1. Beyond Maintenance: Facilitating Recovery from Mental Illness
Cincinnati VA Medical Center Social Work Service
Presented by:
Reneé Kopache Coordinator of Wellness Mgmt. Hamilton County MHRSB
Northern Kentucky University March 28, 2008

2. Agenda Overview of Recovery Personal Chronicle Facilitating Recovery
Q & A

3. Overview of Recovery
A process of reflecting and changing as one searches for identity, purpose, and contentment.

4. Definition of Recovery
ODMH defines recovery as “The process of overcoming the negative impact of a psychiatric disability despite its continued presence.”
“It is a process, sometimes lifelong, through which a consumer achieves independence, self-esteem, and a meaningful life in the community (Power, A.K. & Manderscheid, R.W. (2004). Federal Perspective: Recovery, Now! NASMHPD e-Report on Recovery)
Will come back to this later

5. Important Factors to Recovery
Clinical care
Hope
Support
Work/meaningful activity
Empowerment
Community involvement
Access to resources
Education/knowledge
Self-esteem
Self-help
Spirituality
Physical health
Self-responsibility
Self-directed
Individualized and person-centered
Holistic
Strengths based
Growth oriented
Refer them to the handout with the nine components (left column)
Clinical Care:
Most important here is the consumer’s opportunity to choice the type of clinical care that they receive and to provide input into their treatment
Power & Control:
This has to do with the consumer’s opportunity to make decisions about their life, including their treatment, housing, employment, etc.
Stigma:
Much more powerful than you can imagine and it impacts every aspect of our life, not just treatment
Community Involvement:
Research has shown that the more involved a consumer is in their community, the less their symptomology and hospitalization rates and the greater their self-esteem, quality of life and satisfaction with treatment
Education/Knowledge:
Knowledge is power; the more consumers understand their illness,medications, treatment options, rights, self-help skills, etc, the better prepared for recovery they are
Spirituality:
Many consumers report that this is the #1 factor that keeps them going, that gives them hope

6. Stages of Recovery* Dependent/Unaware
Consumer relies on others and is not aware of his/her own status or needs.
Dependent/Aware
Consumer relies on others but is aware of his/her status and needs.
Independent/Aware
Consumer relies on self and is aware of his/her status and needs.
Interdependent/Aware
Consumer relies on self and others in a mutual exchange of beneficial support, services and resources.
Two different factors: level of awareness and level of dependence
It’s important to keep in mind that a consumer’s progress in their recovery can be impacted by the mental health system as much as it is impacted by the consumer
Keep in mind that a consumer can be in different stages of recovery across the various components of recovery
The consumer defines where they are in their recovery as well as where they want to be
* Ohio Department of Mental Health (1999). Emerging Best Practices in Mental Health Recovery Process.

7. Stages of Recovery Cont’
ODMH:
Dependent/Unaware
Dependent/Aware
Independent/Aware
Interdependent/Aware
The Village:
Hope
Empowerment
Self-Responsibility
Meaningful role in society
View The Village’s stages as desired outcomes for the Ohio stages

8. Healthy person - Prior to mental illness
Pets
Family
Community
Illness / Disability
Hobbies
Friends
Person
EDUCATION
Values & Beliefs
Work
Education
Let me illustrate….
Hopes & Dreams
Sexuality
Spirituality
Health

9. Person with mental illness
Pets
Family
Community
Hobbies
Friends
Mentally Ill
Work
Values & Beliefs
EDUCATION
Education
Hopes & Dreams
Spirituality
Health
Sexuality

10. Person in Recovery Mental Illness Community Family Hobbies Friends
Work
Values & Beliefs
EDUCATION
Education
Hopes & Dreams
Spirituality
Health
Sexuality

11. The Recovery Process

12. Personal Chronicle of Recovery
Reclaiming personhood!

13. Hope (dependent/unaware) 1989 – 1993:
“You can’t return to school, you’ll never be able to work, and you will have to take medications the rest of your life….I’m starting the paper work to get you on disability.”

14. Empowerment (Dependent/Aware) 1993 – 1999:
On disability and experiencing poverty for the first time.
Tired of poverty, went back to work.
Revolving door of hospitalizations continued.

15. Self-Responsibility (Independent/Aware) 1999 – 2002:
Bridges Burned…time to take care of self!
Free of hospitalizations for the first time in 10 years.
Role of Recovery Coordinator (motivation).

16. Meaningful Role (Interdependent/Aware) 2002 – 2004:
No more medications
Buy a house
Graduate from treatment
Giving back
Life in community

17. Recovered (remission)
2005 to present:
Rarely experience symptoms of mental illness.
Life is independent of mental illness and mental health system.
Absolute proof!

18. No longer a consumer
“You can’t take care of a pet…you can’t even take care of yourself.”
This is Maiya…she weighs more than me and has dominant tendencies. She has helped me realize that I can accomplish whatever I set my mind to.

19. Facilitating Recovery
The Role of the Consumer and the Provider…
Individuals in treatment sometimes burn bridges…. part of the recovery process is building new ones.

20. A Recovery Vision of Service
Grounded in the idea that people can recover from mental illness, and that the service delivery system is constructed based on this knowledge.
A recovery vision is in stark contrast to traditional systems that were/are based on the belief that people with severe mental illness do not recover, and that the course of their illness is at best a maintenance course.
Anthony, William (2000). A Recovery-Oriented Service System: Setting Some System Level Standards. Psychiatric Rehabilitation Journal, 24(2),

21. Guiding Principles of Recovery
The consumer directs the recovery process; therefore, consumer input is essential throughout the process.
The Mental Health System must be aware of its tendency to enable and encourage consumer dependency.
Consumers are able to recover more quickly when their:
hope is encouraged, enhanced, and/or maintained;
life roles with respect to work and meaningful activities are defined;
spirituality is considered;
culture is understood;
educational needs as well as those of their family/significant others are identified;
socialization needs are identified.
Principle I
The consumer directs the recovery process; therefore, consumer input is essential throughout the process.
Principle II
The Mental Health System must be aware of its tendency to enable and encourage consumer dependency.
Principle V
Recovery from mental illness is most effective when a holistic approach is considered.
Principle X
Family involvement may enhance the recovery process. The consumer defines his/her family unit.
Principle XII
Community involvement as defined by the consumer is important to the recovery process.

22. Guiding Principles Con’t
Individual differences are considered and valued across their life span.
Recovery from mental illness is most effective when a holistic approach is considered.
In order to reflect current "best practices," there is a need to merge all intervention models, including Medical, Psychological, Social, and Recovery.
Clinician's initial emphasis on "hope" and the ability to develop trusting relationships influences the consumer's recovery.
Clinicians operate from a strengths/assets model.
Principle I
The consumer directs the recovery process; therefore, consumer input is essential throughout the process.
Principle II
The Mental Health System must be aware of its tendency to enable and encourage consumer dependency.
Principle V
Recovery from mental illness is most effective when a holistic approach is considered.
Principle X
Family involvement may enhance the recovery process. The consumer defines his/her family unit.
Principle XII
Community involvement as defined by the consumer is important to the recovery process.

23. Guiding Principles Con’t
Clinicians and consumers collaboratively develop a recovery management plan. This plan focuses on the interventions that will facilitate recovery and the resources that will support the recovery process.
Family involvement may enhance the recovery process. The consumer defines his/her family unit.
Mental Health services are most effective when delivery is within the context of the consumer's community.
Community involvement as defined by the consumer is important to the recovery process.
ODMH (1999) Emerging Best Practices in Mental Health Recovery
Principle I
The consumer directs the recovery process; therefore, consumer input is essential throughout the process.
Principle II
The Mental Health System must be aware of its tendency to enable and encourage consumer dependency.
Principle V
Recovery from mental illness is most effective when a holistic approach is considered.
Principle X
Family involvement may enhance the recovery process. The consumer defines his/her family unit.
Principle XII
Community involvement as defined by the consumer is important to the recovery process.

24. Essential Services in Recovery SystemD I C A L O
Service Category
Description
Consumer Outcome
Treatment
Alleviating symptoms and distress
Symptom Relief
Crisis Intervention
Controlling and resolving critical or dangerous problems
Personal safety assured
Case Management
Obtaining the services client needs and wants
Services accessed
Basic Support
Providing the people, places and things client needs to survive (e.g. shelter, meals, health care)
Personal survival assured
Anthony, William (2000). A Recovery-Oriented Service System: Setting Some System Level Standards. Psychiatric Rehabilitation Journal, 24(2),

25. Essential Services Con’tY M D L
Service Category
Description
Consumer Outcome
Rehabilitation
Developing clients’ skills and supports related to clients’ goals
Role functioning
Enrichment
Engaging clients in fulfilling and satisfying activities
Self-development
Rights Protection
Advocating to uphold one’s rights
Equal opportunity
Self-help
Exercising a voice and a choice in one’s life
Empowerment
Wellness/Prevention
Promoting healthy lifestyles
Health status improved

26. Potential responses to adverse life events
“Level of Functioning”
Adverse Event
Thriving
Recovery Model
Resilience (recovery)
Survival with Impairment
Why being empowered? The alternative isn’t very enticing….
Succumbing
Medical Model
Time
Carver, C.A. (1988). Issues, Models and Linkage. Journal of Social Issues, 54, p.246.

27. Recovery – Defining Roles
Consumer Role
Provider Role
Do for, do with, have them do for selves

28. Hope – Consumer Role Accept illness, accept treatment
Rely on the hope of others
Learn about illness, medications and treatment
Work on becoming rational thinkers
Hope is an attitude influenced by thought.
To obtain and maintain a sense of hope, we have to change (control) our thoughts…we have to become rational thinkers!
one thing that really hinders our ability to have hope is our thought processes…we tend to be black and white thinkers and we tend to operate from the premise of numerous irrational thoughts.
By becoming rational thinkers, our situation becomes more real and we can start to see that there is hope for a better life
keep in mind that becoming rational thinkers is an ongoing process….it’s not reasonable to expect that it will be perfected at this point

29. Hope - Consumer Role Con’t
Helpful Coping Skills/Techniques:
Medications
Treatment (including hospitalization)
Support from family/friends
Support from a trusted, third party observer
Journaling
Barriers:
Stigma & discrimination from having a mental illness
Symptoms
Lifestyle
Family/Friends
Journaling….helps us identify feelings, helps us slow down, and review our thought processes.
Exercise…..healthy release of energy and helps combat depression
Stigma…this is huge, but it is something that we have to strive to overcome if we want to make progress in recovery.
find the right providers
take matters into your own hands
don’t give providers a reason to say this!
don’t look outside yourself for validation!
Practice....using earlier statements, have participants do a mood log

30. Hope – Provider Role Address core clinical needs Education
Engagement
Trust
Address basic living needs
Education
Help the consumer understand why they do what they do and think the way that they think
Separate the illness from the individual
Avoid Stigmatizing & hope-deflating comments
Instill a sense of Hope!!!

31. Empowerment – Consumer Role
Becoming Knowledgeable
know your illness & yourself
learn to distinguish between symptoms and you
warning signs
triggers
rights
Utilizing Support
Professional
Peer
Friends/family
Become active in your treatment
Medications alone will not improve your life
Your treatment providers cannot fix you
Tools: books and websites

32. Empowerment – Consumer Con’t
Helpful Coping Skills/Techniques:
Continue using skills from previous stage
Read, read, read
Self-Assessment
strengths, weaknesses, needs, wants, goals, etc.
Let people help
Exercise….pursue hobbies
Barriers:
Stigma
Limited access to resources
Lack of support
Trust
Feeling better

33. Empowerment – Provider Role
Educate
Support the process of gaining self-awareness
Homework assignments
“Do with” instead of “doing for”
Encourage taking risks (challenge)
Use “failure” to teach not to discourage
Support
Begin to assist the consumer with the process of developing a healthy support system.

34. Self-Responsibility–Consumer Role
Changing Behaviors/Regulating Emotions
Critical stage where we shift from an external to internal locus of control
Anger is not the only emotion we have
taking on responsibility for our well-being opens the door to feeling the positive emotions
Improve self-esteem
Create a positive lifestyle
change, change, change
risks, risks, risks
Be selfish…put self first for awhile
Most difficult aspect of recovery is being able/willing to accept responsibility for our well-being
Stage of continual and difficult change

35. Self-Responsibility-Consumer Con’t
Helpful Coping Skills/Techniques:
Continue previous skills as appropriate
Identify problems/challenges as well as reasonable solutions…then, develop a plan to implement the solutions (physical, thought/emotional & relationships)
Develop and utilize natural supports
Surround self with healthy people
Barriers:
Low self-esteem & poor social skills
Well meaning but overprotective or enabling people
The system….often times, services don’t match needs

36. Self-Responsibility-Provider Role
Support & encourage efforts to change
Provide tools and techniques
Cheerleader
Sounding Board
Don’t do for the consumer what they can do for themselves
Help the consumer improve self-esteem and sense of self
Help the consumer to live and function in the community (skill development/ enhancement)

37. Meaningful Role – Consumer
Integrated life in the community
Life extends beyond mental illness and the mental health system
Establish valued role in the community
Employee/volunteer
Tenant/home owner (neighbor)
Community organizations (giving back)
Friend, family member, parent, teacher, etc.
Pursue interests/hobbies (outside of MH)
Healthy relationships (outside of MH)
Transition out of mental health services/system

38. Meaningful Role-Consumer Con’t
Helpful Coping Skills/Techniques:
Keep doing what’s worked
Try new things/explore interests
Giving back (focus on others)
Establish & pursue life goals
Barriers:
Old habits are hard to break
returning to the comfort zone
Self
Hotel California syndrome

39. Meaningful Role - Provider
You’re job is just about done!
Encourage activities in the community
Help the person connect to natural supports and become active members in their community
Help the individual transition out of services (or reduction of services)
Be prepared for self-sabotage

40. Resources – Books/Articles
Pathways to Recovery
Ridgeway, McDiarmid, Davidson, Bayes & Ratzlaff (2004)
Wellness Recovery Action Plan
Mary Ellen Copeland (2000)
Feeling Good Handbook
David Burns, MD (?)
Dual Disorders Recovery book
Hazelden (1993)
Self-Determination Series
Univ. of Illinois at Chicago (Cook, Petersen, Jonikas, )
(articles, reports, tools)
(self-help books)

41. Q&A and Contact Info.
Renee Kopache
Hamilton County Mental Health and Recovery Services Board
2350 Auburn Ave.; Cincinnati, OH 45219
(513)
A copy of this presentation will be available online…