Schizophrenia & Paranoia in Association Members: When Concern Becomes a Crisis

Discussion with Legal Expert Jennifer Cunha, Esq. and Board-Certified Psychiatrist Dr. Ivan Cichowicz

Have you ever encountered a resident who seems confused, withdrawn, or detached from reality — and you weren’t sure how to respond?

Schizophrenia is one of the most misunderstood mental health conditions, yet people living with it are part of every community, including your HOA or condominium. Misinterpretation can lead to unnecessary fear, conflict, or even discrimination.

Join us for Schizophrenia & Paranoia in Association Members, where we separate myths from facts and explain how psychosis, delusions, and disorganized behavior may appear in real-world community settings.

Learn what the Fair Housing Act requires, how to respond safely and respectfully, and how your association can balance compassion with responsibility.

Discover practical steps for promoting awareness, preventing crises, and supporting residents who struggle with serious mental illness — all while protecting your community and reducing liability.

Knowledge replaces stigma. Understanding saves lives — and strengthens communities.

Here is a link to our handout: https://tinyurl.com/3epb6sex

Check out our website: https://jennifercunhalawoffice.com/ 

Transcript

Warm-Up And Vitamin D Study

SPEAKER_00 0:06

Hi everyone, we're giving just a couple seconds for Zoom to add everybody. Welcome, welcome, welcome. Hello everyone. And then we'll get started. But while we're waiting, Dr. Zikovitz, you have a you have a fun new study you read this morning about vitamin D and telomeres?

SPEAKER_02 0:32

So yes, super interesting study I was looking at this morning. Vitamin D apparently helps um preserve or keep your telomeres um healthy and maybe even grow a little bit. Now, telomeres are the part of the chromosomes, the little corners at the end of the chromosomes, and we believe that those getting shorter is what causes us to get older. So the aging process, so keeping our vitamin D levels up may be the best thing we can do right now to help stay a little bit younger.

SPEAKER_00 1:05

And you said this is even better than like um omega-3s?

SPEAKER_02 1:09

Better than omega-3s and better than any of the other, I'm gonna say, so-called miracle cures that are out there on the markets, apparently.

SPEAKER_00 1:16

Interesting, interesting. So this makes them grow where other stuff like just preserves you in other ways.

SPEAKER_02 1:22

Yeah, and and again, I'm gonna use the word not that it makes them gonna say grow significantly. Your chromosome normally just gets chipped at the ends. It gets shorter and shorter and shorter as time goes by, and this is why our cells get unhealthier and unhealthier and unhealthier, and by that we we look older, and our organs like don't work as well. So if you keep those telomeres healthy, and and I I guess maybe grow is not the best word, the word is like we keep them healthy, um as opposed to just disappearing like it normally happens, then your organs and your body, you know, your skin, everything just stays a little bit younger for a little bit longer.

SPEAKER_00 2:05

That's super cool.

SPEAKER_02 2:06

So let's see what happens. It's just uh, you know, the first study that kind of shows this, but it'll be interesting to see if something straightforward and simple can actually make a difference.

SPEAKER_00 2:16

Yeah, very interesting, very interesting. Welcome everybody. Looks like Zeeem has added everyone to our um podcast

Setting The Topic: Schizophrenia

SPEAKER_00 2:23

today. This is the mental health and law podcast. We'll be talking about schizophrenia today. Um, we have lots of questions that came in ahead of time, and we would love to answer your questions as well. Um, we see primarily the QA. Um, and I put into the chat the handout that um is on the topic today for schizophrenia. Um, and I'll put it in there periodically. This again isn't a CE class in particular. It is a course about, you know, or it's like a podcast about mental health. Um, so and I was looking at the handout um again this morning. We have a lot to talk about. I feel like I'm gonna learn a lot about various um like mental health challenges that come with paranoia and delusions and hallucinations, and it just into schizophrenia because the question always is like, what is it? Um we'll also be talking about you know de-escalation and and confrontation and safety. Um, okay, so Dr. Chikkowicz, tell us a little bit about yourself and what you do um and your experience with schizophrenia.

SPEAKER_02 3:30

Okay. So, hey, again, thank you for having me on, Jen. Um, I'm Ivan Chikkowitz.

What Schizophrenia Looks Like

SPEAKER_02 3:35

I am a psychiatrist um in Boca Ratone, Florida here. I own a private practice. And we're gonna be talking about schizophrenia today and how does knowing a little bit about this or having some type of understanding can help us just interact with the people that live in our communities and HOAs. And the first thing to remember is, you know, the incidence of schizophrenia is about 1%. So it's not something that's super common, but it's out there. So there is likely to be someone in every association or that has some form of schizophrenia or schizophrenia type symptoms. And it's important to remember that not everything that looks like schizophrenia is necessarily schizophrenia, and we need to just be aware of this when we're interacting with them.

SPEAKER_00 4:26

Gotcha. Um, okay, so could you give us a couple of examples, like case examples of individuals who have schizophrenia and how that presents to them?

SPEAKER_02 4:36

So I'm gonna say the first thing is remembering someone who has schizophrenia basically has a few characteristics. One, they have delusional thinking. And by that we mean they have paranoid delusions. They feel that the government is out to get them, but this is not the, you know, oh, they're after, you know, my tax money. No, this is there's actual plots, there's actual ideas that people are spying on them. Um, these delusions can be grandiose delusions. We think we are messengers from God, we think we are beings from another planet. Um, we have hallucinations. And hallucinations are things like we see things that are not there, or we hear things that are also not really happening. And and remember, someone with schizophrenia doesn't see, I'm gonna say, like dogs that don't exist, like or people that don't exist, like you see in the movies, or they're having conversations with other people. That's not what schizophrenic patients really experience. Schizophrenic patients will see shadows, they'll misinterpret like the plant behind you, they'll misinterpret it as maybe, you know, a tentacle, but they're not seeing like devils or little green men. That is not what schizophrenic patients kind of go through. It's more a misinterpretation of their surroundings. And then people with schizophrenia tend to be disorganized. Their thinking makes no sense, they may be incoherent, they just may not be able to express ideas in a way that you're like, okay, I I get what you're saying. Their behaviors will also tend to be disorganized. So they just can't take care of themselves, they can't, you know, keep adequate hygiene a lot of the times, they they can't keep social connections. And then sometimes the biggest challenge that schizophrenic patients tend to have is what we call negative symptoms, which is, I'm gonna say, stuff that's below the norm of how you interact with the world. So they have difficulty enjoying anything or deriving pleasure from anything. That's called anedonia. So a lot of times they stay at home because they they just, you know, there's nothing out there that cannot interest them. They have no motivation, they have difficulty talking. And I don't mean that they can't talk, I mean they have difficulty just starting a conversation. So you say hi and they'll say hi, and and that's it.

SPEAKER_00 7:13

They have no how are you doing, or no is this do you think because they've been so like kind of gotten so much social pressure that they are eccentric, that they're kind of engaged, afraid to engage with people, or is this just a function of the disease that or the the condition that they they have a hard time communicating, don't really value it the way we would.

SPEAKER_02 7:34

No, so unfortunately, schizophrenia, there is like changes in how the brain is structured. So all those brain cells that are connected in schizophrenics, they tend to be connected differently. There tends to be a little bit less of brain mass. So it's not that they don't want to do it or that they're afraid, it's just their brain doesn't kind of let them do it.

SPEAKER_00 7:55

Is this purely genetic, or is there like a trauma aspect to it that somebody, you know, probably has had something that kind of like broke them into schizophrenia where they had genetic predispositions?

SPEAKER_02 8:08

Yeah. So it is mostly a genetic disease. Now that said, if you have the genetic predisposition and you have zero stress and trauma in your life, you may only have a little bit of symptoms, not enough to get you an official diagnosis. But in most cases, it's genetic predisposition. And then as you know, life kind of knocks you down, the symptoms start to come out. It's usually happens during college because that's when stress starts to come out. You're no longer being taken care of by mom and dad. Now you have to like figure your way out in the world, and that's where stuff just gets usually too overwhelming for the brain to manage.

SPEAKER_00 8:46

Now you talked about like the shadows and a little bit of paranoia, and I know that people with PTSD sometimes are hyper-vigilant and they'll initially like see something

Genetics, Onset, And Course

SPEAKER_00 8:56

as something that's not, and then you know, settle down and say, Oh, like the tree isn't a tentacle, it's you know, it's a tree, although like the initial response might be one of fear if there's a trigger. Um, with people who have schizophrenia, do they settle down like they see it and they're like, oh no, no, no, it's not, it's just a tree. Or does it live in their head that, oh no, this shadow is the government and this tree is a tentacle?

SPEAKER_02 9:20

Yeah, so the the difference in schizophrenia from all the other disorders that we'll talk about, because there's a lot of things that could have these delusions and these hallucinations is in schizophrenia, these are chronic um issues. They don't come and go, they're just there. If people are taking medicines and they're in treatment, things can get better, but they stop the treatment and the delusions, the hallucinations, the disorganized thinking kind of comes right back. Schizophrenia, the difference between this and the other presentations is schizophrenia symptoms are chronically present unless you're being actively treated. And unfortunately, even with treatment, I can't say that symptoms go away a hundred percent. They they get better, but people still have a lot of disability, unfortunately. It's a you know, a very serious illness, and it's kind of very hard to, I'm gonna say, to treat effectively.

SPEAKER_00 10:15

Um, so how often are people with schizophrenia able to live independently versus meeting a parent? And when I think of schizophrenia, really I think of two scenarios and associations. One are families who kind of find a condo 55 and over where people are very present and they just kind of like stump somebody in there who has a severe mental health disorder and everyone else lives far away, and they've put their kid here who's you know, like an adult but needs care. Um and the family is fairly remote. They just kind of like or maybe the parents pass away, and the you know, the family member who has schizophrenia is a trust fund baby of sorts, and like the others are like, okay, well, we'll just stick up in Florida in this condo. And then the condo, you know, has someone who has schizophrenia and nobody else who's caring care for them. And you know, there's some disorganized thinking and um paranoid behavior. The second scenario are the caregivers who are the parents. So we have a lot of parents who are seniors who have adult children who haven't been able to live independently, and then the association, you know, especially 55 plus associations might be um unexpectedly kind of dealing with someone who has extremely eccentric behavior that sometimes the ones that we get phone calls for, you know, feel scary for the association. Um so those are the scenarios we come into contact with, you know, not unusually. What is your experience as someone who works with people with schizophrenia?

SPEAKER_02 11:46

Yeah, so I actually have patients who have both situations. I have a lot of patients whose parents have, I'm gonna say, some level of wealth, who they just buy the patients a condo somewhere and they live there. Now, on the right treatments, again, these patients will be, I'm gonna say, low-functioning, but they can live independently. They can, you know, pick up their mail, they can cook. The the problem is they're not gonna be good at taking care of the household. So usually there has to be someone who comes in to do that. They're not

Living Independently In HOAs

SPEAKER_02 12:20

good at following up with any HOA like changes in rules or requests. So usually those things need to go through the parents or the guardians.

SPEAKER_00 12:30

And interesting. Okay.

SPEAKER_02 12:32

They'll they'll tend to be the type of people who are mostly homebound. They're not gonna be social. So the neighbors may say, um, you know, they're not taking care of their yard, or they're not, you know, I'm gonna say, following all the rules, unless there's outside support saying, Oh, you need to turn off the music at, you know, nine, or you can't be, you know, turning your barbecue on inside of the garage. So, unless usually there's outside support with those things, you may run into those issues.

SPEAKER_00 13:05

Um, the light, the light, like we have this come up so often where board members are like, there's just this strange behavior, and we're like, we don't know, is it is it drugs? Is it, you know, like we have no idea, but we see this kind of you know, eccentric behavior. And then of course the association's like, why? Why what's going on here? Um, we had a woman who set up a camera in her window um and like would record everybody using the grill. I don't know if this is the same thing, but just like like she she'd have her blinds kind of like closed, but she'd have one cracked, and then she had a camera set up at all times, like watching some like common areas. Um, not not like her front door, just like the back. Um, I don't know if this is the kind of paranoia, but you know, you would get these kinds of things where people are.

SPEAKER_02 13:57

Yeah, I mean, so that clearly sounds like paranoia. Hard to know if it's schizophrenia or another type of paranoia, but it is classic for patients who have schizophrenia. Let's say they're living in the community. If the neighbor does have like any type of camera, they may get like really scared because they'll be, oh, like you have the camera to spy on me as opposed to you have the camera to just monitor your doorbell or monitor like whatever Amazon packages or Walmart packages are being delivered. So I I could see you know those type of things. Um, I could also see HOA people knocking on the door trying to talk to someone and someone who's at the house just not wanting to come out because they're afraid of what's the purpose of these people knocking on my door.

SPEAKER_00 14:44

And are these the ones that are gonna give us a hard time at extermination time when we have to do extermination? They'll be like, not my house, not my house.

SPEAKER_02 14:51

Yeah, exactly. You you could see a lot of that, you know, just being very worried about oh, these chemicals are gonna be bad for me. And it doesn't matter what exterminator you're using. Um, these could be issues, but but again, on the right treatments, there people can be fairly functional. Um, so it's just a matter of the people who are in the right treatments are usually not gonna give the association much trouble. They're just gonna be people who are disengaged, maybe from the community.

SPEAKER_00 15:18

That's good. I um but I've we're gonna pop into these questions here, but before that, I wanted to ask um two questions. One, what is the compliance rate, would you say, of staying on medication when someone has schizophrenia or like staying on treatment?

SPEAKER_02 15:36

So the problem with schizophrenia is the patients a lot of times do not feel that they have a problem. It's the family, everyone around them who says, you know, you're not okay. Um, so when you get them on medicine and they're doing well, a lot of times they'll be able to realize, oh, okay, so I wasn't doing that well. This is a whole lot better. And then they they'll try to stay on medicine, but they need a lot of support to stay on medicine. They need someone to check in on them like all the time to make sure that they're taking their medicines, or they need to get the medicines in form in the form of an injection that you can do once a month or once every few months. And and I just remind everyone, you know, if you're on cholesterol, blood pressure medicine, it's hard to take your medicine every day. But that, you know, if you're on blood pressure pills, your blood pressure goes up, but you're still usually okay. If you had schizophrenia, missing two or three days could make the symptoms come 100% back. And then that means that you're back to sinking, you know, all the delusional stuff or all the hallucinations are real and you don't need the medicine. So with support, people do well. Without support, it can be very, very hard. And like you said, a lot of times parents live up north, so that support can be limited.

SPEAKER_00 16:58

Yeah, yeah, yeah. My second question is on a scale of zero to 10 of happiness or you know, like positive feelings. Um you know, you you've mentioned that people who have schizophrenia or suffer from schizophrenia are often kind of like isolated, they have different

Medication Adherence And Supports

SPEAKER_00 17:14

kinds of modes of thinking. Where do they fall on the happiness scale? Are they depressed? Are they okay? General like middle ground, are they feel feeling like fairly peaceful and okay with life despite the paranoia? Like what where would you put them?

SPEAKER_02 17:31

So, I mean, when you're sick and you're not aware that you're sick, you don't you don't think you have a problem. So I think that scale would just kind of like not really apply to those people. The people who get treatment and are aware that they have the problem, are aware that they need the medicine, there is usually a level of underlying depression because they can see how there's a difference between their level of functioning and the level of functioning of people around them. So I I wouldn't use the term that they're clinically depressed, but a lot of the stuff that we talk about when we do therapy with someone who has schizophrenia is the loss of function, the loss of being able to, you know, I'm gonna say be in the army, the loss of being able to be the CEO of a company, the loss of the ability to be able to be a lawyer or an engineer. Um I don't have something that there is that sensation. I don't want to say it's always depression, but there is that underlying loss that a lot of them will struggle with.

SPEAKER_00 18:37

So they kind of come into I won't say like the light, but like like a more clear like level of thinking. And then when they come to the space, they realize where they're at and what their limitations are gonna be. And then there can be some like grief and loss around recognition that there will be some challenges.

SPEAKER_02 19:01

Yeah, so there's there's two moments when that happens. One once you're on treatment and you're better and you can see like where you were and where you are now. And the other one is when you're starting to have symptoms. Because a lot of times you realize, you know, what's going on. I was a very good student at school. Now I just can't, you know, get my act together. I can't figure it out. That can also cause um a lot of you know feelings of guilt, of hopelessness, of not being good enough. Um, at those points, sometimes people can be misdiagnosed as having depression or anxiety, as opposed to the underlying schizophrenia because the symptoms are just starting to, I'm gonna say, to creep up.

SPEAKER_00 19:42

That makes sense. Okay, I'm gonna grab some questions from our chat, and then um, I know in our handout you have um some examples of symptoms and then also like other things that have those symptoms and how you distinguish between them. So um Shelly asks, can an elderly person become schizophrenic with age?

SPEAKER_02 20:03

Okay, so no, schizophrenia is a disease that is chronic. Usually you have some type of what we'll call prodromal symptoms during late childhood. And by that I mean little

Quality Of Life And Grief

SPEAKER_02 20:18

things that are not noticeable. No one can usually pick this up, but when you put everything together, you could see there were a little things in childhood, and symptoms tend to rise early 20s to I'm gonna say mid-30s. You do not develop schizophrenia late in life unless you have a neurological issue, and then it's not really schizophrenia. The most common cause for people to develop schizophrenia type symptoms late in life is dementia or other types of neurological issues, like strokes, dementias can cause this.

SPEAKER_00 20:54

Okay. So this is a good time to go into all the other things that can look somewhat like schizophrenia. Um so you have here schizoaffective disorder. I feel like I was pretty good at the list. Like I took I have a degree in psychology. And um, and it's I'm like, I took you know, classes on the different ones, and I've completely forgotten what this one is. So what is it?

SPEAKER_02 21:18

I mean, so schizoaffective disorder is basically schizophrenia that has mood components. So someone who has schizophrenia but can also have mammoc episodes, which is what describes bipolar disorder, or someone that has schizophrenia and can have depressive episodes, but they still always have the delusional thinking, the disorganized thought process and behavior. That's what we call schizoaffective disorder. And and the difference between schizophrenia and schizoaffective disorder is really, I'm gonna say, more a medical kind of semantics thing. So it is the most common confused diagnosis, but I think for in terms of someone from an association or who's like interacting with the public, this is maybe not the one that you need to be, you know, the most worried about.

SPEAKER_01 22:06

Okay.

SPEAKER_02 22:06

I I think the next two are maybe gonna be by far the most common, which is people who have bipolar disorder and depression can have, when these illnesses get complicated, um, hallucinations, they can have uh paranoia, they can have the delusional thinking. And sometimes we can seek their schizophrenics. And it's important to know because these are people who function well, have episodes where functioning completely disappears, but then once they get better, they go back to functioning kind of well again.

SPEAKER_00 22:39

Gotcha. So that that's different than schizophrenia because schizophrenia, we won't go back to functioning well without intervention, but with bipolar, it goes in phases.

SPEAKER_02 22:48

Yeah, and even in schizophrenia, even with treatment, you don't go back to a hundred percent of pre-morbid or pre-diagnostic functioning.

SPEAKER_00 22:57

Okay.

SPEAKER_02 22:58

Um, and something like bipolar disorder or depression, when you're not during in the depressive episode or the manic episode, you are back to functioning at pretty much pre-morbid level.

SPEAKER_00 23:10

Okay. Um, and then

Late-Onset Lookalikes

SPEAKER_00 23:14

go ahead, yeah.

SPEAKER_02 23:16

And then I think the most interesting one to me, or the one that I've had a lot of issues with communities is delusional disorder.

SPEAKER_00 23:26

Oh, okay. I've never heard of this either.

SPEAKER_02 23:28

So delusional disorder is someone who is completely functional, completely, I'm gonna say, able to interact. You can have like conversations, they can go out, they can do everything, they can work every day, no symptoms, but there's one part of their thought process that just doesn't make any sense. And I've had patients who tell me, my neighbor is putting laughing gas into my house. And they have a you know, a high-end job as a VP of a big company, they have you know amazing pedigrees in terms of academic performance. Significant others say they're amazing, you know, they're super loving, they're super caring, kids have no issues, neighbors, family, everyone loves these people, but still there's this usually one complaint that just makes no sense. And because they're very high functioning, they can take this to, you know, I'm gonna say very high up. So a schizophrenic usually doesn't have the ability to hire lawyers and you know sue a neighbor or sue the association, but someone with delusional disorder can hire lawyers, can sue the association saying someone is pouring laughing gas into my house, even though there is zero proof, and sometimes a significant other say, I mean, it makes zero sense to me, but they believe this.

SPEAKER_00 24:57

Okay, so delusional disorder, is it always completely kind of like random, like laughing gas, or can this be like the board is stealing money? No, and there's just not, there's just not.

SPEAKER_02 25:08

It could be the board is stealing money. The difference is delusional disorder is about one thing in particular, usually, it's not like a gross everything. Like you're Dr.

SPEAKER_00 25:18

Tikowitz, I think that you have diagnosed like 80% of our most difficult and and and um able to litigate quite well um individuals in our associations, potentially here, because we we have people who are like they'll bring, they'll they'll broadcast everything on YouTube. They go to every board meeting and they'll put it on YouTube, they'll put it on Facebook Live, they'll put out letters that like the board is stealing money, and the board's just like simply not stealing money. Yeah and and it's like a whole campaign.

SPEAKER_02 25:49

Yeah, but the delusional disorder person would be someone who you you're thinking. I mean, when I talk to them, they're they're reasonable, right? They they make complete sense, they're super nice, but then on this one part, it's just we can't convince them, even if we show them

Bipolar, Depression, And Schizoaffective

SPEAKER_02 26:05

the books, right? They they will just they will not take evidence as proof that they are wrong.

SPEAKER_00 26:11

Interesting. Okay, so so this can be everyday stuff like the boards taking money, or it can be super random. And what would you say the precaution is?

SPEAKER_02 26:20

Is it you know, sometimes like so everyday stuff that they get by and they also just like that, you know, again maybe they got abducted by aliens or the aliens are here or something, or no, it's usually, I'm gonna be honest, it's usually not things that are bizarre. And by that I mean it's not something like abducted by aliens, it's things that could be true in you know, in some realm. So for example, a neighbor is you know putting something in my house. I have a patient who believed that neighbors were coordinating to take his Amazon packages and deliver them a day later. Um, the board um stealing money. I've had people think that their boards are involved in like mafia schemes.

SPEAKER_00 27:10

Yes, I have that too.

SPEAKER_02 27:11

So these are things that, you know, it it's not that it's impossible that they're true. It's just they're, you know, they're kind of like far-fetched and 99.9% untrue. But in delusional disorder, they're you know, they're chronic, you can't prove them wrong, and they're not bizarre. Like they're not thinking, um, oh, it's you know, aliens abducted me or they're lizard men, you know, running the association. It's not that type of stuff. It's the associate, you know, the president's son is an investor in the company that's mowing the lawn. Even though there's kind of no proof of that, there are like intent of this. And it again, this is where you distinguish a delusional disorder from another type of disorder.

SPEAKER_00 27:57

Okay, so definitely we have to have an entire podcast on delusional disorder and what to do, because um, I forgot this existed. And I definitely think that a lot of us um deal with this in associations.

SPEAKER_02 28:12

And you know, and again, like we we talk about these mental health disorders, but we also, you know, bring to it the compassion that somebody who's experiencing it is feeling stressed out and um and no and and and delusional disorders can be very difficult, particularly for family and even for the patient, because they can't understand why people don't believe them, and for the family, because they struggle to kind of like my loved one is a hundred percent okay, except in this one belief that just doesn't make any sense. And I want to address because someone asked, um, would that not be more like a borderline or a narcissistic

Delusional Disorder In Communities

SPEAKER_02 28:51

um idea? And and the difference between that and delusional disorder is again, delusional disorder are, I will say, meant mental health-wise, completely healthy individuals. They can form good relationships, they can be in loving relationships, they can be in stable relationships, they may be very good people in the community, they are not, I'm gonna say, narcissistic, they are not trying to grab the limelight, they are not um impulsive, they are not, you know, someone who would do something out of spite. They truly believe that these wrongs or that these beliefs are happening in the community, and they're voicing concern in a way because they they want to help other people and they want to help their families and they want to help themselves. That's the big difference between a delusional disorder and someone who has borderline personality disorder who just maybe got upset with the president because they didn't mention his contribution to the community in the last meeting. Like The delusional disorder does not get upset because he was not, you know, told how amazing he is. He he or she doesn't need that. They're upset and worried because they feel there's a wrong happening in front of them, and no one is kind of doing anything about it.

SPEAKER_00 30:15

That makes sense. Okay. So definitely we're gonna talk about delusional disorder in the future. Um, substance-induced psychotic disorder. So again, we're looking at like the features of schizophrenia include some kinds of like psychosis sometimes, and what are the other things that can cause psychosis to present.

SPEAKER_02 30:36

I put this in there because substance use is very prevalent. And I mean, these, you know, people who use substances live in every association, and someone who's under the effects of a substance and it's withdrawing can have psychosis. So you can see odd and bizarre behavior in someone. It doesn't mean they have schizophrenia, but substance withdrawals or substance use can be one of those reasons that someone just behaves in an odd and a bizarre way. Um, particularly if they're doing this during a activity, like you know, a Mother's Day celebration or like um, you know, an association meeting. It it could seem as if it was a schizophrenia type representation, but it's really an underlying substance use issue.

SPEAKER_00 31:26

Okay, so some questions. Somebody asks, do people at schizophrenia hear voices telling them what to do?

SPEAKER_02 31:33

So there is a, I'm gonna say a subset of patients who will hear voices telling them what to do. Um, this is not the most common presentation in schizophrenia, and when we do have this, we do worry a little bit more than in someone who does not have the symptom because sometimes the voices are, I'll use the word like encouraging, but a lot of times the voices can be telling you, you know, X person is bad, they're trying to hurt you, and and that creates like uh one, a risk factor for them hurting someone else, or they can tell the patient, you need to hurt yourself because you're bad, and that creates potential for them hurting themselves. I mean, that said, schizophrenics do not tend to be, and we use the word violent, they they do not like engaging with other people, they would rather be left alone, but because they can be paranoid, if you try to confront them, they could react in um, I'm gonna say, aggressive and violent way, but they are not aggressive by nature.

SPEAKER_00 32:38

And most of them you mentioned um in the the handout are actually like victims violence.

SPEAKER_02 32:43

Yeah, so it's easy to take advantage of them because cognitively, again, they don't have these social skills to know who is, I'm gonna say, trying to take advantage of them versus who is actually being kind.

SPEAKER_00 32:57

And so we have we had somebody who like brought in a lot of homeless people over and over and over and over again, and these people would just like cause all kinds of problems, do all kinds of things. I mean, on both sides, this is like, you know, there's mental health, this challenge. But is this somebody who might do something like this? Or is that something else?

SPEAKER_02 33:18

No, no, I I don't want to say that this person did have schizophrenia, but it it could be that type of behavior where someone who's homeless could say, Hey, um, you know, I I'll cook for you, I'll clean for you in exchange of you letting me like live at the house. And they'll say, That sounds reasonable, but next thing they know, there's another five people coming in because they're friends of the other person, and then they just don't have the skills to say, no, this is not okay.

SPEAKER_00 33:46

We have seen this not uncommonly. We've had multiple associations where someone, you know, a lot of times it's with like the family, somebody in the family passes away, and the you know, adult child is a friend, or some some mental disorder inherited the unit or is living in the unit, but somebody's been helping them, and then those caregivers are gone, parents or whatever. And then things just fall apart. And we have seen them like invite in you know, homeless people

Substance And Sleep-Related Psychosis

SPEAKER_00 34:15

or other people who take horrible advantage of them, and then those people are breaking the rules. This person, you know.

SPEAKER_02 34:22

Yeah, the reality is they don't have the cognitive skills to navigate that landscape. So it's easy for someone who's kind to just convince them or take advantage of them.

SPEAKER_00 34:33

Okay, so in this scenario, are there local resources? Like somebody's somebody's, you know, parents have passed and they have schizophrenia and they're living in a unit in, you know, whoever's association, and we see this going down. What happens on the legal side is that they don't pay their, they don't pay their assessments or and they're not following the rules. So you go at like a multi like modal approach where um we're going after the rule violations. Like the rule violations is a the fridge is full of maggots, you know, and like the air conditioning is off and the mold is growing in the unit, and um, they've brought in, you know, like other people homeless or you know, caregivers and all the caregivers' families, and like all this kind of stuff's going on. And the association is like, we can't even, like, we can't even. What do we do? So, so you know, we take a tiered approach that we do rule enforcement, we do collections, and we hope the family gets involved. The family doesn't always get involved. Um, you know, what I mean, yeah.

SPEAKER_02 35:42

So, I mean, in in Florida, I think there's two big uh systems that can help. Number one is 988 can provide assistance. If it's someone who has the capacity to understand I need help, they can call 988, they can help that person connect with mental health providers, they can help them connect with services in the community that could help them. That is, um, if the person has that capacity. For example, they can get a case manager that could go to the home and could help set the patient up with services of cleaning the house, helping, making sure that he's on the medicines or she's on the medicines. Now, if it's more of an emergency or someone who is living in deplorable conditions, the association just doesn't know what to do, the person is refusing to engage. There is a crisis response team. Um it if it's under the umbrella of what's called South County Mental Health, and they serve all of Palm Beach County. They will send what's called a fact team to the patient's home, and they will address the mental health issues at the patient's home. Um, usually it's a therapist, sometimes there's a psychiatrist involved. Um, there tends to, again, on occasions will be like police officers if they feel it's more something that could become a legal issue. Um, it's a pretty amazing service. They're available 24-7. I mean, just as a reminder for patients, um, not for patients, for communities out there, it's not something that you call and they say, Oh, you're the first one on the list, we'll be there in five minutes. It's not 911. Um, but they do a good job and they will really help. They have a lot of experience. And if they feel the situation is unsafe, they will baker act um the person and have them then go to a hospital to get further care.

SPEAKER_00 37:44

That's amazing. I I feel often like very thankful and happy to live in like Palm Beast County. Like, I just love I love the the resources that are available here for people. I didn't know about this one, and this is like makes me even happier.

Who Ends Up On Boards And Why

SPEAKER_00 37:58

I love I love like the things that are available for people to help.

SPEAKER_02 38:01

Yeah, there's okay. No, no, there's there's a lot of more mental health support out there than what we imagine.

SPEAKER_01 38:08

Yeah.

SPEAKER_02 38:08

And the handout, I put other phone numbers, they're all excellent. And if anyone just doesn't know what to do, if you call 911 and you say it's a mental health issue, they'll usually be able to connect you to the appropriate kind of like agency or the appropriate kind of phone number.

SPEAKER_00 38:25

Okay. And Bev's asking what about Broward? Does Broward have a lot of resources?

SPEAKER_02 38:29

Um, so Broward is as well, if not even better, staffed than Palm Beach County. Um, the difference is in Broward, and I don't have the phone number on the top of my head, but I I can get that for anyone. Um, the name of the company that has the mobile crisis team is oh my god. Having my senior moment here.

SPEAKER_00 38:55

No worries, we can we can uh put it into the No let me look this up. This is Oh yeah, somebody's asking for the handout. I'll put it in the chat here. Um and and while you're looking that up, again, what we see on the law side, um we do take a we've had recently a couple where um, you know, we went again rule enforcement collections kind of like full force, hoping that family would get involved somewhere. And typically they do. So one of them was a man who thought that the board like is comprised of not like Nazis, like literally Nazis. Um, and then you know, the board was really scared about this because he I think was speaking in ways that he just thought that they were like gonna like hurt him. Um we with our clients, we always say, like, yes, and rule enforcement reminder, like don't bring the rule kind of letters. Um, but if you're ever scared or worried, toss it to us. It's why we exist. Like, toss it to your lawyer. Lawyer literally exists to be your team member and help you feel safe when things come up like this.

SPEAKER_02 40:14

No, and like yeah, and Jen, I think it's super important for people to remember that because these are actual mental health diagnoses, these are not people who are, I'm gonna say, acting out or anything like that. They are protected um under the law. Um, so you just can't, I'm gonna use the word, kick them out of a community or not provide reasonable accommodations for them.

SPEAKER_00 40:38

It's a conversation, right? So, so what happens is that um, you know, and this is something that like the lawyer, this is this is a reason you want your lawyer to have these conversations, because you can get you can get sanctions. You could you could have the right plan, and if you say it wrongly, you can get sanctions. Um, but these are like conversations where people come and say, like, I have bipolar disorder, or I have, you know, my child has schizophrenia or whatever. We need a reasonable accommodation, please. And then and then the conversation becomes like, what does that reasonable accommodation look like? And um, and what does that support look like? And is it um reasonable for the association to provide it or reasonable for the association to like provide a second chance, but also be getting updates that you know somebody's being compliant with their medication. Um, and in a way, you know, like it's a little bit, you know, more work for the community sometimes, but it also provides a space for people to, you know, to live and and and and stay, you know, encouraged to be on their medicine and not be homeless, right? Like the alternative is somebody becomes homeless. Um so sometimes there's a little bit of like nurturing support around this. And again, your lawyer can handle your lawyer can handle all this. Um, everything works out.

SPEAKER_02 41:57

Um okay, so well, I just want to add something because I have I'm putting in the chat right now the phone number for the service Embrower Crisis Response Center. It's it's through a company called Henderson Behavioral Health.

SPEAKER_01 42:13

Yeah.

SPEAKER_02 42:14

And I'm putting in the phone number here at the in the chat so everyone can look that up if they need it.

SPEAKER_00 42:19

Perfect. Yeah.

Crisis Resources And Mobile Teams

SPEAKER_00 42:20

And Ron, thank you, mentions as well. Um, okay, so John asks, can alcohol abuse trigger psychosis?

SPEAKER_02 42:31

Um, so not usually the using of the alcohol, and people who are intoxicated by alcohol could act very bizarrely, but it's usually the withdrawal from the alcohol, what can look like psychosis. Um, alcohol withdrawal has a lot of other medical issues that go with it. There's instability in your blood pressure, um, but it can look like psychosis. And the other common thing that we see in communities that can look like psychosis is withdrawal from benzodiazepines, which are things like Sanax, Valium, clonopin, or withdrawal from pain medications, you know, percocets, oxycontin, all these things can present just a hundred percent like if someone had like schizophrenia um with symptoms of psychosis.

SPEAKER_00 43:21

Does lack of sleep cause this? Barbara asks.

SPEAKER_02 43:24

I mean, lack of sleep could give you symptoms of psychosis. The the answer is yes, but it has to be, you know, significant lack of sleep. It's usually not that you slept only four hours or two or three hours the night before. It's usually sustained lack of sleep. But yes.

SPEAKER_00 43:44

Now we have people who ask like about board members who are suspected of having schizophrenia or have some sort of like bizarre behavior. My my hunch is people who have schizophrenia are probably not on the board because they are more reclusive. Is this accurate? Or do you think that sometimes people with schizophrenia might be on the board?

SPEAKER_02 44:02

No, I mean, so this is okay, right?

SPEAKER_00 44:04

Like of course, you know, we want to do that.

SPEAKER_02 44:06

Yeah, no, so someone with schizophrenia is not going to be able to be on the board. And I think this is important um in the past when you went to see a psychoanalyst as opposed to seeing a psychiatrist, um, we just didn't have that much knowledge about mental health as we do now. So if you were a little bit different than the average person, they would tell you you're a schizophrenic. So I sometimes see people who tell me, you know, I'm a schizophrenic and it's a you know 62-year-old CEO of a company. I mean, this is not a schizophrenic, okay? You can have a bunch of other things, but you don't have schizophrenia. Schizophrenia is chronic, it is debilitating, it is maybe the most serious mental illness that we have out there. So these people just do not have the cognitive ability to manage being on the board. Um, but people who are on the board can have psychosis for a bunch of other reasons. Like people with bipolar disorder can be on the boards, people with depression can be on the boards, even someone with delusional disorder that we talked about could be on the boards. And someone asked about borderline personality disorder. Borderline personality disorder um could at some points develop some type of psychosis, it's usually short-lived and very mild, uh, but it could happen. So these are the people who you would see on the board, not a schizophrenic.

SPEAKER_00 45:31

Okay, that makes sense. So um if somebody is having some like psychosis behavior, right, presentation um from whatever other causes, someone is asking whether they can be removed from the board. Um, what would happen is that you would strip them of their officer position if they're an officer. We had a president of the board who became like violent and he would on his in his car, he'd like run people who were walking like off into the, he'd like go by them very quickly and like at them. He'd like run them off the road. He ran people in the cars off the road. He told people he wasn't on their med, he wasn't on his medicine anymore, they had guns. Just the president of the association. Um, first of all, Dr.

SPEAKER_02 46:21

Tikowitz, do you have a possible diagnosis of I mean, there's a lot that's going on there. Again, because he's the president of the board. I'm assuming he doesn't have schizophrenia, but he could have bipolar disorder that's kind of getting out of control, or it could be some type of dementia that's kind of setting in. Um, I I mean I think those are hard conversations to have outside of a doctor's office. So hey, I I think it's pretty impressive that that was managed.

SPEAKER_00 46:50

Yeah, so um, so he was no longer the president, he was stripped from his president position. The association did begin an injunction lawsuit to

Myths, Safety, And Communication

SPEAKER_00 47:00

um, because like he was breaking the rules to have a judge say he couldn't do these things anymore. Um, and as part of that, you know, like a judge can declare that he's not mentally competent to be on the board anymore. Um, that would be, or and they were also, you know, in paralegging a recall vote. So so it's not really if someone's been arrested and he wasn't arrested. I think they were working on trying to find the cameras, like the camera shots, the video, or they set up, it was a couple years ago, they might have set up cameras, which would help a lot, right? Um, with paranoia. But they were setting up cameras so they could catch him on camera doing these things that they'd have more proof for a criminal case. Um, but you know, they they weren't at a place where he'd been arrested. But certainly if somebody's arrested for or charged on some level for criminal behavior, they could be removed from the board instantly, um, you know, or suspended from the board. Um so so those are some of the the things. If somebody on the board is causing a problem with their behavior, the board members can just strip them of their officer position and make them a director at large. Even if this means that a couple of your officers have to be in two roles, or one of your officers needs to have two roles, that's okay. Um but you know, you could just have them as a director at large. Um if they're non-functioning, if they're hospitalized, um, you can have an assistant to them who functions in their stud. Um, and then, you know, and then there are some legal things that you can do, whether it's a recall or a court case. Um okay, so how do you um let's go through the rest of these super fast and then we're gonna talk a little bit about like um management and interaction. When I say super fast, um let's do like three minutes and see if we can tackle these in three minutes, and then we'll get into interaction. Yeah, how to manage it. Yeah, like how do you interact, right? Like what do we do with interactions? Um, okay, so you have here brief psychotic disorder.

SPEAKER_02 49:03

Yeah, I mean, brief psychotic disorder is similar to schizophrenia, but it just it happens for a week, two weeks, less than a month. And what's important to know is because remember, these are people who are neighbors, they live in a community. Just because someone has an episode of these symptoms doesn't mean they have schizophrenia. I want people to understand you could have episodes because of a myriad of reasons, and then next week, next month be okay.

SPEAKER_00 49:33

Okay. So um schizop schizophreniform disorder?

SPEAKER_02 49:39

Yeah, so uh again, these are just, I'm gonna say, different versions of schizophrenia. Schizophreniform is the it's a different time frame, but it's the same type of symptoms. But it's the same thing as with pre-psychotic disorder, just a reminder that not everyone who has these symptoms is going to have um schizophrenia. But I I don't think anyone needs to like pay too much attention. The one that's super important is the medical stuff. Because a lot of times, particularly communities where there's a lot of geriatric populations, um, there's a lot of underlying medical issues that can cause psychosis and can look like schizophrenia when you're interacting with someone. So if you have someone who's usually paying all their rents and stops paying and they have lupus, it could be that they're having a bad lupus flare-up, or it could be that they lost their thyroid medicine and their thyroid um disorder is now out of control, and they're presenting as they if they had schizophrenia, but it's an underlying medical disorder.

SPEAKER_00 50:42

Okay. Um then autism spectrum disorder.

SPEAKER_02 50:47

Yeah, so autism spectrum disorder is maybe the bigger challenge sometimes in differentiating um what behaviors are autism and what behaviors are schizophrenia. And remember, autism is a big term. Some people with autism are just a little socially awkward, but some people with autism have significant impairments. And there can be a lot of overlap in terms of what you would see in a community because a lot of people with severe autism or moderate to severe autism can end up also living in the community with some supervision. As opposed to living alone, maybe they live with an aide or with an elderly parent or with a family member, and the autistic person usually is not able to take care of the household or to manage things, but with a little bit of support, they're okay to live independently. The question is again, that person who's providing support, how good are they at controlling um the behavior of the of the autistic adult? Um and you could also see kind of breakdowns happening in terms of maybe not so much taking care of the place, but you know, just behavioral episodes happening in, I'm gonna say common areas.

SPEAKER_00 52:02

Okay, that makes sense. Um, I have seen some communities who had, you know, like a an adult childhood of like a learning disorder who lived with their parent and the parent passed away. And the community basically just adopted this family, this person. They make sure that they have food, they make sure their room is like the house is tight, like they just they just adopted them. And then, you know, this person's in their 40s and their 50s, they they they age through community care with like learning disorders.

SPEAKER_02 52:31

And and I'll give like a an example. I have an autistic um lady, she's in her late 50s, um,

Reasonable Accommodations That Work

SPEAKER_02 52:40

she lives with her sibling, but if her sibling will go on a vacation, she may knock on the neighbor's door to tell them that she just went to the bathroom. And I and I get it that this could be frustrating and disturbing to the community, uh, but it's not that she has schizophrenia. I mean, it's just there's no one there. She can, you know, put food in the microwave and figure that stuff out, but she's just not able to deal with the fact that she has no one to express some of these anxieties and worries that she has.

SPEAKER_00 53:12

That makes sense. And and some of our communities kind of like absorb this with, you know, like some of them have people who are like nurturing and extroverted, and just like, hey, I have no worries, you want some cookies, right? Like, like some of them are just like super, and others are, you know, it's just it it varies and it's okay, whatever that is in the community. Like some communities are like, listen, like we're a lot of shy people here, and and it is hard for us to work with somebody who's like needing all this extra support. So there are community resources, and there are some communities that become that resource, and both are okay. Um personality disorders, we talked about schizotypal, paranoid, medical conditions, we talked about um like super fast. Let's chat about the conditions, epilepsy, brain tumors, you talked about lupus, Huntington's, Wilson's, all these come out with some presentations of schizophrenia that are similar.

SPEAKER_02 54:08

Again, the they they all can have the real word is psychosis, but it can look like schizophrenia. And and the point here is when someone who's been living in the community and has not expressed these symptoms or these impairments, and all of a sudden it starts to happen, we have to understand it's likely not schizophrenia. Schizophrenia, again, is a disease that has early onset, it's chronic. So these are people who are chronically struggling. When someone starts to struggle at any point later in life, we have to always assume there's something else going on. And the reason this is important is because if someone has schizophrenia, um, you know, getting their parents or their siblings involved is very important because this is a chronic issue. But if someone has an untreated hypothyroidism and their styroid hormone is through the roof, you may find that family say, I talked to this person a month ago, they're perfectly fine, don't bother me with whatever's going on. Um, they they're adults, they can just go to the doctor. And and the difference is because of the lived life experience. If you have a sibling who has schizophrenia and you get a call, you're like, yeah, my sibling is sick. Um, what can I do to help or how can I be helpful? If you have a sibling who, again, you believe it's perfectly fine, you could find that family's just less willing to get involved or or get be engaged. I mean, not always, but we tend to find this a lot.

SPEAKER_00 55:40

Okay, that makes sense. Okay, so um, let's talk about interactions. Um you have here myths versus facts. One is that like people are not dangerous, people think that they can be dangerous, but generally they are the victims of violence. Um, they can't live independently.

SPEAKER_02 55:59

Schizophrenia means multiple personalities, and then you know, like interactions with the I think number one, they're generally not they not dangerous, but because a lot of them just don't take care of their hygiene, they can seem a little scary because they'll tend to smell, um they'll they won't be groomed, they'll have, you know, sometimes, you know, I sometimes see people who have five t-shirts on, and it's just it's you know, not what we're used to, and that can always set up, you know, alarms or their posturing can be can be strange. They can pace. That is like a common side effect of some schizophrenia medications. Um, sometimes they'll they'll groan another side effect of medicines, and those can be interpreted as they're agitated. I mean, again, this stuff is hard, but just remember if someone has schizophrenia and you send them a cold letter saying you're in violation because you left your trash can outside past the date, they can feel like threatened or paranoid about that. If someone knocks on the door and says, Hey, you know, Mr. Whatever, friendly reminder that the trash has to be brought in, or you send a little bit of a more personalized email saying, Hey, this is so-and-so from your association, just reminding you about the trash can. And you know, again, in a kind way, usually you get them to respond very well. They they don't not interact with people because they don't want to, they don't interact with people because they just don't have the skills. So if you can kind of be kind and be go down to their level and say, Are you okay? Do you need us to you know bring you some muffins or whatever? They will be usually very kind and very appreciative of this kind of stuff.

SPEAKER_00 57:54

Okay, so let's dive into this a little bit more. And um, a reminder for anyone who um is new, we usually go until about 1.15 on our webinars or up to 115.

Collections, Notices, And Triggers

SPEAKER_00 58:05

So um, and then the other thing is um some people may have to pop off for work. Um Dr. Shika, what's in the chat? Could you put your contact information? Um, I know you have a full service practice with psychologists, psychiatrists, sure, mental health counselors, um, and you treat especially like difficult and persistent conditions, but the whole gamut of things that are um make people uncomfy in the head. If anybody's uncomfying in the head, they can call and uh feel better with a variety of treatments, which are really cool. Um, okay, so what we're gonna dive into now are some various scenarios and possible accommodations that might exist, right? If somebody comes and says, you know, um, my son is living here and he has schizophrenia and we like to ask for an accommodation for him around us, it sounds like one of those accommodations might literally just be friendlier letters or, you know, um potentially, you know, we'd have to like think about think around it, but like knocking on the door and a reminder about the garbage or a reminder about something. This these might be like accommodations that could be requested versus like the hard, scary letter that I am certainly guilty of sending.

SPEAKER_02 59:26

Um no, and and another thing is, you know, with dogs and cats, the issue is they don't tend to be good at taking care of them. Okay, but they can be sometimes the only companionship that they have. So associations could maybe, you know, have if there's a family member who can make sure that you know comes to the house and you know make sure that there's not like feces and urine everywhere. Um, these would be like people who accommodations for this kind of thing. Stuff would be okay, but as long as there's someone else who can help support that.

SPEAKER_00 1:00:04

Okay, so so some accommodation might also just be that the point of contact is someone else, the point of contact is a different family member, and the other family member is the one that if something's going sideways with rules, you just call them and say, Hey, we have a we have you know a problem with the animal, we have a problem with this, we have a problem with that. Um and then, you know, again, the idea is that if people, you know, are people whose schizophrenia are generally nonviolent, and this is a everyone needs a place to live, right? Or they could potentially be homeless, you know, if that accommodation that the law requires, the law is like encouraging people to allow people who have individuals to live full as full of as possible lives in the community, you know, having a different point of contact that gets the first call when there's a violation, the probably the accommodation that would be requested. Um and then the next question I have is um if somebody like falls into collections, they're not paying regularly, what does this look like? And there could be some tension because it's just processes. You don't pay, you get a notice, you don't pay, you get a foreclosure. What does it look like for collections with someone who has schizophrenia?

SPEAKER_02 1:01:17

Yeah, I I mean, and I think the challenge is in schizophrenia, you just may not have the cognitive ability to manage any complicated, I'm gonna say, legal issue. And and I am and that would mean, you know, figure out what to do if you get a collections letter. It it may just be overwhelming, and I I could see most of them just throwing the letter away and kind of hoping for the best, as opposed to to dealing with the problem. And then that could create tension. It's not that they want to be confrontational, it's just they read the letter, they can't figure out exactly what it means, they know it's bad, and they're like, just you know, pretend it doesn't exist and and hope for the best. It it would always be better to have these discussions with a family member, a guardian. And if someone is, you know, is on medicine and they're doing well, then again, I would just say you have to maybe not send a strengthening letter, but just send a letter saying, hey, you are out of compliance, we'd like to talk to you to see what we can do

Alternative Contacts And Care Networks

SPEAKER_02 1:02:25

to get you back into compliance. Because again, with treatment, you can get a whole lot better, but you're still gonna be sensitive to any strengthening remark. If I get a strengthening letter, I know, okay, it's you know, this is the way it is. But if someone with schizophrenia gets a threatening letter, they're gonna maybe feel, oh, they're they're against me.

SPEAKER_00 1:02:43

Right, like triggered. It's like a trigger. It's like you know, we think of PTSD and we think of the triggers that exist for war veterans and how we want to be like gentle and accommodating for people with PTSD. And it we might just think of people with schizophrenia as having like threat triggers that like something that makes them feel threatened can trigger their paranoia. Um and I I'm almost thinking that along these lines, updating sales and leasing contracts to say, are you a person with a disability? Um, you know, optional, are you a person with a disability and do you have a contact person? And is there an alternative, you know, do you want us to send notices to this con this contact person? Um and that way it would actually just be like upfront that when somebody's moving in, if they're a person with a disability who, you know, particularly like this, maybe, maybe that alternative contact is the is the primary contact. Um, and I think, I think again, of you know, like our communities who somebody has Down syndrome and they're 45 and their you know, parent is 80, um, or or have some other learning disabilities in the community, it's just like, yeah, like we're here, you know, we can only support the situation. I mean, what would that look like for someone who has schizophrenia when we know that generally it's non-violent, the triggers are gonna be threats, but you know, for shy, we're not functionally um cognitive on the level everybody else's lack of resources to be able to like come into compliance. So maybe just like this extra, like one touch of let's just accommodate with a little more nurturing.

SPEAKER_02 1:04:16

And I'm gonna say, like most of the patients who I see who live in communities independently, um, they do have one, um, someone who comes in to help clean and make sure that there's food in the fridge, um, maybe once or twice a week. And they have like a family member who is in charge of paying all the bills. So I'm gonna say 90% of the time, it's just being aware that these are the people who you want to interact with, as opposed to maybe just kind of interacting with the person. But a lot of times some of my patients like, well, you know, they'll go for walks at two in the morning. It's not that they're threatening, it's just this is the time that they feel comfortable being outside. There's no one there, they don't have to be bothered. Uh, but they're not trying to create chaos or mischief. But it's it's remembering that sometimes it's a little bit of these things that we need to be aware of, and that if they have one friend in the, I'm gonna say, association, that could also make a difference because they might say, oh, you know, John the treasurer, I know it's a kind person. So if he says, I need to bring in the garbage cans, I get it, he's a good person. I'm just gonna go and bring in the garbage cans. Um, so any of those type of relationships are just always gonna be good.

SPEAKER_00 1:05:38

That makes sense. Okay, so on a legal side, I think the first thing is that the best way to stay out of lawsuit is to um, you know, like follow, I mean, for through the board, right? Like if you think of a reasonable accommodation lawsuit or things like this, um, which exists and they end up in sanctions. Um, none of our associations have had this happen, like, you know, um, over an issue like this. Um, but but the possibility is that, you know, John Doe has schizophrenia, he's out of compliance, he has various issues, and the board doesn't know what to do, and the board's like nervous.

Boundaries, Kindness, And Limits

SPEAKER_00 1:06:15

Um and and he hasn't acted in a like a threatening manner, just eccentric, maybe, and violating rules, violating like just collections are a problem. So if John comes back and says, like, I would like a reasonable accommodation, the law is gonna require some measure of reasonable accommodation. And one possibility you know, to avoid even getting to that space of like burn a reasonable accommodation, there's tension, tension, tension, is if there's someone who's somewhat eccentric in the community, whether or not we know their diagnosis, just like kind of being extra-friendly. Um, you know, if it if it fits, just kind of like making people feel safe and included. And then um potentially, you know, if this fits the style of the board, this is again like not necessarily required, but avoiding that like confrontation of fair housing issues. It could really be a management thing that you can say, oh, John, it's so good to see you today. Just want to remind you, we have to take the trash, you know, thins in right after the garbage comes. Are you good? Okay, awesome. It's good to see you. Um, that kind of approach sounds more management oriented, not legally required, but avoiding lawsuits in the future and maybe avoiding other issues in the future. And then possibly adding to sales and leasing contracts. Like, are you optional? Are you a person with a disability? Do you have an alternative contact? And do you want this alternative contact to be the primary contact of, you know, for for notices and for violations? And honest God, like this moment, I'm like, oh, I wish all of our sales leasing contracts have this because it's not uncommon for associations to have somebody who's having challenges in this way. And then we don't know who's the contact. You know, our hope is we send these threatening letters that are scary, which we send, and then and then people get them, and then they hold like they send them off to family, and we hope that the family gets it and is like scared enough to intervene. Like, this is our method, is like, let's scare the family into intervening here because we have a problem. Then it often works. Um, but maybe even better, just like hey Rachel, John's having a little challenge. Can you go help him out? Okay, awesome. Or hey, Rachel, here's like the violation notice. She's like, oh, sorry, okay. You know, so so and and you know, that seems like it would avoid a lot of headaches in the future.

SPEAKER_01 1:08:36

Yeah.

SPEAKER_00 1:08:37

What are your thoughts?

SPEAKER_02 1:08:38

Do you have any like last minute thoughts around supporting and and avoiding lawsuits or managing or feeling safe um with the Yeah, so I I mean I I want to rent around me, like someone who has schizophrenia is not gonna sue anyone. It's the family that will kind of like sue a community. Um and this is what I mean. People with schizophrenia, it's it's a debilitating illness. Um so if they're doing really well with medicines, I could say maybe, but this is just not usually where they're at. It's usually going to be family. And this is why I feel like you're mentioning just having alternative contacts. And if there is no alternative contacts, you know, it's a 55-year-old and their parents passed away or they have no siblings. It's I mean, in a and again, I know this is just a lot of work for associations, but just trying to bring down the rhetoric from threat to how can we do this to help you out so you can stay in your home? And if at any point that just doesn't feel comfortable, then I think at that point we just call the crisis response team and we have them like assess for is it safe for the person to stay living at the house? Um, are they capable of caring for themselves if there's no one there? Because the, you know, the association can't make these determinations, but the crisis response team can. So if that's a worry, then we we can go ahead and do that.

SPEAKER_00 1:10:16

Okay. I have um another question is

HIPAA, Family Outreach, And Help

SPEAKER_00 1:10:20

if, you know, one one thing I think people might think is, oh, if I become like super friendly, then I be might become like kind of on the hook for caregiving and I don't have the space and capacity for caregiving. So if like John comes to trust me and you know, like I'm very friendly, is John gonna like be over all the time needing things? Um, what do you see with schizophrenia in this? And is there a way to manage that? So you can feel very like comfortable being extra friendly, like being friendly and somebody that is trust uh trustworthy and also not worrying that there's gonna be caregiving involved.

SPEAKER_02 1:10:58

Yeah, I mean, so there's an important part here, which is I I don't want anyone to feel that it's their job to then be the caregivers. Um, what I'm saying is it's you can be kind and empathic to someone, but you can still set limits. So you can say to whoever, you know, the the the person in the community is with schizophrenia, um, hey, you know, you say good morning, how are you doing? You can, hey, I brought you over, like, you know, some fruits or whatever it is. I went to the supermarket, got you some biscuits. But you can also tell them, you know, I need to go. Um, you I'm not available to talk right now. I I don't want anyone to think that it's, you know, it's all or nothing. There's a lot of gray zone in between where it's perfectly fine to set limits and say, hey John, you know, you know that I appreciate you, but I have other responsibilities. I need to go deal with them. Hope you have a great day. I mean, that is perfectly fine and okay. And in general, these are not people that love long conversations.

unknown 1:12:08

Okay.

SPEAKER_02 1:12:09

You know, someone's gizophina, usually a five-minute conversation is usually five minutes too long. So I I don't usually envision them, you know, just reaching out just to say hi. I I could see them calling if they get a threatening letter and they don't know what to do and they don't want to maybe mention it to their family because they're afraid the family may kind of you know belittle them or tell them, here you go, messing up again. But these are not the type of people who are gonna call just to say, hey, what are you doing today?

SPEAKER_00 1:12:39

You want to go and I'm not gonna show up at two in the morning knocking and wanting to like chat and things like this. Is this gonna be family?

SPEAKER_02 1:12:46

I I think it would have to be like an emergency, you know. If if for some reason they feel that you know someone is trying to break into their place, you know, maybe they get out of the house and they go and they knock on someone's door, but they're just they're not social butterflies, they don't crave attention.

SPEAKER_01 1:13:03

Okay.

SPEAKER_02 1:13:03

Um, they tend to just, you know, enjoy more being by themselves. It feels a whole lot safer and it requires less cognitive load um than having to just interact with multiple people.

SPEAKER_00 1:13:16

That sounds good. Yeah. Thank you so much. Okay, so we're gonna go ahead and wrap up. Um, we have um quick question. I'll answer if someone's showing symptoms of any disorder, can board members contact family members or others without permission, I would say yes. Um, I think that um, you know, like you don't have HIPAA, I mean, unless you have personal information, like like somebody has like an accommodation they've they've put into the association, like that we can't go publishing that, but for sure, I think that if you have someone who's going, you know, exhibiting some symptoms, reaching out to family is fine.

SPEAKER_02 1:13:53

Yeah, and Jen, so for people to remember, like HIPAA means you can't share um personal health information,

When To Seek Mental Health Care

SPEAKER_02 1:14:00

but it doesn't mean you can't ask questions, and it doesn't mean you can't share general concerns. So if you know someone has schizophrenia, you you shouldn't go like if you're under HIPAA rules, you shouldn't go tell someone else, oh, they have schizophrenia, but you can say, hey, I'm worried that they're not doing well, I see that they're paranoid. Um, can you guys, you know, intervene or make sure that they're evaluated? That is perfectly fine, even if you're under HIPAA, I'm gonna say, provisions.

SPEAKER_00 1:14:31

Okay, that makes sense. And then, um, okay, then outside of the realm of schizophrenia and into the realm of everyday everybody's, when should people see somebody for mental health? If somebody is feeling sad, if feel someone's like having a challenge, like when do people go get some mental health um help and and and what does that help look like?

SPEAKER_02 1:14:50

I mean, so I think whenever you're starting to feel, I'll use I I use the word overwhelm, but I know that we can feel overwhelmed in daily day life, but when you start to feel it's a little bit too much, I'm having difficulty managing this, I am maybe being shorter tempered with my kids, with my friends, with my family, I'm just not sleeping well, you do need to do something about it because these things usually don't just kind of go away on their own. And I see so many people who tell me, oh, when my job changes, I'll be happier. Yeah, but you've been at the same job for 10 years. Like it it's likely not gonna change. Or when my relationship gets better, or when my child moves out of the house, and and these are things that it's never a good plan to say when the world around me changes. It's about what you can do to manage the situation. So it's not about having a bad day, but if you notice that you're struggling, it's always easier to treat something when it's this big than to treat something when it's kind of this big. So the sooner you come in, the less medicine you need, if you even need medicine, and the less time it's gonna take you to feel better.

SPEAKER_00 1:16:03

Amazing. Um, and your practice to work particularly with kind of like creative solutions, not just medicine, but TMS, and you have a PTSD program now that is non-invasive and clinically improves PTSD. So you're not just all meds.

SPEAKER_02 1:16:20

But yeah, I mean, I I think human beings are more complicated than just you know biology. There's the biology component, which is significant. Like a lot of these issues are you know genetic. It's not that someone is weak or strong and they have schizophrenia or bipolar disorder because of uh of it. It's just it's our genetic predisposition. But then we have to counteract that with our real life, you know, psychosocial situation, like our stressors, um, the things that you know keep us awake at night or the things that we worry about. And some things require medicine and some things we can treat with behavioral issues, with just changes to our, you know, I'm gonna say daily living habits. Um and the beauty of it is it's not just about, I'm gonna say, taking a pill to solve everything, but sometimes you do need to take the pill to get better. But that shouldn't be the only goal.

SPEAKER_00 1:17:14

That makes sense.

Wrap-Up And Next Topic Teaser

SPEAKER_00 1:17:15

Awesome. Um, everyone, thank you so much for joining us. Um, if you have any legal questions or need help with anything, I'm always happy to assist. Feel free to um to call us or email me. Um and Brett is asking, is a recording of this podcast? Brett, we're hoping to put this onto podcast platforms. Um, that's uh in the works with some changes we have coming up with our um with our webinars. We're trying to to maybe move them into a space of podcast and conversation, but also we're working on getting some CEs um attached for our general, um, our general ones as well. Um, thank you so much. Next month we'll be talking about OCPD and OCD. These are people who are really detail-oriented, perfectionists, um boarding a lot of times, um, can you know give the board a little bit of a hard time because like every detail matters. Um, so we'll be talking about that on the first Thursday in July. Might be a second Thursday, I have to double check the July 4th situation. Um, but that is our game plan. If you enjoyed this, you want to invite your board member friends or others who are involved in the community, we'd love to have you. Um, Dr. Zikowitz, thanks for all you do, and we'll see everybody next month.

SPEAKER_02 1:18:30

Thank you, Jen, for having me on, and thank you, everyone, for attending.

SPEAKER_00 1:18:34

Bye, everyone.

SPEAKER_02 1:18:35

Bye, everyone.