beyond maintenance: facilitating recovery from mental illness cincinnati va medical center social...
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Beyond Maintenance:Facilitating Recovery from Mental Illness
Cincinnati VA Medical CenterSocial Work Service
Presented by:
Reneé KopacheCoordinator of Wellness Mgmt.
Hamilton County MHRSB
Northern Kentucky UniversityMarch 28, 2008
Overview of Recovery
A process of reflecting and changing as one searches for identity, purpose, and contentment.
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)
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
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.
* Ohio Department of Mental Health (1999). Emerging Best Practices in Mental Health Recovery Process.
Stages of Recovery Cont’
ODMH:
Dependent/Unaware Dependent/Aware Independent/Aware Interdependent/Aware
The Village:
Hope Empowerment Self-Responsibility Meaningful role in society
http://www.village-isa.org/index.htm
EDUCATIONP
ets
Fam
ily
Friends
Work
EducationSexuality
Hea
lth
Spir
itual
ityHopes & Dreams
Values & Beliefs
Illness / Disability
Person
Hobbies
Com
munity
Healthy person -
Prior to mental illness
EDUCATIONP
ets
Fam
ily
Friends
Work
Education
SexualityHea
lth
Spir
itual
ityHopes & Dreams
Values & BeliefsMentally Ill
Hobbies
Com
munity
Person withmental illness
EDUCATIONM
ental Illn
ess
Fam
ily
Friends
Work
Education
SexualityHea
lth
Spir
itual
ity
Hopes & Dreams
Values & Beliefs Person
Hobbies
Com
munity
Person in Recovery
Hope
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.”
(dependent/unaware)
Empowerment
1993 – 1999:
On disability and experiencing poverty for the first time.
Tired of poverty, went back to work.
Revolving door of hospitalizations continued.
(Dependent/Aware)
Self-Responsibility
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).
(Independent/Aware)
Meaningful Role
2002 – 2004:
No more medications
Buy a house
Graduate from treatment
Giving back
Life in community
(Interdependent/Aware)
Recovered (remission)
2005 to present:
Rarely experience symptoms of mental illness.
Life is independent of mental illness and mental health system.
Absolute proof!
No longer a consumer
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.
“You can’t take care of a pet…you can’t even take care of yourself.”
Facilitating RecoveryThe Role of the Consumer and the Provider…
Individuals in treatment sometimes burn bridges….part of the recovery process is building new ones.
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), 159-168.
Guiding Principles of Recovery
1. The consumer directs the recovery process; therefore, consumer input is essential throughout the process.
2. The Mental Health System must be aware of its tendency to enable and encourage consumer dependency.
3. 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.
Guiding Principles Con’t
4. Individual differences are considered and valued across their life span.
5. Recovery from mental illness is most effective when a holistic approach is considered.
6. In order to reflect current "best practices," there is a need to merge all intervention models, including Medical, Psychological, Social, and Recovery.
7. Clinician's initial emphasis on "hope" and the ability to develop trusting relationships influences the consumer's recovery.
8. Clinicians operate from a strengths/assets model.
Guiding Principles Con’t
9. 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.
10. Family involvement may enhance the recovery process. The consumer defines his/her family unit.
11. Mental Health services are most effective when delivery is within the context of the consumer's community.
12. Community involvement as defined by the consumer is important to the recovery process.
ODMH (1999) Emerging Best Practices in Mental Health Recovery
Essential Services in Recovery SystemService 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), 159-168.
M
E
D
I
C
A
L
M
O
D
E
L
Essential Services Con’tService 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
R
E
C
O
V
E
R
Y
M
O
D
E
L
“Lev
el o
f F
un
ctio
nin
g”
Time
AdverseEvent
Thriving
Resilience (recovery)
Survival withImpairment
Succumbing
Carver, C.A. (1988). Issues, Models and Linkage. Journal of Social Issues, 54, p.246.
Potential responses to adverse life events
Recovery Model
Medical Model
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!
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
Hope – Provider Role Address core clinical needs
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!!!
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
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
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.
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
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
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)
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
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
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
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, ) http://www.cmhsrp.uic.edu/nrtc/tools.asp
http://mhrecovery.com/online_articles.htm (articles, reports, tools) http://mhrecovery.com/books.htm (self-help books)
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