What's the connection between IPM and mental health?

I returned last week from the annual conference of the Entomological Society of America--or, as I heard it referred to by a (non-entomologist) hotel visitor, "that Bug's Life group". With over 3100 attendees this year the ESA meeting is probably the largest gathering of professional entomologists in the world, with papers ranging from highly technical reports on new molecular biology techniques to an artist's perspective on the aesthetic beauty of insects.  Regardless of your interest or background, there's always something of interest at ESA.

While a number of sessions and talks were devoted to bed bugs this year, one of the most interesting perspectives I heard was from Dr. Christiana Bratiotis of the Boston University School of Social Work.  She addressed a symposium on how to engage people from diverse backgrounds in urban IPM. Bratiotis's expertise is on hoarding behavior, but she addressed the wider question of how to recognize and deal with people who, for a variety of physical or mental reasons, pose a special challenge to the PMP. 

Making IPM work, Bratiotis said, is especially difficult when pest control customers suffer from a variety of mental and emotional disorders, cognitive limitations, and limitations due to age. Some of the primary mental illnesses likely to be encountered by anyone in the service industry include depression, anxiety, hoarding (of both belongings and animals), schizophrenia and psychoses.  Personality disorders include obsessive-compulsive disorder, histrionics, borderline personalities, and narcissistic personality disorder. In addition, cognitive limitations in the mentally challenged and older adults, as well as visual and hearing deficits in many people can lead to difficulties with communication and getting clients to recognize and report pest control problems.

Mental health disorders, especially, can lead to unexpected encounters with a pest control technician, such as the violently angry customer, or the customer hallucinating about unseen pests in walls or crawling on skin at night (delusory parasitosis).   Add to this that the PMP may be one of the few visitors that a depressed or reclusive person may have in his or her home for months (even years), and the stage is set for some interesting interactions.

Mental health problems are far more common that most of us realize.  According to the National Institutes of Mental Health, approximately 6% of the U.S. adult population suffers from severe mental illness.  Over 26% of American adults experience some form of mental disorder in any given 12 month period.  The chance of any of us experiencing a mental disorder of some form over our lifetime is approximately 46%. Clearly, this is not a minor issue.

The relevance of Bratiotis's paper to pest management is obvious, yet I'd wager that most of us in the pest control industry rarely give much thought to how many of our clientele are struggling with mental and emotional health issues.  I know I tend to approach most people with the attitude that they will be just like me--that they will have the same needs and desires, that they will approach problems rationally, and they will be looking for solutions in their own and others' best interests. Sadly, this is not a valid assumption for many people.

If your company's PMPs interact with dozens to hundreds of people daily, having tools and skills to recognize and deal with mental health issues is essential.  If you're an employer with one or more employees, you need skills to recognize and deal with mental illness within your staff as well.  This point came home tragically to the Dallas pest control community last August, when an employee of one of our local companies shot and killed a co-worker in an incident almost certainly due to mental illness.

According to Bratiotis, learning a few simple phrases or techniques can, in many cases, help a PMP better deal with customers who are not acting or thinking rationally.  For the person with obsessive-compulsive disorder, who is fearful that they must perform in a specific manner to get rid of pests, affirmation is important.  Assure them that things don't have to be done perfectly to make a big improvement.  For the emotionally unstable or angry customer the best response may be, "I can see you're not doing well today.  I'll come back when you're feeling better." A self-centered (narcissistic) person should be affirmed and empowered to be part of the pest control solution.

Recognize that some problem clients may simply be visually- or auditory-impaired.  Such limitations do not necessarily imply cognitive (thinking) disorder or mental illness, but they can present similar challenges for the PMP.  Visually-impaired clients may not be able to read notices or see the bed bugs or cockroaches in their home.  Auditory-impaired clients may not hear instructions or reports, even though they nod or imply that they do.  Technicians should be aware and on the lookout that some clients will fall in these categories, and will need extra help.

In many cases outside help may be called for.  Letting the apartment manager know what's going on with a problem tenant is important for multi-family housing accounts.  Elderly or mentally challenged customers may need a personal care attendant or access to support services that can help with residence clean-up.  Extreme cases of hoarding will likely also require the help of a professional. 

Additional suggestions include:

• Help identify resource people or agencies that can help a physically or mentally challenged person (this means educating yourself about the social and mental health resources in your community).
• Schedule ongoing follow-up and monitoring. Knowing that someone cares and plans to return can make a significant difference in rate of compliance with challenged customers.
• When making sanitation recommendations to challenged customers, break suggestions down into manageable tasks.  Breaking a recommendation into small steps can make all the difference between progress and paralysis.
• Realize that many of your customers may be struggling with mental and physical challenges that may not be immediately apparent.  Liberal praise and encouragement  is especially important for these customers when they make an effort to participate in the IPM effort.

Finally, get to know some of the mental health professionals in your community.  These folks may be willing to conduct awareness training and provide resources for your staff.  Conversely, your knowledge and expertise may be of value to the health care community.  It was obvious to me after last week's paper that we in the IPM business need to communicate more with social workers and mental health physicians.