SCDMH Recovery Training

Special Thanks to the Contributors of These Slides

Carla Damron

Beth Adams

Katherine Roberts

Vicki Cousins

Doug Cochran

Michele Murff

Training Agenda Today

The History of the Mental Health Recovery Movement

… Medical Movement … Psychosocial Rehabilitation Model … Recovery Movement … Consumer Empowerment … Where we are today

Training Agenda Today

Recovery from a Consumer’s Perspective Importance of Hope Creating Recovery Environments Emphasis on Consumer Rights

The degree to which I can participate in creating the life

that I want is directly related to the degree in which I am truly

aware of my participation in creating and sustaining the life

that I have.

(Ike Powell, 2002)

If your clients are not taking an active role in their own recovery,

it is probably because they are receiving negative messages about their own abilities and

potential for growth.

(Ike Powell, 2002)

The South Carolina Department of Mental Health

The

Mental Health

Recovery Movement

South Carolina Lunatic Asylum was the second to open in nation

1828

People were placed in long term institutions, separated

from families and loved ones.

By the 1900s, the SC asylum had 1,040 patients

More than 30 percent of the patients died annually, due in part to poor living conditions and inadequate supervision.

1909 Legislative StudyFindings

Poor sanitation Dilapidated buildings

Patients living in unclean quarters Patients forced to sleep in corridors

Many of the problems at the state hospital were common to facilities nationwide.

Through the 1950s,

the Mental Health Service System was almost exclusively in the

domain of large state-operated, public mental hospital systems.

In 1955, the national State Mental Hospital population reached

559,000.

Major Facts Leading to De-institutionalization

Inhumane conditions in state hospital facilities (restraints,

seclusion, etc.)

Technological advances of the late 1950s

Technological Advances

Introduction of phenothiazinesprovided symptom management of seriously disabling psychoses

Increased the number of patients who could potentially live outside of the

hospital Decreased the length of stay within the

hospital

Technological Advances Result in a Philosophical Shift

New emphasis ... On the value of community care

and treatment On the need to remove barriers between hospital and community

On discontinuing the use of restraints and seclusion

Community Mental Health Centers Act of 1963 (PL94-163)

Provided funding for outpatient, inpatient, emergency, consultation

and education, and partial hospitalization services

1500 centers were to be funded; 789 were actually funded

Community Mental Health Centers Act of 1963 (PL94-163)

Funding was supplemented by Medicare (Title VIII) and

Medicaid (Title XIX) insurance South Carolina had 14 centers

funded. A total of 17 are now in place throughout the state.

Major Characteristics of the Model

Principles of psychotherapy prevail utilizing an insight-oriented,

developmentally focused, non directive approach.

Responsibility for change is placed on the patient.

Medication maintenance for “chronically disabled patients”

Major Characteristics of the Model

Treatment of the seriously mentally ill was not the focus of mental health

professionals Professional prejudice toward

“the mentally ill” The sanctity of the professional’s

office

Emergence of Psychosocial Rehabilitation Model

In the mid-1940s, ten former patients in a state mental hospital formed a self-help group in New York City called “We Are Not Alone” or “WANA.” Based on the concept of mutual self-help their goal was to assist each other and ex-patients like themselves find jobs, places to live, friendship -- and to make their paths own way back to independence and productivity.

This led to the creation of FOUNTAINHOUSE.

Psychosocial Rehabilitation

A holistic approach that addresses multiple needs of the consumer

Emphasizes strengths and wellness Services encompass whole life of

consumer

Psychosocial Rehabilitation

Hope, empowerment, and positive expectations emphasized

Staff/member relationships are egalitarian and respectful

Skill building and focus on WORK are stressed

Early Consumer Self-Help Movement

1970’s: Network Against Psychiatric Assault, Mental Patients’ Liberation Front was committed to the premise that mental illness does not exist.

1990’s: One Our Own, National Mental Health Consumers Association accepted presence of mental disorders but wished to change the consequences of having such disorders.

National and Local Consumer Self-Help Groups Through the 1990s

Contac - Consumer Org.& TA Ctr.

National Consumer Self-Help Clearinghouse

NEC - National Empowerment Center

SC Share - Self-Help Association Regarding Emotions/Recovery for Life Groups

MHASC - Mental Health Association’s CORE/ SA - Schizophrenics Anonymous groups

Consumer Involvement in Mental Health Systems in the 1990s

Self-identified consumers employed by systems as management team members in Offices of Consumer Affairs/Consumer Affairs Coordinators/CCET Members

Planning Policy Makers

Program Evaluators Service Providers

The Evolution of theRecovery Movement

The current movement is a result of consumer involvement in systems for

over 30 years.

It is based on the belief that consumers can and do recover from mental illnesses.

Mental HealthRecovery Movement

“Consumers are beginning to ask for more than a survival, maintenance, stay-out-of-the-hospital concept of life. Consumers are asking for hope - that life will be of quality, productive, and based on equality.”

-- Colleen Jaspers, M.A., Consumer Affairs Director,

Michigan Dept. Of Mental Health

What are Consumers and the Mental Health System

Recovering From? Illnesses

Symptoms and Consequences of Symptoms

Negative Treatment or Lack of Treatment

Institutionalization / Dependence on the System

Discrimination (Stigma) and SHAME

What are Consumers and the Mental Health System

Recovering From? Labels

Limited Expectations Wounds of the Spirit

Poverty, Unemployment and Homelessness

Hopelessness

The absence of negative messages is more important in

developing a positive self-image than the presence of positive

messages.

(Ike Powell, 2002)

What you believe about yourself because you have a diagnosis of mental illness can often be more disabling than the illness itself.

(Ike Powell, 2002)

Recovery From A

Consumer’s Perspective

Dignity and Respect

When I walk in the door I am a person, not a diagnosis. Diagnoses are useful to place a set of symptoms I may be experiencing into a recognizable, describable category and to determine possible treatments. Please don’t refer to me as a bipolar, schizophrenic or depressive.

HopeFrom the minute I walk in through

the door please try to remember that I am probably angry and scared. My life is turning upside down and I don’t understand why. I’m terrified that once you formally pronounce me mentally ill my life will be changed – for the worse – forever.

HopeSensing, seeing, hearing messages that

recovery is not only possible, by probable, are the threads I need to hang on. Put up something on the walls, place messages of hope in the bathroom by the coke machine or in the smoking area, and in your office that says you will recover from this.

ResponsibilityOne of the best ways for me to retain

my personal dignity, respect and hope is for me to be as responsible as a patient and in my other life roles as I can be. Don’t let me abdicate my power to you and please don’t take it from me.

Responsibility

Teach me skills to help me manage, cope and excel. Let me know what your expectations are. Ask me about mine. Being relegated back to a childhood role is demoralizing. It makes me more dependent and your job harder.

InclusionInsist that I participate in my treatment. A

good treatment plan is like a good road map. I may know where I want to go but without the map I can’t get there. Give me a copy of my treatment plan and review it each time we meet. It gives me and you a good picture of where we have been, and where we are going. It may be time consuming at first but eventually we will both benefit. I will become more independent and your job will become easier, more enjoyable.

Inclusion

Nobody likes not having a voice. My future is my own, my goals are my own. Don’t tell me that my dreams are unreasonable or unattainable. Let me find that out by trying to reach them.

Success isn’t always measured by accomplishing a goal. Often the journey is more important than the end result.

Step Into My ShoesThink for a moment what it’s like to be

me. I wasn’t that different from you. I had a college education and a graduate degree. I had a job, car, house, friends, pets and hobbies. Then one day I started to lose those things. First, my friends – they couldn’t handle my illness. Next went the hobbies, them my job, then my home.

Step into My Shoes

Along the way my self confidence eroded, my laughter disappeared and despair took over. My family was told to place me in a community care home – there was no hope. A couple of people still believed in me and with help I began my journey toward recovery. It took a long time and it has been the hardest thing I have ever done.

-- Katherine Roberts

If you listen to the person/patient/consumer long enough, not only will they tell

you what the diagnosis is but you will also learn the best way to

deal with the problem.

(Ike Powell, 2002)

Creating Hope through Recovery Programs and Services

Discussion

A Service Provider’s Perspective

Hope

Anticipation of a continued good state, an improved state, or a release from a perceived entrapment.

Hope

It may or may not be founded on concrete, real world evidence. Hope is an anticipation of a future world which is good.

Judith Miller, Coping with chronic illness: Overcoming powerlessness, 1992.

Hope Instilling Strategies

Building Relationships Rapport

Trust

Valuing the person

“Find the spark, light the fire”

Ongoing

Hope Instilling Strategies

Facilitate Success

Assist in setting and reaching goals

Holistic approach: housing, employment, education, etc.

Link with resources

Hope Instilling Strategies

Connect to others Importance of role models, peers,

and peer support Share the stories of consumers

Connect through consumer organizations (NAMI-SC, SC

Share, MHASC)

Consumers as Partners in the Treatment Process

Value the person in the treatment planning process

Take a holistic approachMaximize the therapeutic relationship Maximize extended support systems

Consumer as Partners in the Treatment Process

Respect cultural differencesSpirituality

Combat stigma/social justice issuesOperate on a strengths model

Egalitarian relationships

“Growing Edges”

Consumers: I’m not a case - I don’t want to be managed

Treatment Planning versus Recovery Planning

Consumer input in all aspects of service agencies (planning, policy, evaluation)

Consumers as providers

The mental health system must be aware of its tendency to enable and encourage consumer dependency.

SC Peer Support Training Manual

2003

Created by Ike Powell

Ike Powell’s Ten Building Blocks

of RecoveryNo one knows more about my life than I do -- how it feels, how it is and how I

want it to be.(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of Recovery

I can act

on my own behalf.(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of RecoveryWhen I realize how much I

have overcome, to get to where I am, I know that I

am a walking miracle.(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of RecoveryIt is not what happens to

me that is important;

it is the meaning that I give it.

(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of Recovery

I can influence my life by my actions.

(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of RecoveryThe locus of my power is

my ability to make a decision and

to act on it.(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of RecoveryI have the ability to be aware of and manage

my thoughts and emotions.

(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of RecoveryI choose to focus my

energies on what I want to create, not on what I

want to change.(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of Recovery

I have the freedom to decide what I do with

my life.(from the SC Peer Support Training Manuel)

Ike Powell’s Ten Building Blocks

of Recovery

I am responsible for my own life. I cannot expect anyone else to make my life the way

I want it to be.(from the SC Peer Support Training Manuel)

Rights and Recovery

There is a negative health impact when a person’s rights are violated.

There is a positive health impact when a person has the freedom to exercise his or

her rights.

Rights in the Past Consumer treatment

and consumer rights seen as separate areas

Many times opposed to each other

Treatment goals seemed to focus on

restrictions and control

Consumer rights seemed focused on

civil rights

Consumer treatment ignored rights

Consumer rights ignored treatment

Rights in the Present, Future

Emphasize what is in common with consumer rights and consumer treatment and recovery – not

the differences

Realize that each supports and requires the fulfillment of the other

In our own activities and those of our programs promote and protect the rights of consumers

Understand the Basics of Consumer Rights.

The legal protections – confidentiality, ADA, advance directives, fair housing, employment discrimination, presumption of competency, abuse, neglect, exploitation

The non-legal protections – consumer choice and involvement, recovery oriented delivery systems, positive culture of healing

Know and Use the Resources Available to Protect Consumer Rights.

South Carolina Protection and

Advocacy Long Term Care

Ombudsman SC Share NAMI-SC

MHASC

SCDMH Client Advocacy

Program

SCDMH Offices of Consumer Affairs/

Consumer Affairs Coordinators

Practice the Basic Principles of Consumer Rights.

Dignity Autonomy

Self Determination Individual Involvement

Most consumer complaints to the SCDMH Client Advocacy Office are generated

from the failure to practice these principles

Address Consumer Complaints.

Most consumer complaints to the SCDMH Client Advocacy Office probably could have or should have been resolved by staff.

Inform and Assist Consumers in

Understanding and Exercising

their Rights.

Promote Self Advocacy.

When someone truly listens to me, and does not interrupt me

with judgements, criticisms, stories of their own or even good

advice, I feel better and often figure out what I needs to do for

myself.

(Ike Powell, 2002)

A Final Quote from

Daniel Tarantola, M.D.Senior Policy Advisor to the Director of the World Health

Organization and Associate of the Francois-Xavier Bagnoud

Center for Health and Human Rights

“THE ATTAINMENT OF THE HIGHEST STANDARDS OF PHYSICAL, MENTAL AND SOCIAL WELL-BEINGNECESSITATES AND REINFORCES DIGNITY, AUTONOMY AND INDIVIDUAL PROGRESS.”

WORKWORKAND AND

RECOVERYRECOVERY

Consumers who say they want to work:? 70%

Are currently working? < 15%

Current access to Supported Employment? < 5%

Supported Employment Mainstream job in community

(integrated employment) Pays at least minimum wage

Job placement based on consumer’s interest

Minimal pre-employment assessment and training

Willingness to work only requirement

Job Coach

Assists in finding job Helps consumer learn job

Provides on-going supports Coordinates with mental health

treatment team

Why Work?

It helps define us. It helps us structure our time.

It provides an income. It connects us with the community

in which we live.

CONSUMER EMPLOYMENT IS EVERYBODY’S JOB!

Practitioners should begin talking about work as early as possible in the recovery of the consumer. This instills hope and sends the message that the person can, in time, reach

their goals.

Recovery in the

Community

Consumer Living in the Community NOW

Isolated/segregated/lacking mobility Limited in choices of leisure activities

Shunned and feared Considered a burden with nothing

to offer Considered different and feels

conspicuous

Consumer Living in the RECOVERING Community

of Our Future

Is a part of/integrated into the larger community

Is an educator Has important roles that have

nothing to do with mental illness

Consumer Living in the RECOVERING Community

of Our Future Using gifts and talents to

contribute to the community Lives next door Is an usher at church Is active in neighborhood

associations and local politics

What Needs to Occur for Consumers

to Begin Living in a RECOVERING

Community?

Elevate Community Consciousness

through ConsumerInvolvement.

Educate the Community. Churches/religious

organizations Civic organizations

Parks and recreation staff

Public library staff Schools/universities

Local/government Industry

Other service providers (DSS,

DHEC, homeless services, food banks,

primary care providers,

pharmacists)

Live as a Healthy Individual in the Community

by Practicing Recovery Skills.

Living in a RECOVERING Community

Housing that’s conducive to recovery Affordable (30% of income)

Quality construction Safe neighborhoods

Array of options (Rental, Owner-Occupied, Shared, Services on site) Integrated in the community

Education=Empowerment

Accessing mainstream housing services

Understanding Fair Housing Laws

Being active in neighborhood associations/local politics

SCDMH Recovery Training

Thank you for coming today!