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Subject: Games for people with psychiatric disorders rss

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David Robert
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I'm starting with a project at work, and I could use a bit of a advice. I work with people who suffer or have suffered from psychiatric disorders. They are people who are dismissed from a psychiatric hospital and are stabile ( though often still on prescribed drugs ) but are not ready to function in society yet. They live together in groups of five to ten people in houses owned by the organisation I work for. We offer them psychological assistance but also aid them with everyday household chores.
Anyway, I had some time left and got the idea in my head to organize a weekly afternoon of games. The idea is to incite them to leave their homes. A common problem for people with a psychiatric disorder is that they have trouble finding a meaningful pastime. We already have a few games but they just lay there and nothing is really being done with them. We are talking of the usual collection of Monopoly, Scrabble and Rummycub. I am planning on buying a collection of games that is fun and has simple rules. I want enough games so I can provide something if only two people show up or if twenty show up. I will be present during those afternoons to explain the rules, but it's very important the rules be simple. For example, I think something like Pandemic would already be too complex.So far, I'm thinking of:

Settlers of Catan ( base game )
Carcassonne ( no farmers )
Chinatown
Ticket to Ride
Time's up
Can't stop
Hey that's my fish

I'm sure you guys have plenty of suggestions
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Steve R Bullock
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Oh, you know we have plenty of suggestions...

Sanitarium sounds good.


And this suggestion is coming from a guy diagnosed with agoraphobia!

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James Newton
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I understand a bit of where you are coming from - my Dad used to work in the rehabilitation unit of a psychiatric hospital, and took patients to football matches and things so that they could learn how to function in normal society. Some of them had been in an institution for so long that they had to be taught things like you have to pay for things in shops and cafes. So best wishes with what you are doing.

Back to the subject in hand ... while I do not have direct experience with the type of people you are dealing with, my mum does sometimes invite a few "lame ducks" from her church round at holiday times (who wouldn't otherwise have company) and we often end up playing board games. One of them in particular is a "slow learner" in some areas (there is probably a more accurate description but that will do for now) and there are some games which have been rejected as too complicated for her. However, with a bit of coaching and understanding (someone who is prepared to answer questions like "can I play this now") we have played Settlers and Ticket To Ride. Other games we have played are Dominion, Roborally and Great Dalmuti. All have been enjoyed.

I think the key here, as well having relatively simple main rules and someone on-hand (with the patience) to explain the occasional complexities, is that the game is played in a spirit of communal fun rather than competitiveness; with those who are better able to understand the game and strategy helping/coaching those who are less able (especially me as the games "expert").

For example, in Roborally if I have finished selecting my program, and someone less programatically-minded is struggling, then I will help them work out what they want to do ... or someone might even say where they are planning to go to help someone else decide. And if someone gets shot five times we manage to treat it as a laugh rather than take it personally.

I hope that helps a bit, and I hope the games idea works out.
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lisa smith
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I would advise againist games with a take that element. Co-ops might be good


You need to separate out into two groups I think - mentally challnged people and normal or higher intellegence.

I've gone to dance classes for people with disabilities. The one that was mostly physical disabilities was great fun. The one with a population that was mostly developmentally delayed folks was no fun for me although clearly fun for them.
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Nagato Fujibayashi

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You can think of Dixit, perhaps? I don't know, you know your people better. Do you believe that they can handle the freedom and request for creative thinking and imagination the game offers? If yes, maybe you can get some good results with that!

That's the one that immediately came to my mind, should anything else appear I'll come back.
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David Robert
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shinobu wrote:
You can think of Dixit, perhaps? I don't know, you know your people better. Do you believe that they can handle the freedom and request for creative thinking and imagination the game offers? If yes, maybe you can get some good results with that!

That's the one that immediately came to my mind, should anything else appear I'll come back.


Excellent suggestion! Don't know how I managed to forget that one.
 
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David Robert
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churchmouse wrote:

I think the key here, as well having relatively simple main rules and someone on-hand (with the patience) to explain the occasional complexities, is that the game is played in a spirit of communal fun rather than competitiveness


That is exactly the point. I probably already was aware of this at some level but you put it into focus for me.
 
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Ralph T
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It would be fascinating to hear how the patients do at Dixit.
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Tom McPhee
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I think you need to be a lot more specific in what patient group you are working with. You say the patients are stable. I am a psychiatrist and 'stable' for some patients is entirely relative. In these situations a specially trained occupational therapist with expertise in dealing with psychiatric conditions would be very valuable.

It would be important to bear in mind the effects of the underlying condition and on top of that the effects of medication. Someone with significant depression may have poor concentration and/or motivation to engage with a relatively longer, more complex game, and the depressive cognitive distortions might magnify a simple loss in a game. Even co-op games might prove troublesome with a combined loss being very much magnified by the depressed person into it all being their fault.

Someone who is hypomanic may not have the staying power to follow a game through to completion, causing annoyance in the other players. In hypomania attention can be difficult to maintain, despite possible early enthusiasm. Someone with a psychotic illness may be too distracted by auditory hallucinations to focus, although actually playing a game with friends might be just the thing to help distract them. In more chronic states the so-called 'negative symptoms' of schizophrenia can intervene and result in an amotivational state with anergia, apathy and alogia, so despite a lot of effort on your part the patient may appear to be simply 'lazy'. This is not the case, but is often a source of upset to friends and family, as the patient appears to not 'want to help themselves'.

The effects of medications can also be troublesome. Most antipsychotics result in some degree of sedation, and many can cause stiffness in joints and therefore dexterity based games might be more difficult. Other antipsychotics and some mood stabilisers can also boost appetite to a great extent. Some antidepressants can also e.g. Cause dry mouth, helped by having a glass of water on hand (so watch your game board). There is also a huge comorbidity with medical conditions, e.g. Diabetes, heart disease etc.

My take home advice, regardless of the above is to simply ask your clients what interests them and personalise the game choice to them, regardless of their psychiatric condition. although I suspect I am simply teaching granny how to suck eggs. Be prepared though for setbacks but celebrate the successes. Having worked in rehab settings success comes slowly and gradually but it does come!
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Scott Wheelock
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Great advice from Tom! I'd emphasize his last point; don't get paralyzed by all of the different factors you need to consider. Give it a shot, and see what worked and what didn't. If only a couple of people stay interested, that's a couple of people who have a new hobby, and maybe we'll see them on the Geek soon.
 
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David Robert
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Thanks for the great advice, Tom. I am very much aware of the potential problems I may come across. I have experience with explaining games but this will be a challenge for me no doubt. That's a good thing though.
You should know that we work by the principle of 'assistance on demand'. The people who rent homes from us are basically independent and manage their own lives. We only help where they think it is needed ( though we often drop hints where we think it is needed and all activities we organize are optional. We try to cater to individual interests but, as you pointed out, with schizofrenic people, those are often not very strong.

The large majority of people we work with suffer from schizofrenia, but I also work with people with borderline personality disorder, social phobia and some with autism. Not a perfect setup for a smooth game, I know, but I'm prepared for a dud and will cherish any success.

Sadly, you are in the perfect position to mention some games for me but you failed to do so . Any suggestions ?
 
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Tom McPhee
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Hi there, yes, I realised that after I posted, sorry. I have been using my ipad and am not a fan of typing on it, hence any spelling or grammar errors (at least that's my excuse and I'm sticking by it).

I have to say you have a very eclectic group of psychiatric conditions there! I'm also not exactly sure how these conditions are managed in Belgium, but here in the UK there is a greater move towards using medication for borderline personality disorder symptoms. I think you have your work cut out for you. I also think, particularly with the patients with borderline personality disorder you will have to make it clear that you are not acting in a 'therapeutic model' per se (although if they derive 'therapeutic beneift' (however that might be defined) then that's great).

Having spoken with my Occupational Therapy colleague in rehab, unfortunately he has tended to use games sparingly as he has found it hard to motivate and interest patients in them. The games he has used are rather simple and straightforward, such as jigsaws, connect 4, ludo, and basic card games using a standard deck of cards, e.g. rummy or blackjack. In terms of my own ideas with regards to specific games then I think the rules of Stratego are easy enough, although of course only for two players. High functioning autism patients might enjoy more euro-style games (my partner isn't Aspergersy really, but has a few traits and loves games with logical, easy to follow mechanics). Social phobia, in and of itself, is unlikely to result in any need for long term residential care, and so imagine this would be part of some other psychiatric condition. However, this is where you could perhaps achieve some 'therapeutic' success, by gradually exposing folk to games with more and more social interaction, starting with two player games and working up to games with much more, such as party games, but do it very very gradually and sensitively. Social phobics, of course, are utterly terrified of being shamed and humiliated by others in a social setting and often fear being expelled from a group and so I could imagine this would only be 'safe' after some time, once they are comfortable with the whole group.

Again, regardless, I think games that make each person feel worthwhile again (usually they do occupy the margins of society as we generally shun the mentally unwell), and make them feel that they have something to offer are good. I wish you all the best in your endeavour, Tom.
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Joel Gabelman
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Telestrations comes to mind.

Ingenious
Pente
Cathedral
Pit
For Sale

I'm just thinking of interactive games with very easy rules.

Best of luck!

-JRG









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Chris Fee
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No fair! They're using brains against us! We removed our brains to make room for guns and explosives!
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Forbidden Island is simpler than Pandemic for a co-op.
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David Robert
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I wonder: Isn't Castle Panic the best option for a co-op game? It's more intuitive and has even simpler rules.
 
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David Robert
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I've been given a budget of 300 euro, with which I should be able to buy ten games. What do you guys think of this selection, bearing in mind I'm trying to cater to different numbers of players and a healthy diversity in mechanics:

Settlers of Catan
Carcassonne
Hey that's my fish
Ticket To Ride
Dixit
Chinatown
Time's Up
Wits & Wagers ( on the fence about this one )
Castle Panic / Forbidden Island
Ingenious

 
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Peter Miller
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Hi David, one issue that I have know of that can cause problems is if one member has a favourite colour that they must always play with. Within my games group everyone knows that I tend to play with black if they are part of the game, one friend tends to play blue etc. In this case this is the way things have developed but I know that for some people this can be a real issue.
Other issue that I have had is the competitive nature of some games for example with the Cities and Knight expansion of Settlers of Catan, so if this is a problem you could play Settlers without the burglar. I would be interest to know how you get on with Chinatown as I could see this being quite competitive and frustrating for some people.
My suggestions for your group would be Pandemic or Forbidden Island, for the same reason given by Chris Fee. I would include Ingenious on the list because I know that this game suits my personality and the whole abstract thing. I’m sure there is a list of abstract games on BBG but you may want to consider Blokus. I would also recommend Mexican Train as this is always a fun evening with friends.
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Frank Zinzi
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Hi, I am a psychiatric social worker who has been using games and using/designing gaming and recreation programs for kids and young adults with psychiatric and behavioral issues for 10 years. This is a fantastic method, so keep at it and I am sure you will fing something that will stick. The games you use really do depend on the individuals involved. The big question is co-op vs. head to head. I have seen seen positive results for both.

For head to head, I have seen CCG's like Magic; World of Warcraft, or simpler, like Harry potter TCG, C-23 and Pokemon work really well. Let them choose the theme, and buy a huge lot of a "dead" CCG for all parties to use while in the program. Deckbuilding is a motivator in and of itself if you run the activity in a tournament format where there are prizes. Keep a couple of tuned decks handy for those who leave them at home, though. There is more to this, as I have done it several times....If you want to talk more about it, let me know.

Co-Ops have been the thing for me lately, but they have to be simple, fun, and quick. Forbidden Island and Castle Panic have been my go to games and the young adults I have been working with can't get enough of it.

I could go on for hours about this topic.....good luck!

Frank
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Jack Smith
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You mentioned Monopoly in your first post, I would suggested avoiding it. In my opinion the length of the game, the lack of decision making, little control over choice and player elimination make it unsuitable and a frustrating experience. You also mentioned Scrabble. A member of the family with several disorders loved this game although we had to be a bit generous with spelling mistakes for the bigger words.
 
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