1. Recovery from Serious Mental Illness:
Conceptual Overview
Mary A. Jansen, Ph.D.
Bayview Behavioral Consulting, Inc.
Vancouver, BC

2. Topics 1. Recovery 2. Rehabilitation 3. Barriers and Challenges
4. Psychology’s Expertise
5. 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 time
Client’s process of regaining functional capability
Rehabilitation
Consists of the supports and interventions provided
The 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)
Hope
Essential catalyst
Person Driven
Consumer leads; empowered
Many Paths
Based on person’s experiences
Highly Personal
Dependent on person’s own goals; individualized
Non-Linear
Continual growth; ups and downs
Holistic
Encompasses entire life
Support
Supported by peers & allies
Relationships & Social Networks
Belief in person’s capability for recovery
Based in Person’s Culture
Key aspect
Addresses Trauma
Often a pre-cursor
Individual, Family & Community Responsibility
Foundation for recovery
Respect
Acceptance

5. Mental Health Recovery
Recovery is what people with illnesses and disabilities do
Treatment, 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 being
Recovering from the iatrogenic effects of treatment settings
Recovering from lack of opportunities for self determination
“Nothing about us, without us”
Recovering from the negative side effects of unemployment
Recovering from crushed dreams
Recovery 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 Retardation
But 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 focused
Past traumas/failures
Doing for the individual
provider/team recommends
Long-term dependence
Office, clinic & community based
Recovery Approach
Strength based
Success oriented
Doing with the individual
Integrated team/partnership
Graduated independence
Community based
Present/future focused

12. Life People with SMI Want What do you want? Meaningful relationships
A safe place to live
Satisfying activities
Adequate income
Job satisfaction
An enjoyable social life
What do you want?

13. Psychosocial Rehabilitation
Focus
The primary focus of rehabilitation is on improving the capabilities and competencies of persons with serious mental health disorders
How
By using evidence based practices and other empirically supported clinical interventions
Within a recovery oriented framework
i.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 fidelity
These 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?
Barriers
Low expectations of what is achievable by consumers, clinicians, and families
Lack of knowledge about what symptoms are due to illness and what are due to client’s and society’s reaction to that illness
Lack of will to provide proven interventions to bring about optimal recovery
Lack of resources to provide proven interventions to bring about optimal recovery
Fear 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 lives
Eliminate 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 expertise
Clinical expertise
Team leadership expertise
Policy and administrative experience and know-how
Training expertise and programs
We 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 change
Very few doctoral training programs teach or emphasize the concept of recovery, and the methods of psychosocial rehabilitation
Most psychologists are still trained in the traditional methods that their mentors were trained in, i.e., a pathology and deficits approach
New 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 needed
Develop, advocate for, overcome resistance to, and implement: recognized specialty programs in SMI in APA accredited doctoral and post doctoral programs
De-stigmatize working with people with SMI, even those who are most seriously ill
Recognize and reward psychologists who work with people with SMI
Encourage 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 projects
To conduct research in less well-resourced environments on:
effectiveness of already identified EBPs
efficacy of promising practices
To provide coordinated and integrated services to adults with mental illnesses who have co-occurring primary care conditions or chronic medical diseases
Develop patient-centered treatment models, e.g., “medical home” and others
Funding 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 offer
Stigma, trauma, and iatrogenic effects of treatment itself are some of the worst aspects of the illness
Psychology training is behind the times: Accredited doctoral programs do not provide training in the new concepts and methods
Just released:
APA Curriculum to train psychologists in Recovery and Psychosocial Rehabilitation
Available from

22. Curriculum Modules Instruction Module 1. Introduction to Recovery
2. Recovery, Health Reform and Psychology
3. Assessment
4. Partnership and Engagement
5. Person Centered Planning
6. Health Disparities
7. Interventions I
8. Interventions II
9. Interventions III
10. Forensic and Related Issues I
11. Forensic and Related Issues II
12. Community Inclusion
13. Peer Delivered Services
14. Systems Transformation
15. 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