On Our Way: Recovery News Vancouver Acute & Community Mental Health Services Happy Reading!
Volume 1, Issue 6
Spring 2011
Hope Goal-Directed Self-Determination Awareness & Potentiality Meaning & Purpose
Recovery at the Northeast Team By Suzanne Hawkins
From the editor:
Recovery: Moving Forward Welcome to the sixth edition of “On Our Way: Recovery News”. Our last issue featured a cover story about South Team’s Recovery Pathway. This issue continues the exploration of what is happening at the teams with a look at Recovery at the Northeast Team, a team with an active Consumer Advisory Committee and many other recovery oriented projects and programs. As well, there is an article about Jude Swanson’s experience facilitating the Your Recovery Journey Program at Strathcona Team, an article on the Recovery Dialogues, “Things that Make us Strong,” by one of the participants, the “Ask Dr. BenningtonDavis” column and, of course, the “Perspectives Pages”. We’ve also added an introduction to the Recovery Advisory Committee and plan to include updates on its work as a regular feature of this newsletter. As always, we welcome your articles, letters and ideas on topics related to recovery. Please send to renea.mohammed@vch.ca Happy reading!
The Northeast Mental Health Team, along with all other services provided by Vancouver Community Mental Health, has undergone a major shift over the past few years. We have been challenged to apply the concepts and philosophy of recovery into practice. There are projects and programs that are recovery focused, many of which were in existence before the term “recovery” was applied to them. For example, we have always had a strong, representative Consumer Advisory Committee (CAC). Our CAC is well attended and fully involved in team operations. This Committee encourages the involvement of all team clients and is in the process of developing an e-mail distribution list for all
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interested clients and families to inform them of team and community events. We consult with the CAC about Team and systems policies. The CAC serves as a conduit for information sharing and for seeking feedback about how the team is doing. When we moved into our new building just over a year ago, the CAC was actively involved in planning and designing the new client resource room. The CAC organizes all client events, such as Resource Room Open House and the consumer Christmas party. It was also actively involved with our Community Open House. Our CAC has offered orientation to new clients if needed. As well, the CAC operates the Resource Library. Volunteers provide computer support and other information to consumers of the library. We have offered a team-based Consumer Engagement Grant to help clients financially with education, training and leisure goals. Peer Support Workers (PSWs) attend monthly staff meetings. There is consumer representation on interview panels including the recent hiring of a new physician. Consumer Contractors and PSWs are invited to all team events including retreats and social events. We seek client feedback about the physical space in the building. Consumer art decorates our whole office and we look for ways to promote consumer artists. For example, at our recent open house, we showcased the art of many consumers. We regularly highlight successes and good news stories about consumers in our staff meetings. We want to share the successes. It provides hope for us all. Over 100 team clients took part in a Consumer Needs Survey in 2010. The goal was to take a holistic view of what consumers need to help with their recovery and to identify their priorities. This survey has been the basis of developing groups and other goals for rehab and case management.
Page 2 Our programs are based on the results of this survey. We have developed novel ways of partnering and integrating with the community to provide programs which fit with the recovery model. We have integrated walking, fitness and Mah Jong groups with Hastings Community Centre. These programs are open to team clients as well as other community members. We have a partnership with Hastings Library. We share resources and they providing training for our librarians in the Resource Room. Soon the regional resource library, open to clients, family and staff, will be moving to our site. This will open up opportunities to welcome the community to learn more about mental illness and hopefully will help reduce stigma. This will vastly expand our library resources at the team so that consumers and families can have access to up-to-date information. Education is a key recovery principle. We are looking at ways of working with other community agencies to provide a seamless continuum of services. We have a case manager who works at Evergreen Health Centre once a week and sees clients referred by Evergreen Primary Care and Addictions. We are exploring shared education and resources with Primary Care and Addictions. Having an Addictions staff member serve as a team consultant would aid recovery. We meet regularly with Evergreen AOA and our goal is to do more case conferences with our AOA partners again to provide best care. Probably the most significant step we have taken toward Recovery is that we have changed our thinking about what is possible. While we have implemented concrete steps towards a Recovery-based service, it is also a change in staff attitude that has evolved. We use Recovery language in all our case discussions and ongoing dialogues about the challenges of being a Recovery-based service. We have been fortunate to have an
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IPS worker who regularly reminds us of what our clients are capable of achieving. We are learning to let go and give responsibility to the consumer. It has not been an easy task and we often discuss our struggles particularly around risk taking. We listen more to what the consumer wants, what their strengths and dreams are. We are trying to step back in a responsible way and have the consumer lead their recovery. How to ensure that every client’s voice is heard and every family member is involved is important. One huge challenge is how people move on from the team. For so many there is no where to move on to. General Practitioners (GPs) are hard to find and are so busy that they are often hesitant to take on new clients. We wonder what would make it easier for clients to continue on their recovery path “after the team”; what would help them? We need to involve consumers in this discussion. Perhaps we could provide more consultation and support to GPs and/or offer a consultation service to former clients on a yearly or as needed basis. Partnering with primary care to provide clinics may be another consideration.
Did You Know? The compilation of the Oxford English Dictionary began in 1857 and was a highly ambitious project. As definitions were collected, the overseeing committee discovered that more than ten thousand definitions had been submitted by Dr. William Chester Minor. When the committee went to honor him for his exceptional contributions, they discovered that he lived with mental illness, probably schizophrenia, and was submitting his definitions from an insane asylum. Check out The Professor and the Madman by Simon Winchester for more of the story.
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Ask Dr. Bennington-Davis Question: People have said to me that I wasn’t very ill with my mental illness because I am doing so well now. Yet, I suffered for seven years with severe mental illness (psychosis, bipolar). What are your thoughts on this? Answer: The pleasure in the question comes from how well it supports the FACT that people with severe mental illness can and do recover. During symptomatic periods, psychosis, mania, depression, anxiety, obsessions and compulsions - I suspect there are not worse things humans must bear. Additionally, perhaps because of the nature of the symptoms - which are psychic, physical, spiritual, and social - people's lives tend to unravel to some extent in many realms. So, perhaps unlike symptoms of purely bodily nature, psychiatric symptoms are often accompanied with families falling apart, loss of jobs and school placement, loss of homes and housing, loss of friends and partners. The questioner's report of suffering greatly with symptoms of psychosis and bipolar disorder is not in any way, I am sure, an exaggeration! Yet, thankfully, even the most severe of psychiatric conditions tend to wax and wane, tend to respond to treatment, tend to improve with social, spiritual, and physical healing. And, in good circumstances, where the person is able to recapture (or not lose) his/her sense of SELF, then that person can (and does) recover - even when some of the symptoms persist. Although I love the story behind the question, it also reminds me of how much education we've yet to do in the general public, which remains ignorant of the pain of severe mental illness and even more ignorant of the promise of recovery. Be well! Dr. Maggie
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A New Role Facilitating Your Recovery Journey By Jude Swanson
I recently added a new role in my Recovery process, Facilitator. I have been honoured to help facilitate a program called “Your Recovery Journey” at the mental health team where I also receive mental health services. Working together with a Recreational Therapist, we have facilitated this program to a group of mental health consumers. I would like to share a bit about the “Your Recovery Journey” program itself and my experience facilitating it. The “Your Recovery Journey” program was designed to be a peer-led program, where at least one of the facilitators would have lived experience with mental illness. It is designed to be offered in five-90 minute sessions including: “What is Recovery,” “Quality of Life,” “Self-Management,” “Medication as a Tool for Recovery” and “Personal Action Planning.” The materials are free and include workbooks, PowerPoint presentations and videos. The videos are inspiring as there are consumers, family members and professionals all sharing their perspective on the various topics. I think the “Your Recovery Journey” program is valuable because the workbook has written exercises that ask reflective questions for the participant to consider. Also during each session there are frequent discussion topics where the group is able to share their perspective, experience and/or opinions. I also feel the program offers a chance to have dialogue about recovery by consumers regardless of where each
Page 4 individual is in their recovery. The workbook is also a treasure trove of information regarding topics, tools and resources available. As for my experience in facilitating, it has been similar to other recovery goals I have taken on. Looking back, I’m proud of what I have done but it took lots of planning and support from a variety of people in my social network. For example, my cofacilitator is a professional that liked the look of the program and was willing to work together with me to offer it to Team clients. My co-facilitator and the consumers who attended provided me with direct support and feedback that helped me facilitate. I am grateful for the input and compliments in what is a new role for me. Planning has been a big part of the facilitation process. We ordered all the free materials over the internet and had the materials shipped to the mental health team. Then my co-facilitator and I mapped out how we thought this program would be structured to suit the consumers who would likely attend. For example, we chose to have ten one-hour long sessions with lots of time budgeted for in-class discussion and exercises. I was also given the opportunity to present the program and showcase the workbooks at a mental health team staff meeting. In the week prior to starting, my co-facilitator and I did some final planning. Of course, even with careful planning some unforeseen challenges have occurred. However, I feel that the fact we did have a planned flexible framework is what enabled us to adapt successfully to those challenges. So, I’d like to thank my mental health team (Strathcona and its staff), my co-facilitator and all the consumers who chose to attend our “Your Recovery Journey” program. I also like to thank the group of people who created the program and shared about their life experience about recovery.
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Recovery Dialogues: Things that Make Us Strong By D.B. This is an account from the continuing series of Recovery Dialogues, based on a recent session entitled "Things that Make Us Strong". I want to share my experience because I have been inspired by the Dialogues and hope that I can share my enthusiasm with others. Individuals approach strengths in our own ways. We each find our own individual strengths to draw on – there is no universal list of things that make us strong. Here are some of the themes that came up in the “Things that Make us Strong” dialogue: Knowledge: • Knowledge (of resources, options, paths forward) can give power; • Sometimes we have to stop and admit to ourselves "I don't know how." Then we can get the knowledge we need and move forward; • Knowledge gives reasons to hope. Hope: • Hope provides a seed of possibility; • Hope should be based on knowledge: o If a clinical perspective creates "knowledge" that destroys hope, this should be countered-balanced with direct knowledge of people who have achieved recovery; • Hope, belief and knowledge are all keys to starting the recovery process. Meaning and Purpose, Acceptance, and sense of being valuable: • The value that we can provide to others is one way to provide meaning and purpose for our lives; • How can we recognize our own inherent value?
Page 5 o It starts with self-acceptance (for who we are, as we are now), o Our ability to do this is influenced by support from friends and family (as well as how other people treat us). Where do we find strength when we are not feeling well? • A good support system helps; • Putting faith in something larger than ourselves (faith in a Higher Power or faith in knowing that there are other people looking out for us) helps. Community: The theme for the day had us reflecting on the things that makes strong as individuals working towards recovery. But the topic also led me to think of the things that make us strong as a community of people (consumers, providers, family members), all working towards the common goal of facilitating recovery. It made me ask the question: "Can we be strong as individuals without strong community?" I believe that one of the most important factors for mental health, but also one of the most difficult to achieve, is a healthy community. Working in mental health (or living with a mental health issue) seems to be full of tensions between valid and important concerns (such as the right to privacy vs. the potential benefits of disclosing information, to name just one). All these tensions can lead to mistrust, fragmentation, animosity and self-stigma within the community. I believe that a strong and vibrant community comes from putting emphasis on what we have in common (recovery) and being willing to reach out and learn from others and their point of view (dialogue). In my life and in my work, I have found that by seeing a common goal and being able to understand our differences, I can communicate more effectively, see opportunities and find success.
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Introducing the Recovery Advisory Committee (RAC) The VCMHS Recovery Advisory Committee is made up of staff, people with lived experience of mental illness and family members. Its aim is to support recovery work across the mental health system. It was formed in 2007 as a task group as a result of a shift in service delivery philosophy and model. The Recovery Philosophy was chosen as it is endorsed by the literature as best practice in service delivery from mental health clients in the adult population. The task group was set up to support staff, consumers, families and the organization to implement the recovery philosophy as it relates to children/youth, adults and older adults. As the organization has moved forward in implementing Recovery Philosophy, the work of the Recovery Task Group changed and it became apparent that what is now required is an advisory committee to continue the work of implementing recovery philosophy. Stay tuned for updates on the committee’s work in future newsletters.
PERSPECTIVES PAGES Recovery by Eternal In’Lakesh In 1988, I was diagnosed with drug induced schizophrenia. At that time, I also had a physical injury. With everything happening at once, I went into silent catatonia for my first hospital stay. I was put on medication and was there for 10 days. About a year after that, I went on a trip to visit family and friends in Calgary. Seeing my condition and not knowing how to access resources; my aunt flew me back to Vancouver with her. There my aunt and grandma took me back to the hospital I was first at; with the belief my aunt was going to get some tests done. While there she suggested we go say “Hello” to the nurses on the Unit. They asked to check my blood pressure and when doing so, my family left without saying “Goodbye”. I ended
Page 6 up being committed for 30 days which turned into 49 days. As with most bitter moments, there is sweetness; I met a friend there. She has been a mentor, and an amazing support along the way. It seems that every perceived cloud does have its silver lining. I lived with the pain of my injury for two and a half years without getting treatment. By the time I went to my first chiropractor treatment, I was experiencing pain 24/7. For the next three and a half years I went to the chiropractor and had massage often. I then adjusted my nutritional intake to support my mental health wellness. I started volunteering one day per week and continue to do so now. When the physical care supports I was already accessing didn’t completely allow me to live without pain. I looked elsewhere to find some relief. I have tried acupuncture, cranial sacral therapy, reiki, yoga, sound healing, and at least six more therapies. When I came upon BodyTalk (an integrated system that includes techniques from many established systems), I was amazed at the results. As well as improving my wellbeing, my mental health has improved immensely. I am able to focus and retain information. My energy is more consistent. I have learned to attend to my needs, which has given me the courage to explore my goals and dreams. I have been through so many changes my psychiatrist re-examined the file and rediagnosed me. It was decided by a “therapeutic alliance” of myself, the nurse, and psychiatrist to discontinue the medications very gradually. Then, while staying in contact with the mental health team; we will be able to assess if another medication for the new diagnosis is necessary. I have to say, at the time of writing, this has been a year of much stress and grief. Still, I have looked for the lessons and the message in continuing to enjoy the journey. Life isn’t always about the details - it’s about the transferable skills that are learning living it. I am now a part of the peer support network and feel very hopeful for the future.
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Debugging the Brain: A Path to Recovery Interview with “Victor Race” By Renea Mohammed
I recently had the opportunity to interview Victor about his unique approach to recovery. Victor has a background in computer programing, design and problem solving. When he was struck with mental illness and diagnosed with schizoaffective disorder, he decided to take an active approach to his own recovery. He decided to apply the problem solving skills he used in the computer industry to his own mental health. He said with computers, you are working with information all the time. The human brain does the same thing. When he became ill, it meant his brain was misprocessing information. Recovery, for Victor, was like debugging a computer. In programming, he said, if there was a software malfunction, then information or input needs to be controlled and analyzed. Victor started to look at the things in his life as information: that included food, people and the environments he found himself in. It was all input for his brain. Because his brain was no longer working correctly, he went through a process of deliberately restricting the input it received in order to better understand the illness he was dealing with. Victor was attempting to eliminate random variables so that he could see things more clearly. He used the analogy of a speeding car. When the car is speeding, it’s hard to see the car in detail. But when you slow it down, you can pick out details like the license plate, the person driving, dents, hub cap design, et cetera. With his illness he
Page 7 had to slow everything down and control the information. He started to walk the same path every day. He ate the same thing every day. He eliminated meat, alcohol, sugars and chemical stimulants from his diet in an effort to eat in a way that was pure. He became vegan, seeing veganism as being about compassion to animals, passivity, having the least impact on things, and about having self-control. He said a big part of illness was not being able to control the self. Veganism was the opposite. He also had to understand his triggers and eliminate them via the restrictions he adopted in his life. It wasn’t always easy. When Victor was hospitalized, he found himself in an environment he could not control. The experience made him more ill. He described the hospital as an irregular environment full of irregular people. He noted people in hospital are affected by each other and react to each other. There is no private space. You don’t even get your own room. And, in this unnatural environment, people are observed for symptoms. He said the observers aren’t going to get reliable results in the hospital context because it is so unnatural. He described being told that if he didn’t sleep, medication would be forced on him. Yet how was he supposed to sleep with the guy beside him snoring loudly? He described one doctor saying he was paranoid, delusional and suicidal because he wouldn’t eat the food offered to him. Yet the reason he wasn’t eating was that the food being offered didn’t fit within his vegan diet. Victor said everything was manageable up to the point of his hospitalization. But the hospital experience exacerbated his situation to the point where he lost the control he had so carefully cultivated, making recovery more difficult. When he was released from hospital, Victor got control back and continued to approach his recovery by controlling all the elements in his life. As a result he has come
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Absurdities
Debugging the Brain Continued…
By D.B. to understand the mechanism behind the delusions of reference he once experienced. He understands them now as his brain malfunctioning in its analysis of the relationships of information. He is relearning at a cognitive level and dealing with misprocessing. He is also feeling a lot better as a person. His anxiety is down. He is more grounded. He is making progress in his recovery. But Victor noted that recovery hasn’t been about going back to the state he was in before he became ill. He said you can’t really do that because all of the experiences people go through leave us in a state of constant change. Recovery wasn’t about going back. It was about being able to deal with the current situation and being able to move forward. And recovery is something we all do. Take our physical bodies for example, our cells are constantly dieing and being replaced - a form of recovery. Recovery is something everyone does whether they are conscious of it or not. He notes recovery from illness shouldn’t be foreign to us, but it can be overwhelming. A big part of it is noticing that your reality is conflicting with the realities of others. You have to look at the contradictions going on, figure out why others are able to function better, understand that there are issues of your illness preventing you from functioning at a standard level and then figure out how to deal with those issues. When asked about tips for people supporting others in their recovery process, Victor suggested putting in as many foundations for recovery as possible. These include resources, time, money, diet and services available. The more foundations that are in place, the better the outcome. Victor said it took him over a year to really understand what reality was. With a better foundation, his recovery might have been faster.
We have created a secret shame. It goes by the name of BD, SZ, etc... We know you have it you mustn't be ambivalent about accepting it. *Dedicated to a good hearted soul who wrote a paper "Ambivalent Acceptance of a Diagnosis of Bipolar Disorder." In a well written introduction, the author clearly states her starting point, and in so doing, lays bare some of the absurdities of modern psychiatry. A true science of mind is yet to be developed. Luckily, in the mean time, we can trust our hearts, as well as our brains. To heal, we must seek to understand. d.b.
On Our Way: Recovery News Vancouver Acute & Community Mental Health Services
Credits Renea Mohammed, Editor Contributing Writers: D.B., Dr. Maggie Bennington-Davis, Suzanne Hawkins, Eternal In’Lakesh, Renea Mohammed and Jude Swanson,
Correction from last issue: In the article on CONKER by Michael Crain, the name Eric Lennon should have read John Lennon. The editor should have been more careful while using “find and replace”. My apologies!