1. Recovery 2. Rehabilitation3. Barriers and Challenges4. Psychology’s Expertise5. What We Need To Do To Bring About Change

RecoveryRecovery is based on the novel idea that individuals with serious mental illness can recover and live productive lives in the community – just like anyone with an illness that may flare up from time to time

Client’s process of regaining functional capability

RehabilitationConsists of the supports and interventions provided

The primary focus of rehabilitation is on improving the capabilities and competencies of persons with serious mental health disorders

HopeEssential catalyst

Person DrivenConsumer leads; empowered

Many PathsBased on person’s experiences

Highly PersonalDependent on person’s own goals; individualized

Non-LinearContinual growth; ups and downs

HolisticEncompasses entire life

SupportSupported by peers & allies

Relationships & Social NetworksBelief in person’s capability for recovery

Based in Person’s CultureKey aspect

Addresses TraumaOften a pre-cursor

Individual, Family & Community Responsibility

Foundation for recoveryRespect

Acceptance

Mental Health Recovery:

Recovery is what people with illnesses and disabilities do

Treatment, case management, support and rehabilitation are the things that helpers do to facilitate recovery (Anthony, 2002)

A journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential (SAMSHA, National Consensus Statement on Mental Health Recovery, 2006)

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMHSA, Definition of Recovery, 2012).

Recovery from mental illness involves:

Challenging and overcoming the stigma that persons with SMI have incorporated into their very being

Recovering from the iatrogenic effects of treatment settings

Recovering from lack of opportunities for self determination“Nothing about us, without us”

Recovering from the negative side effects of unemployment

Recovering from crushed dreams

Recovery is often a complex, time-consuming process – just as it is with any serious illness

“The mental patient lens is the one many of those with mental illnesses have learned to look through every time we are uncomfortable, have intense feelings or experiences, or difficult relationships.”

“It is a lens that reminds us that our feelings and thoughts are different than other peoples’ and that we must take care. We must avoid stress, risk-taking, and challenges, assume others know better than we do, and that there is a medication for everything.”

Mary Ellen Copeland, 2004, NASMHPD National Consensus Conference, Report on Recovery

Getting the label out of the person:

“Not too many years ago, I was Mary Ellen Copeland, manic depressive. Because I had this label, my family was told not to expect much of me. I learned not to expect much of myself. I became dependent on the mental health system to maintain, at best, a minimal life style. I saw myself through a mental health system lens that was confining and oppressive. Now I see myself through a different lens, a lens that is Mary Ellen Copeland, educator, author, mother, wife, woman.”

Mary Ellen Copeland, 2004, NASMHPD National Consensus Conference, Report on Recovery

Those working to recover struggle to realize that being uncomfortable and having difficult feelings is something they can deal with. These feelings and thoughts don’t have to be symptoms of anything. One’s strengths and resources can be used to get through difficult times.

This is the process of changing from mental patient to person, from patient with symptoms, to person with thoughts, feelings, and experiences.

Normalization

Principle that those with any disability or impairment should be treated with respect, provided functional supports, and treated as normal human beings. Wolf Wolfensberger, 1972, The principle of Normalization in Human Services, Toronto, National Institute on Mental Retardation

But when will those with mental illnesses become people instead of their label?

When will it be commonly accepted that people, who from time to time, have troubling feelings, thoughts, behaviors, and experiences (does this include you and me??), can also have control over their own lives, do the things they want to do, and be the way they want to be?

Medical Model

Illness/problem focusedPast traumas/failuresDoing for the individualprovider/team recommends Long-term dependenceOffice, clinic & community based

Recovery Approach

Strength basedSuccess orientedDoing with the individualIntegrated team/partnershipGraduated independenceCommunity basedPresent/future focused

People with SMI Want

Meaningful relationshipsA safe place to liveSatisfying activitiesAdequate incomeJob satisfactionAn enjoyable social life

What do you want?

FocusThe primary focus of rehabilitation is on improving the capabilities and competencies of persons with serious mental health disorders

HowBy using evidence based practices and other empirically supported clinical interventions

Within a recovery oriented frameworki.e., one which is driven by the client and one which operates from a belief that recovery is possible

Research has determined that certain interventions are rehabilitative for persons with serious mental illness, i.e., they foster gaining or regaining of functional capabilities*

When delivered as designed and researched – with fidelity

These interventions are now the gold standard for helping individuals with serious mental illnesses regain their maximum functional capability

*The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements

Barriers

Low expectations of what is achievable by consumers, clinicians, and families

Lack of knowledge about what symptoms are due to illness and what are due to client’s and society’s reaction to that illness

Lack of will to provide proven interventions to bring about optimal recovery

Lack of resources to provide proven interventions to bring about optimal recovery

Fear of changing the status quo

Challenges:

A difficult challenge is to change the attitude of existing staff and those being trained in traditional professional training programs in order to:

Let everyone know that that people with SMI can, and do recover and lead satisfying lives

Eliminate the stigma that many professionals have even today;

Change the service delivery system from one which delivers medication and psychotherapy to one which focuses on rehabilitation and the potential of each person to recover to the greatest extent possible

More than any other discipline, psychologists have the expertise to change the mental health service delivery system:

Research expertiseClinical expertiseTeam leadership expertisePolicy and administrative experience and know-howTraining expertise and programs

We have an ethical mandate to promote and use the most efficacious interventions – those that have been proven to make a difference in the lives of those we work with

Limitations Psychology Faces

There are not enough psychologists trained in recovery/rehabilitation assessments, interventions, and systems change

Very few doctoral training programs teach or emphasize the concept of recovery, and the methods of psychosocial rehabilitation

Most psychologists are still trained in the traditional methods that their mentors were trained in, i.e., a pathology and deficits approach

New models train psychologists in how to help people improve their functional skills using a strengths approach

What We Need To Do

Training programs that offer coursework, practica, internships, and post doctoral fellowships in these new models and methods are needed

Develop, advocate for, overcome resistance to, and implement: recognized specialty programs in SMI in APA accredited doctoral and post doctoral programs

De-stigmatize working with people with SMI, even those who are most seriously ill

Recognize and reward psychologists who work with people with SMI

Encourage APA, State Psychological Associations, and relevant APA Divisions to advocate for those who are most vulnerable in society

What We Need To Do, cont’dUse the provisions of the Affordable Care Act – Below Are All Available in the Act:

Demonstration projectsTo conduct research in less well-resourced environments on:

effectiveness of already identified EBPs efficacy of promising practices

Demonstration projects To provide coordinated and integrated services to adults with mental illnesses who have co-occurring primary care conditions or chronic medical diseases

Develop patient-centered treatment models, e.g., “medical home” and othersFunding for training of psychologists in mental and behavioral health to work with vulnerable populations, including those with severe mental health disorders

People with SMI DO recover and lead satisfying lives

Our job is to support them and offer the best interventions that science has to offer

Stigma, trauma, and iatrogenic effects of treatment itself are some of the worst aspects of the illness

Psychology training is behind the times: Accredited doctoral programs do not provide training in the new concepts and methods

Just released:APA Curriculum to train psychologists in Recovery and Psychosocial RehabilitationAvailable from www.apa.org/pi/rtp

AMERICANPSYCHOLOGICALASSOCIATION

Instruction Module1. Introduction to Recovery2. Recovery, Health Reform and Psychology3. Assessment4. Partnership and Engagement5. Person Centered Planning6. Health Disparities7. Interventions I8. Interventions II9. Interventions III10. Forensic and Related Issues I11. Forensic and Related Issues II12. Community Inclusion13. Peer Delivered Services14. Systems Transformation15. Scientific Foundations

AMERICANPSYCHOLOGICALASSOCIATION

Citation for this Module:

American Psychological Association & Jansen, M. A. (2014). Introduction to Recovery Based Psychological Practice. Reframing Psychology for the Emerging Health Care Environment: Recovery Curriculum for People with Serious Mental Illnesses and Behavioral Health Disorders. Washington, DC: American Psychological Association.

www.apa.org/pi/rtp

Citation for the full Curriculum:

American Psychological Association & Jansen, M. A. (2014). Reframing Psychology for the Emerging Health Care Environment: Recovery Curriculum for People with Serious Mental Illnesses and Behavioral Health Disorders. Washington, DC: American Psychological Association.

mjansen@bayviewbehavioral.org

Mary A. Jansen, Ph.D.Bayview Behavioral Consulting, Inc.Vancouver, BC

mjansen@bayviewbehavioral.org