Recovery from Serious Mental Illness: Conceptual Overview Mary A. Jansen, Ph.D.

1. Recovery from Serious Mental Illness: Conceptual Overview Mary A. Jansen, Ph.D. Bayview Behavioral Consulting, Inc. Vancouver, BC

2. Topics • 1. Recovery • 2. Rehabilitation • 3. Barriers and Challenges • 4. Psychology’s Expertise • 5. What We Need To Do To Bring About Change

3. Recovery and Rehabilitation:What’s it all about? • Recovery • Recovery is based on the novel idea that individuals with serious mental illness can recover and live productive lives in the community – just like anyone with an illness that may flare up from time to time • Client’s process of regaining functional capability • Rehabilitation • Consists of the supports and interventions provided • The primary focus of rehabilitation is on improving the capabilities and competencies of persons with serious mental health disorders

4. Hope Essential catalyst Person Driven Consumer leads; empowered Many Paths Based on person’s experiences Highly Personal Dependent on person’s own goals; individualized Non-Linear Continual growth; ups and downs Holistic Encompasses entire life Support Supported by peers & allies Relationships & Social Networks Belief in person’s capability for recovery Based in Person’s Culture Key aspect Addresses Trauma Often a pre-cursor Individual, Family & Community Responsibility Foundation for recovery Respect Acceptance Recovery Principles (SAMHSA, 2006, updated 2011)

5. Mental Health Recovery • Mental Health Recovery: • Recovery is what people with illnesses and disabilities do Treatment, case management, support and rehabilitation are the things that helpers do to facilitate recovery(Anthony, 2002) • A journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential (SAMSHA, National Consensus Statement on Mental Health Recovery, 2006) • A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (SAMHSA, Definition of Recovery, 2012).

6. What Does it Take to Recover? • Recovery from mental illness involves: • Challenging and overcoming the stigma that persons with SMI have incorporated into their very being • Recovering from the iatrogenic effects of treatment settings • Recovering from lack of opportunities for self determination • “Nothing about us, without us” • Recovering from the negative side effects of unemployment • Recovering from crushed dreams • Recovery is often a complex, time-consuming process – just as it is with any serious illness

7. The “Mental Patient” Lens • “The mental patient lens is the one many of those with mental illnesses have learned to look through every time we are uncomfortable, have intense feelings or experiences, or difficult relationships.” • “It is a lens that reminds us that our feelings and thoughts are different than other peoples’ and that we must take care. We must avoid stress, risk-taking, and challenges, assume others know better than we do, and that there is a medication for everything.” Mary Ellen Copeland, 2004, NASMHPD National Consensus Conference, Report on Recovery

8. What Difference Does a Label Make? • Getting the label out of the person: “Not too many years ago, I was Mary Ellen Copeland, manic depressive. Because I had this label, my family was told not to expect much of me. I learned not to expect much of myself. I became dependent on the mental health system to maintain, at best, a minimal life style. I saw myself through a mental health system lens that was confining and oppressive. Now I see myself through a different lens, a lens that is Mary Ellen Copeland, educator, author, mother, wife, woman.” Mary Ellen Copeland, 2004, NASMHPD National Consensus Conference, Report on Recovery

9. Mental Patient to Person • Those working to recover struggle to realize that being uncomfortable and having difficult feelings is something they can deal with. These feelings and thoughts don’t have to be symptoms of anything. One’s strengths and resources can be used to get through difficult times. • This is the process of changing from mental patient to person, from patient with symptoms, to person with thoughts, feelings, and experiences.

10. Normalization – From Old Wine to New Bottles • Normalization • Principle that those with any disability or impairment should be treated with respect, provided functional supports, and treated as normal human beings.Wolf Wolfensberger, 1972, The principle of Normalization in Human Services, Toronto, National Institute on Mental Retardation • But when will those with mental illnesses become people instead of their label? • When will it be commonly accepted that people, who from time to time, have troubling feelings, thoughts, behaviors, and experiences (does this include you and me??), can also have control over their own lives, do the things they want to do, and be the way they want to be?

11. Medical Model Illness/problem focused Past traumas/failures Doing for the individual provider/team recommends Long-term dependence Office, clinic & community based Recovery Approach Strength based Success oriented Doing with the individual Integrated team/partnership Graduated independence Community based Present/future focused Approaches Differ

12. Life • People with SMI Want • Meaningful relationships • A safe place to live • Satisfying activities • Adequate income • Job satisfaction • An enjoyable social life • What do you want?

13. Psychosocial Rehabilitation • Focus • The primary focus of rehabilitation is on improving the capabilities and competencies of persons with serious mental health disorders • How • By using evidence based practices and other empirically supported clinical interventions • Within a recovery oriented framework • i.e., one which is driven by the client and one which operates from a belief that recovery is possible

14. Psychosocial Rehabilitation • Research has determined that certain interventions are rehabilitative for persons with serious mental illness, i.e., they foster gaining or regaining of functional capabilities* • When delivered as designed and researched – with fidelity • These interventions are now the gold standard for helping individuals with serious mental illnesses regain their maximum functional capability *The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements

15. Why Are Recovery and Rehabilitation Underutilized? • Barriers • Low expectations of what is achievable by consumers, clinicians, and families • Lack of knowledge about what symptoms are due to illness and what are due to client’s and society’s reaction to that illness • Lack of will to provide proven interventions to bring about optimal recovery • Lack of resources to provide proven interventions to bring about optimal recovery • Fear of changing the status quo

16. Challenges • Challenges: • A difficult challenge is to change the attitude of existing staff and those being trained in traditional professional training programs in order to: • Let everyone know that that people with SMI can, and do recover and lead satisfying lives • Eliminate the stigma that many professionals have even today; • Change the service delivery system from one which delivers medication and psychotherapy to one which focuses on rehabilitation and the potential of each person to recover to the greatest extent possible

17. Psychology’s Expertise • More than any other discipline, psychologists have the expertise to change the mental health service delivery system: • Research expertise • Clinical expertise • Team leadership expertise • Policy and administrative experience and know-how • Training expertise and programs • We have an ethical mandate to promote and use the most efficacious interventions – those that have been proven to make a difference in the lives of those we work with

18. Training Limitations • Limitations Psychology Faces • There are not enough psychologists trained in recovery/rehabilitation assessments, interventions, and systems change • Very few doctoral training programs teach or emphasize the concept of recovery, and the methods of psychosocial rehabilitation • Most psychologists are still trained in the traditional methods that their mentors were trained in, i.e., a pathology and deficits approach • New models train psychologists in how to help people improve their functional skills using a strengths approach

19. Steps to Change • What We Need To Do • Training programs that offer coursework, practica, internships, and post doctoral fellowships in these new models and methods are needed • Develop, advocate for, overcome resistance to, and implement: recognized specialty programs in SMI in APA accredited doctoral and post doctoral programs • De-stigmatize working with people with SMI, even those who are most seriously ill • Recognize and reward psychologists who work with people with SMI • Encourage APA, State Psychological Associations, and relevant APA Divisions to advocate for those who are most vulnerable in society

20. Steps to Change • What We Need To Do, cont’d • Use the provisions of the Affordable Care Act – Below Are All Available in the Act: • Demonstration projects To conduct research in less well-resourced environments on: • effectiveness of already identified EBPs • efficacy of promising practices • Demonstration projects To provide coordinated and integrated services to adults with mental illnesses who have co-occurring primary care conditions or chronic medical diseases • Develop patient-centered treatment models, e.g., “medical home” and others • Funding for training of psychologists in mental and behavioral health to work with vulnerable populations, including those with severe mental health disorders

21. Conclusion • People with SMI DO recover and lead satisfying lives • Our job is to support them and offer the best interventions that science has to offer • Stigma, trauma, and iatrogenic effects of treatment itself are some of the worst aspects of the illness • Psychology training is behind the times: Accredited doctoral programs do not provide training in the new concepts and methods • Just released: • APA Curriculum to train psychologists in Recovery and Psychosocial Rehabilitation • Available from www.apa.org/pi/rtp

22. Curriculum Modules • Instruction Module • 1. Introduction to Recovery • 2. Recovery, Health Reform and Psychology • 3. Assessment • 4. Partnership and Engagement • 5. Person Centered Planning • 6. Health Disparities • 7. Interventions I • 8. Interventions II • 9. Interventions III • 10. Forensic and Related Issues I • 11. Forensic and Related Issues II • 12. Community Inclusion • 13. Peer Delivered Services • 14. Systems Transformation • 15. Scientific Foundations

23. Citation for this Module: American Psychological Association & Jansen, M. A. (2014). Introduction to Recovery Based Psychological Practice. Reframing Psychology for the Emerging Health Care Environment: Recovery Curriculum for People with Serious Mental Illnesses and Behavioral Health Disorders. Washington, DC: American Psychological Association. www.apa.org/pi/rtp Citation for the full Curriculum: American Psychological Association & Jansen, M. A. (2014). Reframing Psychology for the Emerging Health Care Environment: Recovery Curriculum for People with Serious Mental Illnesses and Behavioral Health Disorders. Washington, DC: American Psychological Association. mjansen@bayviewbehavioral.org

24. Mary A. Jansen, Ph.D. Bayview Behavioral Consulting, Inc. Vancouver, BC mjansen@bayviewbehavioral.org