Mental Health Recovery

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Mental Health Recovery

• James G. McDonagh, Psy.D.,
• Clinical Psychologist,
• Local Recovery Coordinator,
• Ralph H. Johnson Veterans Administration
  Medical Center
• james.mcdonagh_at_va.gov

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Mental Health Recovery

• Topics
• What is Recovery?
• What are the origins of Recovery?
• How is Recovery different than B.A.U.?
• When, where, and how can we change the system?
• Why should we try to affect change?

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Mental Health Recovery

• is 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. (emphasis added)
• - U.S. Dept. of Health and Human Services

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Mental Health Recovery

• The 10 Essential Premises of Recovery
• An individual with mental illness
• 1. Self-direction can lead, control, and
  exercise choice over his/her future.
• 2. Person-Centered is considered to be fully
  human the individual is not primarily defined
  by his/her mental illness rather, his/her mental
  illness is only component of his/her existence.

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Mental Health Recovery

• The 10 Essential Premises of Recovery
• An individual with mental illness
• 3. Empowerment has capacity to exercise choice
  to consider a range of options
• 4. Holistic has a life marked by mind, body,
  spiritual, and community dimensions

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Mental Health Recovery

• The 10 Essential Premises of Recovery
• An individual with mental illness
• 5. Non-linearity will have an individualized
  life course set-backs and relapses are both
  anticipated and serve as opportunities for future
  growth
• 6. Strengths-based will possess strengths
  these strengths serve a primary role in
  self-fulfillment strengths are the core to
  effective interventions

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Mental Health Recovery

• The 10 Essential Premises of Recovery
• An individual with mental illness
• 7. Peer-support is part of social system as
  such, he/she can give support and receive support
  from others
• 8. Respect often confronts the debilitating
  effects of stigma often internalizes the
  shame/guilt of mental illness needs to be
  treated like everyone else.

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Mental Health Recovery

• The 10 Essential Premises of Recovery
• An individual with mental illness
• 9. Responsibility is assumed to be accountable
  for here-in-now decisions and future decisions
  has to make the decision to recover.
• 10. Hope can (and often will) obtain a
  meaningful life will always have the capacity to
  continue to enhance his/her life.

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Mental Health Recovery

• So, is Recovery a
• Process?
• Product?
• Culture?

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Mental Health Recovery

• Recovery isa Philosophy.
• It informs processes
• It yields distinct outcomes
• It is reflected in the totality of socially
  transmitted behaviors patterns, arts, beliefs,
  and institutions of human work and thought
  i.e., culture.

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Mental Health Recovery

• The Origins of Recovery
• 1. World Health Organization (1970s)
• Longitudinal Studies of Persons with SMI
• Heterogeneous outcomes

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Mental Health Recovery

• Origins of Recovery
• 1. Americans with Disabilities Act (ADA)
• 2. Consumer Movement (NAMI, etc.)
• 3. Substance use/abuse AA/NA

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Mental Health Recovery

• Origins of Recovery
• The Presidents New Freedom Commission on Mental
  Health (July, 03)
• Commitment to evidenced-based practices
• Consumer driven
• Expand rehabilitative services

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VA Recovery

• The Uniform Mental Health Services in VA Medical
  Centers and Clinics (9/11/08)
• Delineates the essential components of the
  mental health program to be implemented
  nationally(page T-1)

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VA Recovery

• The Uniform Mental Health Services in VA Medical
  Centers and Clinics (9/11/08) (43 page document)
• Recovery mentioned 27 times
• Evidence-Based mentioned 27 times
• Suicide mentioned 21 times
• Only 2 Positions are directly mentioned/elaborated
  in the Handbook Local Recovery Coordinator
  Suicide Prevention Coordinator
• Reason Recovery Suicide Prevention efforts are
  to cut-across all services

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Mental Health Recovery

• Recovery vs. Business as Usual (BAU)
• Partnership vs. Provider-driven
• Strength-based vs. Sympt. Reduction
• Treats Person vs. Treats Illness
• Rewards Progress vs. Rewards Illness

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Mental Health Recovery Changing the System

• Psychosocial Rehabilitation and Recovery Center
  (PRRC)
• Provide ambulatory (non-residential) services to
  veterans with serious mental illness
• Designed to maximize functioning in all domains.
• Intensity of service utilization is expected to
  decrease over time as veterans develop skills
  necessary for community reintegration
• Individual therapy, social skills training,
  psycho-ed. groups, illness management, general
  wellness programming, family ed programs,
  peer-support services, CWT, etc.

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Mental Health Recovery

• Measuring Outcomes
• Achieving a meaningful role
• Subjective life satisfaction
• Perception of control over his/her MI
• Number and quality of interpersonal Rel.
• Object measures of physical health

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Landmark Studies that Support Recovery in People
with Schizophrenia
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Definitions of Recovery

• Most of the researchers in these studies defined
  recovery as
• being without symptoms
• off psychotropic medications
• living independently in community
• working
• relating well to others with no odd/unusual
  behaviors

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SAMHSAEvidenced Based Practices

• Assertive Community Treatment
• Integrated Dual Disorders Treatment
• Wellness Management Recovery
• Supported Employment
• Medication Management
• Family Psychoeducation

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Research to support Evidenced Based Practices

• Mc Hugo G, Bebot R, Harris M, Cleghorn S, Herring
  G, Xie H, Becker D, Drake R A Randomized
  Controlled Trial of Integrated Versus Parallel
  Housing Services for Homeless Adults With Severe
  Mental Illness. Schizophrenia Bulletin 2004
  30949-982
• Patterson T, Bucardo J, McKibbin C, Mausbach B,
  Moore D, Barrio C, Goldman S, Jeste D Development
  and Piolot Testing of a New Psychological
  Intervention for Older Latinos with Chronic
  Psychosis. Schizophrenia Bulletin 2005
  31922-930
• Reeder C, Newton E, Frangou S, Wykes T Which
  Executive Skills Should We Target to Affect
  Social Functioning and Symptoms Change? A Study
  of a Cognitive Remediation Therapy Program
  Schizophrenia Bulletin 2004 30 87-100
• Wolff N, Helminiak T, Morse G, Calsyn R,
  Klinkenberg W. D, Trusty M Cost-Effectiveness
  Evlauation of Three Approaches to Case Management
  for Homeless Mentally Ill Clients Am J Psychiatry
  1997 154341-348

• Barrowclough C, Haddock G, Tarrier N, Lewis S
  ,Moring J, OBrien, R ,Schofield N Mc Govern
  JRandomizedControlled Trial of Motivational
  Interviewing, Cognitive Behavior Therapy, and
  Family Intervention for Patients with Co Morbid
  Schizophrenia and Substance Abuse Disorders. Am J
  Psychiatry 2001 1581706-1713
• Kern R, Liberman R, Kopelowicz A, Mintz J, Green
  M Applications of Errorless Learning for
  Improving Work Performance in Persons with
  Schizophrenia. Am J Psychiatry 2002 159 1921-
  1926
• Mc Gurk S, Mueser K, Feldman K, Wolfe R, Pascaris
  A Cognitive Training for Supported Employment2-3
  Year Outcomes of a Randomized Controlled Trial.
  Am J Psychiatry 2007 164 437-441
• McHugo G, Drake R, Teague G, Xie H Fidelity to
  Assertive Community Treatment and Client Outcomes
  in the New Hampshire Dual Diagnoses Study.
  Psychiatric Services 1999 Vol 5 No. 6

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Mental Health Recovery

• Why try
• It works, it saves money
• The people we serve (and their elected officials
  who fund us) want it
• Beneficence and avoid harm Ethical Resp.

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Mental Health Recovery

• The Mantra
• Nothing about us, without us.

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Mental Health Recovery

• Change, as is Recovery, is an on-going journey
  that takes a lifetime.
• It takes time.

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Mental Health Recovery

• A debt of gratitude
• Direct Supervisor Dr. Hugh Myrick
• VAMCs Chief of Staff Dr. Flo Hutchison
• VAMCs Director Mr. John Goldman
• VISN Director Mr. Lawrence Biro
• Most Importantly The Veterans we serve