The Importance of Collaborative Care in Anosognosia Treatment

In this segment, Lindsay Galvin Rauch, owner of Event Design Group, and Xavier Amador, PhD, cofounder and CEO, The Henry Amador Center on Anosognosia and the LEAP Institute, address how to incorporate the LEAP (Listen-Emphasize-Agree-Partner) approach in collaborative care as a way to improve relationships.

In Parts 1 and 2, they addressed defining and diagnosing anosognosia as it relates to severe mental illnesses, such as schizophrenia, and how anosognosia impacts treatment noncompliance and the impact on family dynamics.

Continue with the series:

>>Watch Part 4 Now: DSM-5 Revisions, Educating Clinicians About Anosognosia

Catch up on previous installments:

>>Watch Part 1 Now: Defining and Diagnosing Anosognosia

>>Watch Part 2 Now: The Impact of Anosognosia and Noncompliance

Read the transcript:

Rauch: And so then I come back and think the treatment or your approach, your communication as opposed to treatment is in large part a prescription for the family, for the friends, for those who are trying to help those who suffer.

Dr Amador: And for mental health professionals and law enforcement as well, by the way.

Rauch: Right. Right. First responders, ER doctors.

Dr Amador: Yes.

Rauch: ER doctors are one of my favorites that have so little knowledge of this. And I mean, I can't blame them. Here, I have a family who didn't know the first thing about it and had 6 affected siblings thinking that they were just stubborn.

Amador: Right.

Rauch: And I think one of the big things that was confusing is why do you have people who do have severe schizophrenia or schizoaffective or severe bipolar that are able to have a much higher functioning in their lives than those that don't. And I think that was maybe where it was disheartening to see somebody with schizophrenia that didn't have anosognosia and how successful they could be in their lives. I think of my collected schizophrenia is the author of that as a prime example. Here's somebody who was able to recognize that she was becoming schizophrenic, was becoming affected while in real time it was happening to her and then able to go on and write a book about her experience.

Dr Amador:

She doesn't have anosognosia. You're absolutely right. She doesn't have it. Now, when I look at people like that, I think they're blessed. They're fortunate. They understand they have an illness. I work with peer support specialists. And these are people with lived experience with these illnesses who have recovered, who are doing well. And then they get certified, and they work with other people with mental illness. And one of the things I have to really kind of drill into their heads is you're going to be helping a lot of people who do not understand in the way that you have come to understand that they have mental illness. And so you need to learn a different technique.

And the technique that you and I have been talking about is called the leap technique, which stands for “listen, empathize, agree, and partner.” There's actually 7 communication tools and teaching the peer support specialists and the first responders and psych ER doctors and family members how to communicate in this way that absorbs the person's experience, their experiences, accepts it even when they say there's nothing wrong with them, and I feel certain there is, is an important first step to building that relationship where they're interested in our opinion about treatment.

Rauch:

So how does somebody learn about this? What's the way that a clinician or a family member or an EMT or police officer or ER doctor would learn about how to communicate and get better treatment for somebody who suffers?

Dr Amador:

Well, you mentioned the Ted talk that I did. You can find that at hacenter.org. H-A stands for Henry Amador, hacenter.org, which you're a board member of on the board of directors. And one of the people who voted for the name change, which I was worried about having anosognosia in the name, because it's such a tongue twister, but I think it was a good idea. So you can go there. There's a tab for free videos. And we have a number of videos like the Ted talk. We have a video where we have 2 actors where the young woman finds her husband's bottle of antipsychotic medication in the trash can. She gets it out and goes and talks to him and confronts him. And you see her make all the same mistakes I made with my brother early on and that so many of us make.

And then we redo it the whole scene with her using the LEAP approach, by listening to him, empathizing with his desire to stop taking the medication, understanding why he didn't tell her and he threw it in the garbage and then looking for areas where they could agree. In that case, it was getting along better, not fighting, her not calling the crisis team on him and partnering on that. So I'm giving you a very quick overview of just one of many videos that you can see to a lot about how to do the LEAP approach. There are free chapters of my book, I'm Not Sick. I Don't Need Help on the National Alliance on Mental Illness website, nami.org. So you don't have to buy the book. You can look at the free chapters. And then we have trainings. We have one coming up in Denver, thanks to you and our partners. So we have in-person trainings and we have virtual trainings where we teach people the skill sets, how to actually learn and implement LEAP.

Rauch: That is so great that we're able to do in-person training again. I'm really excited because as a new board member, I really have yet to go through the in-person training. I've been able to read the book and listen to all the of videos. And it certainly has helped my approach with my brothers tremendously in terms of their communication with me and the success of their compliance with their treatment has really... I've seen a big difference in the last, whatever it has been year or 2, that I've been trying to learn more about this. So.

Dr Amador: Can I ask a question? You're the interviewer, but can I ask a question?

Rauch: Absolutely.

Dr Amador: Has it also helped your relationships with them?

Rauch: Yes, no question. I think the hardest part is wishing that my other siblings would be interested in learning more about it. I think getting other family members to get on board. I know my parents would have loved to have had a different approach because their approach was my way or the highway.

Dr Amador: I have a suggestion, and I teach when I work with families, which I do every week repeatedly. And they talk about other family members who are angry and upset, and they don't want anything to do with the mentally ill loved one. Use LEAP with those siblings. Why are you upset with Michael? What's the problem you have with him? And as they tell you, reflect it back, be empathic. I can see why are upset with him and so angry about him. And then you ask, "Can I make a suggestion?" And then you start talking about what you've learned, but first listen and empathize. I don't know if you've already done that, but use LEAP with... You can use it with anybody.

Rauch: Right.

Dr Amador: That you pass headbutting.

Rauch: Right.