Core 3: Stages in the Recovery Process
Belief About Recovery Until 1980
People diagnosed with a severe mental illness would not recover, and more than likely the illness would get progressively worse.
The most you could expect in terms of treatment was to get people stabilized and then maintain them as best you could in ‘supervised’ environments in which they would not be able to harm themselves or others and be less problematic for society.
This stabilization and maintenance usually involved high doses of medication, long stays in secure institutions and/or years in ‘day treatment programs’ designed to entertain with TV, table games, recreation, trips, outings and other ‘low stress’ activities.
4 Key Roles in Enabling This Change
Consumers like Judi Chamberlain, Patricia Deegan and others began to write and talk about their own lives. Consumers were saying to providers in a variety of ways that “our lived experience with mental illness does not agree with your learned experience about mental illness. “We are capable of moving on with our lives – often in spite of the system.”
Researchers like Dr. Courtney Harding were designing and implementing longitudinal research projects that were challenging some of the old myths about schizophrenia. Their research showed that people who have been very disabled by a severe mental illness could live a meaningful and productive life in the community when given the right skills, resources and supports.
The philosophy of psychosocial rehabilitation began to emerge. This philosophy was based on the belief that people diagnosed with a mental illness can live in the community when given the opportunity to develop skills, resources and supports in relation to working, living, learning and socializing.
Improving medications which better controlled symptoms and had less harsh side-effects.
Studies That Influenced the Behavioral Health System in a Recovery Oriented Way
Results
• This group of back-ward patients represented the most severely ill group from Vermont's only state hospital. Two to three decades after a comprehensive rehabilitation program and a planned deinstitutionalization, one-half to two-thirds of these patients were rated as considerably improved or recovered. The findings also showed a wide variation in many areas of functioning for these patients.
Recovery: The Lived Experience of Rehabilitationby Patricia E. Deegan, Ph.D.
Handout
https://www.youtube.com/watch?v=yawlKbOvHHo
Recovery: The Lived Experience of Rehabilitation
• As evidenced, recovery is not a linear process marked by successive accomplishments. The recovery process is more accurately described as a series of small beginnings and very small steps. To recover, psychiatrically disabled persons must be willing to try and fail, and try again. Too often, rehabilitation programs are structured in such a way as to work against this process of recovery. These programs tend to have rigid guidelines for acceptance. They tend to have linear program designs in which a person must enter at point “A” and move through a series of consecutive steps to arrive at point “B.” Failure at any point along the way will require that participants return to entry level.
Recovery: The Lived Experience of Rehabilitation
Rehabilitation programs can be environments which nurture recovery if they are structured to embrace, and indeed expect, the approach/avoid, try/fail dynamic which is the recovery process. This means that rehabilitation programs must have very flexible entry criteria and easy accessibility. The design of rehabilitation programming must be nonlinear, i.e., with multiple points of entry and levels of entry into programming. The real challenge of rehabilitation programs is to create fail-proof program models. A program is fail-proof when participants are always able to come back, pick-up where they left off, and try again. In a fail-proof environment where one is welcomed, valued, and wanted, recovering persons can make the most effective use of rehabilitation services.
Recovery: The Lived Experience of Rehabilitation
A second point regarding the establishment of rehabilitation environments conducive to the recovery process derives from the understanding that each person’s journey of recovery is unique. Of course, there are certain fundamental constituents of the process of recovery that are similar in all persons with a disability, e.g., the experience of despair and the transition to hope, willingness, and responsible action. However, disabled people are, above all, individuals and will find their own special formula for what promotes their recovery and what does not. Therefore, it is important to offer recovering persons a wide variety of rehabilitation program options from which to choose, e.g., supported work programs, social clubs, transitional employment programs, consumer run drop-in centers and businesses, workshops, skill training programs, and college support programs.
Recovery: The Lived Experience of Rehabilitation
The third recommendation for creating programs that enhance recovery involves recognition of the gift that disabled people have to give to each other. This gift is their hope, strength and experience as lived in the recovery process. In this sense, disabled persons can become role models for each other. During that dark night of anguish and despair when disabled persons live without hope, the presence of other recovering persons can challenge that despair through example. It becomes very difficult to continue to convince oneself that there is no hope when one is surrounded by other equally disabled persons who are making strides in their recovery!
Recovery: The Lived Experience of Rehabilitation
Finally, and perhaps most fundamentally, staff attitudes are very important in shaping rehabilitation environments. There are a number of common staff attitudes that are particularly unhelpful to recovering persons. For instance, too often staff attitudes reflect the implicit supposition that there is the “world of the abnormal” and the “world of the normal.” The task facing the staff is to somehow get the people in the “abnormal world” to fit into the “normal world.” This creates an us/them dichotomy wherein “they” (the disabled) are expected to do all of the changing and growing. Such an attitude places staff in a very safe position in which they can maintain the illusion that they are not disabled, that they are not wounded in any way, and that they have no need to live the spirit of recovery in their own lives. Indeed, when the us/them attitude prevails, “staff” and “clients” are truly worlds apart. Such an environment is oppressive to those disabled persons who are struggling with their own recovery.
Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s
• This article outlines the fundamental services and assumptions of a recovery- oriented mental health system. As the recovery concept becomes better understood, it could have major implications for how future mental health systems are designed. The seeds of the recovery vision were sown in the aftermath of the era of deinstitutionalization. The failures in the implementation of the policy of deinstitutionalization confronted us with the fact that a person with severe mental illness wants and needs more than just symptom relief.
Basic Assumptions of a Recovery-Focused Mental Health System
1. Recovery can occur without professional intervention.
• Professionals do not hold the key to recovery; consumers do. The task of professionals is to facilitate recovery; the task of consumers is to recover. Recovery may be facilitated by the consumer’s natural support system. After all, if recovery is a common human condition experienced by us all, then people who are in touch with their own recovery can help others through the process. Self-help groups, families, and friends are the best examples of this phenomenon.
2. A common denominator of recovery is the presence of people who believe in and stand by the person in need of recovery.
• Seemingly universal in the recovery concept is the notion that critical to one’s recovery is a person or persons in whom one can trust to “be there” in times of need. People who are recovering talk about the people who believed in them when they did not even believe in themselves, who encouraged their recovery but did not force it, who tried to listen and understand when nothing seemed to be making sense. Recovery is a deeply human experience, facilitated by the deeply human responses of others. Recovery can be facilitated by any one person. Recovery can be everybody’s business.
3. A recovery vision is not a function of one’s theory about the causes of mental illness.
• Whether the causes of mental illness are viewed as biological and/or psychosocial generates considerable controversy among professionals, advocates, and consumers. Adopting a recovery vision does not commit one to either position on this debate, nor on the use or nonuse of medical interventions. Recovery may occur Recovery...the Guiding Vision in the 1990s 531 whether one views the illness as biological or not. People with adverse physical abnormalities (e.g., blindness, quadriplegia) can recover even though the physical nature of the illness is unchanged or even worsens.
4. Recovery can occur even though symptoms reoccur.
• The episodic nature of severe mental illness does not prevent recovery. People with other illnesses that might be episodic (e.g., rheumatoid arthritis, multiple sclerosis) can still recover. Individuals who experience intense psychiatric symptoms episodically can also recover.
5. Recovery changes the frequency and duration of symptoms.
• People who are recovering and experience symptom exacerbation may have a level of symptom intensity as bad as or even worse than previously experienced. As one recovers, the symptom frequency and duration appear to have been changed for the better. That is, symptoms interfere with functioning less often and for briefer periods of time. More of one’s life is lived symptom-free. Symptom recurrence becomes less of a threat to one’s recovery, and return to previous function occurs more quickly after exacerbation
6. Recovery does not feel like a linear process.
Recovery involves growth and setbacks, periods of rapid change and
little change. While the overall trend may be upward, the moment-to-moment experience does not feel so “directionful.” Intense feelings may overwhelm one unexpectedly. Periods of insight or growth happen unexpectedly. The recovery process feels anything but systematic and planned.
7. Recovery from the consequences of the illness is sometimes more difficult than recovering from the illness itself.
• Issues of dysfunction, disability, and disadvantage are often more difficult than impairment issues. An inability to perform valued tasks and roles, and the resultant loss of self-esteem, are significant barriers to recovery. The barriers brought about by being placed in the category of “mentally ill” can be overwhelming. These disadvantages include loss of rights and equal opportunities, and discrimination in employment and housing, as well as barriers created by the system’s attempts at helping—e.g., lack of opportunities for self-determination, disempowering treatment practices. These disabilities and disadvantages can combine to limit a person’s recovery even though one has become predominantly asymptomatic.
8. Recovery from mental illness does not mean that one was not “really mentally ill.”
At times people who have successfully recovered from severe mental illness have been discounted as not “really” mentally ill. Their successful recovery is not seen as a model, as a beacon of hope for those beginning the recovery process, but rather as an aberration, or worse yet as a fraud. It is as if we said that someone who has quadriplegia but recovered did not “really” have a damaged spinal cord! People who have or are recovering from mental illness are sources of knowledge about the recovery process and how people can be helpful to those who are recovering.
Overview New Freedom Commission on Mental Health
The New Freedom Commission on Mental Health was established by U.S. President George W. Bush through Executive Order 13263 on April 29, 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findings. The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.
The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximize the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.
A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission's findings as a launching point for recommending widespread reform of the nation's mental health system.
A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the Texas Medication Algorithm Project mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed 'atypical antipsychotic drugs', such as Seroquel, Zyprexa, and others, for a wide variety of non-psychotic behavior issues. These drugs were later found to cause increased rates of sudden death in patients.
In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. In 2009, Eli Lilly was found quality of wrongfully marketing Zyprexa for non-psychotic people.
Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the pharmaceutical industry to foster psychotropic medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative's wider objectives are to foster chemical behavior control of American citizens, contrary to civil liberties and to basic human rights.
TRANSFORMING MENTAL HEALTH CARE IN AMERICA
• Transformation of the mental health system in America is a monumental task, but one that cannot be delayed. This Federal Mental Health Action Agenda makes clear that the system must be redirected toward its primary goal-helping adults with serious mental illnesses and children with serious emotional disturbances achieve recovery to live, work, learn, and participate fully in their communities. This vision requires nothing short of a complete transformation of administrative policies, funding mechanisms, and the hearts and minds of everyone who has a stake in our nation's health care system. The time for action is now.
Peer Support SAMHSA
• Peer support encompasses a range of activities and interactions between people who share similar experiences of being diagnosed with mental health conditions, substance use disorders, or both. This mutuality—often called “peerness”—between a peer support worker and person in or seeking recovery promotes connection and inspires hope.
• Peer support offers a level of acceptance, understanding, and validation not found in many other professional relationships (Mead & McNeil, 2006). By sharing their own lived experience and practical guidance, peer support workers help people to develop their own goals, create strategies for self-empowerment, and take concrete steps towards building fulfilling, self-determined lives for themselves.
How Peer Support Differs from Clinical and Non-Clinical Staff
Peer Supporters do not talk about medication. They do not give their opinion or experience on such matters.
Peer supporters can meet their client outside the office and physically assist in reaching goals rather than discussing how they would obtain a goal.
Communication happens more frequently with peer supporters, at times via phone or text message.
Offers a continuum of care if a client transitions from inpatient.
Peer Support as an Evidenced Based Practice
Adult Peer Support
• Peer support arrangements offer an evidence-based alternative to an exclusive reliance on paraprofessional support.
• Over the last twenty years, the practice of peer support in behavioral health has virtually exploded around the globe, with many more recovering persons being hired to provide peer support than ever before. Estimates place the number of peer support staff currently to be over ten thousand in the US alone (Davidson, L. et al, 2012). Peer support was declared an evidence-based practice by the Center for Medicare and Medicaid Services in 2007.
Evidenced Based Practice
• The practice based on information gathered by a systematic and critical review of published literature. Evidence-based practice promotes decision-making that reflects best-available information, rather than experience and perceptions of therapeutic efficacy, which can be inaccurate.
Other Evidenced Based Practices
• Supported employment A program of paid work in regular workplace settings by people with physical, cognitive, developmental, and mental health disorders. Ongoing training is provided by an interdisciplinary team of rehabilitation professionals, employers, and family members.
• Assertive community treatment (ACT) is an intensive and highly integrated approach for community mental health service delivery. ACT programs serve outpatients whose symptoms of mental illness lead to serious functioning difficulties in several major areas of life, often including work, social relationships, residential independence, money management, and physical health and wellness.
• Illness Management and Recovery- IMR is an evidence based practice that provides a step by step approach to provide knowledge on mental illness and substance abuse to support a person in setting meaningful goals, making informed decisions about treatment, gathering information and skills to generate mastery over the symptoms of his/her mental illness, and making progress towards his/her personal recovery.
• SAMSHA defines a Recovery-Oriented System of Care (ROSC) as a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve improved health, wellness, and quality of life.
Recovery Oriented Model vs Medical Model
Regarding the treatment of serious mental Illness (SMI), there is currently a fundamental rift between two camps, one known as the "Medical Model," basically scientific psychiatry, and the "Recovery Model," based of personal experience, learning and support. Bad feelings, misspent public funds, and bad medical outcomes have resulted from this apparent dichotomy.
This combined model is used by the most successful outpatient treatment program for SMI.
An Overview of Behavioral Health
Behavioral health is defined as:
An interdisciplinary field dedicated to promoting a philosophy of health that stresses individual responsibility in the application of behavioral and biomedical science knowledge and techniques to the maintenance of health and prevention of illness and dysfunction by a variety of self-initiated individual and shared activities.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
A system of classification, published by the American Psychiatric Association, which divides recognized mental disorders into clearly defined categories based on sets of objective criteria. Representing a majority view (rather than a consensus) of hundreds of contributors and consultants, DSM is widely recognized as a diagnostic standard and widely used for reporting, coding, and statistical purposes.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
The need for a classification of mental disorders has been clear throughout the history of medicine, but until recently there was little agreement on which disorders should be included and the optimal method for their organization.
The many different classification systems that were developed over the past 2,000 years have differed in their relative emphasis on phenomenology, etiology, and course as defining features. Some systems included only a handful of diagnostic categories; others included thousands. Moreover, the various systems for categorizing mental disorders have differed with respect to whether their principal objective was for use in clinical, research, or administrative settings.
DSM History
• In 1840, the term idiocy/insanity was used to describe certain individuals in the census. The government decided that it needed to collect data on the prevalence of mental illness. As time went on, the idiocy/insanity category grew to seven categories that included melancholia, paresis, mania, monomania, dipsomania, dementia, and epilepsy. The expanded categories resulted in confusion regarding mental illness diagnoses and led to issues with uncertainty attempting to formally identify these diagnostic categories
History
In 1917, the Statistical Manual for the Use of Institutions for the Insane was created by the Committee on Statistics of the American Medico-Psychological Association (which later became the American Psychiatric Association [APA]) and another organization, the National Commission on Mental Hygiene. These two committees separated forms of mental illness into 22 different groups, and this information was used by the Bureau of Census.
The publication continued to be revised and went through 10 editions up until 1942. This manual is considered to be the predecessor to the first edition of the DSM. It contained very broad categorizations of mental disorders and had very limited use in diagnosing them. In addition, the Freudian model was predominant in psychiatry during this period, and diagnoses represented this influence.
Psychotic Disorders
• Psychosis Psychiatry A broad class of mental disorders, classified in the DSM-IV under the umbrella of 'Schizophrenia and other psychotic disorders' Examples of PD Schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, shared psychotic disorder, psychotic disorder due to a general medical condition, substance-induced psychotic disorder, psychotic disorder-not otherwise specified.
Mood Disorders
• A group of mental disorders involving a disturbance of mood, along with either a full or partial excesseively happy (manic) or extremely sad (depressive) syndrome not caused by any other physical or mental disorder. Mood refers to a prolonged emotion.
Substance Use Disorders
• A disorder involving problematic use of a drug, alcohol, or another substance, characterized by symptoms such as excessive use of the substance, difficulty limiting its use, craving, impaired social and interpersonal functioning, a need for increased amounts of the substance to achieve the same effects, and withdrawal symptoms upon discontinuance.
Co-Occurring
• The term co-occurring disorder refers to the condition in which an individual has a co-existingmental illness and substance use disorder. While commonly used to refer to the combination ofsubstance use and mental disorders, the term also refers to other combinations of disorders, such a mental disorder and an intellectual disability.
Top 5 Co-Occurring Disorders
Post-Traumatic Stress Disorder and Prescription Opioid Addiction
• Prescription opioids are often abused in order to boost feelings of pleasure and calm inside the brain. Those struggling with post-traumatic stress disorder (PTSD) often end up abusing these medications in order to both experience that feeling of euphoria and to numb themselves to physical pain and/or emotional trauma.
Depression and Heroin Addiction
• Advances in Psychiatric Treatment estimates that approximately 48% of opioid users have experienced depression at some point in their lives. In fact, extended use of heroin and other opioids can alter brain chemistry and demoralize portions of the brain responsible for producing pleasure sensors and mood changes.
• This does not mean that these disorders and addictions are only found in these combinations. It is also common for people with depression to abuse alcohol, or people with anxiety disorders to abuse marijuana. Regardless of the mental illness or the substance, both conditions should be treated as co-occurring primary disorders.
Schizophrenia and Marijuana Addiction
• The American Journal of Psychiatry released a study that suggests approximately half of all people with schizophrenia also have a substance abuse disorder. In particular, marijuana addiction was most common for those with schizophrenia.
Anti-Social Personality Disorder and Alcoholism
• Alcoholism quite often co-occurs with many mental health disorders. However, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), anti-social personality disorder (ASPD) is the most common for those with alcoholism. In fact, people who drink to excess on a regular basis are 21 times more likely to deal with ASPD.
Anxiety Disorders and Cocaine Addiction
• Not only do the symptoms of anxiety mirror those experienced with cocaine abuse,
but statistics suggest there is a very high risk of anxiety and cocaine abuse occurring together. For those who already have an anxiety disorder, the risk becomes even higher that you will develop a severe emotional problem when using a drug like cocaine, due to its stimulant properties.
Situations Commonly Occurring With Co-occurring Disorders
• Homelessness
• Incarceration
• Victimization
• Serious medical illness
• Suicide
Homelessness
• Most researchers agree that the connection between homelessness and mental illness is a complicated, two-way relationship. An individual’s mental illness may lead to cognitive and behavioral problems that make it difficult to earn a stable income or to carry out daily activities in ways that encourage stable housing. Several studies have shown, however, that individuals with mental illnesses often find themselves homeless primarily as the result of poverty and a lack of low-income housing. The combination of mental illness and homelessness also can lead to other factors such as increased levels of alcohol and drug abuse and violent victimization that reinforce the connection between health and homelessness.
Incarceration
• Individuals with co-occurring disorders had a higher risk of violent behavior than did those with major psychiatric disorders alone (Melnick et al., 2006). Also, Steadman and colleagues (1998) found a higher probability of violence among persons recently released from psychiatric hospital facilities than among others sampled from the same community, when substance abuse symptoms were present in both groups. A relationship between violence and co-occurring substance use and mental illness has been found among jail inmates (McNiel, Binder, & Robinson, 2005)and schizophrenic patients (Swanson et al., 2006)
Victimization
• Stigma and discrimination are common barriers to reporting crime. Many victims with mental disorders fear they are perceived as not being credible because they suffer from delusions. They fear this is thought to impair their ability to recount events accurately. Victims often suffer from shock, confusion, anger, humiliation and guilt, which can be intensified by a mental health condition.
Serious Medical Illness
• Bottom line, Mieses says, is that mental health "is part of overall health. There is a ton of evidence that shows the way you physically feel and your physical health affects your mental health and vice versa. We know that people who have mental health issues have higher rates of cardiovascular disease and cancer.
Suicide
• Among the most common causes of suicide is that of mental illness. Although there are a variety of treatment options for people with mental illnesses, they are far from perfect. Most people end up trying a variety of psychiatric drugs and/or talk therapies. After years of trying various medications (and cocktails), going through medication withdrawals, and experimenting with therapies, some people are stuck in a constant state of mental pain and despair.
Behavioral Health Recovery SAMHSA’S Working Definition of Recovery
• A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
4 Major Dimensions
Health- Overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem— and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.
Home - A stable and safe place to live
Purpose -Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society
Community -Relationships and social networks that provide support, friendship, love, and hope
SAMHSA’S 10 Guiding Principles of Behavioral Health Recovery
• Recovery emerges from hope The belief that recovery is real provides the essential and motivating message of a better future that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.
• Recovery is person-driven Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives.
• Recovery occurs via many pathways Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds— including trauma experience — that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized. They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches. Recovery is non-linear, characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence from the use of alcohol, illicit drugs, and non-prescribed medications is the goal for those with addictions. Use of tobacco and non-prescribed or illicit drugs is not safe for anyone. In some cases, recovery pathways can be enabled by creating a supportive environment. This is especially true for children, who may not have the legal or developmental capacity to set their own course.
• Recovery is holistic Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, transportation, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, and community participation. The array of services and supports available should be integrated and coordinated.
• Recovery is supported by peers and allies Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helps one’s self. Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths. While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.
• Recovery is supported through relationship and social networks An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Family members, peers, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.
• Recovery is culturally-based and influenced Culture and cultural background in all of its diverse representations—including values, traditions, and beliefs—are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.
• Recovery is supported by addressing trauma The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
• Recovery is based on respect Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems—including protecting their rights and eliminating discrimination—are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.
• Recovery involves individual, family, and community strengths and responsibility Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.
Commonalities Between Mental Health and Substance Use Diagnosis
Hope to recover
Manage or eliminate
symptoms
Live meaning and purpose filled lives
Be apart of their community
Develop and maintain valued relationships
Hope to Recover
• Hope is more than mere wishful thinking; it is the bedrock upon which you build your recovery. Without hope, or a desire to recover, there would be no motivation to get better. With no motivation, there would be very little meaningful action. Finally, with proper action comes improvement through a series of steps leading to a plan for recovery, and working the plan for years to come. I cannot stress harder the significance of hope in recovery. This applies to both mental health and substance use diagnosis.
Manage or Eliminate Symptoms
• Focus on learning about symptoms and treatments. You may come across discouraging predictions about how it's impossible to "cure" serious mental illness or may think you’re a hopeless case with recovering from drugs and alcohol. However, with treatment you can reduce or eliminate your symptoms for both mental health and substance use. ANYONE can find recovery regardless of how “far gone” one may think they are.. A diagnosis is a gateway to good treatment, not a sentence to lifetime imprisonment.
Live Meaningful and Purpose Filled Lives
• What is a meaningful life? The World Health Organization defines “participation” as being involved in life situations. Such participation brings about satisfaction and meaning to one’s life. A sense of purpose and meaning increases quality of life and longevity and can act as both a protective factor for our health, and can help in the building a healthier life. Addiction and most mental health diagnosis is often preceded by a lack of meaning or satisfaction in one’s life. During addiction, it is typical to label alcohol or drug use as the most meaningful thing in one’s life. When someone has a mental health diagnosis it is hard to break free of the symptoms that go along with the diagnosis and can cause a sense of feeling trapped. Finding or developing meaning in one’s life is crucial. Just as we treat underlying psychological and emotional causes of addiction and mental health, we must create a meaningful life in order to achieve a holistic and sustained recovery.
Be a Part of Their Community
There are many benefits for someone that has a mental health or substance use diagnosis to be apart of their community. Five of these are:
Inspiration and motivation – in strong communities there is always someone doing something amazing, which can have the effect of inspiring you to go harder and achieve bigger goals.
Shared lessons – rather than having to learn from your own mistakes or successes you can reach out to the community and ask if anyone has had an experience that could be valuable to your situation.
Contacts – in life and in business you are always in need of a particular service or may like to meet a particular person. When you are in strong community it is highly likely that someone can make an introduction for you.
Opportunities – successful people are always doing cool stuff and when you are associated with them you often get to go along for the ride. Whether it’s a social activity, a once in a lifetime experience or a business opportunity, there is always an opportunity to be had.
Fun – we are social animals and when you are part of a community there are always social aspects involved that you can have a lot of fun at.
Develop and maintain valued relationships
Typically with a mental health or substance use diagnosis we damage the relationships that we value most. While being in recovery from a mental or substance use diagnosis it is important to mend those relationships. Mending old relationships and developing new healthy relationships and maintaining those relationships is an important component in recovery.
Recovery is a non-linear process
Recovery has no one specific path. One person’s experience will likely be different from others even if the diagnosis is the same. Recovery is unique to the individual and should be treated as such. Because someone isn’t recovering on the path that worked for you doesn’t mean that path is ineffective.
What is this thing called recovery?
5 Stages in the Recovery Process
Impact of Illness
Life is Limited
Change is Possible
Commitment to Change
Actions for Change
Impact of Illness
What individuals are experiencing
There are times when the person is overwhelmed by the disabling power of the illness. She is struggling with the symptoms of the illness, the behavior brought on by the symptoms and the ramifications of this behavior and finds it difficult to function.
Dangers for individual in this stage
The danger is that the person will re-define him- or herself in mental illness terminology that will automatically limit his or her future.
Role of peer support service
The role of services is to decrease the emotional distress by reducing the symptoms and communicating that there is life after diagnosis.
Life is limited
What individuals are experiencing
The person has given in to the disabling power of the illness. The person doesn’t like his or her life the way it is, but believes it is the best it will ever be. The person is not ready or able to make a commitment to change.
Dangers for individual in this stage
The danger is that the person will resign to this life and refuse to acknowledge that there is anything he or she can do that will make a difference in his or her life.
Role of peer support service
The role of services is to instill hope and a sense of possibility and to rebuild a positive self-image.
Change is Possible
What individuals are experiencing
The person believes that there has to be more to life than he or she is currently experiencing and is beginning to believe that his or her life can be different.
Dangers for individual in this stage
The danger is that the person will be afraid to or discouraged from taking the necessary risks and remain in the “life is limited” stage.
Role of peer support service
The role of services is to help the person see that he or she is not so limited by the illness, and in order to move on, he or she will need to take some risks.
Commitment to Change
What individuals are experiencing
The person is challenging the disabling power of the illness. The person believes there are possibilities, but isn’t sure what they are or what to do. He or she is willing to explore what it will take to make some changes.
Dangers for individual in this stage
The danger is that the person will not get the necessary skills, resources, and supports that he or she needs to do what he or she wants to do and will not succeed in moving forward.
Role of peer support service
The role of services is to help the person identify the strengths and needs in terms of skills, resources, and supports.
Action to Change
What individuals are experiencing
The person is moving beyond the disabling power of the illness. The person had decided the direction that he or she wants his or her life to go and is willing to take more responsibility for his or her decisions and actions.
Dangers for individual in this stage
The danger is that he or she will begin to doubt his or her ability to function on his or her own, trust his or her own decisions, and revert back to a life lived in the system.
Role of peer support service
The role of services is to help the person trust in his or her own decision-making ability and take more responsibility for his or her life.
Stages of Change
Stage 1: Pre-Contemplation
• This is the entry point of a person into the change process. The individual has not even considered the prospect of change and is unlikely to perceive a need for change. It is usually someone else who perceives a problem. At this stage, a person is not likely to respond positively to anyone (family or professional) being confrontive or demanding change.
Indicators
• Total resistance to doing anything• No willingness to meet, talk to a professional, or get assessed• Angry at any indication from another that there is a problem• Blaming others• “Everything is okay” statements• Willingness to work on other things, but not the specific problem • Refuse to let a professional in and work with him/her• Lack of awareness
Peer Supporters Role
• Build a relationship.
• Diffuse the crisis.
• Assess safety concerns.
• Show empathy and caring.
• Provide needed services in areas other than the specific risk.
• Assess and affirm the individual’s strengths and capacity to change if he or she wishes to do so.
• Provide information and feedback on the possible risks of behavior to raise the awareness of the possibility of change.
• Listen for windows of opportunity where the person talks about problems, concerns and need to change.
• Provide specific information.
Stage 2: Contemplation
• Once the person has some awareness of the problem, then the person enters the stage called Contemplation. It is an ambivalent state where the individual both considers change and rejects it. If allowed to just talk about it, the person goes back and forth about the need to change without justification for change.
Indicators
• Saying one thing, doing another
• Rationalizing, minimizing
• Anxiety rises while trying some things that do not work • Both talking about change and arguing against it
Peer Supporters Role
• Help tip the balance to favor change.
• Evoke reasons to change and risks of not changing.
• Continue to strengthen the client’s self-efficacy.
• Strategically use open-ended questions, affirmations, and summarizing.
• Have the person voice the problem, concern, and intention to change.
• Have the person self-assess values, strengths, and needs.
Stage 3: Preparation
• The person is ready to change. This is a window of opportunity when the person resolved the ambivalence enough to look at making change.
Indicators
• Admitting the need for change• Accepting negative ramifications of their behavior• Asking for help• Starting to look at alternatives
Peer Supporters Role
• Facilitate the development of a vision for their future.
• Provide information on all available options.
• Explore all available options, and the benefits and consequences of each.
• Help the person set specific goal(s).
• Help the person develop the plan.
• Help the person choose strategies to use, resources needed, and potential barriers to the plan.
Stage 4: Action
• The person engages in particular actions that intend to bring about change.
Indicators
• Starting to work out a plan
• Making changes in behavior
• Asking for professional help, or using professional help to make their plan more successful
Peer Supporters Role
• Introduce and practice coping strategies to avoid, change, replace, or change a client’s reactions to triggers and conditions leading to problem behavior.
• Suggest methods, provide support in trying them out, and help evaluate the effectiveness of those methods.
• Keep steps small and incremental• Teach skills.• Access resources for the specific target behavior.• Reward small steps of progress.• Assess success.• Make necessary changes in planning as the person continues to progress.
Stage 5:Maintance
• The person identifies and implements strategies to maintain progress, and to reduce the likelihood of slips or full relapse into old behaviors.
Indicators
• Making the long-term life changes needed to “actualize” the changes made in the action stage
• •Focusing less on refraining from old behavior and more on a “recovery” lifestyle
Peer Supporters Role
• Assist in sustaining changes accomplished by the previous actions.
• Help the person to develop the skills and self-efficacy to build a new life.
• Build relapse roadmaps.• Prepare crisis plans for when a relapse might happen. • Review warning signs of a possible slip or relapse.
• Help the person connect to other support systems for a healthier lifestyle
Stage 6: Relapse
• The person has a slip, or returns to behavior at a level higher than acceptable to either the person or family. At times, the person might slip and not regard it as serious enough to be concerned, yet someone may be at risk. A professional needs to help the person holistically look at the situation.
Indicators
• Repeating behavior that they are trying to change• Engaging in different, but equally problematic behavior. • Feeling shame about behavior
Peer Supporters Role
• Assist in processing the emotions resulting from the slip.
• Help the person understand what happened to lead to another slip.
• Help the person process the experience and use the slip as a learning experience.
• Review the plan and commitment to continue. • Adjust the plan as needed.• Implement the plan (as adjusted).
Spirituality
Common themes in spirituality
Sense of purpose- The quality of having great value or significance. Being directed towards something you feel strongly about
Transcendence- existence or experience beyond the normal or physical level. Developing a spiritual level to self.
Belief in higher beings- Being directed by a higher calling or high power.
Difference between Religion and Spirituality
Religion is all about beliefs and worship. In short it can be said that religion refers to a group. Religion focuses more on the outside due to its indulgence in dogmas and rules that are often felt rigid by the people.
Spirituality is about the soul within matter. The matter corresponds to our body. Soul is different from the body. Anything pertaining to the soul or the spirit is spiritual. Spirituality refers to an individual. Unlike religion, spirituality on the contrary concentrates and focuses more on the ‘within.’ The term ‘within’ applies to the individual soul.
Spirituality in the Behavioral Health Recovery
• Spiritual beliefs are personal, and spirituality means something different to everyone. Exploration of a person’s spirituality in healthcare can happen when beginning the process of gathering and sharing information, in a moment of crisis or loss, or as part of a long-term process of client engagement.
Ethic of Reciprocity
• The ethic of reciprocity is a general moral principle found in virtually all religions and culture, often as a fundamental rule, a fact which suggests that it may be related to innate aspects of human nature.
• The ethic of reciprocity, or Golden Rule of ethics
• “Do unto others as you would have them do unto you.”