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Recovery Model: 12 Part Recovery Series - By Roland Turk CEO/COO Glenside Regional Office 10/20/2006

Recovery Model

Recovery Series - Part #1
July 14, 2003
By Roland Turk
CEO/COO Glenside Regional Office

The recovery literature is replete with consumer anecdotal reports.  A number of researchers have analyzed these reports and summarized their findings.  The following is a brief overview of these findings:
 Recovery is:
• The reawakening of hope after despair
• Breaking through denial and achieving understanding and acceptance.
• Moving from withdrawal to engagement and active participation in life.
• Active coping rather than passive adjustment.
• Moving from alienation to a sense of meaning and purpose.
• A complex and nonlinear journey.
• Not accomplished alone—the journey involves support and partnership.
• Recovery means no longer viewing oneself primarily as a person with a psychiatric disorder and reclaiming a positive sense of self.
Some major themes of the recovery process are the following:
• Right kinds of medication
• A group of supportive people
• Meaningful activities
• A sense of control and independence
• A strong determination to maintain recovery
• A positive outlook on the present
• Optimism about the future.

Some perspectives of the recovery process:

The mental health system has gone from the process of deinstitutionalization through the establishment of community support and rehabilitation services and now, to recovery as the next step in the process.  Deinstitutionalization focuses on new uses of buildings and facilities, community support system is designed as a network of essential services to support persons with psychiatric disabilities and the field of psychiatric rehabilitation (psychosocial rehabilitation) emphasizes treating the consequences of mental illnesses.  Recovery speaks about how recipients of service will live and choose the services they need and want.  Service providers must be understanding and tolerant of the range of intense emotions experienced by consumers during recovery without diagnosing behavior as abnormal or pathological.  We must provide the environment that stimulates and encourages recovery.

The purpose of this note is to further set the groundwork for Milestones moving into the “recovery” arena.  As said earlier, this is not a question of simply changing the name of what we do.  This is changing what we do and how we do it.  It will involve teaching consumers what this model means and to apply it to themselves.  It will involve teaching ourselves what the words really mean and how we can apply them, day in and day out, in our work.
 
The following are essential services needed in the vision of recovery in the mental health system.  They were developed by Dr. William Anthony, a leader in the field.  These are:
• Treatment—alleviating symptoms and distress—symptom relief
• Crisis Intervention—controlling and resolving critical or dangerous problems—personal safety assured
• Case management—obtaining the services clients need and want –services accessed
• Rehabilitation—developing client’s skills and supports related to client’s goals—role functioning.
• Enrichment—engaging clients in fulfilling and satisfying activities—self development
• Rights protection—advocating to uphold one’s rights—equal opportunity
• Basic support—providing the people, places, and things clients need to survive—personal survival assured
• Self-help—exercising a voice and a choice in one’s life—empowerment
• Wellness/prevention—promoting health lifestyles—health status improved.

 
Recovery Model

Recovery Series - Part #2
July 29, 2003
By Roland Turk
CEO/COO Glenside Regional Office

Everyone should now be aware of a session on “recovery” sponsored by the Montgomery County Office of Mental Health on Thursday, August 7th, 2003 from 1 to 4 at the Human Services Center in Norristown  (please register if you would like to attend—and I urge you to attend).  The speaker will be from Contra Costa County in California and will discuss how the model is working in California.  The following is a definition of the Recovery Model from the Contra Costa, California Mental Health system:

“Recovery is often called a process, an outlook, a vision, a conceptual framework, a guiding principle.  There is no single agreed upon definition of recovery.  However, the main message is that hope and restoration of a meaningful life are possible, despite serious mental illness (Deegan, 1988, Anthony, 1993).  Recovery is….”both a conceptual framework for understanding mental illness and a system of care to provide supports and opportunities for personal development.  Recovery emphasizes that while individuals may not be able to have full control over their symptoms, they can have full control over their lives.  Recovery asserts that persons with psychiatric disabilities can achieve not only affective stability and social rehabilitation, but transcend limits imposed by both mental illness and social barriers to achieve their highest goals and aspirations.”
Please attend the session on August 7th and try to figure out how to implement these ideas fully into our program.   I am sure that there are many unanswered questions in all of our minds. 

There are many states that have implemented the recovery model.  One of the earliest and one where the most work seems to have been done is Ohio.  I have downloaded much information on the Ohio recovery model (as well as the recovery model of Spokane Washington) and have them on the table outside my office.  Please feel free to review the material and to copy anything you would like to have.  I will be selecting a number of these documents to distribute in the weeks and months to come.  The following 3 pages are from the Ohio Recovery Model and describes some basic components.
 
Recovery Model

Recovery Series - Part #3
July 1, 2003
By Roland Turk
CEO/COO Glenside Regional Office

The following statement regarding the recovery model of mental health services is designed to give you a beginning understanding of the model. I am urging your strong commitment to learn about them, to understand their implication and to do all that you can to implement the application of these new concepts.  PLEASE UNDERSTAND—THESE ARE NEW CONCEPTS NOT NEW NAMES TO OLD IDEAS.  The process is called a paradigm shift—that is to move from one set of ideas to another.  It does require an understanding of a basic approach to the delivery of services.  In coming weeks and months we will give more concrete information on these ideas.  First the following is an overview of service development:

1. These changes will take place over a 2 year period
2. The new concept is called the “recovery” model of service delivery and includes elements from several major researched ideas.
3. Long term partial hospital programs will no longer exist being replaced by several other programs (one being acute partial program),
4. Another major program will be an intensive outpatient program and a Mobile Psychiatric Rehabilitation Team.
5. There will be an expansion of CTT and ICM services (these programs will be delivered in the manner that these programs were designed NOT necessarily in how they are being managed in Montgomery County.  That is there will be a move to outcome evaluations, to a team model of CTT, and use of  “recovery” coaches)
6. Initiation of a Certified Peer Specialist program
7. Initiation of a Mobile Psychiatric Rehabilitation service
8. Evaluation of the function and program specifications for current Social Rehabilitation Programs.
9. Expansion of the Intensive Support Network program for persons with serious mental illness

The following are some expected outcomes:

1. Decreased inpatient utilization through decreased re-admissions (these outcomes will be carefully tracked)
2. Increased consumer satisfaction on critical measures
3. Increased in “recovery status”
4. Increased number of consumers whose medication regimens are consistent with nationally accepted norms (see Texas Algorithm Study—detailed information to come!)
5. Increased use of atypical medications.
6. Increased number of consumers with ICM and CTT involvement.
7. Increased use of crisis residence (rather than ER or inpatient bed)
8. Increased “engagement” for inpatient discharges and aftercare follow up.
9. Increased number of consumers with a WRAP (Wellness, Recovery, Action, Planning).
10. Increased number of ICM working the 2nd and 3rd shifts in “non conventional” work week.

We are certain that no one will disagree with the ideas and ideals presented above.  However, to truly understand these words requires an understanding of the philosophy behind the words.  The “recovery” model has the following mission statement:  Applying principles of disease management to assist in the treatment of chemical dependency and/or serious mental illness”. 

The concept of “recovery” requires a paradigm shift in our thinking as mental health providers.  We must no longer think about people with mental illness as always being disabled.  We must, first of all, see people who experience mental illness as human beings who can move on to better times in their lives.  And yet—recovery does not mean “cure”.  It is a way of living in order to make the most out of life.

Just as we have learned about JCAHO and HIPPA, we now must understand the concepts of the “Recovery” model of service delivery and need to become familiar with  its basic elements and its philosophic underpinnings. 

Stay tuned and be prepared to learn and apply.
 
Recovery Model

Recovery Series - Part #4
August 6, 2003
By Roland Turk
CEO/COO Glenside Regional Office

The following is a continuation of our efforts to share with you the new direction and vision of the recovery model.  This service model is, increasingly, becoming a trend around the United States.  The information that I am distributing is designed to give you a better understanding of this model and how it will be applied here at Milestones.  Interestingly, most Pennsylvania Counties have expressed a strong desire to follow this model and have developed plans to implement it. 

The following “Assumptions about Recovery” were developed by Bill Anthony at the Center for Psychiatric Rehabilitation at Boston University.  He is one of a number of leading experts of this model and wrote the following in 1993. 

 

Factors/ Items

1.   Recovery can occur without  professional intervention

Reasons

Professional do not hold the key to recovery; consumers do.  The task of  professionals is to facilitate recovery; the task of consumers is to recover.  Recovery may be facilitated by the consumer’s natural support system.

2.   A common denominator of recovery is the presence of people who believe in and  stand by the person in need of recovery

Seemingly universal in the recovery concept is the notion that critical to one’s recovery is a person or persons in whom one can trust to “be there” in times of need

3.   A recovery vision function        

is not a function of one’s           theory about the causes of         mental illness   

Recovery may occur whether one views the illness as biological or not. The key element is understanding that there is hope for the future, rather than understanding the cause in the past.

4.   Recovery can occur even though symptoms reoccur

The episodic nature of severe mental illness does not prevent Recovery.  As one recovers Symptoms interfere with Functioning less often and for Briefer periods if time.  More of One’s life is lived symptom-free.

 

 

5.   Recovery is a unique process

There is no one path to recovery, nor one outcome.  It is a highly personal process

6.   Recovery demands that a person has choices

The notion that one has options from which to choose is often more important than the particular option one initially selects.

7.   Recovery from the cones-quences of the illness is sometimes more difficult than recovering from the illness

These consequences include discrimination, poverty, segregation, and consequences of detrimental treatment/medications and services from the mental health community

It is important to note that the recovery model and some of the ideas discussed in the CSP (Community Support Programs) developed by the National Institute of Mental Health in the 1980’s (and followed by the Consumer Satisfaction Teams, particularly) are in total congruence with one another.  The elements in the following table are almost identical to the principles of the CSP model of care.  Thus, the recovery model is moving in the same direction as the CSP and will add to those ideas.    The following gives a brief overview of the essential services in a recover-oriented system with expectations for consumer outcome. These were  also developed by Dr. William Anthony and his colleagues at Boston University.

Essential Services in a Recovery-Oriented System

Service Category

Description  

Consumer outcome

1. Treatment       

Alleviating symptoms

Symptom relief

2. Crisis Intervention

Controlling and resolving critical or dangerous problems

Personal safety

3. Case management

Obtaining the services clients need and want

Services accessed

4. Rehabilitation

Developing client skills and supports related to their goals

Role functioning

5. Enrichment   

Engaging clients in fulfilling and satisfying activities

Self development

6. Rights protection

Advocating to uphold one’s rights

Equal opportunity

7. Basic Supports  

Providing the people, places and things clients need to survive (e.g.shelter, meals, health care)

Personal survival assured

8. Self Help

Exercising a voice and a choice in one’s life

Empowerment

9. Wellness/prevention

Promoting healthy lifestyles

Health status improved

There will be much more specific information coming in weeks/months on the recovery model.  Please continue to acquaint yourself with the language, the concepts and the principles. 

 
Recovery Model – The Importance of Language Use

Recovery Series - Part #5
October 17, 2003
By Roland Turk
CEO/COO Glenside Regional Office

There are many aspects relating to the shift from a “disease model” of mental health services to a “recovery model”.  Earlier documents you received described, in general, some of the global differences.  You also know that consumers are the focal point of recovery, that figuring out ways of helping consumers find hope and strength in their recovery are some of the critical elements of this new paradigm.  The following information requires you to think about traditional ways you have used language to describe consumers and consumer related problems.

Many words used in the past to describe psychiatric patients and their disabilities are obviously problematic.  Highly offensive words such as “basket case”, “looney tunes”, “funny farm” communicate condescension, blame and the perception that these individuals are defective.  The offensive aspects of seemingly professional terminology are often more subtle.  How these terms are used from an interpersonal or systemic standpoint is generally more important than their overt meaning.   

A good example is the term “decompensate” which is used to indicate that a person is having more distress.  It does not refer to a specific clinical finding, spectrum of symptoms or event, so that the clinician who is referred a person who “decompensated” knows nothing about the person’s needs or history.  The term is generally used to designate someone who is defective and fragile, who cannot take care of him/herself and who cannot tolerate
stress and therefore falls apart.  “Decompensating” is an us-them term; under stress “we” may not do well’ “we” may cocoon, take to bed, get bummed out, get burned out, get a short fuse, throw plates, scream, call in sick, or need a leave of absence.  “they” decompensate.  Occasionally, the term is used with overtone of superiority that is clearly intended to convey the power difference between the “competent professional” and the “sick client”.  The recovery literature suggests that people abandon this term in favor of describing, briefly but accurately, what the person is experiencing.  For example “after skipping his medication for a week, Tom could not sleep, started pacing at night and complained of hearing voices.”  This brief statement factually describes Tom’s experience and gives meaningful information that begins to suggest interventions that may be helpful. 
Respectful clinical language should focus both the clinician and the recipient on the search for the most successful tools for health and recovery.  

Other words or terms that are problematic:

1. “He/she is at baseline” What does that really mean? 
2. “he/she “trashed the place and needs to be 302ed ” This does not describe anything.  What trashing to me may not be trashing to you. Furthermore a 302 is NOT a punishment but one of the ways to ASSIST consumers receive adequate service.
3. Consumer “resists” or “rejects” services.  Could it be that what you are offering does not meet the consumer’s needs? 

I think that it would be helpful to engage consumers in our program in a dialogue and ask what words or phrases THEY find offensive and why.  How are they “turned off” when people speak to them or with them.  What words are particularly offensive. 

It is important to hear our words as we speak with one another.  Hear them from your perspective but also hear them as they are heard by others.  Are there words that you find offensive as they are spoken by others on the staff—colleagues, supervisors, supervisees, administrators, family members?   Offensive and destructive language becomes accepted when we ignore them or when we fail to realize their meaning or intent.  The recovery model (as well as common decency) is a change in philosophy and a change in philosophy requires serious thought about not only, conceptual issues but also basic language issues.   
 

Recovery Model

Recovery Series - Part #6
November 25, 2003
By Roland Turk
CEO/COO Glenside Regional Office

The series of overviews which have been sent, 1 through 6, focused on many of the underlying ideas, philosophy and conceptual thoughts regarding the paradigm shift from a medical or clinical focus of service delivery to one described as the recovery model.  We have learned that focusing on consumer needs, wants, desires and dreams is one of the most important aspect of this change.  In order to assist in accomplishing these ideas, we need tools appropriate to this model.  There is of course, the WRAP (wellness recovery action plan) methodology which will be offered by Montgomery County Office of Mental Health.  Milestones purchased a series of 7 Life Management Skills manuals which can be replicated and which may be used with consumers in a variety of ways.  Enclosed we have replicated the table of contents of each of the 7 manuals and I will ask the hearing partial program, the Deaf partial program and Durham House to select one of the manuals to field test its contents in their program.  I will then ask the director of the program to give a report at our December 23 Management Meeting. The verbal report ought to include its effectiveness, relevance to consumer needs, appropriateness in terms of the recovery model, and  its acceptance by the consumers and staff using it etc. 

As you may know, Central Montgomery CMHC has begun to implement the recovery model and has made significant changes to its program.  As with any change, this can be difficult and painful.  We hope to minimize as best we can some of the difficulties by giving staff as much information as possible to clarify, specify and describe forthcoming major changes.  We cannot read for you nor “spoon feed” any more information than we have done.  It is up to you, as individual professionals, to learn as much as you can and to take the information given, share it widely and use it. 
ASK QUESTIONS, DISCUSS AND LEARN 

  
Recovery Model – Partners for Excellence

Recovery Series - Part #7
March 3, 2004
By Roland Turk
CEO/COO Glenside Regional Office

Our SPEAK UP program is well under way.  A number of training programs have been held (the most recent led by Tracie Bryce Chandler last week) and letters to consumers and their families are going out. We are progressing well with this activity.   

This note and the following document will highlight our Partners in Excellence program which is just beginning.  The enclosed overview will give you a basic idea of the program and its content.  I must say that last week’s experiences in Piscataway proved to be very exciting.  Fran, John, Claire and I attended the training along with agencies representing  Florida, Western New York, Georgia, and Lenape Valley, a CMHC in Bucks County.  Agencies from 30 states have already been trained and, this year, we were a part of 150 other agencies being trained.  Thus, this is a national endeavor designed to revolutionize care for people with severe mental illnesses. 

As you will learn in the year to come, we are indeed, on the leading edge of a national movement to empower consumers and their families, giving them information and tools to assist in their recovery.  New ideas are sometimes frightening since their outcome is generally unknown.  I can assure you that the new ideas discussed in the material that you will see, has been tested and the major researchers have outstanding reputations.  One of the individuals, I have known and worked with personally and am confident of his incredible talent.  Dr. Kim Mueser, was at EPPI a number of years ago and worked with Dr. Allan Bellack in developing new and wonderful tools to assist persons with severe mental health illnesses.  He is one of the key individuals who helped develop and design many elements of this program. 
You may view the title of his many writings on the “recovery” table outside my office.  Dr. Mueser’s work as well as that of Dr. Bill Anthony’s are on the forefront of “best practices” in our nation.  Consumers at Milestones will profit immeasurably!     

The Recovery Model—SPEAK UP—Partners for Excellence in
Psychiatric Training Program

The next steps in Milestone’s progression toward the recovery model of mental health care has come.  Two major developments are occurring before the implementation phase of the Montgomery County plan (see Overview
# 1 July 1, 2003 if you are unsure of this plan).  These next 2 steps  are related to the recovery model and require some actions on your part.

1.  Milestones has been selected by Bucks County OMH to participate in Partners for Excellence in Psychiatric Training Program.  This is a three modules training program given by the University of Medicine and Dentistry of New Jersey—University Behavioral HealthCare in Piscataway.  John Bulman, Fran McDonald, Claire Heilman   and I will be attending a 3 day program at the end of February to learn how to train staff, consumers and family members in administering the 3 modules.  Consultants from the school will meet with all of us during the next year to assure that we are implementing the program adequately.  The first phase of this project includes a 10 minute questionnaire all of our staff will need to complete.  John and Fran will hand out these questionnaires within the next few days (or may have done it already). Please complete it as soon as possible and return them to Fran and John. 

This exciting venture will help us “…become part of an elite group of 150 behavioral healthcare organizations from across the nation with a common mission of advancing psychiatric care beyond symptom reduction to further enhance the lives of persons suffering from severe and persistent mental health disabilities….” (CEO of UMDNJ-University Behavioral Healthcare).  The ideas and ideals of this training program are perfectly fitted to the recovery model.  We are indeed, happy to be involved and are looking forward to the training sessions.

2.  SPEAK UP! JCAHO, the national accreditation organization which accredits Milestones (as well as all of the Salisbury Behavioral Health entities) has designed the SPEAK UP Campaign in its continuing endeavor to improve the quality of life for all consumers.  SPEAK UP promotes empowerment and self-advocacy in consumers and their families by providing them with the knowledge and tools that they need to be full-participants in decisions that affect them and their care, treatment or services.  SPEAK UP is the recovery Model in action.

S—speak up if you have questions or concerns about your treatment or
       services you are are receiving
P—Pay attention to the care you are receiving,
E—educate yourself about your treatment, care and service plan,
A—ask a trusted family member or friend to be your advocate
K—know what medication you take and why you take them
U—use a behavioral health care program that has undergone rigorous on-site
       Evaluation
P—participate in all decisions about your treatment, care or service.

This campaign requires a lot of people’s involvement and participation.  Consumers and families need to be educated to understand these ideas and to utilize them in the best possible way.  Pam and Tracie will take the lead in helping learn the actions we need to take.  However, key staff must participate actively if this is going to be successful.  This note asks you to take two actions steps. 

1. Everyone who receives this memo must read it, sign and date the bottom of this page to indicate that you have received it and return it to my attention as soon as possible.
2. The persons listed below, must attend a training meeting with Pam and Tracie to begin to implement this SPEAK UP Campaign.
This meeting will be in early February and we will notify you in terms of specific place, date and time.

Brett Talbot             Marshall Stokes      Karen Jones    Debra Sloane
Tonie Anderson      James Cole              Linda Jones     Megan Perillo
Emily Swann          Chris Gontar            Wendy Heines
Julie Diaz-Poore     Keely P.-Stamps      Amy Bacon
Tareeta Steward     Barbara Hamilton     James Brown

At the end of this month,  all consumers will receive a letter from Paul Volosov, the President of our company, giving them a broad overview of the SPEAK UP Campaign.  The staff listed above will meet during the 2nd week of February to begin the training by Pam and Tracie in order to help all consumers and family members become involved in implementing the campaign.  Immediately, you ought to discuss this memo in all community meetings and keep SPEAK UP as a permanent agenda item.   

Much more information will follow through meetings and memos.  Please stay involved, ask questions and PARTICIPATE.


 
Recovery Model – Where are we today?

Recovery Series - Part #8
June 3, 2005
By Roland Turk
CEO/COO Glenside Regional Office

The next page is a statement by the American Psychiatric Association which is endorsing the recovery model.  Mental health services has come a LONG way!

Where are we today?

You will agree with me that we have come a long way in our understanding of the recovery model and its implication.  The 9 previous overviews, the many training programs attended by us, the new Peer Specialist Program instituted by Montgomery County Office of Mental Health, the Co-Op residential program we pioneered, the SPEAK-UP Campaign and the Partners for Excellence training program currently going on in several of our programs and sponsored by Bucks County Office of Mental Health are all examples of the recovery program in action. These are extentions of the long history our organization has had in supporting consumers humanely and effectively.   Enclosed you will find a document presented yesterday for Executive Directors and Senior Management Staff of Bucks County Provider agencies by Joan King and Betsy Gorski which gives a nice summary of the recovery model. The material ought to be familiar to you and ought to be a refresher rather than anything new.  As always, the most important concern is not only in understanding the model but in APPLYING the principles in your day to day work. 

• How do you engender hope?
• How do you encourage consumers to use the WRAP? 
• How do you help consumer relieve the symptoms which can be so debilitating? 
• How can you assist in enriching a consumer’s life? 
• How do you assure that consumer’s rights are protected? 
• How do you use language to support not to demean?

These and many other points need to be applied daily in our work.  How to do that effectively is an ongoing challenge.  Training, education, creative thinking and continuing to “raise the bar” of our work is my challenge to all of us.  


Recovery Model – A Psychiatric Perspective

Recovery Series - Part #9
June 3, 2005
By Roland Turk
CEO/COO Glenside Regional Office

The 5 county region sponsored a wonderful training held on June 2, 2005, featuring Dan Fisher, M.D., Ph.D. who is the Executive Director of the National Empowerment Center (NEC) and a practicing psychiatrist.  Dr. Fisher is one of the few psychiatrists in the country who publicly discusses his recovery from mental illness.  He is a role model for others who are struggling to recover, and his life dispels the myth that people do not recover from mental illness.  Dr. Fisher is a board certified psychiatrist who completed his residency at Harvard Medical School and who has received many awards for his seminal work.  A few highlights of his presentation follows:

1. Long-term studies (25 years and more—see Courtney Harding’s work completed in 1987) clearly indicate that up to 60% of persons with severe and persistent mental illness have been shown to recover completely.
2. President Bush’s 2004 New Freedom Commission’s vision on this issue states “ a future when everyone labeled with mental illness will recover and to do so care must focus on increasing the consumer’s ability to successfully cope with life’s challenges….not just on managing symptoms”
3. Medication is like a foundation of a house.  The house, however, must be build by the consumer.  Nevertheless, medication may not always be the answer.  Dr. Fisher was diagnosed with schizophrenia, spent time in psychiatric hospitals, was on medication but now has not used medication for 25 years and has been managing his symptoms  using a variety of supports to help him. 
4. Principles of recovery:

    a. trust
    b. self-determination
    c. hope: believing you’ll recover
    d. believing in the person
    e. connecting at a human level 
    f. people are always making meaning
    g. having a voice of one’s own
    h. all feelings are valid
    i. important to follow dreams
    j. relating with dignity and respect

5.  Step one in recovery
    a) recovery principle:  People need to believe they will recover in order to recover
    b) consumer’s initial beliefs: I have no hope, and I will never recover
    c) Peer coach’s response:  You can and will recover like I and many others
    d) Consumer’s new beliefs:  I have confidence I can and will recover

6. Step two 
    a) Recovery Principle:  People need people to believe in them, to help them believe in themselves
    b) Consumer’s initial belief:  I don’t believe in myself and no one else believes in me
    c) Peer coach’s response: I believe in you at your deepest level
    d) Consumer’s new belief:  I accept that other people believe in me and now I believe in myself

          There are eight additional steps which I would be happy to share with you

7. Characteristics of a person who has recovered from mental illness
          • makes their own decisions
          • fulfilling network of friends
          • Major social role other than consumer
          • Copes with severe emotional distress
          • Most untrained person would not consider him/her sick
          • Primary supports are outside the MH system

Recovery Model – Do People with Schizophrenia recover over time?

Recovery Series - Part #10
June 3, 2005
By Roland Turk
CEO/COO Glenside Regional Office

An intriguing question whose answer has dramatically changed over time.
Dr. Courtney Harding’s work in the “Vermont Longitudinal Study” AND 10 other long-term scientific investigations confirms that a full ½ to 2/3rds of those suffering from schizophrenia recover significantly over time.  Dr. Harding studied dozens of chronic patients who were ill for as long as 16 years and totally disabled for over 10 years.  They were released from Vermont State Hospital and were served in the community via medications and psychosocial rehabilitation.  Dr. George Brooks who was the clinical director of a community facility used a comprehensive, flexible program of psychosocial rehabilitation and medications to develop social and work skills, to help the consumers regain confidence and cope with daily living.  All of the former patients were studied extensively for over 30 years.  It was found that 62% to 68% were significantly improved or completely recovered.  45% of Dr. Brook’s program graduates no longer had sign or symptoms of any mental illnesses.  60% were productive;40% were working and 20% were volunteering.  After several decades a majority tapered off medication.  The LEAST effective treatments were by those doctors who espoused stabilization and maintenance, medications and entitlements.  The MOST successful had symptom and medication management, case management, individualized treatment planning; a social life; productive work; self-sufficiency; integration into the community and HOPE.

Dr. Harding states: “ We’ve forgotten a secret weapon is on our side—resilience.  People facing life challenges, such  as serious illness, trauma, disability or disadvantage, can significantly improve through their ability to sustain grief and loss and renew with hope and courage.

If you are interested in reading more, please see the Journal of Psychiatry, “The Vermont Longitudinal Study of Persons with Severe Mental Illness, Long Term Outcomes of subjects who retrospectively met the DSM-III Criteria for Schozophrenia”  June 1987.
 

Recovery Model – How do we measure recovery?

Recovery Series – Part #11
September 28, 2005
By Roland Turk
CEO/COO Glenside Regional Office           

Since July 2003, we have been hearing and reading about the “Recovery Model” of service delivery.  We have learned various definitions, understood the many components of this model, learned various “tools” in our “tool box”, learned some words and concepts to use and not use as well as heard and read about a range of ideas and ideals of this model. 

The next step is to find ways of identifying outcome measures to help us understand whether we are indeed using this model and/if it is understood by consumers and/if it is working.  A CQI (Continuous Quality Improvement) workgroup led by the Southeast Regional Office of Mental Health has been meeting to “wrestle” with this matter.  One of our staff members, Eric Bigelow, was involved with Rich Gladstone and other members of a sub group, in designing a beginning document to address this important topic.  We will “test” the draft document at Durham House in an attempt to see how the concepts are implemented in vivo (that is in real life).  The expectation is that we will then go back to the CQI group with our findings for further revisions.  Ultimately, we hope that all mental health offices of the 5 counties will use the tool to measure the Recovery orientation of all provider agencies. 

Enclosed you will find the first draft of the tool.  It includes working definitions and Elements of Self Determination, Elements of Community Integration and Elements of Recovery.  Under each bullet we hope to describe how the concept is applied or seen within our programs or services.  I urge you to review the tool and help us come up with a wide range of views of how those bullets are applied in your work environment.   

If you have questions, comments or suggestions, please feel free to speak directly to me or give me feed back in any way that you chose.
 

Recovery Model

Recovery Series - Part #12
By Roland Turk
CEO/COO Glenside Regional Office

First and foremost it is important to understand that the last 2 year’s focus on the Recovery Model, has as much to say about our relationship to one another as it does about our relationship with consumers.  The principles outlined in the past 13 overviews must affect how we treat one another as well as how we work with consumers.  Having said that, there are some differences and some important principles which must be understood.

1. As employees of this organization we have a moral and ethical responsibility to know our job, to understand its critical features, to continue to learn and refine our skills, and to help others with these ideals.
2. As responsible adults we must be self-motivated, ethical in all of our behaviors, and function as if we “owned” the company.  That is to say, be careful on how money is spent, how energy is used, how vans are driven, how safety conscious we are, how seriously we put into play the many policies and procedures we have, and how we use our time.  Obviously, we will not be perfect  but our goal is to  understand the most important elements of our work and strive to improve and achieve.
3. As supervisors and managers we need to find ways of “catching people doing the right thing”.  That is, in assuring that people know their job, know the range of their responsibilities, know where and how to receive help if they so need it, and be supported in doing it.  AND, say what you mean, mean what you say and say it to all who 
need to hear it.  I have yet to work in an organization that was not concerned about its system of communication.  It will NEVER be perfect but we must constantly strive to improve it. AND, rumors are terribly destructive.  Find ways to hear truth and if in doubt ask your supervisor or managers, or operations director or chief operating officer or chief executive officer. 
4. Understand the mission and values of the organization and pursue excellence
5.  Most importantly, treat everyone like you want to be treated.  A universal statement often forgotten in our day to day existence.

Of course, there is much more to be said in terms of these important principles.  Let us hope that in this new year, we embark on a continuing mission to strengthen our in-service and training program, that we continue to learn ways and means of becoming even more creative and innovative that we have been, and that we not wait for our supervisors or administrators to figure out problems we are having or are seeing.  It is only by working together that we strengthen one another and help make our organization the best that it can be.


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