Citizenship, Mental Health, and the Citizens Project

1. Citizenship, Mental Health, and the Citizens Project Michael Rowe, Ph.D. Patricia Benedict, B.A. Yale Program for Recovery and Community Health *Work on this presentation was funded in part by NIMH grant R21 #MH08776201 “Social Inclusion and Mental Illness: Outcome Measure Development

2. Where Did Citizenship Come From? • Citizenship came from a social & economic situation—homelessness in America— • from a programmatic response to homelessness among people with mental distress, • and from a man named Jim who popped the balloon of that response.

3. Where Did Citizenship Come From? There were two related parts to the programmatic response to homelessness and mental distress: One was integrated, “No wrong door” mental health systems of care with an array of services for people with complicated needs.

4. Core System Response: “Homeless Outreach” The other was mental health outreach (“Homeless outreach”) • No expectation of “motivation for treatment • Leave the office to find and make contact with the person not the patient • Build trust, working at the person’s pace • Build on the person’s strengths • Client choice among and array of services • The Golden Rule of outreach

5. Homeless Outreach IT WORKED!

6. Homeless Outreach Until it didn’t

7. Homeless Outreach Jim’s Story, and Ron’s

8. Hitting the wall with Jim (and others) • We could do lots of things for people who were homeless: provide mental health and medical care, person to person case management, access to income, and housing, and more. • What we could not do is provide people who were homeless with the status of being neighbors in their neighborhood, full participating members of their communities, and full citizens of society.

9. Where does citizenship come from? • We could provide ‘Program Citizenship’ within systems of care. We could not offer our clients full participating citizenship.

10. How do we define citizenship? Citizenship is: • A strong connection to the 5 Rs of rights, responsibilities, roles & resources that society offers its members, & relationships including friends & supportive social networks. and • A sense of belonging that is validated by others.

11. What about the mental distress part of citizenship? • Citizenship is citizenship, not “psychiatric citizenship.” • Citizenship for people with lived experience of mental distress implies their full participation in and access to the goods and opportunities of society. • So . . . What do we do with citizenship?

12. Citizens Project Is designed to assist students with… • Understanding and exercising their rights • Identifying ways to fulfill their goals & responsibilities • Enhancing their roles as valued members of their communities • Enhancing their knowledge & access of community resources • Enhancing their ability to develop supportive relationships andnetworks • Enhancing their skills to aid in their process of recovery

13. What do Students Receive? • Mutual support group students coined “What’s Up” • Peer Support inside and outside the class room; non-traditional classes geared towards the 5 R’s • Rights, Roles, Responsibilities, Resources, and Relationships. • Individual or group Valued Role Project

14. What is “What’s Up?” What is Student created and facilitated support group: • Sharing of personal challenges and accomplishments • Receiving honest supportive and constructive feedback from classmates and staff • Confidential and safe environment “I learned how to talk to people, listen better and deal with my problems”…CP student What’s Up?”

15. Some of our Classes • Communication Skills • Financial Health • Relationship Building • Healthy Alternatives • Negotiating the Criminal Justice System • Housing Options and Issues • Vocational Skills & Education • Communication Skills • Financial Health • Relationship Building • Healthy Alternatives • Negotiating the Criminal Justice System • Housing Options and Issues • Vocational Skills & Education • Spirituality • Stigma and Micro-aggressions • Advocacy • Goal Development • Public Speaking • Family Matters • Voting and the Legislative Process • “I learned how to advocate for myself, it gave me the courage to go back to school.”...CP student

16. Valued Role Projects • Student developed individual or group projects • Utilizing their talents, knowledge, skills and life experiences challenging their own and others underestimation of their capabilities • Educating and sharing with others • Develop meaningful social roles for themselves that contribute to their community • “This group has made me realize that I have good qualities and I can contribute to my community.”…CP student

17. Who can benefit from a Citizens Project? • People with Mental Health Issues • People with Addictions • People who are the process of re-entering society,(incarceration, in-patient treatment) • Can be held inside a program or in the community The replication of a Citizens Project is based on the needs and culture of the individual community.

18. Results: Randomized trial of the Citizens Project Citizenship Project participants, compared to a usual services group, had significantly: • Lower drug use at 6 months & significantly lower drug & alcohol use at 12-month follow-up. • Higher quality of life at 12 month follow-up • Higher satisfaction with work at 6- & 12-month follow-up • Higher of satisfaction with finances at 6 months.

19. Results: Observational, Qualitative Research • For Citizens Project participants, “being a student” is a valued role in itself • The Citizens Project becomes a supportive community over time for each group and across groups over time. It’s a program, but it’s more than a program.

20. Moving Forward……. Citizens Project has begun replicating in different communities meeting the needs of a variety of venues and service populations. • Connecticut Valley Hospital • West Haven Mental Health YAS Program • Pennsylvania Jails and Prisons • Montreal, Canada • Glasgow, Scotland

21. Citizenship, Mental Health, & the Citizens Project Thank you! Questions?

22. References Rowe M. Crossing the border: Encounters between homeless people and outreach workers. Berkeley: University of California Press, 1999. Rowe M, Kloos B, Chinman M, Davidson L & Cross AB. Homelessness, mental illness, and citizenship. Social Policy and Administration, 2001, 35 (1), 14-31. Rowe M, Benedict P, Sells D, Dinzeo T, Garvin C, Schwab L, Baranoski M, Girard V, Bellamy C. Citizenship, community, and recovery: A Group- and peer-based intervention for persons with co-occurring disorders and criminal justice histories. Journal for Groups in Addiction and Recovery, 2009, 4 (4), 224-244. Rowe, Clayton, O’Connell et al. Going to the source: Citizenship outcome measure development. Psychiatric Services 2012, 63: 45-50. Clayton, A., M.J. O’Connell, C. Bellamy, P. Benedict, and M. Rowe. The citizenship project, part II: Impact of a citizenship intervention on clinical and community outcomes for persons with mental illness and criminal justice charges. American Journal of Community Psychology 2013, 51: 114-22. Rowe, M. Citizenship and mental health. NY: Oxford University Press, 2015. Ponce, A.N. & M. Rowe. Citizenship and community mental health care. American Journal of Community Psychology, 2018, 61, 22-31. Hamer, H. M. Rowe, C. Seymour. Social inclusion, mental health service users and citizenship “The right thing to do”: Fostering social inclusion for mental health service users through acts of citizenship. International Journal of Mental Health Nursing. 2018, DOI: 10.1111/inm.12533