction, okay. How do we expect parents that are living a chaotic life that are just trying to figure out what to do and how to keep this kid on the straight and narrow or at least alive until they get to be 18? How can we expect them to understand what we're talking about? You know, in the first session this morning we heard about literacy and how to use words that people understand and how intimidated people feel. When we ask them a question, do you understand? Yeah. No, they don't. They just don't want to look stupid, especially in front of their kid. And the kids, they're worse. God forbid they're going to admit to us that they don't know anything, especially the older ones. They know everything. Ask a teenager. They'll tell you. How are we doing? Not okay? Is it hot in here? Is it me? It's hot. Okay. Thought I was having a hot flash. Pardon me. Okay. It might be. We're all in it together. Okay. It's all me. Okay. The action step. The first step is to make the call. Now you've got all this great information. Somebody's told you you need to go see a counselor. Call the insurance company. You've got a list of people. You got the list from whoever said you need to go see this person. Now you have to make the call. That's usually, that's usually where everybody else, all right, how do I do this? It's just like making an appointment with any other doctor, actually. Always have the insurance information available because they're going to ask. You know they're going to ask, right? Unless you're one of those few people that can actually private pay for healthcare. I don't know many. Always have that. If you're talking about a kid, they're going to want to know the birth date. They probably are going to want to know immunization history, especially if it's inpatient. Those kinds of things. Have all that stuff ready and have questions that you might want to know. Like cancellation policies. All of that good stuff. How much does it cost? What about the insurance? Do you file it? This was a shock to me, not for mental health stuff necessarily, but for other things it's like what do you mean you don't file insurance? You say you take it, but I had to file it so that makes no sense to me. So you know check things out and make sure that you know what you want to talk about when you get these people on the phone. Make sure the person that you're talking to knows if the need is urgent or critical. Two words they mean almost the same thing. But on the other end of the phone, if you're calling especially for mental health, you're going to get a litany of questions that say okay you know is the person at risk of harm right now. Basically are they in danger themselves? Are you in danger? Is anybody around them in danger because this person is there? That's what we need to know. Is it something that we need to do something about right here right now? If so that's critical. That means yes you know call 911 do something help me please. We got a lot of parents that are in this state. Urgent, you know it'll be okay. I mean I'm not we're not going to lose it or anything and nobody's getting ready to die, but I need some help pretty quickly. Those are two completely different things, but it's going to make a difference as to how quickly you get seen and that's the key. We want to make sure that everybody that is in a critical need get seen as quickly as possible and in instances in San Antonio where we don't have a lot of mental health beds available for children especially during the school year, you're probably going to end up having to go to an emergency room simply because there's no place else to go. Yes that's a good point and I'm glad you brought that up because I was going to get to that at the end about the training. I'm part of a committee and a group of people that trains the police officers in crisis intervention which is basically how to intervene in a mental health issue to get the person to the most appropriate place that they need to be. If they're not actively aggressive or violent or threatening that will be to a mental health facility. If the opposite is true then they're going to go to jail. Sometimes that's not the best place but that's the best available place at the time. As of I want to say September all of SAPD officers were trained in CIT and we are continuing to train the academy. Those that go through there so everybody will be trained. It's a 40 hour it's very intensive. Now the next thing is the paramedics. We've had them come, some of them, to find out how to intervene in a mental health issue without making it worse and we're working on it. It's one of those things where you really don't know what's going on and if if you're in the position of having to protect the public good you're going to do what you need to do. Anytime anybody needs to call San Antonio Police Department or whatever police department you're in you know always recommend ask for a CIT officer. They don't always send the mental health guys out. You know they don't know. I mean if you call you know somebody is you know lurking around my house you don't know what's going on if they're armed any of that stuff. They're going to send you know regular officers out there. So that's the other thing in letting people know what's going on. If you know somebody has a mental health issue you probably won't you know if it's the odd thing I was talking about but let these people know. Let the dispatchers know. CIT is crisis intervention training. Yes ma'am. If you if you're a parent and your child is out of control yes you can call 911 you can ask for police to be dispatched and tell that dispatcher you need a CIT officer. Absolutely and also speaking for us personally if you're calling and especially if it's somebody that we know you know we know your kid and you know that you're going to be coming in call ahead tell us we'll hold a bed. You know we will hold beds. We won't go there. Ask Joe. Ask Joe. Okay oh okay yeah yeah um yeah so you know it really is important to get all the information. It's important for people to actually make calls you know to find what what they need and sometimes they won't know. So with us like with intake at our facility and we have intake for in patient and outpatient. We help the person calling figure out what it is they need. Sometimes they're just calling say how's you know told to call you guys my kid is whatever and we're okay let's get all this information and it's a tedious process. Granted um we get them in get you come in to the physical place and do an assessment then we'll figure out is it outpatient is it inpatient is it maybe medication tweaking if you're already on meds and something's gone a little haywire we don't need to go through all this stuff we just need to figure out what's wrong with the meds. So it's it's not an easy fix um hopefully we'll get you did I skip a slide no okay um individual therapy this is generally an hour-long meeting with a therapist and the child um usually sometimes we'll do the kid by themselves um depending on the age of the child the older the kid we don't want the parent in there because teenagers are not going to talk to us when their parents there little kids usually hesitate talking to us when their parents are there because they don't want to tell us anything bad about their parents because they know they're going to get hammered when they walk out of there they're not stupid they're kids so we're going to have to adjust their family theory this is a discussion with the child and the parents um sometimes including siblings sometimes including grandparents whoever is in the child's environment at home or is responsible for taking care of the kiddo um we've had telephonic you know via telephone therapy with mom and dad when dad is overseas and mom is here so you know it's everybody included in the child's life usually it's an hour sometimes it could be longer it doesn't have to take place in an office sometimes we can do this outside we do a lot of therapy outside with our families group therapy this one works really well for adolescents um generally it's a number any number of uh same age kids with the same basic issues they don't have to be identical but say all the kids are dealing with some kind of behavior issue they all have some kind of mood disorder doesn't all have to be depressed but they're kind of all there together same general age and they get together with a therapist and they talk about what's going on this really works well with adolescents because then they figure out hey i'm not the only one by the same token we do enter family therapy with a whole bunch of families where the parents go oh my gosh you too your kid does that it's amazing what happens when people figure out that they're not the only ones dealing with this the stigma goes away they make relationships they support each other getting through this kids need that just as much as parents do our caregivers and that's pretty much outpatient um it can be we can do psychological testing which i'll talk about a little bit later um but for the most part therapy individual and family and group is pretty much where it's at for outpatient um more options acute care that is inpatient um that means it's a life-threatening kind of thing either that somebody's suicidal somebody's homicidal they're wanting to kill themselves or somebody else or they are just not able to think clearly um they're not able to get up and go to school maybe they're hearing things maybe they're seeing things that aren't isn't really there maybe they're smelling things that is not really happening all of this can really interfere with a child's ability to function at school so if any of those things are true we bring them into the hospital it offers safety for the patient while getting their treatment and we can deal with a whole lot of different issues at the same time we can help the parent um get the resources that they need the understanding about whatever's going on with the kid the diagnosis what that means where to go for additional help we can also assess the family to see if do they need help with rent do they need help getting set up for Medicaid food stamps what you know what what does this family need so it's a big huge assessment um subacute just what it says underneath the cute it's residential pretty much um short-term residential which means the kids still stay in there overnight they're monitored they have somebody watching them 24-7 but nobody's afraid that this kid is is gonna hurt themselves they're able to go outside they're able to play they're able to go on outings they can go to the dining room they go to school with us on campus they can do things like they kind of normally would when they go back to their normal life generally the therapy here is focused with strong family involvement we usually do uh one to two maybe three family sessions a week depending on what's reasonable for the kid kids can only take so much adult interaction we drive them right up the wall i think and what's of it you know what's appropriate for the parent people have to work you know so we're not going to ask them to you know to ditch their career for this day treatment in partial hospital this is and they both mean the same thing it's less restrictive even than the residential that we were just talking about this is the kids come in during the day they stay with us they have their meals they have a nurse they get seen by the doctor they do their therapies they do whatever sometimes they go to school and then they go home so we get the best of both worlds we can see if everything that we've done up to this point is actually working if the parents know what their needs are what's going on there what they need to do are there any questions with the medications are we having side effects all of this stuff and then we can deal with it the next day so it's a really good option either for coming out of acute care or maybe they're not ready for acute care but they're a little bit more meaty than the outpatient people can handle yes yeah partial or day treatment is usually less costly both from a managed care standpoint or private pay yes managed care companies are pushing everybody out of the hospitals doesn't matter what you got going on we can get approval for outpatient pretty much without too much hubbub partial or day treatment we can get that pretty easily and usually in blocks of 10 days acute care we're back to the every single day having to justify so yeah sure hey abbreviations i'm going to try and get you all out of here early um residential rtc not a big one there we actually call it rtp at clarity because we're not a freestanding residential center we have a residential program so we're going to complicate it a little bit more for you adhd what's that guys yes attention deficit hyperactivity disorder is that a mouthful or what now you know why we call it adhd these are common things that you'll see for kids stuff mhmr actually we don't call it mhmr anymore here do we it yeah it is in the rural areas it still is it's still mental health and mental retort retardation now we have mental health authority here which is chcs which is another abbreviation center for health care services is it any wonder people get confused about where am i supposed to go um the which part um actually there's a whole big story the mhmr in bear county uh because they were authorizing or approving the uh treatment they were also a provider there was a a conflict of interest also they wanted to take out the mental retardation part so they took that away from them and switched it over to acog whoever they are now they changed their name so now we have mental health authority in bear county which confuses the rest of the counties i got to tell you okay mdd major depressive disorder does anybody really call it that outside of the psych world no you just call it depression right bpd borderline personality disorder that is a diagnosis that basically means teenage girls um yeah teenage girls are are were held up to be the um the poster kids for borderline personality disorder um with good reason i mean you know teenage girls are i love teenage girls that's my favorite bunch of people to work with but they're hard right yeah they're mean too um oppositional defiant disorder odd that does not mean the kids weird not odd oppositional defiant disorder now we've actually had on our discharge summaries before we started spelling out all this stuff when we just put the the diagnosis like this somebody got really upset because they thought we were calling their kid weird i said no no it's not odd it's like um i worked ob for a while and the one of the things that they used to chart in the nursery and i didn't know this because i was like what in the world is that what diagnosis flk which is funny looking kid the charting that i saw was flk has flf funny looking father i'm telling you we make it up if we go along terms you'll hear assessment that's a fancy way of saying we're going to ask you a bunch of questions and try and figure out what's going on it's very very detailed extremely detailed a normal assessment at clarity we warn everybody it's going to take probably around three hours is that right yeah yeah so you know and unfortunately we haven't made the progression over to um electronic medical records like everybody else in the free world has you know medicine is actually rocketing forward into technology and here's the psych people going do what you know we're not there yet we're getting there no no i hear you yeah yeah and that's that's true and so with the kid i mean the poor kid is going through this you know and the parents and the child have to go through this whole thing for us on the other side we have the admissions people that may have maybe an hour then we have the psychiatrist that comes in then we have the nurse that comes in then we have a therapist that comes in you know we have all these people that have kind of broken it up in pieces but the people that are needing the care have to sit through this whole thing so we're really working on getting that nailed down and and getting it done quicker our forms are horrifying and hopefully we will fix that too because they're they're not user-friendly diagnosis everybody knows what diagnosis is right we know that from the medical side everybody knows what's wrong with me why did i go here what do you think um and it's really interesting in the psych world there i showed you just a few of the diagnoses and honestly if you really want if you really want to shock um just look up psychiatric diagnoses and we're changing them the diagnostic manual that's used by psychiatrists to to diagnose people based on a bunch of behaviors is changing they keep threatening to change it they've been threatening to change it for two years i haven't seen it yet but there's going to be new diagnoses that pop up so we're going to have to learn new terms and new abbreviations isn't that fine i love it oh gee 2009 maybe maybe i think yeah that was when the dsm was last revised i think okay cognitive behavior therapy that's talking it's all it is cognitive behavior therapy is the type of therapy that we use at clarity even if the child it doesn't have the the vocabulary like i said earlier the key is is they have to be developmentally able to think about things like a normal human being to make rash well not even rational kids aren't rational to make judgments to make conclusions to problem solve that's all this is is problem solving at their level we get a lot of kids that are with us that may have developmental disabilities and we do take some kids that that are on the spectrum autism and we'll work with them if they can do this cognitive behavioral therapy so um you know those that's one of the things we're looking at maybe branching out a little bit more into to the spectrum issues terms of here psych testing this is crazy um psychological testing can mean anything from intelligence testing iq to um the cognitive stuff again to problem solving to learning disabilities to processing how how the kid actually takes in information and spits it back out it can be a bunch of stuff it's designed a way to look at the way that a child takes in the information from all these different sources and how they use that how they can recall it when they need it it may include questions usually it's pictures blocks it looks like they're playing the game and most of our psychologists make it a game so the kids will actually do it um and it's usually used to make a diagnosis or if the doctor is not real sure if this is the accurate diagnosis they'll use it to clarify what they're doing because the diagnoses have so many different layers we usually try and find out specifically what areas we're needing to work on um some kids are affected differently by different diagnoses so it really depends this this is can be very beneficial um it uh it is also very expensive to be flat honest with you it's usually about anywhere from four to six hours at a time that is is done and it can be anywhere from 800 to several thousand dollars depending on exactly what is going on and what kind of testing is being done it can be effective in uncovering learning issues and usually school districts like to have this information however some school districts won't take testing from a private source they have to be done by their psychologists we fortunately um have a good relationship with most of the school districts in san antonio so if a kid has gone through psychological testing with us usually the school districts will take them that means what are we going to do how are we going to do it informed consent this gets tricky um everybody knows what consent is right that means you say okay yeah i'll do that informed consent is a little bit different because that means that whatever you're going to give consent to be done whoever is asking you to sign that release needs to have you repeat back to them what they said what are you consenting to in texas 16-year-old kids can consent to mental health treatment by themselves we don't need a parent to do that the kid needs to be aware of what's going on medications every time a new medication is started a consent needs to be gotten and there needs to be education about that medication for both the child and the parent you can see where we're sitting there talking a whole lot about this stuff some of the the information about medications instead of talking and explaining the patients are given a handout here read this do you understand it do you have any questions again we're back to you know they have no idea what this is about with informed consent one of the things that we try and and highlight is not only do you need to sign it and read it and we need to hear back what you think you just consented to especially with medications what are some of the things you need to watch out for drug to drug interactions how is this going to interact with stuff you're taking already and things like you really don't need to be out in the sun when you take this medicine or you need to drink a lot of water not coke not red bull water and it gets specific with these kids as you know you give them an inch they'll take a mile yeah it is and it does you know jaco came out with the the new consents which do say they have to be very detailed um at a language that the patient or caregiver can understand um and sometimes that involves pictures we do a lot of pictures um but the thing that that psychiatry again we like to use our words you know that we've all gone to school for eons to learn to use correctly so we fall back on that it's going to be it's really a culture change for all of medicine to stop using those words to talk like normal people that's a very good point malpractice is on the rise because of that like i'm also the patient rights officer at the hospital so i get a lot of calls where a parent may say you know what they gave my kid this medicine and nobody asked me i'm horrified when that happens unlike excuse me you know what are you saying um and it does happen i mean with you know 52 kids yes it does happen where they've been on the medication before okay we know we you know it's just processes but in all those processes there's people and that's what you know that's what we need to all remember is there's people behind all of this stuff if it's confusing for us it's going to be confusing for people that are trying to get services with us informed consent we did to death i think integration of services well you know that that sounds like something spectacular right that means that we're gonna talk to whoever is going to be caring for this child whoever they may be now in a perfect world that means that the family gets the services they need not ones they don't so they don't have to duplicate everything again and tell the story one more time to another heard of people who look bored and that everybody involved in the care is aware of what the other ones are doing this is a key thing especially when it comes to medications why you remember the video guys from this morning with those that list of medications this lady was reciting oh my gosh how many medications are you taking for a thyroid you only need one usually so all of it all that means is everybody's going to be on the same page that includes school for children now i know is there any teachers or school people in here they have their own set of HIPAA guidelines confidentiality issues FERPA another set of initials so in order for doctors and schools and parents and providers mental health providers to all talk all these consents have got to be circulated we're back to inform consent so all of this stuff that was going on over here all of that has to be straightened out again is it any wonder that people don't read consents anymore you're constantly being asked to sign another consent to give away information and it's all out there anyway on the internet right nothing's secure so um that's all that is and it's really important that this happen especially with kids that fun when yeah absolutely and it's very important for the psychiatrist to talk to the therapist just for that reason because you have kids that are going to be playing one against the other and what really gets interesting is if you have a therapist a psychiatrist and another therapist maybe that mom and dad are seeing for family therapy then you've got a whole another layer of well they said I didn't need to do that so it gets it gets complicated more words involuntary admission that means somebody is taken to a mental health hospital against their will basically what it says involuntarily that's by court order um usually or by police officer um voluntary that's parents are taking you there or you're going yourself because you need you need to be admitted prognosis that's the outlook okay what what is what's going to happen what does it mean how is this going to go am i going to go crazy someday is it going to be a good outcome that's restraint this is something that is used police officers use restraint parents use restraint the seatbelt in your car is a restraint so restraint is a way of holding someone or securing someone in a mental health environment it's only you should only be used if somebody is in danger of hurting themselves or somebody else in order to help them regain control you don't do it just for a power trip it's never good to do that if you can keep from it multidisciplinary team that's a whole bunch of different people that are working on the same case and hopefully are on the same page so that can be the nurse the therapist the doctor a psychologist a school teacher a play therapist a recreational therapist a speech therapist an occupational therapist did i leave out any therapist i think i got most of them and all these people need to be talking symptoms that's what does it look like how is this involved in your normal everyday life case manager hopefully everybody has one of these they're usually social workers or nurse and they manage the care while the patient's in the hospital hopefully we're going to get to the point where outpatients have case managers that can help people navigate the system because it's not going to get any less complicated in fact as new regulations kick in it's going to be more complicated so somebody's going to have to help people get through this i'm already looking for myself and my mother lives with me she's 93 i know this stuff i'm an rn i worked in managed care i worked for try care oh my gosh this stuff is crazy it's very complicated it's not going to get better case managers also assist with school issues and in some cases getting assistance for housing and other issues there really are bugs up here i'm fine so you know case managers are the navigators they help us get through this finally make sure you understand what medical or mental health professionals are saying to you if you don't know ask um and make them be crystal clear when they're talking to you tell them use words i can understand that may take them a little bit you may have to push them on that one and make sure you understand what the plan is they need to have a plan they need to have that plan written out for you so that you understand it the second time you walk in the door once you understand and agree to that be an active member of the team show up for the appointments make phone calls if there's something you don't understand if your medication looks funny when you pick it up at the pharmacy ask the pharmacist is this the same stuff that throws people a lot and they always change manufacturers so it never looks the same always maintain an open communication with the doctor and the therapist talk to them you know don't don't second guess anything if it's important to you it's important to them or it should be if it's not maybe it's time to sever that relationship have a plan for an emergency find support groups for you and the family be kind to yourself always be kind to yourself be active in a kid's life and stay involved learn all you can about their condition if you have a hard time remembering questions that come up write them down and take them with you and if the kid is old enough have them write their questions down because they're going to have a bunch mostly it's why but still you're paying these people or your insurance are paying these highly qualified professionals to deal with this stuff let them answer your kids questions if you can't it's what they're there for call if there are concerns no matter what time call them again they're getting paid for this stuff know where to go some resources for you are listed on this thing and i know you have the flash drives in your uh packets nami san antonio is a hugely hugely important resource for san antonio for anybody with mental health needs adult or child they have all kinds of educational classes that are free all around the city they're bilingual they're just a great resource center for healthcare services there we are our mental health authority and us of course and there are some other places too there's lots of places on the web check out our website we're going to be launching some new stuff probably the first of the year that are going to be very high touch lots of apps social media you can like us on facebook and check us out come by for a tour if you ever want to know where we are and what we do here's some other the other resources and the health collaborative by all means they will hook you up all right any questions awesome thank you guys