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An electronic circular of the Coalition's Center for Rehabilitation and Recovery
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No. 59, March 2010
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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.
THE DIRECTOR’S NEW YORK MINUTE Turning Points “A long time ago in a galaxy far, far away,”(1) a young psychiatrist, named George Brooks, was flummoxed. He had received one of the first Smith Klein French fellowships to study the effects of the new drug called Thorazine. He put all the so-called hopeless cases on it and lo and behold 178 profoundly ill people became well enough to leave the backwards of Vermont State Hospital. However there was The message here is two-fold. First, we have known for a long time about a recovery model. It is 55 years old! We are now trying to transfer it to New York as the philosophical underpinning for PROS (Personalized Recovery Oriented Services) programs. Secondly, these Vermonters pioneered this collaborative, level playing field approach and it worked. It was an enormously creative and bold joint endeavor by both staff and patients. It was a turning point in mental health care. We now have that opportunity again to fully operationalize a recovery model within PROS, but it is very anxiety provoking. There is no question that this change is unnerving. Recently, the Center’s Associate Director, Aaron Vieira, LMSW, led a meeting with agency leaders about managing the human side of the PROS conversion process. Together, they generated a long and varied list of fears that people often experience when confronting organizational change. These included fears of the unknown, of being temporarily incompetent, of being judged and punished for this temporary incompetence, of losing status and professional identity. There are also fears of being marginalized by colleagues who are opposed to change. It is worth noting that consumers share many of the same fears. Everyone agreed that these underlying concerns need to be addressed if staff and consumers are to work together to create a stronger, recovery-based culture in a PROS program. Such a culture would provide the enhanced support that consumers need to achieve their life goals. Developing a person-centered, recovery-oriented culture must begin in the planning and implementation phases of PROS. Program leaders would do well to avoid using authoritarian and micromanaging methods during the PROS conversion process. That is because these approaches simply do not work. Authoritarianism provokes covert resistance. Micromanagement is very time consuming and disrespectful. It also stifles creativity and produces only incremental change. Fortunately, as Aaron pointed out, there are organizational strategies that do work. These include: comprehensive and transparent communications about the need to convert to PROS, presentation of the benefits of the new program design (e.g. reclaiming more lives), development of a clear vision and plan for PROS conversion, involvement of all levels of staff and consumers in the process, creation of a supportive learning environment, and regular celebrations of agency, staff and consumers achievements. These change strategies are supported by substantial research in organizational development as well as the direct experience of agency leaders running successful PROS programs in early adopter counties. The work of starting PROS programs in New York City will be hard at first. There will be fears and resistance pushing back against change. Everyone thinks that they are already using a “recovery model” so why change. However, PROS is actually a real cultural shift from the “one up and one down approach” used by many providers as they were trained by applying the “doing things to or for others” who are struggling. Just as George Brooks did, one has to admit that we do not know everything and ask “What do you need?” Then, one begins the process of working together, each pooling the knowledge between the two partners to make a plan and celebrate every little gain. The new system is being built on the strengths of everyone at the table just as rehabilitation is built on strengths. The old system and current providers display a depth of knowledge and experience upon which the new one is founded. We are not throwing the baby out with the bath water and starting from scratch. We are putting on a new set of glasses with which to see the world, our jobs, and our customers. The recovery movement is going on around the world. This is another turning point in mental health care. A couple of months ago, I took our OMH Statewide Comprehensive Plan(3) to Beijing for their NIMH to consider in restructuring their own mental health system. Suddenly we are seeing all sorts of new possibilities, discovering new strengths, and perhaps New York will become the next place where people come to see how we did it! 1) Lucas, G. Star Wars, 1977 2) Chittick, R.A., Brooks, G.W., Irons, F.S. and Deane, W.: The Vermont Story: Rehabilitation of Chronic Schizophrenic Patients. Burlington, VT., Queen City Printers, 1961 3) New York State Office of Mental Health: Statewide Comprehensive Plan (2009-2013), Albany, NY, Oct 1, 2009. Heart of PROS (Personalized Recovery Oriented Services) On February 4, Dr. Courtenay Harding, the Director of the Center for Rehabilitation and Recovery, presented on the worldwide evidence for recovery of people suffering from severe mental illnesses. Dr. Harding has spent her career investigating both the short and long distance course and outcome of schizophrenia and other disabling and episodic disorders. She drew not only from her own research with hundreds of individuals across two to three decades, but also eight other longitudinal studies around the world which showed a significant improvement or recovery rate higher than 50%. The research definition for recovery is very stringent: no more symptoms, no odd behaviors, no further medication, living in community, and working and relating well to others. The presentation emphasized the importance of seeing the person behind the disorder and focusing on a person’s strengths, needs and desires, all of which are conducive to recovery. The very basis and possibility of recovery for people suffering from severe mental illnesses highlight the effectiveness of a recovery-based approach to care and create an underlying pulse for PROS. Recovery in Clubhouses If Used As Transition
Through RECOVERe-works, he plans to showcase recovery stories he has collected from agencies around New York City in hopes of revealing that recovery from mental health issues is very much possible and expected. “It’s such a wonderful place,” Nica Wallenborn shared as we sat at the kitchen table in East New York Clubhouse. “When I came here as a member, I was very skeptical. But I fell in love with the model.” A clubhouse model is a unique way of caring for people who have mental health issues by emphasizing an egalitarian partnership between staff and members. It provides a safe and voluntary space for people, among other things, to develop relationships, gain confidence, and recover. As Blaise Sackett, the director of East New York Clubhouse, described, “We’re hoping that you don’t come here to end up here but to use the resources to move back to the community and live a more fulfilling and independent life.” For Nica, it has helped her battle major depression and refocus her hopes and dreams. Three years ago Nica suffered from depression when her son died, and she was subsequently hospitalized for multiple suicidal attempts. Stigmatized and locked in a “state of humiliating defenselessness,” Nica suffered the loss of her identity as not just a doctorate in genetics and biochemistry but also more importantly as a person. After Nica was referred to the East New York Clubhouse in November 2008, she was “stunned by the human way conflicting groups are harmonized in this small society of its own” that allowed for “regeneration” and a “new self-worth.” Through the constant support of the clubhouse community, Nica recovered from depression, organizes monthly newsletters and smoking cessation groups, and looks to become an international advocate for clubhouses and establish a clubhouse in Haiti. Nica’s story is just one of many I heard during my conversations with staff and members. I had the privilege of visiting East New York Clubhouse and Metro Club, both clubhouses under the Brooklyn Bureau of Community Service. Among the people I talked to, Dr. Lori Tannenbaum, the former director of Metro Club, highlighted the future of not just clubhouses but also behavioral health agencies in general by pointing out that we could do better in “helping people maximize their human potential by providing a culture of expectation that people will recover from their mental health issues and go on to lead happy, productive lives.” Nica’s recovery story is unique to her life, but at the same time it serves as an example of people who can recover and go on to lead happy, productive lives.
Note: Trainings sessions from the Center have been filling up fast and in some cases have been sold out. Thank you for your continued enthusiasm and support, and we will look to add new training sessions to meet the incoming strong demand. Introduction to Benefits Management FREE half day training offered in various locations across the city designed for clinicians and other staff interested in learning the nuts and bolts of benefits management. The latest changes in SSA guidelines will also be discussed. Facilitator: Margie Staker and Patricia Feinberg, MS To register for any Center training or presentation, please go to: www.coalitionny.org/the_center/training/ Note: If you are typing the URL in your browser, the space between “the” and “center” is in reality an underscore symbol “_”. Spanish-Language Health Care Conference Changing Your Destiny: Step by Step, for Latino families of individuals with developmental disabilities. Keynote speakers New York State Assemblyman Peter Rivera, Chair of the Assembly’s Committee on Mental Health, and Dr. Fabricio Balcazar, Professor in the Department of Disability and Human Development at the University of Illinois at Chicago and Director of the Center for Capacity Building on Minorities with Disabilities. Organization: Presented by Premier HealthCare, YAI/National Institute for People with Disabilities, and the Center for Rapid Re-Housing Services Grant Rapid Re-Housing Services, also known as Housing First, is focused on quickly providing homeless families with permanent housing first and then providing a set of services to promote housing stability. It is anticipated that DHS will award a single contract to serve 125 families Citywide who have shown the longest length of stay in shelter and possess barriers to permanency, the most significant of which are mental illness, substance abuse disorder or disabling medical conditions. The maximum available funding for the first two years is expected to be $1 million. Organization: NYC Department of Homeless Services (DHS) Positive Alternatives to Restraint and Seclusion Conference This two-day seminar will address the challenges of providing a safe and coercion-free environment for individuals in inpatient and residential treatment facilities. The conference will feature national best practices for preventing the need for restraint and seclusion Organization: New York State Office of Mental Health Bronx Mental Health Borough Council Meeting At this meeting, staff from the Center for Excellence in Integrated Care (CEIC) will present their plan to improve outpatient services for adults with co-occurring mental health and substance use conditions in NYC. Your contributions at the Mental Health Council Meetings provide us with valuable information to better support the community and each of you. Organization: Center for Excellence in Integrated Care (CEIC) Social Work Seminar This is a free open forum on social work services, community resources and building self esteem. Organization: Community Healthcare Network OMH/DOL Launch Training and Employment Initiative for Service Recipients The NYS Office of Mental Health (OMH) and the Department of Labor (DOL) are launching an exciting new initiative in partnership with the City University of New York (CUNY) to provide free training in Wellness Coaching for recipients of services in mental health programs. Service recipients who successfully complete a certificate program in Wellness Coaching at CUNY will be qualified to assume wellness coach or similar positions in mental health agencies that agree to sponsor the recipients. It is expected that the employment opportunities described here will benefit the provider community by adding enthusiastic, hard-working individuals to the work force. For service recipients, the benefits include increased stability and purpose, thus improving recovery outcomes. The Center strongly encourages agencies to sponsor qualified applicants for this initiative. For more information about the initiative, please download the documents below: Overview of the CUNY Wellness Coaching Certificate Program DEADLINE: Applications must be received by March 29th, 2010. Manhattan Consumer Educational Forum on PROS Presentation will be geared to the specific concerns of consumers, but providers are welcome to attend. Topics covered include services offered by a PROS program, the individual recovery plan, the current status of PROS in NYC, and the effect of PROS on the services consumers currently receive. Organization: New York City Department of Health and Mental Hygiene, Division of Mental Hygiene/Office of Consumer Affairs Palliative Care Conference The events of the conference will focus on the realities of health care and the compassionate continuum of palliative care to the thoughts and actions of the caregivers and those they serve. It has been said that the first step to compassion is competence. The main object of this year’s conference is for the participants to come away empowered to provide professional, competent, empathetic care to patients and their families. At this year’s conference we will provide frontline health and social care professionals with a wide variety of palliative care topics, presented by an outstanding group of speakers. Organization: Molloy College and F.E.G.S. Crazy Like Us In his book, Ethan Watters writes about the globalization of Western ideas of mental illnesses and he argues that such an effect is threatening local customs and understandings and our very understanding of the human mind. http://www.amazon.com/Crazy-Like-Us-Globalization-American/dp/141658708X Lloyd Sederer, MD Dr. Sederer, the Medical Director of the New York State Office of Mental Health, writes two articles about depression and antidepressants, and argues that doctors should take depression more seriously and that many different kinds of interventions, such as cognitive-behavioral therapy, interpersonal therapy, and psychodynamic therapy, are effective for people with depression. http://www.huffingtonpost.com/lloyd-i-sederer-md/lets-not-get-too-depresse_b_452599.html and http://www.huffingtonpost.com/lloyd-i-sederer-md/the-good-news-about-the-b_b_457464.html Mental Illness Manual Rewritten WedMD Health News reports on the latest changes to the DSM-V. http://www.webmd.com/mental-health/news/20100210/mental-illness-manual-rewritten OMH Update and Executive Budget Testimony OMH Commissioner Michael F. Hogan presented testimony supporting Governor Paterson's 2010-2011 Executive Budget proposal for the Office of Mental Health, to members of the State Legislature. http://www.omh.state.ny.us/omhweb/budget/2010/testimony.html Substance Use Treatment Need Among Uninsured Workers SAMHSA reports that more than 18.4 million full-time employees aged 18-64 have no health insurance coverage and out of those an estimated 3.0 million needed substance use treatment in the past year. http://www.samhsa.gov/SHIN/#NewPub |
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Eric Lu is a Junior Fellow in Behavioral Health at the Coalition’s Center for Rehabilitation and Recovery. The Coalition Home | Center for Rehabilitation and Recovery | Site Map
Tel: (212) 742-1600 Fax: (212) 742-2132