Recovery to Practice and American Association of American Psychiatric Association and American Association of Community Psychiatrists   Recovery to Practice

Presenter: Annelle B. Primm , MD, MPH Deputy Medical Director Director, Office of Minority and National Affairs American Psychiatric Association

Recovery to Practice - Psychiatrists The goal of the Recovery to Practice Project is to equip psychiatrists with the knowledge, skills and attitudes to provide recovery-oriented psychiatric care in which they will work in partnership with people in recovery to assist them in achieving their goals and living a fulfilling life in the community. Recovery to Practice - Psychiatrists

Recovery to Practice - Psychiatrists Project Partners Advisory Group people in recovery psychiatrists in recovery psychiatrists other mental health professionals Work Group – APA staff and community psychiatrists Recovery to Practice - Psychiatrists

Information Gathering – Year 1 Literature review Face-to-face Dialogues Consumers and psychiatrists Psychiatrists and family members Psychiatrists and other mental health professionals Facilitated conference calls Consumers Targeted groups of psychiatrists (16)

Facilitated Conference Calls (psychiatrists) Community psychiatrists Inpatient psychiatrists State mental health program directors Psychiatry residents Residency training directors Addiction psychiatrists Consumer-psychiatrists VA psychiatrists International medical graduates Psychiatrists working with: Women African Americans Asian Americans American Indians Hispanics LGBT populations Youth/young adults

“Hope is the catalyst of the recovery process and provides the essential and motivating messages of a positive future.” (SAMHSA)

SAMHSA 10 Recovery Components Hope Self-direction Individualized and person-centered Empowerment Holistic Non-linear Strengths-based Peer support Respect Responsibility Recovery to Practice - Psychiatrists

From People in Recovery Psychiatrists hinder recovery by “viewing crises as something to be medicated away or restrained away instead of opportunities for people to learn and grow.” “It’s no good when things feel clinical, when it is all about the medications and symptoms, and not about the rest of my life.” “Psychiatrists must not lose sight of how fearful it is for someone to lose control of their mind.” “The most powerful thing anyone said to me was ‘I have so much hope for you.’’’ Recovery to Practice - Psychiatrists

Recovery to Practice - Psychiatrists From Psychiatrists “Change the goal of services from treating illness to helping people rebuild lives.” Recovery oriented practice for psychiatrists: “We’re talking about a fundamental change in values, not just a change in techniques.” “Believing in the possibility of recovery is key; I want psychiatrists to believe that consumers can recover and to have a positive attitude.” (Consumer psychiatrist) Recovery to Practice - Psychiatrists

System Challenges Contrasting perceptions and separation of programs for addictions and mental health recovery Psychiatrists and multi-disciplinary teams

Recovery Services Require Strong Teams We need to integrate a range of quality of life services beyond any one person’s competence People at different stages of recovery require different staff skills – engagement, building skills and support, moving on To increase accessibility to “someone I know” (Adapted from Mark Ragins, M.D.)

Recovery Services Require Strong Teams A team can create a culture of acceptance, welcoming, engaging, and emotionally connecting to people who are often rejected because of stigma and discrimination To adopt multiple roles we need to support and watch out for each other To maintain staff morale and avoid burnout we need to stick together and take care of each other Adapted from Mark Ragins, M.D.

Recommendations for Training Connect to participants’ prior knowledge and experiences Demonstrate recovery-oriented practices that address common clinical challenges Focus on how to use recovery principles in real situations (e.g., within time/resource limitations); provide concrete exercises Involve consumers as trainers, provide personal recovery stories

Target Audience 1) Direct service providers, including: psychiatry residents, medical students, and fellows Very early career psychiatrists Public/community psychiatrists Inpatient psychiatrists and emergency psychiatrists (acute care settings)   2) Trainers/supervisors, including Residency program supervisors and lecturers, and medical student educators Case conference/grand rounds organizers “Early adopter” local training providers

Recovery to Practice - Psychiatrists Goals of Training Familiarize psychiatrists with: Principles of recovery oriented care Benefits for individuals in recovery Benefits for psychiatrists Practical strategies for clinical settings Recovery to Practice - Psychiatrists

Recovery to Practice - Psychiatrists Training Modules 1. Introduction and Rationale 2. Engagement and Welcoming Environment creating an environment of hope for recovery where all people feel valued and respected 3. Person-Centered Planning and Shared Decision-Making Recovery to Practice - Psychiatrists

Recovery to Practice - Psychiatrists Modules, cont. 4. The Role of Medication in Recovery collaborative medication management; discussing options (including not taking medication) 5. Health and Wellness Focused Care integrated approach to recovery and well-being (mental, physical, spiritual, social, etc.) 6. Building Living Skills and Achieving Goals self-sufficiency and meaningful activity; building emotional skills to deal with adversity Recovery to Practice - Psychiatrists

Recovery to Practice - Psychiatrists Modules cont. 7. Culturally Appropriate and Trauma Informed Care incorporate understanding of beliefs, cultural identity spirituality, and experiences into recovery planning 8. Developing Peer Supports and Working with Peer Specialists 9. Developing Natural Supports and Facilitating Community Integration family members, peer support groups, strategies to strengthen support systems Recovery to Practice - Psychiatrists

Recovery Training for Psychiatrists Online training – will provide CME, approximately 1 hour/module  Recovery Toolkit of materials for use of trainers during in-person training All training presented jointly by a psychiatrist and a consumer

Recovery Toolkit An introductory discussion A video vignette demonstrating several key points in the curriculum A video of a panel discussion of the key points in the module Suggested topics/questions for discussion Summary discussion Supplemental materials and resources

Ongoing opportunities for feedback All of the materials will be pilot tested before they are finalized. We will seek review and comment from psychiatrists in various work settings and people in recovery as part of that process. Recovery to Practice - Psychiatrists

Project Directors: Annelle Primm, MD, MPH American Psychiatric Association Wes Sowers, MD American Association of Community Psychiatrists Questions/comments, contact: Debbie Cohen, dcohen@psych.org