2SAMHSA Primary and Behavioral Healthcare Integration Program The Power of HopePaolo del Vecchio, MSWActing Director, Center for Mental Health ServicesSubstance Abuse and Mental Health Services AdministrationSAMHSA Primary and Behavioral Healthcare Integration ProgramBaltimore, MD ♦ May 18, 2012
3Recovery Emerges From Hope “Hope is to the soul what oxygen is to the body.” – Larry Fricks
4The Spark of Hope“But one day, something changed in us. A tiny, fragile spark of hope appeared and promised that there would be something more than all of this darkness…This is the mystery. This is grace. This is the birth of hope called forth by the possibility of being loved.”– Patricia Deegan
6Defining HopeRecovery begins with hope…Sustained recovery perpetuates and strengthens one’s hope for the future.— E. Sally Rogers, Sc.D., Director of Research at the Center for Psychiatric Rehabilitation
7Quest for a Better Life“Without hope, recovery can seem like an elusive goal, a quest that demands too much of our body, our minds, and our spirit. But, hope gives us strength to fight for that better life. Hope helps us overcome hurdles that we otherwise could not scale, and it moves us forward to a place where healing and recovery can begin.” – Jerome Groopman. M.D. The Anatomy of Hope
8Comorbid Mental and Physical Conditions Adults experiencing major depressive episodes had higher rates of the following physical illnesses than adults without past-year major depressive episodes:high blood pressure (24.1% vs. 19.8%)asthma (17.0% vs. 11.4%)diabetes (8.9% vs. 7.1%)heart disease (6.5% vs. 4.6%)stroke (2.5% vs. 1.1%)Source: SAMHSA National Survey on Drug Use and Health
9Social Exclusion“By any measure, it is clear that people with mental illnesses are on the margin, actually not on the page at all. Dying decades earlier than the general population is testament enough about how those with mental illnesses have been marginalized.”– Paolo del Vecchio
10SAMHSA Integrated Care Initiative Seeks to better coordinate and integrate primary and behavioral health care resulting in:Improved access to primary care servicesImproved prevention, early identification, and intervention to reduce the incidence of serious physical illnesses, including chronic diseaseIncreased availability of integrated, holistic care for physical and behavioral disordersBetter overall health status of clientsimproved access to primary care servicesimproved prevention, early identification, and intervention to reduce the incidence of serious physical illnesses, including chronic diseaseincreased availability of integrated, holistic care for physical and behavioral disordersbetter overall health status of clients
11Prescription for a Healthier Life Physicians wish they could write prescriptions for:Fitness program 75%Nutritional food 64%Transportation assistance 47%For those whose patients are mostly urban and low-income, they would write prescriptions for:Employment assistance 52%Adult education 49%Housing assistance 43%Source: Robert Wood Johnson Foundation. (2011, Dec.). Health Care’s Blind Side: The Overlooked Connection between Social Needs and Good Health.
12Recovery-Promoting Competency (RPC) Study Consumers ranked the RPC ingredients most important to them. They indicated that providers must:Have genuine respect for consumersHelp clients develop skills to cope and manage symptomsSee clients as persons, apart from their diagnoses and symptomsTrust the authenticity of clients’ experiences and accountsHelp clients accept and value themselvesListen to clients without judgmentBelieve in clients’ potential to recoverCare about clientsBe accessible to clients when they need helpUnderstand clientsRussinova, Z., Rogers, E.S., Ellison, M.L., & Lyass, A. (2011). Recovery-promoting professional competencies: perspectives of mental health consumers, consumer-providers and providers, Psychiatric Rehabilitation Journal, 34(3), 177–185.Russinova, Z., Rogers, E.S., Ellison, M.L., & Lyass, A. (2011). Recovery-promoting professional competencies: perspectives of mental health consumers, consumer-providers and providers, Psychiatric Rehabilitation Journal, 34(3), 177–185.
13Recovery Is Based on Respect Individuals in recovery are:WorkersTenantsParticipantsMembersNeighborsEmployeesThey are not cases.
14Eight Dimensions of Wellness – Adapted from Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29,(4)
15Lack of Healthy Choices More than 42 percent of adults with serious mental illnesses are obese.Fewer than 20 percent of people with schizophrenia engage in regular moderate exercise.People with schizophrenia consume fewer fruits and vegetables and more calories and saturated fats than the general population.– Bartels, S., & Desilets, R. (2012). Health promotion programs for people with serious mental illness. (Prepared by the Dartmouth Health Promotion Research Team). Washington, D.C. SAMHSA-HRSA Center for Integrated Health Solutions.Bartels, S., & Desilets, R. (2012). Health promotion programs for people with serious mental illness. Washington, D.C. SAMHSA-HRSA Center for Integrated Health Solutions.
16SAMHSA’s Pledge for Wellness “We envision a future in which people with mental health problems pursue optimal health, happiness, recovery, and a full and satisfying life in the community via access to a range of effective services, supports, and resources.”
17Shared Decision Making The new SDM site offers a print/video link, online decision aid, workbooks, and cool tools:
18Importance of Choice Common Antipsychotic Side Effects: Abnormal movementsDiabetesDry mouthMetabolic syndromeNeuroleptic malignant syndrome (NMS)Sexual side effectsSleep problemsStrokeSudden cardiac deathWeight gain
19Medication Best Practices Shared Decision-Making: Provide individuals with to up-to-date information about the drugs they take, including potential side effects.Individualized, Person-Centered Care: View medication use as a dynamic process that evolves over each person’s unique recovery journey.Holistic Approach: Adopt a bio-psycho-social-cultural-spiritual model to assess benefits and costs of using medications as a tool for recovery.Relational: Prescribe and monitor medications within the context of a trusting and collaborative relationship.Integrated Treatment: Prescribe and monitor medications within an integrated community-based recovery plan.Need for Protocols: Use medication “if needed, as needed, and as seldom as possible” and in combination with psychological and social supports.not view medications from a “one size fits all” perspective, but rather
20Education + Activity = Better Health Interventions lasting longer than 3 months were 39% more likely to report statistically significant weight loss (89% versus 64%).Programs that combine education and activity are 34% more likely to report statistically significant weight loss than programs that provide education alone (75% versus 56%).81% of the studies with significant body weight findings incorporated both exercise and nutrition into their interventions.Bartels, S., & Desilets, R. (2012). Health promotion programs for people with serious mental illness. Washington, D.C. SAMHSA-HRSA Center for Integrated Health Solutions.
21Choosing HealthThe My Activity Pyramid for Adults is modeled after the USDA's MyPyramid and is based on the 2008 Physical Activity Guidelines for Americans. University of Minnesota Extension.The My Activity Pyramid for Adults is modeled after the USDA's MyPyramid and is based on the 2008 Physical Activity Guidelines for Americans.
22Peer Support“Peer specialists bring the essential message of hope that acts as a catalyst for people to begin their journey of recovery.”– Paolo del Vecchio– Visions of Hope Arizona
23Peer Support = Wellness SAMHSA’s Transformation Transfer Initiative grants are supporting peer specialists in the following ways:Pennsylvania and New Jersey – Wellness and Older Adult Peer Support ServicesMichigan – Certified Peer Support Specialists at Federally Qualified Health CentersGeorgia – Peer Supported Whole Health and Wellness Coaching– Bowl Of Apples Painting – Arline Wagner – Fine Art America,
24SAMHSA Peer Support and Consumer-Operated Activities SAMHSA funds and supports the following initiatives, among others:Peer-Run and Recovery Community OrganizationsExpert Panel Meeting on Peer Specialists and Peer Recovery CoachesPillars of Peer Support Services SummitStatewide Consumer and Family Network GrantsNational Consumer and Consumer Supporter Technical Assistance CentersAnnual Consumer Conference – Alternatives Conference“Peer recovery coaches go where no other group goes.” – Joe Powell, Executive Director, Association of Persons Affected by Addictions
25Defining RecoveryA process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.– SAMHSA, 2011
26Four Dimensions of Recovery Individualsand FamiliesPreferred slide
27KSAPs: Knowledge, Skills, Abilities, and Personal Characteristics Elements of Competency:Knowledge – Awareness, information, or understanding about facts, rules, principles, guidelines, concepts, theories, or processes needed to successfully perform a task.Skill – Capacity to perform physical or mental tasks with a specified outcome.Ability – A demonstrated cognitive or physical capability to successfully perform a task with a wide range of possible outcomes.Personal Characteristics – Values, attitudes, traits, etc.– Miller, 1990Hoge, M.A., Tondora, J., & Marrelli, A.F. (2005). The fundamentals of workforce competency: implications for behavioral health. Administration and Policy in Mental Health, 32(5/6), 509–531.
28Recovery to PracticeThe following organizations have been funded to develop recovery-oriented educational materials and train practitioners:American Psychiatric AssociationAmerican Psychological AssociationAmerican Psychiatric Nurses AssociationCouncil on Social Work EducationNational Association of Alcoholism and Drug Abuse CounselorsNational Association of Peer Specialists.
29Closing ThoughtsHope Is Saying Yes to Life!Say “Yes” to Life!