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Communication Environment & Mental Health

Issues Specific to the Communication Environment

• At intake, a survivor discloses that she has been diagnosed with Bi-Polar Disorder.  The provider begins asking questions specific to her mental health status, including what types of medication she is taking and which doctor she is seeing.  When the survivor explains that she has not been on her medication for several weeks and that she does not have a regular doctor, the provider determines that she will need to be assessed by a clinician prior to receiving services for domestic violence. 
• During a counseling session, a survivor changes the details about what happened to her several times.  The advocate, knowing her mental health status, begins to think that the assault the survivor describes is a product of her mental health condition.  When the advocate asks the survivor if she is sure about the assault, the survivor feels disbelieved and invalidated.  She does not return for services in the future.
• A survivor living in a domestic violence shelter will shout loudly at herself while preparing dinner.  The other residents report this behavior to the staff, explaining that it is frightening and reminds them of the abusive environment they just left.  The staff determines that the survivor is disrupting the shelter community and give her a written warning.

• A fifty-seven year old survivor who has been recently homeless, was attacked by an unknown assailant at night in a town park. While in a domestic violence shelter, she seeks out staff daily to report that she hears other survivors plotting to hurt her and throw her out of the house. She avoids contact with other residents and glares at them if she finds them looking at her.

Suggested Solutions

• Equal access to safety for a woman with a psychiatric condition means equal access to the trust and good will of staff and volunteers. Given the likelihood of negative experiences that many women with mental health conditions have lived through, a clear and repeated communication of support and trust can be central to her safety and recovery.
• Jane Doe, Inc. addresses the needs of survivors who have experienced significant treatment during their life for psychiatric conditions. Survivors can have issues with authority that will range from total compliance to irritable outbursts. In order for a survivor to feel that she is the authority in setting her course for the future, it requires that the staff member or volunteer be extra attentive to communicating that the survivor is the authority. Body language, eye contact, using common language, and talking about roles can help.
• If a survivor expresses anger, trust that her anger might be general to treatment providers. Individually, a woman might have lasting consequences from a bad relationship with a service provider. It may take extra time to build trust. In some sense, you may have to make up for past service relationships for her to reach self-determination.
• When a survivor approaches staff with fears that seem paranoid or irrational, offer gentle but firm reassurance while refocusing her attention to safety planning and recovery. Acknowledge how frightening these thoughts must be and ask how she has managed them before. Let her know that you are willing to take a few minutes each day to reassure her.
• The survivor may have trouble focusing or have tangential thoughts. Jane Doe, Inc. recommends being patient and to keep rephrasing questions, all the while offering reminders to the subject. Let her know that you are trying to keep the discussion structured or on topic. She may know that others have to guide the conversation to help her stay on topic.
• Build in extra time for listening to people who require it so that they can function effectively in your programs. Compassionate volunteers who are willing to listen despite the survivor’s neediness for one-on-one time, lessen the burden on staff to provide support. Supportive listening goes a long way. What any woman needs who uses unfamiliar coping mechanisms is to be heard and not judged, criticized, or blamed for her perceptions. Women with differences in mental and emotional functions often just need another to listen. Differences in ability are treated as normal rather than becoming markers for discriminating what staff and volunteers or other survivors can handle.
• Listening and reassuring support regardless of your perceptions of her will help the survivor to recognize the validity of her own experiences. Seeing through her confusion, possible medication side effects, individual patterns of coping, and displaying trust are of enormous value to a person who may have been discredited in the past.  

Medication Side Effects

• Medication side effects can lead to confused speech and communication. You may need to give a person more time to communicate. She may have moments of being unable to speak which increases her vulnerability. When traumatized, a person with a previously mild condition may experience a significant exacerbation of symptoms. She may weigh the costs of dealing with medication side effects versus living with symptoms.
• Other medication side effects may lead to difficulty accessing aspects of her memory. Jane Doe, Inc. recommends if trying to figure out the order of events is difficult, you may use cues to help determine the order of events – find out her daily routines, sunlight patterns, TV patterns, internet habits, cooking patterns, that have times of day associated with them. These may trigger her memory for when certain things occurred.
• A person may require a glass of water at their side to speak, or need any written material read to them. Medication side effects of strong psychiatric drugs include :
  • acute dystonia (muscle spasms, especially the eye, neck or trunk)
  • stiffness, shakiness or restlessness
  • drowsiness or faintness
  • dry mouth
  • blurred vision
  • tardive dyskinesia (involuntary twitches in the face, limbs, or trunk)
• See the Understanding Welcoming Environments section on the Information Environment for universal design ideas to facilitate the communication of visual and textual information for people with visual limitations.

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