1. Speaking of Recovery…. Presentation Carole Eaton, BA(Hons), MA, R.Psych, RTC,CPRP Executive Director Phoenix Residential Society

2. Recovery What does it mean? What does it involve? What is required to achieve it?

3. Historical Perspective Deinstitutionalization –“The Saskatchewan Plan” beginning in the 60’s The 1960’s/70 saw the dawn of the Community Based Model – outpatient community clinics, approved home system, CMHA day programs/drop in. ◦ *Phoenix House was the first psychiatric group home of its kind in Saskatchewan (1977)

4. The Evidence for Recovery: Research Studies and Self-Reports “Methodologically-sound studies have found that one half to two thirds of over 1300 subjects studied longer than 20 years achieved recovery with significant improvement” ( Harding et al., 1992) The evidence is widely supported by the self-help and consumer/survivor literature. “We are the evidence!” (Chris Summerville, Schizophrenia Society of Canada)

5. Historical Perspective Schizophrenia and other serious psychiatric disabilities have been viewed as “irreversible illness” with increasing disability over time. Mental health program policies and practices have been developed and implemented to support this uncompromisingly negative view of the predicted outcome for people with psychiatric disability. Harding, C.M., Zubin, J., Strauss., J.S. Chronicity in Schizophrenia: Revisited. British Journal of Psychiatry, 1992,161,27-37

6. While the impact of serious mental illness is devasting to those who experience it and to their families, it does not appear that serious mental illness is necessarily a disease of slow and progressive deterioration as was once widely believed. People with serious mental illness can achieve partial or full recovery from the illness as any point during its course even in the later stages of their life. Reference: (Harding, et al., 1992)

7. Results of Long-term Studies on Outcomes in Schizophrenia Vermont: 32 years, 269 patient, 68% full recovery or significantly improved (Harding et al., 1986) Maine: 32 years, subjects matched to Vermont group, 119 patients, 49% full recovery or significantly improved (DeSisto, Harding et al, 1995) Lausanne: 37 years, 289 patients, 57% full recovery or significantly improved (Ciompi & Muller, 1976)

8. Iowa: 35 years, 186 patients, 46% full recovery or significantly improved (Tsuang, et al, 1976) Zurich: 26 -33 years, 208 patients, 53-66% full recovery or significantly improved (Bleuler, 1972) Bonn: 22 years, 502 patients, 53% full recovery or significantly improved (Huber, 1975)

9. What is Recovery? Recovery, as we currently understand it, means growing beyond the catastrophe of mental illness, and developing new meaning and purpose in one’s life. It means taking charge of one’s life even if one cannot take complete charge of one’s symptoms. Much of the chronicity that is thought to be a part of people’s mental illness may be due to the way the mental health system and society treat people with severe mental illness. Contributing to people’s chronicity are factors such as stigma, lowered social status, restrictions on choice and self-determination, the lack or partial lack of rehabilitation opportunities, and low staff expectations. Drastic system changes are needed if we wish to support people’s recovery, rather than hinder people’s recovery. William Anthony, PhD

10. What is Recovery? Recovery is “a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life. William Anthony

11. Recovery is: “a process in which an individual confronts challenges using a unique combination of strengths, vulnerabilities and available resources” “…a non-linear process that involves making progress, losing ground, and pressing forward again”

12. In other words… “ a process of restoring a meaningful sense of belonging to one’s community and positive sense of identity apart from ones’ condition while rebuilding a life despite one’s limitations imposed by that condition” Davidson, L., Tondora, J. O’Connell, M., Kirk, T., Rockholz, P., and Evans, A. (2007). Creating a Recovery-Oriented System of Behavioral Health Care: Moving from Concept to Reality. Psychiatric Rehabilitation Journal. 31, 23-31.

13. 1. Recovery can occur without professional intervention. “The task of professionals is to facilitate recovery; the task of consumers is to recover”

14. 2. A common denominator of recovery is the presence of people who believe in and stand by the person in need of recovery. “People who are recovering talk about the people who believed in them when they didn’t believe in themselves, who encouraged their recovery but did not force it, who tried to listen and understand when nothing seem to make sense”

15. 3. A recovery vision is not a function of one’s theory about the causes of mental illness. “Whether the causes of mental illness are viewed as biological and/or psychosocial…does not commit one to either position on this debate, nor on the use or nonuse of medical interventions”

16. 4. Recovery can occur even though symptoms re-occur. “the episodic nature of severe mental illness does not prevent recovery”

17. 5. Recovery changes the frequency and duration of symptoms. “as one recovers, the symptom frequency and duration appear to have been changed for the better; interfere with functioning less often and for briefer periods; and return to previous function occurs more quickly”

18. 6. Recovery does not feel like a linear process. “recovery involves growth, setbacks, periods of rapid change, and little change and across different areas of functioning”

19. 7. Recovery from the consequences of the illness is sometimes more difficult than recovering from the illness itself. “disabilities, disadvantages and barriers brought on by being placed in the category of mentally ill can limit a person’s recovery even though one has become predominately asymptomatic”

20. 8. Recovery from mental illness does not mean that one was not mentally ill. “at times people who have successfully recovered from severe mental illness have been seen as an aberration or a fraud, rather than their successful recovery being seen as a model or a beacon of hope” for others. Anthony, William Reference: Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990’s Psychosocial Rehabilitation Journal, 1993, 16(4), 11-13

21. The ‘Davidison’ Distinction Recovery from serious mental illness ◦ Involves the amelioration of symptoms and the person’s returning to a healthy state following onset of the illness ◦ Recovery from the psychosis, same as recovering from a broken leg Recovery in serious mental illness ◦ Treatment has limited success and existing care is relativity ineffective ◦ Recovery in means accepting that for the near future the condition will not go away so focus must include learning how to live with it Davidson and Roe (2007). Recovery from versus recovery in serious mental illness: One strategy for lessen confusion plaguing recovery. Journal of Mental Health, 16, 459-470

22. Substance Abuse and Mental Health Services Administration (SAMHSA) 10 fundamental components of recovery Hope Medication/Treatment Empowerment Support Education/Knowledge Self-Help Spirituality Employment/Meaningful Activities

23. “How do you link the abstract concepts that define recovery with specific strategies that systems, agencies, and individuals use to facilitate it”? External conditions include: ◦ human rights ◦ a positive culture of healing ◦ recovery – oriented services Reference: What is Recovery? A Conceptual Model and Explination Jacobson, N., 2001

24. External Conditions Human Rights o Reducing stigma o Protecting the rights of the individual (i.e. shared decision making)-(Patricia Deegan) o Equal opportunities for education, employment, housing o Access to resources o food and shelter (income security) o social and health services (as long as needed)

25. A “coherent social faith” with a culture of inclusion, hope, humor, dignity, respect and love” Providers must embrace the belief that EVERY person can achieve hope, healing, empowerment and connection, regardless of current status Human services environment characterized by tolerance, empathy, compassion, respect, safety, trust Relationships defined by collaboration with active participation and a wide range of options offered, including some with risk

26. Symptom Relief Life Enrichment Case Management Crisis Intervention Rehabilitation Rights Protection Basic Support Self-Help External Conditions

27. What Would A Recovery-Oriented System Look Like? ServiceOutcome TreatmentSymptom Relief Crisis InterventionPersonal Safety Case ManagementServices accessed RehabilitationRole functioning EnrichmentSelf-development Rights ProtectedEqual opportunity Basic Support (housing)Personal Survival Self-HelpEmpowerment Wellness/PreventionHealth Status Improved Anthony, 2000

28. What can help us get there? Recovery oriented Psychosocial (Psychiatric) Rehabilitation Psychosocial (Psychiatric) Rehabilitation is a field, an approach, and a service to people with serious psychiatric difficulties. Psychosocial (Psychiatric) Rehabilitation interventions are specific strategies to assist a person to acquire the necessary skills, behaviours, and resources that will lead them to recovery.

29. What do people with lived experience say helps? Being supported by Others Renewing Hope and Commitment Engaging in Meaningful Activities Redefining Self Incorporating Illness Overcoming Stigma Assuming Control Managing Symptoms Becoming Empowered and Exercising Citizenship (connection) Davidson, L., Tondora, J. O’Connell, M., Kirk, T., Rockholz, P., and Evans, A. (2007). Creating a Recovery – Oriented System of Behavioral Health Care; Moving from Concept to Reality. Psychiatric Rehabilitation Journal, 31, 23-31

30. Recovery Oriented System Their Core Values – Conneticut Experience Recovery encompasses all phases of care People have imput at every level Use “recovery-based” outcome measures Consumers review funding Commitment to peer support and consumer operated services Participation on boards, committees and other decision – making boddies Staff must know all resources and treatment options Individually tailed services – accessible (“no wrong door”) Person centred – self-determination ethic * Kirk, T.A., Evans, AC., Daily, W.F., Implementing a Statewide Recovery – Oriented System of Care: From Concept to Reality, NASMHPD Research Institute, 2005

31. Why Change and Why Recovery? Provides Hope for us all  Because the evidence is simple not there that Schizophrenia and other serious mental illness is necessarily a progressive and chronic illness We are all recovering (or will) from something  Because we can learn from people with lived experience of mental illness;  Because we can learn from other mental health systems experience. They can provide “maps” that they have used to help us move forward.  Because this will help us in our treatment and service decisions  Because the time has come to develop our own vision of a recovery-oriented mental health system.