Psychiatrists Role in Recovery Oriented Systems and Promoting Wellness

1
Psychiatrists Role in Recovery Oriented Systems
and Promoting Wellness

• Presented by
• John B. Allen Jr.
• Special Assistant to the Commissioner
• New York State Office of Mental Health

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What is it?

• A beaver like tail
• A viper like poison spur on the hind leg
• The shoulder girdle of a crocodile
• An otter like webbed foot
• A bill like a duck
• Lays eggs like a lizard
• Nurses its young like a mammal
• Fur coat

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What are we talking about?
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Whats the Problem?

• Pharmacologist Dopamine Receptor Problem
• Family therapist a family systems problem
• Psychologist a psychodynamic conflicts problem
• Behaviorist a contingenceny management problem
• Activities/Vocational therapist insufficient
  skills (deficit) problem
• Rn a management problem
• Half way house staff a living problem
• Family our child
• Patient no problem
• Richard H McCarthy, MD, CM,
  PhD Pilgrim Psychiatric Center

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Norman Sartorius, former head of WHO's mental
health program

• "Social factors play a major and important
  role in the outcome of disease," Sartorius said.
  "Very few solutions are medical in medicine."

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Evidence from the World Health Organizations
Studies

• Patients in poorer countries spent fewer days
  in hospitals, were more likely to be employed and
  were more socially connected. Between half and
  two-thirds became symptom-free, whereas only
  about a third of patients from rich countries
  recovered to the same degree, Sartorius said.

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• Nigerian, Colombian and Indian patients also
  seemed less likely to suffer relapses and had
  longer periods of health between relapses.
  Doctors in poorer countries stopped drugs when
  patients became better -- whereas doctors in rich
  countries often required patients to take
  medication all their lives.

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How do you respond?

• I want to be the King of England
• I plan to become an astronaut
• I am going to be President
• I am going to explore the amazon
• I plan to build a house on the moon
• I am going to be a Rock Star

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HOPE!!!

• Communication and belief in Recovery
• Knowledge of longitudinal data
• Address issues of chronicity versus possibilities
  of recovery
• Linkage to role models of recovery
• Addressing family and natural supports

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Partnership and Collaboration Mark Ragins, M.D.

• The relationship is not centered around a
  powerful helping professional taking care of,
  protecting, and helping a weak, vulnerable,
  damaged patient. It is centered around helping
  someone with a mental illness define and pursue
  their own goals and life visions, empowering and
  educating them to learn to overcome their own
  illnesses, and encouraging risk taking and
  growth, learning from natural consequences and
  failures. It is far more like the role of coach
  than of doctor. Most of us naturally make this
  change when we are trying to help a friend or
  another doctor, treating them as colleagues or
  collaborators rather than as patients.

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Promotion of Self Locus of Care

• Self management teaching
• Motivational interviewing
• Naturalized treatment settings
• Homework
• Working with families and natural supports

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What is my role?

• When a person asks the question, Who am I?,
  is the primary answer I am a schizophrenic? or
  is the answer I am a person with friends I am a
  person who likes to play the piano I am a person
  who is trying to become an artist I am a person
  who also has schizophrenia that I have to deal
  with?

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Self Identity

• Of all of the modes maniacs use to maintain
  themselves, regular employment seems to be the
  most effective.
• Thomas Eddy 1815
• Report to the Governor of New York

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Employment as Therapy

• Source of income
• Way to structure time
• Meet friends
• Feel productive.

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Linkages

• Self-Help / Peer Support Groups
• Social Networking Groups
• Use of Natural Support Systems
• Faith Communities
• Hobbies
• Community Structures

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Medication as a Tool

• Understanding Personal Medicine
• Other treatments
• Physical exercise
• Eating well
• Avoiding alcohol and street drugs
• Love
• Solitude, art, nature, prayer, work, and a myriad
  of coping strategies are equally important to my
  recovery.

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Overcoming Burn-out

• Helpers desire to be helpful
• Literature on Recovery
• National Role Models
• Confounds
• Stagnation of Medication Maintenance
• Revolving door patients

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Keys to Recovery

• Graduates rewarded for success, tell their
  recovery stories
• Individuals award Recovery Keys to thank those
  that made a difference
• Build a body of experiential evidence to create a
  tipping point in individual belief systems

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In Summary

• In country after country, WHO found that
  strong social and family connections trumped
  high-tech medical facilities.

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False Dichotomy

• A false dichotomy has crept into psychiatry
  where you are EITHER a believer in the medical
  model and hard science vs. a believer in the
  'recovery model,' assumed to be based on fuzzy
  thinking, opportunistic pandering to 'consumers,'
  or some faith-based woodstock-like belief in love
  / peace / recovery and all else that's 'new age /
  counterculture.
• Lew Opler, M.D.
• New York State
• Office of Mental Health

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To be a good psychiatrist

• One MUST have a holistic perspective, being
  both an expert in the biomedical aspects of
  mental health, but also the one member of the
  multidisciplinary team who is able to integrate
  the biological / psychological / social into the
  (as George Engels called it) biopsychosocial
  model--the work of Manfred Bleuler, John Strauss,
  others demonstrates UNAMBIGUOUSLY that recovery
  is not only possible, but in many cases the
  'norm

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Contradiction of the Kraepelain Concept

• Most M.D.'s need to see it to believe it
  unfortunately, when someone previously labeled
  'schizophrenic' comes along and is no longer
  symptomatic, it is assumed that the diagnosis was
  wrong given the kraepelian concept of inevitable
  downhill course but this just ain't so!!!

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Modeling

• The thought leaders in psychiatry-and within
  public psychiatry that included NASMHPD Medical
  Directors Council--must embrace and integrate a
  recovery orientation and model it to those who
  work for them and, most importantly, to the next
  generation of psychiatrists