issue 8 recovery newsletter, winter 2012

From the editor:

Recovery in Acute and

Tertiary Settings

Welcome to the eighth edition of “On Our

Way: Recovery News”. By request this issue

starts out with a definition of recovery.

There are many such definitions, and we will

endeavor to start each issue with one of

them, always remembering that recovery

means different things to different people.

We also received feedback that folks liked

the themed issue we did a while back on

Involuntary Treatment and Recovery, so this

issue also has a theme: Recovery in Tertiary

and Acute Settings.

You will find articles about St. Paul’s

Hospital – Ward C, Acute Home Based

Treatment and the Forest Edge Tertiary

Unit. As always, we’ve also included an

update on the work of the Recovery Advisory

Committee as well as the “Perspectives

Pages”, this time featuring two articles by

family members with loved ones receiving

tertiary services, an article by the Peer

Facilitators working at Forest Edge and an

article from a service user.

Happy reading! �

An Egalitarian Model of

Psychiatric Care at St.

Paul’s Hospital – Ward 8C

Isabel Diogo

It all began with a strong and clear vision

of a new way of providing care to our

mental health patients and their families.

After a three week orientation with a strong

focus on family nursing, group therapy and

team building, 8C admitted their first patient

on September 22, 2010. The focus of this

unit is to assess, treat, and monitor

individuals with mental illness and

addictions in a way that promotes maximum

On Our Way: Recovery News Vancouver Acute & Community Mental Health Services

Volume 1, Issue 8

What is recovery?

One definition is: “A process of change through which individuals

improve their health and wellness, live a self-directed life, and strive to

reach their full potential.”

-Substance Abuse and Mental Health Services Administration

(SAMHSA), Dec. 2011

VCMHS has identified the following critical elements of a recovery

culture:

Hope � Goal-Directed � Self-Determination �

Awareness & Potentiality � Meaning & Purpose

On Our Way: Recovery News

Recovery. This is done by involving the

patient and family in all aspects of the care

process (Wright & Leahy, 2009), having

clinically trained staff facilitate therapeutic

groups (Yalom, 2005), and engaging the

patient in therapeutic programming that is

available seven days a week.

The 8C team created five commitment

statements we strive to meet each day with

each patient and their family that we have

the privilege to work with. The first three

speak very clearly to the vision of our unit:

“We give patients and families a voice

by listening to them, identifying

strengths and goals, and by being

creative and open to possibilities about

diagnosis and patients’ capacity to

change. Our therapeutic environment

cultivates feelings of self-esteem, self-

respect, and health in our patients,

families and staff. We all work together

to create a therapeutic atmosphere that

delivers the very best of care. We are

one inclusive team of patients, families,

staff and leaders. We are warm and

loving, respectful and non-judgmental,

transparent and non-hierarchical,

encouraging each other to grow wings.”

You may be asking yourself what does this

look like? When making care and program

decisions staff feel very comfortable in

negotiating the gray areas where rules can

be flexible and questioning the status quo.

Time after time the team revisits the vision

and commitment statements to ensure that

the patients and their families are at the

center core of their decisions. The

interdisciplinary team goes out of their way

to connect with families to hear their stories,

to educate and support them through the

hospitalization and to commend their

resiliency.

We take quality improvement very

seriously and hence continuously try to

improve our practice and processes. In

order to do this we have asked the opinions

of our patients and their families. These are

some comments they have provided us:

“I have been admitted to many different

psychiatric units but 8C is not like them. If I

ever need to be admitted again this is where

I want to come.”

“The 8C team gave me my life back.”

“No thank you, I don’t want my daughter to

go to a hospital that is closer to home, even

if the commute is long, I want to her be

cared for on 8C.”

“I can’t speak highly enough of the attention

and care shown to both my sister and I.

Being so far from Australia and not knowing

Vancouver, the staff were a great help in

advising me with public transport and

accommodation options.”

The recent results from the Gallup survey

and the Ministry of Health Provincial Patient

Satisfaction Survey provide some of the

quantitative evidence that 8 C is well on its

way to truly becoming a unit where staff are

psychologically engaged and where patients

feel they receive exemplary care and staff

value their opinions.

Our journey has only begun and we look

forward to our continued growth as a unit

and program to better serve and collaborate

with our patients and their families.�

Spotlight on Mental Health

Go to the peer-run, Spotlight on Mental

Health website for mental health news and

resources.

spotlightonmentalhealth.com

Look under Resources and then Newsletters

to find On Our Way Recovery News�


Acute Home Based

Treatment

Providing Treatment

Choices to Patients and

Families

Richard Singleton

Developed in the spring of 2009, the

Acute Home Based Treatment (AHBT)

Team is the first program in our system to

offer individuals and their families a choice

on where they get their acute mental health

treatment. Based on similar programs in

Australia, New Zealand, and the United

Kingdom, the Acute Home Treatment Team

conducts home visits from 9:00am to

9:00pm, 7 days a week, 365 days a year.

These visits place the needs of the individual

and his/her family center stage rather than

the system of care.

The AHBT team has nine nurses and one

clinical counselor who drive around the city

in teams of two conducting home visits.

They are joined on these visits by one of

four psychiatrists who work with the team

and also do home visits. These visits and

any treatment interventions are discussed

and planned so that they fit in with the

person’s and his/her family’s lives. The

clinicians will visit up to three times a day

for the first week followed by a gradual

titration in the visits as the individual

recovers. Normally, this happens over a

three week period.

The reality of receiving acute treatment in

one’s own home can offer a different

perspective and meaning to the experience

of severe mental illness. It can provide for a

reorientation towards individual strengths

and meanings and break the individual’s

expectation that hospital admission is

always necessary. It allows the individual

and his/her family to receive treatment

within their own environment surrounded by

their supports. This allows the individual to

retain some personal autonomy while

minimizing the disruption in his/her life.

When an individual is hospitalized,

particularly for the first time, it can be a

traumatic experience, particularly if a long

emergency visit is followed by a stay in one

of the quiet rooms. AHBT allows

individuals suffering from an acute

psychiatric crisis the option of avoiding

admission or getting out of the hospital

earlier. This is particularly effective with

individuals who are suffering from their first

psychotic break, whose families know

nothing about the mental health and/or

Vancouver’s mental health system, and who

are all upset and searching for

understanding.

The ability for the AHBT clinicians to go

to the family home and sit at the dinner table

with the patient and his/her family,

explaining the illness and medications,

providing education and examples, day after

day until the individual recovers, is both

powerful and normalizing. AHBT clinicians

are guests in the people’s homes, promoting

a good understanding of their lives in which

illness is only one aspect.

After 2 ½ years, the AHBT (formerly CIP)

has partnered with over 400 clients, their

families, and their community supports. The

team recently doubled in size and opened its

doors to referrals from St. Paul’s Hospital.

Moreover, similar programs have been

developed on the North Shore and in

Richmond. �


Supporting Recovery at

Forest Edge Tertiary Unit

Colleen McCain

So much is written about Recovery within

a community context. Our newly formed

Tertiary Mental Health Rehabilitation Team

is charged with the task of exploring how to

integrate recovery-centered practices on an

in-patient unit. Our aim is to support

individuals with a mental illness live more

independent and meaningful lives; lives that

can be continued as they transition into a

community setting. We are embarking on an

opportunity to be thoughtful and deliberate

in ‘how’ we support individuals requiring

complex psychiatric support, medical

management and specialized tertiary

rehabilitation.

Recognizing the monumental task our

team had ahead of us, we focused first on

establishing a foundation for future program

development to occur. Our first six months

focused on establishing supports, routines

and safe, effective care individualized for

each unique person in our program. Building

rapport and relationships with these

individuals and their families, as well as

identifying and building on their strengths as

unique individuals, were also critical first

steps in our program development. In the

following six months we used the rapport

gained to encourage and support these

individuals to be involved in the planning of

their own care and rehabilitation process

through participating in rehabilitation and

recovery review sessions. During these

sessions, individuals identified what they

would like to work on, how staff can assist

them, what they like to see changed, as well

as set goals for the next few months.

We are now ten months into our journey

and like the individuals we support, we

experience periods of frustration with the

pace of system growth and change. Yet

when we change the focus of our lens we

can see a recovery supporting culture

emerging within our program, as well as

shifts in the individuals we are supporting.

The majority of the individuals in our

program participated in the development and

review of their goals. Staff are finding new

ways to develop partnerships with clients to

navigate the different challenges that arise

from a place of respect, transparency and

information sharing. Opportunities to

explore new roles and personal strengths are

offered by our interdisciplinary team

through volunteer roles on the unit, work

experience placements in the community,

sharing in festive celebrations such as

Thanksgiving and Halloween, and even a

weekly dance party on the unit. Other

weekly activities on the unit such as walking

groups, art and baking activities are starting

points to assist clients to link to community

activities such as the Art Studios, dance

classes, community recreation centers, and

vocational programs such as Coast

Clubhouse. A peer-led group “Our Recovery

Journey” is also being well attended and

providing individuals a place to explore

what ‘recovery’ might mean for them.

Our team is in a unique position of

creation; however, over the past few months

we have discovered it has been more of a

blending process. We are blending a mix of

knowledge, experience and passion to create

a united, focused team of health care

professionals. We are using our collective

understanding that the essence of personal

recovery is a personally meaningful life

including connections and a sense of

identity. We are discovering that it is a

personal challenge as well as a professional

challenge to develop a recovery supporting

culture on our inpatient unit. It is humbling

to recognize the impact the program culture

has in supporting or hindering the personal

recovery process.


Our team is engaging in a thoughtful,

reflective process to look at what we as

individuals and as a team contribute to the

program culture on our unit, in addition to

developing the components of a

rehabilitation program. By engaging and

committing to reflective and mindful

practice, we can be more deliberate and

purposeful in how we interact with each

other, function as a team, and ultimately

model recovery values and processes to the

individuals we support. Our aim as a team is

to create a space of healing and safety for

individuals to be able to embark on their

own recovery journey. As such, we, like the

individuals we support, are in the exciting

and daunting process of transformation and

growth as we explore how an in-patient unit

can become a recovery-supporting

environment. �

Speakers Wanted

Are you interested in helping to educate the

public about mental illness?

The BC Schizophrenia Society is looking for

individuals who have received treatment for

psychosis within the mental health system to

volunteer as Partner Presenters and share

your personal story of recovery.

Experience sharing your story is an asset but

some training is also provided.

Must be able to access public transportation

within the Vancouver area and be available

weekdays for 2-4 hours/month (days and

times are flexible).

An honorarium is provided.

For more info please contact the BCSS

Coordinator at 604-726-5997 or

[email protected]

www.bcss.org/partnership �

Recovery Advisory

Committee Winter Update

The purpose of the Vancouver

Community Mental Health Services

(VCMHS) Recovery Advisory Committee is

to support the work of implementing

Recovery Philosophy in the organization.

Over the past few months, the committee

has been exploring a range of issues

including people entering into services,

transitioning away from services, and re-

entering services. These discussions have

been informed by work done elsewhere such

as in the US and also by our very own

Recovery Dialogues. The Dialogues are

events where people living with mental

illness, family members and service

providers get together to talk about topics

related to recovery.

Additionally the committee aims to

regularly hear updates from teams and units

about how recovery is being integrated into

practice. The committee recently heard from

Sharon Marmion, Clinical Planner, Adult

Tertiary Mental Health, about how Recovery

Principles are being utilized in the

development of Vancouver Tertiary Mental

Health Services.

The committee has also been exploring

the possibility of having the "Making Sense

of the Mental Health System Guides"

updated and made available via the public

VCH website.

On Our Way: Recovery News has also

been a subject of discussion. A number of

helpful suggestions have been proposed by

the committee, including providing more

print issues for the teams, adding a

definition of recovery to the front page of

the newsletter and possibly doing shorter

versions in between the more extensive

issues.

Watch for continued updates in this

newsletter to see what the committee is up

to. �


PERSPECTIVES PAGES

A Peer Perspective: How

Recovery is Implemented in

Tertiary Services

Theresa Duggan & Doug Locke

Recovery centered clinical practice is the

key to service provision at UBC’s Forest

Edge Tertiary Program. As Peer Support

Facilitators (PFS), we bring lived experience

of mental illness to our work and strive to

create an environment of hope and

inspiration for our clients through consistent

role modeling. As PSFs, we help support

clients through their own recovery journey,

encouraging them to strive for a quality of

life that makes them happy.

The clients at Forest Edge have their own

way of judging their recovery. When asked

what has helped them, they have identified

work experience and exercise as well as

‘home visits’, ‘family outings’, ‘peaceful

living atmosphere’ and ‘treating myself to

meals’. Clients speak of friends and family,

community outings, walks, teaching yoga,

religion, and medications as having helped

them with their journey. Others talk of the

self-esteem they have developed, or how

having things in common with other people

builds their support network.

The entire team (staff and clients) work

together, consulting and supporting each

other, drawing on each person’s experience,

knowledge and skills. We encourage clients

to believe and show that they can live

beyond their illness.

Rehabilitation plans strive to be strength

based and to meet the clients where they are

in their own recovery. We encourage and

support building independence in as many

areas of life as possible.

Since we opened at the beginning of this

year, all disciplines have worked closely

together to assist the clients to build on their

own strengths and develop skills through

meaningful activities such as: exploring

their community; daily walks; shopping;

learning to access transit; beach days;

golfing; and special events. Groups also

occur at Forest Edge such as the baking

group, the leisure group, the stress reduction

group, or the Your Recovery Journey, a peer

created and lead group. The latter group

allows people to share with others what

recovery means to them, and to learn ways

to take charge of their illness and direct their

own recovery.

As PSFs, we are proud to be a part of this

team. The support and acceptance we get

from the team assists in our own recovery as

well. The Forest Edge team has embraced us

as equal partners and will often seek out our

perspective and feedback during discussions

re: program planning; introduction of rules;

medication side effects; and how to engage

clients.

As PSFs we continue to move forward:

sometimes two steps forward and one step

back - but that is what life is about. We

don’t give up and we keep encouraging our

clients to strive for a different, better life. �

Words of Wisdom

“When I started to believe I could recover, I

started to get better.”

- Anonymous


My Experience of the

Mental Health System and

Recovery

Carmen Daly

I have a 34 year old son who is living at

Forest Edge at the UBC Hospital since the

end of August of this year. Before that my

son lived for over five years at Riverview in

Coquitlam because we could not find a place

or home for him to live in. My son has a

mental illness that is very difficult to treat.

By now he has been in and out of hospital

for 20 years.

When he was living at Riverview the

doctors told me to leave him in the system

and go and live my life and not worry that

the system will take care of him. Also, they

told me not to bring someone for support to

the meetings with me. They said I speak

perfect English and do not need anyone with

me - not even my husband. Also, they said

my son had mental illness because of the

mixed marriage!

Now, at Forest Edge, my son still does

not like it and says his treatment isn’t any

better than at Riverview. But there are signs

of an improvement and hope for the future

finally after all these 20 years of suffering

for the whole family.

Firstly, a specialist in behavioral

psychology and a neuro-psychologist

diagnosed my son with an autism spectrum

disorder. We had tried for years to look into

the developmental disorder, but to no avail.

In other words, he has a dual diagnosis and

that is why it has been so hard to treat his

mental illness.

Secondly, for the very first time, I got a

social worker who is actually doing

something positive for my son in that she

followed the recommendations of the

behavior person and sought assistance from

Community Living BC (CLBC). Now the

social worker has had my son accepted in

the Personal Supports Initiative of CLBC

and we are promised that he will get funding

for a person to work with him one-on-one

for five days a week to help him get

integrated in the community - despite the

problems that his spectrum disorder causes

him. Also, we have personally contracted

this woman who did the spectrum disorder

diagnosis to help us have a better

relationship with our son.

So, finally things are looking up and

there is hope for my son for the future. Now,

if we can only find an appropriate place for

my son to live with all the supports that he

needs, then he can finally start to have a life

that he has been denied up until now.

In closing, I would like to say that those

afflicted by mental illness and

developmental disorders need to be treated

like they have an objective illness.

Treatment needs to be focused on the illness

without any blame being placed on the

relatives.�

Recovery from a Family

Perspective

Dick Doerksen

As families, our greatest hope is that

‘recovery’ will include the availability of a

range of community supportive facilities in

order that our loved ones may reach and

maintain their highest possible level of

recovery with a minimal risk of relapse and

rehospitalization.

The greatest fear is that without a

sufficient number and range of supportive

care facilities, time limitations and bed

pressures, combined with unrealistic

recovery expectations, our loved ones may

be discharged without the discharge plan

supports necessary to prevent relapse,

rehospitalization, or worse yet, end in

tragedy.�


Am I Just Being Paranoid?

M.P. Diane Desjardins

Ever since I was a child, my inner sixth

sense has acted as a keen honing device,

which has come in handy and often kept me

from harm’s way. In retrospect, I have

learned to develop my listening eye and

captured facts, rather than stifle them as the

multitudes do.

In some instances, when something is

about to run amiss, there’s a subtle feeling

that comes over me—“rush to take transit or

you will be late to meet your party”.

Another helpful circumstance, which

especially applies to this city—“even though

the weather forecaster hasn’t predicted any

rain, the feeling brings forth the instinctive

thought to pack an umbrella as a

preventative measure from getting

drenched”. These may seem like minor

details, which require only a brief/ attentive

moment; but the accumulative effect of this

precious sense surely helps to address any

topic before it becomes an unmanageable

dilemma and helps keep stress at bay.

Which brings me to emphasize that in

other prevalent cases, the feeling is

definitely more intense. I have managed to

get myself out of precarious predicaments,

in the past, circumstances that might capture

the attention of those who prefer reading

flights of fancy, comparable to predictable

novels. Although, factual perspectives are

justly penned in personal journals and

transcribed. The truth lives on within the

pages of non-fiction books.

For example, life brings us opportunities

where it would be in our best interest to pay

attention to the suggestions prompted by our

inner voice. I do recollect a time when I

chose to ignore the wise one—awakened by

a night terror. The dream was warning me

that due diligence was required in order

to prevent harmful repercussions from

happening. I was reminded that the gift I

have forever needs to be respected and

honored. For whatever reason, someone had

decided to spread gossip and/or rumors. In

any case, do take into consideration the

source(s) and weigh all the facts before

passing judgment upon anyone. Wouldn’t it

be a blessing to remain unscathed by such

malicious acts? I suppose even some of the

history books have been embellished a

tad...To those who have known such grape

vines, please recall peaceful times. It is

wiser to address any doubts before the

butterfly effect takes flight.

I can only express my own point of view.

I do strongly believe that instead of being

paranoid, I equate it to possessing an

awareness (insightful dreams/feelings) that

have assisted me in making positive

decisions. Everyone possesses some level

of premonition. The guidance, that our

intuition provides us with, may lead the way

to all the answers to the questions we are

seeking. The most popular question seems

to be—what is my life all about? Typically,

avoiding negative circumstances and

preventing certain types of people from

making our world a chaotic roller coaster is

what most of us prefer/want anyway.

Wouldn’t you agree? �

On Our Way: Recovery News Vancouver Acute & Community Mental Health Services

Credits

Renea Mohammed, Editor

Contributing Writers: Carmin Daly, Diane

Desjardins, Isabel Diogo, Dick Doerksen,

Theresa Duggan, Doug Locke, Colleen

McCain & Richard Singleton. �

issue 8 recovery newsletter, winter 2012

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