Presentation on theme: "Recovery from Serious Mental Illness:"— Presentation transcript:
1 Recovery from Serious Mental Illness: Conceptual OverviewMary A. Jansen, Ph.D.Bayview Behavioral Consulting, Inc.Vancouver, BC
2 Topics 1. Recovery 2. Rehabilitation 3. Barriers and Challenges 4. Psychology’s Expertise5. What We Need To Do To Bring About Change
3 Recovery and Rehabilitation: What’s it all about? Recovery is based on the novel idea that individuals with serious mental illness can recover and live productive lives in the community – just like anyone with an illness that may flare up from time to timeClient’s process of regaining functional capabilityRehabilitationConsists of the supports and interventions providedThe primary focus of rehabilitation is on improving the capabilities and competencies of persons with serious mental health disorders
4 Recovery Principles (SAMHSA, 2006, updated 2011) HopeEssential catalystPerson DrivenConsumer leads; empoweredMany PathsBased on person’s experiencesHighly PersonalDependent on person’s own goals; individualizedNon-LinearContinual growth; ups and downsHolisticEncompasses entire lifeSupportSupported by peers & alliesRelationships & Social NetworksBelief in person’s capability for recoveryBased in Person’s CultureKey aspectAddresses TraumaOften a pre-cursorIndividual, Family & Community ResponsibilityFoundation for recoveryRespectAcceptance
5 Mental Health Recovery Recovery is what people with illnesses and disabilities doTreatment, case management, support and rehabilitation are the things that helpers do to facilitate recovery (Anthony, 2002)A journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential (SAMSHA, National Consensus Statement on Mental Health Recovery, 2006)A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMHSA, Definition of Recovery, 2012).
6 What Does it Take to Recover? Recovery from mental illness involves:Challenging and overcoming the stigma that persons with SMI have incorporated into their very beingRecovering from the iatrogenic effects of treatment settingsRecovering from lack of opportunities for self determination“Nothing about us, without us”Recovering from the negative side effects of unemploymentRecovering from crushed dreamsRecovery is often a complex, time-consuming process – just as it is with any serious illness
7 The “Mental Patient” Lens “The mental patient lens is the one many of those with mental illnesses have learned to look through every time we are uncomfortable, have intense feelings or experiences, or difficult relationships.”“It is a lens that reminds us that our feelings and thoughts are different than other peoples’ and that we must take care. We must avoid stress, risk-taking, and challenges, assume others know better than we do, and that there is a medication for everything.”Mary Ellen Copeland, 2004, NASMHPD National Consensus Conference, Report on Recovery
8 What Difference Does a Label Make? Getting the label out of the person:“Not too many years ago, I was Mary Ellen Copeland, manic depressive. Because I had this label, my family was told not to expect much of me. I learned not to expect much of myself. I became dependent on the mental health system to maintain, at best, a minimal life style. I saw myself through a mental health system lens that was confining and oppressive. Now I see myself through a different lens, a lens that is Mary Ellen Copeland, educator, author, mother, wife, woman.”Mary Ellen Copeland, 2004, NASMHPD National Consensus Conference, Report on Recovery
9 Mental Patient to Person Those working to recover struggle to realize that being uncomfortable and having difficult feelings is something they can deal with. These feelings and thoughts don’t have to be symptoms of anything. One’s strengths and resources can be used to get through difficult times.This is the process of changing from mental patient to person, from patient with symptoms, to person with thoughts, feelings, and experiences.
10 Normalization – From Old Wine to New Bottles Principle that those with any disability or impairment should be treated with respect, provided functional supports, and treated as normal human beings. Wolf Wolfensberger, 1972, The principle of Normalization in Human Services, Toronto, National Institute on Mental RetardationBut when will those with mental illnesses become people instead of their label?When will it be commonly accepted that people, who from time to time, have troubling feelings, thoughts, behaviors, and experiences (does this include you and me??), can also have control over their own lives, do the things they want to do, and be the way they want to be?
11 Approaches Differ Medical Model Recovery Approach Illness/problem focusedPast traumas/failuresDoing for the individualprovider/team recommendsLong-term dependenceOffice, clinic & community basedRecovery ApproachStrength basedSuccess orientedDoing with the individualIntegrated team/partnershipGraduated independenceCommunity basedPresent/future focused
12 Life People with SMI Want What do you want? Meaningful relationships A safe place to liveSatisfying activitiesAdequate incomeJob satisfactionAn enjoyable social lifeWhat do you want?
13 Psychosocial Rehabilitation FocusThe primary focus of rehabilitation is on improving the capabilities and competencies of persons with serious mental health disordersHowBy using evidence based practices and other empirically supported clinical interventionsWithin a recovery oriented frameworki.e., one which is driven by the client and one which operates from a belief that recovery is possible
14 Psychosocial Rehabilitation Research has determined that certain interventions are rehabilitative for persons with serious mental illness, i.e., they foster gaining or regaining of functional capabilities*When delivered as designed and researched – with fidelityThese interventions are now the gold standard for helping individuals with serious mental illnesses regain their maximum functional capability*The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements
15 Why Are Recovery and Rehabilitation Underutilized? BarriersLow expectations of what is achievable by consumers, clinicians, and familiesLack of knowledge about what symptoms are due to illness and what are due to client’s and society’s reaction to that illnessLack of will to provide proven interventions to bring about optimal recoveryLack of resources to provide proven interventions to bring about optimal recoveryFear of changing the status quo
16 Challenges Challenges: A difficult challenge is to change the attitude of existing staff and those being trained in traditional professional training programs in order to:Let everyone know that that people with SMI can, and do recover and lead satisfying livesEliminate the stigma that many professionals have even today;Change the service delivery system from one which delivers medication and psychotherapy to one which focuses on rehabilitation and the potential of each person to recover to the greatest extent possible
17 Psychology’s Expertise More than any other discipline, psychologists have the expertise to change the mental health service delivery system:Research expertiseClinical expertiseTeam leadership expertisePolicy and administrative experience and know-howTraining expertise and programsWe have an ethical mandate to promote and use the most efficacious interventions – those that have been proven to make a difference in the lives of those we work with
18 Training Limitations Limitations Psychology Faces There are not enough psychologists trained in recovery/rehabilitation assessments, interventions, and systems changeVery few doctoral training programs teach or emphasize the concept of recovery, and the methods of psychosocial rehabilitationMost psychologists are still trained in the traditional methods that their mentors were trained in, i.e., a pathology and deficits approachNew models train psychologists in how to help people improve their functional skills using a strengths approach
19 Steps to Change What We Need To Do Training programs that offer coursework, practica, internships, and post doctoral fellowships in these new models and methods are neededDevelop, advocate for, overcome resistance to, and implement: recognized specialty programs in SMI in APA accredited doctoral and post doctoral programsDe-stigmatize working with people with SMI, even those who are most seriously illRecognize and reward psychologists who work with people with SMIEncourage APA, State Psychological Associations, and relevant APA Divisions to advocate for those who are most vulnerable in society
20 Steps to Change What We Need To Do, cont’d Use the provisions of the Affordable Care Act – Below Are All Available in the Act:Demonstration projectsTo conduct research in less well-resourced environments on:effectiveness of already identified EBPsefficacy of promising practicesTo provide coordinated and integrated services to adults with mental illnesses who have co-occurring primary care conditions or chronic medical diseasesDevelop patient-centered treatment models, e.g., “medical home” and othersFunding for training of psychologists in mental and behavioral health to work with vulnerable populations, including those with severe mental health disorders
21 Conclusion People with SMI DO recover and lead satisfying lives Our job is to support them and offer the best interventions that science has to offerStigma, trauma, and iatrogenic effects of treatment itself are some of the worst aspects of the illnessPsychology training is behind the times: Accredited doctoral programs do not provide training in the new concepts and methodsJust released:APA Curriculum to train psychologists in Recovery and Psychosocial RehabilitationAvailable from
22 Curriculum Modules Instruction Module 1. Introduction to Recovery 2. Recovery, Health Reform and Psychology3. Assessment4. Partnership and Engagement5. Person Centered Planning6. Health Disparities7. Interventions I8. Interventions II9. Interventions III10. Forensic and Related Issues I11. Forensic and Related Issues II12. Community Inclusion13. Peer Delivered Services14. Systems Transformation15. Scientific Foundations
23 Citation for this Module: American Psychological Association & Jansen, M. A. (2014). Introduction to Recovery Based Psychological Practice. Reframing Psychology for the Emerging Health Care Environment: Recovery Curriculum for People with Serious Mental Illnesses and Behavioral Health Disorders. Washington, DC: American Psychological Association.Citation for the full Curriculum:American Psychological Association & Jansen, M. A. (2014). Reframing Psychology for the Emerging Health Care Environment: Recovery Curriculum for People with Serious Mental Illnesses and Behavioral Health Disorders. Washington, DC: American Psychological Association.
24 Mary A. Jansen, Ph.D.Bayview Behavioral Consulting, Inc.Vancouver, BC