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June 2, 2011 Volume 2, Issue 20
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Sewing a Mental Illness Recovery Banner
By Mark Ragins, M.D.
Many people are dissatisfied with our current mental health system, and yet, true change is rare. The combined forces of inertia, politics, reimbursement procedures, bureaucracy, liability fears, and hopelessness often seem too formidable to overcome. They can, however, be vanquished if we work under a banner of clearly articulated vision and values. Deinstitutionalization proved that. I believe that banner now should be passed on to recovery.

When I try to explain to others why I work as a psychiatrist with people with serious mental illnesses, I talk about recovery. I talk about people like John, who has recovered in the year and a half since I met him. John has manic–depressive illness with periods of severe psychosis and homelessness and a severe substance abuse disorder. He had repeatedly lost everything in life due to these conditions, but was ready to try again. He had just gotten out of a locked program after about a year and moved into a board and care. Since I’ve met him, John has stayed on medication, lithium and risperidone (except for an experiment we did together, trying to get him off risperidone). He has worked a strong substance abuse recovery program, going regularly to several meetings a week. He has a sponsor, and is now working step 6. With my assistance, John’s conservatorship was dropped, and he moved in with his old girlfriend, also in recovery. He began working as a computer data-entry clerk for us part time, and within several months was doing so well that he felt limited by this job. So he returned to college and took computer classes, in which he earned all As. John now has a full-time job working with computers, making $2,500 a month. He is off Social Security. He is also engaged to be married. In my opinion, John is recovering.

Recovery versus cure. We often confuse recovery with cure. People can recover. Illnesses can be cured (well, mostly only infections or broken bones, but that’s another story). You can, however, recover without any effective treatment for your illness (e.g., recovering from a stroke or a heart attack). Take Christopher Reeve, for example. Before he passed away, he had recovered, even though his spinal cord was still broken.

It is also perfectly possible to recover without having an illness at all. You can recover from a serious divorce, a parent’s death, being raped—all kinds of terrible things. We get such tunnel vision with our pervasive medical model and get so busy treating illnesses that we never focus on whether the person is being helped with their recovery. It may therefore be easier for us to conceptualize and define recovery for someone without an illness, like a friend recovering from a divorce.

My present conceptualization is that recovery has four components: (1) hope, or a positive vision for the future; (2) empowerment; (3) self-management; and (4) a meaningful role or niche in life.

Applying this conceptualization to my friend recovering from a divorce, first, I’d help him by trying to give him hope for the future. “Things will work out. You’ll get over her; you’ll find someone else. Plenty of women would want you.” (I was touched when a woman recently told me her 5-year-old son had triggered her recovery from a divorce by saying, “It’s all right, Mommy. You and me can make it without Daddy.”) Second, I’d empower him by telling him, “You’re a good guy. You’ve got a lot going for you. Plenty of women will want you. You just have to get out and meet them. I think you’ve really learned from this and grown from this experience.” I’d support him doing things to change his emotions and his life. “Come on, you can hang out with me for a while. We can even go out together to meet women. I know someone you might like.” If, months later, he’s still relying on me to take him out, that’s not recovery. That’s being taken care of. So third, I’d tell him: “Hey man, you’ve got to start going out on your own. You can’t rely on me for everything. I’ve seen you with women. You’re OK; you can do it.” Fourth, he’d have to find a role in life. “Being single is not that bad. You still get to see your kids, and they love you. You’re doing well at work. Your life is OK.” I would submit that these are all familiar components, because they reflect how we naturally view recovery when it’s removed from the medical realm. I think we’d also all agree that if my friend achieved all four steps, he’s recovered from his divorce.

Banner to promote change. These same four components also apply to people recovering from severe mental illnesses. Unfortunately, when these steps are moved back to a medical realm, they begin sounding rather unscientific, difficult to assess, and certainly not reimbursable. Nonetheless, they form a solid value core by which to assess our own practice and techniques, our relationships and our outcomes, and even our program design and system structures. They can be woven together into an effective banner for promoting and evaluating changes in our mental health system.

When I look over many of the things I’ve written in the past several years, they fall into two categories: (1) papers trying to define and expand upon one of these components and (2) papers applying this recovery value set to a particular aspect of my work (e.g., substance abuse or family issues). The banner is gradually becoming clearer, with important pieces fitting together—often in surprisingly integrated ways.

This banner can be used to promote change in two ways. First, on a personal level, individual mental health workers and people with mental illnesses (and even administrators) can be exposed to stories about each of these components and about specific practices and relationships relevant to them. Often, a presentation structured in this way feels rejuvenating or even inspiring, since it touches on the feelings that led us into this work in the first place and that have kept us going since. Old dying embers can be relit. When I present using this approach, many people tell me I’ve given voice to the thoughts and feelings they’ve always had, but had neglected for a long time.

Second, this concept can be used on a program or administrative level to form mission statements, value statements, principles, and purposes for mental health services. Then we can discuss if what we’re doing is serving these values or harming them. Some things may be a necessary evil, while others are good targets for efforts at change. One administrator told me that what he really liked about our program was how clearly he could see the application of our values to our practice. Value-driven reforms, especially when supported from above, can have real power.

According to a story about the formation of a village, when the task force on the issue was first created, members of the task force were advised not to just complain and criticize. Instead, they were advised to identify things they liked and things they wanted. “Tell me,” the Lieutenant Governor said, “does anything work?” I think we are ready now to answer that recovery works, and explain what it is and how we can promote it. It can be a powerful positive force for change in a way that criticism and complaints never could be. It can be our banner. Let’s sew it together.

Forthcoming Solicitation for Proposals for NIMH Outreach
Partnership Program
The National Institute of Mental Health (NIMH) will invite applicants to submit proposals for consideration as an NIMH Outreach Partner for the following States: Colorado, Connecticut, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York and New York City, Ohio, South Carolina, Tennessee, Texas and Texas Border Area, Utah, Vermont, Virginia, and Wisconsin. Nonprofit organizations that conduct outreach on mental health are invited to submit proposals for participation in the NIMH Outreach Partnership Program, which is designed to facilitate and increase the use of science-based information on mental disorders nationwide. Organizations with experience in child and adolescent mental health and/or mental health disparities are encouraged to apply.

The solicitation will be available on the NIMH Outreach Partnership Program Web site at http://www.nimh.nih.gov/outreach/partnership-program/solicitation-process/outreach-partners-solicitation-process.shtml, at 10:00 a.m. ET on Thursday, June 9, 2011.

Applicants are selected as NIMH Outreach Partners through a competitive review process. Outreach Partners receive an annual award of $7,500 for a total of 3 years to: a) conduct statewide dissemination of NIMH research and educational materials; b) implement a special outreach project(s) with a targeted focus on mental disorders in children and adolescents, or mental health disparities that occur by race or ethnicity, age (e.g., older adults), education or income, disability status, geographic location, or risk status related to sex and gender, and among other populations identified to be at risk for health disparities, such as immigrants and military service members and their families; and c) promote NIMH clinical research. Participation in the Outreach Partnership Program provides organizations with numerous opportunities to stay abreast of the latest advances in mental health research, interact with leading researchers in the field, and become involved in clinical research efforts. The program also is an opportunity for Outreach Partners to dialogue with NIMH about the public health needs of communities within their States. Other program benefits include networking opportunities with other State and national organizations, sponsored participation in an annual meeting, and dedicated access to NIMH publications.

Important Dates
  • June 9, 2011, 10:00 a.m. ET - Solicitation posted
  • June 30, 2011 - Deadline for inquiries
  • July 21, 2011 - Response to inquiries posted
  • August 23, 2011, 4:00 p.m. ET - Proposals due
  • End of 2011 - Outreach Partner selection
Eligibility Criteria
  • Organizations located in one of the States listed in the current solicitation
  • Organizations that are tax exempt, with a nonprofit status, under any section of the United States tax code
  • Organizations that have an active record in the Central Contractor Registration (CCR) database
  • Organizations that demonstrate experience and capacity to disseminate information statewide, and conduct State or local outreach
More information about the Outreach Partnership Program is available at: http://www.nimh.nih.gov/outreach/partnership-program/index.shtm

Public Comment on Home and Community-Based Services
The Centers for Medicare & Medicaid Services have issued a Notice of Proposed Rulemaking that would revise the regulations implementing Medicaid Home and Community-Based Services under section 1915(c) of the Social Security Act. There are several proposed changes, including the following:
  • Requirement for person-centered planning
  • Characteristics of home and community-based settings
  • Options for States to combine target groups into a single waiver
  • Clarification of timing and public input requirements for amendments
Please take a few minutes and comment on this important proposed rule.

Click the following link to view the proposed rule and make a comment: http://www.regulations.gov/#!documentDetail;D=CMS-2009-0071-0302

COMMENTS ARE DUE 5:00 P.M. ET, JUNE 14, 2011.

For more information on how the public rulemaking process works, see “The Public Voice in Healthcare Reform: The Public Rulemaking Process,” at: http://www.hhs.gov/od/community/public/index.html.

The RTP Resource Center Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in recovery-oriented work and how it has changed the way they currently practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit personal stories or other recovery resources, please contact Stephanie Bernstein, MSW, at 1.877.584.8535,
or email recoverytopractice@dsgonline.com.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topics,
please contact the RTP Resource Center at
1.877.584.8535 or email recoverytopractice@dsgonline.com.

The views, opinions, and content of this Weekly Highlight are those of the authors and do not necessarily
reflect the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.