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June 30, 2011 Volume 2, Issue 24
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Continuing our inclusion of advances in recovery from other countries, this week’s RTP Weekly Highlight provides a glimpse into an innovative approach to understanding and managing hallucinated voices that is being developed in the United Kingdom.
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.

To access WTR’s research papers, publications, links, and other resources on working with people who hear voices, please visit http://www.workingtorecovery.co.uk.

Webinar Announcement
The RTP Resource Center is pleased to announce
the third Webinar in a four-step series:
Step 3 in the Recovery-Oriented Care Continuum:
Promoting Recovery Through Psychological and Social Means
Thursday, July 28, 2011

2:00–3:30 pm EDT

This Webinar will describe a few approaches to promoting recovery that involve psychological and social interventions. First, David Kingdon, M.D., will update participants on the state of the art in cognitive–behavioral psychotherapeutic approaches to serious mental illnesses (schizophrenia and bipolar disorder). Next, Larry Davidson, Ph.D., will describe the key common elements of psychiatric rehabilitation approaches that involve in vivo support (supported employment, education, housing, etc.). Finally, Jayme Lynch, CPS, will describe the role of consumer-run programs and businesses as offering alternatives to traditional programs and settings (e.g., clubhouses).

David Kingdon, M.D., is Professor of Mental Health Care Delivery at the University of Southampton, UK and Honorary Consultant Adult Psychiatrist for the Hampshire Partnership NHS Trust. Over the past couple of decades, David has worked with Douglas Turkington from Newcastle and other colleagues to develop techniques for treating patients with persistent delusions and hallucinations using cognitive behavior therapy. His research interests are in cognitive therapy of severe mental illness and mental health service development on which he has extensively published.

Larry Davidson, Ph.D., is the DSG Project Director for the SAMHSA Recovery to Practice initiative. A Professor of Psychiatry and Director of the Program for Recovery and Community Health at the School of Medicine and Institution for Social and Policy Studies of Yale University, his work has focused on processes of recovery from and in serious mental illnesses and addictions, evaluation of innovative recovery - oriented practices, including peer - delivered services, and designing and evaluating policies to promote the transformation of systems to the provision of recovery - oriented care. In addition to being a recipient of psychiatric care himself, Dr. Davidson has produced over 200 publications, including the 2009 book written with several of his colleagues, entitled A Practical Guide to Recovery - Oriented Practice: Tools for Transforming Mental Health Care published by Oxford University Press and the more recent book entitled The Roots of the Recovery Movement in Psychiatry: Lessons Learned published by Wiley - Blackwell. His work has been influential both national and internationally in shaping the recovery agenda and in translating its implications for transforming mental health practice.

Jayme Lynch, CPS, is the Director of the Peer Support and Respite Center, a Georgia Mental Health Consumer Network initiative offering 24 hour, 7 day/week, consumer-directed peer wellness and crisis respite services, in Decatur, Georgia. The center utilizes peer support services in a safe, non-coercive, non-clinical and home-like environment in a community setting, and is offered as an alternative to other crisis services. The goal of this project is to encourage consumers to use their crises as learning opportunities, developing their internal and external resources to better understand, manage and avoid future crises and avoid future hospitalizations.

To Register

Please share this announcement with friends and colleagues who may be interested in learning more about recovery-oriented practice in behavioral health services. For more information on SAMHSA’s RTP project, please contact the RTP Resource Center at
recoverytopractice@dsgonline.com, or 1.877.584.8535.

Up to $500 Million in Affordable Care Act Funding Will Help Health Providers Improve Care; Partnership for Patients Announces Federal Contracting Opportunities
The U.S. Department of Health and Human Services (HHS) announced that up to $500 million in Partnership for Patients funding will be available to help hospitals, health care provider organizations, and others improve care and stop millions of preventable injuries and complications related to health care–acquired conditions and unnecessary readmissions. This funding, made available by the Affordable Care Act, will be awarded by the Centers for Medicare & Medicaid Services (CMS) Innovation Center through a solicitation and other procurements for Federal contracts.

“Since the Partnership for Patients was announced, we have had an overwhelming response from hospitals, doctors, employers, and other partners who want to be a part of this historic effort to improve patient safety,” said CMS Administrator Donald M. Berwick, M.D. “We are now looking to contract with local and statewide entities that can foster and support hospitals’ efforts to improve health care and reduce harm to patients.”

The Partnership for Patients is a new public–private partnership that will help improve the quality, safety, and affordability of health care for all Americans. The Partnership’s two goals are to reduce harm in hospital settings by 40 percent and reduce hospital readmissions by 20 percent over a 3-year period. To achieve these goals, the Partnership is seeking to contract with large health care systems, associations, State organizations, or other interested parties to support hospitals in the hard work of redesigning care processes to reduce harm. What the solicitation is calling “Hospital Engagement Contractors” will be asked to conduct the following:
  • Design intensive programs to teach and support hospitals in making care safer

  • Conduct trainings for hospitals and care providers

  • Provide technical assistance for hospitals and care providers

  • Establish and implement a system to track and monitor hospital progress in meeting quality improvement goals
In addition to working with the Hospital Engagement Contractors, CMS will team with other contractors to develop and share ideas and practices that improve patient safety. These efforts include work with patients and families to understand their thoughts on how to best improve patient safety and transitions between different health care settings—such as when a patient is discharged from a hospital to a nursing home.

These contracts make available the first round of funding—which will ultimately total up to $500 million—that the Innovation Center has committed to this effort. Solicitations for proposals are available on the Federal Business Opportunities Web site, https://www.fbo.gov.

When the Partnership for Patients was announced, the Obama administration committed up to $1 billion in Affordable Care Act funding to help achieve the two goals. At the time of the announcement, up to $500 million was made available through the Community-Based Care Transitions Program to ensure that patients safely transition between settings of care. This announcement makes available the start of an additional $500 million in Innovation Center funds to help reduce health care–acquired conditions and reduce unnecessary readmissions.

September Is National Recovery Month
September 2011 will mark SAMHSA’s 21st-anniversary observance of National Recovery Month (Recovery Month). Recovery Month highlights individuals who have reclaimed their lives and are happy and healthy in long-term recovery. It also honors the treatment and recovery service providers who make recovery possible. The observance has evolved over the years and is evolving once again. In 2011, it will include all aspects of behavioral health and will now be known as National Recovery Month. This year’s theme, “Join the Voices for Recovery: Benefits Everyone,” corresponds with SAMHSA’s four core messages—“Behavioral Health Is Essential to Health, Prevention Works, Treatment Is Effective, People Recover”—and underscores the continued gains our Nation is making in addressing behavioral health care. For more information and resources—including a Recovery Month kit, media and event planning materials, and banners/logos—go to http://www.recoverymonth.gov.

The RTP Resource Center Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in recovery-oriented work and how it has changed the way they currently practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit personal stories or other recovery resources, please contact Stephanie Bernstein, MSW, at 1.877.584.8535,
or email recoverytopractice@dsgonline.com.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topics,
please contact the RTP Resource Center at
1.877.584.8535 or email recoverytopractice@dsgonline.com.

The views, opinions, and content of this Weekly Highlight are those of the authors and do not necessarily
reflect the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.