Slide1: Creative Therapies In Mental Health Recovery Sandi Miller, BA/RRT April 4, 2006


Slide2:     Introduction to the ODMH Mental Health Recovery Movement Overview: What is Mental Health Recovery? Utilization of the 9 Components in clinical practice Consumers’ Thoughts on Recovery Q & A Agenda


Slide3: History of IBHS Mental Health Recovery:   1999-ODMH Director Hogan commits to recovery philosophy: “The Emerging Best Practices” model is unveiled 2000-ODMH partners with Labor to offer Recovery Awareness training stipends: 2500 staff trained 2001-System-wide JCAHO Survey, surveyors probe staffs’ knowledge of Recovery     2002-ISS Recovery Initiative Work Group develops inpatient Recovery curriculum


Slide4:     EXPLANATION OF MENTAL HEALTH RECOVERY     Recovery is variously called a process, an outlook, a vision, a guiding principle. There is neither a single agreed-upon definition of recovery nor a single way to measure it. But the overarching message is that hope and restoration of a meaningful life are possible, despite serious mental illness (Deegan, 1988 Anthony, and Stocks, 1995 Spaniol at al., 1997).   Instead of focusing primarily on symptom relief, as the medical model dictates, recovery casts a much wider spotlight on restoration of self-esteem and identity and on attaining meaningful roles in society. The definitions do not, however, imply full recovery, in which full functioning is restored and no medications are needed. Instead they suggest a journey or process, not a destination or cure (Deegan, 1997)


Slide5:     ODMH Definition of Recovery:   The Ohio Department of Mental Health defines mental health recovery as "A personal process of overcoming the negative impact of a psychiatric disability despite its continued presence". .


Slide6: What Recovery May Look Like…. Most definitions of recovery include the following: Accepting “…That which is unacceptable” (Farr & Hurley, 1997), It means accepting that one has a disease and it also means letting go of denial as well as misplaced guilt and blame. “Acceptance is one of the harder tasks in the recovery process” (Spaniol, Gagne & Koehler, 1998) Finding someone who will hold the candle of hope for you. “A common denominator of recovery is the presence of people who believe in and stand by the person in need of recovery”. (Anthony 1993)


Slide7: Everyone of us is a person, not just an illness. If individuals with mental illness remind others that they are more than their illness, they will also remind themselves. “Hanging in there” through the long, often slow process of healing. “Recovery is a process, not an end-point or a destination”. (Deegan 1997) Changing one’s attitudes about mental illness. “Recovery is…a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles…I think my son explained what this change in attitude might look like when he told me one day…..‘I’ve decided not to collaborate with the illness…..I’m not going to stay in bed all day…’” (Anthony 1993)


Slide8: Regarding one’s self not as an illness, but as an individual with strengths, even gifts, who also happens to have an illness. Creating an individual vision of recovery. Because each one of us is unique, recovery is highly individual. Each person recovers in his or her own way. The personal vision might include “Living a satisfying, hopeful and contributing life even with limitations caused by the illness” (Anthony 1993) Expanding a person’s view of themselves and what’s possible for them. Promoting hope for the future and a sense that one has choices and can shape what happens in life”. (Farley & Hurley, 1997) Finding meaning and purpose in one’s life despite the persistence of symptoms. “Recovery can occur even though symptoms reoccur” (Anthony, 1993)


Slide9: Healing from the effects of stigma, a lack of opportunities to work or school, and interacting with others in a positive manner. Realizing that while recovery may be a painful process, it can also be “A process of self-discovery, self-renewal and transformation” (Spaniol, Gagne, & Kohler, 1998) Who knows what achievements or acts of courage and compassion are waiting to be released in every individual who has a mental illness? Excerpts taken from article by Louise Loots Thorton, “Recovery From Schizophrenia”, 2001


Slide10: Guiding Principles The consumer directs the recovery process; therefore, consumer input is essential throughout the process. The Mental Health System must be aware of its tendency to enable and encourage consumer dependency. Consumers are able to recover more quickly when their: Hope is encouraged, enhanced, and/or maintained Life roles with respect to work and meaningful activities are defined Spirituality is considered Culture is understood Educational needs as well as those of their family/significant others are identified Socialization needs are identified Individual differences are considered and valued across a consumer’s life span. V. Recovery from mental illness is most effective when a holistic approach is considered.


Slide11: Guiding Principles VI. In order to reflect current “Best Practices”, there is a need to merge all intervention models, including Medical, Psychological, Social, and Recovery. Clinician’s initial emphasis on “hope” and the ability to develop trusting relationships influences the consumer’s recovery. VIII. Clinicians operate from a strengths/assets model. IX.    Clinicians and consumers collaboratively develop a recovery management plan that focuses on interventions that facilitate recovery and the resources that will support the recovery process. X.      Family involvement may enhance the recovery process. The consumer defines his/her family. XI.     Mental health services are most effective when delivery is within the context of the consumer’s community. XII. Community Involvement as defined by the consumer is important to the recovery process.


Slide12:  Individual Prior to Mental Illness   Prior to mental illness, individuals have many roles as well as numerous hobbies and various relationships. At the center of it all is the person’s core personality or identity. When healthy, no one aspect of a person’s life controls or influences the other aspects. Mary JOB FRIENDS SPIRITUALITY FAMILY HOBBIES SCHOOL SOCIAL PETS COMMUNITY SKILLS


Slide13: Individual with Mental Illness When a person is diagnosed with a serious mental illness, it is common for their diagnosis/mental health issues to become the core of the personality or identity. Often times, their roles, hobbies and relationships either disappear or get weakened as their illness takes control of these aspects of the consumer’s life. Rather than committing a balanced amount of time to all aspects of their life, the illness gets the vast majority of their time. Dx JOB FRIENDS SPIRITUALITY FAMILY HOBBIES SKILLS SCHOOL COMMUNITY SOCIAL PETS


Slide14: Recovery Process A partnership and mutual trust between the consumer and staff sets a foundation on which the process of reconnecting the meaningful parts of the consumer’s life can begin. The integration of recovery into the services delivered will foster a balance between the illness and consumer’s identity. Once the consumer determines what it is he wants to achieve in his reconnection, necessary supports can be provided. Client Staff JOB FRIENDS SPIRITUALITY FAMILY HOBBIES SKILLS SCHOOL SELF-ESTEEM SOCIAL DX


Slide15: Recovery Process Recovery is the process of gradually reconnecting those aspects of the consumer’s life that were important prior to their illness. It’s the process of removing the diagnosis/illness from the core of their identity or personality and replacing it with a healthier, more global sense of self. Often times, the recovery process leads to adding roles, hobbies, and relationships that weren’t prevalent prior to the illness. -Dr. Patricia Deegan, PhD Mary JOB FRIENDS SPIRITUALITY FAMILY HOBBIES SKILLS SCHOOL SELF-ESTEEM SOCIAL DX


The 9 Essential Components of Mental Health Recovery: The 9 Essential Components of Mental Health Recovery Clinical Care Peer Support & Relationships Family Support Work & Meaningful Activity Power & Control Stigma Community Involvement Access To Resources Education


Slide17: Nine Essential Components


Clinical Care: Clinical Care


Slide19: Clinical Practice Brainstorm: What is Clinical Care? What are our physical and mental health needs? Discuss how to talk to your doctor. Role play discussing problem with doctor. Talk about medications, their benefits & side effects Explore stress and what triggers stress- discuss anger management-assertiveness vs. aggressiveness Overview stress management & practice relaxation techniques such as deep breathing. Teach & use positive self talk. As a group, give out personal positive traits certificate. Talk about good nutrition.


Clinical Care (Continued): Clinical Care (Continued) 11. Cut out pictures of different foods & give everyone a paper plate. Have them put together a meal. 12. Practice smiling. 13. Draw an activity that gives you exercise. 14. Make a collage reflecting those things that make up clinical care. 15. Talk about what can affect clinical care.


Slide21: Peer Support & Relationships


Clinical Practice: Clinical Practice Brainstorm: What is Peer Support? Discuss what is friendship? Explore building friendships. Examine how to maintain friendships- role play. Discuss setting limits with friends- role play. Focus on healthy activities with friends. Talk about dealing with the end of a friendship-role play Help those who want, to acquire a pen pal. Role play good friend, bad friend Brainstorm a list of good qualities of a friend-write multiples of them down on small pieces of paper-everyone takes several and then gives them to the person in the group which they feel exemplifies that quality. Listen to the song, “Lean on me”- discuss what the song says


Slide23: Family Support


Clinical Practice: Clinical Practice What is Family Support? How can FS assist in recovery? Discuss: Are all families supportive? Explore “Adopted” family vs. blood relatives Complete “My family tree of support” handout How do we educate families about recovery & disabilities? Healthy activities with family members Role play how to tell a family member that they are not supportive. Discuss how to introduce family members to others. Role play. Examine cultivating family relationships.


Work & Meaningful Activity: Work & Meaningful Activity


Clinical Practice: Clinical Practice 1. Explore the benefits of employment & meaningful activities 2. Draw your dream job. 3. Discuss/list or draw the jobs you have had in the past (even mowing the lawn). 4. Examine how to dress & act for a job interview-role play an interview 5. Explore ways to keep a job. 6. What is a meaningful activity for each group member? 7. Draw a picture of you helping someone, why did you choose this to draw? 8. Talk about volunteering and where you could volunteer. 9. Use the Good Deed Jar. 10. Talk about an experience that was really hard to do, but that you now feel good about. 11. Draw a picture of something you do well.


Slide27: Power & Control


Clinical Practice: Clinical Practice Make a list of things that you have control over & make another of what you do not have control over. Draw a time when you felt you didn’t have control-now reverse it. Explore problem solving models Discuss- How does good health promote good control/choices? Give examples of when you self directed your activities of daily living such as: schedule, choices of who, where, when, what, how and why & goals Define free time and give examples of things to do during that time. Discuss demands on your time and energy-what choices do you have? Role play self control in a tough situation. Review & discuss The Serenity Prayer List the responsibilities of Power & Control


Slide29: Decreasing Stigma STIGMA


Slide30: Clinical Practice Define stigma. Discuss how stigma occurs, i.e., movies, media, consumers not in treatment causing them to act bizarrely. Define disability and list some examples. Discuss who doesn’t have one. Discuss that everyone is a balance of gifts & deficits. List some gifts people have that are not always apparent. Talk about some famous people that were handicapped, e.g., Helen Keller, Steve Reeves, Margo Kidder. What can they teach us? What characteristics about you make you stand out in a crowd- both positive & negative. Draw a time when you were uncomfortable in a crowd. What would you do now to make it better for yourself? Role play what to do when someone is staring-both in a positive light and a negative one. Talk about others’ reaction to both. Brainstorm ideas about how you can advocate and educate others about disabilities.


Community Involvement: Community Involvement


Clinical Practice: Clinical Practice What does it mean to be involved in your community? Have the group make a list of different community activities that they would enjoy. Examine volunteer opportunities in the community. Plan a group trip to a place to volunteer-Clean up day at a park, Food Pantry Have a scavenger hunt using different community sites. Talk about voting, how to register, where to vote, etc. Explore the community using mass transit-take a group trip via bus Discuss shopping in the community-where can you get the best deals? Select one store and take a trip there. Talk about how to deal with emergencies in the community. Make a group collage of community activities. Explore fun, free activities in the community-free concerts, plays


Access To Resources: Access To Resources


Slide34: Clinical Practice List different resources needed to live in the community. Discuss how, where and who can help us connect to those resources. Look at a grocery flyer, give each person $5 in play money and make up 3 meals using the flyer Discuss thrift shops and the benefits of shopping there. Plan a trip to go to one. Have a utilities representative come in and talk about how to set up services and special accounts. Draw a picture of you accessing a resource. Draw a picture of you and your case manager. Talk about how your case manager helps you. Discuss support groups available in the community and the benefits of joining. Have a guest speaker from the community. Draw your dream vacation. What resources would you need to use to go on that vacation? Discuss/role play behaviors (Both + & -) when accessing resources.


Education: Education


Clinical Practice: Clinical Practice Discuss formal & informal education Explore where a person can receive formal & informal education in the community. What are the benefits of education? Ask each member to state something that they have learned informally. Who taught you this? Have each member teach the group an activity (e.g., how to play a game, how to wash your hands, how to ride the bus, how to use the telephone, how to behave in public, etc.) Discuss how to learn more about your mental health condition. What are the benefits of this? Have the group members talk about something about which they would like to learn (e.g., how to play an instrument, a particular card game, how to cook a certain dish, what to do in an emergency, how to use a computer, how to put on makeup). Explore who can teach you this.


Consumer’s Say…..: Consumer’s Say….. “LEARNING TO ACCEPT YOURSELF, LEARNING TO OPEN UP TO YOUR EMOTIONS AND WORK ON THEM......SHARING....AND CONTINUE TO WORK ON THEM OUTSIDE” “LIVING THE BEST QUALITY OF LIFE DESPITE THE PROBLEMS THAT ARE EXISTING WHILE YOU ARE DEALING WITH THEM” “RECOGNIZING THAT IT IS AN ONGOING ILLNESS. GETTING TREATMENT” “RECOVERY IS LIKE LOOKING AT THE SKY AND FINDING A SEAGULL TO GUIDE YOU TO LAND”


Consumers Say….(Cont’d): Consumers Say….(Cont’d) “WHEN YOU START TAKING MEDICINE, YOU START TAKING RESPONSIBILITY FOR YOUR RECOVERY” “WHAT DOES RECOVERY MEANT TO ME? TO HAVE HOPE. TO FEEL LIKE A USEFUL, NEEDED PERSON. TO BE ABLE TO UTILIZE THE ABILITIES I HAVE. TO BE ABLE TO HELP OTHERS AND BE A CONTRIBUTING MEMBER OF SOCIETY” “RECOVERY IS A PERSON-CENTERED PROCESS. IT IS A JOURNEY THAT AN INDIVIDUAL UNDERTAKES. TO BE RECOVERING IS TO BE TAKING PERSONAL RESPONSIBILITY FOR THE CHALLENGES ASSOCIATED WITH MENTAL ILLNESS”


Consumer’s Say…..(Cont’d): Consumer’s Say…..(Cont’d) “RECOVERY MEANS GETTING CONTROL OVER MY LIFE. RECOVERY MEANS BELIEVING IN MYSELF ONCE AGAIN. RECOVERY MEANS NOT GIVIING UP” “WHAT DOES RECOVERY MEAN TO ME? ACCEPTING THAT I HAVE THIS ILLNESS, THE WAY IT HAS AFFECTED MY THOUGHT, REACTIONS AND FEELINGS. I NEED TO LEARN HOW TO SEPARATE THOSE PARTS OF MY ILLNESS I CANNOT CHANGE AND STOP JUDGING MYSELF BECAUSE OF MY SYMPTOMS” “I AM IN THE PROCESS OF RECOVERY AND IT IS REAL TO ME THAT I AM A GOOD PERSON WITH GOOD VALUES WHO HAS A NEED TO BE HELPFUL”


Slide40: MENTAL HEALTH RECOVERY Follow the road to Mental Health Recovery! Clinical care Work and Meaningful Activity Peer Support & Relationships Family Support Community Involvement Access To Resources Power & Control Decreasing Stigma Education