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February 9, 2012 Volume 3, Issue 5
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The resources and publications produced by RTP provide in-depth perspective on issues related to recovery. What are your thoughts on The Issue of Insight, RTP's first Special Feature?

Teaching Recovery-Oriented Practices in Public Psychiatry Fellowships
by Jules Ranz, M.D., and Stephanie LeMelle, M.D.
The Columbia University Public Psychiatry Fellowship has been training public psychiatrists since 1981. Throughout this time, the fellowship faculty has closely followed changes in the field, and the fellowship training program has reflected these changes. Starting in the mid-1980s, psychosocial rehabilitation was presented as the core conceptual model underlying the practices of public psychiatry. To emphasize this concept, the entire didactic curriculum was based on principles of psychosocial rehabilitation. More recently, as the President's New Freedom Commission in 2003 promoted the concept of recovery, the entire curriculum has been refocused to promote recovery-oriented practices (ROP), starting with a discussion of the similarities and differences between psychosocial rehabilitation and ROP.

A second change in the curriculum has focused on inviting consumers to present as guest lecturers to fellows. Starting in the mid-1990s, consumers have been invited to share their experiences with regard to their work and housing. Their presentations focus on their recovery in these areas—not on their psychiatric histories. Because of the increased national attention on peers in the workforce, the fellowship has developed several sessions on peer training programs. During these lectures, peers describe their experiences in both training programs and work settings.

A third curriculum change has been a heightened focus on advocacy. It's been our experience that fellows rarely receive training in advocacy during residency. One of our graduating fellows encouraged us to develop a year-long module on advocacy, starting with an introduction to advocacy and continuing with a wide range of guest advocates over the course of the year. As part of this module, leaders of consumer and family advocacy organizations present their agencies' work. Many self-identify as consumers who use their experience as patients in the mental health system to enhance their roles as leaders of public sector agencies.

The case has been made by many that ROP can simply be viewed as rebranding of good clinical practice. However, we have found that refocusing our training program along the lines of recovery is much more than just a name change. Thus, focusing on the promotion of recovery-oriented practices places special emphasis on a wide variety of questions:
  1. Does the person being served prefer to be identified as a patient, consumer, or peer?
  2. What does that person identify as his/her goals?
  3. How can the psychiatrist assist the patient in attaining his/her goals?
  4. What are the special challenges of interacting with peers in the workforce?
  5. What role does coercive practices such as mandated outpatient commitment play in ROP?
  6. What is the relationship between ROP and evidence-based practices?
Each fellow spends 3 days a week throughout the year carrying out an individually fashioned combination of clinical, administrative, and program evaluation activities at one public sector agency. The fellow organizes seven presentations throughout the year describing how he or she is incorporating principles taught in the didactic program and implementing those principles at field sites. These presentations constitute the basic approach for teaching fellows how to incorporate ROP.

In one presentation, fellows analyze their field placement agencies using a structure called the Congruence Model, which was created at Harvard Business School. The goal of this presentation is to identify one or more incongruence(s) the fellow would like to address during his/her fellowship year. The recovery emphasis encourages fellows to involve consumers in the development and implementation of strategies created to deal with these incongruences.

A second presentation is on advocacy. Fellows explore and describe the kinds of advocacy taking place at their field agencies. This emphasizes the importance of advocacy in promoting recovery-oriented services.

The third presentation has been reorganized from what was called "systems-oriented clinical presentation" to "recovery-oriented clinical presentation." In this presentation, fellows are encouraged to explore how a recovery orientation actually impacts a patient's course of treatment.

We regard ROP's promotion as an ongoing mission of our training program. It is a work in progress for both our program and the 14 public and community psychiatry fellowship programs that have been developed—almost all since 2006. Since 2009, a yearly meeting of all public and community psychiatry fellowships has been held at the Institute on Psychiatric Services. The meeting has helped us explore how to teach psychiatrists to incorporate ROP into their clinical practices. In conjunction with this meeting, an annual survey of training programs is conducted. In the survey, promotion of recovery-oriented services is listed by fellowship training directors as one of the highest priorities (4 of a possible 5-point rating), following only leadership development and clinical services to public sector patients.

Peer Power
An excerpt by Keris Myrick from Mad in America, an online community for news, recovery stories, and perspectives on retooling psychiatric care.

Around the country, consumers of the public mental health system speak of "empowerment," "recovery," and "independence," while being disempowered and made reliant on a system that uses [recovery] as only a buzzword. Mental health programs refer to the people they serve (clients) as "members"—lifelong members in a club that given the choice, most would not choose to join. Yet our peers demand that their wellness, recovery, and [social] groups stay in mental health centers or drop-in (really drop-out) centers. Further, our peer-run organizations are primarily funded by local or State mental health departments, and Certified Peer Specialists are paid [by] billing State Medicaid.

Read the rest of this article.

NEW! RTP Resource
Lessons Learned in Peer Workforce Development
Well-trained peer support specialists can facilitate the recovery process and improve outcomes for people with mental health issues. Working one on one with consumers, peers have effectively lowered hospitalization rates and improved social functioning and relationships. Their ability to navigate mental health service systems often stems from personal experiences, and properly trained peers are uniquely positioned to enrich the lives of those who seek help.

Although peer employees have the potential to dramatically enhance mental health care, their transition to the workforce has its challenges. "Lessons Learned in Peer Workforce Development," a Behavioral Healthcare article written by Drs. Lori Ashcraft and William Anthony, describes the hurdles of peer training and recruitment, along with ways to ensure peer support specialists are positive role models who practice the following skills:
  • Dedication and commitment to work
  • Ability to create immediate connections with people they serve
  • Use of personal stories and lived experiences to inspire hope
  • Understanding of community resources and services, including accessibility
  • Development of healthy, supportive, and trustworthy relationships that others in the community can replicate
Read more about what peers can bring to service delivery.

February Is American Heart Month!
Heart disease and stroke are primary causes of death in the U.S. Unfortunately, people battling serious mental illness and addictions have a significantly higher risk for these life-threatening diseases. Not only do they suffer from conditions like diabetes, high cholesterol, hypertension, and obesity at up to two times the rate of the general population, those struggling with depression (particularly women) have an increased risk of stroke.

SAMHSA has joined the Million Hearts™ Campaign, a national initiative to prevent 1 million heart attacks and strokes over a 5-year period. Million Hearts™ partners with the American Heart Association, American Stroke Association, and countless other agencies to fight the Nation's leading killers.

Visit the new Million Hearts™ Web site to learn about the ABCS of good health:
  • Ask your doctor about the benefits of Aspirin.
  • Get screened for high Blood pressure and Cholesterol, and learn how physical activity and healthy eating can improve your numbers.
  • If you Smoke, seek support from others who can help you quit.

Fewer Foster Kids Prescribed Psychiatric Drugs
Children in Oregon foster care were prescribed fewer psychiatric drugs in 2011, which could be the result of a new law requiring child welfare officials to closely monitor medications.

Data provided by the State Department of Human Services showed 14 percent of children in Oregon foster homes were taking psychiatric medication—a decrease from 2008, when 20 percent of kids were prescribed drugs such as Ritalin, Prozac, and Zoloft.

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 practice.

Happy Valentine's Day!
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The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit stories or
other recovery resources, please contact Cheryl Tutt, MSW, at 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
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.