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The Coalition of Behavioral Health Agencies, Inc. Coalition Briefs
An electronic newsletter of the Coalition's Center for Rehabilitation and Recovery

Elizabeth Saenger, PhD, Editor
No. 104, June 2014

The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.

A Welcome Ethic for Behavioral Health

Elizabeth Saenger, PhD

When I went to the Charles B. Wang Community Health Center as a patient a few years ago, the walls in the lobby and stairwell breathed with colors which made me feel safe, comfortable, and welcome. I mentioned this to a staff member, and she told me the people in charge had thought seriously about the choice and arrangement of colors to achieve exactly this effect. Making patients feel at home had been a priority for them.

How can we make our clients feel at home, and encourage a culture of inclusion and recovery? We may not be able to afford a special paint job, but we can welcome people in other ways.

Be a Copycat

Let the receptionists who book appointments know how vital a welcoming voice is. Tell them about the annual All-Japan Telephone-Answering Competition for office workers. For more than fifty years, employees from companies across Japan have competed to win the title of Japan’s best phone answerer in a culture which prizes good manners.

Perhaps you could suggest your staff read the aforementioned article on answering the telephone. Are there techniques which were not included in the article which would be helpful with the people you serve?  How can a receptionist--or an administrator, or a custodian--transmit an ethic of recovery without even using the word?  Why, and in what ways, is the receptionist a critical part of the team?

Ask all staff members to recite the months of the year in the warmest tones they can. How do these tones compare with their everyday voices? Consider voting for the voice that feels most welcoming.

Think about the importance of welcoming callers in terms of establishing a sense of connection, humanizing the receptionist job, and reducing missed appointments.

Redecorate on the Copier Paper Budget

If your lobby has an institutionalized look, consider softening the decor. You might also post affirmative posters in your lobby and office that say, “Welcome,” verbally and nonverbally. Quotations, such as, “You miss 100% of the shots you don’t take” from Wayne Gretsky, may inspire your clients.

Some quotations can work through indirection, and metaphor. They plant seeds, and depending on the situation, allow clients to overcome barriers they have difficulty addressing successfully on a conscious level.

Warren Buffett’s, “Someone is sitting in the shade today because someone planted a tree a long time ago,” is an example. It reminds readers of the generosity of people in the past, but it also nurtures their patience by telling them it may take a while for acts to reach fruition. This may make them less likely to give up when their actions don’t pay off immediately.

Motivational quotations are easy to find online by Googling “inspiring quotations,” and just using the hits the come up first, such as brainyquote.com and  inspirational-quotes.info, which are collections of quotations.

Learn More About Stigma

Many of us probably believe we have internalized recovery values. Yet research today shows clinicians stigmatize people with mental illness, particularly schizophrenia, albeit less than the general population does. Research also indicates that it is difficult to change attitudes, and that current anti-stigma campaigns may not accomplish what their creators intend.

What could help us improve our attitudes towards people with psychiatric diagnoses? A study by stigma research superstar Patrick W. Corrigan and colleagues explored three possibilities. They found that attempts to suppress prejudice by presenting prejudiced positions, and then telling people these positions were morally wrong, had no effect on attitudes. Education--replacing myths about mental illness with facts--had a small effect. Direct contact with people with psychiatric disabilities had the biggest effect.

These results suggest that perhaps, as clinicians increasingly work with peer support service providers in the changing behavioral health environment, stigma will decrease. However, it would be too easy to suggest stigma will disappear on its own, without effort on our part. In-service presentations and activities using education and direct contact, perhaps with role models and authorities who have  psychiatric disabilities, should reduce stigma.

In addition, we can become more conscious of the little things we do every day that naturally convey acceptance, rejection, or ambivalence, towards clients: our tone of voice; how we lean towards, or away from,  clients in conversation; the completeness of our descriptions of their options.

Increase Cultural Competence

We probably assume that although we don’t know the details about other cultures, our good intentions, sensitivity, and common sense will enable us to provide competent care. But are we fooling ourselves? Are we like the majority of Americans, who think they are better-than-average drivers?

To find out, you may want to check out the Georgetown Cultural Competence Center. Although the Cultural Competence Health Practitioner Assessment (CCHPA) is being revised, other self-assessments and educational tools are available.

Some clinicians may feel that a culturally competent welcome involves merely handing out educational materials in different languages, posting appropriate posters on the wall, or knowing whether clients come from cultures which stress individual (vs group) achievement or identity. However, being truly welcoming means understanding individuals well enough to interpret variation in family constellations, as well as metaphors of faith, and despair.

If a lack of cultural competence reduces a sense of connection, clients may not return, may not feel free to volunteer critical information, and may receive inaccurate diagnoses.

A Welcome Ethic

In short, a welcome ethic requires time, and commitment, but little money. Critically, a welcome ethic embodies the community and support that facilitate recovery.

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To Be Straight But Not Narrow

Elizabeth Saenger, PhD

People who identify as LGBT (lesbian, gay, bisexual, or transgender) are more likely to see mental health professionals, and also more likely to be dissatisfied with the services they receive. This suggests those of us who want to be straight, but not narrow, need to better tailor care to individuals who may not fit into the molds we are used to. The good news is that we can do this: research shows you don't have to LGBT to be effective with LGBT clients.

To do so, check out the Provider Resources tab at the Rainbow Heights siteBasic Guidelines for LGBT Culturally Competent Treatment summarizes five guidelines in a single page, and downloadable materials, including Trans 101, provide accessible information at different levels of complexity.

For tips on how you can ask LGBTQ clients sensitive questions in a supportive way, listen to "Collecting Sexual Orientation and Gender Identity Information on the OMH 725 Patient Admission Form," a panel of national and local experts, including Christian Huygen, PhD, Executive Director of Rainbow Heights. Just enter your name and email address to access the program.

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To subscribe or unsubscribe to RECOVERe-works, a free publication of the Center for Rehabilitation and Recovery at the Coalition, please email esaenger@coalitionny.org.

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