cimh webinar series wellness centers and peer-driven programs session # 1- recovery perspectives in...

CIMH Webinar SeriesWellness Centers and Peer-Driven

Programs

Session # 1- Recovery Perspectives in Wellness

ModelsAnne MacRae, PhD, OTR/L, BCMH, FAOTA

Occupational Therapist and Project ConsultantTrinity County Behavioral Health Service (TCBHS)

Professor of Occupational TherapySan Jose State University

anne.macrae@sjsu.edu

History of the Recovery Movement

© MacRae, 2012

What is Wellness?

QUESTION

Are Mental Health Professionals Prepared to Address Wellness?

Mental Health Service in Two WorldsMedical Model Social Model

•Hierarchical organization•Deficit based (symptoms,

pathology)•“Bottom up” approach

(components)•Focus on illness

•Population based goals and objectives

•Outcome based•“Clinical” Recovery – experiencing a partial to

complete remission of symptoms

•Grass roots organization•Strength based (function,

inclusion)•“Top down” approach (personal

meaning)•Focus on wellness

•Individually based goals and objectives

•Process based•“Personal” Recovery – Finding

meaning and satisfaction as a contributing member of one’s

community

© MacRae, 2012

Top Ten Professional Concerns (Part One)

10. Recovery is old news. “What’s all the hype? We’ve been doing recovery for decades.”

9. Recovery-oriented care adds to the burden of mental health professionals who already are stretched thin by demands that exceed their resources. “You mean I not only have to care for and treat people, but now I have to do recovery too?”

8. Recovery means that the person is cured. “What do you mean your clients are in recovery? Don’t you see how disabled they still are? Isn’t that a contradiction?”

7. Recovery happens for very few people with serious mental illness. “You’re not talking about the people I see. They’re too disabled. Recovery is not possible for them.”

6. Recovery in mental health is an irresponsible fad. “This is just the latest flavor of the month, and one that also sets people up for failure.”

Reference: Davidson, L. , O’Connell, M. Tondora, J. Styron, T., & Kangas, K. (2006). The top ten concerns about recovery encountered in mental health system transformation. Psychiatric Services, 57(5), p. 642.

Top Ten Professional Concerns (Part Two)

5. Recovery only happens after, and as a result of, active treatment and the cultivation of insight. “My patients won’t even acknowledge that they’re sick. How can I talk to them about recovery when they have no insight about being ill?”

4. Recovery can be implemented only through the introduction of new services. “Sure, we’ll be happy to do recovery, just give us the money it will take to start a (new) recovery program.”

3. Recovery-oriented services are neither reimbursable nor evidence based. “First it was managed care, then it was evidence-based practice, and now it’s recovery. But recovery is neither cost-effective nor evidence based.”

2. Recovery approaches devalue the role of professional intervention. “Why did I just spend ten years in training if someone else, with no training, is going to make all the decisions?”

1. Recovery increases providers’ exposure to risk and liability. “If recovery is the person’s responsibility, then how come I get the blame when things go wrong?

QUESTION(S): Addressing Professionals’

Concerns

What concerns have you heard voiced by mental health professionals?

How do you answer them?

Common Peer ConcernsAnger at past treatment

“For years I was told that I would never get better. Now you want me to run things?”

Poor self-image/lack of confidence

“I can barely take care of myself! How can I help others?”

Not feeling prepared –

“I have never held a job. What do I do?”

Lack of trust in professionals/system

“This is not real. The professionals or “Normies” will take over anything I try to do”.

Fear of worsening illness

“I’m not sure I can take the stress of this responsibility.”

Unclear role –

“Aren’t you paid to do this? Why should I do your job?” Sources:

*Underwood, C. & MacRae, A. (2013). Recovery perspectives. In E. Cara & A. MacRae’s Psychosocial Occupational Therapy: An Evolving Practice. (3rd Ed.)Clifton Park, NY: Delmar, Cengage Learning.

* Focus groups conducted in Northern California

QUESTION(S): Addressing Peer Concerns

What concerns have you heard voiced by peers?

How do you answer them?

Peer-Professional Collaboration

Define or re-define roles

(Identify the specific and unique expertise of each stakeholder within a wellness/recovery perspective)

Honor past pains and the difficulty of transition for everyone

(Practice letting go of anger and resentment)

Establish communication

(Develop strategies for enhancing effective communication and trust, as well as mechanisms for airing grievances)

Nurture a supportive environment

(Provide training as needed)

Give up or claim power

(Create a “chain of command” as well as opportunities for shared decision making)

ClosureAny questions/final comments?

Resources(Available from CIMH or from Anne MacRae)

Where do we go from here? March, 30th - Wellness Centers: Models and Programming

April 27th -Employees with Lived Experience within County Systems

May, 18th - Sustainability and Funding Streams

Feedback is welcomed!Shoshana Zatz szatz@cimh.org

Anne MacRae anne.macrae@sjsu.edu