Transcript Title of Presentation - American Psychological Association

Recovery from Serious Mental Illness:
Conceptual Overview
Mary A. Jansen, Ph.D.
BayviewBehavioral Consulting, Inc.
Vancouver, BC
1. Recovery
2. Rehabilitation
3. Barriers and Challenges
4. Psychology’s Expertise
5. What We Need To Do To Bring About Change
Recovery
Recovery is based on the novel idea that individuals with
serious mental illness can recover and live productive lives
in the community – just like anyone with an illness that may
flare up from time to time
Client’s process of regaining functional capability
Rehabilitation
Consists of the supports and interventions provided
The primary focus of rehabilitation is on improving the
capabilities and competencies of persons with serious
mental health disorders
Hope
Essential catalyst
Person Driven
Consumer leads; empowered
Many Paths
Based on person’s experiences
Highly Personal
Dependent on person’s own goals;
individualized
Non-Linear
Continual growth; ups and downs
Holistic
Encompasses entire life
Support
Supported by peers & allies
Relationships & Social Networks
Belief in person’s capability for
recovery
Based in Person’s Culture
Key aspect
Addresses Trauma
Often a pre-cursor
Individual, Family & Community
Responsibility
Foundation for recovery
Respect
Acceptance
Mental Health Recovery:
Recovery is what people with illnesses and disabilities do
Treatment, case management, support and rehabilitation
are the things that helpers do to facilitate recovery (Anthony, 2002)
A journey of healing and transformation enabling a person
with a mental health problem to live a meaningful life in a
community of his or her choice while striving to achieve his
or her full potential (SAMSHA, National Consensus Statement on Mental Health Recovery, 2006)
A process of change through which individuals improve their
health and wellness, live a self-directed life, and strive to
reach their full potential (SAMHSA, Definition of Recovery, 2012).
Recovery from mental illness involves:
Challenging and overcoming the stigma that persons with SMI
have incorporated into their very being
Recovering from the iatrogenic effects of treatment settings
Recovering from lack of opportunities for self determination
“Nothing about us, without us”
Recovering from the negative side effects of unemployment
Recovering from crushed dreams
Recovery is often a complex, time-consuming process – just
as it is with any serious illness
“The mental patient lens is the one many of those with mental
illnesses have learned to look through every time we are
uncomfortable, have intense feelings or experiences, or
difficult relationships.”
“It is a lens that reminds us that our feelings and thoughts are
different than other peoples’ and that we must take care. We
must avoid stress, risk-taking, and challenges, assume others
know better than we do, and that there is a medication for
everything.”
Mary Ellen Copeland, 2004, NASMHPD National Consensus Conference, Report on Recovery
Getting the label out of the person:
“Not too many years ago, I was Mary Ellen Copeland, manic
depressive. Because I had this label, my family was told not to
expect much of me. I learned not to expect much of myself. I
became dependent on the mental health system to maintain, at
best, a minimal life style. I saw myself through a mental health
system lens that was confining and oppressive. Now I see
myself through a different lens, a lens that is Mary Ellen
Copeland, educator, author, mother, wife, woman.”
Mary Ellen Copeland, 2004, NASMHPD National Consensus Conference, Report on
Recovery
Those working to recover struggle to realize that being
uncomfortable and having difficult feelings is something they
can deal with. These feelings and thoughts don’t have to be
symptoms of anything. One’s strengths and resources can be
used to get through difficult times.
This is the process of changing from mental patient to person,
from patient with symptoms, to person with thoughts, feelings,
and experiences.
Normalization
Principle that those with any disability or impairment should
be treated with respect, provided functional supports, and
treated as normal human beings. Wolf Wolfensberger, 1972, The principle
of Normalization in Human Services, Toronto, National Institute on Mental Retardation
But when will those with mental illnesses become people
instead of their label?
When will it be commonly accepted that people, who from
time to time, have troubling feelings, thoughts, behaviors,
and experiences (does this include you and me??), can also
have control over their own lives, do the things they want to
do, and be the way they want to be?
Medical Model
Illness/problem focused
Past traumas/failures
Doing for the individual
provider/team recommends
Long-term dependence
Office, clinic & community
based
Recovery Approach
Strength based
Success oriented
Doing with the individual
Integrated team/partnership
Graduated independence
Community based
Present/future focused
People with SMI Want
Meaningful relationships
A safe place to live
Satisfying activities
Adequate income
Job satisfaction
An enjoyable social life
What do you want?
Focus
The primary focus of rehabilitation is on improving the
capabilities and competencies of persons with serious
mental health disorders
How
By using evidence based practices and other empirically
supported clinical interventions
Within a recovery oriented framework
i.e., one which is driven by the client and one which
operates from a belief that recovery is possible
Research has determined that certain interventions
are rehabilitative for persons with serious mental
illness, i.e., they foster gaining or regaining of
functional capabilities*
When delivered as designed and researched – with fidelity
These interventions are now the gold standard for helping
individuals with serious mental illnesses regain their
maximum functional capability
*The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary
Statements
Barriers
Low expectations of what is achievable by consumers,
clinicians, and families
Lack of knowledge about what symptoms are due to illness
and what are due to client’s and society’s reaction to that
illness
Lack of will to provide proven interventions to bring about
optimal recovery
Lack of resources to provide proven interventions to bring
about optimal recovery
Fear of changing the status quo
Challenges:
A difficult challenge is to change the attitude of existing
staff and those being trained in traditional professional
training programs in order to:
Let everyone know that that people with SMI can, and do
recover and lead satisfying lives
Eliminate the stigma that many professionals have even
today;
Change the service delivery system from one which delivers
medication and psychotherapy to one which focuses on
rehabilitation and the potential of each person to recover to
the greatest extent possible
More than any other discipline, psychologists have the
expertise to change the mental health service delivery
system:
Research expertise
Clinical expertise
Team leadership expertise
Policy and administrative experience and know-how
Training expertise and programs
We have an ethical mandate to promote and use the most
efficacious interventions – those that have been proven to
make a difference in the lives of those we work with
Limitations Psychology Faces
There are not enough psychologists trained in
recovery/rehabilitation assessments, interventions, and
systems change
Very few doctoral training programs teach or emphasize
the concept of recovery, and the methods of psychosocial
rehabilitation
Most psychologists are still trained in the traditional
methods that their mentors were trained in, i.e., a
pathology and deficits approach
New models train psychologists in how to help people
improve their functional skills using a strengths approach
What We Need To Do
Training programs that offer coursework, practica,
internships, and post doctoral fellowships in these new
models and methods are needed
Develop, advocate for, overcome resistance to, and
implement: recognized specialty programs in SMI in APA
accredited doctoral and post doctoral programs
De-stigmatize working with people with SMI, even those
who are most seriously ill
Recognize and reward psychologists who work with people
with SMI
Encourage APA, State Psychological Associations, and
relevant APA Divisions to advocate for those who are most
vulnerable in society
What We Need To Do, cont’d
Use the provisions of the Affordable Care Act – Below Are All
Available in the Act:
Demonstration projects
To conduct research in less well-resourced environments on:
effectiveness of already identified EBPs
efficacy of promising practices
Demonstration projects
To provide coordinated and integrated services to adults with
mental illnesses who have co-occurring primary care
conditions or chronic medical diseases
Develop patient-centered treatment models, e.g., “medical
home” and others
Funding for training of psychologists in mental and behavioral
health to work with vulnerable populations, including those with
severe mental health disorders
People with SMI DO recover and lead satisfying lives
Our job is to support them and offer the best interventions
that science has to offer
Stigma, trauma, and iatrogenic effects of treatment itself are
some of the worst aspects of the illness
Psychology training is behind the times: Accredited doctoral
programs do not provide training in the new concepts and
methods
Just released:
APA Curriculum to train psychologists in Recovery and Psychosocial
Rehabilitation
Available from www.apa.org/pi/rtp
Instruction Module
1. Introduction to Recovery
2. Recovery, Health Reform and Psychology
3. Assessment
4. Partnership and Engagement
5. Person Centered Planning
6. Health Disparities
7. Interventions I
8. Interventions II
9. Interventions III
10. Forensic and Related Issues I
11. Forensic and Related Issues II
12. Community Inclusion
13. Peer Delivered Services
14. Systems Transformation
15. Scientific Foundations
AMERICAN
PSYCHOLOGICAL
ASSOCIATION
Citation for this Module:
American Psychological Association & Jansen, M. A. (2014). Introduction to
Recovery Based Psychological Practice. Reframing Psychology for the
Emerging Health Care Environment: Recovery Curriculum for People with
Serious Mental Illnesses and Behavioral Health Disorders. Washington, DC:
American Psychological Association.
www.apa.org/pi/rtp
Citation for the full Curriculum:
American Psychological Association & Jansen, M. A. (2014). Reframing
Psychology for the Emerging Health Care Environment: Recovery Curriculum
for People with Serious Mental Illnesses and Behavioral Health Disorders.
Washington, DC: American Psychological Association.
[email protected]
AMERICAN
PSYCHOLOGICAL
ASSOCIATION
Mary A. Jansen, Ph.D.
Bayview Behavioral Consulting, Inc.
Vancouver, BC
[email protected]