Transcript Schizophrenia, Psych Rehab, and Recovery: What School

For the Union County School Nurses Association
Tom Pyle, January 29, 2015
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Personal tragedy...
Family calamity...
An opportunity?...
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Positive symptoms
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Negative symptoms
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Cognitive symptoms
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Vincent van Gogh, Starry Night, 1889
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Marcel Duchamp, Nude Descending a Staircase, 1912
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Edward Munch, The Scream, 1895
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https://www.youtube.com/watch?v=yL9UJVtgPZY
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Insufficient meds
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Abrupt Treatment
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Overzealous police
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State Hospitalization
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Adverse publicity
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Differing diagnoses
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Foiled interventions
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Exposure to violence
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Botched discharges
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HIPAA barriers
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Genetic
Neurochemical
 Neurotransmitters? (Dopamine, glutamate, 100+ others…)
 Neuropeptides (Endorphines…)
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Developmental
Infectious
Nutritional
Endocrinal
Stress
Trauma
E. Fuller Torrey, M.D.
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What is Psychiatric Rehabilitation?
Psychiatric Rehabilitation...
helps those with psychiatric disabilities...
get emotional, social and intellectual skills and supports...
to live, love, learn and work...
as and where and how they wish...
as independently of professional supports as possible...
thus to engage, pursue and achieve recovery...
as they determine it for themselves.
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Who Provides PsyR?
Psychiatrists
Peer Providers
Psychologists
Consumer
Direct Care
Nurses
Social Workers
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Where is PsyR?
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Programs
Residences
Service support
PACT (Programs of Assertive Community Treatment)
Workplaces
Schools
Hospitals
Families
Self-help Centers
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PsyR Evidence-Based Practices
(Pratt, Gill, Barrett, & Roberts, 2007)
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Illness Management and Recovery
Integrated Dual Disorder Treatment
Assertive Community Treatment
Family Psychoeducation
Supported Employment
Supported Education
Supported Housing
Other “promising” practices
Psychiatric Rehabilitation  Recovery
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PsyR “Jersey Strong” Expertise
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Family Education
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(Lefley, 2009, p. 41)
Premise: diathesis-stress model
Medications
Compliance
Expectancy of change
Stress identification and control
Family issues
Loved one issues
Joint planning
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Joyce Burland, Ph.D.
Family Psychoeducation
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(Lucksted et al., 2012)
Individual family
Multifamily
Include consumer
Don’t include consumer
Length
Emphasis
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William McFarlane, M.D.
Family Consultation
(Schmidt & Monaghan, 2012)
Intensive Family Support Services
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The National Organization
Since 1975
Formerly IASPRS
Formerly USPRA
8000 members
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The State Organization
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1000 members
30 org members
Leading state chapter
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Annual conference
Various trainings
Advocacy work
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Components
Issues:
• “The System”
• Medicaid’s 3 Big Changes
• Family Needs; Provider’s Role
• Violence
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Medical
Recovery Process: 3 Components
Medical
Psychiatric Rehabilitation
Individual Empowerment
time
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Recovery: Empowerment Component
Psychotherapy
Peer Groups & Services
Individual Empowerment
time
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Recovery: Medical Component
Medical
Hospitals
Doctors
Medical
Psychiatric Rehabilitation
Meds
Individual Empowerment
time
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Recovery: Rehabilitation Component
Illness Management & Recovery
Medical
Supported Housing
Supported Education
Medical
Psychiatric Rehabilitation
Supported Employment
Assertive Community Treatment
Family Psychoeducation
Individual Empowerment
time
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The Whole Recovery System
Illness Management & Recovery
Supported Housing
Medical
Hospitals
Supported Education
Doctors
Medical
Meds
Psychiatric Rehabilitation
Supported Employment
Assertive Community Treatment
Family Psychoeducation
Psychotherapy
Peer Groups & Services
Individual Empowerment
time
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The Common Misperception
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1.
Reform
 “Innovations”
▪ Accountable Care Orgs (ACOs)
 “Benchmark” plans
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Expansion
 25% increase
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Managed care
 Behavioral Health  Admin Service Org (ASO)
 Grant  Fee For Service  Case Capitated
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…bringing the biggest change in Medicaid since it began.
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Getting it all together
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~ 60 mm
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