On Our Way: Recovery News Vancouver Acute & Community Mental Health Services Volume 1, Issue 8 What is recovery? One definition is: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” -Substance Abuse and Mental Health Services Administration (SAMHSA), Dec. 2011 VCMHS has identified the following critical elements of a recovery culture: Hope Goal-Directed Self-Determination Awareness & Potentiality Meaning & Purpose
From the editor:
Recovery in Acute and Tertiary Settings Welcome to the eighth edition of “On Our Way: Recovery News”. By request this issue starts out with a definition of recovery. There are many such definitions, and we will endeavor to start each issue with one of them, always remembering that recovery means different things to different people. We also received feedback that folks liked the themed issue we did a while back on Involuntary Treatment and Recovery, so this issue also has a theme: Recovery in Tertiary and Acute Settings. You will find articles about St. Paul’s Hospital – Ward C, Acute Home Based Treatment and the Forest Edge Tertiary Unit. As always, we’ve also included an update on the work of the Recovery Advisory Committee as well as the “Perspectives Pages”, this time featuring two articles by family members with loved ones receiving tertiary services, an article by the Peer Facilitators working at Forest Edge and an article from a service user. Happy reading!
An Egalitarian Model of Psychiatric Care at St. Paul’s Hospital – Ward 8C Isabel Diogo
It all began with a strong and clear vision of a new way of providing care to our mental health patients and their families. After a three week orientation with a strong focus on family nursing, group therapy and team building, 8C admitted their first patient on September 22, 2010. The focus of this unit is to assess, treat, and monitor individuals with mental illness and addictions in a way that promotes maximum
On Our Way: Recovery News Recovery. This is done by involving the patient and family in all aspects of the care process (Wright & Leahy, 2009), having clinically trained staff facilitate therapeutic groups (Yalom, 2005), and engaging the patient in therapeutic programming that is available seven days a week. The 8C team created five commitment statements we strive to meet each day with each patient and their family that we have the privilege to work with. The first three speak very clearly to the vision of our unit: “We give patients and families a voice by listening to them, identifying strengths and goals, and by being creative and open to possibilities about diagnosis and patients’ capacity to change. Our therapeutic environment cultivates feelings of self-esteem, selfrespect, and health in our patients, families and staff. We all work together to create a therapeutic atmosphere that delivers the very best of care. We are one inclusive team of patients, families, staff and leaders. We are warm and loving, respectful and non-judgmental, transparent and non-hierarchical, encouraging each other to grow wings.” You may be asking yourself what does this look like? When making care and program decisions staff feel very comfortable in negotiating the gray areas where rules can be flexible and questioning the status quo. Time after time the team revisits the vision and commitment statements to ensure that the patients and their families are at the center core of their decisions. The interdisciplinary team goes out of their way to connect with families to hear their stories, to educate and support them through the hospitalization and to commend their resiliency. We take quality improvement very seriously and hence continuously try to improve our practice and processes. In
Page 2 order to do this we have asked the opinions of our patients and their families. These are some comments they have provided us: “I have been admitted to many different psychiatric units but 8C is not like them. If I ever need to be admitted again this is where I want to come.” “The 8C team gave me my life back.” “No thank you, I don’t want my daughter to go to a hospital that is closer to home, even if the commute is long, I want to her be cared for on 8C.” “I can’t speak highly enough of the attention and care shown to both my sister and I. Being so far from Australia and not knowing Vancouver, the staff were a great help in advising me with public transport and accommodation options.” The recent results from the Gallup survey and the Ministry of Health Provincial Patient Satisfaction Survey provide some of the quantitative evidence that 8 C is well on its way to truly becoming a unit where staff are psychologically engaged and where patients feel they receive exemplary care and staff value their opinions. Our journey has only begun and we look forward to our continued growth as a unit and program to better serve and collaborate with our patients and their families.
Spotlight on Mental Health
Go to the peer-run, Spotlight on Mental Health website for mental health news and resources. spotlightonmentalhealth.com Look under Resources and then Newsletters to find On Our Way Recovery News
On Our Way: Recovery News
Acute Home Based Treatment Providing Treatment Choices to Patients and Families Richard Singleton
Developed in the spring of 2009, the Acute Home Based Treatment (AHBT) Team is the first program in our system to offer individuals and their families a choice on where they get their acute mental health treatment. Based on similar programs in Australia, New Zealand, and the United Kingdom, the Acute Home Treatment Team conducts home visits from 9:00am to 9:00pm, 7 days a week, 365 days a year. These visits place the needs of the individual and his/her family center stage rather than the system of care. The AHBT team has nine nurses and one clinical counselor who drive around the city in teams of two conducting home visits. They are joined on these visits by one of four psychiatrists who work with the team and also do home visits. These visits and any treatment interventions are discussed and planned so that they fit in with the person’s and his/her family’s lives. The clinicians will visit up to three times a day for the first week followed by a gradual titration in the visits as the individual recovers. Normally, this happens over a three week period. The reality of receiving acute treatment in one’s own home can offer a different perspective and meaning to the experience of severe mental illness. It can provide for a
Page 3 reorientation towards individual strengths and meanings and break the individual’s expectation that hospital admission is always necessary. It allows the individual and his/her family to receive treatment within their own environment surrounded by their supports. This allows the individual to retain some personal autonomy while minimizing the disruption in his/her life. When an individual is hospitalized, particularly for the first time, it can be a traumatic experience, particularly if a long emergency visit is followed by a stay in one of the quiet rooms. AHBT allows individuals suffering from an acute psychiatric crisis the option of avoiding admission or getting out of the hospital earlier. This is particularly effective with individuals who are suffering from their first psychotic break, whose families know nothing about the mental health and/or Vancouver’s mental health system, and who are all upset and searching for understanding. The ability for the AHBT clinicians to go to the family home and sit at the dinner table with the patient and his/her family, explaining the illness and medications, providing education and examples, day after day until the individual recovers, is both powerful and normalizing. AHBT clinicians are guests in the people’s homes, promoting a good understanding of their lives in which illness is only one aspect. After 2 ½ years, the AHBT (formerly CIP) has partnered with over 400 clients, their families, and their community supports. The team recently doubled in size and opened its doors to referrals from St. Paul’s Hospital. Moreover, similar programs have been developed on the North Shore and in Richmond.
On Our Way: Recovery News
Supporting Recovery at Forest Edge Tertiary Unit Colleen McCain So much is written about Recovery within a community context. Our newly formed Tertiary Mental Health Rehabilitation Team is charged with the task of exploring how to integrate recovery-centered practices on an in-patient unit. Our aim is to support individuals with a mental illness live more independent and meaningful lives; lives that can be continued as they transition into a community setting. We are embarking on an opportunity to be thoughtful and deliberate in ‘how’ we support individuals requiring complex psychiatric support, medical management and specialized tertiary rehabilitation. Recognizing the monumental task our team had ahead of us, we focused first on establishing a foundation for future program development to occur. Our first six months focused on establishing supports, routines and safe, effective care individualized for each unique person in our program. Building rapport and relationships with these individuals and their families, as well as identifying and building on their strengths as unique individuals, were also critical first steps in our program development. In the following six months we used the rapport gained to encourage and support these individuals to be involved in the planning of their own care and rehabilitation process through participating in rehabilitation and recovery review sessions. During these sessions, individuals identified what they would like to work on, how staff can assist them, what they like to see changed, as well as set goals for the next few months. We are now ten months into our journey and like the individuals we support, we experience periods of frustration with the pace of system growth and change. Yet
Page 4
when we change the focus of our lens we can see a recovery supporting culture emerging within our program, as well as shifts in the individuals we are supporting. The majority of the individuals in our program participated in the development and review of their goals. Staff are finding new ways to develop partnerships with clients to navigate the different challenges that arise from a place of respect, transparency and information sharing. Opportunities to explore new roles and personal strengths are offered by our interdisciplinary team through volunteer roles on the unit, work experience placements in the community, sharing in festive celebrations such as Thanksgiving and Halloween, and even a weekly dance party on the unit. Other weekly activities on the unit such as walking groups, art and baking activities are starting points to assist clients to link to community activities such as the Art Studios, dance classes, community recreation centers, and vocational programs such as Coast Clubhouse. A peer-led group “Our Recovery Journey” is also being well attended and providing individuals a place to explore what ‘recovery’ might mean for them. Our team is in a unique position of creation; however, over the past few months we have discovered it has been more of a blending process. We are blending a mix of knowledge, experience and passion to create a united, focused team of health care professionals. We are using our collective understanding that the essence of personal recovery is a personally meaningful life including connections and a sense of identity. We are discovering that it is a personal challenge as well as a professional challenge to develop a recovery supporting culture on our inpatient unit. It is humbling to recognize the impact the program culture has in supporting or hindering the personal recovery process.
On Our Way: Recovery News Our team is engaging in a thoughtful, reflective process to look at what we as individuals and as a team contribute to the program culture on our unit, in addition to developing the components of a rehabilitation program. By engaging and committing to reflective and mindful practice, we can be more deliberate and purposeful in how we interact with each other, function as a team, and ultimately model recovery values and processes to the individuals we support. Our aim as a team is to create a space of healing and safety for individuals to be able to embark on their own recovery journey. As such, we, like the individuals we support, are in the exciting and daunting process of transformation and growth as we explore how an in-patient unit can become a recovery-supporting environment.
Speakers Wanted Are you interested in helping to educate the public about mental illness? The BC Schizophrenia Society is looking for individuals who have received treatment for psychosis within the mental health system to volunteer as Partner Presenters and share your personal story of recovery. Experience sharing your story is an asset but some training is also provided. Must be able to access public transportation within the Vancouver area and be available weekdays for 2-4 hours/month (days and times are flexible). An honorarium is provided. For more info please contact the BCSS Coordinator at 604-726-5997 or vanrich@bcss.org www.bcss.org/partnership
Page 5
Recovery Advisory Committee Winter Update The purpose of the Vancouver Community Mental Health Services (VCMHS) Recovery Advisory Committee is to support the work of implementing Recovery Philosophy in the organization. Over the past few months, the committee has been exploring a range of issues including people entering into services, transitioning away from services, and reentering services. These discussions have been informed by work done elsewhere such as in the US and also by our very own Recovery Dialogues. The Dialogues are events where people living with mental illness, family members and service providers get together to talk about topics related to recovery. Additionally the committee aims to regularly hear updates from teams and units about how recovery is being integrated into practice. The committee recently heard from Sharon Marmion, Clinical Planner, Adult Tertiary Mental Health, about how Recovery Principles are being utilized in the development of Vancouver Tertiary Mental Health Services. The committee has also been exploring the possibility of having the "Making Sense of the Mental Health System Guides" updated and made available via the public VCH website. On Our Way: Recovery News has also been a subject of discussion. A number of helpful suggestions have been proposed by the committee, including providing more print issues for the teams, adding a definition of recovery to the front page of the newsletter and possibly doing shorter versions in between the more extensive issues. Watch for continued updates in this newsletter to see what the committee is up to.
On Our Way: Recovery News
PERSPECTIVES PAGES A Peer Perspective: How Recovery is Implemented in Tertiary Services Theresa Duggan & Doug Locke Recovery centered clinical practice is the key to service provision at UBC’s Forest Edge Tertiary Program. As Peer Support Facilitators (PFS), we bring lived experience of mental illness to our work and strive to create an environment of hope and inspiration for our clients through consistent role modeling. As PSFs, we help support clients through their own recovery journey, encouraging them to strive for a quality of life that makes them happy. The clients at Forest Edge have their own way of judging their recovery. When asked what has helped them, they have identified work experience and exercise as well as ‘home visits’, ‘family outings’, ‘peaceful living atmosphere’ and ‘treating myself to meals’. Clients speak of friends and family, community outings, walks, teaching yoga, religion, and medications as having helped them with their journey. Others talk of the self-esteem they have developed, or how having things in common with other people builds their support network. The entire team (staff and clients) work together, consulting and supporting each other, drawing on each person’s experience, knowledge and skills. We encourage clients to believe and show that they can live beyond their illness. Rehabilitation plans strive to be strength based and to meet the clients where they are in their own recovery. We encourage and support building independence in as many areas of life as possible.
Page 6 Since we opened at the beginning of this year, all disciplines have worked closely together to assist the clients to build on their own strengths and develop skills through meaningful activities such as: exploring their community; daily walks; shopping; learning to access transit; beach days; golfing; and special events. Groups also occur at Forest Edge such as the baking group, the leisure group, the stress reduction group, or the Your Recovery Journey, a peer created and lead group. The latter group allows people to share with others what recovery means to them, and to learn ways to take charge of their illness and direct their own recovery. As PSFs, we are proud to be a part of this team. The support and acceptance we get from the team assists in our own recovery as well. The Forest Edge team has embraced us as equal partners and will often seek out our perspective and feedback during discussions re: program planning; introduction of rules; medication side effects; and how to engage clients. As PSFs we continue to move forward: sometimes two steps forward and one step back - but that is what life is about. We don’t give up and we keep encouraging our clients to strive for a different, better life.
Words of Wisdom
“When I started to believe I could recover, I started to get better.” - Anonymous
On Our Way: Recovery News
My Experience of the Mental Health System and Recovery Carmen Daly I have a 34 year old son who is living at Forest Edge at the UBC Hospital since the end of August of this year. Before that my son lived for over five years at Riverview in Coquitlam because we could not find a place or home for him to live in. My son has a mental illness that is very difficult to treat. By now he has been in and out of hospital for 20 years. When he was living at Riverview the doctors told me to leave him in the system and go and live my life and not worry that the system will take care of him. Also, they told me not to bring someone for support to the meetings with me. They said I speak perfect English and do not need anyone with me - not even my husband. Also, they said my son had mental illness because of the mixed marriage! Now, at Forest Edge, my son still does not like it and says his treatment isn’t any better than at Riverview. But there are signs of an improvement and hope for the future finally after all these 20 years of suffering for the whole family. Firstly, a specialist in behavioral psychology and a neuro-psychologist diagnosed my son with an autism spectrum disorder. We had tried for years to look into the developmental disorder, but to no avail. In other words, he has a dual diagnosis and that is why it has been so hard to treat his mental illness. Secondly, for the very first time, I got a social worker who is actually doing something positive for my son in that she followed the recommendations of the behavior person and sought assistance from Community Living BC (CLBC). Now the
Page 7 social worker has had my son accepted in the Personal Supports Initiative of CLBC and we are promised that he will get funding for a person to work with him one-on-one for five days a week to help him get integrated in the community - despite the problems that his spectrum disorder causes him. Also, we have personally contracted this woman who did the spectrum disorder diagnosis to help us have a better relationship with our son. So, finally things are looking up and there is hope for my son for the future. Now, if we can only find an appropriate place for my son to live with all the supports that he needs, then he can finally start to have a life that he has been denied up until now. In closing, I would like to say that those afflicted by mental illness and developmental disorders need to be treated like they have an objective illness. Treatment needs to be focused on the illness without any blame being placed on the relatives.
Recovery from a Family Perspective Dick Doerksen As families, our greatest hope is that ‘recovery’ will include the availability of a range of community supportive facilities in order that our loved ones may reach and maintain their highest possible level of recovery with a minimal risk of relapse and rehospitalization. The greatest fear is that without a sufficient number and range of supportive care facilities, time limitations and bed pressures, combined with unrealistic recovery expectations, our loved ones may be discharged without the discharge plan supports necessary to prevent relapse, rehospitalization, or worse yet, end in tragedy.
On Our Way: Recovery News
Am I Just Being Paranoid? M.P. Diane Desjardins Ever since I was a child, my inner sixth sense has acted as a keen honing device, which has come in handy and often kept me from harm’s way. In retrospect, I have learned to develop my listening eye and captured facts, rather than stifle them as the multitudes do. In some instances, when something is about to run amiss, there’s a subtle feeling that comes over me—“rush to take transit or you will be late to meet your party”. Another helpful circumstance, which especially applies to this city—“even though the weather forecaster hasn’t predicted any rain, the feeling brings forth the instinctive thought to pack an umbrella as a preventative measure from getting drenched”. These may seem like minor details, which require only a brief/ attentive moment; but the accumulative effect of this precious sense surely helps to address any topic before it becomes an unmanageable dilemma and helps keep stress at bay. Which brings me to emphasize that in other prevalent cases, the feeling is definitely more intense. I have managed to get myself out of precarious predicaments, in the past, circumstances that might capture the attention of those who prefer reading flights of fancy, comparable to predictable novels. Although, factual perspectives are justly penned in personal journals and transcribed. The truth lives on within the pages of non-fiction books. For example, life brings us opportunities where it would be in our best interest to pay attention to the suggestions prompted by our inner voice. I do recollect a time when I chose to ignore the wise one—awakened by a night terror. The dream was warning me that due diligence was required in order
Page 8 to prevent harmful repercussions from happening. I was reminded that the gift I have forever needs to be respected and honored. For whatever reason, someone had decided to spread gossip and/or rumors. In any case, do take into consideration the source(s) and weigh all the facts before passing judgment upon anyone. Wouldn’t it be a blessing to remain unscathed by such malicious acts? I suppose even some of the history books have been embellished a tad...To those who have known such grape vines, please recall peaceful times. It is wiser to address any doubts before the butterfly effect takes flight. I can only express my own point of view. I do strongly believe that instead of being paranoid, I equate it to possessing an awareness (insightful dreams/feelings) that have assisted me in making positive decisions. Everyone possesses some level of premonition. The guidance, that our intuition provides us with, may lead the way to all the answers to the questions we are seeking. The most popular question seems to be—what is my life all about? Typically, avoiding negative circumstances and preventing certain types of people from making our world a chaotic roller coaster is what most of us prefer/want anyway. Wouldn’t you agree?
On Our Way: Recovery News Vancouver Acute & Community Mental Health Services
Credits Renea Mohammed, Editor Contributing Writers: Carmin Daly, Diane Desjardins, Isabel Diogo, Dick Doerksen, Theresa Duggan, Doug Locke, Colleen McCain & Richard Singleton.