Leonard Theological College

Subject: Crisis Counselling

Topic: Unit VI – Caring for People with Emotional and Mental Disturbances and their
Families.
Submitted to: Rev. Dr. Percis Peter
Submitted by: Victor James
Introduction:
Caring for individuals with emotional and mental disturbances, as well as their families, is a
critical aspect of mental health support. Understanding the elementary diagnostic skills
required to identify and refer individuals in need of psychiatric help is essential for providing
timely and effective intervention. Additionally, offering care and counseling to family members
of the mentally challenged is crucial in creating a supportive environment that fosters healing
and resilience. The exploration of these key areas in mental health care, emphasizing the
importance of holistic support for both individuals facing mental health challenges and their
families are important.
1. Importance of Caring for Individuals with Emotional and Mental Disturbances
and Their Families:
Family caregivers play an essential role in the day-to-day care of individuals with mental
illness, monitoring their mental state, identifying early signs of illness, and preventing relapses.
Studies highlight that caring for family members with mental health issues can lead to social
isolation and financial challenges for caregivers, underscoring the need for support systems.
Being a caregiver for someone with a mental illness can be emotionally and physically
demanding but also rewarding, emphasizing the importance of recognizing and addressing the
needs of caregivers.1
2. Types of Mental Illness2
2.1.Neurodevelopmental disorders:
This class covers a wide range of problems that usually begin in infancy or childhood, often
before the child begins grade school. Examples include autism spectrum disorder, attention-
deficit/hyperactivity disorder (ADHD) and learning disorders.
2.2.Schizophrenia spectrum and other psychotic disorders:
Psychotic disorders cause detachment from reality — such as delusions, hallucinations, and
disorganized thinking and speech. The most notable example is schizophrenia, although other
classes of disorders can be associated with detachment from reality at times.
2.3.Bipolar and related disorders:
This class includes disorders with alternating episodes of mania — periods of excessive
activity, energy and excitement — and depression.

1
Dr. Larry E. “Webb, Crisis Counselling in the congregation”, (Nashville: Abingdon Press, 2011), 229.
2
Mayo Clinic, Mental Illness, https://www.mayoclinic.org/diseases-conditions/mental-illness/diagnosis-
treatment/drc-20374974, accessed on 06th March, 2024.
 2.4.Depressive disorders:
These include disorders that affect how you feel emotionally, such as the level of sadness and
happiness, and they can disrupt your ability to function. Examples include major depressive
disorder and premenstrual dysphoric disorder.
2.5.Anxiety disorders:
Anxiety is an emotion characterized by the anticipation of future danger or misfortune, along
with excessive worrying. It can include behavior aimed at avoiding situations that cause
anxiety. This class includes generalized anxiety disorder, panic disorder and phobias.
2.6.Obsessive-compulsive and related disorders:
These disorders involve preoccupations or obsessions and repetitive thoughts and actions.
Examples include obsessive-compulsive disorder, hoarding disorder and hair-pulling disorder
(trichotillomania).
2.7.Trauma- and stressor-related disorders:
These are adjustment disorders in which a person has trouble coping during or after a stressful
life event. Examples include post-traumatic stress disorder (PTSD) and acute stress disorder.
2.8.Dissociative disorders:
These are disorders in which your sense of self is disrupted, such as with dissociative identity
disorder and dissociative amnesia.
2.9.Somatic symptom and related disorders:
A person with one of these disorders may have physical symptoms that cause major emotional
distress and problems functioning. There may or may not be another diagnosed medical
condition associated with these symptoms, but the reaction to the symptoms is not normal. The
disorders include somatic symptom disorder, illness anxiety disorder and factitious disorder.
3. Elementary Diagnostic Skills in Identifying and Referring Persons Who Need
Psychiatric Help3
Significance of Elementary Diagnostic Skills in Identifying and Referring Persons Who
Need Psychiatric Help:
Family engagement is crucial in managing patients with mental illness in primary care settings,
highlighting the importance of involving families in the treatment process. Recognizing signs
of emotional crisis and knowing when to seek professional help is essential in providing timely
support to individuals facing mental health challenges.

3
Tammi D. Kolski, Michael Avriette, Arthur E. Jongsma Jr., “The Traumatic Events Treatment Planner”, (Canada:
ISBN, 2001), 37-117.
 3.1. Gathering Information: Mental health professionals use a detailed interview to
find out the person's main concerns, including their symptoms and life history. The diagnostic
interview is a fundamental component of mental health assessment, where mental health
professionals engage in a detailed conversation with individuals to gather crucial information
about their concerns, symptoms, and life history. This structured process allows clinicians to
assess, diagnose, and develop tailored treatment plans effectively. Through the interview,
patients are encouraged to articulate their main issues, providing insights into the onset, course,
and duration of their symptoms. Additionally, inquiries about past psychiatric history,
substance use, medical background, social context, and mental status are made to form a
comprehensive understanding of the individual's mental health. By utilizing a systematic
approach and targeted questioning, mental health professionals can accurately diagnose mental
health disorders and formulate biopsychosocial perspectives that guide personalized
interventions for those in need of psychiatric help.
3.2. Observation: Observing behavior and emotional expression is essential in
understanding the client's mental state. Observing behavior and emotional expression is a
critical aspect of understanding a client's mental state during a psychiatric evaluation. Mental
health professionals assess the client's emotional state by observing their facial expressions,
body language, and overall demeanor. This observation helps in evaluating the client's
emotional range, intensity, stability, and appropriateness of their emotional responses.
Additionally, behavior observation includes noting any unusual or inappropriate actions such
as restlessness, agitation, or peculiar clothing choices, which can provide valuable insights into
the client's mental well-being. By keenly observing these behavioral and emotional cues,
mental health professionals can gain a deeper understanding of the client's mental state and
tailor interventions effectively to address their needs.
3.3. Assessment Tools: Psychological tests or questionnaires can provide valuable
information about the client's mental health. Psychological assessment measures are designed
to assist clinicians in practicing effectively by providing structured methods to evaluate mental
health and well-being. These tools include screening measures that are quick to administer and
provide indicative results, which can be followed up by more definitive tests if necessary.
Additionally, diagnostic assessment measures support clinicians in making formal diagnoses
of mental health problems by utilizing semi-structured diagnostic items in self-report measures
that align closely with diagnostic criteria.
3.4. Formulating a Diagnosis: The mental health professional begins to formulate the
principal diagnosis, which is the most relevant diagnosis for the individual's chief complaint or
need for treatment. Formulating a diagnosis in mental health involves collecting pertinent
information through interviews and assessments, then analyzing it to determine the primary
diagnosis, often accompanied by considering alternative diagnoses. This process, guided by
the Biopsychosocial Model, incorporates biological, psychological, and social factors. A well-
developed diagnosis facilitates the creation of a tailored treatment plan, addressing the
individual's specific needs comprehensively. This approach allows mental health professionals
to understand the intricate factors contributing to the individual's condition, thus guiding
effective interventions.
3.5. Differential Diagnosis: Two different diagnoses can be attached to a patient who
is exhibiting symptoms that could fit into either diagnosis. Differential diagnosis is a critical
process in mental health assessment where mental health professionals consider multiple
potential diagnoses for a patient presenting with symptoms that could fit into more than one
condition. This method helps rule out alternative causes and ensures the accurate identification
of the primary mental health disorder. By carefully evaluating the patient's symptoms, history,
and possible contributing factors such as substance use or underlying medical conditions,
clinicians can differentiate between various mental health conditions and determine the most
appropriate diagnosis. Through this thorough assessment, mental health professionals can
develop tailored treatment plans that address the specific needs of the individual, leading to
more effective interventions and improved outcomes in mental health care.
3.6. Consideration of Cultural Factors: Cultural formulation interviews and cultural
consultation with interpreters and cultural brokers can help contextualize diagnostic
assessment. Considering cultural factors is essential in mental health assessment and treatment,
as they significantly influence patients' experiences. Mental health professionals must be
culturally sensitive, acknowledging aspects like age, gender, race, ethnicity, and religious
beliefs. Cultural formulation interviews and collaboration with interpreters aid in
contextualizing assessments, fostering effective communication. This awareness helps
clinicians avoid cultural bias, ensuring accurate diagnoses and appropriate treatment
modalities. Ultimately, understanding cultural differences enhances clinicians' ability to
provide culturally competent and effective care, leading to improved treatment outcomes for
patients.
3.7. Clinical Formulation: A clinical formulation, also known as case formulation or
case conceptualization, offers a hypothesis about the cause and nature of the presenting
problems. A clinical formulation, also known as a case conceptualization, provides a hypothesis
regarding the origin and nature of the issues identified during a clinical assessment. It
synthesizes information from the assessment, including background history and presenting
concerns, to explain the development and progression of symptoms over time. Unlike
psychiatric diagnosis, which is more categorical, clinical formulations offer a theoretical
framework for treatment planning based on a comprehensive understanding of the individual's
circumstances. They help clinicians communicate hypotheses about the causes and maintaining
factors of psychological problems and guide personalized interventions to address them
effectively.
3.8. Timely Referral: Referral to psychiatric services is crucial for appropriate
intervention and support. Referring individuals to psychiatric services promptly is crucial for
improving mental health outcomes. Delayed referrals have been linked to longer hospital stays,
underscoring the significance of timely access to care. Factors influencing referral timing
include the presence of psychosis and substance misuse, which correlate with prompt care.
Early consultations with psychiatric services lead to shorter hospital stays, emphasizing the
positive impact of timely referrals. Initiatives like telepsychiatry programs address professional
shortages, improving access to care and enhancing patient outcomes. Timely referrals are vital
for providing timely mental health support and reducing healthcare system burdens.
 4. Care and Counseling for the Family Members of the Mentally Challenged:4
4.1. Challenges of the family members:
The challenges faced by family caregivers of individuals with mental health illnesses are
extensively documented in the literature. These caregivers are at a heightened risk of
experiencing physical, psychological, and social burdens while providing care. Research
indicates that caring for family members with mental health conditions can lead to social
isolation, financial strain, limitations in employment opportunities, and a range of negative
emotions including anger, frustration, and helplessness.
Moreover, caregivers may also experience adverse effects on their health and overall wellbeing,
including reduced life expectancy, diminished life skills, and decreased participation in leisure
activities. Despite previous research highlighting the potential challenges and benefits of
caregiving in this context, there appears to be a lack of a comprehensive overview and synthesis
of the literature.
This gap is concerning as it hinders efforts to fully understand the unique challenges faced by
family caregivers and identify sources of support and assistance to address their needs
effectively. The present study aims to bridge this gap by reviewing empirical studies and
scientific evidence to provide a comprehensive understanding of both the challenges and
positive aspects of caregiving within the family context. By doing so, this study seeks to inform
strategies and interventions that can better support family caregivers in their important role.
4.2. Importance of Providing Care and Counseling for Family Members of the
Mentally Challenged:
The research at Oxford Health Promotion International indicates that caring for family
members with mental health issues can significantly impact the wellbeing of the caregivers,
with both positive and negative effects observed. However, a comprehensive overview of
literature comparing and contrasting these effects is currently lacking. To address this gap, this
scoping review examines how family caregiving influences the wellbeing of the caregivers.
Using a Boolean search, 92 relevant articles were identified for analysis. The findings suggest
that understanding the effects of family caregiving on caregivers’ mental and physical
wellbeing requires considering situational and sociodemographic factors. Specifically, elderly,
female, spousal, and primary caregivers may be particularly vulnerable to experiencing
negative effects on their wellbeing due to the demands of caregiving.
However, certain factors such as extraversion, social support, and religious or spiritual beliefs
can mitigate the negative effects of caregiving. This indicates that future interventions aimed
at promoting caregivers' wellbeing should consider individual personality traits, specific
circumstances, as well as cultural and personal beliefs.
While counseling family members of individuals with mental health challenges, various
techniques can be employed to provide support and promote understanding within the family
unit. Psychoeducation serves as a foundational technique, offering valuable information about
mental health conditions and treatment options to enhance family members' knowledge and
coping strategies. Couples therapy can help address relationship dynamics and communication

4
Elsie Jones-Smith, The Thories of Counselling and Psychotherapy”, (USA: SAGE Publication, 2001), 55-59.
issues that may impact the family's well-being. Intergenerational family therapy delves into
generational influences on behavior and relationships, fostering insight and promoting
healthier interactions. Narrative therapy encourages individuals to construct a cohesive life
story to better comprehend their experiences and roles within the family system. Family
systems therapy focuses on restructuring relationships and communication patterns to improve
overall family dynamics. These techniques, among others like structural therapy, Bowenian
family therapy, and solution-focused brief therapy, aim to empower families with the tools and
skills needed to navigate the complexities of supporting a loved one with mental health
challenges effectively. By utilizing a combination of these techniques tailored to the family's
unique needs, counselors can facilitate healing, understanding, and resilience within the
familial support network.
While caregiving can have both positive and negative effects on caregivers' wellbeing,
understanding the nuanced interplay of various factors is crucial for developing effective
interventions to support caregivers in their role.
Conclusion
While concluding the scoping review underscores that family caregivers of individuals with
mental health conditions face various challenges influenced by situational and
sociodemographic factors. These challenges include physical, psychological, and social
burdens, such as social isolation, financial strain, and negative emotions like anger and
helplessness. However, the review also recognizes potential positive outcomes of caregiving,
such as personal growth and resilience. Various interventions, including psychoeducation and
family therapy, aim to support caregivers in managing these challenges and strengthen family
dynamics. Overall, the review emphasizes the importance of understanding and addressing the
multifaceted needs of family caregivers to promote their wellbeing.

Bibliography
Dr. Larry E. “Webb, Crisis Counselling in the congregation”, (Nashville: Abingdon Press,
2011), 229.
Kolski, Tammi D. Avriette, Michael, Jongsma Jr. Arthur E. “The Traumatic Events Treatment
Planner”, (Canada: ISBN, 2001).
Smith, Elsie Jones. “The Theories of Counselling and Psychotherapy”, (USA: SAGE
Publication, 2001).

Webliography
Mayo Clinic, Mental Illness, https://www.mayoclinic.org/diseases-conditions/mental-
illness/diagnosis-treatment/drc-20374974, accessed on 06th March, 2024.