Engaging Consumers

1. Engaging Consumers Panelists Dr. Robert Freeman, St. Vincent’s Services and Tony Trahan, NYS OMH with Celia Brown and Dr. Anthony Salerno NYS Office of Mental Health

2. Introduction • St. Vincent’s Services • Wellness/Recovery Orientation • Engaging Consumers • Shared decision making & motivational interviewing • Conversations about coping & how to talk about medications • Questions for consumers to ask • Webinar Q&A

3. Setting the Stage Wellness and Recovery Orientation

4. St. Vincent’s Services Wellness Center Initiative Ideas • Fitness Day • Heart Healthy Clinic • Cholesterol/Lipid Screening Day • Blood Glucose Levels • Trendy Topics

5. Wellness Perspective • Learning about recovery and what it can mean for you • Fostering hope in wellness rather than maintenance • Start with consumers goals and hopes, not with their symptoms • Fostering a healthy lifestyle • Resources: Wellness Self-Management Workbook

6. Wellness Self-Management Talking Points • Making the best use of your mental and physical health services • Staying well by decreasing symptoms of a mental health problem • Learning how to manage day-to-day stress and prevent relapse • Staying well by connecting with others • Staying well by living a healthy lifestyle • Recognizing and building on your cultural values and experiences to support your personal recovery *Wellness Self-Management: Personal Workbook (January 2008), NYS Office of Mental Health, Anthony Salerno, Ph.D.; Paul Margolies, Ph.D.; Andrew Cleek, Psy.D.

7. Engaging Consumers • Shared Decision Making • Motivational Interviewing

8. Shared Decision Making • Institute of Medicine’s Rules for Patient-Centered Care • Customize patient needs and values • Patient is the source of control • Shared knowledge and free flow of information • Need for transparency • Anticipation of needs

9. Motivational Interviewing • What is Motivational Interviewing? • The Principles of Motivational Interviewing • Express empathy • Develop discrepancy • Avoid argumentation • Roll with resistance • Support self-efficacy

10. Principles of MI • Express empathy • Goals are to build trust & supporting client • Active and reflective listening • Develop discrepancy • Clarify client’s goals that are both feasible and healthy • Identify steps to reach goal • Avoid argumentation • focus on discrepancy, or ambivalence, within the client's thinking vs. discrepancy between the client and the counselor

11. Principles of MI cont. • Roll with resistance • If a client doesn't want to go in a certain direction, don’t fight it/roll with it • Encourage the client to explore all the possible answers to his own questions and concerns • Support self-efficacy • Demonstrate optimism and belief in the client's ability to change • Help client achieve success on small, realistic goals

12. Engaging Consumers • Conversations about Coping • Talking about Medications

13. Conversations about Coping • Coping with Stigma • Coping with Stress • Identifying personal stress triggers • Strategies for preventing stress • The illusory quest for chemical balance • Coping with Side Effects of Medication

14. Recovery vs. Maintenance (Pat Deegan) Any changes can create some anxiety which can be used for positive change How to discuss side effects with consumers –(refer to NMHA brochure) Resources: Wellness Self-Management: Personal Workbook and National Mental Health Association brochures (NMHA) Medication

15. Medication Discussion Points • Purposes of Medication* • Reducing current symptoms • Reducing the chances of having symptoms in the future • FDA oversight and current issues • Antidepressants *Wellness Self-Management: Personal Workbook (January 2008), NYS Office of Mental Health, Anthony Salerno, Ph.D.; Paul Margolies, Ph.D.; Andrew Cleek, Psy.D.

16. Medication Discussion Points cont. • What is a cross taper? • Risks and benefits of medication • Side effects (NMHA brochure) • Effective use of medication • Making an informed decision • Identifying barriers to effective use • Strategies to overcome barriers

17. St. Vincent’s Services • Medical Staff Meetings • Needed changes discussed at every meeting • Involve each medical staff member • Risk management and liability assessment • Tools • Medical/Psychiatric Assessment Monitor • Chart Review Form • Wellness Materials and Tips

18. SVS: “Medicalize” Office Space • Media: bulletin boards, literature displays, internet • Forms: family medical history, symptom checklist, compliance tool, medication consents & side effects • Tests: physical exam, labs, consults • Keeping appointments “on time” • Able to be reached to discuss problems with medications

19. SVS: Issues/Approach for Successful Medication Change • Engage consumer around problems of medication • Development of medical/psychiatric special review form • Change through the prism of lifestyle enhancements • Non-compliant or is something else happening? • Concept of medical traumatic stress disorder • Encouragement

20. Questions for Consumers to Ask • NMHA “Fostering a Dialogue for Recovery” brochure – how doctors can enhance communication with consumers (http://www.mentalhealthamerica.net/go/dialogueforrecovery for resources) • http://www.fda.gov/Drugs/ResourcesForYou/Consumers/default.htm for questions for consumers to ask about medications (Food and Drug Administration) • http://www.aacap.org/cs/root/facts_for_families/talking_to_kids_about_mental_illnesses for parents to talk about mental illness with their children (American Academy of Child and Adolescent Psychiatry)

21. Webinar Q&A Please feel free to type any questions you may have regarding any of the topics we discussed today. Thank you for your participation.

22. Summary Thanks to panelists and participants. PSYCKES website will be updated for your reference. PSYCKES-Help@omh.state.ny.us for any additional questions or comments about today’s webinar.