California Association of Social Rehabilitation Agencies

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1 Spring 2016 California Association of Social Rehabilitation Agencies CASRA is dedicated to improving services and social conditions for people with psychiatric disabilities promoting their wellness, recovery and civil rights. Spring 2016 Recovery in Practice Upcoming Events May 4-5, 2016 May 22-25, 2016 August 26-27, 2016 CASRA Spring Conference, Concord The Recovery Workforce Summit: PRA Annual Conference, Philadelphia NAMI California Conference, Burlingame Welcome to CASRA CASRA is an association of not-for-profit agencies that serve Californians that turn to the public mental health system for help. Since 1969, CASRA and its member organizations have been dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their wellness, recovery and civil rights. Services are based upon the philosophy and principles of social rehabilitation, a person and culture-centered approach that fosters relationships which promote wellness and a positive sense of self. Our goal is to transform the public mental health system by promoting the development of community-based systems of services which are based on the promise of growth and recovery and to support the work of community-based organizations who strive to implement this vision in their local communities. A diagnosis is not a destiny.

2 Civil Rights Challenges Involuntary Outpatient Commitment There has been increasing interest by County Boards of Supervisors to implement Assisted Outpatient Treatment or more aptly titled, Outpatient Commitment. This increased interest has arisen out of an amendment to the act that allows counties to use MHSA funds to create services for individuals who are committed by a court order to outpatient care. Proponents of outpatient commitment state that it is necessary for a very small group of individuals who resist needed treatment. Conversely, opponents state that involuntary services create more resistance and trauma. While both positions have validity, it appears that the time for debate has ended and we must grapple with how AOT programs will be implemented. In California, outpatient commitment programs must meet the criteria established for those program providing full service partnerships. These services are the most intensive and costly outpatient services available and are modeled on best practices that include a wide range of social rehabilitation services designed to assist the individual to live and thrive within the community. While CASRA remains opposed to outpatient commitment and believes that the mental health system should ensure adequate evidence-based, voluntary services, we do propose that if counties use this option there must be safeguards to protect against unintended consequences. There are a number of issues that must be considered including the limited number of Full Service Partnership (FSP) spaces available, the effect of coercion on the individual as well as judicial unfunded demands. Mark Ragins offers a number of suggestions that we agree should be included in any outpatient commitment program including; A strong grievance procedure Checks and balances to reduce potential abuse of power Seeking voluntary engagement and brokered agreements throughout the process of establishing AOT An AOT access committee that can ensure allocation of FSP slots are not overburdened by the courts A graduation system for current enrollees in FSP s A housing fund outside of the MHSA dollars that persists beyond AOT services AOT courts that are modeled after mental health and drug courts and are adequately funded An ongoing review and improvement of legal services A transparent AOT budget 2

3 Building the Recovery Workforce: Peer Certification Since 1978, CASRA has encouraged the hiring of persons who have received services in the public mental health system and who have learned how to use that experience in support of another s journey. CASRA agencies have been at the forefront of hiring peer providers to provide a range of services that assist individuals on their journey towards wellness. For many CASRA agencies, peers and peer values have become so engrained within the organization that job titles no longer reflect status as a peer. While CASRA members have made great strides in this area, there remains an underutilization of peer providers and a lack of availability of peer support. CASRA supports SB 614, sponsored by the County Behavioral Health Directors and introduced by Senator Leno (San Francisco), which would create a certification process for peer providers and establish a new service within MediCal called Peer Support. The bill proponents hope that this bill will lead to the hiring of more peers and family member providers and create a service that is distinguishable from other mental health services. California is somewhat late in developing this MediCal reimbursable service as more than 30 states have already done so. Some have expressed concern that certification of peer providers will mean that current employees will not be able to bill for the services they are currently providing. The bill expressly states that it is not intended to prevent peer providers as other qualified providers from providing existing mental health services. The intention of the bill is to develop a qualified workforce able to provide the unique service of peer support. This service has been described by Sherry Mead as a system of giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful. Peer support is not based on psychiatric models and diagnostic criteria. It is about understanding another s situation empathically through the shared experience of emotional and psychological pain. When people find affiliation with others whom they feel are like them, they feel a connection. This connection of affiliation, is a deep, holistic understanding based on mutual experience where people are able to be with each other without the constraints of traditional (expert/patient) relationships. 3

4 INITIATIVES THAT PUSH THE ENVELOPE ZERO SUICIDE Suicide is a preventable medical error. The Zero Suicide Initiative seeks to end suicides among people who are being treated in the healthcare system. This is not only a goal but a set of specific strategies designed to help all behavioral healthcare organizations be suicide safe. This work applies the Patient Safety Movement principles (zero preventable deaths in healthcare by 2020) to behavioral healthcare. When we look back at those individuals who died by suicide while under the care of a healthcare professional, we discover that a main reason for this tragedy is simply that the person was not asked about feelings of suicide. Despite years of available suicide prevention training, many professionals still worry that to ask about suicide will make things worse or put the idea into the person s mind. In addition, there are problems with follow-up and a comprehensive care plan for the person at risk. We must do better. Zero Suicide has developed a toolkit aimed at conducting a thorough organizational review, identifying staff training needs and improving monitoring systems to ensure people get the treatment and attention they deserve to be safe. For more information, please go to WHAT S HAPPINESS GOT TO DO WITH IT? Do you actively work with your clients on how to experience more positive emotions? If you are working with people on identifying and using their strengths, you are part-way there! Positive emotions are one of the five core components of well-being as articulated by Martin Seligman, Ph.D., considered to be the father of Positive Psychology. Positive Psychology is a new branch of the field that is focused on studying and understanding what s right with people: strengths, virtues and the best of what makes us human. Seligman defines well-being as 1. Positive emotions (a ratio of at least 3:1, positive emotions over negative) 2. Engagement (the ability to be fully involved and engrossed in something, experiencing flow ) 3. Relationship (having close relationships) 4. Meaning (doing something that gives one s life a sense of purpose) 5. Achievement (having and pursuing a meaningful goal. Yes you read it right. Goals are one of the key five key components of well-being!) It s time for psychosocial rehabilitation specialists to learn about the findings of positive psychology and integrate them into the work we do with individuals who are coping with a major mental health challenge. Positive emotions matter and that s why we re talking about happiness. How can we help ourselves as well as our clients reach that ratio of thriving experiencing at least three positive emotions for each negative one. CASRA is pleased to offer a training on Increasing Positive Emotions: Actively Building Happiness into your Life. In it you ll hear about the research on the most effective strategies to increase your happiness. Spoiler alert: it s going to have something to do with gratitude, a lot to do with kindness, and definitely involves other people. Look for a workshop in the spring on the subject. 4

5 SHARED DECISION-MAKING: Supporting Choice, Self-Determination and a Holistic Approach Shared Decision-Making (SDM) is the practice of collaboration with an individual in determining all of his/her treatment choices. It is based on the ethical and legal directive of informed consent, the importance of reviewing options and the fundamental decision to honor the individual s personal wisdom about what will work best for his/her recovery. There are exciting developments that support SDM: new communication and therapy strategies as well as technology innovations that are geared towards helping people who have mental health challenges self-manage their distressing symptoms. Here s a few examples: CASRA s Spring Conference features the keynote speaker, Dina Tyler, who is a peer leader in working with voices in new ways AND two workshops all dealing with new ways to work with people experiencing severely distressing symptoms, including hearing voices. Robert Whitaker, author of Mad in America has established the Mad in American Foundation which publishes a webzine, madinamerica.com. Mad in America s mission is to serve as catalyst for remaking psychiatric care in the U.S. They believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change. Find out more on two excellent blogs: Stopping Stigma, which includes a Top 10 list of things to consider to improve our approach to psychosis AND the Psychosis Sucks blog. The Bay Area Hearing Voices Network sponsors multiple events each year focused on non-medical approaches to managing voices and extreme states. CASRA s Medication Policy, originally written in 1980, was among the first public statements to set out the message that individuals have the right to the least intrusive treatment necessary to improve their mental health. The policy outlines the importance of the right to be well-informed about psychiatric medication risks as well as benefits and the responsibility to make sure that a full array of non-medication options are available for every mental health consumer - REAL CHOICE. Accepting and Making Sense of Hearing Voices Professor Marius Romme, MD, PhD and his colleague Dr. Sandra Escher have been studying the voice hearing experience for over 25 years. Their research has shown that over 70% of people who hear voices can point to a traumatic event that triggered their voices; that talking about voices and what they mean is a very effective way to reduce anxiety and isolation; and that even when the voices are overwhelming and seemingly destructive they often have an important message for the hearer. Dr. Marius describes three phases found among people who hear voices: The startling phase, the phase of organization coping with the voices and the phase of stabilisation. Dr. Marius is the President of Intervoice which supports the International Hearing Voices Movement. Intervoice has created A Practical Guide to Coping with Voices that is available at their website: NEW AT THE CASRA BOOKSTORE Living with Voices: 50 Stories of Recovery This book is a groundbreaking development in modern mental health because it recognizes the importance of first-hand experience and argues that hearing voices is not a sign of madness but a reaction to serious problems in life. 5

6 Breaking News MEANINGFUL ROLES FOR PEER PROVIDERS CASRA is pleased to announce the availability of our latest toolkit, Meaningful Roles for Peer Providers in Integrated Healthcare. The toolkit was developed by CASRA with support from the Integrated Behavioral Health Project and funding from the CA Mental Health Services Authority s Statewide Stigma and Discrimination Reduction Initiative. HEARING VOICES FACILITATOR TRAINING The Foundation for Excellence in Mental Health Care is offering to come to your community and provide a 3-day intensive training for up to 25 participants. Participants will each receive a comprehensive resource manual and opportunities for ongoing support. To request further information about training and costs, please contact Caroline White, Coordinator, at Caroline@westernmassrlc.org or CRISIS to RECOVERY The initial 2016 issue of the National Council Magazine features an article by Steve Fields, Executive Director, Progress Foundation and Betty Dahlquist, Executive Director, CASRA. Community-Based Alternatives to a System s Acute Care Needs, reports that the most successful residential treatment programs emerge from a broad-based strategy of effective alternatives to hospitals, jails and other institutions. CASRA Member Agencies Asian Pacific Counseling & Treatment Centers Baker Places Bay Area Community Services Berkeley Place Bonita House Buckelew Programs Caminar Community Connection Community Solutions Conard House Consumer s Self-Help Contra Costa Clubhouse Crossroads Diversified Services Didi Hirsch CMH Center El Hogar Encompass Community Services Human Resource Consultants Interim, Inc. Mental Health America LA Momentum for Mental Health Northern Valley Catholic Social Services Pacific Clinics Peers Envisioning and Engaging in Recovery Services Phoenix of Santa Barbara Progress Foundation Project Return Peer Support Network San Fernando Valley CMHC TLCS Transitions-MHA Turning Point Community Programs Turning Point of Central California Turning Point Foundation Yolo Community Care Continuum