RecoveryBased and ClientCentered Services

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Recovery-Based and Client-Centered Services
In 90 Minutes or Less .thats 2 minutes per slide
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Goals for today.

• Blaze through the history of mental health
  treatment in 10 minutes
• Cram the four primary stages of recovery into 30
  minutes
• Give due attention to philosophy and principles
  within 30 minutes
• Spend a whopping 20 minutes on an in-depth
  discussion of services.
• Make some lasting positive impact on yall

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History of Mental Health Treatment

• Mental illness is nothing new has been around
  as long as we have
• By the way, so has recovery from mental illness

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History of Mental Health Treatment United States

• Pre-colonial at home, family
• Urbanization state governments began attempts
  to address problem
• Asylums/Mental Hospital
• Pennsylvania and Virginia mid 1700s
• Essentially locked up
• Those not cared for by family or in asylums wound
  up in jail, almshouses, work houses or other
  institutions
• NOT MUCH HAS CHANGED

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The Rise of Moral Treatment early 1800 - 1850

• the return of the individual to reason by the
  application of psychologically oriented therapy
  (Grob, 1994).
• Philippe Pinel 1793 La Bicetre Paris
• Unchained patients and let them move about the
  grounds
• William Tuke 1796 The York Retreat England
• Minimizing restraints treating people with
  respect
• Dorothea Dix Horace Mann
• Benjamin Rush early 1800s Pennsylvania
• Believed that insanity was a disease of the mind
• Had the cause wrong though
• Also believed in forced treatment

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Money, Medicineand Mental Hospitals 1850 - 1890

• Years and years of moral treatment at nice large
  institutions was very expensive
• Population continued to grow
• So did costs
• Underfunding and overcrowding led to a need to
  figure a way to get people out faster

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Mental Hygiene 1890 - 1920

• Mental hygiene public health scientific
  medicine, social progressivism.
• Believed in the principles of early treatment
• Wanted to move mental health care into the
  mainstream
• Through the use of medicine and public health
  strategies, mental illness could be all but
  eradicated
• Funding responsibility shifted from local govt.
  to state govt.
• Communities starting sending even more people to
  state hospitals
• The medical profession started to become involved
  in providing treatment to this population
  people knew the problem had something to do with
  the brain.

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Mental Hygiene

• The new treatments proved largely ineffective
• Patients continued to stay for years, filling
  hospitals.

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Community Mental Health 1955 - 1970

• Borrowed some ideas from mental hygiene
• New drugs offered new promise
• Treat people in the community -
  deinstitutionalized
• Tied in with civil liberties/social justice
  movement
• Money really never followed

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Community Support - 1975 - present

• Federal legislation led to funding for some
  community centers
• Expansion of Medicaid and Medicare to cover some
  mental health services in the community
• Services not well coordinated
• Communities not welcoming
• Couldnt care for those with severe and
  persistent mental illness

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Bottom Line

• The way in which we treat those with mental
  illness has been mostly dictated by money.
• Society has jumped at new treatments because of
  their anticipated cost effectiveness.
• The science to back up the efficacy of many
  treatments has been questionable at best.
• Those most affected by these treatments often had
  the least input.

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Goals for today.

• Blaze through the history of mental health
  treatment in 10 minutes
• Cram the four primary stages of recovery into 30
  minutes
• Give due attention to philosophy and principles
  within 30 minutes
• Spend a whopping 20 minutes on an in-depth
  discussion of services.
• Make some lasting positive impact on yall

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Recovery is a process not a service

• Human beings recover from a variety of traumatic
  experiences throughout life sometimes well,
  sometimes not.
• Our job as helping professionals is to facilitate
  this natural process, or at the very least to
  make sure we dont impede it.

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Four Primary Stagesof Recovery

• Hope
• Empowerment
• Self-Responsibility
• Meaningful Role in Life

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Hope

• Recovery begins with a positive vision of the
  future.
• Hope is most motivating when it takes form as a
  real, reasonable image of what life can look
  like.
• Individuals need to see possibilities getting a
  job, having an apartment before they can make
  changes and move forward.

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Empowerment

• To move ahead, individuals need a sense of their
  capabilities.
• Hope needs to be focused on what individuals can
  do for themselves.
• Individuals need access to information and the
  opportunity to make their own choices.
• These choices need to be real and varied (a menu).

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Self-Responsibility

• Whose life is it anyway?
• We learn by trying new things, learning from
  mistakes and trying again.
• Involves taking risks living independently,
  applying for a job, asking someone out on a date.

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A Meaningful Role in Life

• To recover, a person must have a purpose in their
  life separate from their illness.
• Applying newly-acquired traits such as
  hopefulness, confidence, and self-responsibility
  to normal roles such as employee, neighbor,
  graduate, boyfriend, etc.
• Meaningful roles help people living with a mental
  illness get a life.

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Goals for today.

• Blaze through the history of mental health
  treatment in 10 minutes
• Cram the four primary stages of recovery into 30
  minutes
• Give due attention to philosophy and principles
  within 30 minutes
• Spend a whopping 20 minutes on an in-depth
  discussion of services.
• Make some lasting positive impact on yall

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Philosophy and Principles

• Client Choice
• Quality of Life
• Community Focus
• Whatever it Takes

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Client Choice

• Stop selling things that no one would buy
• Utilizing a menu approach, services are provided
  based on individuals own goals.
• Clients choose what services they want and the
  staff members with whom they would like to work.
• De-emphasize traditional professional to
  patient relationships.
• Respect individuals as equal partners in their
  recovery.

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Quality of Life

• Focus on key life areas such as housing, work,
  education, finance and social goals.
• The point is to help individuals regain/establish
  their role as a member of the community of their
  choosing.
• Medication/appointment compliance may be a means
  to these ends, but should not be considered ends
  in themselves.

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Community Focus

• Living, learning and working should be done
  through integration rather than segregation.
• Means that staff need to spend most of their time
  out of the office, supporting individuals as they
  pursue their quality of life goals.
• Staff also have a responsibility to cultivate
  relationships with others and share these
  relationships with clients social capital.

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Whatever it Takes

• Services must be made available on a continuous
  basis and offered with a no-fail approach.
• Transferring individuals because of the challenge
  they pose is prohibited.
• High levels of commitment on the provider side of
  the equation engender higher levels of commitment
  on the client side of the equation.

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Goals for today.

• Blaze through the history of mental health
  treatment in 10 minutes
• Cram the four primary stages of recovery into 30
  minutes
• Give due attention to philosophy and principles
  within 30 minutes
• Spend a whopping 20 minutes on an in-depth
  discussion of services.
• Make some lasting positive impact on yall

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Recovery Services

• Teaming between mental health professionals,
  paraprofessionals, clients and family members is
  a powerful tool in service delivery.
• Use of specialized skill sets in employment,
  money management, community involvement,
  substance abuse recovery and others are essential
• All staff including management, treatment, case
  management, and employment staff are recovery
  workers, and all must be focused on the clients
  goals.

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Recovery ServicesWelcoming and Engaging

• The creation and maintenance of an environment
  that provides positive relationships between
  staff and clients, between clients, and between
  staff is an essential service all its own.
• Without positive relationships you have nothing
  period.

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Recovery ServicesService Planning

• Must move away from compliance and/or diagnosis
  based goals.
• Plans need to be tailored to each individual.
• The individual must be highly involved in the
  development of the plan and in its implementation
  defines the relationship.

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Recovery ServicesPsychiatric Care

• Practice of collaborative psychiatry, which
  emphasizes client choice through the use of
  education around symptoms and medication.
• Makes clients in control of their illnesses, and
  partners in their treatment.
• Supports them in their pursuit of work, living,
  education and social goals.

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Recovery ServicesSubstance Abuse Recovery

• This IS our job.
• Coordinate or perish.
• Abstinence may be the goal, but recovery is the
  process.
• Dont sacrifice the relationship in pursuit of
  the goal.
• Might I suggest Harm Reduction?

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Recovery ServicesHousing

• Housing IS treatment.
• Housing IS your job.
• A wide range of options is needed.
• Dump the progressive dinner go straight for
  dessert.
• Failure is a necessary part of success.

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Recovery ServicesEmployment

• Employment IS treatment.
• Employment IS your job.
• A wide range of options is needed.
• Dump the progressive dinner go straight for
  dessert.
• Failure is a necessary part of success.

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Recovery ServicesFinancial Services

• The benefit is worth the risk.
• Incentives in relation to other providers run the
  wrong way.
• Relationship division is essential.
• Transparency will keep the frustration to a
  minimum.

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Recovery ServicesCommunity Involvement

• Resources need to be developed by staff and
  clients barrier reduction.
• You can almost always find it out there.
• Helps to reduce stigma/increase social inclusion
  and increase social capital.
• Some staff will need to operate outside of normal
  business hours, cause thats when life happens.

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Goals for today.

• Blaze through the history of mental health
  treatment in 10 minutes
• Cram the four primary stages of recovery into 30
  minutes
• Give due attention to philosophy and principles
  within 30 minutes
• Spend a whopping 20 minutes on an in-depth
  discussion of services.
• Make some lasting positive impact on yall