JSSA CLERGY TRAINING SERIES

PRESENTS . . .

MITZRAYIM & MENTAL HEALTH:

A WORKSHOP FOR CLERGY Presenters:

Heidi Cohen, LCSW-C - Child and Family

Leslie Kessler, LCSW-C - Senior Services / Jewish Community Outreach / Synagogue Liaison

Orly Zimmerman-Leizerov - Child and Family / Synagogue Liaison

Moderators:

Rabbi James Kahn – Director of Chaplaincy & Jewish Engagement

Natalie Merkur Rose, LCSW-C, LICSW - Director, Jewish Community Outreach

For the best in child, family and senior services . . . Think JSSA

Jewish Social Service Agency • 301-610-8395 • www.jssa.org

MITZRAYIM & MENTAL HEALTH:

WORKSHOP FOR CLERGY

TABLE OF CONTENTS

GENERAL RESOURCES

- THINK JSSA COUNSELING WHEN . . .

- LOCAL RESOURCES – MD, DC, NOVA

- ORGANIZATIONS, RESEARCH, BOOKS, ARTICLES & TOOLS

- GENERAL FACT SHEET ON MENTAL ILLNESS

- MENTAL ILLNESS IN CHILDREN

- MENTAL ILLNESS IN OLDER ADULTS – THE FOUR QUESTIONS

JEWISH RESOURCES

- JEWISH ORGANIZATIONS

- 13 STEPS CONGREGATIONS ARE TAKING TO RESPOND TO MENTAL HEALTH NEEDS IN THE

COMMUNITY

- THE ROLE OF JEWISH CLERGY IN THE SPIRITUAL CARE OF PEOPLE LIVING WITH MENTAL ILLNESS

- A PRAYER OF HEALING FOR MENTAL ILLNESS

- 10 THINGS JEWISH CLERGY AND LAY LEADERS CAN DO TO REACH OUT

PRACTICAL TOOLS

- A JEWISH CLERGY’S GUIDE TO SUICIDE ASSESSMENT AND PREVENTION

- CLERGY CONGREGANT “NO HARM BRIT”

- ADDRESSING THE NEEDS OF FAMILIES

- ADVICE ON REACHING OUT TO THE MENTALLY ILL

Think JSSA Counseling When Encountering Issues of . . . Abuse

Addiction

Adjusting to change

Aggression \ Anger

Aging

Anxiety

Bullying

Commitment issues

Communication

problems

Conflict resolution

Decision-making

Defiant behavior

Depression

Divorce

Employment changes

Family problems

Feelings of panic,

paranoia, rejection

Financial concerns

Food issues

Forgiveness

Grief, loss and

bereavement

Hoarding

Identity issues

Infidelity

Impulsiveness

Intellectual disability

Intimacy/trust

Learning difficulties

Life-limiting illness

Marital conflict

Parenting

Premarital counseling

Self-harm

Social anxiety

Stress

Values clarification

When faced with any of these challenges . . . Think JSSA Counseling. JSSA’s staff of clinical social workers, care managers, psychologists and psychiatrists develop

individualized programs that coordinates a variety of assessment, treatment and support

services specific to an individual or family’s needs. For more information or to schedule an

appointment, please call 301.816.2633 in Maryland or 703.896.7918 in Northern Virginia.

For the best in child, family and senior services . . . Think JSSA

Jewish Social Service Agency • 301-610-8395 • www.jssa.org

301-816-2633

703-896-7918

contactus@jssa.org

LOCAL RESOURCES

JSSA – Jewish Social Service Agency – Wide range of mental health resources and treatments available. Call: 301-816-2633

(Maryland) or 703-896-7918 (Virginia); Email: contactus@jssa.org Family Member Hoarding Support – Beth Shapiro, 301.816.2665 or bshapiro@jssa.org Suicide Grief Support Program – Counseling; Support group for those who have lost a

loved one to suicide. Pre-registration required. Ellen Lebedow, LCSW-C, 301.816.2708 or elebedow@jssa.org

NAMI’s General 24/7 Helpline – 1.800.950.NAMI (6264)

Parents of Young Adults who Struggle – Monthly support group located at Temple Sinai (3100 Military Road, N.W., Washington, DC). Group meets the last Wednesday of every month at 7:30pm. Contact: Nancy Wolf - nlwolf74@gmail.com

NORTHERN VIRGINIA EMERGENCY RESOURCES Child Protective Services (CPS) State Hotline: 800-552-7096

Adult Protective Services (APS) State Hotline: 888-832-3858

NOVA Mental Health Resources by county:

Fairfax County Child Protective Services (CPS) 703-324-7400 (24 hours) Adult Protective Services (APS) 703-324-7450 (24 hours) Community Services Board Emergency Services 703-573-5679, TTY 703-207-7737 (24 hours) For people in crisis with a mental health, intellectual disability or alcohol or other drug emergency. Services include crisis intervention and stabilization, and evaluation for referrals to crisis care facilities, emergency shelters, and hospitals.

City of Alexandria: Child Protective Services (CPS) 703.746.5800 Adult Protective Services: 703.746-5778 24-Hour Emergency Mental Health Services 703.746.3401 24-hour intervention for persons experiencing a mental health or substance abuse-related crisis.

Arlington County: Child Protective Services (CPS) 703.228.1500 Adult Protective Services (APS) 703.228.1700 Mental health Emergency Services 703.228.5160 24 hours Emergency Line: 703.228.4256

Loudoun County: Child Protective Services (CPS) 703.771.5437 Adult Protective Services (APS) 703.777.0353 (after hours hotline is 703.777.0445) Loudoun County department of Mental Health, 24-hours crisis intervention: 703.777.0320

MARYLAND EMERGENCY RESOURCES MD’s Mental Health Mobile Crisis Team Numbers by county:

Anne Arundel: 410.768.5522

Baltimore City:

Adult 410.433.5255

Child/Adolescent 410.433.5175

Baltimore County: 410.931.2214

Frederick: 301.662.2255

Harford: 410.638.5248

Howard: 410.531.6677

Montgomery: 240.777.4000

Prince George’s: 301.927.4500

Eastern Shore: 1.888.407.8018

NAMI Maryland

10630 Little Patuxent Pkwy, Suite 475 Columbia, MD 21044; 410.884.8691;

1.877.878.2371

info@namimd.org; www.namimd.org

DC EMERGENCY RESOURCES DC Department of Mental Health's Mobile Crisis Unit - 202.673.9300 (9 AM - 1 AM)

DC Department of Mental Health's 24 hour Help Line - 1.888.793.4357.

**If you call 911 say that you have a mental health crisis and need a "Crisis Intervention

Officer". All DC Police districts have officers especially trained to help with mental health

emergencies.

NAMI DC

422 8th St SE, 2nd Floor, Washington, DC 20003, 202.546.0646; namidc@juno.com

ORGANIZATIONS, RESEARCH, BOOKS, ARTICLES & TOOLS ORGANIZATIONS THAT PROVIDE MENTAL HEALTH SUPPORT/INFO TO YOUNG ADULTS:

www.activeminds.org - has advocacy/awareness chapters on 400 plus U.S. campuses;

founded by a young woman from Potomac, Maryland.

www.nami.org - National Alliance on Mental Illness; has campus-based support groups

called "NAMI on Campus" at colleges near cities with NAMI chapters

www.jedfoundation.org - a group founded in 2000 by parents of a young man who

committed suicide; goal is to provide emotional health and prevent suicide among

college and graduate students

www.yourbridgeforward.com - local company providing advice, information & resources to

parents of young adults with mental health issues

ORGANIZATIONS THAT PROVIDE MENTAL HEALTH SUPPORT/INFO FOR PARENTS AND FAMILIES: www.nami.org - grassroots organization with local chapters, family to family and peer to

peer training, 24/7 Help Line 1.800.950.6264, Education training, missing person

support, legal support.

www.balancedmind.org - info and support for families of children and teens with bipolar

disorder

www.dbsalliance.org - depression and bipolar national organization; has online info and

support; also local support groups including one that meets in Rockville/.Bethesda.

www.sardaa.org - national organization for persons with schizophrenia and related diseases

that include psychotic components. Has online info and weekly peer and family support

calls.

www.healthyplace.com - a general website with mental health info, groups, blogs.

MEDICAL INFO/RESEARCH ON ALL MENTAL ILLNESSES: www.nimh.nih.gov - look up by topic, name of illness, funds and conducts clinical trials.

www.bbrfoundation.org - private foundation that funds scientists conducting mental health

research; looking towards treatment and cures. Has very good web site with info on all

mental illnesses.

www.nimh.nih.gov - look up by topic, name of illness, funds and conducts clinical trials.

www.bbrfoundation.org - private foundation that funds scientists conducting mental health

research; looking towards treatment and cures. Has very good web site with info on all

mental illnesses.

NAMI’S FACT SHEET ON MENTAL ILLNESS: Bipoloar Disorder - http://www.nami.org/factsheets/bipolardisorder_factsheet.pdf

Schizophrenia - http://www.nami.org/factsheets/schizophrenia_factsheet.pdf

Borderline Personality Disorder - http://www.nami.org/factsheets/bpd_factsheet.pdf

Depression – http://www.nami.org/factsheets/depression_factsheet.pdf

Anxiety Disorders - http://www.nami.org/factsheets/anxietydisorders_factsheet.pdf

ORGANIZATIONS, RESEARCH, BOOKS, ARTICLES & TOOLS (continued)

SUGGESTED BOOKS: "The Burden of Sympathy" by David Karp

Helping families cope with mental illness (the classic, published in 2000). (I did not cause it, I can't cure it, I can't control it. All I can do is learn to cope.)

"I am not sick, I don't need your help. How to Help Someone with Mental Illness Accept Treatment"

by Xavier Amador (his LEAP method - listen, empathize, agree, partner). Particularly for people who have a family member who lacks insight or awareness of his/her mental illness.

"The Family Guide to Mental Health Care" by Lloyd Sederer M.D.

A good intro (and more) guide for both clergy and families. Maybe one clergy want to keep on their bookshelf to recommend to families.

“Caring for the Soul: R’fuat HaNefesh—A Mental Health Resource & Study Guide”

A study guide by Rabbi Richard F. Address, written for congregations to raise awareness and combat the stigma surrounding mental illness for those who are ill and their families.

RECOMMENDED ARTICLES:

U.S. News & World Report article on assisting college students who have mental illness. http://www.usnews.com/education/articles/2014/03/26/learn-how-to-deal-with-mental-illness-in-college My Take: How churches can respond to mental illness by By Ed Stetzer, Special to CNN http://religion.blogs.cnn.com/2013/04/07/my-take-how-churches-can-respond-to-mental-illness/ A fresh perspective on mental health first aid by Rich Kinsey www.mlive.com/news/ann-arbor/index.ssf/2013/10/rich_kinsey_column_mental_heal.html Rabbi shares her experience with depression by Rabbi Ruth Adar http://coffeeshoprabbi.com/2013/09/11/yom-kippur-and-depression/

HELPFUL TOOLS:

3 minute on-line test for depression, anxiety, bipolar disorder and PTSD http://whatsmym3.com/Default.aspx Mental Health Ministry: A Toolkit for Congregations http://www.pathways2promise.org/summit-2009/02.pdf

Numbers of Americans Affected by Mental Illness

One in four adults − approximately 61.5 million Americans−experiences mental illness in a given year. One in 17 − about 13.6 million − live with a serious mental illness such as schizophrenia, major depression or bipolar disorder.

Approximately 20 percent of youth ages 13 to 18 experience severe mental disorders in a given year. For ages 8 to 15, the estimate is 13 percent.

Approximately 1.1 percent of American adults - about 2.4 million people - live with schizophrenia.

Approximately 2.6 percent of American adults − 6.1 million people−live with bipolar disorder.

Approximately 6.7 percent of American adults − about 14.8 million people − live with major depression.

Approximately 18.1 percent of American adults – about 42 million people − live with anxiety disorders, such as panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder and phobias.

About 9.2 million adults have co-occurring mental health and addiction disorders.

Approximately 26 percent of homeless adults staying in shelters live with serious mental illness and an estimated 46 percent live with severe mental illness and/or substance use disorders.

Approximately 20 percent of state prisoners and 21 percent of local jail prisoners have “a recent history” of a mental health condition.

Seventy percent of youth in juvenile justice systems have at least one mental health condition and at least 20 percent live with a severe mental illness.

Getting Mental Health Treatment in America

Approximately 60 percent of adults12, and almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year.

• African American and Hispanic Americans used mental health services at about one-half the rate of whites in the past year and Asian Americans at about one-third the rate.

• One-half of all chronic mental illness begins by the age of 14; three-quarters by age 24. Despite effective treatment, there are long delays − sometimes decades − between the first appearance of symptoms and when people get help.

The Impact of Mental Illness in America

Serious mental illness costs America $193.2 billion in lost earnings per year.

Mood disorders such as depression are the third most common cause of hospitalization in the U.S. for both youth and adults ages 18 to 44.

Individuals living with serious mental illness face an increased risk of having chronic medical conditions. Adults living with serious mental illness die on average 25 years earlier than other Americans, largely due to treatable medical conditions.

Over 50 percent of students with a mental health condition age 14 and older who are served by special education drop out−the highest dropout rate of any disability group.

Suicide is the tenth leading cause of death in the U.S. (more common than homicide) and the third leading cause of death for ages 15 to 24 years. More than 90 percent of those who die by suicide had one or more mental disorders.

Although military members comprise less than 1 percent of the U.S. population24, veterans represent 20 percent of suicides nationally. Each day, about 22 veterans die from suicide.

Mental Illness FACTS AND NUMBERS

MENTAL ILLNESS IN CHILDREN

1. Anxiety – the most common form of mental health problem in children and adults (up to

20% of children suffer from an anxiety disorder).

- Children with anxiety often display nervous behaviors such as seeking reassurance,

checking and rechecking, crying, withdrawing, freezing up and having meltdowns or

tantrums and acting hyperactive.

2. ADHD (Attention deficit hyperactivity disorder) – About one in 20 children in the U.S. have

ADHD symptoms. For approximately 80 percent of these children, symptoms will continue

into the teen years, and some will continue to show symptoms into adulthood.

- Symptoms are pervasive across all different settings and times.

- Anxiety and ADHD share similar symptoms in children: restlessness, difficulty

concentrating, and difficulty sustaining focus. While symptoms are similar, treatment is

very different.

- About 35% of children diagnosed with ADHD also have an anxiety disorder.

3. Depression – about 11% of adolescents experience a depressive disorder by age 18. The

risk of experiencing depression increases as a child gets older.

- In children depression tends to present as irritability and anger towards self and others.

Children who are depressed may complain of feeling sick, refuse to go to school, cling to

a parent or caregiver, or worry excessively that a parent may die.

4. Developmental delays and Autism spectrum – About 1 in 6 children in the United States

has a developmental disability, ranging from mild disabilities such as speech and language

impairments to serious developmental disabilities, such as intellectual disabilities, cerebral

palsy, and autism. About 1 in 68 children are diagnosed with autism spectrum disorder.

- Autism spectrum disorder (ASD) is almost 5 times more common among boys than

among girls.

- ASD is a developmental disability that can cause significant social, communication and

behavioral challenges.

5. Disruptive Mood Dysregulation Disorder (DMDD) – it is estimated that about 3-5% of the

population under age 12 suffers from severe mood dysregulation. DMDD is characterized

by high, impairing levels of irritability and severe recurrent emotional outbursts that are not

consistent with developmental level (most of the day most days) in more than one settings.

6. Marital discord – there is a strong correlation between marital discord and behavior

problems during childhood. Research indicates that marital conflict is related to children’s

cognitive and affective functioning and that its impact on children’s well-being can be

similar to that of having parent with chronic mental illness.

MENTAL ILLNESS IN CHILDREN (continued)

7. Parental mental illness – Children whose parents have a mental illness are at risk for

developing social, emotional and/or behavioral problems. Nevertheless, not all children will

be negatively affected, or affected in the same way. The age of onset, severity and duration

of the parent's mental illness, the degree of stress in the family resulting from the illness,

and the extent to which parents' symptoms interfere with positive parenting, will determine

the level of risk to a child.

8. Bullying – Bullying is a common experience for many children and adolescents.

- Children who are bullied by their peers are: more likely to show signs of depression and

anxiety, have increased feelings of sadness and loneliness, experience changes in sleep

and eating patterns, and lose interest in activities they used to enjoy.

- Children who bully are more likely to engage in criminal activity as adults, abuse alcohol

and drugs and are less likely to do well in school.

Red flags: Serious changes in the ways children typically learn, behave, or handle their

emotions; anything causing a significant interference in a child’s life (academic or social

performance for example) or; interference with the child’s ability to enjoy life (daily

stomachaches or headaches, negative self-image, avoidance).

Additional Resources:

1. Children’s Mental Health Matters – a Maryland Public Education Campaign

http://www.childrensmentalhealthmatters.org/

2. NIMH: Child and Adolescent Mental Health http://www.nimh.nih.gov/health/topics/child-

and-adolescent-mental-health/index.shtml

3. CDC: Attention Deficit/Hyperactivity Disorder http://www.cdc.gov/ncbddd/ADHD/

4. CDC: Children’s Mental Health – New Report

http://www.cdc.gov/features/childrensmentalhealth/

MENTAL ILLNESS IN OLDER ADULTS

THE FOUR QUESTIONS

1. Is the person in immediate danger of abuse, neglect, self-neglect or

exploitation?

If yes, further assessment required. (JSSA, Adult Protective Services.)

2. Has the person had mental illness for years or is this new behavior?

If there is history, we may benefit from hearing more about it. If new, we need

to know more.

3. Has the person undergone medical evaluation from practitioners who are well-

trained and experienced with geriatric patients?

If not, this is an important step.

4. Are the observed changes interfering with a person’s level of functioning or

causing distress for the person, family members or other people around them?

If yes, consider available resources within the congregation, the family, friends

and in the community.

_________________________________________________________________________

For more information please contact: Leslie Kessler, LCSW-C, Synagogue Liaison 301-816-2653 • lkessler@jssa.org

JEWISH ORGANIZATIONS

Beit T'Shuvah - A residential addiction treatment center and full-service congregation offering

religious services, holiday celebrations and study. Address: 8831 Venice Boulevard. Los

Angeles, CA 90034; (310) 204-5200. Website: http://www.beittshuvah.org/

Bay Area Healing Center - Providing Jewish spiritual care to those living with illness, and

resources for individuals, families, clergy and community. http://www.jewishhealingcenter.org/

National Center for Jewish Healing – Assisting communities to meet the spiritual needs of Jews

living with illness, loss and significant life challenges. www.jbfcs.org/NCJH

THIRTEEN STEPS CONGREGATIONS ARE TAKING TO RESPOND

TO MENTAL-HEALTH NEEDS IN THE COMMUNITY

1. Decreasing a sense of isolation and stigma by incorporating in sermons and educational

programs the ways in which faith and a caring community can help with depression,

anxiety, and mental illness. Read sermons on mental health:

"Choosing Life" by Rabbi Jeff Sirkman, Larchmont Temple, Larchmont, New York

"In the Wilderness" by Rabbi Janet Marder, Congregation Beth Am, Los Altos Hills,

California

"We Have Failed Those Who Suffer From Mental Illness" by Rabbi James L. Simon,

Temple Beth Am, Miami, Florida

"From Darkness to Light: Men and Depression" by Rabbi Adam Raskin, Congregation

Beth Torah, Richardson, Texas

The Bay Area Jewish Healing Center offers educational materials and prayer cards

focused on mental health. Here you can find various resources such as Prayers for

Mental Illness, 10 Things Your Congregation Can Do to Reduce the Stigma of Mental

Illness, Ways to Support Those in Your Community With Mental Illness, and Facts

About Mental Illness.

2. Inviting individuals and families who have found a supportive response to their mental-

health needs to share their stories in newsletters or at programs.

3. Having up-to-date materials on hand about mental-health treatment resources in all public

congregational spaces so they can be picked up without anyone being observed during the

week.

4. Posting suicide-prevention materials and hotline information.

5. Encouraging those who may be suffering silently to consult with clergy.

6. Offering text studies and other opportunities to use Jewish ritual and wisdom to provide comfort, strength, and hope to those living with mental-health conditions. Read related text studies:

Thoughts on Parshat Lech L’cha, Rabbi Pamela Wax, Westchester Jewish Community Services

Delving Into Texts, Tales, and Psalms: Spiritual Support in the Midst of Emotional Suffering, Rabbi Pamela Wax, Westchester Jewish Community Services

Texts that Offer Inspiration, Faith, and Wisdom During Difficult Times, Rabbi Dianne Cohler-Esses

Images of Darkness and Light, Rabbi Dianne Cohler-Esses Some Jewish Words on Depression, Loss, and Restoration, Rabbi Simkha Y.

Weintraub, LCSW, Jewish Board of Family and Children’s Services

7. Offering support groups or mentorship to individuals and families living with mental distress.

8. Addressing issues of stress and mental health in newsletters.

9. Formulating plans for calming congregational responses to traumatic events in the community or individual families.

Helping Children Deal with Trauma and Building Blocks of Meaningful Response to Traumatic Events in the Community, Sherry Birnbaum, Westchester Jewish Community Services

10. Inviting professional and lay speakers to men’s and women’s groups, parent meetings, senior clubs, and youth groups to discuss the experience of getting help with depression, anxiety, and mental illnesses. There may be mental-health professionals in the congregation who are able to speak about these issues, and mental-health agencies or the National Alliance on Mental Illness may be able to provide inspiring speakers.

11. Providing simple guidelines on how to recognize and find assistance for those showing signs of depression, self-inflicted violence, post-traumatic stress, and other anxiety disorders.

Recognizing and Responding Effectively to Signs of Emotional Distress Among Adolescents, by Rabbi Edythe Held Mencher, UJA-Federation of New York rabbinic consultant, and Aileen Hoffman, F•E•G•S Health and Human Services System

12. Offering opportunities for members to volunteer at local agencies and in congregational programs that offer help to those living with mental-health issues. Many local organizations could benefit from volunteers, and the very act of joining together to help others offers opportunities for socializing, actualizing Jewish values, and gaining a sense of meaning. Volunteer at a beneficiary agency whose population includes those with mental-health issues.

13. Creating a congregational mental-health or emotional resilience task force made up of

congregational volunteers with interest and expertise in the mental-health field. This can be

a new committee or part of an existing caring or educational committee.

Clergy can encourage awareness and empathy for those struggling with emotional

distress by speaking about it during services, in newsletters, or at fall meetings

welcoming new preschool and religious school parents.

THE ROLE OF JEWISH CLERGY IN THE SPIRITUAL CARE OF

PEOPLE LIVING WITH MENTAL ILLNESS Source: Give Me Your Hand - A Guide To Mental Illness For Jewish Clergy

Bay Area Jewish Healing Center, 3330 Geary Blvd., Third Floor West, San Francisco, CA 94118, 415.750.4197 www.Jewishhealingcenter.org

One in four Americans suffers from mental illness. This means that in every Jewish community, it is likely that at least a quarter of our members are touched by mental illness. Nearly every Jewish family has been impacted by this disease. Research tells us what so many of us know first-hand from the privacy of our offices – nearly 60% of people with mental illness concerns turn to clergy first for spiritual support and referrals before reaching out to anyone else. We have a unique opportunity to make a difference.

Mental illness frequently raises specifically spiritual issues for individuals, families and communities that call for a spiritual care, as well as a mental health care, response. Which means that in addition to being prepared to make mental health referrals we have an opportunity to offer pastoral care. Below are a few of the spiritual needs that may be present for individuals and families living with mental illness and some suggested responses.

1. Self-worth and dignity G-d created the human being in G-d’s own image

- Genesis 1:27

In today’s world mental illness is often surrounded by stigma and shame. Sadly, these societal attitudes can impact the inner sense of self among people who are touched by mental illness. This can lead to feeling a lack of self-worth and a loss of dignity. Judaism has a myriad of sacred sources on the spiritual value of each person. In the Torah we are taught that each and every person is created “b’tzelem Elohim” in the image of G-d (Gen 1:27); in the Mishna we learn that when we save a single human life it is as if we saved an entire world (Mishna Sanhedrin). Individuals with low self-worth benefit particularly strongly from belonging in community but may have difficulty reaching out and asking for help. We can affirm the value and worth of members of our communities living with mental illness through empathetic listening, bikkur cholim visits to home or hospital, publicly naming mental illness from the bimah and offering pastoral care that includes prayers and sacred texts that affirm the worth and dignity of all people.

2. Guidance through grief and loss And the Israelites wailed out loud for Moses in the steppes of Moab for thirty days.

– Deuteronomy 34:8

The journey through mental illness is shaped by loss. Individuals and families may experience losses of physical or mental functions, relationships, employment, financial support, social status and spiritual beliefs. We can learn from Jewish mourning practices about the significance of ritually marking loss in Jewish tradition. The days after a death and before a funeral are known as a period of anninut, a time when everyday life is suspended for mourners. It can be helpful here. After the funeral ritually marks the loss, mourners gradually return to daily life. This cycle of mourning, affirms the idea that loss must be marked before we can begin to heal. As spiritual care-givers we can guide people through the grief connected to mental illness by naming and validating physical, emotional and spiritual losses. These losses can be marked through empathetic listening and sanctified through innovative rituals or prayers. You may also consider adapting traditional rituals such as mikvah or birkat ha’gomel (the traditional blessing for surviving a life threatening experience).

THE ROLE OF JEWISH CLERGY IN THE SPIRITUAL CARE OF

PEOPLE LIVING WITH MENTAL ILLNESS (continued)

3. Reconciliation in Relationships Seeing your face is like seeing the face of G-d

– Jacob speaking to his estranged brother Esav when they are reunited - Genesis 33:10

The symptoms of mental illness and the stigma that surrounds it can cause significant strains on all types of relationships. Individuals living with mental illness may have broken relationships to loved ones, to community and to Jewish tradition. Judaism is rich in sources on the sacred significance of rebuilding relationships through teshuva (repentance) and forgiveness. As clergy and spiritual care-givers we can support individuals in reconciliation by affirming the Jewish value of teshuva and forgiveness. We can also serve as a mirror to individuals, families and the community as a whole to reflect back the damage that has been done in relationships and lift our prophetic voices to highlight the need for repair. 4. Awe and Mystery

Remove your sandals from your feet for the place on which you stand is holy. – Exodus 3:5

Struggling with mental illness is usually extremely painful. It can also lead to shifts in identity and perspective that may provide certain individuals an opening to contemplate the mystery of the universe and the human mind. We should be extremely careful to suggest this approach it can seem minimizing to the very real pain of illness or hint at theological rationales for mental distress and suffering. However, when people living with mental illness themselves wish to see their illness within a larger spiritual context, accompanying them in exploring awe and mystery can be profoundly healing. The concept of awe, yirah, is central to Jewish tradition. The place where those struggling with mental illness are standing is holy ground. We can acknowledge the sacredness inherent in the journey through mental distress toward healing by affirming awe when it is present for individuals, as well as offering prayer, meditation and text study that helps individuals connect their struggles to a larger spiritual context.

© Rabbi Elliot Kukla, Bay Area Jewish Healing Center

A PRAYER OF HEALING FOR MENTAL ILLNESS Source: Give Me Your Hand - A Guide To Mental Illness For Jewish Clergy

May the One who blessed our ancestors bless all those who live with mental illness, their care-givers,

families and friends; May they walk in the footsteps of Jacob, King Saul, Miriam, Hannah and Naomi who struggled with dark moods, hopelessness, isolation and terrors, but survived and led our people. Just as our father, Jacob, spent the night wrestling with an angel and prevailed, may all those who live with mental illness be granted the endurance to wrestle with their pain and prevail night upon night. Grace them with the faith to know that though, like Jacob, they may be wounded, shaped and renamed by this struggle, still they will live on to continue an ever unfolding, unpredictable path toward healing. May they not be alone on this path but accompanied by their families, friends, care-givers, ancestors and the Divine presence. Surround them with loving-kindness, grace and companionship and spread over them a sukkat shalom, a shelter of peace and wholeness. And let us say: Amen

© Rabbi Elliot Kukla, 2008

TEN THINGS JEWISH CLERGY AND LAY LEADERS CAN DO TO REACH OUT TO THOSE LIVING WITH MENTAL ILLNESS

Source: Give Me Your Hand - A Guide To Mental Illness For Jewish Clergy

1. Listen

Listen empathetically to stories of mental distress and healing; respond with compassion and openness.

2. Speak Give a d’var torah on mental illness or publish a newsletter article on the topic.

3. Visit Visit, call or send cards when community members are hospitalized or home-bound due to mental illness. If your congregation has a Caring Committee make sure mental illness is included in congregational outreach.

4. Pray Whenever illness or healing is mentioned in from the bimah in prayer acknowledge mental illness. Due to stigma most people living with mental illness and their care-givers do not assume that they are included in general prayers for healing.

5. Invite Invite members of your congregation living with mental illness to tell their stories; acknowledge the bravery it takes for individuals to speak about their experiences.

6. Educate Educate yourselves about mental illness, read, discuss and take part in trainings; make information on mental illness and community resources available in public places.

7. Examine Your prayers, text studies and expressions of basic theology, so as not to blame those who are ill or perpetuate the concept that sin, guilt or weakness lead to mental illness or suicide.

8. Sanctify Mark moments of healing such as coming home from the hospital or beginning new medications, as well as moments of loss with traditional and innovative Jewish ritual such as mikvah or birkat ha’gomel (the traditional blessing for surviving a life-threatening occasion).

9. Collaborate Help to raise awareness on mental illness by collaborating with other faith groups, social service agencies. spiritual care agencies, and consumer organizations.

10. Support Offer space for support groups to meet or start your own support group!

Created by Rabbi Elliot Kukla, Bay Area Jewish Healing Center

A JEWISH CLERGY’S GUIDE TO SUICIDE ASSESSMENT AND PREVENTION

Source: Give Me Your Hand - A Guide To Mental Illness For Jewish Clergy Bay Area Jewish Healing Center, 3330 Geary Blvd., Third Floor West, San Francisco, CA 94118, 415.750.4197

www.Jewishhealingcenter.org

Suicide is a fact of life – many families within our congregations have been touched by suicide in some way. Clergy are often the first to hear about suicidal thoughts. Here is a brief summary of how to make assessments and some simple suggested responses that can prevent suicide. With all of these suggestions, seek your own professional support as well.

ASSESSMENT

There are four kinds of suicidal people in any community and they correspond roughly to the four children in the Passover Haggadah. 1. There is the BITTER person: This person says, “I am going to kill myself.”

You need to ask this person four questions that determine HOW before WHY. How is more important as the answers will help you know if this person is in immediate danger. The questions are easy to remember as they spell the word “PLAN” vertically.

Plan: “Do you have a plan for how you want to kill yourself?” Lethal Method: “Have you got the means to do it” Access: “Where is the means now? Can you get it easily?” Now? “When do you want to do this? Is it now?”

For the person who says “yes” to all four questions, you need to call 911 to arrange for hospitalization as quickly as possible, involving the family and loved ones as appropriate.

2. There is the INTELLECTUAL person: This person says, “I am thinking about suicide.”

You need to ask this person the four above questions, but it is likely that not much thought has been given to putting the plan into action. You need to arrange for this person to have regular counseling, begun within 24 hours, or to tell his/her existing therapist/counselor about these thoughts.

3. There is the PAINFULLY SIMPLE person. This person simply says “I am always thinking

about suicide.” You need to ask this person the four questions, but it is likely that the person will not even have a plan. There will simply be so much pain, which will have existed for so much time, that the thought is always there. You need to arrange for this person to call a suicide hotline on a regular basis for pain control purposes. You need to suggest a specialized therapist as well.

4. There is the person who DOES NOT SAY ANYTHING but who drops hints.

You need to ask this person whether you are being told that he/she is in a lot of pain, and whether the pain has begun to make him/her think about suicide. And if the answer is “Yes,” you need to begin with the four questions. It will be a relief for both of you. You need to suggest a specialized therapist as well.

A JEWISH CLERGY’S GUIDE TO SUICIDE ASSESSMENT AND PREVENTION

(continued)

ONGOING RELATIONSHIPS THAT CAN PREVENT SUICIDE

Numerous studies have shown that three kinds of painful feelings appear to contribute to

thoughts of suicide, or to make them stronger. Rabbis and congregations are in a special

position to counteract the power of these feelings.

Lack of a sense of belonging - People who are suicidal often mention the sense that they no

longer feel they are part of a community or a family. Often this is true; some mental illnesses

and other forms of emotional distress can cause people to “fade from view.” Clergy can reach

out to this person and invite them to participate in congregational activities to reactivate a

sense of membership. Mentioning mental illness and suicide from the bimah can also help to

reduce isolation.

Burdensomeness - Often the idea that one’s death will be a relief to family and friends

becomes a part of a person’s impulse towards suicide. Pastoral care, support groups and visits

from community members can reinforce the value this person has in community. Peer support

from others who have struggled with suicidal thoughts has the potential of bringing comfort to

the experience of pain, as it reinforces the message that after pain has been conquered, one is

especially suited to help others who are in danger.

Lack of Control - The taking of one’s own life is often seen as the only way of asserting control

over a painful and chaotic situation not of one’s own choosing. Clergy should be well educated

about suicide and able to offer referrals and community resources to individuals that help them

get the support they need to make choices that represent life and enable at least partial

control.

Created by Eve Meyer, San Francisco Suicide Prevention and Rabbi Elliot Kukla, Bay Area Jewish Healing Center

CLERGY CONGREGANT “NO HARM BRIT” (COVENANT) Source: Give Me Your Hand - A Guide To Mental Illness For Jewish Clergy

NO-HARM Anyone who regularly works with people who are thinking about suicide should have a no harm agreement. It is always advisable to ask a person who is thinking of suicide to contact someone whenever the thoughts threaten to turn into action. For clergy, it may make sense to frame this as a brit, a sacred covenant, between an individual and their clergy. This brit, can be very simple and can take the form of a contract that uses wording such as: “Promise me that you will not kill yourself without making a phone call to first and talking to them. The words “”Promise Me” are very important, because people in crisis will do a favor for another meaningful person when they will not do an action for their own benefit. The blank can be filled in with a counselor’s number, a local crisis/ suicide service, 911, or the night emergency service for the congregation. SELF-CARE Increasingly, many crisis centers and community leaders are also using Self-Care contracts. These imply that the person can anticipate the crisis and take action to defuse it and may be especially useful for people who have some congregational supports. Together, a clergy member and a person select 3-5 actions the person can take that are soothing and restoring. The suicidal person will either try to do them first and call an emergency number if they don’t work, or try them during the call to see if they work before other measures are put in place. Examples:

• Herb Tea • Prayer or meditation (you may want to work together on a soothing prayer to use in

these moments) • Listening to sacred or fun music • Hot bubble bath • Frivolous magazine • Neighbor’s pet • Walk around the block

Created by Eve Meyer, San Francisco Suicide Prevention and Rabbi Elliot Kukla, Bay Area Jewish Healing Center

ADDRESSING THE NEEDS OF FAMILIES Source: R'fuat Ha Nefesh: Caring for the Soul (URJPress)

http://urj.org/life/community/health/mental/

Mental illness of a loved one affects everyone in the family. Reactions are varied. Some families have trouble dealing with the reality of the illness or feel a tremendous sense of shame and isolation. Some may become overly preoccupied with what has happened. In reaching out to a family in this situation it is important to remember that living with disease can be bewildering and taxing. It is important for everyone to know that the family did not cause the illness; the family is not responsible for it. Self-blame and blame leveled by others are destructive for all concerned.

The following information is designed primarily for the friends, families, and colleagues of the mentally ill and could be made available to them in the form of a brochure or fact sheet.

Families need to plan for the future. Many family members who work together to deal with the often harsh effects of mental illness may discover a wealth of abilities and assets they possess as individuals and as a unit. The family's discovery of these strengths and skills often gives rise to changes that improve the quality of life for everyone in the family (including the ill member). As time goes by the family may find it elf the first line of defense for their loved one. They must keep themselves physically and mentally healthy so that they are able to give their best help to their ill family member.

Anyone living and/or working with a person who has a mental illness should:

• Place no blame or guilt • Look for support • Seek relief from stress • Continue outside interests • Don't try to be "super parent," "super spouse," or "super friend."

The following are some tips to help in coping with a family member who is mentally ill. Families have found these techniques useful. They can be used in developing coping strategies that complement professional treatment.

• Learn all you can about the illness and educate other family members and friends about it.

• Develop/know resources for help and support before a crisis occurs.

• Designate someone in the ill person's immediate circle (family member, friend) to be available to help when needed.

• Anticipate vulnerable situations (difficult relationships, job stresses, anniversary and holiday dates), and space them out if possible. If Aunt Tess can't handle the relationship, don't have her to dinner when the ill family member is present.

• Space out stressful events. Remember, what is stressful for your ill family member may not be stressful for you.

ADDRESSING THE NEEDS OF FAMILIES (continued)

• Realize that a person with a mental illness can suffer from memory loss or poor concentration. This is frustrating and frightening. Do not be judgmental.

• Break down tasks into small units so that they do not overwhelm the ill person. Focus on successes.

• Avoid pampering. Set reasonable rules and limits and stick to them. If you find this difficult to do, ask the doctor or counselor for suggestions.

• Avoid expecting that all peculiar behaviors and habits can be corrected.

• Learn about medications - what they are and do, the side effects and residual effects they may have, how they work, and how long they take to work.

• Pay attention to medications (are they being taken, do they seem to be working, etc.).

• Realize that common substances, such as coffee, tea, sugar, alcohol, and over-the-counter medications, may adversely affect the ill person.

• Be sure other doctors know what medications the person is taking.

• Realize that another breakdown may be temporary. The person has recovered before and is likely to do so again.

ADVICE ON REACHING OUT TO THE MENTALLY ILL Source: R'fuat Ha Nefesh: Caring for the Soul (URJPress)

As you do with other friends, treat someone who has a mental illness as you would want to be treated, with understanding and respect.

When a person with a mental illness You need to

is withdrawn initiate relevant conversation

is overstimulated limit input, do not force discussion

becomes insecure be accepting

is fearful stay calm

When symptoms or medications cause behaviors such as

You need to

disorientation keep to a known, structured routine

difficulty with conversation slow down, and perhaps repeat; use simple, short sentences

stress in ordinary situations create an uncomplicated, predictable environment

trouble remembering help the person record information

unsound judgment remain rational and reinforce common sense

ADVICE ON REACHING OUT TO THE MENTALLY ILL (continued)

Some symptoms of mental illness are unlike anything you will encounter elsewhere. You can't change, but you can refrain from further destroying the person's integrity.

When a person with a mental illness You need to

is not grounded in reality listen for kernels of truth, or wait for a better time

believes delusions avoid arguing

displays little empathy recognize this as a symptom; try not to respond in kind

has difficulty making contact make direct contact and keep the initiative

seems totally lacking in self-esteem and motivation

affirm the person's value; treat accomplishments positively

Fine inner qualities often remain and develop in spite of mental illness. Do not do "for" persons with a mental illness, do "with them,"as you do with other persons with other dis­ abilities.

When a person with a mental illness You can

shows a talent such as music, writing, or art be open to the person sharing with you

retains an inborn generosity acknowledge the gifts (which may not always

be monetary)

expresses an interest in his or her illness and its consequences

learn together

wants to have a serious discussion remember, even the most severely ill are rational as much of the time as they are psychotic

"We are in your congregations, your synagogues. Just think about how many of us there are and how many more of us there are with our families. We want to make friends with you. We want to work with you .We have capacities to help. Give us that chance."

- Gary

"Remember us when you are trying to help us. Give us a chance to use what we have, what our capabilities are. Don't stop us. Let us fail. Let us try again. Let us reach a. far as we can. That is the love and compassion we seek from you. If you love us, help us to fly, to soar toward our highest goals."

- David