National Practice Standards for Peer Recovery Supporters

National Practice Standards for Peer Recovery Supporters: Comments Welcome

A draft of the National Practice Standards for Peer Recovery Supporters is open for public comment until June 24, 2013. When finalized, the National Practice Standards will be used to set policy and shape the future of peer support services. If you have already commented on the draft, thank you for your input. Please be sure to share this opportunity with others. Every voice matters! The deadline for comments is June 24, 2013. To access the draft, visit http://na4ps.wordpress.com/national-standards. Reposted at http://www.darkestcloset.blogspot.com,

Insight

 by Gina Duncan, M.D.

As defined within the context of psychiatry, insight is the ability to recognize that one has a mental illness or is experiencing symptoms of mental illness.¹

Working with someone who appears to lack insight into having a mental illness—a person who denies or refuses to acknowledge the condition—is often among the most difficult issues facing mental health care providers and loved ones. When speaking in the community, one of the most frequent questions I receive is how to help a loved one realize he or she could benefit from treatment. The challenge may seem daunting, but it remains incumbent on us as providers to cultivate insight by reaching out to people who are suffering and disengaged from care.

A pertinent question, however, is insight into what?

A deficit-oriented approach would focus on a person's recognition and acceptance of a diagnostic label such as schizophrenia; acceptance of the fact that he or she has an illness; and acceptance of the limitations this illness might impose, i.e., accepting there will be things he or she cannot have, do, or achieve as a result. A recovery-oriented approach seeks to foster insight into the possibilities as well as the challenges associated with mental illness.

Not having reliable research data or a crystal ball to predict the long-term outcome of a person's illness (there is tremendous heterogeneity of outcomes for these disorders), it is best to stay away from definitive pronouncements about what a person will or won't be able to have or do in the future. When trying to help someone accept the reality of having a mental illness, suggestions for how to approach the situation and person are included below.

Start with the individual's understanding of the situation. This does not mean the practitioner should ignore or downplay the illness, but recognize that trying to force someone to identify with a diagnostic label he or she rejects is likely to be unproductive and lead to an impasse. This is especially true in the case of diagnostic labels that have been stigmatized by society for centuries, some that are associated with discrimination and suggest to people they have lost their minds or are dangerous. A very common and understandable response to being told one has an illness called "schizophrenia," for example, is for the person to protest that he or she is not a serial killer or doesn't have a "split personality."

Rather than fighting such a lose–lose battle, find out what is meaningful for the person and connect with the goals he or she wants to achieve. What dictates a meaningful life is subjective and unique to each individual, whether the person has a mental illness or not. If we are to help promote significant growth in another person, we must be cognizant of and sensitive to this. What are the individual's unique life goals? What would he or she want life to look like if all current challenges could be magically erased?

Without judgment, positively affirm any goals the person has that would be constructive to pursue. Your own opinion of how realistic the goal is (for example, getting a Ph.D. if the person has yet to complete high school) is not nearly as important as the fact that this individual has a goal he or she is willing to work toward. This offers the two of you a basis for discussing what would help the person progress toward the goal (e.g., a first step might be getting a GED).

Avoid diagnostic labels or terms. Instead, describe elements of the individual's life (over which he or she has some control) that conflict with his or her expressed life goals. Then elicit the person's observations and sense of whether these things are perceived as personally problematic. For example, "You said your goal is to have a job so you can leave the group home and support yourself independently, but as I see it, staying in bed all day and drinking are actively working against that goal. What do you think?"

Find the person's "buy-in." What aspects or byproducts of the illness can you both agree are problematic? Even if the person rejects the diagnosis, he or she may still be able to agree that a painful byproduct of the current situation has been fractured family relationships or job loss. Once these issues are identified as problematic, the two of you can begin to explore ways to improve them.

Inspire hopefulness by highlighting past successes and available strengths and resources. Rather than focusing on limitations, help the person develop insight into what it will take to achieve a specific goal, using past successes as examples. Specifically noting how treatment can aid in this process could also be helpful. If the goal is to have a job, you might point out that when the person took medication in the past, he or she was able to get adequate sleep and had the energy to work and concentrate.

Engage in a discussion about what needs to happen for the person to reach his or her goals. For some people, this might take a long time and the process may stall after you state your concerns. However, do not let this deter you from returning to the discussion on future occasions. You never know when a turning point might present itself. For the person who is ready to engage in this discussion, focus on hopeful and realistic steps. In the above example of an individual with no high school diploma interested in pursuing a doctorate, this means finding resources to connect the person with a GED course.

Be mindful that what concerns you in terms of a person's experience of symptoms may not be significantly concerning to him or her, and accept that what is meaningful to you may not be meaningful to someone else. For example, if the individual's voices have a special spiritual meaning, he or she may not agree the voices are hallucinations that should be treated with medication. Similarly, someone who feels artistic creativity is dampened by medication may choose not to take it. For that person, the ability to creatively express him or herself may be more important than not hearing voices, holding a job, or experiencing other side effects.

As providers, we all too often focus on the complete eradication of symptoms, to the point of excluding other elements of well-being. But it is critical to remember recovery can occur in the illness, not just from the illness—something both the person and the practitioner should know.

Do we seek to foster insight into limitations or possibilities? Regardless of a person's level of impairment, we can strive to offer insight into the possibilities of a meaningful life.

Gina Duncan is Assistant Professor in the Department of Psychiatry and Health Behavior at Georgia Health Sciences University.

Reference
Charmaine C. Williams and April Collins. 2002. Factors Associated with Insight Among Outpatients with Serious Mental Illness. Psychiatric Services, 53, 96–98. Retrieved 2012 from http://ps.psychiatryonline.org/article.aspx?articleid=86973.

Posted at Recovery to Practice Newsletter. Reposted at http:/www.darkestcloset.blogspot.com

How to Live Successfully When You Hear Voices

by Karen Taylor

Working to Recovery (WTR) has always specialized in working with people who hear voices. In this article, Karen Taylor, who has a background in psychiatric nursing, describes the organization’s approach to working with people who hear voices and how WTR helps people recover their lives and live with their voices.

Can you hear voices and be healthy? Can people who hear overwhelming and distressing voices be helped to find ways to live successfully with their voices? Over the past 20 years, research and practice originating in Europe and developed in partnership with voice hearers indicate that this is indeed the case.

This empowering approach to assisting people—both adults and children—who hear voices and are distressed by them starts from the premise that voices are related to real feelings and emotions that need to be investigated and understood. Therefore, voices need to be accepted as a part of oneself rather than eradicated. This perspective has made a significant impact on the way voice hearers and mental health services regard the voice experience, leading to the development of a vigorous peer support network and important changes in the practice and treatments offered by service providers.

A measure of the success of this approach is that there are now networks and activity in more than 23 countries around the world, with an emergent network being established in the United States.

Need to promote recovery. WTR was born out of the need to promote recovery. Established in 2002 by Ron Coleman and myself, the Scotland-based WTR offers training and consulting services around the world to many different kinds of agencies and organizations specializing in mental health practice.

Ron, who survived the psychiatric system for more than 10 years, started his recovery journey when he became a member of a hearing-voices group in Manchester, England, in the early 1990s. After listening to other voice hearers in the group for a year without saying anything at all, he started to speak up. He began by sharing his own experiences, and as an expert (by experience), soon developed a deep understanding of the issues facing people who hear voices. As Ron says of this period in his life:

“At my very first hearing-voices group, a fellow voice hearer asked me if I heard voices. When I replied that I did, she told me that they were real. This does not sound like much, but that one sentence has been a compass for me, showing me the direction I needed to travel and underpinning my belief in the recovery process.”

People around him realized the massive potential he had as a public speaker and innovative thinker on mental health and recovery. Over the next few years, Ron developed and ran training days and spoke at meetings and conferences on the subject of hearing voices, evidencing the possibility and hope of recovery.

Talking with patients, negotiating with voices. Then he started to write. With Mike Smith, a psychiatric nurse he’d befriended, Ron wrote a workbook for voice hearers, Working With Voices. This book has been the foundation of many of WTR’s subsequent training programs and is based on how Ron gained control of his voices. To enable voice hearers to understand their voices better in a systematic way, the workbook asks the voice hearer to consider the ways in which life events and voices can be connected, describes a variety of long-term coping mechanisms, and offers a range of ways that can help the person hearing voices cope better with the experience. The objective of the workbook is to help voice hearers respond to the challenges the voices throw up in a resilient and positive way and ultimately to gain ascendancy over them.

Our best-known workshop is a 1-day event, also called “Working With Voices.” This workshop helps workers understand voices better and develop their confidence, so as not to be afraid of talking with their clients about them. As a psychiatric nurse, I know how important and liberating this is. When I started nursing, it was common practice to be taught to not engage in conversation

with a consumer about his or her voices, as this would be colluding with the consumer in a false belief or delusion and could be harmful. I have yet to see any evidence for this claim; in fact, the research shows the opposite: the simple process of talking to people about their voices reduces anxiety and even lessens hospital stays.

Ron and I have also developed a 2-day workshop for voice hearers and workers, where we bring workers and voice hearers together to work, in pairs, through the Working With Voices workbook. We then bring the larger group together to discuss their findings. As part of the training, Ron runs a hearing-voices group with the voice hearers who are in attendance, to assist workers in better understanding the process. What I find astonishing, no matter where in the world we run this workshop, is the number of workers who will confess that they have learned more about their partner voice hearer during those 2 days than in the previous years of working with them. I believe this is because, unfortunately, we learn to not ask the right questions, learn to take a life history with no interest in the “life story,” and forget the person behind the diagnosis.

Our latest workshop on hearing voices concerns a technique called “voice dialoguing,” which involves voice hearers talking back to their voices and negotiating with them. This is something some voice hearers have always done. We teach workers how to talk to the voices heard by the voice hearer with the objective of finding out more information about the characteristics of the voices, negotiating with the voices themselves, and showing the voice hearer how to do this if he or she has not engaged with these voices before. This may seem bizarre, but it works and has been proven to help the voice hearer gain control of his or her voices.

Significant progress. In our work with voice hearers, we have found that the most common reason a person hears voices is that the hearer experienced sexual, emotional, or physical abuse as a child. In many cases, one of the dominant and controlling voices is that of the abuser. Sometimes, another of the voices is that of the abused child. The recovery work in these cases concentrates on restoring the person’s “emotional innocence,” as many of the voice hearers carry considerable and overwhelming shame and guilt about their experiences, which is not theirs to carry. Once this takes place, there is often significant progress in their journey toward full recovery.

I feel honored to have carried out this work over the past 13 years. I have met many wonderful, talented people who had all but given up on life but, through the influence and support of Ron and other recovered voice hearers, have started to make the journey toward recovery for themselves. I can honestly say that setting up WTR has been the best thing that Ron and I have ever done, and I look forward to many more years of sending our message out to the world.

Ron Coleman and WTR associate Paul Baker will be visiting the United States to conduct a 2-week lecture and training tour in October 2011. They hope that sharing their experiences and knowledge with interested groups and individuals will help stimulate the further development of work with people who hear voices in North America. For more information about this tour, contact Karen Taylor at karen@workingtorecovery.co.uk.
Posted in Recovery to Practice Newsletter. Reposted at darkestcloset.blogspot.com

National Association of Peer Specialists

By Steve Harrington, J.D., Executive Director

Peer specialists1 are persons with a lived history of mental illness and recovery journey who help others on their recovery journeys. Because the peer specialist profession is a relatively new phenomenon in mental health services, it is often unknown or misunderstood by other mental health professionals, medical health professionals, and the general public. Confusion and misunderstandings also exist with regard to the roles peer specialists can or should play in mental health services. Although peer support can be traced to the beginning of humanity, it emerged as a powerful force in mental health in the early 1980s. At this time, mental health institutions were closing across the United States in favor of community-based treatment, where persons with psychiatric conditions could live and obtain support in the communities in which they lived. Peer support outcomes, the popularity of Alcoholics Anonymous, and the reality of recovery from serious and persistent mental health problems combined to create an atmosphere ripe for the creation of a peer support movement in mental health. Change agents. Peer providers are now commonplace in some mental health systems. Factors driving this trend included The growing recognition of the reality of recovery from even severe and persistent psychiatric conditions A political climate that expected cost-effectiveness for public funds Positive outcomes associated with peer support A ready labor force The establishment of formal peer training and certification of peer specialists In 2001, Georgia became the first State to obtain Medicaid reimbursement for peer support services (Salzer, Schwenk, & Brusilovskiy, 2010). Since then, 13 other States have followed. In addition to providing direct services to their peers, peer specialists were providing services in a variety of ways (one-on-one support, facilitating support groups, community resource connecting, education, and more)—they were acting as change agents. As employees of mental health providers, peer specialists found themselves in positions to influence organizational policies and practices to enhance service effectiveness (Fukul, Davidson, et al., 2010). In 2004, the National Association of Peer Specialists (NAPS) was formed to promote the use of peer support in mental health settings. NAPS soon became involved in advising policy makers about peer workforce issues. The organization quickly grew from a handful of dedicated peer specialists to more than 1,000 members representing every State, as well as Australia, the United Kingdom, Japan, Guam, Canada, and several other countries. NAPS acts as a peer support information clearinghouse and frequently responds to inquiries from throughout the United States. Need for national guidelines, certifications. Our Situational Analysis research has found that the number of States creating peer specialist initiatives has grown dramatically in the past 5 years. The number of States with employed peer specialists is somewhat greater than the number receiving Medicaid reimbursement (an estimate of 25 is not unreasonable), but the exact number is often difficult to determine, as programs are sometimes small and/or isolated. At least two States, North Carolina and Texas, are working toward Medicaid reimbursement for peer support and have made much progress in that regard. One of the main findings we have come across is the lack of national guidelines or certification for the profession. Each State with a formal peer specialist program exercises control over that program as it relates to certification, training, professional discipline, and other operational issues. Until recently, training was generally offered as 1-week courses to satisfy State certification requirements. A common feature among virtually all training programs is heavy reliance on peers as advisors in basic curriculum development and as instructors. Training courses do appear to be increasing in length and the topics covered, but findings have indicated a great desire among peer specialists for greater emphasis or education on cultural competency, the role of trauma in mental health, and ethics issues. Meanwhile, certification requirements vary across the States. Some States only require training, while others require training, work experience, successful completion of a comprehensive exam, character references, reference from a psychiatrist, an interview, and background investigations. Despite efforts to foster training and certification reciprocity between States, those efforts have generally resulted in rejections to “outside” assistance or suggestions. Although Kansas, Missouri, and Georgia permit a measure of reciprocity, most States do not and, at this time, appear unwilling to consider doing so. The number of States with formal certification programs is, at least, growing. In August 2007, the Centers for Medicare and Medicaid Services (CMS) issued guidelines to States wishing to use Medicaid funding for peer support services (Smith, 2007). The guidelines addressed supervision, care coordination, and training and certification. But with the issuing of these guidelines and overall growth in the peer specialist workforce, the demand for continuing education opportunities has grown as well. While many States have spent considerable time and effort to develop the basic certification procedure and requirements, many have yet to reach beyond that to develop continuing education programs. Role of peer specialists. Another finding in our assessment is just how diverse the peer specialist workforce is. This can prove both a challenge and a reward for our field as a whole. Each peer specialist brings a unique skill set to the mental health workplace. And because the profession is relatively new, there is often great flexibility in how and where those skills are used. Peer specialists work in such settings as general hospital emergency rooms, psychiatric hospitals, jails and prisons, and nursing homes. They also work as educators in communities, drop-in centers, clubhouses, and vocational placement agencies. The diversity of peer specialists is reflected by more than work setting. Tasks are also variable and include—but are not limited to—individual support, facilitating support groups, educating a variety of individuals and groups about recovery and the true nature of mental illnesses, helping people make the transition from hospital to community, housing and educational support, engagement, wellness coaching, resource connecting, advocacy, supervision, administration, teaching of formal recovery courses, and transportation.2 In recent years, the Department of Veterans Affairs (VA) has made great strides in the training, certification, and hiring of peer specialists for its healthcare facilities. In some ways, the VA’s efforts have encouraged States that once considered peer support meaningless or marginally meaningful to reconsider their positions and, ultimately, create peer specialist programs. Today, the VA has a significant peer workforce that is well-trained and professional and contributes a wealth of positive outcomes (Salzer, 2011; Salzer, Schwenk, & Brusilovskiy, 2010). Lack of understanding. That said, there appears to be a great number of mental health provider agencies that misunderstand the valuable roles peer specialists can play. Reports from the field reveal that some peer specialists are relegated to roles in which they are unable to use their recovery experiences and knowledge for the benefit of those they serve (or should be serving). There are reports that some peer specialists are providing parking lot security, medication monitoring, office support, or other duties that do not present meaningful peer-to-peer contact. This may be because peer specialists are often supervised by non-peers who have no specific training on how to supervise peers in the workforce. In addition, peer specialists may work in an environment where coworkers lack knowledge of the recovery paradigm or feel confused or threatened by the presence of people openly in recovery in the workplace. Failure to understand the important roles peer specialists can play is detrimental to peer specialists, coworkers, persons served, and mental health systems as a whole (Townsend & Griffin, 2006). Lack of understanding often leads to workplace conflicts. And, despite the well-proven abilities of peer specialists to create positive outcomes in these many settings (Salzer, 2011; Salzer, Schwenk, & Brusilovskiy, 2010; SAMHSA, 2009; Davidson, Chinman, Kloos, et al., 1999), the profession remains underpaid. In describing our target audience for the NAPS Situational Analysis, we found that working peer specialists often live in poverty—despite being employed. Workers often feel disrespected and operate without a meaningful career ladder, even though they have a high motivation to work and succeed at employment, and to help others on their recovery journeys. Next steps for future. Based on historical information, however, it seems a certainty that the peer specialist profession will enjoy considerable (and likely rapid) growth in the next decade. One recent study has shown that peer support can reduce rehospitalization by as much as 72 percent (OptumHealth, 2011). It is also clear the need for continuing education will grow as a component of State-sanctioned peer specialist programs, in line with the profession’s growth, maturity, and CMS guidelines. It is in this environment that NAPS will develop, and ultimately implement, training on recovery-oriented practices in our field. Our vision is a peer specialist workforce proficient in all aspects of recovery—and an environment in which others in the mental health field understand not only the value of recovery-oriented practice but the value peer specialists bring to recovery-oriented practice. Work toward this vision will involve, first of all, educating the peer workforce to increase recovery knowledge and increasing recovery knowledge and practices in the long term. NAPS aims to develop a recovery-oriented curriculum that is as participatory and experiential as possible. Among other topics, the curriculum will address cultural competency, trauma-informed practices, and ethics and boundaries. As a field, we should also work to create professional peer specialist standards that can be applied nationally. Continuing education is also important—not only formal continuing education, but also access to the many useful recovery resources that already exist. Too many of these resources remain unknown or inaccessible to peer specialists. NAPS hopes to forge collaborative relationships with organizations across the country to encourage access to depositories of evaluated and organized recovery materials. We also suggest collaborating with other mental health professions to foster recovery knowledge and acceptance of recovery practices and policies. Peer specialists often observe practices and are subject to policies that inhibit their ability to move service providers toward a recovery orientation. Without a peer specialist workforce comfortable with expressing opinions and suggestions, and coworkers and supervisors willing to listen and consider them, the recovery paradigm is inhibited. Ensuring acceptance of recovery-oriented practices will mean working closely with the other disciplines on developing and implementing these practices and, where needed, helping to educate those who work alongside peer specialists on the key aspects of recovery. One basic first step we can take in marketing recovery knowledge is to develop a fact sheet that describes why, how, where, and when peer specialists perform their work. One Indiana State mental health official has already noted our distribution of the Situational Analysis will help him promote the hiring of peer specialists in that State (B. VanDusen, personal communications, Feb. 8, 2011). With hard work, we will achieve a future in which peer specialists, as well as recovery practices as a whole, will be widely respected and adopted. Footnotes: 1Peer specialists may also be referred to as: peer support specialists, peer support technicians, consumer advocates, peer recovery support specialists, recovery specialists, and a myriad of other titles. 2This list is far from exhaustive. Transportation is included here, but it is sometimes debated whether it is a “true” or “valid” peer support task. Transportation of peers can, however, present meaningful opportunities for discussion and relationship-building that supports a individual’s recovery. References: Daniels, A., Grant, E., Filson, B., Powell, I., Fricks, L., & Goodale, L. (Ed.). (2010). Pillars of peer support: transforming mental health systems of care through peer support services. Atlanta, GA: The Carter Center. Retrieved June 8, 2011, from http://r20.rs6.net/tn.jsp?llr=toyssnfab&et=1105905864022&s=2292&e=001660qLvW9O2KDTM-CBtwTPznnUmM7xVaYP7xHvKg-J0I3fq3a0rHoE_mxdyhTSjZmdmqRloqWLQdO6EjKmMNsOAh6kwNGrN1dRl-Opg0DEEPtNti-5u5UqLPjEdD6yDbXBBIJVLC-ZCnhPKHSUAeGQm0BOeSqnISLC4UlAqFJZ3s=. Davidson, L.; Chinman, M.; Kloos, B.; Weingarter, R.; Stayner, D.; & Tebes, J.K. (1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical Psychology: Science and Practice, 6(2), 165–87. Fukul, S.; Davidson, L.J.; Holter, M.C.; & Rapp, C.A. (2010). Pathways to recovery: Impact of peer-led group participation on mental health recovery outcomes. Psychiatric Rehabilitation Journal, 34(1), 42–48. OptumHealth. (2011). Poster presentation from Association for Community Mental Health Administration Summit. New Orleans, La. Salzer, M.S. (2011). Presentation from Texas USPRA Conference 2011: Present and future of certified peer specialists: A research overview. Austin, Texas. Salzer, M.S.; Schwenk, E.; & Brusilovskiy, E. (2010). Certified peer specialist roles and activities: Results from a national survey. Psychiatric Services, 61(3), 520–23. SAMHSA. (2009). What are peer recovery support services? (HHS Publication No. [SMA] 09–4454.) Rockville, Md.: U.S. Department of Health & Human Services. Smith, D.G. (2007). Letter to State Medicaid directors. Baltimore, Md.: Department of Health & Human Services, Centers for Medicare & Medicaid Services. Townsend, W., & Griffin, G. (2006). Consumers in the mental health workforce: A handbook for providers. Rockville, Md.: National Council for Community Behavioral Healthcare.

Reposted at darkestcloset.blogspot.com. From Recovery to Practice Weekly Highlights Volume 2, Issue 21. June 9, 2011. To access the RTP Weekly Highlights and other RTP materials, please visit http://www.dsgonline.com/rtp/resources.html.

The World May One Day Be Led by Persons with Mental Illnesses

By Steve Harrington, J.D., Executive Director, National Association of Peer Specialists

Two bits of information recently came to me that, taken together, caused me to formulate the following, inescapable conclusion: persons with a mental illness, particularly those with schizophrenia, are destined to lead the world.

This conclusion is well-supported by social scientists and organizational theorists. Very recently, researchers have concluded that the best leaders for organizations of all types are those who know themselves best. Experience has shown that those who know themselves well, and are comfortable with who they are, relate to others in a humane, compassionate way. That, in turn, inspires workers with loyalty and a desire to become more creative and productive. Everyone wins! Gone is the attitude that productivity is best driven by cold-hearted bean counters who monitor every move it takes to create a widget.

One business author, Robert Thomas, CEO of Accenture Performance, uses current leaders as examples. In his new book, Crucibles of Leadership, Thomas writes that the best way for people to know themselves, and thus become more effective leaders, is through adversity. He cites cases where deaths and illnesses forced now-effective leaders to reevaluate their lives and reprioritize their values. The result: compassionate people who lead with their hearts and workers who have never been more happy, productive, and creative. Businesses, especially the most successful in the world, know this lesson well.

So, it struck me. Where would you go to find people who have experienced adversity and grown through the experience? Psych hospitals! (Or those who have been there.)

Complementing this revelation is another. I recently heard a respected psychiatrist, sitting on a panel of his peers, go through a litany of challenges persons with schizophrenia face. The doctor painted a pretty ugly (and, fortunately, unrealistic) picture of what life is like for all persons with schizophrenia. At the end of his presentation, an audience member asked if there could be anything positive resulting from schizophrenia.

“Oh, yes,” the doctor replied immediately. “Persons with this illness are often great problem solvers. They think ‘outside the box.’ Once you've had your sense of reality shaken, it's easier to take risks and be creative.” The doctor used Nobel laureate John Nash as an example of how schizophrenia can result in creative thinking.

I thought for a moment about my own reality challenges. Walls moved, ceilings collapsed, lines on the road shifted, and voices--oh, those voices telling me what to do! And then there was that day I had a stimulating conversation with an unseen companion on a street corner. That little incident sent me back to the hospital, where meds ended the conversation—but not its memory.

Then I remembered the words of a professor recommending me for a doctoral program in public administration.

“Steve, you just don't think like other people,” he said. “You come up with ideas and approaches that are totally unique. Your head just doesn't accept reality, and that challenges us to change our perception of reality. That's what creative problem-solving is all about. You don't just think outside the box—you don't even know there is a box!”

Here's the bottom line: Those of us who have been there know all the disadvantages of having a mental illness, especially one like schizophrenia, which can affect cognitive abilities and perceptions of reality. On the other hand, society appears on the brink of recognizing the value of serious life challenges, especially when those challenges are used to foster personal growth.

The professional must therefore work to build upon the person's strengths (such as the perspective of yours truly being a creative problem-solver) and use them as the motivating factors to enhance his/her recovery. As is illustrated above, we can look at strengths instead of just the illness.

I foresee a time when executive headhunters will prowl the hallways of our psychiatric hospitals, looking for new leaders for organizations of all types. Gone will be the days when executive job descriptions require an MBA. Instead, job descriptions will read:

“Life-changing experience through adversity desired; mental illness a plus.”

Look out, world. We're taking over! 

Posted in May 12, 2011, Vol. 12, Issue 17 Recovery To Practice Newsletter.

Recovery to Practice Center Initiative

What is “recovery” in relation to mental illness? And what implications does this concept have for transforming mental health practice to become “recovery‐oriented”? To begin answering these questions, and to promote the transformation of mental health care to a recovery‐orientation, on October 1, 2009, the Center for Mental Health Services (CMHS), Office of the Associate Director for Consumer Affairs, within the Substance Abuse and Mental Health Services Administration (SAMHSA), contracted with Development Services Group, Inc. (DSG) to launch a five‐year Recovery to Practice (RTP) initiative.

Within SAMHSA’s workforce development priority area, this initiative seeks to advance a recovery‐oriented approach to mental health care by developing, promoting, and disseminating training curricula on how to translate the concept of mental health recovery into practice; and by providing a Recovery to Practice Recovery Resource Center for mental health professionals engaged in this work. For more information about this center and to subscribe to their newsletter, visit: http://www.dsgonline.com/rtp/resources.html. To receive all Resource Center communications and join the listserv, visit http://www2.dsgonline.com/rtp_listserv/. New resources are being added to the Resource Center on an ongoing basis. Contributors are invited to submit suggestions for useful articles, videos, curricula, and personal stories—as well as announcements about upcoming relevant conferences and meetings—to keep the center robust and current. Reposted at http://darkestcloset.blogspot.com/

New Free On-line Webinar on Recovery Avaialble

SAMHSA’s Recovery to Practice (RTP) Live Meeting PowerPoint presentation and recording for the April 11th Webinar,

“Step 2 in the Recovery-Oriented Care Continuum: Person-Centered Care Planning,”

is now available for download from the  

 RTP Resource Web page at:

http://www.dsgonline.com/rtp/resources.html

Announcement reposted at darkestcloset.blogspot.com

Peer Support Services for LGBTIQ Community

by Ronald E. Hellman, M.D., FAPA, Director,

LGBT Affirmative Program of South Beach Psychiatric Center published in Recovery To Practice Newsletter, reprinted at http://keystothecloset.blogspot.com/

The LGBT Affirmative Program (LGBTAP) of South Beach Psychiatric Center was initiated in 1996 as one of several multicultural services provided by this large, public sector community mental health center in New York City. The program is based at the Heights–Hill Mental Health Service in downtown Brooklyn, one of seven outpatient clinics at South Beach, which serves a multi-ethnic, low socioeconomic population with serious, chronic mental illnesses.

Several years into the program, we observed that our sexual minority population, much like our general psychiatric population with significant disabilities, had great difficulty reintegrating within the larger LGBT community and the general community at large, despite the provision of LGBT–affirmative therapies. We came to believe that it was incumbent upon us to facilitate the creation of a socio-cultural component within a recovery model, in addition to the psychosocial and medical services already offered.

This resulted in the creation of an affiliated membership program, the Rainbow Heights Club (RHC). As members, individuals did not have to be enrolled at the clinic, and this allowed LGBT patients from all over the New York metropolitan area to attend. The larger numbers helped to approximate the diversity found within the city’s LGBT community. And, with the creation of an LGBT consumer advisory group, members came up with a name for the club and helped steer program development.

LGBT individuals with major mental illnesses can be reluctant to engage in psychiatric treatment and adhere to treatment regimens over time, because they are less likely to identify with mainstream settings. They are a minority in these settings, and are also subject to stigma in the LGBT community because of their mental illness and in psychiatric settings because of their sexual minority status. And, unlike other ethnic and racial minorities, their families typically do not share their sexual identity. Thus they can be particularly prone to a lack of affirmation and supports.

LGBT patients have to adapt to largely heterosexual, cisgendered (those comfortable in their gender of birth) mental health settings in virtually all areas of service delivery. Well-intentioned, “integrated” settings fall short when they do not provide safe, culturally relevant opportunities for the alienated LGBT patient. Culturally appropriate programming, fostered at all organizational levels, has the power to transform these patients into LGBT persons in recovery.

A crucial component of recovery for the LGBT consumer is peer support. LGBT peer support allows for a process of authentic identification with others like oneself. It promotes forms of socialization, role modeling, and individuation not otherwise available in the generic setting. Mainstream cultural settings often inadvertently rob the LGBT patient of their experience as a sexual minority person with a different, yet valid, worldview. LGBTAP and RHC were organized to facilitate peer support by bringing a “proto-community” of individuals together that had never previously connected.

Separation from the dominant heterosexual, cisgendered world and connection with sexual minority peers is a common step in the healthy psychological development of sexual minority individuals. Major mental illness can tear people away from that process, and mainstream psychiatric settings typically provide no substitute. LGBTAP and RHC created the conditions and opportunities for these individuals to connect with each other, thereby creating a unique cultural community in which pride, place, self-esteem, support, and hope could be nurtured, as the weight of mental illness became merely a shared part of that larger process.

As a unique, regional program, RHC has served almost 500 members. Collaborating with staff and peer specialists, members have made their needs and interests known, the result being an ever-evolving program of groups, support, skills training, and advocacy. An outcome study of this recovery model found that participants attributed significant improvement in adherence with treatment regimens, reduction in psychiatric symptoms, enhanced self-esteem, improved stress tolerance and hopefulness to the program, despite an average of 16 years of previous psychiatric treatment.¹ To appreciate the depth of this program, please visit http://www.rainbowheights.org.

¹ Hellman, R.E.; Huygen, C.; Klein, E.; Chew, M.; & Uttaro, T. (2010.) A study of members of a support and advocacy program for LGBT persons with major mental illness. Best Practices in Mental Health: An International Journal, 6(2), 13–26.