Psychiatrists Role in Recovery Oriented Systems and Promoting Wellness

1. Psychiatrists Role in Recovery Oriented Systems and Promoting Wellness Presented by: John B. Allen Jr. Special Assistant to the Commissioner New York State Office of Mental Health

2. What is it? • A beaver like tail • A viper like poison spur on the hind leg • The shoulder girdle of a crocodile • An otter like webbed foot • A bill like a duck • Lays eggs like a lizard • Nurses its young like a mammal • Fur coat

3. What are we talking about?

4. What’s the Problem? • Pharmacologist: Dopamine Receptor Problem • Family therapist: a family systems problem • Psychologist: a psychodynamic conflicts problem • Behaviorist: a contingenceny management problem • Activities/Vocational therapist: insufficient skills (deficit) problem • Rn: a management problem • Half way house staff: a living problem • Family : our child • Patient : no problem Richard H McCarthy, MD, CM, PhD Pilgrim Psychiatric Center

5. Norman Sartorius, former head of WHO's mental health program "Social factors play a major and important role in the outcome of disease," Sartorius said. "Very few solutions are medical in medicine."

6. Evidence from the World Health Organization’s Studies Patients in poorer countries spent fewer days in hospitals, were more likely to be employed and were more socially connected. Between half and two-thirds became symptom-free, whereas only about a third of patients from rich countries recovered to the same degree, Sartorius said.

7. Nigerian, Colombian and Indian patients also seemed less likely to suffer relapses and had longer periods of health between relapses. Doctors in poorer countries stopped drugs when patients became better -- whereas doctors in rich countries often required patients to take medication all their lives.

8. How do you respond? • I want to be the King of England • I plan to become an astronaut • I am going to be President • I am going to explore the amazon • I plan to build a house on the moon • I am going to be a Rock Star

9. HOPE!!! • Communication and belief in Recovery • Knowledge of longitudinal data • Address issues of chronicity versus possibilities of recovery • Linkage to role models of recovery • Addressing family and natural supports

10. Partnership and Collaboration Mark Ragins, M.D. The relationship is not centered around a powerful helping professional taking care of, protecting, and helping a weak, vulnerable, damaged patient. It is centered around helping someone with a mental illness define and pursue their own goals and life visions, empowering and educating them to learn to overcome their own illnesses, and encouraging risk taking and growth, learning from natural consequences and failures. It is far more like the role of coach than of doctor. Most of us naturally make this change when we are trying to help a friend or another doctor, treating them as colleagues or collaborators rather than as patients.

11. Promotion of Self Locus of Care • Self management teaching • Motivational interviewing • Naturalized treatment settings • Homework • Working with families and natural supports

12. What is my role? When a person asks the question, “Who am I?”, is the primary answer “I am a schizophrenic?” or is the answer “I am a person with friends; I am a person who likes to play the piano; I am a person who is trying to become an artist; I am a person who also has schizophrenia that I have to deal with”?

13. Self Identity “Of all of the modes maniacs use to maintain themselves, regular employment seems to be the most effective.” Thomas Eddy 1815 Report to the Governor of New York

14. Employment as Therapy • Source of income • Way to structure time • Meet friends • Feel productive.

15. Linkages • Self-Help / Peer Support Groups • Social Networking Groups • Use of Natural Support Systems • Faith Communities • Hobbies • Community Structures

16. Medication as a Tool • Understanding Personal Medicine • Other treatments • Physical exercise • Eating well • Avoiding alcohol and street drugs • Love • Solitude, art, nature, prayer, work, and a myriad of coping strategies are equally important to my recovery.

17. Overcoming Burn-out • Helpers desire to be helpful • Literature on Recovery • National Role Models • Confounds • Stagnation of Medication Maintenance • Revolving door patients

18. Keys to Recovery • Graduates rewarded for success, tell their recovery stories • Individuals award “Recovery Keys” to thank those that made a difference • Build a body of experiential evidence to create a tipping point in individual belief systems

19. In Summary In country after country, WHO found that strong social and family connections trumped high-tech medical facilities.

20. False Dichotomy “A false dichotomy has crept into psychiatry where you are EITHER a believer in the medical model and ‘hard science’ vs. a believer in the 'recovery model,' assumed to be based on fuzzy thinking, opportunistic pandering to 'consumers,' or some faith-based woodstock-like belief in love / peace / recovery and all else that's 'new age / counterculture”. Lew Opler, M.D. New York State Office of Mental Health

21. To be a good psychiatrist “One MUST have a holistic perspective, being both an expert in the biomedical aspects of mental health, but also the one member of the multidisciplinary team who is able to integrate the biological / psychological / social into the (as George Engels called it) biopsychosocial model--the work of Manfred Bleuler, John Strauss, others demonstrates UNAMBIGUOUSLY that recovery is not only possible, but in many cases the 'norm‘”

22. Contradiction of the Kraepelain Concept “Most M.D.'s need to see it to believe it: unfortunately, when someone previously labeled 'schizophrenic' comes along and is no longer symptomatic, it is assumed that the diagnosis was wrong given the kraepelian concept of inevitable downhill course: but this just ain't so!!!”

23. Modeling “The thought leaders in psychiatry-and within public psychiatry that included NASMHPD Medical Director’s Council--must embrace and integrate a recovery orientation and model it to those who work for them and, most importantly, to the next generation of psychiatrists”