Choosing HopeRecovery, Self-Determination, and Peer Support

Paolo del Vecchio, MSWActing Director, Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

VOCAL Annual Statewide Peer ConferenceHarrisonburg, VA May 21, ♦ 2012

Self-Determination

Self-determination helps people, their families, and friends determine their future; design their own support plans; choose the assistance they need to live full lives; and control a personal budget for their supports. CT Department of Developmental Services

Fire Walking

Helping people heal one step at a time

My Story

Choosing Hope

“The purpose of life, after all, is to live it, to taste experience to the utmost, to reach out eagerly and without

fear for newer and richer experiences.”  

– Eleanor Roosevelt

Time for Change

Recovery Emerges From Hope

“Hope is to the soul what oxygen is to the body.” – Larry Fricks

Defining 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.

– SAMHSA, 2011

Four Dimensions of Recovery

Individuals and Families

Social Exclusion

“By any measure, it is clear that people with mental illnesses are on the margin, actually not on the page at all. Dying decades earlier than the general population is testament enough about how those with mental illnesses have been marginalized.”

– Paolo del Vecchio

SAMHSA’s Pledge for Wellness

“We envision a future in which people with mental health problems pursue optimal health, happiness, recovery, and a full and satisfying life in the community via access to a range of effective services, supports, and resources.”

Eight Dimensions of Wellness

– Adapted from Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29,(4) 311- 314.

Psychiatric Advance Directives

Psychiatric advance directives:• Empower consumers to assume control over treatment

decisions • Enhance communications about treatment preferences

among consumers, their families, and treatment providers• Facilitate appropriate and timely treatment interventions

before situations deteriorate to emergency status • May lead to reductions in adversarial court proceedings over

involuntary psychiatric treatment

– Ronald S. Honberg, National Director for Policy and Legal Affairs, NAMI

Home

Purpose

Contribution – Independence – Hope

Community

“Those of us who have experienced psychiatric symptoms are (…) climbing mountains, planting gardens, painting pictures, writing books, making quilts, and creating positive change in the world.” – Shery Mead, MSW, and Mary Ellen Copeland MS, MA

Shared Decision Making

The new SDM site offers a print/video link, online decision aid, workbooks, and cool tools: http://www.samhsa.gov/consumersurvivor/sdm/StartHere.html

Importance of Choice

Common Antipsychotic Side Effects:• Abnormal movements• Diabetes• Dry mouth• Metabolic syndrome• Neuroleptic malignant syndrome (NMS)• Sexual side effects• Sleep problems• Stroke• Sudden cardiac death• Weight gain

Medication Best Practices

• Shared Decision-Making: Provide individuals with to up-to-date information about the drugs they take, including potential side effects.

• Individualized, Person-Centered Care: View medication use as a dynamic process that evolves over each person’s unique recovery journey.

• Holistic Approach: Adopt a bio-psycho-social-cultural-spiritual model to assess benefits and costs of using medications as a tool for recovery.

• Relational: Prescribe and monitor medications within the context of a trusting and collaborative relationship.

• Integrated Treatment: Prescribe and monitor medications within an integrated community-based recovery plan.

• Need for Protocols: Use medication “if needed, as needed, and as seldom as possible” and in combination with psychological and social supports.

Self-Directed Care

Nerney, T. (2001). Self-determination: understanding the core principles deeded for people with disabilities to control their own lives. Augustine: Training Resource Network, Inc.

Self-determination is based on five principles:• Freedom – to live in the community• Authority – over funds needed for self-

care• Support – to make choices• Responsibility – to manage finances,

choose services, and handle tasks of daily living

• Confirmation or Participation – the opportunity to participate in decision making about the care delivery system

.

Self-Directed Care in Mental Health

Adults with mental illnesses that participate in self-directed care have:

• Higher satisfaction with their quality of life;

• Higher satisfaction with their paid caregivers;

• Fewer unmet needs;

• No more injuries or other adverse health outcomes than other individuals;

• No significant differences in total expenditures;

• The ability to successfully manage the cash option. SAMHSA. (2010). Self-directed care in mental health: Lessons from the Cash & Counseling Demonstration Evaluation.

Constituent-Identified SAMHSA Accomplishments

SAMHSA accomplishments identified by constituents include:• Peer programs that promote complete mental health recovery• Focus on the recovery model and consumer driven care• Realization that forced drugging is a human rights abuse• Implementation of assisted outpatient treatment• Recovery learning communities• Crisis intervention teams for law enforcement• Trauma-informed care• Court ordered outpatient treatment• Peer support• Supported housing for the seriously mentally ill

Peer Support

“Peer specialists bring the essential message of hope that acts as a catalyst for people to begin their journey of recovery.”

– Paolo del Vecchio– Visions of Hope Arizona

Peer Workforce Issues

Challenges:• Financing of peer specialists • Misperceptions or lack of staff knowledge • Over-assimilate and take on roles of

traditional mental health providers• Inappropriate work roles with no

opportunity for advancement

Solutions:• Trust-based relationships• Clearly defined, formal job description • Ongoing skills-based training and

certification• Same performance expectations as other

employees

SAMHSA ADS Center

SAMHSA’s Resource Center to Promote Acceptance,

Dignity and Social Inclusion Associated withMental Health (ADS Center)

Announcing theSAMHSA Million Hearts Social Marketing Programs for Peer-Run/Recovery Community Organizations

• Teleconferences: – Peer Respite Services: Transforming Crisis

to Wellness– Peer Support and Peer Providers:

Redefining Mental Health Recovery

• Information Update, “Promising Practices for Social Inclusion: Peer-Provided Respite Care—Innovative Practices that Promote Wellness and Recovery”

• ADS Center’s My Story section • SAMHSA Consumer-Operated Evidence-

Based Practice Kit • Nuts and Bolts: A Technical Assistance

Guide for Mental Health Consumer/Survivor Self-Help Groups

http://promoteacceptance.samhsa.gov/CSI/awards/default.aspx

SAMHSA Peer Support and Consumer-Operated Activities

SAMHSA funds and supports the following initiatives, among others:• Peer-Run and Recovery Community

Organizations• Expert Panel Meeting on Peer

Specialists and Peer Recovery Coaches• Pillars of Peer Support Services Summit• Statewide Consumer and Family

Network Grants• National Consumer and Consumer

Supporter Technical Assistance Centers• Annual Consumer Conference –

Alternatives Conference

“Peer recovery coaches go where no other group goes.” – Joe Powell, Executive Director, Association of Persons Affected by Addictions

Closing Thoughts

“The choice is ours to make.”

For More Information

SAMHSA1 Choke Cherry Road • Rockville, MD • 20857Phone: 1-877-SAMHSA-7 (1-877-726-4727)TTY: 1-800-487-4889Fax: 240-221-4292http://www.samhsa.gov

CMHSPhone: 240-276-1310 Fax: 240-276-1320

Questions & Answers