Community Supports for People with Serious Mental Illness Psychiatric Recovery: The Role of Peer Support Sheree Neese-Todd Center for Health Care Strategies Hamilton, NJ Beth Szapucki Moving Forward Self Help Center New Brunswick, NJ

Our View of Serious and Persistent Mental Illness Who are these people? What do they need? How has service provision been transformed? What is the necessary scope of community service provision? What is the vision for psychiatric recovery?

Community Mental Health Support Services  Historical  Transformation  Political  Civil Rights  Social  Acceptance

1. Institutionalization - Hospitals Disability and Dependence 2. Community Living Ability and Independence Strength's Model Recovery and Resilience Self-help

Defining Serious and Persistent Mental Illness (SMI) Three Components Psychological Distress Duration of Symptoms, the course of the illness Disability, resulting from the effects of the illness

Biological Model of Mental Illness (Mechanic) Clear genetic evidence that these illnesses are biologically based Social factors may influence the course of the illness and most importantly the patients’ experience

Psychological Distress Primary Symptoms: Psychosis – Disconnected from reality (hallucinations, delusions, paranoia); great anxiety or fear; obsessive behaviors; severe depression Secondary Symptoms: Social isolation, relational deficits, medication side effects, odd physical experiences, bizarre mannerisms, unemotional affect, “flat”, exquisite vulnerability to stress

Duration  This is a chronic illness  Usually strikes in the transitional years from adolescence to adulthood  Symptoms can be managed and controlled BUT  The trajectory of the conditions are long term  Mental health consumers tell us that recovery can begin at any time  However, they note that it is a life long process

Disability  Ability to function in the world independently  Lack of feelings of control and self determination  Work proves difficult, folks are often unemployed  Abject poverty  Lack of self esteem  Social roles are compromised  Restricted social activity  Impacts upon a person’s quality of life

Distress Duration Disability What is needed is a system of care that addresses these three spheres of the illness in order to successfully provide adequate support for people who struggle with SMI.

CSP - PARADIGM

NIMH 1970’s and 1980’s CSP Structure, closing the gaps Philosophy, Consumer Centered Practice 1990’s Managed Care; Cost Containment Care Constraint 1. Ration Care, funding shifts 2. Ideals expressed in the CSP were compromised 1990’s to the Present 1. Mental Health Consumer Movement 2. Political Activism, Demands treatment Choices

2002 (April) Presidents “New Freedom Commission on Mental Health” Addresses Problems of Social Stigma Need for Full Health Parity Fragmentation of the delivery service Names “Recovery” as a desired outcome MISSION: “A Life in the Community for all”

What do we mean by Recovery? Self-help movement has given voice to “recovery” Themes emerge Empowerment Vision Recovery of Function Ability opposed to Disability

Consumers tell us what is required for Recovery 1. Hope and Courage 2. Medication, treatment, and understanding of the illness 3. Social supports (friends, family, other consumers self help, caring practitioners 4. Self-determination 5. Illness management 6. Spirituality 7. Meaningful Activity – Work, volunteering,

When we ask consumers what they want…. “A Place, a job, and a date…..” The same things that anyone wants; a home, productive activity, and emotional connection.

Recovery Living meaningful lives Not “recovered” Living “in recovery” This is a rehabilitation perspective –Strengths Model –Personal Empowerment

Self Help Centers Transformative Power Consumer preferences –Patient and families as a policy factor Peer to peer understanding and wisdom Advocacy Inclusion –State mental health agencies, research initiatives, educators (especially providers)

Part of the Service Continuum Wholly operated by consumer’s A seat at the table Not patronizing or tokenism Outcome oriented Self Help may not be for everyone