Follow through means never — or at least less frequently —having to say “we’re sorry” – Pete Linnett
We may never know what exactly caused or triggered Adam Lanza to shoot his mother, 26 other human beings and then himself. However one thing seems certain to have contributed to it.
“Mental health, alcohol or substance abuse intervention that stabilizes an individual in a psychiatric facility, or in patient alcohol or substance abuse program means little if the treatment necessary to return them to functioning in and with society doesn’t exist,” according to Pete Linnett.
Linnett is the Founder of the Life Adjustment Team (LAT) in Culver City, CA.
For more than 35 years LAT has been helping acutely stabilized psychiatric and alcohol and drug addicted patients move back to functionality.
In discussing the recent shootings at Sandy Hook, Linnett explained that there are three situations where intervention and then treatment focus can successfully prevent or dramatically decrease such tragedies.
- Family doesn’t know, patient doesn’t know they are sick.
- Family knows, patient doesn’t (or refuses to accept) they are sick.
- Family knows, patient knows they are sick.
Family doesn’t know, patient doesn’t know they are sick
Linnett explained, “There is a French term called, ‘folie à deux’ which means shared madness, in which case one or both people are mentally ill, but both deny it or both minimize it as in: ‘They’re just going through a phase,’ ‘All young adults are this way,’ ‘They’ll outgrow it,’ ‘Hormones.’ To deal with this, everyone needs to develop the habit of “noticing” and then be educated about what to notice.” The following are a helpful guide:
What to LOOK for:
- loss of temper on a daily basis
- frequent physical fighting
- significant vandalism or property damage
- increase in use of drugs or alcohol
- increase in risk-taking behavior
- detailed plans to commit acts of violence
- enjoying hurting animals
- carrying a weapon
- agitated movement—difficulty keeping still
- easily irritated—you walk on “eggshells” around him
- very impatient when having to wait in lines or wait to speak
- shifty eye movements—tends to look evasively to left or right as if hiding something, if looks downward this may be a sign of submissiveness, but may then incense him later on
- change in usual routines in terms of hobbies or exercises, etc.
- stays to self or starts associating with “marginal” people
- drawn to violent movies, newspaper stories, internet sites, television and radio shows
- less attention to hygiene
- paradoxical calmness in someone who has been agitated (may signal that has come up with a violent solution to his problems)
What to LISTEN for:
- announcing threats or plans for hurting others
- becomes defensive easily
- takes things personally that are not meant that way
- negative comments about most things
- complaining done with underlying agitation
- blaming—most of what he talks about is blaming someone or something
- sullen more than sulking—he can be silent in an intense way that doesn’t feel quiet, sulking means he’s getting some frustrations out
And if you notice the following signs over a period of time, the potential for violence exists:
- a history of violent or aggressive behavior
- serious drug or alcohol use
- gang membership or strong desire to be in a gang
- access to or fascination with weapons, especially guns
- threatening others regularly
- trouble controlling feelings like anger
- withdrawal from friends and usual activities
- feeling rejected or alone
- having been a victim of bullying
- poor school performance
- history of discipline problems or frequent run-ins with authority
- feeling constantly disrespected
- failing to acknowledge the feelings or rights of others
Family knows, patient doesn’t (or refuses to accept) they are sick
According to Wikipedia “Anosognosia is viewed as a deficit of self-awareness, a condition in which a person who suffers certain disability seems unaware of the existence of his or her disability.” And in some mental illness states such as schizophrenia, bipolar disorder and certain personality disorders the adamant denial or refusal to believe and accept that they have an illness is a symptom of the illness. Telling a person with anosognosia that they have an illness is often ineffective, when one of the symptoms of the that illness is refusing to believe they have anything wrong with them.
To deal with this, Linnett’s Master’s level or higher case managers at LAT use the LEAP method created by Dr. Xavier Amador. Dr. Amador is a psychologist who created it to effectively intervene with his brother who has schizophrenia and anosognosia and which is the subject of his book: I Am Not Sick, I Don’t Need Help! How to Help Someone with Mental Illness Accept Treatment. 10th Anniversary Edition.
Linnett explained that LEAP stands for:
- L = listen – after which the other person feels heard in an uninterrupted fashion
- E = empathize – after which the other person feels understood both intellectually and emotionally vs. misunderstood and worse, presumed upon
- A = agree – after which the other person feels that you have agreed with something they said (even if it’s not all that they have said) and fully agree with how they could come to feel the way they do and to have responded with the stance and position they have taken
- P = partner -after which the other person feels that you are partnering with them vs. fighting with them to push some initiative forward
Family knows, patient knows they are sick
The relapse rate for patients after being stabilized in a psychiatric facility or in patient alcohol or substance abuse program is very high. The reason for that is that when follow through is left up to patients and their families who are on their own recognizance and there is no plan for making it happen, follow through turns into falling through the cracks, becoming destabilized and then needing to be re-hospitalized or readmitted to an inpatient alcohol or substance abuse program. This revolving door is very costly in monetary and emotional terms to everyone it touches.
Linnett’s Life Adjustment Team provides that follow through by having highly trained Master’s level and above case managers go out to patients wherever they are staying after discharge and taking them to doctors’ appointments, training them in skills of daily living and financial budgeting and even participate in recreational activities with them. Their results although not the “complete cure” we would all like have greatly reduced the rate of relapse by as much as 80 % in a wide range of patients.
Linnett summed it up when he said, “We hold their hands until we can hand them back their lives.”