Tony Mantor: Why Not Me ?
Embracing Autism/Mental Health Worldwide
Autism is a complex neurodevelopmental condition affecting millions worldwide, characterized by challenges in social interaction, communication, and repetitive behaviors.
Despite increasing recognition, there remains a lack of understanding and awareness about the condition.
Mental health encompasses a range of conditions impacting emotional, psychological, and social well-being, affecting millions globally.
It includes disorders like anxiety, depression, bipolar disorder, schizophrenia, and psychosis.
Schizophrenia is marked by symptoms such as hallucinations, delusions, and disorganized thinking, while psychosis involves a loss of contact with reality, often presenting with similar symptoms.
Despite growing awareness, stigma and misconceptions about mental health, particularly schizophrenia and psychosis, persist, underscoring the need for greater understanding and support.
From celebrating neurodiversity to breaking down stigma, we create a safe space for listeners to learn, grow, and feel seen.
Whether you're on the spectrum, a caregiver, or an advocate, join our global community for inspiring conversations and empowering resources that uplift and unite.
Tune in to embrace understanding, healing, and hope worldwide!
Together, we can create a more informed and compassionate society for individuals with Autism and Mental Illness.
Tony Mantor: Why Not Me ?
Lynn Nanos: Navigating Psychosis: A Mobile Crisis Worker's Perspective
Lynn Nanos, a mobile psychiatric emergency social worker with 15+ years experience, shares insights on evaluating and helping people with serious mental illness in crisis situations.
Her work bridges the gap between law enforcement and mental healthcare, providing crucial interventions for individuals experiencing psychosis and other mental health emergencies.
• Conducts psychiatric evaluations in various settings including homes, police stations, nursing homes, and even public spaces
• Assesses whether individuals need hospitalization or can be referred to outpatient treatment
• Works with police to divert people from the criminal justice system when possible
• Explains the "revolving door" problem with brief hospital stays leading to recurring crises
• Advocates for Assisted Outpatient Treatment (AOT) to reduce homelessness, hospitalization, and incarceration
• Discusses anosognosia (lack of awareness of illness) affecting up to 97% of untreated schizophrenia patients
• Clarifies that most people with mental illness are not violent and are more likely to be victims
• Highlights the difference between psychosis and borderline personality disorder interventions
• Emphasizes that mental illnesses are brain disorders that shouldn't be stigmatized
Contact us at TonyMantor.com if you would like to share your story on our show. T
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intro/outro music bed written by T. Wild
Why Not Me the World music published by Mantor Music (BMI)
Welcome to why Not Me? The World Podcast, hosted by Tony Mantor, broadcasting from Music City, usa, nashville, tennessee. Join us as our guests tell us their stories. Some will make you laugh, some will make you cry. Their stories Some will make you laugh, some will make you cry. Real life people who will inspire and show that you are not alone in this world. Hopefully, you gain more awareness, acceptance and a better understanding for autism Around the World. Hi, I'm Tony Mantor. Welcome to why Not Me? The World Humanity Over Handcuffs the Silent Crisis special event. Joining us today is Lynn Nanos. She is an LICSW, she has done this for most of her life and she is very passionate about helping people with serious mental illness, especially those involving psychosis. She brings a wealth of experience from her work on a mobile crisis unit in Massachusetts. She's here to share insights on collaborating with law enforcement, navigating complex cases and diagnosing a diverse range of individuals in crisis. Her expertise offers a unique perspective on mental health intervention and we're incredibly grateful for her time and knowledge. Thanks for coming on.
Speaker 2:I'm glad to be here.
Speaker 1:Yes, it's great to have you on If you could tell us a little bit about what it is that you do.
Speaker 2:So I am a mobile psychiatric emergency social worker in Massachusetts. I am in 15th year of full-time work and previously I worked for another emergency services agency for two years. So all in all, that's many years of doing mobile crisis work, in which I assess people who are in crisis and determine whether they need to be hospitalized, and if they don't need to be hospitalized, I can refer them to outpatient treatment programs or give them self-help material. I'm an LICSW which is Licensed Independent Clinical Social Worker, and that gives me the ability to authorize involuntary transfers to the hospital for people who are unsafe.
Speaker 1:Do you work with the police alongside them or, lots of times, do you work without them?
Speaker 2:Some cases involve referrals from police officers and other cases don't involve the police, so it really varies.
Speaker 1:So, when you are involved with the police, what's the criteria for you to work with them so you can get everything you need under control and create a better situation for everyone involved?
Speaker 2:Well, I do a psychiatric evaluation with the police and I try to divert them away from the criminal justice system, from being arrested. I can authorize involuntary holds, which in Massachusetts is called a Section 12. And if the person in crisis is out of control and uncooperative and not willing to go to the hospital, the police can help to, along with me, persuade the person to agree to hospitalization. They use restraint as a last resort and I typically don't see people being restrained because we can usually persuade them to agree to the hospitalization, but occasionally they have to be forcibly restrained.
Speaker 1:So if it does get out of control, where they have to be restrained and they need medication, is that done there or at a different time?
Speaker 2:I don't have anything to do with medication. Have anything to do with medication. The medication occurs at the hospital setting like after they're transported to the hospital.
Speaker 1:Okay, that makes sense. So what led you to get into this business? It's not your everyday nine to five job that people think of, so what drew you to doing this profession?
Speaker 2:Well, I've always been most invigorated by helping the sickest of the sick, the people who are least functional. I really enjoy helping people. I always found it really, you know, tragically ironic that the people who are most sick seem to be the least helped by the government. They seem to be the most underserved, and this motivates me to want to help them, and so I've always felt most comfortable dealing with people who are very sick, with psychosis usually.
Speaker 1:I think that's great. So what's your first approach? When you first come onto the scene? How do you handle this with the person that you're going to be looking at and ultimately trying to help out? So what's the first thing that you do?
Speaker 2:Well, I begin with telling them that I want to get to know them a little bit, ask them a few questions to try to figure out how to best help them out. And I ask some background questions. And then, of course, there are the safety questions which are critical. There are questions involving history of past suicide attempts, history of hallucinations, whether the person is suicidal or having any thoughts of wanting to harm others. Right now I use my instinct and my gut a lot, because I've been doing this work for many years. I can tell if someone needs to be hospitalized, usually pretty quickly. Sometimes it takes longer than other times, but I think my instinct has been well-developed at this point so that I can determine pretty quickly if someone needs to be involuntarily transferred to the hospital or voluntarily hospitalized. They usually go voluntarily. So, like I said, seeing people being restrained and going against their will is not very common. I mean, it does happen.
Speaker 1:So if you're in a situation where someone just does not want to go to the hospital at all and you know they need help, they might be in a situation where they may not realize they need the help, but they do need the help. So what's your approach? How do you get them to settle down, calm down and get them to a point of where you can actually help them?
Speaker 2:Well, oftentimes I say that you know you're not acting like your true self, You're not yourself these days. Or I haven't said this often, but I have on occasion come right out and said you're not in touch with reality, You're not yourself, You're having a hard time taking care of yourself, and they've been down this road many times in the past. The presence of police officers and security guards usually just their presence is enough for them to cooperate.
Speaker 1:That's good. You kind of caught me off guard a little. I thought the presence of the police might be a little more intimidating for them, so that's really good that it worked out. Now, if you've seen a person a couple of times and you've gone through all these situations, how is that handled? Has that created a relationship, so to speak, with them, so they understand you and trust you?
Speaker 2:Yeah, definitely. There are a lot of people cycle in and out of emergency services, and so it's very common for me to be evaluating someone who I have previously evaluated before, because the lengths of stay on inpatient units are usually so short and there are so many premature discharges that patients inevitably fall back into poor self-care and crisis mode when they've been released from hospitals too soon. So we see the revolving door of hospitalizations. People repeatedly presenting themselves to emergency services is very common.
Speaker 1:So how do we fix that? I mean, you're in crisis mode sometimes when you go out to try and help these people. You get them to a facility. You see that it does help them, but then a week or two, a day or two or whatever the time frame may be, here they are back in front of you again. So what are your thoughts on how we can mend this system so you don't have to see these people on a continuous basis?
Speaker 2:Well, there's a tool that's widely underutilized in the United States called assisted outpatient treatment, and all states except for Connecticut and Massachusetts allow this, and Washington DC allows AOT as well.
Speaker 2:Aot is court-ordered outpatient treatment, especially critical for those with anosognosia, which means lack of awareness of being ill. We know that a very high percentage of people with schizophrenia spectrum disorders have anosognosia. A lot of people with bipolar disorder have anosognosia as well, and so when someone lacks insight, of course they're not going to initiate treatment or they're not going to want to get help, and so this anosognosia really interferes with treatment. And AOT oftentimes uses the black robe effect, which is people they're more likely to follow treatment plans and they're more likely to follow through with treatment when there's a judge ordering them to do the treatment because of the judge's power and influence, and that's called the black robe effect. And there have been lots of studies showing that AOT reduces rates of homelessness, hospitalization and incarcerations. It also prevents violence, prevents suicides. It's a tool that Massachusetts and Connecticut really need to adopt if we want to see a decrease in these horrible markers.
Speaker 1:Okay, you just brought up anosognosia. Can you explain that to the listeners so they can understand what it is compared to other serious mental illnesses?
Speaker 2:Well, psychosis involves the most anosognosia among the serious mental illnesses. I can usually tell if there's lack of insight or anosognosia involved when there's lack of adherence to taking medications and not attending outpatient appointments. These are some red flags and signs that there's some anosognosia going on, and a few studies have shown that the rate of anosognosia and schizophrenia spectrum disorders can be up to even 97% for those who are not treated.
Speaker 1:So if they're being treated, then that gives them the opportunity to lead a fulfilling life and it gets rid of all that noise that's going on in their head. Is that correct?
Speaker 2:Right, absolutely. They'll be able to have more organized thought process. Hallucinations will lessen, delusions will hopefully dissipate. As a result, less tragedy is likely to occur.
Speaker 1:So if Massachusetts was to get and pass AOT, that would help everything that you're trying to do, correct?
Speaker 2:Definitely it would decrease the revolving door, it would prevent tragedies from occurring and it would just overall improve the functioning of those with serious mental illness, especially those with psychosis. And when I say psychosis, psychosis can be medically caused, but I'm just referring to psychosis in the context of serious mental illness. So in other words, someone with dementia or even a brain tumor can have psychosis. For our purposes I'm referring to just serious mental illness, psychosis.
Speaker 1:Now, when you mention dementia, the first thing that comes to mind is the elderly. Now do you run into younger people have this, or is this mainly just for the older people?
Speaker 2:No, not as much. It typically affects the elderly, so I've rarely seen dementia affect someone who's younger.
Speaker 1:So do you get calls from people that are older, that's going through dementia? Is that something you have to deal with as well?
Speaker 2:Yes, absolutely so. As a mobile clinician, I can evaluate people in a wide variety of settings. Occasionally, nursing homes call us out to evaluate people. I can evaluate people in doctor's offices, police holding cells, police stations, personal homes, group homes. One time I evaluated someone on a street sidewalk. Another time I evaluated someone in the parking lot of a stop and shop.
Speaker 1:Now, when you evaluate them, you have so many things that it can be. I mean you've got psychosis, you've got dementia and all of the above that you just mentioned. You mean you've got psychosis, you've got dementia and all of the above that you just mentioned. You only get a limited amount of time. You haven't seen them that much. How do you diagnose in such a short period of time? I think it must be really tough. That's my opinion.
Speaker 2:Well, it's tough, it's very tough work. Even with my experience, I find these days the work is really tough and difficult and draining the diagnosis. You know we do our best with diagnosing but you know I'm sure I've made mistakes. The safety of patients is most important in emergency work, of patients is most important in emergency work. So, in other words, making sure that the client is safe and preventing danger or reducing danger is more important than getting the diagnosis correct in emergency services.
Speaker 1:Okay, you just brought up something that I think is very important. You just mentioned people with all the issues that they have that you just mentioned. So at the end of your workday, when you're trying to decompress, you're just trying to relax yourself. How does this affect you?
Speaker 2:Well, I think, naturally there is some desensitization which takes place because otherwise I wouldn't be able to function. There has to be some compartmentalization. That happens and I have to remind myself that whatever dysfunction I saw is a function of the broken system. I have to remind myself to not take responsibility for the negative outcomes that I see on a daily basis.
Speaker 1:Yeah, yeah for sure. I mean, I know a lot of police, a lot of EMTs, a lot of people that do everything on a daily basis and they see these people and there's always one or two that just get to you. You see them struggling, you see them trying. They're just having a rough time. So this is something you have to deal with on a daily basis and I just can't imagine having to do that all the time. So this is something you have to deal with on a daily basis and I just can't imagine having to do that all the time. It's tough.
Speaker 2:Yeah, yeah, definitely. So it's really important to take care of myself and cope well and process difficult cases with supervisors and my support system. I'm really lucky that I have some great colleagues, you know, who are really supportive and knowing when I need help. There's always an administrator on call. The program I work for never closes, so there are social workers like working even in the middle of the night, helping people in crisis, and there's always an administrator on call who is available to help or on call who's available to help.
Speaker 1:What's one of the more things that you would consider straightforward? I mean, you go in there, you look at the situation and you go okay, this isn't gonna be too bad. So what would you consider straightforward for the listeners? I mean, I think they can visualize the worst case scenarios. What's something that you look at and you go to yourself okay, this shouldn't be too much of a challenge?
Speaker 2:When someone is clearly suicidal with planned means intent, that is a very straightforward case. A lot of cases involving psychosis can be really tricky and involve a lot of gray areas, because there are varying degrees of psychosis and someone can be very psychotic with the ability to take care of herself and even have a job, clean herself, eat, sleep, do basic functions. And just because someone is psychotic doesn't necessarily mean that they qualify for hospitalization. Someone can be psychotic and very high functioning. A straightforward case would be if someone tells me that he has nothing to live for, there's nothing going on in his life that gives him hope or motivation to continue living, and he has a plan to hang himself and you know, go to Home Depot and buy the tools for it, and he knows exactly where he's going to do it, and that's a case that's like for lack of a better word easy.
Speaker 1:So how do you talk him down off that cliff? I mean, from what I understand, the ones that talking about about it are the ones that I'm not going to say less likely, but sometimes will not follow through, but the ones that don't talk about it much, they're the ones that might just go ahead and do it because they've kind of pre-planned it. So what do you do to help them, so that way you can talk them down off that cliff?
Speaker 2:Well, I think praising strengths is really important, so reminding them of some light, even though they're only seeing darkness, and making sure that the right questions are asked. I found that secretiveness when it comes to suicidality is a big red flag for me. So if someone is dodging my questions, someone is not answering me directly when I ask about the questions pertaining to suicide, then I get really concerned.
Speaker 1:What happens when you have some that are thinking about it? They don't follow through, but yet they're thinking about it. They go back and forth. Is that a situation to where you get concerned?
Speaker 2:That's very common with borderline personality disorder. People with borderline personality disorder have oftentimes chronic daily thoughts of suicide at baseline.
Speaker 1:Is that something that you deal with quite often?
Speaker 2:A lot. I deal with people with borderline far more often than with autism.
Speaker 1:When you're dealing with someone. That's borderline, that's not psychotic right.
Speaker 2:Borderline personality disorder doesn't involve psychosis. It involves a lot of superficial, self-injurious behavior.
Speaker 1:And you deal with that situation quite a bit.
Speaker 2:A lot yeah, yeah.
Speaker 1:How do you get across to them? I mean, they're talking about self-infliction, hurting themselves. How do you get them down off that cliff?
Speaker 2:It's really tough. It's really tough. I evaluated a young woman with borderline at a group home who was regularly inflicting superficial self-injuries her even though you know she didn't want to be hospitalized. But they wanted me to section 12 her because they were just so burned out by her frequent self-injurious behavior and they said that she's going to just continue harming herself superficially. And I responded with you know, unfortunately the law doesn't allow us to hospitalize people because we predict that they're going to superficially self-injure. There's a difference between superficially injuring oneself and seriously injuring oneself. So a lot of people with borderline personality disorder are at risk for accidentally killing themselves. You know, lacking intent to die, killing themselves, you know, lacking intent to die but engaging in suicidal gestures or overdoses on pills and then becoming fatal as a result.
Speaker 1:Is there a certain age group? This affects more than others. Is it older or is it more younger?
Speaker 2:We're generally not allowed to diagnose teenagers with borderline personality disorder because their personalities have not fully developed yet. But I've evaluated teenagers that show a lot of traits of borderline and I've evaluated them thinking oh well, she's definitely, they're definitely going to develop borderline as an adult, because I can see the signs early on. It's typically it's adults who are diagnosed with personality disorders. We're really not allowed to diagnose kids with personality disorders.
Speaker 1:That's the first time I've heard this kind of information, so that's kind of important for people to know and understand. What would you like to tell our listeners that you think is very important that they know and understand about what you do and what you're trying to do to help the people that need help?
Speaker 2:Well, my main goal is to reduce danger or prevent danger, and to get people to a safe space. Occasionally involves involuntarily transporting them to the hospital, and that's where police officers are necessary, because I'm not able to physically go hands on on anyone who violent and or who's very agitated, and so that's what police are for. So in the mental health system, the police were a necessary evil.
Speaker 1:Quote-unquote yeah, they are yeah yeah, police are there for a reason that's to help situations like that. They need to step up, for sure, because you need the help and the person there needs the help. Situations like that. They need to step up, for sure, because you need the help and the person there needs the help.
Speaker 2:Right, right, right. And, as I said, I have not often seen people being physically restrained. I mean, of course it does happen, it's the nature of the work that I do. But the police really use physical restraint as a last resort. They try everything else first.
Speaker 1:And there's so many different layers of things that it can be, unfortunately, people that don't know will clump them all in together, and the worst is part of that situation. So it's very important that people know the differences between everything so that the understanding is there for them to at least have a little empathy for them.
Speaker 2:Right and it's really important to understand and tell the audience that most people with mental illness are not violent and they're more likely to be victimized, but a small subset of the population with untreated serious mental illness, mostly involving psychosis, can be more violent.
Speaker 1:Right. One of the things that I have heard is the ones that are not violent can oftentimes be the victims, and many people think that they are creating victims when they really aren't.
Speaker 2:Yes, yeah.
Speaker 1:Yeah, it's a very tough subject. Not a lot of people want to do it because there's so much stigma attached to it. Then a lot of people don't want to talk about it for that same reason there's a lot of stigma attached to it.
Speaker 2:Yes, unfortunately there is still stigma associated with mental illness, but there really shouldn't be, because these are brain disorders and the brain is part of the physical body and it's organic. You know, these are brain-based disorders that really shouldn't be stigmatized.
Speaker 1:Yeah, unfortunately it's very sad. People that think about psychosis tend to go to the very worst case scenarios. The news media unfortunately carries a lot of the worst parts of it, where people kill somebody or something bad happens. But, as you said, a lot of people can actually thrive in life.
Speaker 2:Yeah, absolutely, with proper treatment.
Speaker 1:Yeah, Well, this has been great Great conversation, great information. I really appreciate you taking the time to come on.
Speaker 2:Oh, thank you, it was great being here.
Speaker 1:It's been my pleasure. Thanks again. Thanks for taking the time out of your busy schedule to listen to our show today. We hope that you enjoyed it as much as we enjoyed bringing it to you. We enjoyed it as much as we enjoyed bringing it to you. If you know anyone that would like to tell us their story, send them to TonyMantorcom Contact then they can give us their information so one day they may be a guest on our show. One more thing we ask tell everyone everywhere about why Not Me, the world, the conversations we're having and the inspiration our guests give to everyone everywhere that you are not alone in this world.