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Supported Housing. Supported housing is an evidence-based practice that links decent, permanent housing to flexible support services that are provided in a person’s home and in community settings. The program provides access to scattered site apartments or other housing options typical for a given community, made affordable through rental subsidies. Support services are provided in a flexible and individualized manner. Both team-based and individual case management models have been tested and proven effective.
The services provided in such a program are complex. They can include practical assistance with daily living, direct skills teaching, supportive counseling, wellness supports and illness self-management, harm reduction, money management, medication monitoring, community services navigation and connection to resources, attention to social network, leisure activities, peer support, and (often) crisis assistance.
Team-based approaches may include clinical services (psychiatry and mental health nursing), supported employment or education, services for co-occurring disorders, and peer specialists. Housing supports usually include move-in assistance, rent, and (sometimes) utility subsidies, basic housekeeping materials, and assistance with personal furnishing and decorating.
Supported housing has been found to support clinical stability, turnaround to recovery, and community integration. Permanent supported housing vastly reduces street homelessness for persons who are chronically homeless and reduces shelter stays. Thus the program has become a mainstay or primary solution in efforts to reduce or end homelessness, both nationwide and abroad.
For, example, Pathways to Housing—“Housing First”—provides scattered site rental housing and a modified Assertive Community Treatment team approach for persons with prolonged psychiatric disorder and chronic homelessness. The program has no preconditions of sobriety nor does it demand compliance with treatment, yet it achieves success rates approaching 90 percent over a 5-year period.
The costs of supported housing are modest and more cost effective when compared with institutions, jails, shelters, or inpatient costs. Indeed, studies have shown that the costs of supported housing services are largely mitigated by savings in delivering satisfactory services or actually saving money over time, while increasing the quality of life both for participants and for the community as a whole.
SAMHSA has recently released a resource toolkit for permanent supportive housing. These materials include training materials and fidelity criteria. Click here to read the article
Training. RTP provides quarterly training Webinars on implementing recovery-oriented practice. On June 8, 2010 RTP conducted its first Live Meeting Webinar, “Implementing Recovery‐Oriented Practices 1: Emerging Trends in Program and Workforce Development.” You can conveniently download the presentation slides, materials and the complete recorded session from the RTP Web page at: http://www.dsgonline.com/rtp/resources.html
The next RTP Webinar titled, "Supporting People Through an Acute Crisis," will take place Thursday, September 16, 2010 from 3:00-4:30 p.m. ET. Watch your email for an announcement on where and how to register!
AMERICAN PSYCHOLOGICAL ASSOCIATION’S 2010 ANNUAL CONVENTION
NATIONAL ASSOCIATION OF PEER SPECIALISTS’ ANNUAL CONFERENCE
ALTERNATIVES 2010 ANNUAL CONFERENCE
AMERICAN PSYCHIATRIC NURSES ASSOCIATION’S 2010 ANNUAL CONFERENCE
INSTITUTE ON PSYCHIATRIC SERVICES
COUNCIL ON SOCIAL WORK EDUCATION’S 2010 ANNUAL PROGRAM MEETING
AMERICAN COUNSELING ASSOCIATION’S (ACA) ANNUAL CONFERENCE
The RTP resource database is growing, with an array of valuable resources related to recovery: articles, reports, stories, videos, research, clinical tools, case studies, and experiential information.
When the RTP Web site is launched, the database will be easily navigable across the three RTP categories:
For the resource database to continue growing and become an even richer repository for the community, we need your help! To assist us in building this invaluable collection, please submit recovery resources to http://www2.dsgonline.com/rtp_cf/.
SAMHSA sponsors the recovery-oriented practice of shared decision-making--an interactive and collaborative process between individuals and their heath care providers that is used to make health care decisions pertinent to an individual’s personal recovery.
Each year, the SAMHSA 10 x 10 Wellness Campaign conducts approximately six training teleconferences that are designed to help participants enhance mental health consumer wellness by relating the most up-to-date research and information about programs within the United States and beyond that are working to reduce early mortality among persons with mental health problems.http://www.promoteacceptance.samhsa.gov/10by10/default.aspx
The Evolution of the Concept of Recovery. Recently I overheard two senior mental health officials discussing recovery. One said, “I think recovery is a very important concept.” The other replied, “I agree,” and then he whispered, “But what is it?”
Indeed, we have a field and a society that have been highlighting the importance of recovery—and that have had little agreement about its meaning.
The New Freedom Commission stated: “We see a future when everyone with a mental illness will recover.” This vision has inspired many to advocate for recovery at the state and national levels. In 2006, SAMHSA published the 10 Components of Recovery. The Recovery to Practice initiative represents the next step in implementing recovery.
In this new era of healthcare reform, however, we need a broader concept of recovery. We need a concept that gives hope to those of us labeled with a psychiatric diagnosis—and that at the same time can be understood by the rest of society.
Most persons with a variety of other disabilities cannot relate to the concept of recovery. Many think our concept of recovery means that people in wheelchairs will walk or that people with autism will be able to relate socially the way most everyone else does. These are not the primary goals of the independent living movement.
To frame recovery more broadly, we need to go beyond a narrow medical definition of mental health issues. For many years, professionals and researchers have described mental illness as a severe form of mental disorder, characterized by a permanent biological defect and a chemical imbalance from which recovery rarely occurs. In the eyes of this group, recovery would occur only if there were a cure. Countless studies have been carried out to define the supposed biological basis of mental illness. No consistent deficit has been found. It was believed that at best the illness could go into remission, during which the symptoms are managed. This is the maintenance model, which leaves persons who experience distress feeling hopeless.
Recently, through a dialog by the Steering Committee of the Recovery to Practice initiative, we have drafted a broader description of recovery:
[T]he recovery paradigm views mental health issues as challenges that a person can grow beyond through the assistance of culturally appropriate, trauma-informed services and natural supports in the process of the person building a full and gratifying life in the community of his or her choice.
This description fits with the goals mapped out for persons with all disabilities in the Americans with Disabilities Act signed into law 20 years ago:
This broader definition of recovery can also span the fields of mental health and substance use. In the substance use field, these elements are vital aspects of recovery.
The five national professional organizations that have been awarded 5-year subcontracts to develop training curricula for their respective disciplines—the American Psychiatric Association, the American Psychiatric Nurses Association, the American Psychological Association, the Council on Social Work Education, and the National Association of Peer Specialists—are well into their first year’s activities. Each of these five has planned, and is now conducting, research into and assessment of where and how recovery-oriented practice exists throughout its formal organization and operational practices.
The organizations are learning about the evidence of recovery by collecting data through a range of individual and group activities and by sharing common challenges and findings across their memberships. Results of their assessments will be used right away to develop situational analyses that will then inform development—and dissemination—of the customized training programs in coming years.
Here are some common themes that are emerging across the disciplines:
My life was over. That was the message I left with as I was discharged from my first stay at a psychiatric hospital. Although I entered the facility besieged with auditory and visual hallucinations, I also had a small measure of hope.
During my 10-day stay at the hospital, the hallucinations disappeared, but so did the hope. Hospital staff painted a grim picture of my future. They told me in certain terms that I would never live independently again, never again own a car, never again have a job, never obtain more education, nor write another book. My life had been rich as a teacher, lawyer, rancher, writer, photographer, and in a few other careers. But mere days after my discharge, I wrote a note to my son and parents and went to bed with a half-bottle of a powerful painkiller.
That suicide attempt failed. Even so, I spent the next 5 years sobbing on a sofa. Eventually, my parents dragged me off the sofa, and I found my way to a community mental health agency where I was enrolled in case management services.
On my second visit, my case manager gave me a challenge: get up and get out—or get it over with. I was shocked by his bluntness, but those were the words I needed to hear. And the clinician directed me to a group of others living with mental illness, who encouraged me.
The struggle was long and difficult. Eventually, I found hope again and began volunteer work, which led to work as a peer specialist. Success led to more challenges and more success. It wasn’t long before I had proven the hospital staff’s predictions wrong. They were right about one thing: I didn’t write a single book—I wrote three!
Having experienced the power of peer support, I helped found the National Association of Peer Specialists. The organization has grown as it has promoted peer support and continues to expand as it also works to develop the profession. At every turn, there are more challenges I embrace.
Did medications help? Certainly. But it wasn’t medications that got me off the sofa. There is no pill that inspires hope. The power of relationships got me started and kept me going. Because of what others—particularly those with psychiatric conditions—have done for me, I am compelled to give back.
These days, I have many strategies that keep me well. My next challenge is a postdoctoral fellowship at Boston University’s Center for Psychiatric Rehabilitation. Daunting? Perhaps a bit. But nothing compared with getting myself off that sofa.—Steve Harrington, Executive Director, National Association of Peer Specialists
Since epidemiologists first learned that persons with serious mental illnesses die an average of 25 years earlier than their peers, creative efforts have been made around the country to begin addressing the physical health and medical needs of this population. One example of such a program is InSHAPE New Hampshire, developed by Ken Jue, M.S.W., chief executive officer of Monadnock Family Services in Keene, N.H.
Jue found that people with serious mental illnesses who exercise 3 times a week for approximately 4 months lose weight, gain cardiovascular fitness, and experience less depression as well as fewer other psychiatric symptoms. Each participant in the InSHAPE program is paired with a trained health mentor to develop and implement a Self Health Action Plan for Empowerment (SHAPE) that includes physical activities, goals for healthful eating, and attention to medical needs. The program also enrolls participants in community wellness activities that interest them, such as exercise, dance classes, weight loss programs, and smoking cessation groups. For more information on the IN SHAPE program, visit http://www.cmmc-uhs.com/hospitals/hospital-pa/inshape-new-hampshire-promoting-mental-health-wellness-saving-lives.html
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