A Call to Change Toward a RecoveryOriented Mental Health Service System for Adults

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A Call to ChangeToward a Recovery-Oriented
Mental Health Service System for Adults

• The Goal of a Transformed System Recovery!
• November, 2005
• Shelley Bishop, OMHSAS
• shebishop_at_state.pa.us

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A Call for Change - outline

• Why a Call for Change
• The Roots of Recovery historic evolution,
  research, national support
• Views of Recovery
• We Already Do That! Comparisons of traditional
  vs recovery oriented services
• Indicators/Benchmarks
• Challenges Barriers
• OMHSAS Next Steps
• Your Call to Change charge to all stakeholders

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Why a Call for Change?

• People with serious mental illness do, in fact,
  recover
• Voices of those who have experienced recovery
  created recovery movement
• Recovery movement impacting mh system at all
  levels
• Federal government call for sweeping
  transformation
• OMHSAS Leadership Advisory Committee desire to
  formally move forward PA transformation

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The Roots of Recovery in Mental Health

• Historically innovative approaches and strong
  leadership for reform in Pennsylvania
• Recovery is not really a new idea in mental
  health, but a re-emergence of fundamental values
  and longstanding knowledge about what it takes
  for people with serious mental illness to re-gain
  and live meaningful and productive lives.
• Influence of drug alcohol view of recovery,
  12-Step, Mutual Support

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How Did We Get To Recovery? Longitudinal Studies

• Between 45-65 of people with schizophrenia will
  experience significant improvements over time,
  some recovering fully
• 80 of people experiencing a major depressive
  episode will recover fully
• Outcome for bipolar disorder lies somewhere
  between the two (i.e., 60-75)

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How Did We Get To Recovery? Nothing About Us
Without Us

• Early 1900s Clifford Beers
• 1940s We Are Not Alone (WANA)
• 1960s Human/Civil Rights Movement Independent
  Living Movement
• 1970s 1980s Consumer/Survivor/Ex-Patient
  Movement
• 1980s Community Support System (CSP)
• 1980s 1990s Consumer organizing (MHASP,
  PMHCA, State Office of Consumer Affairs,
  Alternatives. Learning from Us
• Growing Voices Stories of Recovery

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How Did We Get To Recovery? National Recognition

• 1999 Surgeon Generals Report - Champions of
  Recovery assert that its greatest impact will be
  on the mental health providers and the future
  design of the service system.
• 2001 Presidents New Freedom Commission - The
  goal of a transformed system Recovery.

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Views of MH Recovery

• Resolution of acute episodes of illness, distress
  or disruption
• Return to full or partial functioning in most
  aspects of ones life regaining valued social
  role
• Worker, parent, student
• The act of gaining something that was lost
• Sense of personal comfort or safety
• Confidence in speaking out
• A new lease on life

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• In a broad sense, to be in recovery refers to
  the active, uniquely personal process of finding
  ways of resolving or managing physical,
  emotional, behavioral, spiritual, or
  interpersonal issues that cause problems or pain,
  and simultaneously learning or creating a more
  positive, constructive, functional, meaningful,
  and ideally satisfying way of being.
• Regardless of the definition, the concept of
  recovery implies a dynamic, multi-dimensional,
  often non-linear and very individual healing
  process.

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A Call for ChangeRecovery Definition

• Recovery is a self-determined and holistic
  journey that people undertake to heal and grow.
  Recovery is facilitated by relationships and
  environments that provide hope, empowerment,
  choices and opportunities that promote people
  reaching their full potential as individuals and
  community members.

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SAMHSA Consensus Statement on Mental Health
Recovery

• Self-direction consumers lead, control, exercise
  choice over, and determine their own path of
  recovery by maximizing autonomy, self-agency, and
  independence.
• Individualized and Person-Centered there are
  multiple pathways to recovery based on the
  individual persons unique consumer needs,
  preferences, experiences including past trauma,
  and cultural backgrounds in all of its diverse
  representations. Individuals also identify
  recovery as being an on-going journey, an end
  result as well as an overall paradigm for
  achieving optimal mental health.

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Consensus - continued

• Empowerment consumers have the authority to
  exercise choices and make decisions that impact
  their lives and are educated and supported in so
  doing.
• Holistic recovery encompasses the varied aspects
  of an individuals life including mind, body,
  spirit, and community including such factors as
  housing, employment, education, mental health and
  healthcare services, complementary and
  naturalistic services, addictions treatment,
  spirituality, creativity, social networks,
  community participation, and family supports as
  determined by the person.

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Consensus - continued

• Non-Linear recovery is not a step-by-step
  process but one based on continual growth,
  occasional setbacks, and learning from these
  experiences.
• Strengths-Based recovery focuses on valuing and
  building on the multiple strengths, resiliency,
  coping abilities, inherent worth, and
  capabilities of individuals.
• Peer Support the invaluable role of mutual
  support wherein consumer encourage other
  consumers in recovery while providing a sense of
  belongingness, supportive relationships, valued
  roles and community is recognized and promoted.

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Consensus - continued

• Respect community, systems, and societal
  acceptance and appreciation of consumers -
  including the protection of consumer rights and
  the elimination of discrimination and stigma
  are crucial in achieving recovery.
  Self-acceptance and regaining ones belief in
  ones self is also vital.
• Responsibility consumers have personal
  responsibility for their own self-care and
  journeys of recovery. This involves taking steps
  towards ones goals that may require great
  courage.

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Consensus - continued

• Hope
• Recovery provides the essential and motivating
  message that people can and do overcome the
  barriers and obstacles that confront them.

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But we already do that!

• Recovery is not a model
• Recovery is not merely another service program
• Recovery is not business as usual
• Recovery is not an add-on or just a new name for
  the same programs
• Recovery is often not what is done, but how its
  done

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Traditional vs Recovery ApproachAdapted
from Noordsy Colleagues
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Non-recovery culture Recovery Culture
Adapted from META agency, Pheonix, AZ
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Pre-recovery System Recovery Enhancing System
Adapted from Ridgway Recovery in Action
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Are We There Yet?

• Being recovery-oriented means that a service or
  system makes strong honest commitment to a set
  of principles and beliefs about the ability of
  each person with a mental illness to grow, change
  and have a life that is personally rich and
  fulfilling, with or without the presence of
  symptoms of a disorder.
• Systems continually evaluate their attitudes,
  policies and practices to align with values and
  principles.

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Are We There Yet? Basic Domains

• Validated Personhood
• Person-centered Decision Making Choice
• Connection Community Integration, Social
  Relationships
• Basic Life Resources
• Self-care, Wellness Finding Meaning
• Rights and Informed Consent
• Peer Support/Self Help

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Are We There Yet?Basic Domains

• Participation, Voice, Governance Advocacy
• Treatment Services
• Worker Availability, Attitude Competence
• Addressing Coercive Practices
• Outcome Evaluation Accountability

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Indicators

• The heart of the change
• By individual perspective, by service/program,
  county/state level
• Unless services and the system can demonstrate
  that personal recovery outcomes are being
  attained, it is not a successful system.

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Challenges Barriers

• Systems, like people, do not change easily.
  Every system is perfectly designed to stay
  exactly the way it is. For meaningful change to
  occur, some discomfort, imbalance, uncertainty
  and acceptance of risk are prerequisite.

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Areas of Critical Review

• Power
• Relationships
• Coordination Community
• Peer Support Consumer-run Services
• Workforce Issues
• Evaluation Quality Assurance
• Medical Necessity Evidence Based Practice
• Financing
• Recovery Dialogues MH Substance Abuse
• Recovery Education
• Licensing, Regulations Policy

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Transformation Next StepsOMHSAS

• Review, consensus commitment
• Training Technical Assistance
• 3-5 Year Implementation Plan
• Integrate internal review process of
  transformation needs, action steps
• Annual Progress on Implementation

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TransformationYour Call to Change

• Promote discussion dialogue
• Identify leaders
• Self-check
• Be honest
• Visioning
• Identify specific problems challenges
• Forge new partnerships
• Make a commitment and take action

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Your Call to ChangeBoiling it Down

• How can/will you use the Call to Change document?
• How can we partner to support peoples recovery?
• What is your constituency willing to take
  responsibility for?

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PA Transformation

• As with the New Freedom Commission
• Transformation was not Achieved by the
  Commission It Depends on Action that We and
  Others Will Advance
• The Pennsylvania Transformation Will Depend on
  the Action of not only OMHSAS, but of all
  stakeholders.

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PA Transformation

• No one can transform someone elseeach must do
  their own work. Hope and supports are
  essential.
• Ed Knight

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• Massive system changes must occur of the vision
  of recovery is to become a reality for an
  ever-increasing number of people with severe
  mental illness. For this very different vision
  to become reality, brilliant leadership is
  required.
• William A Anthony, PhD
• A Call for Change recognizes and calls upon the
  brilliant leadership of all who are a part of our
  system consumers, family members, advocates,
  providers, policy-makers and administrators to
  effect true transformation in Pennsylvania.
• Joan Erney, J.D.
• Deputy Secretary, OMHSAS