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.
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.
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.
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.
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.