Serving Library Patrons with Mental Illness: A ... - NNLM



Serving Library Patrons with Mental Illness: A Crash Course on Controlling ClashesMandy Easter, Law Librarian/Consultant at the State Library of IowaPresented for the National Network of Libraries of Medicine on 02/17/2021The following information is from the slides and script:The National Alliance on Mental Illness describes mental illnesses as “medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning.” It is important that librarians possess the tools necessary to recognize the signs and symptoms of mental illness in order to deal calmly and effectively with patrons suffering from stress or mental health issues. Acquiring these tools takes four steps: (1) train on mental health issues and best practices for interacting with the mentally ill; (2) develop library policies and procedures that aid you in interactions with mentally ill patrons; (3) learn how to have difficult conversations and make difficult decisions; and (4) connect with other community resources for the mentally ill. At a minimum, library policies and procedures should comply with the Americans with Disabilities Act (known as “the ADA”) and other laws that prohibit discrimination based on mental health status. The ADA requires that public libraries provide services to people with disabilities that are equal to services provided to citizens without disabilities. Additionally, librarians have a professional duty to subscribe to the American Library Association’s written policy entitled “Library Services for People with Disabilities,” as well as ALA’s professional ethics principle promoting equitable service policies and equitable access. ALA has many print and online resources to help libraries comply with the tenets of the ADA. The ADA gives the mentally ill specific rights. In particular, Title II of the ADA provides that no qualified individual with a disability may, because of that disability, be excluded from participation or be denied the benefits of public services, programs or activities. In addition, federal case law exists that states libraries cannot bar the homeless from their facilities. Because both statutes and case law support the right of the mentally ill to access public spaces, any library rules must be enforced uniformly with regard to all patrons and not just the homeless or mentally ill. Library policymakers need to consider how current and prospective rules may impact patrons with mental illness. Noise policies, loan periods, and other library rules need to be crafted to ensure the smooth operation of the library, but those same rules should not be so stringent that they alienate patrons with mental illness. Instead of seeing policy modifications as “exceptions” with negative connotations, frame them more positively as accommodations for disabilities. You will come to know particular patrons’ issues. Try to accommodate those issues, rather than trying to talk them out of their concerns or dismissing them. If a patron is convinced that others are trying to look at their computer screen, is it possible to put them in a room alone?A patron who talks to himself or herself may be exhibiting a common symptom of mental illness that can run afoul of noise policies if that talking becomes distracting to other patrons. It is appropriate to inform or remind the patron that the library has a noise policy and that he or she is making too much noise, but the librarian can truly accommodate this patron by offering to let him or her use a study room or move to a place in the library that is more conducive to noise. A common symptom of mental illness is a problematic memory. In one library, a patron was coming in almost daily to work on a long-term research project involving non-circulating reference materials. They were using the same sources, but had difficulty remembering the names and locations of the sources. A staff member decided to keep those sources on a library cart so they could retrieve them more easily and quickly. She also wrote down the titles for them in case they got re-shelved. These are just two examples of modifying library policies so that they become disability accommodations. Requiring little time and effort, these simple accommodations allowed libraries to better serve patrons with mental illness.If a patron is asking questions that aren’t based in reality, you can still respond in a rational manner. Consider whether the patron’s question is based in logic. If so, you could answer it and suspend your own personal beliefs. I once had a patron who wanted to sue aliens for invading their thoughts. Rather than engaging in a discussion about whether that was a rational belief, I responded that their first issue would be to find out if they had jurisdiction to sue a resident of Mars. I guided them to some resources on the topic of jurisdiction and they were quite content.When I worked at a metropolitan public library, a particular patron came in every weekend to ask for directions to Middle Earth. After the first couple of unsuccessful--and frankly, hostile--interactions with them, I learned not to argue about the existence of Middle Earth and the availability of directions to get there (and mind you, this was before the Internet), so I eventually just copied some pages from the World Book encyclopedia about the geological center of the Earth and handed them to them--a copy every week. They seemed grateful and would leave the library without incident. If, however, a patron’s questions are not based in any logic, you can respond firmly in a clear but calm tone that there is nothing more you can do for them and explain that you need to help other patrons. Well-crafted rules provide support to address inappropriate behavior and enough flexibility to develop creative solutions to recurring problems. We need to be creative in order to maximize the library experience for our mentally-ill patrons and consistently provide them with quality customer service.You must also be able to have difficult conversations and make difficult decisions when dealing with the mentally ill patron, and this is not something that most library staff can do naturally. It takes training to develop this skill set. What does a difficult conversation look like? Let’s say that a patron’s severe body odor is disturbing to both library staff and other patrons. You can be empowered to have an appropriate conversation with that patron. It’s an awkward conversation, but it’s not impossible. Rehearsing how the conversation will go with a colleague is helpful. Sometimes it can be easier to make a statement rather than ask a question. For example, you could say: “I need to let you know that, because you haven’t showered in a while, your body odor is noticeable and disturbing to others. Here is a list of places you can go to take a shower. We need you to leave and not return until after you have showered.” Of course, any of these difficult discussions and decisions must comport with your library policies and procedures. If your policies dictate that you cannot have such a conversation, then brainstorm other options with your colleagues. Can you ask the patron to move to a different area of the library perhaps? The point is that difficult conversations and decisions take training and practice. They also require a working knowledge of the boundaries of your library’s policies and procedures. But the more that library administration can help staff by outlining boundaries, the more empowered library staff will be to address these conversations and make decisions within their appropriate authority.What are some tips for communicating effectively with mentally-ill patrons? How do we balance their rights with the rights of other patrons and staff? These methods are recommended by mental health and security experts:1. Treat people with mental health issues with the same empathy, respect and consideration you give to other patrons. 2. Don’t judge. Be compassionate. Allow them their dignity.3. Be aware and communicate. If someone seems to be acting oddly, wait and observe. Talk to other staff; they may be familiar with the person and know the best way to approach him or her. Sometimes, one staff member seems to have a knack for dealing with a particular patron, so if possible, he or she should consistently approach that patron. Otherwise, it’s frequently helpful to confer with other staff on duty about how best to handle a given person or situation. However, most often, the person will come and go without incident.4. If a behavior needs to be addressed, use teamwork; no one should feel alone on the front lines. Call on another staff member to back you up. He or she doesn’t need to act or speak, but should serve primarily as moral support and as a witness. Often, a united front will be enough to convince an unruly patron to either change or leave. It’s very important not to allow staff to be bullied; the administration and staff must back up each other!5. Introduce yourself and try to get the person’s name. Be polite. Try a lighter touch first. Start by saying, “I noticed that…” or “The reason I’m here is…” or “I’m sure you already know this, but…” or “I need to ask you to…”6. Further on in the conversation, the following phrases can have a calming effect: “I can see that you’re upset…” or “I’m sorry; I’m not trying to make you mad.” Or “You could be right…” or “It’s not me, it’s the computer…” or “Please help me do my job for you…” or “I can take your name and number for my supervisor, if you’d like…”7. Assess the seriousness of each situation as quickly as possible and look for clues about the patron’s likely course of action. Does the person’s body language convey anger or cooperation? Move a little closer to build rapport; stay back if you sense anger. Use space and distance and available barriers, such as a desk, a large chair or a countertop to reflect the patron’s attitude. Take immediate action when you understand the problem. Ignoring a problem doesn’t make it go away; on the contrary, it will likely grow. Trust your intuition. Don’t rationalize irrational behavior.8. Respect patrons’ privacy. Have a discreet, but safe place to talk if necessary. Listen carefully to the person’s words; ensure that he or she knows you’re paying attention. Clarify the patron’s messages; make sure you understand what’s being said. Permit verbal venting when possible; let them blow off steam.9. Respect personal space; don’t stand too close for comfort. Avoid physical contact; do not push, grab, or otherwise touch the person. Be aware of body position; don’t stand directly in front of them or appear to block their avenue of escape.10. Use firm, assertive, but not aggressive, language. Avoid a tone of voice or the use of phrases that might be considered judgmental, moralizing, or condescending. Try not to show anger, fear, disapproval or disgust. 11. Do not share your anecdotal stories to demonstrate that you understand; this may convey the wrong message. For example, do not mention “my aunt with the same condition.” Each situation is different; please respect that difference.12. Don’t be hesitant or appear unsure of yourself. It’s important that an apparently unstable patron sees you as strong, confident and in charge.13. Respond in a calm, reasonable, and friendly manner. Staying calm will often help defuse an unpleasant situation and allow you to exercise better judgment. 14. Ignore challenging questions; do not respond to challenges to your authority, training, intelligence, policies, etc. Keep your non-verbal cues and body language neutral and non-threatening.15. Don’t argue or bargain with the patron; it may lead to a confrontation. Do not allow yourself to be sidetracked or angered by personal insults or threats. Repeat your position as often as necessary. Stress your responsibility to the collection and to other patrons.16. Set and enforce reasonable limits; state what you will permit. Avoid overreacting; strive to remain calm, rational, and professional.17. Connect a behavior to a result. Tell a person that their behavior has consequences. Let the patron know clearly what will happen if the behavior persists.18. Suggest realistic alternatives; provide the patron with choices, if at all possible. 19. If the patron demands to see someone “higher up” and there IS someone higher in the chain of command, comply, but first take the time to explain the situation to the supervisor in realistic terms and in a calm manner. 20. Certainly consult with the proper authorities if faced with a new or frightening situation. Don’t be afraid to ask experienced professionals what you can do to address the problem. If necessary, ask for law enforcement’s assistance.21. Fill out an incident report as completely and as soon as possible, including the names of all staff, witnesses and patrons involved. File the report with the director. Some patrons with mental illness can exhibit behaviors that are loud, awkward, or aggressive. These behaviors are disturbing to other patrons and library staff and therefore must be addressed. To do so, focus on the inappropriate behavior, not the patron. Rather than saying, “You are disturbing other patrons,” kindly say, “Yelling and slamming down books are inappropriate behaviors in the library.” Then give the patron the choice of modifying their behavior or being asked to leave the library. For example, “To continue using the library, could you please refrain from such behavior? Otherwise, we’ll have to ask you to leave. It’s up to you.” In this way, you give the patron the power to eliminate the disturbing behavior or subject himself or herself to restricted access.Disturbing behaviors can sometimes escalate into scary and unexpected situations. Patrons with certain types of mental illness can be very emotional, frustrate easily, or lose their tempers quickly. When this happens, such patrons can exhibit frightening or threatening behaviors. The most essential tip I can offer is to not match these behaviors. Know that you have the power to de-escalate the situation by under-reacting. Listen to the patron patiently and respond slowly and calmly with an even, low voice. Keep an arms-length distance so the patron doesn’t feel intimidated. Don’t try to joke with the patron in hopes of reducing tensions because this may only confuse or further upset them. Maintain a professional, detached manner, and try to prevent emotion from influencing your reactions. Of course, your safety is paramount. Providing good customer service doesn’t give anyone permission to abuse you. Follow your library’s policies and procedures for addressing challenging situations. Call on a colleague for assistance or contact security personnel if warranted. After these unexpected situations have passed, remember to appropriately cope with work-related stress, because YOUR mental health is important, too. It can be helpful to vent with a colleague about frustrations and challenges, but these discussions should focus on behaviors without demonizing any patrons involved in the situations. Obviously, such conversations should take place away from any patrons who might overhear. Librarians shouldn’t hesitate to consult a professional therapist if repeated or particularly traumatizing or challenging situations have a lasting negative impact on their emotional or mental health.Sometimes librarians encounter persons who may be suffering from hallucinations or delusions. Hallucinations include hearing voices that other people do not hear and seeing things that are not there. It’s a terrifying reality. If you suspect a patron is hallucinating, look and listen for evidence. For example, the person may look around the room as if checking to see if someone is speaking to them or the person may laugh for no apparent reason. You might say, “I noticed you were looking around the room. Are you hearing voices? What can I do to help you?” If asked, point out simply that you are not experiencing the hallucination. Remember that the hallucination is the patron’s reality. Do not say that what they are seeing or hearing is not real. Instead of trying to explain that normal people don’t hear voices, ask the patron distracted by other conversations in their head to please concentrate on your conversation. Speak slowly and in brief sentences. You may need to repeat yourself several times before the person can process what you are saying. The hallucination may pass; however, if it continues for a long time or if the person may cause harm to himself or herself or others, it is best to get the person professional help. The same concept applies to interacting with those who appear to be delusional. Delusions involve the person’s belief system. A delusional person may believe someone is out to get them or that they are president of the United States. Don’t argue with a person who is delusional; it will only agitate and alienate them. If the individual insists that you comment on delusional material, say you do not know, or hedge. Acknowledge and respect the person’s reality, but explain that there is an honest difference of opinion or perception between you. If strong feelings accompany the delusion, you can address the emotions—such as fear, anger, anxiety, or sadness—without commenting on the delusion. Offer to assist in coping with the feelings. For example, you can ask, “What can you or I do to help you feel safer?” If it seems appropriate, ask, “Is there someone I can call for you?” It’s important to allow yourself enough time to meet the needs of patrons with orientation issues.You might be wondering how your library can help your community cope with mental illness and promote mental health among its residents. Librarians can start the community conversation about mental health by educating individuals and families about mental health, increasing awareness of mental health issues and making it easier for people to seek help. Community connectedness and support are also important to the long-term recovery of people living with mental illnesses. Here are some suggestions for building community connectedness and support:1. Invite local mental health experts, including those who have experienced mental illness, to speak at your library.2. Share facts and common myths about mental health. Take care to correct negative stereotypes, especially with your staff, colleagues and institutional co-workers. Set and enforce standards of tolerance that reflect well on the library and serve as a model for the children and teens in your community.3. Set up displays and programs in the library, and order books and other materials that help increase awareness of mental illness. Select and recommend titles for both children and adults on health issues based upon community needs and requests.4. Organize additional meetings or gatherings for members of your community to have conversations about mental health. (These are known as “civic engagement” activities.)5. Consider offering your meeting spaces for such conversations and for support groups focused on addressing mental health issues. Provide space for peer-led groups that give people the chance to tell their stories in their own time and way. 6. Plan and facilitate a community conversation using the federal government’s “Substance Abuse and Mental Health Services Administration’s Toolkit for Community Conversations about Mental Health.” Share the kit with other community leaders who want to use it with their organizations. 7. Strengthen the connections within your community to mental health services and support and enhance links between mental health, substance abuse, disability and other social services.8. Form partnerships with agencies, professionals, and self-advocates who can help you assess and meet the needs of people with mental illness.9. Reach out to any group homes, public or private institutions, facilities and mental health clinics in your city.10. Identify the social services agencies—both public and private—existing in your area. 11. Identify the resources available to your mentally ill patrons.Resources:National Alliance on Mental Illness Institute of Mental Health Health America National Helpline1-800-662-4357 Suicide Prevention Lifeline1-800-273-8255 211 Brain Health Now ................
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