Transcript The History of the Mental Health

SCDMH
Recovery Training
Special Thanks to the Contributors
of These Slides
Carla Damron
Beth Adams
Katherine Roberts
Vicki Cousins
Doug Cochran
Michele Murff
Training Agenda Today
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The History of the Mental Health Recovery
Movement
… Medical Movement
… Psychosocial Rehabilitation Model
… Recovery Movement
… Consumer Empowerment
… Where we are today
Training Agenda Today
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Recovery from a Consumer’s Perspective
Importance of Hope
Creating Recovery Environments
Emphasis on Consumer Rights
The degree to which I can
participate in creating the life
that I want is directly related to
the degree in which I am truly
aware of my participation in
creating and sustaining the life
that I have.
(Ike Powell, 2002)
If your clients are not taking an
active role in their own recovery,
it is probably because they are
receiving negative messages
about their own abilities and
potential for growth.
(Ike Powell, 2002)
The South Carolina
Department of Mental Health
The
Mental Health
Recovery Movement
South Carolina Lunatic Asylum was
the second to open in nation
1828
People were placed in long
term institutions, separated
from families and loved ones.
More than 30 percent of the
patients died annually, due in
part to poor living conditions
and inadequate supervision.
By the 1900s,
the SC asylum had 1,040 patients
1909 Legislative Study
Findings
 Poor sanitation
 Dilapidated buildings
 Patients living in unclean quarters
 Patients forced to sleep in corridors
Many of the problems at the state
hospital were common to facilities
nationwide.
Through the 1950s,
the Mental Health Service System
was almost exclusively in the
domain of large state-operated,
public mental hospital systems.
In 1955, the national State Mental
Hospital population reached
559,000.
Major Facts Leading to
De-institutionalization
 Inhumane
conditions in state
hospital facilities (restraints,
seclusion, etc.)
 Technological
advances of the late
1950s
Technological Advances
Introduction of phenothiazines
provided symptom management of
seriously disabling psychoses

Increased the number of patients who
could potentially live outside of the
hospital
 Decreased the length of stay within the
hospital
Technological Advances Result
in a Philosophical Shift
New emphasis ...
 On the value of community care
and treatment
 On the need to remove barriers
between hospital and community
 On discontinuing the use of
restraints and seclusion
Community Mental Health Centers
Act of 1963 (PL94-163)
 Provided
funding for outpatient,
inpatient, emergency, consultation
and education, and partial
hospitalization services
 1500 centers were to be funded;
789 were actually funded
Community Mental Health Centers
Act of 1963 (PL94-163)
 Funding
was supplemented by
Medicare (Title VIII) and Medicaid
(Title XIX) insurance
 South Carolina had 14 centers
funded. A total of 17 are now in
place throughout the state.
Major Characteristics
of the Model

Principles of psychotherapy prevail
utilizing an insight-oriented,
developmentally focused, non
directive approach.
 Responsibility for change is placed
on the patient.
 Medication maintenance for
“chronically disabled patients”
Major Characteristics of
the Model

Treatment of the seriously mentally ill
was not the focus of mental health
professionals
 Professional prejudice toward
“the mentally ill”
 The sanctity of the professional’s
office
Emergence of Psychosocial
Rehabilitation Model
In the mid-1940s, ten former patients in a state
mental hospital formed a self-help group in New
York City called “We Are Not Alone” or
“WANA.” Based on the concept of mutual selfhelp their goal was to assist each other and expatients like themselves find jobs, places to live,
friendship -- and to make their paths own way
back to independence and productivity.
This led to the creation of FOUNTAINHOUSE.
Psychosocial Rehabilitation
A holistic approach that addresses
multiple needs of the consumer
 Emphasizes
strengths and wellness
 Services encompass whole life of
consumer
Psychosocial Rehabilitation

Hope, empowerment, and positive
expectations emphasized

Staff/member relationships are
egalitarian and respectful

Skill building and focus on WORK
are stressed
Early Consumer Self-Help
Movement
1970’s: Network Against Psychiatric Assault,
Mental Patients’ Liberation Front was
committed to the premise that mental illness
does not exist.
1990’s: One Our Own, National Mental Health
Consumers Association accepted presence of
mental disorders but wished to change the
consequences of having such disorders.
National and Local Consumer SelfHelp Groups Through the 1990s

Contac - Consumer
Org.& TA Ctr.
 National Consumer
Self-Help
Clearinghouse
 NEC - National
Empowerment Center

SC Share - Self-Help
Association Regarding
Emotions/Recovery
for Life Groups
 MHASC - Mental
Health Association’s
CORE/ SA Schizophrenics
Anonymous groups
Consumer Involvement in Mental
Health Systems in the 1990s
Self-identified consumers employed by
systems as management team members in
Offices of Consumer Affairs/Consumer
Affairs Coordinators/CCET Members
 Planning
 Policy Makers
 Program Evaluators
 Service Providers
The Evolution of the
Recovery Movement
The current movement is a result of
consumer involvement in systems
for over 30 years.
It is based on the belief that
consumers can and do recover
from mental illnesses.
Mental Health
Recovery Movement
“Consumers are beginning to ask for
more than a survival, maintenance,
stay-out-of-the-hospital concept of life.
Consumers are asking for hope - that
life will be of quality, productive, and
based on equality.”
-- Colleen Jaspers, M.A., Consumer Affairs Director,
Michigan Dept. Of Mental Health
What are Consumers
and the Mental Health System
Recovering From?

Illnesses
 Symptoms and Consequences of
Symptoms
 Negative Treatment or Lack of
Treatment
 Institutionalization / Dependence on
the System
 Discrimination (Stigma) and SHAME
What are Consumers
and the Mental Health System
Recovering From?

Labels
 Limited Expectations
 Wounds of the Spirit
 Poverty, Unemployment and
Homelessness

Hopelessness
The absence of negative
messages is more important in
developing a positive self-image
than the presence of positive
messages.
(Ike Powell, 2002)
What you believe about yourself
because you have a diagnosis of
mental illness can often be more
disabling than the illness itself.
(Ike Powell, 2002)
Recovery
From A
Consumer’s Perspective
Dignity and Respect
When I walk in the door I am a person,
not a diagnosis. Diagnoses are useful
to place a set of symptoms I may be
experiencing into a recognizable,
describable category and to determine
possible treatments. Please don’t refer
to me as a bipolar, schizophrenic or
depressive.
Hope
From the minute I walk in through
the door please try to remember
that I am probably angry and
scared. My life is turning upside
down and I don’t understand why.
I’m terrified that once you
formally pronounce me mentally
ill my life will be changed – for
the worse – forever.
Hope
Sensing, seeing, hearing messages
that recovery is not only possible,
by probable, are the threads I need
to hang on. Put up something on
the walls, place messages of hope
in the bathroom by the coke
machine or in the smoking area,
and in your office that says you
will recover from this.
Responsibility
One of the best ways for me to retain
my personal dignity, respect and
hope is for me to be as responsible
as a patient and in my other life
roles as I can be. Don’t let me
abdicate my power to you and
please don’t take it from me.
Responsibility
Teach me skills to help me manage,
cope and excel. Let me know what
your expectations are. Ask me
about mine. Being relegated back
to a childhood role is demoralizing.
It makes me more dependent and
your job harder.
Inclusion
Insist that I participate in my treatment. A
good treatment plan is like a good road
map. I may know where I want to go but
without the map I can’t get there. Give me
a copy of my treatment plan and review it
each time we meet. It gives me and you a
good picture of where we have been, and
where we are going. It may be time
consuming at first but eventually we will
both benefit. I will become more
independent and your job will become
easier, more enjoyable.
Inclusion
Nobody likes not having a voice. My
future is my own, my goals are my
own. Don’t tell me that my dreams are
unreasonable or unattainable. Let me
find that out by trying to reach them.
Success isn’t always measured by
accomplishing a goal. Often the
journey is more important than the end
result.
Step Into My Shoes
Think for a moment what it’s like to be
me. I wasn’t that different from you. I
had a college education and a graduate
degree. I had a job, car, house, friends,
pets and hobbies. Then one day I started
to lose those things. First, my friends –
they couldn’t handle my illness. Next
went the hobbies, them my job, then my
home.
Step into My Shoes
Along the way my self confidence eroded,
my laughter disappeared and despair took
over. My family was told to place me in a
community care home – there was no hope.
A couple of people still believed in me and
with help I began my journey toward
recovery. It took a long time and it has been
the hardest thing I have ever done.
-- Katherine Roberts
If you listen to the
person/patient/consumer long
enough, not only will they tell
you what the diagnosis is but you
will also learn the best way to
deal with the problem.
(Ike Powell, 2002)
Creating Hope through Recovery
Programs and Services
Discussion
A Service Provider’s Perspective
Hope
Anticipation of a continued
good state, an improved state,
or a release from a perceived
entrapment.
Hope
It may or may not be founded on
concrete, real world evidence.
Hope is an anticipation of a future
world which is good.
Judith Miller, Coping with chronic illness:
Overcoming powerlessness, 1992.
Hope Instilling Strategies
Building Relationships
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Rapport

“Find the spark,
light the fire”
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Ongoing
Trust
Valuing the person
Hope Instilling Strategies
Facilitate Success

Assist in setting and reaching goals

Holistic approach: housing,
employment, education, etc.

Link with resources
Hope Instilling Strategies
Connect to others

Importance of role models, peers,
and peer support
 Share the stories of consumers
 Connect through consumer
organizations (NAMI-SC, SC
Share, MHASC)
Consumers as Partners in the
Treatment Process
 Value the person in the treatment
planning process
 Take a holistic approach
 Maximize the therapeutic
relationship
 Maximize extended support
systems
Consumer as Partners
in the Treatment Process
 Respect
cultural differences
 Spirituality
 Combat stigma/social justice issues
 Operate on a strengths model
 Egalitarian relationships
“Growing Edges”
Consumers: I’m not a case - I don’t
want to be managed
 Treatment Planning versus Recovery
Planning
 Consumer input in all aspects of
service agencies (planning, policy,
evaluation)
 Consumers as providers

The mental health
system must be aware
of its tendency to
enable and encourage
consumer dependency.
SC Peer Support
Training Manual
2003
Created by Ike Powell
Ike Powell’s Ten Building Blocks
of Recovery
No one knows more about
my life than I do -- how it
feels, how it is and how I
want it to be.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
I can act
on my own behalf.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
When I realize how much I
have overcome, to get to
where I am, I know that I
am a walking miracle.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
It is not what happens to
me that is important;
it is the meaning that I
give it.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
I can influence my life
by my actions.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
The locus of my power
is my ability to make a
decision and
to act on it.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
I have the ability to be
aware of and manage
my thoughts and
emotions.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
I choose to focus my
energies on what I want
to create, not on what I
want to change.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
I have the freedom to
decide what I do with
my life.
(from the SC Peer Support Training Manuel)
Ike Powell’s Ten Building Blocks
of Recovery
I am responsible for my own
life. I cannot expect anyone
else to make my life the way
I want it to be.
(from the SC Peer Support Training Manuel)
Rights and Recovery

There is a negative health impact when a
person’s rights are violated.

There is a positive health impact when a
person has the freedom to exercise his or
her rights.
Rights in the Past

Consumer treatment
and consumer rights
seen as separate areas

Many times opposed
to each other

Treatment goals
seemed to focus on
restrictions and control

Consumer rights
seemed focused on
civil rights

Consumer treatment
ignored rights

Consumer rights
ignored treatment
Rights in the Present, Future

Emphasize what is in common with consumer
rights and consumer treatment and recovery – not
the differences
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Realize that each supports and requires the
fulfillment of the other
In our own activities and those of our programs
promote and protect the rights of consumers
Understand the Basics
of Consumer Rights.

The legal protections – confidentiality, ADA,
advance directives, fair housing, employment
discrimination, presumption of competency,
abuse, neglect, exploitation

The non-legal protections – consumer choice and
involvement, recovery oriented delivery systems,
positive culture of healing
Know and Use the Resources Available
to Protect Consumer Rights.
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South Carolina
Protection and
Advocacy
Long Term Care
Ombudsman
 SC Share

NAMI-SC
 MHASC


SCDMH Client
Advocacy
Program
SCDMH Offices of
Consumer Affairs/
Consumer Affairs
Coordinators
Practice the Basic Principles
of Consumer Rights.

Dignity
 Autonomy
 Self Determination
 Individual Involvement
Most consumer complaints to the
SCDMH Client Advocacy Office are
generated from the failure to practice
these principles
Address Consumer
Complaints.
Most consumer complaints to the SCDMH
Client Advocacy Office probably could
have or should have been resolved by staff.
Inform and Assist
Consumers in
Understanding and
Exercising
their Rights.
Promote
Self Advocacy.
When someone truly listens to
me, and does not interrupt me
with judgements, criticisms,
stories of their own or even good
advice, I feel better and often
figure out what I needs to do for
myself.
(Ike Powell, 2002)
A Final Quote from
Daniel Tarantola, M.D.
Senior Policy Advisor to the
Director of the World Health
Organization and Associate of
the Francois-Xavier Bagnoud
Center for Health
and Human Rights
“THE ATTAINMENT OF THE
HIGHEST STANDARDS OF
PHYSICAL, MENTAL AND
SOCIAL WELL-BEING
NECESSITATES AND
REINFORCES DIGNITY,
AUTONOMY AND
INDIVIDUAL PROGRESS.”
WORK
AND
RECOVERY
 Consumers
 Are
who say they want
to work:? 70%
currently working? < 15%
 Current
access to Supported
Employment? < 5%
Supported Employment

Mainstream job in community
(integrated employment)
 Pays at least minimum wage
 Job placement based on consumer’s
interest
 Minimal pre-employment assessment
and training
 Willingness to work only requirement
Job Coach
 Assists
in finding job
 Helps consumer learn job
 Provides on-going supports
 Coordinates with mental health
treatment team
Why Work?
 It
helps define us.
 It helps us structure our time.
 It provides an income.
 It connects us with the community
in which we live.
CONSUMER EMPLOYMENT IS
EVERYBODY’S JOB!
Practitioners should begin talking
about work as early as possible in
the recovery of the consumer. This
instills hope and sends the message
that the person can, in time, reach
their goals.
Recovery
in the
Community

Consumer Living in the
Community NOW
Isolated/segregated/lacking mobility
 Limited in choices of leisure activities
 Shunned and feared
 Considered a burden with nothing
to offer
 Considered different and feels
conspicuous
Consumer Living in the
RECOVERING Community
of Our Future
 Is
a part of/integrated into the
larger community
 Is an educator
 Has important roles that have
nothing to do
with mental illness
Consumer Living in the
RECOVERING Community
of Our Future
 Using gifts and talents to
contribute to the community
 Lives next door
 Is an usher at church
 Is active in neighborhood
associations and local politics
What Needs to Occur
for Consumers
to Begin Living in a
RECOVERING
Community?
Elevate Community
Consciousness
through Consumer
Involvement.
Educate the Community.

Churches/religious
organizations
 Civic organizations
 Parks and
recreation staff
 Public library staff
 Schools/universities

Local/government
 Industry
 Other service
providers (DSS,
DHEC, homeless
services, food
banks, primary care
providers,
pharmacists)
Live as a
Healthy Individual
in the Community
by Practicing
Recovery Skills.
Living in a RECOVERING Community
Housing that’s conducive to recovery

Affordable (30% of income)
 Quality construction
 Safe neighborhoods
 Array of options (Rental, Owner-Occupied,
Shared, Services on site)
 Integrated in the community
Education=Empowerment

Accessing mainstream housing services

Understanding Fair Housing Laws

Being active in neighborhood
associations/local politics
SCDMH
Recovery Training
Thank you for coming today!