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Supported Education. “The Michigan Supported Education Program (MSEP) was a hand up, not a hand out. Something that instills confidence within the self that we could do as well as, or better than, so-called normal people. It's as if we are ambassadors going to show so-called normal people we can function to their level or beyond. It has helped me to tear down stereotypes of mental health consumers.” —MSEP Student (Bellamy & Mowbray, 1998)
Supported Education (SEd) is a recovery-oriented practice that was developed to assist individuals with mental illness who want to start or return to school to complete their educational goals (Mowbray et al., 2005). While SEd is generally geared for post-secondary education (as traditional college age has been cited as the time that people may experience their first episode of psychiatric illness), it has also assisted people in getting their GED to help them apply to college or vocational technical school. Most SEd programs offer career planning, academic survival skills, and service and resource outreach.
The principles of SEd are the following:
Hope: All individuals are treated with respect and dignity and as persons capable of growth and positive change. Recovery is possible for all!
Normalization: Non-stigmatizing methods and settings are used. For instance, SEd participants are called “students,” not “patients” or “clients.”
Self-determination: SEd activities should maximize opportunities for choice. Students have been known to be involved in all phases of SEd programming.
Support and relationships: Important to SEd is the opportunity for students to learn from each other and develop supportive relationships.
Systems change: Critical to SEd is the systemwide education and awareness to support students living with mental illnesses. Successful SEd projects involve collaborative work and the sharing of resources between multiple stakeholders (Mowbray et al., 2005).
The first SEd project described in literature was at Boston University's Center for Psychiatric Rehabilitation (Mowbray et al., 2002). Since then, several approaches have been practiced and researched, including the Self-Contained Classroom Model, the On-Site Model, and the Mobile Model.
Research has demonstrated the following benefits from involvement in SEd programs:
Evidence has shown that Supported Education does work and should be a key intervention in recovery-oriented practice (Mowbray et al., 2005).
For a full discussion of the principles of SEd and the approaches used, as well as a complete list of references used for this article, please click here.
—Chyrell Bellamy, Ph.D., M.S.W., Assistant Clinical Professor and Director of Peer Services and Research, Yale School of Medicine, Department of Psychiatry Program for Recovery and Community Health
Training. RTP provides quarterly training Webinars on topics relating to recovery-oriented practice. On Sept. 16, 2010, RTP conducted its second Webinar, What Recovery Means in Acute Care. This Webinar addressed the important and complex question, “How can behavioral health care be provided in a recovery-oriented fashion within an acute care (emergency/crisis/inpatient) setting?” This is a question that is asked often by behavioral health professionals who are grappling with the transformation process and who are trying to ensure that the values and principles of recovery permeate all aspects of a system of care.
The first speaker of the Webinar, Maggie Bennington–Davis, M.D., discussed her experiences with recovery-oriented practices as chief medical and operating officer for Cascadia Behavioral Health Center in Portland. Then Gayle Bluebird, R.N., followed by discussing her extensive experience bringing peer staff into acute care settings; the challenges, successes, and benefits of doing so; and the transformative impact that peer supports can have in an acute care setting. Next, Beth Stoneking, Ph.D., discussed various consumer-managed and -staffed crisis residential alternatives that currently exist, and shared data from a randomized clinical trial that support their use. Finally, Marvin Swartz, M.D., described the development and use of psychiatric advance directives and their potential for transforming the care of people experiencing acute episodes based on each individual's preferences determined and articulated in advance.
You can conveniently download the presentation slides and the complete recorded session from the RTP Resources Web page at: http://www.dsgonline.com/rtp/resources.html.
Technical Assistance. RTP technical assistance (TA) provides valuable resources that support learning strategies for implementing recovery-oriented care in practical and sustainable ways. We have an extensive library of recovery-oriented articles, personal stories and anecdotes, curricula, videos, and links to relevant publications and professional sources. To access TA, contact RTP TA staff, Monday through Friday, from 9:00 a.m. to 5:30 p.m., at 1.877.584.8535, or email requests to RTP_TA@dsgonline.com. Each request will be responded to within 48 hours of receipt. Arrangements for more lengthy consultation are available on a case-by-case basis.
The RTP initiative enters its second year with many accomplishments from its inaugural year to build upon. Our Resource Center provides a breadth of recovery-oriented information through quarterly Webinars, Weekly Highlights every Friday, quarterly e-Newsletters, and ongoing technical assistance to myriad stakeholders. Our Webinar series this year will follow the continuum of discovering and engaging in recovery-oriented care—from outreach and engagement; to person- and family-centered care assessment and planning; to intervention; and finally, to graduation, monitoring, and guidance. To view all available resources, go to: http://www.dsgonline.com/rtp/resources.html .
We have developed a series of print products—brochures and guidance documents—that are in production and will be distributed through a variety of channels. We will announce them along the way.
And finally, the RTP Steering Committee “virtually” met twice over the last 12 months, enjoyed lively and productive conversation, and contributed substantively to both our Resource Center product content and to our professional discipline awardees' process of research and assessment.
Culturally Sensitive Recovery. Recovery values self-direction, empowerment, peer support, respect, and hope. Incorporating these tenets in mental health care creates an environment in which people can manage mental illness and lead fulfilling and productive lives.
Recovery-oriented care holds particular promise for consumers from diverse and underserved populations. Commonly, people with mental illness in these groups experience disparities in the quality of mental health services they receive, leading to negative outcomes, including misdiagnosis, dissatisfaction with care, involuntary hospitalization, and early treatment dropout. Using evidence-based treatments, focusing on strengths, encouraging active consumer participation in decision-making, and tailoring care to cultural preferences are examples of how recovery-oriented care can reduce disparities.
The American Psychiatric Association and the American Association of Community Psychiatrists are working collaboratively on the Recovery to Practice initiative to develop educational materials to enlighten psychiatrists about recovery-oriented practice (see “Professional Discipline Training Awards”). In the process of conducting our situational analysis for this purpose, we have been holding dialogues and conversations across the country with a diverse group of psychiatrists, consumers, family members, and allied mental health professionals. Our goal has been to hear their views about recovery and the differing cultural perspectives on the barriers and facilitators to recovery-oriented care. We look forward to incorporating these diverse views in our final educational product, sending a clear message that one size does not fit all… and culture counts!
—Annelle Primm, M.D., M.P.H., Deputy Medical Director, American Psychiatric Association
Now in their seventh month of collecting data to develop a situational analysis about where and how recovery-oriented practice exists throughout their professional practices, the professional discipline awardees are assessing a variety of sources within their fields to fully understand their target audience, as well as the internal and external forces that influence policy and practice. This will serve as the foundation for developing recovery-oriented training curricula for their members. The awardees—the American Psychiatric Association, the American Psychiatric Nurses Association, the American Psychological Association, the Council on Social Work Education, and the National Association of Peer Specialists—are also exploring and documenting the “contextual conditions” in their respective fields that surround and define the professions. For example, what are the historical and current economic, political, social, and technological factors that influence the profession?
Data collection for the situational analysis is occurring in a variety of settings. All the awardees have advisory or steering committees composed of professionals and consumers. Committee members are helping to facilitate discussions around the country—at the chapter level, during conferences, at community health centers—and asking questions, such as: “How often is recovery discussed in your organization's formal meetings (board meeting, staff meetings, performance appraisals)?” “Do standards of care, certification, and licensure requirements in your profession reflect recovery principles?” “To what extent is recovery evident in your organization's formal clinical training policies, procedures, and curricula?” Some of the facilitated discussions among the professions are revealing differences about the definition of recovery and about the depth and breadth of how recovery does, or does not, occur in practice.
In addition to group discussions, the awardees are consulting with key informants. They, and their advisory group members, are asking questions, such as “How would you describe the opportunities and benefits of implementing recovery-oriented practices in your profession?” “What are the core skills required for a professional practitioner?”
Over the next couple of months, the awardees will complete their assessment activities, analyze the data that they've collected, and prepare their situational analyses. The situational analyses will inform the development of training outlines and subsequent training materials. Training curricula will be based on actual data, as interpreted through the situational analyses. All training curricula will be pilot-tested in order to be finalized and implemented. Other recovery-oriented partners in the Recovery to Practice project—the Annapolis Coalition, Mental Health America, National Alliance of Mental Illness, the National Development and Research Institute, and New York Association of Psychiatric Rehabilitation—will be assisting the awardees as they analyze their assessment data, develop training outlines and training manuals, and market and implement the training materials. We are learning much from the awardees' efforts thus far, and enthusiastically anticipate their upcoming accomplishments to help move recovery forward.
After spending 5 months as a young Marine in a psychiatric ward in the National Naval Medical Center in Bethesda, Md., I was released. I told no one that I had been under treatment for schizophrenia.
I gained admission to a graduate school in international business, and upon graduation, found a job in management with a Fortune 500 company. Within a few months, however, I was hospitalized again after having another “breakdown.” After being released again, I discovered that I could not find employment anywhere.
During the next 2 years, I would be re-hospitalized in Texas, Alabama, and Ohio. It was in Columbus, Ohio, that one day I was picked up by the police, brought before a court, and told that I had a degenerative brain disease. I was further apprised that I would probably spend the rest of my life being cared for in state hospitals. I still remember the words of the magistrate: “I hereby declare you to be an 'insane person' under the laws of Ohio and remand you indefinitely to the care of the state.”
The authorities apparently discovered that I had been in the military and sent me to be treated in the nearby veterans' hospital. After a few weeks, I was discharged. I finally found myself a job a few months later, working in the psychiatric ward of a nearby prison. After a few years at the correctional facility, I went back to graduate school, this time in psychology. And in spite of having to be hospitalized twice while in school, I earned a doctorate and returned to government service. This time, I had a job in psychology at Ohio's largest state psychiatric hospital.
Somehow, just 12 years after having been put away as insane, I was promoted to be the director of psychology in the same hospital system that had committed me. I am still amazed by that. My superiors at the hospital were insistent that I tell no one about my condition, but after a few years, I decided that I would no longer hide in the shadows and not be open about who I am.
That was a little more than 20 years ago. Since then, I have been invited to give more than 2,000 speeches around the United States and abroad. In telling my story, I have several messages, but the main one is that I now absolutely refuse to be ashamed that I am a person with schizophrenia. I very strongly feel that mental illnesses are not conditions that one should have to hide.
—Frederick J. Frese, Ph.D., Associate Professor of Psychiatry, Northeastern Ohio Universities College of Medicine, and RTP Steering Committee Member
Psychiatric Advance Directives. Psychiatric Advance Directives (PADs) are recovery-oriented forms of crisis planning that allow consumers to state their preferences and instructions for future mental health treatment, or to appoint a substitute decision maker in advance of a psychiatric crisis. PADs take effect during a crisis when a consumer may lose capacity to make reliable health care decisions. Increasingly, consumers, families, and clinicians are recognizing that by completing a PAD, a consumer can maintain control over important treatment decisions even during a crisis and ensure treatment that is most consistent with a consumer's own crisis and recovery plan.
Although 25 states have now passed legislation in the past decade establishing authority for PADs, there is relatively little public information available to address growing interest in these legal tools. In addition, in states without explicit PAD statutes, similar mental health advanced-care planning can, and does, take place under generic advanced-care planning statutes.
To that end, with support from the John D. and Catherine T. MacArthur Foundation, the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine and the Bazelon Center for Mental Health Law developed the National Resource Center on Psychiatric Advance Directives (NRC–PAD, accessible at www.nrc-pad.org), a Web portal designed to engage consumers, family members, clinicians, and policy makers in learning about and sharing experiences in drafting and implementing PADs. The portal features up-to-date State information on PADs, links to each State statute, relevant forms to complete PADs, an online presentation discussing important aspects of PADs, and a short documentary film on their use. A blog features news, commentary, and interactive discussion. For more information, visit www.nrc-pad.org.
—Marvin Swartz, Professor of Psychiatry, and Director, National Resource Center on Psychiatric Advance Directives, Duke University Medical Center
SAMHSA has redesigned its home page to correspond to the Agency's eight Strategic Initiatives and has launched a new publications store that increases users' ability to access the behavioral health resources they need. SAMHSA.gov now features topic-based information and an easy-to-use online store. The new publications store replaces the National Clearinghouse for Alcohol and Drug Information and the National Mental Health Information Center.
As noted in the Resource Spotlight, the National Resource Center on Psychiatric Advance Directives (NRC–PAD) has a Web site for patients and consumers, health and legal professionals, and family and friends. The site contains information on how to get started, State by State facts, educational Webcasts, current research, noteworthy current events, legal issues, personal stories, and more.
Gayle Bluebird, R.N., peer networking consultant and one of the presenters of RTP's 2nd Webinar, often speaks at national conferences on the topics of the arts and developing peer roles in inpatient settings. She is the coordinator of a national network of artists, writers, and performers who are current or former recipients of psychiatric services, called "Altered States of the Arts.” The network promotes the arts as a vehicle for social change, personal empowerment, or healing.
The Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed national organization focusing on the most prevalent mental illnesses. The organization—which provides up-to-date, scientifically based tools and information written in language the general public can understand—works to ensure that people living with mood disorders are treated equitably.
To stay informed of all the RTP Resource Center’s many activities and events, and to receive all Resource Center communications, join the ListServ.
For more information about RTP, contact us at firstname.lastname@example.org, or call 877.584.8535.
The views, opinions, and content of this E-News are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.