Scdmh recovery Training Special Thanks to the Contributors of These Slides



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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.



Findings



  • 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 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



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



Psychosocial Rehabilitation

  • A holistic approach that addresses multiple needs of the 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.



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

  • Contac - Consumer Org.& TA Ctr.

  • National Consumer Self-Help Clearinghouse

  • NEC - National Empowerment Center



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 the Recovery 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 Health Recovery 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.



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.



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.



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.



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.



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.



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 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.



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



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 approach

  • Maximize the therapeutic relationship

  • Maximize extended support systems



Consumer as Partners in the Treatment Process

  • Respect cultural differences

  • Spirituality

  • Combat stigma/social justice issues

  • Operate 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 Recovery

  • No 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 Recovery

  • When 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 Recovery

  • It 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 Recovery

  • The 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 Recovery

  • I 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 Recovery

  • I 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



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



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)









Consumers who say they want to work:? 70%

  • 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 Consumer Involvement.



Educate the Community.

  • Churches/religious organizations

  • Civic organizations

  • Parks and recreation staff

  • Public library staff

  • Schools/universities



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!




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