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10 model programs to create complete mental health recovery

Successful examples of peer run programs in the United States that create complete mental health recovery

Ron Unger explains that many people have come to understand complete mental health recovery as being something like, “Doing OK while still being sick.” He says that many organization are working to water down the definition of recovery. Instead, we ought to define complete mental health recovery as, “having regained a meaningful life, no longer having a mental health disability, and no longer being in need of any sort of mental health treatment.”  This definition doesn’t work for all people, and when I was still involved in the mental health system, I found a more useful definition to be the National Empowerment Center’s 7 characteristics of people who have recovered.

Bicycling has been essential for me to find complete mental health recovery

Bicycling has been essential for me to find complete mental health recovery. Photo by Rod McBride

We have many different peer run programs worldwide that work to promote complete mental health recovery. Often the one we talk about most is the Open Dialogue model in Finland, which reports 80% recovery from what would have been called, “schizophrenia.”  However, the United States has great programs too that work  for these goals.  In the peer movement, let’s talk about some of our local home-grown programs, too.  Let’s honor our own successes and models for creating complete mental health recovery.

10 model United States programs working toward complete mental health recovery:

Or: What I learned at Alternatives this year about complete mental health recovery and why you should go next year.

1. Peer support centers – these are programs where people can go and learn from other people who have recovered how to support each other. One of the great ones is the National Empowerment Center in St. Louis, now in business for 20year. They ran with very minimal funding for eight months after the St. Louis mental health board decided that recovery ought to be measurable and planned according to a two to three month calendar. This completely discounts the individualized pace that most people are able to reach complete mental health recovery. The St. Louis Empowerment Center provides support groups, lunches, classes, volunteer opportunities, exercise equipment, meeting rooms, and lots of discussions from other people who have come out the other side.

Eddie Taylor has been a peer specialist at Wyandotte County's peer hospital

Eddie Taylor has been a peer specialist at Wyandotte County's peer hospital

 2. Peer run hospital alternatives – there are at least 8 peer run crisis alternatives in the United States where people in recovery help others in recovery. Emotional distress is not seen as chemical crisis, where the resolution comes from medication changes. Instead the need for extra support is seen as a lifestyle crisis, where people learn to develop other supports in the community, other ways to handle stress, and to choose more effective job opportunities or relationships. This leads to complete mental health recovery much more often and costs about 1/10 to 1/3 as much as a traditional hospital. At Alternatives 2011 there was a great workshop on different crisis care programs including lots of data from Daniel Hazen and Daniel Fisher.

3. Call in support lines. It turns out that 80% of calls made to a crisis line can be handled by peers, because many people just need someone to talk to instead of having an acutal emergency. Warmlines cost significantly less that professionally run crisis lines since the lines can be staff by volunteers or people just on their first stages of re-entering the workforce while still working on their own complete mental health recovery. At Alternatives 2011 Howard D. Trachtman, BS, CPS, one of the nation’s expert on warmlines, ran a caucus along with Angel Moore. Angel’s David Romprey warmline in Oregon has created an excellent program that trains their staff according to the Intentional Peer support model developed by Chris Hansen. Here is a somewhat comprehensive list of all the warmlines in the United States.

Young people gathered at Poetry for Personal Power in Columbia to talk abut hey overcome adversity

Young people gathered at Poetry for Personal Power in Columbia to talk abut hey overcome adversity

4. Social Inclusion Programs – This year SAMHSA awarded six programs small grants for social inclusions campaigns for young people aged 18 – 25. My program, Poetry for Personal Power, was part of this program. I especially liked meeting all my fellow grantees. I liked North Dakota’s program to build conference calls among young people, and expeically Native American people, as a way for them to start telling their stories of complete mental health recovery.  The idea is that most “stigma reduction” programs are really trying to make diagnoses and labels seem not so bad. Yet this just reinforces that people with those diagnoses and labels are different than people without the labels. Instead, it’s much better to see people with emotional suffering on a continuum with the rest of us, and these kind of program promote a “mental diversity” where all people are tolerated.

5. Mind Freedom’s Occupy Mental Health – Frank Blankenship from MindFreedom Florida manned an exhibition booth at Alternatives and talked about the national campaign hosted by MindFreedom to spread awareness about mental health oppression. MindFreedom has done many creative and innovative approaches and the idea of spreading mental health issues to the Occupy community has been very good so far. The Occupy movement is a multi-issue campaign, and psychiatry reform is desperately needed.

6. Emotional CPR – Recently a program came out called “Mental Health First Aid,” which is advertised as a way to train people who know nothing about mental health issues to be first responders to a mental health crisis. Unfortunately, it often mentions the same diagnoses and labels that make people afraid to seek help. Or the label becomes a self-fulfilling prophecy.   This program is heavily backed by the pharma funded National Council on Community Behavioral Health Care. The National Empowerment Center came out with Emotional CPR as a response to this approach that is oriented toward helping people develop methods to reach complete mental health recovery. This workshop presented at Alternatives 2011 by Daniel Fisher and Lauren Spiro talked about a different approach. They emphasize Connecting, Empowering, and Revitalizing. People can use emotional CPR for themselves, for other people, or in groups.

7. Social messaging – One of the most important tools for recovery is knowing that complete mental health recovery is possible and talking to someone who has done it. Now more and more these opportunities are available online via Facebook, blogging, and twitter. Judene Shelley and Leah Harris presented a beginner level social media workshop discussion tools like you-Tube, Facebook, and Twitter. I showed a more advanced workshop at Alternatives with tools for tracking impact, building followers, and connecting online and offline efforts. Social messaging is how we’re going to create an Egypt moment and share the idea that only 1% of mental health funding is spent on recovery or on programs like the ten on this list.

Video about sharing complete mental health recovery information via social messaging:

8. Self-Directed Care – This is a model where people are given budgetary control over their Medicaid decisions. It turns out that when people can choose to spend $80 an hour on a case manager to drive them to five appointments a month, they might instead elect to buy a $40 bus pass and use the other $360 to start looking for a job. This results in a fairly significant savings in overall Medicaid expenses as well as greater recovery outcomes. Self-directed spending  is used much more in the development disability field, but has faced discrimination and prejudice in getting implemented in the mental health field. Erme Maula talked about her successes in implementing the program in Southeastern Pennsylvania.

9. Certified Peer Specialists – These are people who work in the mental health system using their personal knowledge of recovery rather than an academic training in diseases or analysis of people’s lives.  This review of the peer support evidence base, says that services delivered by people in their own process of complete mental health recovery are as effective or more effective than services delivered by people with academic training. Yet costs are much lower. Jeanie Whitecraft talked about her development of a nationally used peer specialist training curricula use in Pennsylvania. Some of their special areas of focus are people developmental disabilities, aged people, and people involved in the forensic system.

Susan Kingsley Smith counsels Dan about medication discontinuation

Susan Kingsley Smith counsels Dan about medication discontinuation

10. Medication discontinuation – People in our community live 25 years less than people without a mental health diagnoses. Many of this comes from disabling effects of medications. Therefore and effective way to solve these problems which needs to be discussed more by SAMHSA’s 10 X 10 Wellness Campaign is a way to safely come off these medications. This year Susan Kingsley-Smith from Iowa and Peter Lehman from Germany both presented excellent workshops on how to come off psychiatric medications very slowly and carefully. One of the best points that Susan made was that doctors often think that two weeks is a slow taper. However, people sometimes needs months and even years to very slowly come off the medications. A good rule of thumb is a 10% dose reduction per month. Here is Susan’s Empowering Solutions blog.

11. Youth leadership programs: Definitely missed these. Check the comments below.

What are the programs I’ve missed? What success do you want to share? Put some awesome stuff in the comments below on join the discussion on Wellness Wordworks’ Facebook page. 

15 comments to 10 model programs to create complete mental health recovery

  • sharon jacobs

    I lived in Wyandotte County and was familiar
    with the progressive programs offered by
    Wyandot Behavioral Health. Super job by my
    peer friends.

  • I like the idea of peer run respite house I wish Hawaii had some or even 1. As for the Forensic Specialist this is somethimg I would like to be trained at. Right now I am just a Hawaii Certified Peer Specialist. I want more.

  • Darby Penney

    Thanks for listing these – but I think people who run peer-run crisi respite wold take issue with them being called “Peer-run hospitals!” They are alternatives ot hospitalization. It would also be helpful to include a citation for the claim that “This leads to complete mental health recovery much more often and costs about 1/10 to 1/3 as much as a traditional hospital.”

  • Tracy Love

    I’m happy to see this listing,and I applaud all of these programs. I would like to know how these programs are incorporating Cultural Responsiveness. The increasing knowledge of mental health recovery and wellness is a critical issue in diverse communities. The question is…What are these programs doing to address the specific cultural issues of wellness within these communities?

  • Natalie stone

    I am so pleased that there are organizations out there devoted to the wellness of consumers in so many ways. I am consumer myself and feel hope when I see that the best of the best approach empowerment from so many directions.

    I am also a person deeply invested in cultural responsiveness within all organizations including, but not limited to, mental health advocates. I believe that creating a small group of qualified, devoted and visionary individuals with the mission to come together and compose a list of “best practices for cultural responsiveness” within this effective group would be a logical next step. This could be a model for those struggling with defining and embracing cultural responsiveness on all levels, ensuring that we are all on the same page.

    I also want to stress that while we try to change the world outside, there must be a zero tolerance policy for discrimination within our own homes.

  • These 10 models are wonderful and you need to make it an even dozen by adding two more models: (1) about YouthMove-National and its 39+ chapters whose advocacy efforts are youth-driven to bolster the voice of individual youth addressing their own emotional health challenges AND unite voices in transforming systems to be youth guided/driven and (2) about the National Federation of Families for Children’s Mental and its 140+ chapters and affiliates whose advocacy efforts are family-driven and youth guided/driven to boster the individual voice of young people and their families to develop resilience, model recovery, and navigate the systems of formal services and natural support AND unite the voices of family members in transforming systems to be family and youth driven.

  • Corinna

    Thanks to Frances Purdy for adding the young adult advocacy efforts.

    To Natalie Stone and Tracy Love: cultural relevance is key. As Ethan Watters pointed out in Crazy Like Us, we have Americanized emotional distress and ignored the ways many other cultures can find healing. http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?pagewanted=all

    To Howard D. Trachtman, BS, CPS I fixed the spelling of your name and posted your warmline.org website.

  • Sarah Knutson

    Hi Corinna – Really love what you’ve done with this page & in high-lighting so many great things peers are doing to take charge of our own wellness & recovery – and, well…, our own lives! The program that changed my life in the peer movement is Intentional Peer Support (IPS) by Shery Mead. If you haven’t heard of it separately, I’d really encourage you to take a look. It fits really well with the other programs you’ve mentioned, but also has a very special emphasis. Instead of being an individual model for recovery (“I work on my own recovery, you work on yours, maybe we share things, hopefully we both get better”), its a relational one. It’s all about the relationships and communities we are building as peers. It posits that what went wrong in our lives is not so much medical or biological, but really a failure of relationship and community to offer the kinds of presence and engagement that is needed by any human being who is facing difficult life challenges.

    Accordingly, IPS teaches us to harness the power of our peer relationships in purposeful ways that foster connection, mutuality, learning and growth. Instead of seeing each other as sick or ill, we look for how each of us has come to make sense of our experiences in the ways we have. We help each other re-examine old beliefs that have kept us stuck, look at things from new angles, and create new possibilities for being and acting in the world. It’s really an approach that is based on building the kind of healthy relationships and healthy communities that we all deserve and ought to be the birthright of every child, youth and adult person having a human experience. And, guess what? At least at the peer center that I’m a part of, the awesome thing is that when we, as mental health peers, start get involved in these communities and start having these kinds of relationships, we stopped feeling and behaving like diagnosed persons and begin to live into our right and our role as full and complete world citizens. What a concept! It’s incredibly exciting to see unfold in our lives together.

    As a bit of background, Shery is one of the true pioneers of the peer mental health movement. Shery started working on the Intentional Peer Support concept nearly two decades ago, before the relevance of creating healthy dialogue between peers – and healthy peer communities in which to have them – were even a blip on the radar of anyone else in the peer mental health movement. She became the director of a peer center in New Hampshire and then grew it into becoming one of the first peer-run respite centers (alternative to hospitalization) in the world. After that, Shery partnered with New Zealand human rights activist Chris Hansen, and proceeded to spearhead a worldwide network of peers and peer-run organizations committed to the principles and practice of Intentional Peer Support.

    Would be interested in hearing your thoughts if you know of Shery’s work, or once you get a chance to take a look at it. Thanks so much for taking the time to read my thoughts! – In solidarity, Sarah Knutson.

    • Corinna

      Thanks, I’ll add Intentional Peer Support to the list. I do know it about, actually, as more of a philosophy than a program, but definitely influential. I think, just as explanation, the reason it got left off this list is because I originally wrote the list as my report for my SAMHSA scholarship for attending Alternatives. I just hadn’t spend much time with Shery Mead or Chris Hansen at that conference so the philosophy didn’t come to the top of my mind. Thanks for the reminder.

  • [...] Check out a list of 10 programs that provide complete mental health solutions and complete recovery here: http://corinnawest.com/10-model-programs-to-create-complete-mental-health-recovery/ [...]

  • [...] see that, so far, the winner by far of the voting is this entry from a Mad In America blogger about 10 peer support alternatives to traditional psychiatry that lead to healing and wellness.  Including the harm reduction approach to decreasing medication!  Love [...]

  • My name is Paige Walker, I live in Auckland New Zealand. Three years ago I found out that my daughter then 8 years old had been sexually abused at the hands of my best friend’s husband. Following her disclosure and having to deal with the multiple agencies involved in our case, the stress of the court case, having to confronting my so called friends in court as I was called to provide witness against them, dealing with my daughter’s trauma and the devastating aftermath that sexual abuse leaves behind, I found myself struggling to cope with the magnitude of it all and was diagnosed PTSD.

    I rapidly became depressed under the stress of it all and developed insomnia where I was prescribed Tamazepam and an anti-depressant by my GP. Over a period of time I developed a prescription drug dependency as my condition was never monitored or reviewed, and after 2 years I became addicted to prescription Benzodiazepines. During this time my mental health deteriorated as my depression had reached critical, I became disassociated with the world around me and started suffering with frequent panic and anxiety attacks, soon after, suicidal thoughts and desires of killing myself emerged.
    I contacted an organisation here in New Zealand called Connect which offer peer support via their Reach-Out Peer Support Service, individuals who had overcome their mental illness and sharing their experience with clients as myself on their recovery journey

    After a period of time working towards my goals with my peer support worker, I was informed by CONNECT of TRANX Drug and Alcohol Services who specialized in drug detox and rehabilitation. I contacted them and enrolled in their drug detox programme. During this time, my mental health deteriorated even further, I started hearing voices which overwhelmed me with negative feedback and many times I had the desire to end my suffering, I was soon referred to my local Community Mental Health Team and was prescribed an anti-psychotic drug on top of all the other medications I was taking..

    The drug detox programme took 17months to complete and I suffered severe withdrawals which came with its own issues. Thankfully I never succumbed to my ideations and with help from my peer support worker I am currently 4 months clean and just published my first book called The Broken Road.
    The Broken Road moves through my emotional journey after the disclosure of my daughter’s abuse, my Benzodiazepine addiction, my mental health issues and details of my recovery. The book highlights the devastating effects sexual abuse has on parents but also addresses the severe addictive nature of Benzo’s and its effects when not monitored by professionals. My book was recently featured at the New York book expo.

    http://www.xlibris.co.nz/bookstore/bookdisplay.aspx?bookid=700096

    The Broken Road is available at the above website and at
    http://www.amazon.com
    http://www.THE BROKENROADbook.com
    http://www.barnesandnoble.com

    Thank You.
    PAIGE WALKER

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