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
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.
By the 1900s, the SC asylum had 1,040 patients

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. National and Local Consumer Self-Help Groups Through the 1990s
SC Share - Self-Help Association Regarding Emotions/Recovery for Life Groups
MHASC - Mental Health Association’s CORE/ SA - Schizophrenics Anonymous groups
Contac - Consumer Org.& TA Ctr.
National Consumer Self-Help Clearinghouse
NEC - National Empowerment Center

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 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.

26. 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

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 A Consumer’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. Hope Instilling Strategies
Building Relationships
Rapport
Trust
Valuing the person
“Find the spark, light the fire”
Ongoing

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

51. The mental health system must be aware of its tendency to enable and encourage consumer dependency.

52. SC Peer Support Training Manual 2003
Created by Ike Powell

53. 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)

54. Ike Powell’s Ten Building Blocks of Recovery
I can act
on my own behalf.
(from the SC Peer Support Training Manuel)

55. 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)

56. 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)

57. Ike Powell’s Ten Building Blocks of Recovery
I can influence my life by my actions.
(from the SC Peer Support Training Manuel)

58. 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)

59. 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)

60. 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)

61. 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)

62. 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)

63. 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.

64. 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
Consumer rights seemed focused on civil rights
Consumer treatment ignored rights
Consumer rights ignored treatment

65. 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

66. 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

67. Know and Use the Resources Available to Protect Consumer Rights.
South Carolina Protection and Advocacy
Long Term Care Ombudsman
SC Share
NAMI-SC
MHASC
SCDMH Client Advocacy
Program
SCDMH Offices of Consumer Affairs/
Consumer Affairs Coordinators

68. 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

69. Address Consumer Complaints.
Most consumer complaints to the SCDMH Client Advocacy Office probably could have or should have been resolved by staff.

70. Inform and Assist Consumers in Understanding and Exercising their Rights.

71. Promote Self Advocacy.

72. 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)

73. A Final Quote from
Daniel Tarantola, M.D.
Senior Policy Advisor to the Director of the World Health
Organization and Associate of the Francois-Xavier Bagnoud
Center for Health
and Human Rights

74. “THE ATTAINMENT OF THE HIGHEST STANDARDS OF
PHYSICAL, MENTAL AND SOCIAL WELL-BEING
NECESSITATES AND REINFORCES DIGNITY,
AUTONOMY AND INDIVIDUAL PROGRESS.”

75. WORK AND RECOVERY

76. Consumers who say they want to work:? 70%
Are currently working? < 15%
Current access to Supported Employment? < 5%

77. 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

78. Job Coach Assists in finding job Helps consumer learn job
Provides on-going supports
Coordinates with mental health treatment team

79. 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.

80. 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.

81. Recovery in the Community

82. 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

83. 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

84. 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

85. What Needs to Occur for Consumers to Begin Living in a RECOVERING Community?

86. Elevate Community Consciousness through Consumer Involvement.

87. Educate the Community. Churches/religious organizations
Civic organizations
Parks and recreation staff
Public library staff
Schools/universities
Local/government
Industry
Other service providers (DSS, DHEC, homeless services, food banks, primary care providers, pharmacists)

88. Live as a Healthy Individual in the Community by Practicing Recovery Skills.

89. 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

90. Education=Empowerment
Accessing mainstream housing services
Understanding Fair Housing Laws
Being active in neighborhood associations/local politics

91. SCDMH Recovery Training Thank you for coming today!