2 Special Thanks to the Contributors of These Slides Carla DamronBeth AdamsKatherine RobertsVicki CousinsDoug CochranMichele Murff
3 Training Agenda TodayThe 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 HopeCreating Recovery EnvironmentsEmphasis 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 1828People 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 quartersPatients forced to sleep in corridorsMany 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 phenothiazinesprovided symptom management ofseriously disabling psychosesIncreased the number of patients who could potentially live outside of the hospitalDecreased the length of stay within the hospital
14 Technological Advances Result in a Philosophical Shift New emphasis ...On the value of community care and treatmentOn the need to remove barriers between hospital and communityOn 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 services1500 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) insuranceSouth 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 professionalsProfessional 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 consumerEmphasizes strengths and wellnessServices encompass whole life of consumer
21 Psychosocial Rehabilitation Hope, empowerment, and positive expectations emphasizedStaff/member relationships are egalitarian and respectfulSkill 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 GroupsMHASC - Mental Health Association’s CORE/ SA - Schizophrenics Anonymous groupsContac - Consumer Org.& TA Ctr.National Consumer Self-Help ClearinghouseNEC - 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 MembersPlanningPolicy MakersProgram EvaluatorsService 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? IllnessesSymptoms and Consequences of SymptomsNegative Treatment or Lack of TreatmentInstitutionalization / Dependence on the SystemDiscrimination (Stigma) and SHAME
28 What are Consumers and the Mental Health System Recovering From? LabelsLimited ExpectationsWounds of the SpiritPoverty, Unemployment and HomelessnessHopelessness
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)
32 Dignity and RespectWhen 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 HopeFrom 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 HopeSensing, 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 ResponsibilityOne 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 ResponsibilityTeach 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 InclusionInsist 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 InclusionNobody 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 ShoesThink 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 ShoesAlong 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 HopeAnticipation of a continued good state, an improved state, or a release from a perceived entrapment.
44 HopeIt 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 RelationshipsRapportTrustValuing the person“Find the spark, light the fire”Ongoing
46 Hope Instilling Strategies Facilitate SuccessAssist in setting and reaching goalsHolistic approach: housing, employment, education, etc.Link with resources
47 Hope Instilling Strategies Connect to othersImportance of role models, peers, and peer supportShare the stories of consumersConnect through consumer organizations (NAMI-SC, SC Share, MHASC)
48 Consumers as Partners in the Treatment Process Value the person in the treatment planning processTake a holistic approachMaximize the therapeutic relationshipMaximize extended support systems
49 Consumer as Partners in the Treatment Process Respect cultural differencesSpiritualityCombat stigma/social justice issuesOperate on a strengths modelEgalitarian relationships
50 “Growing Edges” Consumers: I’m not a case - I don’t want to be managed Treatment Planning versus Recovery PlanningConsumer 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 acton 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 andto 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 RecoveryThere 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 PastConsumer treatment and consumer rights seen as separate areasMany times opposed to each otherTreatment goals seemed to focus on restrictions and controlConsumer rights seemed focused on civil rightsConsumer treatment ignored rightsConsumer rights ignored treatment
65 Rights in the Present, Future Emphasize what is in common with consumer rights and consumer treatment and recovery – not the differencesRealize that each supports and requires the fulfillment of the otherIn 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, exploitationThe 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 AdvocacyLong Term Care OmbudsmanSC ShareNAMI-SCMHASCSCDMH Client AdvocacyProgramSCDMH Offices of Consumer Affairs/Consumer Affairs Coordinators
68 Practice the Basic Principles of Consumer Rights. DignityAutonomySelf DeterminationIndividual InvolvementMost 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.
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 fromDaniel Tarantola, M.D.Senior Policy Advisor to the Director of the World HealthOrganization and Associate of the Francois-Xavier BagnoudCenter for Healthand Human Rights
74 “THE ATTAINMENT OF THE HIGHEST STANDARDS OF PHYSICAL, MENTAL AND SOCIAL WELL-BEINGNECESSITATES AND REINFORCES DIGNITY,AUTONOMY AND INDIVIDUAL PROGRESS.”
76 Consumers who say they want to work:? 70% Are currently working? < 15%Current access to Supported Employment? < 5%
77 Supported EmploymentMainstream job in community (integrated employment)Pays at least minimum wageJob placement based on consumer’s interestMinimal pre-employment assessment and trainingWillingness to work only requirement
78 Job Coach Assists in finding job Helps consumer learn job Provides on-going supportsCoordinates 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.
82 Consumer Living in the Community NOW Isolated/segregated/lacking mobilityLimited in choices of leisure activitiesShunned and fearedConsidered a burden with nothingto offerConsidered different and feels conspicuous
83 Consumer Living in the RECOVERING Community of Our Future Is a part of/integrated into the larger communityIs an educatorHas important roles that have nothing to dowith mental illness
84 Consumer Living in the RECOVERING Community of Our Future Using gifts and talents to contribute to the communityLives next doorIs an usher at churchIs 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 organizationsParks and recreation staffPublic library staffSchools/universitiesLocal/governmentIndustryOther 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 recoveryAffordable (30% of income)Quality constructionSafe neighborhoodsArray of options (Rental, Owner-Occupied, Shared, Services on site)Integrated in the community
90 Education=Empowerment Accessing mainstream housing servicesUnderstanding Fair Housing LawsBeing active in neighborhood associations/local politics
91 SCDMH Recovery Training Thank you for coming today!