SCDMH Recovery Training

1. SCDMH Recovery Training

2. Special Thanks to the Contributors of These Slides Carla Damron Beth Adams Katherine Roberts Vicki Cousins Doug Cochran Michele Murff

3. Training Agenda Today • The History of the Mental Health Recovery Movement • … Medical Movement • … Psychosocial Rehabilitation Model • … Recovery Movement • … Consumer Empowerment • … Where we are today

4. Training Agenda Today • Recovery from a Consumer’s Perspective • Importance of Hope • Creating Recovery Environments • Emphasis on Consumer Rights

5. 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)

6. 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)

7. The South Carolina Department of Mental Health The Mental Health Recovery Movement

8. 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.

9. 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.

10. 1909 Legislative Study Findings 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.

11. 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.

12. Major Facts Leading to De-institutionalization • Inhumane conditions in state hospital facilities (restraints, seclusion, etc.) • Technological advances of the late 1950s

13. Technological Advances Introduction of phenothiazines provided 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

14. 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

15. 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

16. 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.

17. 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”

18. 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

19. 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.

20. Psychosocial Rehabilitation A holistic approach that addresses multiple needs of the consumer • Emphasizes strengths and wellness • Services encompass whole life of consumer

21. Psychosocial Rehabilitation • Hope, empowerment, and positive expectations emphasized • Staff/member relationships are egalitarian and respectful • Skill building and focus on WORK are stressed

22. 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.

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

24. 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

25. 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.

26. 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

27. 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

28. What are Consumers and the Mental Health System Recovering From? • Labels • Limited Expectations • Wounds of the Spirit • Poverty, Unemployment and Homelessness • Hopelessness

29. The absence of negative messages is more important in developing a positive self-image than the presence of positive messages.(Ike Powell, 2002)

30. 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)

31. Recovery From AConsumer’s Perspective

32. 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.

33. Hope From 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.

34. Hope Sensing, 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.

35. Responsibility One 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.

36. 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.

37. Inclusion Insist 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.

38. 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.

39. Step Into My Shoes Think 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.

40. 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

41. 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)

42. Creating Hope through Recovery Programs and Services Discussion

43. A Service Provider’s Perspective Hope Anticipation of a continued good state, an improved state, or a release from a perceived entrapment.

44. 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.

45. “Find the spark, light the fire” Ongoing Hope Instilling Strategies Building Relationships • Rapport • Trust • Valuing the person

46. Hope Instilling Strategies Facilitate Success • Assist in setting and reaching goals • Holistic approach: housing, employment, education, etc. • Link with resources

47. 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)

48. Consumers as Partners in the Treatment Process • Value the person in the treatment planning process • Take a holistic approach • Maximize the therapeutic relationship • Maximize extended support systems

49. Consumer as Partners in the Treatment Process • Respect cultural differences • Spirituality • Combat stigma/social justice issues • Operate on a strengths model • Egalitarian relationships

50. “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