Beyond Maintenance:Facilitating Recovery from Mental Illness

Cincinnati VA Medical CenterSocial Work Service

Presented by:

Reneé KopacheCoordinator of Wellness Mgmt.

Hamilton County MHRSB

Northern Kentucky UniversityMarch 28, 2008

Agenda

Overview of Recovery

Personal Chronicle

Facilitating Recovery

Q & A

Overview of Recovery

A process of reflecting and changing as one searches for identity, purpose, and contentment.

Definition of Recovery

ODMH defines recovery as “The process of overcoming the negative impact of a psychiatric disability despite its continued presence.”

“It is a process, sometimes lifelong, through which a consumer achieves independence, self-esteem, and a meaningful life in the community (Power, A.K. & Manderscheid, R.W. (2004). Federal Perspective: Recovery, Now! NASMHPD e-Report on Recovery)

Important Factors to Recovery Clinical care Hope Support Work/meaningful activity Empowerment Community involvement Access to resources Education/knowledge Self-esteem Self-help Spirituality Physical health Self-responsibility

Self-directed Individualized and

person-centered Holistic Strengths based Growth oriented

Stages of Recovery*Dependent/Unaware Consumer relies on others and is

not aware of his/her own status or needs.

Dependent/Aware Consumer relies on others but is aware of his/her status and needs.

Independent/Aware Consumer relies on self and is aware of his/her status and needs.

Interdependent/Aware Consumer relies on self and others in a mutual exchange of beneficial support, services and resources.

* Ohio Department of Mental Health (1999). Emerging Best Practices in Mental Health Recovery Process.

Stages of Recovery Cont’

ODMH:

Dependent/Unaware Dependent/Aware Independent/Aware Interdependent/Aware

The Village:

Hope Empowerment Self-Responsibility Meaningful role in society

http://www.village-isa.org/index.htm

EDUCATIONP

ets

Fam

ily

Friends

Work

EducationSexuality

Hea

lth

Spir

itual

ityHopes & Dreams

Values & Beliefs

Illness / Disability

Person

Hobbies

Com

munity

Healthy person -

Prior to mental illness

EDUCATIONP

ets

Fam

ily

Friends

Work

Education

SexualityHea

lth

Spir

itual

ityHopes & Dreams

Values & BeliefsMentally Ill

Hobbies

Com

munity

Person withmental illness

EDUCATIONM

ental Illn

ess

Fam

ily

Friends

Work

Education

SexualityHea

lth

Spir

itual

ity

Hopes & Dreams

Values & Beliefs Person

Hobbies

Com

munity

Person in Recovery

The Recovery Process

Personal Chronicle of RecoveryReclaiming personhood!

Hope

1989 – 1993:

“You can’t return to school, you’ll never be able to work, and you will have to take medications the rest of your life….I’m starting the paper work to get you on disability.”

(dependent/unaware)

Empowerment

1993 – 1999:

On disability and experiencing poverty for the first time.

Tired of poverty, went back to work.

Revolving door of hospitalizations continued.

(Dependent/Aware)

Self-Responsibility

1999 – 2002:

Bridges Burned…time to take care of self!

Free of hospitalizations for the first time in 10 years.

Role of Recovery Coordinator (motivation).

(Independent/Aware)

Meaningful Role

2002 – 2004:

No more medications

Buy a house

Graduate from treatment

Giving back

Life in community

(Interdependent/Aware)

Recovered (remission)

2005 to present:

Rarely experience symptoms of mental illness.

Life is independent of mental illness and mental health system.

Absolute proof!

No longer a consumer

This is Maiya…she weighs more than me and has dominant tendencies. She has helped me realize that I can accomplish whatever I set my mind to.

“You can’t take care of a pet…you can’t even take care of yourself.”

Facilitating RecoveryThe Role of the Consumer and the Provider…

Individuals in treatment sometimes burn bridges….part of the recovery process is building new ones.

A Recovery Vision of Service

Grounded in the idea that people can recover from mental illness, and that the service delivery system is constructed based on this knowledge.

A recovery vision is in stark contrast to traditional systems that were/are based on the belief that people with severe mental illness do not recover, and that the course of their illness is at best a maintenance course.

Anthony, William (2000). A Recovery-Oriented Service System: Setting Some System Level Standards. Psychiatric Rehabilitation Journal, 24(2), 159-168.

Guiding Principles of Recovery

1. The consumer directs the recovery process; therefore, consumer input is essential throughout the process.

2. The Mental Health System must be aware of its tendency to enable and encourage consumer dependency.

3. Consumers are able to recover more quickly when their:

hope is encouraged, enhanced, and/or maintained; life roles with respect to work and meaningful activities are

defined; spirituality is considered; culture is understood; educational needs as well as those of their family/significant

others are identified; socialization needs are identified.

Guiding Principles Con’t

4. Individual differences are considered and valued across their life span.

5. Recovery from mental illness is most effective when a holistic approach is considered.

6. In order to reflect current "best practices," there is a need to merge all intervention models, including Medical, Psychological, Social, and Recovery.

7. Clinician's initial emphasis on "hope" and the ability to develop trusting relationships influences the consumer's recovery.

8. Clinicians operate from a strengths/assets model.

Guiding Principles Con’t

9. Clinicians and consumers collaboratively develop a recovery management plan. This plan focuses on the interventions that will facilitate recovery and the resources that will support the recovery process.

10. Family involvement may enhance the recovery process. The consumer defines his/her family unit.

11. Mental Health services are most effective when delivery is within the context of the consumer's community.

12. Community involvement as defined by the consumer is important to the recovery process.

ODMH (1999) Emerging Best Practices in Mental Health Recovery

Essential Services in Recovery SystemService Category Description Consumer Outcome

Treatment Alleviating symptoms and distress

Symptom Relief

Crisis Intervention Controlling and resolving critical or dangerous problems

Personal safety assured

Case Management Obtaining the services client needs and wants

Services accessed

Basic Support Providing the people, places and things client needs to survive (e.g. shelter, meals, health care)

Personal survival assured

Anthony, William (2000). A Recovery-Oriented Service System: Setting Some System Level Standards. Psychiatric Rehabilitation Journal, 24(2), 159-168.

M

E

D

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C

A

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M

O

D

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Essential Services Con’tService Category Description Consumer Outcome

Rehabilitation Developing clients’ skills and supports related to clients’ goals

Role functioning

Enrichment Engaging clients in fulfilling and satisfying activities

Self-development

Rights Protection Advocating to uphold one’s rights

Equal opportunity

Self-help Exercising a voice and a choice in one’s life

Empowerment

Wellness/Prevention Promoting healthy lifestyles

Health status improved

R

E

C

O

V

E

R

Y

M

O

D

E

L

“Lev

el o

f F

un

ctio

nin

g”

Time

AdverseEvent

Thriving

Resilience (recovery)

Survival withImpairment

Succumbing

Carver, C.A. (1988). Issues, Models and Linkage. Journal of Social Issues, 54, p.246.

Potential responses to adverse life events

Recovery Model

Medical Model

Recovery – Defining Roles

Consumer Role Provider Role

Do for, do with, have them do for selves

Hope – Consumer Role Accept illness, accept treatment

Rely on the hope of others

Learn about illness, medications and treatment

Work on becoming rational thinkers Hope is an attitude influenced by thought.

To obtain and maintain a sense of hope, we have to change (control) our thoughts…we have to become rational thinkers!

Hope - Consumer Role Con’t Helpful Coping Skills/Techniques:

Medications Treatment (including hospitalization) Support from family/friends Support from a trusted, third party observer Journaling

Barriers: Stigma & discrimination from having a mental illness Symptoms Lifestyle Family/Friends

Hope – Provider Role Address core clinical needs

Engagement Trust

Address basic living needs

Education Help the consumer understand why they do what

they do and think the way that they think

Separate the illness from the individual Avoid Stigmatizing & hope-deflating comments

Instill a sense of Hope!!!

Empowerment – Consumer Role Becoming Knowledgeable

know your illness & yourself learn to distinguish between symptoms and you warning signs triggers rights

Utilizing Support Professional Peer Friends/family

Become active in your treatment Medications alone will not improve your life Your treatment providers cannot fix you

Empowerment – Consumer Con’t Helpful Coping Skills/Techniques:

Continue using skills from previous stage Read, read, read Self-Assessment

strengths, weaknesses, needs, wants, goals, etc. Let people help Exercise….pursue hobbies

Barriers: Stigma Limited access to resources Lack of support Trust Feeling better

Empowerment – Provider Role Educate

Support the process of gaining self-awareness Homework assignments

“Do with” instead of “doing for”

Encourage taking risks (challenge)

Use “failure” to teach not to discourage

Support Begin to assist the consumer with the process

of developing a healthy support system.

Self-Responsibility–Consumer Role Changing Behaviors/Regulating Emotions

Critical stage where we shift from an external to internal locus of control

Anger is not the only emotion we have taking on responsibility for our well-being opens the door

to feeling the positive emotions

Improve self-esteem

Create a positive lifestyle change, change, change risks, risks, risks

Be selfish…put self first for awhile

Self-Responsibility-Consumer Con’t Helpful Coping Skills/Techniques:

Continue previous skills as appropriate

Identify problems/challenges as well as reasonable solutions…then, develop a plan to implement the solutions (physical, thought/emotional & relationships)

Develop and utilize natural supports

Surround self with healthy people

Barriers: Low self-esteem & poor social skills Well meaning but overprotective or enabling people The system….often times, services don’t match needs

Self-Responsibility-Provider Role Support & encourage efforts to change

Provide tools and techniques Cheerleader Sounding Board Don’t do for the consumer what they can do for

themselves

Help the consumer improve self-esteem and sense of self

Help the consumer to live and function in the community (skill development/ enhancement)

Meaningful Role – Consumer Integrated life in the community

Life extends beyond mental illness and the mental health system

Establish valued role in the community Employee/volunteer Tenant/home owner (neighbor) Community organizations (giving back) Friend, family member, parent, teacher, etc.

Pursue interests/hobbies (outside of MH)

Healthy relationships (outside of MH)

Transition out of mental health services/system

Meaningful Role-Consumer Con’t

Helpful Coping Skills/Techniques: Keep doing what’s worked Try new things/explore interests Giving back (focus on others) Establish & pursue life goals

Barriers: Old habits are hard to break returning to the comfort zone Self Hotel California syndrome

Meaningful Role - Provider

You’re job is just about done!

Encourage activities in the community Help the person connect to natural supports and

become active members in their community

Help the individual transition out of services (or reduction of services)

Be prepared for self-sabotage

Resources – Books/Articles Pathways to Recovery

Ridgeway, McDiarmid, Davidson, Bayes & Ratzlaff (2004)

Wellness Recovery Action Plan Mary Ellen Copeland (2000)

Feeling Good Handbook David Burns, MD (?)

Dual Disorders Recovery book Hazelden (1993)

Self-Determination Series Univ. of Illinois at Chicago (Cook, Petersen, Jonikas, ) http://www.cmhsrp.uic.edu/nrtc/tools.asp

http://mhrecovery.com/online_articles.htm (articles, reports, tools) http://mhrecovery.com/books.htm (self-help books)

Q&A and Contact Info.

Renee KopacheHamilton County Mental Health and Recovery Services Board

2350 Auburn Ave.; Cincinnati, OH 45219

(513) 946-8632

reneek@hamilton.mhrsb.state.oh.us

www.mhrecovery.com

A copy of this presentation will be available online…

http://mhrecovery.com/presentations.htm